December 2010 JMSMA

VOL. LI No. 12

December 2010

DECEMBER 2010 JOURNAL MSMA 348

SCIENTIFIC ARTICLESProlonged QTc Interval Due to Escitalopram Overdose 350Reema Mohammed, MD; John Norton, MD; Stephen A. Geraci, MD;

D. Brian Newman, MD; Christian A. Koch, MD, PhD

Clinical Problem-Solving: Can’t Catch my Breath 355Christopher J. Fort, MD

PRESIDENT’S PAGEUp in Smoke 357Tim J. Alford, MD, MSMA President

SPECIAL ARTICLEMississippi College Commences State’s First Physician Assistant Program 362Karen A. Evers, Managing Editor

EDITORIALSMany Good Things Are Happening at our MSMA 358Lucius M. Lampton, MD, Editor

Creating a Better Climate for the Nation’s Health Care Could Make 360Champions of all PhysiciansWilliam Lineaweaver, MD

RELATED ORGANIZATIONSMississippi State Department of Health 354

MSMA 365

MSMA Alliance 373

DEPARTMENTSPhysicians’ Bookshelf 367

Images in Mississippi Medicine 372

The Uncommon Thread 374

Placement/Classified 375

INSTRUCTIONS FOR AUTHORS 376

INDEX: VOLUME LI 378

ABOUT THE COVER:“ST. JOHN THE BAPTIST”—Robert B. Brahan, MD, an internist in

Hattiesburg, took this photo of John the Baptist at St. Mary’s Basilica inNatchez. The historic Roman Catholic cathedral was undergoing exteriorrenovation which allowed Dr. Brahan to use the scaffolding to frame theiconic statue. Recognized as an architectural masterpiece among Catholicchurches in the South, it is the spiritual home of a vibrant St. MaryCatholic community today. �

DECEMBER 2010 VOLUME 51 NUMBER 12

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2010December

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Medical Assurance Company of Mississippi

“ “Louise A. Gombako-Amos, MD

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Background: Drugs most commonly responsible for theacquired form of long QT syndrome are antibiotics and antide-pressants. Escitalopram overdose leading to prolongation of theQTc interval has only twice been previously described in the lit-erature.

Methods:We report a 33-year-old Caucasian woman whoattempted suicide by ingesting 15-20 pills of lithium (300 mgeach), 15-20 pills of escitalopram (20 mg each), and alcohol.An electrocardiogram (ECG) on admission to the medicinetelemetry unit showed a QTc prolongation of 491 ms and nor-mal sinus rhythm. Repeat ECG 18 hours after admission showeda QTc of 502 ms and sinus bradycardia. Serial ECGs were con-tinued with the following results of QTc/hours after admission:499 ms/2, 485 ms/25 (> 1 day), 469 ms/41, 461 ms/71, 476ms/97 (> 4 days).After the QTc interval had declined to 461 msafter more than 2 days (71 hours), the patient was transferred tothe inpatient psychiatry ward service.

Conclusions: Prescribers may wish to exercise cautionwhen administering escitalopram to patients who have suicidalideations and depression. In the event of an overdose, QT pro-longation can occur and ECG monitoring should take place forat least 2 days after ingestion in order to prevent life-threaten-ing arrhythmias such as torsades de pointes (tdp). Other factorsand drugs that could contribute to prolongation of the QT inter-val should be taken into account when determining the time pe-riod needed for ECG monitoring in the individual patient.

KEY WORDS: PROLONGED QT, ESCITALOPRAM, SUICIDALIDEATION, DEPRESSION, ELECTROCARDIOGRAM,TORSADES DE POINTES

INTRODUCTIONLong QT syndrome (LQTS) occurs due to an irregularity

in cardiac repolarization because of defects in the ion channels.1

Torsades de pointes (tdp) or “twisting of points” may subse-quently develop, leading to palpitations, syncope, seizures, andeven sudden cardiac death. Tdp is a form of ventricular tachy-cardia in which the heart beats too fast and blood flow to thebrain is compromised leading to sudden loss of consciousnessand other complications. A QT interval above 440 ms is con-sidered prolonged. Two forms of LQTS have been described:inherited and acquired. Two phenotypic variants of inheritedLQTS are Jervell, Lange-Nielson and Romano-Ward syndrome.On the other hand, the acquired form of the disorder is due to theadministration of medications.1,2,3,4 Genetic polymorphismsleading to differences in metabolism may increase or decreasesusceptibility to drug-induced LQTS. Drugs most commonly re-sponsible are antibiotics and antidepressants. Other causes ofacquired LQTS are heart disease, neurological disorders, HIVinfection, eating disorders and electrolyte disorders (hy-pokalemia, hypomagnesemia, and hypocalcemia). CorrectedQT (QTc) is defined as QT interval divided by square root ofRR interval. It is the QT interval adjusted for heart rate and isused commonly when measuring QT.1

Here we report a case of 33-year-old white female whoattempted suicide by ingesting lithium, escitalopram, and alco-hol. She had a history of bipolar disorder for at least 10 years.Escitalopram is the generic name for Lexapro. Escitalopram isthe active enantiomer (s-enantiomer) of citalopram.4 Both ofthese drugs are selective serotonin reuptake inhibitors (SSRI)and are used in the treatment of depression and generalized anx-iety disorder. Since it is a fairly new drug (FDA-approval inAu-gust 2002), there is limited data on escitalopram as opposed tocitalopram. The similarities between the two drugs and resultingtoxicities are of importance. The dose of escitalopram is 10 mgonce daily initially and can be increased to 20 mg after oneweek. It is supplied in tablet form as 5 mg, 10 mg, 20 mg, or asoral solution (5 mg/5 ml). It is said that 10 mg of escitaloprammay be equivalent to 40 mg of citalopram (http://www.fpnote-book.com). Compared to tricyclic antidepressants, SSRIs have

• SCIENTIFIC ARTICLES •


Prolonged QTc Interval Due toEscitalopramOverdose

Reema Mohammed, MD; John Norton, MD; Stephen A. Geraci, MD;D. Brian Newman, MD; Christian A. Koch, MD, PhD

AUTHOR INFORMATION: Dr. Mohammed is presently a resident in the Dept. ofPediatrics at the University of Mississippi Medical Center. Dr. Norton is anassociate professor in the Dept. of Psychiatry at UMC. Dr. Geraci is aprofessor of medicine in the Dept. of Medicine at UMC. Dr. Newman ispresently a resident in the Dept. of Medicine at the Mayo Clinic, Rochester,Minnesota. Dr. Koch is director of the division of endocrinology at UMC.

CORRESPONDING AUTHOR: Prof. Dr. med. habil. Christian A. Koch, FACP, FACEDirector, Division of Endocrinology, Dept. of Medicine, University ofMississippi Medical Center, 2500 N. State St., Jackson, MS 39216. Phone:(601) 984-5495 Fax: (601) 984-5769 E-mail: [email protected]

ABSTRACT

few and different adverse effects. However, increasingly morecases of SSRI overdose causing severe side effects are being re-ported. For citalopram and escitalopram, these effects are due tothe metabolites of citalopram and escitalopram. Both of thesedrugs are metabolized in the liver, and the metabolites producedare didesmethylcitalopram (DDCT) and desmethylcitalopram(DCT).

5DDCT is considered the cardiotoxic metabolite and

comprises less than 10% of citalopram’s metabolites. As thetotal amount of overdose increases, the potential for cardiotox-icity increases significantly. In the liver, biotransformation is ac-complished by the isoenzymes (CYP = Cytochrome P450)CYP2C19, CYP3A4, and CYP2D6. Patients who are known tobe poor metabolizers, especially due to polymorphisms ofCYP2C19 or those who suffer from hepatic dysfunction, mayexperience varying degrees of toxicity. The hepatic and renalroutes excrete escitalopram and its metabolites.6

CASE REPORTA 33-year-old white female took 15-20 pills of lithium

(300 mg each) one night with the intention of committing sui-cide. Upon waking the next morning, she took 15-20 pills of es-citalopram (20 mg) amounting to an approximate maximumdose of 400 mg. She also drank alcohol (6 wine coolers madefrom wine and fruit juice, each bottle containing 355 ml of fluid)during the night. By the time she was brought to the emergency

department, it was at least a few hours since her last drug in-gestion. She was found to have altered mental status and waslethargic but arousable, sometimes even combative. Due to thetime lapse, charcoal was not administered. There was no historyof coronary artery disease or heart disease in herself or in anyfamily members.

An ECG on admission showed a QTc prolongation of 491ms and normal sinus rhythm. The patient was monitored ontelemetry at the general internal medicine service. Repeat ECG18 hours after admission showed a QTc of 502 ms and sinusbradycardia (Fig.1a and Fig. 1b). Serial ECGs were continuedwith the following results of QTc/hours after admission: 499ms/2, 485 ms/25 (> 1 day), 469 ms/41, 461 ms/71 (> 2 days),476 ms/97 (> 4 days). After the QTc interval had decreased to461 ms, the patient was transferred to the inpatient psychiatryward service.

A lithium blood level upon admission was 1.0 mmol/L(normal range: 0.5-1.5 mmol/l). Therefore, lithium toxicity wasan unlikely cause of her ECG changes although lithium intoxi-cation can occur with normal lithium serum concentrations.7 Itwas determined that the most likely cause of QTc prolongationwas escitalopram overdose. Unfortunately, we could not meas-ure serum levels of escitalopram or of its major metabolite,DDCT. The patient was provided general supportive care sinceno antidote is known. Further laboratory tests revealed her al-

351 JOURNAL MSMA DECEMBER 2010

Fig 1b: ECG 18 hours after admission. Ventricular rate was 53 bpm, QTc, 502 ms.

• SCIENTIFIC •

Fig 1a.

Fig 1a: ECG on admission. Arrows indicate the QT interval. Ventricular rate was 63 bpm, QTc, 491 ms.

Fig 1b.


bumin and liver enzymes were within normal limits, indicatingabsence of liver damage and normal protein-binding ability.This is of importance because escitalopram is mainly metabo-lized in the liver and 56% of it is bound to human plasma pro-teins.

6Other laboratory values pertinent for the QTc interval

were potassium 4.0 meq/l (normal range: 3.5-5.1), calcium 9.2mg/dl (normal range: 8.4-10.2), and magnesium 1.6 meq/l (nor-mal range:1.3-2.0). Serum sodium was normal (142 mmol), al-though hyponatremia can be seen in patients taking citalopramor escitalopram.8,9 TSH was 2.2 uUI/ml (within normal range).

The patient had a history of numerous suicide attempts inthe past and continued to have suicidal ideation. Therefore, shewas transferred to the psychiatry unit for further medical care 71hours after admission when QTc was 461 ms. She was started onduloxetine (cymbalta) and quetiapine (seroquel).

DISCUSSIONEscitalopram is used therapeutically for major depression,

generalized anxiety disorder, and social anxiety disorder. It isnot recommended for children and adolescents under the age of18 years due to absence of concrete data in this age group, al-though one recent report points out a prolonged QTc interval ina 14-year-old girl.10 Risk of commiting suicide increases withthe use of escitalopram. However, untreated depression in-creases the risk of suicide as well. Frequent monitoring for sui-cidal ideation is recommended in patients being treated with thisdrug and suffering from depression. Other side effects reportedwith the use of escitalopram are hemorrhage, hyponatremia, in-somnia and mania.6,8 However, clinically significant cardiac ab-normalities and ECG changes have only been reported twicewith escitalopram overdose.10,11 An association between citalo-pram and QT prolongation and torsades de pointes has beenshown in studies with dogs and humans.2,12 The cardiotoxicmetabolite DDCT was reported to be the cause. Electrocardio-graphic changes and seizures have been noted above doses of600 mg of citalopram: generalized convulsions are seen in 33%and wide QRS complexes are seen in 33%.12 Because escitalo-pram toxicity has not been well-documented, caution should beexercised when prescribing escitalopram alone or in combina-tion with other medications that may prolong the QTc interval,especially psychotropic drugs. If an overdose occurs, it is diffi-cult to monitor levels of escitalopram in the serum/plasma.5,13

Hence, ECG monitoring for QTc interval prolongation mayserve as a surrogate marker for escitalopram toxicity. Fluo-rimetry has recently been found to be suitable for assessingplasma levels of citalopram and escitalopram.13 With thatmethod, fluorescence spectra of drugs, for instance citalopramand escitalopram, are measured utilizing a spectrofluorimeter asthe fluorescence spectra of these drugs are unique.

Cytochrome P450 (CYP) isoenzymes located in the liverare responsible for oxidative metabolism of many drugs.CYP2D6 and CYP2C19 are specific types of CYP isozymeswhich are mainly involved in metabolizing antidepressants andantipsychotics. Various genetic and environmental factors can

either inhibit or induce metabolism by influencing the CYP sys-tem. As a result, unexpected toxicities can develop. Geneticvariations can result in individuals being either extensive me-tabolizers or poor metabolizers. Poor metabolizers are morelikely to develop toxicity due to the drugs not being adequatelybiotransformed. In order to assess and predict the metabolicidentity of an individual patient, further phenotypic profilingshould be undertaken.

Environmental factors include drug-drug interactions thatcould lead to inhibition or induction of the cytochrome system.

18

In this patient, co-ingestion of other drugs (lithium) and alcoholmay have played an important role in the metabolism of esci-talopram. Alcohol is known to influence hepatic enzymes in-volved in drug metabolism.14 This patient consumed 6 winecoolers (unknown quantities [grams] of alcohol) throughout thenight before ingesting escitalopram. This may have affected thecytochrome system and escitalopram metabolism, contributingto the QTc-interval prolongation. The patient also consumedlarge quantities of lithium. Cases of lithium overdose leading toincreased QTc-interval have been reported, but by the time thispatient was seen at the hospital, her lithium levels were withinnormal range.15 However, since lithium enhances the serotoner-gic effects of escitalopram, it is important to monitor lithiumlevels closely, considering its half life of 22 hours. In addition,signs of lithium intoxication can be seen even in the setting ofnormal lithium serum concentrations.7 When analyzing theSwedish pharmacovigilance database, Astrom-Lilja et al16 re-cently found that tdp is an infrequently reported adverse drug re-action and that several (additional) risk factors are usuallypresent including heart disease, age over 65 years, and femalegender. Interestingly, according to these authors, in two thirds ofthe medications (with citalopram being the third most commonsuspected drug) implicated in the reports of this database, nei-ther QT prolongation nor tdp were labelled in the summary ofproduct information.16

Isbister et al17 developed a management protocol for QTabnormalities after citalopram overdose. The same principlesshould apply to escitalopram overdose since the cardiotoxicmetabolite (DDCT) is the same. In a person with QT changes,it is beneficial to give single-dose activated charcoal (SDAC)within 4 hours of overdose and monitor QT until it is normal.For patients who have ingested a high dose (more than 1000mg), SDAC should be given within 4 hours and cardiac moni-toring continued for 13 hours after ingestion even if QT remainsnormal. For patients with an overdose between 600-1000 mg,SDAC should be given within 4 hours; if it is not, cardiac mon-itoring is recommended for 13 hours.17 Considering the amountof escitalpram ingested (approx. 400 mg with 10 mg escitalo-pram said to be equivalent to 40 mg of citalopram) and the timelapse, our patient most likely falls within this last category.

