ISSUE 1 | 2025 THE OFFICIAL JOURNAL OF THE UTAH ACADEMY OF FAMILY PHYSICIANS UAFP 2025 Legislative Recap Building the Future of Family Medicine Noorda College of Osteopathic Medicine Family Interest Group (FMIG)
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Participation by advertisers does not constitute endorsement by UAFP. ©2025 Utah Academy of Family Physicians (UAFP) | The newsLINK Group LLC. All rights reserved. Utah Family Physician is published two times per year by The newsLINK Group LLC for UAFP and is the official publication for this association. The information contained in this publication is intended to provide general information for review, consideration and education. The contents do not constitute legal advice and should not be relied on as such. If you need legal advice or assistance, it is strongly recommended that you contact an attorney as to your circumstances. The statements and opinions expressed in this publication are those of the individual authors and do not necessarily represent the views of UAFP, its board of directors or the publisher. Likewise, the appearance of advertisements within this publication does not constitute an endorsement or recommendation of any product or service advertised. Utah Family Physician is a collective work, and as such, some articles are submitted by authors who are independent of UAFP. While a first-print policy is encouraged, in cases where this is not possible, every effort has been made to comply with any known reprint guidelines or restrictions. Content may not be reproduced or reprinted without prior written permission. For further information, please contact the publisher at (855) 747-4003. THE MISSION OF THE UTAH ACADEMY OF FAMILY PHYSICIANS To improve the health of all Utahns by advocating for and serving the professional needs of family physicians. 4
Table of CONTENTS ISSUE 1 2025 16 8 26 On the cover: UAFP board members at their 2024 summer retreat in Brighton, Utah PRESIDENT’S MESSAGE 6 A New Addition to the UAFP Family CEOA’S MESSAGE 7 Codifying Discrimination 8 UAFP 2025 Legislative Recap 10 2024/2025 Utah Academy of Family Physicians Board of Directors 12 Utah Family Medicine Match Results 13 2025 Student and Resident Awards 14 Graduating Residents and New Interns 16 CME & Ski 2025 18 Prevention and Recovery from Early Psychosis 20 Regenerative Medicine A Fountain of Youth or Marketing Misnomer? 22 The “Elmer Fudd Syndrome” A Less Common Presentation of Myasthenia Gravis 24 The Role of Family Physicians in Medical Cannabis Access 26 Building the Future of Family Medicine Noorda College of Osteopathic Medicine Family Interest Group (FMIG) STUDENT SPOTLIGHT 30 Jordyn Huecker RESIDENT SPOTLIGHT 31 Akosua Hatch, DO MEMBER SPOTLIGHT 32 Kyle Bradford Jones, MD, FAAFP PROGNOSIS NEGATIVE 34 Doctor Simplifies Documentation by Cutting and Pasting Lyrics From The Cure Into Depressed Patients’ Charts 5
This edition’s President’s Message is a little different than usual but very exciting. We are very happy to announce the arrival of a new member to the UAFP family. UAFP Board President Dr. Tiffany Ho gave birth to Natalie Kwok on March 30. Mom and baby (and dad, Nathan) are doing great and settling into life with a newborn. They are no doubt sleep-deprived but love every minute of it. Please join us in welcoming Natalie and congratulating Tiffany and Nathan on their new little bundle of joy! PRESIDENT’S MESSAGE A New Addition to the UAFP Family 6
CEO’S MESSAGE Codifying Discrimination This year, during the Utah State Legislative Session, a bill was proposed, entitled “Physician Practice Amendments.” This bill is one of those that at first glance — particularly to someone not in healthcare — seems like a reasonable argument. But when you dig deeper and begin to consider the potential ramifications, not just to patients, but also to the practice of medicine as a whole, especially family medicine, it is wholly unacceptable. This bill would have allowed a healthcare provider to refuse service to anyone based on any religious, ethical, professional or personal reasons. It did not include any exceptions and did not acknowledge the existence of state and/or federally protected classes. In other words, if you had a patient who was part of a religion, in a relationship, or had any other characteristic that you did not agree with, you could simply refuse to treat them with zero repercussions. These types of “right of conscience” bills have been making their way around the country. Several states have already passed similar legislation. In my seven years as CEO and UAFP lobbyist, this bill created the most uproar among our membership. I fielded more calls on this than in any previous year — all universally opposed. I love this job — not just for the actual day-to-day, which I enjoy, but for the incredible people I have met. Family physicians are the salt of the earth in healthcare. You care more than any specialty, and your desire for everyone who needs care to receive it is a pillar of family medicine. It is a specialty steeped in empathy and compassion. Is every patient a perfect fit for your practice and personality? No, of course not. I recently heard a story from a member physician about a patient who refused to actively participate in their own treatment, refused recommended medications and so on. After careful consideration, this physician told the patient that they had realized that perhaps they were not the right physician for them, gave them recommendations for other practitioners that might be a better choice, and they parted ways amicably. Legislators weren’t involved in the discussion, no lawyers needed, they simply found a way forward for both patient and doctor. But if push came to shove, I guarantee the physician would have treated that patient or any other patient if they were truly in need. Let’s be honest — as family physicians, you will all encounter challenging patients. If there is truly a bad fit — it happens — there are ways to move forward without the need for statutory guidance. We’ve become a country of “us” and “them,” and this type of law is a dangerous extension of that division. When a physician can decide not to treat someone based on the color of their skin, who they may choose to share their life with, or for that matter, how many tattoos someone has, we’ve lost our way. I am proud to say I worked hard to kill the bill before it even got a committee hearing and I will continue to fight this sort of “conscience” legislation. As was said by one of the many who contacted me, “I didn’t get into medicine to pick and choose who I helped.” Note: As of publication date, this bill has been included on the interim study list, meaning the legislature may discuss it again during interim sessions throughout the year. If you have comments or feedback on this, please email me at martindalemm@utahafp.org. Maryann Martindale CEO, UAFP 7
