MD-UPDATE Issue #93

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #93

SPECIAL SECTIONS

Sports Medicine/ Orthopedics Men’s Health

COVERING ALL THE BASES

VOLUME 6•#4•JUNE/JULY 2015

The collaboration of specialties at KentuckyOne Health/UofL Sports Medicine provides comprehensive care to athletes of all ages MEET THE TEAM



ALSO IN THIS ISSUE  ONE STOP SHOP FOR SPORTS MEDICINE IN NEW ALBANY  PROBLEM SOLVING FOR MOTIVATED, HEALTHY PATIENTS  FIXING ORTHOPEDIC PROBLEMS IN OWENSBORO  THE PROS OF PROSTATE SCREENING  SEX, POWER, & BOUNDARIES FOR MEN

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS

(L-R) Andrew Duffee, MD; Paul McKee, MD; Todd Hockenbury, MD;

Kevin Harreld, MD; Jennifer Daily, MD; Michael Weaver, DO; Ray Shea, MD; Jessica Stumbo, MD; Navin Kilambi, MD; Thomas Loeb, MD; Darryl Kaelin, MD; Jeffrey Stimac, MD; and Greg Rennirt, MD. UNAVAILABLE FOR PHOTO: Jonathan Becker, MD; David Caborn, MD; Mark Duber, DO; Arthur Malkani, MD; and Ed Tillett, MD. Photograph by Robert Burge

KentuckyOne Health/UofL Sports Medicine

Taking the team approach to a whole new level, the KentuckyOne Health/UofL sports medicine, orthopedic and PM&R physicians and staff are ready 24/7/365 to address every aspect of sports medicine care.

WHAT HURTS MORE?

YOUR KNEE OR NOT BEING ABLE TO RUN ANOTHER 10K? Does joint pain keep you from competing? With great services such as prevention, treatment, rehabilitation and wellness, let us help you restore your active lifestyle.

To get back into the game, schedule an appointment today.

Call us at 1.800.325.4421 and visit KentuckyOneHealth.org/Orthopedic-Care.

Presented by the Saint Joseph Hospital Foundation

Register TODAY RUN OR WALK IN THE INAUGURAL

Funding Mammograms | Saving Lives R.J. Corman Railroad Group Headquarters 101 R.J. CORMAN DRIVE NICHOLASVILLE, KY 40356

REGISTER ONLINE

3wayracing.com

MORE INFORMATION

859.313.1705

SATURDAY @ 9 A.M. October 17, 2015 Rain or Shine REGISTRATION (ALL AGES) June 1st – September 1st | $35 September 1st – October 15th | $40 Day of event and Friday pickup | $50 KentuckyOne Health employees | $25

RACE DAY REGISTRATION BEGINS AT 7:30 A.M. The Yes, Mamm! 5K will offer additional fundraising to accommodate the demand and help supplement funds to allow for more mammography screenings. Every dollar raised will be used for Yes, Mamm! in Lexington and Nicholasville which serves individuals in 15 counties.

CHIP TIMERS FURNISHED BY 3 WAY RACING KentuckyOneHealth.org SaintJosephFoundation.org SaintJosephHospitalFoundations

ISSUE#93 33

SEPTEMBER 25-27, 2015 CO-PRESENTED BY

NOVEMBER 13-15, 2015 CO-PRESENTED BY

FEBRUARY 4-7, 2016

JANUARY 8-10, 2016 CO-PRESENTED BY

CO-PRESENTED BY

APRIL 22-24, 2016 CO-PRESENTED BY

VARIETY LIVE ADD-ONS

JULY 23-26, 2015

FEBRUARY 17-18, 2016

MARCH 8, 2016

(859) 233-3535 • LEXINGTONOPERAHOUSE.COM 34 MD-UPDATE

LETTER FROM THE PUBLISHER

Innovations in Medicine I’m going to borrow a line from our financial columnist, Scott Neal, in this issue of MD-UPDATE. On page five Scott writes, “The moral of the story is that it will be very difficult to match the kind of wealth growth we have seen over the past 35 years.”

Substitute “innovations in medicine” for “wealth growth” and how does that make you feel? Think back to 1980. Is it possible that within the next 35 years there will be the innovations in medicine that have occurred since Ronald Reagan was president?

In this, the Sports Medicine and Men’s Health issue, we see the results of advancements in orthopedics, sports medicine, and urology being practiced by Kentucky doctors.

I don’t know what was state-of-the-art in orthopedics or urology in 1980. I know that my father had a radical prostatectomy in 1979 that has affected him for the remainder of his life. He’s still with us at 95 years old, so that’s a great outcome. But I know he suffered from the total removal of his prostate, something that might have been avoided in 2015.

The good news today is that all over Kentucky, sports medicine doctors are treating a patient population of high school and collegiate athletes and adults who want to keep playing their games and staying active but need newer joints and repairs to do so. In spite of what you hear, not everyone in Kentucky is overweight and out-ofshape. Partners like the YMCA help all of us make better health choices.

A word about our cover story…

With a team as big as KentuckyOne Health/UofL Sports Medicine, we needed something special. So we chose the “French door” double cover to include as many of the doctors as possible. As is always the case in medicine, some of the doctors were tied up and unavailable for the photoshoot. But our thanks go to all the doctors who helped us bring you their story.

As always, best regards,

Gil Dunn Publisher, MD-UPDATE

????????

Volume 6, Number 4 ISSUE #93 PUBLISHER

Gil Dunn gdunn@md-update.com EDITOR IN CHIEF

Jennifer S. Newton jnewton@md-update.com GRAPHIC DESIGNER

James Shambhu art@md-update.com

CONTRIBUTORS: Jan Anderson, PsyD Barbara Mackovic Scott Neal L. Porter Roberts Jr Cameron S. Schaeffer, MD Anna L. Taylor Sarah Wilder

CONTACT US:

ADVERTISING AND INTEGRATED PHYSICIAN MARKETING:

Gil Dunn gdunn@md-update.com

Mentelle Media, LLC

38 Mentelle Park Lexington KY 40502 (859) 309-0720 phone and fax Standard class mail paid in Lebanon Junction, Ky. Postmaster: Please send notices on Form 3579 to 38 Mentelle Park Lexington KY 40502 M.D. Update is peer reviewed for accuracy.

However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials.

Copyright 2013 Mentelle Media, LLC. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means-electronic, photocopying, recording or otherwise-without the prior written permission of the publisher.

Please contact Mentelle Media for rates to: purchase hardcopies of our articles to distribute to your colleagues or customers: to purchase digital reprints of our articles to host on your company or team websites and/or newsletter.

Thank you.

Individual copies of M.D. Update are available for $9.95.

Send your letters to the editor to: jnewton@md-update.com, or (502) 541-2666 mobile Gil Dunn, Publisher: gdunn@md-update.com or (859) 309-0720 phone and fax ISSUE#93 1

CONTENTS

ISSUE #93

COVER STORY 3 HEADLINES 5 FINANCE 6 ACCOUNTING 7 HYSICIAN VIEWPOINT 9 COVER STORY 14 SPECIAL SECTION: SPORTS MEDICINE/ORTHOPEDICS 20 MEN’S HEALTH - UROLOGY

COVERING ALL THE BASES The collaboration of specialties at KentuckyOne Health/UofL Sports Medicine provides comprehensive care to athletes of all ages

BY JENNIFER S. NEWTON, PAGE 9

PHOTOGRAPHY BY BRIAN BOHANNON AND ROBERT BURGE

22 MEN’S HEALTH COMPLEMENTARY CARE 24 PHYSICIAN SPOTLIGHT 27 NEWS 30 EVENTS

SPECIAL SECTION  SPORTS MEDICINE/ORTHOPEDICS

14 ONE STOP SHOP: FLOYD MEMORIAL

2 MD-UPDATE

16 MOTIVATED PATIENTS = SATISFIED PHYSICIAN: BAPTIST HEALTH

18 MR. FIX IT: OWENSBORO HEALTH

HEADLINES

KentuckyOne Health Launches Ornish Program for Reversing Heart Disease

BY BARBARA MACKOVIC

KentuckyOne Health is now offering Dr. Dean Ornish’s Program for Reversing Heart Disease™ (the Ornish Reversal Program), the first program scientifically proven not only to prevent heart disease and other chronic conditions, but also to undo it.

Dean Ornish, MD, is the founder and president of the non-profit Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco.

Dr. Ornish was appointed by President Barack Obama to the White House Advisory Group on Prevention, Health Promotion, and Integrative and Public Health in 2010 and, previously, by President Clinton to the White House Commission on Complementary and Alternative Medicine Policy in 2000. The Ornish diet, a critical component of the Ornish Reversal Program, was rated #1 for heart health by U.S. News & World Report in 2011, 2012, 2013, and 2014.

KentuckyOne Health is the first and only health provider in the state providLOUISVILLE

Dr. Deborah Ballard is an internal medicine specialist and co-medical director for the Ornish Reversal Program in Louisville

four key areas:  Fitness emphasizes regular, moderate, and sustainable exercise.  Stress management helps participants cope with and manage stress while also fostering an increased level of physical and emotional self-awareness.  Group support connects individuals

We are working together to help participants take control of their health by providing the knowledge, training, and community resources to sustain a healthier lifestyle.

– Dr. Deborah Ballard ing the Ornish Reversal Program, which is grounded in more than three decades of peer-reviewed studies by Dr. Ornish and others. It uses lifestyle changes to make its impact, altering the way participants eat, move, manage stress, and find emotional support to improve overall well-being. It is delivered in 18 four-hour group sessions over a nine-week period in cohorts of up to 15 people, with a focus on improvement in

with others who are participating in the program and facilitates long-lasting relationships.  Nutrition develops and cultivates a low-fat, whole foods, plant-based eating plan.

The first site to offer the Ornish Reversal Program is KentuckyOne’s Healthy Lifestyle Center at Medical Center Jewish Northeast off Old Henry Road beginning

July 7. Saint Joseph Hospital in Lexington will open the second location in late 2015.

KentuckyOne’s medical leaders echoed the importance of this changing paradigm. “We have to start getting at the root causes of poor health rather than relying on prescriptions and medical procedures to address symptoms,” said cardiologist Paul Rogers, MD, co-medical director of the Ornish Reversal Program in Louisville. “Compared to even the best medical therapy, we know we can decrease heart attacks, strokes, and death by between 35 percent and 45 percent by changing lifestyle. The Ornish Reversal Program builds on KentuckyOne’s excellence in heart care and emerging focus on wellness and gives us a new evidence-based tool to effectively treat and reverse disease.”

The Ornish Reversal Program is facilitated by a dedicated six-person team that includes a medical director, program leader, nurse case manager, and experts in stress management, behavioral health, fitness, and nutrition. “We are working together to help participants take control of their health by providing the knowledge, training, and community resources to sustain a healthier lifestyle,” said Deborah Ballard, MD, MPH, an internal medicine specialist and co-medical director for the Ornish Reversal Program PHOTO COURTESY OF KENTUCKYONE HEALTH ISSUE#93 3

HEADLINES

Compared to even the best medical therapy, we know we can decrease heart attacks, strokes, and death by between 35 percent and 45 percent by changing lifestyle.

– Dr. Paul Rogers

Dr. Paul Rogers is a cardiologist and co-medical director of the Ornish Reversal Program in Louisville.

in Louisville. She noted one unique aspect of the service is the opportunity to be a part of the Ornish community after the program ends. “This alumni concept helps people maintain their gains and adhere to lifestyle changes over the long run. In some communities, participants are still in touch after 20 years or more.

KentuckyOne Health is offering the Ornish Reversal Program through global well-being improvement leader Healthways, Inc. Healthways partnered with Dr. Ornish in 2013 to bring his innovative, evidencebased approach to health systems across the United States in response to growing

demand from consumers and providers for approaches that address the underlying causes of disease through lifestyle changes.

The Ornish Reversal Program is reimbursed by Medicare, Anthem, and other commercial payers for individuals with qualifying heart conditions (acute myocardial infarction within the preceding 12 months, coronary artery bypass surgery, stable angina, heart valve repair or replacement, percutaneous transluminal coronary angioplasty or coronary stenting, and heart or heart-lung transplant). In addition, there is a discounted rate for individuals who choose to pay outof-pocket. ◆

Helping Kentuckians Live Healthier Lives Ask your colleagues about their experience with Passport and call us to learn more about joining our network.

