ARH cardiothoracic and vascular surgeon James Shoptaw, MD, feels the pulse of his community
HAZARD Like the population he has served for years, James Shoptaw, MD, cardiovascular and cardiothoracic surgeon at Appalachian Regional Health, ARH, says he works long and hard each day. He learned his craft starting in 1989 working as an intern for the renowned Michael Sekela, MD, chief of the division of cardiothoracic surgery at UK Healthcare. “We worked long, hard hours together. Dr. Sekela was always encouraging. I’ve worked with him for the last 20 years. Dr. Sekela is how I got to ARH,” says Shoptaw.
Shoptaw describes his patients as people who “work long hours and unfortunately don’t have a lot of good things to eat. A lot them start smoking at a young age. They don’t have a lot of time away from work to take care of their health and exercise, so they generally develop obesity, diabetes, hypercholesterolemia, hyperlipidemia. All these are risk factors of atherosclerotic coronary artery disease and peripheral arterial disease. So that’s kind of where we are.”
Shoptaw states that minimally invasive treatments for heart disease are increasing, so there are fewer people needing sternotomy and bypass surgery. “We can treat their occlusions and blockages with minimally invasive incisions and cannulations of arteries, treating the vessel blockages through the artery.”
“I do bypass surgeries, peripheral arterial surgeries, and some peripheral vascular interventions with balloons and stents. We treat some aneurysms with percutaneous approaches,” says Shoptaw.
The Road to Kentucky
In a deep, smooth baritone, Shoptaw says he grew up in Georgia and went to the Medical College of Georgia. From there he went to Baylor College of Medicine for residency, internship, and fellowship in general surgery. He is board certified by both the American Board of Surgery and by the American Board of Thoracic Surgery. After his training, he worked about five years in Macon, Georgia, then worked a brief stint in Texas before coming to Kentucky. “I’ve been here off and on for about 18 or 20 years, and I’ve been in Hazard about 10 years. It’s been good for me and my family,” he says.
A Population with Heart Disease
In his experience, Shoptaw has observed that Eastern Kentucky patients start having issues with coronary artery disease as early as 20 years old. “Heart disease is younger here. People do not take care of themselves and make dietary choices that have a high risk for causing problems like drinking a lot of pop, like Mountain Dew, and eating a lot of food that is filled with calories that are mostly carbohydrates, not eating proteins, fats, and carbohydrates, in the proportions that are healthy,” he says.
Shoptaw’s typical patient wellness check is a complete history and physical exam. “We check the risk factors: Do they have diabetes? Do they smoke? Do they have hypertension? Do they have high cholesterol, triglycerides? Do they have high sugar? What’s their hemoglobin A1c? Do they have a high BMI? What kind of lifestyle do they live? Are they sedentary? Are they active? Do they have an active exercise plan? Do they have a family history which would put them at great risk to have complications of coronaviruses, for cerebral vascular disease. And then, we talk about how to rectify the situation, get them back on the right track.”
Heredity is also a common factor, says Shoptaw. “
No question that the people that come into the world here in Hazard almost assuredly have a risk genetically for coronary heart disease. I see 25 patients a day, and I’d say 80% of those have brothers, sisters, mothers, fathers, aunts, and uncles with coronary artery disease, peripheral disease, cerebrovascular disease, strokes, heart attacks, and limb loss amputations from peripheral arterial complications,” Shoptaw says.
Looking Ahead: Artificial Intelligence
A lifelong student, Shoptaw is optimistic about the future. “We’re still trying to figure out what the perfect treatment for each patient is, and as we go to advanced artificial intelligence models, then hopefully we can plug in the demographics for a particular patient, and based on the best treatment plans across this country, we can figure out what’s right for each patient. And even further, we could look at their genetics and their propensity to be at risk for problems down the line and figure out what would be the best treatment,” he says.
“The new horizon is ventricular assist devices for people with advanced heart failure. Some people are living on devices for extended periods of time now, waiting to get a transplant,” says Shoptaw.
Rural Population Is Underserved
It is a known fact that the rural population in Kentucky, and elsewhere, is underserved. Shoptaw states, “There’s a big need. I remember when one of the men that worked with my dad came in one day and had an acute myocardial infarction. He was like family to me. I did CPR on him, and tried to resuscitate him, to no avail, and he passed away. He was about 40 years old, and that made me think, if I could help someone to avoid this, or kind of bail someone out that was having this kind of issue, then they get a few more days or months or years with their family. That would be a great gift,” he says.
Shoptaw continues, “To take care of the people in our area, you need to develop a team and a link. You’re never going to be able to do everything, but if you have a partner that does the advanced medicine that you don’t do, and develop a strong relationship with them, then the patients get excellent care wherever they are. If you can’t do it, you send them to the place where the can get the care they need and deserve. That’s why UK has been so helpful in supporting the rural healthcare mission of ARH.”
In conclusion, Shoptaw has one message, “Just to love God and love everyone, through your family, and if you do that, then you’ll never go wrong.”