LOUISVILLE MEDICINE - GLMS Medicine... · LOUISVILLE MEDICINE is published monthly ... William A. Blodgett, MD ... Teresita Bacani-Oropilla, MD

MEDICINELOUISVILLEGREATER LOUISVILLE MEDICAL SOCIETY VOL. 57 NO. 2 JULY 2009

I don’t justhave insurance.

I own the company.

Medical Professional Liability Insurance

Mutual Interests. Mutually Insured.

Contact Susan Decareaux or Jesse Lawler at [email protected] or call 1-800-342-2239. svmic.com

Wayne Hudec, M.D., FACSGeneral Surgery

“Like me, you’ve probably noticed some professional liability insurance providers recently offering physicians what seem to be lowerrates. But when I took a closer look at what they had to offer, I realized they simply couldn’t match SVMIC in terms of value andservice. And SVMIC gives me the peace of mind that comes when you’re covered by a company with a stellar 30-year recordof service and the financial stability of an “A” (Excellent) rating. At SVMIC, I know it’s not just one person I rely on… thereare 165 professionals who work for me. That’s because SVMIC is owned by you, me, and over 15,000 other physicians acrossthe Southeast. So we know our best interests will always come first.”

JJUULLYY 22000099 33

LOUISVILLE MEDICINE is published monthlyby the Greater Louisville Medical Society, 101 W.Chestnut St. Louisville, Ky. 40202 (502) 589-2001,Fax 581-9022, www.glms.org.Articles to be submitted for publication in LLMM

must be received on electronic file on the first dayof the month, two months preceding publication.Opinions expressed herein are those of individ-

ual contributors and do not necessarily reflect theposition of the Greater Louisville Medical Society.LLMM reminds readers this is not a peer reviewed scientific journal. LLMM reserves the right to make the final decision

on all content and advertisements.Circulation: 3,800

GLMS Board of GovernorsMichael W. McCall, MD, board chairLynn T. Simon, MD, presidentKimberly A. Alumbaugh, MD, president-electDeborah A. Ballard, MD, vice presidentDavid E. Bybee, MD, treasurerBernard L. Speevack, MD, secretaryHeather L. Harmon, MD, at-large Kerry Short, MD, at-largeLewis Hargett, MD, at-large Elmer Dunbar, MD, at-large Russell Williams, MD, at-large Robert H. Couch, MD, at-large Bruce Scott, MD, AMA delegateRobert A. Zaring, MD, AMA alternate delegateLinda H. Gleis, MD, KMA ranking memberGordon R. Tobin, MD, KMA 5th district trusteeFred A. Williams, Jr., MD, KMA 5th district alternate

trusteeTimothy S. Brown, MD, GLMS Foundation president Stephen S. Kirzinger, MD, Medical SocietyProfessional Services PresidentEdward C. Halperin, MD, MA, dean,

UofL School of MedicineAdewale Troutman, MD, MPH, director,

Louisville Metro Dept. of Public Health & Wellness

Millicent Evans, GLMSA president

Louisville Medicine Editorial BoardEditor: Mary G. Barry, MDDeborah Ann Ballard, MDLaurie Ballew, EdD, DOWilliam A. Blodgett, MDEugene H. Conner, MDFrank DeLand, MDArun Gadre, MDJeremy Gerwe, MDTracy Ragland, MDStanley A. Gall, MDLarry P. Griffin, MDDarin Harden, MDJonathan E. Hodes, MDThomas James III, MDLouanda M. Kynhoff, MDMichael T. Macfarlane, MDJoe Mauer, MDTeresita Bacani-Oropilla, MDDanielle PigneriM. Saleem Seyal, MDBernard L. Speevack, MDDave Langdon, Louisville Metro Department

of Public Health & WellnessMichael W. McCall, MD, board chairLynn T. Simon, MD, presidentKimberly A. Alumbaugh, MD, president-electLelan K. Woodmansee, CAE, executive directorBert Guinn, MBA, communications & membership

directorMatthew Ralph, communications associateDonna Watts, communications designer Advertising Cheri K. McGuire, director of marketing736.6336, [email protected]

LOUISVILLEGGRREEAATTEERR LLOOUUIISSVVIILLLLEE MMEEDDIICCAALL SSOOCCIIEETTYY

6

MEDICINEVVOOLL.. 5577 NNOO.. 22 JJUULLYY 22000099

10

A Bridge Over Troubled Waters: The 20-Year Span of The Healing PlaceGordon R. Tobin, MD

Greater Louisville Medical Society Boards, Committees,Councils 2009-2010President’s Soiree PhotosDonna Watts

On the Fringes of Greatness: Alban Gilpin Smith(Goldsmith) 1795-1861Eugene Conner, MD

Greater Louisville Medical Society Foundation 50th Anniversary Celebration PhotosMatt Ralph

Pearls From Lynda’s GardenTracy Ragland, MD

Polypharmacy: A Threat to Healthy AgingDemetra Antimisiaris, PharmD, and James G. O’Brien, MD

Medaling In MettleMatthew Ralph

F E A T U R E A R T I C L E S

18

D E P A R T M E N T S5 From the President

RAC and MAC - AttacksLynn T. Simon, MD

Guest CommentaryEthical Issues Involved in Delayed Use of New AMAGuidelines for Evaluation of Permanent ImpairmentRobert F. Sexton, MD

Reflections: Searching, Searching_ No PhoneConnectionTeresita Bacani-Oropilla, MD

Alliance UpdateMillicent Evans, GLMS Alliance President

Book Review: Atlas of Unknowns by Tania JamesM. Saleem Seyal, MD, FACC, FACP

We Welcome YouPhysicians In Print

8

16

17

20

28

3029

22

263138

RAC and MAC-Attacks

I think we always realized thatmedicine was both a profession and abusiness, but it seems that there isless and less time for the practicingmedicine part these days. In my 12years of practice, I was amazed by theincreasing time commitment requiredfor appropriate documentation (“if itwas not documented, it was notdone”), learning appropriate billing(how many review of systems do Ineed to document?) and more recent-ly, the need to document compliancewith quality metrics and best prac-tices.

And just when everyone is tryingto keep their heads above water, andsee what health care reform mightbring, along come the RACs (RecoveryAudit Contractors). After a “successful”demonstration project in which over$900 million in alleged overpaymentswere identified, Medicare has expand-ed this program in an attempt toeliminate fraud and abuse within thesystem. Medicare has contracted withseveral companies across the country,each working under a contingencyfee. Our local contractor will be CGI, aFairfax, Va.-based company. They willaudit claims in Michigan, Ohio,Indiana, Illinois and Kentucky and will“focus on companies and individualswhose billings for Medicare servicesare higher than the majority ofproviders and suppliers in the com-munity.” Yes, they will also be lookingfor underpayments, but in thedemonstration project, only 4 percent

of the claims involved underpay-ments, while 96 percent were over-payments. Audits in Kentucky are tobegin in August 2009.

Clinical focus areas are said initial-ly to include skin grafts and wounddebridements, cardiac procedures,medical back problems and jointreplacement patients in inpatientrehab facilities. Because 62 percent ofthe “audit errors” for hospital inpa-tients involved “medically unneces-sary services or setting,” many healthsystems are hiring consultants or con-tracting with companies to putprocesses in place to help mitigatethe risk of the RACs. The companiesdo not offer the same services forphysician’s offices. And, even if theydid, could these practices afford thecost? And how does what happens inthe hospital affect a physician’sbilling? That’s where the MAC –Medicare Audit Contractor – comes in.They will look for hospital-physicianclaim concordance (hospital bills asinpatient, physician must bill as inpa-tient, or hospital bills as observation,physician must bill the same status ora claim edit will identify these andpayment to each is at risk). Hospitalsand physicians have a very goodreason to work together on this issue.

Because of the impact that thisprocess will have on physician’s prac-tices, the GLMS professional relationsdepartment is offering several educa-tional workshops for physicians andtheir practice staff to help themprepare for these auditors. Office staffneed to learn how to recognize

notices from the RACs, and how totrack, monitor and handle the appealsprocess. Two workshops were held inJune (hosted by Jewish Hospital andSts. Mary & Elizabeth Hospital) butthere are more workshops scheduled(on July 7th at Baptist Hospital East,July 29 at UofL Outpatient Center, July30 at Floyd Memorial Hospital andClark Memorial Hospital - date TBD).CME credit is pending and CEUs forcoders are approved for these work-shops. For more information, pleasecontact Jessica Williams at 502-736-6368 or e-mail [email protected] will also organize a seminarwith some of our CGI representatives.Please watch for the date/timethrough our e-mails and other publi-cations.

Optimally, health care reformwould focus on allowing physicians tospend more time providing care, butthe focus continues to slant towardthe business side. GLMS remains com-mitted to educating its members andhelping them navigate and adapt tothe changes that are occurring inhealth care and impacting the prac-tice of medicine.

From The PresidentLynn T. Simon, MDGLMS President


LM

Gordon R. Tobin, MD

“When you’re down and out, whenyou’re on the street,

when evening falls so hard,I will comfort you. I’ll take your part.

When darkness comes and pain is all around,

Like a bridge over troubled waters, I will lay me down.”

-Simon and Garfunkel, 1969

August 2009 is the 20th anniversaryof The Healing Place. This remarkableprogram has become a bridge fromaddiction and misery to recovery andhope for many once-lost souls. Like thebridges that span our great river at theFalls of the Ohio, THP has been progres-sively built from bedrock to upreachingsuperstructure. The original engineer ofTHP was the Greater Louisville MedicalSociety, named Jefferson County MedicalSociety. Subsequent girders were addedby community support, and THP’s ownstaff and alumni. The result is a national-ly-acclaimed example of humanitarian-ism in action, which has become GLMS’sfinest legacy.

Our city is symbolized by locks andbridges. We are reminded of this duringthe spectacular fireworks of ThunderOver Louisville, and the motif is subtlyreflected in local architecture, such asMichael Graves’ elegant Humana build-ing. These are appropriate symbols for acity that bridged the original colonies tothe frontier, bridged a divided nationduring Civil War, and bridged its healingduring reconstruction. Throughout theseeras, rough, hard-drinking boatmen and

migrants chased their future down theOhio, and often became mired here inthe swamps of their addictions. TheHealing Place story describes a bridgeback to normalcy from those hopelessswamps, and it calls for preservation ofthis fine legacy.

The Foundation: A Homeless Shelter

The beginning of THP was a smallhomeless shelter established by a com-passionate Catholic priest, Father JohnMorgan, in an aging church in the decay-ing neighborhood of 1970s West MarketStreet. Father Morgan brought the plightof his boarders to his physician, Dr. WillWard, who embraced their cause andenlisted support from his JCMS col-leagues. Led by Dr. Ward and PresidentKen Peters, JCMS physicians gave an out-pouring of volunteer medical services,funding and broad support. This led toour adoption of THP and its official incor-poration as the JCMS Outreach Program,Inc., later named THP.

For treating acute intoxication, with-drawal and neglected medical condi-tions, the physicians established a clinic,which included a pharmacy of donatedsupplies and a van for bringing clientsfrom the street. To honor Dr. Ward’sinitial inspiration and ongoing service,this clinic was rededicated as “the WillWard Clinic” in October 2003, and JCMShonored all clinic volunteers, with specialrecognition to Dr. Kitty Henry, the clinicmedical director, and Ken Peters, outgo-ing THP board chairman. The clinic andTHP today save taxpayers over $21million annually in avoided medical, jailand criminal justice costs.

Transformation: The Recovery Program

The physicians quickly recognizedthat the underlying cause of their clients’homelessness was addiction, particularlyalcoholism. Therefore, they added arecovery program that has achieved out-

standing success and national recogni-tion. The principal program architect wasJay Davidson, who joined THP in 1991,and now serves as president and CEO.The program is based on principles pio-neered by Alcoholics Anonymous, and itemphasizes peer mentoring and experi-ence sharing so those progressing inrecovery guide those entering. Progressis closely monitored by peers, programgraduates and staff in a caring but strictlydisciplined environment, where respon-sibility for progress is clearly placed onthe client. In addition to regular AA-typemeetings, THP group meetings are heldthree times weekly to enable self-exami-nation and accountability. The programprogresses through early, middle andlong term recovery leading to job place-ment, legal assistance, housing, educa-tion and family reunification. The successrate is extraordinary, with over 2,500alumni and a sobriety rate over 65percent at one year – five times thenational average.

Outreach to Women and FamiliesIn 1995, the program expanded to

women and their children. The women’sshelter and recovery program replicatesthat of the men, but is smaller (300 men,130 women). A greatly expanded facilityfor women and children is now underconstruction, which will double programsize in September 2009.

The Parenting Program:Breaking Generational Cycles

Addiction, hopelessness and devas-tation of self-respect are tragically passedfrom generation to generation by emo-tional abandonment and/or abuse sur-rounding addiction. Children rarelyreceive the emotional skills and insightsto escape the behavior patterns andchemical dependencies that devastatetheir parents. The Parenting Programaddresses this tragic repetition. First, chil-dren are removed from sexual and physi-cal abuse, crack houses or houses of ill

A Bridge Over Troubled Waters:The 20-Year Span of The Healing Place

LLOOUUIISSVVIILLLLEE MMEEDDIICCIINNEE66

repute. Then, children receive psycholog-ical rehabilitation, addiction educationand insight into their parents’ plight. Themother’s rehabilitation must progresssufficiently and new parenting skills mustbe learned before attempted reunifica-tion. If possible, and when all reach anappropriate stage, a carefully supervisedreunification process may be nurturedwithin THP residency and continued intoindependent outside living. Thisprogram has great potential ultimatelyto reduce large numbers of familiestrapped in generational cycles of addic-tion and abuse.

