MD-UPDATE Issue # 96

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #96

New Visualization Technology Advances Neurosurgery

LEXINGTON CLINIC NEUROSURGEONS USE AIRO® MOBILE INTRAOPERATIVE CT AT SAINT JOSEPH HOSPITAL, AMONG OTHER TECHNOLOGY, TO BALANCE PATIENT NEEDS AND EXPECTATIONS FOR OPTIMAL TREATMENT

SPECIAL SECTIONS NEUROLOGY PAIN MEDICINE MENTAL HEALTH VOLUME 6•#7•DECEMBER 2015

ALSO IN THIS ISSUE  THE

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COVERING ALL THE BASES

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

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MHA Kendra J. Grubb, MD, on, cardiovascular surge a joins U of L to build

PATIENT-RESPONS IVENESS, INNOVATION, AND COLLABORATION

William O. Witt, MD, uses three pillar s to enhance the patien t experience at Cardinal Hill Pain Institute

ALSO IN THIS ISSUE

RO’S  REBUILDING OWENSBO PROGRAM CARDIAC SURGERY  NEW EP SERVICES IN IN NEW ALBANY, SION  MANAGING HYPERTEN EVOLVES  A HEART TEAM GY  PREVENTIVE CARDIOLO G FOR  CT SCREENIN

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Opportunities*

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 FAMILY APPROAC H TO PAIN MANAGEM ENT  INJECTIONS FOR  ENDOSCOPIC MIGRAINES ENDONASAL SURGERY FOR SKULL-BASE TUMORS  BUILDING AN INTERVENTIONAL NEUROLOGY PROGRAM  NEUROLOGIST FILLS SERVICES GAP IN GEORGETO WN

Internal Medicine, Concierge Medicine, Family Medicine & Geriatrics, Ophthalmology, and Bariatric Surgery Issue #98, February HEART & LUNG CARE Cardiology, Cardiac Surgery, Pulmonology, Sleep Medicine, Smoking Cessation Issue #99, March/April INTERNAL SYSTEMS Transplant, Allergy & Immunology, ENT, Rheumatology, Gastroenterology, Endocrinology Issue #100, May GENDER-SPECIFIC MEDICINE OB/GYN, Urology, Genetics, Prevention, and Wellness Issue #101, June/July MUSCULOSKELETAL HEALTH Orthopedics, Sports Medicine, Physical Medicine Issue #102, August/September SKIN DEEP Dermatology, Plastic Surgery, Vascular Medicine Issue #103, October CANCER CARE Oncology, Hematology, Radiology Issue #104, November IT’S ALL IN YOUR HEAD Neurology, Ophthalmology, Pain Medicine, Mental Health Issue #105 – Dec/Jan 2016 PRIMARY CARE AND PEDIATRICS Primary Care, Internal Medicine, Family Medicine, Pediatrics *Editorial topics are subject to change.

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 SEND PRESS RELEASES TO news@md-update.com

ISSUE#96 | 1

CONTENTS

ISSUE #96

COVER STORY 4 HEADLINES 6 FINANCE 7 ACCOUNTING 9 PHYSICIAN VIEWPOINT 10 COVER STORY 13 SPECIAL SECTION: NEUROLOGY 17 SPECIAL SECTION: PAIN MEDICINE

New Visualization Technology Advances Neurosurgery

LEXINGTON CLINIC NEUROSURGEONS USE AIRO速 MOBILE INTRAOPERATIVE CT AT SAINT JOSEPH HOSPITAL, AMONG OTHER TECHNOLOGY, TO BALANCE PATIENT NEEDS AND EXPECTATIONS FOR OPTIMAL TREATMENT

By JENNIFER S. NEWTON PHOTOS BY JOHN LYNNER PETERSON AND STEPHANIE NORTHERN PAGE 10

20 SPECIAL SECTION: MENTAL HEALTH 25 COMPLEMENTARY CARE 27 NEWS 29 EVENTS

SPECIAL SECTIONS NEUROLOGY

13 AN ASTOUNDING DAY IN STROKE CARE: BAPTIST HEALTH

2 MD-UPDATE

PAIN MEDICINE

15 FOCUS ON NEUROLOGY: KENTUCKYONE HEALTH

17 TAKING GREAT PAINS: LEXINGTON CLINIC

COVER PHOTOGRAPH BY STEPHANIE NORTHERN

MENTAL HEALTH

19 EASE THEIR PAIN: BUX & BUX PAIN CLINIC

21 THE UNIQUE MENTAL HEALTH NEEDS OF CHILDREN: OUR LADY OF PEACE

22 INTELLECTUAL PROPERTY: STEWART HOME & SCHOOL

LETTER FROM THE PUBLISHER

MD-UPDATE MD-Update.com Volume 6, Number 7 ISSUE #96 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, LPCC Theodore Miller, MD Scott Neal L. Porter Roberts Matt Smith

CONTACT US:

ADVERTISING AND INTEGRATED PHYSICIAN MARKETING:

Gil Dunn gdunn@md-update.com

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A Dash To The Dot Coms Welcome to the December 2015 MD-Update.

In case you missed it, we’ve slightly changed the name of our publication from M.D. Update to MD-Update.

That’s so you can find MD-Update on the web easier at: www.md-update.com. Our plan in 2016 is to introduce the MD-Update website with a searchable archive of the articles you’ve enjoyed over the last several years.

We’re doing this to help you stay up-to-date with your fellow Kentucky and Southern Indiana physicians and providers and for the Kentucky healthcare consumer to learn more about the great advances that their doctors are making in healthcare.

We strongly believe in the power of intelligent conversation among the principle partners in the statewide medical community. We frequently hear that MD-Update gives you a look at your colleagues across the different specialties throughout the Commonwealth and that is a value to you. By participating in MD-Update, either by reading it or by sharing your story and what’s happening in your medical practice, you benefit the entire community.

The 2016 MD-Update Editorial Calendar is on page one of this issue. Please take a moment, find your specialty, and gives us a call or email that you want to participate. If your specialty isn’t included in the 2016 calendar, that’s even more reason to contact us to let us know what’s going on.

Many thanks go out to the Kentucky and Southern Indiana doctors and practice managers who have taken their time to contribute to MD-Update in 2015. We couldn’t do it without you.

Until next time, all the best,

Gil Dunn Publisher, MD-Update

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#96 | 3

HEADLINES

Baptist Health Expands Cancer Services at Eastpoint Baptist Health Louisville and Baptist Health La Grange have combined efforts to create a new chemotherapy/infusion center at Baptist Health Eastpoint, located at 2400 Eastpoint Parkway, Suite 310. This full-service cancer program provides patients with a local treatment option for chemotherapy, radiation therapy, and medical oncology/hematology.

LOUISVILLE

The new chemotherapy/infusion center includes: • 10 exam rooms • 12 recliners and 4 beds, 16 total stations, for chemotherapy • 2 Consulting in Blood Disorders and Cancer (CBC Group) oncologists available to patients 5 days a week • On-site pharmacy

John L. Huber Jr., MD, medical director of Baptist Health Medical Group, CBC Group Consulting in Blood Disorders and Cancer, notes the positive impact of the expansion. “Baptist Eastpoint was a great choice for us and our patients. Not only will patients have the benefit of visiting our colleagues in Radiation Oncology, but the convenience of CT, MRI, Doppler studies, and other specialties offered at the same location. I can’t say enough about Baptist Health Louisville’s leaders who decided to expand laboratory capability there to provide the rapid turnaround we need in oncology and hematology.”

Input from experienced staff, nurses, and pharmacists were incorporated into the design of the project to ensure the patients will benefit from a convenient, comfortable, and healing environment. Construction of the 9,300 square foot center at Baptist Health Eastpoint began in August 2015 and was recently completed. The new chemotherapy/infusion center is now open for patients. ◆

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HEADLINES

Lexington Clinic Opens New Location

Lexington Clinic held a ribbon cutting and grand opening for Lexington Clinic Beaumont, its newest location, on November 6, 2015. The new location combines the services of Lexington Clinic Palomar Family Health Centre and First Choice Walk-In Urgent Care in one 12,000 sq/ft facility. The Palomar and First Choice locations will close.

“We are excited to open Lexington Clinic Beaumont, a complete state-of-the-art family care center,” said Andrew H. Henderson, MD, Lexington Clinic CEO. “The physicians and staff at this new facility are well-equipped to extend quality patient care for the entire family, including walk-in and urgent care services.”

With eight providers, Lexington Clinic Beaumont offers family medicine and internal medicine and pediatric services as well as walk-in care including lab and X-ray services for minor injuries and illnesses including sprains and strains, general illnesses, lacerations, and work injuries. ◆ LEXINGTON

Lexington Clinic CEO Andy Henderson cuts the ribbon at Lexington Clinic Beaumont.

Pictured left to right are Nick Moran, Lexington Clinic director of facilities; Robert L. Bratton, MD, Lexington Clinic chief medical officer; Kimberly A. Hudson, MD, Lexington Clinic physician; Andrew H. Henderson, MD, Lexington Clinic CEO. (l-r) Brett Setzer, owner of Brett Construction Company, which built Lexington Clinic Beaumont, with Robert L. Bratton, MD, Lexington Clinic chief medical officer, and Denny Boom, president of Brett Construction.

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ISSUE#96 | 5 PHOTOS BY GIL DUNN 2/23/15 8:45 AM

FINANCE

Déjà Vu, All Over Again As of this writing, the stock market has just produced one of its worst quarters (Q3) in a very long time, followed by one of its best months (October). While it might appear to some that the correction of August – September was a non-event in light of the October rally, it is important to note that the Dow and the S&P 500 still are not back to their May highs. They both may break through to reach new highs and that could indeed be quite bullish, but the analysis for now reveals that the stock market rally could be in its final stages.

A few months ago I was perhaps a bit too casual in mentioning the five fundamental drivers of the extraordinary stock market growth during the period 19802014, and the outlook for the next decade.

(You can find the column online at www. md-update.com). Or perhaps I wasn’t clear enough. I say this now because I have recently heard from a couple of readers who asked, “Isn’t there some stock investment that could simply be bought and forgotten about to fund my retirement, still some 10-15 years out?” My answer is that while buy-and-hold may not be completely dead, the strategy is certainly fraught with risk.

To review, the fundamental variables that drive the stock market are (1) the level of aggregate earnings as a share of GDP (a proxy for the rate of return on capital investment); (2) the growth rate of aggregate earnings; (3) the growth rate of earnings per share; (4) the level of interest rates; and (5) the magnitude of stock repurchases by companies. In short, with the exception of interest rates, the higher each of these variables, the higher the stock market.

The inverse is true of interest rates. All five variables have been optimal for growth in the regime 1981-2014. Long time readers may question why I have not included GDP growth since I have extolled its virtue on numerous occasions. Note that the primary impact of GDP growth is accomplished through the growth rate of earnings.

The implication of this is not good for the future of the stock market. Meanreversion is key in all these variables. There is little doubt in anybody’s mind about where both long-term and short-term interest 6 MD-UPDATE

rates are headed.

Members of the Fed have become increasingly vocal about an impending rate hike on the short end.

On long-dated bonds, the yield on the 30-year U.S. Treasury has

BY Scott Neal been on the rise since January, when it bottomed at 2.2 percent. A slowdown in both earnings growth and earnings per share appears to be emerging. With three quarters of the S&P 500 companies reporting their third quarter earnings at this writing, corporate profits are down over 3 percent compared to a year ago. That represents the biggest year-overyear decline since 2009. The world’s economies all appear to be slowing in unison.

It is important to note that mean reversion of these variables does not imply a crash in the markets nearly as much as it signifies a gradual and slow erosion of expected return.

