MD-UPDATE ISSUE #99

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #99 WWW.MD-UPDATE.COM

SPECIAL SECTIONS INTERNAL SYSTEMS

Transplant Surgery and Beyond VOLUME 7•#3•APRIL 2016

at KentuckyOne Health Transplant Center

ALSO IN THIS ISSUE  UK ABDOMINAL TRANSPLANT PROGRAM  CARDIAC ELECTROPHYSIOLOGY AND ICDS  WHEN THE PATIENT BECOMES THE DOCTOR  BATTLING BOWEL INCONTINENCE

“It’s about my heart.”

Ronald C. TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) PATIENT

When patients are not strong enough for traditional open-heart surgery, Transcatheter Aortic Valve Replacement (TAVR) offers new hope. During this procedure, cardiologists and cardiovascular surgeons work together to implant a new heart valve through a small incision in the groin. Recovery time is greatly reduced, giving patients an improved quality of life. The TAVR procedure is available at Jewish Hospital and Saint Joseph Hospital. When it comes to advanced care for your heart, KentuckyOne Health is the clear choice.

Visit KentuckyOneHealth.org/Heart to learn more.

2016 Editorial THE BUSINE

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THE BUSINESS

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OB/GYN, Urology, Genetics, Cassis Der matolog to growing y & Aesthetics Cen a successful ter forges its own independen t practice path

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t rtise to northeas expands its expe ally Cancer Center apies regionally and glob ham Brown ther The James Gra ncing access and cancer Louisville, adva

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ISSUE

VOLUME 6•#5

 MUSCULOSKELETAL HEALTH

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DENT NEW KMA PRESI  Q&A WITH RADIATION THERAPY IN ERSHIP OF KENTUCKY PHYSICIA  ADVANCES RCH PARTN GING NS AND ER RESEA HEALTHC DAMA  A CANC TIVE, LESS ARE PROFESS IONALS BIOZORB™ MORE EFFEC THERAPIES BREAST SURGERY AND TION  TARGETED IC NCES DETEC  ONCOPLAST ISSUE #93 OGRAPHY ENHA MAMM 3D 

VOLUME 6•#6•

NOVEMBER 2015

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S/ORTHOPE DICS GASTRO ENTERO LOGY HEMATO LOGY VASCULAR

•SEPTEMB

& ONCOLOGY RADIOLOGY

ALSO IN THIS

Issue #101, June/July SPECIAL SECT

PLASTIC

SPECIAL SECTI

THE BUSINESS MAGAZIN

Prevention, and Wellness

The Road Less Travel ed

ISSUE  HAND SURGERY IN THE DIGIT  THE IMPA AL AGE CT OF PLAS TIC SURG  MODERN ERY DAY GAST ROENTERO LOGY  ENDO SCOPIC GI TECHNIQU  THE CHAL ES LENGES OF APLA STIC ANEM  THE DRAW IA OF VASC ULAR SURG ERY

DIGITAL AGE

RY IN THE  HAND SURGE SURGERY OF PLASTIC  THE IMPACT Y OENTEROLOG DAY GASTR  MODERN GI TECHNIQUES  ENDOSCOPIC A APLASTIC ANEMI OF ENGES  THE CHALL RY LAR SURGE VASCU OF  THE DRAW

SPECIAL SECTIONS

Sports Medicine/BUSINESS MAGAZINE THE Orthopedics Men’s Health

OF KENTUCKY

Orthopedics, Sports Medicine,  HAND

SURGERY IN THE DIGIT AL AGE  THE IMPA CT OF PLAS TIC SURG ERY DAY GAST ROENTERO LOGY  ENDO SCOPIC GI TECHNIQU  THE CHAL ES LENGES OF APLA STIC ANEM  THE DRAW IA OF VASC ULAR SURG ERY  MODERN

PHYSICIANS

RE PROFESSI

AND HEALTHCA

ONALS

ISSUE #92

Physical Medicine Issue #102, August/September  SKIN DEEP Dermatology, Plastic Surgery,

ONS

SPECIAL SECTI



MEET THE TEAM

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 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

CARE PROFESSION

IANS AND HEALTH

KENTUCKY PHYSIC SS MAGAZINE OF

THE BUSINE

ISSUE #91

HEALTH FROM  WOMEN’S E TO OLD AGE ADOLESCENC & INNOVATION  TECHNOLOGY PRACTICE IN OB/GYN HOSPITAL  COMMUNITY WITH PARTNERS R MEDICAL CENTE OGY

OPHTHALMOL  PEDIATRIC

EATING  ADOLESCENT DISORDERS

INE OF KENTUCKY

PHYSICIANS AND

CARDIOLOGY AND PULMONOLOGY

HEALTHCARE PROFE

SSIONALS iSSue #90

LAND OF OPPORTUNITY

Special SectioN

PAIN MEDICINE AND NEUROLOGY

Issue #103, October  CANCER CARE Oncology, Hematology, Radiology Issue #104, November  IT’S ALL IN YOUR HEAD Neurology, Ophthalmology, ENT

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

Pain Medicine, Mental Health

LUNG CANCER

Volume 6, Number

1

VOLUME 6•#2•MA

RCH 2015

ISSUE

AS PRIMARY  OB/GYN ER CARE PROVID

ed with experienc y lth teams up mall Baptist Hea provide mini surgeons to of patients gynecologic best interest niques in the invasive tech

THE BUSINESS MAGAZ

MHA Kendra J. Grubb, MD, on, cardiovascular surge a joins U of L to build transcatheter and minimally invasive m heart surgery progra at Jewish Hospital.

ALSO IN THIS

T TH E PATI EN OUNT IS PA R A M

ALS

SPECIAL SECTIONS

Vascular Medicine

TH WOMEN’S HEAL S AND PEDIATRIC

MAY 2015 VOLUME 6•#3•

VOLUME 6•#4•JUNE/JULY

2015

COVERING ALL THE BASES

The collaboration of specialti at KentuckyOne Health/UofL provides comprehensiveescare Sports Medicine to athletes of all ages

alSo iN thiS iSSue

 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

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#99 | 1

CONTENTS

ISSUE #99

COVER STORY 4 HEADLINES 6 FINANCE 7 ACCOUNTING 9 LEGAL 12 COVER STORY 16 SPECIAL SECTION: TRANSPLANT

Transplant Surgery and Beyond

18 SPECIAL SECTION: CARDIOVASCULAR 20 SPECIAL SECTION: GENERAL SURGERY 22 SPECIAL SECTION:

KentuckyOne Health Transplant Center at Jewish Hospital offers a comprehensive program of five solid organ transplants plus curative, preventative, and clinical research options to improve long-term survival

BY JENNIFER S. NEWTON PHOTOS BY ROBERT DENSMORE AND KENTUCKYONE HEALTH

GASTROENTEROLOGY 24 COMPLEMENTARY CARE 27 ADVOCACY 29 NEWS 32 EVENTS

SPECIAL SECTIONS TRANSPLANT

CARDIOVASCULAR

GENERAL SURGERY

GASTROENTEROLOGY

16 FINDING INSPIRATION IN NEGATIVE SPACE: UK

18 IT’S ALL ABOUT RHYTHM: SAINT JOSEPH LONDON

20 WHEN THE PATIENT BECOMES THE DOCTOR: OWENSBORO HEALTH

22 BATTLING WITH BOWEL INCONTINENCE: LEXINGTON CLINIC

2 MD-UPDATE

LETTER FROM THE EDITOR

MD-UPDATE MD-Update.com Volume 7, Number 3 ISSUE #99 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 Jenny Miller Jones Scott Neal Andrew Shewmaker Doug Stephan Sarah Wilder

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Bonjour!

In early March, I had the good fortune to travel with a friend for the first time to Paris, France and London, England. I marked a milestone birthday in January, and the trip was the culmination of my birthday celebrations.

Cobblestone streets with patisseries on every corner, café au lait, le vin rouge, not to mention the sites – the iconic Eiffel Tower, the transcendent Sacré-Coeur, the art lovers’ paradise at the Louvre and Musée d’Orsay – Paris lived up to my every dream.

London was no less magnificent. The juxtaposition of the ancient and the modern is quite striking as the London skyline continues to evolve. For example, historic Tower Bridge and St. Paul’s Cathedral share the skyline with glass skyscrapers such as The Shard and The Gherkin. While some view this juxtaposition as a negative, I found beauty in the way history can coexist with progress.

Echoes of the old and new side by side ring MD-UPDATE Editor Jennifer Newton enjoys a view of Paris with the Eiffel Tower in the true for me in this issue’s cover story. When I background from the top of the 271-foot interviewed Christopher Jones, MD, he said high dome of Sacré-Coeur Basilica, the the standard operation for liver transplant first second-highest point in Paris. described in the 1960s still applies, but the progress is in other aspects of care and prevention, such as their new hepatitis C clinic.

In heart failure, Mark Slaughter, MD, tells us solid organ transplant is still the gold standard, while mechanical device support options continue to proliferate. Michael Hughes, MD, has grown Jewish Hospital’s pancreas transplant program, not by just performing traditional pancreas transplants, but by helping to recruit Balamurugan Appakalai, PhD, to institute an islet cell transplant program at U of L’s Cardiovascular Innovation Institute.

Another aspect that I was unexpectedly enamored with in both Paris and London was the lifestyle of walking everywhere, plus fresh food daily. There are no Costcos or giant Walmarts.

There are no shelves filled with food heavily-laden with preservatives. There are neighborhood markets that you pass as you are walking home from the train station. The size of the refrigerator in your modest size “flat” is reminiscent of something out of an American college dorm room and only holds what you need for a day or two. Dinner is an hours-long affair because you take the time to savor the food and enjoy the company. And obesity was something I did not witness there.

Elements of the detriment of the American diet are sprinkled throughout this issue and really every issue that we do. From fatty liver disease, to cancer, to the link between obesity and joint replacements, our diet is a common thread in the state of Kentucky’s poor health, but it’s also in the solution.

I know that I for one will be trying to bring a little of that European la bonne vie home.

Au revoir!

Jennifer S. Newton Editor-in-Chief 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#99 | 3

HEADLINES

The Future of Joint Replacement is Here Jewish Hospital debuts the newest advancements in partial knee and total hip replacement surgery with the robotic MakoPlasty™ Interactive Orthopedic System

BY MELISSA ZOELLER Orthopedic Surgeon Arthur L. Malkani, MD, knows a thing or two about joint replacements. His practice, Shea Orthopedic Group, part of KentuckyOne Health, performs over 1,000 joint replacement surgeries each year, while he himself does over 500 annually at Jewish Hospital.

Malkani attended medical school at Columbia University in New York City, followed by an orthopedic residency at the University of Connecticut. After completing fellowships in total joint surgery at the Mayo Clinic in Rochester, Minn., and pelvic and acetabular surgery at the Hospital for Special Surgery at Cornell University in New York City, Malkani ended up in Louisville in 1993. He started the total joint program at Jewish Hospital in 1997, and is proud to boast a fellowship program for the next generation of residents and fellows in hip and knee replacements.

