Kentucky Doc Fall 2020 by Rockpoint Publishing

fall 2020 • volume 12• issue 3

COVID-19 The Effect on Society

PROFILE

Kraig Humbaugh MD Lexington’s Commissioner of Health heads the local effort to address COVID-19

Testing Methods Exploring the use and limitations of current COVID-19 testing

Returning to School Is Kentucky ready for the classroom in the era of COVID-19?

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CONTENTS P R OFI LE I N COMPASS I ON The Community is My Patient Kraig Humbaugh MD • PAGE 5 SARS CoV2 (COVID-19) Testing: Methods, Use, and Limitations • PAGE 8 Returning to School in the Era of COVID-19 • PAGE 12 PHYS IC IA N HEALTH AND WE L L BE I NG Mindfulness for Kids • PAGE 16 CO M MUNI T Y N E WS • PAGE 22 Teaching our Children in the Middle of a Pandemic • PAGE 26 A Warriors Story: Kentucky High School Football During COVID-19 • PAGE 28

EDITORIAL

BOARD MEMBERS Robert P. Granacher Jr., MD, MBA editor of Kentucky Doc Magazine Tuyen Tran, MD John Patterson, MD Thomas Waid, MD Nicholas Coffey

STAFF Brian Lord Publisher David Bryan Blondell Independent Sales Representative Jennifer Lord Customer Relations Specialist Barry Lord Sales Representative Anastassia Zikkos Sales Representative Kim Wade Sales Representative Janet Roy Graphic Designer Aurora Automations Website & Social Media

FROM THE

EDITOR Robert P. Granacher Jr., MD, MBA, Editor-in-Chief, Kentucky Doc Magazine

Welcome to the fall quarterly issue of KentuckyDoc Magazine. This quarter, we are again focusing on COVID-19 and its negative effects upon our society. The first article is by LMS member, John Patterson, M.D. who profiles LMS member, Kraig Humbaugh, M.D. Kraig is Lexington’s Commissioner of Health, and he is a former pediatrician who shifted his career to Public Health and has been trained in Public Health. He leads our local effort to address the current public pandemic. This is a comprehensive profile of Dr. Humbaugh, and Dr. Patterson covers his early life background, his mission in Public Health, and his mission to help students and patients in Fayette county. The next article is by a new editorial committee member and LMS member, Terry Clark, M.D. Terry, has been tasked with giving us a review of COVOD-19 testing including methods, uses, and limitations. Terry takes us rapidly through various testing techniques that are available at this time, and as a former pathologist, he is well versed in these matters. Following Terry’s article is an article by Dr. Granacher, also an LMS member. Dr. Granacher focuses his article on our children returning to school in the era of COVID-19. He first looked at national opinions of academic pediatricians and parents and contrasted this with local opinions of Fayette County parents and those of Superintendent Caulk. Dr. Granacher was not able to directly communicate with Dr. Caulk, and he used information from the local press covering lectures and town meetings that Superintendent Caulk has given. Following the aforementioned article comes again an article by LMS member, John Patterson, M.D., wherein he teaches us about using mindfulness for children, as well as their parents, teachers, and physicians. Dr. Patterson takes us stepwise through use of mindfulness by children and instructing children how to use mindfulness to reduce the alarming level of stress that is currently in our country, including in our children. I dare say, except for a few of us who spent our early childhood exposed to World War II, the United States has never had such a stressful event for its children. Next, Tracy Francis gives us an article about teaching our children in the middle of a

pandemic. Tracy is experienced in education and also is one of the newer members to the LMS Editorial Board of KentuckyDoc magazine. She takes us through the scariness of teaching school from home within the context of a worldwide pandemic. Finally, is an article by a new member of the LMS Editorial Board, Nicholas Coffey. Nicholas is currently a second-year medical student in the Bowling Green Division of the College of Medicine, University of Kentucky. He gives us a glimpse into Kentucky high school football during COVID-19. As Nicholas was a college football player and a high school football player, he is well versed in the insider functions of high school and college football. He brings to us a perspective that most of us who played high school or college sports have long forgotten. Please enjoy this edition of KentuckyDoc magazine. You may add it to the COVID-19 information that you are requiring as practicing physicians, mothers and fathers, and members of our Central Kentucky community. Stay well, Robert P. Granacher, Jr, MD, MBA

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© Copyright Kentucky Doc Magazine 2020. All rights reserved. Any reproduction of the material in this magazine in whole or in part without written prior consent is prohibited. Articles and other material in this magazine are not necessarily the views of Kentucky Doc Magazine. Kentucky Doc Magazine reserves the right to publish and edit, or not publish any material that is sent. Kentucky Doc Magazine will not knowingly publish any advertisement which is illegal or misleading to its readers. Kentucky Doc Magazine is a proud product of Rock Point Publishing.

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PROFILE IN COMPASSION

The Community is My Patient Kraig Humbaugh MD is Lexington’s Commissioner of Health. He is a former pediatrician who shifted his career to public health. He heads the local effort to address the current COVID-19 pandemic.

By John A. Patterson MD, MSPH, FAAFP When (how old) and why did you want/ decide to be a doctor? "I grew up in rural southern Indiana and attended public schools. No one in my family was a practicing healthcare professional, so I don’t know how I got the idea that medicine could be a career choice. It was a gradual realization; it wasn’t like a light bulb going off or a bolt of lightning striking me. While I was spending a year in New Zealand as a Fulbright scholar studying biochemistry after college, I began to understand more fully that I enjoy being a generalist more than I do being a specialist who concentrates and knows everything about one area of specialty. I thought I would be more suited to working broadly

as a medical professional than as a basic scientist doing research at the bench. At the same time, being a physician allows me to read and evaluate the scientific literature and translate it into practice." Why public health? What does it mean to you to be a public health physician? "My career pathway to public health has been roundabout. I trained as a pediatrician and spent several years in a private, single specialty practice in the Nashville area. I don’t remember much specific public health training in medical school, but we medical students were exposed to a wide array of disciplines. During med school, I often hung out with students who were pursuing public health degrees at the affiliated public health

school, so through them, I was aware of public health and its mission. Several years into my pediatric career, I decided to stretch myself by leaving a wellestablished pediatric practice and taking a position at a Western-style medical clinic in Moscow that got its start after perestroika. It was probably not as much of a stretch as it might seem. I had taken Russian language courses in college, had done a short summer study abroad program there, and it seemed like an exciting adventure to embark on. I think almost all pediatricians consider themselves public health practitioners because of our emphasis on prevention, wellness and working with families. And my KRAIG Continued on Page 6

