LouisviLLe Medicine - Greater Louisville Medical Society

Transcription

Louisville
GREATER LOUISVILLE MEDICAL SOCIETY
Medicine
VOL. 60 NO. 7 DECEMBER 2012
GLMS Board of Governors
David E. Bybee, MD, board chair
Russell A. Williams, MD, president
James Patrick Murphy, MD, president-elect
Bruce A. Scott, MD, vice president and AMA delegate
Heather L. Harmon, MD, treasurer
Robert A. Zaring, MD, MMM, secretary
and AMA alternate delegate
Robert H. Couch, MD, at-large
Rosemary Ouseph, MD, at-large
Tracy L. Ragland, MD, at-large
Jeffrey L. Reynolds, MD, at-large
John L. Roberts, MD, at-large
Wayne B. Tuckson, MD, at-large
Fred A. Williams Jr., MD, KMA president-elect
Randy Schrodt Jr., MD, KMA 5th district trustee
David R. Watkins, MD, KMA 5th district
alternate trustee
K. Thomas Reichard, MD, GLMS Foundation president
Stephen S. Kirzinger, MD, Medical Society Professional Services president
Toni M. Ganzel, MD, MBA, interim dean,
U of L School of Medicine
LaQuandra S. Nesbitt, MD, MPH, director,
Louisville Metro Department of Public
Health & Wellness
Jay P. Davidson, The Healing Place chairman
Adele Murphy, GLMS Alliance president
Louisville Medicine Editorial Board
Editor: Mary G. Barry, MD
Elizabeth A. Amin, MD
Waqar C. Aziz, MD
Deborah Ann Ballard, MD
R. Caleb Buege, MD
Arun K. Gadre, MD
Stanley A. Gall, MD
Larry P. Griffin, MD
Kenneth C. Henderson, MD
Jonathan E. Hodes, MD, MS
Teresita Bacani-Oropilla, MD
Tracy L. Ragland, MD
M. Saleem Seyal, MD
Dave Langdon, Louisville Metro Department
of Public Health & Wellness
David E. Bybee, MD, board chair
Russell A. Williams, MD, president
James Patrick Murphy, MD, president-elect
Lelan K. Woodmansee, CAE, executive director
Bert Guinn, MBA, chief communications officer
Ellen R. Hale, communications associate
Advertising
Cheri K. McGuire, director of marketing
736.6336, cheri.mcguire@glms.org
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Louisville Medicine is published monthly by 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 LM must be
received on electronic file on the first day of the month,
two months preceding publication.
Opinions expressed herein are those of individual
contributors and do not necessarily reflect the position
of the Greater Louisville Medical Society. LM reminds
readers this is not a peer reviewed scientific journal.
LM reserves the right to make the final decision on all
content and advertisements.
Circulation: 4,000
Louisville
Greater Louisville Medical Society
7
Medicine
Vol. 60 No. 7 DECEMBER 2012
f eature articles
History of Louisville National Medical College
and the Red Cross Hospital: African American Medicine
in Louisville, Kentucky – 1872 to 1976
Part 1
Morris M. Weiss, MD, FACC, FAHA, FACP
13
Reaching the Underserved
In Butchertown, Family Community Clinic Fills a Void
Ellen R. Hale
20
Image Gently, Image Wisely
24
Holidays to Remember
Editorial Board members Deborah Ann Ballard, MD, MPH,
Mary G. Barry, MD, Ellen R. Hale, Kenneth C. Henderson, MD,
Jonathan E. Hodes, MD, MS, FACS, Teresita Bacani-Oropilla, MD
35
Pillars of Haiti
Ellen R. Hale
37
Primary Care
Rachel Busse, MD
de p artments
5
From the President
Coaching the Health Care Team
Russell A. Williams, MD
17
Book Review
Aerogrammes: and Other Stories by Tania James
M. Saleem Seyal, MD, FACP, FACC
18
Book Review
The Lost Pearl by Lara Zuberi
M. Saleem Seyal, MD, FACP, FACC
23
Alliance News
Adele Murphy
29
30
39
We Welcome You
Physicians in Print
Doctors’ Lounge
Calling Timeout
Mary G. Barry, MD
On the cover:
Oil painting by George E. Quill Jr., MD.
DECEMBER 2012
3
4
LOUISVILLE MEDICINE
From the President
Russell A. Williams, MD
GLMS President
COACHING THE HEALTH
CARE TEAM
Now that the presidential election
is over and it appears that Obamacare is here to stay (for a while?),
we can expect increasing utilization
of health care with expansion of
Medicaid and formation of health
insurance exchanges covering more
of our population (not necessarily a
bad thing). With physician shortages
looming, providing care will become
an increasingly significant issue over
the next several years. Nurse practitioner (NP) and physician assistant
(PA) organizations see this as an
opportunity and are already lobbying
for more autonomy without supervision. Soon enough, you may see NPs
with “Dr.” in front of their names, as
there is a push to pursue doctoral
nursing degrees.
The primary question I would ask
is, “Do NPs and PAs have enough
knowledge to care for and refer
patients appropriately to physicians?”
We all know NPs and PAs with significant years of experience who can
function somewhat independently,
but getting there requires decades
of close mentorship by physicians.
With the increasing percentages of
NPs and PAs coming into the market
(it seems every nurse I know is taking
classes to become an NP), most lack
the mentorship, knowledge, hours
of training and basic service background required. Therefore, more autonomy would not be a wise move.
Over the past several years, I have
had the opportunity to assist several
PAs with training via surgical rotations. I have found nearly all to be
very intelligent, with good undergrad
GPAs, who could have probably
easily gone to medical school. When
asked why they didn’t, most responded with “too rigorous, too lengthy,
too much responsibility, and not the
lifestyle I want.” When I ask those
practicing NPs and PAs about having
more autonomy, by far most (about
90 percent) actually want physician
supervision, as they feel they lack the
added knowledge to do what is right
for the patient, and they do not want
to miss something important.
An argument may be made that
due to lack of health care delivery in
more remote areas of our country,
NPs and PAs should have more autonomy. However, with the increasing capability of teleconferencing,
videoconferencing and EHRs, those
in remote areas can now easily be an
integral part of the health care team
with appropriate physician supervision and leadership. Certainly with
the increasing cost of medicine, and
the fact that NPs and PAs, in general,
tend to overutilize diagnostic testing,
physician oversight is essential going
forward.
As the 2013 Kentucky legislative
session approaches, we do not want
to be blindsided as we were by
both the optometry bill and the pill
bill. We have all heard that a strong
defense is a good offense, and now is
the time to put one in the end zone.
Recently, Wayne Tuckson, MD, put
together an informal group from
GLMS to meet with our local state
legislators regarding the problems
associated with House Bill 1 and our
recommendations for its needed adjustment. We were received well, and
the legislators indicated that they
gained valuable insights from our
meeting that they wished they had
prior to the last session. They told us
that they are interested in ongoing
dialogue regarding House Bill 1 and
other issues pertaining to health care.
With smart plays like this, we should
be able to move the ball down the
field.
Scope of practice will likely be a
similar issue in the upcoming legislative session. I think most legislators
would welcome collaboration with
physicians to determine how best
to utilize NPs and PAs in our state.
Let’s not be spectators, idly watching
the game. The time to reach out to
legislators is now, and the message is
clear. We are the coach of the medical team. We can send in the plays,
give extenders the ability to change
up as necessary depending on the
situation, but also give them the
means to come to us for direction as
needed. LM
Note: Dr. Williams practices General
Surgery with Associates in General
Surgery.
DECEMBER 2012
5
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History of Louisville National Medical College
and the Red Cross Hospital:
African American Medicine
in Louisville, Kentucky – 1872 to 1976
PART 1
Morris M. Weiss, MD, FACC,
FAHA, FACP
A
ny attempt to compose a history of medicine in Louisville’s
African American community
would have been less than
complete until August 6, 2010, when I
arranged for the copper time capsule
box embedded in the Judge Alex Heyburn cornerstone
of the Red Cross Hospital to be exhumed. This relic from
1950 revealed a rather barren medical landscape, even in
light of the prized new building.1 Now, a more complete
portrait and accounting of African American medicine in
Louisville can be
penned. Enough
information is
available to flesh
out in some detail much of what
evolved from 1872
to 1976, when the
Red Cross Hospital (at the end
called Community
Hospital) declared
Contents of July 16, 1950, time capsule.
bankruptcy and
shuttered its wards.
Two major institutions dominated African American
medicine in Louisville in the last quarter of the 19th
century and into the 20th century. They are the Louisville National Medical College (1888-1912), founded and
ruled by William Henry Fitzbutler, MD, and the Red Cross
Hospital (1899-1976). Along the way, a few physicians, an
important nurse, and an administrator – key figures in our
story – are highlighted.
The organization of this paper is a challenge. The protagonist from the Louisville National Medical College (LNMC)
is William Henry Fitzbutler. This brilliant, perceptive and
strongly opinionated physician with boundless energy was
the force that propelled LNMC into arguably the best proprietary African American medical school of the 19th and
early 20th centuries. So, to understand LNMC, we must
dissect Fitzbutler and the school’s faculty, consisting of his
wife, children and original partners.
The Red Cross Hospital (RCH) presents another problem.
William H.
During the 77
Fitzbutler,
years of the hosonly known
pital’s existence,
photograph,
circa 1895.
no one person or
group of physicians or administrators stands
out like Fitzbutler. The real protagonist of
the Red Cross Hospital is the
institution itself, with the
support and admiration of
Louisville’s African American
community.2 The original
building was on the edge of
west Louisville at Sixth and
Walnut streets (now Muhammad Ali Boulevard), but after
a few years, the hospital
moved to the South Shelby
Street campus. At this site, a
series of houses and buildRed Cross Hospital, 1899, Sixth
ings were frequently remod- and Walnut streets (now
eled, rebuilt and eventually
Muhammad Ali Boulevard).
demolished – except for the
final building, commissioned in 1950. In these inanimate
structures, doctors, nurses, technicians, administrators, lay
volunteers and wealthy donors, usually working in obscurity, added muscle, nerves, a brain and, most importantly,
a heart to a very proud haven for the care of the sick and
injured African American population of the Falls City.
I will set sail with William Henry Fitzbutler and arrive at
my port of destination: the Red Cross Hospital.
William Henry Fitzbutler
William Henry Fitzbutler, better known as Henry Fitzbutler, was born December 22, 1842, and christened William
Henry Butler. Later in life, he added “Fitz” to “Butler” and
was known primarily as Henry.
His father was William Butler, a slave coachman in Virginia. His mother’s name we do not know; all we know is
that she was an indentured white immigrant from England.
Fitzbutler was the first African American graduate from
DECEMBER 2012
7
into local society. The churches in
Amherstburg funded capable students
Detroit Medical College. In 1871,
and exercised a steadying influence
the University of Michigan regents
as they matured. For Henry, another
passed a resolution allowing any
source of self-assurance came from
Michigan resident to enroll at the
his marriage into one of the most
university. The resolution did not
influential families in Essex County:
mention, and therefore did not exthe McCurdys.
clude, African Americans and wom His father-in-law, W.H. McCurdy, a
en. After graduating from medical
prominent well-to-do cattle and horse
school in 1872, Henry, his wife and
farmer, lived in Colchester Township.
by then their three young children,
McCurdy’s father had been a substanmoved to Louisville, Kentucky. It
tial African American farmer in Pennmust have been a hot steamy sumsylvania and moved to Amherstburg
mer day when the newly minted
in 1856 and became a leader in the
physician arrived in the Falls City.
development of the town. His daughThe Fitzbutlers decided to come to
ter, Sarah McCurdy, absorbed much
Louisville because there were an
of this influence and was a steadfast
estimated 18,000 African Americans
help in all of her future husband’s
living in the city – and no African
endeavors. As Henry was growing up,
American physician.3
William H. Fitzbutler (etching possibly from
according to family stories, he actu The next year, in 1873, Dr. Fitza photograph), cover of the Journal of the
ally rented and borrowed books from
butler organized a state convention
National Medical Association, 1952.
