MD-Update Issue #112

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #112 WWW.MD-UPDATE.COM

VOLUME 8 • #1 • January 2018

Holiwell Health Offers Patients Relief from Chronic Disease With a collective focus on healing body, mind, and spirit, this Louisville clinic is innovating and integrating healthcare.

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LETTER FROM THE PUBLISHER

Welcome to MD-Update, Winter 2018!

The Journey Continues “A thousand-mile journey begins with one step,” is accredited to Lao Tzu, an ancient Chinese philosopher.

I don’t claim to be an expert on Eastern philosophy. I’m a fourth+ generation anglo-American, fully immersed in our Western culture. In my opinion though, the simple truth is that sometimes change is hard, but sometimes change is necessary. That’s the truth I learned from talking with the Kentucky doctors and providers in this issue of MD-Update who are walking their own paths of a thousand-mile journey to provide better healthcare for Kentuckians.

Starting with our cover story on Deborah Ballard, MD, the energetic and committed internist who launched her preventive and wellness practice after years of searching for the correct balance of evidence-based, Western medicine and best practices. Dr. Ballard’s self-description, “Call me Dr. Obvious,” along with her emphasis on food, diet, exercise, and mental awareness are the guiding principles for her new practice. I believe you’ll enjoy reading her story.

Dr. Van Breeding literally starts his day with at least a thousand steps. After rounding his hospital patients, he takes a walk on the streets of Whitesburg, then heads to his clinic at Mountain Comprehensive Health Corporation. Dr. Breeding, named the 2017 Staff Care’s Country Doctor of the Year, is a powerful force for change in Eastern Kentucky. Anyone trying to keep up with him better be ready to move fast and listen quickly.

My long-time friend Marty Luftman, MD, is well on his way to a new phase of his plastic and cosmetic surgery practice. Having made the transition from solo practice to a simpler association, Dr. Luftman himself has witnessed and embraced the journey of his specialty from reconstructive to aesthetic.

Similarly, Dr. Michelle Palazzo, utilized her plastic surgery and transplant skills, as a fellowship-trained hand surgeon, to perform breast reconstructive surgery on identical twins. Dr. Palazzo has walked in her patient’s shoes and now can accompany them on their journey.

And finally, the epitome of life’s journey, well-lived, is the U of L Institute for Sustainable Health & Optimal Aging. The Institute’s Flourish program builds a collaborative community network of research, education, innovation, and health practices that empowers individuals “to approach aging as an opportunity, not a disease.”

Introducing the new MD-Update Online MD-Update has a new online presence at www.md-update.com. The last 5+ years of MD-Update are now available to the Kentucky healthcare consumer and searchable by medical procedure, condition, or doctor’s name. We believe this new component completes the circle of doctor to doctor to patient. Better informed patients can make better decisions on their health.

Do you know a good doctor? We do, at MD-Update.

As always, all the best

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ISSUE #112 PUBLISHER

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Donna Ison dison@md-update.com GRAPHIC DESIGN

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Scott Neal Jamie Wilhite Dittert, ESQ. Tuyen Tran, MD Jan Anderson, PSYD, LPPC Lisa Meeker Mac Stone

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CONTENTS

ISSUE #112 ON THE COVER: Deborah Ann Ballard, MD, MPH, who is credentialed in internal medicine and integrative medicine, is the founder of Holiwell Health, an integrative medicine practice.

COVER PHOTO BY ROB DENSMORE

3

PHYSICIAN OP-ED

6 HEADLINES 7 FINANCE 9 LEGAL

10 Holiwell Health Offers Patients Relief from Chronic Disease With a collective focus on healing body, mind, and spirit, this Louisville clinic is innovating and integrating healthcare.

14 SPECIAL SECTION: SENIOR HEALTH, PREVENTION & PLASTICS 23 MENTAL WELLNESS 25 COMPLEMENTARY CARE 28 NEWS 30 EVENTS

SPECIAL SECTION SENIOR HEALTH

14 HELPING OLDER ADULTS FLOURISH FOR A LIFETIME: U OF L INSTITUTE FOR SUSTAINABLE HEALTH & OPTIMAL AGING

17 PLASTIC SURGEONS TRANSPLANT TISSUE BETWEEN IDENTICAL TWINS: KLEINERT KLUTZ HAND CARE CENTER

19 B REEDING SUCCESS: MOUNTAIN COMPREHENSIVE HEALTH CORPORATION

21 A NEW PRACTICE THAT’S JUST RIGHT: MARTY LUFTMAN, MD

ISSUE #112 3

Physician Op-Ed

A Message from Lexington Medical Society President, Tuyen Tran, MD LEXINGTON I would like to begin with, “Thank

you!” It is with great honor that I accept the baton from Dr. Granacher as I take my turn in leading the Lexington Medical Society on its next leg of our race of life. And this race of life is a very long marathon indeed, since 1799! But it is for a very good cause! We want members of the Lexington Medical Society to ignite, sustain, and rekindle their passion for the practice of medicine. We want to be the principal voice and resource for our fellow physicians. We want to support our physicians’ professional lives.

We want to facilitate our physicians’ efforts to improve the health of our community. And when I say, “We,” I mean each and everyone in the Lexington Medical Society.

We have sharpened our vision and mission statements to more precisely define our pur-

Dr. Tuyen T. Tran Associate Chief of Staff, Director Virtual Care, VAMC Lexington

pose at Lexington Medical Society. We have defined goals and objectives to accomplish

our vision and mission; but, more importantly, we have established the values (loyalty, caring, trust, camaraderie, foresight, innovation, candor, and life/work balance) with which we will achieve the desired outcomes.

Where do we want to go in 2018? Where do we want to focus? I believe we should focus on priority goals and do them well.

Our Society has a wide demographic, from our medical students in their early twenties to our retired physicians. We will design events that appeal to our membership as a whole, but will also have events that serve a specific demographic niche. Using a baseball analogy, a home run or grand slam is an event with broad appeal across the demographics.

A double is an event focused on a specific demographic. With this programing strategy

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Physician Op-Ed

in mind, what do we want to achieve in 2018?

I propose that we organize our goals into four categories: 1) Physician Wellness, 2) Physician Leadership Development and Mentorship, 3) Legislative Advocacy, and 4) Improving Community Health.

The most important service LMS can provide to our physician members is physician wellness. If you are not healthy, both body and mind, you cannot help others. The Physician Wellness Program has been a great success, a “grand slam.” The program exemplifies LMS’ commitment to our physicians, resident physicians, and medical students. In a new initiative, we want to invite members to bring their significant others to participate in a couple’s Team Building event at the Life Adventure Center in Versailles on April 21st for residents and fellows and on April 28th for active members. I believe we can all appreciate the importance of a happy spouse.

With a healthy body and mind, we want to assist our physicians with leadership development. In 2017, LMS supported three LMS candidates and KMA supported two additional LMS candidates to attend the KMA Kentucky Physician Leadership Institute (KPLI). In addition to the KPLI, LMS has partnered with the University of Kentucky Gatton College of Business and Economics to offer “Leadership of the Business of Medicine Workshops.”

New for 2018, LMS is starting a “Woman Physician Leadership Series.” Our first event, on March 13 in honor of Women’s History Month, is a dinner at the 21C Museum Hotel with Dr. Ardis Hoven, LMS Member and past President of the American Medical Association, as the guest speaker. This inaugural event is an opportunity to engage more female colleagues to be involved in leadership positions in organized medicine and throughout the community.

For our resident physicians and medical students, we should continue to support their career development. Career Chats has become another “grand slam” for us. Both physicians and medical students have expressed benefit from the encounters.

In regards to legislative advocacy, I encourage our members to commit to increasing their involvement. Remember, part of our

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mission statement is for LMS to be “…the principal voice” for Central Kentucky physicians. Thus, I strongly recommend that we sustain, continue to innovate, and promote our advocacy programs (KMA Physicians’ Day at the Capitol, AMA National Advocacy Conference, KMA Annual Meeting). In 2018, I would like to develop and implement a LMS Legislative Task Force.

Finally, I would like to discuss something that is very dear to me — improving community health. I was called to medicine to serve and contribute to the health of my community. I have been blessed and I want to share with the community that has offered me these opportunities. Therefore, I strongly recommend sustaining fund raising programs like the annual golf event, the LMS Foundation support of medical non-profits, and the Bourbon Chase.

I would be remiss if I did not mention the opioid epidemic, a public health crisis that according to the CDC has led to roughly

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90 deaths per day. The opioid epidemic is currently the 9th leading cause of death in the United States. While I certainly do not have the solutions; I bet that together, we, the Lexington Medical Society can contribute our expertise, wisdom, and resources to help combat this terrible epidemic which is devastating our communities.

In closing, I would like to thank every one of you for giving me the opportunity to serve as your next president. I hope to continue LMS’ course to provide leadership in healthcare issues, support our physician members, provide value to attract more members, and most importantly, ignite the fire and passion within each of us to practice medicine.

PUBLISHER’S NOTE: Tuyen Tran, MD, MBA emigrated from South Vietnam after the war. He completed both an undergraduate in biology/chemistry and medical school at the University of Missouri-Kansas City, in a six-year program. His is currently boarded in internal medicine and addiction medicine and works at the Lexington VA Medical Center.

ISSUE #112 5

Headlines

Central Kentucky Now Boasts a Center of Excellence in Robotic Surgery Saint Joseph East receives distinction of excellence from the Surgical Review Corporation

BY DONNA ISON LEXINGTON Central Kentucky can now count

itself among the regions that can boast having a Center of Excellence in Robotic Surgery, thanks to Saint Joseph East, which is part of KentuckyOne Health. This designation is bestowed by the Surgical Review Corporation and is based on volume, outcomes, and the different types of procedures offered within a program.

