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Transcript of APRIL 2010 JMSMA
VOL. LI No. 4
April 2010
of the
House of Delegates & Medical Affairs Forum 2010
142 nd
Accomodations:
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APril 2010 VOlUMe 51 nUMBer 4
Scientific ArticleS
Pancreas cancer in Mississippi: Present challenges and future Directions 99Thomas S. Helling, MD, FACS
clinical Problem-Solving: Perplexing Pyretic Polyarthritis 114Rajvinder Singh Hanspal, MD
errata: Vol. 51, no. 3 J Miss State Med Assoc. 2010;50(3):83. 116
PreSiDent’S PAge
let’s change the Whole Damn System and Start Over,
but We Have to Wait Until tuesday 121Randy Easterling, MD; MSMA President
eDitOriAl
But Will it take? 123D. Stanley Hartness, MD; Associate Editor
relAteD OrgAnizAtiOnS
Mississippi Academy of family Physicians 106
DePArtMentS
Poetry in Medicine 107
new Members 117
Obituaries 119
the Uncommon thread 125
Placement/classified 126
Una Voce 127
ABOUt tHe cOVer: “DigitAliS DeriVeD frOM tHe fOxglOVe PlAnt” - This exotic flower photographed by Sherman
Bloom, MD comes from a genus of about 20 species of plants commonly called foxgloves. Also known as
digoxin and digitoxin, digitalis is a drug that strengthens the contraction of the heart muscle, slows the
heart rate and helps eliminate fluid from body tissues. In 1785, William Withering published his classic
account of foxglove and some of its medical uses, describing the syndrome of digoxin toxicity and
remarking upon his experience with digitalis. Indians in South America had used cardiac glycosides in
their dart poisons. Some have suggested that the toxic visual symptoms of digitalis may have played a role
in Van Gogh's use of swirling greens and yellows. During the early 20th century,
the drug was introduced as treatment of atrial fibrillation. Only subsequently was
the value of digitalis for the treatment of congestive heart failure established.
Dr. Bloom is a retired professor and former chair of the Department of
Pathology at the University of Mississippi Medical Center who now resides in the
greater Salt Lake City area of Utah. As a fine art photographer Dr. Bloom is
primarily concerned with visual esthetics. The majority of his work emphasizes
personal views of nature and beautiful things rather than commercial objectives.
His photographs have been shown in galleries in Mississippi, Arkansas, Colorado, and New Mexico and
have appeared with articles in a number of photography journals. Photographs by Dr. Bloom can be seen
at www.phototov.com.r
2010April
VOL. LI No. 4
2010April
VOL. LI No. 4
Official Publication
of the MSMA Since 1959
Journal of ThE MiSSiSSiPPi STaTEMEDiCal aSSoCiaTion (iSSn 0026-6396)is owned and published monthly by the MississippiState Medical Association, founded 1856, located at408 West Parkway Place, Ridgeland, Mississippi39158-2548. (ISSN# 0026-6396 as mandated bysection E211.10, Domestic Mail Manual).Periodicals postage paid at Jackson, MS and atadditional mailing offices.
CorrESPonDEnCE: Journal MSMa,Managing Editor, Karen a. Evers, P.o. Box 2548,ridgeland, MS 39158-2548, Ph.: (601) 853-6733,fax: (601)853-6746, www.MSMaonline.com.
SuBSCriPTion raTE: $83.00 per annum;$96.00 per annum for foreign subscriptions; $7.00per copy, $10.00 per foreign copy, as available.
aDVErTiSing raTES: furnished onrequest. Cristen hemmins, hemmins hall, inc.advertising, P.o. Box 1112, oxford, Mississippi38655, Ph: (662) 236-1700, fax: (662) 236-7011,email: [email protected]
PoSTMaSTEr: send address changesto Journal of the Mississippi State MedicalAssociation, P.O. Box 2548, Ridgeland, MS 39158-2548.
The views expressed in this publication reflectthe opinions of the authors and do not necessarilystate the opinions or policies of the Mississippi StateMedical Association.
Copyright© 2010, Mississippi State Medical Association.
Lucius M. Lampton, MDEditor
D. Stanley Hartness, MDMichael O’Dell, MDAssociAtE Editors
Karen A. EversMAnAging Editor
PublicAtions coMMittEE
Dwalia S. South, MDChair
Philip T. Merideth, MD, JDMartin M. Pomphrey, MD
Leslie E. England, MD, Ex-OfficioMyron W. Lockey, MD, Ex-Officio
and the Editors
thE AssociAtion
Randy Easterling, MDPresident
Tim J. Alford, MDPresident-Elect
J. Clay Hays, Jr., MDSecretary-Treasurer
Lee Giffin, MDSpeaker
Geri Lee Weiland, MDVice Speaker
Charmain KanoskyExecutive Director
april 2010 JOUrNal MSMa 97
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98 JOUrNal MSMa april 2010
Pancreatic cancer remains a deadly disease. Currently, the only
hope for cure is surgical resection at an early stage of the disease. How-
ever, there is evidence that many individuals do not receive this treat-
ment, perhaps because of health care disparities. Mississippi, because
of its socioeconomic composition, has been the focus of concern for
health care disparities. In order to determine whether such disparities
exist in Mississippi for pancreatic cancer, a retrospective analysis was
done from 2000 – 2006 of case diagnosis, treatment, and mortality from
this disease. The Mississippi Cancer Registry, the American College of
Surgeons (ACS) National Cancer Data Base (NCDB), and the National
Cancer Institute (NCI) Surveillance Epidemiology and End Results
(SEER) program were surveyed. Outcomes at all 12 ACS Commis-
sion on Cancer (CoC) accredited hospitals within the state were com-
pared to the NCDB nationwide (n=1331 hospitals). In 2006 Mississippi
had the highest death rate from pancreas cancer in the nation
(12.7/100,000). Age-adjusted incidence by county ranged to a high of
26.91/100,000. Fifty-one percent of patients who died from pancre-
atic cancer in the state were treated at ACS CoC hospitals. The fate of
the other 49% is not known. Of the patients tracked at CoC hospitals,
there was essentially no significant difference with respect to age dis-
tribution, stage at diagnosis, or first treatment modalities when com-
pared to NCDB nationwide CoC data. There were fewer patients
surviving two years with locally advanced disease compared to national
figures. Of concern was the large number of patients whose treatment
for pancreatic cancer is unknown. It is incumbent on health care
providers in the state to develop a system of care for pancreatic cancer
that is accessible, inclusive, and comprehensive.
Key WOrDS: PANCREATIC DuCTAl ADENOCARCINOMA (PDA),
HEAlTHCARE DISPARITIES, PANCREATIC CANCER
intrODUctiOn
With a uS Census Bureau population of 2,848,293 in 20001,
Mississippi is largely a rural state with 48.8% of the population resid-
ing outside urban areas. As a grim reminder, Mississippi ranks last
among the 50 states in families below the poverty level and in percent
of the population with less than a high school education, next to last in
median household income, and 48/50 in percent unemployed. Missis-
sippi has the highest of any state in percent of resident African Amer-
icans (AA) (36.6%).2 As such, Mississippi has been used as an example
of disparities in health care.3,4 Residents in certain regions of the state
have been found to die more often from common ailments of cardio-
vascular disease, strokes, injury, and cancer than residents of the united
States (uS). With respect to pancreatic cancer, the age-adjusted death
rate in Mississippi 2002-2006 was 12.7/100,000, the highest in the na-
tion.5
Ductal pancreatic adenocarcinoma is a leading cause of cancer
deaths. In 2008 it was estimated that 37,680 new cases would be di-
agnosed and that almost an equal number, 34,290 individuals, would
die of the disease.6 In fact, five-year survival rates for pancreatic can-
cer remain dismally low with only modest improvement over the past
28 years, from two percent to five percent.6 Rather surprisingly, infor-
mation from the American College of Surgeons (ACS) National Can-
cer Data Bank (NCDB) 2000 – 2006 indicates that 40 percent of
patients with pancreatic cancer received no first line cancer-directed
treatment.7 Socioeconomic status has been linked to poorer clinical
outcomes and refusal of treatment.8 Bilimoria and colleagues9, using
information provided in the ACS NCDB, reported that the majority of
patients (71.4%) with Stage I pancreatic cancer, those with potentially
curative disease, did not, in fact, receive surgery. Patients who were
black, less educated, poorer, or were operated on in smaller community
hospitals were less likely to receive surgery, situations that may exist
in many areas of Mississippi
It is the intent of this study to define the status of pancreatic can-
cer in the state of Mississippi using available state and national data-
bases to guide strategy in the future for the treatment of this lethal
disease.
• SCieNTiFiC arTiCleS •
Pancreas Cancer in Mississippi: PresentChallenges and Future Directions
Thomas S. Helling, MD, FACS
ABStrAct
AUtHOr infOrMAtiOn: Dr. Helling is in the Department of Surgery at the University of
Mississippi Medical Center in Jackson, MS.
cOrreSPOnDing AUtHOr: Thomas S. Helling, MD, Department of Surgery, University of
Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, ph: (601) 815-
1161, Fax: (601) 815-1165, [email protected]
april 2010 JOUrNal MSMa 99
100 JOUrNal MSMa april 2010
MAteriAlS AnD MetHODS
The primary aim of this study was to compare the distribution of
pancreas cancer in a state population with national figures. Age, stage,
first treatment modalities, and survival were examined. The hypothe-
sis was that, due to racial differences and educational and economic
disadvantages, there would be corresponding disparities in treatment
and outcome of pancreatic cancer. The Mississippi Cancer Registry
was established in 1993 through funds appropriated by the Mississippi
legislature. The ensuing Central Cancer Registry was established to
serve as the state's comprehensive resource for statewide cancer data.
Currently, the Mississippi Cancer Registry is supported through funds
from the Centers for Disease Control and Prevention, the Mississippi
Department of Health and the university of Mississippi Medical Cen-
ter. The Mississippi Cancer Registry, the ACS NCDB, and the National
Cancer Institute (NCI) Surveillance Epidemiology and End Results
(SEER) program were surveyed. The NCDB, a joint program of the
ACS Commission on Cancer (CoC) and the American Cancer Society,
is a nationwide oncology outcomes database for more than 1,400 CoC
approved cancer programs in the uS and Puerto Rico. All CoC ac-
credited hospitals, as part of monitoring for quality of care, must sub-
mit their cancer cases to the NCDB. The SEER database provides
organ specific information through its state cancer profiles, a joint proj-
ect between the NCI and the Centers for Disease Control. The Mis-
sissippi Cancer Registry provided information on the number of cases
diagnosed within the state from 2003 – 2006 and all deaths within the
state from 2000 – 2006. The ACS NCDB compared cases diagnosed
in the state of Mississippi, among all 12 ACS CoC hospitals within the
state, with national data. From the NCDB age and stage distribution
and first course treatments were surveyed. The SEER database was
surveyed for information concerning mortality rate, incidence, rate
trends, and historical trends, comparing Mississippi with national sta-
tistics. Survival statistics were supplied by the NCDB.
Descriptive statistics are provided as frequency counts and per-
centages. Pearson’s chi square test with Yate’s correction was used for
differences in categorical variables. Cumulative survival was calcu-
lated according to the Kaplan-Meier technique for estimations of sur-
vival.10
reSUltS
In 2006 the SEER database indicates that Mississippi has the
highest death rate from pancreatic cancer in the nation – 12.7/100,000
population. From 2000-2006, according to the Mississippi Cancer Reg-
istry, 2258 patients died from pancreatic cancer in the state of Missis-
sippi, an average of 376 patients per year. using information supplied
by the NCDB for all 12 ACS CoC hospitals within the state, 1149 pa-
tients were diagnosed and treated during the same time period, an av-
erage of 192 patients per year. This represents 51% of deaths recorded
for pancreatic cancer for that time period. Figure 1 illustrates age-ad-
justed invasive pancreatic cancer incidence by county for 2003-2006,
the earliest year incidence was recorded by the Mississippi Cancer Reg-
istry. Age-adjusted county incidence ranged from 0.00 (Issaquena) to
26.91 (Kemper). There is no apparent clustering of high or low county
incidence across the state. Figures 2 – 4 compare age at diagnosis,
stage at diagnosis, and first treatment for patients encountered at CoC
hospitals within the state with national NCDB data for 2000 – 2006.
figUre 1: age-aDJUSTeD iNCiDeNCe OF paNCreaTiC CaNCer iN
MiSSiSSippi By COUNTy. “UNSTaBle” reFerS TO COUNTS < 15 (TOO Few
TO CalCUlaTe a STaBle age-aDJUSTeD raTe). SOUrCe: MiSSiSSippi
CaNCer regiSTry HTTp://MCr.UMS.eDU/
05101520253035
Percent of pa�ents
Age (years)
% pts MS% pts US
0
5
10
15
20
25
30
35
Perc
ent o
f pa�
ents
Age (years)
% pts MS
% pts US
figUre 2:age aT DiagNOSiS OF paNCreaTiC CaNCer
MS = NCDB COC HOSpiTalS MiSSiSSippi (N = 12)
US = NCDB COC HOSpiTalS US (N = 1350)
NONe OF THe age grOUp COMpariSONS were SigNiFiCaNTly DiFFereNT
SOUrCe: aMeriCaN COllege OF SUrgeONS NaTiONal CaNCer DaTa
BaNk
0102030405060
0 I II III IV Unknown
Percent of pa�ents
AJCC stage at presenta�on
% pts MS% pts US
0
10
20
30
40
50
60
0 I II III IV Unknown
Perc
ent o
f pa�
ents
AJCC stage at presenta�on
% pts MS
% pts US
figUre 3:aJCC STage aT preSeNTaTiON
MS = NCDB COC HOSpiTalS MiSSiSSippi (N = 12)
US = NCDB COC HOSpiTalS US (N = 1350)
THere were NO STaTiSTiCally SigNiFiCaNT DiFFereNCeS aMONg THe
STage grOUpiNgS
SOUrCe: aMeriCaN COllege OF SUrgeONS NaTiONal CaNCer DaTa
BaNk
april 2010 JOUrNal MSMa 101
There are no significant differences with respect to age, stage at diag-
nosis, or first treatment except those patients in Mississippi receiving
only chemotherapy for first treatment (29% vs. 23%, p < 0.001). A large
percentage of patients received no treatment for their pancreatic cancer
(42% Mississippi, 45% uS). The AA race comprised 36% of the pan-
creatic cancer patients in the NCDB for Mississippi compared to 11%
nationally (p < 0.0001). From the Mississippi NCDB 83% of patients
received no surgery on the pancreas; nationally, the figure was 80% (p
= 0.005). Therefore, 190 patients in Mississippi from 2000 – 2006 in
12 CoC hospitals likely received potentially curative surgery for their
pancreatic cancer (17%), or 2.6 procedures/hospital/year. The corre-
sponding figure from uS NCDB data is 3.8 procedures/hospital/year.