A Model for Statewide andNational Expansion

Although the size, scope andbudget of THP grew explosively, thenumber needing shelter and recoveryremains vastly larger. In 1998, the U.S.Department of Health and HumanServices cited the program’seffectiveness, designating it a“model that works.” Thiscaught attention of state,national, and internationalleaders, and widespread repli-cation of THP is now under-way. In 2005, Gov Ernie Fletcherinitiated Recovery Kentucky, a programto establish 10 new sites across the state.Seven are now functioning. Nationally,replication has occurred in Lexington,Raleigh, N.C., Richmond,Va., andHuntington, W.V. (with six other loca-tions planned). Internationally,Belgarad, Russia, and Bristol,England, are evolving. TheTHP model has a spectac-ular future everywhere.

A Call forRenewedSupport

Bridgesover great rivers requiremuch effort, but in turn givetheir builders new freedomsand new reach. Similarly,building The Healing Placerequired great effort butgave back purpose andmeaning to GLMS physi-cians, and demonstrates toall the ethical side of ourprofession. It personifies theprinciples of medical ethics,

as summarized in the Belmont Report asbeneficence (creating good), justice(bringing the good to all in need) andrespect for persons (adapting the goodfor each unique individual). Few otherprofessions possess this high degree ofethical mission, and even fewer cantranslate ethical callings so readily intohuman benefit.

Celebrate The Healing Place’s 20thanniversary with us. Moreover, volunteerpersonally. Our longtime volunteers haveserved many tours of duty, and neednew replacements of active and retired physicians to staff clinics andsupport programs. A core principle of AAis that “helpingothers helps me.”If treating theworried well has

eroded your store of patience and good-will, you find renewal and joy in takingcare of truly needy men and womenwho are desperately trying to deal withlife honestly. Sign up by contacting LelanWoodmansee at GLMS, or talk to Dr. WillWard. We need you, and you will lovethis revitalizing experience. The HealingPlace is a noble, ethical legacy of theGreater Louisville Medical Society, and itprovides a bridge to a future of humani-tarian purpose for us and for cominggenerations of our profession. LM

“When you’re down and out, whenyou’re on the street,

when evening falls so hard,I will comfort you. I’ll take your part.

When darkness comes and pain is all around,

Like a bridge over troubled waters, I will lay me down.”

-Simon and Garfunkel, 1969

August 2009 is the 20th anniversaryof The Healing Place. This remarkableprogram has become a bridge fromaddiction and misery to recovery andhope for many once-lost souls. Like thebridges that span our great river at theFalls of the Ohio, THP has been progres-sively built from bedrock to upreachingsuperstructure. The original engineer ofTHP was the Greater Louisville MedicalSociety, named Jefferson County MedicalSociety. Subsequent girders were addedby community support, and THP’s ownstaff and alumni. The result is a national-ly-acclaimed example of humanitarian-ism in action, which has become GLMS’sfinest legacy.

Our city is symbolized by locks andbridges. We are reminded of this duringthe spectacular fireworks of ThunderOver Louisville, and the motif is subtlyreflected in local architecture, such asMichael Graves’ elegant Humana build-ing. These are appropriate symbols for acity that bridged the original colonies tothe frontier, bridged a divided nationduring Civil War, and bridged its healingduring reconstruction. Throughout theseeras, rough, hard-drinking boatmen and

migrants chased their future down theOhio, and often became mired here inthe swamps of their addictions. TheHealing Place story describes a bridgeback to normalcy from those hopelessswamps, and it calls for preservation ofthis fine legacy.

The Foundation: A Homeless Shelter

The beginning of THP was a smallhomeless shelter established by a com-passionate Catholic priest, Father JohnMorgan, in an aging church in the decay-ing neighborhood of 1970s West MarketStreet. Father Morgan brought the plightof his boarders to his physician, Dr. WillWard, who embraced their cause andenlisted support from his JCMS col-leagues. Led by Dr. Ward and PresidentKen Peters, JCMS physicians gave an out-pouring of volunteer medical services,funding and broad support. This led toour adoption of THP and its official incor-poration as the JCMS Outreach Program,Inc., later named THP.

For treating acute intoxication, with-drawal and neglected medical condi-tions, the physicians established a clinic,which included a pharmacy of donatedsupplies and a van for bringing clientsfrom the street. To honor Dr. Ward’sinitial inspiration and ongoing service,this clinic was rededicated as “the WillWard Clinic” in October 2003, and JCMShonored all clinic volunteers, with specialrecognition to Dr. Kitty Henry, the clinicmedical director, and Ken Peters, outgo-ing THP board chairman. The clinic andTHP today save taxpayers over $21million annually in avoided medical, jailand criminal justice costs.

Transformation: The Recovery Program

The physicians quickly recognizedthat the underlying cause of their clients’homelessness was addiction, particularlyalcoholism. Therefore, they added arecovery program that has achieved out-

standing success and national recogni-tion. The principal program architect wasJay Davidson, who joined THP in 1991,and now serves as president and CEO.The program is based on principles pio-neered by Alcoholics Anonymous, and itemphasizes peer mentoring and experi-ence sharing so those progressing inrecovery guide those entering. Progressis closely monitored by peers, programgraduates and staff in a caring but strictlydisciplined environment, where respon-sibility for progress is clearly placed onthe client. In addition to regular AA-typemeetings, THP group meetings are heldthree times weekly to enable self-exami-nation and accountability. The programprogresses through early, middle andlong term recovery leading to job place-ment, legal assistance, housing, educa-tion and family reunification. The successrate is extraordinary, with over 2,500alumni and a sobriety rate over 65percent at one year – five times thenational average.

Outreach to Women and FamiliesIn 1995, the program expanded to

women and their children. The women’sshelter and recovery program replicatesthat of the men, but is smaller (300 men,130 women). A greatly expanded facilityfor women and children is now underconstruction, which will double programsize in September 2009.

The Parenting Program:Breaking Generational Cycles

Addiction, hopelessness and devas-tation of self-respect are tragically passedfrom generation to generation by emo-tional abandonment and/or abuse sur-rounding addiction. Children rarelyreceive the emotional skills and insightsto escape the behavior patterns andchemical dependencies that devastatetheir parents. The Parenting Programaddresses this tragic repetition. First, chil-dren are removed from sexual and physi-cal abuse, crack houses or houses of ill

77

New THP Women’s Center at –scheduled to be completed Fall 2009 Sissy Ward,

Will Ward,MD, JayDavidson,ShirleyDavidson

THP on Market St.2001

THP Clinic onMarket St. 2001

Will Ward, MD, andGordon Tobin, MD

Jay Davidson,Gordon Tobin, MD,Sr. GlynnisMcManamon, WillWard, MD, and PhilMarshall (formerTHP DevelopmentDirector) at the ded-ication of the THPWill Ward Clinic


Ethical Issues Involved inDelayed Use of New AMAGuidelines for Evaluation of Permanent Impairment

Since the early 1980s, the AmericanMedical Association has published verycarefully crafted guidelines for objec-tively assessing the degree of perma-nent impairment sustained by an indi-vidual patient from injury or disease.Currently, the fifth edition of the com-pendium, “The AMA Guidelines to theEvaluation of Permanent Impairment,” isin use in the Commonwealth ofKentucky. Medical professionals, insur-ance companies and the judiciary allaccept these fifth edition guidelines asauthoritative.

These guidelines serve both individ-uals and the public. The guidelinesprovide an objective measurement bywhich to evaluate a patient's degree ofimpairment. This tool has obviousimportance in the following contexts:

1. Disability determinations by either the Social Security Administration or by private insurance. 2. Assessment of medical permanency of injuries mediated byWorker's Compensation Insurance.3. Assessment of the nature and degree of personal injuries outside the workplace. Using these guide-lines protects the individual patient

from those who would minimize the permanent effect of an injury ordisease. The guidelines also protect the public, the bottom-line payor for all such claims, from exaggerated non-verifiable claims of impairment.

These guidelines are taken veryseriously by medical professionals. Theobjective nature of the guidelinespermits a transparency to decisionsregarding degree of impairment orinjury such that any medical profession-al should be able to make the samedetermination. There is not a great dealof room for creative elasticity.

Through six editions, the AMA hasupdated these guidelines. Derived fromevidence-based medicine and specialtysociety consensus recommendations,these specific criteria continue to bemade more precise. This work has beenso lucid and detailed that other coun-tries increasingly use the AMAGuidelines to the Evaluation ofPermanent Impairment.

According to Kentucky StatueKRS/342 – 00/0011, the edition of theguidelines considered authoritative isthe most recent edition. Subsection 35of the Worker's Compensation Act pro-vides: "Permanent Impairment ratingmeans percentage of whole bodyimpairment caused by the injury oroccupational disease as determined bythe “Guides to the Evaluation of

Permanent Impairment (AMA), latestavailable edition.” There is now a sixthedition which by law should be theedition used in making determination ofdegree of permanent impairment.However, the fifth edition is still in use.

Why is the fifth edition still in use?There is strong opposition to use of thesixth edition by plaintiff's attorneys andsome doctors. In my opinion, thesegroups object to the new and improvedstandards because they do not like tosee the degree of impairment fromchronic pain syndromes and psychologi-cal disorders more objectively delineat-ed. Likewise, there is objection to theupdated and more realistic ratings inthe area of disability after spine surgery.

Neither the Greater LouisvilleMedical Society nor the KentuckyMedical Association was willing toforward a resolution to the KentuckyGeneral Assembly to encourage theCommonwealth to follow its own laws.The proper use of the most recentguidelines impacts both patient careand health care cost. I believe that wemedical experts should offer guidanceto the people of the Commonwealth ofKentucky and assure that the latestguidelines are implemented. If you havequestions concerning this issue, pleasecontact me at the GLMS BioethicsCommittee. My e-mail address is [email protected].

Dr. Sexton is a member of the GLMSBioethics Committee.

Guest Commentary

Robert F. Sexton, MD

LM

The views expressed in this commentary or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine.

If you would like to respond to an article or commentary in this issue, please submit your response in the form of a Letter to the Editor. You may submit letters to the Editor online @www.glms.org or by emailing our editor directly at [email protected]. The GLMS Editorial Board reserves the right to choose which letters will be published.



Ex-Officio Members of All GLMS CommitteesMichael W. McCall, MD, GLMS board chair Lynn T. Simon, MD, GLMS presidentKimberly A. Alumbaugh, MD, GLMS

president-elect

Board of GovernorsMichael W. McCall, MD, chairLynn T. Simon, MD, presidentKimberly A. Alumbaugh, MD,

president-electDeborah Ballard, MD, vice presidentBernard L. Speevack, MD, secretaryDavid E. Bybee, MD, treasurerRobert H. Couch, MD, at-large member

(appointed by Dr. Simon 2009-2011)Elmer Dunbar, MD, at-large member

(2011-elected)Russell Williams, MD, at-large member

(2011-elected)Kerry Short, MD, at-large member

(2010-elected)Heather L. Harmon, MD, at-large member

(2010-elected)Lewis Hargett, MD, at-large member

(appointed by Dr. McCall 2008-2010)Ex-Officio with VoteBruce Scott, MD, AMA delegateRobert Zaring, MD, AMA Alternate delegateLinda H. Gleis, MD, KMA ranking memberGordon R. Tobin, MD, KMA trusteeFred A. Williams, Jr., MD, KMA alternate trusteeK. Thomas Reichard, MD, Foundation presidentStephen S. Kirzinger, MD, MSPS presidentEdward C. Halperin, MD, MA, dean,

UofL School of MedicineAdewale Troutman, MD, MPH, director,

Metro Department of Public Health & WellnessJay Davidson, The Healing Place, president & CEOMillicent Evans, GLMS Alliance presidentEx-Officio without VotePatrick Padgett, KMA executive vice presidentCharles J. Cronan, IV, society legal counselGLMS StaffLelan K. Woodmansee, CAE, executive directorGlenda Klass, controllerDottie Hargett, professional relations directorCheri K. McGuire, director of marketingBert Guinn, communications &

membership directorMatthew Ralph, communications associateTerry Todd, Foundation directorOnvia McDaniel, administrative assistant

to executive director

Athletic Subcommittee(To be announced in the August newsletter) Mark G. Smith, MD, chair

Bioethics CommitteeEsther Costel, MD, chairDavid Doukas, MD Peter Hasselbacher, MDBarbara S. Isaacs, MDSerge Martinez, MDRoy J. Meckler, MDTerry Meyer, RNKathie Rose, RNRobert F. Sexton, MDPaul Simmons, PhDRebecca Tamas, MDElisabeth Tobin, PhDJuan Villafane, MDEd Wunsch, Ed.D

Hospital Ethics CommitteeRepresentativesMaureen Chambers, KindredMary Haynes, Nazareth HomeGLMS StaffDonna Jones, administrative assistant

CAPS CommitteeJohn F. Klink, III, MD, chairThe centralized application processingservice oversight committee is composed ofrepresentatives nominated by the creden-tials committees of participating hospitals.

