A HEART DOCTOR WITH A KIND HEART

Growing up on a busy farm in rural Virginia, milking cows before and after school every day, Cary Blaydes assumed he would grow up to become a farmer. When his father convinced him to consider medicine instead, his goal was to go back home as a general practitioner and help the people he grew up with. Luckily for Central Kentucky, his plans changed.

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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….

….FULL ARTICLE

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As an aside, Buddhism & Sufism more than any other philosophy helped me understand this. This combined with curiosity in physiology, neuroanatomy, and the existential perplexities of anesthesiology (where does the mind/soul go when anesthetized?) led me toward anesthesiology and subsequently pain.


Beyond the immediate symptomatic complaints, every patient I see is a fascinating puzzle. It's a privilege to have insight into the physiology causing symptoms of pain as well as to gain insight into the variety of ways of coping with every patient I meet. It gives me a tremendous respect for the aging process -- our physiology and the limitations imposed by aging bodies. When I followed this line of thought, it was a natural evolution from managing the symptoms of pain, which is primarily my training, to ‘why is this hurting in the first place, and how can it be fixed?’


This is the reason we changed our name from Pain Management Medicine to Wellward Regenerative Medicine. I don't think it's enough to simply minimize the impact of pain with palliation. Rather, my thoughts go to the kinetics and pathophysiology causing pain, and then to ‘how do we leverage the healing mechanisms of the body to maximize its ability to heal?’ So I guess, it's not ‘why I chose pain’ but rather ‘how did I evolve from pain and into the regenerative practice that I now do.’ “


What role did kindness and compassion play in your parents’ pain management practice?

“My parents were never in medicine for the money. If anything, they both turned down better paying jobs to do what they did with their practice. Many pain clinics with histories as old as theirs grew into mega-practices and devolved into impersonal operations. My parents intentionally chose to remain small so they could have 1:1 contact with their patients. And they often served the under-served, under-insured, or uninsured. I remember driving hours with my father to Corbin, Hazard, and Cumberland as he sought to aid those with limited access to healthcare.


My parents’ embodiment of the humanistic side of medicine is largely what influenced my values and those of my siblings. As medicine has changed, I know that how they practiced is no longer sustainable, which is very disappointing. Even in the short time that I have taken over the practice, there have been so many changes in healthcare, making it evident that the system and values they embodied are challenging to sustain financially and personally. These days it seems that the volume of patients needed to make a private practice sustainable makes it idealistic (and uncommon) to invest emotionally as deeply as my parents did in the lives of their patients.”


How do you and your wife practice together?

“We practice kindness and compassion to each other regularly. I think if I wasn't married to a psychologist, I would have gone crazy by now. Her fellowship was in disordered eating. She meets individually with patients, focusing on over-eating and under-eating as part of our comprehensive regenerative medicine program that includes the association between diet and chronic pain. These lifestyle approaches  complement our other regenerative modalities, including stem cell, PRP (platelet-rich plasma), and prolotherapy injections that mobilize the patient’s own cellular healing mechanisms, as opposed to the conventional injection therapies that can actually hinder progress with supra-physiologic steroid doses.”


How does delivering compassionate care impact you, your marriage, your family?

 “It's difficult. I've always imagined myself as a father, but frankly we have tabled having kids because of the vision and mission we have sought in building this practice. It has a huge impact on our stress levels and endurance for additional challenges. Every individual can only delay gratification (starting a family, having financial stability) for so long, and setting limits has been an important lesson for me.”


What role does compassion play in addressing our opioid crisis?

“It is really the loss of compassion, manifested by complacency and greed, that has created this epidemic. Chronic pain patients are stripped of their goals, vitality, sense of purpose, and dignity on top of any physical manifestations of pain. Yet, our healthcare system seems to enable dysfunction and hopelessness sometimes in subtle messages and other times in very blunt ways. Patients with pain have a morbid quality of life and are in a desperately vulnerable state. They have often been told ‘there is nothing that can be done for you and so you need to take this medicine – opioid‘ when in reality there are many non-surgical options yet unexplored.