One of the factors leading to this award is Saint Joseph East’s offering of the da Vinci Xi surgical system, the most advanced technology available for minimally invasive surgery. According to a recent KentuckyOne press release, “The da Vinci Xi Robot allows surgeons to perform the most complex and delicate gynecological, urological and general surgery procedures through very small incisions with unmatched precision. Using a console, surgeons control in real-time the equipment being used on the patient, offering surgeons precision and vision far beyond what their own hands and eyes could provide.” Along with Saint Joseph East, Saint Joseph Hospital also offers the da Vinci Xi surgical system.

In addition to providing a minimally inva-

Mike Guiler, MD, of Saint Joseph East, employs robotic surgery to enhance precision on minimally invasive procedures.

sive surgical option for patients facing an open procedure, robotic surgery, using the da Vinci technology, gives surgeons magnified and high-definition vision. Surgeons can see inside and outside the body, which allows them to control the surgical instruments with much smaller incisions.

“Robotic surgery helps our hospital offer patients the most advanced technology, leading to shorter hospital stays, faster recoveries and minimal scarring. At Saint Joseph East, we have dedicated staff with leading-edge technology skills that are specifically trained

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for robotic surgery. This technology is certainly an asset to our hospital, patients and the community,” says Mike Guiler, MD, of Saint Joseph East. Guiler, whose specialty is obstetrics and gynecology, is certified by the Fellow of The American Congress of Obstetricians and Gynecologists. He completed his undergraduate studies, medical degree, and residency at the University of Kentucky.

According to the Surgical Review Corporation website, “The Center of Excellence in Robotic Surgery (COERS) program was developed to recognize surgeons and facilities worldwide performing robotic procedures and achieving defined standards for patient safety and care quality. The COERS designation requirements were developed to address the present and future needs of patients and providers, and they are coupled with an objective evaluation process that enables a thorough review of each candidate.”

Saint Joseph East is the only hospital in our area to receive this distinction. “It is an honor to be the only hospital in the region to receive this designation from the Surgical Review Corporation, which further demonstrates our strength in robotic surgery,” concludes Guiler.

Empowering physicians to focus solely on the demands of their clinical practice

PHOTO PROVIDED BY KENTUCKYONE HEALTH

Finance

Taxes: A New Day Has Dawned, or Has It?

BY SCOTT NEAL

This past year, Halloween was barely over when House Republicans introduced their version of tax reform with the goal of getting something into law before Christmas. Few observers thought such an undertaking could be done within seven short weeks. But, that is exactly what happened. In the hectic days that preceded Christmas, the president signed into law what was billed as massive tax reform.

An oft-stated goal of tax reform is simplification. The promise was a postcard-size tax return, but simplification in Washingtonspeak seems to be merely a reduction in tax rates. Rate reduction can only be achieved if cherished deductions and credits are done

away with. This bill could hardly be called simplification.

According to the Tax Policy Center, as reported in the Washington Post, over 80% of Americans will get a tax cut in 2018, while just 5% of taxpayers are expected to pay more.

Who falls into which category is very circumstantial with a lot of factors to consider.

This is by no means a comprehensive look, but given many of your questions lately, an overview is in order.

1. The 10% bracket remains unchanged, while the 15% bracket declines to 12%; the 25% goes to 22%; the 28% to 24%; the 33% to 32%. Meanwhile, the 35%

holds steady. And, the 39.6% slips to 37%. The income thresholds are modestly adjusted above the new 22% bracket.

2. The standard deduction nearly doubles to $12,000 for single filers and $24,000 for married filers. This move reduces the incentive to itemize and is a point of some simplification.

3. The $4,150 personal exemption is eliminated, and the $1,000 child tax credit doubles to $2,000.

4. The rules for charitable contributions remain largely unchanged, but the limit did increase from 50% to 60% of adjusted gross income for many contributions.

ISSUE #112 7

Finance

By itself, the combination of these factors will provide some tax relief for most families.

But I must caution, it depends on your individual circumstances. Hitting many readers of MD-Update, other changes to itemized deductions could have a more substantial impact, including the following.

5. There will be a $10,000 cap on deductions for taxes such as state and local income tax and property tax. This will negatively affect many of you.

6. Miscellaneous itemized deductions have largely gone away. That means that deductions for investment fees and tax preparation fees will be eliminated. Most employee business expense deductions will also vanish.

7. For investors, the preferential treatment for long-term capital gains and dividends remains intact, as is generally the case for retirement accounts.

One important change to note is that the new law repeals rules that allow for recharacterizations of Roth conversions back into traditional IRAs. Once you convert into a Roth, there’s no going back.

8. The 3.8% Medicare surtax on investment income for high-income taxpayers was retained.

9. The AMT for individuals was not repealed as advertised, but exemptions have been widened.

10. The estate tax survived, but the exemption per person will double from $5.6 million to $11.2 million per person.

(This high exemption doesn’t eliminate the need for effective estate planning to control the disposition of one’s estate.)

The annual gift tax exemption was increased to $15,000 from $14,000.

11. Starting in 2019, the new tax bill does away with the Obamacare mandate that requires all individuals to obtain health insurance.

Finally, it’s important to point out that many of the changes in the tax code for individuals will sunset in 2025. While many may eventually be made permanent, as we saw with the Bush tax cuts of 2001 and 2003, there’s no guarantee this will happen again.

This always makes for interesting, yet chal8 MD-UPDATE

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12. And for businesses: The 21% corporate tax rate applies only to C-corps. There will be a 20% deduction for pass-through entities, such as S-corps, partnerships, and LLCs. I believe this will be a welcome benefit for many business owners, but don’t simply estimate a 20% deduction on your practice income. Many professionals, doctors included, will have limitations placed on the deduction.

Undoubtedly, the rewrite of the tax code will produce unintended benefits and unexpected consequences. We have begun to project the impact for our clients to eliminate surprises.

From an economic standpoint, Congress and the president hope to unleash the “animal spirits” that have been lethargic for much of the economic expansion. They hope that changes, especially as they relate to business, will encourage firms to open new plants,

expand in the US, and level the playing field with the global community. The question remains – will it work? About 90% of economists surveyed by the Wall Street Journal expect a modest boost to growth in 2018 and 2019, but after that, opinions diverge.

Frankly, I have my doubts. The kind of hoped-for growth would only be fueled by borrowing and spending, á la the roaring ’90s.

Boomers aren’t likely to do that, and younger folks can’t, not just yet anyway.

Again, I understand that uncertainty breeds questions and concerns. If you would like to talk, I’m simply a phone call or an email away.

I’d be happy to talk with you. To download the rate tables and other financial facts for 2018 go to my website. It’s free.

Scott Neal is president of D. Scott Neal, Inc., a feeonly financial planning and investment advisory firm in Lexington and Louisville. You may call him at 1-800344-9098. Or email to scott@dsneal.com

Legal

Kentucky Declines to Adopt Negligent Credentialing

BY JAMIE WILHITE DITTERT, ESQ.

LEXINGTON Kentucky’s appellate courts have

debated for years on whether Kentucky allows hospitals to be sued for “negligent credentialing.” Generally, this claim involves allegations that a hospital breached its duty to ensure a competent medical staff by granting privileges to an incompetent or unqualified physician, and that the physician breached the applicable standard of care, resulting in harm to a patient. As recently as 2014, Kentucky’s highest court punted on the issue, stating it was “for another day.” This fall, the Kentucky Supreme Court finally made the call. In three consolidated cases, it ruled that negligent credentialing is not a viable cause of action in Kentucky, Lake Cumberland Regional Hospital, LLC v. Adams, 2016-SC-00181 (Ky. 2017). This decision is not yet final, but all six Kentucky Supreme Court justices reviewing the issue joined in the opinion. While this may seem like a positive step for health care providers, the Court’s rationale for declining to adopt the new cause of action was that the tort would not add to existing avenues of recovery against hospitals.

The crux of a negligent credentialing claim is the independent actions or omissions of the hospital that grants privileges to nonemployee, independent contractor physicians.

Certain claims against hospitals are based on the theory that the hospital is “vicariously liable” for harm caused by an employed physician. These claims are based on the nature of the relationship between the hospital and the physician and do not require an analysis of the hospital’s behavior. Conversely, negligent credentialing claims depend on whether the hospital itself fell below the standard of care.

In its new opinion, the Kentucky Supreme Court held that the duty of hospitals to employ competent staff has existed in Kentucky for decades, and that there is no need to adopt a tort of negligent credentialing to apply

to hospitals. Like a negligent credentialing claim, a common law negligence action against a hospital is based upon the hospital’s own independent acts. The Court noted claims against hospitals are permitted for circumstances such as infections acquired during a hospital stay, premises liability, and negligent selection of staff. It recognized hospitals are moving into a for-profit system and shifting from employed physicians to independent contractor physicians with hospital privileges. But, a hospital may be liable under existing law in cases involving non-employee physicians.

The opinion also addresses how to handle jury trials in cases involving claims against the physician and the hospital. Generally, the claim against the hospital cannot succeed unless the patient proves the physician breached the standard of care, resulting in harm to the patient. It would be a waste of judicial time and resources to address the hospital claim before resolving the physician claim. Additionally, evidence that is relevant to the hospital claim may be too prejudicial to share with a jury who is hearing the claim against the physician. For these reasons, the Court indicated claims based on hospital negligence should be split from, and decided after, the physician claims. It is not clear if this bifurcation would apply for the purposes of trial only, or should also mean that discovery on the hospital claims should not be commenced until after the resolution of the physician claims.