Community Health CommitteeRobert W. Powell, MD, chairDeborah Ballard, MDJuliana Hayden, MDScott Hedges, MD John P. Howard, MDThomas James III, MD John N. Lewis, MDBryan Loy, MDMichael D. Needleman, MDNancy J. Newman, MDIsabella B. Nyan, MDNeal J. Richmond, MDJacqueline Simmons, MDMark G. Smith, MDGerald F. Sturgeon, MD, Adewale Troutman, MDMatthew M. Zahn, MDEx-Officio Members with voteRon Alsup, American Heart Association

state alliance directorJulie Brackett, American Heart AssociationBonnie Ciarroccki, Health Promotion Schools of ExcellenceRon Crouch, director of Kentucky Data CenterJay Davidson, executive director of The

Healing PlaceKim Dees, Kentucky Hospital Association

Lori Fields, Health Promotion School of Excellence

Ryan Irvine, Metro Louisville Department of Health and WellnessKristin Paul, Kentucky Cancer Program, UofLPhyllis Skonicki, community representativeWendy Corrigan, VNA Nazareth Home Health GLMS StaffLelan K. Woodmansee, CAE, executive directorOnvia McDaniel, administrative assistant

Editorial BoardMary G. Barry, MD, editorDeborah Ann Ballard, MDLaurie Ballew, Ed.D, DOWilliam A. Blodgett, MDEugene H. Conner, MDFrank DeLand, MDArun Gadre, MDJeremy Gerwe, MDTracy Ragland, MDStanley A. Gall, MDLarry P. Griffin, MDDarin Harden, MDJonathan E. Hodes, MDLouanda Kynhoff, MDThomas James III, MDMichael T. Macfarlane, MDTeresita Bacani-Oropilla, MDDanielle PigneriM. Saleem Seyal, MDBernard L. Speevack, MDJoe Mauer, MDDave Langdon, Health DepartmentGLMS StaffLelan K. Woodmansee, CAE, executive directorBert Guinn, communications &

membership dir.Matthew Ralph, communications associateDonna Watts, communications designer

Public Safety and Diversion CouncilWilliam S. Smock, MD, chairPaul Barth, suburban fire districtsRichard Bartlett, KY. Hospital AssociationLisa Benner, Jewish & St. Mary’s HospitalNathan Berger, MD, VA HospitalDavid Biddle, MD, Baptist EastJenny Blanchard, WMD Coord., Louisville FBIMichael Brown, EMA deputy director*Randa Bryan, Norton Audubon HospitalRuth Carrico, RN, School of Public HealthRoger Cecil, University Hospital EDDonald Clark, Rural/Metro EMSChristopher Collett, 41st Civil Support UnitKevin Combs, FPS*Robert Couch, MD, JHSMHEdward Cox, Metro Safe Communications*Ron Crafton, MD

Greater Louisville Medical SocietyBoard, Committees, Councils 2009-2010 Membership in appointed committees remains open throughout the year.

If you are interested in serving, please email the GLMS Executive Director [email protected].

1111JJUULLYY 22000099

Stuart Crawford, Oldham Co. EMSSean Denton, MD, Jewish & St. Mary’s HospitalKim Doan, Jewish & St. Mary’s ED MgrGreg Gitschier, law enforcement coordinatorMarcy Heilman, LM EMA Medical Reserve CorpsSherman Hockenberry, Yellow AmbulanceMindy Glenn, MetroSafePaul Freibert, University HospitalKathy Jenkins, Norton Aubudon safety officerMarty Johnson, University Hospital EDBelinda Jolly, Yellow AmbulancePatricia Keeling, VA*Robert Knies, Baptist East HospitalYES*Chief Walter J. Lage, Anchorage Fire/EMSLana Lynch, LM EMA*Ken Marshall, VP, University HospitalMario Maya, MD, Medical Supp. Ryder CupBenita McNally, Baptist NortheastKaren Newman, vice president, Baptist EastKevin Nuss, Oldham Co. EMA director*Daniel J. O’Brien, MD, Major Roger Parvin, LM EMSSteve Petty, Dir., Public Safety, Lou Int’l AirportMike Phillips, Bullitt County EMSJoyce B. Pickett, Jewish & St. Mary’s HealthCare*Robert Pringle, MD, Norton Suburban EDLisa Richardson, Sts. Mary & Elizabeth ER*Neal Richmond, MD, LM EMS directorDerrick Riddle, Rural/Metro EMSMaurice Risner, Jefferson County SchoolsLt Col Craig Rodgers, LM EMSLt Col Rick Roller, LM EMSLewis Rowe, MDMelissa Schreck, School of Public HealthCaptain Jeff Sherrard, LM PoliceSteve Sikkema, US Marshals Service*Kathy Watson, Jewish & St. Mary’sBill Wetter, LM Public Health & Wellness*Ron Wilder, Oldham EMS*Ken Wilson, MD, Norton HealthcareNathan Wilson, RN, BSN, Audubon ERMatt Zahn, MD, LM Public Health & Wellness*Voting members of voting Diversion CouncilGLMS StaffLelan K. Woodmansee, CAE, executive directorOnvia McDaniel, administrative assistant

GLMS Foundation Board of TrusteesK. Thomas Reichard, MD, PresidentDavid R. Watkins, MD, Vice President Barton H. Reutlinger, MD, SecretaryWilliam Summers, Central Bank, TreasurerClass of 2009Greg Ehrhard, Stites & HarbisonJohn Roth, MDSteven Smoger, MD Sandra Vance Neal, Advance ResourcesClass of 2010Linda H. Gleis, MD Lewis Hargett, MDThomas James, MDVirginia Keeney, MDMichael McCall, MD, GLMS Board ChairRichard S. Wolf, MD Class of 2011Timothy S. Brown, MDW. Stewart Cobb Joseph E. Kutz, MDToni Linville, GLMS AllianceLynn Simon, MD, GLMS President Janice W. Yusk, MD

GLMS Foundation CommitteesHealthcare Careers & Scholarships –

Linda Gleis, MD, chairIndigent Care – Sandra Vance Neal,

Advance Resources, chair Medical Missions – Tim Brown, MD, chairOld Medical School Building Preservation –

Barton Reutlinger, MD, chairGLMS StaffLelan K. Woodmansee, CAE, executive directorTerry Todd, GLMS Foundation directorGlenda Klass, controllerAngelique Bagshaw, Foundation assistant

Louisville Health InformationExchange (LouHIE) Liaison CommitteeS. Lyle Graham, MD, chairWilliam Hymes, MD, vice chairKenneth N. Zegart, MDDavid H. Bizot, MDDivya Cantor, MDStephen S. Kirzinger, MDJohn N. Lewis, MDKetan Mehta, MDCynthia Rigby, MDStephen R. Roszell, MDWayne Tuckson, MDGLMS StaffLelan K. Woodmansee, CAE, executive directorBert Guinn, communications &

membership director

Grievance CommitteePhilip T. Browne, MD, chairDavid A. Casey, MDSandra M. Elam, MDSamuel G. Eubanks Jr., MDLewis Hargett, MDJames I. Harty, MDMorton L. Kasdan, MDTerry McCurry, MDJason M. Meckler, MDJ. Patrick Murphy, MDCharles R. Oberst, MDVinay Puri, MDMolloy G. Veal, MDGLMS StaffJohn Downs, credentialing specialist

Judicial CouncilKenneth C. Anderson, MDJannice O. Aaron MDDavid H. Bizot, MDRebecca J. Booth, MDRichard T. Holt, MDJohn M. Karibo, MDChristopher J. Schrodt, MDStephen Wheeler, MDDanny Woo, MDGLMS StaffM. Stephen Bassett, peer review directorLelan K. Woodmansee, CAE, executive director

KMA DelegationElected DelegatesDavid R. Watkins, MD, chairKimberly A. Alumbaugh, MDDeborah A. Ballard, MDSusan M, Berberich, MDDavid H, Bizot, MDRebecca Booth, MD

David E. Bybee, MDMary Helen Davis, MDR. John Ellis, Jr., MDBeverly M. Gaines, MDJeffrey Glazer, MDRobert A. Goodin, MDRobert R. Goodin, MDLarry Griffin, MDAnna K. Huang, MDSheri A. Kalbfleisch, MDJohn M. Karibo, MDMorton L. Kasdan, MDVirginia T. Keeney, MDA. O’tayo Lalude, MDMichael W. McCall, MDC. Kenneth Peters, MDCynthia R. Rigby, MDG. Randolph Schrodt, Jr., MDLynn Simon, MDBernard Speevack, MDStephen Wheeler, MDFred A. Williams, Jr., MDRussell A. Williams, MDDanny Woo, MDKenneth N. Zegart, MDElected In-Training Delegates:Kelly Church, MDJonathan Wilkerson, MDAppointed DelegatesCharles J. Bisig, Jr., MDFrank O. Bonnarens, MDTimothy S. Brown, MDStephen D. Burton, MDMichael G. Cassaro, MDEugene H. Conner, MDRobert Couch, MDMichael W. Dee, MDElmer E. Dunbar, MDW. B. Owen Edelen, MDSamuel G. Eubanks, Jr., MDDarius Ghazi, MDEugene Giles, Sr., MDShawn D. Glisson, MDHarold D. Haller Sr., MDEdward C. Halperin, MDRobert Hammer, MDLewis Hargett, MDHeather L. Harmon, MDPeter Hasselbacher, MDJiapeng Huang, MDArthur H. Issacs, MDThomas James, III, MDStephen S. Kirzinger, MDEric F. Lydon, MDKenneth Mook, MDJames P. Murphy, MDJohn D. O’Brien, MDChristopher K. Peters, MDK. Thomas Reichard, MDLewis L. Rowe, MDRicky L. Rowe, MDJohn D. Rumisek, MDCharles Shane, MDRajesh K. Sheth, MDKerry Short, MDMichael Sowell, MDWilliam Trent, MDJuan Villafane, MDA. Franklin White, MDErica Williams, MDRobert A. Zaring, MD

Continued on page 13


JJUULLYY 22000099 1133

Appointed In-Training DelegatesWilliam Adams, MDMartin Huecker, MDVolunteer DelegatesJannice O. Aaron, MDChristine, B. L. Adams, MDSusan G. Bornstein, MDCharles F. Bowlds, MDW. Cooper Buschemeyer Jr., MDMarjorie R. FitzGerald, MDMichael B. Flynn, MDGregory E. Gleis, MDLinda H. Gleis, MDDaniel L. Hafendorfer, MDKevin J. Heine, MDSteven T. Hester, MDJohn G. Hubbard, MDScott Jones, MDVeronnie F. Jones, MDJulie Summers Lee, MDMichael T. Macfarlane, MDSamuel B. Pollock Jr., MDTrudi L. Rash, MDBruce A. Scott, MDKenneth L. Silk, MDLloyd R. Taustine, MDGordon R. Tobin, MDGeorge H. Zenger, MDGLMS StaffLelan K. Woodmansee, CAE, executive directorBert Guinn, communications &

membership director

Leadership and ProgramDevelopment CommitteeErica Williams, MD, chair Traci Edwards, MDChristopher Peters, MD John Roberts, MDDavid Watkins, MDRobert Zaring, MDGLMS StaffLelan K. Woodmansee, CAE, executive directorBert Guinn, communications &

membership director

Medical Society ProfessionalServices Board of DirectorsOfficersStephen S Kirzinger, MD, presidentCynthia R. Rigby, MD, secretaryForrest Kuhn, MD, treasurerDivya B. Cantor, MDSamuel G. Eubanks Jr., MDRichard T. Holt, MD Bryan A. Loy, MDKathy Vincent, MDGLMS StaffGlenda Klass, controllerLudmilla Plenty, employment service directorLelan K. Woodmansee, CAE, executive director

Nominating/Tellers CommitteeDavid Watkins, MD, chairSusan M. Berberich, MDDavid H. Bizot, MDRebecca J. Booth, MDJerry B. Buchanan, MDJames F. Fitzpatrick, MDJeffrey D. Glazer, MDRobert G. Hammer, MD

Steven T. Hester, MDAnna Huang, MDSheri A. Kalbfleisch, MDMichael W. McCall, MDKenneth A. Mook, MDChristopher K. Peters, MDC. Kenneth Peters, MDG. Randolph Schrodt, Jr., MDKerry Short, MDLynn T. Simon, MDBernard Speevack, MDGordon R. Tobin, MDJames E. Wheeler, MDErica D. Williams, MDFred A. Williams, Jr., MDRussell A. Williams, MDRobert A. Zaring, MD

Pictorial RosterLawrence G. Goldberg, MD, chairDavid E. Borden Jr., MDNemesio B. Bucayu Jr., MDRichard A. Fellows, MDBernard L. Speevack, MDGLMS StaffCheri McGuire, director of marketing

Physician Practice Advocacy CommitteeMichael Dee, chair Frank O. Bonnarens, MD Cooper Buschemeyer, Jr., MDRenee Girdler, MD Lawrence Goldberg, MDRichard Goldstein, PhD, MDCathy Hammond, MD, Family Medicine Kenneth M. Hodge, MDSteven M Howell, MD Alvin W. Martin, MD Vani Nadar, MDBen A Reid, MD John Rumisek, MDDaniel Scullin, MDRajesh Sheth, MDC. Steven Smith, MDStuart White, MDGLMS StaffDottie Hargett, director of professional relationsStephanie Woods, advocacy specialist,

professional relationsJessica Williams, compliance specialist,

professional relations

Practice ManagementRepresentatives to PPACDarin Bennett, Rehab AssociatesSusan Bezy, Norton HealthcareHolly Bracco, The Physicians Group Angela Capshaw, Beverly M. Gaines,

MD & Associates Anita Carr, Endocrine & Diabetes Assoc. Terri Christian, Endocrine & Diabetes Assoc. Alice Cissell, University Physicians Associates Paul Coogan, Avoca Jeanie Crow, Louisville Bone & JointAnita Daily, Louisville Neurology Jolene Eicher, Commonwealth Ear, Nose & Throat Mary Emmons, Chest Med AssociatesElaine Esterle, Scott Jones, MD, Surgery Shelley Gast, Norton Healthcare Danielle Graham, Commonwealth ENT Charlotte Granzow, Total Woman

Sharon Grasch, Ellis & Badenhausen Ortho. Joe Laden, Anesthesia Associates of Louisville, PSC Mary Langdon, X-ray Assoc of Louisville Bunny Leep, Accredited Asthma & Allergy CareConnie Leffler, Just For Women Theresa McCoy, Kentuckiana Allergy Loretta McGinty, Caritas Physicians GroupJulie Morris, Norton Physicians Svc. Diane Myers, East Louisville Pediatrics Paul Newsom, Cardiovascular Specialists Tricia Niendam, Women’s Health CareLora Norrenbrock, Accredited Asthma & Allergy Care Roxanne Oyler, KY Eye Care PSC Genny Pellerin, Women First of Louisville Cyndi Powell, Norton Healthcare Mark Prussian, The Eye Care Institute Karen Risinger, Gastroenterology