Figure 5 depicts the cumulative percent survival by stage for
pancreatic cancers diagnosed at 12 CoC hospitals within Mississippi
compared to uS statistics nationwide among 1331 CoC hospitals.
There is no statistically significant difference in survival by stage com-
pared to the NCDB for patients treated at the CoC hospitals in Missis-
sippi, although there may be a clinical trend towards better survival for
Stage II and III patients nationwide compared to Mississippi at two
years (Stage II: uS 17.4% vs. MS 9.8%; Stage III: uS 21.7% vs. MS
12.0%).
Figure 6 shows the average annual percent change for cancers in
the state of Mississippi. While pancreatic cancer has not increased or
receded, further demographic portrayal of death trends is depicted in
Figure 6. Figure 7 shows trends in deaths per 100,000 comparing Mis-
sissippi to the united States. While deaths in AAs have decreased
across the uS, there has been a noticeable rise in deaths from pancre-
atic cancer in Mississippi to over 16/100,000. In contrast, deaths
among whites, both in Mississippi and the uS, have remained fairly
flat at 10-11/100,000.
DiScUSSiOn
There is an average of 376 individuals who die from pancreatic
cancer each year in Mississippi. According to available data from local
(Mississippi Cancer Registry) and national (NCDB) sources, only
about one-half of these patients are treated in CoC hospitals with avail-
ability of state-of-the-art cancer care. Of those treated, as recorded in
the NCDB, there does not seem to be a disparity with age of onset or
stage at diagnosis. Mirroring the demographics of the state, over one-
third of the patients were AA. While, generally, there was no difference
05101520253035404550
Surgery only Rad + Chem Chemonly Surg + Rad + Chem Other specified treatment No treatment
Percent of Pa�ents
% pts MS% pts US
p<0.001
0
5
10
15
20
25
30
35
40
45
50
Surgery only
Rad + Chem
Chemonly
Surg + Rad + Chem
Other specified
treatment
No treatment
Perc
ent o
f Pa�
ents
% pts MS
% pts US
p<0.001
figUre 4:FirST COUrSe TreaTMeNT FOr paNCreaS CaNCer
SUrgery = CUraTive iNTeNT ; raD = raDiaTiON THerapy;
CHeM = CHeMOTHerapy
MS = NCDB COC HOSpiTalS MiSSiSSippi (N = 12)
US = NCDB COC HOSpiTalS US (N = 1350)
all grOUpiNgS exCepT “CHeM ONly” NOT SigNiFiCaNTly DiFFereNT
SOUrCe: aMeriCaN COllege OF SUrgeONS NaTiONal CaNCer DaTa
BaNk
0102030405060708090100
Cumula�ve Survival Percentage
Years From DiagnosisI II III IV I II III IVMS n = 476 US n = 54909
US Stage III 21.7% 2 year survivalMS Stage III 12.0% survival
US Stage II 17.4% 2 year survivalMS Stage II 9.8% 2 year survival
Stage at Diagnosis 1.0 2.0 3.0 4.0 5.0
0
10
20
30
40
50
60
70
80
90
100
Cum
ula�
ve S
urvi
val P
erce
ntag
e
Years From DiagnosisI II III IV I II III IV
MS n = 476 US n = 54909
US Stage III 21.7% 2 year survival
MS Stage III 12.0% survival
US Stage II 17.4% 2 year survival
MS Stage II 9.8% 2 year survival
Stage at Diagnosis
1.0 2.0 3.0 4.0 5.0
figUre 5: kaplaN-Meier OBServeD CUMUlaTive SUrvival OF
paTieNTS wiTH paNCreaTiC CaNCer, CaSeS DiagNOSeD 1998-2001. NO
STaTiSTiCally SigNiFiCaNT DiFFereNCeS were realizeD BeTweeN
MiSSiSSippi (MS) aND UNiTeD STaTeS (US) paTieNT pOpUlaTiONS.
THere appearS TO Be a CliNiCally relevaNT DiFFereNCe iN
CUMUlaTive 2 year SUrvival FOr STage ii aND iii paTieNTS US
verSUS MS (arrOwS).
SOUrCe: aMeriCaN COllege OF SUrgeONS NaTiONal CaNCer DaTa
BaNk
-5 -4 -3 -2 -1 0 1 2 3All Cancer SitesProstateBrain & ONSNon-Hodgkin LymphomaStomachAcute lymphocy�c leukCervixLung & BronchusBreast (Female)BladderLeukemiaOral Cavity & PharynxColon & RectumPancreasThyroidMelanoma of the SkinLiver & Bile DuctOvaryEsophagusLymphomasUterus
Average Annual Percent Change
-5 -4 -3 -2 -1 0 1 2 3
All Cancer SitesProstate
Brain & ONSNon-Hodgkin Lymphoma
StomachAcute lymphocy�c leuk
CervixLung & Bronchus
Breast (Female)Bladder
LeukemiaOral Cavity & Pharynx
Colon & RectumPancreas
ThyroidMelanoma of the Skin
Liver & Bile DuctOvary
EsophagusLymphomas
Uterus
Average Annual Percent Change
figUre 6: 5-year raTe CHaNge FOr MOrTaliTy, MiSSiSSippi 2002-2006,
all ageS, BOTH SexeS, all raCeS. aNNUal perCeNT CHaNge Over THe
5-year periOD CalCUlaTeD By Seer STaT. DeaTH DaTa prOviDeD By
THe NaTiONal viTal STaTiSTiCS SySTeM pUBliC USe DaTa File. DeaTH
raTeS CalCUlaTeD By THe NaTiONal CaNCer iNSTiTUTe USiNg Seer
STaT. DeaTH raTeS are age-aDJUSTeD TO THe 2000 US STaNDarD
pOpUlaTiON.
102 JOUrNal MSMa april 2010
in first course treatment for their cancers, the NCDB revealed that more
patients in Mississippi received chemotherapy only, as opposed to com-
bination treatment, and more patients did not receive any type of sur-
gery on their pancreas compared to national figures. On average, fewer
operations on the pancreas with intent to cure were performed per hos-
pital per year compared to all uS hospitals. These data must be put in
the context, however, of the total number of deaths from pancreatic
cancer per year in Mississippi and the fact that, in almost one-half of
these deaths, there is no retrievable information on age, stage, or treat-
ment rendered. It is not clear if these patients left the state to obtain
treatment elsewhere, received treatment at non-ACS CoC hospitals, or
whether they simply did not receive any treatment. There did not appear
to be appreciable differences in patient outcomes for early (stage I) or
late (stage IV) disease. However, there is some discrepancy in out-
come for patients with locally advanced (stage II and III) disease.
Fewer patients in Mississippi survived to two years compared to the
national sample for both stages. Prolongation of survival may be pos-
sible in these patients with a combination of surgery, chemotherapy,
and radiation therapy. It could be that Mississippi patients were not
afforded the scope of treatment found in other centers nationwide.
Pancreatic cancer, specifically ductal adenocarcinoma, has been
notoriously difficult to cure. While five-year survival rates have no-
ticeably improved for breast and colon cancers over the past 30 years,
similar survival rates for pancreas cancer have remained disappoint-
ingly stagnant, usually not exceeding five percent. Data from the
NCDB indicate that only 22% of patients with invasive cancer present
with localized disease (stage I or II) and only 16% are resected for cure.
In fact, over 40% of patients receive no treatment at all for their pan-
creatic cancer. Even with patients who survive more than one month,
Krzyzanowska and colleagues11 reported that only 49% received can-
cer-directed treatment. More disturbingly, the report by Bilimoria and
colleagues9 points to a potential problem in delivering the only current
curative treatment for pancreatic cancer – pancreatectomy. Riall and
lillemoe12 believe this could be an issue with referral for surgical eval-
uation by primary physicians (including gastroenterologists and on-
cologists) and lack of familiarity and training by surgeons who are
consulted. Perhaps most disturbing is the association of inadequate (or
no) treatment with race and socioeconomic class13,14,15, despite present-
ing at similar age and stage as our data indicate. In fact, some specu-
late that the shift of patients to high volume centers where outcome is
expected to improve may leave the poor and socioeconomically disad-
vantaged to seek care at less qualified low volume hospitals.16
There are additional data to show that stage for stage, AA re-
ceive potentially curative surgery less often than their Caucasian coun-
terparts.17 This may be due to the fact that the AA population less often
have a primary care physician, less often are referred for surgical eval-
uation, and less often are advised and receive surgical treatment.18 This
may be due to consultation with surgeons who are less qualified to eval-
uate and treat patients with pancreatic cancer, a reflection of treatment
at low volume hospitals.
Both hospital and surgeon volume has been linked to better out-
comes as a surrogate marker for quality care, including disease spe-
cific and overall hospital resources.19,20 As volume increased significant
increases were seen in hospitals meeting leapfrog criteria, Health-
Grades five-star ratings, teaching programs such as surgery and gas-
troenterology, and availability of interventional radiology services.
This applies not just to individual surgical procedures such as pancre-
atectomy but also to overall outcomes following cancer-directed treat-
ment. Birkmeyer and co-authors21 reported an adjusted decrease in
hazard ratio of mortality in high-volume hospitals for pancreatic can-
cer of 0.77 for patients surviving surgery. While reasons for improved
late survival in cancer victims are not entirely clear, Murray Brennan
commented in an editorial that “high-volume institutions create sup-
port environments essential to quality care”.22 High volume hospitals
treating cancer victims are also often National Cancer Institute recog-
nized cancer centers with availability of collaborative oncological care
and access to early phase clinical trials.
Despite the difficulties and disappointments in treating pancre-
atic cancer, there are still system issues that might enhance care and
provide the infrastructure for progress in the future. On behalf of the
American College of Surgeons, a panel of 20 pancreatic cancer experts
ranked potential quality indicators for validity using accepted appro-
priateness methodology.23 Among validated indicators were surgical
resection for clinical stage I or II disease, administration of adjuvant
chemotherapy/radiation therapy for resected patients, initiation of can-
cer directed treatment within two months of diagnosis, performance of
at least 12 pancreatectomies per year, retrieval of at least 10 lymph
nodes with resected specimens, monitoring of resected margins for
residual tumor, risk-adjusted perioperative mortality (< 5%), monitor-
ing of 30-day readmission rate following surgery, and, importantly, par-
ticipation in clinical trials. While only a minority of hospitals surveyed
complied with these performance indicators, the gauntlet has been
thrown and performance parameters have been set. It is incumbent on
hospitals and health care systems to provide care that all citizens de-
figUre 7: DeaTH DaTa prOviDeD By THe NaTiONal viTal STaTiSTiCS
SySTeM pUBliC USe DaTa File. DeaTH raTeS CalCUlaTeD By THe
NaTiONal CaNCer iNSTiTUTe USiNg Seer STaT. DeaTH raTeS are age-
aDJUSTeD TO THe 2000 US STaNDarD pOpUlaTiON. regreSSiON liNeS
CalCUlaTeD USiNg THe JOiNpOirT regreSSiON prOgraM. CreaTeD By
STaTeCaNCerprOFileS.CaNCer.gOv ON 11/17/09.
april 2010 JOUrNal MSMa 103
serve as well as a foundation for progress into the future.
The major limitation of this report is the lack of uniform data on
all victims of pancreatic cancer in the state of Mississippi. Information
concerning demographics and treatment is lacking in almost one-half
of the deaths, and this could dramatically skew the otherwise not too
dissimilar statistics from uS NCDB reports. It is not immediately clear
what happened to these patients. Some, no doubt, left the state to re-
ceive care in out-of-state facilities. Some may have received care at
non-ACS CoC hospitals within the state. Others, for a variety of rea-
sons, may not have received any care at all and were sent home (or
chose to return home) to die. With this in mind, it is important to rec-
ognize barriers to care for vulnerable groups that could lead to outcome
disparities, as outlined by Bierman and coauthors24: access to the health-
care system, barriers within the healthcare system such as difficulty
getting appointments and referrals to specialists, and the ability of
providers to address the patients’ needs such as referral to the proper
specialists for comprehensive care. Equally important, systems of care
should be established that are patient-centered rather than provider-
centered. The maze through which patients who are already burdened
by illness and its psychological impact must navigate can be formida-
ble and discouraging. This process should be as simple as possible in
order to deliver compassionate, timely, and appropriate care.