CONCLUSIONIn summary, escitalopram overdose leading to QTc-inter-

val prolongation and potentially life-threatening arrhythmia has


only twice been previously described but increased awareness isneeded, especially considering the now widespread use of suchmedications. Prescribers may wish to exercise caution when ad-ministering escitalopram to patients who have suicidal ideationsand depression. In the event of an overdose, administration ofcharcoal and ECG monitoring for at least 2 days after ingestionare recommended in order to prevent life-threatening arrhyth-mias like torsades de pointes. Other factors and drugs that couldcontribute to prolongation of the QT interval should be takeninto account when determining the time period needed for ECGmonitoring in the individual patient.

REFERENCES1. Berul CI, Seslar SP, Zimetbaum PJ, et al. Acquired long QT

syndrome. UpToDate 2008:16.1.2. Blaschke D, Parwani AS, Huemer M, et al. Torsades de points

during combined treatment with risperidone and citalopram.Pharmacopsychiatry 2007;40:294-295.

3. Pliquett RU, Eichfeld U, Stumvoll M, Koch CA. Long QT syn-drome under mitotane therapy. J Endocrinol Invest.2007;30:167-168.

4. Reilly JG, Ayis SA, Ferrier IN, et al. QTc-interval abnormalitiesand psychotropic drug therapy in pychiatric patients. Lancet2000;355:1048-52.

5. Reis M, Cherma MD, Carlsson B, et al. Therapeutic drug moni-toring of escitalpram in an outpatient setting. Ther Drug Monit.2007;29(6):758-766.

6. Escitalopram: Drug information. UpToDate 2008:16.1.7. Habermeyer B, Hess M, Kozomara-Hocke P, et al. Lithium in-

toxications at normal serum levels. Psychiatr Prax.2008;35(4):198-200.

8. Covyeou JA, Jackson CW. Hyponatremia associated with esci-talopram. N Engl J Med. 2007;356(1):94-5.

9. Miehle K, Paschke R, Koch CA. Citalopram therapy as a riskfactor for symptomatic hyponatremia caused by the syndrome ofinappropriate secretion of antidiuretic hormone (SIADH): a casereport. Pharmacopsychiatry 2005;38(4):181-2.

10. Scharko AM, Schumacher J. Prolonged QTc interval in a 14-year old girl with escitalopram overdose. J Child Adolesc Psy-chopharmacol. 2008;18(3):297-298.

11. Baranchuk A, Simpson CS, Methot M, et al. Corrected QT inter-val prolongation after an overdose of escitalpram, morphine,oxycodone, zopiclone and benzodiazepine. Can J Cardiol.2008;24(7):e38-40.

12. Catalano G, Catalano MC, Epstein MA, et al. QTc interval pro-longation associated with citalopram overdose: a case report andliterature review. Clin Neuropharmacol. 2001;24(3):158-62.

13. Serebruany V, Malinin A, Dragan V, et al. Fluorimetric quantita-tion of citalpram and escitalpram in plasma: developing an ex-press method to monitor compliance in clinical trials. Clin ChemLab Med. 2007;45(4):513-520.

14. Miners JO, Birkett DJ. Cytochrome P4502C9. an enzyme ofmajor importance in human drug metabolism. Brit J Clin Phar-macol. 1998;45(6):525-538.

15. Mamiya K, Sadanaga T, Sekita A, et al. Lithium concentrationcorrelates with QTc in patients with psychosis. J Electrocardiol.2005;38(2):148-51.

16. Astrom-Lilja C, Odeberg JM, Ekman E, et al. Drug-induced tor-

sades de pointes: a review of the Swedish pharmacovigilancedatabase. Pharmacoepidemiol Drug Saf. 2008;17(6):587-592.

17. Isbister GK, Friberg LE, Duffull ST. Application of pharmacoki-netic-pharmacodynamic modelling in management of QT abnor-malities after citalopram overdose. Int Care Med.2006;32:1060-1065.

18. Schrauzer GN, Shrestha KP. Lithium in drinking water. Br JPsychiatry. 2010;196(2):159-60.

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• MSDH •

For the most current MMR figures, visit the Mississippi State Department of Health web site: www.HealthyMS.com

* Totals include reports from Department of Corrections and those not reported from a specific district.** Address unknown for 10 cases.

Mississippi Reportable Disease Statistics

September 2010

A55-year-old Caucasian female presented to theemergency department after being sent fromclinic with complaints of fatigue, persistent

cough, worsening shortness of breath on exertion and chestdiscomfort. The chest discomfort was described as severalweeks of intermittent pressure and tightness which radiatedinto her left shoulder and neck. The pain was worse with ac-tivity and better with rest.

In this patient, our differential diagnosis is broad. Multi-ple systems could be contributing to her symptoms, includingpulmonary, cardiovascular, gastrointestinal, hematological,musculoskeletal or endocrine. Since the symptoms seem to beassociated with the respiratory or cardiac system, I would ini-tially consider pulmonary or cardiac pathology. I would obtaina complete blood count, electrolytes, cardiac enzymes, D-dimerand chest radiograph.Additional history is needed to narrow thedifferential diagnosis.

The patient admitted to a history of smoking but hadnot smoked for over 30 years. She also denied any historyof asthma. The patient reported a history of bronchitis,which had developed into pneumonia within the previousyear. She was prescribed levofloxacin (Levaquin) andguaifenesin/dextromethorphan (Mucinex DM). Chest radi-ograph at that time did not show any focal infiltrates; how-ever, due to her leukocytosis, she was treated withantibiotics. She felt some improvement with the treatment;however, her symptoms never fully resolved. The patientwas seen in clinic 4 months later for limb and abdominalpain at which time she was taking ibuprofen. She was thenprescribed meloxicam (Mobic) and ibuprofen was discon-

tinued due to the abdominal pain. She was evaluated sev-eral months later for abdominal and chest pain.At the mostrecent visit, she had complained of abdominal pain and leftchest pain that radiated to her back. These symptomsstarted the night prior to evaluation and had slightly im-proved with over-the-counter omeprazole (Prilosec). The ab-dominal pain was thought to be due to esophageal reflux orgastritis. After examination, the chest pain was determinedto be musculoskeletal in nature, and she was continued onmeloxicam. She reported having a normal echocardiogramand treadmill stress test 5 years earlier for mid-sternal chestpain.

Our differential is still broad and further tests are required.The patient would benefit from further evaluation for possiblemyocardial infarct, congestive heart failure, pulmonary embo-lus and pneumonia. I will order an electrocardiogram, anechocardiogram and a chest radiograph. Though a myocardialinfarct needs to be explored, her past history suggests that thecause of her symptoms is most likely pulmonary related.

The patient’s cardiac enzymes were normal. Electro-cardiogram showed sinus tachycardia, nonspecific ST and Twave abnormalities and left atrial enlargement. There wasno ST elevation or depression. The patient reported wakingat night with shortness of breath which was relieved bysleeping in an upright position.

The electrocardiogram findings do not indicate an activemyocardial infarction; however, further history and studies arestill needed to investigate for myocardial infarction, congestiveheart failure or another cardiac pathology. The patient will needrepeat cardiac enzymes, and a possible cardiac stress test to fur-ther investigate for a myocardial infarction. This additionalsleep history suggests that her presentation could still be relatedto the cardiac or pulmonary system. These symptoms suggestpossible congestive heart failure, pulmonary hypertension orpneumonia, all of which can cause similar symptoms.

• CLINICAL PROBLEM-SOLVING •

Can’t Catch my BreathChristopher J. Fort, MD

Presented and edited by the Department of Family Medicine, University of Mississippi Medical Center, Diane K. Beebe, MD, Chair

AUTHOR INFORMATION: Dr. Fort is a former resident in the Department ofFamily Medicine at the University of Mississippi Medical Center.

CORRESPONDING AUTHOR: Christopher J. Fort, MD; Mississippi Baptist MedicalCenter, 1151 N. State St., #504, Jackson, MS 392026. Ph: (601) 601-968-4155E-mail: [email protected].



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THAT YOU FOUND THEM IN THE

On physical examination the patient had an oxygensaturation of 97%while breathing room air. She was awake,alert and oriented to person, place and situation. She waswell developed and in no distress. Pulmonary examinationrevealed clear breath sounds in the bilateral lung fields. Car-diac and abdominal examinations were normal. She did nothave any signs of cyanosis or edema. However, it was notedthat the she was extremely short of breath with ambulationto her room. Her white blood cell count (WBC) was 13.6K/uL, and chest radiograph findings suggested a possible in-terstitial pneumonia. Her D-dimer was 0.81 ug/dL. Her com-prehensive metabolic panel (CMP) was normal. The patientwas given supplemental oxygen for comfort and levofloxacin(Levaquin) for the leukocytosis and suspected pneumonia.She was then admitted. The patient demonstrated someslight improvement over the following 2 days; however, hersymptoms had not completely resolved. Her leukocytosisalso resolved initially and then returned on day 3 with awhite blood cell count (WBC) of 12.5 K/uL.

At this point our differential is still broad, but her findingscontinue to suggest pneumonia. However, her elevated D-dimersuggests that she could also have a pulmonary embolus. A com-puted tomography (CT) will be ordered. The patient’s historyand physical examination lead to some additional considera-tions. Her diagnosis did not seem to be simply a bacterial inter-stitial pneumonia as she experienced no improvement withrepeated courses of antibiotic therapy.

On day 3 the patient was questioned regarding otherpossible exposures that could have contributed to her symp-toms. She reported spending much of her free time traininghorses. She worked in horse stalls that contained old, wet hay.

With this additional history, other causes of pneumoniasuch as blastomycosis or histoplasmosis are considered, as thiscould explain why she did not respond appropriately to antibi-otics. It was thought the patient would benefit from a futurebronchoscopy and serology for blastomycosis and histoplasmo-sis. Also needed are anti-neutrophil cytoplasm antibodies forWegener’s granulomatosis and angiotensin converting enzymeconcentration for consideration of alpha antitrypsin deficiency.

CT findings demonstrated mild patchy ground-glassinterstitial densities in the lower lobes, most prominent inthe right lower lobe. It also demonstrated a soft tissue at-tenuation lesion measuring 4.7 x 3.6 cm within the leftatrium. A cardiologist was consulted for further evaluationof the right atrial mass. The patient underwent an echocar-diogram that confirmed a left atrial mass encompassing theentire atrium. The cardiac ejection fraction was estimatedto be greater than 60%. The patient underwent surgerywithout complications and tolerated the procedure very well.The patient had a follow-up transesophageal echocardio-gram which demonstrated that the left atrial mass had beensuccessfully removed.

A definitive diagnosis of a left atrial myxoma is made. Itis now evident that this was most likely the cause of the patient’ssymptoms. A cardiac myxoma can cause decreased cardiac out-put and increased pulmonary edema, both of which can causeshortness of breath, chest pain, coughing and fatigue. It is alsobelieved that this was the cause of the interstitial lung changesand improvement will soon follow. Bronchoscopy will not bepursed, but follow up to evaluate for resolution of the interstitiallung changes is important.

Cardiac tumors are very uncommon occurring with a life-time incidence of 0.0017% to 0.02%; however, myxomas arethe most common type of cardiac tumors found in adults.

1,2,3Ap-

proximately 75% of primary tumors are benign and 50% of be-nign tumors are myxomas, resulting in 75 cases of myxoma permillion autopsies.4 The incidence of primary tumors tends to de-crease with age. Although cardiac tumors are more likely tooccur in females (61%) than males (39%),

2the frequency of pri-

mary tumors is found to be approximately 46% in men and 32%in women.5 The long term survival after myxoma resection isnot significantly different from that of the general population.

2

The patient continued to show signs of improvementand was stable enough to be discharged home. The patientwas scheduled to follow up with her primary care physician,pulmonologist, cardiologist and cardiovascular surgeon. Shehas been followed for 6 months and is currently undergoingcardiac rehabilitation with a low intensity exercise program.The patient’s symptoms have completely resolved, and she isdoing very well with no current complications.

KEY WORDS: CARDIAC NEOPLASMS, MYXOMAS,LEFT ATRIAL MASS, HEART FAILURE

REFERENCES:1. Silverman N. Primary cardiac tumors. Ann Surg.191:127–

138;1980.2. ElBardissi AW, Dearani JA, Daly RC, et al. Survival after resec-

tion of primary cardiac tumors: a 48 year experience. Circula-tion. 2008;118:S7-S15.

3. Gokhan I., Vedat E. Nilgun. et al. Surgical management of car-diac myxoma. J Card Surg. 2005;20:300-304.

4. McAllister HAJ, Fenoglio JJJ: Tumours of the cardiovascularsystem. Atlas of Tumour Pathology. 2nd Series. Washington,DC: 1977:122–124.

5. Bussani R, De-Giorgio F, Abbate A, Silvestri F: Cardiac metas-tases. J Clin Pathol. 2007;60(1):27-34.

When one of your dissecting partners from medical school calls and asks you tobe somewhere, you go— especially if she is the reigning State HealthOfficer. Dr. Mary Currier recently asked me to attend a meeting in Jackson.

I am not going to divulge the topic yet because you will stop reading at this point. The subjectat hand would be presented at the Blue Cross building in Jackson and the topic appeared to bea bit far-fetched. As I left the clinic to drive to Jackson, I mentioned the purpose of my trip toa clinic partner, and he was a bit skeptical about the pending discussion.

I had just heard Mississippi Public Radio’s news release of a 13% reduction inheart attacks in Hattiesburg as a result of its comprehensive smoking ban in 2007 inpublic places. My first thought was that this simply could not be correct and that theSocial Science Research Center’s (SSRC) data was off base. Even though we knowmany of the hazards of passive cigarette smoke exposure including lung cancer andincreased childhood illnesses, the whole idea has seemed like one of those public health abstractions that you really can’t domuch about. So now you know the rest of the story… But not really!

The featured guest at Dr. Currier’s meeting was Dr. Terry Pechacek, associate director of science in the Office onSmoking and Health at the Center for Disease Control’s Smoking Prevention Division. Dr. Pechacek also writes the SurgeonGeneral’s report and has concluded that there is an indisputable link between passive smoke and heart attacks , that the cause andeffect is much greater than previously thought. Due to the fact that Mississippi is the proverbial black hole of cardiovasculardeath in these United States, Dr. Pechacek believes that Mississippi would have the most to gain by enforcing a statewidesmoking ban in public places. Further that acute coronary syndrome often occurs only minutes to hours after exposure to secondhand smoke. He reminds us that second hand smoke also increases the risk of SIDS and low birth weight babies which issignificant since Mississippi continues to hold the dubious distinction of the highest infant mortality rate in the United States.

The Surgeon General is soon to release this alarming information. For those who would say that our public health friendsare getting ahead of their data, Dr. Pechacek reminds us that the Surgeon General has never had to “take back a report.” TheSSRC has compiled statistics which show marked reduction in admissions for heart attacks in communities that haveimplemented a comprehensive smoking ban in public places. Liz Sharlot, spokesperson for the Mississippi State Department ofHealth, is running a bedazzling information and media campaign, taking into account that the deep claws of nicotine addictionhave found safe haven in the culture of the southeastern United States. The secret weapon in this campaign is the “voice ofchildren” who are often the best ambassadors for unseating immovable prejudices within our culture.