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Kentucky

KRAIG continued from Page 5

experiences as an American physician in Russia further helped lead me to return to school to study for a graduate degree in public health and launch a career in more traditional public health practice. As a public health physician, I view the community as my patient. Because I am a physician, I can appreciate firsthand that the medical care and environment that produce individual wellness help influence population health. Our dedicated public health team helps educate and influence people to do the right thing for their health." Have you ever felt burned out or compassion fatigue? "I have felt worn out or less able to function optimally, especially when I don’t get the sleep I need. With me, it can take the form of being more irritable with colleagues and having less tolerance for others’ viewpoints. The burden of thinking that if we could just do more, we could save more lives, can be stressful. The current pandemic is a good example. Even in wartime, though, people are allowed to take some breaks and have some “down time” to relax, if we want to be as effective as we can be in fighting the enemy." How have you handled stress/burnout/work-life balance? What is your go-to stress reliever? "In a helping profession, boundaries between home and work life can often blur, making it especially important to set aside wellness time.

Swimming is a reliable stress reliever, and one exercise I really enjoy participating in. For me, being in the water is calming, therapeutic and almost meditative. Aquatic centers were closed early in the pandemic and my regular morning swim routine was interrupted, which was a real challenge. On the other hand, it gave me the opportunity to pursue land-based strength training and calisthenics at home. Pools have now re-opened and I am back to my morning swims. I tend to laugh a lot at work. I find that seeing the humor in situations helps promote camaraderie and relieve tension at work. Also, my faith enables me to stay centered. Support from my faith community and my family and friends has been especially vital to my well-being during the pandemic." Describe your personal mission, purpose, values and how you express them in your job "This is a tough one. I strive to optimize my performance and that of our staff by consistently modeling reliability and responsibility for those we serve. My objective at work is to move the health department forward in its mission to help Lexington be well. I’m often striving for something that’s just a bit out of reach. My goals aren’t always realized exactly as I envision them. Public health professionals recognize the realities of the world we live in and try to achieve our objectives working in the confines of those realities. The constantly evolving challenge of this pandemic illustrates the grey zone public health professionals work in. Public health is

About the author Dr Patterson is board certified in family medicine and integrative holistic medicine. He teaches mindfulness-based stress reduction (MBSR) for the University of Kentucky Wellness Program and Saybrook College of Integrative Medicine and Health Sciences (Pasadena). He operates the Mind Body Studio in Lexington, where he offers classes and consultations for people with stress-related conditions and burnout prevention for health professionals. He can be reached at www.mindbodystudio.org.

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TEST SARS CoV2 (COVID-19)

METHODS, USE, AND LIMITATIONS By Terry Clark, MD, FCAP The technology and applications for SARS CoV2 testing is changing so rapidly that it is impossible for community physicians and the general public to get a clear picture of testing realities.

There is a morass of media coverage, corporate product promotion and government information that is often contradictory and incomplete. Since there are few independent clinical evaluations of testing products in peer-reviewed journals, it is even difficult for specialists in the field to stay current. This article is an attempt to present the most current

information available as of September 8th. The material is summarized predominantly from a review article in the August issue of the College of American Pathology Today magazine.1 I have included additional information gleaned from multiple specialist webinars and test manufacturer technical documents as well. It is important to note that all of the

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TING Most epidemiologists estimate at least 2 million tests per day are needed under current infection rates.

tests were released outside of the usual FDA approval process for diagnostic tests. They were instead released under Emergency Use Authorization (EUA) after March. There was an urgent need for tests to confirm SARS CoV2 infection as U.S. cases overwhelmed the testing capacity of the Center for Disease Control and Prevention (CDC) laboratories. Polymerase Chain Reaction (PCR) for SARS CoV2 RNA is the most frequent

test type used to confirm diagnosis of Covid-19 disease. This is the most sensitive and specific method of testing to date. Several commercial PCR platforms had years ago received formal FDA approval for use in diagnosing many infectious agents. With this experience, several established testing companies were able to rapidly adapt their instruments to Covid testing. Many less experienced companies and research institutions also developed new

tests and applied for EUA. The FDA website currently lists 163 laboratory developed PCR tests with EUA approval for diagnostic use. The PCR process generates many copies of the virus nucleic acid code. This enables the method to detect what was originally very low concentrations of virus. Results are qualitative; with a positive, negative or equivocal result. TEST Continued on Page 10

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Unfortunately, clinical sensitivity has been questioned with one study finding up to 30% false negative rates. Most false negative cases are thought to be due to inadequate sampling.

TEST continued from Page 9

How good are these PCR tests? In their EUA application most companies document analytic sensitivity at the lowest limit of detection (LOD) of 97% or greater. However, LODs for different brands of PCR are listed from about 1006000 viral genomes/ml of assayed fluid.2 Symptomatic patients usually shed virus for about 5-7 days at levels well above these LODs. However, levels drop markedly after that, although some patients remain positive for weeks. Asymptomatic patients often shed virus at numbers equal to early symptomatic patients, but many show lower levels. Methods target variably 2 to 4 gene sequences that are thought to be rare sites of mutation. Thus, it is not surprising that occasionally specimens with low virus load may result as qualitatively “positive” on one machine but “negative” on another. This can be also be due to repeat testing at later days, sampling techniques, delays in transport, or conditions of transport to the testing lab. Additionally, most large labs use more than one brand of PCR test. Testing supplies continue to be seriously limited, and this allows labs to have at least one machine with all the components needed to be up and running. This means even within the same laboratory; discrepant results sometimes occur when virus load is low. The tests do not distinguish infectious virus from “dead” virus or RNA fragments present in later stages of disease. This causes uncertainty as to whether the PCR test can be used to tell if a patient is actively contagious during a patient’s recovery phase. In order to test large numbers of specimens efficiently, most machines run samples in batches and require 4-6 hours for each batch. One large reference lab tests 200,000 specimens daily. National reference laboratory turn-around times currently range from 2 to 6 days. Longer delays, once common, are now infrequent but do occur. Unfortunately, traditional PCR turnaround times are too long for diagnosis of symptomatic patients in the ER. Faster methods of PCR are now available; one test within 15 minutes. Many large hospitals (and the White House) have