This report has served to illustrate the state of care for victims of
PDA in Mississippi. While those that receive care in CoC hospitals are
on equal par with national outcomes, there are a sizeable number of
patients, probably half, for whom there is no information on treatment
or outcome. In recognition of the prevalence of PDA in Mississippi, it
is incumbent on the state’s health care providers to ensure that all pa-
tients have easy and timely access to physician specialists and facilities
which are qualified to deliver expert care. This can be done through
dissemination of information and coordination of treatment programs
throughout Mississippi as a network of cancer care.
referenceS
1. united States Census Bureau population estimates: http://www.census.
gov/popest/states/NST-ann-est.html accessed December 1, 2009.
2. united States Census Bureau: http://www.census.gov/main/www/cen2000.
accessed December 1, 2009.
3. Jack l Jr, Hayes SC, Wilson V. Social inequities in Mississippi: a call to
action. J Public Health Manag Pract 2009; 15:167-172.
4. Cosby AG, Bowser DM. The health of the Delta Region: a story of
increasing disparities. J Health Hum Serv Adm 2008; 31:58-71.
5. National Cancer Institute state cancer profiles: http://statecancerprofiles.
cancer.gov/ accessed December 1, 2009.
6. American Cancer Society: Cancer Facts and Figures 2008. American
Cancer Society, Atlanta, GA.
7. National Cancer Data Base. American College of Surgeons Commission
on Cancer Benchmark Report Vol 9.
8. Zell JA, Rhee JM, Ziogas A, et al. Race, socioeconomic status, treatment,
and survival time among pancreatic cancer cases in California. Cancer
Epidemiol Biomarkers Prev 2007; 16:546-552.
9. Bilimoria KY, Bentrem DJ, Ko CY, et al. National failure to operate on
early stage pancreatic cancer. Ann Surg 2007; 246:173-180.
10. Kaplan El, Meier P. Nonparametric estimation from incomplete
observations. J American Statistical Assoc 1958; 53:457-481.
11. Krzyzanowska MK, Weeks JC, Earle CC. Treatment of locally advanced
pancreatic cancer in the real world: population-based practices and
effectiveness. J Clin Oncol 2003; 21:3409-3414.
12. Riall TS, lillemoe KD. underutilization of surgical resection in patients
with localized pancreatic cancer. Ann Surg 2007; 246:181-182.
13. Zell JA, Rhee JM, Ziogas A, et al. Race, socioeconomic status, treatment,
and survival time among pancreatic cancer cases in California. Cancer
Epidemiol Biomarkers Prev 2007; 16:546-552.
14. Krzyzanowska MK, Weeks JC, Earle CC. Treatment of locally advanced
pancreatic cancer in the real world: population-based practices and
effectiveness. J Clin Oncol 2003; 21:3409-3414.
15. Chang KJ, Parasher G, Christie C, et al. Risk of pancreatic
adenocarcinoma: disparity between African Americans and other
race/ethnic groups. Cancer 2005; 103:349-357.
16. Stitzenberg KB, Sigurdson ER, Egleston Bl, et al. Centralization of cancer
surgery: implications for patient access to optimal care. J Clin Oncol 2009;
27:4671-4678.
17. Murphy MM, Simons JP, Hill JS, et al. Pancreatic resection: a key
component to reducing racial disparities in pancreatic adenocarcinoma.
Cancer 2009; 115:3979-3990.
18. Riall TS, Townsend CM, Kuo Y-F, Freeman Jl, Goodwin JS. Dissecting
racial disparities in the treatment of patients with locoregional pancreatic
cancer: a 2-step process. Cancer 2010.
19. Bellal J, Morton JM, Hernandez-Boussard T, et al. Relationship between
hospital volume, system clinical resources, and mortality in pancreatic
resection. J Am Coll Surg 2009; 208:520-527.
20. Eppsteiner RW, Csikesz NG, McPhee JT, et al. Surgeon volume impacts
hospital mortality for pancreatic resection. Ann Surg 2009; 249:635-40.
21. Birkmeyer JD, Sun Y, Wong Sl, Stukel TA. Hospital volume and late
survival after cancer surgery. Ann Surg 2009; 245:777-783.
22. Brennan MF. Quality pancreatic cancer care: it’s still mostly about volume.
J Natl Cancer Inst 2009; 101:837-838.
23. BIlimoria KY, Bentrem DJ, lillemoe KD, et al. Assessment of pancreatic
cancer care in the united States based on formally developed quality
indicators. J Natl Cancer Inst 2009; 101:848-859.
24. Bierman AS, Magari ES, Jette AM, et al. Assessing access as a first step
toward improving the quality of care for very old adults. J Ambul Care
Manage 1998; 21:17-26.
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Jackson, MS 601-974-1250 millsaps.edu
It can take more than medical expertise to run a lab, department, or private practice. From using resources wisely to managing employees, Millsaps Business Advantage Program for Professionals provides the basic business principles you need to operate more efficiently and successfully. Led by nationally acclaimed Else School of Management faculty, the 15-week program meets two nights a week. Classes are small and engaging – no staring at statistics here. The dynamic curriculum delivers real-world knowledge and insight, so you can give your business the same level of care you provide your patients. Classes fill up quickly, so please call 601-974-1250 to register for the fall.
SOME OPERATING PROCEDURES AREN’T TAUGHT IN MEDICAL SCHOOL.
106 JOUrNal MSMa april 2010
• MaFp •
Celebrity Roast ofDaniel W. Jones, MD
Chancellorof the Universityof Mississippi
university of Mississippi Chancellor Dr.
Daniel W. Jones was the focus of the third
annual celebrity roast benefiting the
Mississippi Academy of Family Physicians (MAFP)
Foundation. The event was held February 6 at the Inn at
Ole Miss in Oxford to benefit the Mississippi Academy
of Family Physicians Foundation which provides
scholarships and programs for aspiring family doctors
and community health programs. Roasters for the
evening included: Dr. Randy Easterling, Dr. James E.
Keeton, Dr. Robert C. Khayat, Mr. Ken Ray, Dr. Helen
R. Turner and Dr. louAnn Woodward.
JOneS celeBrity rOASt — Cartoonist Marshall
ramsey created this caricature for the MaFp
Foundation fundraiser.
Dr. JAMeS e. KeetOn, vice chancellor for health
affairs and dean of the school of medicine at the
University of Mississippi Medical Center, roasts
his predecessor Dr. Dan Jones.
During the celebrity roast of Dr. Daniel Jones,
MaFp Foundation Board president Dr. Michael
O’Dell presented a check in the amount of
$2,000 to Janie guice, Mississippi rural
physicians Scholarship program Director.
cHAncellOr Dr. DAn JOneS poses by a drawing of his
likeness on a Bankplus sponsor sign.
• pOeTry iN MeDiCiNe •
april 2010 JOUrNal MSMa 107
[This month, we print the remarks of Robert C. Khayat, Chancellor
Emeritus at the University of Mississippi at Oxford. Although not a
physician, Khayat has written a song about a physician, inspired by the
old Irish ballad “Danny Boy.” In the tradition of pun and poetry, this
humorous tongue-in-cheek verse was presented at the Mississippi
Academy of Family Physicians Foundation Celebrity Roast of Daniel
W. Jones, MD, Chancellor of the University of Mississippi. The black tie
optional event was held at The Inn on the Ole Miss campus on Saturday
night February 6, 2010. This third annual physician roast (previous
roasts were Dr. Ed Hill and Dr. Randy Easterling) was a grand success,
with over 114 tickets sold and over $10,000 raised for medical
education in the state. Kim Erickson, foundation executive director, and
Beth Embry, MAFP chief executive, deserve much praise for pulling off
such a classy event. Among the roasters were MSMA President Randy
Easterling, UMC Vice Chancellor James E. Keeton, Past MSMA
President Helen Turner, and UMC Associate Vice Chancellor Lou Ann
Woodward. Many of the comments were memorable, and Dr. Khayat’s song captures the mood of the evening and the warm sentiment
expressed for Dr. Jones. Strumming a guitar at the podium and standing next to defenseless Dr. Jones, Khayat warbled the following
producing smiles and laughter at almost every line. Any physician with Mississippi ties is invited to submit poems for publication in the
journal, attention: Dr. Lampton or email [email protected].] —Ed.
Former University of Mississippi Chancellor robert C. khayat
shares a jingle he wrote in jest of his successor, Dr. Daniel w.
Jones (l.). Master of Ceremonies Dr. lucius lampton (r.) said
the crowd was enamored with the lyrics.
Danny’s Song
Oh Danny Boy, the chapel bells are ringing
An ode to you and your sweet lydia.
It’s 3 a.m. and the Kappa Sigs are singing
Just a hint of what they plan for you.
Ole Miss is a place of free expression
Of thoughts your Baptist ears have never heard.
We see you leading Hotty Toddys late at night
And await your Calvinistic cleansing of
HEll YES, DAMN RIGHT!
Your devotion to academic quality
And relentless quest for research grants
Will be pushed aside by home-runs and TD’s
And how to repair an aging sewerage plant.
There was no alcohol in your childhood home
And whiskey has never touched your lips.
You earned your white coat and served mankind
With no need to take a sip
THEY SAY WHEN IN ROME…
And now you live on a famous street
That we know as Fraternity Row
Where more beer is consumed on Saturday night
Than you ever want to know.
You’ll search for ways to rest your mind
And hope to reduce the pain.
So please take comfort in knowing this simple truth
THE SOuTH SHAll RISE AGAIN.
But I jest, and it’s time for me to close.
So together let’s raise a glass of cheer
And offer a toast in lieu of a roast
To a couple we hold so dear.
We pray that God will bless you
And bring you happiness.
Remember that we love you
And wish you the very best.
—Robert Khayat
February 5, 2010
of the 142 nd annual Session
June 3-6 natchez Convention CenterHouse of Delegates & Medical affairs Forum 2010
Join us: The Physicians Who Care for Mississippi
CME
M ake reservations now
ursday, June 4, “lunch and learn” -MaCM golf Tournament
Diagnosis and Prevention of Diabetes Mellitus
Drs. Ed Daly and Ken Stubbs
Saturday, June 5Update on Healthcare Reform - Cynthia Brown (AMA)
Can We Save the Profession? - Charles Bond, Esq.
The Eye in Relation to Diabetes Mellitus - Ching J. Chen, MD
The Feet in Relation to Diabetes Mellitus - Bradley Boland, MD
Pharmacy/Treatment of Diabetes Mellitus - Wes Pitts, PharmD
natchez grand hotelnatchez grand hotel111 North Broadway St.
1-866-488-0890$129.99 per night, cut off date: May 15
EolaEola110 North Pearl Street
601-445-6000$79.00-$150.00 per night, cuts off date: May 15
Mississippi State Medical Association is accredited by the Accreditation Council
for Continuing Medical Education (ACCME) to sponsor continuing medical
education for physicians. The Mississippi State Medical Association designates
this educational activity for a maximum of 6 AMA PRA Category 1 Credit(s)TM.
Physicians should only claim credit commensurate with the extent of their
participation in the activity.
EExperience Dunleith Mansion at a welcomereception on the grounds of this circa 1856historic landmark. Shuttles will depart from
the Natchez Grand Hotel. The University of MississippiMedical Alumni Chapter is the official sponsor of thisevening soiree and will present its first ever “DistinguishedMedical Alumnus of the Year” award to a deservingmedical alumnus from the University of MississippiMedical Center. Afterwards, you’re invited to observe otherlocal “spirits” with the famous “Angels on the Bluff ” guidedcemetery tour at dusk.
A complete schedule of meeting events is availableat: MSMAonline.com. Highlights include:
• Opening session of the MSMa House of Delegateson Friday with the closing session and election ofofficers on Sunday.
• Friday sessions for history buffs - A program onmilitary medicine and surgery during the Civil Warpresented by Dr. William Hanigan and apresentation by Dr. Michael Trotter on Dr.Tichenor’s Mississippi medical practice and use of hisfamous elixir.
• Seersucker & sundresses on the bluff President’sreception... Shouts & murmurs political stumpspeeches... Make a splash with the carnival dunktank featuring MSMA Pres. Dr. Randy Easterlingtrying to stay high and dry.
• official inauguration of MSMa’s 143rd PresidentDr. Timothy J. alford - Acclaimed novelist GregIsles will kick off the gala reading from his bestsellersand signing books. Celebrity Chef Luis Bruno willhost an eclectic dinner with wine pairing and sharehis inspirational healthy eating and wellness story.Dance to the swing of crooner Ned Fasullo and thefabulous big band orchestra. Van’s Photography willprovide professional formal photos available forpurchase.
• Kids only - Build & fly a kite, float a boat, riverrat races, a treasure hunt and more... Events are free,but you need to pre-register.