When someone with this type of experience says the future of joint replacement is here, you listen. “The Mako robotic system is the most exciting thing that’s happened with joint replacements in a long time,” states Malkani.

The Mako robot (RIO™ Robotic Arm Interactive Orthopedic System), designed

by MAKO Surgical Corp. and recently purchased by Stryker, is a surgeon-controlled, robotic arm system that enables accurate alignment and placement of hip and knee implants. Jewish Hospital, part of KentuckyOne Health, is one of the first in Kentucky to offer robotic partial knee resurfacing and robotic total hip replacement procedures.

LOUISVILLE

4 MD-UPDATE

ABOVE:

Dr. Malkani places the infrared pelvic tracker that helps the Mako robot identify the location of the pelvis and hip during surgery RIGHT: Orthopedic Surgeon Dr. Arthur Malkani is a partner with Shea Orthopedic Group, part of KentuckyOne Health, and started the total joint program at Jewish Hospital in 1997.

BELOW: The Mako robotic system enables surgeons to place joints perfectly every time.

“When we do a hip replacement, for example, we have to make intraoperative decisions as to what size implants to place into a patient along with the implant alignment or position,” states Malkani. “We also have to make decisions on how to adjust for leg length during surgery in order to match the opposite side and give the patient the best result. A lot of this intraoperative decision-making is performed using the patient’s own anatomy and bony landmarks as a visual guide. This involves exposure of the hip, along with some guesswork and experience, for us to put the parts in the best position. Most of the time

TOP: PHOTOS BY ROBERT DENSMORE. BOTTOM IMAGE PROVIDED BY STRYKER

we’re pretty good, but we’re not perfect.

“The Mako robotic system helps us put the implants in exactly to match the patient’s own anatomy and gives us realtime intraoperative information on the patient’s implant position and leg length without a large exposure. Using the Mako robotic system makes us better doctors, ensuring our patients have the correct size and implant position, as well as correcting their leg lengths to as close to perfect as possible. These hip implants are made from amazing technology, and with the Mako robot, they are now being inserted with the best technology,” he says.

The first procedure was completed on December 21 at Jewish Hospital, and patients are already showing improved outcomes in terms of function, pain relief, and quality of life. Since the Mako does not rely on seeing landmarks and is therefore less invasive, patients are bouncing back faster with much less pain. The system is FDA-approved, so all hip replacement and most partial knee replacements in Malkani’s office are now performed using Mako robot-assisted surgery. Partial knee replacement patients are even going home the same day or the next day. Full knee replacements will be added by the end of the year.

“The number one reason why a hip replacement fails is dislocation; the ball joint comes out of the socket, which is extremely painful,”

be in the body. Mako changes that,” states Stimac.

And because of the accuracy and decreased complications, replacements will last longer. Traditional hip or knee replacements can last many years, and vary depending on patient age, activity level, and weight. With Mako, he hopes to add longevity.

“People think of a car assembly where the robot is doing most of the manufacturing,” states Stimac. “In the operating room, the robot is just a tool for us.

It takes what we already do well and makes it a little bit better.”

Ultimately, it’s all about better quality of life, and that’s is definitely what is being achieved.

“Our goal is to have patients feel as natural as they can with their own knee and hip so they can go back to enjoying life, and we are getting phenomenal results,” adds Malkani. ◆

ABOVE:

Dr. Jeffrey Stimac is an orthopedic surgeon with the Shea Orthopedic Group, part of KentuckyOne Health.

RIGHT: A pre-operative CT scan generates a computer image of the patient’s hip anatomy that acts as a map during surgery for the Mako robotic system.

states Malkani. “The Mako robotic system uses a pre-op 3D CT scan to tell us exactly what size and position to put the cup and femoral implant in to match the patient’s anatomy, minimizing the incidence of dislocation. The Mako system also uses haptic technology, which will only allow the implants to be placed in the best position for the patient. The robot will shut off if the surgeon is not in the correct position.

“Partial knees are the same. We do our best to put the knee implants in the right spot, but sometimes it’s not perfect, which can lead to pain and early loosening. The Mako robotic system helps us put the parts in the perfect spot every time. Not every patient needs a total knee replacement, and a partial knee using the Mako robot feels more like a normal knee and allows the patient to bounce back to their activities much faster and with less pain,” says Malkani.

Any patient in need of a hip or partial knee replacement is currently eligible for the procedure, including those with hip or knee arthritis.

Jeffrey Stimac, MD, also with Shea Orthopedic Group, agrees that this changes the game for hip and knee replacements.

“Studies have shown that even the best fellowship-trained surgeons are only accurate about 65 percent of the time getting the replacement exactly where it should

Dr. Arthur Malkani places the leg length marker to get real time information during surgery in order to accurately equalize the patient’s leg length.

PHOTOS BY ROBERT DENSMORE

ISSUE#99 | 5

FINANCE

Urgent Reminder about Social Security Last month, someone told me that he planned to retire when reaches age 66 years and two months. I knew, of course, how he had come up with such a precise date.

That is his full retirement age (FRA) set by the Social Security Administration, and he planned to claim his benefit at that time.

For as long as most of us can remember, full or “normal” retirement age was 65.

Legend has it that when Social Security was introduced, the average life expectancy for a male was 66; thus, Congress granted a year of benefits to the average worker.

Early, reduced benefits were, and still are, available at age 62. However, the FRA is being gradually increased until it reaches age 67 for those born in 1960 or later. It’s important to note that an increase in benefit occurs for those who wait to start their

Security claiming ages are sensitive to how the information or question is framed. If the focus of the information or question is on the amount gained, the choice will more likely be to

BY Scott Neal start the benefit later. If the question is posed around some sort of break-even analysis, the start date is likely to be earlier.

For most of our clients, and perhaps many readers of this column, the greater risk is outliving one’s assets, not dying before they collect Social Security benefits.

APRIL 29, 2016 IS AN IMPORTANT DEADLINE. benefits beyond their FRA. The growth is usually seven-to-eight percent for each year. The significant effect is found in the compounding effect of the larger beginning benefit plus the cost of living increases each year. Starting with a higher number makes the difference much larger later in life.

While Social Security benefits may pale in comparison to your other sources of income during retirement, the benefit can be substantial, and the timing of your start date could mean thousands of dollars over your lifetime. It is not a decision to be taken lightly or made simply by default.

A few years ago, The Wharton School at the University of Pennsylvania conducted a large-scale study on Social Security claiming strategies. They concluded that peoples’ intentions with regard to Social

6 MD-UPDATE

Informally, we often encounter resistance when we suggest that financial decisions need to be considered in the context of a very long-lived life, e.g. to age 100. Many people casually respond that they don’t think they will live that long and, in fact, most will not. Do not be swayed by actuarial tables. It’s important to remember that those tables reflect a 50 percent probability for longevity. Exactly half of the entire population is expected to die sooner, and half later, than the expected lifetime expressed in the table. You are a population of one with unique characteristics. Furthermore, for a married couple doing financial planning, it is vitally important to consider the joint probabilities of life expectancy. You might be surprised to learn the results of that analysis, since it will turn out to be longer than most people expect. We believe that age 100 seems to be a sufficiently conservative estimate for most people.

Traditionally, two popular claiming strategies for maximizing benefits have been: 1) file and suspend and 2) a restricted application. Under a restricted application, the higher-earning spouse files an appli-

cation for only spousal benefits at FRA, allowing his or her own benefit to continue to grow until age 70. Meanwhile, the lowerearning spouse files for benefits under his or her own earnings history, making spousal benefits available for the higher-earning spouse. In the file and suspend strategy, the higher-earning spouse files for benefits at FRA, then immediately suspends the benefit, allowing his or her benefit to build. He or she will have made the spouse eligible for spousal benefits.

On November 2, 2015, Congress made significant changes that impact Social Security options and can affect your optimal claiming strategy. April 29, 2016 is an important deadline for taking advantage of the strategies mentioned above.

The new rules effectively divide individuals into one of three groups: 1) people born on or before May 1, 1950; 2) those born between May 2, 1950, and January 1, 1954; and 3) those born on or after January 2, 1954. If you find yourself in group one and you plan to suspend your retirement benefit in the future, you must request to do so before April 29, 2016. Those who do that can still receive auxiliary benefits, i.e. spousal and child benefits, during suspension. People in group two will see mixed results under the new rules. People in group three will be most affected by the new rules and will not be able to receive auxiliary benefits during suspension. Individuals in the second and third group, as well as married couples with at least one spouse in group two or three, should recalculate their optimal maximized strategy.

Scott Neal is president of D. Scott Neal, Inc. a fee-only financial planning and registered investment advisory firm with offices in Lexington and Louisville. Reach him at scott@ dsneal.com or by calling 1.800.344.9098. ◆

ACCOUNTING

Implementing a Successful Denials Management Program Third party payer insurance denials are a common source of frustration for many physician practices. Not only do denials create headaches for those who have to research and resolve them, but they also represent a source of leaking revenue for the entire organization. It takes a sustained organization-wide effort to tackle the issues associated with denials and turn those denied claims into collected cash. Often, a coordinated approach to denials management is not in place, resulting in sluggish cash collections and aged A/R.

A successful denials management program has three key components: Utilize meaningful metrics When implementing a denials management program, begin with the following questions facing most practices: A) Are there trends associated with the practice’s denials?

B) What are the top reasons for denied claims?

C) Which payers represent the largest percentage of denied claims (# and $)?

D) What is the financial impact of denials on total A/R? E) Who is responsible for resolving denied claims?

efficient to implement meaningful metrics when the facility has a better understanding of the internal processes impacting denied claims.

Implementing a coordinated denials dashboard

BY Adam Shewmaker with the key metrics defined above will build the foundation of a successful denials management program and empower the organization with the information necessary to continue with the next two components.

1)

Because some practices cannot answer the questions above until an effective denials management program is in place, it is recommended that these questions drive the metrics that the practice wants to track.

Once tracking has been implemented, the practice can then start trending the data and implement goals and track progress against industry benchmarks. It is more

Implement standardized workflows The second key component to implementing a successful denials management program is resolving the denial and adjudicating the claim. Although metrics are important to any program, it is this component 2)

essential to sustaining a successful denials management program. The committee should have representation from key departments within the practice, including the provider. The steering committee should be accountable for providing feedback in their respective areas and bring insight into process breakdowns and failures for specific accounts. The committee is also tasked with establishing the metrics goals and benchmarks for the practice and communicating those results back to their teams.

Although implementing a denials management program is not a daunting task, it does take a sustained effort to ensure the program successfully meets the three criteria listed above. Once fully operational, the provider will begin to see improved operational and financial results in staff productivity, increased cash collections, and decreased days in A/R. Adam Shewmaker, FHFMA, is director of Healthcare Consulting Services at Dean Dorton. He can be reached at 502.566.1054 or ashewmaker@ddafhealthcare.com. â—†

IT TAKES A SUSTAINED ORGANIZATIONWIDE EFFORT TO TACKLE THE ISSUES ASSOCIATED WITH DENIALS AND TURN THOSE DENIED CLAIMS INTO COLLECTED CASH. that ensures claims are resolved appropriately and cash collections are maximized.