The goal is to complete a two-year campaign that will inform Mississippians about the benefits of smoke-free air, educateresidents about the harmful effects of breathing secondhand smoke, and support a comprehensive Mississippi smoke-free air law.Other Mississippi health advocate organizations are partnering with MSDH to help with the Smoke Free Air Mississippicampaign. The campaign will include extensive grassroots efforts, a statewide media campaign, and collaboration with keypartners to support the passage of a comprehensive smoke-free air law. Check out the campaign at:http://www.smokefreeairms.com.

So, as a member of this Association you are asked to endorse the enactment of a statewide comprehensive smoke-free airlaw for Mississippi that will restrict smoking in all public indoor environments and workplaces, thereby protecting the health ofall Mississippians. This will represent a huge step in addressing the problem of too many preventable deaths across the age andgender spectra. We will work with our elected officials to this end and need your help to promote a Smokefree Air Mississippi in2011!

References:http://www2c.cdc.gov/podcasts/player.asp?f=10294http://mstobacco.childhealthdata.org/DataQuery/SurveyAreas.aspx.

• PRESIDENT’S PAGE •

Up in Smoke

TIM J. ALFORD, MD2010-11 MSMA PRESIDENT


TheMSMABoard of Trustees has been hard at work on many matters of great importance to our membership. At itsmost recent gathering on September 10 and 11 at MSMA headquarters in Ridgeland, the board welcomed a newchairman and discussed matters ranging from a record jump in membership to plans for an innovative website. At

the end of the Natchez annual session on June 6, Dr. James A. “Jim” Rish of Tupelo was handed the chair’s gavel by Dr. SteveDemetropoulos of Pascagoula. Although many perceive the presidency as our association’s top position, the constitution and by-laws bestow the board chair more actual power and responsibility, and it is easily the most important position of all of theassociation leadership. Dr. Demetropoulos had served several terms as chair with distinction, leading our MSMA through manytrying and difficult issues. Rish, a pulmonologist and critical care specialist, is known for his ubiquitous bow tie, his sharpintellect, and his calm and reassuring manner. Jim will fill Steve’s big shoes as chair with similar grace and integrity. The boardusually meets in August but this year moved its quarterly meeting to September with several new board members, Dr. DwightKeady of Meridian, Dr. Bill Grantham of Clinton, and Dr. Brent Smith of Jackson, in attendance with the rest of the board and itsinvited guests. Dr. Daniel Edney of Vicksburg, who has served our association in many important capacities, is the new vice chairof the board, and Dr. Claude Brunson of Jackson is the board’s new secretary (not to be confused with the MSMA officer positionof secretary-treasurer, now held by Dr. Clay Hays of Jackson).

The membership report is certainly deserving of mention. The association totals 4,618 members, up 909 from 3,709 in2009. This is an historic number, the highest number of members ever for our MSMA as well as one of largest percentages ofmembership of total physicians for any state association currently. (According to 2009 numbers, Mississippi has 5,606 licensedphysicians; thus more than 82% of the state’s physicians are members!) Large jumps were seen in all areas of membership: paidactive members, up 351; student members, up 163; and resident/fellow members, up 401. In June, the board had votedunanimously to waive all dues requirements for medical students, residents, and fellows living in Mississippi. Thus, student andresident increases can be explained by this action. However, a significant increase was also seen in active and paid members, andthere is no doubt that this increase is directly the result of our association’s deunification with the American Medical Association(AMA). Those against deunification, including this writer, had pointed to membership declines resulting from similar action inother states. Such had been the experience nationally. But Mississippi bucked that trend. That action not only attracted manymembers who wanted local membership without belonging to the AMA, but also lowered dues prices enough for the UniversityMedical Center’s physicians to join as a group. UMC leadership had long expressed a desire to increase faculty membership inMSMA, and the AMAmembership requirement made such cost prohibitive. MSMAmember Claude Brunson, with the assistanceof MSMA staff, crafted agreements which brought into our association most of the UMC faculty.

Anna L. Morris, our new director of external relations, revealed at the board meeting many creative ideas to invigorate theassociation’s electronic capabilities and fund-raising efforts. “Anna has been on board only for two and a half months and alreadyhas moved us so far ahead,” said Charmain Kanosky, MSMA executive director. Morris gave an exciting presentation on ourupdated website which includes at our board’s request online venues giving Mississippi docs an electronic forum to discuss hotissues affecting the practice of medicine in a members-only format. A similar online forum was offered earlier this year as a wayfor our membership to post comments on the annual session House of Delegates resolutions. Dr. Rish summed up the feeling ofthe board that this would be “a great tool” for our physicians to communicate and discuss issues of importance. Many rememberwith appreciation the blog created by Dr. Ben Kitchens of Corinth during the tort reform crisis and hope that similar energy will


• EDITORIALS •

Many Good ThingsAre Happening at our MSMA

Lucius M. Lampton, MD, Editor


be stimulated by the new forum. Also, a new “job bank,” patterned after a similar one on the Iowa Medical Society’s website, wasintroduced. This job bank will have the appearance of classified ads and allow people to submit jobs through the site and searchfor jobs by specialty. There was also discussion of a media campaign to influence the public to encourage Congress to fix thedysfunctional SGR formula which annually has physicians facing 20% cuts. An extensive campaign was felt too expensive by theboard, but they did vote to prepare a $25,000 media campaign to communicate to the state’s citizens that the SGR formula isbroken and Congress refuses to fix it.

Significant board discussion was held on where to have our annual sessions in the future. Most felt this year’s session inNatchez was a grand success, not necessarily in numbers of attendance (which was almost 300) but in terms of satisfaction ofthose who attended the events, the CME, and the family friendly activities. “If you want young blood, you have to be sure that thesession is family oriented,” said Dr. Grantham. Sadly, numbers reached their highest at annual session in Biloxi before Katrina (in2005 more than 350 physicians attended annual session). A 2007 resolution was passed which requires the annual session to beheld within the state’s borders, and a 2008 resolution was passed requiring the annual session site to be smoke-free, eliminatingmost of the hotels on the Coast. There is also sentiment on the board to rotate the annual session site around the state.

Tupelo is next year’s gathering place. However, the board has changed the dates for the meeting due to scheduling conflictswith the 2011 graduation of the University of Mississippi School of Medicine. Tupelo’s BancorpSouth Conference Center and theadjacent hotel were able to accommodate a change for the meeting to be held May 19 to 23, 2011. Problems have emerged withthe 2012 annual session in Hattiesburg. The only dates the Hattiesburg Convention Center had available were Memorial Dayweekend which most of the board felt would negatively impact attendance. Dr. Clay Hays was asked to lead a board appointedgeographically diverse committee to explore locations and dates of the 2012 meeting. Also, there was a suggestion to exploreasking the House of Delegates to reconsider the in-state requirement for all annual sessions.

Since this September meeting, the board has discussed on phone conferences the establishment of a relationship with DeltaHealth Alliance to help implement health information exchange under the Beacon grant. Says Dr. Alford, “This will help facilitatecommunication between physician offices and hospitals.”

One final item discussed by the board was the creation of the first ever “Give-Back Gala” to be held December 3. Thisbenefit for the MSMA Foundation will be held that Friday from 7 p.m. to 11 p.m. at the Trustmark Ballroom of the JacksonConvention Center Complex. The black tie event will feature cocktails, dinner, dancing, and live jazz entertainment. The $500 percouple cost is a tax deductible donation to the MSMA Foundation, and members can designate the gift to such deserving causes asthe Rural Physicians Scholarship Program, the Journal MSMA, or the Mississippi Professionals Health Program.

NEW IN OUR JMSMAJournal MSMAAssociate Editor Dr. Rick deShazo has developed guidelines for two new features our JMSMA will

introduce in the New Year:

1. “UpToDate” series - The purpose of this series of articles is to provide to practicing physicians ofMississippi brief reviews on topics of general interest in areas where recent developments in diagnosis ortreatment have occurred. For instance, an article on recent advances in the diagnosis and treatment of lupuserythematosis would be an appropriate submission.

2. “Top Ten Facts You Need to Know” series - The purpose of this series of articles is to providereferenced information on clinical management of medical conditions in a concise fashion. The submissionsshould be directed toward practitioners who do not have specialty training on the specific topic as a matter ofgeneral information. The author of the best “top 10” submission for each year will receive a prize.

All articles should be forwarded to the Editor for peer review using the usual guidelines in the “Information for Authors,”found on page 376 of this issue or at MSMAonline.com. While you’re on the MSMAwebsite, be sure and check out the flip-through pages of your JMSMA online too. Your editors hope you like the clean pages and rapid loading of searchable online issuesand find the website's reading pane easy to navigate.

As this journal arrives at your offices, the board will be gathering again on December 4th for its winter meeting at theMSMA headquarters. The Committee on Publications, chaired by the gracious Dr. Dwalia South of Ripley, will also be gatheringthat weekend to select photographs for next year’s journal covers. Many good things are happening at your MSMA. Become moreinvolved in your association: attend annual session and your local component society meetings, give to the worthy causes of theMSMA Foundation, write a letter to the editor or submit an article to your JMSMA, serve on one of MSMA’s councils orcommittees, or serve as a doctor of the day for the Legislature! Come be an active part of Mississippi’s medical family!�


Creating a Be$er Climate for the Nation’s HealthCare Could Make Champions of all Physicians

William “Bill” Lineaweaver, MD

Myoffice fax machine recently delivered a series of messages. They required some assembly. When put togetherin apparent order, the story went as follows:

A prominent national figure, whose hairstyle and vigorous use of categoricals and non-sequitors have influenced countlessaspiring politicians, serves as the “General Chairman” of an entity entitled “American Solutions for Winning the Future.” TheGeneral Chairman wrote a memo to a more operational executive of the committee announcing that I had “made the cut as one ofour 2010 Champions of Medicine.” At the bottom of this memo, in a handwritten addendum addressed to me, the operationalexecutive congratulated me, informing me that a table was reserved at the awards ceremony “so your guests will have a greatview of you receiving the award.”

I was dazzled. I could not imagine what selection process singled me out for such distinction. I envisioned my virtues as adoctor spontaneously emanating from my Mississippi office to win recognition at high national levels.

Next in line was a photograph of a very professional desk holding a world globe and a handsomely framed certificate. Thecertificate stated that “American Solutions hereby recognizes Dr. William Lineweaver as 2010 Champion of Medicine inrecognition for succeeding in the face of adversity and economic turmoil.” The minor misspelling of my name did not detractfrom my gratitude for being congratulated upon surviving the economic catastrophes of 2006-2008 with retention of my homeand over 60% of my retirement investment funds. Amessage superimposed on the picture stated “this would look great in youroffice!”

The next document was an “agenda and itinerary” for the Champions of Medicine Ceremony. The full day’s scheduleincluded a Business Roundtable, a Meet and Greet event with the General Chairman (including photo opportunities), a dinner inthe “historic and intimate Reagan Ballroom” (chestnut and artichoke risotto, beef tenderloin with potatoes, wild mushroomfricassee, truffle sauce, and more), several hours of speeches, participation in a nationwide election night broadcast (“You’ll bepart of the broadcast….”) and, finally, “exclusive networking opportunities with….top business owners.”

I felt more and more honored as these details unfolded.Finally, there was a personal memo to Dr. Lineweaver from the General Chairman himself. He kindly reiterated the

distinctions conferred upon me by this award and its ceremony. One paragraph, however, startled me.I know how difficult this year has been with the uncertainty caused by the Obama Administration and the

Democrat held Congress essentially dismantling the world’s greatest healthcare system and replacing it withthe failed model of socialized medicine. As I have stated since the day after ObamaCare was passed, “THISWILL NOT STAND.”

As grateful as I was for the General Chairman’s recognition of my achievement, I was worried that he might be proceedingto make statements that would be embarrassingly mistaken. I understand that such a person as the General Chairman must relyon staff research for analysis of complex issues, and sometimes such secondary sources can go awry. I proceeded to forwardsome supplementary information to him to give him a chance to perhaps revise some statements. Given his generous recognitionof me, I thought such a service was the least I could do.

In calling the U.S. health care system “the world’s greatest,” it really is necessary to account for this system’s staggeringlyhigh costs, part of which are results of insurance company overhead and profits. Relative to many other countries, the U.S.system has depressingly low outcomes in many areas including infant mortality and life expectancy. While the U.S. health caresystem has many remarkable features, there seems to be room for improvement in many areas.1

What the General Chairman called ObamaCare must be the Patient Protection and Affordable Care Act. Despite a blizzardof collateral national debate and perhaps some imprecise staff work underlying the General Chairman’s statements, this piece oflegislation does not clearly dismantle or socialize anything. Generally, the act serves as a regulation of the insurance industry. Itsprovisions include:1

• Mandated individual insurance purchasing, with associated exemptions and subsidies;

• GUEST EDITORIAL •


Feel the BurnExercise at a moderate intensity to get the most benefit from your workout. A light sweat, fasterbreathing and some strain in your muscles are all good indicators you’re exercising effectively.

If you have a health condition or any other physical barrier, it’s a good idea to talk to

your doctor before you begin.

be healthy. exercise.

www.bcbsms.com

Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company, is anindependent licensee of the Blue Cross and Blue Shield Association.

® Registered Marks of the Blue Cross and Blue Shield Association, an Associationof Independent Blue Cross and Blue Shield Plans.

• Expansion of Medicaid eligibility and increased reimbursement rates for services;• Establishment of Health Insurance exchanges which will provide standardized formats for insurance policies,

centralized enrollment, and options for group enrollments;• Prohibition of pre-existing condition exclusions for children, rescission (coverage cancellations during illness),

and lifetime amount limits for specific illnesses.I bundled up a set of my previous editorials covering these topics and sent them to the General Chairman.2-4 I hope they

gave him additional resources to contribute to balanced, un-embarrassing statements on health care.Sadly, I was not able to attend the ceremony. As an old-fashioned voter, I still need to go to my neighborhood fire station to

cast my ballot on election day, the day of the ceremony. Also, I was scheduled to take call that day.During call, I have some great advantages relative to patient evaluation. I practice within a business model that identifies

my specialty patients as a group. The group’s overall economic performance is the determinant of the financial viability of thepractice. 5,6 Most recently, my definition of my practice (microsurgery and complex reconstruction) has extended to burns, andmanagement of these cases now represents 50% of my practice. Remarkably, the state’s only trauma center refuses to treat thesepatients, and they have fit comfortably into the scope of my practice interests. Within these defined clinical areas, my hospital andparent practice group allow me to accept patients according to their medical need without economic screening. The overallpractice generates satisfactory income for the principals, and I do not have to formulate a business plan for each referral. Workingto create such a practice environment really does make me feel like a Champion of Medicine. Creating a similar climate for thenation’s health care could make champions of us all.REFERENCES1. Connors E, Gostin L. Commentary: Health care reform. JAMA 2010;303:2521-2522.

2. Lineaweaver W. Is health care a commodity? Ann Plast Surg. 2009;61:1-2.

3. Lineaweaver W. Health care reform: Some scenes from the cheap seats. Ann Plast Surg. 2010;63:363.

4. Lineaweaver W. Old deals, new deals. Ann Plast Surg. 2010;64:266-267.

5. Lineaweaver W, Hui K, Krave K, Mailhot C. Economics of microsurgical cases and routine cases in a medical center. Plast Reconstr Surg. 2000;105:46-54.6. Lineaweaver W, Rogers B, Oswald T. Hospital income from patients managed through a Center for Microsurgery and Complex Reconstruction. Ann Plast

Surg. 2008;60:573-578.


