OAFP Newsletters

New District Officers Installed



The Frontier Country and Green/Kiamichi Country Districts held their annual Family Holiday Celebrations on December 1st at the Waterford Hotel in Oklahoma City and on December 6th at the Renaissance Hotel in Tulsa.

The Districts inducted new officers for 2012. Serving the Frontier Country District is president, Dustin Baker, MD; president-elect, Suben Naidu, MD; vice president, Matt Dowell, DO; secretary/treasurer, Rachel Franklin, MD; member at large, Misty Bogle, MD; immediate past president, Phil Palmer, MD.

Serving the Green/Kiamichi District is president, James Beebe, MD; vice president, Sam Ratermann, MD; secretary/treasurer, Mitch Duininck, MD; and immediate past president, Andrew Donnelly, MD.

Members and their families enjoyed a wonderful evening visiting with friends and colleagues. Holiday entertainment was provided by the Edmond Memorial High School Show Choir – Act II in Oklahoma City and the Tulsa Memorial High School Show Choir – Sounds of the Season.

OAFP Holds Fall Board Meeting in Branson



OAFP members addressed Academy business at the Oklahoma Academy of Family Physicians Annual Fall Board Meeting November 12-13 at the Welk Resort in Branson, Missouri.

At this fall’s gathering of the Board, OAFP President Phil Palmer, MD, reported that the OAFP has been involved in several discussions with other health care organizations regarding pseudoephedrine and whether or not legislation needs to be developed to make products containing this ingredient prescription only. The discussion focused on the impact this move would have on patients, pharmacists and physicians. OAFP Legislative Consultant, Claudia Kamas, will keep members updated on the issue and any pending legislation.

Mr. Blackstock reported that the OAFP staff and leadership has been busy expanding the Choice CME Partner Program. As a result of these efforts the OAFP now has 18 Choice CME Partners which include an array of organizations throughout the state who have an interest in improving the health of the people of Oklahoma. They include: the Allergy Clinic of Tulsa; ; Central States Orthopedic Specialists; Cornerstone Hospice; Deaconess Hospital; Diagnostic Laboratory of Oklahoma; Harold Hamm Oklahoma Diabetes Center; INTEGRIS Health; Mercy Health Center / Mercy Clinic; Midwest Dairy Council / Dairy MAX; Oklahoma Allergy & Asthma Clinic; Oklahoma Heart Hospital Physicians; OU Physicians / OU Medical Center; PLICO; Saint Francis Health System; Servant Medical Imaging; St. Anthony Hospital; St. John Health System; and Works24.

Russell Kohl, MD, reporting for the Legislative Committee stated that over the past two years the OAFP has focused on, and continues to work toward a solution to recruit and retain primary care physicians to serve in the rural and underserved areas of our State. The OAFP was successful in broadening the scope of the Physician Manpower Training Commission’s ability to help retire the medical school debt of physicians who are willing to serve in these areas of the state. The OAFP has been seeking funding for these programs by trying to change a loophole in the law that allows moist smokeless tobacco to be taxed differently than all other tobacco products. If all tobacco were taxed the same, based on the weight rather than the cost of the product, $8 million dollars would be generated in the first year alone. These efforts for funding have not been successful thus far.

Alton Rae, MD reported that the OAFP Scientific Assembly Chair has agreed to incorporate the AAFP’s Americans In Motion—Healthy Interventions (AIM-HI) program into its theme and program content. AIM-HI is an initiative designed to improve the health of all Americans through a multifaceted fitness program addressing physical activity, nutrition and emotional well-being in the individual, family and community. Information on this program can be found at www.aafp.org; under the Clinical & Research tab.

Support a FMIG Medical Student for 2012

Please mail your donation directly to: FHFO, 1900 NW Expressway, #501, OKC, OK 73118 
Your donation to the FHFO needs to be made directly to the FHFO at the address indicated above.
Donations are tax deductible!

Please contact Sue Hinrichs with the OAFP at 405-842-0484 or 800-678-6237 with any questions.