1-800-578-0775

www.passporthealthplan.com 4 MD-UPDATE PHOTO COURTESY OF KENTUCKYONE HEALTH pass3891v3_MD Update_7.375x4.8125.indd 1

2/23/15 8:45 AM

FINANCE

Looking Back, Looking Forward Back in the ‘80s, legendary stock picker Peter Lynch was famous for looking for those stocks that he thought would grow by a multiple of ten. A “ten-bagger,” he called them. He was simply referring to the increase in the nominal price of the stock, not its real return, measured by the total return over inflation. What nobody realized at that time was that we were on the front end of what has turned out to be the most remarkable stock market of the past century.

Indeed, one that would rise nearly tenfold in real terms between 1981 and 2015. One could have simply invested in the broad index and nearly had a ten-bagger in real terms after inflation.

Looking for causality, acclaimed economist Dr. Woody Brock points to five fundamentals that explain stock market returns: 1) aggregate earnings as a share of GDP; 2) the growth rate of aggregate earnings; 3) the level of interest rates; 4) the growth rate of earnings per share; and 5) the magnitude of

us to ask, “What’s next?” Enter the concept of mean reversion.

Nearly everyone today posits a gradual rise in interest rates, both short and long term. Indeed, all eyes seem to be

BY Scott Neal focused on the Fed. Mean reversion also points to a likely slowdown in earnings growth, a reduction in share repurchases as baby-boomers demand dividends over share buy-backs, a reduction in earnings per share, and a reduction in PE ratio back to perhaps a more “normal” 15 from its current 20+. Today, as the market keeps producing new record highs, most people seem to fear an impending stock market crash. However, these meanreverting developments do not portend a

The moral of the story is that it will be very difficult to match the kind of wealth growth we have seen over the past 35 years. stock repurchases by firms.

A good question to ask would be what, precisely, caused such an unexpected rise in the stock market. The answer, according to Brock, is that not just one, but all the aforementioned fundamental drivers performed optimally for the stock market for the period in question. All five! This accounts for why nobody in 1981 would have or could have predicted such a rise in the market. Taking the five variables into question, a rational prediction by a normal investor would have been a DOW of 9,000 at the end of 2014, not 17,800. The odds of reaching that level were about one in 3,000 in 1981. That leads

stock market crash nearly as much as they do a sustained lower level of growth. In fact, some estimates call for an equity growth rate that is 60 percent lower than that created by the 1981-2015 regime. Crashes can still occur for quite non-fundamental reasons, and the possibility of one or more crashes should not be totally written off. The real concern may simply be a long-lived lower than expected level of growth.

So what does this say about where we are today, and where we might be headed?

Nobody contradicts the demographics that indicate we are on the leading edge of boomer retirements, that pension funds are

woefully underfunded, and that it’s soon coming time to pay the piper for the outof-control profligate deficit spending that has occurred over the past several years. The moral of the story is that it will be very difficult, and highly unlikely, to match the kind of wealth growth we have seen over the past 35 years, just when we need it most.

Long time readers may recall that I like to ask the “So what?” question. Knowing what we have just revealed, what does an investor do now? Indexing stocks and bonds over the past three plus decades has produced extraordinary results. If the prediction above holds true, indexing over the next few decades could become the investor’s worst enemy if he or she hopes to grow a portfolio. Very low or even negative real returns could be the outcome. This should cause us all to rethink active investing vs. passive buy-hold-and-rebalance portfolio management. Over the past six years, it has been so difficult for active managers (stock pickers and active fund managers alike) to beat the index. The drum of indexing is being beaten ever more loudly today as automated advice and management built on indexing is becoming commonplace. Be careful that you do not become mesmerized by the passive drumbeat filling the airwaves and consuming advertising ink. It is likely that high-conviction active management will win the portfolio management battle over the coming decades. We will have more to say about that, as well as behavioral portfolio management, in future articles.

Think clearly about this. Go back to your financial plan and review what real return projections were used to project your wealth and spending power for the rest of your life. Update your plan if the assumptions were based on recent historical averages. Stress test your portfolio. Call us if we can be of help.

Scott Neal is the president of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. He can be reached at scott@dsneal.com or by calling 1-800-344-9098. ◆ ISSUE#93 5

ACCOUNTING

Do You Have the Tools to Effectively Manage Your Practice?

CO-AUTHORED BY ALEX CONRAD As the healthcare industry has changed, so has the relationship between a physician and their practice advisor. Practice advisors should be providing more than annual tax returns and tax planning services. There is certainly value in minimizing your tax and at the same time maintaining compliance.

However, if your practice advisor services are limited to tax and bookkeeping, you may be missing out on a lot more. Here are three areas that we have found to provide additional value to practices.

Real time financial statements with explanations on where your business is going

Our firm recently met with a physician who was receiving monthly financial statements.

When we asked what he does with them each month, the response was, “Nothing, I just put them in this file.” Upon further discussions it became clear that the physician was not using them because there were no comparisons or explanations on what was happening financially and operationally. Having regular meetings with your practice advisor to go over your financial statements can go a long way. Your practice advisor should be helping identify trends and point to areas of improvement along the way. They can also help explain what the numbers actually mean, and set budgets and goals for how to arrive at the results you want.

In addition to reviewing the financial statements regularly, using a cloud based accounting system can provide an opportunity to have real-time financial statements that both you and your advisor can access regularly. Whether you have an internal bookkeeper to post entries and maintain records or you outsource it completely, having this remote access can provide an opportunity for everyone to stay on the same page and provide real-time advice and monitoring. These systems also store your accounting data securely on off-site servers, which reduces the risk of data loss.

6 MD-UPDATE

Implementing Helping to establish and internal monitor key performance controls indicators (KPI)

Establishing effective internal controls in the bill paying process can be difficult for many reasons. The most common problem

BY L.Porter Robers Jr., CPA we encounter is that there is not adequate staffing to segregate the duties.

Physicians may not have the time to pay the bills themselves and instead delegate this work to the office staff to prepare and record. If not set up properly, the accounts payable process can turn into an opportunity for employees to take advantage of the practice. We have seen too many instances where employees were put into situations without adequate controls that eventually led to fraud. Your practice advisor should be able to help identify areas of concern or improvement that would help mitigate the possibilities that fraud would happen and go undetected. This advice could also span beyond accounts payable processes.

In addition, some practice advisors may be able to offer more services, such as a bill pay service for your practice. In this scenario, practice advisors have the ability to record and process accounts payable with high efficiency while maintaining strong controls. Some electronic bill pay systems will allow the owner to simply login to a secure site and approve and pay their accounts payable. This site should also have the ability to display any invoices at any time and document the persons that approved and paid the invoice. After all of the preliminary work of scanning, approving the invoices, and recording the transactions are done, it often takes just a few minutes for a management physician to pay an entire month of bills.

Your practice advisor should know healthcare in order to understand your operational processes. Having this knowledge, your practice advisor will be able to help develop key performance indicators specific to your practice. Implementing a metrics board that aligns with your goals is important too. Understanding your financial statements and what areas to focus on will be important in setting those goals.

Your advisor should be starting those discussions and monitoring your progress.

To ensure that you are meeting your goals, you need to manage by monitoring several key performance indicators.

Examples of key performance indicators in the revenue cycle that we think help facilitate accountability and progress are: • Days in receivable outstanding • Aged Accounts Receivables by payer • Time between date of service and date billed • Percentage of claims denied • Denials by payer Your practice advisor should be working hard to ensure you have the tools to effectively manage your practice and monitor your results. Value extends beyond good tax planning and compliant tax returns.

It’s a partnership that offers value through improving processes, developing strong internal controls, tracking key performance indicators, benchmarking, providing operational assessments, financing analysis, and many more areas. Your patients expect more out of you, shouldn’t you expect more out of your practice advisor?

L. Porter Roberts Jr, CPA, is with the Medical Services Group of Barr, Anderson & Roberts, PSC, in Lexington, KY. If you would like more information, they can be reached via email at lproberts@barcpa.com and via telephone at 859-268-1040. ◆

PHYSICIAN VIEWPOINT

Honoring a Tradition and a Master

BY CAMERON S. SCHAEFFER, MD When people think about the Hippocratic Oath, “first, do no harm” is what comes to mind, though the phrase is not found there. One provision of the Oath that is often forgotten is the promise to honor one’s mentors. One of mine was Dr. Dale M. Roberts, a Louisville plastic surgeon who closed his solo private practice in June to wind down his career as an academic cleft lip and palate surgeon in Iowa City.

For Dale, surgical training was not a means to an end, but an end itself. These days, one can get a degree in dentistry and medicine in a combined program, and one can become a plastic surgeon in an “integrated” residency. Dale took no short cuts, first becoming an oral surgeon via dental school, then going to medical school. He completed residencies in otolaryngology and plastic surgery, and he did a craniofacial fellowship in Paris with the father of that LOUISVILLE

field, Dr. Paul Tessier.

Such training is now almost impossible in an era of crushing debt incurred by aspiring doctors.

After finishing a pediBY Cameron S. Schaeffer, MD atric urology fellowship at Duke University, I entered the plastic surgery residency at the University of Louisville in 1995. My urology mentors told me I was taking a step backwards, and changing diabetic foot dressings at night seemed confirmatory. But watching Dale surgically dismantle a face made it feel more like a giant step sideways into a new world of complex problem solving, something I had craved.

The care urologists provide is often very private, and most patients can be helped. Successes are a source of secret, solemn pride, and sometimes only two people are aware that something great has been accomplished.

Plastic surgery can be different. The results are often right there for everyone to see.

In some cases, that is entirely the point. I remember being in downtown Louisville and noticing a particularly attractive young woman. It took a few extra glances to realize she was a patient who, until recently, had possessed a disastrous nose, which I had helped Dale fix.

Working with Dale was always fun and educational. I Dr. Dale M. Roberts, a plastic surgeon, closed his Louisville practice to become an academic cleft lip and palate surgeon in Iowa City.

still remember his quiet dignity, his stamina, his commitment to excellence, and his consummate artistry and skill. He received our program’s teaching award my first year in Louisville.

In his book Mastery, the philosopher Robert Greene advises the student to submit to the ideal apprenticeship, which occurs in three modes: deep observation, skills acquisition, and experimentation, and to choose a mentor according to his particular needs and inclinations. Once the master is selected, the student must gaze deeply into the master’s mirror and transfigure his ideas.

I perceived in my urology training a limited understanding of soft tissues, and I had come to Louisville to become a better reconstructive genital surgeon, to transfigure the ideas of plastic surgery. As I expected, I learned there are principles in nasal surgery that can be applied to other solitary, midline structures, particularly when you are learning from a master.

In reflecting on Dale’s move, I cannot but think about the transformation of medicine. Louisville medicine in the 1990s was passionate, energetic, and entrepreneurial. It was at the forefront of reconstructive surgery, particularly hand and microsurgery.

It was a world where hospitals catered to doctors and doctors catered to patients, as it should be.

That world is ending, and, in my view, the patients will eventually suffer for it.

These days, hospitals employ doctors and advertise for patients. Physicians have been commoditized. Patients, long used to excellence in patient care and completely disconnected from paying for it, have little sense of physician value. They have come to believe a provider is a provider, and we have let them. If a hospital needs a certain type of doctor, they simply hire one. Young physicians, having given up their freedom by incurring debt, have little choice, especially given the cost and complexity of starting a practice.

This new world is straining the 2500-year-old Hippocratic Oath. We are bound by that Oath to work for the sake of our patients. What will they now think

PHOTO COURTESY OF GREATER LOUISVILLE MEDICAL SOCIETY

ISSUE#93 7

PHYSICIAN VIEWPOINT

of our divided loyalties? room at Kosair Children’s Will they trust us to preHospital, the Chief of scribe the more expensive Anesthesiology, Dr. Steve yet more efficacious drug Auden, said, “Welcome against our employer’s home.” I was deeply wishes? Will they perceive touched. our bonuses are fattened Feeling embraced by by withholding care? Will the pediatric community, they trust the care and my partner, Ann Muth, privacy we have guarded APRN and I have opened for centuries when the a new, larger office in the focus of our attention is Medical Arts Building on not their minds and their Eastern Parkway. It is an Ann Muth, APRN bodies, but a computer older building with the screen? Does anyone faint smell of camphor, using an EMR really believe that patient the smell of Hippocratic medicine. My new privacy still exists? prized possession is the surgical table Dale It is in this world that I decided to gave me when he left town. expand my pediatric urology practice.