An analysis of the three cases addressed in the Kentucky Supreme Court opinion also provides valuable guidance to hospitals and their counsel in this type of litigation. First, Kentucky has limits on how long a plaintiff may wait before filing a lawsuit. This time can depend on when the plaintiff learns key information. As physician malpractice and

hospital negligence claims may be based on different facts, the plaintiff ’s deadline for filing each type of claim may be different and should be reviewed.

Additionally, what happens if the patient settles her claim against the physician but not the hospital? Under these circumstances, the hospital may be obligated to litigate the underlying claim against the physician as well as the negligence claim against the hospital.

This could lead to an increase in defense costs and present problems with proof and discovery that would not otherwise exist.

Finally, the Court addressed hospital bylaws.

The standard of care a hospital should meet in addressing credentialing issues will typically be determined by expert opinion testimony.

In some cases, the hospital may have adopted bylaws that go above and beyond the standard of care, but these bylaws do not change the standard applicable to the hospital. While an entity’s noncompliance with its own internal standards is not ideal, it will not necessarily equate to a finding the hospital breached the standard of care.

This opinion will certainly be monitored in the legal field, as the Kentucky Supreme Court still has jurisdiction to modify its opinion. Once it is final, hospitals and their attorneys handling hospital negligence claims should consider seeking bifurcation and should monitor how this decision is applied in lower courts.

Jamie Dittert is a healthcare and insurance defense attorney with Sturgill, Turner, Barker & Moloney, PLLC. She may be reached at jdittert@sturgillturner.com or 859.255.8581. This article is intended to be a summary of state law and does not constitute legal advice.

ISSUE #112 9

Cover Story

Holiwell Health Offers Patients Relief from Chronic Disease With a collective focus on healing body, mind, and spirit, this Louisville clinic is innovating and integrating healthcare.

10  MD-UPDATE

PHOTO BY DEBORAH LENORE

BY HOLLY HINSON LOUISVILLE For Deborah Ann Ballard, MD,

MPH, “Lifestyle is medicine.” With this philosophy in mind, Ballard, who is credentialed in internal medicine and integrative medicine and holds a Master’s in Public Health, opened

Holiwell (pronounced wholly well) Health in June of 2017. This integrative medicine practice is located in Louisville, Kentucky in the St. Matthews neighborhood. Among many other holistic features, the practice houses a teaching kitchen where clients can learn how to prepare healthy food from a gourmet chef.

(back row, l-r) Vicki Stanley, practice manager: Rik Ehmann, Asian Medicines; Kimberly May, certified life and health coach; Mathew Mattingly, client services; Joyce Sherdin, MSC, LFMFT, family therapist; (front row l-r) Rhona Kamar, chef; Michelle Eckhart, registered dietician; Deborah Ballard, MD, Lisa Flannery, certified yoga instructor. Missing from picture, Pam Valentes, certified pilates instructor; Melissa Tralfa, massage therapy

The staff of integrative medicine providers at Holiwell Health includes a family and marriage therapist, a wellness chef, an Asian medical practitioner, a massage therapist, a health coach, a dietitian, a Pilates instructor, and a yoga instructor. The collective focus is on healing body, mind, and spirit.

When asked to define integrative medicine and her mission for her practice, Ballard gives the definition offered by the Academic Consortium for Integrative Medicine and Health: “Integrative medicine and health reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing.”

Ballard’s increasing focus on integrative therapies and lifestyle medicine parallels the arc of her career. Initially, Ballard specialized in internal medicine, completing her residency and graduating from the University of Louisville in 1991. Following, she established her own practice in Bardstown, Kentucky as part of Bardstown Primary Care that also included Physicians to Children and Family Medical Center. After 11 years at the Bardstown primary care office, Ballard spent six years practicing endocrinology, exclusively, and doing research for the pharmaceutical industry.

It was there that her interest in integrative medicine was piqued. “I was treating people with chronic diseases that were mostly lifestyle induced, such as diabetes, hypertension, and obesity,” says Ballard. “I became very discouraged at seeing patients who had these great sacks full of drugs and although I could temporarily make the numbers look better with more medications, I did not make them well.

I was horrified at the outrageous cost and side effects of the drugs, and the many hoops I had to jump through to get these drugs approved by insurance companies. But the most disappointing reality was the patients were still obese, tired, depressed, and often in pain. I observed that if patients made the lifestyle changes, they got better. I decided then that I wanted to work more on lifestyle medicine and prevention and wellness.”

ISSUE #112 11

Cover Story Holiwell Health, an integrative medicine practice in the St. Matthews neighborhood of Louisville, opened its doors to patients in June of 2017.

The Journey to Integrative Medicine When she left the endocrinology practice in 2006 and went to work for Norton Cancer Institute in their prevention program, Ballard focused more on early detection, prevention, and wellness. According to Ballard, during that time, the Norton cancer prevention program had been undergoing an evolution and moving from cancer prevention only to a broader approach. Concurrently, Ballard obtained her Master’s in Public Health degree from The University of Kentucky.

“There is a huge overlap between public health strategies and integrative medicine because both look at the root causes of chronic disease,” states Ballard. “Most chronic diseases are related to how people live their lives — their diet, physical activity, sleep patterns, exposure to environmental toxins, and the stress accumulated over the course of their lives due to adverse childhood experiences, low socio-economic status, social injustice, lack of sense of purpose, loneliness, and unhappy relationships. It is a huge task to address all those issues for patients, but it is necessary if we want to make people well.”

In 2011, Ballard was invited by members of The Kentuckiana Holistic Nurses Association to attend an integrative medicine Continuing Medical Education (CME) conference in San Diego, where she met Dr. Mimi Guarneri, one of leading physicians in the integrative medicine field. Ballard says, “I remember when I got there I thought, ‘Wow I have found my tribe.’

12 MD-UPDATE

These doctors were enthusiastic and happy, and didn’t look worn down or discouraged by practicing medicine. They seemed to have a lot of joy in what they were doing.”

When Norton’s prevention department was reconfigured, it was time for Ballard to seek a new venture. Then, she got a call from a recruiter to join the new Healthy Lifestyle Centers that had been created by the KentuckyOne Health system. Ballard worked for KentuckyOne Health as medical director of the healthy lifestyles centers and co-director of the Ornish Reversal program, an advanced cardiac rehabilitation program proven to reverse coronary artery disease.

Always very dedicated to learning, Ballard took the next step by participating in an intensive, year-long Leadership in Integrative Medicine training program through Duke University as one of the inaugural class of 36 students. Upon its completion, she decided the time had come to realize her dream and build her own clinic. So, when KentuckyOne Health made the decision to sell its properties and leave the Louisville market, Ballard was ready.

She founded Holiwell Health and DABIM (Deborah Ann Ballard Integrative Medicine), which now offers a full slate of services combining the best of evidence-informed medicine from allopathic (traditional western medicine), integrative medicine, and functional medicine.

The Solo Practice Ballard’s mission for the clinic is to give patients the tools to help them create a healthy PHOTO BY ROB DENSMORE

lifestyle for themselves. “The questions are always the same. How are you eating? Are you getting exercise? Are you controlling stress?

Do you have a sense of purpose or meaning in your life? Are you avoiding toxins like tobacco, excessive alcohol or drugs?

Sometimes, I call myself Dr. Obvious. For example, patients routinely come in with a complaint of chronic fatigue or pain. I find out they persistently sleep only 4-5 hours per night, or they are under huge amounts of stress from a miserable marriage or overwork. No wonder they are tired and in pain. Of course, I order the appropriate diagnostic studies, but many times, the cause is an inherently unhealthy and unhappy lifestyle. I empower my patients with strategies to change that lifestyle and feel well,” Ballard says.

Ballard encourages patients to review the ample evidence that integrative medicine and lifestyle factors are the key to wellness. Research has consistently shown that common chronic conditions such as type 2 diabetes, hypertension, coronary artery disease, and many others, can be reversed with proper diet and nutritional support, physical activity, stress reduction, and toxin avoidance. “Type 2 diabetes is an epidemic in our country and a classic example of a disease that is mostly lifestyle-induced. Helping people understand that—that you can change the way you eat and move and lower stress— and you can reverse an expensive, serious chronic disease. It’s a very hopeful message.”

As both an internal medicine physician and integrative medicine specialist, Ballard’s feet rest in both worlds. “Traditional Western medicine has its role and can be helpful and lifesaving,” she says. “But integrative medicine is about answering those needs for people with chronic conditions that traditional medicine just doesn’t address very well.”

She points to chronic pain, and the recent epidemic of narcotic addiction as a classic example. “The fact is we’ve prescribed medications to people and they don’t work very well, and now we have a lot of people addicted to pain medicine and not functioning well.

It’s about learning how to thrive despite having a chronic condition. That is what we try to give people in integrative medicine.”

Holiwell Health, founded by Dr. Deborah Ann Ballard, houses a teaching kitchen where clients can learn how to prepare healthy food from a gourmet chef.

A major flaw with traditional Western medicine is that there’s a ‘pill for every ill,’ says Ballard. “Look at the outcomes for traditional Western medicine, for example, hypertension.

It’s well known that very few patients get to gain control of their high blood pressure with traditional drugs. With holistic care, we’re doing as well or better in those realms and the patients feel better.”

As an integrative medicine specialist, Ballard believes it’s a false paradigm to try to treat the body without treating the mind and spirit, too.

“The idea of holistic care is about a whole lot more than ‘Oh, you offer some acupuncture,’ it’s really about the whole health care system, the way we live our lives, the choices we make about everything from food to activity to

how we think.” Ballard recommends healing practices such as acupuncture, massage therapy, and herbal medicine as non-pharmaceutical, non-surgical approaches to chronic pain, fatigue, and other common ailments.