That is not to say that we are immune to

a bullish or very bullish sentiment. AAII, which measures sentiment on an individual level, saw the bullish percent break above average at the end of October. The percent of cash held by mutual fund managers has also declined to very low levels. Contrarians see all these factors as quite bearish.

Societally, the slowdown in wealth growth, if it occurs, could not be happening at a worse time. We know the demographics associated with retiring baby boomers.

Couple that with the underfunding problem of public and private pension funds and the lack of real growth is exacerbated.

So what can we, as individual investors, do?

If long-range plans have been built on an expected annual return greater than 6 percent, it is high time to re-run the plan.

Stress-testing portfolios and financial plans are of paramount importance. Asset allocation is not the panacea for risk control that it once was believed to be. Protection of capital requires a deeper look at risk than simply attempting to reduce portfolio volatility. If the portfolio follows a buy-holdand-rebalance strategy, it is perhaps time to consider a more robust trading strategy

. . . WHILE BUY-AND-HOLD MAY NOT BE COMPLETELY DEAD, THE STRATEGY IS CERTAINLY FRAUGHT WITH RISK.

crashes, for certainly they can be brought on by non-fundamental factors that belie prediction. Much more likely, the result will be a rate of return that is substantially below the long run return touted by those advisors who rely solely upon historical index data to build their models.

Sentiment or investor psychology is often looked to as a contrary indicator. The level of optimism in both individuals and money managers is seen to be downright alarming by some. Bullish Consensus performs a daily survey of advisors and analysts and finds that there are 65 percent bulls.

Barrons Big Money poll reports an increase since April in money managers registering

that can take advantage of market moves like we saw in August thru October. If the portfolio is invested in primarily passive investments, it may be time to consider those that are more actively managed. If the portfolio is long-only it may be time to consider the use of reverse index funds that go up while the market goes down. We will take up these topics in future issues.

Stay tuned.

Scott Neal, is President of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. Write him at scott@dsneal.com or call 800-344-9098. ◆

ACCOUNTING

Giving the Gift of Tax Savings Tax planning is a year-round endeavor, but there are numerous year-end strategies that might reduce your 2015 tax bill. As we approach the gift-giving season, we would like to provide a few ideas that may provide tax saving gifts to you.

only does this go a long way towards meeting your retirement goals, but it can save you thousands in taxes every year. The maximum annual deferral for employees under age 50 is $18,000. If you are 50 or older on December 31, you can defer an additional $6,000 for a total annual deferral of $24,000.

Health Savings Accounts (H.S.A.)

You may be eligible to fund an H.S.A. account if you have a high-deductible health plan (HDHP). An H.S.A. is a separate account that is used to pay for out-of-pocket medical expenses. When you contribute into the account, the contributions are pre-tax or tax-deductible up to certain limits. For a family plan, the contribution limit for 2015 is $6,650.

Funds can grow tax-free in the account, and the disbursements are tax-free when used for medical expenses. For certain taxpayers, utilizing an H.S.A. can save around $3,500 per year in taxes. You will

Qualified Retirement Plans

BY L Porter Roberts Jr, CPA

need to check with your benefit administrator to determine if you are eligible.

401(k) Deferrals

If you own your business and it doesn’t already have a retirement plan in place, we recommend that you consider implementing some type of plan as soon as possible. There are numerous employer-based qualified retirement plans to choose from.

Each type has different limits, criteria, deadlines, and other aspects, but all have the common goal of sheltering income from taxes.

BY Matthew S. Smith, CPA, CFE

You may need to increase your 2015 401K deferrals. If you are employed and are not contributing the maximum annual amount to your particular employer’s retirement plan, we encourage you to make that one of your primary goals. Not

Dependent Care Assistance Programs

ISSUE#96 | 7

ACCOUNTING Many taxpayers are aware of the child and dependent care credit claimed by filing Form 2441. For higher income taxpayers, this credit’s benefit is limited to $600 for one child or $1,200 for two or more children. However, many taxpayers are unaware of the option to pay for these costs using pre-tax dollars if your employer offers this option. You can exclude up to the first $5,000 of wages by allocating them to this

plan. The plan then pays your child/dependent’s care provider directly. For a taxpayer in an upper tax bracket with one child, the additional tax savings by using this plan instead of the tax credit can be over $1,000.

Capital Gains/Losses Planning The tax rate on long-term capital gains can be 0 percent, 15 percent, 20 percent, 25 percent, or 28 percent, depending on your tax-

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able income. In addition, you may be subject to an additional 3.8 percent net investment income tax on this same income. Because of this, proper tax planning becomes more valuable. In certain situations, harvesting losses by selling a security that has decreased in value, then purchasing the same security at least 31 days later can be beneficial.

Donations to Charity

Making charitable donations before year end can reduce your 2015 tax bill. An effective strategy is to donate appreciated stock owned for more than one year. That way, you’ll enjoy a charitable tax deduction for the security’s full market value (subject to certain limitations), while avoiding capital gains tax and the net investment income tax on its appreciated value. Or, if you’re considering donating securities that have lost value, you’re better off selling them and donating the cash to the charity. Otherwise, you’ll miss out on the chance to deduct the capital loss.

Avoid Estimated Tax Penalties

If you’re behind on estimated tax payments, you may be able to catch up and avoid penalties on your 2015 return by increasing withholdings on your remaining wages and retirement distributions – or, if you file jointly, on your spouse’s remaining wages – for the year. Unlike estimated tax payments, taxes withheld from wages are treated as if they were paid throughout the year, regardless of when they’re actually withheld.

These are just a few tips that you may be able to implement in order to lower your 2015 income taxes. You also want to be thinking of 2016 opportunities because the best tax planning is year-round tax planning.

Every individual’s tax situation is different.

These strategies have very specific rules that must be followed, so please discuss these items with your tax preparer before implementing. It is extremely important that you are aware of these and other tax saving measures as they can keep thousands more in your pocket each and every year.

Porter Roberts, Jr., CPA, and Matthew S. Smith, CPA, CFE, are 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 msmith@barcpa. com and via telephone at 859-268-1040. ◆

PHYSICIAN VIEWPOINT

Commit to Quit

The Kentucky Medical Association and the Kentucky Foundation for Medical Care develop a campaign to encourage patients to work with physicians to develop a smoking cessation strategy Kentuckians are proud when their basketball teams reach the top of national polls. But leading the country in other rankings does not instill a lot of pride in people of the Commonwealth. Kentucky regularly ranks at the top of the list – battling West Virginia for the number one spot – in the number of adults who smoke, according to the Centers for Disease Control and Prevention (CDC).

Smoking is the leading cause of cancer in the United States and tobacco use increases the risk of many types of cancer, including those that affect the lungs, throat, mouth, pancreas, and cervix. With nearly 30 percent of adults and about 14 percent of teens in Kentucky self-reporting as smokers, it’s no surprise that Kentucky leads the nation in the number of cancer deaths, according to the CDC. Smoking also contributes to other health problems, LOUISVILLE

lengers is nicotine.

The American Cancer Society says the nicotine found naturally in tobacco is as addictive as heroin or cocaine.

Users become as dependent on

BY Theodore H. Miller, MD, PhD nicotine as they may become on those other drugs and suffer similar withdrawal symptoms when they try to quit.

Developing a winning formula for quitting, like developing a winning basketball strategy, takes a good coach, and that’s where physicians can play an important role. Every smoker is different and faces different hurdles. Some may be able to quit “cold turkey,” without interventions, while

STUDIES SHOW THAT UP TO SEVEN IN 10 SMOKERS WANT TO QUIT. THOSE WHO QUIT SMOKING SEE NEARLY IMMEDIATE BENEFITS. including heart disease, stroke, emphysema, and bronchitis.

Studies show that up to seven in 10 smokers want to quit. Those who quit smoking see nearly immediate benefits.

After quitting, smokers can cut their risk of lung cancer by 30 to 50 percent after 10 years. They can cut the risk of cancer of the mouth or esophagus by half within five years after quitting. Smokers reduce their risk for heart disease and stroke within one to two years of quitting, and also see a reduction in the respiratory symptoms associated with smoking, according to the CDC. Unfortunately, the desire to quit does not always translate into success. As in tough-fought basketball games, an opponent stands in the way of getting the win. With smoking cessation, one of the toughest chal-

others need counseling, nicotine patches, or medication to kick the habit. Because physicians know their patients best, they can help smokers make the decision best for them, prescribe any needed medication, and provide the support patients need to put smoking on pause – for good.

Studies show physicians can play an important role in helping patients reach their goals and quit smoking. A 2013 review of trials involving physicians working with patients to quit smoking found their intervention led to a significant increase in the quit rate. A 2007 report from the Association of American Medical Colleges found that physician interventions can increase long-term abstinence rates to 30 percent versus a seven percent success rate among smokers who attempt to quit on

their own.

The Kentucky Medical Association (KMA) and the Kentucky Foundation for Medical Care (KFMC) recognize the important role physicians can play and are embarking on a campaign to encourage patients to work with their doctors as they commit to quitting smoking. The KMA and the KFMC will work with local medical societies throughout the Commonwealth as well as with other organizations committed to improving the health of Kentuckians in order to promote this “Commit to Quit” campaign.

The ultimate goal of the campaign is to help Kentuckians who are ready to quit smoking. That will take dedication … and a good coach who can assess the challenges a particular smoker faces and develop the strategy to help them win the smokingcessation “game.”

For more information, visit committoquitky.com.

Dr. Theodore H. Miller is an ENT physician with ENT & Allergy Specialists in Northern Kentucky. He is currently the 2015 president of the Kentucky Medical Association and a board member of the Kentucky Foundation for Medical Care. ◆

Help Your Patients Commit to Quit www.committoquitky.com Kentucky Foundation for Medical Care 4965 US Highway 42, Suite 2000 Louisville, KY 40222 (502) 426-6200 www.kyfmc.org

PHOTO PROVIDED BY THE KENTUCKY MEDICAL ASSOCIATION

ISSUE#96 | 9

COVER STORY

The Airo® Mobile Intraoperative CT scanner, available at Saint Joseph Hospital, part of KentuckyOne Health, improves outcomes for brain and spine surgery. “It increases the accuracy of instrumentation placement and that equals fewer potential complications.” says Robert D. Owen, MD, neurosurgeon with Lexington Clinic.

New Visualization Technology Advances Neurosurgery

LEXINGTON CLINIC NEUROSURGEONS USE AIRO® MOBILE INTRAOPERATIVE CT AT SAINT JOSEPH HOSPITAL, AMONG OTHER TECHNOLOGY, TO BALANCE PATIENT NEEDS AND EXPECTATIONS FOR OPTIMAL TREATMENT BY JENNIFER S. NEWTON It may sound unusual to hear a surgeon predict that the future of their specialty will be not to operate, but that is exactly the prediction of the neurosurgeons at Lexington Clinic.

“The long-term future of neurosurgery, I hope, is not surgical,” says Matthew P. Tutt, MD, with Lexington Clinic Neurosurgery. “I really hope that someday we’re not doing surgery on brain tumors. It’s going to be more targeted, immune-modulated treatments.”

Lexington Clinic Neurosurgeon Robert D. Owen, MD, agrees: “I think we will be able to diagnose what type of brain tumor it is based upon a scan … There are going to be fewer cranial surgeries for brain aneurysms. Even today the vast majority are LEXINGTON

10 MD-UPDATE

being treated endovascularly … There will be more indications for functional neurosurgery – placing brain stimulators to treat movement disorders and different psychiatric orders, which is already happening now.”