By implementing standardized workflows, the provider increases staff productivity across the denials management spectrum.

An important aspect of this component is establishing resolution rates among the collections staff and implementing these results into the metrics package defined above.

Developing a denials steering committee Developing a denials steering committee to provide guidance and feedback is 3)

ISSUE#99 | 7

From health care transactions and compliance to litigation defense, Sturgill Turner’s health care team is committed to providing comprehensive legal services to health care providers, hospitals and managed care organizations.

Find us in Lexington and at STURGILLTURNER.LAW

8 MD-UPDATE

LEGAL

Liability for Prescription Drug Interactions

What will a jury believe in terms of liability and damages when a patient claims harm against his healthcare provider for a drug interaction?

According to the law, a healthcare provider must exercise “ordinary” care in delivery of healthcare services. That means the provider must not engage in conduct that would create an “unreasonable” risk of harm to the patient. When this standard is not met, there is a “breach” of the healthcare provider’s legal duty, and the provider may be liable for damages to the patient.

When a patient sues his/her healthcare provider for injuries arising out of medical treatment, the cause of action is generally one for “medical malpractice.” The cause of action is the same when a patient complains that he/she has been injured as the result of a prescription drug interaction.

For the purposes of this article, a “drug interaction” is defined as an adverse reaction that occurs when two drugs chemically overlap. One example would be an elderly patient with psoriatic arthritis who takes Methotrexate as prescribed by her rheumatologist. Perhaps she is seen by her family medicine physician for a serious infection and is prescribed an antibiotic. After taking a couple days’ worth of the antibiotic, the patient becomes very weak and sick.

She reports to the hospital where she is diagnosed with a rare, but serious, drug interaction between the Methotrexate and antibiotic. She files a lawsuit, claiming that her hospitalization resulted from the family medicine physician committing medical malpractice when he prescribed her the antibiotic.

Interactions may also exist between drugs and food as well as drugs and medicinal plants or herbs. There is increasing evidence that over-the-counter herbal and botanical supplements can interfere with a wide range of prescription medications.

For a plaintiff to succeed on a medical malpractice claim involving a prescription drug interaction, he/she must prove duty, breach of that duty, causation, and injury.

The first of these four elements requires the patient to prove that the prescribing physician owed a duty to the patient. This condition is almost always

met where the physician has prescribed one of the drugs involved in the prescription drug interaction.

Once the presence of a duty is established, the patient must

BY Doug Stephan demonstrate that the physician did not act with ordinary care when prescribing the drug, and that the provider’s failure to do so was the direct cause of damage to the patient. In other words, the drug interaction must be caused by the physician’s actions and not some intervening act or condition.

Finally, the patient must prove that he/

medical malpractice. With respect to prescribing medications, this means choosing a medication that is tailored to, and takes into account, all of the patient’s clinical conditions. Maintain an updated list of the patient’s current medications, including those prescribed by other physicians.

This list should also include over-the-counter medications, supplements used by the patient, and alcohol/tobacco/illicit drugs.

Physicians should make sure that lab work is ordered and reviewed prior to starting certain medications. Also, consider coordinating suspension of a medication used for a chronic condition if necessary to achieve immediate short-term relief of an acute condition (e.g. infection).

2. Maintain accurate and detailed documentation of prescribing practices.

HOW CAN A PHYSICIAN AVOID BEING SUED FOR MEDICAL MALPRACTICE ARISING OUT OF PRESCRIPTION DRUG INTERACTIONS? she has suffered damages as the result of the drug interaction. While some drug interactions might directly cause minor discomfort or inconvenience to the patient, the law generally confines itself to compensating serious harm, such as serious illness, incapacitation, lost wages, and medical bills.

With an ever-growing number of prescription medications available in the marketplace, the courts have seen a rise in medical claims arising from prescription drug interactions. How can a physician avoid being sued for medical malpractice arising out of prescription drug interactions? The following are some practical tips for keeping yourself out of court: 1. Conform your prescribing practices to the current standards of medical care.

Providing high-quality medical care is always the best defense against claims of

Proper documentation of prescription drug interactions is critical in the defense of malpractice claims. Physicians must document what service was provided, when and by whom it was provided, and the medications prescribed, including the dose, directions, and number of refills provided. Most physicians are careful to weigh the reasons for choosing one medication over another; unfortunately, they may neglect to document these reasons in the patient’s medical record. A well-reasoned choice on the part of the physician may tend to prove that he or she acted with ordinary care.

3. Engage in interactive informed consent discussions that allocate appropriate responsibility to the patient.

All good physicians educate their patients about new treatments and medicaISSUE#99 | 9

LEGAL

DRUG INTERACTION MUST BE CAUSED

BY THE PHYSICIAN’S ACTIONS AND NOT SOME INTERVENING ACT OR CONDITION.

10 MD-UPDATE

tion, but the depth of that education varies according to several factors. All patients should be told the common side effects of a drug and the potential for interaction with other drugs the patient is taking. The patient should also be told if alternative treatments are available. The patient should also be strongly encouraged to read the package insert and to call the physician or pharmacist with any questions. Finally, the patient should be advised to seek medical attention if serious side effects occur. In short, the patient must make a knowing, voluntary, and competent decision regarding his medical care, and this includes the decision to accept or decline a medication.

The question may be asked: Did the physician provide enough information based on the standard of care, and was it conveyed to the lay person in a manner in which the lay person would understand it? The prescribing physician is generally

guided to disclose the patient’s diagnosis, the proposed treatment, the consequences of accepting or declining the treatment, and existing alternatives to the treatment proposed. All discussions should be noted in the patient’s record.

E. Douglas Stephan is a partner with Sturgill, Turner, Barker & Moloney, PLLC. His practice concentrates in the areas of healthcare and medical malpractice defense. He can be reached at dstephan@ sturgillturner.com; (859)255-8581, or via www.sturgillturner.com.

This article does not constitute legal advice. ◆

A voice of experience during complicated pregnancies

Dr. Thomas Tabb MATERNAL AND FETAL MEDICINE SPECIALIST

For over three decades, families have trusted Dr. Thomas Tabb to help them navigate pregnancy complications. As a specialist in maternal and fetal medicine, he has built successful practices in Galveston, Memphis and Louisville.

Now, as a member of Owensboro Health’s One Health medical group, Dr. Tabb is helping expectant mothers across Kentucky and Indiana enjoy healthier pregnancies, even when the circumstances are unique.

From diabetes management to genetic counseling, Dr. Tabb provides specialized services that improve the health of our region — one pregnancy at a time.

MATERNAL & FETAL MEDICINE 2211 Mayfair Avenue, Suite 305 Owensboro, KY 42304 Phone: 270-688-2018

To learn more about Dr. Thomas Tabb and One Health Maternal & Fetal Medicine, visit www.owensborohealth.org/onehealth.

ISSUE#99 | 11

COVER

Transplant Surgery and Beyond

KentuckyOne Health Transplant Center at Jewish Hospital offers a comprehensive program of five solid organ transplants plus curative, preventative, and clinical research options to improve long-term survival Dr. Michael Hughes removes the pancreas from a patient at Jewish Hospital for a total pancreatectomy with auto-islet transplant.

ABOVE:

12 MD-UPDATE

PHOTOS PROVIDED BY KENTUCKYONE HEALTH

BY JENNIFER S. NEWTON LOUISVILLE Surgeons in the U.S. performed over 30,000 transplants in 2015, according to Organ Procurement and Transplantation Network (OPTN) data, the first time the country has exceeded that benchmark in a calendar year. Of those, 302 organ transplants were performed in Kentucky between the state’s two adult transplant centers. Jewish Hospital in Louisville, part of KentuckyOne Health, is one of those centers and the site of 123 of those organ transplants last year.

Jewish Hospital Trager Transplant

Center, a joint program of Jewish Hospital and the University of Louisville (U of L) School of Medicine, has been a leader in the state, having performed Kentucky’s first adult heart, pancreas, heart-lung, and liver transplants, and continues to be integral in furthering transplant care, particularly in the areas of hepatitis C, mechanical device support, and islet cell transplantation.

Jewish Hospital’s transplant program includes all five solid organs, plus the recent addition of an islet cell auto-transplant. The program’s volumes are moderate in relation to national averages. Jewish Hospital trans-

plant surgeons estimate they perform 45 to 50 liver transplants a year, 75 to 100 kidney transplants, five to 10 pancreas transplants, and a total of 25 to 35 transplants between heart and lung. The program performed nine islet cell auto-transplants with total pancreatectomy in 2015, its first year.

Of the 942 overall organ donation candidates in Kentucky, 352 are on the waiting list at Jewish Hospital, according to OPTN. Those numbers draw a picture of solid organ transplant but do not tell the whole story. Much more is underway at Jewish Hospital in an effort to prevent transplant, cure life-threatening diseases, and provide bridge-totransplant options that improve patients’ long-term survival.

16 to 18 years as opposed to eight to 10.

Fifteen of the center’s kidney transplants in 2015 were from living donors, the highest number in six years, yet still well short of the program’s ideal of 50 percent. In an effort to boost living donation, Jewish Hospital is developing a donor champion program modeled after one at Johns Hopkins. Rather than putting the burden of asking for donation on a recipient, the program has the recipient identify a champion, who, with educational support, spreads the word on the recipient’s behalf.

The Most Common Organ Transplant – Kidneys

Kidneys are the most commonly transplanted organ, and for endstage kidney failure, transplant

year or two ago the number one reason for getting a liver transplant was hepatitis C. Because of this, we have created a hepatitis C clinic here at Jewish Hospital. People that are deemed appropriate for treatment can be treated and cured from their hepatitis C prior to getting a liver transplant.” In other cases, physicians have patients remain hepatitis C positive so they can receive a liver from a hepatitis C donor. The clinic treats them on the back end after their transplant.

The clinic operates three days a week and sees about 10 to 15 patients a day, but Jones expects that number to grow as more people learn of the program.

Jones, who attended medical school at Georgetown University, completed his residency at Vanderbilt University, and completed a fellowship at UCLA Medical Center, LEFT AND BELOW:

Dr. Balamurugan Appakalai administers the infusion of the separated islet cells back into the patient at Jewish Hospital during an islet autotransplant.

ABOVE: Dr.

Balamurugan Appakalai separates insulin-producing islet cells from the pancreas for an islet auto-transplant in a special “cleanroom” at the Cardiovascular Innovation Institute.

surgery is still the best option for improved mortality. “Anybody on dialysis that is well enough to undergo surgery and take immunosuppression is better off getting a kidney transplant than staying on dialysis,” says Michael G. Hughes Jr., director of the living donor kidney transplant program.

Living donor kidneys on average last twice as long as deceased donor kidneys,

A Revolution in Liver Treatment

In liver transplant, the advent of medications for hepatitis C is revolutionizing treatment.