According to Ballard, emotional health is a vital facet of holistic health. “It goes back to, ‘Do you have a sense of purpose in your life? Why are you here?’ That’s why we have a mental health practitioner and a health coach here. Attitude is key to getting well.”

Since, as in most medical practices, Ballard’s patients are predominantly women, she hopes to launch a new comprehensive program, “Healing Her,” in late January or early February 2018.

Ballard explains, “Many women reach their PHOTO BY ROB DENSMORE

40s or 50s with broken bodies and spirits because of the stress they’ve endured over the course of their lives. By addressing the components holistically, we can help them heal.

Optimizing nutrition, getting them moving in a way that suits their own body, avoiding toxins like smoking and junk food, sleeping well, and reconnecting with people who love them and with their purpose in life. All this reduces stress, supports the immune system, and promotes healing. I often tell my patients that I want them to have an MPH, a Master of Personal Health. ‘Healing Her’ is a program to help them become masters of their personal health and thrive with joy and renewed sense of purpose and meaning. Empowering patients to thrive is my mission at Holiwell Health.”

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Senior Health

Helping Older Adults Flourish for a Lifetime

The U of L Institute for Sustainable Health & Optimal Aging brings an innovative approach to coordinated, interdisciplinary care for older adults

BY DONNA ISON LOUISVILLE By 2030, one in five Americans

will be considered an older adult; therefore, it is imperative that the healthcare industry innovates to meet the need. The University of Louisville Institute for Sustainable Health & Optimal Aging (ISHOA) is leading the way. According to their website, “The U of L Institute for Sustainable Health & Optimal Aging empowers older adults to flourish by building collaborative community networks of research, education, innovation, and prac­ tice. We are dedicated to bringing about a new

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vision of aging where individuals and society are able to approach aging as an opportunity, not as a disease.”

The Institute leadership team, which is made up of Anna Faul, PhD, Christian Furman, MD, Joe D’Ambrosio, PhD, JD, and Pamela Yankeelov, PhD, is acutely aware of the unique problems facing older adults.

“Geriatrics is a specialty. There are things that we do different in geriatrics and gerontology that we don’t do with someone who is twenty or thirty years old,” says D’Ambrosio, who serves as the director of health innovation and sustainability. D’Ambrosio holds his PhD in

social work with a specialization in gerontolo­ gy and also a JD from U of L’s law school. In addition, he is a licensed marriage and family therapist and certified social worker.

Furman, ISHOA’s medical director, elab­ orates, “In geriatrics, we look at older adults differently. We really focus on patient medi­ cations and psychosocial factors. We do a lot of dementia care. We understand that older adults often need palliative care, so we’re focused on advanced care planning. We’re focused on functional status, making sure they can do their daily activities and function at home.” Upon receiving her medical degree

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Anna Faul, PhD

Christian Furman, MD

from U of L, Furman began practicing geria­ tric medicine, which she has continued to do for over fifteen years. She is also a professor of geriatric and palliative medicine at U of L. “We are experiencing a major demographic shift. In 2030, one in every five Americans will be an older adult that comes with a specific amount of complex health issues. We need to have an interdisciplinary-trained geriatric workforce to help with their care coordination, so our older adults can flourish in their com­ munities, homes, and families,” adds director of research Yankeelov. In addition to her role with the Institute, Yankeelov, who possesses a PhD in experimental psychology with an emphasis in social psychology, is a professor and an associate dean of academic affairs at the U of L Kent School of Social Work.

To meet these burgeoning needs, the Institute has developed the Flourish Network, an initiative that seeks to improve the health and well-being of older adults living in rural Kentucky communities. The foundation of the Flourish Network is the Flourish Care Coordination Model. The Flourish Care Coordination Model is based on having indi­ viduals from diverse disciplines share patient information and insights to form a compre­ hensive care plan. “This innovative model integrates behavioral and clinical care plans with community care plans,” says Faul, exec­ utive director of ISHOA. Faul holds a PhD in social work, the distinction of Hartford Geriatric Scholar, and has over 20 years of experience in gerontology. She also serves as professor and associate dean at the U of L Kent School of Social work.

“The Flourish Network encompasses five programs that work together in a coordinated, multi-prong approach to provide integrated, interdisciplinary care to older adults,” explains

Joe D’Ambrosio, PhD, JD

Faul. The other initiatives in the Flourish net­ work address professional education, develop­ ment of community supports, and dementia awareness and outreach.

“You have to stand shoulder to shoulder with the primary care doctors and go through the cases and show them how you can really take care of older adults using a health team.” — Dr. Christian Furman Through the Flourish Program, patients receive coordinated care that begins with an in-home visit from a specially-trained health­ care navigator. “What we’re doing differently is meeting with the patients in their homes.

And, in meeting with the patients at home, we’re finding a lot of times there are per­ sonal issues that have to be addressed,” says D’Ambrosio.

During the meeting, the healthcare naviga­ tor performs an in-depth assessment, which often involves speaking with the patient, their caregiver, and family members. During the interview, they not only take the patient’s detailed medical history, but assess their med­ ications, nutrition and exercise, home and personal hygiene, environmental hazards, and psychosocial wellbeing. Traditionally, health­ care navigators were registered nurses, but the Institute has expanded their force to include social workers, behavioral health clinicians, and community workers. In 2018, they are going to begin to train a community work­ force that can provide health care navigation.

Upon completing the assessment, the

Senior Health

Pamela Yankeelov, PhD

healthcare navigator brings their findings back to the team at a case conceptualization meeting to decide how to best proceed in coordinating the patient’s care. Furman adds, “You have to stand shoulder to shoulder with the primary care doctors and go through the cases and show them how you can really take care of older adults using a health team.” All interdisciplinary providers of care to older adults benefit from this model, adds Faul.

The focus is to help all professionals to work within a transdisciplinary team when support­ ing vulnerable older adults living in the com­ munity with their health care needs. These professionals include primary care physicians, nurses, social workers, dentists, community support workers, and physical therapists.

Participating providers receive knowledge and skills focused on the unique challenges of caring for older adults in the community.

Primary care practices receive extra benefit as the Flourish team also guides them to maxi­ mize their understanding of Medicare billing codes and to work toward coordinated care in a new financial model that can greatly benefit medical practices.

The ultimate goal of this transdisciplinary approach is to ensure that the geriatric patient receives holistic, integrative care. D’Ambrosio states, “What is really exciting about the Flourish Model is that patients are finally able to receive coordinated care that involves not only their body, but also their mind, their heart, and their soul. So, we’re offering a holistic view of health within the Flourish Program.”

“Integrated primary care and communi­ ty-based models of care have the potential to improve outcomes in frail older adults,” says Faul. Instead of traditional outcome measures focused on a reduction of hospitalizations, ER

PHOTOS OF FAUL, FURMAN D’AMBROSIO BY ROB DENSMORE. YANKEELOV PHOTO BY NATALIE POPE

ISSUE #112 15

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Senior Health

visits, and improved disease management, the Flourish Care Coordination Model focuses instead on all the determinants of health promoted by the CDC: biological, individ­ ual health behaviors, environmental, health services, psychological, and social. “Our data shows that even though these vulnerable older adults did not necessarily improve in terms of actual health outcomes, they improve because

“We are driven by the idea that all patients should be able to flourish in spite of illness. As the body ages, it is more susceptible to disease. But, in spite of disease, all of us should be able to flourish.” — Dr. Joe D’Ambrosio

they have more support to perform activities of daily living.”

To illustrate, Furman recounts the story of a female patient who was thought to have severe dementia. A healthcare navigator realized that the patient was not suffering from dementia, but rather that the woman was on a multitude of unmonitored medications which caused the symptoms of dementia, had very poor nutri­ tion, and was suffering from social isolation.

Using the team approach, the Institute devel­ oped an integrative plan that involved modify­ ing her medications, addressing her loneliness, and connecting her with a food delivery service.

Furman says, “She turned around and now has no memory problems. Everyone thought she had dementia. She did not have dementia. She was lonely, and she was depressed and on all of these medications she didn’t need.”

Six months after the initial assessment, the healthcare navigator performs a follow-up interview to track patient progress. Over the last 18 months, the Flourish Program has

“Flourish is all about helping individuals achieve optimal aging experiences. And, who doesn’t want that?”

— Dr. Pamela Yankeelov taken 70 referrals, worked with 50 individu­ als, and gathered pre-and post-data assessment results for 25 patients. Of this data, Yankeelov says, “We are seeing changes—significant, positive changes in all determinates of health.”

This proves that ISHOA is meeting its mis­ sion as described by D’Ambrosio, “We are driv­ en by the idea that all patients should be able to flourish in spite of illness. As the body ages, it is more susceptible to disease. But, in spite of disease, all of us should be able to flourish.”

Yankeelov adds, “Flourish is all about help­ ing individuals achieve optimal aging experi­ ences. And, who doesn’t want that?”

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16 MD-UPDATE

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Senior Health

Plastic Surgeons Transplant Tissue Between Identical Twins Surgery was like a long-distance marathon, run by relay teams of surgeons and staff

Only three weeks after transplant surgery, surgeons joined arms with smiling patients. (l-r) Laxminarayan Bhandari, MD, Donald Graham, MD, Cheryl Adair, recipient, Uzair Qazi, MD, Katherine Fu, MD, Cherona Craig, donor.

BY GIL DUNN LOUISVILLE After watching her identical twin

sister go through chemo and radiation thera­ pies not once, but three times, Cherona Craig just wanted to do something. She opted to become a donor. And, on October 31, 2017, surgeons transplanted abdominal skin and fat from Cherona to her sister, Cheryl Adair, to create a new breast.