MSMA Annual Session & Medical Affairs Forum ’10 Registration Form
Clip & fax form to: 601.853.6746or register at: MSMaonline.com
Please print the following information
Name __________________________________________________________________________________________________
Title or Degree ___________________________________________________________________________________________
Mailing Address (Street/P.O. Box) ____________________________________________________________________________
City __________________________________ State ____________________ Zip Code ________________________________
Daytime Telephone Number _______________________________________FAX number _______________________________
E-mail address ________________________________________ Non-Member CME Registration Fee: $150
Make check for CME fee payable to MSMA and mail with registration form to: MSMA, P. O. Box 2548, Ridgeland, MS
39158-2548. MSMA members may FAX registrations to (601) 853-6746 and pay on site or you can pay online now at
www.MSMAonline.com. Click on “Annual Session” in the top tab and complete fields in the registration form. Please direct
inquiries to Susie Pettit: (601) 853-6733, or [email protected]. MSMA offers equal opportunity in employment and
education, M/F/D/V. Please call (601) 853-6733 prior to 5/3/10 if special accommodation is required.
Wednesday June 2
6:00 PM MsMA Welcome reception ____________7:30 PM Angels on the bluff cemetery tours ____________
Thursday, June 03
11:30 AM - 12:30 PM Medical Affairs Forum "lunch and learn" (1 hour cME) ____________1:00 - 5:00 PM Kids only: go Fly a Kite ____________
Friday, June 4
7:00 AM breakfast With Exhibitors ____________10:30 AM - 2:30 PM Kids only: Float-a-boat ____________11:00 AM - 3:00 PM MsMAA Pre-convention board Meeting - $30 ____________11:30 AM - 1:30 PM Pizza Party With Exhibitors ____________6:00 - 10:00 PM Kids only: bubbles on the bluff ____________6:00 - 8:00 PM President reception "seersucker & sundresses in the Park" ____________
Saturday, June 05
7:00 AM - 9:00 PM breakfast ____________7:00 - 12:00 PM Medical Affairs Forum (5 hours cME) - non-member fee: $150 ____________
8:30 - 2:30 PM Kids only: river rat relay ____________12:00 PM - 2:30 PM MsMAA installation luncheon - the carriage house - $35 ____________6:00 - 10:00 PM Kids only: treasure hunt ____________8:00 - 11:00 PM inaugural gala saturday - per person: $100 ____________
Sunday, June 06
8:30 AM - 10:30 AM MsMA Alliance Past President breakfast - callon Petroleum bldg. ____________7:00 - 9:00 AM continental breakfast honoring 2010-2011 President ____________7:00 - 9:00 V.i.P. breakfasts: 50-Year club & Past Presidents ____________9:00 - 11:00 house of delegates ____________
Please indicate
the number of
individuals
attending
CALL FOR ENTRIES
Seeking Nominations for the2010 MSMA Award for Community Service
The Annual Physician Award for Community Service, sponsored byMississippi State Medical Association, is designed to provide recognitionto members of the association who are actively engaged in the practice ofmedicine, for the many and varied services above and beyond the call ofduty which they render to their respective communities.
Each recipient of the award is nominated by his or her component society and selection ismade by the members of the Council on Public Information. The intent of the program is tohonor only living persons, and to honor no person more than once. Presentation is made at theannual meeting of the association’s House of Delegates. Every society has many membersworthy of this distinguished award. It is your society’s responsibility to see that they arenominated. A nomination form is avaiable on the MSMA Web site. All nominations should besubmitted to the Mississippi State Medical Association by May 7, 2010.
The award is a handsome plaque which features a cast bronze medallion. The medallion’s designsymbolizes the close relationship between medicine and the community. A $500 contribution isalso made by the association to a civic organization designated by the award recipient.
Nominations should be submitted in writing. Since the award is for outstanding communityservice it is important that all accomplishments of the nominee in this regard be presented indetail. The Council on Public Information encourages you to seek the assistance of your localMSMAAlliance in preparing the written nomination and supporting materials.
Nomination supporting documents may include all or some of the following: a narrativeabout the person and his community involvement, newspaper clippings, letters of support fromcommunity leaders, newspaper or magazine articles written about the person, photographs andother materials that show the physician’s community involvement.
Nominations should be sent to MSMA, P.O. Box 2548, Ridgeland, MS 39158-2548, as soon aspossible, but no later than May 7, 2010. For further information contact: Karen Evers, Directorof Communications, (601) 853-6733 or 1-800-898-0251, or [email protected].
110 JOUrNal MSMa april 2010
Let Us SHOWCASE Your ARTWORK by donating it to the Silent Auction to be
held at Annual Session
ALL types of artwork welcome: photography, paintings, pottery, ceramics, woodwork, jewelry, sculpture, etc.
Silent Auction
Annual Session June 3-6, 2010
Natchez, Mississippi
Benefiting the University of MS Medical Center AMA Foundation Scholars Fund
for M3’s and M4’s
MSMA & MSMA ALLIANCE
Contact Amy Gammel, AMA Foundation Chair, at [email protected] or
Sondra Pinson @[email protected]
april 2010 JOUrNal MSMa 111
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112 JOUrNal MSMa april 2010
april 2010 JOUrNal MSMa 113
A67-year-old black male presented in the emergency
department with vague complaints of moderate,
persistent fever; decreased appetite; chest and back
pain; generalized arthralgia and myalgia for 1 to 2 weeks. The dif-
fuse pain was so severe that he could not stand or sit; he had been
voiding in a bedpan for the previous 7 days.
In a 67-year-old man with a history of chest pain, back pain,
mild fever and generalized arthralgia and myalgia, the differential may
include myocardial infarction, septic arthritis, viral arthritis, os-
teoarthritis, endocarditis and rheumatoid arthritis. Considering his age,
we will keep in mind prostate cancer with possible bone metastasis or
primary bone malignancy. We will also consider lyme disease, West
Nile virus and syphilis. We’ll explore his past medical history in detail.
He had a past history of coronary artery disease , diabetes
mellitus type II, hypertension, gout, chronic renal insufficiency, pe-
ripheral vascular disease and congestive heart failure. His surgi-
cal history included a triple bypass, a femoral-popliteal bypass and
hand surgery. There was no significant family history. He quit
smoking and alcohol use years ago and denied ever using illicit
drugs.
A coronary event can explain the patient’s chest pain but not the
generalized joint pain and myalgia. Gout usually involves one joint,
but the patient reports generalized arthralgias. Patients with rheuma-
toid arthritis can present with generalized arthralgias. Severe peripheral
vascular disease could cause pain in the limbs at rest but does not ex-
plain the chest pain and fever. Congestive heart failure can cause de-
creased appetite and shortness of breath, but the patient did not
complain of shortness of breath or edema. Patients with renal insuffi-
ciency can present with anemia, general weakness and decreased ap-
petite. The clinical picture is still not very clear. We will see what
medications he is taking.
The patient’s medications were gabapentin (Neurontin),
spironolactone (Aldactone), esomeprazole (Nexium), colchicine,
metoprolol (Lopressor), glipizide (Glucotrol), indomethacin (In-
docin), aspirin, allopurinol (Aloprim), hydralazine and nitroglyc-
erine (Nitrostat) for chest pain.
The patient has been taking colchicine, allopurinol and in-
domethacin without relief which indicates his symptoms may not be
gout related. His other medications are appropriate for his clinical con-
ditions. We are also considering the possibility of hydralazine induced
lupus. I’ll complete the physical examination.
His vital signs included a temperature of 100.5° F, pulse of
128 beats per minute, respiratory rate of 25 breaths per minute,
blood pressure of 120/84 mmHg and an oxygen saturation of 98%
while breathing room air. He was well developed, well nourished,
but in acute distress due to pain. His physical examination revealed
dry mucous membranes and poor oral-dental hygiene. Cardiovas-
cular examination revealed tachycardia, regular rhythm and no
murmur, rub or gallop. Chest wall tenderness was present all over,
and his lungs were clear to auscultation bilaterally with good air
movement and no rubs, wheezing or rhonchi. Strength could not be
detected because of the patient’s condition; he was unable to move
his limbs, hands and feet due to pain. No joint deformity was noted
except for clubbing of inter-phalangeal joints of both hands. There
was diffuse tenderness of his hands, elbows, shoulders, back, hips,
knees and feet. Also there was tenderness on palpation of limbs and
chest wall. He could feel pain when touched on any area of his body.
He had intact cranial nerves II to XII but was unable to walk due
to pain. His reflexes were 2+. His head, eye, ear and nose; psychi-
atric; gastrointestinal; genitourinary and skin examinations were
within normal limits.
The patient is mildly febrile, has tachycardia and tachypnea but
his blood pressure is not elevated. Fever with leukocytosis and joint
tenderness makes us think of infective arthritis, but involvement of
multiple joints gives a confusing picture. We will order an echocardio-
gram to investigate for endocarditis and also order blood and urine cul-
tures. We will also do cardiac studies. He has a history of gout so I will
also order uric acid determination. I’ll also ask for a computed tomog-
raphy (CT) of abdomen and pelvis to look for any malignant lesions.
His abdomen and pelvis CT without contrast showed a
scarred right kidney. His complete blood count showed white blood
cells 15000/hpf, and his uric acid was 8.6 mg/dL (2.5-8.5 mg/dL).
His echocardiogram, urine and blood cultures were pending.
The scarred kidney indicates chronic kidney disease, and his
slightly elevated uric acid may be related to gout but the cause of his
elevated white blood cell count is not yet clear. At this stage I am going
to admit this patient. I will order prostate specific antigen (PSA) and
• CliNiCal prOBleM-SOlviNg •
Perplexing Pyretic Polyarthritis
Rajvinder Singh Hanspal, MD
AUtHOr infOrMAtiOn: rajvinder Hanspal, MD is a former resident in the Department of
Family Medicine at the University of Mississippi Medical Center in Jackson and
practices in Canada.
cOrreSPOnDing AUtHOr: rajvinder Singh Hanspal, MD, 159 Fatima Drive, Sydney, Nova
Scotia, Canada, B1S-1l9
Presented and edited by the Department of Family Medicine, University of Mississippi Medical Center, Diane K. Beebe, MD, Chair
114 JOUrNal MSMa april 2010
bone scan to investigate for prostate malignancy, although he had a
normal PSA about 5 years ago. To further investigate the fever, I will
also order West Nile titers, lyme titers and rapid plasma reagin (RPR)
for syphilis. We will discontinue hydralazine because his symptoms
may be caused by hydralazine induced lupus. We will also discontinue
colchicine, allopurinol and indomethacin because these medicines don’t
appear to be working. We’ll continue his other medications and also
order a 1800 calorie diet, furosemide (lasix), ciprofloxacin (Cipro),
doxycycline (Adoxa), hydrocodone/acetaminophen (lortab), morphine
(Avinza), enoxaparin (lovenox) and lorazepam (Ativan) for anxiety
and rest. For diabetes we will start a flexible insulin dosage regimen
with regular insulin (Novolin R).
On day 2, his vital signs included a temperature of 101.1° F,
pulse of 120 beats per minute, respiratory rate of 24 respirations
per minute and blood pressure of 183/81 mmHg. Despite taking
hydrocodone/acetaminophen and morphine, there was little im-
provement in pain, and he was unable to move in bed due to pain.
The results of the echocardiogram, fecal occult blood, hepatitis
panel, HIV, hemoglobin A1C, lipid panel, PSA, RPR, rheumatoid
factor, antinuclear antibodies, West Nile, systemic lupus erythe-
matosus (SLE) and ehrlichia antibodies were normal. Additional
studies included an elevated erythrocyte sedimentation rate (ESR)
of 65 mm/hr (<17 mm/hr), a C-reactive protein of 33.5 mg/L (<1
mg/L) and a hemoglobin A1C of 6.6%; his blood and urine cul-
tures were still pending.
The echocardiogram does not show evidence of infective endo-
carditis though his blood culture is still pending. Test results do not in-
dicate rheumatoid arthritis, SlE, West Nile, syphilis, hepatitis or HIV.
His diabetes appears to be well controlled. His digital rectal examina-
tion is normal, and his PSA is 0.98 ng/ml, so a malignancy of the
prostate is not indicated. His raised C-reactive protein concentration
only indicates an inflammatory process, and his elevated ESR only tells
me it’s a chronic condition. Our patient is not having much relief from
pain and is still febrile. A neurologist suggested magnetic resonant im-
aging (MRI) of lumbar spine to look for epidural or paraspinal ab-
scesses and advised to continue with the same medications. I think an
abscess can explain his raised white blood cell count and his general-
ized pain and fever. We will also ask for a whole body bone scan to
make sure we are not missing any bony lesions.
On day 3 the patient’s vital signs were normal except for a
pulse rate of 150 beats per minute. The patient denied any im-
provement in pain and was still unable to move any part of his
body. The MRI of lumbar spine with and without contrast to eval-
uate for a possible abscess showed significant spinal stenosis at the
L3-L4 level secondary to a central bulging disc; similar changes
were seen at the level of L4-L5. There was no evidence of an ab-
scess. A whole body nuclear scan showed multiple areas of joint
centered uptake consistent with arthritic changes. There was mild
uptake in the lumbo-sacral region suggestive of degenerative
changes. The whole body nuclear scan also showed multiple joints
with degenerative changes, and the patient still had an elevated
ESR. His blood and urine cultures were negative.
At this stage, there is no evidence of paraspinal and epidural ab-
scesses, but we find spinal stenosis at l3-l4 and l4-l5 levels. I think
it could be a coincidental finding because it can explain pain in the
lower extremities, but what of the pain in his shoulders and upper ex-
tremities? The patient has nuclear scan findings consistent with os-
teoarthritis, and his elevated ESR probably indicates chronicity of the
problem. We will consult a neurosurgeon and rheumatologist.
