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November 2013 Nancy A. Hasenfus, MD, FACP, ACP Governor

From the Governor

Dr. Hasenfus

Chapter Meeting

The weekend of September 27th to 29th was the annual Maine Chapter Meeting. The Chapter Meeting was held at the Atlantic Harborside in Bar Harbor. It was a gorgeous September weekend and the fall foliage was breathtaking from our ocean view rooms. The meeting, “Infectious Disease: Catch the Latest”, was well attended with more than 70 attendees. Rob Smith started the educational sessions explaining that new patients with HIV are not being diagnosed early enough in their course to get optimal treatment. The thinking about who should be treated at what level of a CD4 count has changed several times over the years. The current consensus is that everyone with a CD4 count less than 350 should be treated and that probably most people between 350 and 500 should also receive treatment. Does it make sense to treat people with CD-4 counts above 500 - who knows? If patients are diagnosed late in their course their outcome is not as good. The CDC has recommended that all people between the ages of 13 and 64 be tested at least once for HIV. Some organizations have put a disclaimer in for low incidence areas. Maine is on the edge of a low incidence area.

Alan Kilby said the world of Hepatitis C is about to change drastically. There is a recommendation for universal screening in America for Hepatitis C for all people born between 1945 and 1965. This makes sense because a whole generation of well-tolerated drugs is about to be released. Dr. Kilby sees the treatment of Hepatitis C becoming something that primary care doctors rather than specialists will provide. These drugs are well tolerated although very expensive. In many cases treatment will be curative.

Next Rob Smith also talked about the fascinating world of Lyme disease. He discussed the difficulty of diagnosing Lyme disease in some cases and the complicated political world surrounding Lyme disease. An anti-science element argues that many problems are due to chronic Lyme disease despite a lack of scientific evidence. He also had an interesting discussion of other diseases carried by ticks.

Saturday morning was fascinating. A series of clinical vignettes were presented by Maine Medical Center Internal Medicine Residents.

Katherine Skelly, MD started with a presentation of a Case of Rat Bite Fever in which an acutely ill patient revealed to the perplexed medical staff at Maine Medical Center 5 days after he was admitted that he had been bitten by a rat. She went on to discuss Rat Bite Fever and the fact that 1% of animal bites in America are rat bites.

Lauren Daniels, DO followed with a Case of an Allergic Reaction in a patient who also had Significant ST Elevations. She was treated with an IV Solumedrol for Hypotension and Dyspnea and the ST elevations resolved. A cardiac catheterization was done which was normal.

Nathan Shively, MD provided the next vignette. It was a case of UFO in a 29-year old man from the Dominican Republic who was first thought to have Sarcoid manifested by Lymphadenopathy and Erythema Nodosum. He was treated with steroids, broad-spectrum antibiotics and then IV Remicade. He was not responding when the T-spot came back positive and it became clear that this was all a case of Active Miliary Tuberculosis. The name “Primary Miliary Tuberculosis” comes with the fact that most people with this syndrome have a chest x-ray that looks like it is filled with millet seeds. This gentleman’s chest x-ray was normal except for a small pleural effusion. This led to an interesting discussion about whether he ever actually had Sarcoid or if all of this was Tuberculosis and the diagnosis was difficult to arrive at because of the anchoring effect of the potentially incorrect diagnosis. Dr. Shively was the vignette winner and will present his case at IM 2014.

The 4th case presented by Brian Crabtree, MD was the story of a 54 year old Gentleman with HIV, fevers and altered mental status. He is a HIV positive man originally born in Cuba who was on many medicines for numerous medical conditions including a Schizo-Affective Disorder. An extensive workup led to the diagnosis of Aseptic Meningitis but no etiological agent could be found. A review of the possible causes of Aseptive Meningitis caused Dr. Crabtree to graph out the relationship of Ibuprofen administration to the patient’s temp curve and led to the diagnosis of a NSAID caused reaction. All NSAIDs were stopped and his Meningitis totally resolved. This was case of internal medicine type thinking and analysis arriving at a solution without any further testing. It illustrates the new ACP motto “I think therefore I. M.

Clinical Vignette Presenters

Clinical Vignette presenters

Next there was a panel discussion on antibiotic selection and resistance and the concept of stewardship. Dr. Randall Edson, Dr. Patty Stocksdill & Jennnifer Ott, Pharm D had a spirited discussion of this complex world and there was a good hour of questions from the animated audience.