Consultants of Louisville Sherri Ryan, Joseph Banis Plastic Surgery Patti Sacra, University Ped Surgical Assoc, PSCFrances Shouse, Pediatric AssocJaimelee Steurer, The Eye Care Institute Kathy Wilkinson, Women First of LouAlma Williams, University Physicians Associates Jane Hyland, Tyson, Schwab, Short & WeissKathy Key, Louisville Medical Associates Debbie King, dGv Services, LCL GLMS StaffDottie Hargett, director of professional relationsStephanie Woods, advocacy specialist,

professional relationsJessica Williams, compliance specialist,


PPAC INSURANCE ISSUES RESOLUTION COMMITTEESGLMS StaffDottie Hargett, director of professional relationsStephanie Woods, advocacy specialist,

professional relationsJessica Williams, administrative assistant, professional relations

Insurance Issues Resolution CommitteesAnthem IIRCBen Reid, Jr. MD, chairConnie Lefler, office manager, LKMGMA

representativeSusan Thompson, Precision Healthcare DeliveryRichard Lane, MD, Anthem medical directorMike Lorch, Anthem vice presidentKathy Lower, director, provider relations

and network operationsRosie Jones, Anthem senior provider relationsMary Alvey, Anthem provider relationsKaren White, Anthem senior network relations

Humana IIRCLawrence Goldberg, MD, chairJoe Laden, Business Mgr, co-chairDiane Myers, CPA, officer manager and

LKMGMA rep.Bryan Loy, MD, Humana market medical officerThomas James III, MD, Humana national

director for network operationsCatherine Sauner, Humana director of

network operations

National Government Services – NGS IIRCFrank Bonnarens, MD, chairCarolyn Cunningham, MD, NGS medical director

Continued from page 11



For these and a list of other available properties, please call or visit:

502 429 6700 | www.cbrelouisville.com

6060 Dutchmans Lane, Suite 100 | Louisville, KY 40205

AVAILABLE MEDICAL OFFICE PROPERTIESLOUISVILLE | KENTUCKY

FOR SALE

2303 GREENE WAY

13,335 square foot building Single story, easily accessible / ample parking Easy I-64 access off Hurstbourne Pkwy near

Stony Brook Shopping Center

FOR LEASE

SHOPPES AT FOREST GREEN

From 1,510± SF to 9,900± SF Fronting Hurstbourne Pkwy near Dorsey Ln Former medical office space available Across from Hurstbourne Green Office Park

FOR SALE

1901 EMBASSY SQUARE BLVD

18,000± square foot building on 2.10± acres Near Bachman Chevrolet Visible from Hurstbourne Pkwy/I-64 interchange Near retail amenities

FOR SALE9710 BUNSEN PARKWAY

8,424± square foot building on 1.06± acres Convenient location off Hurstbourne Pkwy with

easy access to I-64 Near Wal-Mart & Swope Auto Center

JJUULLYY 22000099 1155

Mark Prussian, office administrator and LKMGMA rep.

Mike Davis, NGS manager of external affairsLindy Lady, NGS provider outreach and educationNathan Kennedy, NGS Part B POE team lead

Passport Health Plan IIRCRenee’Girdler, MD, chairPatti Sacra, office administrator and LKMGMA repDenise Schifano, Passport Vice president

provider relationsJeri Cross, Passport manager of provider relations

United Healthcare IIRCKenneth M Hodge, MD, chairJeffrey Beardmore, MD, UHC medical directorRyan Miller, UHC physician lead, KY/INMatthew Holbrook, UHC network account managerJolene Eicher, office administrator and

LKMGMA rep.Holly Bracco, office administrator and

billing specialist, LKMGMA rep.

Payor Survey Task ForceAnita Carr, billing managerTerri Christian, office administratorDiane Myer, CPA, office administratorMark Prussian, office administratorPatti Sacra, office administrator

Public Policy CouncilDeborah A. Ballard, MD, chairMichael W. McCall, MD, chair, board of governorsLynn T. Simon, MD, presidentKimberly A. Alumbaugh, MD, president-electBruce A. Scott, MD, AMA delegateDavid A. Watkins, MD, KMA delegation chairLinda H. Gleis, MD, KMA treasurerGordon R. Tobin, MD, KMA trusteeFred A. Williams, Jr., MD, KMA alternate trusteeRobert A. Zaring, MD, Legislative Quick

Action Team chair & AMA alt. delegateMary G. Barry, MD, Editorial Board chairRebecca J. Booth, MD, Judicial Council chairEsther E. Costel, MD, Bioethics Committee chairMichael W. Dee, MD, Physician Practice

Advocacy Committee chairStephen S. Kirzinger, MD, Medical Society

Professional Services, Board chairJohn N. Lewis, MD, Quality Improvement

and Patient Safety Committee chairRobert W. Powell, MD, Community

Health Committee chairK. Thomas Reichard, MD, GLMS Foundation chairG. Randolph Schrodt, Jr. MD, Trends in

Medicine Committee chairErica D. Williams, MD, Leadership &

Program Development Committee chairMary Helen Davis, MD, at-large memberS. Lyle Graham, MD, at-large memberJohn B. Roth, MD, at-large memberCharles C. Smith, Jr., MD, at-large memberGLMS StaffLelan K. Woodmansee, CAE, executive directorBert Guinn, communications &

membership director

Quality Improvement & Patient SafetyJohn Lewis, MD, chairCynthia Rigby, MDThomas James, MDGeetha Joseph, MDA O’Tayo Lalude, MDRick Rowe, MD

James O’Brien, MDDemetra Antimisiaris, PharmD, U of LRanda Deaton, UAW-FordMary Lyle, UAW-FordGLMS StaffLelan K. Woodmansee, CAE, executive directorDottie Hargett, director of professional relationsJessica Williams, compliance specialist,


Patient Safety Task ForceThomas James III, MD, chairJohn Lewis, MDGeetha Joseph, MDCynthia Rigby, MDRick Rowe, MDLyle Graham, MD representing LouHIEJames O’Brien, MDDemetra Antimisiaris, PharmD from U of L

School Medical Transfers SubcommitteeBernard L. Speevack, MD, chairStephen H. Church, MDJohn P. Howard, MDBarbara Isaacs, MDDavid Lohr, MDBrenda O. Osborne, MD

Senior Physicians CommitteeEugene H. Conner, MD, chairBilly F. Andrews, MDJoseph B. Brill, MDPhillip T. Browne, MDAnne Dunbar-Richman, MDWilliam C. Durham, MD David Nightingale, MDNicholas W. Glaser, MDJohn R. Gleason, MDPaul P. Hess, MDHunt B. Jones, MD Virginia T. Keeney, MDFrank W. Lehn, MDJames F. Molloy, MDWilliam N. Nash, MDWilliam H. Powers Sr. MDMary A. Smith, MDHarry D. Stambaugh, MDNorton G. Waterman, MDGLMS StaffDonna Jones, administrative assistant

EMERITI MEMBERSRobert J. Alberhasky, MD

Trends in Practice of MedicineCommitteeG. Randolph Schrodt, Jr., MD, chairJames Fitzpatrick, MD – JHSMH physiciansJon Wilding, MD – Norton physiciansRichard Goldstein, MD – U of L physiciansJeff Reynolds, MD – Baptist physiciansH. Lynn Speevack, MD – VA physiciansJenny Gentner, MD – young physiciansJohn O’Brien, MD – private practice/KMAKMA RepresentativesDiane Maxey Miranda MoselyGLMS StaffLelan K. Woodmansee, CAE, executive directorDottie Hargett, director of professional relationsJessica Williams, compliance specialist,


Vital SignsDavid R. Watkins, MD, editorWilliam J. Oliver, MDJohn Roth, MDCharles Smith, MDMary Smith, MDGLMS StaffLelan K. Woodmansee, CAE, executive directorBert Guinn, director of communications

and membershipMatthew Ralph, communications associateDonna Watts, communications designer

The Healing Place Board of DirectorsOfficersJohn G. Hubbard, MD, immediate past chairKelley Abell, chairMike Joksimovic, chair-electScott Neff, treasurerDeane Stewart, secretaryDirectorsJohn Y. Brown IIINancy BushChristi Lanier-RobinsonSandra McLaughlinKim BlinkhornKeith ReynoldsJan KarzenDan CaudillHelena SchulzMary Therese DingaLaura DouglasMarcia LewisJennie MeadorTim MartinRob SamuelsGreg Brown, MDDavid CronanRev. John G. (Fr. Jerry) EiflerA. G. Artie MeyerStephanie MasslerDaniel SwintoskyEx-Officio Members with voteK. Thomas Reichard, MD, GLMS Foundation

presidentLouis R. Kirtley, MDDavid H. Bizot, MDChristopher M. Stewart, MDLelan K. Woodmansee, CAE, GLMS

executive directorKaren DeCosta, alumna memberCharles Anderson, alumnus memberBoard Advisory Members without voteJay P. Davidson, president and chief

executive officerGreg Givan, chief operating officerKaryn Hascal, vice president for mission

advancementCliff Whalin, vice president of development

and communicationsBurns Brady, MD, volunteer medical directorRob Campbell, MD, volunteer clinic medical directorElizabeth Allen, GLMS Alliance


LM


“When it’s springtime inthe Rockies, I’ll becoming back to you”-From the song, “Springtime in the Rockies”

A successful youngish physician and his wife, havingattained their professional and financial dreams, faced theprospect of their elder daughter having been asked for herhand in marriage. As a little girl, she loved to stage outdoorweddings with her Barbie dolls. Having grown into a lovelyaccomplished woman she now wanted to have her ownwedding in a mountain lodge in Colorado where her parentsonce worked. Among the imposing buttes whose tops lookedlike castles one could almost expect an Indian sentinel on ahorse scouting the vast valley below. The air, crisp and cool,was scented by wild flowers that peeked out of the mountain-sides. In the distance the snow-capped Rocky Mountain peaksprovided an imposing view.

Her parents indulged her wish and to make it more festive,invited relatives and friends to join them. They were warnedthat this was the West and to bring proper attire, bootsperhaps? They were told their quarters would be at a mountainlodge. Sure enough, the view was breathtaking, the peace andquiet palpable.

Guests found out that their rooms had all the amenities ofthe modern world that would please any tenderfoot, with oneexception. In order to have cell phone contact with the outsideworld they had to drive down the mountain to the nearesttown. The monitor would read “Searching, searching, nocontact available.” With everyone devoid of the electronicdevice that seems to be a permanent fixture to the modern ear,people turned to each other for company.

It was a great bonding ploy. Brothers, sisters, friends, andguests talked to each other and reestablished relationships,

found new friendships, and dis-cussed the different life stylesthat they led.

However, two physicianguests were practicing tele-radiology. One covered nightcalls for emergency rooms inCleveland on a regular oncall basis. The other had alicense to cover emergencyrooms all over the UnitedStates. Both did it fromhome, enabling theyounger of the two toattend to his six and two yearold daughters’ needs. Another physi-cian opined that these readings were reliable, helpful, andcould alert physicians on call to get with it instead of procrasti-nating.

The wedding was exactly how the bride had planned it,under a rose covered arch beside a little woodland bower, andbehind, the grandeur of the mountains as the sun begun to set,as a backdrop. Whether it was a rehearsal dinner at an elegantlodge beside a lake, a formal tent reception at the wedding site,a garden barbecue, or breakfasts at the nearest town’s quaintrestaurants, simple and elaborate cuisine was in abundance. A side trip to the Rocky Mountains National Park the day after

the wedding was an added treat. A 12,000-foot-high peak hadbecome accessible by car via a newly opened road after thespring melt. It was exhilarating to be surrounded by snow-covered peaks on every side and breathe rarified air. Getting tosee the miniature flora of the tundra below the alpine altitudeand the stand of pine trees at an even lower level made onetruly appreciative of the beauties of this earth and the need topreserve them.

A wedding, a visit to a wonderful place in this vast land,where even cell phones dare not disturb the peace. What a tripto renew one’s soul!

Teresita Bacani-Oropilla, MD

LM

Searching, Searching - No Phone Connection

R E F L E C T I O N S

Photoaboveand inseton cell-phone byTeresitaBacani-Oropilla,MD

JOB#: B005970000CLIENT: CONCENTRA PUBS: LOUISVILLESIZE: 3.625 X 4.625

DATE: 6.1.09ARTIST: ADCOMP: LSREV: 0

At Concentra, one of the largest providers of health care services in the nation, we’re reinventing the health care experience, reshaping it, and making it what it should be for our patients and our care providers. Founded and still led by physicians today, our focus is on clinically excellent care and long-term wellness programs in a practice that becomes a rewarding experience for every patient and doctor. We are seeking BE/BC physicians, preferably with Occupational Medicine and/or Urgent Care experience for the following position in Louisville:

To learn more, please contact Julie Thomas at 866-839-7660 or email: [email protected].

www.concentra.com/careers

We are a diverse team dedicated toimproving America’s health,one patient at a time. EOE.

Center Medical Director

Uplifting the Patient ExperienceUplifting the Patient Experience

One patient at a time.

JJUULLYY 22000099 1177

628 Wataga Drive

· Approximately 2,038 square feet

· Three bedrooms, two and a half bathrooms.

· Freshly painted interior.· Hardwood floors; arched doorways.

· Nine foot ceilings on first floor.

· Updated kitchen and bathrooms.· Glassed porch. · Large deck overlooking private rear yard.

· In ground pool with removable, child-resistant fence.

· $375,000.

LM

I am a Louisville native and currently live in the housewhere I grew up as an only child. My father, Oscar Demling,was a pharmacist and owned Demling’s Drug Store for 50years. My mother, Belle Pace Demling, was a music teacherand a business owner. I graduated from University ofKentucky with a BA degree, received a MA in counselingfrom Western Kentucky University, as well as a Rank I inteaching.

While attending the University of Kentucky, I met myhusband, Dr. Donald Lee Evans. He is a diagnostic radiologistpresently working for University Radiological Associates. Itaught biology for eight years before having two childreneleven years apart. My older daughter, Dr. Laurelee Rubsch,is a small animal veterinarian at Crestwood VeterinaryHospital. She has a five-year-old daughter, Isabelle Donna.My younger daughter, Kristilee Williams is a real estateagent. She has a three-month-old son, Evan Jay. I am blessedto have both daughters living in Louisville.