On day 4 the patient had temperatures of 98.7° F and 101.3°
F and mild tachycardia. He still complained of persistent pain and
was still unable to move. He was sleepy due to the effects of lo-
razepam and morphine. The neurosurgeon advised that we deal
with the spinal stenosis at a later stage. He was suspicious of
paraspinal or epidural abscess around cervical or thoracic spine
due to raised white blood cells count, fever and generalized back
pain. An MRI of cervical and thoracic spine to look for abscesses
was normal. A rheumatologist performed an arthrocentesis on the
right knee. Synovial fluid analysis showed white blood cells
8964/hpf, polymorphs 94%, lymphocytes 3%, red blood cells
1674/hpf and many intracellular and extracellular uric acid crys-
tals under polarizing light. The culture was pending.
The normal MRI of cervical spine and thoracic spine does not in-
dicate abscesses in the cervical or thoracic spine. The rheumatologist’s
diagnosis is polyarticular gout (PAG), based on synovial fluid results
from arthrocentesis. He recommends colchicine and 15-day tapering
dose of steroids. PAG can be suspected in the case of chronic sero-neg-
ative polyarthritis, and diagnosis can be confirmed with plain radi-
ographs and laboratory results showing uricemia.1 Risk factors for gout
in the general population include hyperuricemia, obesity, weight gain,
hypertension and diuretic use.2 Patients with hematological malignancy
may present with joint pain and hyperuricemia.3 PAG may lead to sec-
ondary amyloidosis recognized by monoclonal antibodies. PAG may be
misdiagnosed in the elderly as rheumatoid arthritis, which may appear
to be “diuretic gout” with polyarticular onset.4
On day 5 his vital signs were temperature of 99.9° F, pulse of
89 beats per minute, respiratory rate of 20 respirations per minute,
blood pressure of 146/72 mmHg and oxygen saturation of 97%
while breathing room air. The patient felt better and was able to
move his T-spine. He still had some pain in his lower back but was
improving.
The next day the patient continued to improve and started
moving and lifting his hands. We continued prednisone and
colchicine along with his other medications. On day 6 he was doing
much better and was able to move arms and sit up on the side of his
bed.
In the next 4 days the patient was able to move around in a
wheel chair but was weak. He needed help standing and walking,
so he was transferred to swing bed for physical therapy to regain
his strength. After 2 weeks he was discharged. He was doing well
at one-month followup.
PAG has also been seen in patients with hypouricemia receiving
total parenteral nutrition (TPN) with a purine free diet.5 Post-
menopausal females present at a younger age than males with PAG,
and it is usually mistreated as rheumatoid arthritis which may lead to
joint damage. Several conditions may precipitate PAG including acute
myocardial infarction, heart transplantation and kidney transplantation.
Medications or therapies including TPN, immunosuppressant drugs
april 2010 JOUrNal MSMa 115
such as cyclosporine, and uricosuric therapy can also precipitate PAG.5,6
Episodes of PAG are common in renal transplant patients and have re-
solved after switching from cyclosporine to tacrolimus-based im-
munosuppression.6 In a South African population, PAG was seen in
44.4% of gout patients.7 Similarly, in a German population, 40% of the
male patients suffering from gouty arthritis treated during a 3-year pe-
riod showed a chronic polyarticular course. About 40% of patients with
gout have polyarticular involvement after years of prolonged illness.8
Elderly patients on long-term diuretic therapy are at higher risk of de-
veloping PAG and are usually misdiagnosed and inadequately treated
for the condition.4,9 Acute PAG may mimic common rheumatological
disorders such as septic arthritis, rheumatoid arthritis, degenerative
joint disease and even hemiparesis.10 Physicians should be aware of the
potential for PAG in patients with consistent risk factors.
Corticosteroids have proven benefit in patients with gout.11 They
are especially useful when colchicine and anti-inflammatory drugs are
contraindicated. A uric acid concentration of 6.8 mg/dl is considered
the saturation point for the crystallization of monosodium urate.12 urate
lowering treatment is required for hyperuricemia, especially in patients
with chronic gout that causes joint damage, tophi and nephrolithiasis.13
The concentration should be kept at or below 6 mg/dl. Allopurinol, a
xanthine oxidase-dehydrogenase inhibitor, is commonly used to inhibit
uric acid synthesis. It decreases the concentration of uric acid within 24
hours, but maximum benefit usually takes up to 2 weeks. Therapy
should begin with 100 mg per day and increase by 100 mg per week to
a maximum dose of 300 mg per day. uric acid should be monitored
every 2 – 3 weeks until stabilized, then every 6 months.14
Key WOrDS: POlYARTICulAR GOuT (PAG)
referenceS
1. Pouye A, Fall S, Diallo S, et al. Polyarticular gout in young adults: a
curable rheumatic disease. Med Trop (Mars). 2006;66(3):273-276.
2. Stamp l, Searle M, O’Donnell J, et al. Gout in solid organ
transplantation: a challenging clinical problem. Drugs.
2005;65(18):2593-2611.
3. Meijer FA, Peeters HR, Starmans-Kool MJ, Van der Tempel H, Houben
HH. Two patients with joint pain as initial presentation of a
haematological malignancy. Ned Tijdschr Geneeskd.
2005;149(39):1799-1801.
4. Sewell Kl, Petrucci R, Keiser HD. Misdiagnosis of rheumatoid arthritis
in an elderly woman with gout. J Am Geriatr Soc. 1991; 39(4):403-406.
5. Moyer RA, John DS. Acute gout precipitated by total parenteral
nutrition. J Rheumatol. 2003;30(4):849-850.
6. Pilmore Hl, Faire B, Dittmer I. Tacrolimus for the treatment of gout in
renal transplantation. Transplantation. 2001;72(10):1703-1705.
7. Tikly M, Bellingan A, lincoln D, Russell A. Risk factors for gout. Rev
Rhum Engl Ed. 1998;65(4):225-231.
8. Becker-Capeller D, Helker K, Weber MH. Polyarticular gout--change in
the clinical picture. Z Arztl Fortbild (Jena). 1996;90(3):227-231.
9. Schousboe JT, Davey K, Gilchrist Nl, Sainsbury R. Chronic
polyarticular gout in the elderly: a report of six cases. Age Ageing
1986;15(1):8-16.
10. Raddatz DA, Mahowald Ml, Bilka PJ. Acute polyarticular gout. Ann
Rheum Dis. 1983;42(2):117-122.
11. Harris MD, Siegel lB, Alloway JA. Gout and hyperuricemia. Am Fam
Physician. 1999;59:925-934.
12. Rott KT, Agudelo CA. Gout. JAMA. 2003;289(21):2857-2860.
13. Eggebeen AT. Gout: an update. Am Fam Physican. 2007;76(6):801-808.
14. Terkeltaub R. Gout in 2006: the perfect storm. Bull NYU Hosp Jt Dis.
2006;64(1-2):82-86.
Errata: Vol. 51, No. 3
J Miss State Med Assoc. 2010;50(3):83.
In Clinical Problem-Solving: “Pseudo Seizures Vs Pseudo
Zebra” — March 2010 on page [83] (authored by D. Mark
Pogue, MD; Judith G. Gearhart, MD and George Moll, Jr.,
MD, PhD), part of the diagram identified as Figure 1:
Hypocalcemia – Diagnostic Pathways was omitted when the
PDF did not display properly. The corrected figure appears
here:
FIGUREHypocalcemia – Diagnostic Pathways
Low Serum Calcium – Confirmed with ionized Calcium and/or serum protein
High Creatinine/BUN Renal Failure High Serum Low/Normal Serum
Phosphorous Phosphorous
Low Urine High Urine High Urine Low Urine Phosphorous Phosphorous Calcium Calcium
Functional PTH Deficiency Functional Vit D deficiencyNormal Alkaline Phosphatase Elevated Alkaline Phosphatase (normal for bone/age) (normal for bone/age) No Clinical Rickets Clinical Rickets
Low PTH or High PTH High PTH High PTH High PTH High PTHInappropriate“Normal” PTH
Severe Activating Excessive RTA Hypo- Calcium Receptor Phosphorous Magnesemia Mutations Load - Vit. D deficiency Calcium(<1.0 mg/dL) (High urine Tumor Lysis, Vit. D resistance Sequestration Calcium) Excessive VDDR types 1,2 “Hungry
Phosphorous Bone Intake Syndrome”
Hypo-PTH PTH Resistance Malabsorption Transient, PHP Liver Disease Familial, Drugs Autoimmune, 2nd to metabolic disease
concentrations
PHP – Diagnostic Pathways
PTH TEST: determine PTH stimulated plasma or urinary cAMP, TmP/GFR PHP type 2 – cAMP equivocal or normal, TmP/GFR decreased PHP type 1 – cAMP decreased, then erythrocyte Gs decreased (PHP 1A) or normal (PHP 1B) Abbreviations: BUN=blood urea nitrogen, PTH=Intact Parathyroid Hormone, Vit. D=Vitamin D analogues as primarily 25OH-VitaminD (calcifediol), RTA=renal tubular acidosis, VDDR=Vit. D dependent rickets, PHP=pseudohypoparathyroidism, cAMP=cyclic Adenosine MonoPhosphate, TmP/GFR=quotient maximum rate of tubular phosphate reabsorption and glomerular filtration, Gs =guanine nucleotide stimulating regulatory intra-membrane multi-subunit protein
PLEASE TELL OUR
ADVERTISERS THAT YOU
FOUND THEM IN THE
116 JOUrNal MSMa april 2010
april 2010 JOUrNal MSMa 117
• New MeMBerS •
ADILI-KHAMA, BABEK K.,
union; Born 9/14/1971 Tehran, Iran;
Graduated MD Debrecen Medical
university, Hungry 2000; Specialty:
Family Practice; laird Hospital, Inc.
BOSARGE, JOSEPH R., Gulfport;
Born 5/7/1973 Pascagoula, MS; Grad-
uated MD university of Mississippi
School of Medicine, Jackson 2004;
Specialty: Internal Medicine; Pul-
monary @ MHG.
BRITTON, MARCUS L., Tupelo;
Born 9/8/1977 Jackson, MS; Gradu-
ated MD university of Mississippi
School of Medicine, Jackson 2004;
Specialty: Nephrology; Nephrolosy &
Hypertension Assn.
CUMMINS, CHRISTOPHER J.
M., Ripley; Born 9/26/1974 Clarks-
dale, MS; Graduated MD 2003; Spe-
cialty: Family Practice; Magnolia
State Family Medicine.
DUNCAN, WILLIAM L., Mc-
Comb; Born 3/6/1972 Tupelo, MS;
Graduated MD university of Missis-
sippi School of Medicine, Jackson
1998; Specialty: urology; Southwest
urology.
FINCH, JON D., laurel; Born
6/12/1963 Michigan; Graduated DO
Kirksville College of Osteopathic
Medicine, Kirksville 1990; Specialty:
Emergency Medicine; South Central
Regional Medical Center.
FOSTER-GALBRAITH, PAULETT ,
Gulfport; Born 1/15/1967; Graduated
MD university of Texas Medical
School, Houston 1992; Specialty:
Family Practice; New Coast Cardiol-
ogy, PllC.
FOWLKES, THOMAS D., Oxford;
Born 4/8/1963 Greenwood, MS;
Graduated MD university of Ten-
nessee College of Medicine, Memphis
1989; Specialty: Emergency Medi-
cine; Thomas Fowlkes, MD, PA.
GEORGE, STEVEN, Meridian;
Born 10/10/1956 Birmingham, Al;
Graduated MD university of South
Alabama College of Medicine, Mo-
bile 1991; Specialty: Obstetrics & Gy-
necology; Woman's Group of
Meridian PllC.
GOEL, NISHEETH K., Jackson;
Born 6/29/1975 Hardwar, India;
Graduated MD university of Missis-
sippi School of Medicine, Jackson
2001; Specialty: Cardiovascular Dis-
ease; Baptist Health Systems.
HASHMI, RAZA U., Hattiesburg;
Born 9/22/1978 Pakistan; Graduated
King Edward Medical College, Pak-
istan 2002; Specialty: Internal Medi-
cine; Hattiesburg Clinic.
HENSON, ZEB, Jackson; Born
11/17/1978 Jackson, MS; Graduated
MD university of Mississippi School
of Medicine, Jackson 2007; Specialty:
Internal Medicine; university Internal
Medicine Associates, llP.
IRVING, JOSEPH L., Jackson;
Born 11/17/1973; Graduated MD
university of Mississippi School of
Medicine, Jackson 2004; Specialty:
Anesthesiology; Jackson Anesthesia
Associates.
LAM, SON G., Tupelo; Born
3/8/1976 Ho Chi Mingh VM; Gradu-
ated MD university of Mississippi
School of Medicine, Jackson 2003;
Specialty: Nephrology; Nephrology
& Hypertension Associates.
LOTT, MARTIN, Hattiesburg; Born
1/19/1957 Hattiesburg, MS; Gradu-
ated MD university of Mississippi
School of Medicine, Jackson 1983;
Specialty: Emergency Medicine;
South Mississippi Emergency Physi-
cians, PA.
LUZARDO, GUSTAVO , Jackson;
Born 11/21/1972 Zulia, Venezuela;
Graduated MD Faculty Medicine
Alexandria university, Egypt 1998;
Specialty: Neurological Surgery; uni-
versity Physicians, PA.