these machines. Unfortunately, clinical sensitivity has been questioned with one study finding up to 30% false negative rates.3 Other laboratories have seen similar possible false negative rates. Most false negative cases are thought to be due to inadequate sampling, perhaps due to dry nasal passages, excessive mucus or inflammation, timing of the sampling or delays in transport rather than significant analytic failings. Still, there remains an urgent need for rapid testing in ERs and other point-of-care (POC) settings, especially given the shortage of rapid PCR testing capacity and PCR supplies in general. Currently machines, as well as other testing supplies, are distributed under the control of the White House Coronavirus Task Force, through the Health and Human Services Department (HHS). Rapid tests for SARS CoV2 using viral antigen detection rather than nucleic acid sequences by PCR are now available. It is hoped these may help expand national rapid on-site testing capacity. These antigen tests are inexpensive and can be done in a wide variety of settings with results in 5-15 minutes. Some can be read visually. There are four that have received EUA from the FDA. Sensitivity is not felt to be as high as PCR methods, most reported as 80-90% analytic sensitivity. Most of the antigen tests are not reliably positive after 5-7 days of symptoms, so physicians will often order confirmation of negative tests by PCR as soon as possible. Again, I do not find independent, peer-reviewed clinical evaluation in asymptomatic individuals published. Their utility is predominantly speed in urgent settings without rapid PCR availability and their low cost. Recently, HHS has contracted for purchase of one rapid antigen test. The company claims 97.5% positive analytic sensitivity in SARS CoV2 infections.4 To my knowledge details of those studies have not been published in any medical journal. The contract calls for 150 million tests by the end of December, to be produced at a cost of $5 per test. There appear to be government plans to have these rapid antigen tests available for screening in schools and long term care facilities. Private sector employer

on-site use as well as point-of-care clinical use is promoted by the company. The company also markets a phone app which interfaces with the test. They anticipate that eventually some entities will require negative Covid status for entry and the app will serve as documentation. In summary, SARS CoV2 testing capacity in the US continues to grow rapidly. Current testing is at about 1 million tests per day. Most epidemiologists estimate at least 2 million tests per day are needed under current infection rates. Expectations are that during the fall and winter the need may reach 7 million per day, partly because of influenza presenting with almost identical clinical features. Testing is also increasing due to lessening of the restrictions on social and business interactions which will result in more new infections, contact tracing is expanding, and elective surgeries resume. Businesses in general, long term care facility staff, prisons, the military, universities, professional and college sports are now using or investigating frequent testing programs. Testing in K-12 schools presents special problems. Pediatric cases in the US have been kept to a minimum due to spring school closings, so the real epidemiology in those age groups is still unclear. CDC guidelines for in-person school does not include any recommendations for or against testing at the time of research for this article. References 1. Titus, K., College of American Pathology Magazine, The Laboratory Tests of Pandemic Summer. CAP Today, 2020 08:1, College of American Pathology Publishing Co. Available at: https:/CAP. org/publications/CAP Today/August 2020 issue/page 1. 2. Prinzi, Andrea. False Negatives and Reinfections: The Challenges of SARSCoV-2 RT-PCR Testing. https://asm. org/Articles/2020/April 27 3. A. Bassu, et al. Performance of Abbott ID Now Rapid Nucleic Acid Test….,DOI: 10.1128/JCM.01136-20 4. Abbott Laboratories, press release. Aug 26, 2020.

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Returning to School in the Era of COVID-19: National Opinions of Academic Pediatricians and Parents vs. Local Opinions of Parents and Superintendent Caulk By Robert P. Granacher Jr., MD, MBA Stanford University pediatrician, Jason Wang, M.D., Ph.D. published an opinion piece in the Journal of the American Medical Association Pediatrics that K-12 schools should aim to reopen in-person classes during the 20202021 school year.1,2 The COVID-19 pandemic has significantly affected K-12 education in 2020.3 K-12 virtual schooling is not suited for all students or all families. Individual students need to be motivated, organized, and supported. Differences in their environment, meaning their access to instructional support as well as their internet access, can cause significant variations in school success. While research is scant, one review does indicate that specific teaching strategies used in online and blended environments can have a dramatically positive effect on outcomes.4 These authors have found in their research that online learning can be a more suitable solution than attending face-to-face in school, especially when a student may experience frequent absences due to illness and/or frequent visits for chronic health management. Moreover, it has been shown that children with special healthcare needs feel more in control of their education when participating in online learning.5 Black et al. note that many schools are still considering online or blended instruction as a necessary alternative in the COVID-19 environment.5 Also, many families may be

considering whether some or all of their children’s current or future education should take place online. Thus, parents should evaluate the unique strengths and needs of their child (children) by considering the following questions: • Can the child maintain a study schedule and complete assignments with limited supervision? • Would their child be able to ask for help and effectively communicate with a teacher via telephone, text, email, or video? • Does their child have an intrinsic drive to learn skills, acquire knowledge, and complete assignments? • Does their child possess foundational reading, writing, math, and computer literacy skills? Parents should also learn more about the virtual school options available to them. They should seek to understand the following:5 • How will student information be shared with their local school district? • Is the virtual school accredited? • How does the virtual school comply with state standards for K-12 educators? (e.g., licensure) • Are Universal Design for Learning6 standards incorporated into instructional material? • What support does the school provide for children with special needs? • What expectations does the school have for parents/caregivers? SCHOOL Continued on Page 14

Access to instructional support and the internet can cause significant variations in school success.

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There is no question that COVID-19 is providing phenomenal challenges to our school systems throughout the United States.

