Ophthalmic Surgery, Lasers and Imaging Retina

Eight Questions with Carmen Puliafito 

Eight Questions With Dr. Puliafito

Carmen A. Puliafito, MD; John W. Kitchens, MD

Abstract

Carmen A. Puliafito

John W. Kitchens

Carmen A. Puliafito, MD: Who has had the greatest influence on your career?

John W. Kitchens, MD: After a solid but not stellar medical school career, I was incredibly lucky to match at the University of Iowa. The training program must have been pretty darn good: I passed my boards, got a great fellowship, and even won a national cataract surgery competition. Ed Stone and Culver Boldt were huge influences at Iowa. Culver’s recommendation went a long way to helping me get a great fellowship. Another huge influence on my career was actually you, Dr. Puliafito. You were the one who first contacted me about the chief residency position and retina fellowship opportunity at Bascom Palmer. That phone call changed everything.

But the greatest influence on my career has been from my wife, Sarah. Without her, I would never have ended up in medicine. I grew up in a tiny farming community in southern Indiana. After a pedestrian high school career and dreams of playing college basketball, I enrolled at the University of Evansville in pre-med mainly because it sounded like a major that would be popular with the ladies. After a 2.8 GPA in my freshman year, I seriously considered switching majors. A summer on the maintenance crew, during which I was offered to stay on full time and drop out of school, and a sophomore year in which I dropped organic chemistry due to my D average all seemed to turn around when I met Sarah. She instilled a confidence and purpose in my life. I learned to study hard and properly. Friday and Saturday nights were spent in empty classrooms with chalkboards filled with notes. Summer classes and 20+ credit-hour semesters ensued. I graduated on time, with degrees in biology and chemistry and a medical school acceptance. It’s amazing looking back where I could have ended up if things had gone differently.

Dr. Puliafito: What was the defining moment that led you to your field?

Dr. Kitchens: After my third year of medical school, I was searching for a career that I could be passionate about. By default, I was set to do internal medicine, but a schedule anomaly (and the fact that I hated doing rectal exams) led me to reconsider ophthalmology and orthopedics. I switched my rotation schedule entirely. The first rotation was ophthalmology, and during a glaucoma week, Lou Cantor was leaving for a meeting and suggested that I “hang out” with Ron Danis for the week and observe some retina cases. I fell in love with retinal surgery the first 5 minutes of the first case. I then worked with Ron as a medical student, doing research and observing the life of a retina specialist. I will forever be indebted to him for introducing me to the field.

Dr. Puliafito: What area of research intervention most interests you right now and why?

Dr. Kitchens: I really enjoy surgical retina, as no two cases are alike. I like working with surgical retina companies to develop new products and ideas. Another area of interest is ocular histoplasmosis syndrome. In Kentucky, we see more “histo” than almost anyplace in the world, which allows us to see the effect of therapies on CNV alone without the overlay of RPE dysfunction that comes with dry AMD. It also allows us to evaluate the factors in CNV development without having to worry about 60 to 70 years of environmental exposure, etc., that can contribute to a disease process like AMD.

Dr. Puliafito: What advice would you offer a student in medical school today?

Carmen A. Puliafito

Carmen A. Puliafito

John W. Kitchens

John W. Kitchens

Carmen A. Puliafito, MD: Who has had the greatest influence on your career?

John W. Kitchens, MD: After a solid but not stellar medical school career, I was incredibly lucky to match at the University of Iowa. The training program must have been pretty darn good: I passed my boards, got a great fellowship, and even won a national cataract surgery competition. Ed Stone and Culver Boldt were huge influences at Iowa. Culver’s recommendation went a long way to helping me get a great fellowship. Another huge influence on my career was actually you, Dr. Puliafito. You were the one who first contacted me about the chief residency position and retina fellowship opportunity at Bascom Palmer. That phone call changed everything.

But the greatest influence on my career has been from my wife, Sarah. Without her, I would never have ended up in medicine. I grew up in a tiny farming community in southern Indiana. After a pedestrian high school career and dreams of playing college basketball, I enrolled at the University of Evansville in pre-med mainly because it sounded like a major that would be popular with the ladies. After a 2.8 GPA in my freshman year, I seriously considered switching majors. A summer on the maintenance crew, during which I was offered to stay on full time and drop out of school, and a sophomore year in which I dropped organic chemistry due to my D average all seemed to turn around when I met Sarah. She instilled a confidence and purpose in my life. I learned to study hard and properly. Friday and Saturday nights were spent in empty classrooms with chalkboards filled with notes. Summer classes and 20+ credit-hour semesters ensued. I graduated on time, with degrees in biology and chemistry and a medical school acceptance. It’s amazing looking back where I could have ended up if things had gone differently.

