COMPASSION IS WHAT SUSTAINS ME: CAROL COTTRILL

It seems so fitting that Carol Cottrill’s medical specialty is the hearts of children - both physical and emotional. Her career path began when her 4th child was born with congenital heart disease.  Growing up on a family farm, she learned to balance compassion and necessity, a skill she would use in caring for her daughter and later during 18 years as medical director of UK’s pediatric ICU. Her daughter’s illness introduced her to wonderfully compassionate doctors and nurses who….

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FRIEND TO THOSE WHO ARE AILING: DANESH MAZLOOMDOOST, MD

Danesh Mazloomdoost, MD has inherited a tradition reflected in his name itself. In his family’s native Iran, Mazloomdoost means “friend to those who are ailing.” His life in medicine seems almost preordained by his family history. His father (a U.S. trained anesthesiologist who specialized in pain management) and mother (who trained in anesthesiology in Iran and retrained in psychiatry in the U.S.) built their practice around a comprehensive mind-body approach to pain management, long before such….

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SUSTAINING AN ALTRUISTIC SPIRIT: TERRY BARRETT

Terry Barrett is Chief of the Gastroenterology Division of the Department of Medicine, University of Kentucky College of Medicine. He came to Lexington in 2013 from Northwestern University Medical School in Chicago.  Becoming a Doctor.   Although there were no doctors in his family, he always felt a parental expectation of excellence and high achievement. He had a poor impression of the competitive nature of pre-medical education he witnessed among his peers.

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Kentucky Board of Medical Licensure’s Impaired Physicians Program. I was relieved of my duties as a resident and given the opportunity to go into a residential drug treatment center in Atlanta.”


Rehab- Relapse- Rehab

“I connected with recovery, but it was only superficial. I had not yet fully surrendered to the disease. I thought if I could just stop abusing opioids, perhaps I would be able to still drink alcohol. I could not imagine my life without alcohol. I returned to the anesthesia residency only to suffer a relapse which could easily have resulted in my death. But that was not to be my story.  The relapse resulted in termination from the anesthesia residency two months into my fourth and final year. I returned to the same residential treatment center in Atlanta, staying for six months and this time it was different. My parents had to pull away and let me experience this without their support. This was an incredibly painful experience, as my Mom was going through treatment for small cell lung cancer at that time. I knew I was going to lose her and didn’t know if I could get through that without using drugs and alcohol, which at the time was my chief coping skill.”


“During this second stay in residential treatment, my whole attitude and outlook on life changed. I had fully surrendered, admitted defeat, accepted help from something greater than me and experienced a spiritual awakening as a direct result of working the 12 steps of recovery.”


12 Steps

“My sobriety date is November 26, 1999. I continue involvement with a 12-step program and have maintained abstinence from all mood-altering substances and alcohol since that date. For the first 7 years, I participated in a monitoring program with The Kentucky Physicians Health Foundation. I am forever grateful for the support from Dr Burns Brady, Dr Jim Jennings and now, Dr Greg Jones. I was allowed to return to work as a physician at UK Hospital in 2001 and completed a family medicine residency in 2003. I passed my family medicine boards in December of 2003, and in this same month, lost my Mom.”


“With the support of the 12-step fellowship and my friends and family, I was able to get through this without drinking or using drugs. During the family medicine residency, I had discovered a passion for treating and helping patients that were suffering from the disease of addiction. I moved to Gainesville, FL and completed a fellowship in addiction medicine, becoming ASAM certified in addiction medicine in 2004. I have also studied urine drug testing/toxicology and became certified as a Medical Review Officer. I’ve been practicing mindfulness meditation and yoga for many years. In 2013, I became a certified yoga instructor and will soon achieve advanced yoga teacher certification.”


“I continue participation in 12 step recovery programs. I have a sponsor and I have sponsored many women over the past 18 years, including other physicians. I have served as peer support for the Kentucky Physicians Health Foundation for more than 6 years.”


Practicing compassion for myself and my patients

“My compassion for patients struggling with drug dependency comes from this direct personal experience with addiction. I really am concerned about the abuse and over-prescribing of Suboxone. Just like the overprescribing of antibiotics for non-bacterial conditions, Suboxone is being overutilized and is not addressing the underlying problem. I do see its benefit in short term use to stabilize and engage someone into the treatment process, but without some kind of spiritual awakening, addiction is just too complex a disease to be treated with a drug. If we neglect the spiritual suffering of these patients, we will do more harm than good. I’ve declined to be a prescriber of Suboxone.”


“I treat addiction using a 12-step model. I teach yoga and mindfulness classes twice a week and share my personal story, using my experience to educate about the disease of addiction and give hope that there is a way out.  I take the patients hiking. We learn together how to live one day at a time and how to reconnect with a spiritual life.”