Director of Abdominal Transplant at Jewish Hospital and U of L Christopher Jones, MD, says, “Really, up until about a

came to U of L in 2010. He says an early childhood experience shaped his career path.

As a young boy, he and his brother would visit their grandmother in Georgia during the summer where the girl next door became a close friend. The brothers were unaware the girl suffered from Alagille syndrome, a genetic disorder that affects the liver, kidneys, and eyes, among other things.

PHOTOGRAPHY PROVIDED BY KENTUCKYONE HEALTH

ISSUE#99 | 13

COVER One day while waiting for her to come out and play, an ambulance pulled up. Jones overheard the EMT say that the girl needed a liver transplant but would probably not get one and would probably die. That was the last time they would see her. “I said to myself, ‘I can never let that happen to anybody else,’” says Jones. “I knew at an early age that I was going to do transplant, and in particular, liver transplant.”

Jones describes their program as “not very cut happy,” meaning they work closely with hepatologists to explore every option available to allow a patient to keep his or her native liver whenever possible.

Jones and his colleagues also work closely with interventional radiologists when a TIPS (transjugular intrahepatic portosystemic) shunt is necessary to relieve portal hypertension in the abdomen, a condition that used to warrant surgery.

Now that hepatitis C is curable, providing the opportunity to prevent transplant if treated early enough, Jones says, “Now the biggest reason for liver transplant is NASH – non-alcoholic steatohepatitis. That’s basically fatty liver disease. It comes from obesity and our diet in this country.”

The liver transplant program is also involved in numerous clinical trials. Jones is working with a multi-institutional group of researchers to investigate cellular therapies that induce immunologic hyporesponsiveness, which would preclude the need for immunosuppression.

Islet Cells - The Future of Diabetes and the Pancreas

Although Hughes is also the director of the living kidney donor transplant program, he was brought to U of L in 2010 to grow the pancreas transplant program, a goal that has been accomplished as the program is at its most prolific in 18 years.

Hughes attended medical school at Wake Forest University, took his residency at the University of Virginia, and completed his fellowship training at the University of Minnesota – Fairview Medical Center. It was in Minnesota during his training that Hughes met Balamurugan Appakalai, PhD. A year and a half ago, Bala, as he prefers to be called, left the nation’s busiest islet cell transplant program at the University of Minnesota to establish an islet program at U of L. Now the scientific director of 14 MD-UPDATE

Balamurugan Appakalai, PhD, is the scientific director of Islet Biology and Transplantation at the Cardiovascular Innovation Institute.

Islet Biology and Transplantation at the Cardiovascular Innovation Institute (CII), a partnership of U of L and the Jewish Heritage Fund for Excellence, Bala says, “My specialty is collecting the maximum number of islets from every processed pancreas with better care so the quality of islets and the number of islets from the pancreas are in good condition, and the patients will be highly benefitted.”

Hughes identifies three tightly linked diagnoses that affect the pancreas – diabetes, chronic pancreatitis, and gastroparesis.

Islet cells, which are found in the pancreas and produce all the body’s insulin, are at the core of advanced treatment for diabetes and chronic pancreatitis.

There are two types of islet cell transplants: 1) Islet allo-transplant involves transplanting islet cells from a donor to a recipient, where the recipient must take immunosuppressive drugs, with the purpose of curing diabetes. However, it is not yet FDA approved in the U.S., but it is routinely done in other countries.

2) Islet auto-transplant is used to prevent diabetes in a patient who has their pancreas removed to cure chronic pancreatitis. In islet auto-transplant, the patient’s own islet cells are harvested from their pancreas and then trans-

TOP PHOTO BY ROBERT DENSMORE. BOTTOM PHOTO PROVIDED BY KENTUCKYONE HEALTH

planted into their liver to restore insulin production.

Until islet allo-transplant is approved, whole organ pancreas transplant is the standard of care for type 1 diabetics with highly unstable diabetes who either have repeated hospital admissions for ketoacidosis or have hypoglycemic unawareness. “People don’t typically die from high blood sugars, but people can die from low blood sugars,” says Hughes. “Diabetics rely on being able to feel their sugars go low. Diabetes goes from being a chronic disease to a daily life threatening disease when they no longer have that ability.”

Chronic pancreatitis affects both the production of insulin and the production of digestive enzymes, leading to malabsorption. “Kentucky has a disproportionate amount of chronic pancreatitis. It’s chronic inflammation of the pancreas that results in structural changes that eventually result in failure of the enzymes and failure of the insulin, so patients develop diabetes 3C,” says Hughes. Type 3c diabetes is pancreatogenic diabetes and results in complete destruction of the pancreas.

In 2015, Jewish Hospital/UofL transplant surgical teams performed nine total pancreatectomies with islet auto-transplant for the treatment of chronic pancreatitis.

Currently their patient population is exceeding benchmarks with all patients having a functional graft and nearly half off insulin.

The benchmarks for total pancreatectomy of non-diabetic patients, as established in Minnesota, are a rule of thirds – one-third will get off insulin, one-third will remain on a small dose, and one-third will be standard diabetics requiring daily insulin.

Islet auto-transplant is a same-day process where Hughes removes the pancreas and Bala takes it to his clean room facility to isolate the islet cells in a five-hour procedure. The isolated cells are then infused back into the patient through the portal vein in the liver. Precision and experience are key. The more diseased the pancreas, the more difficult it is to extract Christopher Jones, MD, is the director of the abdominal transplant program at Jewish Hospital and U of L.

viable islet cells. “When you collect those islet cells, from a 100-gram pancreas, you may only get two grams of islet cells,” he says. Bala has harvested islet cells from over 1,000 human pancreases between his work in Minnesota and his previous position at the University of Pittsburgh. He continues his research in allo-transplant at the CII with brain-dead donor pancreases.

For potential islet auto-transplant patients, Hughes says, “Ultimately it comes down to whether they want to trade their pancreatitis for diabetes. Because we don’t have 100 percent insulin independence at three months, there is a possibility they could end up diabetic when they weren’t before. However, there’s an important perspective that given enough time with chronic pancreatitis you will eventually get diabetes.”

Michael Hughes, MD, is the director of the living donor kidney transplant program at Jewish Hospital and U of L and has been integral in growing the pancreas transplant program.

Gastroparesis is the third overlapping diagnosis. It can be caused by diabetes, and its symptoms mimic that of chronic pancreatitis. Treatments, however, are distinctly different. “One of the advantages of our program is we have the largest gastroparesis program in the world. We’re doing 250-300 gastric stimulators a year,” says Hughes. If imaging studies cannot differentiate between chronic pancreatitis and gastroparesis, surgeons can implant a temporary gastric stimulator to see if the body responds, therefore confirming a diagnosis of gastroparesis.

Research Drives New Therapies in Heart and Lung Transplant

Mark Slaughter, MD, has been surgical director of the thoracic transplant program for eight years and has seen the biggest changes in “the emerging success of new therapies,” as well as the increased education of primary care and referring doctors throughout the region.

After receiving his medical degree from Indiana University, Slaughter pursued his general surgery residency at McGaw Medical Center of Northwestern University.

He then completed a fellowship in cardiovascular/thoracic surgery at the University of Minnesota.

Much like the kidney, “Everybody gets evaluated to see if they are eligible for a heart transplant because it’s still the gold standard for end-stage heart function,” says Slaughter. Unlike the kidney, for those who do not qualify for transplant, end-stage heart failure patients have multiple options at KentuckyOne. Those options include both FDA approved devices and devices/ therapies offered through clinical trials. The HeartMate II® is a mechanical heart pump approved for both bridge-to-transplant and destination therapy. Pumps under investigation include: HeartMate 3, HeartWare HVAD®, and the ReliantHeart HeartAssist 5®. Other studies the center is currently participating in are the Sunshine Heart counter pulsation device, cell therapy, and cell therapy plus ventricular assist devices (VADs).

Clinical trials are an integral part of their program because technology continues to get incrementally better. Says Slaughter, “We always want to offer patients the option and access to what would be the next approved pump and potentially have the opportunity to have that new technology sooner rather than later.”

And they are not just using the technology, but are helping to develop it along the way. “Essentially every pump currently in use or under study, we also did preclinical testing and helped with the testing and development for the companies at the Cardiovascular Innovation Institute over the past eight years,” says Slaughter.

Myocardial recovery is another important aspect being studied at Jewish Hospital.

U of L is the main center administering the Restage Trial under the leadership of Emma

Birks, MD, where a VAD is placed and a treatment program is followed to allow the heart to recover to a point where the VAD can be removed and the patient does not need a transplant. In the past two years, the center has done upwards of 20 patients, who

Mark Slaughter, MD, is the director of the thoracic transplant program at Jewish Hospital and U of L.

come from across the country for the trial.

When it comes to lung transplant, it is not just for ex-smokers with COPD (chronic obstructive pulmonary disorder) or emphysema. “Lung transplant has continued to expand access, including patients with pulmonary hypertension, cystic fibrosis, and idiopathic pulmonary fibrosis,” says Slaughter.

Two advances that have made a difference include ECMO (extracorporeal membrane oxygenation), which provides temporary artificial lung support that allows patients to stabilize and potentially get stronger prior to transplant, and which can now be done with the patient extubated and ambulatory, and ex-vivo lung perfusion systems, which resuscitate lungs that were thought to be unusable in the past, allowing more people to receive lung transplants.

In the future, Slaughter sees continued work on miniaturized and more durable artificial lungs that will someday function like permanent mechanical heart pumps and prevent lung transplant altogether.

From a curative hepatitis C clinic, to islet cell transplant, to investigative mechanical support devices, to traditional transplant surgery, Jewish Hospital Transplant Care provides a comprehensive range of leading-edge services to improve mortality for end-stage organ failure patients. ◆ PHOTOS BY ROBERT DENSMORE

ISSUE#99 | 15

SPECIAL SECTION  TRANSPLANT

Finding Inspiration in Negative Space

UK Chief of Abdominal Transplantation follows his passion to increase program volume, expand services, and further research BY BOB BAKER It was not the intricate anatomy or pathology of an organ that set Roberto Gedaly, MD, on a career path to becoming a nationally renowned transplant surgeon; it was negative space. Specifically, it was looking at a large absence in the abdominal cavity after a diseased liver had been removed and the donor liver not yet placed.

“As soon as I saw that huge space where a new liver would be, I knew I must become a transplant surgeon,” said Gedaly, who had previously been contemplating a career as a surgical oncologist.

That transcendent experience has led to a successful reality for the chief of abdominal transplantation at the University of Kentucky (UK). There is no short path to becoming an expert clinician, a cuttingedge researcher, and an academic teacher and administrator, as Gedaly’s educational background proves. He attended medical school in Caracas, Venezuela, at the Razetti School of Medicine, Central University of Venezuela, and then completed his surgical residency at the University Hospital of Caracas, Central University of Venezuela.

That training was followed with three transplant fellowships over five years at Deaconess Hospital at Harvard University in Boston, Mass., Jackson Memorial Hospital at the University of Miami in Florida, and at Methodist Hospital at the University of Tennessee in Memphis.