Before the thoughts of mid-levelprovider threat enter your mind,consider this: According to a study by

the American Medical Association, solo practicephysicians who employ physician assistants (PAs)are able to work one week less per year on averageand provide greater access to care for theirpatients. “Physician assistants can lighten theworkload considerably, giving physicians moretime to do what they need to do,” says Dr. RobertPhilpot, Chairman of the Department of PhysicianAssistant Studies at Mississippi College (MC) inClinton.

“The primary mission of the MississippiCollege Physician Assistant Program (MCPAP) isto prepare physician assistants to provide primaryhealth care services in medically underserved areasof Mississippi and surrounding states. As part ofthe health-care team, PAs allow physicians toextend their office hours. The capstone clinicalexperience places students in primary caresettings. Many of those will be with potentialemployers in underserved areas,” Dr. Philpot said.

“One of the greatest challenges forphysicians in medically underserved areas is thelack of time to meet the needs of all of the patients.PAs can help the physician find more time,whether it’s for research and special cases orpersonal and family time. As part of the medicalteam, a PA can provide patients with qualitymedical care on a daily basis with limitedsupervision,” he said.

According to the Medical GroupManagement Association (MGMA), PAs generaterevenues well beyond the cost of their paychecks.A 2009 study by the MGMA revealed that forevery dollar generated for PA care, the employerpaid an average of 30 cents to employ a PA.

Studies conducted by the Kaiser PermanenteCenter for Health Research found patientsatisfaction levels with PAs high, ranging in the90th percentile. “When hospitals and privatepractices have one or more PAs on staff, themedical team can serve significantly more patientsin a day, expand office hours to serve workingfamilies, or extend practice by opening satelliteoffices. PAs can diagnose patients, write

Mississippi College CommencesState's First PhysicianAssistant Program

• SPECIAL ARTICLE •

Karen A. Evers, Managing Editor

DR. RODERICK "ROD" CUTRER, MCPAP MEDICAL DIRECTOR, AND DR. ROBERT "BOB"PHILPOT, PROGRAM DIRECTOR— Dr. Cutrer was born and reared in Magnolia. Aftergraduating from Mississippi College in 1972, he attended the University ofMississippi Medical School and completed his Family Practice Residency at UMMCin 1979. He has also served as an Adjunct Professor at the University of SouthernMississippi. Dr. Cutrer is Board Certified in Family Practice and has practicedmedicine for 31 years in Hattiesburg. Dr. Cutrer said, "For me, the PA educationmore closely resembles a condensed version of medical school than does any otherhealth professions curriculum. Within the Physician-PA relationship, PAs exerciseautonomy in medical decision-making and provide a broad range of diagnostic andtherapeutic services. Flexibility and a broad-based education makes the PAprofession very attractive to prospects, and even more so, to future employers."

Dr. Philpot, who heads the new initiative, earned a bachelor’s degree fromBelhaven University in 1983. A National Health Service Corps Scholar, he graduatedfrom the PA Program at Emory University College of Medicine in 1994. Hepracticed primary care medicine in medically underserved areas of South Floridauntil he was recruited to the PA Program at the University of Florida College ofMedicine in 1998. A retired military officer with 26 years of service, Dr. Philpotserved in Operation Iraqi Freedom and directed medical operations for the FloridaArmy National Guard during relief operations following the 2004 Florida hurricanesand Hurricane Katrina. He earned a PhD in Education from the University of Floridaand completed a Fellowship in Medical Education from the University of FloridaCollege of Medicine in 2006. Dr. Philpot recently served as the Chairman of theDepartment of Physician Assistant Studies at South University, providing oversightand supervision of PA programs in Savannah, GA and Tampa, Florida. OnSeptember 1, 2009, he was appointed as the Chairman of the Department ofPhysician Assistant Studies at Mississippi College in Clinton.

prescriptions, and counsel patients on preventive health strategies underphysician direction. Even in growing practices PAs can lighten theworkload considerably,” Dr. Philpot said.

Dr. Rod Cutrer, MCPAP medical director says his association withthe PA profession has been one of mutual respect and has led him toobserve some very positive attributes of a good PA. “They have a broad-based knowledge of most medical and surgical disciplines; they showexcellent judgment and have a good grasp of their limitations; they are theultimate team-players and as a group are humble; and probably the mostattractive trait is they genuinely care about people and communicate thatcaring to their patients. Personally, for me, I am extremely excited aboutteaching and mentoring these bright young minds, as is our entire faculty,”he said.

“Hopefully a lot of gray hair has produced some small amount ofwisdom, and combined with a good sense of humor, the combination willallow me to have a little fun as I do what I truly love to do: Teach,” Dr.Cutrer exclaimed.

THE CURRICULUMThe MCPA curriculum is a 30-month master of medicine

curriculum. The first 15 months provide a broad grounding in medicalprinciples with a focus on their clinical applicability. First-year instructionis in the classroom and the lab and consists of coursework in the basicsciences, including anatomy, physiology, biochemistry, pharmacology,physical diagnosis, pathophysiology, microbiology, clinical laboratorysciences, behavioral sciences and medical ethics. Courses are scaffolded ina manner that allows synchronization of relevant topic discussions acrossa number of concurrent courses such as Clinical Medicine, DiagnosticMedicine, Pharmacology, and Fundamentals of Medical Science. The final15 months of the program place students in various 6-week supervisedclinical rotations where they receive over 2,000 hours of patient careexperience in disciplines such as internal medicine, family medicine,pediatrics, behavioral health, surgery, OB/GYN, emergency medicine, andcritical care. Students may also choose an elective. After successfulcompletion of clinical rotations, students participate in a semester-longclerkship. Throughout the program, there is a great deal of emphasisplaced on teaching students to work with physicians as part of the healthcare team.

On matriculation, the students are each assigned to a 6-memberfaculty-coached learning team. Learning teams work with their facultycoaches on a weekly basis to develop important critical thinking and


Established: May 25, 2011

Building target date: January 15, 2011

Inaugural class size: Anticipate 30

students. As resources grow, the size of the

class will gradually increase to a maximum

of 48 students.

Initial Graduation: December 2013

Core Faculty: The core faculty of the

physician assistant program currently

consists of 2 board certified physicians and

3 NCCPA certified physician assistants.

Along with some teaching responsibilities,

each core faculty member performs integral

administrative tasks within the program.

Clinical and classroom teaching is

augmented by over 100 board certified

physicians and physician assistants serving

as guest lecturers and adjunct instructors

from area hospitals, medical centers and

private practices.

Core Competencies: The competencies

for this program and for the PA profession

are:

• Patient Care

• Medical Knowledge

• Practice Based Learning and

Improvement

• Systems Based Practice

• Professionalism

• Interpersonal Skills and

Communication

Specialty Distribution: According to the

Twenty-Fifth Annual Report on Physician

Assistant Educational Programs in the

United States, 2008-2009, 2,609 PAs

graduated in 2008, about half (49.8%) of

those were employed in primary care

specialties and half (50.2%) in non-primary

care specialties.

Demographics: Nationwide, 70% of

matriculants into PA programs are female.

The average age is 27 years and the males

tend to be a couple of years older than the

females.

MISSISSIPPI COLLEGEPHYSICIAN ASSISTANTS PROGRAM (MCPA)

Pre-clinical phase curriculummap: The physician assistant

professional program typically takes about two and a half years to

complete.

problem-solving skills. This model also facilitates the use of anumber of innovative approaches such as Team BasedLearning, Objective Structured Clinical Examinations, andProblem Based Learning.

Once students complete the 30-month program, they willbe eligible to sit for the Physician Assistant NationalCertification Examination (PANCE). Following successfulcompletion of the PANCE, they can apply for licensure in all50 states. Physician assistant training differs from traditionalmedical school in that PAs enter supervised medical practicewithout years of residency training. PAs are then required tolog 100 hours of continuing medical education every two yearsand pass a recertification exam every six years.

PRACTICAL EXPERIENCEAfter 15 continuous months of laboratory and classroom

training, the students are evaluated by the program to determinetheir readiness to participate in supervised clinical training.Prior to entering the clinical phase of the program, the studentsmust demonstrate competency in history taking and physicalexamination, specific clinical procedures and familiarizationwith concepts of Advanced Cardiac Life Support (ACLS.)Strong emphasis is placed on training in inter-professionalteams, and each student will be required to complete eight corerotations: internal medicine (inpatient), family medicine(outpatient), pediatrics, general surgery, critical care, behavioralhealth, OB/GYN and emergency medicine. Students will alsocomplete an elective rotation of their choice and the semesterlong clerkship at the end of their training. The training will beperformed at numerous hospitals, community health centers,and outpatient clinics across the state.“We have been fortunate to have strong support from

institutions such as the University of Mississippi MedicalCenter (UMMC), Mississippi Baptist Medical Center, NorthMississippi Medical Center, Central Mississippi MedicalCenter, River Region Health System, Central MississippiHealth Services, Mississippi Primary Health Care Association,Baptist Memorial Hospital – DeSoto in Southaven, and anumber of other outpatient clinics and community healthcenters,” Dr. Philpot said.

FACILITYUnder construction is a 10,000 square foot learning center

on the third floor of the Baptist Healthplex building on MC’smain campus. The center will feature numerous classrooms,mock exam rooms and offices. The entire facility has beendesigned to support the learning team approach to medicaleducation. According to Dr. Philpot, “We’re also installing astate-of-the art video recording system (http://www.323link.com/), which will allow us to video stream or podcast lecturesand demonstrations of clinical procedures, record simulatedpatient encounters, and videoconference with experts from themedical community. Construction is expected to be completeby mid January 2011,” he said. “Some of the preclinicaltraining will occur on MC’s Clinton campus with theremainder conducted at UMMC.”

REGULATION“Because the PA practice is relatively new to the state of

Mississippi we still face some challenges in drafting legislationand policies which will optimize the use of PAs in all practicesettings,” Dr. Philpot said. “Ideally, state laws should requiresupervision, define it and include provisions that allow forcustomization of health care teams to best meet the needs ofpatients. Because of the diversity of settings and specialties inwhich PAs practice, a specific requirement for on-site presenceof the physician will be unavoidably arbitrary. Certainrequirements may be appropriate for some settings, but wouldbe too restrictive or permissive in others. For example, statelaws that require a physician to be on-site for a specifiedamount of time can be a barrier to care in some circumstances.Amuch more patient sensitive approach is to allow thephysician(s)-PA(s) teams to match supervision to the specificneeds of the practice,” he said.“Similarly, we are still working to help define the

appropriate ratio of PAs to supervising physicians,” headded. Several organizations have evaluated appropriate ratiosof PAs per supervising physician. In 1996, the AmericanAcademy of Family Physicians (AAFP) revised its policy onthe ratio of PAs to supervising physicians. The AAFP deleted asentence in its Guidelines on the Supervision of CertifiedNurse Midwives, Nurse Practitioners and Physician Assistantspolicy that recommended a physician supervise no more thantwo “non-physician” providers.The American College of Emergency Physicians (ACEP)

also supports the practice level determining its own ratios ofPAs to supervising physicians. In 2007, the ACEP approved apolicy stating that the medical director of an emergencydepartment should define the number of PAs whose clinicalwork can be simultaneously supervised by one emergencyphysician.The AMA adopted the recommendation of its Council on

Medical Service in 1998. Charged with studying the issue ofratios, the Council recommended: The appropriate ratio ofphysician-to-physician extenders should be determined byphysicians at the practice level, consistent with good medicalpractice and state law where relevant.The American Academy of Physician Assistants believes

the appropriate number of PAs is best determined at thepractice level rather than in state law. Health professionalregulation should allow for flexible and creative innovationand appropriate use of all members of the health careworkforce. In many primary care settings, such as well-child orfamily planning clinics, a supervising physician couldsupervise multiple PAs.

IN CLOSINGWhen asked about this, Dr. Cutrer closed by saying, “If

there is anything I can do to help explain the role of the PA as apart of the medical team, just let me know. We take veryseriously the education of our PA students. We plan on workingvery hard to make the first PA school in Mississippi somethingwe will all be proud of!”

Dr. Philpot added, “We feel that a PA program in the statecan be more responsive to the needs and concerns ofMississippians and the medical community. We look forwardto working with the medical organizations and boards withinthe state to make PA practice a winning solution for all.” �



• MSMA •

Patients First During the 2011 Legislative Session

In 2011, the Mississippi State Medical Association will continue to advocate at the Mississippi Legislature for fiscalresponsibility and meaningful regulatory measures that result in expanded access to quality health care, enhancedprotection of patient safety, and the promotion of individual health awareness. Based on the amount of incipient

activity that has already taken place in and around the Capitol this fall in preparation for the 2011 session, next year promises tobe yet another busy year for legislators and those who follow their business. Amidst the backdrop of statewide elections inNovember of 2011, legislators will convene in January for the upcoming annual session to grapple with not only the normal arrayof thousands of proposed bills but also other serious measures that could potentially affect the delivery of quality health care tothe citizens of the State of Mississippi in some form. They will have to shape an untoward budget that attempts to adequatelybalance the needs of the public in light of the current financial realities associated with a nationwide economy in recovery from arecession. Also on the Legislature’s agenda will be the decennial redistricting process and some state implementation of portionsof the new federal health care reform law. While conventional wisdom suggests that these issues may result in dissonance andperhaps at various times even contentious debate among legislators, MSMA finds itself uniquely positioned in 2011 to submit tothe legislature a set of refreshing initiatives for consideration that will transcend the political schism and place patient care first.

A priority for the Association next year will involve seeking minor revisions to the state’s compulsory automobileinsurance laws which will have a major impact on driver and/or owner compliance and financially strengthen the MississippiTrauma Care Trust Fund. Since the law’s enactment in 2001, it has provided the public with some protection from the perilsassociated with uninsured motorists on the roadways. However, a distributing trend has also emerged in response to the lawwhereby drivers have circumvented the intent of the law. They do so by terminating their insurance after they obtain a physicalinsurance card that they can present to law enforcement if and when they are involved in a traffic stop. In a state where therewere an estimated seven hundred traffic fatalities last year, this kind of irresponsible driver behavior presents a threat to publicsafety and places a strain on a trauma system which is already struggling to cover the costs of uncompensated trauma care. Inresponse to this issue, MSMAwill support legislation that creates a database containing a cross-listing of insurance policies withvehicle identification numbers to assist officials with real time enforcement of the law. MSMA also supports amending thepresent law to increase monetary fines for those found to be in violation of the law with a portion of the fines collected allocatedto the State Trauma Care Fund.

In an effort to foster healthier lifestyles through the consumption of healthier foods, the Association intends to encouragelegislation which eliminates state sales tax on health foods. This would include bottled water, fresh fruits, fresh vegetables, andother foods. The goal is to encourage consumers to make healthier grocery choices by making these foods more affordable thanunhealthy alternatives. Hopefully this will lead to the increased consumption of these essential foods, leading to better healthand ultimately reducing long term care costs for individuals and the state alike. The increased demand for these fresh foodscould also represent an economic boost to local farming communities as well.

In recognition of the state’s critical rural physician shortage, MSMAwill continue to push for increased financial supportof the Rural Physicians’ Scholarship Program. Last year, the program received $900,000 to support thirty scholarships. Thisyear, the Association will encourage the legislature to dedicate an additional $300,000 to the program in order to create ten morescholarships for a total of forty. This nascent program will soon prove to be an invaluable mechanism for keeping young andtalented physicians in our state as opposed to other states to practice. This will not only address a health care workforceshortage, but it will also increase patient access and begin to address minority health disparities in areas such as the Delta wheresuch care is desperately needed.