MCAFEE, JAMES E., Columbus;
Born 6/11/1935 Dyersburg, TN;
Graduated MD university of Ten-
nessee College of Medicine, Memphis
1963; Specialty: Occupational Medi-
cine; Columbus Occupational Medi-
cine PllC.
MCCOWAN, TIMOTHY, Jackson;
Born 4/7/1956 Hot Springs, AK;
Graduated MD university of
Arkansas School of Medicine, little
Rock 1981; Specialty: Radiology;
uMC Dept. of Radiology.
MCMURPHY, ANDREA B.,
Pascagoula; Born 8/13/1974 Mobile,
Al; Graduated MD university of Al-
abama School of Medicine, Birming-
ham 2000; Specialty: Otolaryngology;
South MS Ear Nose & Throat.
MOORE, CHARLES R., Hatties-
burg; Born 4/10/1972 Baton Rouge,
lA; Graduated MD louisiana State
university School of Medicine, New
Orleans 2003; Specialty: urology;
Southern urology, PA.
OTTO, KRISTEN J., Jackson; Born
5/18/1978 Newburg, NY; Graduated
MD university of South Florida Col-
lege of Medicine, Tampa 2002; Spe-
cialty: Otolaryngology; university
Physicians, PA.
PREWITT, THOMAS, Jackson;
Born 2/24/1961 Jackson, MS; Gradu-
ated MD university of Mississippi
118 JOUrNal MSMa april 2010
School of Medicine, Jackson 1988;
Specialty: General Surgery; uMC,
Dept. Surgery.
ROBERTSON, DONALD C., Iuka;
Born 8/7/1972 Poughkeepsie, NY;
Graduated DO university of Health
Sciences, College of Osteopathic
Medicine, Kansas City 2004; Spe-
cialty: Internal Medicine; Iuka Med-
ical Clinic.
SCHAFFER, DAVID I., union;
Born 5/13/1966 Pittsburg, PA; Gradu-
ated MD Spartan Health Science uni-
versity, St. lucia West Indies 1997;
Specialty: Family Practice; laird
Hospital, Inc.
SCHIEFER, AMANDA R., Jackson;
Born 6/22/1977 Nacogoloches, TX;
Graduated MD university of Missis-
sippi School of Medicine, Jackson
2003; Specialty: Internal Medicine;
Premier Medical Group of MS llC.
SCHNEGG, JOANN C., Mc Comb;
Born 8/20/1965 Detriot, MI; Gradu-
ated MD College of Osteopathy of the
Pacific, Pomona 1990; Specialty:
Family Practice; Premier Medical
Clinic.
SPREHE, SAMUEL E., Amory;
Born 11/26/1955 Oklahoma City, OK;
Graduated MD university of Okla-
homa College of Medicine, Oklahoma
City 1983; Specialty: Otolaryngology;
Amory ENT & Allergy.
TAYLOR, KATHRYN G., Jackson;
Born 3/15/1979 Flowood, MS; Grad-
uated MD university of Mississippi
School of Medicine, Jackson 2005;
Specialty: Family Practice; university
Physicians, PA.
TIDWELL, WILLIAM, Tupelo;
Born 4/15/1976 Biloxi, MS; Gradu-
ated MD university of Mississippi
School of Medicine, Jackson 2003;
Specialty: Neurological Surgery; Im-
aging Associates of N. MS.
TULI, PAMELA J., Gulfport; Born
3/7/1971 Altoona, PA; Graduated MD
Temply university School of Medi-
cine, Philadelphia 1998; Specialty: In-
ternal Medicine; The Medical
Oncology Group, PA.
VIJAYAKUMAR, SRINIVASAN,
Jackson; Born 8/29/1954 India; Grad-
uated MD Sri Venkatesvara Medical
College, Sri Venkatesvara university,
Tirupati 1978; Specialty: Radiation
Oncology; university Physicians -
Radiation
WALDROP, CHRISTINE, Jackson;
Born 12/15/1975; Graduated MD
university of Mississippi School of
Medicine, Jackson 2004; Specialty:
Anesthesiology; Jackson Anesthesia
Group, PA.
BlueCross BlueShieldof Mississippi
Committed to a Healthier Mississippi.
april 2010 JOUrNal MSMa 119
• OBiTUarieS •
DR. GLENN BENNETT – LAFAYETTE, LOUISIANA
Dr. Glenn Harris Bennett, 65, formerly of Baldwyn and Sidon,
Arkansas, died Friday, Feb. 26, 2010, at his home. Services were
held Sunday, Feb. 28, at Sidon Baptist Church in Sidon. Graveside
services were held at Sidon Cemetery. Roller-Daniel Funeral Home
of Searcy, Ark., was in charge of the arrangements.
He was born Aug. 23, 1944, in Searcy, Ark., to the late Em-
mett and Tessie lemon Bennett. He obtained his medical degree
from the university of Arkansas and practiced family medicine and
emergency medicine in Northeast Mississippi for over 25 years.
upon moving to lafayette, la., he continued to serve as an emer-
gency room physician for several local hospitals.
Survivors include one son, George Bradley Bennett of
Tuscaloosa, Ala.; one daughter, lindsay Bennett Page and her hus-
band, Brandon, of Petal; and one sister, Mary Bennett Ardemagni of
Kingsport, Tenn.
Memorials may be made to Baldwyn First united Methodist
Church, Baldwyn, Miss. Expressions of sympathy may be left at
www.rollerfuneralhomes.com.
DR. RAYMOND GRENFELL - JACKSON
Dr. Raymond Frederic Grenfell, 92, died on April 5, 2010, at
St. Dominic Hospital after a brief illness. Funeral services were held
April 7, 2010, from the Chapel of First Baptist Church, Jackson, fol-
lowed by interment in lakewood Memorial Park. He was preceded
in death by his wife, Maude Byrnes Chisholm Grenfell.
Dr. Grenfell was born an only child to Elisha Raymond and
Pearle Nelly Grenfell in West Bridgewater, Pennsylvania. When Dr.
Grenfell was 16 (during the Great Depression) his father passed
away. He then began working in the mill for uS Steel Corporation.
Dr. Grenfell received a full Carnegie Scholarship which enabled him
to earn Bachelor of Science and Doctor of Medicine degrees from
university of Pittsburgh.
During WWII, he enlisted and served as a Captain in Puerto
Rico. After the war, Dr. Grenfell was transferred to Fort Jackson in
Columbia, S.C., where he met his future bride, Maude Byrnes
Chisholm. They were married on August 19, 1944 in Columbia, S.C.
After an Honorable Discharge as a Major in 1946, they moved
to Jackson where Dr. Grenfell began the private practice of medicine
followed by the study of the drug treatment of hypertension. In 1955,
Dr. Grenfell opened the Hypertension Clinic of the university School
of Medicine which he maintained as Clinical Assistant Professor of
Medicine until 1979. From 1979 until his retirement in 1999, Dr.
Grenfell limited his practice to the diagnosis and treatment of hyper-
tension.
During his work at the medical school, he was a pioneer in the
double blind evaluation of many new antihypertensive drugs. Dr.
Grenfell published many papers in the united States and Swiss jour-
nals. He was a member of many professional societies including
American Medical Association, Southern Medical Association
(Served as Counselor), American College of Chest Physicians, Amer-
ican Society of Hypertension and American College of Clinical Phar-
macology.
Dr. Grenfell was a life deacon and long term member of the
sanctuary choir of the First Baptist Church of Jackson. He also
served as president of the Jackson Symphony Orchestra 1961-62.
He is survived by his four sons and their wives, Raymond
Frederic Grenfell, Jr. (Pat), Milton Wilfred Grenfell (Gioia), James
Byrnes Grenfell (lynn), and Robert Chisholm Grenfell (Amy); eight
grandchildren, Ric Grenfell (Tracy), Matt Grenfell (Caroline), Sarah
Grenfell, Catherine Grenfell, Robert Grenfell, Jr., Eleanora Grenfell,
Mallory Bass, and Ross Bass; and two great-grandchildren.
In lieu of flowers, memorials may be made to the charity of
your choice.
DR. FRANK LAROY LEGGETT - BASSFIELD
Dr. Frank laRoy leggett, 83, died at Hospice Ministries in
Ridgeland on February 22, 2010, after a lengthy battle with cancer. A
family physician in Bassfield for 44 years, Dr. leggett lived in Ox-
ford after his retirement before moving to Trace Pointe Assisted liv-
ing Community in Clinton last year. Funeral services were held
February 27 at College Hill Presbyterian Church in Oxford, Rev.
Alan Cochet, pastor. united Funeral Service of New Albany was in
charge. A memorial service was held March 6 at Bassfield High
School.
Those who say doctors don’t make good patients weren’t
around Dr. leggett in the last year as he thanked and joked with
every doctor and nurse for performing their duties. The fourth child
born to Clarence Wesley and Bessie Chandler leggett of Brookhaven
on November 6, 1926, Roy, as he was known by his family, grew up
on the family farm. After moving to Bassfield, he closed his medical
office and spent every Thursday afternoon with his parents.
He left New Site High School to enter the u.S. Navy where he
served as an operating room corpsman in Norfolk, Va. during World
War II. After his discharge, he attended Copiah-lincoln Junior Col-
lege, Baylor university and the university of Mississippi Medical
School under the two-year program then in place. He completed his
M.D. at Baylor university Medical School. under the terms of a state
of Mississippi scholarship program, he was to serve five years in
rural Mississippi.
Frank, as others knew him, remained in Bassfield from 1956
to 2000, serving as an alderman from 1967-2001, including several
terms as the Mayor Pro Tempore. He served three terms as the Jeffer-
son Davis County Coroner. Dr. leggett was the chief of staff at the
Jefferson Davis County Hospital for many years. He was a Sunday
School teacher and chairman of deacons at Bassfield Baptist Church.
upon his retirement, the local library was named in his honor.
He retired to Oxford where he was active in College Hill Pres-
byterian Church serving as an elder and as chairman of the missions
committee. A world traveler, Dr. leggett made numerous mission
trips to Central and South America and Eastern Europe. He provided
financial assistance for several young men to attend seminary.
Doc, as many knew him, is survived by his brothers, Ray
leggett of Columbia, Jay leggett of Orlando, Fla., David leggett of
Haughton, la., Johnny leggett of Sevierville, Tenn. He was pre-
ceded in death by two brothers, Woodrow and Chandler, in child-
hood, his parents, his brother, Robert leggett, and his sister, Evelyn
Davis.
Donations may be made to the Frank l. leggett library in
Bassfield.
DR. RON E. PERSING - BRANDON
Dr. Ron E. Persing, 59, died March 13, 2010, at the Crossgates
River Oaks Hospital in Brandon. Visitation was held March 18, 2010,
at Ott & lee Funeral Home in Brandon. Funeral Services were held
March 19, 2010, at the St. Jude Catholic Church in Pearl.
120 JOUrNal MSMa april 2010
• OBiTUarieS •
Dr. Persing was born in Sioux Falls, S.D. and has been a resi-
dent of Brandon for the past 10 years. He was a member of the St.
Jude Catholic Church in Pearl and was also a member of the Model
Railroaders Club. Dr. Persing retired after 25 years of service with
the united States Air Force and was currently employed in the Dept.
of Pediatrics at the university of Mississippi Medical Center in Jack-
son.
He is preceded in death by his father, George Persing; and his
brother, Tom Persing. Dr. Persing is survived by his wife, Joan Pers-
ing of Brandon; his mother, Morine Persing of Sioux Falls, SD; his
daughter, Carol Olszewski and husband, Mark of Solon, OH; his son,
Brian Persing and wife, Jammie of Ocean Springs; two sisters, Carol
Born and husband, Terry of Sioux Falls, SD and Sue Mollison and
husband, John of Sioux Falls, SD; one brother, Scott Persing of Eau
Claire, WI; and five granddaughters, Gavriella Persing, Hannah Ol-
szewski, Erica Olszewski, Genevieve Persing and Emree Olszewski.
Memorials may be made to the Blair E. Batson Children's
Hospital, 2500 N. State St. Jackson, MS 39216.
DR. FASER TRIPLETT - JACKSON
Dr. Rodney Faser Triplett, 77, died at home on Thursday, Jan-
uary 28, 2010. Visitation and funeral services were held at Christ
united Methodist Church with burial at Wright and Ferguson's Park-
way Cemetery in Ridgeland, January 30, 2010.
A native of louisville, Dr. Triplett was the son of the late Mr.
and Mrs. Rod Triplett. He graduated valedictorian of his class from
louisville High School in 1951 where he was named All-Choctaw
Conference halfback after an undefeated season. Faser earned the
rank of Eagle Scout in an 18 month period at the age of 13, evidence
of the exceptionally bright, remarkably driven, boundlessly energetic
man he soon became.
He had a passion for politics from an early age, delivering po-
litical circulars every summer from age 10-14. At age 15, in 9th
grade, he was the personal page to lieutenant Governor Sam lump-
kin for the entire legislative session, returning to louisville each
weekend to pick up his school work which he taught himself during
the week. In the summer of 1951, he was assistant to the campaign
manager for Hugh White and was the youngest person on the gover-
nor's staff for White's inauguration. In 1955, Faser worked in the
campaign headquarters of J.P. Coleman, who was elected governor.