SCHOOL continued from Page 12

• What technology is necessary for participation? Who is responsible for providing it? • How will the virtual school facilitate communication about their child’s unique needs? There is a recent national survey of U.S. parents regarding school attendance for their children in the fall of 2020 published by the Seattle Children’s Research Institute.7 The conclusions of this study of 730 parents was that many parents planned to keep their children home in the fall of 2020. The authors of this article suggested that schools need to act soon to address parental concerns and provide options for what will be available for them should they opt to keep their children home. Structural barriers, such as lack of workplace flexibility for the parents and potential school-level inequities in implantation of preventive measures, must be acknowledged and addressed where possible. Superintendent Caulk’s office at the Fayette County Public Schools (FCPS) was contacted by phone twice and personal email once with no responses. Therefore, current information about FCPS reopening policy had to be gleaned from public sources. Valarie Spears wrote an article on September 6, 2020 on Kentucky.com.8 She reports that on August 26, 2020, Fayette County Public Schools started virtual classes from home. Ms. Spears quotes one parent whose third grader had not been able to participate virtually, as their home did not have internet access, and her children’s school did not have a hotspot mobile device for her. This parent said that there were hundreds of others in Fayette County just like her. The article goes on to say that Fayette County has been offering hotspots to families without internet access at home, and they have been in high demand. In late August, the District distributed 1100 hotspots and was ordering more. This parent is one of many parents who have posted in a new Facebook group that drew more than 1300 members in its first week that, in part, takes aim at the district’s back-to-school decisions. The article by Ms. Spears goes on to point out that Superintendent Manny Caulk met with the Lexington Forum on Thursday, September 3, 2020. Dr. Caulk is quoted as

saying that “300 families in the District need hotspots for internet connectivity, and he is hoping after Labor Day, the District will receive 500 hotspots to reduce learning loss.” In a letter to families on Friday, September 5, 2020, he said “more hotspots would be arriving the week of September 14, 2020.” Ms. Spears quoted another parent from the Facebook group who has two children, including one in kindergarten, who was just pulled out of public school to attend a private school. This parent said that “physically, she could not help her child in a 30-member Zoom call with crashing Chromebooks while taking care of her 2-year-old child and helping her KG child with math.” She claimed that “Fayette County Schools had not listened to the parents whatsoever.” Superintendent Caulk is quoted by Ms. Spears as saying that he “would rather have loss of learning by children not being able to attend school than loss of life from COVID19.” He went on to say, “We can always recover the learning. You can never recover a loss of life.” (I think educational research will not always give us a consensus that “we can always recover the learning;” reference 5 suggests otherwise due to child variables.) Ms. Spears’ article points out that at the recommendation of Governor Beshear, Kentucky schools shut down in-person learning in March 2020, and he has asked that they not return to the classroom in-person until September 28, 2020. The Fayette County District has had a delay in large Chromebook shipments, but Caulk said at the Lexington Forum meeting that one shipment came in on Wednesday. His Friday letter to parents said that an additional 2000 had arrived. One of the parents stated that her school-aged children who stayed at daycare while she worked, used textbooks while they waited for their hotspot. She went on to say that Fayette County “should have had a head count of kids who needed hotspots months ahead.” There is no question that COVID-19 is providing phenomenal challenges to our school systems throughout the United States. Pediatric recommendations are stringent, and many schools, frankly, will not be able to economically meet those recommendations. Moreover, it is likely that many school systems will not have the digital ability to provide proper in-home instruction.

References 1. American Academy of Pediatrics. COVID-19 Guidance for School Re-entry. JAMA Pediatrics. Available at: https://services.aap.org/en/ pages/2019-novel-coronavirus-covid19-infections/clinical-guidance/covid19-planningconsiderations-return-to-inperson-education-in-schools/ Accessed September 7, 2020 2. Dibner KA, Schweingruber HA, Christakis DA. ReopeningvK-12 schools during the COVID-19 pandemic. A report from the National Academies of Sciences, Engineering and Medicine. JAMA. Published online July 29, 2020. doi: 10.1001/jama.2020.14745 3. Black, E, Ferdig R, Thompson LA. K-12 virtual schooling, COVID-19, and student success. JAMA Pediatrics. Published online: August 11, 2020. doi: 10.1001/ jamapediatrics. 2020.3800 4. Molnar A, Miron G, Elgeberi N, et al. Virtual Schools in the US 2019. National Education Policy Center: 2019 5. Harvey D, Greer D, Basham J, Hu B. From the student perspective experiences of middle and high school students in online learning. American Journal of Distance Education, 2014; 28(1):14-26. doi:10.108 0/08923647.2014.868739 6. CAST. About universal design for learning. Available at: http://www.cast.org/ourwork/about-udl.html#.XyH3KJ5KjlU. Accessed September 7, 2020 7. Kroshus E, Hawrilenko M, Tandon PS, et al. Plans of US parents regarding school attendance for their children in the fall of 2020: a national survey. JAMA Pediatrics. Published online August 14, 2020. doi:10.1001/jamapediatrics.2020.3864 8. Spears, VH. Let Them Learn: Lexington Families Flock to Facebook Demanding Back-to-School Voice. Available at www. kentucky.com/news/local/education/ article25489855.html Accessed September 7, 2020

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PHYSICIAN HEALTH AND WELLBEING

Mindfulness for Kids (and Their Parents, Teachers and Physicians)

By John A. Patterson MD, MSPH, FAAFP

Recent surveys describe an alarming level of stress in our country. Anxiety, depression, loneliness and suicide are increasing- not just in adults, but also in children and youth. Public health officials and educators are looking for ways to limit the harm caused by the pandemic, the pace of modern life and the endless stream of disturbing news. Mindfulness practice has emerged as an important tool that can benefit children as well as their teachers, parents and physicians. What is mindfulness? Mindfulness is a portable tool for effectively coping with stress. It consists of intentionally maintaining a moment-

by-moment awareness of thoughts, emotions, body sensations and surrounding environment with openness, acceptance and curiosity. It’s simple- but not easy. What are the benefits of mindfulness? Research shows that mindfulness improves attention, impulse control, emotional resilience, memory, and chronic pain. It strengthens the “mental muscle” to bring attention and focus back to the task at hand- whether that is a child dealing with test anxiety, a teacher dealing with guns in schools, a parent dealing with their own chronic disease or a physician at risk

during this pandemic. Mindfulness can help us reverse the downward spiral of worry, rumination, awfulizing and catastrophizingpreventing or reducing recurrent bouts of anxiety, panic, depression and substance abuse. Mindfulness helps us accept and even forgive ourselves for harmful habits and actions and, in the process, cultivate empathy, forgiveness and compassion for others who are on this same life journey, doing the best they can. By mindfully paying attention to our emotions, we learn how fleeting they are and learn to see how we cling to pleasant emotions we like and