Bon voyage, Dale, and best of luck. I Last year, after 14 years in Lexington, I will do my best to use that table to honor opened an office in downtown Louisville, your teaching, your mastery, and our trathe city of my birth. Back in the operating dition. ◆

8 MD-UPDATE

PEDIATRIC UROLOGY FOR PATIENT REFERRALS

(502) 410-4700 1169 Eastern Parkway Suite 2358 Louisville, KY 40217 Lexington (859) 275-5437 (KIDS) (866) KIDS-URO Fax (859) 275-5434 (Both Locations) www.pediatricurology.com

COVER

COVERING ALL THE BASES

Dr. Jennifer Daily, a family medicine/sports medicine specialist with UofL Physicians and associate director for the UofL Primary Care Sports Medicine Fellowship, focuses on form with sports medicine patient Kristie Dearing at the Cardinal Station clinic.

The collaboration of specialties at KentuckyOne Health/UofL Sports Medicine provides comprehensive care to athletes of all ages BY JENNIFER S. NEWTON “You can provide sports medicine care from many different vantage points,” says Darryl Kaelin, MD, medical director of Frazier Rehab Institute, part of KentuckyOne Health, and chief of the division of Physical Medicine & Rehabilitation (PM&R) for University of Louisville (UofL) Physicians. The key to KentuckyOne Health/UofL Sports Medicine is the collaboration of a diverse network of services that creates a holistic approach to sports medicine care for pediatric to geriatric athletes.

At the center of the collaboration is a trio of medical specialties – primary care sports medicine, orthopedics, and PM&R. The KentuckyOne/UofL team includes 18 physicians from all three sports medicineLOUISVILLE/BARDSTOWN

related specialties and across locations from Louisville to Bardstown. In addition, the program follows a performance team model, which includes providers from any specialty that can help keep an athlete from being sidelined. This is where KentuckyOne Health’s large network adds immeasurable value to the program. From emergency medicine physicians to cardiologists and mental health professionals to sports nutritionists, an athlete’s health is covered from every angle.

KentuckyOne Health/UofL Sports Medicine focuses on four main components of sports medicine care: education, prevention, treatment, and rehab. It is important to note that two of these categories are about wellness, not just reactionary medicine.

KentuckyOne’s educational programming

includes road race training, concussion management, and sports nutrition. Prevention programs include: function movement screening, golf swing analysis and training, and sports performance programs.

The Home Team: Primary Care Sports Medicine

Primary care sports medicine providers are the gatekeepers of the program. Often the first practitioners in the system to see patients, they serve to funnel patients to the appropriate specialist when needed.

KentuckyOne Health is the official healthcare provider for UofL Cardinal Athletics. “We serve as the primary care and sports medicine physicians for UofL athletes as part of that partnership,” says PHOTO BY BRIAN BOHANNON

ISSUE#93 9

COVER Jessica Stumbo, MD, an internal medicine/ pediatrics specialist with UofL Physicians and program director for the UofL Primary Care Sports Medicine Fellowship.

As a med/peds physician fellowshiptrained in primary care sports medicine, Stumbo says, “When athletes come to campus, we see all their medical problems, not just their sports injuries.” That means taking care of coughs, colds, rashes, and female issues, in addition to sports injuries and musculoskeletal problems. Her training in primary care allows her to evaluate sports medicine issues from a deeper perspective, always asking – Is there an underlying medical issue contributing to this injury or illness?

Stumbo practices at the program’s primary clinic at Cardinal Station, along with colleagues Jennifer Daily, MD, and Jonathan Becker, MD, who also provide leadership to the fellowship program. Stumbo’s clinic time is split between seeing primary care and sports medicine patients. While the partnership with Cardinal Athletics creates a unique population of Division I collegiate athletes, she also sees sports medicine patients of any age from the community.

Sports medicine services that Stumbo and her colleagues provide include: chronic

exertional compartment syndrome testing for exertional leg pain; concussion management; female triad management; stress fracture management; fatigue and underperforming athlete evaluation; treatment of exercise-induced asthma or shortness of breath from non-asthma causes, such as vocal cord dysfunction; musculoskeletal ultrasound for diagnostic purposes and injection guidance; and prolotherapy for chronic tendon issues, which increases healing by injecting a special solution to irritate the area and increase blood flow.

Stumbo is well-acquainted with the sports medicine fellowship because she was Dr. Darryl Kaelin (top left), medical director of Frazier Rehab Institute and chief of the division of PM&R for UofL Physicians, looks on as Ashton Smith, PT, DPT, (right) works with Frazier Rehab patient Arnold Johnston, who was injured in a bicycle accident.

a fellow at UofL from 2007-2008.

The fellowship is a one-year program with fellows rotating with various orthopedic surgeons in the community, as well as through the UofL athletic training rooms, including covering athletic events, and through the sports medicine clinic. While fellows are not trained in surgery, Stumbo says, “They still get that aspect, so they have a more comprehensive view of sports medicine and how injuries are handled.”

The Relief Pitcher: Orthopedic Shoulder & Elbow Care

Specializing in orthopedic care for the shoulder and elbow allows Kevin Harreld, MD, orthope10 MD-UPDATE

TOP PHOTO BY ROBERT BURGE, BOTTOM PHOTO BY BRIAN BOHANNON

Dr. Mark Duber, orthopedic surgeon with KentuckyOne Health Orthopedic Associates at Flaget Memorial Hospital in Bardstown, is the team physician for St. Catharine College.

dic surgeon with KentuckyOne Health Orthopedic Associates, the opportunity to employ aspects from every area of orthopedics and see patients of all ages – from 10 and 11 year-old little league pitchers, to high school athletes, to adult weekend warriors, to octogenarians. “I had several fractures as a child. We had a neighborhood orthopedic surgeon I got to know really well, and that led me into orthopedics,” he says.

Harreld, who is from Owensboro, has been with KentuckyOne Health since 2011.

His training includes medical school at UofL, residency at Wake Forest University in North Carolina, and a one-year shoulder and elbow fellowship at Florida Orthopedic Institute in Tampa. He is one of three orthopedic surgeons in his practice at Sts. Mary and Elizabeth Hospital, which also includes Todd Hockenbury, MD – foot and ankle care, and Navin Kilambi, MD, - knee, shoulder, and elbow treatment.

One area of growing concern is an epidemic of overuse in little league baseball players, among other athletes, who play one sport year round. “The number of Tommy John surgeries has gone up exponentially since 2000,” says Harreld.

Platelet rich plasma (PRP) is one nonsurgical treatment Harreld uses in acute and chronic sports injuries. By injecting the patient’s own platelets, containing growth factors, into injury areas, PRP can speed recovery in both non-surgical and surgical patients.

Arthroscopy plays a major role in Harreld’s surgical practice. Beyond rotator cuff tears, the technique is also being used to address cartilage issues, such as osteochondritis dissecans (OCD) lesions in the elbow. “People are beginning to push the frontiers of what we can do through the

scope in terms of elbow surgery as well,” he says. While not necessarily just for athletes, Harreld does perform reverse total shoulder replacement.

Underlining the importance of the continuum of care, a supervisor from Frazier Rehab sees patients in tandem with Harreld in the office one day a week. “That’s been a tremendous help to both of us and to the patients because he’s here when they come back for post-op follow-up … I think working very closely with a therapist is key to maximizing outcomes.”

Other KentuckyOne Health Orthopedic Associates physicians who specialize in shoulder repairs include Andrew Duffee, MD, and Greg Rennirt, MD, both of whom man solo sports medicine/orthopedics offices as part of the KentuckyOne network. Duffee also performs knee arthroscopy and arthroplasty, meniscus repair, ACL reconstruction, trigger finger release, and carpal tunnel release. In addition to shoulders, Rennirt’s practice emphasizes knee repairs.

Extra Innings: Joint issues in an aging population

Jeffrey Stimac, MD, orthopedic surgeon with KentuckyOne Health Orthopedic Associates, knew he wanted to go into orthopedics in high school, when he shadowed an orthopedic surgeon.

Stimac, who is approaching his two year anniversary with KentuckyOne, attended Tulane University Medical School in New Orleans, did an orthopedic surgery residency at UofL, and a fellowship in adult reconstruction and joint replacement at the Hospital for Special Surgery in New York.

His practice includes six physicians, who do a mix of sports medicine and joint replacement, and has locations on the Jewish Hospital downtown and Jewish Northeast campuses. Other physicians in the practice include: David Caborn, MD, who specializes in knee and sports surgery; Dr. Jeffrey Stimac, orthopedic surgeon with KentuckyOne Health Orthopedic Associates, specializes in adult joint reconstruction and joint replacement, including hip and knee revisions and infected joint replacements.

Dr. Kevin Harreld, orthopedic surgeon with KentuckyOne Health Orthopedic Associates, specializes in shoulder and elbow care.

Arthur Malkani, MD, complex joint cases; Paul McKee, MD, non-surgical orthopedics and UofL baseball team physician; Raymond Shea, MD, UofL football; and Edward Tillett, MD, UofL football.

Stimac’s areas of interest include joint replacement, anterior approach total hip replacement, complex primary hip replacement, revision hip and knee replacement, and treating infected joint replacements. He treats mostly adults over age 50. Because he does revisions and infected joints, he sees patients from a wide geographic area.

Stimac estimates 95 percent of his primary hip replacements are done with the anterior approach. A trending technique, he notes, “It probably accounts for 15 to 20 percent of hip replacements in the US. I think that number continues to grow.”

Contraindications to the anterior approach include revision surgery for previous posterior approach surgery, significant hip dysplasia, significant defects within the acetabulum, or previous trauma or surgical incisions.

Another general orthopedist who

is part of the KentuckyOne network is Thomas Loeb, MD, who specializes in partial and total knee replacements in a solo practice as part of KentuckyOne Health Orthopedic Associates.

The Team “Captain”: Military experience informs sports medicine treatment

UofL is not the only area college benefitting from the expertise of KentuckyOne Health Sports Medicine. In Bardstown, Mark Duber, DO, orthopedic surgeon with KentuckyOne Health Orthopedic Associates, serves as team physician for St. Catharine College, a partnership that has flourished under Duber’s one-year tenure.

“It started as an open door policy, now we are on campus evaluating athletes two times a month and involved at sporting events as backup,” says Duber. Working closely with the athletic trainers, he provides next-day care and evaluation for injuries.

Duber grew up in Cleveland with a lot of athletic interests. “I looked at orthopedics as kind of the complete spectrum that relates to the musculoskeletal system,” he says. He went to medical school at Kirksville College of Osteopathic Medicine (KCOM) in Missouri on a US Army scholarship and did his residency in orthopedic surgery at Cleveland Clinic. He fulfilled his scholarship require-

TOP PHOTO BY BRIAN BOHANNON, BOTTOM PHOTO BY ROBERT BURGE

ISSUE#93 11

COVER

ments with four years of active duty service at Fort Knox, specializing in sports medicine. “We treat every troop like an athlete … based on the type of work they’re doing, especially with deployment and anything else related to military activity,” Duber says.

Upon completion of his military service, Duber settled in Bardstown at Flaget Memorial Hospital, part of KentuckyOne Health. It is a high-volume practice that treats patients from age four to 90. “I engage in big city orthopedic surgery with excellent results and rehabilitation with a small town feel,” he says.

Fifty percent of his practice is sports medicine, including covering athletes from the four area high schools, as well as grade school athletes. The other 50 percent is devoted to fracture care, degenerative conditions, and degenerative sports medicine.

Dr. Jessica Stumbo, an internal medicine/ pediatrics and sports medicine specialist with UofL Physicians and program director for the UofL Primary Care Sports Medicine Fellowship, consults with sports medicine fellow Rebecca Popham, DO.

An ageless issue, concussion treatment has undergone diverse changes over the last decade. With Duber’s military service, “I got to see firsthand a lot of the changes that were happening in evaluation and treatment because of the traumatic brain injuries we were seeing with roadside bombs and other types of injuries,” he says.

Duber also notes the evolution of techniques for the anterior cruciate ligament 12 MD-UPDATE

PHOTO BY BRIAN BOHANNON

(ACL), particularly graft selection and anatomic reconstruction. “If positioned correctly, you have a much lower failure rate of ACL over the long haul and a much better return to sport without any type of disability than we had with non-anatomic reconstruction,” he says. Graft selection is also just as critical. The use of allografts has been shown to be less effective in the athletic population for long-term outcomes. Duber uses only autografts in athletes and has learned which type of tissue gives the best results.

Off the Bench: Rehab for a quicker recovery

Effective surgery is important for sports medicine injuries, but effective rehab may be just as important to recovery. Frazier Rehab has over 20 outpatient clinics throughout the community contributing the KentuckyOne’s continuum of care.