Because he believed it was his duty to help elect strong leaders, he
worked diligently for many other campaigns. His yearning to make a
difference led him to run for the state Senate in 1988. Although he
was defeated in the race for the Senate seat, he never missed a beat as
he moved on to medical politics on a national level. He served on the
board of the American Medical Association Political Action Commit-
tee (AMPAC) and later as Chairman.
Faser attended the university of Mississippi as a freshman on
a full scholarship as football manager. He was a member of Phi Delta
Theta fraternity where he was Rush Chairman his sophomore year.
His junior year, he was elected cheerleader, was President of the
School of liberal Arts, was on the Debate Team and was a member
of the academic fraternity, ODK. Faser was a double Taylor Medalist
in Political Science and Speech, completing his B.A. in 2½ years. He
attended the university of Mississippi School of law in January,
1954, but became disenchanted with law. Faser then entered the uni-
versity of Mississippi School of Medicine in September 1955, gradu-
ating with his medical degree from Tulane university in 1959.
Faser completed a year of internship in San Francisco and a
year of pediatric residency in Memphis where he met and married
Jackie, his wife of 48 years. They moved to Abilene, TX, where
Faser was a flight surgeon in the u.S. Air Force for two years. He re-
turned to Memphis for a second year of pediatrics followed by a pe-
diatric allergy fellowship. He completed his training in Denver with a
yearlong fellowship in immunology. Dr. Triplett became the first
Board Certified Allergist in Mississippi and was one of the founders
of the Mississippi Asthma and Allergy Clinic where he practiced for
34 years.
Dr. Triplett has served as president of many organizations in-
cluding the Central Medical Society, the Mississippi State Medical
Association, the American College of Allergy and Immunology, the
university of Mississippi Alumni Association, and the Country Club
of Jackson. He has served on the Board of Directors of MCCA, Sky-
Tel, Mtel, Jackson Federal Savings, Gulf Guaranty life Insurance
Company, Cal-Maine Foods, Great Southern National Bank, and the
Wilson Foundation of the Mississippi Methodist Rehabilitation Cen-
ter.
In addition to Faser's innate medical ability, his business acu-
men and entrepreneurial prowess were what set him apart. He was a
passionate investor in many public and private business ventures.
One of his first investments was with his fraternity brother, John
Palmer, in 1969. He helped acquire the Doctor's Exchange which
eventually grew to become the very successful Mtel. Faser's advice
has always been “invest in people, not ideas.” Other business ven-
tures include Outback Steakhouse, Avanti Travel, and Swensen's.
Faser was also instrumental in starting the physician-owned medical
malpractice insurance company, Medical Assurance Company of
Mississippi (MACM), where he served as President and Chairman of
the Board from inception until 2005. All of these accomplishments
along with his undying love for the university of Mississippi led to
his induction into the Ole Miss Alumni Hall of Fame in 1998.
Faser was a loyal member of Christ united Methodist Church,
serving in several roles including chairman of the Finance Commit-
tee. He inspired many with his determined will to walk down the
aisle of his church after his stroke. When he could no longer walk, he
rose humbly from his wheelchair with the help of two of his friends
who sat nearby each time the Affirmation of Faith was recited. He
regularly visited Methodist Rehab to encourage stroke survivors by
example.
He was preceded in death by his sister, Diane Pearson Guyton;
and his twin infant grandsons, William Faser and Thomas Clayton.
He is survived by his wife, Jacqueline (Jackie) Dempsey
Triplett; son, Chip Triplett (Susan) of Ridgeland; daughters, Diane
Holloway (J.l.) of Ridgeland, Suzy Fuller (Jim), liz Walker (Chip),
and lou Ann Woidtke (Trent) all of Jackson; and grandchildren, Jay,
lindsey, Kelsey, and Caroline Fuller, Elizabeth, Mary Faser, and Fel-
ton Walker, Parker, Gage, and Reece Woidtke, as well as Wes Mc-
Cubbins, Wendy Martin, Tiffany Holloway, and Greg Holloway. He
also leaves behind his beloved friend and caretaker levon Williams.
The family would like to thank John Jones, K.B. Bolton, and Win-
netka love-Mcleod for their outstanding care.
In lieu of flowers, memorials may be made to the R. Faser
Triplett, Sr., M.D. Chair of Allergy and Immunology at the univer-
sity of Mississippi School of Medicine, attn. Travis Schmitz, Dept. of
Medicine, 2500 North State St., Jackson, MS 39216.
• preSiDeNT’S page •
Let’s Change the WholeDamn System and Start
Over, but We Have to WaitUntil Tuesday
april 2010 JOUrNal MSMa 121
There is nothing like a friendly face! How many times have we heard that, said
that, felt that? No truer words were ever spoken. Allow me a moment to elaborate.
Yesterday morning, March 6, Janie was out of town visiting her mother, and I
was winging it alone. I slept late (until 6:00 a.m.), got up, ate breakfast, and watched
the news, the whole time preparing myself mentally for a full day of “things that
needed to be done.” The few Saturdays that I am in town are spent catching up on
errands and clearing items off the proverbial “to do” list.
The first stop: the hospital. Make rounds for an hour and then head off to the
hardware store for a few odds and ends. The rest of the day was to include the
grocery store, bank, cleaners, and then home to spend several hours working in the
front pasture on my tractor prior to Janie and me going to an announcement party that
evening (she would be back home around 5:00 p.m. from louisville).
The second stop: Haden’s Hardware. With a few purchases in tow, I climbed into the cab of my two-year-old Ford F150 pickup truck,
and guess what, it would not crank! Nothing, nodda, not a whimper, graveyard dead (you get the picture). My day flashed before me. What
was I to do? Right away, two friendly faces jumped to my aide. A pair of jumper cables and 10 minutes later, I was on the road again.
However, calling on my well-honed diagnostic skills, I was haunted by the knowledge that my truck was not well. The battery was only
one and a half years old; the truck, well maintained, should not have suffered such an abrupt multi organ failure. My solution: get to T.D.’s as
soon as possible!
Point of information: T.D. is the founder and owner of a local tire store and garage. He is many things to me – friend, patient, honest and
reliable merchant, and of all things, he and I share the same last name (no kin though).
As I charted a B-line for T.D.’s, my once reliable means of transportation began renewed signs and symptoms of a yet undiagnosed
illness. A strange sound bellowed from the engine, fatigue was apparent, and there was obvious dyspnea on exertion. Having seen it many
times before I knew I had a “CODE BluE” just around the corner. If I could just make it to T.D.’s, he would solve the problem.
Well, low and behold, as I limped down Clay Street I could see his familiar sign just ahead. As I approached the garage, “CODE BluE,”
total shutdown, time to intubate. I literally coasted into the garage and came to a dead stop just in time to see the entire Saturday morning crew
punching out. I opened the door (the power windows would not work) and asked in a desperate tone “Is T. D. here?” About that time, I saw the
friendly face of T.D. Easterling rounding the corner. “What’s up? Doc?” he bellowed. In the wink of an eye, like a well-trained OR crew, they
descended on my lifeless vehicle like a swarm of bees. The diagnosis: a sudden infarct to the alternator had drained my otherwise healthy
battery and resulted in a complete cardiac arrest.
By this time it was 1:00 p.m. on a Saturday, and there was no alternator in sight. T. D. assured me he could have me up and running by
noon Monday, but how was I to get the eight miles back to Bovina? (Remember my dear wife is still out of town.)
Without hesitation T.D. said, “Well Doc, just take this old pickup I have here in the garage.” As much as I appreciated the offer, I could
not further impose on him by bringing one of his company vehicles home. He insisted and would not have it any other way. With a warm
handshake and a transfer of the keys, I was on my appointed rounds.
long story short, Janie made it home, and she and I went to the party that evening (in her car of course).
Now for the contrast: the opposite, the omega following the alpha. After the party, Janie and I decided to make a late night run to our
local Kroger Grocery Store (the death of my truck had resulted in the grocery store getting eliminated from my earlier chores). As we grabbed a
few essentials for Sunday dinner and some additional staples, the clock struck 10:30 p.m. in our local 24-hour Kroger. As we approached the
checkout stand there were no human beings in sight. Not a single friendly face!
rAnDy eASterling, MD
2009-10 MSMA PreSiDent
122 JOUrNal MSMa april 2010
There I was, a 58-year-old baby boomer pushing a cart full of groceries and staring down the barrel of the “dreaded automatic computer
machine self-checkout.” I was as frightened and frustrated as hours before when I left my beloved truck on life support at T.D.’s Intensive Care
unit.
To make matters worse, one of the checkout machines (not persons) was having chest pain and the 19-year-old store clerk was frantically
engaging in computer resuscitation. The harder he worked, the longer the lines grew and the angrier the store patrons became. It was obvious
to me; I was in the midst of a corporate nightmare. At the first utterance of complaint, I was abruptly informed that all clerks were sent home at
10:00 p.m. and my only means of escape from this food conglomerate was through the jaws of a computer maze that was at best a challenge to
me, but more importantly, not properly working at the time. Where was T.D. when I needed him? There was no friendly face, no assurance that
things would be okay, no old pickup to loan. Frankly, I got the impression that Kroger could have cared less.
Well, thank you for indulging my rant, but what does this have to do with medicine? This page is, after all, the appointed method by
which the President of the Mississippi State Medical Association reports monthly on the “State of Medicine.”
At the risk of waxing philosophically, I think my two contrasting experiences on this given Saturday highlight in a very real sense the
essence of our seemingly never ending “health system reform” debate.
What our patients want, what America wants, is exactly what you and I try to deliver in our practices day in and day out, 24-7. We seek
out, yes, we even hunger for relationships. I am convinced that our patients (remember all Americans are patients at one time or another) want a
relationship with their doctor. America needs to know that when they are sick or a loved one is ill, there will be a friendly face to care for them:
someone who has their individual best interest at heart, someone who works for them…not the federal government, not a drug company, not an
insurance company.
I am of the opinion that in the united States today there exists a frightening degree of mistrust and isolation between “Joe lunchbucket”
citizen and those whom we have elected to look after our best interest in Washington. The health system debate is a symptom of a more
malignant process.
Healthcare is very personal to us all. It has become obvious that the majority of Americans are having serious reservations about turning
over additional control of our healthcare to a bureaucracy that has grown impersonal and out of touch.
We, both patients and physicians, are fed up with systems that have been put in place over the past decades that increasingly separate us
from each other. The “system” tells us how much our services are worth, what medicines we can prescribe, how long we can keep our patients
in the hospital, and what studies and lab work we can order. While some measure of regulation and oversight is necessary, the federal
government has taken it to an unreasonable and even unhealthy level.
I submit to you that the last 10 months have not been so much about President Obama, Harry Reed, Nancy Pelosi, or even Health System
Reform, but more about an American electorate that feels disenfranchised and ignored.
Hey, I got a great idea! Why don’t we reform the health care system in
America?
Why don’t we create a system where doctors answer to patients, where
hospitals provide quality care because it is the right thing to do, and not
because the joint commission requires it?
• Why don’t we create a system where providers are paid fairly and
commensurate with years of education, training, and experience?
• Why don’t we create a system that responds to the needs of patients
and not to a federal bureaucracy that seems to have lost sight of its
charter?
We need a health care system that allows physicians to practice good
medicine, not wasteful and unnecessary defensive medicine.
I think we might be on to something here! let’s change the whole damn
system! I have even got a better idea. let’s put T.D. in charge! But, we have
to wait until Tuesday; he has a truck to fix!
Partnering with you to make Mississippi healthier,
Randy Easterling, Md
President, Mississippi State Medical Association
We specialize in the business of healthcare
• eDiTOrial •
But Will It Take?
So what's all the fuss about? I know for a fact that Healthcare Reform was initiated months ago in (of all places) rural
central Mississippi. Granted this abbreviated version pales in comparison to the overarching Obama/Reid/Pelosi plan
and also calls to mind the familiar opening lines of “A Tale of Two Cities.”
In the fall of 2009, the now former administrator of Kosciusko's Montfort Jones Memorial Hospital (note the operative
word “former”) convinced his board of trustees to agree to a $650,000/year contract with a Texas outfit (read “monies
hemorrhaging from our community”) to supply hospitalist services for our 82-bed facility. Hospitalist services confined to
unreferred (read “indigent”) patients admitted to our hospital from the emergency department (perhaps 2 or 3 during a really busy
week) which services had historically been provided pro bono by our clinic physicians. I might add that this arbitrary decision
was made without any dialogue with the hospital medical staff (read “our clinic physicians”).
As strange as it may seem, this turned out to be a win-win situation: It was the proverbial straw that broke the beleaguered
administrator’s back (hence “former”), and it started our doctors’ toying with the idea of developing a hospitalist service for our
own patients. While this practice may already be de rigueur in communities across our state, I wasn’t totally convinced that the
idea would fly in small town Mississippi where doctor/patient relationships are special, if not downright sacred.
The basic plan goes something like this: Each week a different clinic physician manages all hospitalized patients (except for
the ones under the care of those high-priced longhorn recruits). The remaining clinic physicians, no longer obligated to hospital
rounds, begin morning appointments earlier and are free in the evenings to vacate the premises when the last patient is seen. Well,
this old dog, only a heartbeat away from retirement at the time and fairly resistant to new tricks especially when they involve my
patients, opted out of the hospitalist rotation, continued to make morning AND EVENING hospital rounds (which seemed to be
appreciated by both patients and nursing staff), and conducted a clinic practice as usual.