UAFP 2025 Legislative Recap By Maryann Martindale, CEO, UAFP If asked to describe this year’s legislative session, I would liken it to a kid who hides behind a tree or bush to avoid being seen by someone. Health care advocates did a bit of duck and cover this session, as the attention of lawmakers was focused on issues (real or imagined) other than health care. In a “knock on wood” moment, this session was actually not too bad, certainly not as bad or potentially bad as previous years, but there were still several key bills worth discussing. The following bills passed: • HB81 Fluoride Amendments: Utah is No. 1 again ... for being the first state to ban fluoride in the water, and as our legislators take a victory lap, this isn’t the “win” they seem to think it is. We opposed this, but once we learned this was a leadership-supported bill, we knew the writing was on the wall. We’ll see the negative impacts of this change, particularly in children, with increased tooth decay and weakened enamel leading to lifelong dental issues. UAFP Rank: VERY BAD • HB257 Pharmacy Benefit Amendments: For several years now, we have supported bills that would ensure pharmacy rebates and credits go directly toward patient costs or copays. While the copay accumulator bill didn’t pass, this bill requires pharmacies to count rebates directly against patient costs rather than keeping them as additional revenue. UAFP Rank: GOOD • HB233 School Curriculum Amendments: Unfortunately, this is a bill that gave opponents of Planned Parenthood a win while depriving our schools of a solid and state-supported health curriculum. For years, Planned Parenthood has provided sound health education programs, particularly around maturation. They follow state‑mandated content rules to the letter. Now, schools are faced with creating their own programs, finding appropriate people to teach and covering those costs entirely. UAFP Rank: BAD • HB402 Food Available at Schools: This bill requires healthier food to be provided in school lunches. While we fully support healthier food for our students, we were initially opposed to portions of the bill that mandated immediate adoption of these changes, putting schools and their already limited budgets at risk. Fortunately, changes were made that allowed for more time to comply and we switched to supporting the bill. UAFP Rank: GOOD Rep. Grant Miller and Dr. Brian Bertsche Sen. Nate Bluin and Dr. Elise Blaseg Rep. Grant Miller and Dr. Brandon Buffington 8
The following bills did not pass: • HB245 Tobacco Amendments: After many years of proactive anti‑tobacco legislation, this one was a headscratcher. It would have allowed for telephone, mail or internet purchase of tobacco products. This would have opened up a whole new avenue for people, especially those underage, to purchase tobacco. Thankfully, it had resounding opposition and never made it out of Rules. UAFP Rank: VERY BAD • HB288 Healthcare Malpractice Amendments: Luckily, this one never gained any traction. This bill proposed to double the amount of time a patient could sue for malpractice — in some cases allowing as much as eight years to elapse. The burden on providers would have been immense. This would have been a gold mine for medical malpractice insurance, as most claims would have required settlement, and insurance costs would have increased. UAFP Rank: VERY BAD • HB400 Blood Transfusion Amendments: Referred to as the “bring your own blood” bill, this was one of the more unusual bills of the session. The first version of the bill was so broad that it literally would have allowed a patient to bring in a quart jar with their blood in it for the upcoming surgery. Fortunately, after much discussion with the sponsor, that was never the intent, and language was added to require adherence to all blood donation protocols, which meant the bill essentially was just affirming the right to autologous blood donation and donor blood donation. However, it took too long to get it right and it never made it across the finish line. UAFP Rank: NEUTRAL • SB320 Physician Practice Amendments: This one was discussed in the CEO’s Message —the physician right of conscience bill that we worked to defeat early. Too broad, too far afield from the ethical practice of medicine, this was a good one to leave behind. UAFP Rank: VERY BAD All in all, we had some wins and a few losses, but with other issues taking up the air in the room, health care survived to fight another day. A huge thank you to all our members who participated in the Legislative Advocacy calls and helped determine our positions. This would not be possible without your expertise and willingness to get involved. IF YOU’D LIKE TO SEE THE UAFP POSITIONS ON THE BILLS WE REVIEWED, SCAN THE QR CODE. https://utahafp.org/wp-content/ uploads/2025/04/2025-UAFP-Bill-Tracker.pdf Carrie Butler, executive director, UPHA; Rep. Jake Fitisemanu; and Maryann Martindale, CEO, UAFP Dr. Vickie Armstrong, Rep. Jen Dailey-Provost, medical student Braden Cunningham, and Rep. David Shallenberger Primary and Preventive Day on the Hill 9