Frazier’s physical therapists work closely with physicians to ensure the best possible treatment plan for patients.

Kaelin and his PM&R colleagues head the rehab component for Frazier.

Michael Weaver, DO, a sports medicine fellowshiptrained rehab specialist, is the point person for rehab care of sports medicine injuries, while Kaelin specializes in neurologic injuries, such as concussions and spinal cord issues. “We tend to provide very distinct and specific prescriptions for therapy, in addition to using medications and treatments like injections, ultrasound, electrical stimulation, etc. Therapists are a big part of the team in giving correct guidance,” says Kaelin.

Kaelin cautions that not all therapy programs are alike. “Because we are the provider for UofL, we are using stateof-the-art techniques in helping [all our athletes] recover. So, those include things like reduced weight-bearing treadmills that allow people to get back to running and jogging without putting their full weight down, aquatic exercise, electrical stimula-

tion to help muscles recover quicker, and some unique injections, including PRP and ultrasound-guided injections to insure we’re putting medications where they need to be without injuring other tissues,” he says.

Concussions are also an issue being emphasized in rehab. In addition, KentuckyOne Sports Medicine is highlighting injury prevention by providing functional movement screens for athletes to evaluate flexibility and muscle balance to assess injury risk.

From prevention to injury assessment, to treatment, to recovery and return to sport, KentuckyOne Health/UofL Sports Medicine’s immense network of professionals has covered all the bases, making athletes of all ages and all levels in Kentucky part of the winning team. ◆

MEDICAL MANAGEMENT AND COMMUNITY OUTREACH PARTNERSHIPS KentuckyOne Health/UofL Sports Medicine provides medical management to area events, as well as athletic training services to community schools.

MEDICAL MANAGEMENT:  JCPS Cross Country Championships  UofL Football  PGA Championship and Senior PGA  Ryder Cup  Triple Crown of Running  Louisville Sports Commission • Urban Bourbon Half Marathon • Cross Country Classic • Kids Finish First • NCAA DII National Championship Fall Festival ATHLETIC TRAINER COVERAGE:  Area high schools: Doss, Manual, PRP, Bullitt East (all sports)  UofL Rugby  St. Catharine College (all sports) SPEAKER INVOLVEMENT:  Traumatic Brain Injury Symposium – KentuckyOne Health (Frazier Rehab and UL Physicians)

䴀䄀刀䬀 䴀䌀䜀䤀一一䤀匀Ⰰ 䴀䐀

刀䔀䤀䐀 圀䤀䰀匀伀一Ⰰ 䴀䐀

圀䠀䔀一 伀䘀䘀䤀䌀䔀刀 䔀䄀刀一䔀匀吀 一䔀䔀䐀䔀䐀 匀伀䴀䔀 䠀䔀䰀倀 圀䤀吀䠀 䠀䤀匀 䄀䤀䰀䤀一䜀 䄀刀䴀Ⰰ 圀䔀 䜀䄀嘀䔀 䠀䤀䴀 吀䠀䔀 䰀䤀䘀吀 䠀䔀 一䔀䔀䐀䔀䐀⸀

嘀攀琀攀爀愀渀 瀀漀氀椀挀攀 漀ϻ挀攀爀⸀ 䘀愀琀栀攀爀 漀昀 琀栀爀攀攀⸀ 䘀愀椀琀栀昀甀氀 挀漀洀洀甀渀椀琀礀 猀攀爀瘀愀渀琀⸀ 䌀氀椀渀琀漀渀 䔀愀爀渀攀猀琀 搀攀ǻ渀椀琀攀氀礀 猀栀漀甀氀搀攀爀猀 栀椀猀 猀栀愀爀攀 漀昀 爀攀猀瀀漀渀猀椀戀椀氀椀琀椀攀猀⸀ 匀漀 眀栀攀渀 愀渀 漀ûⴀ琀栀攀ⴀ挀氀漀挀欀 椀渀樀甀爀礀 爀攀搀甀挀攀搀 栀椀猀 愀戀椀氀椀琀礀 琀漀 眀漀爀欀 愀渀搀 瀀氀愀礀Ⰰ 䌀氀椀渀琀漀渀 琀甀爀渀攀搀 琀漀 伀渀攀 䠀攀愀氀琀栀 伀爀琀栀漀瀀攀搀椀挀猀 琀漀 洀攀渀搀 栀椀猀 愀爀洀 愀渀搀 爀攀猀琀漀爀攀 栀椀猀 猀琀爀攀渀最琀栀⸀ 䐀爀⸀ 䴀愀爀欀 䴀挀䜀椀渀渀椀猀 爀攀瀀愀椀爀攀搀 琀栀攀 琀攀愀爀 椀渀 䌀氀椀渀琀漀渀ᤠ猀 愀爀洀Ⰰ 愀渀搀 琀漀搀愀礀 琀栀攀 漀ϻ挀攀爀 椀猀 戀愀挀欀 琀漀 琀栀攀 氀椀昀攀 栀攀 氀漀瘀攀猀 ᐠ 欀椀搀猀Ⰰ 栀漀戀戀椀攀猀 愀渀搀 愀 昀甀氀氀 搀愀礀 漀渀 琀栀攀 樀漀戀⸀ 吀栀愀琀 栀攀氀瀀猀 甀猀 愀氀氀 猀氀攀攀瀀 戀攀琀琀攀爀 愀琀 渀椀最栀琀⸀

伀眀攀渀猀戀漀爀漀䠀攀愀氀琀栀⸀漀爀最⼀刀攀猀琀漀爀攀

䌀䄀䰀䰀 㠀㐀㐀ⴀ㐀㐀ⴀ䴀夀ⴀ伀一䔀 琀漀 猀攀攀 栀漀眀 眀攀 挀愀渀 栀攀氀瀀 刀䔀匀吀伀刀䔀 礀漀甀爀 焀甀愀氀椀琀礀 漀昀 氀椀昀攀⸀

伀爀琀栀漀瀀攀搀椀挀猀 倀氀攀愀猀愀渀琀 嘀愀氀氀攀礀 䌀攀渀琀攀爀 ㄀㌀ ㄀ 倀氀攀愀猀愀渀琀 嘀愀氀氀攀礀 刀漀愀搀Ⰰ 匀甀椀琀攀 ⌀㔀 伀眀攀渀猀戀漀爀漀Ⰰ 䬀攀渀琀甀挀欀礀 㐀㈀㌀ ㌀ 倀䠀伀一䔀㨀 ㈀㜀 ⴀ㐀㄀㜀ⴀ㜀㤀㐀 ISSUE#93 13

SPECIAL SECTION  SPORTS MEDICINE/ORTHOPEDICS

One Stop Shop

Orthopedic surgeon and physical therapist team up to keep athletes active

BY JILL DEBOLT

Young athletes deserve topnotch prevention and treatment interventions for sports-related injuries that can be provided by a multi-disciplinary team. Floyd Memorial Medical Group - Orthopedics in New Albany, Indiana provides these services for the Kentuckiana area.

Kris Abeln, MD, orthopedic surgeon and sports medicine specialist at Floyd Memorial, describes their practice as a “one stop shop” for sports medicine. “We provide all levels of service from evaluation, surgery, and non-surgical treatment to rehabilitation and prevention,” he says. Abeln describes his practice as 80 percent sports medicine with most patients in the young teen to middle age range. “Our clients include high school and college athletes, as well as recreational athletes,” he says. A graduate of the NEW ALBANY, IN

Team Physician

Abeln is a team physician for the University of Louisville and Indiana University Southeast and works with several local high school sports teams. In this role, he is involved in athletic training, injury clinics,

strengthening exercises, and rest. “I’m a strong believer in injury prevention clinics for all athletes and trainers,” he says. Abeln’s training included a fellowship in the PEP (Prevent Injury - Enhance Performance) program, developed by the Santa Monica Sports Medicine Foundation to reduce risk of ACL injury in organized sports (1).

Treatment: Avoiding, Minimizing Surgery

Abeln utilizes non-surgical treatment whenever possible, including rest, physical therapy, rehab, and Platelet Rich Plasma (PRP) therapy. “If surgery is required, I can perform surgeries such as no-incision ACL reconstruction and minimally invasive hip arthroscopy. These procedures have a faster recovery time with reduced blood loss, pain, and swelling,” states Abeln.

Platelet Rich Plasma Therapy

(ABOVE) Dr.

Kris Abeln, an orthopedic surgeon and sports medicine specialist at Floyd Memorial, describes his practice as a “one stop shop” for sports medicine.

(LEFT) Nate

Nevin, PT, DPT, Floyd Memorial Physical Therapy – Highlander Point, is a former starting pitcher for Bellarmine University and is known as the “Baseball PT.”

University of Louisville School of Medicine, Abeln completed his sports medicine fellowship in Santa Monica, California, where he worked with high school, college, and professional athletes. He is board certified in sports medicine and orthopedics.

14 MD-UPDATE

advising coaches and players, and treating sports-related injuries. “Common sports injuries include sprains, strains, fractures, and anterior cruciate ligament (ACL) and rotator cuff tears,” says Abeln.

Philosophy of Prevention

“My guiding philosophy is prevention of sports injuries,” says Abeln. Prevention includes educating coaches, players, and parents on such issues as stretching,

PHOTOS COURTESY OF FLOYD MEMORIAL HOSPITAL & HEALTH SERVICES

“Platelet Rich Plasma Therapy is a way to harness the body’s own healing power,” says Abeln. This short procedure involves collection of blood, centrifuge to concentrate platelets and growth factors, and injection of the autologous PRP into the area of injury. PRP, used by many famous athletes, has shown promise in recovery from sprains, strains, and tendonitis of knees, elbows, shoulders, and heels, as well as other applications (2). “PRP can be a good alternative to arthroscopic surgery, especially for meniscus tears and partial rotator cuff tears,” says Abeln.

Role of Physical Therapy

The physical therapist (PT) plays an integral role in sports medicine practice by performing evaluation, injury prevention, and rehabilitation post injury/surgery. Nate Nevin PT, DPT, has provided these services at Floyd Memorial Physical Therapy – Highlander Point for five years. Nevin, who received his doctorate in physical therapy from Bellarmine University, enjoys treating a multitude of orthopedic injuries by

implementing an evidence-based approach to rehabilitation. “I treat each patient on an individual basis,” says Nevin, who starts with a full body exam to identify underlying issues, such as weakness of the core or other areas of the body that can lead to sports injury. “Rest and strengthening can be the main treatment as players become more specialized in sports, repeating the same movements versus playing multiple sports that develop overall athleticism,” states Nevin.

Baseball Physical Therapist

As a former starting pitcher for the Bellarmine Knights, Nevin receives great satisfaction from treating young athletes. He’s known as the “Baseball PT,” focusing on pitching and overthrowing injuries. Nevin has worked numerous baseball camps and assisted local and

traveling teams with prevention and screening. “I receive many referrals of high school baseball players for injuries, such as shoulder and elbow pain, and rehab post-Tommy John elbow surgery,” states Nevin. He feels pitching injuries are becoming more common due to overuse and repetition. Nevin encourages education of players, parents, and coaches, saying, “Kids need to be active in multiple sports and avoid over- repetition.”

Message for Healthcare Providers

Nevin advises pediatricians and primary care providers to evaluate young adolescents for growth plate injuries in the presence of shoulder or medial elbow pain. He recognizes the risks associated with overuse of imaging studies, but says, “X-rays may be needed

to rule out stress fracture in this population.”

Individuals can schedule a physical therapy screening by calling any Floyd Memorial Physical Therapy location.

Primary care providers and other specialists can refer patients for evaluation of injury and physical therapy. Orthopedic surgeons with Floyd Memorial Medical Group Orthopedics and physical therapists then team up to provide treatment for sports injuries and get players back into action.

(1) Santa Monica Sports Medicine Foundation website on PEP www. smsmf.org.

(2) Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA (2009). “Plateletrich plasma: From basic science to clinical applications”. AM J Sports Med 37 (11):2259-72. ◆

Sturgill Turner’s health care legal team is committed to providing comprehensive legal services to health care professionals, institutions and managed care organizations.

Serving health care providers with integrity.

LEXINGTON ◆ STURGILLTURNER.COM

THIS IS AN ADVERTISEMENT ISSUE#93 15

SPECIAL SECTION  SPORTS MEDICINE/ORTHOPEDICS

Motivated Patients = Satisfied Physician

Baptist Health Sports Medicine physician Mark Puckett, MD, finds satisfaction in solving problems for motivated sports medicine patients and seeing them get better BY JENNIFER S. NEWTON In much of medicine, care is focused on the sick. An abundance of chronic health issues, particularly in Kentucky, means physicians are providing lifetime care for patients whose problems may fluctuate in severity but are never actually resolved.