Dr. Kahn discussing a poster

Dr. Kahn discussing a poster

Attendees viewing posters

Attendees viewing posters

The poster presentation this year was a big success. The poster presenters were each given 2 – 3 minutes to introduce their poster prior to poster viewing. We had 9 presenters two of whom were medical students. Dr. Katherine Garlo won with a clinical vignette of Postpartum Atypical Hemolytic Uremic Syndrome. All the cases were fascinating. Dr. Ian Pennell-Walkin presented a Case of Bullous Pyoderma Gangrenosum, Dr. Katie Stokem a Case of Esopinophilic Granulomatosis with Polyangitis, Dr. Scott Gruarin a Case of West Nile Virus, Dr. Emily Zarookian a classic Case of Wernicke’s Encephalopathy, Dr. Hana Akselfrod a Case of a Patient with Acute Chest pain and Fabry’s Disease and Dr. Alia Teja an Evaluation of a Fever of Unknown Origin. The students were John Daggett who provided a poster concerning Chronic Loin Pain and Hematuria in Thin Basement Membrane Nephropathy and Jasmine Hanifi with a Case of Rat Bite Fever. Everyone listened with bated breath to these brief interesting presentations.

Stephen Hayes, MD, FACP, Laureate winner

Stephen Hayes, MD, FACP, Laureate winner

Dr. Hayes and wife Dr. Carol McCarthy

Dr. Hayes and wife Dr. Carol McCarthy

At the awards banquet on Saturday evening Dr. Stephen Hayes, FACP was awarded the 2013 Maine Chapter Laureate.

Kathleen Fairfield, MD, FACP

Kathleen Fairfield, MD, FACP

Dr. Kathleen Fairfield, FACP was the recipient of the Chapter Volunteerism and Community Service Award.

The awards were followed by the “Leonard M. Keilson, MD, FACP Memorial Presentation”. This year the presentation, “History of Bar Harbor and the Contribution of Medicine” was provided by the Curator of the Bar Harbor Historical Society, Deborah Dyer.

Sunday morning Randall Edson, MD, MACP presented “Pearls of Infectious Disease”, Emily Wood, MD next provided the presentation “Travel Related Infections”. Dr. Mohamad Mooty brought us up-to-date with his presentation on MRSA. This brought the 2013 Maine Chapter Annual Meeting to a close.

Besides Infectious Disease the other theme of the meeting was Advocacy.

The meeting opened with a presentation from Alan Currie, MD, FACP provided an over view of the activities of Leadership Day 2013 in Washington DC. Gordon Smith, EVP, Maine Medical Association talked about the legislative accomplishments of the Maine Medical Association this year but spent most of his time discussing the need for expansion of MaineCare or in other words that Maine needs to accept the Medicaid expansion. We have not lost any money in Maine yet but starting January 1st we will unless the Governor chooses to accept the Medicaid expansion or the Legislature overrides his veto. If we do not expand Medicaid during the next 3 years we’ll lose a billion dollars. If we expand Medicaid 70,000 more Mainers will have insurance and the federal government will pay 100% the first year tapering down to 90% in the 3rd year. This will bring a lot of money into Maine. It will be brought up to the legislature again in January and hopefully the Maine physicians will rise and help educate the public and our legislators about the importance of this passing. For more information contact the Maine Medical Association, 207 622 3374

At our recent GAC meeting we resolved to try to facilitate passage of the Medicaid expansion in Maine. The Maine Medical Association is leading this effort and if you want to be involved please contact either the Jesse Barnard at the Maine Medical Association, myself, Nancy Hasenfus, MD, FACP or our new chairman of our Health and Public Policy Committee Daniel Morgenstern, MD, FACP.


Membership Updates

Fellows: The Maine Chapter congratulates Maine members awarded Fellowship status in the past 6 months.

Thomas Gearan, MD
Mohamed S. Hameed, MD
Jacquelyn Hedlund, MD
Steven Nadeau, MD
Bruce Sigsbee, MD
Calvin Yates, MD

Douglas Couper, MD, MACP

Douglas Couper, MD, MACP

Mastership: We are pleased to announce that Dr. Douglas Couper has been bestowed ACP Master status. Mastership is the American College of Physicians highest honor. It is awarded to a Fellow who has been selected because of “personal character, positions of honor, contributions toward furthering the purposes of the ACP, eminence in practice or in medical research, or other attainments in science or the art of medicine.”

Unlike applying for ACP Fellowship a candidate must be nominated for Master status. The nomination for Master is made by a member of the Chapter without the nominee being informed of the nomination. Only those nominated and awarded Master status are made aware of their nomination. Those who may be nominated, but not awarded are never informed of their nomination. The identity of the nominator is not released to the recipient or even to the Chapter Governor.