Even those intense years of training do not tell the full story of running a successful transplant program. It is in the long hours of patient care followed by immersion in research after the lights are out in most of the building. Moreover, Gedaly’s achievements require the imagination and determination to work over, under, and around road blocks and problems whether in clinical work or research. It is the “refuse to lose” mentality.

LEXINGTON

Abdominal Transplant in Practice

With his fellowship resumé and proven 16 MD-UPDATE

PHOTO BY GIL DUNN

Roberto Gedaly, MD, chief of abdominal transplantation at the University of Kentucky, recently performed the largest kidney exchange in the history of Kentucky.

research capacity, Gedaly had several opportunities for practice, both private and academic. After assessing the patient population, and the many avenues of research collaboration, he decided UK was the best fit.

It is well documented that Kentucky is near the top of the list for obesity incidence in the U.S. This leads to a high rate of diabetes and hypertension, which can result in end-stage kidney disease requiring transplantation. Another difficulty in transplant surgery for the obese patient population is that in spite of higher than normal weight, many of these patients have muscle wasting, which complicates recovery. Gedaly has made treatment of very obese patients one

area of clinical research at UK. Now, after 10 years of building, the abdominal transplant department is performing about 90 kidney transplants and 45 liver transplants per year, plus a regular flow of kidney/pancreas transplants. But, in the transplant world, it is not just about the number of procedures performed; it is about survival rates. The national numbers show that UK has a success rate as good as any transplantation center in the country.

Some of the credit for excellence involves procurement of transplantable organs, and Gedaly works closely with Kentucky Organ Donor Affiliates (KODA) to increase awareness about the gift of organ donation. UK participates in two exchange programs through the United Network for

Organ Sharing (UNOS) and the National Kidney Registry. A paired kidney exchange, also known as a “kidney swap” occurs when a living kidney donor is incompatible with the recipient, and so exchanges kidneys with another donor/recipient pair. This matching and sharing chain can involve more than two patient/donor pairs. Gedaly and his team have recently performed the largest kidney exchange in the history of the state.

How Can I Make My Specialty Better?

When asked why he directs research in both liver cancer and immunosuppressive therapy, Gedaly states that anyone who fills his position has to be constantly asking, “How can I make my specialty better? How can I turn questions in clinical practice into questions that can be answered in the research lab? How can I translate research findings into pertinent changes in clinical care?”

These questions have led Gedaly to participate in research ranging from the molecular level, to animal models, to patient care by way of clinical trials and multi-center trials. These collaborative efforts have resulted in a staggering development of more than 200 new cancer drugs and advances in understanding the immune system’s response to transplanted organs and the immunology of cancer cells. Gedaly and his collaborators in biochemistry have created and are testing dozens of new molecules to destroy tumor cells, and molecules that work to upregulate the activity of T cells that attack tumor cells. With immunology collaborators, he is investigating the manipulation of the balance between attack T cells and modulator T cells and stopping the host immune system. He has also performed significant contributions to the field of cancer treatment by studying different aspects of liver cancer stem cells, a relatively new concept in cancer development and therapeutics.

This latter project addresses the very frustrating clinical problem of being able to

kill most of the cells in a tumor only to see survival of the less differentiated tumor cells (stem cells), which then begin to regenerate tumor growth.

No One Person

Teamwork and collaboration are issues Gedaly stresses with every turn of phrase.

For instance, a decrease in procedure time is often credited to the senior surgeon.

THE ABDOMINAL TRANSPLANT DEPARTMENT AT UK IS PERFORMING ABOUT 90 KIDNEY TRANSPLANTS AND 45 LIVER TRANSPLANTS PER YEAR, PLUS A REGULAR FLOW OF KIDNEY/PANCREAS TRANSPLANTS. Gedaly makes clear that the surgeon is one part of an OR team; nursing, scrub tech, anesthesiology, and pre- and post-op

2016

©2016 DONATE LIFE AMERICA

involvement of medical physicians are all crucial. Maintaining the health of a transplant patient is also a team effort involving nephrology, hepatology, endocrinology, and immunology, to name a few. In the last two years, Gedaly and his team from UK have been involved in the development of the first kidney transplant program in Honduras. This has an enormous impact since Honduras is the country with the second highest rate of end-stage renal disease in Latin America. This year and for the first time in their history Honduran surgeons trained by UK physicians performed the first three kidney transplant procedures without assistance.

Gedaly leads his teams by example.

His passion for the work combined with an open and friendly personality is key to attracting and maintaining all of these relationships. The availability of transplant surgery at UK is especially important since many people in the service area simply cannot get to a large out-of-state center for a desperately needed transplant. The day is gone when medical practitioners have to look beyond Lexington to make a transplant referral. ◆

What can YOU make possible? www.DonateLifeKy.org ISSUE#99 | 17

SPECIAL SECTION  CARDIOVASCULAR

It’s All About Rhythm

Cardiac electrophysiologist commits to Kentucky and develops ICD program that saves lives BY BOB BAKER When Oluwale John Abe (ah’ bay), MD, first came to London, Kentucky, it was not because he chose London, it was because London chose him. He needed to fulfill a three-year commitment to practice in an area underserved by cardiologists, and London had none within a 60-mile radius.

Abe had enjoyed his three years in London, but he knew that his greater interest was in further training in cardiac electrophysiology. When his commitment was fulfilled, Abe returned to New York for fellowship training in that subspecialty.

Once back in New York City, Abe and his wife were making plans to stay, but he remained in contact with his colleagues and some of his patients in London. As he communicated with his friends in London, he came to think, “Why stay in New York City? There are hundreds of cardiologists here, but there are none in London. And some people there can’t get to a cardiologist.

If I really want to make a difference, there is no better place than London.”

London and Saint Joseph Health Care welcomed him with open arms, and he immediately set up the cardiac electrophysiology program to provide the latest advancements in treatment of irregular heart rhythms.

LONDON

Medical Education

Abe attended medical school in his native Nigeria, then came to the U.S. for an internal medicine residency at Columbia College of Physicians and Surgeons in New York City and a cardiology fellowship at the State University of New York (SUNY) in Brooklyn. As earlier stated, he later returned to New York for a fellowship in cardiac electrophysiology. Abe is a Fellow of the American College of Cardiology (FACC).

Practice Focus

Abe states that one of the main objectives in his practice is to save people from sudden cardiac arrest (SCA), a leading cause of death in America, causing more deaths 18 MD-UPDATE

PHOTO PROVIDED BY KENTUCKYONE HEALTH

Oluwole John Abe MD, FACC, is the medical director of cardiac electrophysiology at Saint Joseph London.

than stroke, lung cancer, breast cancer, and AIDS, combined. In fact, the death rate from SCA is exceeded only by combining all forms of cancer. Nothing else is close. In America there are 1,000 deaths a day from SCA. The most common reason for SCA is the sudden development of a disruption of the normal, synchronous rhythm of the heartbeat. When these arrhythmias occur, the heart does not contract in a way that pumps blood to the brain and body.

Prevention and treatment of these abnormal heart rhythms is the goal of a cardiac electrophysiologist.

Identification and Treatment of Patients at Risk for SCA

It is well known that the incidence of heart disease in Kentucky is significantly higher than the national average, which means more Kentuckians have permanent damage to heart muscle from heart attacks, also known as myocardial infarction (MI).

This leads to the number one risk factor for SCA, low output of blood from the beating heart and subsequent sudden cardiac death (SCD).

Abe stresses two very important points.

First, low cardiac output is easily screened for with a non-invasive echocardiogram.

Second, SCD in these high risk patients can

SPECIAL SECTION  CARDIOVASCULAR

be almost totally eliminated by insertion of a small implantable cardioverter defibrillator (ICD).

ICDs save lives that would otherwise be lost in a matter of minutes. If a high

IF AN ARRHYTHMIA OCCURS IN A HIGH RISK PATIENT WHO DOES NOT HAVE AN ICD, 98 PERCENT WILL DIE. IF THEY HAVE AN ICD, 96 PERCENT WILL SURVIVE. risk patient develops a sudden severe cardiac arrhythmia and they do not have an ICD, the chance of survival goes down by 10 percent per minute. In other words, if these patients do not receive a cardiac shock from a defibrillator within nine minutes of MI, the chance of survival is near zero. Abe points out that it is rare for even the very best 911 teams to be able to arrive within nine minutes of the onset of symptoms.

In other words, if an arrhythmia occurs in a high risk patient who does not have an ICD, 98 percent will die. If they have an ICD, 96 percent will survive.

When Abe arrived in London in 2002, he quickly assembled a team capable of identifying high risk patients and implanting ICDs. From 2002 to 2006 the team implanted 1,200 ICDs with a complication rate significantly below the national average and no mortality from the procedure or device. These promising numbers have continued through 2015, and Abe projects additional improvement in MI outcomes to continue in the future.

or more cc. Today we have ICDs that are near 30 cc, or one ounce. This trend will continue with the implants getting smaller and electrical resynchronization becoming more sophisticated.”

Another exciting development being tested is the non-invasive ICD, which requires no electrical leads placed into the heart. Instead of direct wiring, these devices will deliver electrical resynchronization through the chest wall from a very small implant under the skin.

Finally, Abe concludes the future must bring better ways to reduce heart disease everywhere but especially in high risk areas like Kentucky. After 10 years of practice in London, Abe says it was the best career decision he ever made. He gets up every day to go to work knowing that he is going to save lives. For job satisfaction, it doesn’t get any better than that. ◆

Cardiology Associates 1210 West 5th Street London, KY 40741 P 606.878.3100 F 606.878.3137 John Abe, MD, FACC, FHRS

The Future of Cardiac Electrophysiology

Looking forward, Abe says, “We must and we will find better ways to get high risk patients to cardiac centers for screening and treatment. From a technical point of view, the past tells us what will happen in the future. In 2000, ICDs were large, 200 ISSUE#99 | 19

SPECIAL SECTION  GENERAL SURGERY

When the Patient Becomes the Doctor Chris Nebel, DO, FACS, has a unique insight into the doctor-patient relationship BY JIM KELSEY

They say that doctors make the worst patients. But doctors-to-be? That’s a different story.

Before he became a general surgeon at Owensboro Health, Chris Nebel, DO, FACS, was just beginning his path toward a career in medicine when his journey was interrupted with a dreaded diagnosis.

Cancer. Testicular cancer, to be specific.

Hearing the “C” word just months after graduating from Shorter College in Rome, Ga., was stunning and scary. Preparing for a wedding and studying for MCATs is stressful. Add in chemotherapy and it can be overwhelming.

Nebel’s basic medical knowledge and desire to learn more enabled him to draw some valuable knowledge from the experience. They are lessons he employs every day.

“I am a cancer survivor,” Nebel says.

“Dealing with it, being a cancer patient, I was also learning as I was going along. I was also building empathy, which I think is probably the most important tool a physician has, regardless of specialty. I can be empathetic when the patient comes into my office and they’re dealing with colon cancer because I am able to say, ‘You know what, I’ve been there.’ I’ve had chemo. I know what the ‘C’ word sounds like when you first hear it. It goes through your skull and rattles your brain. I can use that experience to build rapport and improve the doctorpatient relationship.”