Dr. Daniel Pearson, a well-read exin Louisville to consider educational
slave physician who owned a 900-volume library and was
interests of African Americans. He accepted chairmanship
a close friend of the Butler family. The inquisitive young
of the Education Committee. Resolutions demanded equal
man was an outstanding student and soon finished the disschool privileges for African American children in Kentrict school. To further finance his education, Henry signed
tucky, which became the basis of agitation in and out of
the Kentucky State Legislature. In 1874, at a convention in contracts to cut roads through the forest from Canadian
Covington, Kentucky, Dr. Fitzbutler was the chief opponent villages around Amherstburg, serving as a surveyor and a
contractor to lay out the roads, and also was a part-time
of a resolution advocating separate schools as the best
schoolteacher. In addition to these diverse activities, Henry
course of action.
began his medical education as a preceptee with Dr. Pear He also acted as the preceptor for young men interested
son. We see at this early period the ambition, intelligence
in practicing medicine. At that time, there were four mediand motivation that drove him throughout his life.
cal schools in Louisville – all closed to African Americans.
The two medical colleges in America best equipped to train In 1864, Henry enrolled in the preparatory course at
Adrian College. Two years later, he married Sarah, the
African American physicians were Howard University in
daughter of W.H. McCurdy. After three years of marriage,
Washington, D.C., and Meharry Medical College in Nashin 1869, Henry enrolled as the first African American in
ville. In 1888, Fitzbutler secured a charter for a medical
the Detroit State Medical College. His wife and two young
school from the Kentucky Legislature.4 He remained the
children remained in Amherstburg and lived with the
majority owner and dean of Louisville National Medical
widowed Dr. Pearson, who continued to mentor Henry and
College until his death in 1901. LNMC was the only Afriurged his protégé to pursue his medical education.
can American medical college in the United States owned
After two years of Detroit Medical College, with the usual
and operated entirely by African Americans. How did this
curriculum of chemistry, toxicology, anatomy, therapeutics,
young Canadian begin to achieve so much in such a short
physiology, gynecology and principles in the practice of
period of time? How did he emerge from the general mass
medicine, Henry transferred to the University of Michigan.
of people to enter medical school and establish himself so
In 1872, he was the first black student to graduate from
quickly in Louisville, Kentucky?
the University of Michigan College of Medicine.
His parents escaped Virginia in the early 1840s, before
His graduate thesis survives at the University of Michithe United States Fugitive Slave Act of 1850. After the act,
escaped slaves could be legally hunted down, captured and gan; it concerned Cardiology. As a cardiologist, I have had
the pleasure of reading his well-written paper, incorporatreturned to their owners. Thousands of blacks poured into
ing all the 19th century knowledge of cardiac physiology
Canada, and the young Fitzbutler learned much from their
5
stories. The chief entry point for the Underground Railroad and pathology.
We know little about why Fitzbutler chose Louisville,
into Essex County in 1860 was Amherstburg, where his
other than that it was a business opportunity. Unfortuparents lived. Essex County had the highest concentration
nately, he left no diaries or memoirs, and only one page of
of blacks in Canada, of which there were some 40,000.
his newspaper, The Ohio Falls Express (published weekly
The land was fertile, and the immigrants became prosperfrom 1879-1901), survives.6 The newspaper is lost forever
ous farmers. This area of Canada was underpopulated,
and the refugees from the U.S. slave states melded easily
Continued on page 10
Continued from page 7
8
LOUISVILLE MEDICINE
DECEMBER 2012
9
and we have been deprived of Fitzbutler’s passion, ideas,
philosophy and foibles. The McCurdy family is said to have
a few reminiscences, but nothing ever was written down.
Dr. Pearson possibly suggested: “Fitzbutler – go South,
young man, because southern blacks need medical help.”
The Falls City area was providing enormous wealth from
wholesaling, warehousing, commission business and
shipping. The Civil War had ended seven years before,
and America’s South was in the throes of the Reconstruction period. Louisville was a gateway to the South and the
Louisville & Nashville Railroad was far-flung in both rail
and water transportation. During the Civil War, the L & N
Railroad and Louisville profited from shipment of Union
troops and supplies.
When he settled in Louisville, Fitzbutler became the first
regular physician of the then-called “colored race” to enter
the practice of medicine in Kentucky, and he attracted
much attention. This attention was accelerated by his involvement in social and political issues during the Reconstruction period.
Louisville was controlled by an oligarchy at this time,
and some predicted this “damn Yankee from Canada would
not last long.” He ignored the establishment and became
active in community affairs. Dr. Fitzbutler and the famous
medical educator Abraham Flexner, who was born in
Louisville and was a contemporary of Fitzbutler, both commented that “Louisville was a Confederate-leaning society.”
In addition to his thriving medical practice, his political activities and the medical school, Fitzbutler published
The Ohio Falls Express newspaper. The single page of one
issue is in the archives of the University of Chicago library.
A photocopy can be found in the University of Louisville
Ekstrom Library archives.6 Prior to 1879, Fitzbutler contributed to The Planet, an African American newspaper
founded by Alfred Froman in 1872, the year Fitzbutler
arrived in Louisville. When Froman moved to Memphis,
Tennessee, Fitzbutler began publication of The Ohio Falls
Express and was the owner and editor-in-chief until his
death 22 years later. The paper did not survive his death.
The newspaper included local news, the announcement
of deaths, church and lodge events, and was printed exclusively for the African American community. With it Fitzbutler continued his crusade for equality in human rights and
education, which he believed necessary for all members of
society.
Throughout the 1880s and 1890s, Fitzbutler’s energy
never waned. In 1889, the first six students graduated with
MD degrees from LNMC. The school’s first classes were
conducted at the United Brothers of Friendship Hall at the
corner of Ninth and Magazine streets. Commencement
ceremonies were held at Center Street Methodist Church
in Louisville.
In 1901, Dr. Henry Fitzbutler died from “acute bronchitis.” He is buried in the Greenwood Cemetery in Louisville.7
References
1. Cornerstone for addition to Negro Hospital is laid.
The Courier-Journal 16-July-1950 (photo of Miss Mary
Merritt placing hospital documents in a copper box in the
cornerstone while Rev. Charles Tachau and Dr. Horace
Morris watch).
At 60, building still hub of help. Shelby Street units feted
for service. The Courier-Journal 9-Aug-2010.
2. Red Cross Hospital: History of Service. A photographic
Record 1898 to 1988 compiled by J. Scott Lux, MA, CADC,
May 2009, Volumes 1 & 2.
This volume, the work of the late J. Scott Lux, is unpublished, but copies have been presented to the Filson Historical Society and the Archives Division of the University
of Louisville Ekstrom Library. This is the most extensive
collection of photographs, newspaper articles and hospital
broadsides ever assembled about the Red Cross Hospital.
(The volumes have only spiral bindings.)
Professor of History Thomas Owens saved at the time of
bankruptcy proceedings 26 boxes of assorted records
(board minutes, hospital proceedings and financial records). These are found neatly filed and preserved in the
University of Louisville Ekstrom Library Archives Division.
A third and fascinating source is a 1939 magazine entitled
Souvenir, published October-November 1939, Lucille E. St.
Clair, Editor. I believe the only copy of this issue (no other
issues are known to exist) resides in the Filson Historical
Society. This issue of Souvenir was dedicated to Red Cross
Hospital. Rare photographs and excellent biographical portraits of the original hospital fathers make this the single
most valuable source to understand the early Red Cross
Hospital.
3. Leslie L. Hanawalt – “Henry Fitzbutler: Detroit’s First
Black Medical Student,” Detroit in Perspective, A Journal of
Regional History, Volume 1, Number 2, Winter 1973.
Morris M. Weiss, MD – “William Henry Fitzbutler and The
Louisville National Medical College,” Louisville Medicine,
Volume 54, Number 1, June 2006, page 46.
McCraven, Marilyn – “Recognition for Kentucky’s First
Black Doctor Sought,” The Courier-Journal, 18-May-1986.
W. Montague Cobb – “Henry Fitzbutler,” Journal of the
National Medical Association, 1952, pages 403-407.
4. Acts of the General Assembly of the Commonwealth of
Kentucky v. 3 1888, Chapter 1234, pages 443-445, Commonwealth of Kentucky State Law Library, Act to incorporate the Louisville National Medical College.
5. William Henry Fitzbutler’s senior thesis, University of
Michigan, 1872, to Corydon S. Ford and Henry S. Cheeves,
Physiologists, “In grateful homage, is this treatise respectfully inscribed by Henry Fitzbutler,” pages 1-11.
6. Ohio Falls Express – one page (1891) – a copy in the
University of Louisville Archives. Microfilm project 70.
Original at the University of Chicago.
7. Obituary of William Henry Fitzbutler, The Courier-Journal 28-Dec-1901. LM
Note: Dr. Weiss practices Cardiovascular Diseases with
Medical Center Cardiologists. He is a member of the Innominate Society, Louisville’s medical history society.
10
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10/11/12 10:47 AM
DECEMBER 2012
11
R eac h ing t h e underserved
A total of 101,366 residents of Jefferson County are uninsured,
or 16.1 percent of the population under age 65, according to 2010
estimates from the U.S. Census Bureau. Emergency rooms and federally
funded community health centers are straining to meet the need.
In the coming months, Louisville Medicine will feature the good work
being done by local physicians to reach the underserved and highlight
ways that others can join them in the effort.
In Butchertown,
Family Community
Clinic Fills a Void
Ellen R. Hale
They come from Central America and Iraq and Haiti
and the Sudan to East Washington Street on Saturday
mornings, where they head to the basement of St. Joseph
Catholic Church. Inside the recently renovated space,
they find volunteer doctors and nurses ready to examine
and treat them at no cost. This is the Family Community
Clinic, a nonprofit that opened its doors in January 2011
specifically to provide free health care to the uninsured in
Louisville.
“There are literally tens of thousands of indigent people
in our own city,” said George Fischer, one of the clinic’s
founders. “It’s very sad that we have in our own city
underserved people that we’re passing by every day. Our
mission over the long haul is to take care of these underserved people.”
The walk-in clinic operates from 8 a.m. to noon each
Saturday. There are four exam rooms. Pediatrician Fernanda Nota, MD, who serves as medical director, describes
it as an immediate care center for acute illnesses. Patients
can be treated for colds, flu, sore throat, cough and allergies. Doctors also see adults for respiratory illnesses, skin
conditions and minor injuries, while they perform wellchild checkups and sports physicals for children. Hearing
and vision tests are done. There is a small lab. Doctors try
to write prescriptions for generic medications that can be
filled for $4. Dr. Nota said patients are directed to other
free or low-cost resources in the community for such
things as vaccinations, mammograms and prenatal care.
The Family Community Clinic currently averages 15-20
patients each Saturday, or about 700 patients annually.
Sixty percent of patients are
Hispanic,
many of
whom are The Family Community Clinic is located at
1406 E. Washington St. on the campus of
undocuSt. Joseph Catholic Church.
mented
individuals. Others hail from a variety of countries, according to clinic manager Mary Lee Eady, RN, BSN, MSN. The
volunteer staff always includes a Spanish interpreter.
“These are patients who have no place to go,” said Dr.
Nota, who recalled one female patient who was unable to
hear until getting an ear irrigation. “She was so grateful.”
Father David Sanchez and a group of St. Joseph parishioners teamed up with Fischer to establish the clinic,
which is modeled on the People’s Health Clinic in Park
City, Utah. Fischer said he traveled to Park City in 2010 and
learned that a donor had just purchased new equipment
for the facility, open daily with a volume of 10,000 patients
each year. The staff was willing to give Fischer the used
equipment (worth about $500,000) if he could move it out
quickly.
“Within 48 hours, I got a trailer and a van and loaded all
their equipment,” Fischer said.
The clinic depends on volunteer physicians, who are
asked to commit to no more than one shift per month. Liability insurance is available. Medical students also can be
of assistance.
DECEMBER 2012
13
Dr. Nota said the clinic is seeking specialists willing
to volunteer their services, either at the clinic or by accepting referrals for one or two patients per month they
would agree to treat pro bono. She pointed to cardiologist
Michael Imburgia, MD, as a valued partner who offers free
clinics on a regular basis. In particular, the Family Community Clinic is seeking
gastroenterologists and
neurologists.
“Our big need is specialists,” Dr. Nota said.
In January, the Family
Community Clinic plans
to expand with hours on
Tuesdays from 5-9 p.m.
The minimum number of
total volunteers needed
per shift is nine.
“It’s a very professional operation, even
though we’re still small,”
Volunteers serve in the clinic.
