medicina September 1 2016

Ingham County Medical Society edicina

September 2016

College Readiness Guide:
Books, Hot Plate & Meningitis B Vaccinations

David Walsworth, MD, FAAFP, ICMS President

A s college campuses start to fill up for the • After learning about Meningitis B, 89
fall semester, now is the time to make percent of parents said that immunization is

sure your patients are aware of the im- something they should seek out to protect

portance of Meningitis B immunization. their child.

Meningitis B accounts for nearly 50 percent of We know that meningitis is a vaccine-
all meningitis cases in persons 17 to 22 years preventable disease and that many high
of age and college students are at particular school and college aged individuals may not
risk because of the communal setting at most yet be vaccinated against Meningitis B. As
colleges and universities. your teenage patients (or teenage children
of your patients) head back to school, please
According to a recent survey by the Kimberly be sure to remind them to get immunized with
Coffey Foundation: all recommended vaccines.

• 81 percent of parents were not aware that
there are vaccines to protect against 5 differ-
ent strains of meningitis;

• 79 percent of parents did not know that
their adolescent is not fully immunized against
all 5 types unless they had each of two
unique meningococcal vaccinations; and

ICMS medicina SEPTEMBER 2016

PO Box 280 (517) 336-9019
Dewitt, MI 48820 Fax: (517) 827-4945

In this issue... ICMS BOARD OF DIRECTORS

Letter from the Editor-In-Chief President
___________________________ 3 David Walsworth, MD, FAAFP

Local Physicians Craft State & National Policy President-Elect
___________________________ 4 J. Randy Hillard, MD

Meet New MSU Student Representatives Secretary-Treasurer
___________________________ 5 Joseph Wilhelm, MD, FACS

Student Concussion Guidelines Immediate Past President
___________________________ 6 Amit Ghose, MD

Updates from Sparrow Health System Itfiker Ahmad, MD
___________________________ 8 Farhan Bhatti, MD
Steven Cross, Student Representative
Updates from McLaren Greater Lansing Douglas Edema, MD
___________________________ 9 Kenneth Elmassian, DO
Ved Gossain, MD
Updates from MSU HealthTeam Narasimha Gundamraj, MD
___________________________ 7 Raza Haque, MD
Richard Honicky, MD
Advocacy Alert– Contact through Coffee Ronald Horowitz, MD
__________________________ 11 James Richard, DO
Dawn Springer, MD
Member Spotlight: Ved Gossain, MD
__________________________ 12

Welcome to Ingham County
__________________________ 12

2 medicina

Welcome to medicina

Dear fellow ICMS members: Welcome to the mation, tidbits, articles or anything that you think
relaunch of medicina. Each month, ICMS is might add value to this informational resource.
dedicated to bringing you the latest news about
advocacy, reimbursement and coding, and up- We invite your feedback on our new format.
coming educational and social events, as well as Please let us hear from you about what you like
highlighting how your fellow members are making and would like to see improved or modified in
a positive impact on the practice of medicine. future editions. Also, please send us ideas, infor-
mation, tidbits, articles or anything that you think
We invite your feedback on our new format. might add value to this informational resource.
Please let us hear from you about what you like
and would like to see improved or modified in We invite your feedback on our new format.
future editions. Also, please send us ideas, infor- Please let us hear from you about what you like
mation, tidbits, articles or anything that you think and would like to see improved or modified in
might add value to this informational resource. future editions. Also, please send us ideas, infor-
mation, tidbits, articles or anything that you think
We invite your feedback on our new format. might add value to this informational resource.
Please let us hear from you about what you like
and would like to see improved or modified in fu- Sincerely,
ture editions. Also, please send us ideas, infor-
mation, tidbits, articles or anything that you think J. Randy Hillard, MD
might add value to this informational resource.
ICMS President-Elect &
We invite your feedback on our new format. medicina Editor-in-Chief
Please let us hear from you about what you like
and would like to see improved or modified in
future editions. Also, please send us ideas, infor-

ICMS Family Game Night
October 22, 2016
7:30 pm
2<<?562>D2B

Join ICMS for food and refreshments and
cheer on MSU as they take on Maryland!

September 2016 3

Local Physicians Craft State & National Policy

A vital part of your membership is your ability party payers and outside vendors in health care
help shape policy at both the state and na- decision making. Not only did the resolution re-

tional level. If there is an issue you are passionate ceive overwhelming support at the MSMS House

about, your ICMS Board of Directors wants to of Delegates, it also led to the establishment of

hear from you. new national AMA policy.