As brain surgery continues to evolve, Owen expects that neurosurgeons will adapt to fill those roles. However, spinal surgery is not something the physicians see going away. “What we do in the spine, where there is pressure on a nerve and the only way to make it better is to take pressure off, that can’t be done with medicine. I don’t see that changing. The advances in spine surgery will be – what can you do with less?” says Gabriel H. Phillips, MD, of Lexington Clinic Neurosurgery.

PHOTOS BY JOHN LYNNER PETERSON AND STEPHANIE NORTHERN, LEXINGTON CLINIC

For now, there are plenty of surgical and non-surgical treatments and technologies the neurosurgeons employ that are defying misconceptions and improving outcomes for brain and spine surgery. One such technology is the Airo® Mobile Intraoperative CT scanner, available at Saint Joseph Hospital, part of KentuckyOne Health.

A Comprehensive Brain and Spine Surgery Practice

The surgeons of Lexington Clinic Neurosurgery see adult patients with a wide range of brain and spinal cord problems, with the exception of acute trauma, aneurysms, or vascular problems. They treat primary brain tumors, brain metastases,

The advances in spine surgery will be – what can you do with less?

- Gabriel H. Phillips, MD.

pituitary tumors, hydrocephalus, and chiari malformations, as well as spinal tumors, lumbar and cervical disc herniations, and degenerative spine problems. The physicians at Lexington Clinic Neurosurgery estimate their practice is 30 percent cranial and 70 percent spinal. Geographically, the practice draws patients from central, eastern, and southeastern Kentucky.

With spinal issues representing the largest portion of their practice, the most common presentations the Lexington Clinic neurosurgeons see are severe neck and arm pain or severe back and leg pain. Sources of the pain are usually herniated discs or degenerative issues, caused by the daily toll of gravitational forces on the body. “One way the body reacts to wear and tear disease is by losing a lot of the cushion in the spine with the disc space, and when you lose that cushion, the body reacts to it by building excessive bone or arthritis. And those can be contributing problems that cause pinching of the nerves,” says Phillips.

Their first approach is non-surgical, including conservative therapies such as physical therapy, steroids, and short-term anti-inflammatories. If those fail, they discuss surgical options, both minimally invasive and open. While their main focus is minimally invasive techniques when they are in the best interest of the patient, Owen says, “There is a role for open surgery when a more aggressive opening and exposure to do an adequate operation is required.”

particularly advantageous when We’re a young group doing fixations in the pelvis and we get along or mid-spine, which are diffiwell. A surgeon who cult to visualize with traditional is happy with their intraoperative x-ray. partners and their In addition to better visupractice is a better surgeon I believe. alization for the surgeon, the - Robert D. Owen, MD technology allows for quicker, less invasive procedures and less exposure of the spine, which minimizes and less invasively than what we’ve done in pain and post operative issues for patients. the past,” says Phillips.

“If I’m going to intervene, I want as little Airo also has the potential to affect and damage as possible to the surrounding tis- improve long-term patient outcomes. “In sue while still accomplishing the goal of the select patients, this equipment increases the surgery. Airo is one more weapon in our accuracy of instrumentation placement and arsenal where we can do that and do it safer that equals fewer potential complications.

Improving Surgical Accuracy with Airo CT

When surgery is indicated, one technology that is improving accuracy and decreasing post-op issues for Lexington Clinic neurosurgeons is the Airo Mobile Intraoperative CT at Saint Joseph Hospital. Just like a regular CT, but with a very large opening to accommodate a surgical patient, the Airo CT is “utilized during surgery and immediately allows us to touch points in the spine and look at the CT scan and verify that our position is accurate and we’re placing the screw in its precise location, in the strongest possible position,” says Tutt. It is

The long-term future of neurosurgery, I hope, is not surgical.

-Matthew P. Tutt, MD

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COVER STORY

Well-placed instrumentation means a lower chance of a fixation failing down the road,” says Owen. “Yesterday when I used the equipment, there were two instances where I altered the location of the instrumentation after checking with the navigational system.”

The surgeons say they often use the Airo CT for revision spine surgery because of the complexity of the procedure. In some cases where patients have been told there is nothing more that can be done, the Airo is allowing surgeons to extend the fusion down to the pelvis safely. “The intraoperative CT is the correct tool for that problem. It enables us to place fixation down into the pelvis

AIRO ACROSS THE BLUEGRASS

The Airo Mobile Intraoperative CT is similar to a regular CT but has a very large opening to accommodate a surgical patient.

Saint Joseph Hospital was the eighth center in the country to acquire the Airo CT and is the second busiest center in the country. The Lexington Clinic neurosurgeons estimate they use it three to four times per week.

more safely and faster than we’ve ever been able to do,” says Tutt.

And not only can the surgeons use the Airo CT during surgery for screw placement, they can also repeat the CT at a lower radiation dose before closing and leaving the operating room to ensure everything is correct.

Saint Joseph Hospital was the eighth center in the country to get the Airo CT and is the second busiest center in the country.

The Lexington Clinic neurosurgeons estimate they use it three to four times per week.

Managing Expectations and the Successful Practice

Deciding which treatment option to pursue is not always KentuckyOne Health is investing in Airo® Mobile clear. Despite common misconIntraoperative CT technology to the benefit of ceptions, Tutt says, “not every physicians and patients back pain is a surgical probacross the state. Not only is lem.” He divides patients into the Airo CT available at Saint three categories: those that do Joseph Hospital in Lexington, not have a surgical option, it is also available at Jewish Hospital in Louisville. those that definitely need sur“At Jewish Hospital, we are gery, and those that fall in pleased that KentuckyOne between. “So many patients has committed to the Airo fall in the middle. There are technology by also installing options for helping them but a unit at our facility in gray areas as to how much it Louisville. This will allow will do for pain. “That’s the access to the advantages of art of what we do, talking this navigational technology patients through understandfor brain and spine care to all Kentuckians that rivals Thomas Becherer, MD, FAANS, FACS ing the risks and benefits of what is available at the most the procedure.” advanced research centers across the country,” says Whatever the future of neuroThomas Becherer, MD, FAANS, FACS, KentuckyOne surgery holds, the physicians of Health Neurosurgery Associates in Louisville.

Lexington Clinic Neurosurgery 12 MD-UPDATE

BECHERER PHOTO PROVIDED BY KENTUCKYONE HEALTH

are united in their collaborative effort to find the best solution for each patient, whether surgical or not.

Tutt, originally from Lexington, joined Lexington Clinic in 2010 after completing medical school at Emory University in Atlanta, Ga., and a residency in neurosurgery at the University of Kentucky (UK).

He says he enjoys neurosurgery because it “is a very clean surgery, very precise, and usually involves the newest technology for brain and spinal surgery,” and probably learned his love of medicine from his father, a neurosurgeon, who still works next door, although he has retired from surgery. Tutt’s other loves are spending time with family, the outdoors, and working with horses.

Owen grew up in rural Indiana in a family of firemen. He decided he wanted to attend medical school at Indiana University after his father got him a job in an emergency room as an orderly. After pursuing interests in emergency medicine and internal medicine, Owen spent a month in pediatric neurosurgery, and was hooked. “I remember the first time I saw a craniotomy.

I didn’t know this even as a medical student, but the brain pulsates every time you have a heartbeat. That’s something I’ll never forget,” he says. Owen also attended UK for his neurosurgery residency and completed a fellowship in pediatric neurosurgery. He then went on to practice at UK for six years prior to joining Lexington Clinic in 2011.

Phillips is the newest member of the team, joining Lexington Clinic two years ago. A native of Tennessee, he says his grandfather, a family physician, was one of the role models that piqued his interest in medicine. After earning his undergraduate degree at Duke University, Phillips completed a year at the National Institutes of Health doing research in neurogenetics before starting medical school at the University of Tennessee in Memphis, where he also completed a residency with an emphasis on complex spine minimally invasive surgery and cranial surgery.

“We’re a young group and we get along well. A surgeon who is happy with their partners and their practice is a better surgeon I believe,” Owen concludes. ◆

SPECIAL SECTION  NEUROLOGY

An Astounding Day in Stroke Care

Clinical trials present overwhelming evidence that endovascular treatment of stroke, like that offered at Baptist Health Louisville, is effective at improving stroke outcomes in select patients. BY JENNIFER S. NEWTON LOUISVILLE The

days of fatalism in stroke care are long gone, or at least they should be, according to Alex Abou-Chebl, MD, interventional neurologist and medical director of stroke with Baptist Neuroscience Associates, part of Baptist Health Louisville.

“Stroke used to be the third leading cause of death. It’s now the fifth leading cause of death. Our treatments and efforts have resulted in a significant reduction in stroke mortality,” he says.

Not only are new treatments evolving, but the standard of care has changed. AbouChebl points to one day in particular that is transforming the treatments and outcomes for stroke patients. “On a remarkable day, February 11, 2015, probably one of the most astounding days in the history of clinical medicine, five randomized trials were presented back-to-back at the International Stroke Conference in Nashville. All five trials were positive, not just mildly positive, but amazingly positive with overwhelming benefits,” says Abou-Chebl.

The trials evaluated the use of endovascular treatment for large vessel stroke, where the blockage of an artery causes major deficits and carries a high risk of mortality.

This type of stroke accounts for 40 to 50 percent of all stroke patients. The endovas-

STROKE PREVENTION “The majority of stroke work is in the prevention of stroke,” says Alex Abou-Chebl, MD, interventional neurologist with Baptist Neuroscience Associates. One common cause of large vessel stroke, particularly in the elderly, is atrial fibrillation. Several new treatments are decreasing the risk of stroke from atrial fibrillation.

About 30 percent of strokes are considered

Dr. Alex Abou-Chebl, with Baptist Neuroscience Associates, is a proponent of treating stroke regardless of time elapsed from onset when imaging studies show brain tissue worth saving.

cular treatment utilized a stent retriever to remove the blockage. “For that category of stroke patients, we have had devices that can pull clots out of the brain since 2004. What we have not had is any evidence that doing so resulted in improvement in neurological

cryptogenic, in that the source of the stroke cannot be immediately identified.

“We have long suspected that those patients have paroxysmal atrial fibrillation, or atrial fibrillation that comes and goes,” says AbouChebl. In some cases the atrial fibrillation is so rare that it is not recorded on an electrocardiogram during a hospital stay. A new, very small device that is implanted under the skin above the left breast in a five-minute

outcomes,” says Abou-Chebl.

Four out of the five trials were stopped early because of overwhelming efficacy, a feat unheard of in stroke care. Abou-Chebl explains, “Most of our trials are stopped early because of futility, meaning they will never show benefit, or because they actually show harm. That’s what we in stroke have been used to, one depressing trial after another.”

The result of these trials is a new standard of care, as evidenced by the American Heart Association and American Stroke Association amending the stroke guidelines.

“Any patient with ischemic stroke due to a large vessel occlusion within six hours from stroke onset must be considered for endovascular treatment with one of these stent retriever devices. It is no longer optional,” says Abou-Chebl.

Prior to February 11, 2015, Abou-Chebl and many of his colleagues at larger institutions were utilizing endovascular treatment, but he says it was, in a sense, “experimental” because it was not the standard of care in national published guidelines. Now he says it is “unethical” not to evaluate stroke patients for endovascular treatment.

procedure under local anesthesia and can stay in place for two to three years is finding atrial fibrillation in up to 25 percent of patients.

Those patients can now be treated for the atrial fibrillation, decreasing their risk of stroke.

New, safer anti-coagulants, or blood thinners, are on the market for atrial fibrillation treatment.

However another new device is improving treatment for patients who cannot tolerate

anti-coagulants. The FDAapproved WATCHMAN™ Left Atrial Appendage Closure Device is used endovascularly to exclude the left atrial appendage, where clots are most likely to form, from the left atrium, decreasing the risk of clots forming.