THE PERFECTPRACTICEPARTNER

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In addition to the foregoing efforts, MSMAwill continue to remain attentive and responsive to efforts that pose a threat tothe practice of medicine and patient safety. These threats include but are certainly not limited to recurring nurse practitioner andmidwifery scope of practice issues, state changes prompted by the Patient Protection and Affordable Care Act (PPACA), stateadministration of the Medicaid program, and fair treatment of reimbursements by insurance companies and third party payers.

As in prior years, active physician involvement in the legislative process will be critical to the MSMA’s success this year.While legislators appreciate the efforts of lobbyists to call important issues to their attention for consideration, hearing a concerndirectly from a local physician can make an indelible impression. There are numerous ways for you personally to get involved inthe process. You can sign up to become one of our legislative team’s “key contacts.” As a “key contact” you will become one ofa group of individuals responsible for coordinating communications with a particular local legislator(s) throughout the session. Asan MSMA physician, you can volunteer to participate in the Doctor of the Day program at the State Capitol and or the CapitolScreening Initiative (CSI) hosted by the MSMAAlliance. Each of these experiences offers physicians a close-up view oflegislative action and the opportunity to promote the practice of medicine to our elected officials with a distinctive and personalapproach. Member physicians who are contributors to the Mississippi Medical PAC can also participate in the legislative processin a unique way at the upcoming MMPAC legislative reception event on January 19, 2011.

MSMA’s membership has proved time and again that it is up to the task of improving quality, cost-effective care whileprotecting patient safety. This ability was demonstrated and proven strong during prior scope of practice disputes and the tortreform debate. We look forward to your participation in MSMA’s efforts in 2011 to strengthen the practice of medicine in thestate of Mississippi.

—Christopher W. Espy, Esq.Counsel and Government Liaison

Mississippi Native Pens Epic on Tort King’s FallBradford J. Dye, MD

[ The following essay was written by Dr. Ford Dye,an Oxford otolaryngologist who is also a memberof the MSMA Board of Trustees. Ford’s Oxfordneighbor, Curtis Wilkie, is one of the mostrespected Mississippi writers and journalists,and Ford has explored Wilkie’s life andliterary contributions. Wilkie’s book, TheFall of the House of Zeus, is one of the mosteagerly awaited books written by aMississippian this year. It will be of greatinterest to Mississippi physicians who have akeen interest in learning of the tort king’s fallfrom power. The book details the sordid activitywhich at times pained the lives and practices ofMississippi’s physicians. Ford offers a fascinatingreflection on this unique Mississippian, Curtis Wilkie,and the editors felt our readers would enjoy this article.]–ED.

Curtis Wilkie is one of Mississippi’s most wellknown and respected journalists. He is also asuccessful author whose latest book The Fall of

the House of Zeus was recently released. His writing skillshave carried him from his native Mississippi to the easternUnited States and various locations around the world. Hisroots in writing and journalism began in Pike County,Mississippi. He was kind enough to sit down and share hisinteresting life story with me.

Curtis was born in Greenville and lost his father at ayoung age. He lived in seven or eight different towns the firstsix years of his life. He and his mother settled in Summit whenhe was seven years old. She got an administrative and teachingjob at Southwest Mississippi Junior College, and they lived ina girls’ dormitory there. Curtis was “the campus brat and hadall sorts of pretty girls who were live-in babysitters” for him.His first foray into journalism began with a paper he startedcalled the Southwest Times. It contained stories about theschool as well as a gossip column containing “who might beseen kissing which girl goodnight on the steps of the girls’dorm.” In one edition, it also contained an obituary for BabeRuth which was copied verbatim from the Times Picayune.

Summit was a charming small town with a traditionalmain street, Southern values and a host of characters whocalled it home. Curtis and his mother moved from the juniorcollege into town when she remarried. Like most Southerntowns, Summit was racially divided but Curtis recalls” apeaceful town with no real racial conflict.” It was a loggingtown and rail town on the Illinois Central railroad line whereeveryone knew everyone else. Nobody locked their doors andit was not unusual for Curtis to walk a few blocks to the Foxmovie theater at night. “I am not sure these kinds of townsexist anymore,” he adds. Summit provided a sense of stability,and he still considers it his home.


• PHYSICIANS' BOOKSHELF •

By Curtis Wilkie

ISBN: 9780307460707

400 pages. Crown Publishing Group,

New York.

Hardcover: $25.99

Thekindness ofmany of thetownspeople isone of his mostendearingmemories ofSummit. Hisstepfather was aPresbyterianminister, andmany wonderfulfamilies in hiscongregation“kind ofadopted me.”The Atkinsons,Covingtons,Watkins, andBarnes are someof the familiesCurtis mostfondlyremembers.Lew Barnes wasan earlyinfluence onCurtis. Lew wastwo years olderand was a “wellknown characterand practicaljoker.” OneSaturday night he “invaded the Baptist church and put `RedHot Boogie’ on the chimes.” Curtis has never forgotten Lew’ssense of humor and misses his friend who was killed in awreck in his early thirties. Curtis recalls some other friendsand peewee football teammates such as Billy Ray Jones, CarlRay, Fulton Beck, and David Blackwell. Curtis played allsports but was not as athletic as most of his running mates.

Curtis got his first job as a journalist when he becamesports writer for the Summit Sun in sixth grade. He followedPaul Atkinson and Jack Wardlaw who both went on to workfor the Times Picayune. Curtis finds it “interesting that threepeople who became career journalists got their start beingsports writers for the Summit Sun.” He wrote up articles andscores from the local high school sports teams for the weeklypaper. He got to travel with the teams and keep score duringgames.

The legendary Mary Cain was another influence onyoung Curtis. She was editor of the Summit Sun and also gaveCurtis his first job in journalism. She ran for governor in 1951and in 1955, and Curtis was “very intrigued by the idea of

having a neighbor running for governor.” He rememberspassing out leaflets for her knowing nothing about herpositions and realized later in life that “her positions weremuch more conservative than my own.” Mary Cain felt thatthe Social Security program was communistic, and she got introuble for refusing to pay Social Security taxes. This led to agovernment agency padlocking the door to the Summit Sunoffices until Mary Cain got a hacksaw and cut the lock. Thisaction inspired the nickname “Hacksaw Mary.” She was agifted speaker and colorful character who ran respectableraces for Governor. Although she didn’t win the election andher views were different, she instilled an interest in politicsthat stayed with Curtis throughout his life.

Curtis and his family moved to Corinth for his senioryear when his stepfather got transferred to a church there. Hadhe stayed in Summit, he would have gone to McComb HighSchool. That was the same year Summit High School wasconsolidated into McComb. Curtis grew up playing baseball inMcComb due to its close proximity to Summit, and he hadmany friends there. Warner Alford, Louis Guy, Billy Neville,


PhotobyBruceNewman

Curtis Wilkie, Overby Fellow and Kelly G. Cook Chair of Journalism—Wilkie has served as

visiting professor of journalism at the University of Mississippi since 2002. He was appointed to

become the first Overby Fellow with the Overby Center for Southern Journalism and Politics at

the University of Mississippi in 2007.


and Butch Cothren were some of his buddies from McComb.There was no TV so they listened to the radio or played gamesfor entertainment. One of his fondest memories of McCombwas meeting Elvis Presley there during Curtis’s sophomoreyear of high school. Elvis opened for Johnny Cash that night.Elvis was friendly and visited with Curtis and his friends, andCurtis got Elvis to autograph his arm in red ink. This did notimpress Curtis’s mother when he arrived home after hiscurfew. She had never heard of Elvis and instructed her son towash off his arm and go to bed.

Curtis entered Ole Miss in 1958. “It was much smallerthen but we had great football teams” losing only four gamesin his five seasons at the school. Most students lived oncampus and very few had cars. Oxford was dry at the time andto get a beer legally required a drive to either Holly Springs orMarks. He majored in journalism, and there were “no morethan five or six of us in my freshman class who were majoringin journalism.” There were only two journalism professors atthe time. Dr. Sam Talbot was chairman, and Dr. Jerry Hoarwas a young professor. Dr. Hoar is still living in Oxford andhas become a good friend of Curtis despite the fact that heflunked Curtis in feature writing. “I was late turning in a paperand he gave me an F. He taught me a lesson about deadlines,”Curtis recalls. The irony is that Curtis teaches that course atOle Miss today.

Another irony of that class failure is that it was thereason Curtis was still in Oxford during the 1962 fall semesterwhen James Meredith entered Ole Miss. “Thanks to JerryHoar I was still here because I had to come back and takefeature writing again.” He should have graduated in the spring,but he was still around to witness one of the university’s mostsignificant and difficult times. “By that time I was consideredby Mississippi standards a liberal and that was a rarity amongthe student body,” says Curtis, who closely followedeverything that was going on with much interest. He was onthe scene to witness some of the events firsthand as “thebudding journalist” in him heightened his curiosity. Hewitnessed Governor Ross Barnett reject Meredith the first day,and he was in the crowd outside the Lyceum the night of theriots.

Curtis recalls that most of the students that night werenot causing trouble, but a handful of them were shouting andthrowing things at the U.S. Marshals. This led to tear gasbeing fired into the crowd of around 500 students. Curtis andhis friend Franklin Holmes from Tunica scampered across thecampus into the lobby of a girl’s dorm to evade the tear gas.On the lobby television set was President John F. Kennedymaking a speech to the nation saying that James Meredith hadbeen peacefully enrolled at Ole Miss. The president called onthe students to carry on the great and fine traditions of theuniversity, and he didn’t know that “all hell had broken looseoutside.” The riots escalated much more as a result of outsideagitators than from the students within. Curtis hovered on the

fringes of the rioting until he “realized a fellow could getkilled out here and was smart enough to go back to my room.”

James Meredith was very much a loner at Ole Miss, andCurtis has some inner guilt concerning this. Curtis has gottento know Meredith over the years through numerous interviewsand newspaper articles. Curtis has told Meredith how much “Iregret that I never offered to go have a cup of coffee with youat the student union or go have lunch with you.” He wasmostly shunned by the student body and was nearly alwaysaccompanied by a military escort. In one instance, a fewstudents who did have lunch with him went back to their dormrooms to find them trashed. There was a certain amount ofpeer pressure concerning Meredith, and Curtis regrets “nevermustering enough courage to try to make life easier for him.”

Acclaimed author Curtis Wilkie has written numerous

articles for national magazines such as The Nation,

The New Republic, Newsweek, Playboy, George,

Washington Journalism Review as well as many

articles published in the Boston Globe Magazine. He

is the co-author, with the late Jim McDougal, of

Arkansas Mischief: Birth of a National Scandal

published by Henry Holt 1998; author of Dixie: A

Personal Odyssey Through Events That Shaped the

Modern South published by Scribner 2001; co-author,

with six others, of City Adrift: New Orleans Before and

After Katrina published by LSU Press 2007.

PhotobyBruceNewman


Unfortunately, the riots surrounding Meredith’sadmission to Ole Miss were the enduring imprint ofMississippi in the minds of the national media for years.Curtis thinks the “Presidential debate was the finishing touchof the rehabilitation of Ole Miss” in the eyes and minds ofmost journalists. Most of the leading American journalists areeither friends or acquaintances of Curtis, and they “loved it” atOle Miss during the debate. The debate was not his first trip toOxford, but Tom Brokaw visits enough that Curtis is “ready toenroll him as honorary citizen. He loves coming to Ole Missand Oxford.” Mark Shields, Tom Oliphant, Al Hunt and JudyWoodruff are some others who have all been impressed byOxford and Ole Miss.

Curtis has enjoyed his return to Oxford and the facultyat Ole Miss. “If you had told me fifty years ago that I wouldbe living in Oxford happily as an old man, I would say youwere out of your mind.” He finds the university town veryappealing. He has been on the faculty for ten years andparticularly enjoyed working under Chancellor Robert Khayat.Dr. Khayat was his platoon sergeant in ROTC during theirdays at Ole Miss. “The idea of me teaching here is verygratifying to me.” The journalism department now has over500 students majoring in journalism and over 30 facultymembers.

Curtis has taken a very winding and rewarding path backto Oxford since he left Ole Miss as a student. He graduated inJanuary 1963 and went to work for the Clarksdale PressRegister. He stayed there for nearly seven years which was along time for a first job. He enjoyed the job due to the activityand excitement of the civil rights movement in the MississippiDelta during his time there. In 1969, he got a Congressionalfellowship and moved to Washington and worked with WalterMondale from Minnesota and John Brademas from Indiana fortwo years. Mondale would later serve as Vice President andBrademas would become president of NYU. Curtis hasremained friends and stays in touch with both men. In 1971,Curtis returned to journalism and worked for The NewsJournal in Wilmington, Delaware, for three years.

His next job was with the Boston Globe. Curtis wouldwork for that paper for the next 26 years. He did a little bit ofeverything at the Boston Globe. One of his first jobs was tocover the Boston mayor’s election. As the “only Southerneron the staff,” his next assignment was to cover “this peanutfarmer from Georgia named Jimmy Carter.” Carter’s electionas President led to a job as White House correspondent forCurtis and a move back to Washington, D.C., one year later.Curtis stayed in Washington through the Carter and Reaganadministrations. He then began to have overseas assignmentsmostly in the Middle East. He moved to Jerusalem in 1984and established a Middle East bureau for the Boston Globeand was there for four years. He enjoyed living abroad but hada difficult time becoming fluent in the local languages.

He moved back to Boston and lived there for a few years

but “didn’t care for the cold weather.” He persuaded hissuperiors at the Boston Globe to allow him to work out ofNew Orleans. He already owned a place in the French Quarter,and this allowed him to care for his ailing mother in Summit.He created a Southern bureau for the Boston Globe andworked his last six or seven years for the paper out of NewOrleans. His mother was in a coma for a few years and died in1997. He was able to be close to her during this time whichwas very important to Curtis. Both his mother and stepfatherare buried in Summit, and he visits their gravesites regularly.

Curtis covered many exciting stories during his tenurewith the Boston Globe. Some that stand out are Three MileIsland, the refugee story in Southeast Asia in 1979, theRomanian revolution, the Camp David Accords between Israeland Egypt, and many diplomatic missions of President Carter.He also covered many civil wars in the Middle East. Onememorable story was the TWA hijacking in 1985 in Beirut thatlasted for about three weeks. This story was very important inBoston. The plane that had been hijacked was bound forBoston, so many of the hostages were from the city. It was avery “dramatic story that had a happy ending” for the mostpart. Sadly, there was one fatality when the plane was initiallyhijacked, but the remaining hostages survived the ordeal.

One of his most enjoyable assignments was a two weekstint traveling with the Boston Red Sox in 1977. That teamhad future Hall of Fame players Jim Rice, Carlton Fisk andCarl Yastrzemski. Don Zimmer was the manager. There alsowas a kid from Ole Miss on the team named Steve Dillardwho was a utility infielder. “I would have paid to have thatassignment,” Curtis adds. Needless to say, Curtis had come along way from his first job as sportswriter for the Summit Sun.