Currently, I am secretary of the Kentucky MedicalAssociation Alliance and the secretary of InvestHersInvestment Club. I am on the board of St. Matthews AreaMinistries representing Beargrass Christian Church where Iam a member and deacon and a past president of thewomen’s group, Disciples Women. I am also past presidentof The Mutual Investment Club of Louisville and present sec-retary of that club. I am a member of The Fillies, University ofLouisville Woman’s Club, and The Woman’s Club ofLouisville. I have been a substitute teacher for 17 years in theparochial and Jefferson County Public Schools.

My family and friends have given me strength andencouragement when I needed it most. They have been themost supportive of me. My personal goal is to live my life tothe fullest, and my favorite saying is: “cherish yesterday,dream tomorrow, live today.” I look forward to my year asthe alliance president and working with such a terrific anddedicated board.

WWeellccoommee ttoo tthhee 22000099--22001100 OOffffiicceerrss ooff tthhee GGrreeaatteerr LLoouuiissvviillllee MMeeddiiccaall SSoocciieettyy AAlllliiaanncceePresident: Millicent (Mrs. Donald L.) EvansPresident-Elect: Lisa (Mrs. Barry) SosninVice-President: Michelle (Mrs. Timothy A.) Feger Recording Secretary: Rhonda (Mrs. John D.) RhodesCorresponding Secretary: Ann (Mrs. Morton ) KasdanFinancial Secretary: Karin (Mrs. George) SonnierTreasurer: Adele (Mrs. James Patrick) MurphyParliamentarian: Ruth (Mrs. John) Ryan

Alliance UpdateMillicent Evans, GLMS Alliance President

TThhee mmiissssiioonn of the GreaterLouisville Medical Society Allianceis to encourage support amongdoctors’ families and to promotehealth education and communityservice.

A CharmingHome with

Warmth andCharacter

View online atWRRealtors.com

A.

E.D.

C.B.

F. G. H.

I.

J.

K. L.

M.N.

O.P.

Q. R. S.

T.

U. V. W.

President’s Soiree SSuunnddaayy,, MMaayy 3311,, 22000099 at the Speed Art MuseumA.Past President & Outgoing Chair, Randy

Schrodt, MD, President, Lynn Simon, MD and Outgoing President, Michael McCall, MD

B.Randy Schrodt, MD presents Michael McCall, MD with a plaque honoring his service as President

C.Randy Schrodt, MD presents an award to Clifford Kuhn, MD , the Richard Spear,MD Memorial Essay Contest Practicing and Life Member Category Winner

D.Mindy Needleman and Lynn Simon, MD

E.Kim Alumbaugh, MD and husband, Dan Varga, MD

F.Gregory Gleis, MD and Clifford Kuhn, MDG.Rishi Kumar, MD and guestH.Randy Schrodt, MD presents an award

to Lyle Bohlman, MD, Richard Spear, MD Memorial Essay Contest Honorable Mention

I. Kristen Miller and Neil Richmond, MDJ. Sharon Watkins and David Watkins, MDK.Ceremony slide presentationL.David Easley, MD andDavid Seligson, MD

M.Lelan Woodmansee, Patrick and Elizabeth Padgett and Bert Guinn

N. Marsha James and Thomas James, MDO.Glenn Stoutt , MD and wife, Tyleen,

Roger Shott, MD and wife, DianeP.Marlena Woodmansee, Liberacion

Soriano, MD and Nora Sessoms, MDQ. Mona Changaris, Stephanie Mosley,

MD and David Changaris, MDR.Elaine Stauble, MD, Bruce Tasch,MD

and Rebecca Terry, MDS.Miren Asumendi, MD and guest

T.Kenneth Harrison, PhD and Jessica Dowe-Harrison, MD

U. Tom Courtenay, MD, Ro VanVooren, Charles Smith, MD, Rosemary Smith and Glenda Haller

V.Venkat Sharma, Aneeta Bhatia, MD and Bob Goodin, MD

W.Marilyn Bornstein, Alan Bornstein, MD, and Harold Haller, Sr., MD

JJUULLYY 22000099 1199


LBAN GILPIN SMITH wasborn in New Castle County,near Wilmington, Del., toQuaker parents, Samuel and

Lydia Gilpin Smith, on March 22, 1795.Nothing much is known of his parents,although his maternal ancestors were

paper makers for several generations.Alban’s parents established a permanent residence in

Philadelphia in 1797. Alban’s formal schooling was obtained atthe Westtown (Quaker) School in Westtown, Chester County,Pa., from January 1809 until April 1810. He apparently then trav-eled to Danville, Boyle County, sometime before his 15th birth-day, to begin his apprenticeship in surgery and medicine underEphraim McDowell (1771-1830). His apprenticeship was com-pleted prior to September 1815, for on Sept. 27 he stated hehad begun practice in Port Tobacco, Md. At this time, he trans-ferred his membership from the South Philadelphia (Quaker)Monthly Meeting to the one in Alexandria, Va. This change wasgranted Dec. 21, 1815.

In Port Tobacco, he met and married Taliaferro H.Middleton (died 1849) in 1817. She was not a member of theSociety of Friends. This alliance resulted in Alban’s removal frommembership in the Alexandria Meeting in April 1818. Thecouple eventually had seven children, but only three lived tomaturity. One, Middleton (1818-1887) became a physician,graduating from the College of Physicians and Surgeons atColumbia College in 1840.

Alban left his established practice in Maryland andremoved his family to Philadelphia, where he could further hismedical education. He chose to enroll in the private medicallectures of the Quaker physician Joseph Parrish (1779-1840) atthe Philadelphia Alms House. He chose to attend these privatelectures instead of enrolling in the University of PennsylvaniaMedical Department as Dr. Parrish’s tuition was much lessexpensive, and classes were conducted during the summermonths. Parrish’s didactic lectures were supplemented by clini-cal cases from his larger practice caring for both public andprivate patients. Surgical operations by Dr. Parrish, as well as

other practitioners, could be monitored in the hospitals thatParrish attended.

In 1822, Dr. Smith returned to Danville where he became apartner of his former preceptor, Ephraim McDowell, until 1826.During this partnership, Dr. Smith performed the third success-ful ovariotomy on a free black patient in May 1823. In October1827, Dr. Smith performed the world’s first dorsal laminectomyfor treatment of fracture of the spine and subsequent paralysisbelow the shoulders. Although function did not return, theoperation had demonstrated that the fragments of the frac-tured vertebrae could be removed and the spinal cord exposed.It would be over a century before more definitive informationconcerning management of such procedures would be forth-coming.

Alban studied chemistry under his preceptor and Dr.Parrish, and in 1823 he received his first academic appointmentas professor of chemistry at Centre College in Danville.

Since there was a very high incidence of urinary tractstones among local patients, Dr. Smith sought a less invasiveand traumatic method for the treatment of patients sufferingwith urinary calculi. In 1824, the French surgeon Jean Civiale(1792-1867) introduced the technique of crushing urinary tractstones with specially designed instruments by transurethralapproach, a technique known as lithotrity. This eliminated theinvasive and risky open surgical method of treatment.

Dr. Smith went to Paris in mid-1829 to study under Dr.Civiale, and returned to the U.S. in December 1830. On hisarrival in Philadelphia, he met, by chance, fellow Kentuckyphysician Daniel Drake (1785-1852). Dr. Drake was then theeditor of The Western Journal of Medical and Physical Sciences.He requested that Dr. Smith submit some comments on Dr.Civiale’s technique and the special instruments for publicationin his journal. Dr. Smith complied. After his return to Danville,Dr. Smith soon performed the first lithotrity in the Westerncountry.

Being frustrated by the absence of a hospital in Danville,Dr. Smith moved to Louisville in 1831. He soon received anappointment to the surgical staff of Louisville Marine (City)Hospital, the first and only general hospital in Kentucky at thetime.

Eugene Conner, MD

On the fringes of greatness:Alban Gilpin Smith (Goldsmith)1795-1861

A

JJUULLYY 22000099 2211

In Louisville, the largest city in Kentucky, Dr. Smith soughtto utilize the Louisville General Hospital patients for clinicalteaching. He obtained a charter in 1833 for the LouisvilleMedical Institute. The charter named Dr. Smith and eight otherlocal physicians as incorporators. Oversights and omissions inthe original charter resulted in several revisions in 1835, 1836and a final workable charter was completed in 1837, identifyinga board of trustees separate from the faculty. Dr. Smith did notbecome a member of this faculty.

Unwilling to tolerate inaction on the part of his fellowincorporators, Dr. Smith left Louisville for Cincinnati in 1833 toaccept the chair of surgery at the Medical College of Ohio. Themedical-political climate inCincinnati was unfavorable; someaspects of which were directlyattributed to the newcomer. Manyof these polemics were publishedin the Cincinnati Whig andCommercial Intelligencer (1835).

Alban Smith was a multi-tal-ented individual whose profes-sional attainments were confinedto the fringes of greatness. He wasa skillful and innovative surgeonand anatomist. He obtained thefirst charter in 1833 for the firstmedical school in Louisville, butwas too impatient to await thecompletion of the necessary revi-sions in the charter until a medicalfaculty could be assembled in1837. He left for Cincinnati in1833, and soon left from there togo to New York City in 1837. Hecontinued to practice genitor-urinary surgery, but was unable tomaintain his focus on academicactivities. He published severalbooks, including “Lithotripsy ofthe Breaking of the Stone in theBladder” (1843) and “Diseases ofthe Genito-Urinary Organs” (1857).

While in Cincinnati, Dr. Smithbecame identified with and anactive participant in an informalgroup of artists. His artistic talentwas promising and he utilized itby illustrating one of his publishedtexts.

Seeking a more favorablelocation in which to teach andpractice, Dr. Smith accepted thechair of surgery at the College of

Physicians and Surgeons of the University of the State of NewYork in New York City in 1837, which he resigned after only twosessions. He continued to practice in New York City. Afterassuming and soon resigning his academic appointment in1837, he petitioned the legislature of the State of New York tochange his surname to Goldsmith. This was granted in 1839.

He continued to practice his specialty in the vicinity of NewYork City until his death in Barrytown, New York, on Aug. 5,1861. LM

Aimee and Gordon Smith and his cousin, Eric.

GLMS Foundation board

member Joseph Kutz, MD,

working the cake wheel.

GLMSFoundationPresidentTimothyBrown, MD,(middle) andDavid Watkins,

MD.

Popsy the Clown poses for aphoto with Matthew, Michael,Brandon and Natalie Chou.

Natalie Chouhoola hoopsto the musicon the dance floor in The OldMedicalSchoolBuilding.

Cynthia Rigby,MD, (bottomleft) andhusband RonRigby with theirgrandchildrenNoah Rigby andTaylor Nguyen.

LLOOUUIISSVVIILLLLEE MMEEDDIICCIINNEE2222Continued on page 24

JJUULLYY 22000099 2233

2244 LLOOUUIISSVVIILLLLEE MMEEDDIICCIINNEE

LM

(From left) Nick, Jake, Greg

(a foundation board member),

Kathryn and Carrie Ehrhard.

Harper Woodmansee, 3,

on the inflatable slide.

Drs. Braidi and MartinHuecker with their children Isabella andEmerson.Natalie Chou gets her face

painted by Beth Romine as

her younger brother Michael

looks on.

Kim’s Dance Studio keeps guests engaged in dancing to '50s era music.


JJUULLYY 22000099 2255


AS I AM WRITING THIS, IT ISSPRING, A WONDERFUL TIME OFYEAR FOR MANY REASONS. Forthose of us who love the outdoors and sun-

shine, it brings the promise of many months of

leisure, recreation, and adventure -- water activities, hiking, cook-

outs and get-togethers, sports, and family vacations. Gardeners

and yard people get especially excited this time of year. My

mother, a teacher and woman of many talents, was a Master

Gardener. I remember, as a young child, watching her transform

into a high-energy, incredibly happy person in April or May every

year. Her garden was like a magnet, drawing her outdoors for

hours at a time.

Mom had an impressive work ethic in the garden. She diligent-

ly tilled and hoed the vegetable garden, mowed the yard, pulled

weeds, and pruned plants. Without a hint of fatigue, she sowed

seeds, planted and transplanted, fertilized, harvested, mulched,

and developed compost. Amazingly, she did nearly all of it herself,

while excelling in her career and taking care of my brother and me.

Mom shared a lot, giving away bushels of vegetables regularly and

taking freshly cut flowers to neighbors and friends. She loved

helping others develop their own gardens. Enthusiastically, she

transferred countless plants and shared design and pest control

ideas with other yard people. There are many gardens in my home-

town that carry her signature style. As she got older and retired,

with fewer family obligations, her garden and yard became full-

time work. Nearly 10 acres of a rustic paradise was her reward.

My mom died suddenly and unexpectedly nearly two years

ago. She was 64 years old, but looked and acted like a “young 50.” I

miss her terribly, of course. Since her death, I have been drawn to

her sister and two best friends, and naturally, the garden. Spending

time there and transplanting some of her plants

to my much smaller and less interesting yard

has become a very important part of my

life. Her name was Lynda. As the growing

season is gearing up, I'd like to share a

little bit of what I've learned about some

of mom's favorite things.

Tracy Ragland, MD

JJUULLYY 22000099 2277

TThhee IIrriissThe iris was mom's signature flowering plant, probably her overall favorite in the

garden. Every garden should have one sort of iris or another. The plant is named for theGreek goddess of the rainbow, and is available in a variety of stunning colors. Momloved purple irises; she planted them primarily along fence rows separating her yardfrom the cattle pasture and in clusters around trees. Daylilies are great companions inflower beds, especially in cottage gardens. Most irises grow very well in our climatezone, blooming from late spring to midsummer. They all have flat, sword-shaped foliageand a flower made up of three outer petals (falls) and three inner petals (standards).They generally grow best with full sun.

Rhizomatous irises are often preferred by growers over bulbous ones. These irisesare generally either bearded or beardless. The bearded irises have a row of hairs at thebase of the falls and they require good drainage. Beardless irises have smooth falls andneed much more moisture. The Japanese iris, a particularly lovely plant, thrives in heavysoil like the muck of a lake or pond.