Nebel beat cancer – a triumph he reflects on every October, the anniversary of his diagnosis – and went on to graduate from the College of Osteopathic Medicine at Nova Southeastern University in Davie, Fla. He completed an internship at Vanderbilt University Medical Center and performed his residency at Good Samaritan Hospital in Cincinnati, Ohio.

Nearly five years ago, he moved to Owensboro with his wife and three children, joining the surgical team at Owensboro Health.

“One of my partners, Brad Cornell, MD, FACS, is from Kentucky and moved OWENSBORO

20 MD-UPDATE

PHOTO PROVIDED BY OWENSBORO HEALTH

Chris Nebel, DO, FACS, has been part of the surgical team at Owensboro Health for nearly five years.

to Owensboro when he graduated from our residency program in the mid-90s,” Nebel says. “I went and talked to him, and it just felt right. It ended up being the easiest grown-up decision I’ve made to come here.”

Nebel would like to encourage more patients to make that same decision. He and the staff at Owensboro Health have been working hard in recent years to change the mindset that top-tier healthcare is only available in larger cities.

“I feel that I’m part of one of the best general surgery practices in the state,” Nebel says. “A common misconception we have

tried to change in our community is when some patients in our population receive a diagnosis of cancer, they feel like they need to go to the bigger cities – Louisville, Nashville, or Lexington – to get specialized care. We’ve been working hard to let our population know that there are competent, capable, well-trained professionals in their own community.”

Nebel also stresses that he and his staff are able to provide more personalized care than might be available in a larger teaching facility, where patients might see more of residents and interns than their attending physician. As a doctor of osteopathic

medicine, Nebel embraces the philosophy of mind, body, spirit and the psychology of the doctor-patient relationship.

That emphasis, which is shared by his colleagues at Owensboro Health, has developed into a team approach in patient care.

Naturally, Nebel is particularly sensitive to cancer patients and understands the shock and fear that come with a diagnosis.

“I approach the cancer patient in a slow, methodical way,” Nebel says. “I let them get all their questions asked. I let them meet everybody that’s going to be on the team.

Then we come up with a plan together and go and execute that plan. What we’re seeing is, if you’re managing patients as a team, the patients do better, and they have fewer complications.”

Another example of this teamwork leading to fewer complications is their focus on enhanced recovery. Nebel credits his colleagues in anesthesia and pain management with leading the charge to find a way to deliver quality care while getting the patient home sooner and with less pain. The hurdle was limiting pain without disrupting the gastrointestinal physiology. Drugs like morphine are great at blocking pain but also block the neuroreceptors in the bowels, resulting in delayed bowel function after surgery.

“What we’ve found is if we can do regional pain control that doesn’t involve giving them so many narcotics, their bowels will turn on quicker,” Nebel says. “The theory is if their bowels turn on quicker, we can advance their diet sooner, and they get to go

home quicker. We had the courage to leave some of our old dogma behind and try something new and be more aggressive. It’s something I’m proud of. Our anesthesia team is really good at putting in those regional pain catheters, and they really work well.”

Nebel gives an example of a patient who recently underwent colon surgery on a Friday. Through the enhanced recovery methods, she was able to go home on Monday and missed just seven days of work. “That’s pretty phenomenal,” he says, pointing out the financial savings that less hospital time means to a patient.

But Nebel knows that getting home and on the road to recovery means even more than money to the patient. He knows … because he’s been there. ◆

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ISSUE#99 | 21

SPECIAL SECTION  GASTROENTEROLOGY

Battling with Bowel Incontinence

Lexington Clinic colorectal surgeon offers bowel control treatment option to improve patients’ lives BY SARAH WILDER For some patients, the urge to go just can’t be controlled, resulting in embarrassing accidents, social problems, and a fear of leaving the house or travelling for long periods of time. However, those patients are not alone. According to the Centers for Disease Control and Prevention, approximately half of the older American population struggles with incontinence.

Bowel incontinence, sometimes called fecal incontinence, is defined as the inability to control bowel movements. The condition can be a result of many different factors, including:  Diarrhea  Constipation  Damage to nerves that sense stool or nerves in the rectum (from multiple pregnancies or diabetes)  Injury to sphincter muscles at the end of the rectum  Loss of storage capacity in the rectum  Surgery  Rectal prolapse  Rectocele LEXINGTON

The condition also ranges in severity and can sometimes be attributed to minor medical problems. When the incontinence becomes recurring or chronic, however, further medical attention should be sought.

“Fecal incontinence is a condition that can have a significant impact on a patient’s life, with most patients not speaking up about the condition due to embarrassment or the thought that nothing can be done.

When a patient’s bowel incontinence fails to respond to conservative measures or starts to affect quality of life, a consultation with a specialist is necessary,” says Matthew Bailey, MD, Lexington Clinic colorectal surgeon.

“Following this consultation and further evaluation, an individualized treatment plan is devised to provide the most relief possible and meet the unique needs of the patient.”

There is a wide range of treatment options for bowel incontinence. Dietary 22 MD-UPDATE

PHOTO BY STEPHANIE NORTHERN

"When a patient’s bowel incontinence fails to respond to conservative measures, a consultation with a specialist is necessary," says Matthew Bailey, MD, Lexington Clinic

and medical management are recommended as first-line therapy. Obvious anatomic defects such as rectovaginal fistula, hemorrhoidal or rectal prolapse, or fistula-in-ano should be corrected. Surgical treatment options include sphincteroplasty, bulking agents such as hyaluronic acid dextranomer gel, and radiofrequency energy. A newer, minimally invasive procedure called sacral neuromodulation (bowel control therapy) may also be considered as a first-line surgical option.

“Sacral neuromodulation has been a real game-changer in the management of

fecal incontinence. I have seen this have a tremendous impact on the quality of my patients’ lives, allowing them to avoid a pad for the first time in years,” says Bailey.

“What make this procedure so unique is that it does not eliminate the viability of future surgical options, and there is a trial phase to conclude if the treatment will work before implanting the neurostimulator.”

Sacral neuromodulation works by modulating rectal sensation by activating and deactivating chemical mediating receptors and stimulating the afferent pathway. The treatment consists of placing a lead in the S3 foramina, which is tunneled to a neuro-

D. Scott Neal,Inc. Thoughtful Financial Planning Remember the name.

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SACRAL NEUROMODULATION HAS BEEN A REAL GAME-CHANGER IN THE MANAGEMENT OF FECAL INCONTINENCE. stimulator implanted in the upper buttock.

This procedure is performed with minimal sedation. Depending upon the number of episodes per week, the patient may qualify for a one-week or two-week trial. The patient keeps a bowel diary and is compared to their baseline. If the patient improves by 50 percent from their baseline, they have a long-term neurostimulator implanted in a procedure with minimal sedation.

Not only is bowel control therapy easy to use and well tolerated by most patients, it is also highly successful in reducing, or completely stopping, the number of accidents that occur. In pooled analysis of clinical trials, 79 percent of patients experience greater than 50 percent improvement in weekly episodes over one year, and 84 percent of patients experience greater than 50 percent improvement long term (more than 36 months). Approximately 35 percent of patients experience complete continence at five years. Also, the presence of a sphincter defect (up to 120 degrees), pudendal neuropathy, or history of previous sphincter repair does not appear to impact outcomes of sacral neuromodulation.

“While we consider complete cessation of bowel accidents the ideal outcome for the patient, even the slightest reduction of accidents works wonders in these patients’ lives,” says Bailey. “A reduction, even 50 percent, proves to be a huge relief and gives patients the ability to travel and go out in public for extended periods of time.

Essentially, this treatment allows patients to live their lives once again.” ◆

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ISSUE#99 | 23

COMPLEMENTARY CARE

The Power of Self-Talk: Change a Word — Change Your Brain People naturally talk to themselves.

Whether it’s the out-loud self-talk of young children as they learn to master a new task or our grownup unspoken private talk, it seems we have an almost continuous internal conversation with ourselves.

Much of our inner dialogue is an attempt to manage how we think, feel and behave — how to get ourselves to do the things we need to do and stop doing things that are self-defeating or self-limiting. It’s the kind of self-talk we’re asking our patients to cultivate — self-talk that gets them to replace behaviors that are risky or self-destructive with healthier lifestyle and relationship choices.

What we didn’t know until recently (at least not with scientific certainty) is that how people talk to themselves has an enormous effect on their success in life.

The Quick Fix

In a series of groundbreaking experiments at the Emotion & Self-Control Laboratory at the University of Michigan, psychologist Ethan Kross found that using first-name self-talk frees up your psyche to focus, think more clearly and perform more effectively than addressing yourself with pronouns like I or you. In his initial studies, Kross found that addressing yourself by first name minimizes social anxiety before a stressful event and also shuts down ruminating about it afterwards.

So changing one word can change your brain?

Jason Moser, a neuroscientist and clinical psychologist at Michigan State University, suggests the answer may be yes. Moser measured the electrical activity in the brain and observed a dramatic reduction in anxiety levels when participants referred to themselves using their first names in a stressful situation. Electrical activity in the frontal cortex, involved in problem-solving, judgment, impulse control and social and sexual behavior, reduced dramatically. In the primitive limbic brain, where emotional 24 MD-UPDATE

memories form, activity decreased by almost half.

When our sense of self is threatened, it’s easy to take things personally and overreact -reflexively or

BY Jan Anderson, PsyD, LPCC i m p u l s i v e l y.

First-name self-talk appears to work by giving us just enough emotional and psychological distance to be a helpful, healthy coping mechanism -- a way to step back, calm yourself, keep the situation in perspective and make a more conscious choice about how to respond.

Think about the potential to get anxious patients to undergo needed medical tests or procedures: “Jan, hundreds of people in Louisville get MRIs every day. No one has

are at odds with each other. Like with the quick fix, some detachment can be enormously helpful when we keep repeating the same old pattern or find ourselves chronically sidetracked from doing what matters most to us.

Psychotherapist and author Kim Schneiderman — who claims that thinking about yourself in the third person is something many successful people do naturally — uses research-inspired techniques to get her clients to write about themselves in the third person. Schneiderman uses perspective-bending questions to help clients get a fresh outlook on a familiar story — their own — as a way to reinterpret and reclaim their personal narratives and help themselves get “unstuck,” whether it’s in a job, a relationship or a stage of life.

One of my favorite approaches to issues that refuse to budge or that won’t go away and stay away, is voice dialogue facilitation (VDF). It’s a non-judgmental way

WHAT WE DIDN’T KNOW UNTIL RECENTLY IS THAT HOW PEOPLE TALK TO THEMSELVES HAS AN ENORMOUS EFFECT ON THEIR SUCCESS IN LIFE. ever gotten stuck in one and asphyxiated.

You can get through it with the Calming Breath — and maybe a Xanax. Now pick up the phone, dial the number and schedule the appointment.”