Just as questions continue to swirl about national healthcare reform, several uncertainties concerning the local variety waft
through my head. Are patients content to absolve “their doctor” of their hospital care? How will this hospitalist movement truly
impact continuity of care? Will patients view the hospitalist system as self-serving for money-grubbing doctors anxious to head
out early to the golf course? How will patient/family rapport and trust established over the years and even more crucial in the
hospital setting be sustained? Who sees the patient in hospital followup?
I’m now removed from the scenario described above, but I plan to monitor the process. I would venture to guess that many
of our readers have answers to the above questions. If not answers, then surely opinions ... unless already totally spent on
Obama/Reid/Pelosi!
—d. Stanley Hartness, Md
Associate Editor
The Pen is Mightier than the Sword!Express your opinion in the JMSMA through a letter to the editor or guest editorial. The Journal MSMA welcomes letters to the editor. letters for publication should
be less than 300 words. Guest editorials or comments may be longer, with an average of 600 words. All letters are subject to editing for length and clarity. If you are
writing in response to a particular article, please mention the headline and issue date in your letter. Also include your contact information. While we do not publish
street addresses, e-mail addresses or telephone numbers, we do verify authorship, as well as try to clear up ambiguities, to protect our letter-writers.
You can submit your letter via email to [email protected] or mail to the Journal office at MSMA headquarters: P.O. Box 2548,
Ridgeland, MS 39158-2548.
april 2010 JOUrNal MSMa 123
2010 MSMA Annual SessionGolf Tournament
Thursday, June 3, 2010 Beau Pre Country Club in Natchez
Shotgun start at 1 P.M. Box lunch will be served.
For more information and to sign up, call Wendy Powell at
Medical Assurance Company of Mississippi1.800.325.4172
124 JOUrNal MSMa april 2010
• THe UNCOMMON THreaD •
Idon’t know much about ghost stories. I don’t like reading them
‘cause my life is scary enough as it is. You want to scare me
you can hold the ghosts and tell me about a woman and her two
daughters loose in Bergdorf’s with my credit card. Now that’s what scares the bejesus out of me. As far as trying to tell a ghost story, I was
never any good at ‘em. I usually messed up the scary part, and everybody’d laugh when they were supposed to be hollering and screaming.
Although that happens about a lot of stuff for me. The laughing part, not the hollering and screaming. I guess it’s just the way I say things.
I remember once when I was just going into radiation oncology and was still doing a lot of work at the Children’s Hospital of the Kings
Daughter. I was trying to tell a friend with whom I’d deployed on dive jobs around the world about how it was making me feel, about how I
was running a lot better now because I wasn’t running through woods imagining getting away from Russians or Arabs or whatever, about how I
was running down the streets of Virginia Beach trying to get away from the eyes of the dead children I’d taken care of.
His response didn’t help me find a way to deal with the way I was feeling about stuff. He cracked up and said, “Man you should do
stand-up. This stuff is hilarious.”
I changed the subject.
So if you’re hoping for a scary ghost story, save yourself the trouble and bail out now ‘cause that’s not what this is going to be. Anyway,
Barry Hannah died last month (March 1st). He was the kind of author that took chances, sometimes too many, but he was a good writer for it-
and despite it, too. He died up in Oxford where he taught creative writing, but I never knew him there. He was born here in the town where I
live (Meridian, Mississippi), but I never knew him here either. I went to the university of Alabama. When I was there we won the national
championship in football twice, Bear Bryant was our coach, Sela Ward was one of our cheerleaders, and Barry Hannah was in a drunken
whirlwind, shooting arrows through folks’ houses, stealing motorcycles, and teaching in the English Department. That’s when I was aware of
his existence.
I wasn’t the kind to get too impressed with a wild man English professor back then. I was in the honors English program and was
studying Southern literature because I liked it, but I was a pre-med major. All I really cared about was Biochemistry and Physics and Advanced
Analytic Spectroscopic Technique. My one stab at writing was a research paper on “The Clinical and laboratory Characteristics of
Macroamylasemia”, a clinical syndrome where your amylase molecules are too big with large redundant sections so they don’t get excreted
normally and you get high serum amylase levels. I’m pretty sure Barry wouldn’t have viewed it too
favorably as it didn’t take a lot of chances with the English language. Anyway, Airships had just come out,
and one of the big stories that drew a lot of local ire was Constant Pain in Tuscaloosa. The constant pain
had ended up with him in Bryce Hospital, the local inpatient psychiatric unit, for alcoholism explaining
some things later in the story.
Now this morning was a rodeo Saturday at Casa Charlo (that’s the name we gave our new house; the
last one was called The Monkey House because of all of the kids who lived in it with us). We were up at
5:45 am to get ready, get everything together (horses, trailers, trucks, etcetera) so the girls could drive across
the state to ride horses around stuff in a dirt pen somewhere else instead of here. Since I wasn’t going, after
I took them to breakfast and the barn and watched them drive away in a pick-up with a gooseneck horse
trailer on the back, I got to go home and go back to bed for another hour or so.
That’s when Barry showed up. Which was kind of disconcerting because I’d known about his being
dead for about a week or so. Anyway, I was lying there asleep and there he was. His hair was even still
r. Scott Anderson, MD
The Ghost
Barry Hannah
1942-2010
april 2010 JOUrNal MSMa 125
• plaCeMeNT/ClaSSiFieD •
PHYSICIANS NEEDED
Physicians (specialists such ascardiologists, ophthalmologists,pediatricians, orthopedists,neurologists, etc.) interested inperforming consultative evaluations(according to social securityguidelines) should contact theMedical relations office.
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dark, no gray in it yet, althought he died with a bunch of gray hair. He was leaning over the bed and shouting down into my face, like he was
famous for doing in class all those years ago.
“Tom…Tom…listen to me now, Tom.” My name’s not Tom, but I figured it was the alcohol talking. “…just listen. You’re never going
to be a real writer if you keep yourself all bottled up in your own life. You got to let go. You just got to let go and see what in the hell
happens. let your characters run their own lives. Stop getting in the middle of it. You gonna be dead soon enough, just like me. Write
something worth leaving before you go, Tom. Damn it, write something worth leaving.”
It never occurred to me that he might have gotten the wrong address. Somehow I knew he was talking to me; he just had the wrong
name, which wasn’t unusual back then either.
“So what is it you’re trying to tell me to do, man?” I asked, still in college, I suppose.
“When opportunity knocks, you open the door, Tom. Open the freakin’ door.”
In the dream, I guess, I heard the doorbell ring, and I was confused. Barry was gone, and I didn’t know if the doorbell had really rung
or not. The dogs weren’t barking. That was a sign that it was just in the dream, but I couldn’t just lay there. I got up, put on my robe, and
went from door to door, but I didn’t see anybody out there. Opportunity had not knocked.
I tried to figure it all out, but it didn’t make sense. I poured a cup of coffee and sat down at my desk and rewrote the ending of The
Hard Times, the novel I was editing, and I wrote well, which is always a nice thing. It was raining outside, the coffee was still warm, and I
knew that while opportunity knocks and is gone, inspiration’s the one that takes the time to ring the bell.
— R. Scott Anderson, Md
Meridian
the 142nd Annual session of
the MsMA house of
delegates and Medical
Affairs Forum 2010
will be held
June 3-6, 2010in natchez.
Mark
Your
Calendar!
R. Scott Anderson, MD, a radiation oncologist, is medical director of the Anderson Regional Cancer Center in
Meridian and vice chair of the MSMA Board of Trustees. Additionally, he is an accomplished oil-painter and
dabbles in the motion-picture industry as a screen-writer, helping form P-32, an entertainment funding entity.
126 JOUrNal MSMa april 2010
• UNa vOCe •
“Celebrate. Remember.Fight Back.” -
Thoughts on the AmericanCancer Society Relay for Life
Recently I was asked to make a ten-minute talk to the student body of Blue Mountain College in preparation for the American
Cancer Society Relay for Life on the subject of cancer. Wow! When your head stops spinning you realize that this is akin to
asking a freshman Congressman to give a synopsis of the new 10,000 page healthcare reform bill in 100 words or less. I hope
that sharing the following text of my speech will motivate Mississippi physicians to help educate and enlighten our youth on the dangers of
cancer.
Considering the request, I contemplated whether I should talk about my personal experience just over one year ago as a cancer patient. Do
I talk about my journey through the valley of the shadow of death from lung cancer with my husband Robert last fall…a journey that I am still
on each day as I navigate the process of grief? Do I provide the scary scientific statistics? Do we discuss the warning signs of cancer? Cancer
prevention and/or, cancer screening?
Then I began to think about my audience: the fine young people they call “Generation Y,” the “Millennium Generation” and sometimes
referred to as the “Dot Com Generation.” Rather than try to pigeon-hole this group of young students, I decided to simply put myself in the
position I was in when I was a student there, not so many moons ago it seems…for they were not so different than I was then. At age 20, we are
all ten feet tall and bullet-proof. The undercurrent is that ‘Cancer means nothing to me right now…that is something only old people die of.’ I
am here to tell you this is just not so.
The hallmark of Generation Y is touted to be encapsulated by this phrase: “I need to know why this is important to me, why do I need to
care about this?”
In one simple sentence, you should care about this because sooner or later cancer will touch your life if it has not already. At any given
time, and right now in this room, every one of us has cancer cells floating around in our bodies. Did you know that? We all have these stray
mutant cells that have the potential to thrive and develop into a malignancy. With the fantastic capability of a stealth bomber, our immune
system attacks and kills these rogue cells.
But what happens one day when our immune system fails us? One day when tobacco abuse has finally overloaded it, or environmental
toxins or ultraviolet radiation or the onslaught of a viral intruder or, for some, simply a sequelae of a ripe old age, our immune system becomes
inadequate and cancer takes a foothold in our bodies.
Thus, one out of three of you in this auditorium will have cancer in your lifetime. look around you. One third of the people in this room!
I am already a statistic. And if you are one of the fortunate ones who doesn’t become a cancer patient yourself, then your parent, your spouse, or
your child might not be so lucky. And this, I guarantee you, will touch your life. This, in a bullet point, is why you need to care and care deeply
about the Relay for life effort.
april 2010 JOUrNal MSMa 127
Dwalia South-Bitter, MD
128 JOUrNal MSMa april 2010
There’s a lot going on in organized medicine so it’s easy to miss something if you’re on the go. To help you stay in touch no matter where you are, MSMA is now communicating via “Twitter.”In about three minutes, you can set up a free Twitter account for yourself. Simply visit www.twitter.com and submit your name, email address and mobile phone number (optional, standard text messaging rates apply). Once you’re signed up with Twitter, you can add MSMA by going to the following web page http://twitter.com/MSMA1 and clicking “Follow” next to the MSMA icon.MSMA1
For a bird’s eye view on medicine follow MSMA on!
There’s a lot going on in organized medicine so it’s easy to miss something if you’re on the go. To help you stay in touch no matter where you are, MSMA is now communicating via “Twitter.”In about three minutes, you can set up a free Twitter account for yourself. Simply visit www.twitter.com and submit your name, email address and mobile phone number (optional, standard text messaging rates apply). Once you’re signed up with Twitter, you can add MSMA by going to the following web page http://twitter.com/MSMA1 and clicking “Follow” next to the MSMA icon.
MSMA1
For a bird’s eye view on medicine follow MSMA on
!
Simply put, cancer is the second leading cause of death in
America. In this year alone, 1,500,000 Americans will learn, as did I,
that they have cancer. And every year, more than a half million
Americans will die from their cancer. And it is not just a disease of us
old folks. In your age group, the most prevalent cancers are the
leukemias, the lymphomas, cervical cancer for young women, and
testicular cancer in young men. I will give you one statistic that startles
me. When I was in med school, we learned that approximately one
woman in 14 will develop breast cancer in her lifetime. Thirty years
later that stat now says one in eight.
The good news is that at long last the death rate from cancer has
finally begun to fall. Why? Part of this progress has come from early
diagnosis and cancer awareness. The earlier you detect a cancer, the
greater the likelihood that you will be cured: a survivor.
Another big part of the reduction in the cancer death rate has
stemmed from advances in cancer treatments that have been made
possible by money that has been poured into cancer research. Much of
this money has been raised by the American Cancer Society through
fundraising efforts for cancer research such as this Relay for life effort.
What you are going to do here is truly going to make a difference in
folk’s lives.
Knowledge is power. If you don’t believe it, ask your major
professor. If you make yourself knowledgeable about cancer and are on
the alert for early warning signs, you stand a much greater chance for a
complete cure. If you have a cancer warning sign, see your doctor and
discuss it with him or her. The only stupid question is the one you don’t
ask.
Why do you need to care about cancer and the Relay for life? As
we have earlier demonstrated, cancer can and will affect your life sooner
or later. Here then today is a very important opportunity to begin to
fulfill the noble goal of a Blue Mountain College education, doing God’s
work on earth in service to all his children.
Today, at this Relay for life ‘pep rally,’ we need to celebrate with
those who have won their battle with the enemy cancer. We must
remember our loved ones who were not victorious in their personal war.
And we must join in the FIGHT with those of us who are still struggling
with cancer both personally and professionally each and every day.
Celebrate. Remember. Fight Back.
—dwalia South-Bitter, Md
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Life Insurance. Quickly.
Life Insurance. Quickly.
If you prefer personnaall service, Larry FortenGroup can give you straight answers you needCall1-888-285-9477 or visit MSMAqui
Life InsLife ILife I