If they become problematic or have pain after what is deemed as a fix (surgery), then as a palliative option they are sent to a pain specialist to ‘get your meds because the government prevents me from helping you,’ For years, they'd been told that the solution to their ailment is a one-size- fits-all pill, we just need to get the dose right. This is an injustice, deftly marketed by pharmaceutical manufacturers. Often the evidence-based workup to understand the pain is ignored while palliating with opioids and as time goes on, the line is blurred between the original pain and the subsequent opioid dependency, hyperalgesia, or even addiction. Through an over-reliance on opioids, healthcare has forgotten that there are identifiable cause and effect relationships in pain. Pain is not a condition, it is a symptom, and the underlying cause needs to be diagnostically worked-up. Pain cannot be diagnosed simply from a radiographic image any more than hypertension can.


Compassion comes in recognizing that the patient did not choose this direction. Yes, they share accountability but we also need to acknowledge the role society, healthcare and pharmaceuticals have played in creating this problem. Patients may cling to their medications because it's the only thing that gives the illusion of comfort. It is incumbent on all healthcare practitioners to correct the myths around opioids and pain. Patients often feel abandoned because they have been maintained on opioids for years and now all of a sudden, the system is changing around them. They become distrustful of the healthcare system because of the subtle messaging that conveys complacency or stigma around this topic. It is so critical for all clinicians to speak with a unified message to patients that pain is a natural reflection of tissue damage that needs attention, some pain is unavoidable, and mitigating the symptom does not eliminate the disease.


Most important of all, is changing how we approach the patient with a new onset of pain. The current model of health provides very little training in understanding pain. All clinicians need a better understanding of how injuries heal and why some do not- eventually becoming chronic pain. We need more centers that focus on the fundamentals of treating pain as a result of tissue damage, instead of just palliating symptoms or prematurely jumping to invasive surgery. Our rates of failed treatments (failed back surgery, unavoidable surgeries, routine steroid injections, or persistently painful joint replacements) are too high. This can change. “


How can we keep compassion alive?

“My grandfather use to say, ‘People may act out but they do so because they are sick. It's my obligation as a physician to help them back to health.’ Compassion is easy when the other side is friendly and compliant. Our patience grows thin when they are not. What has helped me keep compassion alive is keeping that in mind. “


Lexington and southeastern Kentucky have been fortunate to have two generations of Mazloomdoosts offering innovative pain management based on a compassionate, humanistic, whole-person model of medicine- truly ‘friends to those who are ailing.’

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 a collaborative approach was common. Their names are Manoochehr and Camellia (Shirazi) Mazloomdoost. In keeping with the family tradition, Danesh now practices with his psychologist wife, Andrea Z. Omidy, PhD.


What inspired you to become a physician?

“There were influences from both sides of my family. I never met my maternal grandfather; nevertheless, he was a tremendous posthumous influence. He was the quintessential family physician in a small Iranian town who then later became the regional health director and defender of human rights at a politically tumultuous time in Iran. Incidentally, before my parents met, my father worked under him in the department of public health.


It was through my grandfather's encouragement that my mother pursued medicine when it was unpopular for women to do so. Unfortunately, in my mother's second year of medical school, her father, mother, youngest sister, grandmother and cousin were all killed in a tragic car accident. My grandfather had such an influence on the region

BY JOHN A. PATTERSON MD, MSPH, FAAFP

that his body was hand carried 50 miles back to his hometown. Growing up, I was always reminded of his selflessness and compassion. This has been a value closely held by all members of my family. I was always drawn to the humanism of medicine and it's embodiment of our family values.”


Why pain medicine?

“When my parents immigrated to the US, they were both anesthesiologists but escaped Iran, like many other immigrants, starting from scratch. They had seen a lot of human suffering during the political fall-out from the revolution and war in Iran. So, after they immigrated, my mother sought psychiatry and my father pain management. All my free time growing up was spent at the family medical office helping in anyway I could. It was a large influence on my thinking as I sought higher education.


While it was not intentional, my interests in pain started philosophically. Having heard the stories and seen the struggles of my parents both in immigration and in starting a practice in a novel field, the endurance of human strife and suffering fascinated me. What differentiated someone who coped well from someone who capitulated to their stressors? What is the purpose of pain and discomfort?

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