Thank you for your continued support of the Family Health Foundation of Oklahoma!

The Family Health Foundation of Oklahoma supports:

 Family & Community Medicine Interest Group (FCMIG) – The most active student interest group on the OUHSC campus, FCMIG hosts several events on campus and in local communities.

 Future Physicians for Oklahoma (FPO) – A 4-week externship with a family physician for students completing their first year of medical school.

 7-Days in August – A one week shadowing experience for incoming first year medical students.

 Oklahoma Physicians Resource/Research Network (OKPRN) – Provides community physicians with access to information, education, research and technology in ways that enhance their practices and to generate new knowledge through practice-based research.

 Tar Wars Program – A tobacco-free education program for 4th & 5th grade students. The program is designed to teach kids about the consequences of tobacco use.

Dr. Brian Coleman honored at Change of Command Ceremony

As part of his preparation to leave in September to serve in Afghanistan, Dr. Coleman was honored at a formal Change Of Command Ceremony in Broken Arrow. This ceremony was held before a packed audience, and was a touching tribute to both Dr. Coleman, and the officer who will replace him here in his absence.

Lieutenant Colonel Brian Coleman’s awards include The Joint Service Commendation Medal, Army Reserve Component Achievement Medal, National Defense Service Medal, Iraq Campaign Medal with Campaign Star, Global War on Terrorism Service Medal, Armed Forces Reserve Medal with M Device, Army Service Ribbon, Army Reserve Components Overseas Training Ribbon, and the Combat Medical Badge.

There was a special thank you to the Coleman family for their unwavering support of the 120th Medical Company (Area Support)

After Dr. Coleman gave his remarks, he was presented with a plaque which states

“Presented To An American Patriot For Support Of Our Soldiers In The National Guard
Who Are Defending Freedom At Home And Around The World.”

Additionally, his commanding officer hand-wrote on the plaque the following,

“LTC Coleman, outstanding effort from an outstanding soldier!
Thanks for everything you’ve done and do for our soldiers.”

We would like to give a big thank you to Dr. Coleman and to all the other soldiers in the military, and indeed we all join Brian and Sarah Coleman in their constant prayers for all the soldiers who serve in every capacity here and abroad.

Thank You 2011 FHFO President Club Members

The Family Health Foundation of Oklahoma would like to give a special thank you to the following Presidents Club Members. Each physician, individual, or family below has contributed at least $1,000 this year to the Family Health Foundation of Oklahoma and American Academy of Family Physicians Foundation. For information on how you can become a President’s Club Member contact the OAFP office at 800.678.6237. Click here for a list of donors.

Family Medicine Nees to Take Advantage of Buzzwords
by MaverickMD2012 | in Physician

I was driving into work recently listening to the radio and heard one of the fancy ads that our hospital has been airing over the last few years of its “Good People, Great Medicine” campaign. The ad was talking about getting results for a patient recovering from a heart attack. Around central PA, this patient is far too common. And listening to the ad brag about how quickly this patient got to the cath lab, how great our HVICU is, or even mentioning the fact that our hospital has a great cardiac rehab program I could only think of one thing: why did this guy have a heart attack in the first place?

And that’s when I heard it: _____ _____ Heart and Vascular Institute (name of institution left out intentionally).

It got me thinking, what is in a name? Why do our ivory tower, academic, tertiary care health centers insist upon having things like Heart and Vascular Institutes, Eye Institutes, Cancer Institutes, and well the list goes on. Calling something an “institute” to me makes it sound like a place where great minds gather to think about things and work on the cutting edge of science and technology. And I can only help but think that our patients are thinking the same thing. Why go talk to Dr. Smith the cardiologist at his solo practice when you can go to the Heart and Vascular Institute? Why settle for the ordinary, when the top of the line is right next door?