Curtis thinks there are two reasons why Mississippi hasproduced an inordinate number of writers and literary figures.One is “the reason everybody gives and I agree that we have astorytelling tradition. At our parties we don’t debate policy orpontificate – we tell stories. We like to entertain each otherwith stories in Mississippi and the South. Secondly, conflict isinherent in any good story.” Mississippi has had conflict onmany levels. Racial conflict, conflict between wealth andpoverty, and social conflicts have all been woven into thefabric of Mississippi. Southerners grew up with conflict muchmore so than those who grew up outside the South. Curtisbelieves this conflict is a driving force behind Southern writersincluding Faulkner and even Welty.

Curtis is pleased with his latest book. The book is aboutDick Scruggs’s involvement in a judicial bribery scheme.“Dick is a friend of mine,” Curtis points out. The name of thebook is The Fall of the House of Zeus. Zeus was Scruggsnickname in college. “It was not a pleasant undertaking but astory that appealed to me as I knew so many of the players onall sides of the story.” These relationships have providedCurtis with unparalleled access to those involved as well as aunique perspective on the story. Jim Greenlee, the U.S.


attorney prosecuting the case, has described the case as a Greektragedy. Curtis did not think he would ever write another bookafter Dixie: A Personal Odyssey Through Events that Changed theModern South, which he wrote over eight years ago. However, itwas “such a mystery as to what in God’s name is Dick Scruggsdoing involved in something like this” that Curtis felt compelledto write the story. The book was released in October and is nowavailable.

Growing up as an only child has given Curtis greatappreciation and satisfaction with his family. Curtis has threechildren and many grandchildren. His daughter Leighton livesnext door to Curtis in Oxford with her husband Campbell McCooland their three sons. His son Carter lives in Boston with his wifeAllison and their three daughters. Carter is a writer for Bank ofAmerica. His younger son Stuart lives in Wilmington, Delaware,and is a teacher there. Stuart is named for Curtis’s stepfather.Curtis has a lovely wife Nancy who also has three children andfive grandchildren. He can often be seen walking his retriever andbest friend Willie around Oxford. Yes, the dog is named for hisgood friend and fellow Mississippi author Willie Morris, but that’sfor another story. �

Save the Date for MSMA’s 143rd Annual

annual session Coming to you live

from Tupelo, Mississippi

Birthplace of

elvis presley

MAY 19 – 22, 2011

REGISTER ONLINE TODAY AT www.MSMAonline.com!

For more information: Becky Wells

601-853-6733, Extension 340 [email protected]

Obtain CME credits!

Take part in the state’s largest

yearly gathering of physicians!

Find out the latest info on health reform

and what it means for physicians!

Network and socialize with your

peers during special events and

receptions!

Shape the future of health policy in

Mississippi!

Left: Overby Fellow and Kelly G. Cook Chair of Journalism

Curtis Wilkie walks his dogs, Binx and Willie, in his quaint

Oxford neighborhood. He says he has enjoyed his return to

Oxford and the faculty at Ole Miss, “If you had told me fifty

years ago that I would be living in Oxford happily as an old

man, I would say you were out of your mind.”Photo by Bruce Newman


• IMAGES IN MISSISSIPPI MEDICINE •

JACKSON INFIRMARY, 1916 - 1954 — This old postcard is of the important Jackson Infirmarywhich was a large private hospital established in Jackson by Dr. George Adkins and Dr. N. C.Womack in the second decade of the twentieth century. This institution served as Jackson’sprincipal hospital for many years. Located in the capital city on the corner of President andAmite Streets, this hospital structure was erected in 1916, which is close to the time of thispostcard. The Infirmary was purchased by the Dominican Sisters (of Springfield, Illinois) in 1946,and they assumed the hospital’s operation, renaming it St. Dominic Hospital. This building wasused until 1954 when St. Dominic opened its new hospital on Lakeland Drive. The old Infirmarybuilding was then torn down, and the Baptist Book Store was built at the site. Governor Earl L.Brewer (term 1912-1916), the only occupant of the Governor’s Mansion to be elected withoutopposition, died in March 1942 at the Jackson Infirmary. One of the first chiefs of staff of theInfirmary was Dr. John Woodson Barksdale (1876-1953), a native of Vaiden, who helped foundone of the first hospitals in North Mississippi, the Winona Infirmary. The term “Infirmary” isfrom the Latin “infirmus” which means “weak” or “frail” and by definition is a place where thesick or injured are cared for, especially a hospital, clinic, or dispensary, often within anotherinstitution. Infirmary was a common name for a public hospital in 18th century England. If youhave an old or even somewhat recent photograph which would be of interest to Mississippiphysicians or further information on the old Jackson Infirmary, please contact the Journal or meat [email protected].

—Lucius Lampton, MD, EditorMagnolia

Where did you grow up?My parents wereliving in Decatur, my birth place wasMeridian, and I grew up in Lexington. I

graduated from Lexington High School and MSCW with aB.S. in mathematics and a minor in accounting.

How did you meet your physician spouse? Aftergraduation from the “W,” I landed a job with IBM as anassistant systems engineer in Jackson and moved into theParkview Arms apartment on Lakeland Drive that Stanley’ssister had moved out of when she got married. Conveniently,Stanley and his roommate Arthur Jones had decided if theywere ever to meet any “decent prospects,” they needed toupgrade their living situation so they also relocated toParkview Arms. The mutual roommate introduced us.Stanley and Arthur quickly learned when we were usuallyfinishing dinner and would appear for any leftovers. I soondiscovered that the way to a starving med student’s heart wasthrough his stomach!

What are the names and ages of your children?Myolder daughter, Julie, is 41-years-old and is the executivedirector of the Mississippi Academy of Family PhysiciansFoundation. She and her attorney husband, KevinHumphreys, live in Madison and are the parents of Kyle (13)and Will (11).

My 37-year-old daughter Laura is married to DerekDyess, a radiologist. They live a stone’s throw from us downMeadowbrook Road with their two daughters, Mary Beth (10)and Ginny (8). Laura is an assistant teacher with 4 year oldsat Jackson Academy.

How do you spend your free time? As strange as itmay sound, I really enjoy using my organizational skills forfamily, friends, and my church. Since moving to Jackson,Stanley and I are enjoying the art/theater/music/restaurant/grandchildren scene.

How did you come to join the Alliance?When myhusband became active in the medical association, it seemedonly natural to become involved in the organization thatsupported his profession. I was impressed with the auxiliary’scommitment and thought their various projects worthwhile.

What is your favorite Alliance memory?My favoriteauxiliary memories include visiting local auxiliaries across thestate, serving on the national AMA-ERF committee, andassisting with Jean Hill’s inauguration as AMAAuxiliarypresident.

What are the highlights of your presidential year?Highlighting my year as president were auxiliary donations of$13,000 to AMA-ERF and $10,000 to the ImpairedPhysicians’ Program, both sizable contributions in 1984. Ourlong range planning committee recommended to the MSMABoard of Trustees that a part-time auxiliary executivesecretary be hired and thus began our long relationship withBarbara Shelton whose assistance proved invaluable.

Do you have any advice for fellow physicianspouses? Show your support for your spouse and his/herprofession by joining the Alliance – and becoming anACTIVE member! Be flexible! Roll with the punches! �


• ALLIANCE SPOTLIGHT •Past President’s Spotlight: Mrs. Stanley (Beth) HartnessMSMAAuxiliary President, 1983-1984 • Kosciusko

Above center: Beth

and Stanley

Hartness at the Inaugural Dinner for MSMAPresident Dr. Whitman

Johnson, Jr. 1984. Above right:MSMAAChair Linda Martin and MSMAA

President Beth Hartness accept membership awards fromAMAA

Membership Chair Donna Fields at the AMAAuxiliary Annual Convention,

Drake Hotel, Chicago, June 1983.

MSMAA Presidential

Portrait - Beth Hartness

Right: Dr. and Mrs.

Hartness when Beth was

Hospitality Committee Chair.

• THE UNCOMMON THREAD •

Hard


If he wasn’t dying, Charlie Lee was doing a damned good impression of it. It all started when somebody hit him inthe center of the chest with a baseball bat right after he’d finished his walk. Now he was lying face down on thefloor and there was a bus parked on top of him. The weight of it was crushing him. He fought to breathe. Trying

with all of his strength to lift the bus and let his ribs expand. He had to find some way to suck air into his lungs, but as hardas he tried, the bus wouldn’t budge.

He got carried away for a moment by the pain and when he came back, his wife had rolled him over and was shakinghim, calling his name again and again. He tried to say something back, but he couldn’t. He could only really see her whenshe was directly over him now. Looking up as she bent down over him what struck him most was the look of panic in hereyes. He wanted to tell her it was going to be all right, he’d be fine in a minute, if he could just catch his breath. Then shemoved to the side and when he looked for her his eyes wouldn’t cooperate. He gave up on that as another wave of pain beganto crush down upon him. With all of the weight of the universe centered in his chest, the thing that he was most aware of wasthat his heart didn’t seem to be beating any more. It was something that had gone on his entire life and he’d never noticed it,but he certainly was taking notice now that it had stopped. Instead of a nice steady lub-dub, it felt like bags of snakes werecrawling around inside him. That was a bad sign, it meant the electrical impulses that controlled his heart had gone haywire,and there wasn’t much chance that they were going to get fixed by themselves. He needed…

The pain carried him away again, getting worse and worse until he didn’t think that he could stand it for anothersecond. Somehow, he stood it. He didn’t have a choice. There wasn’t anything else he could do. All he could do was ride itlike a wave. Death didn’t much care what he wanted. He was going wherever it took him.

He’d watched people die for thirty-five years of his life. He knew what it looked like. Now he was finding out for thefirst time just exactly what it felt like from the inside. His wife started to blow air into his mouth, pinching his nose shut. Shewas calling someone on the phone at the same time. The pain got slowly better. Subsiding little by little as she blew into hismouth. She spoke to someone on the phone and checked his pulse.

“No,” she said. “He doesn’t.”Then she started to pump on his chest. She was doing it all wrong. He tried to tell her, but that wasn’t any use either.

The sequences were crazy. There wasn’t any rhythm at all. Five pumps-one breath then eight compressions and two breaths.On she went, crying as she did it, four-one, seven-two, six-one, eleven-three. It was maddening, but apparently, it wasworking. He was still here wasn’t he? Or was he? He had to be, he was hurting too much not to be. He should have lostmore weight he thought momentarily. He could feel the fat on his stomach shaking as his wife continued pumping with hererratic rhythm and then the pain carried him away again.

R. Scott Anderson, MD

Author’s note: For all of you that didn’t, Connect theDots was a picture of three accidental deaths that presented toan ER in a 24 hour period. You explain it how you like: divineprovidence, random happenstance, whatever. I chose a little birdcalled death. It seems that for me accidental deaths are so muchharder to make sense of than those that we expect because wehave been tipped off by the onset of symptoms. Maybe we justunderstand that the chronicity of disease has an inevitabilityabout it. I had a patient with an advanced head and neck cancerthat was essentially incurable. If the tumor would have killedhim, he would have been just as dead, but a piece of tin roofingflying off of a pick-up truck on the highway and cutting off hishead just seemed like a different thing somehow, a more dramaticthing, a worse thing. I don’t know why.

This column is another way to look at death. It is theopening of a novel I’m rewriting right now, The Hard Times. Itis from a doctor’s perspective this time, but maybe a littledifferent viewpoint than you might expect.

• PLACEMENT/CLASSIFIED •

PHYSICIANS NEEDED

Physicians (specialists such ascardiologists, ophthalmologists,pediatricians, orthopedists,neurologists, etc.) interested inperforming consultative evaluations

DISABILITY DETERMINATION SERVICES1-800-962-2230

Toll Free 1-800-962-2230Jackson 601-853-5487Leola Meyer (Ext. 5487)


He came back sometime after the paramedics hadarrived, he could hear a voice he recognized, Bobby Pearson,talking on the radio to someone. He could feel himself lyingon a stretcher now. He knew what was coming when he heardBobby yell “clear” but there was nothing he could do about it.Then they shocked him. Nothing that you thought you knewcould prepare you for what that felt like. The horrible jerkingenergy threw him out into space he spun, rigid, and awfulaway from the world and drifted back just in time to hearBobby call “clear” again. Then it happened all over. This timeit was harder and it took him longer to get back. He never didbecause they hit him again before he made it, and he was gonenow. Gone but not all the way gone, just a long long wayaway, like looking through a telescope backwards.

He felt the bumping as they locked him into place in theback of the ambulance, felt his wife’s hand. He could hear hervoice coming to him. He could tell that she was talking tosomeone else and then to him. His eyes wouldn’t focus anymore so he couldn’t see her. He felt her squeeze his hand.Even though he couldn’t really make out what it was that shewas saying, he began to feel better as he listened to therhythm of her voice, and he knew that whatever it was thatthey were doing now, it was working. He wasn’t going to dieafter all. He felt so much better.

Hope you liked it.

—Scott

R. Scott Anderson, MD, a radiation oncologist, is medical directorof the Anderson Regional Cancer Center in Meridian and past vicechair of the MSMA Board of Trustees. Additionally, he is anaccomplished oil-painter and dabbles in the motion-pictureindustry as a screen-writer, helping form P-32, an entertainmentfunding entity.

We specialize in the business of healthcare

The Pen is Mightier than the SwordExpress your opinion in the JMSMA througha letter to the editor or guest editorial. TheJournal 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 toediting for length and clarity. If you are writing in responseto a particular article, please mention the headline and issuedate in your letter. Also include your contact information.While we do not publish street addresses, e-mail addressesor telephone numbers, we do verify authorship, as well ustry 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 MSMAheadquarters: P.O. Box 2548, Ridgeland, MS 39158-2548.


• INSTRUCTIONS FOR AUTHORS •The Journal of the Mississippi State Medical Association

(JMSMA) welcomes material for publication submitted in ac-cordance with the following guidelines. Address all correspon-dence to the Editor, Journal of the Mississippi State MedicalAssociation, P.O. Box 2548, Ridgeland, MS, 39158-2548.Contact the managing editor with any questions concerningthese guidelines.

STYLE: Articles should be consistent with JAMA/JMSMA style. Please refer to explanations in the AMA Man-ual of Style: A Guide for Authors and Editors. 10th ed. NewYork, NY: Oxford University Press; 2007. JAMA and JMSMAstyle differs fromAPA style. See JAMA: http://jama.ama-assn.org/misc/ifora.dtl Any manuscript that does not conformto the AMA Manual of Style will be returned for revision.

MANUSCRIPTS should be of an appropriate length due tothe policy of the Journal to feature concise but complete arti-cles. (Some subjects may necessitate exception to this policyand will be reviewed and published at the Editor’s discretion.)The language and vocabulary of the manuscript should be un-derstandable and not beyond the comprehension of the generalreadership of the Journal. The Journal attempts to avoid theuse of medical jargon and abbreviations. All abbreviations, es-pecially of laboratory and diagnostic procedures, must be iden-tified in the text. Manuscripts must be typed, double-spacedwith adequate margins. (This applies to all manuscript ele-ments including text, references, legends, footnotes, etc.) Theoriginal and one duplicate hard copy should be submitted.In addition, the Journal also requires manuscripts in theform stated above be supplied in IBM-compatible digitalformat. You may email digital files as attachments to [email protected] or supply a compact disk with thefiles burned to to the CD.All graphic images should be in-cluded as individual separate files in TIFF, PDF or EPS format.Please identify the word processing program used and the filename. Pages should be numbered. An accompanying cover let-ter should designate one author as correspondent and includehis/her address and telephone number. Manuscripts are re-ceived with the explicit understanding that they have not beenpreviously published and are not under consideration by anyother publication. Manuscripts are subject to editorial revisionsas deemed necessary by the editors and to such modificationsas to bring them into conformity with Journal style. The au-thors clearly bear the full responsibility for all statements madeand the veracity of the work reported therein.