2024/2025 Utah Academy of Family Physicians BOARD OF DIRECTORS THANK YOU FOR YOUR SERVICE TO THE UAFP BOARD! Executive Committee Tiffany Ho, MD, MPH, FAAFP President Lynsey Drew, DO, MBA, FAAFP President-Elect Michael Chen, MD, FAAFP Immediate Past President Tyson Schwab, MD, MS Treasurer At-Large Board Members Shannon Baker, MD Craig Batty, DO Colten Bracken, MD Marlin Christianson, MD Katherine Hastings, MD Matthew Johnston, MD, MMM, FAAFP, CPI Jessica Jones, MD, MSPH Bernadette Kiraly, MD, FAAFP Collin Lash, MD Matthew McIff, MD David Miner, MD Jamie Montes, DO Daniel Payne, MD Saphu Pradhan, MD, FAAFP Thea Sakata, MD Heather Sojourner, MD, FAAFP Chad Spain, MD, FAAFP Kirsten Stoesser, MD, FAAFP Sally Tran, MD Mark Wardle, DO, MIH, FAAFP Sara Walker, MD, MS, FAAFP AAFP Delegates and Alternates Thea Sakata, MD AAFP Delegate Chad Spain, MD, FAAFP AAFP Delegate Saphu Pradhan, MD, FAAFP AAFP Alternate Delegate Nick Duncan, MD AAFP Alternate Delegate Family Medicine Residency Representatives Akosua Hatch, DO McKay-Dee Family Medicine Residency Representative Elise Blaseg, MD St. Mark’s Family Medicine Residency Representative Mario Pucci, MD University of Utah Family Medicine Residency Representative Natalia Garcia, MD Utah Valley Family Medicine Residency Representative Medical Student Representatives Jordyn Heucker Noorda College of Osteopathic Medicine Katelyn Bercaw Rocky Vista University — Southern Utah Jake Momberger University of Utah School of Medicine Thank You For Your Service We would like to recognize and thank the following board members who are completing their term(s) of board service and will be stepping down in July. We are very appreciative of their willingness to share their time and expertise to help make UAFP a strong and effective voice for family medicine in Utah. Matthew Johnston, MD, MMM, FAAFP, CPI Saphu Pradhan, MD, FAAFP Thea Sakata, MD Chad Spain, MD, FAAFP Mark Wardle, DO, MIH, FAAFP 10
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Utah Family Medicine Match Results Family medicine residencies offered a record number of positions in the National Resident Matching Program for the 16th year in a row, and the specialty is poised to enter the 2025-26 academic year with the largest intern class in its history. UAFP congratulates all of the Utah med students who matched! Below is a list of all Utah medical school graduates who matched into family medicine. Welcome to the family medicine family! Noorda College of Osteopathic Medicine Jaden Arnold — Alaska FM Residency, Providence Family Medicine Center, Anchorage, AK Seema Arshed — University of Michigan Health-West, Wyoming, MI Marianne Becnel — Alaska FM Residency, Providence Family Medicine Center, Anchorage, AK Cassandra Bovee — Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA Cameron Chalmers — Madigan Army Medical Center FM Residency, Tacoma, WA Garrett Haggler — Nellis Air Force Base, Las Vegas, NV Brittney Harrell — Duke University Medical Center, Durham, NC Caleb Harrop — University of Utah Health, Salt Lake City, UT Nathaniel Hill — Baylor Family Medicine Residency Program at Baylor University Medical Center, Dallas, TX Odette Homsi — Loma Linda University, Loma Linda, CA Roshni Jogin — Riverside Community Hospital, Riverside, CA Caleb McKee — Full Circle Family Medicine, Caldwell, ID Weston Murdock — Naval Medical Center Camp Lejeune, Lejeune, NC Jonathon Reynolds — University of Wyoming, Casper, WY Newsha Sedghi — Community Health Centers Inc., Salt Lake City, UT Marina Settelmayer — Community Health Centers Inc., Salt Lake City, UT Zoe Stauffer — McKay-Dee Hospital, Ogden, UT Nathan Swallow — Washington State University, Pullman, WA Justin Taylor — Chickasaw Nation Family Medicine Residency, Ada, OK Chad Thompson — Midwestern University, Mesa, AZ Rocky Vista University College of Osteopathic Medicine Utah Campus Dominic Allan — Central Iowa Health System, Des Moines, IA Keenan Barr — Naval Hospital Camp Pendleton, Oceanside, CA Patrick Barthman — University of Minnesota Medical School, Minneapolis, MN Jessica Chen — Centura Health Corporation, Colorado, Westminster, CO Ali Coffee — St. Mark’s Hospital, Salt Lake City, UT Brandon Cox — Idaho State University, Rexburg, ID Alexander Cummock — Eastern Idaho Regional Medical Center, Idaho Falls, ID Daniel Garrish — Center for Family Medicine South Dakota, Sioux Falls, SD Steven Gawrys — University of Florida, Gainsville, FL Sean George — Community Health Care, Washington, Tacoma, WA Thomas Gordan — Mercy Medical Center, Redding, CA Tyler Hal — University of Texas Health Science Center, Tyler, TX Clark Hollingshead — Deaconess Hospital, Evansville, IN Andrew Larson — Skagit Regional Health, Mount Vernon, WA Nicholas Longe — Idaho State University, Pocatello, ID Alexander Mattias — Creighton University, Phoenix, AZ Hope Menning — Mayo Clinic School of Graduate Medical Education, Rochester, MN Taylor Nelson — HonorHealth, Scottsdale, AZ Thien Ngo — Texas Tech University, Amarillo, TX Luke Richards — Idaho State University, Pocatello, ID Tanner Roberts — Centura Health Corporation, Westminister, CO Alexander Seegrist — Spartanburg Regional Healthcare, Spartanburg, SC Nathan Sperry — Martin Army Community Hospital, Fort Moore, GA Evan Starr — Mayo Clinic School of Graduate Medical Education, Rochester, MN Matthew Steffensen — Texas Tech University, Lubbock, TX Lucas Sterr — Halifax Medical Center, Daytona Beach, FL Austin B. White — Dignity East Valley, Gilbert, AZ Steven York — Scott Air Force Base, Belleville, IL University of Utah School of Medicine Shanena Allen — University of New Mexico, Santa Fe, NM Joseph Allred — University of Missouri, Kansas City, MO Maddie Bernardo — Full Circle Family Medicine, Boise, ID Hailey Graviet — Full Circle Family Medicine, Caldwell, ID Tyler Kellis — HealthONE, Aurora, CO Jessica Kunzman — Valley Medical Center, Renton, WA Angelina Liu — Swedish Medical Center, Cherry Hill, Seattle, WA Merri Luczak — McKay Dee Hospital, Ogden, UT McKayla Miller — Madigan Army Medical Center, Tacoma, WA Jake Momberger — Full Circle Family Medicine, Boise, ID Jade Mulvey — University of North Carolina, Chapel Hill, NC Austin Peppers — Greenfield Family Medicine at UMass, Greenfield, MA Jordan Tucker — McKay Dee Hospital, Ogden, UT Alec Van Detta — Honor Health, Scottsdale, AZ 12
2025 Student and Resident Awards Each year, UAFP recognizes an outstanding graduating medical student from each of our three medical schools in Utah who has matched into family medicine. Special congratulations to Noorda College of Osteopathic Medicine (COM), which graduated its first class of students this year! All three of these outstanding future family medicine physicians have shown evidence of active student leadership in family medicine activities and demonstrated evidence of superior scholastic achievement in their medical school studies, particularly in the field of family medicine. The inaugural Noorda COM Distinguished Family Medicine Scholar was awarded to Brittany Harrel, who matched at Duke University Medical Center, North Carolina. The Outstanding Senior Award at Rocky Vista University — Southern Utah was given to Ciara Robb, who has matched into family medicine at Idaho State University. At the University of Utah, the F. Marian Bishop Award was awarded to Jake Momberger, who will be starting his residency with Full Circle Family Medicine in