But are the cardiologists who work in our Heart and Vascular Institute any better than the other physicians at our hospital? Is the care we give to patients post MI any better than the care we give to the nursing home patient with pneumonia or the 15 year old with appendicitis, or even the 4 year old with type 1 diabetes. I would hope not! So what then earns you the distinction of being named an institute? Can anyone be called an institute?

This brings me to the question I asked driving in to work: why did this guy have a heart attack in the first place? Is it because his BMI was 28? or his LDL 183? or his BP 155/85? Is it because he, like many men, didn’t routinely get a physical by his primary care doctor? He sounded all too pleased to come to our Heart and Vascular Institute, because in his mind it was the best there was, but what if our hospital had a Family Medicine Institute? Or a Preventative Care Institute? Or maybe more to the point, a “We keep you from getting sick in the first place Institute.”

Well maybe that one isn’t so easy to say. But I think my point is clear – what if we in family medicine took advantage of the buzzwords that seem to draw patients in to these tertiary care clinics and used it to bring them to our primary care clinics first? What if we finally owned up to the fact that what we do is just as state of the art and cutting edge: after all, we keep people from getting sick in the first place.

“MaverickMD2012″ is a medical student who blogs at Future of Family Medicine.

 


Concussion Update
by Troy Glaser, DO, Sports Medicine Physician, Central States Orthopedic Specialists, Inc.

Competitive sports are becoming more prevalent throughout Oklahoma and the pressure to succeed does not allow time to recover from injuries especially concussions. Emergency room visits in the US have tripled for concussions for ages 14-19 and there is an estimated 3.2 million concussions a year (4). On July 1st, 2010, Senate Bill 1700 became effective in the state of Oklahoma requiring all athletes suspected of having a concussion be removed immediately from play and not allowed to return until cleared by a licensed health care provider trained in managing concussions (1). Currently, I am the team physician for Bixby High School and have managed grade school, high school, college, and professional athletes with concussions. This article summarizes the most current recommendations on concussion management as well as how I use computerized neuropsych testing in my office.

A concussion is defined as a complex pathophysiologic process in the brain that is secondarily induced by a traumatic force which can be a direct blow to the head or some other area of the body the causes a sudden force through the brain (5). When a person suffers a concussion, he or she may have signs or symptoms from the following clinical domains: symptoms (headache, feeling in a fog, or emotional lability ), physical signs (loss of consciousness or amnesia), behavioral changes (irritability), Sleep disturbance (drowsiness), and Cognitive impairment (delayed reaction times). According to the Zurich Third Consensus on Concussion Guidelines, a concussion should not be graded and does not have to include loss of consciousness. Also, anyone who suffers from a concussion should be removed from play. To aid in sideline management for concussions, a provider should use a tool such as a Sport Concussion Assessment Tool or SCAT 2 form which incorporates a symptom scale, testing memory, cognitive function, balance testing, and has patient information for follow-up (5). A fulneurologic exam should be done on each patient and anyone with prolonged loss of consciousness or worsening headache should be emergently transferred to the nearest emergency room. A regular MRI or CT scan will be normal if the patient has a concussion, but may be needed to rule out other intracranial pathology. Each patient with a concussion should be treated individually (5). The majority of the time post-concussion symptoms resolve in 7-10 days, but the symptoms can be prolonged which is more common in children and younger adolescents. Once a concussed patient is asymptomatic they can start a progressive return to play protocol which is a six step process with 24 hours separating each step before being released for to return to sport (5).

The Zurich Guidelines recommends including some form of neuropsychologic testing in addition to the history and physical exam for concussion management. There are multiple ways to perform neuropsych testing ranging from a written test with an evaluation by a neuropsychologist to a computerized test such as the Immediate Post Concussion Assessment and Cognitive Testing (ImPACT). Currently, I use the ImPACT test and ideally have all the athletes at the school I cover have a baseline test. If an athlete is concussed, I have them take the ImPACT test within 48-72 hours of their injury. When the athlete is asymptomatic and has completed the progressive return-to-play protocol, I have the athlete take the ImPACT test one more time to make sure they are close or at their baseline. If the athlete does not have a baseline then I compare the athlete’s values to normative values for their age and education level (3). The ImPACT test has been shown to add 19-29% sensitivity to clinical examination when evaluating a patient for a concussion and only takes approximately 20 minutes (7).