REVIEWING PROCESS: Each manuscript is received by themanaging editor, and reviewed by the Editor and/or AssociateEditor and/or other members of the MSMACommittee on Pub-lications. The acceptability of a manuscript is determined bysuch factors as the quality of the manuscript, perceived interestto Journal readers, and usefulness or importance to physicians.Authors are notified upon the acceptance or rejection of theirmanuscript. Accepted manuscripts become the property of the

Journal and may not be published elsewhere, in part or inwhole, without permission from the Journal.

TITLE PAGE should carry [1] the title of the manuscript,which should be concise but informative; [2] full name of eachauthor, with highest academic degree(s), listed in descendingorder of magnitude of contribution (only the names of thosewho have contributed materially to the preparation of the man-uscript should be included); [3] a one- to two-sentence biogra-phical description for each author which should includespecialty, practice location, academic appointments, primaryhospital affiliation, or other credits; [4] name and address ofauthor to whom requests for reprints should be addressed, or astatement that reprints will not be available.

ABSTRACT, if included, should be on the second page andconsist of no more than 150 words. It is designed to acquaintthe potential reader with the essence of the text and should befactual and informative rather than descriptive. The abstractshould be intelligible when divorced from the article, devoid ofundefined abbreviations. The abstract should contain: [1] abrief statement of the manuscript’s purpose; [2] the approachused; [3] the material studied; [4] the results obtained. Empha-size new and important aspects of the study or observations.The abstract may be graphically boxed and printed as part ofthe published manuscript.

KEYWORDS should follow the abstract and be identifiedas such. Provide three to five key words or short phrases thatwill assist indexers in cross indexing your article. Use termsfrom the Medical Subject Heading list from Index Medicuswhen possible. Available at: http://www.nlm.nih.gov/mesh/meshhome.html.

SUBHEADS are strongly encouraged. They should provideguidance for the reader and serve to break the typographic mo-notony of the text. The format is flexible but subheads ordinar-ily include: Methods and Materials, Case Reports, Symptoms,Examination, Treatment and Technique, Results, Discussion,and Summary.

REFERENCES must be double spaced on a separate sheetof paper and limited to a reasonable number. They will be criti-cally examined at the time of review and must be kept to aminimum. You may find it helpful to use the PubMed SingleCitation Matcher available online at: http://www.ncbi.nlm.nih.gov/entrez/query/static/citmatch.html to find PubMed citations.All references must be cited in the text and the list should bearranged in order of citation, not alphabetically. Referencenumbers should appear in superscript at the end of a sentenceoutside the period unless the text cited is in the middle of thesentence in which case the numeral should appear in super-script at the right end of the word or the phrase being cited. Noparenthesis or brackets should surround the reference numbers.Personal communications and unpublished data should not be


included in references, but should be incorporated in the text.The following form should be followed:

Journals: [1] Author(s). Use the surname followed by ini-tial without punctuation. The names of all authors should begiven unless there are more than three, in which case thenames of the first three authors are used, followed by “et al.”[2] Title of article. Capitalize only the first letter of the firstword. [3] Name of Journal. Abbreviate and italicize, ac-cording to the listing in the current Index Medicus availableonline at http://www.nlm.nih.gov/bsd/aim.html. [4] Year ofpublication; [5] Volume number: Do not include issuenumber or month except in the case of a supplement or whenpagination is not consecutive throughout the volume. [6] In-clusive page numbers. Do not omit digits. Do not includespaces between digits of the year, volume and page numbers.

Example: Bora LI, Dannem FJ, Stanford W, et al. A guidelinefor blood use during surgery. Am J Clin Pathol. 1979;71:680-692.

Books: [1] Author(s). Use the surname followed by initialswithout punctuation. The names of all authors should begiven unless there are more than three, in which case thenames of the first three authors are used followed by “et al.”[2] Title. Italicize title and capitalize the first and last wordand each word that is not an article, preposition, or conjunc-tion, of less than four letters. [3] Edition number, [4] Edi-tor’s name. [5] Place of publication, [6] Publisher, [7]Year, [8] Inclusive page numbers. Do not omit digits.

Example: DeGole EL, Spann E, Hurst RA Jr, et al. Bedside Ex-amination, in Cardiovascular Medicine, ed 2, Smith JT (ed).New York, NY: McGraw Hill Co; 1986:23-27.

ILLUSTRATIONS require high resolution digital scans to beprovided. Printed copies should also be submitted in duplicatein an envelope (paper clips should not be used on illustrationssince the indentation they make may show on reproduction).Legends should be typed, double-spaced on a separate sheet ofpaper. Photographic material should be high-contrast glossyprints. Patients must be unrecognizable in photographs unlessspecific written consent has been obtained, in which case acopy of the authorization should accompany the manuscript.All illustrations should be referred to in the body of the text.Omit illustrations which do not increase understanding of text.Illustrations must be limited to a reasonable number. (Fourillustrations should be adequate for a manuscript of 4 to 5typed pages.) The following information should be typed on alabel and affixed to the back of each illustration: figure num-ber, title of manuscript, name of senior author, and arrow indi-cating top.

TABLES should be self-explanatory and should supplement,not duplicate, the text. Each should be typed on a separatesheet of paper, be numbered, and have a brief descriptive title.Tables should be on individual pages separate from manuscriptbody text with placement indicated within.

ACKNOWLEDGMENTS are the author’s prerogative; how-ever, acknowledgment of technicians and other remuneratedpersonnel for carrying out routine operations or of residentphysicians who merely care for patients as part of their hospitalduties is discouraged. More acceptable acknowledgements in-clude those of intellectual or professional participation. Therecognition of assistance should be stated as simply as possi-ble, without effusiveness or superlatives.

SUBMISSIONS TO JMSMASCIENTIFIC SERIESTop Ten Facts You Need to Know Series

The purpose of this series of articles is to provide refer-enced information on clinical management of medical condi-tions in a concise fashion. The submissions should be directedtoward practitioners who do not have specialty training on thespecific topic as a matter of general information. The author ofthe best submission for each year will receive a prize. Guide-lines: 1) Articles should consist of 10 numbered paragraphs.Each of the paragraphs will begin with a fact that physiciansneed to know and a brief explanation of why. Facts will be ref-erenced for each of the 10 points. 2) Suggested organization ofmanuscript is Introduction, Point 1, Point 2, etc., Conclusion,and References. 3) Articles will be about 3 pages (about 700words) in length written at a level that can be easily understoodby a practicing physician of any specialty. 4) A reference sup-porting the fact offered should be provided for each of the 10points. Citations should not be review articles. 5) If there arespecialty society guidelines in the area being discussed, the es-sential features of the recommendations should be included inthe official guidelines cited in the references.

UpToDate SeriesThe purpose of this series of articles is to provide brief re-

views on topics of general interest to the practicing physicians ofMississippi in areas where recent developments in diagnosis ortreatment have occurred. For instance, an article on recent ad-vances in the diagnosis and treatment of lupus erythematosiswould be an appropriate submission. Guidelines: 1) Articlesshould be practical and useful to physicians in office or hospitalpractice. 2) Suggested organization of manuscripts is Introduc-tion, Diagnosis, Recent developments, Conclusion, and Refer-ences. 3) Articles will be about 6 pages (1500 words) or so inlength written at a level that can be easily understood by a prac-ticing physician of any specialty. 4) Only those references thatwill be used to those physicians who desire further informationin the area. Five to eight references that will be useful to thosewho desire further information should be included. 5) Figuresare great as are “call-outs,” i.e., boxes with key points to remem-ber emphasizing the “take home” messages. 6) If there are spe-cialty society guidelines on the topic, the essential features of therecommendations should be summarized in the text and the offi-cial guidelines should be cited in the references.

GALLEY PROOFS will be emailed to the principal author for re-view. Corrections should be clearly marked and returnedpromptly. To order reprints, request a price quote and placeyour order when you return your galley proof. �


• INDEX •

VOLUME LIJanuary - December 2010

SUBJECT INDEXThe letters used to explain in which department the matter indexed appears are as follows:“BR,” BookReview; “CPS” for Clinical Problem Solving”; “E,” Editorial; “H” Hardy Abstract; “I,” Images inMississippi Medicine; “L,” Letters to the Editor; “NC” Numbers Count;“PB” Physician’s Bookshelf; “PM,”Poetry in Medicine; “PP,” President’s Page; “S,” Special Article; “UV” Una Voce; the asterisk (*) indicatesan original article in the Journal, and the author’s name follows the entry in brackets. Matters pertaining torelated organizations are indexed under the medical organization.

-A-Abstracts from the 2010 James D.

Hardy Surgical Forum, 282-H

Abnormal 1 hour Glucose ChallengeTest Followed by a Normal3 Hour Glucose ToleranceTest: Does it IdentifyAdverse PregnancyOutcome? [S. Pugh, APoole, J Hill, E Magann, SChauhan, J Morrison], 3*

Advanced Squamous CellCarcinoma Presenting asOsteomyelitis of the Hand:Midpalmar Resection andSuspensionoplasty Closureof Complex Defect [RMyers, P Blevins], 287-H

An Interview with Timothy J.Alford, MD, 2010-2011MSMA President [K Evers],158-S

-B-Bilateral Cavernous Sinus

Thrombosis FollowingCommunity-AcquiredMethicillin-ResistantStaphylococcus aureusInfection: A Case Report andReview of the Literature [RChick, J Glisson, S. Pierce],317*

Blood Levels in Mississippi Children[R Cox, P Kyle, B Brackin,

T Snazelle, J Surkin], 206*Blunt Renal Trauma and the

Predictors of Failure of Non-operative Management [JSimmons, N Haraway, RSchmieg, Jr., J Duchesne],131*

-C-Can the Delta Stop Singing the

Blues? [J Bailey, TBeacham, K Weeks, CSmith, M Horn, V Herrin],242*

Cardiovascular Disease inRheumatoid Arthritis:Disease and TreatmentInteractions and theirImplications on TreatmentDecisions [S Sanders, SGeraci], 75*

Chemical Colitis from a HydrogenPeroxide Enema [Y Desai, JOrledge], 314*

Clinical Problem-Solving[presented and edited by theDept. of Family Medicine,UMMC]

Can’t Catch my Breath [C Fort],355-CPS

Deceptive Irritations [N Darby],323-CPS

I See Dead People [J Nielsen], 135-CPS

Now You See It, Now You Don’t [N

Islam], 183-CPSOff by a Factor of Eight [E Eldred],

211-CPSPerplexing Pyretic Polyarthritis [R

Hanspal], 114-CPSPseudo Seizures vs. Pseudo Zebra

[M Pogue, J Gearhart, GMoll, Jr.], 83-CPS

The Gastroenteritis That Wasn’t [DNorris], 289-CPS

Uncommon but Not Rare [LOrozco], 11-CPS

Comparison of ConventionalLaparoscopicAppendectomy and SingleIncision LaparoscopicAppendectomy in PediatricPatients: A RetrospectiveReview [B Hamilton, DSawaya, C Blewett, WReplogle], 283-H

Cover“Country Comes to Town at the

Farmers’ Central Market” [CStroud], August

“Crown Jewel of Attala County” [SHartness], October

“Digitalis Derived from theFoxglove Plant” [S Bloom],April

“Dunleith Historic Inn” [MPomphrey, Jr.], May

“Hope Prevails” [W Pontius],September

“Leaf on the Trace” [M Pomphrey,


Jr.], January“St. John the Baptist” [R Brahan],

December“Stairway to Heaven” [M Pomphrey,

Jr.], November“Stars and Stripes” [M Pomphrey,

Jr.], JulyTimothy J. Alford, MD; 2010-11

MSMA President, June“Tricyrtis Hirta (Toad Lily)” [B

Tisdale], March“Uppsala Cathedral” [J Jackson],

February

-D-Day 100 of the BP Oil Spill Disaster

and Public Health inMississippi [K Evers], 224-S

Deaths, 45Domestic Violence Screening in a

Military Setting: ProviderScreening and Attitudes [MLutgendorf, J Busch, EMagann, J Morrison], 155*

-E-EditorialsATrip to Boston: Reflections on

Battling the ObesityEpidemic [J Storey], 219-E

Awestruck [M O’Dell], 192-EBut Will It Take? [S Hartness], 123-ECreating a Better Climate for the

Nation’s Health Care CouldMake Champions of allPhysicians [WLineaweaver], 360-E

Dignity [M O’Dell], 52-E“Draumatized” [M O’Dell] 143-EGetting Over It [S Hartness], 295-EHumanism [R deShazo], 331-EIf Only We Knew [S Hartness], 170-

ELet’s Not Go Down Without A Fight

[T Joiner], 257-EMany Good Things Are Happening

at our MSMA [L Lampton],358-E

Sacred Spaces and Higher Ground[R deShazo], 255-E

Start to Finish [S Hartness], 22-EThe Great Myth [D South], 92-EThe Perfect Storm: A Clinical

Vignette [R Cannon], 220-EThere is a Tide in the Affairs of Men

[LWeems], 91-EWill Politicians Ever Change? [M

Lockey], 53-E

-I-Images in Mississippi MedicineFin de Siecle Gross Anatomy for

Medical Students [LLampton], 236-I

Hospital, Alcorn A& M, 1890s [LLampton], 148-I

Jackson Infirmary [L Lampton],372-I

Jackson Sanitorium, 1902-1916 [LLampton], 276-I

Miles A. Jones, B.S., AlcornCollege, M.D., MeharryMedical College, CollegePhysician, Alcorn A& MCollege, 1925-6 [LLampton], 171-I

The Taborian Hospital, MoundBayou [L Lampton], 200-I

Impact of 80-Hour Duty RestrictionsUpon Self-Reported TotalOperative Experience [EPicarella, J Simmons, KBorman, M Mitchell], 287-H

Impact of the Night Float System onResident OperativeExperience [M Hunt, MMorris, Jr., J Simmons],285-H

Improvement of Pre-ArterializedVenous Flap Survival Ratewith Surgical Delay in theRat Model [D Jackson, FZhang, MAngel], 285-H

Instructions for Authors, 61, 376

IQH1-800-784-8669 - QUITNOW [J

McIlwain], 94Dr. Frothingham Named Recipient

of the A. A. DerrickPhysician Quality Award,201

Drs. Hartness and Herrin Join IQHStaff, 301

Information & Quality Healthcare,301

Patient Safety and Core Prevention[J McIlwain], 144

Regional Centers for Certified EHRs[J McIlwain], 94

Tobacco Quitline Updates [JMcIlwain], 144

-L-LegaleaseTalking to Lawyers about Patients:

When is it really Okay? [SRippee], 273

LettersIn Reply to Editorial, “But Will It

Take?” 223-LObservations, Analysis,

Consideration, and Concernsof a Delegate [C Caine],222-L

Why Fight When You Can Go Cash?[S Owen], 333-L

Local Legends Recognized in“Changing the Face ofMedicine” Exhibit, 271

-M-MACMMaples’Musings: Assessing Risks,

296

MAFPCelebrity Roast of Daniel W. Jones,

MD, Chancellor of theUniversity of Mississippi,106

Management of the SubsternalGoiter: A TeamApproach [RCannon, R Lee, R Didlake],179*