Clinic manager Mary Lee Eady, RN, BSN, MSN, (left) and medical
director Fernanda Nota, MD, in an exam room.
said Fischer, who noted that the clinic even has an EHR system. “We can open as fast as we have qualified volunteers
to help us.” To volunteer, go to www.famcomclinic.org and
click on “Volunteers.” LM
Note: Ellen R. Hale is the communications associate for the
Greater Louisville Medical Society.
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LOUISVILLEMEDICINE
MEDICINE
LOUISVILLE
SEPTEMBER 2012
37
boo k review
Aerogrammes:
and Other Stories
By Tania James
Publisher: Alfred A. Knopf, New York, 2012
Reviewed by M. Saleem Seyal,
MD, FACP, FACC
Tania James is a native Louisvillian
who now resides in Washington, D.C.,
and is the daughter of Dr. K. James, a local cardiologist. Atlas of Unknowns was
her irresistibly engrossing debut novel,
published in 2010 to rave reviews. She
has now written an exquisite mélange of nine riveting
short stories in this book. She appeared at Carmichael’s
Bookstore on Frankfort Avenue as part of her book tour on
a sweltering day in May to a rousing welcome by her fans,
friends and family, including her beaming parents. Before
signing my copy of the book, she asked me if I wanted it
written “To Uncle Saleem.” But I opted for just plain “To
Saleem,” and she obliged. According to the norms of the
Indian-Pakistani culture, as an expression of respect, every
male or female acquaintance of the family is an uncle or an
aunt respectively.
An “aerogramme” or “aerogram” was a thin, foldable,
gummed and pre-stamped letter sent by international
airmail that was first used in Iraq by the British in 1933 and
later introduced in the United States for 10 cents in 1947.
I used to anxiously wait for my older brother’s aerograms
from the United States to Pakistan and, after my arrival here,
I used to exchange aerograms with my younger brothers
and my late mother in Pakistan. Relegated to the dustbin
of history, aerograms have been out of circulation in the
United States since 2006. The fictional story “Aerogrammes”
is a haunting tale of a retired Indian émigré, Hari Paniker,
who used to own a produce store on Chenoweth Lane.
Because of worsening dementia, he has been “temporarily”
placed in the Renaissance Gardens, a nursing home, by his
38-year-old son, Sunit, who enjoys “a year-long vacation
interrupted by sporadic jobs” rather than a job that offers
yearly vacation. Hari Paniker befriends his neighbor, May,
and they start frequenting the cafeteria together and then
back to his or her room for small talk. She shows him an
aerogramme from India, and it appears to have been written by a Satyanand, her adopted Street Angel from Bombay
who thanks her for her generous donation of $20 with
which he was “able to buy a chappal (a flip-flop sandal) and
plenty of rice for the family.” Hari discovers some discrepancies in the next two aerogrammes from India and is con-
vinced that the Street
Angel business is most likely a trick
to extract donations, but May won’t hear
of it. Her grandniece, Leanne, who is a nurse at Baptist East,
visits May, while Sunit calls Dad about a job offer in New
York. The story is emotionally charged, with May becoming
delusional due to her multiple strokes and thinking that
Satyanand is going to pay a visit soon. When she challenges Hari that he does not have a son since he never visits,
Hari produces a childhood picture of Sunit. May, however,
promptly tells him that it is in fact a picture of Satyanand,
her adopted son, and not Sunit – Hari’s real son!
“Lion and Panther in London” is an interesting story that
deals with two legendary wrestler brothers, Gama and
Imam, from British India in the 1900s. They have arrived in
London to challenge anyone to wrestle with them, but no
contender shows up for a while. They are bored in their
rented house, keeping themselves busy with exercise,
wrestling practices with one another and playing chess.
Eventually, their tour manager, Mr. Benjamin, nervously
suggests that the matches can be “fixed” and, if they want
to make money, they should consider taking the fall on
occasion, but both brothers scoff at the idea. Mr. Benjamin
eventually arranges for some challengers for both Gama
and Imam, and both brothers defeat all wrestlers. They are
dubbed the Lion and the Panther of the Punjab (area of India where they had hailed from) respectively. The final bout
of Gama with the Polish wrestler Zbyszko for the coveted
title of world wrestling champion culminates in a draw, to
the chagrin of the spectators. When a rematch is scheduled, the Polish wrestler skips town and Gama, by default,
is declared the champion. There are very tender moments
and feelings between the brothers, with Imam’s deep
respect and virtual worship of his elder brother from their
childhood days. The specter of a “fixed” match, however,
hangs in the air.
With deft narration, these beautifully constructed stories
that deal with complex yet tender interpersonal interactions between the characters are a delight to read. LM
Note: Dr. Seyal practices Cardiovascular Diseases at River
Cities Cardiology.
DECEMBER 2012
17
boo k review
The Lost Pearl
By Lara Zuberi
Publisher: CreateSpace Independent Publishing
Platform, July 2012
Reviewed by M. Saleem Seyal,
MD, FACP, FACC
Dr. Lara Zuberi is an immigrant physician, a hematologist-oncologist married to her interventional cardiologist
husband, Omer Zuberi. Both live in Jacksonville, Florida,
with their young son. The Lost Pearl is Dr. Zuberi’s debut
novel, and the story is narrated in the first person by Sana,
the main character in the book.
Sana is 9 years old and lives in a posh area of Karachi,
Pakistan, with her younger brother and her loving parents. The idyllic life is shattered irrevocably by the tragic
death of her father from an assassin’s bullet while he is
in his study. The last moments of her father’s death are
etched in Sana’s memory and will torment her perpetually and immeasurably, since she happens to be behind
the curtain and witnesses the bullet’s impact close up. On
top of that, she even sees the face of the assailant. This
cataclysmic event changes things in multiple ways including her mother’s eventual remarriage, her friction with her
mother over that decision and the dislike she harbors for
her stepfather. She makes a momentous decision to move
far, far away from her family under the guardianship of her
paternal aunt and her husband, who are a childless couple
living a comfortable life in California.
She describes growing up in the United States with
the usual immigrant angst and her long acculturation
process, sometimes exhilarating and sometimes exas-
18
LOUISVILLE MEDICINE
perating. Sana narrates the political landscape of Pakistan
encompassing almost two decades. She visits her family,
now including her new sister, in Pakistan, but the strained
relationship with her mother and essentially no relationship with her stepfather continues. These sojourns to Pakistan, however, keep her grounded with her past including
memories of her father, her culture and visits with the
family. She works hard, is academically sound and pursues journalism at the renowned Stanford University. Her
meeting with Ahmer at Stanford is serendipitous. Once
they start talking and getting to know one another, both
know that they are soul mates. Ahmer is also from Karachi,
is studying law and has had a terribly sad past, losing his
parents as a child. They start spending much time together and are emotionally very compatible. The fortuitous
encounter blossoms into love and eventual engagement,
with wedding plans in Pakistan. There are many twists and
turns in the story, and they keep the reader engaged until
the very end, which is rather unexpected but very intriguing. For a debut novel, Dr. Zuberi has done a superb job
indeed. Her book is available at the Amazon and Barnes &
Noble websites. LM
Note: Dr. Seyal practices Cardiovascular Diseases at River
Cities Cardiology.
IMAGE GENTLY,
IMAGE WISELY
20
LOUISVILLE MEDICINE
I can remember when diagnostic radiologists could easily lose the battle for
the hearts and minds of referring physicians by declaring, “Study not indicated.”
I seem to recall that this was almost a triumphant war
cry among the residents in the Radiology Department at
“Old General” (Louisville General Hospital on Chestnut
Street). The good thing was that it did generate a one-onone, in-your-face discussion with the resident from the referring team, and one way or another the appropriate test
was done. I have to believe that our resistance was often
motivated by the relative brutality/injury one would feel
was being inflicted on the patient for a dubious outcome
(especially, this meant those of the “rule out” category). I
still shudder at the thought of air encephalography (brain
herniation), Pantopaque® myelography (every drop to
be removed otherwise, in addition to suffering the worst
headache imaginable, the patient would eventually return
with problems related to arachnoid adhesions), direct carotid sticks and the relatively benign hypotonic duodenography. Then, in the mid-’70s, along came EMI (yes, Ringo
was involved) and Godfrey Hounsfield in the U.K.; Allan
Cormack in the U.S.; and the CAT scan era was born.
Almost in anticipation of the future development of
medical imaging, Diagnostic Radiology and Therapeutic
Radiology became separate specialties in 1973. Technological advances in CT scanning started slowly at first but
proceeded relentlessly, from the 1980s on, with increasingly detailed images that became indispensable to clinical diagnosis and management. Increased resolution and
thin slice technology did not necessarily mean increased
exposure dose for the patient. Increased frequency of
CT scanning did. During fluoroscopy and vascular/interventional procedures where technologist and radiologist
would be in the same room as the patient undergoing the
examination, heavy lead aprons and the need to record
“fluoro times” were constant reminders that we were
dealing with a not-entirely-benign imaging modality. CT
allowed the radiology staff to work outside the scanner
room without the worry of possible radiation exposure.
Perhaps these are just some of the reasons why the known
exposure of the patient to ionizing radiation took a back
seat to clinical need and relative ease of use.
According to the National Cancer Institute at the National Institutes of Health, the use of CT in adults and children
has increased about eightfold since 1980. Annual growth
in the last decade averaged 10 percent, with between
5 million and 9 million CT scans being performed annually on children in the United States. It is estimated that
currently CT scans account for approximately 49 percent
of the U.S. population’s collective radiation dose from all
medical X-ray examinations. CT is the largest contributor
to medical radiation exposure in the U.S. population.
In October 2008, the FDA was required to investigate
reports of excessive radiation exposure to individual patients undergoing CT brain perfusion scans. The lay press
reported these cases including the side effects that were
easy for readers to visualize, i.e. obvious hair loss and scalp
reddening and blistering. The potential for early cataract
formation was also repeatedly mentioned. It was not
too surprising that suddenly questions about the safety
of ionizing radiation were popping up everywhere, with
the main concern being the potential for causing cancer
in individuals receiving multiple diagnostic CT scans. As
recently as September 4, 2012, I came across the following from American Medical News: “CT cancer risk prompts
high-tech efforts to cut radiation dose. Physicians are
urged to skip unneeded tests. Now more facilities are
adopting methods that can dramatically slash the radiation delivered from the scans.” (Radiation physics for
lawyers anyone?)
In fairness to our professional bodies, by 2006 the
membership of the Society for Pediatric Radiology had
determined that guidelines for and control of the use of
CT scans in the pediatric population had to be established.
By the summer of 2007, the Alliance for Radiation Safety in
Pediatric Imaging launched its campaign, Image Gently®.
In addition to the Society for Pediatric Radiology, the
founding organizations in the alliance were the American
College of Radiology, the American Association of Physicists in Medicine and the American Society of Radiologic
Technologists.
In April 2010, E. Stephen Amis Jr., MD, and Priscilla F.
Butler, MS, authored the “ACR White Paper on Radiation
Dose in Medicine: Three Years Later.” This reported on the
developments that had occurred since the initial recommendations of the alliance’s panel in 2007 and the launch
of the Image Gently® campaign. One of the outcomes of
the 2010 white paper was the establishment by the ACR
and the Radiological Society of North America of the Joint
Task Force on Adult Radiation Protection. Since that time,
the Image Wisely® campaign has been developed “to create educational resources for radiologists, medical physicists and technologists who provide medical imaging care
within the United States and to communicate the availability of these educational resources using a wide variety
of electronic and print media.”
Each of these two campaigns has its own website:
www.imagegently.org and www.imagewisely.org.
The websites are easy to navigate with separate sections for patients/parents/guardians as well as health care
professionals. Simple imaging record charts can be downloaded for patient use, functioning in much the same way
as immunization records. In addition, these charts should
help educate the population as far as imaging tests that
use ionizing radiation versus those that do not. There are
even posters available showing why “one dose does not
fit all,” which has become one of the mantras of pediatric
imaging. The websites are worth looking at for anyone
who orders imaging tests. There are many useful links
to peer-reviewed articles including such subjects as CT
technology and dose modification. Although the primary
focus of ionizing radiation dose reduction is CT utilization,
both campaigns address other radiologic imaging modalities including interventional radiology, computed radiology, fluoroscopy and nuclear medicine.