Boise, Idaho. UAFP also awards the Resident Leadership Award to recognize the accomplishments of one of our third-year family medicine residents in Utah. Nominations are sent in by residency faculty, peers and other residency staff. Those nominated needed to demonstrate promotion of family medicine, leadership skills and serving as a role model to peers. Additional consideration was given for teaching skills, professionalism, research skills and community service. The UAFP Member Engagement Committee voted on the final winner and chose Ishaah Talker, MD, from Utah Valley Family Medicine Residency. One of the two nominations submitted for Dr. Talker says, “Dr. Talker does not like being the center of attention or recognized for her hard work. With that said, she leads by example. She is always prepared for her clinic or the inpatient team. She remains current on the latest information and how to apply it to the care of her patients. She is passionate about the care of her patients as well as how women in medicine are treated. She wants to make sure her patients receive the best care regardless of their situation and will go the extra mile to make sure her patients have what they need. Several of the younger residents will often say they hope to be like her as they advance through residency.” Congratulations to all of you on your many accomplishments! Noorda College of Osteopathic Medicine Distinguished Family Medicine Scholar, Brittany Harrel Rocky Vista University — Southern Utah Outstanding Senior, Ciara Robb Bernadette Kiraly, MD, Division Chief for the Division of Family Medicine for the University of Utah; award winner Jake Momberger; UAFP CEO Maryann Martindale; and former UAFP board president, Saphu Pradhan, MD, FAAFP 2025 Resident Leadership Award Winner Ishaah Talker, MD 13
MCKAY DEE FAMILY MEDICINE RESIDENCY Rebekah Edwards, DO Undecided at time of print Taylor Gillis, MD Durango Integrated Healthcare, Durango, CO Akosua Hatch, DO Intermountain Heber Valley Clinic, Heber City, UT Alexander Olaveson, DO Intermountain North Ogden Clinic, North Ogden, UT Dallon Ray, DO Intermountain Cassia Family Practice, Burley, ID Chase Reynolds, DO Intermountain Layton Clinic, Layton, UT McKenzi Yocus, MD Intermountain South Ogden Clinic, South Ogden, UT ST. MARK’S FAMILY MEDICINE RESIDENCY Cannon Nelson, MD Outpatient Family Medicine, Utah Branden Buffington, DO Outpatient Family Medicine, Utah John James, MD Outpatient Family Medicine, Utah Elise Blaseg, MD Outpatient Family Medicine, New Hampshire UNIVERSITY OF UTAH FAMILY MEDICINE RESIDENCY Brian Bertsche MD Primary Care Physician, Seattle, WA Daniel Brandley, MD Intermountain Healthcare, Syracuse, UT Prashanth Fenn, MD Family Medicine Hospitalist, University of Utah, Salt Lake City, UT Annie Gensel, MD Physician at Planned Parenthood, San Jose, CA Caitlin Henry, MD Family Medicine Clinical Attending, University of Utah, Salt Lake City, UT Sarah Hourston, MD Family Medicine, University of Utah, Salt Lake City, UT Siri Loken, MD Physician at Sutter Health, San Francisco, CA Leila Noghrehchi, MD Family Medicine Physician at North Arizona Healthcare, Flagstaff, AZ Mario Pucci, MD Locums Tenens Physician with Comphealth Tommy Troy III, MD Primary Care Physician, Lexington, KY UTAH VALLEY FAMILY MEDICINE RESIDENCY Samantha Derzon, MD Intermountain Health, South Jordan, UT Jordan Rawlings, DO Intermountain Health, Orem, UT Jasmine Davila, MD Common Spirit St. Elizabeth Hospital in Fort Morgan, CO Ethan Hall, DO Intermountain Health, Spanish Fork, UT Brett Jackson, MD Chief Head Executive at Western Colorado Physicians Group Bryan May, MD Intermountain Health, Manti & Ephraim Clinic Ishaah Talker, MD Undecided at time of print Jessica Wissenbach, DO Undecided at time of print Graduating Residents and New Interns Congratulations to the graduating family medicine residents of 2025! We wish you all the best in your career as a family medicine physician. 14
Welcome New Interns! We are also excited to welcome the new class of family medicine interns, who will start in July 2025. A special congratulations also goes out to the CHC Family Medicine Residency, which accepted its first class of residents this year! CHC FAMILY MEDICINE RESIDENCY Newsha Sedghi, DO Noorda College of Osteopathic Medicine Marina Settlemayer, DO Noorda College of Osteopathic Medicine Andrew Sorenson, DO Touro College of Osteopathic Medicine, New York Saar Yaniuta, MD, PhD, MHA Medical Academy named after S.I. Georgievskiy, Crimean Federal University named after V.I. Vernadsky ST. MARK’S FAMILY MEDICINE RESIDENCY Hunter Mansfield, MD Texas A&M Health Sciences Center College of Medicine Elsie Valencia, MD Medical College of Wisconsin Alexander Fishburn, DO Rocky Vista College of Osteopathic Medicine Harriet Koball, DO Rocky Vista College of Osteopathic Medicine McKAY-DEE FAMILY MEDICINE RESIDENCY Carson Clark, DO Rocky Vista University College of Osteopathic Medicine Samantha Johnson, DO Western University of Health Sciences College of Osteopathic Medicine of the Pacific Meredith Luczak, MD University of Utah School of Medicine Rhett Schlader, MD University of Washington School of Medicine Ruben Sosa, MD University of Texas School of Medicine at San Antonio Zoe Stauffer, DO Noorda College of Osteopathic Medicine Jordan Tucker, MD University of Utah School of Medicine UNIVERSITY OF UTAH FAMILY MEDICINE RESIDENCY Morgan Allen, MD Texas Tech University Health Sciences Center School of Medicine Valerie Chieng, DO, MPH AT Still University of Health Sciences School of Osteopathic Medicine, Arizona Julia Engel, MD University of Louisville School of Medicine William Ervin, MD University of Kansas School of Medicine, Wichita Joseph Gallagher, MD Virginia Commonwealth University School of Medicine Matthew Harris, MD Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo Caleb Harrop, DO Noorda College of Osteopathic Medicine Gideon Lawi, MD University of Nevada, Reno School of Medicine Jordan Marsh, MD, MBA Carle Illinois College of Medicine Christine Zhang, MD University of Texas Southwestern Medical School UTAH VALLEY FAMILY MEDICINE RESIDENCY Jeremy Allred, MD Virginia Commonwealth University School of Medicine Dalton Beeson, DO Rocky Vista University College of Osteopathic Medicine Rachael Coy, DO AT Still University of Health Sciences School of Osteopathic Medicine Porter Edwards, DO Rocky Vista University College of Osteopathic Medicine Nate Gottfredson, MD University of Central Florida School of Medicine Rustin Limb, DO Pacific Northwestern University School of Medicine Mariangela Santiago, DO Rocky Vista University College of Osteopathic Medicine Easton Weaver, DO AT Still University of Health Sciences School of Osteopathic Medicine 15