Learning when and how to divide irises is an important part of keeping the planthealthy. Generally, this is done in the late summer and fall after flowering. Clumpsshould be kept relatively small. After leaves and stems are trimmed, a square-bottomedspade can be used to cut pie-shaped wedges from the large clump. These can bereplanted like any other transplant. Yellow foliage on irises, one of mom’s pet peeves, isprobably the result of a too alkaline soil. Other common problems include boringinsects that create small holes in the rhizomes (roots) and diseases like “mosaic” and“rot” that can attack stems and leaves. There are often several possible remedies forthese common problems. A great local resource during trial-and-error learning is theLouisville Area Iris Society (www.lais-ky.org).

MMoonnkkeeyy ((MMoonnddoo)) GGrraassss aanndd ootthheerrFFaavvoorriitteess

Monkey grass was definitely mom’s favorite ground cover and border plant.Growing up to 16 inches in length, Mondo has half-inch wide green leaves with laven-der flowers and blue berries in the fall. It is a tough plant, thriving in either sun or fullshade. It prefers moist soil, but stands up well to drought. Mondo grows well in ordi-nary garden soil and requires very little attention once established. It stays attractive allyear, although leaves may become ragged by late winter. Shearing shaggy leaves inearly spring is about all the care my Mondo requires. I use it primarily as ground cover inareas of my yard where erosion has been a problem. Mom used it along her sidewalksand path borders, between flower beds, and to “fence in” her fruit orchard.

Speaking of fruits, her favorite was the tomato. As she never felt she mastered itand I know very little about tomatoes myself, I won't offer any advice about growingthem in this article. I have discovered a very helpful question and answer book ongrowing and caring for vegetables and fruits, however. Published in 2008, Barbara Ellis’The Veggie Gardener’s Answer Book offers more than 20 pages of easy-to-read insightson tomatoes. Further, the summer 2009 publication of Gardeners Supply Company(www.gardeners.com) is officially the annual tomato issue. I think it is a very goodcatalog.

I will mention a few other favorite gardening resources. Fine Gardening (www.fine-gardining.com) was probably mom’s favorite monthly magazine. Although it has thepotential to make the average yard person feel like an under- achiever with its stunningphotographs, I think it can be quite helpful with garden design ideas. HomeGrown, aradio show on National Public Radio, is a favorite of mine. It is more entertaining thaneducational; but it is definitely worth listening. The Flower Gardener’s Bible, by Louisand Nancy Hill, has a lot of technical and problem solving information about growingand caring for many different types of plants. Finally, local cooperative extension offices are often very helpful in diagnosing and treating problems in plants, as well as recommending good companions for specific plants locally.

I am not a gardener. I am merely a yard person. As I learn more about plants, however, I can't help but be grateful to my mom for being a wonderful example for me. She taught me about hard work, patience, giving, resilience, overcoming adversity and faith. I still have much to learn. LM

Publisher: Alfred K. Knopf in the USASimon & Schuster in the UK, 336 pages, April 2009

ON A CRISP AFTERNOON IN THESPRING OF 2009, Tania James read from

her remarkable debut novel in her American patois to astanding-room-only crowd at the Carmichaels Book Store onFrankfort Avenue, to high applause. For Tania, it was a home-coming and to her beaming father, Dr. Koduvathara James,who has been practicing cardiology in the Kentuckiana areafor over 25 years, it was a triumphal moment. She was born inChicago, raised in Louisville and attended Kentucky CountryDay. She graduated from Harvard in film-making andobtained her MFA from Columbia in fiction. She has writtenfor the New York Times and her short story “Aerogramme”was judged as one of the 100 Distinguished Stories of 2008by “Best American Short Stories.”

Atlas of Unknowns is a fresh, nuanced and poignantnovel about sisterhood, betrayal, the pangs of uprootednessand complex family dynamics. The main characters are twoteenage sisters, Linno and Anju, who live in a small city inKerala, South India, with their father of limited means, Melvin,and their perceptive and opinionated grandmother, lovinglycalled “Ammachi.” Their mother Gracie died mysteriously. Theyounger sister, Anju, is academically brilliant while the oldersister, Linno, a one-hand amputee because of a freakish fire-works accident, has cultivated artistic proficiency in drawingand sketching. Anju wins a scholarship to attend an Americanhigh school in New York. Unfortunately, the main reason shereceived the prestigious scholarship was the artistic work shesubmitted as hers although in fact it was the creation ofLinno. Linno did not know of Anju’s shenanigans. Anju arrivesin America, boards with a highly successful Indian Americancouple, the Solankis, in their mansion and also meets withtheir quirky American-born and bred son, Rohit. She workshard and wins accolades at the school regarding her academ-ic performance but when asked to produce artistic work byher teacher, she cannot deliver and grapples with her misrep-resentation of Linno’s work as her own. Finally filled withshame and embarrassment, she absconds from school and

runs away fromher host family.She is tooashamed toinform her familyback in Keralaabout the incident andher whereabouts. She ends up staying with anolder Kerala émigré by the name of Bird, a one-time actress ina traveling theater company many years before. Bird procuresa job for Anju in Queens in the Indian-dominated JacksonHeights, in a beauty salon where she ends up working as abikini waxer.

Meanwhile, her family back in India is devastated by thenews of her disappearance. Linno has been working success-fully as an invitation cards designer and her employer’s busi-ness has blossomed due mainly to her originality and artisticgift. Linno tries to procure a visa to come to America and lookfor her sister, and the description of the scene at the con-sulate by the author is memorable. Rohit, the quirky son ofthe fabulously wealthy Solankis, is a Princeton dropout andan aspiring documentarian who is looking for a break for hisown success. He eventually seeks Anju out and locates her inthe salon. He is bent on documenting Anju’s travails andstruggles in gaining legal immigrant status, much to herchagrin.

Tania James has produced an engrossing debut novelwhich is a true page-turner. Throughout the book, she hascreated a magnificent and impressive array of characters in abeautifully evocative prose. There are many unexpected turnsand twists in the story, described with vivid expression andheart-felt conviction. I have been an avid reader and admirerof Chitra Banerjee Divakaruni’s literary work that deals withthe main theme of immigrant experience( her work includesa collection of short stories, “Arranged Marriage” in 1995 anda novel “Mistress of Spice” in 1997). Regarding Atlas ofUnknowns, she writes, “Tania James paints the dual worlds ofthe novel - India and America - with masterful care, choosingbeautiful, shocking details, and peopling them with charac-ters we will remember long after closing the book.” I thor-oughly enjoyed reading the book and am looking forward toher upcoming collection of short stories that is reportedly setin Louisville.


LM

Atlas of Unknownsby Tania James

Reviewed by M. Saleem Seyal, MD, FACC, FACP

B O O K R E V I E W

JJUULLYY 22000099 2299

• Full Time Hospitalist • Well Established Private Practice• One Hospital Location

Salary and Bonus combined above $200K

Confidential responses to:Hospital Internal Medicine Associates, PLLC201 Abraham Flexner WaySuite 1003Louisville, KY 40202Attn: Susan [email protected]

W E W E L C O M E Y O U

Candidates Elected to Provisional Active Membership

GLMS would like to welcome and congratulate the following physicianswho have been elected by Judicial Council as provisional members.During the next 30 days, GLMS members have the right to submit writtencomments pertinent to these new members. All comments received will be

forwarded to Judicial Council for review. Provisional membership shalllast for a period of two years or until the member’s first hospital reap-pointment. Provisional members shall become full members upon com-pletion of this time period and favorable review by Judicial Council.

Sattenberg, Ronald J (20407)Nancy SattenbergUL Radiology 530 S Jackson StCCB-C07 40202852-5875Radiology 99; Neururadiology00 Albert Einstein College 93

Stewart, Aaron David (2964)Anne Stewart4130 Dutchmans Ln Ste 40040207897-0697Obstetrics Gynecology 97,07 U of Louisville 91

Gardezi, Nasir Hussain (3106)Nausheen207 Sparks Ave Ste 104 Jeffersonville IN 47130282-1617Cardiovascular Diseases 91; InternalMedicine 89 Nishtar Medical College 80

Hadley, Terence James (544)SusanAudubon Medical Plaza West 2355 Poplar Level Road Ste 40540217636-7845Oncology; Hematology 88; InternalMedicine 79 Columbia U 74

Keller, Bradley (20516)Susan Keller601 S Floyd St Ste 602 40202585-4802Pediatric Cardiology 91,01, 08Pediatrics Pennsylvania State U 85

Downey, Mark P (20440)Carolyn Roth DowneyPO Box 34748 40232473-2132Anesthesiology 92 Jefferson Medical College

Edwards, John Dudley (20578)Susan3991 Dutchmans Ln Plaza 2 Ste 10340207897-0635Vascular Surgery Rush Medical College 82


Adamkin DH. Late preterm infants: severe hyperbilirubinemia andpostnatal glucose homeostasis. J Perinatol. 2009 May;29 Suppl2:S12-7.

Bates PJ, Laber DA, Miller DM, Thomas SD, Trent JO. Discovery anddevelopment of the G-rich oligonucleotide AS1411 as a noveltreatment for cancer. Exp Mol Pathol. 2009 Jun;86(3):151-64.

Bryant KA, Wesley GC, Wood JA, Hines C, Marshall GS. Use of stan-dardized patients to examine physicians' communication strate-gies when addressing vaccine refusal: A pilot study. Vaccine. 2009Jun 2;27(27):3616-9.

Chang W, Chen J, Schlueter CF, Hoyle GW. Common pathways foractivation of proinflammatory gene expression by G protein-coupled receptors in primary lung epithelial and endothelial cells.Exp Lung Res. 2009 May;35(4):324-43.

Crawford CH 3rd, Carreon LY, McGinnis MD, Campbell MJ,Glassman SD. Perioperative complications of recombinant humanbone morphogenetic protein-2 on an absorbable collagen spongeversus iliac crest bone graft for posterior cervical arthrodesis. Spine.2009 Jun 1;34(13):1390-4.

Dimar JR 2nd, Glassman SD, Burkus JK, Pryor PW, Hardacker JW,Carreon LY. Clinical and radiographic analysis of an optimizedrhBMP-2 formulation as an autograft replacement in posterolaterallumbar spine arthrodesis. J Bone Joint Surg Am. 2009Jun;91(6):1377-86.

Gadient P, Bolton J, Puri V. Juvenile myasthenia gravis: three casereports and a literature review. J Child Neurol. 2009 May;24(5):584-90.

Harandi A, Zaidi AS, Stocker AM, Laber DA. Clinical Efficacy andToxicity of Anti-EGFR Therapy in Common Cancers. J Oncol.2009;2009:567486.

Harris BT, Franklin GA, Harbrecht BG, Richardson JD. Impact ofhollow viscus injuries on outcome of abdominal gunshot wounds.Am Surg. 2009 May;75(5):378-84.

Henson JT, Roberts CS, Giannoudis PV. Gluteal compartment syn-drome. Acta Orthop Belg. 2009 Apr;75(2):147-52.

Huang J, Bouvette MJ, Zhou J, Dwyer GJ 3rd, Bhopatkar S,Bhatia A. A large angiosarcoma of the right atrium. Anesth Analg.2009 Jun;108(6):1755-7.

Khan MI, Chesney JA, Laber DA, Miller DM. Digitalis, a targetedtherapy for cancer? Am J Med Sci. 2009 May;337(5):355-9.

Lane AN, Fan TW, Higashi RM, Tan J, Bousamra M, Miller DM.Prospects for clinical cancer metabolomics using stable isotopetracers. Exp Mol Pathol. 2009 Jun;86(3):165-73.

Liu J, Gunn L, Hansen R, Yan J. Combined yeast-derived beta-glucan with anti-tumor monoclonal antibody for cancerimmunotherapy. Exp Mol Pathol. 2009 Jun;86(3):208-14.

Martin RC 2nd, Augenstein V, Reuter NP, Scoggins CR, McMastersKM. Simultaneous versus staged resection for synchronous col-orectal cancer liver metastases. J Am Coll Surg. 2009May;208(5):842-50; discussion 850-2.

Mirsaeidi M, Peyrani P, Ramirez JA; Improving Medicine throughPathway Assessment of Critical Therapy of Hospital-AcquiredPneumonia (IMPACT-HAP) Investigators. Predicting mortality inpatients with ventilator-associated pneumonia: The APACHE IIscore versus the new IBMP-10 score. Clin Infect Dis. 2009 Jul1;49(1):72-7.

Montoya-Durango DE, Liu Y, Teneng I, Kalbfleisch T, Lacy ME,Steffen MC, Ramos KS. Epigenetic control of mammalian LINE-1retrotransposon by retinoblastoma proteins. Mutat Res. 2009 Jun1;665(1-2):20-8.

Parker LP, Taylor DD, Kesterson S, Gercel-Taylor C. Gene expres-sion profiling in response to estradiol and genistein in ovariancancer cells. Cancer Genomics Proteomics. 2009 May-Jun;6(3):189-94.

Pugh AJ, Barve AJ, Falkner K, Patel M, McClain CJ. Drug-inducedhepatotoxicity or drug-induced liver injury. Clin Liver Dis. 2009May;13(2):277-94.

Rabinowits G, Laber DA. Bladder cancer: clinical practice. J Ky MedAssoc. 2009 Apr;107(4):129-33.

Richardson JD, Franklin G, Santos A, Harbrecht B, Danzl D,Coleman R, Smith J, Miller F, McMasters K. Effective triage canameliorate the deleterious effects of delayed transfer of traumapatients from the emergency department to the ICU. J Am CollSurg. 2009 May;208(5):671-8; discussion 678-81.

Snow AB, Khalyfa A, Serpero LD, Capdevila OS, Kim J, Buazza MO,Gozal D. Catecholamine alterations in pediatric obstructive sleepapnea: effect of obesity. Pediatr Pulmonol. 2009 Jun;44(6):559-67.