Clearly the optimization of each diagnostic CT scan to
each individual patient is no easy task. It would be disingenuous to think that tweaking machines, multiplying
protocols and flooding the market with new, expensive
technology will put us in a safe zone. For one thing, there
will still be a difference between exposure and absorbed
dose for each patient and each study. Ultimately, the purpose of imaging is to optimize resolution (technical) and
ensure that each imaging study contributes to the establishment of the clinical diagnosis.
The mnemonic for the campaign efforts is easy to remember: “ALARA = As Little As Reasonably Acceptable.” I
hope this will not just become a new shrub in the radiologists’ hedgerow, but that a greater mutual understanding
will move us beyond “study not indicated.” LM
Note: Dr. Amin is a retired diagnostic radiologist.
DECEMBER 2012
21
22
LOUISVILLE MEDICINE
alliance news
Adele Murphy
GLMSA President
“Strange, isn’t it? Each man’s life
touches so many other lives. When he
isn’t around he leaves an awful hole,
doesn’t he?”
–Clarence from “It’s A Wonderful Life”
Sometimes I feel like the Greater Louisville Medical Society
Alliance is the George Bailey of the medical community. We
are in the background, offering support, resources, encouragement and a lot of love ... just like that old Building and
Loan in Bedford Falls. But unlike George, I don’t need a visit
from an angel looking to earn his wings to make me realize
that it is a wonderful life and a wonderful Alliance.
Just take a look at what’s been going on recently and
you can see that the world is a better place because of
the Alliance. Many people are unaware that one of the
ways we support our medical community is by providing a
member for the board of the GLMS Foundation. In October, we built camaraderie and supported the GLMS Foundation when we met and toured the historic Old Medical
School Building. The Greater Louisville Medical Society and
GLMS Foundation staffs were so warm and welcoming
and sent us home with a lovely souvenir book of the Wolf
Gallery. My favorite part of this event was looking over the
archived pictures from 1980 during the time when Barbara
Davis was president of the GLMSA.
In November, the GLMSA met at Gilda’s Club. The Gilda’s
Club mission is to create welcoming communities of free
support for everyone living with cancer – men, women,
teens and children – along with their families and friends.
The GLMSA
served a meal
to Gilda’s Club
members.
We also
wrapped gifts for
a School Choice
holiday party.
School Choice
offers scholarships to low(Left to right) At Gilda’s Club are Adele Murphy, Michelle Feger, Rhonda Rhodes, Carol
income children
Lambert, Karin Sonnier, Millicent Evans,
throughout
Audrey Carter and Ilene Bosscher.
Greater Louisville
to attend their family’s quality school of choice.
On December 1, we will be doubling as Santa’s helpers at
the Nativity Academy. The Nativity Academy at St. Boniface
is a private middle school serving students of academic
promise in the Louisville area from low-income families.
We have had a couple of “just for fun” events recently as
well. Our members gathered for a wine and bourbon tasting
at Taste Fine Wines and Bourbons in the trendy NuLu neigh-
(Left to right) At The Old Medical School Building are Chitra
Kayerker, Adele Murphy, Elizabeth Paulsen, Michelle Feger, Karin
Sonnier, Anita Garrison, Kristi Mattingly, Carol Lambert, Barbara
Davis and Lisa Sosnin.
borhood. Afterwards,
we walked down to the
Garage Bar for some
delicious food in the
avant-garde atmosphere
inspired by the creative
minds behind Louisville’s world-famous 21c
Museum Hotel. From the
great response to this
(Left to right) Enjoying NuLu are
event, I’m sure we will be Karin Sonnier, Angela Pecha, MD,
scheduling a similar event James Patrick Murphy, MD, George
Sonnier, MD, and Kristi Mattingly.
in the spring.
We also gathered at the Frazier History Museum to visit
the “Diana: A Celebration” exhibit. In that same spirit, our
December 4 meeting will be a visit to the historic Wakefield-Scearce Galleries in Shelbyville with lunch to follow at
the Science Hill Inn.
Should auld acquaintance be forgot and never brought to
mind? Not in 2013. We will keep the GLMS Alliance busy as
we partner with School Choice for a health fair on Saturday,
January 12, at the Nativity Academy. We also will continue
our work with the Kentucky Science Center, GLMS and Jewish Hospital to present Pulse of Surgery for middle and high
school students from all over Kentucky. Our partnership with
Jefferson County Public Schools to collect used medical texts
continues in 2013. And we are now and will continue to collect
gently used OR scrubs, yoga pants and new ladies underwear
to donate to the Center for Women and Families in Louisville.
As you can see, it’s a wonderful life and a wonderful time
to join in the fun and the work of the GLMS Alliance. Happy
holidays! LM
Note: Contact Adele Murphy at adelepmurphy@aol.com or
502-664-5925.
DECEMBER 2012
23
Holidays to
Remember
Stories celebrating the season
from the Louisville Medicine Editorial Board
Gingerbread and Gluhwein
Mary G. Barry, MD
When you fly to Munich from ATL, if
you’re lucky the sun comes up about two
hours before you land. You can watch the
more haphazard fields of France give way
to the unmistakable rolling farmland of
Bavaria, green and neat, with baroque onion-domed churches
rising above tiled roofs. It looks like a homecoming to me now,
but the first time I went in winter, from my Delta window there
were no green fields. We saw long swathes of snow carved by
gray slivers of road and black trees. It was new, it was cold, and it
was Christmas.
Cold and I go badly together. I only interviewed for residency
below the Mason-Dixon line. I wear so much fleece that static
electricity sends blue sparks from my fingers. When my patients
flinch from cold hands, I tell them I have alien blood. I like it to be
85 and sunny and then maybe, at midday, I will shed my socks
and boots. Munich with a foot of snow, at 10 degrees below zero,
was terrifying. I would be a guest, to be a part of all activities
outdoors, and not the one in charge of the timetable. I foresaw
frostbite.
Goetz’s parents Hans and Hertha met us at the airport with
their dog, Bobbi, a doe-eyed dachshund who was incurably
amorous. Only Hertha could spit the word “Basta!” at him and he
would, for a moment, be cowed into behaving. Bobbi was shivering despite his tartan car blanket. I took this as a bad omen, and
snuggled up next to him in the back seat.
With Anne, Linde and the rest, we had a breakfast of fresh
pretzels, cheese, fruit and cucumbers, and cookies – wondrous
cookies! Hans’ living room was lined with books top to bottom,
bird feeders hung outside the window, and Hertha liked my hostess gift, a silver pineapple that Dr. Greg Brown had approved of.
This was promising. Inside it was warm and golden and lovely.
Outside we launched into a full schedule of visiting, sightseeing
and getting ready for Christmas Eve, when all across German
Christendom the towns are still, the real wax candles on the
trees are lit, and families draw close in their homes. It’s not a time
for strangers, by tradition. (No wonder baby Jesus stayed in the
barn.) I was just Goetz’s American, not quite a stranger but not
yet a daughter.
In Munich we headed straight for the Christkindlmarkt in
Marienplatz, the main downtown square, where we had hot
cocoa and then gluhwein (“glow” wine: hot red wine, mulled
and spiced) and then sausage and more gluhwein. The mug
warmed my fingers and Hertha warmed my heart, as she
24
LOUISVILLE MEDICINE
charmed the imposing sales staff of Loden-Frei. Loden-Frei is
what Byck’s used to be. It’s in the heart of downtown, stocks
the genteel sort of dry goods, and has eagle-eyed saleswomen
who are formidably capable. Hertha was intent on getting
Goetz a presentable coat for Christmas, so soon he was surrounded by women who studied him seriously, stood him this
way and that, and fit his shoulders perfectly. They took care
of him in a proprietary maternal way, for after all he was a son
of Munich, and they had standards to uphold. I enjoyed it immensely.
At night we took walks, for exercise, tramping through the
neighborhood snow, sliding on the wooded paths, admiring
the very occasional candle display in a window. There was no Hillcrest Avenue sort of Christmas décor. Rarely, a Santa-on-a-ladder
dangled from a chimney. No trees lit up living rooms; it was not
yet time. The wind whistled past my ears and sliced through my
layers of down. From time to time, I counted my toes to see if
they were still all there, and warmed my nose with my glove. My
glasses fogged up uncontrollably. They spoke kindly to me in
German, and I smiled a lot in English.
On the 22nd we drove the autobahn to Aschau, a little town
at the foot of the Alps, to their summer house where Christmas
was always kept. Huge shopping went on at the bakery, the
butcher and the Edeka grocery. The Germans actually close
everything for three days, including Boxing Day, and only gas
stations are open; you have to stock well up on every breakfast staple, and plan meals minutely. Later we went to the
FrauenIsle, the convent island in the center of the Chiemsee, a
gorgeous lake dubbed the “Bavarian Ocean.” Ice drifted on the
waves. The wind howled off the water and cut into my knees,
the ferry rocked, and I thought of my ancestors. They had come
across the Atlantic in steerage, in the winter, with no fleece to
their names and no gluhwein to speak of. What a faintheart I’d
have been.
Christmas Eve Mass by tradition was the children’s service, late
in the afternoon, and featured boy shepherds in green felt hats
and lederhosen. They had a rousing Munchkin sort of entrance
that brought down the house; then girl angels sang the story of
the Manger. The church was old, simple on the outside and shining with gold and ornate marble carvings on the inside. It did not
look at all like St. Louis Bertrand, the family seat of my clan. After,
we carried candles lit from the altar precariously, gingerly, all the
way through the village and up the long hill to the house, which
glowed at the edge of the woods, off by itself. Cattle lowed and
the horses from the farm next to us stamped at their barn door.
Feeding time was nigh, and so was our Christmas, where I was far
away from Sixth and St. Catherine, but next to the one closest to
my heart.
Holy Cross Christmas
Deborah Ann Ballard, MD, MPH
I grew up in the tiny rural area of Kentucky called Holy Cross. It has the distinction
of being the first Catholic settlement west of
the Allegheny Mountains and the birthplace
of many of the founders of the infamous
“Cornbread Mafia.” My ancestors were among the first 25 families
that migrated to the area from Maryland in the mid-1700s. It was
a place where the spiritual and progressive (Thomas Merton, the
Sisters of Loretto and the Sisters of Charity of Nazareth) dwelt
side by side with red-necked criminals, who set bear traps in their
pot fields to snap off intruders’ feet.
I was fortunate that my parents both came from relatively
well-to-do and educated families in the area. My father taught
us to reject material things. He would wear his shirts until they
were so thin you could see through them. He never owned
a fancy car and could care less about what the house looked
like. But he and my mother bought us books and saw that we
attended the summer day camps run by the nuns and seminarians in the area. We were all expected to go to college and to
pay our own way for it.
Hanukkah Happiness
Jonathan E. Hodes, MD, MS, FACS
I became aware that being Jewish was
different from the kids around me in public
school, and this was most evident in public
school during the mandatory morning
prayer. As an independent-thinking young
person, and Jewish person, I simply was not going to say this
prayer, but by not saying the prayer, I was “different.” When the
Supreme Court ruled in 1962 and 1963 that mandatory prayer
and Bible reading were prohibited in public schools, I was
elated – now there was not a daily reminder to my friends that
I was different from them! My parents were involved in the Civil
Liberties Union at the time, and school prayer was dinner table
conversation. My family was religious: We went to synagogue
every Saturday, stayed home from school while observing Jewish
holidays and experienced home prayer and religious traditions.
My mother, a Holocaust survivor, was fiercely proud of being an
American, and for her America meant religious freedom, with
separation of church and state. She had experienced firsthand
the devastation that intolerance and religious bias can bring. The
First Amendment of the Constitution, “Congress shall make no
law respecting an establishment of religion, or prohibiting the
free exercise thereof ...” was her mantra.
Christmastime in elementary school was a very challenging
time for me. The trees and ornaments and Santa and elves and
reindeer and sleighs and and and ... the richness of the Christmas
tradition OVERWHELMED any non-Christian one. The school
pageants and crèche and Christmas art projects, the play “A
Christmas Carol,” the mall holiday displays and Macy’s windows,
the caroling and the bell-ringing Santa, and all the presents my
friends got were just hard to bear. If I’m honest, as a child it was
We were taught how to work hard and be self-sufficient. We
grew our own fruits and vegetables, raised cattle for meat and
dairy, and even had chickens and hogs for a while. I was glad
when we stopped raising chickens and hogs because they really
stank. When my siblings and I got old enough, we all had jobs to
do. We knew we would have a big Christmas if the tobacco crop
was good that year.