In sports medicine, the balance of health is different. “It is rewarding to be able to take care of patients who are motivated to make the investment to resolve their own condition,” says Mark Puckett, MD, a family practice physician specializing in sports medicine with Baptist Health Sports Medicine. “I enjoy the concept of seeing a problem, doing some problem solving, getting to the root cause of what that problem is, and seeing people get better.”

Originally from Louisville, Puckett went to medical school at the University of Louisville and attended residency and fellowship at Self Regional Healthcare in Greenwood, S.C., in family medicine and primary care sports medicine respectively.

During his training, he worked with recreational and collegiate athletes and tended to a lot of endurance sport athletes, such as triathletes and collegiate soccer players. He joined Baptist Health Medical Associates Family & Sports Medicine at Baptist Health Eastpoint in 2012.

As a family practice sports medicine specialist, Puckett’s focus is non-surgical sports medicine, but he is quick to note the general focus is sports health issues and not just injuries. For instance, “Sometimes that can be an endurance athlete who has fatigue or breathing issues when he or she runs,” he says. Puckett also sees non-athletes with repetitive motion injuries, such as a bow hunter with elbow issues and musicians with overuse injuries.

response without surgery.”

Prolotherapy can be as simple as aggressive physical therapy. It can also include using ultrasound to break up scar tissue under direct visualization, or platelet rich plasma (PRP), “where we take somebody’s own blood and separate the component that has growth factors for healing and inject into the injured tissue,” he explains.

Other treatments include steroid injections for pain relief or “gel” injections to lubricate damaged joints. The practice is also equipped for testing for conditions such as compartment syndrome.

LOUISVILLE

Problem Solver

Getting to the root cause of problems is part of Puckett’s treatment philosophy, one 16 MD-UPDATE

PHOTO COURTESY OF BAPTIST HEALTH

Barrier-less Communication

Mark Puckett, MD, joined Baptist Health Medical Associates Family & Sports Medicine at Baptist Health Eastpoint in 2012.

he learned from mentors during his training. For example, if a runner has an injury, he looks at how they run, not just their symptoms. Once a problem and its cause are properly assessed, Puckett focuses on the best solution for each patient, whether it be medication, physical therapy, a non-surgical procedure, or even surgery. “Because of that, I see a range of patients from 10-year-old soccer players with knee pain, to professional athletes, and older folks trying to stay active and healthy.

In terms of non-surgical treatments, perhaps the newest approach Puckett employs is loosely referred to as prolotherapy, which he defines as “pro-inflammatory treatments to prompt a healing

Baptist Health Sports Medicine services are headquartered at their Eastpoint location in east Louisville, where Puckett and his sports medicine colleagues share office space with orthopedic surgeons and physical therapists.

When the best prescription for a sports issue is surgery or physical therapy, or something that falls outside of Puckett’s purview, he can simply walk the patient down the hall to the most appropriate provider. “We can put our heads together right while we are seeing patients. It really allows us to think about what’s the best thing for the patient on an individual basis, not just, ‘What can I do within my skill set?’” he says.

He describes the connectivity with Baptist Health physical therapists as an “invaluable tool for everything we do” and says there are “no barriers to us communicating.”

Community Participation and Education

As an organization, Baptist Health Sports Medicine provides athletic training and team physician services to a number of area high schools. Puckett and orthopedic surgeon J. Steven Smith, MD, are the team physicians for Ballard High School in Louisville.

The group recently entered the proathlete arena becoming the team physicians for the Louisville City Football Club, the city’s new professional soccer team.

Puckett, Christopher Pitcock, MD, family and sports medicine physician, and Nicholas Kenney, MD, orthopedic surgeon, serve as the team physicians. Baptist also provides a full-time athletic trainer for the Louisville City FC, as well as training, performance, and injury prevention exercise programming through their sports performance program.

Education is also high on the group’s priority list. On July 29, 2015, Baptist Health Sports Medicine will host its third annual female athlete seminar. The seminar was created in response to a trend in injuries physicians and athletic trainers were seeing in the community. “We began to see a cluster of folks with stress fractures that

Sports medicine physicians, orthopedic surgeons, and physical therapists can put our heads together while we are seeing patients. It really allows us to think about what’s the best thing for the patient on an individual basis, not just, “What can I do within my skill set?” may have been related to nutritional insufficiencies with training,” says Puckett. The seminar will include presentations from orthopedic surgeon Kittie George, MD; Baptist Health Sports Performance Program Coordinator Nick Sarantis; a Baptist Health physical therapist; and a private practice sports nutritionist, Anna Grout. Topics will be specific to female athletes and will cover issues such as preventing injury patterns in runners, preventing ACL injuries in soccer players, and nutritional components that help promote bone health in female athletes.

A knack for problem-solving and a propensity for treating healthy, motivated patients may give Puckett and sports medicine physicians like him a great sense of satisfaction, but the connectivity and comprehensive nature of services Baptist Health

Sports Medicine provides are bound to equal that level of satisfaction with athletes of all ages. ◆

2400 Eastpoint Pkwy Louisville, KY 40223 (502) 253-6699 www.baptistsportsmedky.com

2335 Sterlington Road, Suite 100 Lexington, Kentucky 40517 (859) 268-1040 Fax: (859) 268-6165 Email: lprober ts@barcpa.com www.barcpa.com

ISSUE#93 17

SPECIAL SECTION  SPORTS MEDICINE/ORTHOPEDICS

Mr. Fix It

Mark McGinnis, MD, enjoys the immediate gratification of fixing orthopedic problems BY JIM KELSEY Watch any block of commercials these days and you’ll recognize a common theme – fitness, activity, movement, healthy lifestyles. Reality shows are centered on survival techniques, extreme obstacle courses, sports, and dance and fitness competitions.

Weekends are now filled with races, walks, mud runs, glow runs, mini marathons, triathlons, and more. Everyone is, in a sense, an athlete. And that, says Mark McGinnis, MD, is one of the hurdles being in sports medicine presents.

“My specialty is anything that falls under the category of sports medicine, but that doesn’t mean that you have to be an athlete to be seen by me,” says McGinnis, an orthopedic surgeon at One Health Orthopedics, a part of Owensboro Health. “The term ‘sports medicine’ is kind of misleading. It’s just the type of surgery that you do and typically is referring to arthroscopic surgery. A patient may be a 50-year-old with a rotator cuff tear, but if I repair the tear arthroscopically then this could still be considered a ‘sports medicine’ case.”

McGinnis, who is originally from eastern Kentucky, did his sports fellowship at Washington University in St. Louis. He has now been at One Health Orthopedics for two years, working with two other orthopedic surgeons in the practice, Reid Wilson, MD, and Anthony McBride, MD. McGinnis began to develop an interest in orthopedics during his first year of medical school at the University of Louisville.

There, he met a spine surgeon named Mitch Campbell, MD, whom McGinnis credits with teaching him what orthopedics is all about and piquing his interest in the field. That, combined with the opportunity to see virtually instant results, was enough to launch his career. “Orthopedists in general enjoy fixing things,” McGinnis says. “For a lot of things we do there’s a sense of immediate gratification. If there’s a very bad joint with arthritis, we can replace OWENSBORO

18 MD-UPDATE

PHOTO COURTESY OF OWENSBORO HEALTH

Dr. Mark McGinnis, an orthopedic surgeon with One Health, a part of Owensboro Health, says his specialty is anything that falls under the category of “sports medicine.” it, and the arthritis is gone … That’s rewarding.”

Part of that “fix it” mentality is the desire to see people return to the level of fitness and activity that they enjoyed prior to their injury. He estimates that roughly 60 to 70 percent of his practice involves arthroscopy, and 30 to 40 percent relates to treating fractures, broken bones, or joint

replacements. “With the arthroscopy I do, those patients are typically in their 30s or 40s,” McGinnis says.

“They are reasonably active, and that’s what we’re trying to restore.

The other spectrum I see are older patients – 60 and above – that have arthritis. For those patients we are typically looking at knee replacement, hip replacement, or shoulder replacement.”

McGinnis also sees school-age athletes. In fact, One Health Orthopedics employs a team of trainers who work at the local schools, assisting with their sports teams. That has developed a strong relationship between the clinic and the schools and provides a seamless means to care for younger athletes. “For instance, this morning one of the trainers at one of the high schools texted me and said he had a kid he wanted me to see,” McGinnis says. “Our answer to those requests is always, ‘send them on over.’ We have a built-in relationship that directs many of those patients to our care.”

Other referral sources for One Health Orthopedics come from primary care physicians and the Owensboro Health emergency room.

Creating a successful practice with a patient population steadily flowing in from a variety of referral points, One Health

Orthopedics is helping to accommodate the demand by adding a primary care sports medicine doctor and a fourth orthopedist within the next year. In addition, they work closely with a physical therapy office also run by One Health just down the hall and outpatient physical therapy services through the hospital.

The result is a mix of resources and access that greatly benefits the patient.

“We have a large network of providers and contact points, from primary care doctors employed by the hospital to ones that we know in the community, to the athletic trainers we employ to provide services to the area schools,” McGinnis says. “I think that gives us a cohesiveness that I would consider unique.”

Nowhere is that cohesiveness more evident than between McGinnis and his partners. “We’re willing to cover calls for each other or help out with difficult surgeries,” McGinnis says. “We all have open doors for our offices and operating rooms. That’s different compared to some other practices I’ve been around.”

A common theme among those in the practice is listening to the patient and finding out what they want and expect out of their treatment. At times that might conflict with the “fix it” mentality, but McGinnis stresses that serving the patient is the first priority. “In some ways, being patientcentered is moving us more and more away from the traditional practice of medicine, but listening to the patient and providing a service that they are wanting is really important,” McGinnis says. “Even though I’m a surgeon, the goal is to avoid surgery if you can get them back to a level that they are satisfied with. It’s a win if you can avoid surgery altogether.

“I’m a big advocate of just listening to the patient. The vast majority of the time they will tell you pretty much everything you need to know if you’ll just let them talk for a while.” ◆

What Is Your Greatest Financial Concern?

Chances are, the financial advisors at D. Scott Neal, Inc. know how to address it.

Thinking clearly. Caring deeply.

F E E - O N LY F I N A N C I A L P L A N N I N G L E x I N G t O N | L O u I s v I L L E | C I N C I N N At I

800.344.9098 |

DSNEAL.COM

See how we think about money.

Subscribe to our free newsletter!

ISSUE#93 19

MEN’S HEALTH  UROLOGY

The Pros of Prostate Screening

BY SARAH WILDER

One in seven men will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society, making it the second most common cancer and second leading cause of cancer death in American men. However, as high as these rates seem, the good news is, the earlier the cancer is detected, the lower that death rate will be.

“Depending upon when detected, prostate cancer can be manageable, with high survival rates if caught within the first two stages of the disease,” said Andrew C. McGregor, MD, Lexington Clinic urologist and head of Lexington Clinic Urology.

“In fact, in most cases of prostate cancer, if detected before the disease has spread beyond the prostate to distant areas of the body, the five-year survival rate is nearly 100 percent.”

Unfortunately prostate cancer, a disease that grows slowly and remains confined to the prostate, is not a disease that is easily detected by warning signs or symptoms.

“Usually, there are no symptoms associated with early prostate cancer. However, as the disease progresses, certain symptoms can occur. These include problems urinating and a decrease in the force of urine, blood in the urine or semen, erectile dysfunction, pain in the pelvic region, specifically hips, back, chest, and other areas of the body, bone pain, and weakness or numbness in the legs or feet,” said K. Eric Ruby, MD, FACS, urologist with Commonwealth Urology - Somerset, a part of Lexington Clinic. “The surest way to detect prostate cancer is through screening or an exam.”

There are two ways to detect prostate cancer –either through a prostate-specific antigen (PSA) blood test and/or a digital rectal exam (DRE). If signs of the disease are detected through either of these two methods, a prostate biopsy is then conducted to confirm diagnosis.

Of the two screening methods, a PSA test is most commonly recommended. This test measures the level of PSA, a protein produced by cells of the prostate gland, in the patient’s blood. In men with prostate cancer, the test usually reveals elevated levels LEXINGTON

20 MD-UPDATE

PHOTOS BY ELIZABETH MURPHY

ABOVE:

Andrew C. McGregor, MD, Lexington Clinic urologist, performs surgery on a patient.