The surgical team consisted of plastic sur­ geons Michelle Palazzo, MD, and Donald Graham, MD, both from the Kleinert Kutz Hand Care Center; Terry McCurry, MD, from University of Louisville (U of L) Physicians; and four fellow surgeons. With a collaboration between the team and staff, the sisters’ com­ bined procedures took place over a 14-hour

timeframe. Each portion of the procedure was performed simultaneously in a double operating room at Jewish Hospital, part of KentuckyOne Health, with Craig’s surgery starting at 8:30 am and Adair’s at 11 am.

Background Adair, 47, was first diagnosed with breast cancer in 2009 at the age of 39. At that point, she had the cancer lump surgically removed from her right breast, followed by six weeks of radiation. Three years later, in 2012, she developed another tumor in her right breast. This time, Adair underwent a double mastectomy with reconstruction, fol­ lowed by more radiation. With her twin sister by her side throughout her journey, Adair thought she had breast cancer behind her.

PHOTO BY GIL DUNN

Unfortunately, yet another tumor appeared in the skin of her right chest last year. Adair had to have more skin removed, as well as, che­ motherapy. She battled infections and wound problems, and was ultimately left with the right half of her chest significantly deformed from scars and radiation. After recovering from her cancer treatments, Adair hoped to one day have her right breast rebuilt.

Though she had never undergone any sur­ gery, Craig felt the need to do something for her twin. Becoming a skin and tissue donor for a deep inferior epigastric perfo­ rator (DIEP) flap breast reconstruction, an advanced microsurgical technique that is used to rebuild the breast tissue lost during a mastectomy, was the one thing Craig knew she could do. This microsurgical technique ISSUE #112 17

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Senior Health

Michelle Palazzo, MD, plastic surgeon, has now added breast reconstruction to her practice.

has become an increasingly common way to reconstruct a breast from a patient’s own abdomen. This approach to breast recon­ struction, being gentler, is preferred to older breast reconstruction techniques. However, using a twin sister’s abdomen to create a breast has only happened five times in the world.

Palazzo, Graham, and McCurry worked in teams of two, additionally uti­ lizing the skills of microsurgery Using a twin sister’s abdomen to fellows Laxminarayan Bhandari, create a breast has only happened During the 14-hour surgery, two surgical MD, Katherine Fu, MD, teams switched back and forth between patients, five times in the world. and Uzair Qazi, MD, of the taking brief breaks to rest.

Christine M. Kleinert Institute; and plastic surgery fellow Nitin Engineer, Once the right abdominal flap was successfully Hospital and were discharged within three MD, from U of L. transplanted to Adair’s right chest, we could days. Since the twins are identical, there is “In the operating room, images of blood then cut away the damaged skin.” no need for Adair to use immunosuppressive flow to the abdominal tissue were visual­ Graham adds, “The left abdominal flap (rejection) medications, as in the case of other ized using a LUNA Fluorescence Angiography did not flow well through its tiny network of transplants.

System, both before disconnecting the flaps vessels even before being disconnected from This transplant surgery gave Adair back from Craig and after connecting the flaps to Craig, but an attempt was made to connect volume and shape to her breast. Craig will also Adair,” says Palazzo. “The right side of the it to Adair’s left chest. The left flap still did benefit with an improved abdominal shape, abdominal flap flowed well, so it was connected not flow well, so it was discarded, and a breast much like a “tummy tuck.” Using fat from first to Adair’s right chest. Using a double-head implant was returned to Adair’s left chest.” unwanted areas to transplant to her twin will microscope and tiny instruments and needles, Craig left the operating room around 6 produce a flatter, tighter abdomen. The twins we sewed together blood vessels the size of pm and Adair before midnight. The sisters continue to do well at home and have been spaghetti noodles with stitches the size of hairs. recovered together in a double room at Jewish seen weekly in the physicians’ office.

18 MD-UPDATE

PHOTOS PROVIDED BY KENTUCKYONE HEALTH

Upon completing his medical degree and family practice residency at the University of Kentucky, Dr. Breeding returned home to serve the people of Eastern Kentucky.

Breeding Success

Van Breeding, MD, and the Mountain Comprehensive Health Corporation do it all in Eastern Kentucky

BY JIM KELSEY WHITESBURG Van Breeding, MD, has always

been an early riser. He gets up at 4:30 am every day, arrives at the hospital at 5, completes his rounds by 7, exercises from 7 to 8, and then goes to work to see patients. It’s a routine he started as a child in Whitesburg, Ky., perform­ ing chores on the farm before going to school.

But, 3 am is early, even for Breeding.

However, when he was young and his grand­ mother was suffering from heart disease, he and his family would get up at 3 am and make the four-and-a-half hour drive to Lexington for her medical appointments. He never for­ got those trips.

“Those trips were just devastating,” Breeding says. “I saw how hard it was on her. I thought ‘this would be much better if we could do this right here in Whitesburg.’ I always had an interest in first aid when I was in Boy Scouts aid and just had a craving to see

if I could help people to be healthier and not have to travel so far to get good healthcare.”

Now, his dream of providing comprehensive healthcare to the people of Eastern Kentucky is a reality. Breeding serves at the Director of Clinical Affairs at Mountain Comprehensive Health Corporation (MCHC), headquartered in Whitesburg. What began as a little clinic in a trailer in 1971 has become a non-profit corporation of clinics located in Letcher, Perry, Owsley, Harlan, and Bell counties. In all, MCHC operates eight clinics, 16 schoolbased clinics, and the largest black lung clinic in the United States.

And, true to Breeding’s vision, the clinics strive to offer a full array of primary health­ care services, so patients can get the care they need without the extensive travel. Though Breeding, himself, traveled to Lexington to complete his undergraduate and medical degrees, as well as a family practice residen­ cy at the University of Kentucky, he always PHOTOS BY MALCOLM WILSON

intended to go back and serve the people of Eastern Kentucky.

“I always thought it would be better if I could manage everything my patient needed there at home, because we didn’t have very many specialists,” Breeding says of his deci­ sion to focus on family practice. “We needed more primary care doctors than we did spe­ cialists at that time. I always had an interest in being able to take care of the whole patient.”

MCHC offers a wide range of services, including family practice, internal medicine, pediatrics, OB-GYN, dental, and optometry.

Each clinic has a pharmacy. Appointments with behavioral health professionals, licensed clinical social workers, substance abuse coun­ selors, and psychologists are also available.

In addition, MCHC also offers specialty care, including critical care pulmonology, infectious disease, and cardiology. Visiting specialists include neurology, orthopedics, and nephrology.

ISSUE #112 19

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Senior Health

Breeding, whose wife Pauletta is a registered nurse, gets his determination to bring quality healthcare to the people of Eastern Kentucky by still being deeply rooted in his childhood and his connection to the community. “I’m kin to half my patients and the other half I grew up with,” he jokes.

But, to Breeding, community involvement “We try to find what barriers are limiting is no laughing matter. He and the staff at our patients from getting the best healthcare MCHC have committed themselves to being they can get and break those and provide those visible, active partners and leaders in the com­ services locally,” Breeding states. “We can offer munity. Breeding gives all of his patients his our patients everything they need. We can pro­ personal cell phone number and encourages vide their medical care in one stop.” fellow doctors to do the same. He also encour­ ages staff to be community leaders, coaches, A Commitment To and volunteers.

Community Healthcare “My practice is like a country doctor,” MCHC saw 40,000 unduplicated patients Breeding says. “I saw how our local family in 2017, totaling 200,000 visits. As a com­ doctors were able to thrive in the community. munity health center, MCHC receives about They were coaches and teachers and church $4 million per year. Overall, MCHC is a $25 members. We want to hire doctors who are million nonprofit operation, meaning any doctor leaders who take an active part in the profits are invested back into the clinic in the community.” form of facility upgrades, quality of patient One example of MCHC’s connection to the care, and staffing. While the size and scope community is the forming of the “Farmacy” are impressive, Breeding is most proud of the program. Recognizing that many locals were quality healthcare provided. taking up farming instead of working in the “Most community health centers are kind coal mines, MCHC saw a way to help the of looked at as the clinic that you have to go to local economy and their patients at the same because you can’t go anywhere else,” Breeding time. Through the program, any MCHC explains. “We wanted to change that image. patient with two or more chronic illnesses can We wanted to make our community health go to the farmer’s market and get $8 worth of center not the place that you had to go, but fruit and vegetables each week. That includes the place you wanted to go to.” every member of the family, all paid for

by MCHC. Breeding points out, Mountain Comprehensive Health Corporation offers a wide range of services, including family practice, internal medicine, pediatrics, “That’s a $250,000 program that puts money back into the farmers’ OB-GYN, dental, and optometry. pockets and helps our patients to learn to eat better.”

MCHC has responded direct­ ly to community health needs as well. Notified by Clinical Decision Support (CDS) that the rate of qualified patients who had their colonoscopy was a “dis­ mal” 19 percent, Breeding and his staff formed a task force and made patient education a priority.

Today, the percentage of patients ages 50 to 70 who have had colo­ noscopy screenings is up to 63

“We wanted to make our community health center not the place that you had to go, but the place you wanted to go to.”

20 MD-UPDATE

Dr. Van Breeding is the Director of Clinical Affairs at Mountain Comprehensive Health Corporation in Whitesburg, Kentucky.

percent. A similar approach has helped the clinics fight diabetes. Four years ago, less than 40 percent of their patients had their diabetes adequately controlled. With education and dieticians going to every clinic, that rate is now over 65 percent.

Being responsive and innovative are cen­ tral to MCHC’s goals of being a high-qual­ ity, one-stop shop for patients in Eastern Kentucky. Breeding, who was named Staff Care’s 2017 Country Doctor of the Year, says he and his staff are trying not only to make quality healthcare accessible, but also to break down misconceptions about the region.