Winters SJ, Chennubhatla R, Wang C, Miller JJ. Influence of obesityon vitamin D-binding protein and 25-hydroxy vitamin D levels inAfrican American and white women. Metabolism. 2009Apr;58(4):438-42.

Woods CR. Congenital syphilis-persisting pestilence. Pediatr InfectDis J. 2009 Jun;28(6):536-7.

Yalcin A, Telang S, Clem B, Chesney J. Regulation of glucosemetabolism by 6-phosphofructo-2-kinase/fructose-2,6-bisphos-phatases in cancer. Exp Mol Pathol. 2009 Jun;86(3):174-9.

P H Y S I C I A N S I N P R I N T

JJUULLYY 22000099 3311

EDICAL SCIENCE is at acrossroads, caughtbetween extending life

with multiple chronic diseases, improvingquality of life, and managing the means

by which this is achieved. Today we are able to extend lifeexpectancy due to improvements in sanitation, living condi-tions and medical technology. In 1900 those aged 65 years andolder constituted 4 percent of the population, which had a lifeexpectancy of 46 years. Today those over 65 represent 13percent of the population, which enjoys a life expectancy of 75years for men and 80 years for women (1). By 2030 elders willconstitute 22 percent of the population with the percent over80 years of age set to quadruple (2). Elders are most vulnerableto medication problems, and suffer increased exposure to med-ication. They are frailer and lack the physiological reserve tosurvive adverse events.

The PDR in 1969 contained 1,415 pages, inclusive of OTCproducts in 2008, the PDR held 3,482 pages of prescriptionproducts with a separate OTC and dietary supplements book. Inaddition to the supervised use of medicationsthere is an unprecedented level of self medica-tion due to direct to consumer marketing andmore prescription items going over the counterannually. Surveys of mean daily OTC drug use inpeople over 65 years old range from 31-96percent of the population, with a 70 percentaverage (3). A 2004 Boston College surveyreports that 42 percent of all adults take vitaminsdaily and 19 percent take herbals and supple-ments daily. In any given week, 82 percent of U.S.adults take at least one medication (prescriptionor nonprescription drug, vitamin/mineral,herbal/natural supplement), while 30 percenttake at least five (4).

The use of multiple medications is accompa-nied by significant risk due to anything fromdrug-drug and drug - disease interactions to apatient’s own cognitive ability to manage his orher medications. A linear relationship existsbetween the number of medications taken con-comitantly and the risk of adverse reactions. Thesame linear relationship has been seen with thenumber of medications used and mortality, even

after adjusting for disease severity (5, 6). At particular risk arethe elderly. Eighty-eight percent of people over 65 live withchronic health problems. Adults over 65 years of age currentlyaccount for just 13 percent of the general population, but con-stitute 40 percent of all hospitalizations and 50 percent of hos-pital days. Approximately one third of hospital admissions inthe elderly result from medication related problems (7, 8). Withincreasing pressure on primary care physicians to managecomplex medical problems in less time, it is not surprising thatadverse events occur. Similarly, sub-specialists adhering topractice guidelines may excessively treat an older, frail adult,with negative consequences.

If “Medication Related Problems” were a disease, it wouldrank sixth of the top ten with regard to the economic impact ofdiseases affecting Americans 65 years of age and older (9). Inparticular, the state of Kentucky ranks second in the country forexpenditure on antidiabetics, antihypertensives, GI medicationsand analgesics/anti-inflammatory meds, and antidepressants.We lag behind West Virginia but rank ahead of Alabama,Mississippi, Louisiana, and Arkansas (10, 11). In prescriptions perperson in 2006, Kentucky ranked 3rd (see figure 1 below).

Demetra Antimisiaris, PharmD, and James G. O’Brien, MD (pictured at left)

Polypharmacy: A Threat to Healthy Aging

M



Strategies to minimize the risk of multiple medication userequire awareness and the use of a systematic approach to min-imize adverse events. The points offered in this discussion rep-resent basic mechanisms to fight unintended medicationrelated problems.

A Diagnosis for Each DrugA simple way to minimize unnecessary medication use is to

ensure that each medication used has a purpose, so a diagnosisshould be next to each medication listed in the chart. The listshould include medications prescribed by other physicians.Additionally, a medication that had been acquired throughother prescribers may no longer be indicated, as frequentlyhappens during hospitalization when a medication for GI pro-phylaxis is added but not removed at discharge. In the officesetting perhaps an ancillary medical staff member could betrained to do medication verification and then the 15-minuteoffice visit could be reserved for other priorities.

Avoid the Prescribing CascadeThe prescribing cascade is when a non specific symptom

caused by a medication side effect results in a new prescription.Ideally, an identified medication side effect can be remedied byremoving the offending agent. There are some times howeverwhen the offending medication is essential and not substi-tutable, and another medication needs to be used to help thepatient remain on that essential agent. In general, side effectsof medications tend to be non-specific (particularly in elderlypatients), such as confusion, nausea, headache and falls.Because these symptoms are identified as an organic problem,more medication is added to the patient’s current regimen,leading to more symptoms or side effects, and then in turnmore medication. An example of a prescribing cascade isdepicted in Figure 2.

This poor outcome perhaps could have been avoided byprevious detection of the patient’s liberal and inappropriate useof OTC nonsteroidal anti-inflamatories, or earlier detection and

adequate treatment of osteoporsis. Whenever an elder presentswith a status change, medication related problems must first beruled out, particularly when the onset of symptoms coincideswith a new prescription (12). The consideration of medication-induced problems should be included when confronted with anew symptom complex. A detailed history may reveal the onsetof symptoms proximate to introducing a new medication.

Assessment of OTC, Herbal, and Supplement Use

The use of over the counter medications, herbals and sup-plements is often overlooked. Patients and prescribers maypossess the view that these substances are safe, that’s why theyare over the counter in the first place. Unfortunately, this is farfrom true. Under-reporting of OTC and supplement use issometimes due to the common belief by patients that if thedoctor did not prescribe it, then they don’t have to report it.However, disclosure of what a patient is truly taking can be veryimportant. Acetaminophen, for example, is a safe choice forpain relief and definitely a better choice than Nonsteroidal Anti-inflammatory for chronic pain treatment (13), however, in 2002acetaminophen related liver toxicities accounted for 13,000Emergency Department visits, 2,100 hospitalizations and 100deaths after adjustment for intentional suicide attempts annu-ally (14). Although acetaminophen is the analgesic of choicewith warfarin therapy, it may elevate the INR, especially athigher doses. Chronic use of acetaminophen for example canlead to toxicity just as well as over dosing. Acetaminophen hasbeen shown to be safe up to three grams daily in elders andfour grams daily in younger adults; however other factorsincluding total drug burden on hepatocytes and alcohol inges-tion can make chronic acetaminophen ingestion unsafe (15).

A major hazard of OTC medications is an anticholinergiceffect. Anticholinergics decrease acetylcholine, a vital neuro-transmitter in cognition. Many OTC sleep aids, antitussives, cold,sinus and allergy remedies contain the same class of antihista-mines with powerful anticholinergic effects resulting in confu-

sion, disorientation, sedation and memory loss.The elderly are most vulnerable as a result ofdecreased muscarinic receptors (16, 17).

Herbals and supplements may markedlyaffect coagulation and sometimes patients donot realize when told to stop taking medicationsbefore surgery that they also need to stop allherbals and supplements. Lastly, supplements inthe form of dietary shakes may contain weightcontrol supplements that can raise blood pres-sure, cause insomnia and encourage anorexia.Guarana, which is present in many energy drinksand diet supplement drinks, can cause the aboveeffects.

*The mechanism of warfarin-acetaminopheninteraction is unknown, however it is recom-mended that patients ingesting 2-4 grams dailybe closely monitored for elevated INR levels (18).



Physicians Benefit Morefrom GLMS Disability Plans

Physicians Benefit Morefrom GLMS Disability Plans

MORE...Own-occupation coverage for

your premium dollar

MORE...Room to add coverage on top of

existing Group and Individual Disability plans

MORE...Flexibility. Simple application

without tax returns or exams

A Greater Louisville Medical Society Company

MedicalSocietyProfessionalServices

For more information

502-425-3232800-928-6421

or visit us online atwww.NIAI.com

National Insurance Agency, Inc.Professional Association Insurance Program Administration

11801 Brinley Avenue • Louisville, KY 40243

Is very pleased to announce

The “OPENING” of our CHAMBERLAIN POINTE OFFICE

Conveniently located across from the Norton Brownsboro HospitalServing North Eastern Jefferson, Oldham, Henry, and Trimble Counties

& SHIVELY OFFICE

Conveniently located in the newly renovated Shively Center on Dixie HighwayServing PRP, Valley Station, Shively, Auburndale, River Port, Iroquois,

Beechmont & FairdaleFor appointment information please call (502)-426-1621 or (800)-548-6543

John G. Riehm, M.D.Stuart W. White, M.D.

Adriana S. McCubbin, M.D.Angela D. Thomas, M.S.N., A.R.N.P.

Daniel P. Garcia, M.D. Derek A. Damin, M.D.Jeremy D. Jones, M.D.

Tiffany L. Simpson, M.S.N., A.R.N.P.

JJUULLYY 22000099 3355

The Brown Bag AssessmentPrescribers are increasingly utilizing this method of getting

a realistic view of their patients medication use. The Brown Bagassessment was named as such because patients are asked tobring in all their medications that they take in a grocery bag.This is a very revealing assessment. It can be helpful to giveyour patient a “homework” assignment if you suspect medica-tion mismanagement. The assignment is to track the numberand frequency of OTC and herbal supplements used betweenoffice visits. Your medical assistants can give medication track-ing forms to patients or mail them out to be brought back atclinic visits. Asking patients to bring a filled out log can serve asdocumentation for the chart as well as be very revealing aboutyour patient’s ability to manage his medications appropriately(Figure 3).

The Elderly: A special population vulnerable topolypharmacy problems

The majority of the medications that are used in the elderlywere brought to market based on safety and efficacy studiesperformed in either younger or healthier subjects than thoseactually taking the medications. To participate in a safety andefficacy drug trial, the exclusion criteria eliminate most frailpatients with multiple co-morbidities. Additionally, the frailestof the frail cannot even make their way to clinic to participate instudies. Be cautious using medications new to market.Rofecoxib (Vioxx®) was introduced with claims of improvedsafety but was found in post marketing data to cause adversecardiac effects and increased mortality.

Impaired physiology is important to take into accountwhen prescribing for elders. Current science pertaining to ourunderstanding of the physiology of aging is changing daily,thus our understanding of how drugs behave in elders is alsochanging rapidly. Hepatic metabolism slows with age resultingin impaired first pass effect. INCHIANTI, a 12,000 subject longi-

tudinal study measured biomarkers of frailty and illustrates aprinciple of medication use in elders that is often unaddressed:renal function impairment as a function of age. Many drugsrequire renal dosage adjustment such as memantine andquinolones, or are contraindicated in elders with renal impair-ment, for instance metformin. A deceiving feature of elderlypatients is that their serum creatinine level may seem normaldespite marked renal impairment. Most labs do reportGlomerular Filtration Rate however they calculate using theMDRD which has not been validated in elderly subjects. TheCockroft and Gault formula is recommended because it hasbetter valida-tion in elders(Figure 4).

Elderlypatients haveless physiologi-cal reserveresulting in a decreased ability to adjust to neurotransmitteralterations, changes in blood pressure, glucose and otherparameters. These cardiovascular, renal, neural hormonal,endocrine and otherchanges result in theelderly patients being lessable to recover from hypo-glycemia, hypotension,confusion and delirium. Itis useful to recognize thatthe goals of care may bequite different in elders.Tight glucose control maynot be the goal of treat-ment in elders due to theirincreased risk of falls, decreased ability to survive hypoglycemicevents and decreased need to prevent end organ damage withrespect to their expected survivability (19). The same approachis useful with respect to blood pressure control in elders.Reaching JNC7 guideline recommendations in elderly patientsmay be a recipe for disaster if the patient falls due to hypoten-sive events or experiences marked orthostasis (20). At the ageof 80 or earlier with weaker patients or anyone with Parkinson’sDisease, a standing blood pressure should be the measure ofsafety, not a seated one.

Safe Prescribing in Frail PatientsThe Beers Criteria is a comprehensive reference addressing

medication use in frail elderly patients. There’s an updatedversion: Updating the Beers Criteria for PotentiallyInappropriate Medication Use in Older Adults: ARCH INTERNMED/VOL 163, DEC 8/22, 2003, and can be found at www.arch-internmed.com. The Beers Criteria lists medications that shouldbe avoided in the elderly, as well as listing alternatives that aresafer. Polypharmacy as a morbidity however, is difficult to quan-tify and predict because each individual patient has her ownmix of diseases, altered physiology, drugs (OTCs too), and cog-nition. Thus a seemingly very frail patient may do well on a



JJUULLYY 22000099 3377

Beers drug while a robust-appearing younger patient may sufferadverse consequences on the same medication. So, the BeersCriteria attempts to lessen adverse events by avoiding certaindrugs but is not an absolute mandate.

The mixing of multiple medications in any given patient isan experiment that has not been studied and verified throughthe scientific literature because it is impossible to control for allthe confounders in clinical trials. Prescribers can through goodhistory taking, accurate diagnosis, understanding of frailty anddrug behavior (utilizing drug data bases such as Lexicomp®,Micromedex ®, Epocrates®) anticipate drug related problemsand minimize their impact.

An approach that emphasizes drug reduction and asking“What medication can I discontinue today?” can markedlyimpact morbidity and mortality beyond the level of today’scurrent practices (21). Awareness of the risk factors for adversedrug events (Figure 5) can assist prescribers with recognition ofpatients likely to have poor outcomes with their medications.The Beers Criteria, discov-ery of unreported medica-tion use, detailed historytaking (even using ancil-lary health care profes-sionals and the patientthemselves to assist),awareness of physiologicalcompromise, using elderappropriate goals of careand overcoming literacy barriers can move us closer to reducingthe polypharmacy risk.Figure 5.Demetra Antimisiaris, PharmD, and James G. O’Brien, MD, aremembers of the faculty of the U of L Department of Family andGeriatric Medicine. The department’s Polypharmacy Initiativewas funded by Jean Frazier to support research on polypharma-cy and to combat its potential for patient harm.