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resist or deny unpleasant emotions we donâ&#x20AC;&#x2122;t like. Relaxation is a common side benefit of mindfulness practice, though mindful attention can also be brought to activity and movement. Mindfulness benefits for children A childâ&#x20AC;&#x2122;s autonomic nervous system responds to the stress of a math test in the same way it responds to actual physical danger. Children need tools to decrease the fight-or-flight stress response and increase the rest-and-digest relaxation response. Like adults, children also need to balance their goal-oriented, achievement-focused doing mode with their calm, peaceful, quiet being mode. By helping them cope with stress, mindfulness helps many children reduce distractibility and hyperactivity, learn better, score higher and reach their full

potential. Children get more grounded, slow down, relax their bodies, quiet their minds and open their hearts. They learn to regulate their unskillful physical, mental and emotional reactivity and become more skillfully responsive at school and at home. At-risk children with disabilities, living in poverty, unstable or violent homes, homeless shelters or juvenile detention centers can learn that these conditions do not define them. Their true nature is not their life circumstances or their diagnosis. Mindfulness benefits for teachers Roughly half a million U.S. teachers leave the profession each year due to chronic stress, anxiety, depression and burnout. Teachers feel tremendous pressure to do their best for their students in an age of classroom disrespect, school violence and unfriendly state legislative actions.

Teachers who train to teach mindfulness in their classroom notice a difference in their own stress management, resilience, self-awareness, emotion regulation and interpersonal communication skills. As they help children speak kindly and listen quietly, they deepen their own capacity for effective, compassionate communication. Especially gratifying (and humbling) for teachers are the moments when children remind them to slow down, take a breath, chill and just relax. Mindfulness benefits for parents Many parents have stress-related chronic conditions- common among them are anxiety, depression, headache, sleep disturbance, pain conditions and digestive and inflammatory disorders. Most MINDFUL Continued on Page 18

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MINDFUL continued from Page 17

mindfulness skills that kids learn in school are portable. Even very young children can learn mindful breathing to manage stress, anger, fear and sadness- increasing their emotional intelligence at an early age. This behavior can be a model for parents and siblings who can learn from and practice with the mindful child in the house. Inspired by their children’s progress toward becoming a mindful child, parents can be motivated to formally study and practice mindfulness as well- creating a mindful family. In classes I teach for adults, I often hear stories from parents whose children want to practice the home assignments along with them. Mindfulness benefits for physicians Kids deserve a doctor that is happy, resilient, compassionate and listens well. The pandemic has led to great suffering among physicians. Mindfulness-based training for physicians has demonstrated significant personal and professional benefits. Ongoing research by the Mindful Practice Program at the University of Rochester School of Medicine shows that participating physicians experience improvements in empathy, burnout and attitudes associated with patient-centered care. Heartfulness In many Asian languages the word for heart and mind are the same. Thus, it is said that mindfulness is also heartfulness. The growth of self-awareness that occurs with regular mindfulness practice helps children and adults touch and grow their warm interior feelings of love, friendliness, kindness, forgiveness, empathy and compassion. This is the basis for the Mindfulness-Based Kindness Curriculum for Preschoolers of the Center for Healthy Minds. Adults and children of all ages have the capacity to cultivate heartfulness and all its associated virtuous personality traits. Mindfulness exercises for kids (and their adults) Paying attention to the body and the breath are basic introductory mindfulness practices. We train the mind to pay attention by using the grounded dependability of the body. Even though our mind may be in some other place-

our body is always here. Even though our mind may be in the past or future, the body is always in the present. Our body is always here and now. We train in feeling the physical sensations in the body, especially noticing the presence of opposite sensations, such as warmth and coolness, heaviness and lightness, comfort and discomfort, liking and disliking. As we gain confidence in experiencing the simultaneous presence of opposite physical sensations, we can transfer that skill to our thoughts and emotions. Children can experience the simultaneous presence of test anxiety and the joy of learning. Adults can experience the simultaneous presence of depression and gratitude for the love in their life. I have made audio recordings for “Soft Belly Breathing” and “Body Scan.” Below are links to these introductory mindfulness practices. I have also provided links to resources created by the Aetna Foundation’s public awareness campaign promoting mindfulness for children and throughout society. Mindfulness is a natural human capacity that kids, teachers, parents and physicians can cultivate- and it can change everything. References • Calm and clear: What mindfulness can do for your kids (Aetna Foundation), www.aetna. com/health-guide/calm-and-clear-whatmindfulness-can-do-for-your-kids.html • How to introduce mindfulness to kids (Aetna Foundation) www.aetna.com/health-guide/ how-to-introduce-mindfulness-to-kids-3-funexercises.html • Audio recordings of “Soft Belly Breathing” and “Body Scan” (Mind Body Studio) http:// www.mindbodystudio.org/?page_id=1594 • A mindfulness-based kindness curriculum for pre-schoolers, Center for Healthy Minds, University of Wisconsin https://www.mindfulmomentsinedu. com/uploads/1/8/8/1/18811022/ kindnesscurriculum.pdf • Mindful Medical Practice Program–U of Rochester School of Medicine https:// www.urmc.rochester.edu/family-medicine/ mindful-practice.aspx

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These dogs ranged in age from 6 to 9 years. They had lived in outside kennels with little human contact for years. Needless to say, they were shy and nervous when they arrived at LHS. Luckily, they are now blossoming, thanks to the love and attention they’ve received from our staff. Some have already been adopted, while others have needed more extensive medical care and time in foster homes. All of them will receive the TLC they so desperately deserve. A lot of coordination goes into assisting with a rescue operation. Establishing safe transport,

doing medical and behavioral assessments and providing enrichment and medical care requires lots of hours and money – all while caring for the hundreds of animals already with us. But that didn’t deter us. These dogs needed us and they deserved our help. Now we need YOUR help! Adopt a senior pet into your family. If you can’t adopt, please DONATE today to help us care for young and old alike.