According to Abou-Chebl, only a few centers in the nation are qualified to use the device and the roll out is slow. However, Baptist Health is currently trying to acquire the technology. ◆

PHOTO PROVIDED BY BAPTIST HEALTH

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SPECIAL SECTION  NEUROLOGY

Why These Trials Are Different

While it sounds intuitive, a major advancement of these trials is that they only included patients who could benefit from endovascular therapy. All previous stroke trials did not discriminate, and consequently included patients that both would not benefit from treatment or would actually be harmed by treatment because of the presentation of their stroke.

These trials mandated all patients get a CT angiogram to determine whether they had a blockage and where it was located.

Additional perfusion studies were then used to select patients with the smallest amount of dead brain tissue and the largest amount of tissue at risk, known as the ischemic penumbra. The result was a two- to fourfold higher probability of restoring patients to normal or nearly normal brain function compared to standard treatment.

The devices also proved safe and easy to use. One of the challenges in stroke care is that all treatments for blockages in the brain

can result in intracerebral hemorrhage and all treatments for intracerebral hemorrhage can result in blockages and blood clots. In these five trials, the hemorrhage rate “was lower than it had ever been and was no higher than just giving patients IV tPA (intravenous tissue plasminogen activator),” says Abou-Chebl.

Finally, the success rate of opening blockages and re-cannulating the artery was 70–100 percent. This is important for outcomes because, Abou-Chebl says, “The primary theory in all of vascular disease is if you reestablish flow through the blockage and limit the extent of ischemia, you will reduce mortality and increase function.”

The stent retrievers used in the trials are wire mesh tube-shaped stents made of selfexpanding material and connected to a wire.

They are deployed inside a blockage, immediately permitting the return of blood flow to the brain. The blood clot enmeshes in the stent, which is pulled out within five minutes of deploying. The clot is removed on the first pass of the device over 50 percent of the time.

The benefit of endovascular therapy in

THE PAIN TREATMENT CENTER OF THE BLUEGRASS ABOLISHING THE T YRANNY OF PAIN Ballard Wright, MD, PSC MAIN OFFICE:

SATELLITE OFFICE:

2416 Regency Rd., Lexington KY 40503 NEUROLOGY / NEUROIMAGING Peter D. Wright, M.D. Medical Director Director of Neuroimaging ANESTHESIOLOGY Ballard D. Wright, M.D. Founder and Medical Director Fred Coates, M.D. Dennis Northrip, M.D. PHYSICAL MEDICINE AND REHABILITATION Katherine Ballard, M.D. Lauren Larson, M.D Steven Ganzel, D.O.

Affiliated Surgery Center 280 Pasadena Drive, Lexington

110 Hardin Ln. STE 4, Somerset ADDICTION MEDICINE Traci Westerfield, MD FAMILY PRACTICE Laura Hummel, M.D. BEHAVIORAL MEDICINE Narda Shipp, ARNP Kellie Dryden, LCSW Marie Simpson, LCSW INDEPENDENT MEDICAL EVALUATIONS Ballard D. Wright, M.D.

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these trials was above and beyond any benefit from IV tPA. The new standard of care does not change guidelines for IV tPA treatment. The difference is that physicians no longer wait for the IV tPA to work. If a CTA confirms an occlusion, patients should be taken immediately to the interventional lab for treatment. Abou-Chebl adds that even if a patient does not get IV tPA, they can still be eligible for endovascular treatment.

For now, the published guidelines state that endovascular treatment is indicated for patients presenting within six hours of stroke onset, but Abou-Chebl contends, “To me and many of my colleagues, limiting this treatment to six hours is quite controversial and we don’t agree with that. I have published data that treatment is irrelevant of time if you prove there is brain tissue worth saving. Time is an important guide only if you’re unable to assess if there is brain tissue still at risk.” Data shows 58 percent of patients present outside of six hours.

At Baptist Health Louisville, Abou-Chebl has established a multimodal imaging protocol in collaboration with the neuroradiologists to help garner evidence and evaluate which patients would benefit from treatment regardless of time. Baptist Health Louisville is also a Joint Commission certified primary stroke center experienced in endovascular therapy.

While the standard has changed, AbouChebl cautions that many physicians and centers are not trained in the technique.

Until the training becomes more prolific, he advises that smaller centers need to refer patients to larger centers with endovascular capabilities for patients who qualify.

The overall message for Kentucky and the nation is one of hope. “For a long time, people diagnosed with stroke and their families were told there was nothing that could be done. That’s no longer the case. We have so many effective treatments and preventive measures. There is something that can be done for most patients,” he says. ◆

Alex Abou-Chebl, MD 3900 Kresge Way, Suite 56 Louisville, KY 40207 502.895.7265 www.baptisthealthkentucky.com

SPECIAL SECTION  NEUROLOGY

Focus on Neurology

Game-changing treatments now available for multiple sclerosis, migraines, and Parkinson’s disease BY JILL DEBOLT Neurologists have much hope to offer patients with chronic neurological conditions by using new and aggressive therapies that significantly improve quality of life, according to Gregory Anderson, MD, and Nicole Everman, MD, neurologists with KentuckyOne Health Neurology Associates. They want healthcare providers to know that the days of the “conservative” neurologist with little to offer these patients are over. While these chronic neurological conditions cannot be cured, new treatments can enable patients to lead productive lives.

LEXINGTON

Leadership, Passion, and Complexity

Anderson graduated from Mayo Medical School and completed his neurology residency and a fellowship in neurophysiology there. He has spent 30 years in central Kentucky with Associates in Neurology (AIN), which joined the KentuckyOne Health network to become KentuckyOne Health Neurology Associates.

In addition to his general neurology practice, Anderson serves as medical director for the independent AIN clinical research division. Anderson, a certified principal investigator, describes his passion for research, saying, “Clinical research keeps us on the cutting-edge of the newest treatment options for our patients.”

His most recent personal goal is physician leadership. “About four years ago, I recognized the need for physician involvement in the transformation of healthcare currently occurring in the United States,” Anderson says. He is on the board of directors for the KentuckyOne Health medical group and serves as physician market leader for the eastern half of Kentucky. “Clinicians need to drive quality of care and patient satisfaction and be involved in making wise decisions about managing healthcare populations,” notes Anderson.

Everman, a Kentucky native who completed medical school and residency at the University of Kentucky, joined Kentucky

Dr. Nicole Everman, a Kentucky native who completed medical school and residency at the University of Kentucky, describes her role in helping patients as that of detective and investigator.

ABOVE:

Anderson notes the importance of early referral and diagnosis, stating, “The goal is to identify and treat early and switch to another medication when a drug begins to fail.” He describes the recent FDA approval of Lemtrada, a monoclonal antibody, as a “game changer” in the treatment of MS. He adds that Associates in Neurology research center was involved in the clinical trials of this drug for 12 years before approval and was the second highest enrolling site in the US.

Dr. Gregory Anderson has been with Associates in Neurology, now KentuckyOne Health Neurology Associates, for 30 years and is the medical director of Associates in Neurology’s independent clinical research division.

RIGHT:

One Health Neurology Associates full time in 2015 to help meet the needs of this busy neurology practice. Everman enjoys the challenges of complex neurology cases, describing her role as being part “detective and investigator.”

Offering New Hope to MS Patients

“Tremendous advances have been made in the treatment of multiple sclerosis (MS) over the past five years. The number of medications has risen from four to 12,” notes Everman. MS is an auto-immune disorder that causes demyelization of the nerve fiber sheaths and is characterized by relapse and remission. Symptoms include optic neuritis, new onset weakness, imbalance, and double vision.

KentuckyOne Neurology Associates is the only certified multidisciplinary MS center in Kentucky and treats the “whole” patient by using a wellness approach to complement drug therapy. Diet, exercise, cognitive rehab, physical, speech and occupational therapy, and a nurse navigator, Nancy Heckler RN, support patients throughout treatment. KentuckyOne Health, in association with the YMCA, provides access to yoga, tai chi, water therapy, and special equipment for MS and other neurology patients. Anderson envisions this healthcare model being used more globally for treating chronic neurologic diseases.

PHOTOS BY GIL DUNN

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SPECIAL SECTION  NEUROLOGY

Migraines and Parkinson’s Disease

According to Everman, many migraine sufferers are reaping the benefits of successful treatment for this debilitating condition that affects over 45 million people.

Migraines occur three times more frequently in the female population due to hormonal effects. Symptoms include pounding, pulsating, often one-sided headaches that don’t respond to conventional headache medications. Migraines can be chronic or episodic and often have environmental triggers. Treatments include anti-epileptics, beta blockers, calcium channel blockers, tricyclic anti-depressants, and Botox® therapy.

Everman notes that Botox therapy, delivered by multiple small injections around the head every three months, has been very successful in treating chronic migraines.

Parkinson’s disease, characterized by resting tremors, gait changes, and stiffness on one side of the body, occurs in 1/200 people over age 60, more predominately in males. Everman notes that treatment is aimed at replacing dopamine, as more than 50 percent of dopamine stores are gone in

these patients. Medications include carbidopa levodopa and dopamine antagonists but tend to wear off quickly. She states that more research is needed to find ways to get and keep dopamine in the brain. Deep brain stimulation is also a treatment option for this neuro-degenerative disease that has a higher prevalence in farmers, dry cleaners, and artists due to chemical exposure.

shortage of neurologists and expense/insurance coverage for new treatments. These two physicians are committed to getting their Kentucky patients the best therapies on the market as quickly as possible and to improving the quality of life for their patients with chronic neurological disorders. ◆

The “Win-Win” of Clinical Trials

Anderson describes his role in Associates in Neurology clinical research center by using a sports analogy. He is the “player-coach” of a team of support staff at the research center. “We do a lot of clinical trials for new drugs, and it’s a win-win for our patients and practice,” states Anderson. “Patients get additional care and attention; many of the costs are covered by the sponsoring drug company; patients get long term follow-up for safety and efficacy of treatment; and they have access to the newest treatments.”

Anderson and Everman expect the neurology field to grow due to the aging population. Challenges will include a projected

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SPECIAL SECTION  PAIN MEDICINE

Taking Great Pains

Joshua Bailey, MD, brings a new approach to pain medicine in Kentucky BY JIM KELSEY Regardless of the source, frequency, or intensity, one thing all pain sufferers can agree upon is they just want it to go away.

“Pain doesn’t discriminate,” says Lexington Clinic’s Joshua C. Bailey, MD, MS, addressing the scope of his patient population. “It appears at all ages.” And Bailey treats all ages, with the exception of pediatric patients.

The Mount Vernon, Ky. native began his education with an interest in pediatric oncology, but a rotation in anesthesiology piqued his interest in patient comfort.

After earning his medical degree from the University of Louisville School of Medicine, he completed a fellowship in pain medicine and a residency in anesthesiology at the Mayo Clinic in Jacksonville, Fla. Bailey, who joined Lexington Clinic in August of 2015, hopes to bring the “Mayo model” of pain medicine to Kentucky and to offer alternatives to the high-dose narcotic-based pain treatments prevalent in the state.

“One of the reasons I came back to Kentucky is that it is one of the states that suffered most from the popularization of narcotics in the early 90s,” Bailey says. “I want to be a balancing force for Kentucky.

I combine low-dose opiate management with other interventional and behavioral treatments, and I avoid high-dose narcotic management unless the patient has cancer. My goal is to bring new approaches to pain medicine that individuals haven’t utilized before and try to get away from treating pain with opiate medications only, or altogether.”