So a simple shift from a) personal pronoun to first name, coupled with b) some specific directives and c) a healthy dose of perspective is all it takes?

Sometimes it is a quick fix. You read an article like this, give it a try and it does the trick.

The Not-So-Quick Fix

When the quick fix doesn’t work, we often have to drill down a little deeper to resolve a gridlock between two parts of ourselves that

of accessing our unspoken inner dialogue and giving a voice to different sides of the personality that often represent two very different, maybe even opposite, orientations to life. A classic relationship example is the part of us that is deeply in love with and totally dedicated to our significant other and the other more instinctual part of us that is not naturally monogamous and would like to be free to explore other relationships. These two parts of us are natural opposites, we can’t get rid of either of them, and VDF does a better job than anything I’ve encountered in helping us wrestle with the challenges of our human condition — how to find a way to integrate our two opposite natures into our one life.

COMPLEMENTARY CARE

Since I work primarily with professionals and executives, an overrepresented side of the personality I often encounter is what we call the Inner Pusher. It’s a great part of our personality — It’s great at kicking our butts and getting us to do the things we need to do, but when it’s on overdrive, it’s almost impossible to de-stress, relax and enjoy ourselves and — let’s face it — an Inner Pusher part of us is not very good at relationships.

Start with a Subclinical Dose

I like the non-pathologizing quality of VDF. Rather than approach a client’s out-ofcontrol Inner Pusher like there’s something wrong with it that needs to be fixed or changed, there’s just an acknowledgement that it’s more a matter of “too much of a good thing.”

Rather than try to convince my client’s Inner Pusher to be less intense and driven, I focus on helping the client access the (usually fainter) voice connected to another part of his or her personality — one that naturally finds it easier to rest when tired, practice better health habits and that connects more easily with other people.

Then we start exploring what it might be like to incorporate very small amounts of these underutilized, unfamiliar skills and abilities. The trick is to manage any “side effects” (like the Inner Pusher’s concerns that the client may become lazy, lethargic and lose their edge).

The client gets to continue to be who they are — he or she just becomes more versatile, balanced and whole… and a whole lot happier. ◆

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A Joint Commission accredited private surgery center where our physicians perform diagnostic and surgical procedures for the treatment of pain, to include: Epidurals Intrathecal Pumps Spinal Cord Stimulation MILD Facet Blocks Vertebroplasty Neurolytic & Sympatholytic Denervation For further information on the region’s largest freestanding pain treatment facility, call: (859) 278-1316 ext 258 • Fax: (859) 276-3847 • www.pain-ptc.com

Issue #100, May  GENDER-SPECIFIC MEDICINE OB/GYN, Urology, Genetics, Prevention, and Wellness Issue #101, June/July  MUSCULOSKELETAL HEALTH Orthopedics, Sports Medicine, Physical Medicine *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 ISSUE#99 | 25

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

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

--- Gregory Gleis, MD, Orthopedist

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

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

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

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

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

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

26 MD-UPDATE

ADVOCACY

April is National Donate Life Month For several decades, organ and tissue donor awareness has been emphasized during the month of April with the purpose of saving and healing lives. Kentucky Organ Donor Affiliates (KODA) fills the month of April with events in hospitals and communities that share the lifesaving message of donation and transplantation. The goal of National Donate Life Month is to make life possible by educating and motivating individuals to register their decision to be organ, eye, and tissue donors, and sharing their decision with their family.

Each year, Donate Life Month features unique artwork that helps tell the story of donation. The art for 2016 National Donate Life Month (NDLM) is inspired by sunflowers. If you look closely at a sunflower, the face contains as many as 2,000 seeds. One sunflower has the potential to create an entirely new field of flowers. As individuals we each have a similar potential - to make life possible for many when we register our decision to become organ, eye, and tissue donors. One organ donor can save the lives of up to eight people, restore sight to two people through cornea donation, and heal countless others through tissue donation.

Individuals can register their decision to make life possible and become organ, eye, and tissue donors at www.donatelifeky.org.

LEXINGTON

About Kentucky Organ Donor Affiliates (KODA)

Kentucky Organ Donor Affiliates (KODA)

is dedicated to saving lives through organ and tissue donation and transplantation. KODA is an independent, non-profit organ and tissue procurement organization and was

BY Jenny Miller Jones formed to establish a statewide educational and procurement network. KODA serves 114 counties in Kentucky, four counties in southern Indiana, and two counties in western West Virginia. The KODA service area includes 112 hospitals, three transplant centers, and

THE GOAL OF NATIONAL DONATE LIFE MONTH IS TO MAKE LIFE POSSIBLE BY EDUCATING AND MOTIVATING INDIVIDUALS TO REGISTER THEIR DECISION TO BE ORGAN, EYE, AND TISSUE DONORS, AND SHARING THEIR DECISION WITH THEIR FAMILY. a multicultural population of four million.

For more information about KODA visit www.kyorgandonor.org.

Jenny Miller Jones, MA, is director of Community Outreach & Education for Kentucky Organ Donor Affiliates, 2201 Regency Road, Suite 601, Lexington, KY 40503. She can be reached at 859.278.3492, 859.967.2910 (Direct Line). ◆

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deandorton.com ISSUE#99 | 27

ADVOCACY

Saving Kidneys - Not Just Saving Lives!

BY JILL DEBOLT Lightening the burden of kidney disease in the state of Kentucky is the goal of the Kidney Health Alliance of Kentucky (KHAKY). KHAKY’s mission is to serve kidney disease patients and their families, increase awareness and early detection of Chronic Kidney Disease (CKD), provide a network of collaboration among healthcare providers, and promote organ donation.

Based in Lexington, this independent, nonprofit group has been serving Kentucky kidney disease patients for over 40 years.

LEXINGTON

Promoting Awareness and Early Detection of Kidney Disease

KHAKY has recently increased its focus on stemming the tide of kidney disease in the state of Kentucky.

“Hypertension was the silent killer of the last century. We attacked it with education and awareness, and it worked. Chronic kidney disease is the silent killer of this century. We must do the same with it,” according to Dr. B. Peter Sawaya, professor, Department of Nephrology, University of Kentucky School of Medicine. As alarming as that is, more alarming is the fact that very few of the general public have heard of CKD or have any idea what it is. KHAKY is leading the way to healthier kidneys in Kentucky through public education and awareness programs and free kidney health screenings.

Serving Kidney Disease Patients and Their Families

KHAKY serves patients and their families across Kentucky. Patients are often referred by nephrologists and renal teams for assistance with nutritional supplements, as maintaining adequate nutrition plays a significant role in improving quality of life for CKD patients. In fact, nutrition and proper diet is so important that KHAKY sponsors several “Kidney Smart Shopping” sessions throughout the year.

The KHAKY website (www.khaky.org) provides links to shopping videos and mul28 MD-UPDATE PHOTOS BY GIL DUNN

tiple resources for renal patients and their families. Additionally KHAKY’s “Get Healthy, Get Transplanted” program helps patients overcome challenges they face in qualifying for the transplant list such as dental clearance and weight loss.

Providing a Network of Collaboration Among Renal Care Providers

KHAKY works closely with area renal providers to improve collaboration on issues that face the renal care community. This year, they will host the fifth annual KHAKY Renal Conference to bring together multiple disciplines involved in renal patient care.

“The goal of this educational conference is to network, collaborate, and learn together to help save kidneys, not just save lives,” says KHAKY Executive Director Pat Ham.

Promoting Organ Donation

Kidney transplant is often the best hope for improving quality of life and life expectancy for CKD patients. KHAKY partners with other organ donor programs to increase awareness of organ donation. Last year was the inaugural 5K run to assist in overcoming some of the barriers CKD patients face in achieving successful renal trans-

Stephanie Rachels, RN, transplant coordinator at UK Transplant Center talks with 4th grade students at Sandersville Elementary in Lexington during “Life Is Cool” event. Lauren Middleton, 4th grade student teacher, looks on.

plantation. As a member of the Donation Life Kentucky Coalition, KHAKY participates in “Life Is Cool” – a program about healthy life choices and the impact of organ donation – for 4th grade students across Kentucky.

The Kidney Health Alliance of Kentucky looks forward to partnering with healthcare providers and businesses to be a significant force in identifying kidney disease in its early stages and reducing the incidence and burden of severe chronic kidney disease in the state of Kentucky. ◆

Kidney Health Alliance of Kentucky (KHAKY) 1517 Nicholasville Road, Suite 203 - Lexington, KY 40503 P: 859.277.8259 F: 859.277.2229 www.khaky.org

NEWS  EVENTS  ARTS

KentuckyOne Health CMO Damian “Pat” Alagia Named a Top CMO

Damian P. “Pat” Alagia III, MD, CMO, KentuckyOne Health, was recognized as one of “100 Hospital and Health System CMOs to Know,” in Becker’s Hospital Review, a leading hospital magazine for hospital business news and analysis for hospital and health system executives. The magazine recently released the 2016 edition that features esteemed clinical leaders from healthcare organizations from across the nation. Alagia is an experienced clinician, health care executive, and entrepreneur.

The chief medical officers and other leaders named to the list with equivalent titles have exhibited dedication to clinical leadership and have contributed to establishing standards of excellence at their respective organizations. Leaders were selected for this list based on editorial research and discretion. Nominations were also considered when making selections for the list.

LOUISVILLE

Ganzel Appointed to LCME LOUISVILLE

Toni Ganzel, MD, MBA, dean of the University of Louisville School of Medicine, has been appointed to the Liaison Committee on Medical Education (LCME), the governing body that accredits medical educa-

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tion programs throughout the United States and Canada. Her three-year term begins July 1.

Ganzel will be one of 19 voting members of the LCME – 15 medical educators/ administrators/ practicing physicians, two public members, and two medical students.

Each year, the LCME reviews annual survey data and written reports on all accredited U.S. and Canadian medical schools, and conducts survey visits to 20-30 institutions.

LCME accreditation is a peer-reviewed process of quality assurance that determines whether a medical education program meets established standards. This process also fosters institutional and programmatic improvement.

Ganzel’s appointment follows the U of L School of Medicine’s success in revising its program and seeing the probationary status of the school fully lifted in 2015.

DeFilippis to Test Biomarker that May Predict Heart Disease in Women

Heart disease is the leading cause of mortality in women worldwide, including in the United States. Although deaths from cardiovascular disease (CVD) in men have declined since the 1970s, the rates of death for women have not followed.

University of Louisville cardiologist Andrew DeFilippis, MD, MSc, may be on the verge of a breakthrough in detecting cardiovascular disease before a heart attack occurs. Thanks to a $100,000 Heart to Heart Grant from Alpha Phi Foundation, DeFilippis will study archived blood samples from thousands of patients to determine whether the presence of certain LOUISVILLE

lipids in a person’s bloodstream can be used to pinpoint women at risk for having a heart attack.

The buildup of fats, cholesterol and other substances in and on the artery walls, known as atherosclerosis, is the underlying cause of heart attack and stroke.

Atherosclerotic plaques contain large amounts of oxidized phospholipids (OxPL).