CME & Ski 2025 February 2025 marked another educational and ski-filled weekend at UAFP’s annual CME & Ski conference in Park City, Utah, at the Westgate Resort. This year, we set a record with over 130 physicians and APCs from across the country and Canada in attendance. We are so fortunate to have an abundance of local physicians who are both experts in their fields and happy to present at our conference! We hope you’ll join us next year to see what keeps guests coming back year after year. Here’s what some of our attendees had to say about CME & Ski: “This was my first time attending the CME & Ski conference. Loved the setup for the presentations with a ski break during peak hours and the location was great!” “Enjoyed the conference. Well organized, great communication.” “Excellent conference, I have attended for my third year in a row. Always relevant lectures that either reinforce topics or provide helpful new ideas to implement into practice. Highly recommend this conference.” 16
FIRST PLACE Efficacy of Osteoporosis Education in Rural Populations — Presented by Serin Baker, Lauren Draper, and Rachael Prawitz SECOND PLACE Investigating Aspirin Prescribing Rates for Preeclampsia Prophylaxis — Presented by Prashanth Fenn THIRD PLACE Utilizing Osteopathic Manipulative Medicine to Support Lifestyle and Behavior Change — Presented by Catherine Arnold and Katelyn Bercaw Poster Session UAFP hosted a poster session for students and residents in conjunction with our CME & Ski conference. Ten groups of residents and students presented their research to our judges and attendees at the conference and all of them did an outstanding job. Thank you to our judges and to our Poster Session sponsor, Comagine Health, for providing the prize money for our three winners! Save the Date! We look forward to another year of learning and skiing on Feb. 2-4, 2026. Epic and Ikon passes are available now for the 2025-26 ski season. Get them early for the best prices! Scan the QR code to sign up for email updates https://confirmsubscription.com/ h/t/81A510B788FCE605 SIGN UP FOR UPDATES 17
Prevention and Recovery from Early Psychosis By Kelcy Brock, MPA, Utah Office of Substance Use and Mental Health The Utah Department of Health and Human Services (DHHS) Office of Substance Use and Mental Health (SUMH) has partnered with five local mental health authorities to build teams (as well as a newly launched website) across the state to address a specific mental health need — psychosis. While this mental health issue can impact anyone anywhere at any age, it most commonly develops in teens and young adults. Clinical High Risk for Psychosis (CHR-P) and First Episode Psychosis (FEP) most often occur in transition-age youth between the ages of 14-26. The Prevention and Recovery From Early Psychosis (PREP) teams across the state utilize the Coordinated Specialty Care model to provide early identification and intervention services to support young people in managing their symptoms and transitioning into adulthood in a safe and healthy way. Psychosis is a term used to describe a mental health disorder that is common and treatable and recovery is possible. This disorder can include symptoms such as: • Hallucinations: hearing voices that other people don’t hear or seeing things that other people don’t see. • Delusions: a fixed belief not based in reality. • Paranoia: intense, anxious, or fearful feelings. These symptoms are very responsive to early treatment and intervention. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), most individuals with clinical high risk for psychosis or first episode psychosis experience warning signs of illness during adolescence and early adulthood. Failing to recognize and provide early treatment for persons experiencing psychosis often leads to individuals living with a lifetime of disability. Through the promise of early intervention for psychosis treatments, individuals with psychosis are much more able to live healthy and productive lives — at school, at work and at home. Some examples of specific signs and symptoms include: • Thinking others can read your mind. • Withdrawing from family and friends. • Suspicious or fearful of others. • Thoughts or beliefs that seem strange. • Belief that the media sends hidden messages to you. • Loss of interest in things you used to enjoy. • Difficulty sleeping or sleeping too much. Primary care clinicians in Utah can provide help for individuals who might be experiencing psychosis. The first step for someone experiencing symptoms or for someone concerned about their family, friend, coworker, etc. is to get screened utilizing the PRIME screening tool. 18
The PRIME screening tool is part of the referral process for the Utah PREP Teams and has 12 questions that the youth or young adult can fill out on their own or have someone else read aloud and document. Utah has five teams statewide ready to help youth and their families identify and diagnose potential psychosis. These teams include members at Weber Human Services covering Weber and Morgan counties, Davis Behavioral Health in Davis County, Volunteers of America in Salt Lake County, Wasatch Behavioral Health for Utah and Wasatch Counties, and Southwest Behavioral Health Center in Iron County. These PREP team members are skilled professionals who can advise clients on how to find treatment and support the management of their symptoms. Their services include: • Referral, screening, assessment and engagement. • Shared decision-making. • Treatment planning. • Therapy, including Cognitive Behavioral Therapy for Psychosis (CBTP). • Case management. • Supported education/employment. • Individual and family psychoeducation. • Peer support. • Occupational therapy. • Medication management and nursing. • Crisis services, transition planning and post‑treatment supports. Other partners aiding in this important work and providing critical resources throughout the state include: • LiveON Utah (by the Utah Suicide Prevention Coalition). » Suicide Prevention Playbook. • SafeUT Crisis Chat and Tip Line. • Youth of Utah Advocacy Coalition. • Students with Psychosis. • Mental Health America: Psychosis. • Schizophrenia and Psychosis Action Alliance. • NAMI: Psychosis. » NAMI Tips for family/friends supporting mental health crises. • SAMHSA: coping for teens and young adults. • NAMI: self-help techniques for coping with mental illness. • SAMHSA: coping skills. • Utah SUMH: Safety planning. These teams are committed to reducing the effects of early psychosis through comprehensive, individualized services rooted in family-guided, youth-driven approaches to help each individual and their family build resiliency, reduce symptoms and improve life functioning. Please feel free to contact Jessica Makin, the program administrator at DHHS SUMH, at jmakin@utah.gov for any questions or concerns. FOR MORE INFORMATION AND RELATED RESOURCES, SCAN THE QR CODE. https://utahafp.org/prevention-andrecovery-from-early-psychosis/ 19