Earlier this year, Joseph Willhelm, MD, FACS, Physician Decision Making H-450.928
ICMS Secretary-Treasurer and a local ophthalmol-
ogist, was concerned that his patients were run- Our AMA advocates that treating and
ning out of their prescription eye drops. He ex- attending physicians, regardless of
plained to the Board that while 50-60 percent of employment status, must maintain
experienced glaucoma patients regularly adminis- overall leadership in decisions affecting
ter more than one drop at a time, pharmacy bene- the health care received by patients in
fit plans typically have strict limitations and refill order to ensure quality of the care given
conditions. to patients.

The ICMS-sponsored resolution overwhelmingly Do you have an issue or concern that you would
passed both the Reference Committee and full like to see addressed? Or would you like to serve
MSMS House of Delegates. MSMS has now been as a Delegate for ICMS? Please contact the ICMS
directed to work with the appropriate stakeholders Office at [email protected] or 517-336-
to adopt policies that would permit early refills of 9019.
prescription glaucoma eye drops.

A second resolution offered by ICMS emphasized
the importance of the physician-patient relation-
ship as the foundation for quality patient care.
Kenneth Elmassian, DO, ICMS and MSMS Past
President and a local anesthesiologist, brought to
the ICMS Board concerns that the reach of third-

4 medicina

Meet the 2016/2017 MSU Student Representatives

This spot is for a blurb regarding what being a student rep means, what they do. This spot is for a
blurb regarding what being a student rep means, what they do. This spot is for a blurb regarding
what being a student rep means, what they do. This spot is for a blurb regarding what being a student
rep means, what they do. This spot is for a blurb regarding what being a student rep means, what they

Steven Cross, ICMS and MSMS delegate
Hometown: Bay City, MI
After earning his BS in Nursing from Saginaw Valley State University, Steve vol-
unteered at the Helen Nickless Volunteer Clinic in Essexville, MI and worked at
two skilled nursing facilities in the Great Lakes Bay Region. When not studying for
his classes, he can be found in Fee Hall working for Kenneth Rosenman, MD,
with his wife and family at home, or in the middle of the woods chopping wood.

Paul Hanona, AMA Delegate
Hometown: Detroit
Paul earned a BS in Biomolecular Sciences from the University of Michigan and
worked at an NIH dermatology lab this summer studying xeroderma pigmento-
sum. In his spare time, he actively eats wild things to try to get food poisoning.

Marten R. Hawkins, Vice Chair

Hometown: Plymouth, MI

Marten earned his BS in Biochemistry and MPH in Hospital and Molecular Epide-
miology from the University of Michigan. He has worked on research focused on
Clostridium difficile transmission and optimizing a mouse model for human no-
rovirus. He plans to practice infectious disease medicine, working in hospital
infection prevention and antimicrobial stewardship and teaching these skills to
medical and graduate students. At U of M, Marten was a member of the trombone
section in the Marching Band for three years and the Hockey Band for six years.

Mike Baumgartner, Community Service and Recruitment Chair

Hometown: Colfax, WI

After earning his BS in Psychology from the University of Wisconsin – Madison, 5
Mike worked as a therapist for children with autism, a drug counselor for at risk
youth, and a teacher in a minimum security prison. He earned a second BS in
Neurobiology from UW Madison before starting work at a pharmaceutical re-
search company. His research includes studies on schizophrenia, neuroplasticity,
and Ubiquitin protein in Arabidopsis plants. Mike loved his alma mater so much
that he married a former Bucky mascot.

September 2016

Evaluation and Management of Concussion in Athletes

Reprinted with permission from the American Academy of Family Physicians

Concussion is a clinical syndrome of biomechani- week are also at greater risk.
cally induced altered brain function that typically
affects memory and orientation, and may involve Headgear use likely has a protective effect in rugby,
loss of consciousness. An estimated 1.6 to 3.8 mil- but it is unclear whether it affects concussion risk in
lion sports-related concussions occur each year in soccer. There is no compelling evidence that mouth
the United States. The American Academy of Neu- guards protect athletes from concussion, and there
rology (AAN) studied the incidence of concussion in is insufficient evidence to determine whether one
high school and college athletes to address the fol- type of football helmet is superior to others in pre-
lowing clinical questions: venting concussions.

• Which factors increase or decrease the risk of con- Among college football players, the risk of concus-
cussion in athletes? sion is greater for linebackers, offensive linemen,
and defensive backs, and lower for receivers. Data
• Which diagnostic tools are useful in identifying ath- were insufficient for the AAN to determine concus-
letes with a concussion, and for identifying those at sion risk by position for any other sport. The AAN
risk of severe or prolonged early impairment, cata- also could not determine whether age or level of
strophic neurologic outcomes, or chronic neurobe- competition affects the risk of concussion.
havioral impairment after a concussion?