That is where the Mayo Clinic model comes into play. Bailey describes a program that was designed to take a more comprehensive look at a patient’s pain. The Mayo Clinic’s three-week program began with taking fibromyalgia and central sensitization patients off of their opiate medications, combined with a cognitive, behavioral, and LEXINGTON

Dr. Joshua Bailey, Lexington Clinic pain medicine specialist, says, “My goal is to bring new approaches to pain medicine that people haven’t utilized before and try to get away from treating pain with opiate medications.”

comprehensive approach to pain medicine.

The 15-person program saw one patient graduate each day while a new patient joined the group, giving them an opportunity to see how they would transition through the program. The “Boot Camp for Pain,” as Bailey describes it, consisted of physical therapy, occupational therapy, biofeedback, and cognitive behavioral therapy as the primary components of the classbased program.

“The biggest component was cognitive behavioral therapy, teaching the body what normal feels like again, retraining your normal pain pathways,” Bailey says. “When patients left, they were off all opiate medications with improved pain scores after this

three-week program.”

Bailey is working to duplicate that model at Lexington Clinic and he has already begun to implement many of the same components and philosophies. He is referring patients to cognitive behavioral therapy, physical therapy, and occupational therapy.

A major component in Bailey’s approach is to work with the referring physicians to determine the underlying cause of the pain. That is one of the things that drew him to Lexington Clinic, where he found that collaborative spirit already alive and well. “With neurosurgery and orthopedics, we are all part of one provider. It’s a close collaboration,” Bailey says.

“That’s one of the biggest benefits of the Mayo model – collaboration with consultants. That’s what I saw when I came here.

Everything was already in place. They were just missing a pain department.”

With the pain department in place, Bailey can now work closely with neurosurgery, for example, to determine the underlying cause of a patient’s back pain, be it nerve entrapment, arthritis, or fractures.

PHOTOS BY STEPHANIE NORTHERN

ISSUE#96 | 17

“In medicine we have a tendency to treat all back pain as equal, but it’s not,” Bailey says.

With more treatment options available and patients asking for alternatives to narcotics, determining the underlying cause of pain is central to restoring a patient’s comfort level and functionality. “My goal is to keep patients functioning and to minimize the systemic and psychological effects they are having from their pain,” Bailey says, citing some of the newer treatments that allow him to do so without relying on narcotics. “The future is in neuromodulation, radiofrequency ablation of nerves, and spinal cord stimulators. We are able to mask the pain by controlling how the brain perceives it.”

Perception is also key to Bailey’s goals

18 MD-UPDATE

The future is in neuromodulation, radiofrequency ablation of nerves, and spinal cord stimulators. We are now able to mask the pain by controlling how the brain perceives it.

– Dr. Joshua Bailey

about pain medication in general. He wants to put an end to misconceptions that all pain treatment centers are “pill mills” and help both patients and physicians see that there are alternatives that offer better longterm results.

“The newer data is showing an exponentially higher risk of deaths when you increase narcotic dosage,” Bailey says. “My goal is to provide patients with alternatives to narcotics. I don’t want patients to feel like they’re coming to a pain clinic, but are coming to find answers.” ◆

SPECIAL SECTION  PAIN MEDICINE

Ease Their Pain

Pain relief is the primary goal for Cristina Lamar, DO, of Bux & Bux Pain Clinic BY JIM KELSEY Pain travels. And now, so do the doctors of Bux & Bux Pain Clinic.

Three days a week, providers from the Danville-based group travel to Cynthiana to operate a pain clinic located within Harrison Memorial Hospital.

In the summer of 2015, Anjum Bux, MD, who operates Bux & Bux Pain Clinic with his father Madar Bux, MD, was approached by Pain Management Group (PMG), a pain clinic management partner with Harrison Memorial Hospital in Cynthiana, Ky. PMG was looking for a provider to run the pain clinic. Bux accepted that role. “We are operating 3 days a week in Cynthiana and doing everything including epidural injections, joint injections, spinal cord stimulators, intrathecal pain pumps and medication management,” says Bux. “We get patients from Georgetown, Harrison County, and even Lexington.

Again, it gives us the opportunity to spread out and expand our services to different areas. There certainly is a need in the area,” Bux says, noting that they already see over 1,000 patients in Cynthiana.

One of the newest members of the Bux & Bux Pain Clinic group is Cristina Lamar, DO. She works in Cynthiana on Mondays and Fridays and operates out of Danville the rest of the week at the Bux & Bux Pain Clinic. Lamar joined the practice in mid-August of 2015 after DANVILLE & CYNTHIANA

Anjum Bux, MD, operates Bux & Bux Pain Clinic with his father Madar Bux, MD.

Cristina Lamar, DO, joined Bux & Bux Pain Clinic in 2015. Her osteopathic training brings a different approach to evaluating how disease, dysfunction, and disorder in one part of the body affects another part of the body.

completing her fellowship through the University of Kentucky (UK) at Good Samaritan Hospital. A native of Georgia, Lamar completed her undergraduate work at the University of Georgia before attending the Philadelphia College of Osteopathic Medicine in Georgia. Lamar, whose husband is from Harrodsburg, Ky., completed her residency in anesthesia at UK. Lamar’s interest in pain began even before medical school when she was a medical assistant at Atlanta Orthopedics.

There she assisted Dr. Amy Lang, who was fellowship-trained in pain management, and introduced Lamar to that field.

“I always kept that in the back of my mind going into medical school,” Lamar says. “I saw their practice style, their level of enjoyment with their career, their ability to appropriately manage personal lives with career. I saw that it would also enable me to be part of my community, being able to return patients to function with minimal pain and able to get back to their way of life

and improve their quality of life. That was always something I wanted.”

Lamar’s doctor of osteopathy training allows her to bring a different approach to evaluating her patients and understanding how disease, dysfunction, and disorder in one part of the body affects another part.

“Osteopathic manipulative medicine can also be applied in pain medicine in various ways, especially in patients with myofascial pain syndrome,” Lamar says. She adds that manipulative medicine can help with muscular pain, spasms, and inflammation, as well as gentle manipulation of the arthritic joints or joints that are out of place and out of alignment.

A high percentage of the patients coming to the Bux & Bux Pain Clinic suffer from conditions such as complex regional pain syndrome, back pain, and compression fractures. These are often candidates for intrathecal pain pumps.

“It’s great to learn from Dr. Bux as he does so much of the pain pump insertion and implantation,” Lamar says. “He does this in combination with a surgeon, so the procedure itself becomes much quicker for the patient.”

The pain pump itself represents a significant improvement in pain management for many patients who come to the clinic with a history of taking pain medicine orally and have developed a dependency or have suffered other side effects. “It can be challenging when new patients come in already on many different medications,” Lamar says.

“They become tolerant of these medications. Our goal is to help patients transition, using a multi-modal approach, which may include a pain pump to help minimize what they are taking by mouth and diminish the Photos by Gil Dunn

ISSUE#96 | 19

Bux & Bux Pain Clinic

SPECIAL SECTION  NEUROLOGY

SPECIAL SECTION  PAIN MEDICINE

Providing Anesthesia and Pain Management Services to the Patients of Central Kentucky for over 35 years

PAIN MANAGEMENT

Anjum Bux MD, Madar Bux MD Cristina Lamar D.O. Pat Duff CRNA Conditions Treated:

Treatment Methods:

Chronic Back & Neck Pain Degenerative Disc Disease Fibromyalgia & Myofacial Pain Shingles/ Post Herpetic Neuralgia Pain Cancer Pain Hip/ Sacroiliac Joint Pain Reflex Sympathetic Dystrophy

Pain & Steroid Injections/ Nerve Blocks Pain Pumps/ Neurostimulators Radiofrequency Ablation TENS unit and Bracing Physical Therapy & Occupational Therapy Nutrition Counseling Family Education & Stress Management

Bux & Bux Pain Clinic 2 LOCATIONS

230 West Main Street Suite 200 Danville, Ky 40422 (859)236-3726

Harrison Memorial Hospital 1210 Ky. Highway 36 East Cynthiana, Ky 41031 (859)235-3725

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side effects of what they have been taking.”

Because of the potentially negative side effects of high doses of opioid pain medications, Bux & Bux Pain Clinic operates with a low-dose opioid prescription philosophy.

The preference instead is to focus on the patient’s overall condition and look for other means to pain reduction.

“Our goal is to make sure that they have been appropriately rehabbed in physical therapy and that we have tried to optimize their pain intervention,” Lamar says, adding that a multimodal approach can better serve the patients’ lifestyle necessities. “A lot of our patients have severe depression and anxiety. That’s all part of chronic pain.

Many of our patients are younger and have families and are figuring out how to take care of their family while suffering from pain. Being a mom myself and imagining what they are going through provides that much more of an incentive to get my patients out of pain.”

New methods to achieve that goal are here or are fast approaching. Ultrasoundguided joint injections and ultrasoundguided neuraxial techniques can help improve accuracy in administration of targeted pain blockers.

“There are going to be advances in the spinal cord stimulation technology in the type of leads that are going to be used and the type of pain that can be covered,” Lamar adds. “I’m excited to learn more about these and the ultrasound-guided techniques.”

Kyphoplasty, infusing cement into the vertebral structure to restore it to its prior height, will soon be added to the procedures offered by Lamar and Bux.” Kyphoplasty works well for patients with lumbar compression fractures from osteoporosis and pain from cancerous tumors on the spine,” says Lamar. “It provides immediate pain relief.”

“With new techniques and treatments for chronic pain,” Bux says, “we look forward to employing a multi modality treatment approach to help people better manage their pain.” Expanding services throughout Central Kentucky, Bux and Bux Pain Clinic continues to employ a family type atmosphere in treating their patients providing better options in dealing with their chronic pain. ◆

SPECIAL SECTION  MENTAL HEALTH

The Unique Mental Health Needs of Children

Our Lady of Peace’s Innovations program offers evidence-based psychiatric and behavioral care BY SUNIL CHHIBBER, MD

Our Lady of Peace, a service of KentuckyOne Health, is one of the nation’s leading psychiatric facilities offering specialized programs for persons with emotional, behavioral, psychiatric, and chemical dependency disorders. Licensed to take care of 396 acute care patients and a current operating capacity of 243 beds, it is one of the largest private, nonprofit psychiatric hospitals in the United States. Our Lady of Peace is unique in both the volume of patients it serves and the range of programs it provides. Although originally established in 1954 as an adult psychiatric treatment facility, programs and service lines have continued to change and grow to meet the ever-changing mental health needs of our community.

Children and adolescents who have both psychiatric disorders and developmental disabilities have unique needs that are all too often neglected. While communitybased services for these populations are limited, inpatient acute psychiatric services are almost non-existent. Throughout Kentucky and the surrounding states, families of children and adolescents with intellectual and developmental disabilities in crisis struggle to find services. Traditional hospitals are unequipped to meet their needs. A specialized program at Our Lady of Peace has offered hope to families. The Innovations program, established in 1997, provides cutting-edge treatment for children and adolescents with developmental disabilities.

The Innovations program is comprised of three separate inpatient units specifically designed to meet the needs of this unique population. The adaptations are immediately visible when walking on to one of these specialty units. The children’s unit offers child-friendly fluorescent light coverings to decrease extraneous sensory stimulation and communication boards to assist patients with limited verbal skills in communicating their wants and needs. Treatment is delivered by a diverse team of professionals that includes psychiatrists, registered nurses, mental health LOUISVILLE

technicians, licensed clinical social workers, certified teachers, board-certified behavior analysts, occupational therapists, and a speech and language pathologist. Treatment is truly multi-disciplinary and integrated into the patient’s daily activities. Behavioral data is collected every 15 minutes and graphed, and trends are discussed weekly with the psychiatrist and other treatment team members.