We have all benefited from the years of Dr. Couper’s commitment to the ACP. Dr. Couper was the Maine Laureate recipient in 2005. He has been the Chair of the Maine Chapter Program Committee for the past 16 years. He develops chapter meetings with interesting topics, lively panel discussions and updates on a variety of diseases, diagnoses and treatments all of which broaden our expertise.

We are happy to report that Doug was speechless when informed of being awarded the status of Master! The ACP Maine Chapter congratulates Douglas Couper, MD, MACP on his award.

Health and Public Policy Committee Chair: The ACP Maine Chapter thanks Dr. Jane Pringle for her years of service as the Chair of the Health and Public Policy Committee. Dr. Pringle was elected to the Maine House of Representatives District 111 in 2012.

The Maine Chapter is pleased to announce that Dr. Daniel Morgenstern, FACP has agreed to be Chair of the Health and Public Policy Committee.

Dr. Morgenstern practiced IM at Bowdoin Medical Group in Brunswick and recently retired. If you have an issue you would like to discuss with Dr. Morgenstern.


2013 Chapter Excellence Award

I am pleased to announce that our Chapter is in receipt of the 2013 Chapter Excellence Award!

The award recognized chapters, which successfully meet the standards for managing a chapter. In order to achieve the Chapter Excellence Award, chapters must meet all basic criteria and seven optional criteria.

Criteria include such activities as formulating an effective Governor’s Council and committees, communicating frequently with membership, providing educational opportunities, recruiting and advancing members and celebrating membership through local awards. I would like to extend a special thanks to those chapter members who assisted me in all of these endeavors! For their hard work and dedication, we received this award.

Governor Hasenfus receives Chapter Excellence Award and Flowers

Governor Hasenfus Receives Chapter Excellence Award & Flowers

Recognizing Dr. Hasenfus

It’s hard to imagine that nearly 4 years have passed since Dr. Nancy Hasenfus took the helm from Dr. Richard Engel in leading the Maine Chapter as Governor. Nancy was recognized at her last Annual Chapter Meeting as Governor, although she continues as Governor until the close of ACP IM 2014. Nancy was presented with flowers and a gift from the Chapter. Despite tough economic times and turbulent medical seas, under Nancy’s watch the Maine Chapter has grown by 5%, with Resident/Fellow Membership increasing over 32% and Medical Student Membership increasing over 61%! The chapter has won Chapter Excellence Awards in 2011 and 2012 and distinguishes itself by being one of a select few continuing to host high quality, multiple day Annual Chapter Scientific Meetings.

I recently had the distinct honor and opportunity to attend the Board of Governors meeting in Savannah as your Governor Elect, and was enthusiastically welcomed by many of Nancy’s fellow Governors who spoke with great fondness and respect for her as a person and physician / leader. We have been fortunate indeed that our representative on the national stage has been one who truly embodies the ACP’s commitment to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine. I know that you join me in heartfelt thanks to Nancy for her gift of time, spirit and leadership.

As I prepare, with Nancy’s help, for the transition in April to my own term as Governor, I sincerely hope that I can serve you and the ACP with the dedication and enthusiasm of my distinguished predecessors and ask you to join me in making the legacy of this great organization even greater still.

John Erickson, MD, FACP, Governor-Elect


From ACP

New Ethics Case Study Offers Guidance for the Care of Cognitively Impaired Patients

Preventive Health Screening, Ethics, and the Cognitively Impaired Patient is a new ACP ethics case study that is available online for CME credit. The case study presents the ethical issues in decision making regarding screening tests for patients with cognitive impairment and is designed to help primary care physicians, geriatricians, neurologists, and other physicians who care for patients with intellectual disabilities.

CME credit is available through Medscape for completion of this and other ACP case studies in the professionalism case study series.


Save the Date

Atlantic Oceanside, Bar Harbor, ME

Hope to see you next year.

Maine Chapter Annual Meeting
September 12-14, 2014
Atlantic Oceanside
Bar Harbor, ME

Nancy A. Hasenfus, MD, FACP
Maine Governor


Contact Information

Maine Chapter Governor:
John E Erickson, MD, FACP

Chapter Staff:
Warene Chase-Eldridge
Chapter Coordinator
PO Box 411
Gardiner ME 04345-0411
Phone: 207-215-7118
Email: MaineChapterACP@gmail.com