Regenerative Medicine A Fountain of Youth or Marketing Misnomer? By Jordan Know, MD, CAQSM, FAAFP, COPC Sports, Spine & Joint Humans always seem to be looking for the fountain of youth, or just about any way to delay getting older. The field of “regenerative medicine” is one that aims to reverse, or at least slow and delay, the damage and decay of our bodies’ organs and tissues by utilizing the body’s own existing cells, structures and mechanisms for healing and repair. At the moment, however, “regenerative medicine” may be more of a misnomer, or perhaps false advertising. It might be tempting to think that “regenerative medicine techniques” could regrow cartilage in an arthritic knee, build up a thinned and degenerated disc in the spine, or regrow a knee’s anterior cruciate ligament (ACL). While this last example does actually show some promise, with the development of the Bridge-Enhanced ACL Restoration implant, for a patient thinking about “regenerative medicine,” they are more often looking at treatments for chronic degenerative conditions, such as osteoarthritis or tendinopathy. Treatment options such as Platelet-Rich Plasma (PRP), Bone Marrow Aspirate Concentrate (BMAC), stem cell therapies, and extra-corporeal shockwave therapy (ESWT); or even viscosupplementation with hyaluronic acid formulations, are often touted as alternatives for the more classic steroid or cortisone injections. Many of these are more accurately described as orthobiologics, a subset of regenerative medicine that consists of orthopedic treatments derived from biologic materials. PRP In the case of PRP, a volume of the patient’s blood is taken out by venipuncture, processed through a centrifuge to separate the components and the concentrated plasma fluid containing platelets, associated cytokines and growth factors is collected. This fluid is then injected into the target area, often a tendon or joint space, sometimes around a nerve, or into or around an intervertebral disc. Treatment may consist of a single injection, or sometimes two or three spaced a few weeks apart. Best practices and protocols are still in development, and there is some variability in these methods. Typically, insurance will not cover PRP, which may generate a bill anywhere from several hundred to several thousand dollars — much of this comes from the materials used for processing the patient’s blood. A centrifuge may cost $5,000-$10,000, but can be reused, while the non-reusable blood draw and processing kits typically cost $200-$500. PRP tends to be most effective in cases of early knee arthritis or chronic tendinopathy lasting six months or longer, including tennis elbow, Achilles tendinitis, patellar tendinitis and rotator cuff tendinopathy. It can also be particularly effective in treating rotator cuff tears without surgery. BMAC and Stem Cell Therapies BMAC costs are typically even higher than PRP, ranging from $3,000-$10,000 or more, due to the more complicated processing of the extracted materials. Conceptually, it is somewhat similar to PRP, although instead of taking blood, a sampling of bone marrow is taken, typically from the iliac crests in the back of the pelvis, and processed to extract circulating mesenchymal stem cells, which can theoretically differentiate into cartilage, bone and other tissues. However, while there are certainly anecdotes and individual cases where it seems that cartilage and joints have “reversed” their degeneration, the overwhelming body of literature, meta-analyses and randomized controlled trials indicate that the miraculous regrowth of cartilage or reversal of aging are more likely rare exceptions, and those results cannot be reliably expected. Adipose Derived stem cells, essentially a combination of liposuction followed by processing the removed fat cells to extract stem cells from the fat tissue, can then be injected into the target tissue for repair. It is very similar to BMAC, with a similar typical price 20
range of $5,000-$10,000. However, studies have found high variability in the number and quality of stem cells actually obtained from these extraction techniques, which makes studying the reliability of this treatment technique particularly challenging when the “dose” is not held constant. Viscosupplementation Sometimes called the “gel shot,” this treatment involves injecting laboratory-derived hyaluronic acid, which is a chemical typically found in cartilage and joint structures, into a joint to rehydrate the cartilage structures (typically in the knee) and decrease the inflammatory pain signals thought to account for arthritis pain. This treatment has been around and in widespread use much longer than PRP, and accordingly, has more developed studies. Some support greater efficacy and longer pain relief than steroid injections, while others tend not to show much of a difference. Because it uses FDA-regulated materials for injection, Medicare will often cover the cost in approved clinical situations, and commercial insurances often follow suit. However, these vials of hyaluronic acid can cost over $1,000 each (and were studied and approved as a three-shot series), and it may be difficult to get insurance company approval. Out-of-pocket, these can end up at a comparable cost to PRP injections, and the newer research, particularly for mild-to-moderate osteoarthritis of the knee, may in fact favor PRP as more likely to help overall and for a longer duration. ESWT ESWT is a non-invasive, non-injectable treatment that is sometimes grouped with orthobiologics because of the theoretical regenerative potential. This treatment uses high-energy sound waves to send pulses of vibration deep into the damaged