In contrast to traditional psychiatric hospital programs that offer stabilization through medication management and traditional psychotherapy, the Innovations program’s focus is on long-term stability and decreasing the need for future hospitalizations. According to Kimberly Dwyer-Moore, board-certified behavior analyst, “The mission of our program is to provide behavioral and psychiatric stabilization to address those behaviors that impede meaningful family, social, and community integration. Our program is designed to teach patients alternative behaviors to promote a long-term behavioral change.” Utilizing an objective, data-driven model of care, the treatment team is able to identify variables influencing behavioral and psychiatric symptoms and works to formulate both medication and environmental changes to positively impact the patient’s long-term success.

Due to the acute nature of the inpatient hospital setting, access to engaging, recreational, or functional activities are limited to those found within the locked facility.

The components of this setting provide the structure and security that many children and adolescents with developmental and psychiatric disorders may need, but the sterile nature of the environment makes it difficult for therapists to identify meaningful methods of instruction that will motivate the participant to actively engage in the therapeutic activities. However, the Innovations program continues to work towards creating a therapeutic environment by way of community outings, passes with family mem-

bers, and the development and integration of programs that patients can continue to be involved in after discharge.

Children and adolescents admitted to the Innovations program receive art therapy, music therapy, and play therapy on a weekly and sometimes daily basis. These programs, led by Nevia Greenwell, licensed art therapist and manager of the activity therapy department, provide patients with meaningful, therapeutic activities that are also fun and engaging.

Over the past year, Margaret Giffin, occupational therapist, has led the Innovations team in developing an equine-assisted therapy and hippotherapy program. There is a significant amount of research supporting this therapy with both the general child and adolescent population and children and adolescents with developmental disabilities. According to Giffin, “Hippotherapy involves using the movement of the horse as part of an integrated intervention to achieve functional outcomes such as improving balance and motor skills and addressing sensory integration. Equine therapy is learning to interact with the horse through grooming, feeding, and interaction on the ground in order to improve communication, problem solving, and relationship-building skills.”

Dr. Sunil Chhibber is a board-certified child and adolescent psychiatrist with KentuckyOne Health Psychiatric Associates and a medical director for Our Lady of Peace. ◆

For further information call our Assessment and Referral Center at 502.451.3333 2020 Newburg Road Louisville, KY 40205

Kentuckyonehealth.org/ourladyofpeace

ISSUE#96 | 21

Intellectual Property

Stewart Home & School has a long history of helping those with intellectual disabilities BY JIM KELSEY Imagine you have an adult child with Down syndrome, cerebral palsy, autism, or another intellectual disability.

Federal mandates ensure that your community provides some sort of learning opportunities, but what if they aren’t a good fit?

What then? Where do you go and what happens when you are no longer able to care for your special needs adult dependent?

For thousands of students, the answer to those questions for more than a century has been the Stewart Home & School in Frankfort, Ky. Dr. John Quincy Adams Stewart founded the Stewart Home & School in 1893, and it has been part of the family ever since, owned and operated by five successive generations. Currently, John D. Stewart, MD, serves as the campus’ medical director in addition to practicing as a surgeon in Lexington. “We have an underappreciated need in our society for the care of the intellectually disabled,” Stewart says. “It is our mission and our proven track record to provide the best opportunities for the intellectually disabled. That’s what we’re here for.”

Stewart Home & School is a residential FRANKFORT

school akin to a boarding school or small college. There, people with intellectual disabilities – most over the age of 18 – live and learn with their peers on a campus that includes 18 dormitories and 260,000 square feet of building space. Approximately 350 students live on the campus, which has 165 staff members, many of whom live on or near the campus, which is operational 365 days a year. The current resident population represents 38 states and half a dozen foreign countries.

From a medical perspective, Stewart sees

older,” Stewart says. “We’re not a hospital or nursing home. But we definitely serve a healthcare need.”

Some residents of the Stewart Home & School are on psychiatric medication or medication for seizure disorders. The school operates its own infirmary and has a nurse practitioner, and Dr. Stewart has a clinic on campus one evening a week and is in touch with the staff on a daily basis. In addition, specialists in psychiatry and neurology visit and hold clinics on a monthly basis.

The Stewart Home & School operates much differently from a group home, the more widespread solution of choice for many communities across the country. In group homes, adults with intellectual disabilities live together in small groups of people, working together to maintain the home with supervision from staff. The intent is for the residents to be more immersed in the community.

Sandy Bell, Director of the Stewart Home & School, says there are misconceptions about how the school operates com-

OUR FOCUS IS PROVIDING A LIFELONG EXPERIENCE OF LEARNING. – SANDY BELL, DIRECTOR

22 MD-UPDATE

PHOTO BY GIL DUNN

the school providing much-needed answers for many physicians. “If you’re a primary care physician, pediatrician, psychiatrist, or neurologist with a developmentally disabled child that you’re taking care of, the question becomes, where is the proper place for this person to be as he or she gets a little bit

SPECIAL SECTION  MENTAL HEALTH

pared to a group home. “There are people who are ideologically opposed to settings like ours,” she says. “If you have more than a few people staying in one place, there are those who feel that’s segregation and that you’re somehow denying the right to be included in our culture and our society.

Most people fail to see this as more like a boarding school or small college. But you can’t help but see that when you come here.”

LEFT Sandy

Bell started at the Stewart Home & School as a speech and hearing pathologist in 1970 and became director in 1995.

A Different Approach

Taking a different approach from the group home model, the philosophy of the Stewart Home & School is focused on providing an atmosphere in which the students can be comfortable, confident, and safe. “We are here to provide an environment of peers,” Stewart says. “They can be with their friends with the same mental and physical capability. They can compete with them and enjoy things with them on a level playing field.”

They also are far from sheltered. There are daily activities and trips, including amusement parks, ballparks, movies, and concerts.

And there is growing connectivity with the central Kentucky community, with people in the community working at the school and residents from the school volunteering at places like the humane society and soup kitchens.

That exposure will only help with a couple of the school’s biggest hurdles – getting the word out that it exists and exactly what it is. “Our name makes people think we’re a home school, and they don’t understand how that works with special needs students,” says Barry Banker, CEO of the Stewart Home & School and Stewart’s brother-in-law. “We have to explain that we’re like a residential prep school or college for intellectually disabled students of all ages.”

The Stewart Home & School is a private, for-profit entity. They carry no debt

LEFT John

and solicit no donations. Tuition to attend the school is a little over $36,000 per year, and the school operates with a budget of around $14.5 million. That comes as a surprise to many. “We operate in the black and earnings are devoted to the school,” says Banker.

Planned new construction and renovations include a new clinic, a renovation

D. Stewart, MD, medical director and fifth generation of Stewarts to guide the Stewart Home & School, stands before a portrait of school founder Dr. John Quincy Adams Stewart.

RIGHT A Stewart son-in-law and businessman, Barry Banker has served as CEO for the last 27 years.

of the pre-academic space and a new gym floor. “Every decision we make is for the happiness, safety, and well-being of our students,” says Banker.

“A misperception is that because we’re in PHOTOS BY GIL DUNN

ISSUE#96 | 23

SPECIAL SECTION  MENTAL HEALTH

WE ARE HERE TO PROVIDE AN ENVIRONMENT OF PEERS. – DR. JOHN D. STEWART Kentucky, which is a wonderful state, folks from other regions wonder ‘How on earth could a facility in Kentucky be what our child needs? How could they provide it?’” Banker says. “All we ask is that they come and see us.”

Once visitors see the facility, the vision of a boarding school or small college becomes much clearer. And that is by design, says Bell. “We hope that everything we do is on the same level as a top boarding school,” she says. “We hope that our students have the very best. Most of our families want that. They have been able to provide college experiences for their other children, and they have a sense that their child with a dis24 MD-UPDATE

ability deserves that too.”

“Parents ask us, ‘What’s your admission criteria?’ We tell them, ‘It’s you, because you know your child.’ You come into this place, and you’re going to look at everything through the lens of your child.”

Residents of the Stewart Home & School have access to a variety of classes, a library, a pre-academic computer lab for those students who don’t read yet, and another lab for the academic students.

Physical activities include exercise classes, horseback riding, swimming, yoga, dance and music classes, Bible studies, and many more. The focus is on life-long learning.

PHOTOS PROVIDED BY STEWART HOME & SCHOOL

“The danger in any long-term care situation is that it’s not exciting,” Bell says.

“Most people when they come are fearful that this will be depressing. That’s the last thing we want. We want our students to be excited about their lives every day.”

The future of Stewart Home & School rests in continuity and connectivity, says Stewart. “Father Time forces generational transfer on all of us. Our mission gives us the strength and the foundation to create continuity. This team has been together for a long time running the administration, the business, and educational aspects of the school. We’re ready for the next step.” ◆

COMPLEMENTARY CARE

Practicing Gratitude Enhances Well-being Studies show that the regular practice of gratitude can not only increase our well-being and happiness, but also improve our physical health and our relationships.

I was in the audience as David Novak, then-president and CEO of Yum! Brands, explained to Business First Publisher Tom Monahan how a boy who’d lived in 32 trailer parks in 23 states by the time he reached seventh grade became the head of the world’s largest restaurant company at age 47.

As they discussed Novak’s unique leadership style, he shared two seemingly unrelated perceptions: Novak observed, “It’s the soft stuff that drives the hard results.”

He also offered two observations about why people leave jobs: 1) They don’t get along with their bosses; or 2) They don’t feel appreciated.

And it’s not just work relationships that suffer when people feel taken for granted.

The primary driver of many unhappy marriages or those that end in divorce is not fighting or infidelity, according to marriage researcher and relationship expert John Gottman. It’s simply not feeling appreciated.

On the other hand, positive emotions, including those associated with appreciation, thankfulness or gratitude, have been observed to have an “un-doing” effect that causes negative emotions to dissipate more

rapidly (including the cardiovascular aftereffects of negative emotions) and appear to help people effectively handle stressful situations.

LOUISVILLE

How Gratitude Can Improve Your Health, Happiness, and Relationships BY

Jan Anderson, PsyD, LPCC

My favorite gratitude study involved three groups, each with a very different assignment. One group was instructed to focus each week on things they perceived as irritating, annoying, or frustrating. The second group focused each week on things for which they were grateful, thankful, or appreciative. The control group focused on ordinary life events during the week.

The research conclusions found that the people who focused on gratitude were unmistakably happier – in just about all aspects of their lives. They reported fewer negative physical symptoms, such as headaches or colds, and they spent almost an hour and a half more per week exercising than those who focused on negatives.

Simply put, those who were grateful had a higher quality of life.

In a follow-up study, those who found something to appreciate every day were

observed to be less materialistic, less depressive, envious, and anxious, and much more likely to help others, a fact not lost on those around them. When others were asked their impressions of the daily-gratitude group, they generally judged them as empathic and helpful to others. This effect was not observed in either of the other two groups.

As research author Robert Emmons put it, “This is not just something that makes people happy, like a positive-thinking/optimism kind of thing. A feeling of gratitude really gets people to do something, to become more pro-social, more compassionate.”

The Bottom Line

The study found that the participants who were consciously grateful felt better about their lives, and were more optimistic, more enthusiastic, more determined, more interested, more joyful, and more likely to have helped someone else.

Other studies suggest that these psycho-emotional benefits are accompanied by health benefits as well: more energy, more restful sleep, clearer thinking, better resilience during tough times, fewer illnesses, and fewer stress-related conditions.

Blocks to Gratitude and How to Overcome Them

In spite of all the evidence, you may be surprised to uncover some subtle doubts about cultivating a daily gratitude practice.