We LOVE our seniors!

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COMMUNITY NEWS A N N O U N C E M E N T S , AWA R D S , E V E N T S & M O R E

Frank Paul Taddeo Joins CHI Saint Joseph Medical Group – Orthopedics Frank Paul Taddeo, MD, has joined CHI Saint Joseph Medical Group – Orthopedics in Lexington, Winchester and Mount Sterling as a sports medicine physician. Originally from Fort Lauderdale, Florida, Dr. Taddeo and his wife are excited to move to Kentucky and make Lexington their home. Dr. Taddeo originally began his career in family medicine, but his passion for musculoskeletal medicine drove him to further specialize his skills. This pursuit allowed him to focus on the science of healing acute and chronic muscle, tendon and bone issues in all age groups. His dedication to personal wellness and caring for athletes of all ages and fitness levels led him to pursue a career in sports medicine. “My passion has always revolved around how we move. If we can better understand how or why we get injured we can begin to correct how to move. Once we accomplish that healing should soon follow. My job is to take patients through that process and hopefully ease some of the burden along the way,” said Dr. Taddeo. “I spent the early part of my career helping to save lives, now I get to focus on saving lifestyles,” he said lightheartedly. “It’s important that people enjoy staying active throughout every stage of their lives. This is why I focus on identifying a treatment plan based on each patients’ individual goals.” After graduating from Florida State University with a degree in Exercise Science, Dr. Taddeo received a scholarship and traveled to the Caribbean, where he earned his medical degree from the University of Medicine and Health Sciences on the island of St. Kitts. His clinical training took place in hospitals throughout the United States, from New York to Arizona. Dr. Taddeo then moved to Georgia to complete a family medicine

residency at Piedmont Columbus Regional and spent two years at a family practice clinic in Statesboro, GA. Dr. Taddeo pursued a sports medicine fellowship at University of North Dakota in Grand Forks. During his fellowship, he developed advanced diagnostic and procedural-based ultrasound techniques that he is excited to bring to the community. He is now board certified in both family medicine and sports medicine Dr. Taddeo is accepting new patients. He will serve patients from offices at 211 Fountain Court, Suite 320 in Lexington, 624 Maysville Road, Suite A in Mount Sterling and 1850 Bypass Road in Winchester. To make an appointment with Dr. Taddeo, visit www.CHISaintJosephHealth.org or call 859.264.9820.

organ donation community with workplaces across the nation in spreading the word about the importance of donation. The Baptist Health sister hospitals are three of 1,700 organizations to participate in the 2020 campaign. The campaign has been credited with adding 59,662 registrations to state registries, including registrations from Puerto Rico and the U.S. Virgin Islands. Every ten minutes, another person is added to the organ transplant waiting list, reaffirming the critical and growing need for registered organ, eye, and tissue donors. For more information about the WPFL Hospital Organ Donation Campaign, visit www. organdonor.gov/hospitals. To learn more about organ donation in Kentucky visit www. donatelifeky.org.

Baptist Health Corbin, Lexington, and Richmond have received platinum recognition

Dr. Roger Humphries on overdose awareness – and how you can help

Baptist Health Corbin, Lexington, and Richmond have received platinum recognition from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) for their efforts in encouraging enrollment in Kentucky’s organ donor registries. Between October 2019 and April 2020 the hospitals participated in HRSA’s Workplace Partnership for Life (WPFL) Hospital Organ Donation Campaign. The program challenges hospitals and healthcare organizations to “let life bloom” by educating their staff, patients, visitors, and communities about the critical need for organ, eye, and tissue donation, including offering opportunities to register as organ donors. The campaign is a national initiative that unites the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), and the

Monday, August 31 was International Overdose Awareness Day – a global event aimed at raising awareness of overdose and spreading the message that overdose death is preventable. Every year, thousands of people from all walks of life die from preventable drug overdose, so we sat down with Dr. Roger Humphries, chair of the UK Department of Emergency Medicine, to discuss the important work we’re doing to reduce and treat drug overdoses – and how you can help. Are overdoses on the rise? Over the last few years, overdoses had been trending downward for a variety of reasons likely related to all of the efforts to improve treatment for patients with addiction as well as the availability of intranasal naloxone (Narcan). However, COVID-19 is causing a great deal of stress and disruption, and while we don’t have the official numbers, we do know that overdoses are on the rise again.

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SHARE YOUR STORY WITH THE COMMUNITY. E M A I L B R I A N @ R O C K P O I N T P U B L I S H I N G . C O M T O H AV E Y O U R N E W S P U B L I S H E D.

What work is UK HealthCare doing to reduce overdoses? Throughout UK HealthCare there are a lot of efforts to reduce overdoses. We are working in the emergency department to train all of our staff to make sure that we offer Narcan to people at risk. It’s incredibly important that people have access to Narcan and be able to administer it if they think someone is suffering from an opioid overdose. We’re also encouraging patients with opioid use disorder, or OUD, to be treated with medication assisted therapy, and we’re using Suboxone in the ED to help patients in acute withdrawal. Suboxone – a combination of buprenorphine and naloxone – is a very safe treatment for patients with OUD and can actually help protect patients from overdose. We’re encouraging patients to get into treatment. Once patients are in treatment, like at our First Bridge Clinic, they are much less likely to overdose. But most importantly for the public, we’re doing lots of awareness about Narcan. The more people who can administer it, the better. What is naloxone (Narcan)? Narcan is the antidote for an opioid overdose. It is an incredibly safe drug. Basically, it is an opioid receptor blocker, and it will reverse the lethal effects of opioids like respiratory depression – either from a prescribed medicine or illicit drugs. Who should carry naloxone? Anyone who has a relative or friend with opioid use disorder should definitely carry it and have it on them at all times. People who either take opioids or have family members or friends who take opioids for chronic pain should also have it available. Think of naloxone as a safe and incredibly effective miracle drug for opioid overdose – it really should be in a first aid kit that you carry with you in the car. Having this drug available at the right time could absolutely save someone’s life.