“People in larger cities think that culturally, spiritually, financially, and educationally we are at a reduced level than where they are.”

Breeding elaborates, “Our patients may not have gone to college, may not drive the finest cars, or have the best clothes, but they have strong wills and desires to be healthier. They have great common sense. They are very intel­ ligent. They have never had the opportunities to be able to excel. But that’s changing.”

He goes on to say, “When people hear we’re from Eastern Kentucky, we want them to say ‘They know what they’re doing up there.

They’re making a difference and making it every day.’ We are going to continue to be innovative and barrier-breaking. We are going to continue to blaze this trail that we’re blis­ tering right now, no matter what happens.”

With so much to do, is there any wonder he gets up so early?

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Senior Health

Marty Luftman, MD, Transitions to a New Practice That’s Just Right

BY GIL DUNN LEXINGTON The Goldilocks moment is finding

the “just right” balance between life, work, and everything else. Upon transitioning to his new Lexington practice, plastic surgeon Marty J. Luftman, MD, achieved such a moment.

After 35+ years of solo practice, Luftman joined forces with M. Bradley Calobrace, MD, and feels he now has the ideal situation to continue his work in plastic, cosmetic, and aesthetic surgery. “I’m in a wonderful spa-like facility with the support of a full staff who help me with my surgical and non-sur­ gical patients on the days that I work,” says Luftman.

Luftman started his solo practice in Lexington in 1981. Previously, he was a student athlete at Brown University in Rhode Island; went to medical school at the University of Cincinnati College of Medicine; did his residency in general surgery at Wake Forest University in Winston-Salem, North Carolina; and then completed specialty train­ ing in plastic surgery at the Medical College

of Northern Ohio, now known as the Toledo School of Medicine. “We landed in Lexington because my wife Ginny drew a big red circle around Cincinnati, her hometown. She said we could live anywhere within that 200-mile circle. We visited Lexington and loved it.”

Virginia Luftman, PhD, LCSW, MSW, is a professor in the Department of Psychiatry at UK Healthcare.

The New Attitude about Cosmetic and Aesthetic Surgery Attitudes about plastic, cosmetic, and aes­ thetic surgery have changed radically over the years. For most of Luftman’s career, the majority of plastic and cosmetic surgeons wouldn’t operate on a patient who had under­ lying health issues such as smoking, obesity, pre-diabetes, or high cholesterol. “A patient has a much better outcome when they are healthy with a healthy lifestyle before cosmet­ ic surgery,” explains Luftman.

However, the general public didn’t realize underlying poor health factored into the cos­ metic surgical equation. Nor, did they grasp

Marty J. Luftman at his new practice location on Euclid Avenue in Lexington.

PHOTO BY GIL DUNN

how cosmetic surgery could lead to positive lifestyle changes and better health. Now, patients are more aware of this link. “There’s a much greater understanding that life is chal­ lenging, and how someone feels about them­ selves affects their health,” states Luftman. “A good self-image has a powerful and positive effect on someone who struggles with how they are seen by others and themselves. I believe that when you feel better about your­ self, you have more to give to others.”

He goes on to state, “I’ve seen that effect in my patients who come from many different walks of life, occupations, and family circum­ stances. Cosmetic surgery may not completely change your life, but it can certainly change your outlook.”

Scope of Practice and the Future of Cosmetic Surgery Throughout his career, Luftman has become an expert in aesthetic facial surgery.

“I really enjoy surgery that balances the facial features such as eyelid lifts, brow and face lifts, and chin implants.” Luftman notes that there are non-surgical and mini-surgical treatments that are commonly used, such as Botox fillers, radio frequency, and lasers. As options for aesthetic facial reconfiguration have increased, patients have become more educated and have a better understanding of what can and cannot be accomplished through aesthetic surgery and non-surgical options.

In Luftman’s opinion, breast reconstruc­ tion led the way for the current acceptance of cosmetic and aesthetic surgery, not only within the medical community, but also in the patient population. “After a mastectomy, no one argues now that breast reconstruction shouldn’t be performed if the patient wants it done. Oncologists and general surgeons saw the benefits that cosmetic surgery had on the patient’s well-being. It really set the tone for where we are today in aesthetic surgery.”

ISSUE #112 21

2018 EDITORIAL CALENDAR & OPPORTUNITIES Issue #112 (January)

YOU’RE AS HEALTHY AS YOU FEEL & LOOK

Internal Medicine, Geriatrics, Integrative Medicine, Prevention, Wellness, Plastic & Aesthetic Surgery, Dermatology

Issue #113 (February)

To participate, please contact Gil Dunn, Publisher GDUNN@MD-UPDATE.COM 859.309.0720

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HEART & LUNG HEALTH

Cardiology, Cardiovascular, Cardiothoracic, Pulmonology, Sleep Medicine

Issue #114 (March/April)

LET’S TAKE A MOMENT TO DIGEST THIS

Gastroenterology, Radiology, Endocrinology, Bariatric Surgery, Nutrition & Wellness

Issue #115 (May/June)

WOMEN’S & CHILDREN’S HEALTH

OB/GYN, Women’s Heart Care, Urology, Pediatrics, Prevention and Wellness

Issue #116 (July/August)

MUSCULOSKELETAL HEALTH

Orthopedics, Sports Medicine, Physical Medicine, Rehab

Issue #117 (October)

CANCER CARE

Oncology, Hematology and Radiology

Issue #118 (November/December)

IT’S ALL IN YOUR HEAD

Neurology, Pain Medicine, Ophthalmology, ENT, Psychiatry, Mental Health

Issue #119 (January 2019)

YOU’RE AS HEALTHY AS YOU FEEL & LOOK

Internal Medicine, Geriatrics, Integrative Medicine, Prevention, Wellness, Plastic & Aesthetic Surgery, Dermatology

*Editorial topics and dates are subject to change.

Mental Wellness

The Easiest Way to Make a Tough Decision

BY JAN ANDERSON, PSYD, LPPC

LOUISVILLE You might say I’m in the “change

business.” Most people seek me out because they want to change something in their lives.

This usually starts with some variation on these questions: “How can I get along better with myself?” and “How can I get along better with other people?

These aren’t really ordinary “problems,” where something is wrong and there’s a single, discrete solution or a clear choice based on a cost-benefit analysis. No, the people I run into are usually wrestling with “dilemmas.” They are asking themselves things such as, “Do I give up or keep trying in this relationship?” or “Do I stay with this career or change

course?” or “Do I try to have kids or not?”

These challenging, complex considerations can only be managed over time towards a resolution while still realizing there is no perfect solution.

As Dr. Russ Harris says in 10 Steps for Any Dilemma, “So, whichever choice you make, you are likely to feel anxious about it, and your mind is likely to tell you, ‘That’s the wrong decision,’ then point out all the reasons why you shouldn’t do it. If you’re waiting until the day there’s no feelings of anxiety and no thoughts about making the wrong decision, you’ll probably be waiting forever.”

But, know, there’s no way not to choose. If you’re thinking you haven’t made a decision, beware, you may just be on autopilot.

“Recognize that whatever your dilemma is, you’re already making a choice,” points out Dr. Harris. Each day you don’t quit your job, you are choosing to stay—until the day you hand in your resignation, you are staying in that job. Each day that you don’t leave your marriage, you are choosing to stay—until the day you pack your bags and move out of the house, you are staying in that marriage. Each day you continue to take contraceptives, you are choosing not to have children.

As the person sitting in front of me agonizes over competing priorities, risks, and shortand long-term consequences, I’m thinking, “And that’s just the external stuff.”

A Tale of Two Selves We’re dealing with the “Divided Self.” It’s a classic struggle between two opposite and equally valuable parts of our personality, with their own uniquely intelligent ways to make decisions and manage situations.

Here’s the problem. The parts of us that are in conflict may have equally valid insights and equally valuable strengths and skills, but most of the time they are not equally heard

“As we continue to lean on this trusty primary identity, it becomes more and more muscular, capable of drowning out the voice on the other side.”

— Jan Anderson or equally represented in the decision-making process.

Sometimes the less dominant part doesn’t get heard at all—and we’re not even aware of it. Most of us have a strongly-developed primary identity that is exquisitely designed to make life work for us. That’s how it got formed in the first place—to make things work. And, it does work, most of the time.

That primary approach may be the very best thing to do right now. But, it can be a problem if your primary identity gets a whiteknuckle grip on your ability to even consider all the options, weigh the pros and cons, and thus come to a resolution that you can live with and act on. As we continue to lean on this trusty primary identity, it becomes more and more muscular, capable of drowning out the voice on the other side. When push comes to shove, it can easily overwhelm and overrule our non-dominant side. Again, this is often happening outside of our fully-conscious awareness.

And, that’s what I don’t like about it.

Freedom, Choice, and Balance The primary identity can keep us stuck, falling again and again into the same old habitual patterns while consistently getting less than optimal results in our lives and relationships. What I’m interested in for my ISSUE #112 23

Mental Wellness

clients is freedom, choice, and balance. I want them to have the ability to stay the course or do something different and have the freedom to choose instead of being at the mercy of the primary part of their identity that’s calling the shots most of the time.

I’m not interested in trying to change my client’s basic personality or my own, for that matter. I just want the non-dominant part of us to have a seat at the table and its voice to be heard.

Paradoxically, I’ve found that this nondominant part of us doesn’t require an equal vote to create balance and harmony.

Here’s an example. Let’s say your primary identity is to approach life at only one speed —overdrive. But, sometimes you try too hard and it actually messes things up for you or you eventually hit a wall and lose steam. From a big picture standpoint, when you sense that it would be more effective to not push the river, wouldn’t it be nice to sometime be able to listen to the fainter voice inside that

“What I’m interested in for my clients is freedom, choice, and balance.”