We celebrated Christmas Mass at midnight in the same place
my ancestors had worshipped two centuries prior. My mother
played the organ, and there was no choir. The congregation sang
cheerfully and boisterously, if not on key. The priest would break
out the incense, and we always wondered if one of the altar boys
would pass out from its pungent aroma.
Christmas and New Year’s Eve were the only time we had
“party food” like soda pop and potato chips. We loved all the
Christmas TV shows like “Rudolph the Red-Nosed Reindeer,” “A
Charlie Brown Christmas,” “Frosty the Snowman” (remember Burl
Ives?) and my favorite, “The Little Drummer Boy.” One year when I
was probably 7 or 8 years old, my uncle Frank came over dressed
as Santa Claus and handed us all our presents from a huge red
velvet sack. I got a Drowsy doll and a set of art supplies. I was
never so happy.
Christmas in those days was simple and sweet and magical. I
wish I could go back there just one more time.
the presents that made me feel most left out.
Then one year, in seventh grade, my parents suggested that I
invite some school friends over for latkes and candle lighting on
the last day of Hanukkah. I didn’t really want to do this because
our Hanukkah home tradition was typically European. We lit the
candles on the Hanukkah menorah, played dreidel (a spinning
top game) with gold foil-covered chocolate coins and, on the
eighth night, typically we would get an envelope with some
money. We did not give one another presents and, since it was
my bar mitzvah year, I expected that my parents wouldn’t give
me money that year, but rather a tallit bag (which holds the
prayer shawl to be given on my bar mitzvah day), perhaps some
tefillin (prayer boxes to be worn for daily prayer) or maybe a
Tanakh (Hebrew bible). I had witnessed this scenario with my two
older brothers. I had also become aware of Jewish stereotypes
and was worried that our humble tradition of chocolate coins
and a bit of cash in an envelope would reinforce my otherness
with my friends. But this was the 1960s and they were my parents, so I complied.
On the eighth night of Hanukkah, four friends rang the doorbell. It was the end of Christmas break and I DREADED returning
to school after Christmas vacation. Everyone came back wearing
new sweaters, some with a tan from Florida or the Bahamas, all
talking about their great presents, the latest remote-controlled
cars, portable tape players, toy grand pianos, etc. I had no topic
of conversation. We didn’t get a bunch of new toys in the middle
of the winter.
On this particular Wednesday, my mother had been very secretive. She didn’t let us into the living room or the kitchen. She was
cooking all day. On all the other days of Hanukkah, my little sister
and I put the candles into all the menorahs (our parents had one,
and each of us four kids had one). On this day, we were told to
“disappear.” I had spent the day walking around some stores,
DECEMBER 2012
25
visiting some Jewish friends and reading in my room. Something
was up.
My buddies were greeted by the smell of latkes. If you haven’t
had the gastronomic opportunity of indulging in this coronary
artery-clogging, smile-inducing hedonistic fried Jewish soul
food – be sure to get invited to a Hanukkah party! These fried
potato pancakes originated in Eastern Europe but are enjoyed
from northern England to the Middle East. The aroma of cooking
latkes can be overwhelming but remarkably welcoming. Mom
had even made sufganiot – homemade jelly doughnuts! Hanukkah celebrates a miracle that occurred after the Maccabees
successfully conquered Jerusalem and rededicated the Temple
in 167 BCE (Before the Common Era). The legend indicates that
there was only one small flask of oil to rekindle the eternal light
of the Temple – enough to last for one day, but miraculously
the flask lasted eight days, the time needed to press and purify
more oil.
After my friends and I played in my room with some of the cool
toys they got for Christmas, we were called for dinner. The doors
Pajamas, A Sign of the Times
Teresita Bacani-Oropilla, MD
At our 25th medical class reunion, a classmate seemed overweening in praise of her
granddaughter. The little girl had a matching outfit like hers and marched with our
class. Promising
never to do the same, I found out that
one must never say never, that one of
the greatest joys grandparents have is
to show off their grandchildren. One
falls in love with them, wants them
to be in sight, much like a besotted
lover. One heaps lavish gifts on them,
and likely overvalues their assets. It
takes discipline not to condone their
antics when they cross certain lines,
and to maintain consistency in explaining values that one should hold
dear.
Birthdays and holidays are special
times to indulge them. As they grow
in number and age, one treasures
and hoards their uniqueness, yet
tends to preserve their unity as one
flock. One establishes patterns and
traditions that one hopes they will
remember so as to keep them together through the years, and maybe
pass them on to their progeny in the
future. Lastly, one tries to be fair and
treat them equally well despite one’s
tendencies to – well, overdo.
Precious now are the pictures of them as toddlers, dressed
alike in red suits, or of the group innocently singing “Happy Birth-
26
LOUISVILLE MEDICINE
to the living room remained shut. After one of my mother’s truly
remarkable dinners, including latkes with sour cream and applesauce, Dad said we would light the menorah and play dreidel
before having sufganiot.
We went into the living room, and for the first time in my short
life it was decorated with Hanukkah streamers, crepe dreidels,
stars of David and menorahs, sparkles on the table and a pile of
wrapped presents! All five of the family menorahs were set up
with all the candles ready for lighting, and there was a sixth menorah for my friends to light as well. Mom and Dad had thought
of everything. With the light from 54 candles blazing, we played
dreidel and opened presents, peeled the gold foil off the chocolate coins and ate a thousand dollars worth of dreidel money,
then stuffed ourselves with the crispy homemade doughnuts
oozing sweet jelly. As the candles extinguished themselves one
by one and the smell of wax-smoke was evident, I said good
night to my friends and went up to bed. Wow! That was a Hanukkah to remember! And yes, I did get a tallit bag that year, but I
also got the coolest toy of the season – a Hot Wheels track and
several Hot Wheels cars!
day” to a baby Jesus in a crèche, with their pointed tassel hats
sometimes askew on their heads.
Every year, among the tricycles, toy cars, books and everything a child desires, six of mine receive matching pajamas.
Lined up by age after all the gifts are opened, a picture is
taken, fodder to feed distant family members. There came a
year when the oldest, a young adolescent man-child by now,
gamely took his place – but it was clear he felt it was kids’
stuff. After a hiatus of two years, a
granddaughter complained that
they didn’t get pajamas anymore.
How come? But I had thought they
no longer cared. I was wrong, they
still did. The next Christmas, in a
rush to resume what had become
tradition, I asked my daughter to
buy pajama tops while I bought the
bottoms. The boys now had man
pajamas without superheroes.
When picture-taking time came,
the four girls, now teenage ladies,
retired to don their stuff. Surprise!
Instead of long-sleeved, soft flannel
tops, out traipsed four model-like
ladies in Victoria’s Secret tops. I didn’t
know styles had changed! But times
and circumstances had too.
Four of the six are now in college
and the last two are hurrying up to
join them, dreaming of the joys and
tribulations of independent living.
Little do they know what lies ahead!
For us, their protectors and mentors, we hope and pray that they will
realize their dreams. May they live in
a world where God reigns on high and where there is peace on
Earth among people of goodwill.
Stockings Hung by the Chimney with Care
Ellen R. Hale
The last Christmas gift I gave my grandmother was a framed
photograph of my husband and me standing next to a glistening
18-inch tree on our piano, which Nana had made for me about 10
years earlier. The tree sparkles with white lights, strands of pearls
and red rosebuds, with a cardinal perched on top. I hoped the
photo would convey our deep love for her, because there wasn’t
much else Nana needed a year ago. At 85, she finally had to leave
the home she and my late grandfather had built in 1951 in the
Pennsylvania town where I grew up, in favor of an assisted living
facility, where she was cared for very nicely in her own room. She
had heart problems, breathing problems and short-term memory
loss, but she remained characteristically full of joy. I’m thankful we
spent one last Christmas together. She died in March after a hospitalization led to emergency surgery and multiple complications.
During my childhood, Nana and Papa made Christmas magical
for everyone in my family. I remember it as the same every year.
We would arrive at their home to an enormous pot of soup for
lunch. My brother, my two cousins and I would each open the
It’s Not What You Say,
But How You Say It
Kenneth C. Henderson, MD
The first Christmas I can remember and
still recall most of the events we spent at the
home of my maternal grandparents. My dad
was in the U.S. Navy somewhere in the South
Pacific. My mother, older brother, sister and I were spending Christmas Eve and Day on the farm with Meme and Granddaddy. They
owned a 910-acre farm along the Ohio River in Ballard County,
Kentucky, about 30 miles west of Paducah. My maternal greatgrandfather, Case Rickman of Paducah, had originally purchased
the property during the Depression as three adjoining farms. Our
grandparents and great-grandparents were all considered affluent
for the time and place; however, our immediate family was not. As
yet our young family did not own land.
I can recall a few months earlier that my dad had come home
on leave. I remember for some reason that seeing him in uniform
had frightened me. I was scared when he grabbed me in his arms
to hug me and his beard scratched me. He was a powerful, allmuscle-and-no-fat man. He could fix anything with his hands and
use his strength to break anything that did not cooperate. When
I grew older, I came to appreciate him more for volunteering to
serve in World War II. I understand that he initially avoided the
draft based on his farming and having three children. I am told
he kept track of his draft status at the county courthouse. When
his number came up, he volunteered for the Navy because he
said he loved the water. He had grown up in the Purchase district
of Western Kentucky, where the water dominates the land. I
wore his old uniforms several times for dress-up as soon as I was
almost large enough. He was always larger than life to me.
My granddaddy Gross Hayden was the man in charge almost
no matter the situation or the circumstances. He was likely the
only farmer in Western Kentucky who was a graduate of Paducah
wrapped gifts in the bulging stockings bearing our names, which Nana
had knitted for us when we were
born. There were always stacks of
five gifts for each of us – no more,
no less. Later, at my aunt and uncle’s
home, we would eat turkey and
ham and corn and Nana’s famous
potato filling (a delicious Pennsylvania Dutch dish).
Then, in 2005, something
changed. There were no stockings
hanging at the fireplace. Instead, Nana wrapped them up with
a note. “It is time you have this stocking to hang in your home,”
she wrote, explaining that she was “a bit too tired” to continue
that tradition. “It surely was my pleasure to play the role of
Santa for you.”
Nana’s greatest gifts came all through the year, however, in the
form of home-cooked meals, attendance at school concerts and,
later, frequent letters after I’d moved away from home. When I
set out my tree and hang my stocking this bittersweet Christmas,
I will remember my nana and all that she has given me.
Tillman High School, and had one year of college as a premedical
student on a football scholarship at the University of Louisville.
He took the Sunday Courier-Journal that I recall always arrived in
the mail on Monday or Tuesday. He was our spiritual leader and
had a profound influence on my life.
Christmas Eve was to be spent by all attending midnight Mass
in the only mission Catholic Church in the county. This small
wooden structure was heated by a central coal-burning stove.
Gross Hayden was responsible for the building of the church and,
of course, built the fire this night about an hour before midnight
Mass. I remember falling asleep inside the church wrapped in a
quilt that was handmade by my great-grandmother Rickman.
Granddaddy Hayden made sure all of us were awake and alert
before Mass started. My older brother Donnie had just started as
an altar boy and served at the Mass. I was later to serve at Mass in
this church from the third grade through high school graduation.
After about a 10-mile ride on gravel roads, we arrived back at
home. Granddaddy allowed all to go to bed but would get everyone back up early the next morning for a country ham breakfast
cooked by Colonel Hayden himself. He killed his own hogs, made
sausage and cured his own hams, shoulders and bacon. He was
known as Mr. Gross or Colonel Hayden by all the men in the
county. He had never seen military service.
As we ate breakfast, Mother read to us about Christmas. I do
not recall the story she read, but I will always remember how
she read it. Mother was very bright and literate although never
college-educated. She could read aloud like no other. The words
seemed always to be formed somewhere deep inside her and
could never escape without precise timing and her advice and
consent. She was also very capable of writing her own words.
Later she became a syndicated columnist and historical novel
author. She did crossword puzzles for recreation. She always expected more of me than I could give. However, she was successful in teaching me to be all that I could be.
Finally we were allowed to open presents. Presents from Santa
DECEMBER 2012
27
There’s no place like home for healing.
Recommend Floyd Memorial Home Healthcare to
patients recovering from illness or injury.
At Floyd Memorial Home Healthcare, we believe a comfortable
and familiar setting is a vital part of the healing process. We’re
proud to bring comprehensive, high-quality and convenient care
to your patients’ doorstep — 7 days a week.