Is naloxone training available to everyone? Yes. There is training available online and in-person frequently. Narcan is simple to use and easy to administer. It does not take any significant medical skills – it’s an intranasal prescription, so it works just like an over the counter nasal spray. You do have to have a prescription for naloxone, but many pharmacies (including UK Pharmacy Services) are able to train people, give them a prescription and dispense Narcan all at the same time. Who is at risk for overdose, and how do we recognize an overdose? Anyone with OUD or a history of overdose is at increased risk. People who take opioids for chronic pain are at risk, or anyone who takes an opioid with a sedative at the same time. Drug use is far and away the biggest risk – injection use especially. The signs of an overdose are a decreased level of consciousness and slowed or stopped breathing. Small pupils is another sign, or if someone is not acting normal or is unresponsive.

Dr. Yuri Boyechko, Gill cardiologist, lends expertise to Frankfort Regional Medical Center Frankfort Regional Medical Center (FRMC) is pleased to announce UK Gill Heart & Vascular Institute cardiologist Yuri Boyechko, MD, has joined Bluegrass Cardiology Consultants at 279 King’s Daughters Drive, Suite 204 in Frankfort. “We are excited that Dr. Boyechko decided to come back to his childhood roots in Central Kentucky,” said Reed Hammond, CEO. “He will be a great addition to the team of cardiologists from UK HealthCare’s Gill Heart and Vascular Institute that have allowed us to expand our cardiovascular services in our region.”

Physicians from UK HealthCare’s Gill Heart & Vascular Institute provide 24/7 coverage for cardiac emergencies at FRMC. They also provide services for outpatient and inpatient general cardiology, cardiac catheterization and angioplasty, outpatient electrophysiology consultations, and patient education, and training. Dr. Boyechko grew up in Versailles and earned his medical degree, graduating with high distinction, and completed his residency in internal medicine at University of Kentucky College of Medicine in Lexington. He was then awarded a fellowship to the University of Tennessee—Erlanger Heart and Lung Institute in Chattanooga where he served as chief fellow of cardiovascular disease. Dr. Boyechko also holds a bachelor of science in biology, graduating summa cum laude from University of Kentucky. Dr. Boyechko is board-certified in internal medicine by the American Board of Internal Medicine. He was a fellow-in-training with the American College of Cardiology and plans to continue his involvement as a full member.

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Teaching our Children in the Middle of a Pandemic By Tracy Francis Starting in March many parents were faced with the dilemma of educating their children from home. The last half of the spring semester was an absolute nightmare. No one was prepared for weeks and then months of NTI (non-traditional instruction). The number of tears (from parents, students, and teachers) was more than most people could imagine (see youtube link1). It was very commonplace for these new homeschool parents to end the day with a good cry, a screaming match with their child(ren), or a stiff drink. We all took a breath of relief when the last day of school ended the torture that was online Learning. But now starts the next chapter in the anxiety-filled, depression laced, angermanagement (or the lack there of) crisis... Welcome to NTI 2.0. Is it better than before? Yes. It’s not great, but it’s better. Many families are struggling with

The only thing scarier than a worldwide pandemic is having to teach school from home. computer issues, spotty internet, and a basic lack of understanding of all the different learning platforms the kids and teachers use. If you are in this situation take a deep breath. There is no right or wrong answer. Let your kid(s) lead the way and you will find a learning style what works for your family. Here are a few popular options… Option 1: Educational Pods Before school started, I created an educational pod of like-minded families. I reached out to our kids’ friend’s parents and interviewed several teachers. We currently have six kids (4th-7th graders) that get together at our home and do their NTI work. Everyone wears masks and sits 8-15 feet apart. The other parents and I have jointly hired a teacher to help the kids navigate their classes. Our teacher

is amazing and there are many educators who feel they cannot go back to a regular classroom for fear of getting themselves or a loved one sick. They are out there, and they want to teach! We are integrating our own priorities into the curriculum and adding things like cooking classes, a dissection unit, foreign language, and a community art project. Once I got the pod organized, I reached out to my girl’s teachers to see where I could condense lessons and find ways to get them off online learning! Almost all the teachers I talked to were supportive and helped me find creative ways to decrease the screen time. In most cases electives are optional and sometimes you can find other parts of the class time that can be decreased. Both steps took some time, but as of today, we are moving in the right direction.

1. https://www.youtube.com/watch?v=dZg2qarllWo&list=PLNA6f1KeukMiL9_lud57-pWRpK3cjdOAb&index=8&t=20s

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The long and the short of it is, everyone needs a little something different.

Option 2: Home Schooling Many families have decided to try out home schooling to address the educational, emotional, and time constraints associated with at home learning. I talked to several parents who use home schooling for their families. One Mom is a retired teacher. She said home schooling takes significant less time than the current 5-7 hours most of the kids are enduring with NTI. On-line learning complaints include, it takes too long, their kids are or aren’t challenged enough, and it’s too much screen time. With home schooling you have control of the schedule and the curriculum. Johnny wants to know more about environmental issues? Set up a socially distanced meeting for him to interview someone from fish and wildlife. Suzie loves animals? See if one of the large animal vets will let her observe a medical procedure. You do not have to reinvent the wheel on this one. If you want more information on this option check out http://www.bluegrasseducation.com/howto-homeschool.html. Central KY has many great home-schooling programs. The biggest thing my home-schooling parents told me was that NTI is NOT home schooling.

Option 3: Private School Many parents are turning to private schools with in-person and at home learning opportunities. Private schools (with their small class sizes) are structured to better perform social distance for in person learning AND on-line learning. Public school classes can easily have 22-28 kids per class, but private school classes have significantly fewer kids to manage. The long and the short of it is, everyone needs a little something different. Some kids are thriving in NTI. My introvert misses her friends but seems to love rolling out of bed and stepping straight into her class. (Bed head and all!). She loves staying up later and getting extra one on one time with her Dad. There is no right answer to this. We all must do what’s right for our families. During a time of extreme stress let us all remember to support one another, check in with each other, and remember the best examples of humanity can be seen during a time of crisis. If you have time today – check on your friends with kids. Our stress level is thru the roof and we could all use a little extra grace.