McGregor says, “In most cases of prostate cancer, if detected before the disease has spread beyond the prostate to distant areas of the body, the five-year survival rate is nearly 100 percent.”

“Usually, there are no symptoms associated with early prostate cancer.

However, as the disease progresses, certain symptoms can occur,” said K. Eric Ruby, MD, FACS, urologist with Commonwealth Urology – Somerset, a part of Lexington Clinic.

LEFT:

of the protein. As is often the case, this test is performed in conjunction with a DRE, in order to help confirm prostate cancer as opposed to some other condition.

Recent developments, however, have led to changes in the recommendations for who should be screened for prostate cancer via a PSA test, and how often they should be screened. “Until recently, it was recommended that men, ages 50 and older, be tested yearly for prostate cancer,” said Ruby.

“The commonly accepted guidelines now, recommended by the American Cancer Society, are that men with an average risk of developing prostate cancer begin screening at age 50, men with a high risk should begin at age 45, and men with an even higher risk should begin at age 40.”

There are certain characteristics to determine a patient’s individual risk factors.

These include older age, as the risk of developing the disease increases with age; ethnicity, as African-American males are more likely to develop prostate cancer, as well as develop a more aggressive or advanced cancer; a family history of prostate cancer, breast cancer, or genes that increase the risk of breast cancer (BRCA1 or BRCA2); and weight, as men who are obese may develop an advanced form of the disease.

McGregor agrees with these recommendations, and added that men who are beginning to reach the recommended ages for PSA testing should always consult with a physician first to determine which testing schedule is right for them. “A trained urolo-

gist who provides diagnosis and treatment of prostate cancer can accurately provide a patient with a testing schedule to fit his individual needs,” said McGregor. “The physician can evaluate the risk-level of developing prostate cancer for the said patient and determine a personalized screening schedule that best fits that patient’s needs.”

Equally important to discuss with patients, particularly younger patients, is ways they can reduce the risk of developing prostate cancer. These include consuming a low-fat diet high in fruits, vegetables, and whole grains, maintaining weight through a regular exercise schedule, and knowing what risk factors they currently have for developing prostate cancer later on in life. ◆

Charles G. Ray, MD, urologist with Commonwealth Urology – a part of Lexington Clinic, offers screening for prostate cancer, alongside the other urologists with Commonwealth Urology and Lexington Clinic Urology.

PHOTO BY ELIZABETH MURPHY

Floyd Memorial Sports Medicine can help you get back on your feet.

The Floyd Memorial Sports Medicine specialists can get you or your young athlete back in the game as quickly and safely as possible. You don’t have to be a professional athlete to be treated like one. Exceptional sports medicine is available right here — right where you need it most.

So no need to go far, because Health Happens Here.

Call (812) 944-2263 to find a location near you, or visit: FloydMemorial.com/Sports

ISSUE#93 21

MEN’S HEALTH  COMPLEMENTARY CARE

Sex, Power, and Boundaries How it’s different now for men The period drama “Mad Men” highlighted the American cultural revolution during the 1960s, when it was a man’s world at home and when sexual banter at the office wasn’t yet harassment. Not long after the final episode ended in 1970, researcher John Gottman began revolutionizing the study of marriage, using methods and standards as rigorous as those used by medical science.

As a relationship strategist, I am fortunate to be able to develop approaches based on continuing solid research about what makes couples happy and marriages last.

Sharing Power with Your Partner Safeguards Your Marriage

A generation ago, a wife might not leave her husband if he treated her with disrespect or disregard. Now these behaviors are recognized as one of the most dangerous things a man can do to jeopardize his marriage.

Even in the 1990s, when Gottman’s research first revealed that the happiest, most stable marriages were those in which the husband shared decision-making with his wife and negotiated versus dominated during arguments, it was pilloried by Rush

Limbaugh and parodied (hilariously, I must admit) on Saturday Night Live. Even so, Gottman’s study in unprecedented detail of real life couples disBY Jan Anderson, PsyD, LPCC cussing areas of conflict in their marriages gives us a glimpse into how successful couples are able to navigate marital minefields.

The flip side of Gottman’s research is a staggering statistic: “When a man is not willing to share power with his partner, there is an 81 percent chance that his marriage will self-destruct.” WHOA! Now that I have your attention…

How a Man Can Destroy His Marriage in Four Easy Steps:

So exactly how does a man go about resisting his partner’s influence? Gottman observed four very specific types of behavior that actually “escalated the negativity and

When a man is not willing to share power with his partner, there is an 81 percent chance that his marriage will self-destruct.

22 MD-UPDATE

led to instability in the marriage.”

Here are some specific examples cited in the study of how a husband can be unresponsive to his wife’s feelings in a way that escalates the negativity. Let’s say the wife says, “You’re not listening to me!”  Husband’s critical response: “I don’t listen because what you say never makes any sense.”  Husband’s contemptuous response: “Why waste my time?”  Husband’s defensive response: “Yes I am!”  Husband’s stonewalling response: Says nothing. Ignores her.

How a Man Can Save His Marriage in Two Easy Steps:

So how might a man tone down the negativity or at least not make it worse? Here are some examples observed in the study: Matching the negativity without going beyond it: “I’m finding it hard to listen to you!”

Toning down the negativity: “Sorry, I’m listening now.”

In my experience, helping couples operationalize “respect, shared decision-making, and searching for common ground” into practical, doable behaviors like the ones cited above is some of the most important (and rewarding) work I do in counseling sessions.

Misreading Cues of Sexual Interest from Women Can Land a Man in Trouble Professionally and Personally

Early on in my counseling and consulting practice, I encountered a number of organizations and individual men and women dealing with sexual boundary issues in a variety of work and family settings. I was not prepared for the two very different planets men and women are from in terms of their perceptions about sexuality in daily life — or the degree of complexity of these gender differences, which I found are biological, psychological, and cultural.

I found a man’s perspective, in the form of Dr. Peter Rutter’s in-depth research,

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS

CALL FOR PARTICIPATION 2015 Editorial Opportunities * invaluable to me as a female therapist, not just in helping men manage their relationships with women in ways that don’t land them in trouble, but in helping women trying to figure out how to effectively handle sexual boundary tensions with the men in their worlds.

Men and Women See It Differently. Vastly Differently.

Rutter’s research reveals that, whereas men tend to see sexual boundary events as “interesting opportunities,” women are more likely to perceive them as “threatening” and “burdensome.” In his book Sex, Power and Boundaries, he notes, “In general, a man monitors boundary behavior with more attention to cues about whether a woman is sexually interested in him and has an added tendency to project sexuality into an interaction even when she has no such interest.

Relationship and Life Strategy Expert Individual & Couples Counseling Relationship & Life Strategy Coaching Mindfulness-Based Cognitive Therapy

complimentary preliminary Consultation 502.426.1616 DrJanAnderson.com Jan Anderson, PsyD, LPCC

In general, a woman monitors boundaries with concern for harmonizing relationships; she is less likely to look for a sexual connection.”

It is these inaccurate “reads” of how women are interpreting the experience that can land a man in trouble professionally, personally, and maybe even legally.

I found that women also have a “blind spot.” Although a man tends to be able to easily and instinctively locate the sexual boundary between himself and a woman, many women are rather clueless about recognizing where the boundary is and/or feel inept at how to manage it — making it even easier for a man to misinterpret or disregard her intentions or even making her an “easy target” for sexual predators.

Seeing Spots

Can you see how these two gender “blind spots” can interact to wreak havoc in the workplace and beyond? Here’s how I like to work with men and women to avoid what I call potential “gender-based chemical reactions”: For a man, I wholeheartedly validate his right to have and appreciate his attractions, and I help him become more skillful in accurately reading women’s cues regarding sexual interest, so he doesn’t act on his attractions with impropriety.

For a woman, it’s about increasing her understanding of how sexual boundary dynamics work and helping her develop her skillfulness in effectively managing sexual boundary tensions, so she can be successful at work and enjoy being in relationships with the men in her world.

Issue #94 August/September INSIDE & OUT Gastroenterology, Rheumatology, Urology, Dermatology, Plastic Surgery / Occupational Health Issue #95 October SURVIVING CANCER, Oncology, Radiology, Imaging / Hospice, Home Health Issue #96 November IT’S ALL IN YOUR HEAD, Neurology, ENT, Pain Medicine / Mental Health, Smoking Cessation Issue #97 December/January 2016 PREVENTION AND SENIOR HEALTH, Internal Medicine (including Hospitalists and Concierge Medicine), Family Medicine & Geriatrics, Ophthalmology / Physician Extenders, Residential Care

The New Aphrodisiac

There’s another surprising way it is different now for men. Check it out in my latest blog at ww.DrJanAnderson.com. ◆ TO PARTICIPATE CONTACT: Gil Dunn, Publisher gdunn@md-update.com/(859) 309-0720 Jennifer S. Newton, Editor-in-Chief jnewton@md-update.com/(502) 541-2666

ISSUE#93 23

PHYSICIAN SPOTLIGHT

All in a Day’s Work

Surgery on Sunday provides hope, and essential outpatient procedures, to the medically underserved BY ANNA L. TAYLOR, EXECUTIVE DIRECTOR OF SURGERY ON SUNDAY

RIGHT

Fred P. Hadley, MD, urologist with Urological Associates, performs a transobturator urethral suspension for stress incontinence on a patient that needed the surgery for years but had no options until SOS. BELOW

Barry Bussell, RN, Lexington Surgery Center, SOS board member, and Shirley Ramsey, DNP, FNP-BC, clinical director for SOS, are two long-time volunteers.

Every surgery day, they run the operating rooms and prepare the schedules.

PHOTOGRAPHY BY JOE OMIELAN In the early morning hours of Sunday, June 14, over 50 physicians, nurses, clinicians, and administrative personnel volunteered their Sunday to provide surgeries to individuals unable to afford such care. This group of selfless volunteers came together for one common goal – to change lives through Surgery on Sunday.

Surgery on Sunday provides, at no charge, essential outpatient surgeries to the uninsured and the underinsured. Now in its 10th year, the program has provided nearly 5,600 outpatient surgeries for individuals who would otherwise not receive care.

Founded in 2005 by Dr. Andrew Moore, II, the program began as a solution for the working poor who are so often overlooked in healthcare – those that “fall between the cracks.”

This past Sunday was no different, with surgical cases including hernia repairs, urology, orthopedics, ophthalmology, and mass excision. Trevor Wilkes, MD, an orthopedic surgeon is honored to be a part of the program: “Healthcare is a complicated topic but Surgery on Sunday is a great example, one we can all support, of meeting a need of those that fall through the system.”

Relying entirely on volunteers, Surgery on Sunday performs outpatient surgeries the third Sunday of each month (unless it falls on a holiday) at the Lexington Surgery Center, utilizing 450 volunteer physicians, anesthesiologists, nurses, and administrative help who have donated nearly 90,000 hours of service since 2005.

Volunteers are the heart of Surgery on Sunday. Without our 24 MD-UPDATE

PHOTOS BY JOE OMIELAN

dedicated physicians and clinical staff, we could not have the impact on our patients that we do. Many have volunteered with us since we began surgeries in 2005, not ever missing a surgery day.

One such volunteer is Paul Kearney, MD, now the chairman of Surgery on Sunday. “I derive great satisfaction from helping those that would otherwise go untreated. All of us have a responsibility to give back the blessings bestowed upon us.

Surgery on Sunday has always provided me an outlet to care for the medically underserved,” states Kearney.

Many volunteers share the same sentiment. “Unless you have experienced a Surgery on Sunday day, it is hard to explain the energy that is present. Everyone is happy – the volunteers, patients, and their families. The volunteers, no matter their background, or where they normally work, come together, for one purpose –to serve others,” says Fred Hadley, MD. Surgery on Sunday’s mission has always been to serve those in need and has adapted as needs have changed. In 2015, in response to the Affordable Care Act, the Board revised criteria for acceptance in the program to include the underinsured, by expanding to include individuals who have a high deductible plan that is 10 percent or more of their household income.

LEFT

Trevor Wilkes, MD, orthopedic surgeon with Lexington Clinic, provides meniscal repair for a patient that has been living in pain for the past few years. “Volunteers get an invaluable reminder of why we choose this profession … doing our best to help patients,” says Wilkes.

BELOW LEFT

Levi Procter, MD, general surgeon with UK HealthCare, repairs a hernia for a patient from Tennessee. A longtime volunteer, Procter performs surgeries each month for SOS. BELOW RIGHT

Wayne Graff, MD, anesthesiologist with Anesthesia Associates of Lexington, student Tran Thein Huong, and Shirley Ramsey, DNP, FNP-BC, are just three of the 50+ volunteers that are required for a surgery day to occur.