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

ISSUE#96 | 25

COMPLEMENTARY CARE Author Kathy Freston offers insightful solutions to faulty thinking about gratitude: MYTH #1: If I am grateful for my present situation, it means I’m satisfied with what I have and cannot hope for something more.

REALITY: When we are grateful for what we have now, we are actually programming ourselves for more — it becomes natural to gravitate toward more satisfying situations.

MYTH #2: If I am grateful, I’ll be taken advantage of — I’ll be a sucker in a tough world.

REALITY: It takes confidence and strength to express gratitude. Being appropriately appreciative tends to make people want to do more for us, not less.

MYTH #3: If I get too grateful, I won’t be motivated or ambitious to move forward.

REALITY: Gratitude doesn’t make us lazy — it inspires and energizes us to get more of that feeling of well-being.

26 MD-UPDATE

A Daily Practice to Cultivate Gratitude

To begin cultivating gratitude, be open and receptive (and if necessary, look diligently) for something to be thankful for on a daily basis in each of the following areas of your life. Good times to do this are as you are waking up in the morning or going to sleep at night.

1. Body/Physical health 2. Home/Environment 3. Money/Resources 4. Work/School 5. Relationships 6. Random acts of kindness 7. Appreciation of beauty It is particularly helpful to do this practice when things are going well – when you’ve had a good day or something good happened. In other words, “dig the well before the house is on fire.” It’s like making deposits into a bank account — you can draw on those reserves in times of need. ◆

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

NEWS  EVENTS  ARTS

Bertolone Receives Marc Lehmann Spirit of Service Award

Salvatore J. Bertolone, Jr., MD, professor and previous chief of pediatric oncology and hematology at the University of Louisville, received the third annual Marc A. Lehmann Spirit of Service Award for physicians on Oct. 30. The award recognizes Louisville-area physicians in hematology & oncology and is presented in memory of Marc A. Lehmann, a Louisville native and U of L student who succumbed to acute myeloid leukemia in 2012.

The Marc A. Lehmann Spirit of Service Award Foundation endeavors to seek out and identify physicians and support staff in the field of blood cancers and hematology to honor longstanding service to patients and their families that encompasses exceptional proficiency, empathy, and understanding.

Each year the foundation presents an award to one physician and to three support staff members from the Greater Louisville area.

LOUISVILLE

Bolli Receives Schottenstein Prize for Cardiovascular Research

Roberto Bolli, MD, chief of the University of Louisville’s Division of Cardiovascular Medicine, will receive the 2015 Jay and Jeannie Schottenstein Prize in Cardiovascular Sciences from The Ohio State University Wexner Medical Center’s Heart and Vascular Center. The Schottenstein Prize is among the largest monetary prizes in the United States dedicated to cardiovascular research.

“We congratulate Roberto for achieving this award. He is such a scientist,” said LOUISVILLE

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Thomas Ryan, MD, director of The Ohio State Heart and Vascular Center. “His work on heart muscle protection and regeneration has greatly increased our understanding of the cellular changes that occur during a heart attack and how to minimize and repair the damage that results.”

The Schottenstein Prize was established in 2008 with a $2 million gift from Jay and Jeanie Schottenstein for an endowed fund for a biennial award. The prize goes to a physician or researcher who is an international leader in cardiovascular medicine, cardiothoracic surgery, or molecular or cellular cardiology. Bolli received his award during a ceremony on Nov. 4 in Columbus, Ohio. The prize includes an honorarium of $100,000.

Bolli is the Jewish Hospital Heart & Lung Institute Distinguished Chair in Cardiology and serves as director of U of L’s Institute of Molecular Cardiology, scientific director of the Cardiovascular Innovation Institute, and executive vice chair in the Department of Medicine.

Casey Named U of L Chair of Psychiatry, Behavioral Sciences

David A. Casey, MD, has been named chair of the Department of Psychiatry and Behavioral Sciences at the University of Louisville School of Medicine. He has served as interim chair since Jan. 1.

Casey, a professor in the department, has served as senior vice chair and head of clinical services, charged with oversight of the patient care activities of the department. Previously, he was director of the geriatric psychiatric program and he practices as a geriatric psychiatrist with University of Louisville Physicians. He joined the faculty in 1985.

Casey received his undergraduate degree in biology with honors and his medical degree, summa cum laude, from LOUISVILLE

the University of Louisville. He completed his psychiatric residency training at the University of Washington School of Medicine where he served as chief resident.

He earned board certification in general psychiatry in 1988 and in geriatric psychiatry in 1991.

Casey’s appointment was approved by the U of L Board of Trustees at its Oct. 8 meeting.

Hattab Appointed U of L Chair for Pathology

Eyas Hattab, MD, MBA, professor of pathology and laboratory medicine and neurological surgery at Indiana University School of Medicine, will be appointed as the new chair of the Department of Pathology and Laboratory Medicine at the University of Louisville School of Medicine. The appointment will begin Jan. 1, 2016.

Hattab is currently the vice chair of education for pathology and laboratory medicine at Indiana University and serves as the director of the residency program.

He joined Indiana University in 2002 and has risen through the ranks during the past 13 years.

Hattab earned his medical degree from Jordan University of Science and Technology in Irbid, Jordan. He completed his residency in combined anatomic and clinical pathology at the University of Florida Health Science Center – Jacksonville, where he also served as chief resident. He then performed a fellowship in neuropathology at Stanford University Medical Center and surgical pathology fellowship at Washington University Medical Center in St. Louis.

Hattab also earned his Business of Medicine MBA from Indiana University Kelley School of Business.

ISSUE#96 | 27

NEWS

Jackson Wins National Fellowship

A third-year resident in the University of Louisville Department of Psychiatry and Behavioral Sciences has been awarded the Jeanne Spurlock, MD, Congressional Fellowship of the American Psychiatric Association and the association’s related organization, the American Psychiatric Foundation.

Daniel T. Jackson, MD, is serving in the Capitol Hill office of U.S. Rep. James McDermott, MD, (D-Wash.) for the 10 months of the fellowship beginning in September. The award is offered to only one individual each year and provides the opportunity to represent the profession of psychiatry in Congress, working with federal policy makers to shape public policy.

“My work with Rep. McDermott – who is a psychiatrist himself – focuses on mental health issues including the Mental Health Reform Act of 2015 in the Senate and the Helping Families in Mental Health Crisis Act of 2015 in the House,” Jackson said.

“We hope to see action on one or both bills in the coming months.”

Jackson is a two-time graduate of U of L, earning his medical degree in 2013 and a bachelor of arts degree cum laude in psychology with concentration in the natural sciences in 2007. He entered the residency program in July 2013.

LOUISVILLE

Phillips Elected President of CHEST

Dr. Barbara Phillips, professor of pulmonary, critical care, and sleep medicine in the Department of Internal Medicine at the University of Kentucky, was elected the 78th president of The American College of Chest Physicians (CHEST) effective Nov. 1, 2015.

Phillips is also involved with numerous other outside organizations. She has been chair of the National Sleep Foundation and has also served on several boards including the American Lung Association, the American Academy of Sleep Medicine, and the American Board of Sleep Medicine.

She was awarded with the Sleep Academic LEXINGTON

28 MD-UPDATE

Award from the National Institutes of Health. In 2013, she was presented with the College Medalist Award at CHEST.

Schooler Receives Sports Medicine Team Physician of the Year

The Indiana Athletic Trainers Association’s fall meeting was held Sunday, November 1, and Floyd Memorial emergency medicine and sports medicine physician, Stan Schooler, MD, was selected as the recipient of the Indiana State Medical Association’s Committee on Sports Medicine’s 2015 Team Physician of the Year Award. This award is granted to a physician who has provided significant long-term contributions and support to the field of sports medicine.

Currently, Schooler is an emergency physician for Floyd Emergency Medical Associates (FEMA) and a sports medicine physician at Floyd Memorial Physical Therapy – Charlestown Road location.

He also sees patients at Floyd Memorial Medical Group – Urgent Care Centers at Highlander Point and Charlestown Road.

NEW ALBANY, INDIANA

Harrison Memorial Hospital Earns Trauma IV Center Designation

Harrison Memorial Hospital (HMH) announced it is officially designated as a Level IV Trauma Center by the Kentucky Trauma System and verified by the Commonwealth of Kentucky Cabinet for Health and Family Services Department of Public Health. The designation was presented at the 2015 Kentucky Trauma and Emergency Medicine Symposium on November 5.

As a Level IV Trauma Center, HMH has the ability to provide initial care and stabilization of traumatic injuries while arranging transfer to a higher level of trauma care. The goal is to ensure that the trauma patient is treated within the “golden hour” of injury.

Using the standards set forth by the state and having pre-arranged transfer agreements with several Level I Trauma Centers, HMH ensures that the patient receives proper trauma care in a timely manner. The process of applying to the program began in 2014. HMH established a trauma program under the leadership of Christina Buckler, HMH Emergency Department manager.

CYNTHIANA

Pictured are members of the HMH Trauma Committee: (l-r) Traci Taylor, HMH chief nursing officer; Christina Buckler, Emergency Department manager and trauma coordinator; Sheila Currans, HMH chief executive officer; Dr. Brady Reid and Dr. Karl Schulstad, HMH Trauma Services medical co-directors.

The program includes several physician and management leaders along with local emergency management services.

Ephraim McDowell Offers New Treatment for PAD

Ephraim McDowell Regional Medical Center, as part of its Heart & Vascular Program, is the first hospital in Kentucky to acquire and use a new and innovative tool to treat patients with peripheral artery disease (PAD).

With the acquisition of the FDAapproved Ocelot Optical Coherence Tomography (OCT), EMRMC is taking a large step forward in the treatment of patients with PAD, an under-recognized epidemic that affects between eight and 12 million adults in the U.S. and 202 million people globally. PAD is caused by a buildup of plaque in the arteries that blocks blood flow to the legs and feet.

The innovative technology allows physicians, for the first time ever, to see from inside the artery during a procedure, using optical coherence tomography (OCT) to navigate through the vessel. In the past, physicians have had to rely solely on x-ray as well as touch and/or feel to guide catheters through complicated blockages. With the recently developed lumivascular approach, physicians can more accurately navigate through chronic total occlusions (CTO), a complete blockage of an artery, thanks to the OCT images they see from inside the artery.

Ocelot is the first-ever CTO-crossing catheter that uses OCT technology to access exact regions of the peripheral vasculature where the blockages occur, while simultaneously providing Ephraim McDowell’s physicians with visualization for real-time navigation during an intervention. ◆ DANVILLE

EVENTS

Doctors’ Ball Raises Funds for New Mobile Cancer Screening Van

- The 20th Anniversary of the Doctors’ Ball, presented by the Jewish Hospital & St. Mary’s Foundation, a part of KentuckyOne Health, honoring physicians and medical and civic leaders, was held Saturday, October 17, 2015 at the Marriott Louisville Downtown. The 2015 Doctors’ Ball proceeds are going to help fund the new mobile cancer screening van for the James Graham Brown Cancer Center, which will screen for seven different cancers.

This year’s honorees were: Morris Weiss, MD, Ephraim McDowell Physician of the Year; Eugene Shively, MD, Compassionate Physician Award; John Shaw, MD, Excellence in International Humanitarian Service; Jesse Wright, MD, PhD, Excellence in Mental Health; Melissa Currie, MD, Excellence in Community Service; Michelle Perry, RN, Excellence in Nursing; Debbie Scoppechio, Community Leader of the Year; and Lelan Woodmansee, Distinguished Lifetime Achievement Award.