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A WARRIORS

The Bowling Green Warriors were started by Dr. Brown and others in 2015. They are a member of the Middle Tennessee Athletic Conference.

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STORY A Glimpse Into Kentucky High School Football During COVID-19 By Nicholas Coffey

The cool, crisp September air embraces me as warmly as an old friend when I stroll through the gate. The sound of popping shoulder pads greets me with its beautiful symphony as I get even closer to the field. However, I am not truly transported back in time until I look out across the field at the young men of the Bowling Green Warriors football team preparing for their first game of the 2020 season. I remember the excitement and thrill of the seasonâ&#x20AC;&#x2122;s arrival as the monotony of summer weightlifting and practices came to an end. The prize of gameday had finally arrived! It was time to show what all that work had been done for. The gleam in the playerâ&#x20AC;&#x2122;s eyes and the excitement filling the air so thickly that I can taste it. It tells me that this is true for them too. This is not exclusive to the players though. I catch a glimpse of the Warriors head coach and I see the same gleam. I know all too well he feels it too.

FOOTBALL Continued on Page 30

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“I have built great relationships with the kids on the team. They wanted me to stick around to coach and I enjoy coaching them, so I did. Coaching is really like therapy for me as it gives me a way to decompress and have some fun.” – Dr. Donald Brown

FOOTBALL continued from Page 29

As the game progresses, I see the Warriors head coach signal in plays, direct his players, and steer the offense. Tonight, he is a leader of young men on the gridiron. By morning’s light, he will return to his day identity: Dr. Donald Brown. Dr. Brown serves as a vascular surgeon and director of medical education at Med Center Health, along with being the general surgery residency program director for University of Kentucky College of Medicine Bowling Green. However, tonight that seems a world away as Coach Brown celebrates with his players as they score their first points of the season. The Bowling Green Warriors were started by Dr. Brown and others in 2015. They are a member of the Middle Tennessee Athletic

Conference, which runs an 8-man high school football league for teams composed of homeschooled and small private Christian school students throughout middle Tennessee and Kentucky. Dr. Brown has been the head coach of the Warriors since their conception and was able to coach his two sons through the program. His youngest son graduated two years ago. However, Dr Brown continues coaching saying, “I have built great relationships with the kids on the team. They wanted me to stick around to coach and I enjoy coaching them, so I did. Coaching is really like therapy for me as it gives me a way to decompress and have some fun. I love football and I really love coordinating as it allows me to dream up plays and new ways to attack defenses.”

Dr. Brown went on to say that he loved the relationships that he had developed with his players and that this team acts as his ministry. He and his assistant coaches not only present an opportunity for young men to be active and exercise, but also try to teach their players life lessons and values throughout the season and offseason program. These lessons have a wide range of topics and everyday uses with discipline, organization, selflessness, and teamwork being a few mentioned during our talk. Most of these lessons arise organically within the context of what is happening to the team. That being the case, the 2020 season has already presented many opportunities for lessons with the challenges this team has faced just to play their first game. The first major challenge was the loss of their sponsor school, Bowling Green Christian Academy, over the summer. This was due to a merger with another school, Anchored Christian School, to form a new school in Bowling Green called Legacy Christian Academy. While the opportunity to be associated with this new school or another school may arise in the future, this merger ultimately resulted in the Bowling Green Warriors being an independent football team without a school sponsor for this season and resulted in practices and games being held at the Hattie L. Preston Intramural Complex on Western Kentucky University’s campus. Lacking a school sponsor also means that they are not provided basic amenities that other football teams enjoy, such as a weight room and workout equipment. However, they do have a strength and conditioning coach that helps lead offseason activities using the resources they have obtained. The loss of a sponsor for a football team would be a significant challenge at any time, but context is key in this instance. All of this was happening in the midst of a pandemic, which brought a host of other challenges. The first major challenge was getting enough players to fill the roster. The Bowling Green Warriors had 10 men on their roster by July,

as many kids decided not to play amid the uncertainty of a season occurring at all due to COVID-19. However, as the season appeared to materialize, they were able to almost double their roster by opening night. The next big challenge that the team faced as a result of COVID-19 was meeting the Kentucky High School Athletic Association (KHSAA) and Kentucky government

mandates. Although the team is not a KHSAA member, the Hattie L. Preston Intramural Complex is following these guidelines and the team must as well to use the facility. This meant that the Warriors were like every other high school team in the state, waiting for a green light to have the season. This also meant that the Warriors had to follow the COVID-19 guidelines set forth by the state. To ensure compliance, Dr. Brown indicated that the team has assigned a “COVID-19 monitor” coach. His major responsibilities are to remind players to follow social distancing guidelines and screen for COVID-19 before every practice and game utilizing COVID-19 screening questions and temperature checks. This does not exclude the games either, as fans were screened entering the facility. Also, Dr. Brown announced prior to kickoff that everyone must wear masks at all times. If these guidelines are not met, spectators will no longer be allowed to attend the games. The Warriors find themselves in the unique predicament though of being behind most of their competition from the start.

Most football teams on their schedule are from Tennessee and thus fall under different guidelines. According to Dr. Brown, Tennessee guidelines have allowed teams to practice for the last month and start playing games 2-3 weeks ago. Meanwhile, the Warriors were only able to start padded practices a week ago due to Kentucky guidelines. Similarly, Dr. Brown indicated that they had to cancel games against opponents in COVID-19 hotspots as they would lose access to their facility. The first game of the season is in the books, but that by no means guarantees the last game of the season will ever be played. The challenges facing this football team are ever-present and changing, with COVID19 being at the forefront. Unfortunately, this is the reality of existence for most high school football teams. There is always an unease that, at any second, something could change to alter the season, or even cancel it completely. However, if only for the night, I was able to see the world revert back to a time before COVID-19 for the young men out on that field.

LMS / KMA 10th District Virtual Meeting October 27, 2020 • 7:00pm GUEST SPEAKERS Dale Toney, MD, KMA 2020–2021 President Tuyen T. Tran, MD, MBA, KMA 10th District Trustee Dale Toney, MD

Tuyen T. Tran, MD

When: October 27, 2020. 7:00pm Program Where: Zoom virtual event

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