— Jan Anderson

safer than doing something different, so you don’t rock the boat, even if the ship is sinking.

In this article, I’ve covered how the process works when you need to make a tough decision. In Part Two, I’ll talk about how we make that happen, including the easiest way to change something about yourself. Stay tuned!

knows how to be “in the flow?” Maybe you’ve observed that approach working for others, at times, and wish you could sometimes use it as well.

But, if you’re on primary identity autopilot, that thought may a fleeting one that quickly evaporates or never occurs to you at all.

Everybody gets that doing something different can be scary, but here’s what concerns me just as much. When you’re locked into your primary identity, you aren’t scared enough. The problem is your autopilot doesn’t feel scary when you’re in it. It feels reliable, familiar. It feels pretty safe. At least,

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24 MD-UPDATE

Complementary Care

Senior Health and Hearing Loss leads to conditions like diabetes, high blood pressure, and heart disease. Social isolation due to hearing loss has also been linked to higher rates of cognitive decline in the elderly.

Hearing loss can take a toll on the physical health of the elderly in the form of diminished personal safety, disease, or falls. Those with hearing loss might have difficulty hearing an alarm or a siren. In addition, they might not hear instructions regarding medication or

BY LISA MEEKER LEXINGTON Imagine being cut off from commu-

nication with your loved ones. Conversations happen around you, but you can’t really participate like you used to. It becomes easier to stay home rather than go out to a restaurant or social event because it is just too frustrating to try and hear what everyone is saying.

Unfortunately, this is the reality of hearing loss for many seniors every day. About 25 percent of those 65 to 74 years old have significant hearing loss. And, for those 75 and older, the number increases to 50 percent.

As a physician, you are aware of many senior citizens in your practice who have hearing loss. You know that more than any other sensory deficit, hearing loss closes a person off from other people. Problems that stem from

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It is a wonderful moment Doctor of Audiology Stacey High serves patients in Bluegrass Hearing Clinic’s Bardstown and Elizabethtown locations.

when a person cries tears of joy just for being able to hear the rustle of paper

hearing loss in the elderly include: • Depression • Withdrawal from social life • Loneliness • Anger • Decreased personal safety • Cognitive decline • Poor health Seniors with untreated hearing loss report a lower quality of life than those without hearing loss or those whose hearing loss has been treated with hearing aids. The emotional toll alone is devastating, let alone the toll on physical and social health.

All aspects of life are affected by all types of negative emotions. Those who are experiencing age-related hearing loss, quite often, find that their family relationships suffer due to their inability to hear adequately or fully participate in conversations. A person with hearing loss might be irritable, and lash out with frustration. Blaming others for mumbling or speaking too softly is common for those with age-related hearing loss, as are arguments over the volume of the TV. Social isolation often accompanies hearing loss and can also be detrimental to physical health. Those who are socially isolated are less likely to exercise or eat a healthy diet. This PHOTO BY TIM WEBB

or the clicking of a pen.

All of which they forgot made a sound.

— Stacey High other vital medical information. Also, studies have shown, due to balance issues, those with untreated hearing loss are three times more likely to suffer falls than those without.

In conclusion, hearing loss affects every aspect of life for seniors, from physical well-being to emotional health to family relationships. Fortunately, the solution may lie in a simple hearing evaluation done by a doctor of audiology.

Stacey High, AuD, CCC-A, states, “It is a wonderful moment when a person cries tears of joy just for being able to hear the rustle of paper or the clicking of a pen. All of which they forgot made a sound. Then, they come back in two weeks and tell you how much they have enjoyed hearing their family. And then, they come back for a six month and one year follow-up, and they are a different, much happier person. They get their life back and that’s amazing!”

ISSUE #112 25

Complementary Care

Mac Stone

Farm-U-See versus Pharm-A-Cy

Elmwood Stock Farm promotes whole health through whole foods.

BY MAC STONE The correlation between diet and disease is undeniable. Where else would the obesity epidemic come from? Where else would the rise in diabetes and increase in cardiovascular diseases and many digestive disorders come from? How long will the focus be on synthetic chemical pharmaceuticals that treat one specific aspect as the solution to these problems instead of a holistic long-term fix for such a complex organism as the human body and what ails it? Why does society consider it normal for people to be drug users, have coronary artery bypass surgery, even open-heart surgery, stomach stapling, gluten/lactose intolerance, daily insulin injections, kidney dialysis, food allergies, routine colonoscopies, but think of 26 MD-UPDATE

those of us that shop the farmers market and eat kale salads as weirdos?

The ads that inundate us during a football game on television, espousing the benefits of some miracle drug, use more of their airtime warning us of all the potential side effects — some even warning users to not stop taking them even if they are having unintended consequences — than they do describing the benefits. When ‘users’ routinely take numerous drugs, the matrix of complications is even more compounded.

While good fats are demonized, sugar, fake sugar (high fructose corn syrup), and fake fake sugar (pink, yellow, and blue packets — whatever they are) are seen as normal. The politics behind this misinformation is criminal, much like the actions of the tobacco industry. Then,

there are the thousands of food additives, processing aids, and food technologies that produce products never seen in nature, which are all now endemic in processed foods and considered normal or mainstream. On top of this, pesticide use on produce, some which is systemic through the irrigation water, is legal and considered normal. This dangerous practice is even required for commercial produce distribution, and yet organic farmers are the oddballs. There is much more work to be done in assessing the impact of genetic manipulation of our food supply and the effect on human health, but GMOs are highly problematic. You can learn more about the topic on our Elmwood Stock Farm website.

At the end of the day, the ingestion of toxins in our food supply is up, as is the rate of can-

PHOTO BY SARAH JANE SANDERS

cer. Coincidence? I think not.

The evidence emerging out of the human microbiome project and the relationship between gut health and immune health should be the focus of nutritional research. In organic farming, the robustness and diversity of the microbes in the soil not only supply the crops the nutrients they need to grow, but stimulate a robust and diverse plant biome for them to thrive. Any reasonable person would conclude that healthy soil equals healthy plants equals healthy humans. Sure it is complicated, but what we see in nature indicates that we are what we eat.

We at Elmwood Stock Farm, along with several other organic farms in central Kentucky, are part of a pilot project where employers provide vouchers for their staff to join a CSA,

which provides a weekly delivery of organic vegetables throughout the growing season as a wellness benefit. The preliminary results show that employees who consistently consume fruits and veggies over an extended period of time spend less on pharmaceuticals and make fewer trips to see a medical professional than those that do not. Does that not make food medicine?

Whole foods contain hundreds, if not thousands, of nutrients necessary at the cellular level. How many research studies must be conducted about the benefits of consuming fruits and vegetables on a regular basis before physicians insist patients do so? If someone is stricken with an injury or insidious disease, wouldn’t we want their body to be strong and well-nourished in order to help fight?

Wouldn’t we all rather spend time in our kitchen, preparing and consuming tasty foods instead of sitting in a waiting room full of other sick people before heading off to the drug store? We can no longer assume that a multivitamin or synthetic pill is a suitable replacement for consuming whole foods. Let’s focus on the Farm-U-See, and make the Pharm-A-Cy a thing of the past.

Mac Stone, his wife, Ann Bell Stone, and extended family operate Elmwood Stock Farm in Scott County, Kentucky.

Mac was the executive director of marketing for the Kentucky Department of Agriculture, administering the Kentucky Proud program among many others. He is former chair of the U.S. Department of Agriculture’s National Organic Standards Board. His focus is on farming and marketing organic foods for the family and working with nonprofit agriculture and food organizations.

Mac can be reached at 859.621.0756.

ISSUE #112 27

News Baptist Health Foundation Names Mary Michael Corbett Executive Director LOUISVILLE Mary Michael Corbett brings

Robert Bolli, MD

Roberto Bolli, MD, receives the prestigious 2018 Honorable Maestro Award LOUISVILLE The

recipient of the 2018 Honorable Maestro Award, awarded by the Kentucky Chapter of the American College of Cardiology, will be University of Louisville (U of L) cardiologist and researcher Roberto Bolli, MD. The award, which is the chapter’s highest honor, recognizes achievements in the field of cardiology and medicine, as well as leadership in the regional and national cardiology community, mentorship, charity work, and vigilant care of the sick.

In addition to serving as director of U of L’s Institute of Molecular Cardiology, Bolli is a scientific director of the Cardiovascular Innovation Institute and a professor and chief of the Division of Cardiovascular Medicine at the School of Medicine.

In 2017, Bolli received a $13.8 million research grant from the National Institutes of Health to study a revolutionary treatment of heart disease, which focuses on repairing the heart and curing heart failure using a patient’s own stem cells. Last year, at the annual meeting of the American Heart Association in Anaheim, California, Bolli led the Stem Cell Summit.

Bolli also serves as editor of the journal Circulation Research. This official journal of the American Heart Association is considered the world’s leading journal on basic and translational research in cardiovascular medicine.

28 MD-UPDATE

her impressive background in business and brand development and public affairs to her new role as the executive director of Baptist Health Foundation Greater Louisville. Prior to joining Baptist Health, Corbett served as system vice president for government relations with Norton Healthcare; chief marketing officer with Frost Brown Todd; and marketing director with Wyatt, Tarrant & Combs. During Martha Layne Collins’ tenure as Kentucky’s Governor, Corbett held a role as senior adviser.

Corbett also possesses an extensive knowledge of corporate strategic philanthropy, which will allow her to fulfill the organization’s new plan, which will focus on greater philanthropy to support the missions of both Baptist Health Louisville and Baptist Health La Grange.

Within the community, Corbett currently serves as chairs of both the Kentucky Arts Council and Leadership Kentucky board of directors. Additionally, she is a member of the Judicial Nominating Commission for the Appellate and Supreme Courts of Kentucky and the Rotary Club of Louisville.