• Which clinical factors are useful in identifying ath- Diagnostic Tools
letes who are at risk of severe or prolonged early Table 1 compares tools commonly used to diagnose
impairment, catastrophic neurologic outcomes, or concussion. The reference standard by which the
chronic neurobehavioral impairment after a con- tests were compared was a concussion diagnosed
cussion? by a physician or certified athletic trainer. A combi-
nation of these tests likely improves diagnostic accu-
• Which interventions enhance recovery and dimin- racy, but there is not enough evidence to determine
ish long-term sequelae after a concussion, and re- the best combination of specific tests. None of the
duce the risk of recurrent concussion? tools are intended to rule out concussion or replace
a thorough medical, neurologic, or neuropsychologi-
Risk Factors cal evaluation.
Because of the greater number of male athletes in
the sports studied by the AAN, the total number of Postconcussive Problems
concussions is greater in males for all sports com- In addition to confirming concussions, the tools listed
bined. However, the relationship of concussion risk in Table 1 can be used to identify athletes with con-
and sex varies among sports. Concussion risk is cussion-related early impairments, chronic neurobe-
greater for females who play soccer or basketball. havioral impairments, or catastrophic outcomes such
Concussion risk is also greater for football and rugby as subdural hematoma. Elevated postconcussive
players, and lower for gymnasts and baseball, soft- symptoms, lower neuropsychological test scores,
ball, and volleyball players. Body checking likely in- and deficits on the Balance Error Scoring System
creases the risk of concussion in ice hockey players. are associated with more severe or prolonged early
Athletes with a body mass index greater than 27 kg impairments. Gait stability dual-task testing may help
per m2 and those who train less than three hours per identify athletes with early postconcussive impair-
ments.
6 medicina

Risk factors for severe or prolonged early postcon- intracranial hemorrhage, in athletes with suspected
cussive impairments (e.g., persistent neurocognitive concussions who have loss of consciousness, post-
impairments, prolonged return to play) include ongo- traumatic amnesia, persistently altered mental sta-
ing clinical symptoms; a history of concussion or tus, focal neurologic deficit, evidence of skull frac-
headaches; early posttraumatic headache; fatigue or ture, or signs of clinical deterioration.
fogginess; early amnesia, altered mental status, or
disorientation; dizziness; playing the quarterback Cognitive Restructuring
position in football; and wearing a half-face shield in Cognitive restructuring is a form of brief psychologi-
hockey. Younger age and level of play may also be cal counseling that consists of education, reassur-
risk factors for prolonged recovery. In football, play- ance, and reattribution of symptoms. Although no
ing on artificial turf may be a risk factor for more se- studies have examined the use of cognitive restruc-
vere concussions. turing specifically in sports concussions, several
studies that used this intervention in persons with
Risk factors for recurrent concussions include a his- mild traumatic brain injury demonstrated decreased
tory of concussion, longer duration of sports partici- rates of postconcussion syndrome.
pation, and playing the quarterback position in foot-
ball. The risk may be highest in the 10 days after the Therefore, physicians may consider cognitive re-
initial concussion. structuring for athletes with concussion to shorten
the duration of subjective symptoms and reduce the
There is insufficient evidence to identify specific risk risk of postconcussion syndrome.
factors for catastrophic neurologic outcomes after a
concussion. Because of a lack of good-quality stud- RETURN TO PLAY
ies, the AAN could not determine the effect of post- To reduce the risk of recurrent injury, athletes with
concussive activity level on recovery, or the likeli- concussions should be prohibited from returning to
hood of developing long-term complications. play or practice until they are asymptomatic without
medication and an LHCP has determined that the
Recommendations concussion is resolved. Supplemental information,
Athletes, their families, and coaches should be coun- such as results from neurocognitive testing, may be
seled about risk factors for concussion by a licensed used to assist in determining concussion resolution.
health care professional (LHCP) experienced in the Return-to-play decisions for athletes who are high
diagnosis and management of sports concussions. school–aged or younger should be made more con-
Inexperienced LHCPs should be instructed in the servatively than those for older athletes. Individual-
administration of standardized validated sideline as- ized graded plans may be used for return to physical
sessment tools, emphasizing that these tools are and cognitive activity; these plans should be devel-
only a supplement to the evaluation of the athlete oped using a monitored, clinically based approach to
and should not be used alone to diagnose concus- minimize exacerbation of early postconcussive im-
sion. pairments.