More information about our nationally acclaimed services can be
found at floydmemorial.com/home-health or call 812-948-7447.
Our award-winning services available
in six Indiana counties include:
• Skilled registered nursing
• Prevention of re-hospitalization
• Fall prevention assistance
• Chronic disease management
• Intravenous (IV) therapy and
medication management
• Rehabilitation Services including:
- Physical therapy- ortho/spinal post operative
- Occupational therapy
- Speech therapy
- Mental health/Alzheimer’s/Dementia services
- Social services needs
- Wound care
- Certified aide assistance with daily living
- Telemedicine services
Scott
Washington
Clark
Floyd Memorial Home Healthcare is recognized on the 2011 HomeCare Elite List
of top-tier home healthcare agencies, achieving Top 500 national status.
O
H
IO
Harrison
RI
VE
R
Floyd
Crawford
we W elcome you
GLMS would like to welcome and congratulate the following physicians who have been
elected by Judicial Council as provisional members. During the next 30 days, GLMS members
have the right to submit written comments pertinent to these new members. All comments
received will be forwarded to Judicial Council for review. Provisional membership shall last
for a period of two years or until the member’s first hospital reappointment. Provisional
members shall become full members upon completion of this time period and favorable
review by Judicial Council. LM
CANDIDATES ELECTED TO PROVISIONAL ACTIVE MEMBERSHIP
Bailen, Erica Lane
(31105)
217 Breckenridge Ln
40207
895-9421
Pediatrics 09
U of Louisville 06
Boswell, Mark Vance
(30100)
Barbara A. Boswell
530 S Jackson St
Rm C2A01 40202
852-5851
Anesthesiology 88, 09
Pain Management
93, 04,14
Hospice & Palliative
Medicine 10
Case Western Reserve
U 84
Bullock, Smitha
(31090)
Joshua Bullock
601 S Floyd St Ste 602
40202
585-4802
Pediatrics 08
George Washington
U 05
Clark, Kelly J (17671)
3821 Ormond Rd
40207
Psychiatry 97,06
U of Wisconsin 89
Fogle, Anne Marie
(31203)
Michael Ross Fogle
4420 Dixie Hwy
Ste 114 40216
449-6464
Family Medicine 05
U of Louisville 02
Daniel, Stanley
Robert (18659)
Kings Daughters Dr
Frankfort KY 40601
875-5240
Emergency Medicine
U of Alabama 06
Hill Ali, Marlyce R (18893)
Jermaine A. Ali
Internal Medicine
U of Louisville 02
Downing, John
(30313)
Sheryl M. Downing
301 E Muhammad Ali
Blvd 40202
852-0710
Ophthalmology 70
U of Louisville 62
DECEMBER 2012
29
P HY S ICIAN S IN P RINT
Ballantyne CM, Bays HE, Kastelein JJ, Stein
E, Isaacsohn JL, Braeckman RA, Soni PN. Efficacy and Safety of Eicosapentaenoic Acid
Ethyl Ester (AMR101) Therapy in StatinTreated Patients With Persistent High
Triglycerides (from the ANCHOR Study).
Am J Cardiol. 2012. Epub.
Bays HE. Adiposopathy: Is “Sick Fat” a Cardiovascular Disease? Journal of the American
College of Cardiology. 2011;57:2461-2473.
Bays HE, Gadde KM. Phentermine/topiramate for weight reduction and treatment
of adverse consequences in obesity. Drugs
Today. 2011;47:903-914.
Bays HE. Colesevelam HCl added to
background metformin therapy in patients
with type 2 diabetes mellitus: A pooled
analysis from three clinical studies. Endocrine Practice. Endocr Pract. 2011;17:933938.
Bays H, Giezek H, McKenney JM, O’Neil
EA, Tershakovec AM. Extended-Release
Niacin/Laropiprant Effects on Lipoprotein
Subfractions in Patients with Type 2 Diabetes Mellitus. Metab Syndr Relat Disord.
2012. 10:260-266.
Bays HE. Long-term (52-78 weeks) treatment with colesevelam HCl added to
metformin therapy in type 2 diabetes mellitus patients. Diabetes Metab Syndr Obes
2012;5:125-34.
Bays HE, Schwartz S, Littlejohn T 3rd, Kerzner B, Krauss RM, Karpf DB, Choi YJ, Wang
X, Naim S, Roberts BK. MBX-8025, A Novel
Peroxisome Proliferator Receptor-deta
Agonist: Lipid and Other Metabolic Effects in Dyslipidemic Overweight Patients
Treated with or without Atorvastatin. J Clin
Endocrinol Metab 2011;96:2889-97.
Bays HE. Lorcaserin: drug profile and illustrative model of the regulatory challenges
of weight-loss drug development. Expert
Rev. Cardiovasc. There. 2011; 9(3), 265–277
(2011).
Bays HE. Specialty Corner: Investigational
Anti-obesity Agents to Treat Adiposopathy
and “Sick Fat.” Lipid Spin. Pages 22-23.
2011.
Bays HE, Ballantyne CM, Kastelein JJ,
Issacsohn JL, Braeckman RA, Soni PN.
Eicosapentaenoic Acid Ethyl Ester (AMR
101) Therapy in Patients With Very High
Triglyceride Levels (from the Muticenter,
plAcebo-controlled, Randomized, doublebliNd, 12-week study with an open-label
Extension [MARINE] Trial). Am J Cardiol
2011 108;5:682-690.
Bays HE, Davidson MH, Massaad R, Flaim
D, Lowe RS, Tershakovec AM, Jones-Burton
C. Safety and Efficacy of Ezetimibe Added
on to Rosuvastatin 5 or 10 mg Versus UpTitration of Rosuvastatin in Patients With
Hypercholesterolemia (the ACTE Study)
Am J Cardiol 2011;108:523-530.
Bays HE, Evans JL, Maki KC, Evans M,
Maquet V, Cooper R, Anderson JW. Chitinglucan fiber effects on oxidized low-density lipoprotein: a randomized trial. Eur J Clin
Nutr. 2012 Epub ahead of print.
Bays H, Frestedt JL, Bell M, Williams C,
30
Kolberg L, Schmelzer W, Anderson JW.
Reduced viscosity Barley Beta-Glucan
versus placebo: A randomized controlled
trial of the effects on insulin sensitivity for
individuals at risk for Diabetes Mellitus.
Nutr Metab 2011 Epub ahead of print.
LOUISVILLE MEDICINE
Bays H, Shah A, Dong Q, McCrary Sisk C, Maccubbin D. Extended-release niacin/laropiprant lipid-altering consistency across patient
subgroups. Int J Clin Pract. 2011 65(4):436-45.
Bays HE, Shah A, Lin J, Sisk CM, Dong Q,
Maccubbin D. Consistency of ExtendedRelease Niacin/Laropiprant Effects
on Lp(a), ApoB, non-HDL-C, Apo A1,
and ApoB/ApoA1 Ratio Across Patient
Subgroups. Am J Cardiovasc Drugs
2012;12:197-206.
Boyd TG, Huber KM, Verbist DE, Bumpous JM, Wilhelmi BJ. Removal of Exposed
Titanium Reconstruction Plate After Mandibular Reconstruction With a Free Fibula
Osteocutaneous Flap With Large Surgical
Pin Cutters: A Case Report and Literature
Review. Eplasty. 2012;12:e42. Epub 2012
Aug 31. PMID: 22977677.
nique for producing an ischemic wound
model. J Vis Exp. 2012 May 2;(63):e3341.
doi: 10.3791/3341. PMID: 22588601.
Hazani R, Engineer NJ, Elston J, Wilhelmi
BJ. Anatomic landmarks for basal joint
injections. Eplasty. 2012;12:e2. Epub 2012
Jan 18. PMID: 22276223.
Hazani R, Whitney R, Wilhelmi BJ. Optimizing aesthetic results in skin grafting. Am
Surg. 2012 Feb;78(2):151-4. Review.
PMID: 22369820.
Huber KM, Boyd TG, Quillo AR, Wilhelmi
BJ. Implications of anomalous pectoralis
muscle in reconstructive breast surgery:
the oblique pectoralis anterior. Eplasty.
2012;12:e44. Epub 2012 Sep 10. PMID:
22977679.
Kaufman CL, Ouseph R, Blair B, Kutz JE,
Tsai TM, Scheker LR, Tien HY, Moreno R,
Ozyurekoglu T, Banegas R, Murphy E, Burns
CB, Zaring R, Cook DF, Marvin MR. Graft vasculopathy in clinical hand transplantation.
Am J Transplant. 2012Apr;12(4):1004-16. doi:
10.1111/j.1600-6143.2011.03915.x. Epub
2012 Feb 11.PubMed PMID: 22325051.
Keeling WB, Leshnower BG, Thourani
VH, Kilgo PS, Chen EP. Outcomes following redo sternotomy for aortic surgery.
Interact Cardiovasc Thorac Surg. 2012
Jul;15(1):63-8. Epub 2012 Apr 3. PubMed
PMID: 22493099; PubMed Central PMCID:
PMC3380996.
Kehdy F. Current management of
paraesophageal hernia. Am Surg. 2011
Dec;77(12):1565-73. Review. PubMed
PMID: 22273209.
Lee SM, Rahman MF, Thirkannad S. Combination V-Y advancement flap and composite graft for reconstruction of an amputated
fingertip. Hand Surg. 2012;17(1):145-9.
PubMed PMID: 22351555.
Brown WV, Bays H, Davidson M, Goldberg
A. Drugs in development for management
of lipoprotein disorders. J Clin Lipidol.
2011 5(2):66-75.
Lee TJ, Fox MP, Trivedi J, van Berkel V.
Donors with a history of cocaine use and
lung transplant outcomes. J Heart Lung
Transplant. 2012 Oct;31(10):1144-6. Epub
2012 Aug 23. PubMed PMID: 22921404.
Brown WV, Bays H, Harris W, Miller M.
Using omega-3 fatty acids in the practice of clinical lipidology. J Clin Lipidol.
2011;5(6):424-33.
Lederer ED, Klein JB. New Treatments for
CKD--New Insights into Pathogenesis. J
Am Soc Nephrol. 2012 Oct;23(10):1601-3.
Epub 2012 Sep 13.
Chien S, Wilhelmi BJ. A simplified tech-
ROBERT PFEIFFER KRAFT JR., MD (1949-2010)
Many of you knew and worked with Bob. Bob received his Doctor of Medicine
degree from the University of Louisville in 1975. He was board certified in both
Internal Medicine and Gastroenterology. He began a private gastroenterology
practice that was later named Gastro East Physicians and practiced until his
retirement in 2004.
Bob, as everyone called him, was a native of Louisville and was devoted to his
hometown. He always said that Louisville was a wonderful place to pursue a
medical career because of the high caliber of physicians in the community
and the strong culture of commitment to learning, research and innovation in
so many different areas of medicine.
He was a natural teacher, and patients and medical personnel alike often
commented that he had a real knack for explaining diagnoses and procedures
to people in different ways that helped to reduce anxiety and increase
understanding. He loved being a physician, and that showed in his performance,
infectious smile and upbeat manner.
So many more things could be written about Bob, but one gentleman who had
been his patient for years summed it all up eloquently. He simply said, “Dr. Kraft
was the best doctor I’ve ever had and the best man I’ve ever known.”
To celebrate and honor the hard work and dedication of Bob, an anonymous donor
has created the Robert Pfeiffer Kraft, Jr., MD Endowed Scholarship Fund at the
University of Louisville School of Medicine. This fund will assist students seeking
a medical degree at the School of Medicine. To receive additional information
regarding the Robert Pfeiffer Kraft, Jr., MD Endowed Scholarship Fund, please
contact Allison Gardner at 502-852-7817 or allison.gardner@louisville.edu.
DECEMBER 2012
31
Maccubbin DL, Chen F, Anderson JW, Sirah
W, McCrary Sisk, Kher U, Olsson AG, Bays
HE, Mitchel YB. Effectiveness and Safety of
Laropiprant on Niacin-Induced Flushing.
Am J Cardiol 2012 Epub.
MacLean A, McKenney JM, Scott R, Brinton
E, Bays HE, Mitchel YB, Paolini JF, Giezek
H, Vandormael K, Ruck RA, Gibson K, Sisk
CM, Maccubbin DL. Efficacy and safety of
extended-release niacin/laropiprant in patients with type 2 diabetes mellitus. British
Journal of Cardiology Volume 8 February
2011 (Published ahead of print).