Mary Michael Corbett

Clint Kaho, FACHE, MSHA, MBA

Baptist Health La Grange Names Clint Kaho President LA GRANGE After serving as interim president

at Baptist Health La Grange since August of 2017, Clint Kaho, FACHE, MSHA, MBA, has been named president. Kaho succeeds Chris Roty, who was recently named president of Baptist Health Paducah. In his new position, Kaho will serve as president of Baptist Health La Grange and as a vice president of Baptist Health Louisville to lead cardiovascular services at both hospitals.

As vice president at Baptist Health Louisville, a role he has held since 2011, Kaho oversees cardiovascular services, is instrumental in helping establish the new infusion center at Baptist Health La Grange, and active in the expansion and renovation of the Baptist Health Louisville Emergency Department. As vice president, Kaho also guided the transition of Floyd Memorial Hospital and Health Services, now Baptist Health Floyd, into the Baptist Health family in 2016.

“It is both an honor and privilege to be entrusted with the role of president at Baptist Health La Grange,” said Kaho. “I’m fortunate to be joining a team that demonstrates its commitment to the care of our patients and the overall health and well-being of our community on a daily basis. As a resident of Oldham County, I’m looking forward to now being an integral part of continuing and growing the Baptist Health mission and vision to the community I call home.”

PHOTOS PROVIDED BY UNIVERSITY OF LOUISVILLE AND BAPTIST HEALTH

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

Markey Unveils New Inpatient Floor to Enhance Patient Stays LEXINGTON To meet Kentucky’s growing need,

in December of 2017, the University of Kentucky Markey Cancer Center unveiled a new inpatient floor occupying the Albert B. Chandler Hospital Pavilion A, with units in each tower.

“For more than thirty years, Markey has been providing exceptional cancer care to the citizens of Kentucky, and our patient volume has increased dramatically in the past several years,” says Dr. Mark Evers, director of the UK Markey Cancer Center. “This is the first time we›ve been able to expand clinical care into new space. We are thrilled to open up this state-of-the-art facility for our inpatients, which has been specifically designed to cater to the needs of our patients and staff alike.”

Located on the 11th floor of Tower 100, the James and Gay Hardymon Patient Care Unit is a 31-bed unit for medical and surgical oncology patients. In Tower 200, the 32-bed Darley Blood and Marrow Transplantation Unit will house patients who have undergone a bone marrow transplant, as well as patients with blood cancers. Between the two units, eight

U of L Implements Curriculum to Teach the Signs of Human Trafficking LOUISVILLE. The National Human Trafficking

Resource Center Hotline documented 8,042 cases of reported trafficking in 2016. With these statistics, it imperative healthcare professionals know how to spot the signs and intervene. So, along with Harvard University and the University of South Florida, the University of Louisville (U of L) has developed and initiated a curriculum designed to help future health care professionals recognize victims of human trafficking.

“One survey shows that sixty-three percent of HCPs, including physicians, nurses, social workers and physician assistants, did not have training on how to identify and intervene in human trafficking situations,” says Olivia F. Mittel, MD, associate professor

new cancer inpatient beds have been added.

In order to facilitate a multidisciplinary approach to care, the floor contains conference spaces where a wide array of specialists can meet and discuss the patient as a team. In addition, to minimize the time spent away from the patient’s bedside, each room is equipped with a nurse work station right outside the door.

The new rooms are also substantially larger, and many have expansive windows to provide natural light and outdoor views.

Additionally, the two units boast the family comfort center, which provides an area for families to congregate outside the clinical space; a workstation-equipped business center where patients and family can fulfill job responsibilities; and the family suite, a hotel-

style room directly connected to a patient room. For a nominal fee, loved ones can live here throughout the patient’s stay To further enhance their treatment experience, patients on the new floor will have access to both oncology rehabilitation and integrative medicine services, including pet therapy, art therapy, music therapy, and narrative medicine.

“Some of our patients may stay between twenty and forty days as an inpatient,” says Dr. Gerhard Hildebrandt, division chief of hematology and blood and marrow transplant for Markey. “The new floor lets patients feel more at home. If you’re away from your family and you undergo such aggressive treatment, it’s important that you have an environment where you feel very comfortable.”

of pediatrics at U of L and Norton Children’s Hospital. “Providers must be educated about the issue of trafficking, including how to recognize it in the clinical setting.”

To prepare students Olivia Mittel, MD to identify the signs of human trafficking and know how to best intervene, the U of L School of Medicine developed a curriculum that includes a forensic medicine lecture to impart basic facts; online learning; medical documentation; and standardized patient-based simulations, in which an adolescent female patient presents with the common characteristics of a victim of human trafficking.

“We want to ensure that all students receive the training,” Carrie A. Bohnert, MPA., direc-

tor of the standardized patient program at U of L says. “Every medical student, regardless of their chosen specialty, must be able see human trafficking when it presents and intervene for Carrie Bohnert, MPA the victim.”

The initial project was implemented over a 16-month period, and the data gained is now being thoroughly evaluated and shared. Along with Hanni Stoklosa, MD, of Harvard University and Michelle Lyman, a student at the University of South Florida’s Morsani College of Medicine, Mittel and Bohnert compiled their research in a paper titled, “Medical Education and Human Trafficking: Using Simulation,” which was recently published in Medical Education Online.

PHOTOS PROVIDED BY UNIVERSITY OF KENTUCKY AND UNIVERSITY OF LOUISVILLE

ISSUE #112 29

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Events

Shriners Corporate Council Celebrates a Year of Giving VERSAILLES The Shriners Corporate Council, a group of

Central Kentucky business leaders, celebrated a year of giving to the new Shriners Medical Center at a festive holiday event at The Kentucky Castle in Versailles on December 7, 2017. Over 100 members, guests, and Shriners orthopedic surgeons attended.

In 2017, the Council funded a grant of $90,000 for the surgical mini C-arm and a grant of $47,485 for the orthopedic trauma instruments for use at the medical center. The summer event, “An Evening in a Magic Garden,” raised over $76,000 to begin funding the children’s garden and playground at the new facility on the UK campus and $800 to help send a patient ambassador to the Shriners Golf Open.

The Kentucky Castle was purchased by Drs. Matthew Dawson and Brian Adkins, along with several other co-owners, in July of 2017. Since acquiring the property, a major renovation has taken place transforming The Castle into a farm-to-table restaurant, boutique hotel, and event space.

Scott Riley, MD, with wife, Kathy Riley, and Janet Walker, MD.

Jackie Dawson, philanthropy assistant for Shriners Medical Center Lexington, welcomed guests to the annual holiday party.

Kevin and Dawn Bazner. Kevin Todd and Karen Ziegler. Todd is the is a Shriners Corporate Council Central Kentucky market president member and president, and for Republic Bank and a member of CEO of A&W Restaurants, Inc. the Shriners Corporate Council.

Tony Lewgood, CEO, Shriners Medical Center Lexington, Leslie Iwinski, and Chip Iwinski, MD.

Jeff and Diana Koonce embraced the holiday spirit. Jeff is 2018 chair of the Shriners Corporate Council and city president for WesBanco Lexington.

Vish Talwalker, MD, with Alyssa and Zachery Sterling. Alyssa is the daughter of Leslie and Chip Iwinski, MD, chief of staff, Shriners Medical Center, Lexington.

PHOTOS BY JOE OMIELAN

Claire and Ryan Muchow, MD; Brian Adkins, MD, UK Emergency Medicine, and proprietor of The Kentucky Castle; and Elizabeth Hubbard, MD, enjoyed the festive holiday atmosphere.

ISSUE #112 31

Events

The Nude is Back to Its Most Bare Form LEXINGTON For over 30 years, the Lexington Art

League has continued to push the boundaries beyond the traditional “figure exhibition” toward a deeper exploration of the human experience and form. On January 26, the Art League will present The Nude: Brutal Beauty, a stunning survey of the figure, touching upon our innermost instincts that crave satisfaction, pleasure, and comfort.

This year, The Nude is stripped down and back to its most bare, featuring works that seek to convey a universal rawness that reveals our desires and limitations, while boldly approaching the way we experience

32 MD-UPDATE

the human form. For the Art League, The Nude exhibition connects deeply to the roots of the organization, which has been a catalyst for advancing contemporary visual arts, throughout the region, for over 60 years.

While this exhibition has a long history, this year’s installment will challenge its viewers to examine the motivations and desires that are part of our collective human experience.

“The title for the exhibition was inspired

by Patrick Smith, a Lexington artist who I met with a year ago to discuss his newest body of work,” says Stephanie Harris, the Art League’s executive director. “Patrick’s ability to create hyper-realistic works that exude an astonishing authenticity is unmatched, and to me these works seems to communicate on a very deep and primal level.” Harris goes on to state, “Smith’s studio practice is very unique in the way he works with his subjects. For example, he may ask them to do

PHOTOS PROVIDED BY LEXINGTON ART LEAGUE

something that they find satisfying or he will incorporate something that is important to them within the composition. This approach has an astounding result, leaving the works resonating with life and energy upon their completion.”

The entire collection of Smith’s recent works will be seen together for the first time during the The Nude: Brutal Beauty exhibition. Featuring more than 80 works of art, culled from over 1,000 submissions, The Nude: Brutal Beauty, which is supported

by MD-Update will feature works by artists ranging from local to international in scope.

The Nude Opening Celebration will provide guests with an opportunity to feed their senses on all things brutal and beautiful during the Bacchanalian-Fest on January 26 from 7-11pm at the Loudoun House Galleries.

For more information visit the Art League’s website at www.lexingtonartleague.org.