Example of an ImPACT Composite Score.


When the diagnosis of a concussion is determined, patients with specific risk factors may have prolonged symptoms such as post-traumatic amnesia (PTA) has been associated with four times poorer post-injury outcomes versus those without PTA (7). High school athletes took longer to get back to their baseline on ImPACT testing than college athletes. Females are more susceptible to concussions and to prolonged symptoms versus males. The apoliprotein E e4 allele has been associated with a greater risk for concussion and more severe symptoms (7). Using a series of symptom clusters (migraine, cognitive, sleep, and neuropsychiatric) combined with ImPACT testing enhanced the ability to predict which patients would have prolonged recovery (4).

Initial management of a concussed patient is cognitive rest avoiding stimuli such as video games, school work, television, and extracurricular activities (5). Once the patient is asymptomatic they can start the progressive return to play. Managing post-concussive symptoms may require pharmacological treatment such as sumatriptan for persistent type migraine headaches or amytriptyline for insomnia. Cognitive rehab may play a role for persistent symptoms to help improve recovery (7).

After an athlete suffers from one concussion and they return to sport while still symptomatic, they may be at risk for Second-Impact Syndrome, which is a second concussion that causes profound brain swelling and vascular dysregulation. 17 deaths have been reported in the literature from second-impact syndrome (7). Patients who have suffered from multiple concussions have longer recovery with each additional concussion and are more susceptible for having another concussion by a factor of 5 (7). Lastly, multiple concussions can lead to chronic traumatic encephalopathy which can cause chronic motor, cognitive, and behavioral problems. A study done with 1063 retired NFL players of average age of 50 years old had 5 times more dementia related diagnosis then the general population (7). Unfortunately more studies are needed to help determine how many concussions are needed to develop chronic sequelae.

Preventing a concussion is can be challenging and nearly impossible since accidents do occur. In order for a patient to protect themselves they must have the proper fitted equipment for their sport and continue to check their equipment on a daily basis (6). For example, some adolescent athletes playing football like to have looser fitting helmets because they are more comfortable. However, once the athlete starts to sweat the helmet can be extremely loose which can make the athlete more susceptible for a concussion. One preliminary study showed that a custom mouth piece could decrease the rate of concussion by 7 times (6). Also, abiding by rules of a sport can prevent concussions as well. Increasing the awareness of concussions and the dangers of improper management is very important to educate our athletes, parents, and coaches. (CDC youth heads up program)The U.S. Centers for Disease Control and Prevention has videos and handouts through their “Heads Up” program for athletes, parents, and coaches (2). An overall team approach with athlete, parents, coaches, athletic trainers, and physicians can help keep athletes safe.

Bibliography
1. Anderson, G. G. (2010). An Act Oklahoma Senate Bill No. 1700.
2. CDC youth heads up program. (n.d.). Retrieved from CDC: http://www.cdc.gov/concussion/HeadsUp/youth.html
3. ImPACT. (n.d.). Retrieved from ImPACT: http://www.impacttest.com/  
4. Lau, B. (2011). CutOff Scores in Neurocognitive Testing and Symptom Clusters that Predict Protracted Recovery from Concussions in High School Athletes. Neurosurgery .
5. Mcrory, P. (2009). Consensus Statement on Concussion in Sport 3rd International Conference on Concussion in Sport Held in Zurich, November 2008. Clinical Journal of Sports Medicine , 19 (3), 185-200. 6. Navarro, R. (2011). Protective Equipment and the Prevention of Concussion--What is the Evidence? Current Sports Medicine Reports , 27-31.
7. Zafonte, R. (2011). Diagnosis and Management of Sports-Related Concussion. A 15-Year-Old Athlete with Concussion. JAMA , 306 (1), 79-86.