Mississippi College CommencesState’s First PhysicianAssistant Program [KEvers], 362-S

Mississippi Welcomes FirstOsteopathic Medical School[K Evers], 334-S

Mississippi Women in MedicineLeading the Way [K Evers],258-S


Mississippi Women PhysiciansRecognized as “LocalLegends”, 270

MSDHDr. Mary Currier Named State

Health Officer, 58Health Department Commends

Smokefree Cities, 252In Memoriam, State Health Officer

Ed Thompson, Jr., MD,MPH, 1947-2009, 28

Mississippi Reportable DiseaseStatistics, August 2010, 327

Mississippi Reportable DiseaseStatistics, March 2009, 139

Mississippi Reportable DiseaseStatistics, May 2009, 164

Mississippi Reportable DiseaseStatistics, July 2010, 292

Mississippi Reportable DiseaseStatistics, June 2010, 250

Mississippi Reportable DiseaseStatistics, November 2009,57

Mississippi Reportable DiseaseStatistics, October 2009, 27

Mississippi Reportable DiseaseStatistics, September 2010,354

MPHA Seeks Contributions to FundPortrait for Dr. F.E. “Ed”Thompson, Jr. State PublicHealth Laboratory, 233

MSMAMember Appointed to theMississippi State Board ofHealth, 251

Physicians Can Make a Child’sSmile [E Felder, N Mosca],232

State Epidemiologist and DeputyState Health Officer forMedicine and Science Dr.Mary Currier AppointedInterim State Health Officer,29

MSMAAddress of the MSMA President

2009-2010, S. RandyEasterling, MD, 197

June 3-6, 2010 in Natchez, 142ndAnnual Session of the

MSMAHouse of Delegates,39

MSMAAwards: CommunityService, Leadership, andWellness Promotion ProjectHonored, 195

MSMAElection Results Announced,194

Patients First During the 2011Legislative Session [CEspy], 365

Public Health in Mississippi, ReportCard 2010 [R Easterling], 15

Richard D. DeShazo, MDAppointedJMSMAAssociate Editor,193

MSMAAllianceAlliance Past President’s Spotlight,

Faye B. Lehmann, 1969-1970, Natchez, 231

Past President’s Spotlight: Mrs.Stanley (Beth) Hartness,MSMAA President, 2002-2003, Kosciusko, 373

Past President’s Spotlight: DanitaHorne, 2004-05, Laurel, 275

Past President’s Spotlight: Mrs. JohnMcRae (Eileene), MSMAAPresident, 2002-2003,Hattiesburg, 309

-N-New Members, 43, 117, 165, 230

Numbers CountPhysicians Licensed by the

Mississippi State Board ofMedical Licensure, 56-NC

-O-Obituaries, 119On Disaster Response Call with Dr.

Dan Edney [K Evers], 298-SOperator Estimate of Surgical

Margins in Colon and RectalSurgery [M Keller, DSnyder, D Sawaya], 286-H

-P-Pancreas Cancer in Mississippi:

Present Challenges andFuture Directions [T.

Helling], 99*Personals, 46

Physicians’ Bookshelf“Bringing Down High Blood

Pressure” [Chad Rhoden,MD, PhD with Sarah WileySchein, MS, RD, LDN,National Book Network][reviewed by L Lampton],146-PB

Forthcoming: “The Fall of the Houseof Zeus” by Curtis Wilkie [PMerideth], 54-PB

Kings of Tort: The True Story ofDickie Scruggs, Paul Minor,and Two Decades ofPolitical and LegalManipulation in Mississippi[Alan Lange and TomDawson, PedimentPublishing, Battle Ground,WA, 2009] [reviewed by PMerideth], 54-PB

Mississippi Native Pens Epic on TortKing’s Fall [B Dye], 367-PB

Stiff: The Curious Lives of HumanCadavers [Mary Roach, W.W. Norton & Company, Inc.][reviewed by A Roy], 307-PB

The Color Atlas of Family Medicine[Richard P. Usatine, MindyAnn Smith, E. J. MayeauzJr., Heidi Chumley andJames Tysinger, McGrawHill Publishing, New York,NY, 2008] [reviewed by SPetersen], 25-PB

Poetry in MedicineDanny’s Song [R Khayat], 107-PMEchocardiogram: A Reading [W

Lineaweaver], 237-PMGratitude [R deShazo], 172-PM“Just a Little Xylocaine” [J

McEachin], 277-PMRhythms of Life [R deShazo], 145-

PMThe Macon Post-season Glee Club [J

McEachin], 202-PM


President’s PageA Prayer for Baby Cobb [TAlford],

329-PPBe Careful What We Ask for, We

Might Get It [R Easterling],49-PP

Be Part of the Solution [REasterling], 140-PP

Have a Good Night [R Easterling],19-PP

I Wish You Hearts that Race, Mindsthat Dream... [R Easterling],168-PP

Inaugural Address of the 143rdMSMA President [TAlford],188-PP

Let’s Change the Whole DamnSystem and Start Over, butWe Have to Wait UntilTuesday [R Easterling], 121-PP

Pigs Have Already Flown [REasterling], 89-PP

Playing Like a Team [TAlford], 293-PP

Promise and Hope for HealthySchools [TAlford], 253-PP

Rising Tides [TAlford], 217-PPUp in Smoke [TAlford], 357-PP

Prevalence and Trends in Obesityamong Mississippi PublicSchool Students, 2005-2009[E Molaison, J Kolbo, LZhang, B Harbaugh, MArmstrong, K Rushing, LBlom, AGreen], 67*

Prolonged QTc Interval Due toEscitalopram Overdose [RMohammed, J Norton, SGeraci, B Newman, CKoch], 350*

-R-Radical Prostatectomy for High-Risk

Prostate Cancer: A Single-Center Experience [DSpencer, J Griffin, J Bridges,J Seidmon, C Pound], 288-H

Recurrent, Transformed Non-Hodgkin’s LymphomaPresenting as Chiasmal

Syndrome withHyperprolactinemia andHypopituitarism [A Sumrall,V Herrin], 35*

-S-Sacral Neuromodulation in Patients

with Voiding Dysfunctionand ConcomitantGastrointestinal Dysfunction[A Haraway, M Runnels, TAbell, W Duncan], 284-H

Screening for Vitamin D Deficiencyin the Elderly [J Kositsawat,S Geraci], 7*

Short and Medium Term Results ofIliac Artery Angioplasty andStenting Combined withSuperficial Femoral ArteryAtherectomy [B Ghosheh, HMcDaniel, F Rushton, ZBaldwin, M Hunt, MMitchell], 283-H

Surgical Management of Eyelid andPeriocular Cancers [MCotten], 247*

-T-The Uncommon ThreadBoils and Goiters [S Anderson], 278Connect the Dots [S Anderson], 310Creative Writing [S Anderson], 203Evidence Based [S Anderson], 238Hard [S Anderson], 374The Ghost [S Anderson], 125The Loss of Magic [S Anderson],

341The Manchurian Candidate [S

Anderson], 173The Thomasine Confluence [S

Anderson], 149

-U-UMHCUMHC Congenital Heart Surgeon

Makes Mississippi History,305

UMMCDr. James Keeton Becomes New

Vice Chancellor, 95Jackson Heart Study to Mark 10th

Anniversary withConference, 272

Stringer, Robbins Named Finalistsfor UMMC Vice Chancellor,59

UMMC School of MedicineProfile of an Entering Medical

School Class [S Case], 59The School of Medicine Class of

2014 [S Case], 306University of Mississippi School of

Medicine – Moving in theRight Direction [LWoodward], 234

Una VoceANote of Thanks (In Memoriam,

Robert “Rob” Walter Bitter,1928-2009) [D South-Bitter],96-UV

Culture and Sensitivity: Part 1,“Adventures with Juan andBud” [D South-Bitter], 175-UV

Canine Behavior [S Anderson], 31-UV

“Celebrate. Remember. Fight Back.”- Thoughts on the AmericanCancer Society Relay forLife [D South-Bitter], 127-UV

Eavesdropping [S Anderson], 63-UVMeditations from Room 324 [D

South-Bitter], 343-UVShocking, Isn’t It? [D South-Bitter],

151-UV

-W-Willard Boggan, MD: AGiant of

Mississippi Medicine [PLevin], 214*

Women in Leadership at theUniversity of MississippiMedical Center School ofMedicine [R deShazo], 269


INDEXVOLUME LI

January - December 2010AUTHOR INDEX

The letters used to explain in which department the matter indexed appears are as follows:“BR,” BookReview; “CPS” for Clinical Problem Solving”; “E,” Editorial; “H” Hardy Abstract; “I,” Images inMississippi Medicine; “L,” Letters to the Editor; “NC” Numbers Count;“PB” Physician’s Bookshelf; “PM,”Poetry in Medicine; “PP,” President’s Page; “S,” Special Article; “UV” Una Voce; the asterisk (*) indicatesan original article in the Journal, and the author’s name follows the entry in brackets. Matters pertaining torelated organizations are indexed under the medical organization.

AAbell, Thomas L., 284-HAlford, Tim J., 188-PP, 217-PP, 253-

PP, 293-PP, 329-PP, 357-PPAnderson, R. Scott, 31-UV, 63-UV,

125, 149, 173, 203, 238, 278,310, 341, 374

Angel, Michael F., 285-HArmstrong, Mary G., 67*

BBailey, Jessica Harpole, 242*Baldwin, Zachary, 283-HBeacham, Tracilia “Drew”, 242*Blevins, Phillip K., 287-HBlewett, Christopher J., 283-HBlom, Lindsey C., 67*Bloom, Sherman, April coverBorman, Karen R., 287-HBrackin, Bruce, 206*Brahan, Robert B., December coverBridges, Jason P., 288-HBusch, Jeanne, 155*

CCaine, Sr., Curtis W., 222-LCannon, C. Ron, 179*, 220-ECase, Steven T., 59, 306Chauhan, Suneet P., 3*Chick, Rebecca S., 317*Cotten, Milam S., 247*Cox, Robert D., 206*

DDarby, Nathan, 323-CPSDesai, Yagnesh, 314*deShazo, Richard D., 145-PM, 172-

PM, 255-E, 269, 331-EDidlake, Ralph, 179*Duchesne, Juan D., 131*Duncan, William L., 284-HDye, Bradford J., 367-PB

EEasterling, Randy, 15, 19-PP, 49-PP,

89-PP, 121-PP, 140-PP, 168-PP, 197

Eldred, Edward B., 211-CPSEspy, Christopher W., 365Evers, Karen A., 158-S, 224-S, 258-

S, 298-S, 334-S, 362-S

FFelder, Elizabeth M., 232Fort, Christopher J., 355-CPS

GGearhart, Judith G., 83-CPSGeraci, Stephen A., 7*, 75*Ghosheh, Bashar, 283-HGlisson, James K., 317*Green, Ashley, 67*Griffin, Joshua G., 288-H

HHamilton, Brian S., 283-HHanspal, Rajvinder Singh, 114-CPSHaraway, A. Neal, 131*Haraway, Allen M., 284-HHarbaugh, Bonnie, 67*Hartness, Stanley, 22-E, 123-E, 170-

E, October cover, 295-EHelling, Thomas S., 99*Herrin, Vince, 35*, 242*Hill, James B., 3*Horn, Michelle, 242*Hunt, Matthew J., 283-H, 285-H

IIslam, Nahid, 183-CPS

JJackson, John J., February coverJackson, W. Dotie, 285-HJoiner, Thomas E., 257-E

KKeller, Michael A., 286-HKhayat, Robert, 107-PMKoch, Christian A., 350*Kolbo, Jerome R., 67*Kositsawat, Jatupol, 7*Kyle, Patrick B., 206*


LLampton, Lucius, 146-PB, 148-I,

171-I, 200-I, 236-I, 276-I,358-E, 372-I

Lee, Robert, 179*Levin, Philip, 214-SLineaweaver, William C., 237-PM,

360-ELockey, Myron W., 53-ELutgendorf, Monica, 155*

MMagann, Everett F., 3*, 155*McDaniel, Huey B., 283-HMcEachin, John D., 202-PM, 277-

PMMcIlwain, James S., 94, 144Merideth, Philip, 54-PBMitchell, Marc E., 283-H, 287-HMohammed, Reema, 350*Molaison, Elaine Fontenot, 67*Moll, Jr., George, 83-CPSMorris, Jr., Michael W., 285-HMorrison, John C., 3*, 155*Mosca, Nicholas G., 232Myers, Robert S., 287-H

NNewman, D. Brian, 350*Nielsen, Janet M., 135-CPSNorris, David R., 289-CPSNorton, John, 350*

OO’Dell, Michael, 52-E, 143-E, 192-

EOrledge, Jeffery, 314*Orozco, Lynne A., 11-CPSOwen, Stanford A., 333-L

PPetersen, Snow Marika, 25-PBPicarella, Emile A., 287-HPierce, Samuel, 317*Pogue, D. Mark, 83-CPSPomphrey, Jr., Martin M., January

cover, May cover, Julycover, November cover

Pontius, William F., Septembercover

Poole, Aaron T., 3*Pound, Charles R., 288-HPugh, Suzanne K., 3*

RReplogle, William H., 283-HRippee, Stephanie M., 273Roy, Alex, 307-PBRunnels, Mark A., 284-HRushing, Keith, 67*Rushton, Fred W., 283-H

SSanders, Suzanne, 75*

Sawaya, David E., Snyder, Davis C.,283-H, 286-H

Schmieg, Jr., Robert E., 131*Seidmon, E. James, 288-HSimmons, Jon D., 131*, 285-H, 287-

HSmith, C. Cory, 242*Snazelle, Teri, 206*Snyder, David C., 286-HSouth-Bitter, Dwalia S., 92-E, 96-

UV, 127-UV, 151-UV,175-UV, 343-UV

Spencer, Jr., David L., 288-HStorey, Joanna Miller, 219-EStroud, Catherine H., August coverSumrall, Ashley, 35*Surkin, Joe, 206*

TTisdale, Brett, March cover

WWeeks, Katie, 242*Weems, W. Lamar, 91-EWoodward, Lou Ann, 234

ZZhang, Feng, 285-HZhang, Lei, 67*

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In a lif ement agreement, the current life insurance policy owner transfers the ownership r ons to a third party, who receives the death proceeds at the passing of the insured. As a result, this buyer has l interest in the seller’s death. When an individual decides to sell their policy, he or she must provide complete access to his or her medical history, and other personal infor hat m ect his or her life expect on is requested during the l for a life er the co he sale, there may be an ongoin to disclose si onal infor ater date. lement may a ect the seller’s eligibility for certain public assistance programs, such as Medicaid, and there may be tax consequences. Individuals should discuss of the proceeds received with their tax advisor. ValMark Sec considers ecurit n. ValMark and its registered repres brokers on the transac receive a fee from the purchaser. A life se t on may require an extended period o o complete. Due to complexity of t on, fees and costs incurred wit lement tran e ally higher than othe es.

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1640 Lelia Drive, Suite 220PO Box 16566

Jackson, MS 39216

Documents

December 2010 JMSMA