ISSUE#93 25

PHYSICIAN SPOTLIGHT

Patients must also meet income requirements, which are up to 250 percent of the federal poverty guidelines.

Patients served by Surgery on Sunday are extremely grateful. “The patients are grateful because Surgery on Sunday provides hope. Though they cannot pay, they often express their gratitude in other forms,” states Kearney. “I had a man, at his post-operative appointment, give me his hat as a thank you. It was obviously a meaningful item for him, but he wanted me to have it. Often patients cry and hug 26 MD-UPDATE

you because they are so thankful. As a physician, you do not get that every day.”

All surgeries are performed at the Lexington Surgery Center (LSC), which has been the home of Surgery on Sunday since 2005. LSC provides the operating rooms, overhead, and equipment that is necessary for a surgery day to occur. “Without the support of Lexington Surgery Center, we would not have the ability to provide the array of surgeries we do and change lives. They have been our biggest blessing,” states Shirley Ramsey, DNP, FNP-BC, clinical director for Surgery on Sunday.

LSC’s assistance allows Surgery on Sunday to provide surgeries at a cost of approximately $300 per patient.

Surgery on Sunday is blessed to have a wide array of supporters, individuals, and foundations that share in our mission and see the impact of our program. The end result of their generosity can be seen the third Sunday of every month. Patients leave grateful to have received care with no financial burden. Families are relieved, and volunteers walk away with more than they walked in with. What more can you ask for on a Sunday? ◆

Paul Kearney, MD, general surgeon and board chairman of SOS, performs an inguinal hernia repair. A volunteer since the beginning, he states, “I derive great satisfaction from helping those less fortunate.

This is really an obligation to the community rather than charity.”

ABOVE LEFT

John Collins, MD, ophthalmologist with Lexington Clinic, removes a chalazion from a six-year-old patient.

ABOVE RIGHT

RIGHT Trevor

Wilkes, MD, orthopedic surgeon with Lexington Clinic, provides meniscal repair for a patient that has been living in pain for the past few years.

To become involved or support Surgery on Sunday, contact Anna L. Taylor, Executive Director (859) 288-2495 anna@surgeryonsunday.org www.surgeryonsunday.org

NEWS  EVENTS  ARTS

Freeman joins HMH Active Staff

Dr. Gerald Harpel and Dr. Derek Clarke welcome Robin Freeman, MD, to their team of obstetricians/ gynecologists at Harrison Memorial Hospital (HMH).

Freeman comes to Cynthiana from Martin, Tennessee. She is board certified in obstetrics and gynecology and joined the HMH Physician Group: Obstetrics and Gynecology. She specializes in obstetrics, adult and pediatric gynecology, infertility, urodynamics, and gynecologic ultrasounds.

A native of New Jersey, Freeman earned her bachelor’s degree in Biological Sciences from the University of Maryland, College Park, Maryland. She then went on to earn her medical degree from the University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey. Freeman completed her internship and residency in Obstetrics and Gynecology from the University of Medicine and Dentistry of New Jersey and Robert Wood Johnson University Hospital, New Brunswick, New Jersey.

Freeman will join colleagues Derek Clarke, MD, and Gerald Harpel, MD, in providing full-service care and coverage for women in the surrounding area. She will deliver newborns at Harrison Memorial Hospital as well.

Freeman began seeing new patients in June. Her office is located in the HMH Professional Arts Building in Suite G4.

CYNTHIANA

Bumpous Named UofL Chair

The University of Louisville Board of Trustees has named Jeffrey “Jeff ” Bumpous, MD, chair of the newest department in the UofL School of Medicine, the Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders. Bumpous was named chair at the board’s meeting on June 4.

The board estabLOUISVILLE

????????

SEND YOUR NEWS ITEMS TO M.D UPDATE > news@md-update.com

lished the new department at its May 14 meeting by elevating the program from two divisions within the Department of Surgery in a move that strengthens the provision of clinical care to patients and education and training to future physicians as well as audiologists and speech pathologists.

At UofL, otolaryngologists practice with

University of Louisville Physicians-Ear, Nose and Throat. Communicative disorders professionals practice with UofL Physicians-Hearing & Balance and UofL Physicians-Speech Pathology.

Bumpous is the J. Samuel Bumgardner Professor of Otolaryngologic Surgery and chief of the former Division of Otolaryngology in the Department of Surgery. He has been at UofL since 1994 and leads a multidisciplinary team of healthcare providers in treating cancers of the head and neck. These include cancers of the mouth, larynx (voice box), pharynx (throat), nasal cavity, sinuses, salivary glands, and thyroid gland.

A native of Fort Benning, Ga., Bumpous earned his bachelor’s degree from Morehead State University and his medical degree from UofL. He completed his internship and residency in general surgery, otolaryngology and head and neck surgery at Saint Louis University and a post-graduate fellowship in advanced head and neck and cranial base surgery at the University of Pittsburgh.

Bumpous currently is president of the Society of University Otolaryngologists and a member of the Board of Directors of the American Board of Otolaryngology. He is board-certified in otolaryngology and is lead or co-author of more than 60 journal articles and scientific book chapters.

Harper Chosen for Executive Leadership Program

University of Louisville Family and Geriatric Medicine Chair Diane M. Harper, MD, MPH, MS, has been selected as a member of the 2015-2016 class of the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program. Harper is one of only 54 women in the nation selected for the program.

LOUISVILLE

ELAM is a year-long fellowship for women faculty in schools of medicine, dentistry, and public health. The program develops professional and personal skills required for leadership and management in health care. More than 800 ELAM alumnae hold leadership positions in institutions around the world.

Harper was named the Rowntree Endowed Chair and professor in the Department of Family and Geriatric Medicine at the UofL School of Medicine in 2013. She is an award-winning clinician, educator, and researcher with a background in family medicine, obstetrics and gynecology, epidemiology, and biostatistics, as well as chemical engineering.

Harper was the U.S. principal investigator who designed the global trials to understand the efficacy of both of the prophylactic human papillomavirus (HPV) vaccines to control cervical cancer. She was a lead author in multiple Lancet publications, New England Journal of Medicine, and JAMA, and co-author of more than 140 additional articles on cervical cancer prevention. She also has consulted for and published with the World Health Organization on the use of prophylactic HPV vaccines. Harper is a member of the NIH’s Population Sciences and Epidemiology Integrated Review Group of the Epidemiology of Cancer Study Section, as well as the Center for Disease Control and Prevention’s Special Emphasis Panel on HPV Vaccine Impact among Men who have Sex with Men (MSM) and Serosorting and Other Seroadaptive Behaviors Among Men Who Have Sex With Men (MSM) in the US. In ELAM’s 20-year history, 16 faculty members from UofL have completed the fellowship, including UofL School of Medicine Dean, Toni M. Ganzel, MD, MBA, who participated in 2003-2004.

Harper finds single dose of HPV vaccine may prevent cervical cancer LOUISVILLE

A single dose of the human papilISSUE#93 27

NEWS lomavirus (HPV) vaccine Cervarix appears to be as effective in preventing certain HPV infections as three doses, the currently recommended course of vaccination. That is the conclusion of a study published in The Lancet Oncology and co-authored by Diane Harper, MD, PhD, the Rowntree Endowed Chair and professor in the Department of Family and Geriatric Medicine at the University of Louisville School of Medicine.

In the study, data from two large trials of the vaccine Cervarix were analyzed to compare the effectiveness of one, two, or three doses of the vaccine in preventing HPV infection. In the trials, women were randomly chosen to receive three doses of Cervarix or a control vaccine. Although a number of the women received fewer than the three doses, follow-up tests were completed to evaluate the effectiveness of the vaccine in all the women for a period of four years.

The analysis determined the protection from one dose is similar to that achieved by three doses of the vaccine.

“These exciting findings address the fact that nearly two-thirds of people who get HPV vaccines do not get all three doses in a timely manner,” said Harper, who was a principal investigator in one of the trials included in the analysis. “Knowing that Cervarix offers protection in one dose reassures public health agencies that they are not wasting money when most of their vaccines are given to those who never complete the three-dose series.”

The study is published in The Lancet Oncology with the title, “Efficacy of Fewer than Three Doses of a HPV-16/18 AS04 adjuvanted Vaccine: a Meta Analysis of Data from the Costa Rica Vaccine Trial and the PATRICIA Trial.”

Chesney, UofL Study Virus Attack on Cancer

LOUISVILLE It’s a new weapon in the arsenal of cancer fighting treatments: utilizing genetically modified viruses to invade cancer cells and destroy them from the inside.

University of Louisville researcher Jason

Chesney, MD, PhD, deputy director of the James Graham Brown Cancer Center (JGBCC), and a team of international scientists found that stage IIIb to IV melanoma patients treated with a modified cold sore (herpes) virus had improved survival. The results of the findings were published recently in the Journal of Clinical Oncology.

UofL was one of the major sites for the phase III clinical trial involving 436 patients who received the viral immunotherapy, talimogene laherparepvec (T-VEC). Scientists genetically engineered the herpes simplex I virus to be non-pathogenic, cancer-killing, and immune-stimulating. The modified herpes virus does not harm healthy cells, but replicates when injected into lesions or tumors, and then stimulates the body’s immune system to fight the cancer.

“The results from this study are amazing,” Chesney said. “Patients given T-VEC at an early stage survived about 20 months longer than patients given a different type of treatment. For some, the therapy has lengthened their survival by years. ” The U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) are considering findings from the trial to make the treatments available to more patients with advanced melanoma.

Psychiatrist recognized for work on worldview in clinical psychiatry

In recognition of his work on understanding the importance of both the patient’s and the clinician’s worldview in clinical psychiatry, Allan Josephson, MD, chief of child and adolescent psychiatry and psychology in the University of Louisville Department of Pediatrics, will be the 2015 recipient of the Oskar Pfister Award from the American Psychiatric Association.

This award recognizes individuals who have made professional contributions to the interfaces of psychiatry, religion, and spirituality in research and clinical practice.

For more than a decade, Josephson coordinated workshops, symposia, and lectures on religion, spirituality, and psychiatry at the annual meetings of the American Psychiatric Association. These events LOUISVILLE

28 MD-UPDATE

NEWS resulted in several publications, including the “Handbook of Spirituality and Worldview in Clinical Practice,” co-edited

by Josephson and John Peteet, MD, of Harvard Medical School. The work is now used in the teaching programs of many psychiatry residencies throughout the country.

Josephson received the award at the annual meeting of the American Psychiatric Association in Toronto May 16-20, and will deliver the 33rd Oskar Pfister Lecture in New York in October at the American Psychiatric Association’s Institute of Psychiatric Services meeting.

Nash Named Kentucky Representative to AANP

Whitney Ann Nash, PhD, MSN, ANPBC, associate dean of practice and service for the University of Louisville School of Nursing, has been elected to serve as the Kentucky representative for the American Association of Nurse Practitioners. She will begin a two-year term following the Annual Membership meeting of the AANP National Conference on June 13 in New Orleans.

In her role, Nash will serve as a liaison for AANP members and other nurse practitioners at state and local events.

In 2005, Nash helped establish the Kentucky Racing Health Services Center, an award-winning, nurse-practitioner-directed clinic providing healthcare for racetrack workers. She has lead the center since its opening.

Prior to her appointment as associate dean in 2014, Nash was the director of practice and international affairs at UofL and has attended more than 20 international programs and medical service trips.

Nash, a 2014-15 Duke-Johnson and Johnson Nurse Leadership Fellow, has been a member of the nursing faculty at UofL for more than 10 years and has been an adult nurse practitioner since 1997. She has numerous publications, presentations and research projects to her credit, including a LOUISVILLE

grant from the Department of Health and Human Services, Health Resources Services Administration for a project to enhance interprofessional practice between nursing and dental students. In 2011, she developed a web-based career networking site to connect UofL nursing students and alumni to career opportunities.

Lockhart Named Regional Director for KentuckyOne Health Partners in Lexington

Dorothy Lockhart, RN, has been hired as the regional director for the KentuckyOne Health Partners Lexington market.

Prior to joining KentuckyOne Health Partners, Lockhart served as director of cardiothoracic transplant and mechanical circulatory support at the University of Kentucky. Prior to that, she worked in the organ transplant programs at UCLA and Cedars Sinai.

In addition, she coordinated an interdisciplinary medical care delivery system for transplant patients, starting with receiving organ donor offers from organ procurement agencies, all the way through providing individualized patient and family teaching, and coordinating all team members in the event of a transplant.