“Over 650 attended and $380,000 was raised at the 2015 Doctors’ Ball,” said Leslie Buddeke Smart, KentuckyOne Health vice president of development. “The Doctors’ Ball honors deserving individuals in our community who are improving the lives of the patients and families we serve every day through philanthropic support, education, research, service, and leadership. This year’s honorees are making a true difference in our community and around the globe.”

LOUISVILLE

(l-r) Morris Weiss, MD, honored with the Ephraim McDowell Physician of the Year and wife Terry Weiss, MD.

(l-r) Eugene Shively, MD, honored with the Compassionate Physician Award with wife Susan Shively.

(l-r) John Shaw, MD, honored with the Excellence in International Humanitarian Service with wife Sharon, occupational psychologist.

(l-r) Susanne Wright and Jesse Wright, MD, PhD, honored with the Excellence in Mental Health award.

(l-r) Melissa Currie, MD, honored with the Excellence in Community Service award with husband Alan Currie, MD, internal medicine at Norton Healthcare.

(l-r) Leslie Buddeke Smart, VP of Development for KentuckyOne Health, with husband John Smart.

(l-r) Michelle Perry, RN, honored with the Excellence in Nursing award, with friend Lee Collins.

(l-r) Rick and Debbie Scoppechio, who was honored with the Community Leader of the Year.

(l-r) Mark Milburn, VP of Oncology Services for KentuckyOne Health, and wife Sharon.

Mark Slaughter, MD, and wife Martha, member of 2015 Doctor’s Ball planning committee.

PHOTOS BY ROBERT DENSMORE

ISSUE#96 | 29

EVENTS

An Evening with the STARS Gala Honors Leaders

LEXINGTON-THE 27th annual Evening

with the STARS Gala was held Saturday, November 7, 2015 in the Bluegrass Ballroom at the Lexington Convention Center, downtown Lexington. Nearly 350 guests attended to support KentuckyOne Health’s Saint Joseph Hospital Foundation raise over $95,000. STARS is an acronym for Saint Joseph Associates for Renowned Service.

Physician of the Year winners were Mahmoud Moammar, MD, Saint Joseph East, and Charles Kennedy, MD, Saint Joseph Hospital. Nominated finalists also included Kal Jundi, MD, and Ketan Merchant, MD, for Saint Joseph East and Jeffrey Weaver, MD, and Timothy Adkins, MD, from Saint Joseph Hospital.

Community Volunteer of the Year went to Larry Cowgill and Doug Hacker representing Congleton – Hacker Company.

KentuckyOne Health Vice President of Development Leslie Buddeke Smart, CFRE, said, “I’m very grateful to the STARS Gala committee, who worked tirelessly to make this annual gala such a memorable evening. Over $1.3 million has been raised since its inception to help support our hospitals and patients.

It was an inspiring evening to celebrate and honor our physicians and community leaders.” ◆

(l-r) Tim Adkins, MD, and wife Connie. Dr. Adkins was nominated for Physician of the Year at Saint Joseph Hospital.

30 MD-UPDATE

PHOTOS BY JOE OMIELAN

(l-r) Susan and Dr. David Blake, the 2014 Physician of the Year, attended Evening with the STARS to honor this year’s nominees.

(l-r) Andy Moore, MD, and wife Kathy were on hand to honor the Saint Joseph physicians.

(l-r) Saint Joseph East pulmonologist Dr. Mahmoud Moammar and his wife Sahar.

Dr. Moammar was honored as the 2015 Physician of the Year at Saint Joseph East.

(l-r) John Sartini, MD, and wife Kathy came out to honor this year’s Evening with the STARS. Lexington Clinic has been a longtime supporter of the event.

(l-r) MD-UPDATE publisher Gil Dunn with nominee Dr. Magdalene Karon and her husband Dr. John Stewart.

(l-r) Elizabeth Killen, MD, and Derek Weiss, MD, joined the celebration at the Evening with the STARS.

(l-r) Gil Dunn, Elaine Duvall, and Amy and Rick Lozano, MD, were all smiles at the Evening with the STARS.

Dr. Charles Kennedy and wife Carrie celebrate Dr. Kennedy being named Physician of the Year at Saint Joseph Hospital. Dr. Kennedy is an infectious disease physician. PHOTO BY PAUL ATKINSON

KentuckyOne Health Cancer Care oncologist Dr. Jessica Croley and husband Matthew Croley, DMD, attended Evening with the STARS to support the Saint Joseph Hospital Foundation.

(l-r) Saint Joseph Hospital Medical Director Dr. Jeffrey Weaver (second from left) from Team Health was a finalist for Physician of the Year with wife Rebecca, KentuckyOne Vice President of Development Leslie Buddeke Smart, and Saint Joseph Hospital President Bruce Tassin and wife Hallie.

(l-r) KentuckyOne Vice President of Development Leslie Buddeke Smart with Ruth Brinkley, KentuckyOne Health president and CEO, and Dr. Pat Alagia, KentuckyOne Health chief medical officer.

(l-r) Physician of the Year nominee Dr. Kal Jundi and wife Burletta.

Dr. Jundi is a neonatologist in the NICU at Women’s Hospital at Saint Joseph East.

(l-r) Dr. Courtney Markam-Abedi with husband Dr. Nick Abedi support the Saint Joseph Hospital Foundation.

EVENTS

Lexington Medical Society Gives Community Service Award and Receives KY Legislative Preview

It was a busy and fact-filled night at the November 10, 2015 meeting of the Lexington Medical Society (LMS) at the Hilary J. Boone Center, University of Kentucky.

The Jack Trevey Award for Community Service was presented to Ardis D. Hoven, MD, past president of the AMA and LMS. Hoven said she feels she “has come full circle” following her career path through organized medicine leadership. She is once again involved in public health and infectious disease at the UK Department for Public Health while chairing the Council for World Medicine. “Get your flu shot, and make sure your staff gets theirs too,” she exhorted the gathering while accepting the award.

Details on the new Physician Wellness Program (PWP) developed by the LMS were discussed by Robert Granacher, MD, who along with Dr. John Patterson developed the PWP for LMS. The PWP is designed to provide physicians a safe harbor to address normal life difficulties in a confidential and professional environment.

The PWP provides confidential counseling sessions for LMS active physician members with a local psychologist group. The PWP starts January 1, 2016, and the confidential appointment hotline is 1.800.350.6438.

LEXINGTON

Lexington Medical Society Elections

New officers were elected for 2016.

They are president-elect was Robert P. Granacher, MD, and vice president-elect V. Theresa Little, MD. Dr. Nat Sandler was selected for the judicial committee.

A family get-together at the LMS meeting included Sean Dineen, MD, surgical oncology at UK, father John Dineen, MD, sleep medicine at Lexington Clinic, and Richard Floyd, IV, MD, cardiologist.

Legislative Preview

Dr. Ralph Alvarado, KY State Senator-R, 28th District, gave an extensive preview of topics and bills coming up at the Kentucky Legislative session beginning in January, 2016. Alvarado, a family practice doctor in private practice in Fayette and Clark counties, said, “There was pent-up demand for bills dealing with medical issues after the 2015 year-long lay-off.”

Alvarado said he will introduce a “comprehensive smoking bill in the January 2016 session.” He declined to give details but said it will be stronger than the bill proposed in 2014. “The public is behind us now,” he said, citing a survey that 56 percent of Kentuckians favor smoking legislation.

Other topics Alvarado mentioned that may be addressed included: a bill that would limit the KBML and disallow maintenance of certification as a condition for maintaining Kentucky physician license; medical review panels and protection of hospital peer review; protecting an “I’m sorry” statement by doctors following a patient’s death from liability; adding drug convictions to KASPER reports; reigning in scope of practice and oversight of prescribing controlled drugs by nurse practitioners and physician assistants; and curtailing Medicaid fraud/waste and restructuring Medicaid by modeling Indiana’s Medicaid system, which requires all recipients to pay a premium, as little as a $1 per month for the poorest. “A dollar a month doesn’t sound like much,” said Alvarado, “but it’s a start for people to have some skin in the game of paying for their healthcare.”

“I take a common sense approach to healthcare and legislation,” Alvarado said.

“And that includes keeping the physician as captain of the healthcare team.” ◆

(l-r) Mark Einbecker, MD, Kentucky Orthopaedic & Hand Surgeons, and wife Janet seemed pleased to be at the LMS November meeting.

(l-R) Dr. Ralph Alvarado, family practice, with LMS president Dr. Rice Leach. Alvarado, KY State Senator-R, 28th District, was the keynote speaker for the meeting.

Ardis Hoven, MD, past-president of the LMS and AMA, receives the Jack Trevey Award for Community Service from LMS President Rice Leach, MD.

Attending the LMS meeting were (l-r) Betty Nolan, Tracy Francis, husband Mike Francis, MD, Nephrology Associates, and Danesh Mazloomdoost, MD, Pain Medicine and Management.

“Tougher sentences for importers, out-ofstate sellers of heroin and other controlled substances are being considered in this year’s session,” says Dr. Ralph Alvarado, KY State Senator-R, 28th District.

PHOTOS BY GIL DUNN ISSUE#96 | 31

EVENTS

(l-r) Denise Hundley, administrator, Women’s Hospital at Saint Joseph East with Dr. Richard Budde, radiologist with Kentucky One Health Breast Care, were part of the 400+ who supported and participated in the race day activities.

Kentucky Counseling Association Fall Conference

at Saint Joseph Jessamine RJ Corman Ambulatory Care Center.

Di Boyer, Saint Joseph Hospital Foundation director of major gifts, indicated that, thanks to the generosity of Saint Joseph Hospital Foundation donors, over 500 free mammograms will be funded this year. “It was an inspiring day,” said Boyer. “The late Rick Corman was the largest single benefactor to the Saint Joseph Hospital Foundation. It is very special to see his children and company continue that generosity by hosting this race on this beautiful private course. ” The runners were also treated to prizes, homemade ice cream, and lunch. Plans for next year’s 2nd Annual Yes, Mamm! 5K are already underway. ◆

The Kentucky Counseling Association (KCA) Fall Conference was held on November 4-6 at the Crowne Plaza Hotel in Louisville. Heather French Henry, commissioner of the Kentucky Department of Veterans Affairs, addressed over 400 licensed professional clinical counLOUISVILLE

Heather French Henry, commissioner of Kentucky Department of Veterans Affairs, with Jan Anderson, PsyD, LPCC, president of LifeWise Inc., at the Kentucky Counseling Association Fall Conference in Louisville.

YES, Mamm! 5K Raises Funds for Mammograms for the Underserved

Over 400 runners and walkers turned out for the Saint Joseph Hospital Foundation’s Inaugural Yes, Mamm! 5K race on a cool Saturday morning, October 17, 2015, at the RJ Corman Railroad Group complex in Nicholasville, Ky. The race raised over $22,000 and will support the successful Yes, Mamm! program that provides free mammograms for women and men at KentuckyOne Health Breast Care at Saint Joseph East and also at the Sandra J. Adams Digital Mammography Suite NICHOLASVILLE

selors at the conference as she continues to advocate for the healthcare needs of veterans. Jan Anderson, PsyD, LPCC, president of LifeWise Inc. and columnist for MD-UPDATE, also presented at the conference – Hooking Up is the New Dating: What You Need to Know About College Hookup Culture.

The KCA is a nonprofit professional organization with over 1300 members statewide and is an affiliate with the American Counseling Association. ◆

MD-UPDATE joined RJ Corman Railroad Group and many other sponsors to support providing free mammograms for the underserved in Fayette and Jessamine counties.

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LEFT AND CENTER PHOTOS BY GIL DUNN, RIGHT PHOTO BY DR. IMELDA BRATTON, WKU

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“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.”

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