Madsen MJ, Kushner GM, Alpert B. Failed
Fixation in Atrophic Mandibular Fractures:
The Case against Miniplates. Craniomaxillofac Trauma Reconstr. 2011 Sep;4(3):14550. PubMed PMID: 22942943.
Maki KC, Bays HE, Dicklin MR. Treatment
options for the management of hypertriglyceridemia: Strategies based on the
best available evidence. J Clin lipidol.
2012;6:413-26.
Maki KC, Bays HE, Dicklin MR, Johnson SL,
Shabbout M. Effects of prescription omega3-acid ethyl esters, coadministered with
atorvastatin, on circulating leels of lipoprotein particles, apolipoprotein CIII, and
lipoprotein-associated phospholipase A (2)
mass in men and women with mixed dyslipidemia. J Clin Lipidol. 2011;5(6):483-92.
Martin R, Geller D, Espat J, Kooby D, Sellars
M, Goldstein R, Imagawa D, Scoggins C.
Safety and efficacy of trans arterial chemoembolization with drug-eluting beads
in hepatocellular cancer: a systematic
review. Hepatogastroenterology. 2012 JanFeb;59(113):255-60. doi: 10.5754/hge10240.
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Martin RC, Aiyer HS, Malik D, Li Y. Effect
on pro-inflammatory and antioxidant
genes and bioavailable distribution of
whole turmeric vs curcumin: Similar root
but different effects. Food Chem Toxicol.
2012 Feb;50(2):227-31.Epub 2011 Nov 4.
PubMed PMID: 22079310; PubMed Central
PMCID: PMC3267883.
Martin RC, Robbins K, Fagés JF, Romero FD,
Rustein L, Tomalty D, Monaco R. Optimal
outcomes for liver-dominant metastatic
breast cancer with transarterial chemoembolization with drug-eluting beads loaded with
doxorubicin. Breast Cancer Res Treat. 2012
Apr;132(2):753-63. PubMed PMID: 22200868.
Mascio CE, Gaynor JW. Historical per-
32
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spectives of The American Association
for Thoracic Surgery: Edward M. Kent
(1908-1970). J Thorac Cardiovasc Surg.
2012 Sep;144(3):527-9. Epub 2012 Jul 4.
Mbah NA, Brown RE, Bower MR, Scoggins
CR, McMasters KM, Martin RC. Differences
between bipolar compression and ultrasonic devices for parenchymal transection during laparoscopic liver resection.
HPB (Oxford). 2012 Feb;14(2):126-31.
doi: 10.1111/j.1477-2574.2011.00414.x.
PubMed PMID: 22221574; PubMed Central
PMCID: PMC3277055.
Mowlavi A, Huynh PM, Huynh DC, Wilhelmi BJ. A New Technique Involving
a Spherical Stainless Steel Device to
Optimize Positioning of the Umbilicus.
Aesthetic Plast Surg. 2012 Jul 7. [Epub
ahead of print] PMID: 22773024.
Mowlavi A, Pham S, Lee R, Huynh P, Wilhelmi B. Cortical thickness parameters for
endoscopic browlift fixation. Aesthet Surg
J. 2012 Jul 1;32(5):547-51. Epub 2012 Apr
13. PMID: 22504826.
Nweze IC, Smith JW, Zhang B, Klinge
CM, Lakshmanan J, Harbrecht BG.
17β-Estradiol attenuates cytokineinduced nitric oxide production in rat
hepatocyte. J Trauma Acute Care Surg.
2012 Aug;73(2):408-12. PubMed PMID:
22846947; PubMed Central PMCID:
PMC3422572.
Ozyurekoglu T, Turker T. Results of a
method of 4-corner arthrodesis using
headless compression screws. J Hand Surg
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Pagni S, Ganzel BL, Williams M, Slater AD,
Trivedi JR. Inflammatory aneurysms of the
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Rodbard HW, Bays HE, Gavin JR 3rd, Green
AJ, Bazata DD, Lewis SJ, Fox KM, Reed ML,
Grandy S. Rate and risk predictors for development of self-reported type-2 diabetes
mellitus over a 5 year period: the SHIELD
study. Int J Clin Pract. 2012;66:684-691.
R O’Hagan A, Morton R, Eid N. Loss of
asthma control in pediatric patients after
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Slaughter MS. Invited commentary.
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Slaughter MS. Summary of the 19th congress
of the international society for rotary blood
pumps. Artif Organs. 2012 Aug;36(8):6535. doi: 10.1111/j.1525-1594.2012.01516.x.
Sobieski MA, Giridharan GA, Ising M, Koenig
SC, Slaughter MS. Blood Trauma Testing
of CentriMag and RotaFlow Centrifugal
Flow Devices: A Pilot Study. Artif Organs.
2012 Aug;36(8):677-82. doi: 10.1111/j.15251594.2012.01514.x. PubMed PMID: 22882437.
Stalenhoef AF, Davidson MH, Robinson JG,
Burgess T, Duttlinger-Maddux R, Kallend D,
Goldberg AC, Bays H. Efficacy and safety
of dalcetrapib in type 2 diabetes mellitus
and/or metabolic syndrome patients, at
high cardiovascular disease risk. Diabetes
Obes Metab 2011 Epub ahead of print.
Stein EA, Bays H, O’Brien D, Pedicano J,
Piper E, Spezzi A. Lapaquistat acetate: development of a squalene synthase inhibitor for the treatment of hypercholesterolemia. Circulation. 2011 10;123:1974-85.
Verbist DE, Boyd TG, Malkani AL, Wilhelmi
BJ. Simultaneous Latissimus Dorsi Myocutaneous Flap Transfer and Revision Total
Knee Arthroplasty With Allograft Extensor
Mechanism Reconstruction: A Case Report.
Eplasty. 2012;12:e43. Epub 2012 Aug 31.
PMID: 22977678.
Williams ML, Ganzel BL, Slater AD, Slaughter MS, Trivedi JR, Edmonds HL, Pagni SA.
Antegrade versus retrograde cerebral protection in repair of acute ascending aortic
dissection. Am Surg. 2012 Mar;78(3):349-51.
Zhu DL, Bays H, Gao P, Mattheus M, Voelker B, Ruilope LM. Efficacy and Tolerability
of Initial Therapy With Single-Pill Combination Telmisartan/Hydrochlorothiazide
80/25 mg in Patients With Grade 2 or 3 Hypertension: A Multinational, Randomized,
Double-Blind, Active-Controlled Trial. Clin
Ther. 2012 Jun 18. Epub ahead of print.
NOTE: GLMS members’ names appear in
boldface type. Most of the references have
been obtained through the use of a MEDLINE computer search which is provided
by Norton Healthcare Medical Library. If
you have a recent reference that did not
appear and would like to have it published
in our next issue, please send it to Alecia
Miller by fax (736-6363) or email (alecia.
miller@glms.org). LM
Santa came first. Later, individual presents to each other were
passed out. I recall Donnie got a wooden machine gun, and he
spent the rest of the day killing the “yellow Japanese.” The only
toy that I can remember that Santa brought for me was a large
blue and black rubber truck. I spent many hours playing with it
the next several years. I think that I kept the old rubber truck until
after high school, but by then all the paint had fallen off. My sister
Pam got another doll and some furniture, as I recall. She had a
hard time growing up with her first two brothers, plus the three
more brothers yet to come.
Christmas lunch, called dinner, was Meme’s domain. My
mother was a good cook, but Stella Hayden had no peer. With
Granddaddy out of the kitchen, she was queen of her castle. She
had a huge wood-burning stove that took wood on both sides
and heated water internally as well. She usually roasted a fat hen
and made sage dressing with canned oysters inside. She made
both mashed potatoes and potato salad. She made the giblet
gravy that I loved so much to spill over the mashed potatoes and
dressing. She made pecan pie from the nuts that she picked up
from the wild pecan trees along the Ohio River. The nuts were
very small and very tasty. It took the whole family several hours
to crack the nuts she collected. She also made fruit salad from
fresh fruit and coconut. Yes, she cracked the coconut fresh from
the shell. She made the best homemade biscuits in the whole
world and pan-fried her cornbread. I can taste this meal now by
simply recalling it.
Grandmother Hayden always started the games to be played
after dinner. She loved Monopoly, Chinese checkers and any type
of card game. She got the games started and tried to take part in
all of them at the same time. I always laugh to myself every time I
play, when I recall that my sainted grandmother cheated at cards.
The evening meal was generally leftovers but included deviled eggs and Granddaddy’s country ham, sausage and bacon to
be put on the homemade biscuits. Granddaddy Hayden always
said the blessing before any meal under his roof. Much to the
surprise of us all this evening, my mother asked his permission
to say the grace before the meal. She wanted to pray for the
safe return of our father and her beloved husband from the war.
Again, I cannot recall what she said, but I will never forget how
she said it. LM
DECEMBER 2012
33
34
LOUISVILLE MEDICINE
pillars
of haiti
Ellen R. Hale
“Tou muen se muen.”
–Haitian Creole for
“All humans are people.”
Haiti are the women. They are the ones who give strength
to the society and to the family. And they’re the ones who
hold the family and community together under the most
adverse of circumstances.”
Dr. Hilgers, speaking to the GLMS Foundation’s Medical Missions and Indigent Care Committee, described
the life of a Haitian woman as being very difficult. Many
women earn money by cooking on the street or preparing charcoal to sell. Charcoal is used to heat living spaces, resulting in a high incidence of childhood asthma and
pneumonia.
In Haiti, 90 percent of women have no access to cancer
care, Dr. Hilgers said. Pap smears are generally not available; neither are pathologists to read the tests. Cancer
doesn’t get as much attention as other pressing health
problems like HIV/AIDS, tuberculosis, malaria, childhood
diarrhea and malnutrition.
There is no cancer treatment center and no radiation
therapy. As cervical cancer
advances, women become
incontinent, develop a foul
odor and suffer a tremendous
amount of pain. They are
pushed to the margins of their
families and society, often
leaving them isolated. They
may not even know that it is
cancer that is killing them.
When the devastating earthquake struck Haiti in January 2010, homes and buildings collapsed. The presidential
palace in Port-au-Prince, near the epicenter, was almost
entirely destroyed. More than 250,000 lives were lost in
the earthquake, while another 1.5 million people were
displaced. Most moved into tent cities.
A deadly disease is threatening another “pillar” that
sustains the structure of Haitian society. Cervical cancer,
so closely linked to high rates of poverty and illiteracy, is
believed to be the leading cause of death among women
in Haiti. When women die of
cervical cancer, mostly at ages
35-55 when everyone needs
them most, Haitian families
suffer.
“The entire family complex
begins to fall apart,” explains
Robert D. Hilgers, MD, MA,
CAE, a gynecologic oncologist who is seeking to expand
cervical cancer screening in
Haiti through a nonprofit organization he founded, called
the Women’s Global Cancer
The presidential palace in Port-au-Prince following the earthAlliance. “The real pillars of
quake.
DECEMBER 2012
35
(Above) Haitian women
work in the street.
(At right) Patients at a
see-and-treat clinic.
Dr. Robert Hilgers in Haiti.
There may be some
pelvic discomfort, but
no significant morbidity. The procedure can
be performed in one visit to the clinic. HIV screening can
also take place at the clinic.
The WGCA is raising money to operate the clinic in
Gonaives for five years, which will require about $500,000.
The WGCA held a three-day cervical cancer prevention
conference in Port-au-Prince this month with the American Society of Colposcopy and Cervical Pathology, Haiti’s
Ministry of Health, JHPIEGO (an affiliate of the Johns
Hopkins School of Public Health), and Partners in Health, a Boston-based group that
is constructing a new 320-bed teaching
hospital about 60 miles outside the capital
in Mirebalais.
“Every child deserves a mother,” Dr. Hilgers said. For more information on WGCA,
visit www.womensgca.org. LM
“When treatment is not available, prevention is the solution,” Dr. Hilgers said. The Women’s Global Cancer Alliance
is raising awareness about cervical cancer through education, both to physicians and women themselves, and establishing “see-and-treat” clinics. One has been operating
in Gros Morne (population 30,000) for two years, screening almost 2,000 women in that time. WGCA is working on
developing another clinic and training center in the larger
nearby city of Gonaives (population 300,000), located
about 100 miles north of Port-au-Prince.