DeFilippis believes that the release of OxPL from plaque out into the bloodstream may allow doctors to identify women at increased risk for cardiovascular disease events.

To test this theory, DeFilippis and his research team in U of L’s Institute of Molecular Cardiology will evaluate blood samples and data collected in the MultiEthnic Study of Atherosclerosis (MESA) trial, a multi-center prospective study of cardiovascular disease involving 6,814 men and women in six cities in the United States.

Beginning in 2000, blood samples were taken and stored for MESA subjects, and their health was followed for up to a decade.

DeFilippis plans to evaluate the blood samples and data to determine whether OxPL can be used as a biomarker in predicting cardiovascular disease.

“If our project confirms OxPL as a biomarker of atherosclerotic CVD, it opens the possibility of the development of a totally new class of medications for the treatment of CVD years before the onset of an acute event,” DeFilippis said.

Doty Receives AAEM Award

HealthCare’s Dr. Christopher Doty was awarded the Joe Lex Educator Award by the American Academy of LEXINGTON UK

ISSUE#99 | 29

NEWS

Emergency Medicine (AAEM) at the 22nd Annual Scientific Assembly.

The Joe Lex Educator of the Year Award is named after long-time emergency medicine educator, Dr. Joe Lex, recognizing an individual who has made an outstanding contribution to AAEM through work on educational programs. Doty, vice chair and residency director in the Department of Emergency Medicine at the University of Kentucky, was recognized for his outstanding contributions to AAEM through his work in educational programs and serving as the cochair of the planning committee, contributing to the success of the Scientific Assembly.

As an associate professor of emergency medicine, Doty has been awarded numerous national teaching awards in the research inter-

ests of cognition, andragogy, residency education, and acute decompensated heart failure.

UK and Kentucky Neuroscience Institute to Host Practical Update in Neurology and Neurosurgery

The University of Kentucky College of Medicine Departments of Neurology and Neurosurgery and the Kentucky Neuroscience Institute will host an accredited event to bring healthcare providers up to date on care practices dealing with neurology and neurosurgery.

On April 29, healthcare providers, from primary care physicians to occupational and physical therapists, who treat patients with neurological issues are invited to join LEXINGTON

t Dr. John Stewart

Surgery on Sunday Provides Surgeries for 15 Patients

On Sunday, March 20, 60 volunteers, including physicians, surgeons, nurses, and administrative staff gave their time at the monthly surgery date for Surgery on Sunday (SOS).

The surgeries were performed at the Lexington Surgery Center at no cost for patients who were unable to pay for these essential outpatient procedures.

The physicians and surgeons volunteering their services included: Phil Hall, MD; Greg Marta, MD; Jon Bowen, MD; Paul A. Kearney, MD; K.V. “Tad” Hughes, MD; Trevor Wilkes, MD; David Cowen, MD; Jared Nimtz, MD; J. Martin Favetto, MD; John Stewart, MD; Ross Tekulve, MD; and Jennifer Harris, MD. The surgeries performed on March 20 included mass excisions, tonsillectomies, rotator cuff repair, gallbladder removal, hernia repair, carpal tunnel release, and colonoscopies.

Surgery On Sunday was founded in 2005 by plastic surgeon, Dr. Andrew Moore, II. Relying entirely on volunteers, Surgery On Sunday performs outpatient surgeries the third Sunday of each month at the Lexington Surgery Center utilizing volunteer physicians, anesthesiologists, nurses, social workers, and administrative personnel who have donated over 92,000 hours of volunteer service. To date, nearly 5,700 patients have been served.

To learn more about Surgery On Sunday or to refer a patient, please call Anna Taylor, executive director, at 859.246.0046.

and the SOS team members perform hernia repair on an SOS patient.

LEXINGTON

PHOTOS COURTESY OF SURGERY ON SUNDAY 30 MD-UPDATE

the Practical Update in Neurology and Neurosurgery — several forums discussing new evidence-based practices in neurology.

Presentations will cover advances in medical management for headache, memory complaints, Parkinson’s disease, epilepsy, and acute ischemic stroke.

The event is free, but participants must register through CECentral before April 11 to reserve a spot. Onsite registration and breakfast will start the day at 8 a.m. in the Pavilion A auditorium of the UK Albert B. Chandler Hospital with the welcome and introduction beginning at 9:30 a.m. The event ends at 4 p.m. Participants attending this event will receive free validated parking in the hospital parking garage at the corner of South Limestone and Leader Avenue.

Dr. Trevor Wilkes and the SOS team perform rotator cuff surgery on an SOS patient. 

t Dr. Tad Hughes and the SOS team perform tonsillectomy on an SOS patient.

NEWS

Lexington Neurology joins Lexington Clinic as Associate Practice

Lexington Clinic is pleased to announce the association of Lexington Neurology. This partnership allows the two practices to work together to provide the high-quality neurologic care to the Lexington community for which each is known.

For more than 20 years, Lexington Neurology has provided services to patients including treatment of Parkinson’s disease, stroke, multiple sclerosis, headaches, spasticity, migraines, muscle diseases, epilepsy and seizures, and neuropathy. Additionally, Lexington Neurology provides advanced diagnostic procedures that include electromyography (EMG/NCV), nerve conduction studies, and lumbar puncture.

The association is effective on April 1, 2016, at which time Lexington Neurology will become a member of Lexington Clinic’s Associate Physician Network. Lexington Clinic and Lexington Neurology will work together to ensure a smooth transition.

LEXINGTON

Floyd Memorial Announces Pending Acquisition by Baptist Health

After a little more than seven months, Floyd Memorial Hospital and Health Services’ Board of Trustees, the Floyd County Commissioners, and the Floyd County Council have announced the intent to pursue an acquisition of Floyd Memorial Hospital and Health Services by Baptist Health.

Floyd Memorial and Baptist Health are entering into a non-binding agreement that allows them to move forward with necessary steps to pursue a proposed acquisition.

Following the due diligence and negotiation process, which is expected to take approximately 90-120 days, the organizations would then finalize a binding asset purchase agreement, which would be subject to the review and approval of the Floyd Memorial Board of Trustees, Floyd County Council, and Commissioners. Assuming the purchase agreement is approved, they NEW, ALBANY, IN

anticipate the binding asset purchase agreement being signed by July 1, 2016 and the actual transition taking place on or before October 1, 2016.

The proposed acquisition includes a guaranteed capital investment of $125 million over the next five years to expand services, invest in improved technologies, and transition to Epic, one of the highest-rated information technology platforms in the nation.

Hospital administration sees this pending acquisition as an opportunity for the organization and the patients it serves to reap the benefits of greater economies of scale through improved operational efficiencies and synergies, high-quality, comprehensive healthcare services for our community, and better preparation for the next phase of healthcare transformation.

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, and third hospital in the nation, to acquire and use a new and innovative tool to treat patients with Peripheral Artery Disease (PAD).

With the acquisition of the FDAapproved Pantheris lumivascular atherectoDANVILLE

my system, EMRMC is taking yet another 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 new technology allows physicians to precisely

remove plaque while avoiding injury to normal arterial wall structures.

The new technology can help to prevent leg amputations and bypass surgeries through a minimally invasive procedure that sends most patients home within a few days.

Atherectomy is a minimally invasive treatment for PAD in which a catheterbased device is used to remove plaque from a blood vessel. Lumivascular technology utilized in the Pantheris system allows physicians, for the first time ever, to see from inside the artery during a directional atherectomy procedure by using imaging called optical coherence tomography, or OCT. In the past, physicians have had to rely solely on X-ray as well as touch and feel to guide their tools while they try to treat complicated arterial disease. With the lumivascular approach, physicians can more accurately navigate their devices and treat PAD lesions, thanks to the OCT images.

Baptist Health Express Care Opens in Georgetown

Baptist Health will offer convenient, affordable basic health care services at its newest Baptist Health Express Care clinic, which opened February 29 at 210 Bevins Lane, Suite E in Georgetown.

No appointment is necessary at the clinic, which will offer screenings, check-ups, immunizations, and treatment of minor injuries and illnesses. Hours will be 8 a.m. to 8 p.m. Monday-Friday, 8 a.m. to 5 p.m.

Saturday and 10 a.m. to 5 p.m. Sunday.

Baptist Health Express Care services include treatment for coughs and sore throat; bumps, cuts and scrapes; nausea, vomiting or diarrhea; minor headaches and back pain; minor allergic reactions; ear or sinus pain; minor fevers and colds; sprains and strains; and eye swelling, pain, irritation, or redness.

Baptist Health operates 16 additional Baptist Health Express Care clinics throughout the state, including Central Kentucky sites in Berea, Lexington, Nicholasville, and Paris. ◆ LEXINGTON

ISSUE#99 | 31

EVENTS

Honoring the Commissioner EDITOR’S NOTE: DR. RICE LEACH (19402016) PASSED AWAY ON APRIL 1, 2016 AFTER BATTLING LYMPHOMA. Rice Leach, MD, commissioner of health for Lexington–Fayette County, was honored on Thursday, March 17, 2016 by both the Lexington Fayette Urban County Government (LFUCG) and the Lexington Medical Society (LMS) for his years of service to the community and to the medical society.

Mayor Jim Gray and the LFUCG Council honored Leach for receiving the 2016 Public Health Hero Award from the Lexington-Fayette County Board of Health.

Leach, who was in hospice care while battling cancer, received the honor for his 50-plus years of medical and public health services and for being a shining example of the health department’s motto: “Helping Lexington be well.”

LMS President Thomas Slaybaugh Jr. presented Leach with the Jack Trevey Award for Community Service.

A large gathering of friends, family, colleagues, and government officials welcomed Leach in the LFUCG council chambers.

Leach accepted the awards with his customary low key nature, humility, wisdom, and humor. ◆

ABOVE: A

gathering of dignataries came out to honor Dr. Rice Leach.

LEFT: (l-r) Dr. Rice Leach, commissioner of health for Lexington, received the Public Hero Award from Lexington Mayor Jim Gray.

LEXINGTON

Dr. Rice Leach displayed his customary understated eloquence and humor while accepting Lexington’s highest award for public health.

32 MD-UPDATE PHOTOS BY GIL DUNN

(l-r) Dr. Rice Leach received the Jack Trevey Award for Outstanding Service to the Medical Community from Lexington Medical Society President Thomas Slaybaugh Jr.

(l-r) Dr. Rice Leach received congratulations from fellow infectious disease specialist Dr. Ardis D. Hoven, past chair and president of the American Medical Association and past president of the Kentucky Medical Association Society. (l-r) Mireille Leach, wife of Dr. Leach, with Dr. Thomas Slaybaugh Jr., Dr. Rice Leach, seated, and Lexington Mayor Jim Gray, enjoyed Leach’s customary low-key approach and humor.

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UK Alumni and Associate Alumni Membership Rates for The Club at UK’s Spindletop Hall

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General Member SPRING PROMOTION Initiation Fee Ends April 30, 2016

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4 Award Winning Executive Chef Seth Russell

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