Lockhart is a member of the International Society of Heart and Lung Transplantation and the American Society of Transplantation. She is the co-author of a number of scientific papers about organ transplantation, and has given presentations across the nation on that subject. She is a board member of Kentucky Trust for Life and a proponent of organ donation and awareness.

LEXINGTON

Saint Joseph London Names New President

KentuckyOne Health has named Terrence G. Deis as the new president of Saint Joseph London. He assumed the role on June 1, 2015.

Deis has more than 20 years of diverse hospital management experience, including financial, operational, technical, and strategic leadership. He most recently served as president and chief executive officer of UH Parma LONDON

Medical Center, a 332-bed acute care facility with 2,000 employees located in Parma, Ohio.

Deis is a certified public accountant and a fellow of the American College of Healthcare Executives.

He holds a bachelor’s degree in accounting from Bowling Green State University, and a master’s in business administration from Cleveland State University.

New GLMS President Installed

The Greater Louisville Medical Society Presidents’ Celebration was held on May 31 in the Muhammad Ali Center.

Robert (Bob) Couch, MD, MBA, was installed as the new GLMS President for 2015-2016.

The Greater Louisville Medical Society (www.glms.org) is a professional organization of 3,800 physicians and medical students who advocate for the health and wellbeing of the community and strive to protect the patient-physician relationship. Over 80 percent of practicing physicians in Louisville are GLMS members. Louisville Medicine is the medical society’s monthly journal.

LOUISVILLE

Spine Surgery Breakthrough at the Floyd Memorial Spine Center

Mohammad E. Majd, MD, a Floyd Memorial Medical Group – Orthopedics surgeon who performs surgery at the Floyd Memorial Spine Center, is the first orthopedic/spine surgeon in the Kentuckiana region to successfully perform cervical spine surgery on patients with two-level (more than one affected adjoining disc) artificial disc replacement using the Mobi-C device, which was recently approved by the FDA. It is the only device approved for two-level disc indications.

Majd explained, “The Mobi-C device is ideal for qualifying younger patients who desire a greater range of motion that traditional fusion surgery, with a titanium plate, would not provide. Patients are able to go back to normal activities that were limited by severe neck pain caused by a ruptured disc, pinched nerve, spinal cord pressure, or bone spurs.”

NEW ALBANY, IN

ISSUE#93 29

EVENTS

(L-R) Michael

Karpf, MD, executive VP of UK for Health Affairs, wife Ellen Karpf, and Gil Dunn, MD-UPDATE. UK HealthCare was the presenting sponsor of the Ashland Lawn Party.

Ashland Lawn Party Celebrates Lexington History and Famous Citizen

The sun shone brightly on Ashland, the Kentucky estate of Lexington’s famous favorite son, Henry Clay, on June 27, 2015 as nearly 400 guests attended the annual Lawn Party fund-raiser and celebration.

Ashland was first built in 1809, and Clay lived there until his death in 1852. His son, James Clay, razed the original mansion, designed in part

by Benjamin LaTrobe, architect of the U.S. Capitol in Washington, DC. The younger Clay rebuilt the estate in 1962 and incorporated Italianate, Greek Revival, and Victorian details.

Among multiple other achievements, Henry Clay owned the first syndicated stallion in America, “Buzzard,” who was imported from England in 1806. Eleven of the descendants of the female line of Clay’s Ashland Stud have won the Kentucky Derby.

The Lawn Party raises funds for the maintenance and operation of Ashland, the Henry Clay Estate. Ashland is a National Historic Landmark.

LEXINGTON

(L-R) Lexington

City Councilman Bill Farmer with friends Peggy and Dr. John Collins, Lexington Clinic.

Magdalene Karon, MD, and Gil Dunn, MD-UPDATE publisher, enjoyed the Lawn Party at Ashland. Karon says she checks every Derby to see if there’s a descendent of Henry Clay’s Ashland Stud running for the Roses.

(L-R)

(L-R) Scott

Neal, CPA, CFP, and MD-UPDATE financial columnist, with Evie and Dr. Ron Shashy, who participated in the event’s theme of “Summer White.”

Gil Dunn, MD-UPDATE, sharing a laugh with friends Ron Tritschler, CEO of Webb Companies, and Derek Weiss, MD. (L-R)

30 MD-UPDATE

PHOTOS BY DAVID FITTS

EVENTS

KentuckyOne Health Breast Care at Saint Joseph East Dedicates Rooms

Four dressing rooms at the KentuckyOne Health Breast Care center were dedicated in honor of past employees, family members, and cancer survivors at a ceremony on June 10, 2015.

Rooms were named: PAT for Patricia Campbell, a long-time employee of the LEXINGTON

Central Kentucky YMCA Breaks Ground in Hamburg

A ground-breaking ceremony for a new branch of the Central Kentucky YMCA at Hamburg Place took place on a warm June 18, 2015. Lexington Mayor Jim Gray addressed an overflowing crowd of 150+ saying, “Projects like this are what make Lexington special.”

The $20 million project is built on land donated by Bill Gatton, the namesake of the University of Kentucky College of Business and Economics. The new 58,000 square ft. complex will include an aquatics center, health and fitness centers, a gymnasium, running track, group exercise studios, community rooms, adult locker rooms, and an outdoor playground.

Projected opening is fall 2016.

LEXINGTON-

Radiologists Richard Budde, MD, Kimberly Stigers, MD, and Marta Kenney, MD, cut the pink ribbon at the newly named dressing rooms at KentuckyOne Health Breast Care at Saint Joseph East.

(L-R)

PHOTO COURTESY OF SAINT JOSEPH FOUNDATION

Saint Joseph Hospital Foundation; KATHLEEN for Kathleen Marnhout, who was honored by her son Mike Marnhout, president of Bluegrass Oxygen; LYNNIE for the older sisters of both Saint Joseph Foundation Director of Major Gifts Di Boyer and her husband Rod; and NISE’ for an anonymous donor whose life was saved by a mammogram.

KentuckyOne Health Breast Care at Saint Joseph East uses 3D mammography and 3D biopsy. The program performs almost 15,000 mammograms a year and over 500 mammograms through the Yes MAMM! Grant, which provides, at no charge, screening mammography and diagnostic services to women and men who are underinsured and underserved.

Doing their part to break ground with shovels and dirt are (l-r) Elmer Whitaker, president Whitaker Bank, David Martorano, president / CEO of YMCA Central Kentucky and donor, entrepreneur Bill Gatton.

PHOTO BY GIL DUNN

Kentucky Doctor Runs Boston Marathon – Has meniscal repair four days later

A cold, wet Monday, April 20, 2015 marked the second running of the Boston Marathon since the bombing of 2013. Central Kentucky physician Ron Shashy, MD, ENT, returned with several of his friends from residency to “Take Back Boston.”

“The feel of the city was upbeat as it embraced runners from around the globe,” said Shashy.

The Boston Marathon is the oldest annual marathon and one of the few which requires a qualifying time to enter.

The race was similar to 2014, with security precautions in plain “Not ideal sight. As nearly 30,000 runners conditions, but fun entered the town of Hopkinton, nevertheless,” Shashy said they were greeted with said Dr. Ron enthusiasm and scrutiny by police, Shashy. sheriffs, FBI, ICE agents, and PHOTO COURTESY OF National Guard soldiers. Shashy DR. RON SHASHY recalled “a reassuring feeling to see security personnel all along the course.”

Shashy finished in three hours, 10 minutes, about a 7:15 min/mile average.

Later that week, Shashy had meniscal repair on his right knee, performed by Tim Wilson, MD, orthopedic surgeon, Central Kentucky Orthopaedics in Georgetown, KY. Shashy ran with the injured meniscus knowing he had arthroscopy planned post-race. “I couldn’t miss this race, bad knee or not,” he said. “This was, after all, the Boston Marathon.”

BOSTON, MA/LEXINGTON, KY

ISSUE#93 31

EVENTS

Alan VanArsdall, market president, Central Bank, chair of the board of the Saint Joseph Hospital Foundation; Dan Howard, operations director Bluegrass Oxygen, Paddy Cochrell, Golf Pro-Charity Golf International, Craig Rauvolabouta; Dr. John Stewart; Lynnette Rauvolabouta, VP Mission Services, SJH. (L-R)

Saint Joseph Hospital Foundation Golf Event

The 26th Annual Saint Joseph Hospital Foundation Golf Event was held on Monday, June 8th at the University Club of Kentucky. The event, presented

by Bluegrass Oxygen, hosted 200 golfers and 30 volunteers for a full field at the UK Club. The event raised over $106,000 to support mission and outreach programs at Saint Joseph Hospital, Saint Joseph East, and Saint Joseph Jessamine RJ Corman Ambulatory Care Center.

In 25 years, the event has raised more than $2.1 million to fund projects including the expansion of KentuckyOne Health Breast Care at Saint Joseph East, nursing scholarships, the Appalachian Outreach Program, Yes, Mamm! Mammography financial assistance, and other hospital outreach needs.

“We are grateful to the community for its tremendous support of this event over the past 25 years. Every dollar raised here, stays here,” said Mike Marnhout, long-time chair of the Golf Committee and Saint Joseph Hospital Foundation board member. “The proceeds from this event will make a significant impact on the patients and families that rely on us. We understand the importance of hosting over 200 golfers who all share in the goal of providing wellness, healing, and hope to those served by Saint Joseph Hospital.”

Photo caption: LEXINGTON

32 MD-UPDATE PHOTOS PROVIDED BY SAINT JOSEPH FOUNDATION

Mike Marnhout, president, Bluegrass Oxygen and chair of Saint Joseph Hospital Foundation golf committee; Brian Dineen, SJ Foundation board member; John Dineen, MD, Lexington Clinic, Bruce Broudy, MD , Lexington Clinic.

(L-R)

Sue Downs, Interim president Saint Joseph Hospital, Ron Downs, Carol Dwyer, VP, Patient Services, Saint Joseph Hospital, Tim Holbrook, director of HR, Saint Joseph Hospital.

(L-R)

WHAT YOU SAY ABOUT M.D. UpDATe “MD-UPDATE showcases the KY region’s medical practices and how they are providing cutting-edge medical care with evidence-based medicine. We get to see the faces and interviews of doctors who we normally do not see but hear about from our patients and colleagues.

“I especially enjoy reading the financial advice of Scott Neal, since aiming for retirement and more travel is a goal. The complementary medicine articles are good because I often see patients who have had lots of evidence-based medicine but still need an alternative medicine provider for a different approach to break through their failure to improve.”

--- Gregory Gleis, MD, Orthopedist

“I enjoy the focus of MD-UPDATE. It truly offers a unique perspective on the physicians in our state. I look forward to receiving it to be able to learn about the personal histories and activities of our physicians in an authentic way.

“Most of our healthcare publications focus solely on the scientific or program aspects. Many times I will have heard about the programs and the physician lead but never really know anything about the physician otherwise.

Thank you for expanding our awareness of how physicians serve our community in various ways.”

--- Linda Gleis, MD, PM&R physician

“MD-UPDATE is an excellent publication. It is a great source for physicians who want to stay current on colleagues, and up-todate on healthcare trends and |innovations. It connects physicians from across the Commonwealth, empowering all of us to provide the very best care for our patients.”

-- Damian P. “Pat” Alagia III, MD, MBA KentuckyOne Health, Chief Physician Executive

26th Annual

Lexington Medical Society Golf Outing Register Now Wednesday, August 26, 2015 University Club of Kentucky 12:00 p.m. Lunch 1:00 p.m. shotgun start

All proceeds to beneAt the Lexington Medical Society FoundaFon.

#ach 'ear the +,S Founda3on distributes grants to over a do9en local non;pro=t organi9a3ons, including Surgery @n Sunday, Baby Bealth Service, Camp Borsin’ Around, God’s Food Bank, and Faith Pharmacy.

Format: Shamble Tournament (play best drive then play own ball to the hole) Teams: Put together own Foursome or CommiNee will help form teams White Tee Sponsorship: $2,500 + foursome & 2 mulligans Hole Sponsorship with 4 players: $1,000 Hole Sponsorship: $500 Foursome: $500 Individual Players: $150 Can’t Play, you can s3ll help. #ach dona3on of $25 will enter you in a drawing to win an Apple Watch Sport. All players are automa3cally entered.

Sign Up or for more informaFon: Go to lexingtondoctors.org Point of Contact: Cindy Madison, cmadison@lexingtondoctors.org, (859) 705-­‐0003.