References1. U.S. Census Data 2. AGS: Underrepresentation of Older Adults in Clinical Trials.

http://www.americangeriatrics.org/policy/clinical_trials.shtml

3. Hanlon JT, et al. Epidemiology of over-the-counter drug use in community dwelling elderly: United States perspective. Drugs Aging. 2001;18:123-131

4. Slone Survey, Boston College. Patterns of Medication Use inthe United States. http://www.bu.edu/slone/SloneSurvey/AnnualRpt/SloneSurveyWebReport2005.pdf

5. Denham MJ, Adverse Drug Reactions. Brit Med Bull 1990 (46): 53-62

6. Bath, PA et al. Identification of Risk Factors for 15-year Mortality Among Community-Dwelling Older People Using Cox Regression and a Genetic Algorithm. Journal of Gerontology, 2005. (60A) 8, 1052-1058.

7. Woodford H, Walker R. Emergency hospital admissions in idiopathic Parkinson's disease. Mov Disord. 2005;20:1104-1108.

8. Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001;49:200-209.

9. Alzheimer’s Disease Foundation and Referral Center, National Cancer Institute, Am Diabetes Assoc, Arthritis Foundation, National Center for Health Statistics, National Parkinsons Foundation, National Stroke Foundation.

10. Express Scripts: http://express-scripts.com/ourcompany/news/outcomesresearch/

11. Novartis, Pharmacy Benefits Report, Facts and Figures, 2007Edition

12. Gurwitz, Jerry MD(quotation): Meyers Primary Care Institute Fallon Foundation and University of Massachusetts Medical School

13. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in olderadults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716-2724.

14. Nourjah, P et al. (2002, September). Safety analysis of aceta-minophen (APAP)-associated hepatotoxicity. Presentation at the meeting of the U.S. Food and Drug Administration’s Nonprescription Drugs Advisory Committee, Rockville, MD

15. Temple AR, et al. Clinical Therapeutics. Multicenter, randomized, double-blind, active-controlled, parallel-group trial of the long-term (6-12 months) safety of acetamino-phen in adult patients with osteoarthritis 28(2):222-35, 2006.

16. Oberhauser V, et al. Acetylcholine release in human heart atrium: influence of muscarinic autoreceptors, diabetes, andage Circulation 2001; 103:1638-1643

17. Tayabati SK, et al. Age-related changes of muscarinic cholinergic receptor subtypes in the striatum of Fisher 344 rats. Exp Gerontol. 2004; 39: 217-223.

18. Parra, D et al. The Effect of Acetaminophen on the International Normalized Ratio in Patients Stabilized on Warfarin Therapy. Pharmacotherapy 2007 27 (5): 675-83

19. The Action to Control Cardiovascular Risk in Diabetes Study Group (ACCORD) Effects fo Intensive Glucose Lowering in Type 2 Diabetes NEJM 358;24 www.nejm.org june 12, 2008

20. Oates, D et al. Blood Pressure and Survival in the Oldest Old.JAGS 2007 55 :383-388

21. Garfinkel D, et al. The war against Polypharmacy: A New Cost-Effective Geriatric-Palliative Approach for Improving Drug Therapy in Disabled Elderly People IMAJ 2007;9:430–434. LM



hen second-year medical student Jenny Blandfinally reached the home stretch of the KentuckyDerby Festival Marathon, she had given just aboutall she could give on a scorching hot day were

even the most experienced marathoners were pressing to thefinish. With her knees threatening to buckle beneath her, Ms.Bland looked up and saw a four-year-old boy in his mother’s armswaiting to run the last 15 yards with her.

The boy was Aiden Johnson, of Sellersburg, a kid who for twoyears has shown the kind of mettle and courage battling acutelymphocytic leukemia that pales in comparison to the four-hourstruggle and test of will Ms. Bland experienced on April 25.

Wearing the yellow bracelet Aiden had given her before therace, Ms. Bland greeted the boy she would give her medal to inthe Red Cross tent, mustering up the strength to smile at a childwhose own courage made the running of the 13.1 and 26.2-milehalf marathon and marathon for Ms. Bland and a dozen of herclassmates all the more significant.

“To tell the truth, thinking about seeing Aiden at the finish iswhat got me there,” Ms. Bland said after the race. “I desperatelywanted to stop running the race several times, especially whenthe course passed within a couple blocks of my house. But I keptthinking about little Aiden at the finish and told myself that I hadto get there for him.”

Coordinated through an Indianapolis-based program knownas Medals4Mettle, the idea for a local exchange of medals from 13medical student marathoners to cancer patients came to medstudent Riley Jones when he says he should have been studyingfor a Gross Anatomy test.

“I wanted to donate my medal but keep it here in Louisville,”said Mr. Jones, who e-mailed Medals4Mettle founder StevenIsenberg, MD, about his idea and started recruiting other med stu-dents to participate. Normally, participants in the Medals4Mettleprogram mail their medals in and the organization then presentsthem to patients. But thanks to Mr. Jones’ inspired study breakand a joint effort between students and faculty, the studentrunners were able to meet the recipients before the race andpresent their medals in person a day after the race. Mr. Jones, likeMs. Bland, was even able to run the last few yards to the finish linewith the medal recipient.

Approaching the finish line of the half marathon, Mr. Jones

spotted 10-year-old Carter Dewitt and knowing his leg had beenbothering him asked if he wanted to walk the rest of the way tothe finish line. Carter’s response: “No, I want to run.”

Mr. Jones said knowing that Carter would be there waitingnear the finish line gave him “an extra spring” in his step and anappreciation for the little things he can do as an aspiring physicianwith an already full schedule to make a difference.

Salvatore Bertolone, MD, chief of the U of L Division ofHematology, Oncology, Blood and Marrow Transplant, said partic-ipation in a program like Medals4Mettle will make the studentsbetter doctors.

“It’s one thing to read about a disease and another to see theimpact that disease has on patients and their families,” Dr.Bertolone said. “This makes it real.”

Ms. Bland echoed Dr. Bertolone’s statement in her owndescription of the experience.

“We learn so much in school about different diseases and ill-nesses, but medicine is more than that,” Ms. Bland said. “It’s aboutthe people who have to live with the diagnoses we make and thetreatments we offer.”

Running along with Ms. Bland and Mr. Jones were studentsElizabeth Doll, Sarah Todd, Alex Sweet, Martin McKinney, JoshuaYuen, Marc Ettensohn, Wes Brown, Brent Road, Stevie Carraro,Jennifer Wrubel and Mark Noll. The medal recipients ranged inage from three to 17 and all but two are undergoing treatmentfor acute lymphocytic leukemia or brain, bone and ovariancancers. They were chosen in consultation with the child psychol-ogist and nursing staff of the U of L faculty-operated PediatricHermatology/Oncology Specialists.

Aiden’s mother, Gena Johnson, said the marathoners’Kentucky Derby Festival sacrifice was an inspiration.

“The one thing she’s earned for all her hard work she’s givingto Aiden,” Ms. Johnson said. “That’s just selfless.”

Medaling In MettleBy Matthew Ralph

LM

Photos: (top right) Carter Dewitt & Riley Jones (photo by Kate Eldridge),(bottom left to right) Med students Joshua Yuen, Joel Lanceta & RileyJones. Jenny Bland & Riley Jones. Jason & Gena Johnson wait with theirson Aiden near the finish line. Riley Jones, Jenny Bland, Gena & AidenJohnson.

W

www.WRrealtors.com [email protected]

Ken Reutlinger DIRECT 502.271.2724 OFFICE 502.425.0225 TOLL FREE 800.837.5696 FAX 502.425.7793

JJUULLYY 22000099 3399

Practice Administrative Systems“ Outsource your billing problems,

increase your collection income. “

(502) 371-9700Lindsay A. Hudson, C.P.C.

BBUUSSIINNEESSSS CCAARRDD GGAALLLLEERRYY

Maureen A. Walker, M.A.KY Board Licensed, Clinical, Marriage and Family

Systems Psychotherapist

Office (502) 425-5482Direct (502) 553-5482

YOUR REFERRALS ARE ALWAYS APPRECIATEDEast End Location: Lynnhurst Office Centre, 8009 LaGrange Road, Suite 4, Louisville, KY 40222

• 20 Years Private Practice• Specializing in Bowen Systems Theory• Individual • Couple • Marital & Divorce

• Family • Group

WALKER COUNSELING SERVICES, INC.

“Around The Clock Services”Simply an extension of your office

following HIPAA guidelines, providing quality,expeditious and confidential services.

Jackie Lovett, CPCSr. Medical Billing Administrator

4010 Dupont Circle, Suite 418 Louisville, KY 40207

p: 502.217.5309p2: 502.714.1410

e: [email protected]

Specializing inmedical coding, pre-auditing, charge entry,

secondary claim processing, insurance verifica-tion, follow-up, payment posting, credit balances,correspondence, scanning and quality assurance.

Do you have a physician who will bejoining your practice?

We Offer A ProfessionalAnnouncement Package Service

Call or email for more informationCheri K McGuire

Director of MarketingGreater Louisville Medical Society

502.736.6336 or [email protected] service provided by Medical Society Professional Services

Do you plan an office

relocation?


AADDVVEERRTTIISSEERRSS’’ IINNDDEEXX

CCLLAASSSSIIFFIIEEDDSSMMeeddiiccAAll OOffffiiccee ccOOnnddOO ffOOrr SSAAllee OOrr lleeAASSee Located at 1005 DuPont Square North, between Norton Suburban Hospital and Jewish Hospital Medical Center East. 2980 Sq. Ft. Call 502-348-9888.

eeXXeeccUUTTiiVVee HHOOMMee –– AAlliiAA cciirrcclleeLuxury freestanding home in maintenance free gated community. Located off Brownsboro Road. Priced BELOWAPPRAISAL. 6700 square feet of beauty. Ebrenz custom built.Call Karen Kraft / Keller Williams Realty 502-727-1070

HHeeAArrTTSS iinn MMOOTTiiOOnnLooking for an unconventional gift for the person who haseverything? Buy a "cinderblock" and help Hearts in Motion, a501(c)3 organization, build a daycare center for impoverishedchildren in Gualan, Guatemala. Your $25 tax deductible dona-tion will help us provide for children, whose parents to work inthe fields. All contributors’ names will appear on a plaqueabove the door of the daycare center. For more informationcontact Lauren or Anne Vaughan at 253-4313.

OOllddHHAAMM ccOOUUnnTTyy PPccPP--iiMMMMeeddiiAATTee OOPPPPOOrrTTUUnniiTTyy Well established, solo practice, seeking full-time or part-timeCertified Internal Medicine & Pediatrics Physician. No routinehospital rounds, no nights/weekends, call share. CVs to [email protected] subject: 40031-10464.

SSTTOOnneeccrreeSSTT ccOOnnddOO:: 775500 ZZOOrrnn AAVVee UUnniiTT ##4411 $$116699,,9900001600 square feet with 2 bedrooms/baths, bright kitchen,great/dining room, sunroom/den, laundry, pantry, lots of closetspace and covered porch. Ground Floor. Detached garage.Insight of VA hospital and approximately 9 minutes to down-town. Sandy Gulick (502)-271-5142 Kentucky Select Properties

TTiiMMeeSSHHAArree AAVVAAiillAABBllee at Norton Old Brownsboro Crossing:Great opportunity for part-time lease of a fully equipped physi-cian office including 6 exam rooms. Available in August whenthe “new” Norton hospital opens. Please call 587-8000 for moredetails.

llOOUUiiSSVViillllee HHOOSSPPiiTTAAlliiSSTT PPrrAAccTTiicceeLooking for part time and full time physicians to provide patientcare at Norton Suburban Hospital. CVs to [email protected].

Baptist Hospital East IBC

CB Richard Ellis Louisville 14

Concentra 17

Hospital Internal 29Medicine Associateswww.himassociates.com

Jewish Hospital IFCSt Mary's Healthcare

Keller Williams Realty 39Louisville East (Karen Kraft)

Kentuckiana Allergy 34Asthma & Immunologywww.kentuckianaallergy.com

Kentuckiana Pain Specialists 25www.painstopshere.com

KMA Insurance Agency 9www.kmainsurance.com

MAG Mutual Insurance Co 12

Medical Protective Co 19www.medicalprotective.com

Medical Society 24Employment Serviceswww.glms.org

Murphy Pain Center 4www.murphypaincenter.com

National City (John Allen) 23www.nationalcity.com

National Insurance Agency 33www.niai.com

Passport Advantage 1

Practice Administration Services 39

Prudential Parks Weisberg 36(Dave Parks)

Remote Access Billing 39(Jackie Lovett)

Republic Bank & Trust Co 9www.republicbank.com

State Volunteer Mutual 2Insurance Cowww.svmic.com

The Pain Institute OBCwww.thepaininstitute.com

Wakefield Reutlinger 17 &(Ken Reutlinger) [email protected]

Walker Counseling Services 39

PRSRT STDU.S. POSTAGE PAIDLOUISVILLE, KYPERMIT NO. 6

Greater Louisville Medical Society101 WEST CHESTNUT STREETLOUISVILLE, KY 40202

252 Whittington Pkwy. • Louisville Ky 40222 502-423-7246 in Louisville

800-599-7246 toll free in Kentucky 800-788-7549 toll free in Indiana www.thepaininstitute.com

location

Hanover

New Albany

Madison

Louisville Shelbyville Frankfort

� e Pain Institute was the fi rst non-hospital pain management facility in this area. And now, � e Pain Institute has expanded to include six locations in Kentucky and Southern Indiana.

Documents

LOUISVILLE MEDICINE - GLMS Medicine... · LOUISVILLE MEDICINE is published monthly ... William A. Blodgett, MD ... Teresita Bacani-Oropilla, MD