tissues, stimulating the body’s intrinsic healing mechanisms or otherwise modulating an abnormal inflammatory response. These high-energy vibrations are reported to stimulate cellular repair pathways and increase blood flow to the affected area. The cost of treatment varies depending on the duration of treatment and the type of machine used. The machines can cost $20,000-$60,000. The probe that contacts the skin and delivers the sound waves wears out over time and needs to be replaced periodically, adding an additional hardware cost of around $3,000 per probe. Most benefits are realized between three to five treatments, depending on the condition being treated, with each treatment typically costing the patient about $250. For the needle-averse patients with chronic tendinopathy or plantar fasciitis, this may be a superior treatment option and may in fact be more effective as an intervention than traditional orthotics, physical therapy, home stretching and analgesics. There is also a 2023 meta-analysis to support its use in chronic low back pain, demonstrating better pain relief and lumbar dysfunction at both four and 12 weeks with the use of ESWT compared to control groups. While “regenerative” may be an overstatement, there certainly is potential for symptomatic and (in some cases) structural benefits from these newer, yet established, treatment options. Studies demonstrating reliable regeneration of cartilage or cellular tissue repair is missing, but these treatments do have a robust body of literature demonstrating their potential for pain relief and/or improved physical function. When a patient asks if they need surgery, these options, and their financial cost, should be weighed against the financial and other costs of surgical intervention. However, it is important to help manage patient expectations as results are certainly not guaranteed. REFERENCES ARE AVAILABLE ONLINE BY SCANNING THE QR CODE. https://www.ohioafp.org/ news-publications/the-ohiofamily-physician-references/ This has been reprinted from the spring 2025 issue of The Ohio Family Physician, the quarterly publication of the Ohio Academy of Family Physicians. 21
Introduction D.G. is a 79-year-old Caucasian male. He is a retired educator who taught political science and law at the high school level. The patient presented with a three-week history of slurred speech and some difficulty completing his weekday golf game. He was concerned that after a few minutes of talking, he sounded like Elmer Fudd and his “wascally wabbit” pattern of speech. D.G. was also worried about his ability to give a talk at his local church within the coming weeks due to the worsening dysarthria. He also complained about some difficulty closing his lips fully and reported dribbling when brushing his teeth. Upon physical examination by his family physician, he noted some weakness of the eye while mouth closure was strong. There was no external ophthalmoplegia — eye movements were normal and there was no ptosis. However, there was some fatigability of the proximal limb muscles, deltoids, and hip flexors. Due to the symptoms, he was concerned that this could possibly be Myasthenia Gravis (MG), especially with the dysarthria that came with prolonged speech. D.G. was referred to a neurologist who ordered labs, including an Acetylcholine receptor panel for diagnosis. Discussion Neuromuscular junction disorders can be genetic, such as congenital myasthenic syndromes, or caused by external toxins like botulinum toxin and curare. Others are acquired autoimmune conditions, including MG, Lambert-Eaton myasthenic syndrome (LEMS), and neuromyotonia.1 MG is the most common neuromuscular disorder and presents primarily with muscle weakness and fatigue.4 It is an autoimmune, B-cell-mediated disease in which antibodies attack key proteins, such as acetylcholine receptors (AChR), muscle-specific kinase (MuSK), LRP4, agrin, titin, and ryanodine.1 Due to its clear mechanism and location of action, Myasthenia Gravis is not only a prototype for autoimmune diseases but also a valuable model for understanding synaptic function. MG is categorized into subtypes based on clinical features and antibody profiles, including early-onset MG, late-onset MG, thymoma-associated MG, MuSK, LRP4, seronegative, and ocular MG.1 Although it is a rare disease, the number of Myasthenia Gravis cases has been rising over the past two decades, particularly among the elderly. This increase is likely due to improved availability of antibody testing and a growing aging population.5 It affects individuals of all ages, sexes, and ethnic backgrounds, though it is most commonly seen in young adult women under the age of 40 and older men over the age of 60.3 Despite its prevalence across various populations, Myasthenia Gravis is neither inherited nor contagious, although in rare cases, more than one member of a family may be affected. A Less Common Presentation of Myasthenia Gravis By Kody Korth, Pre-Med Student at Weber State University, and Johnnie Cook, MD, Family Physician at Tanner Clinic The “Elmer Fudd Syndrome” 22
The underlying pathophysiology of MG involves antibodies that exert their influence on skeletal muscle acetylcholine receptors and impede the normal function of acetylcholine at the neuromuscular junction.3 This disruption impedes normal muscular contraction, leading to fluctuating muscle weakness and fatigue. The thymus gland, which plays a central role in immune system development during childhood by producing T-lymphocytes, is often implicated in the pathogenesis of Myasthenia Gravis. While the thymus normally atrophies after puberty, in many adults with MG it remains enlarged and may contain clusters of lymphoid tissue.1 Some individuals may also develop thymomas. The thymus is thought to contribute to the autoimmune process by generating autoreactive T cells that direct the production of pathogenic antibodies against the acetylcholine receptor. Common features of Myasthenia Gravis include3: • Eye muscle weakness causing ptosis and diplopia. • Bulbar weakness causing dysarthria and dysphagia. • Dyspnea. • Limb weakness. • Fatigability. All of these features can wax and wane, often worsening as the day goes on or with sustained activity. There are a few ways to diagnose myasthenia gravis which include3: • Blood tests. » The main blood test used is very sensitive and specific: acetylcholine receptor antibodies of which there are three types — binding, blocking