Screening and Diagnosis CLICK HERE for the full study.
Athletes with a suspected concussion should be
removed from play immediately, and should not September 2016 7
be allowed to return until they have been as-
sessed by an LHCP with training in the diagnosis
and management of concussions and in the
recognition of more severe traumatic brain injury.

Diagnostic tools should be used by sideline
LHCPs, and the results should be made available
to other health care professionals who evaluate
the athlete in the clinical setting. Physicians car-
ing for athletes may use individual baseline
scores on concussion assessment tools, especial-
ly in younger athletes, those with previous con-
cussions, and those with preexisting learning dis-
abilities or attention-deficit/hyperactivity disorder.

Computed tomography should not be used to di-
agnose concussions, but may be necessary to
rule out serious traumatic brain injury, such as

Ingham Cou

It’s a Breast Thing Event Kicks Off Breast Sparrow Participates in New National Re-
Cancer Awareness Month search on Stroke Prevention

MSU Health Team’s 9th Annual It’s A Breast Thing Sparrow is among up to 120 medical centers na-
(IBT) Event will be held on October 4, 2016, from tionwide participating in the so-called CREST-2
5:00 – 8:00 pm at the Eagle Eye Golf Club in East study, which seeks 2,480 participants across the
Lansing. The evening event includes a presenta- United States and Canada. Qualified participants
tion of the latest information on breast health, can- are needed at the Sparrow Clinical Research Insti-
cer prevention and treatment, many health related tute over the next five years, said Joel Cohn, MD,
exhibitors as well as a themed bra decorating con- a Sparrow Cardiovascular Interventionist and local
test. Winners of the contest are featured in the principal investigator of the research.
yearly It's a Breast Thing Calendar featuring local
breast cancer survivors. To qualify, participants must be at least 35 years
IBT is a 501c3 charity committed to helping wom- old, have a significant narrowing of one carotid
en with breast cancer in the local community. Pro- artery with at least 70 percent blockage, and have
ceeds from the annual evening event and calen- no history of stroke or transient ischemic attack
dar sales go towards awarding grants in support of within the last six months.
local breast cancer patients who have unmet
needs related to their breast cancer treatment. In “Physicians want to identify the best way to pre-
2015, a total of 23 grants were awarded to help vent strokes in people who have a narrowing in
local patients with their out of pocket expenses their carotid artery,” Dr. Cohn said.
while they are in treatment.
This year’s bra decorating theme is “Animated Buildup of atherosclerosis, or plaque, commonly
Cartoons of the 50’s and 60’s.” Call 517-980-0357 known as hardening of the arteries, occurs where
to purchase or inquire about an IBT calendar. the carotid artery divides into the internal and ex-
ternal arteries. Patients with carotid artery disease
8 medicina may be at risk of stroke if clots or debris from
plaque are dislodged from the carotid artery wall.
As the material travels through blood vessels it
can interrupt blood flow to the brain, resulting in
stroke.
Stroke is the fifth most common cause of death in
the United States and the leading cause of disabil-
ity in adults. To date, no research has been con-
ducted to compare medical management of Pa-
tients with two common stroke treatment proce-
dures, carotid endarterectomy and carotid stent-
ing.

“The information from this study will help us learn
more about the best treatment for stroke preven-
tion,” Dr. Cohn said.

unty News

September 2016 3

Coffee & Conversation:

Get to Know Your Elected Officials

This spot is for a blurb regarding the importance of getting to know your elected officials, if there are
coffee hours, etc. This spot is for a blurb regarding the importance of getting to know your elected
officials, if there are coffee hours, etc. This spot is for a blurb regarding the importance of getting to know
your elected officials, if there are coffee hours, etc. This spot is for a blurb regarding the importance of
getting to know your elected officials, if there are coffee hours, etc. This spot is for a blurb regarding the
importance of getting to know your elected officials, if there are coffee hours, etc. This spot is for a blurb
regarding the importance of getting to know your elected officials, if there are coffee hours, etc. This spot
is for a blurb regarding the importance of getting to know your elected officials, if there are coffee hours,
etc. This spot is for a blurb regarding the importance of getting to know your elected officials.

Senator Curtis Hertel, Jr. (D-23)

Senator Joe Hune (R-22)

Representative Tom Cochran (D-67)

10 medicina

Representative Andy Schor (D-68)
Representative Sam Singh (D-69)
Representative Tom Barrett (R-71)
Representative Tom Leonard (R-93)

September 2016 11