Dr. Puliafito: What was the defining moment that led you to your field?

Dr. Kitchens: After my third year of medical school, I was searching for a career that I could be passionate about. By default, I was set to do internal medicine, but a schedule anomaly (and the fact that I hated doing rectal exams) led me to reconsider ophthalmology and orthopedics. I switched my rotation schedule entirely. The first rotation was ophthalmology, and during a glaucoma week, Lou Cantor was leaving for a meeting and suggested that I “hang out” with Ron Danis for the week and observe some retina cases. I fell in love with retinal surgery the first 5 minutes of the first case. I then worked with Ron as a medical student, doing research and observing the life of a retina specialist. I will forever be indebted to him for introducing me to the field.

Dr. Puliafito: What area of research intervention most interests you right now and why?

Dr. Kitchens: I really enjoy surgical retina, as no two cases are alike. I like working with surgical retina companies to develop new products and ideas. Another area of interest is ocular histoplasmosis syndrome. In Kentucky, we see more “histo” than almost anyplace in the world, which allows us to see the effect of therapies on CNV alone without the overlay of RPE dysfunction that comes with dry AMD. It also allows us to evaluate the factors in CNV development without having to worry about 60 to 70 years of environmental exposure, etc., that can contribute to a disease process like AMD.

Dr. Puliafito: What advice would you offer a student in medical school today?

Dr. Kitchens: First, don’t listen to the people who say they would not advise their kids to go into medicine. Medicine is a great field and one of the few where every day you are helping people while making a good living. It has its obstacles and issues just like any career, but it’s well worth it. Second, don’t do it for the money. Money is great, and certainly a lack of it can lead to a great deal of pain in life. But once you have enough money, more will not make you any happier than you would be. This has helped me relax and not worry about the slow weeks in clinic or the OR. It also keeps my focus on being a doctor, not a businessman. The final bit of advice is to “get unplugged.” My first two years at Iowa, we didn’t get cable TV or have Internet the way we do today. I spent my time reading and studying, which set the groundwork for a great residency. I honestly don’t know how students and residents deal with the distractions of today, but getting unplugged would help a lot.

Dr. Puliafito: Have you ever been fortunate enough to witness or to have been part of medical history in the making? If so, please explain.

Dr. Kitchens: During my chief residency year at Bascom, I had the chance to witness the start of the anti-VEGF era with the introduction of Macugen. Bascom was also involved in the ANCHOR and MARINA studies, and there was a real buzz around the potential effects of a compound we knew as rhuFab (later Lucentis). And Phil Rosenfeld was doing a study of systemic Avastin for wet AMD. Those all pale to the day that you seemed particularly excited during a surgical case we were doing. I remember you saying, “You are not gonna believe what we just did. … It’s gonna change the world.” After a little prying, you finally came clean with the fact that the first-ever injection of intravitreal Avastin had been given. And it did change the world of retina forever.

Dr. Puliafito: What are your hobbies outside of practicing medicine?

Dr. Kitchens: I enjoy hanging out with our family. We have three kids: Ella (age 8), Zach (age 5), and Wynston (a foster child; age 2). I enjoy keeping in shape as much as possible by lifting weights and running or riding my bike. I’ve also gotten into photography over the last few years, and I really enjoy anything tech-related.

Dr. Puliafito: What do you enjoy doing to relax?

Dr. Kitchens: I love watching sports, especially football and basketball. Although I grew up an Indiana fan, being in Lexington has led me to betray my heritage and adopt University of Kentucky basketball as my favorite college team. I love going to conferences and meeting new people. Retina is such a small and collegial world that it makes the conferences a lot of fun.

Dr. Puliafito: What’s up next for you?

Dr. Kitchens: Focusing on our practice here in Kentucky. We were very fortunate to have my good friend and former co-fellow Andrew Moshfeghi join us this past summer. We have a great mix of young guys (Tom Stone, Andrew, and myself) and more “mature,” MPS-era retina guys (Rick Isernhagen and William Wood) to balance the practice. It’s relatively unique to have a group of five with diverse backgrounds in training at great institutions. Beyond that, I’ve considered getting an MBA, but my wife would kill me if I took on anything else at this point, so it may have to wait awhile.

John W. Kitchens, MD, can be reached at Retina Associates of Kentucky, 120 N. Eagle Creek Drive, Suite 500, Lexington, KY 40509; 859-263-3900; email: jkitchens@gmail.com.

10.3928/23258160-20130909-01

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