and modulating. Some labs will only run two of the three. » While uncommon, MUSK is another blood test used. This is almost nonexistent in Utah, but can help diagnose young Black women. • Electrophysiology, specifically repetitive nerve stimulation, can be performed. • Single-fiber EMG. • Imaging, a CT to look for a thymoma, however not useful for diagnosis of MG. • A trial of Mestinon can also help in confirming diagnosis. As seen, there are a few ways to help recognize MG; however, antibody testing has revolutionized its diagnosis. Treatment2 While there is no cure, the following treatments can manage symptoms effectively: • Medications: » Pyridostigmine (brand name Mestinon) is used as a first line, with immediate effect. » Steroids. » Immunosuppressive drugs like azathioprine (brand-name Imuran). » Vyvgart, a new medication that may work with a variety of autoimmune diseases; however, it is very expensive. • IVIG: These are short-term treatments used in some cases. • Very rare, but a thymectomy in which surgical removal of the thymus gland may improve symptoms or lead to remission in some cases. Myasthenia Gravis is treated differently by different specialists but is relatively gratifying to treat, often responding to meds. Conclusion Upon meeting with the neurologist, the initial concerns of MG in the patient were confirmed through the AchR Panel. D.G. was prescribed pyridostigmine, which he is responding well to. He reported that he is able to golf five days a week, give talks in church and no longer sounds like he is hunting wabbits. 1. Bubuioc, A.-M., Kudebayeva, A., Turuspekova, S., Lisnic, V., & Leone, M. A. (2021). The epidemiology of myasthenia gravis. Journal of Medicine and Life, 14(1), 7–16. https://doi.org/10.25122/jml-2020-0145 2. Farmakidis, C., Pasnoor, M., Dimachkie, M. M., & Barohn, R. J. (2018). Treatment of myasthenia gravis. Neurologic Clinics, 36(2), 311–337. https://doi.org/10.1016/j.ncl.2018.01.011 3. Myasthenia gravis. (n.d.). National Institute of Neurological Disorders and Stroke. Retrieved April 6, 2025, from https://www.ninds.nih.gov/health-information/disorders/myasthenia-gravis 4. Phillips, L. H., 2nd. (2003). The epidemiology of myasthenia gravis. Annals of the New York Academy of Sciences, 998(1), 407–412. https://doi.org/10.1196/annals.1254.053 5. Thanvi, B. R., & Lo, T. C. N. (2004). Update on myasthenia gravis. Postgraduate Medical Journal, 80(950), 690–700. https://doi.org/10.1136/pgmj.2004.018903 23
As family physicians, we stand at the intersection of patient-centered care, where trust, continuity and a deep understanding of individual health histories converge. This unique position enables us to play a critical role in the safe and effective integration of medical cannabis into patient care when clinically appropriate. Having served both as a Qualified Medical Provider (QMP) and as a member of Utah’s Medical Cannabis Compassionate Use Board*, I have observed firsthand how family physicians are best positioned to guide patients through the complex process of medical cannabis consideration. Why Family Physicians? Family physicians excel at managing complex, chronic conditions through a longitudinal relationship with their patients. This foundation is vital for assessing when conventional therapies are insufficient and exploring alternative options (increasingly popular in our community), such as medical cannabis, in a thoughtful and informed manner. Patients seeking medical cannabis often visit specialized cannabis clinics (I’m sure you can recall various radio ads and billboards for these), which may lack the broader context of the patient’s medical history. In contrast, we as family physicians have a holistic view of our patients’ health, encompassing their physical, emotional and social well-being. This knowledge facilitates: 1. Tailored Care Plans: Family physicians can integrate trials of conventional therapies, monitor their effectiveness, and determine when a shift to alternative treatments, including medical cannabis, might be appropriate. 2. Risk/Benefit Analysis: By understanding the patient as a whole, family physicians can lead nuanced discussions about the potential benefits and risks of medical cannabis, including its interactions with existing therapies and lifestyle factors. 3. Continuity of Care: The longitudinal nature of family medicine allows us to provide ongoing monitoring and adjust treatment plans as needed, ensuring that medical cannabis is used safely and effectively. In contrast, medical cannabis clinics often lead to higher costs for patients and frequently do not include comprehensive evaluations or robust education about medical cannabis. This can result in fragmented care and limited understanding for patients about how medical cannabis fits into their broader treatment plan. Lessons from the Compassionate Use Board Utah’s Compassionate Use Board serves as a safety net for patients who fall outside the state’s qualifying conditions for medical cannabis. This role underscores the importance of thorough documentation and careful consideration of patient cases. Additionally, the Board reviews cases involving patients under 21 years of age, ensuring that this vulnerable population receives careful oversight and guidance. I have been involved with many thoughtful and deep discussions about various patients to best determine the next course of action for them. Some petitions that come from medical cannabis clinics lack the comprehensive information necessary for quality patient care. Family physicians are ideally equipped to navigate this balance. Our comprehensive understanding of a patient’s medical journey ensures that we can present a compelling case for medical cannabis use when conventional therapies have failed. Bridging the Knowledge Gap One of the barriers to greater family physician involvement in medical cannabis prescribing is the knowledge gap. Most of us have not had any training surrounding cannabis. Unlike specialists in cannabis clinics, family physicians may feel less confident navigating this relatively new area of medicine. However, learning about medical cannabis should be no different than learning about any other therapy and I would argue the knowledge gap between family physicians and those clinicians at cannabis clinics is not that large. The Role of Family Physicians in Medical Cannabis Access By Michael Chen, MD, FAAFP 24
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