“I see patients with high risk situations such as termination from a previous pain clinic, repeated inappropriate urine testing, high dose opioid use and alcohol use with opioid medication. Sometimes it is appropriate to offer a trial of continued opioids- sometimes it is not. I treat each patient individually, taking into consideration the pain condition and, depending on the situation, I consider if opioids are appropriate and safe. When it is clear that there is a co-occurring substance use disorder, I discuss my findings with the patient, helping with locating treatment and offering information on 12 step meetings and treatment options in the community. If the patient is at that time on high dose opioids, I advise them I plan to taper and stop opioids, but that this will be done gradually, and in a manner that will minimize acute withdrawal. If the dose is reduced gradually and the patient will take the medication as prescribed, severe withdrawal symptoms can be avoided.”


“My practice allows me to have an hour with a new patient and I spend much of this time building rapport, offering education and instilling hope for effective alternatives to opioids. I focus on non-pharmacologic methods of chronic pain management, encouraging mild, daily exercise and gentle movement, learning and adopting new coping skills and self-care. Some are not able to follow the treatment plan due to the severity of their addictive disorder and continue to have inappropriate urine testing and manipulative behaviors. Unfortunately, they often discharge themselves from the practice and are lost to follow up- enrolling in another pain clinic or seeking substances illicitly.”


“I see the misunderstanding of addiction among my colleagues- their lack of appreciation of addiction as a primary disease- not a symptom of an untreated psychiatric condition or poor parenting. Patients have also inherited this misunderstanding. Over these past 18 years in recovery from my addiction, I have come to accept and not judge myself. This carries over to my care of patients, who sense that I am there to help and not to judge. My conscious creation of a therapeutic office includes an aquarium, potted plants, windows and natural light, and a therapy dog named Q-tip. I dress casually to avoid intimidating patients. I often have to advise patients that I do not recommend use of opioids for their chronic pain condition. This provokes a dramatic and emotional response in some individuals. I try to diffuse this situation by providing a supportive, caring and compassionate space.  I always strive to offer dignity and respect, even if there is dishonesty about drug use or deception discovered during the encounter. My response is non-blaming and non-shaming. I want to offer help and hope rather than judgment.


My message for physicians in training and in practice

“The opioid crisis in Kentucky and across America is not just a medical crisis. It is a spiritual crisis. I believe the solution is much more complex than a pharmacologic product. These are only temporary band aids to a gaping, hemorrhaging spiritual wound. The solution must include the spiritual. As physicians, we may not all be equipped with the skills to provide this spiritual help ourselves, but we can refer to community resources that are.”


“We all must find the inner resource that fills our spiritual cup- whether it is a religious practice, community connection, meditation, yoga- some way to connect to something bigger than ourselves. Carrying the message of hope and recovery to others, to the readers of this article and in the patient encounter - this keeps me connected to my spiritual center and allows me to stay sober.”


On behalf or our physician readers, I wish to extend a heartfelt thanks to Traci Westerfield for sharing her personal story.           

Traci Westerfield MD treats and teaches patients struggling with addiction and chronic pain. One of her most effective therapeutic and educational tools is her powerful and compelling personal story.  For that reason, I will share her story here in her own words- for the benefit of our physician colleagues, our patients and our community.


In August of 2011, the American Society of Addiction Medicine released the following revised definition of addiction:   


Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. (https://www.asam.org/docs)


Teenage addiction

“My first recollection of having a problem with alcohol use was at the age of 14, when I took a bottle of bourbon whisky to school and drank

BY JOHN A. PATTERSON MD, MSPH, FAAFP

to the point of toxicity- requiring an overnight stay in the hospital.  Throughout high school and college, my drinking and substance abuse led to DUI arrests, court appearances and late-night phone calls to my parents for help.”


Med school and residency addiction

“Along the way, my desire for approval and achievement led to success in academic studies and I was accepted into UK College of Medicine (much to my surprise) in 1992. I recall thinking “it’s going to be different now. I’m a medical student, time to straighten up and get it together...” Within the first month of medical school, my classmates had elected me to be our social chair and I proceeded to place myself in the center of drinking and planning parties. Following medical school, I focused in the practice of anesthesia, following in my Dad’s career path and thought again, “its going to be different now, I’m a doctor, time to straighten up.”


“It wasn’t different. My alcohol and substance use continued. Things took a serious turn for the worse when I began abusing opioids during anesthesia residency. Through what I now see as a set of miracles, I was able to find the courage to surrender and ask for help. The help came from what was then the

JOHN A. PATTERSON MD, MSPH, FAAFP

Dr Patterson chairs the Lexington Medical

Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998. Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org