The see-and-treat method involves using
ordinary household vinegar (Dr. Hilgers
calculates that one gallon of vinegar can
potentially save 250 women’s lives; four
gallons can save 1,000 Haitian women).
The cervix is painted with vinegar, which
allows the clinician to see a clear picture of
the cervix. Using a colposcope, worrisome
lesions can be evaluated and, if necessary,
frozen using liquid nitrogen delivered
through a cryosurgical gun. This approach Gonaives is about 100 miles north
of Port-au-Prince.
is 90 percent effective, Dr. Hilgers said.
36
LOUISVILLE MEDICINE
Note: Ellen R. Hale is the communications
associate for the Greater Louisville Medical
Society.
Primary Care
Rachel Busse, MD
I would walk down Fifth
Avenue, past Anthropologie
and the fancy boot stores,
past the corn dog cart and
faux watches, and I would
jump between worlds.
I was there for an integrative medicine
fellowship, dividing my time between a family health
center and private medical clinic.
At the community health center, I met patients from Jamaica bringing in bottles of herbs I’d never heard of. There
were Russian immigrants with fat-cheeked babies worried
about every diaper rash. There were gay teens escaping
their families in New Jersey and now living in shelters
in Manhattan, trying to find jobs and the best way back
out of New York. I would fly from room to room, trying to
keep up with accents and families and lack of resources.
The most amazing thing was that I was there to practice
integrative medicine. I was there to see the whole person
and try to understand how their physical, emotional and
spiritual worlds came together to create their health. And
I had only a few minutes. I learned to smile, make eye contact and listen before beginning my round of questions,
and then hope that this would be enough.
At the other end of my walk was the private holistic medicine center, calm and beautiful compared to the chaotic
streets. The waiting room had real wood, beautifully soft sofas and a whole wall of windows shining all over you. It was
hushed up there, high above the noisy streets, with only the
twinkling of chimes in the background. The exam rooms had
sconces on the walls. Smells of lavender and citrus hung in
the air. The patients were wealthy, intelligent, attractive and
optimistic. But they were also demanding and anxious, often
coming with stacks of Internet research. Down the hall I had
a therapist, nutritionist, massage therapist, acupuncturist and
homeopath, and we would have once-weekly conferences
to discuss difficult or interesting cases.
It was a fascinating year. I learned to be committed and
thoughtful from the community health center; I learned about
new systems of medicine and the latest evidence from the
private clinic. I attended classes on homeopathy, Reiki, medical hypnosis, functional medicine and more. I struggled with
a lack of continuity in both locations and wondered how I
would find the time and connection with patients. I was there
in New York in order to bring together my idea of being a
physician and a healer. I wanted to bring together the best of
conventional medicine with a whole-person approach.
Finishing the fellowship, I looked for a practice where
I could see patients who want to be able to bridge conventional and alternative medicine but in the context of
evidence-based care. For the past two years, I’ve been
grateful to be at a family medicine practice within walking
distance of my house here in Louisville.
On a typical morning, I see a middle-aged man with the
familiar list of diabetes, hypertension and hyperlipidemia.
My patient is very motivated to lose weight and eat well, but
at the same time is slowed by the difficulty of exercise and
healthy diet. So we try to go at it together, looking for types
of exercise that are fun, food changes that are realistic and
sustainable, gathering labs and data as we go but still in the
context of this complex and lovely and stressful world.
Next I head to a 4-month well visit, distracted by the
baby’s vibrant smiles from the task before me – to monitor growth, developmental milestones, calorie intake,
sleep habits, safety and parental concerns, and document
it all along the way.
I find that I’m already a little behind as I head into my next
patient, a new patient in her 40s with persistent fatigue. She
is looking for a holistic approach, or answers, or both. We
talk about her family and her daughter who is in college. She
lives alone and sleeps poorly. She has had the same office
job for 15 years and fears she is allergic to the building. We
check labs for anemia, vitamin deficiencies, thyroid. We look
at supplements for anxiety and sleep and ways to reduce allergy exposures. She agrees to begin a daily restorative practice, yoga or meditation. (I will see her back in two weeks to
go over labs, and she will tell me that she is walking several
times a week and the melatonin is helping with her sleep,
but she is gaining weight and feeling frustrated.) Then I dash
to my office to pump milk for my 9-month-old, put away the
bottles and clean the supplies.
From there I see a 60-year-old female with asthma and
COPD who only comes in with an acute exacerbation, next a
5-year-old with a rash, then a college student with an upper
respiratory infection and then a well woman exam where I
counsel the patient she doesn’t need a Pap for another two
years. I advise a male teacher about environmental measures and herbal supplements that may help his worsening
allergies, and then I navigate the lengthy problem list for my
83-year-old male accompanied by his daughter. I take time
then for phone messages, pharmacy callbacks, rehab orders
and mail, then zip home for lunchtime with my daughters
before afternoon clinic. It feels full, but I love the work itself
and the relationships formed in the process.
And so these days I smile at my own luck. I see 3-day-old
babies, white-haired sweet little old ladies, healthy moms,
persons with 15 chronic medical conditions and everything
in between. I run into my patients at the farmers’ market. I
ask my librarian patient for book recommendations. If I’m
lucky, I see three generations of a family. Most importantly,
I get to be a continuous part of my patients’ health care.
Some days I have the opportunity to ask about the ways in
which my patients take care of themselves – I may be able
to delve into nutrition and sleep and stress reduction more
completely. Other days, we have to focus on when to check
sugars and setting up a colonoscopy. But I know that I get
to have the long view. LM
Note: Dr. Busse practices Family Medicine with Norton
Community Medical Associates-Highlands.
DECEMBER 2012
37
LM
LM
38
LOUISVILLE MEDICINE
Speak Your Mind The views expressed in Doctors’ Lounge 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 in this issue, please submit
an article or letter to the editor. Contributions may be sent to editor@glms.org or may be submitted online at www.glms.org.
The GLMS Editorial Board reserves the right to choose what will be published.
Mary G. Barry, MD
Louisville Medicine Editor
editor@glms.org
Calling Timeout has a scheduled life (which is why they
Since April, when
we began the allconsuming EMR,
there are days it’s
well past noon and I have not eaten
since 5, except for Hershey bars. There
are days I don’t even look at work
email or AOL till suppertime, days I
miss Jazzercise and days I fail to mail
the birthday card or even buy it, for my
clan of loved ones. I am continuously
sleepless now, going on eight months,
even more than at Grady, when I could
sink into eight or nine hours when off
call. My prospects for improvement will
only appear on Memorial Day, when
I should have finally succeeded in
abstracting 25 years of medical records
on 2,000 people into the Epic system,
and will then only need to keep up
with the damn thing.
For sanity I continue to call the
30-second timeout (Words with
Friends moves), the officials’ timeout
(check on hospital patients in Carelink
while signing various important pieces
of paper) and the TV timeout (my favorite: when my call is put on hold for
any reason, I read the ESPN and Breaking News apps on my cell). Even better
is the game-update function, where
I can follow faraway soccer matches
– and the Olympics, ah the matchless Olympics, what a massive dose of
cheering-up they brought us all.
So when my thoughts turn to December and Christmas, I think about
giving, and about time. I spent years of
summers doing nothing but laundry,
reading books and swimming. I got to
walk to the library twice a week to get
more books, but straightway went back
to whatever chair my older sisters had
not commandeered. The modern child
grow up with so many more practical
skills than we did) but I wish, for them,
a Christmas of unfettered hours, lots of
new books and daydreaming. For their
parents, my colleagues who have to do
everything I do AND raise their kids, I
wish several Mary Poppinses who magically appear and render children bathed
and smiling, with completed homework
in hand. As for the teachers who assign
gradeschoolers the sort of projects
where you build your own ziggurat – fie
on them. If you can fit Tab A into Slot B,
I consider you qualified for at least high
school. Having to invent a Tab A for a
Slot B, to construct a temple of any kind
out of available household materials, is
a nightmare destined to provoke mutiny. I’d steal time from those teachers
and make them grade 500-word essays
on “Drywall: Ten Ways to Use Those Big
Orange Buckets.”
There are a lot of us out there living
on borrowed time – people on chemo,
people in war zones – who know it’s
borrowed and live that way. Most of
the rest of us prefer to pretend that
Later is really Never, for who can hold
his own mortality in his mind? One
benefit of never having enough time, I
have discovered, is a surreal appreciation of the clock. I can tell you to the
minute what time it is these days, and
every grain of happiness I snatch from
the maw of Epic I snatch speedily, with
greed, and with gratitude. The big
crumbs – like home football games –
and the little ones, like the first junco of
the season today at my feeder – I seize
and hold dear. Every minor pleasure
is more meaningful these days. Got a
sunrise? Check. Got a joke? Check. Got
some more ice? Wow!
Time with the ones you love is the
most precious gift of all. I think of our
men and women far away, getting shot
at on our behalf, and wish them home
safe with their families. Missing major
rituals is only one of the things they
give up for us. Every minute I have with
my family makes me happy, and I wish
the same joy for them.
As for greed, I quote Franz Messerli,
MD, in NEJM of Oct. 18: “There was a
close, significant linear correlation (P <
0.0001) between chocolate consumption per capita and the number of Nobel
Prize laureates per 10 million persons
... among 23 countries.” It’s those flavonoids that increase cognitive function,
you see. Switzerland won, far and away,
if you throw out Sweden (home court
advantage). The U.S., Ireland and Germany were even, but all below the Brits,
Austria, Norway and the Danes. China
was last. By Dr. Messerli’s calculations,
“The minimally effective dose seems to
hover at 2 kg per year, and the doseresponse curve reveals no ceiling on the
number of Nobel laureates at the highest
chocolate dose level of 11 kg per year.”
(Only 11 kg? They’re pikers.) However,
he advises caution. “The specific dose of
chocolate needed to increase the odds
of being asked to travel to Sweden is
uncertain, and the research is evolving.”
Therefore, for general giving, to
increase our IQs, aim our thoughts like
lasers and help us type even faster, I
suggest milk chocolate. Dark chocolate
is for the intellectual type – you know
who you are. We warrior types stick
with our K-ration milk bars, and wish
you a happy new year. LM
Note: Dr. Barry practices Internal Medicine with Norton Community Medical Associates-Barret. She is a clinical
associate professor at the University of
Louisville School of Medicine, Department of Medicine.
DECEMBER 2012
39
B U S INE S S CARD G A L L ERY
Pediatrician Needed
Seeking full time BE/BC Pediatrician to join
a busy, growing downtown practice.
Comp salary and benefits.
Please send CV to: cheri.mcguire@glms.org
or call 502.736.6336 for more information.
ADVERTI S ER S ’ INDE X
Athena Health
12
Canfield Development
1
Elmcroft
6
www.athenahealth.com
www.canfielddevelopment.com
www.elmcroftseniorliving.com
Floyd Memorial Home Healthcare
www.floydmemorial.com/
home-health
28
Hall Render Killian Heath
& Lyman
www.hallrender.com
34
Jewish Hospital St Mary’s HealthCare
IFC
John Kenyon Eye Center
11
Kentuckiana Pain Specialists
22
www.painstopshere.org
40
33
ResCare
38
Medical Society Employment Services
16
State Volunteer Mutual Insurance Co
2
Merkley Kendrick Jewelers
19
The Doctors Company
www.thedoctors.com
11
Murphy Pain Center
4
The Pain Institute
OBC
Norton Healthcare Physicians
www.nortonhealthcare.com
15
The Physicians Billing Group
40
www.mkjewelers.com
Passport Health Plan
IBC
www.passporthealthplan.com
Professionals’ Purchasing Group14
www.ppginc.net
LOUISVILLE MEDICINE
www.rescare.com
www.svmic.com
www.glms.org
www.murphypaincenter.com
www.jhsmh.org
www.johnkenyon.com
KMA Insurance Agency
www.kmainsurance.com
ProNational Insurance
www.pronational.com
9
Re/Max Metro
14
www.thepaininstitute.com
www.thephysiciansbilling.com
University of Louisville School 31
of Medicine
Greater Louisville Medical Society
101 WEST CHESTNUT STREET
LOUISVILLE, KY 40202
PRSRT STD
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PAID
LOUISVILLE, KY
PERMIT NO. 6

LouisviLLe Medicine - Greater Louisville Medical Society

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