Fall 2011
the magazine from FirstHealth of the Carolinas
Diagnosing it‌
Treating it‌ www.firsthealth.org
Orthopaedics at FirstHealth Richmond Memorial Hospital We help people with bone, joint and muscle problems maximize their quality of life and improve their level of function in a safe and efficient manner. - Local treatment for sports injuries - Pain relief in knees, hips and shoulders - Repair disorders of the knees, hips and shoulders - Both full and partial joint replacements provided - Minimally invasive surgeries - Convenient arthritis care - Many other procedures to restore normal function to damaged joints. For more information, please call (910) 417-4090.
David Casey, M.D.
John R. Moore IV, M.D.
Ward Oakley, M.D.
David Strom, M.D.
Kurt Wohlrab, M.D.
Kevin Slater, P.A.-C
Pinehurst Surgical Orthopaedic Surgeons
www.firsthealth.org 856-150-11
CEO Message
The power of the FirstHealth team
O
Charles T. Frock Chief Executive Officer FirstHealth of the Carolinas
ne of the wisest observations I’ve come across lately originated with an unlikely source, someone you’ve almost certainly never heard of unless you’re a fan of South American football. (That’s soccer here in the U.S.) The speaker is Wanderley Luxemburgo. He’s a Brazilian football manager and former player who a dozen or so years ago shared this characterization of what it takes to be a team player: “A player who conjugates a verb in the first person singular cannot be part of the squad. He has to conjugate the verb in the first person plural (We).” In a nutshell, that explains how we operate at FirstHealth of the Carolinas. “Working together” is the opening principle of our 2020 Vision. It is how we deliver on our core purpose, “to care for people.” It’s how every member of the FirstHealth team works daily to make us “first in quality, first in health.” I’ve had occasion to reflect on these ideas many times in the past few weeks, and each makes me very proud. As you may know, FirstHealth of the Carolinas now has a new team captain. It is a position that I had the privilege of holding for more than 20 years. Actually, 20 years ago, there was no FirstHealth of the Carolinas, just one hospital—Moore Regional—but one that in only six decades had distinguished itself among the state’s many fine medical institutions. Exciting things, including a firstclass cardiac catheterization and open-heart program, were either under way or on the horizon when Moore Regional’s leadership was approached by some Montgomery County residents who were as concerned about the future and quality of their community hospital as we were about ours. The two groups got together, talked and learned they had much in common. Within a couple of months, Moore Regional Hospital in Pinehurst and Montgomery Memorial Hospital in Troy had merged, forming the core for the FirstHealth of the Carolinas bench. As other groups learned about this friendly expansion of health care operations, they approached our new organization with their own ideas and concerns. Family care centers, health and fitness centers, a hospice, an insurance company, a foundation, dental care centers, EMS programs and a third hospital, Richmond Memorial in Rockingham, became a part of the FirstHealth team. With each new program, we added a new set of players with a new chorus of community voices that made our team even stronger. Each player on our team— board member, physician, staff member, donor, volunteer, leadership—has a unique role in our rich, vibrant and dynamic organization, and reflects the talents and versatility of the communities we serve. There is no better way to serve these communities’ needs. Now I don’t presume to offer unsolicited advice to my successor, Mr. David J. Kilarski. He’s a proven leader with an ear tuned for listening. I will, however, make a few observations as he begins what I know will be an exciting new professional journey. Listen to your communities. Empower your team. Be transparent. Act when you know that it’s the right thing to do. And enjoy your role as captain of the FirstHealth team. I certainly have. This is Mr. Frock’s final CEO Message. David J. Kilarski became FirstHealth’s chief executive officer on Nov. 1.
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Departments
155 Memorial Drive P.O. Box 3000 Pinehurst, NC 28374 Editor, FirstHealth of the Carolinas . . . . . . . . . . . . . . . . . . Brenda Bouser Managing Editor. . . . . . . . . . . . . . . . . . . . . . . . . . . Jason Schneider Creative Director. . . . . . . . . . . . . . . . . . . . . . . . . . . Jan McLean Senior Art Director. . . . . . . . . . . . . . . . . . . . . . . . . . James Davis Production Director. . . . . . . . . . . . . . . . . . . . . . . . . . Traci Marsh
f i r s t h e alt h . o rg
Contributing Writers
Brenda Bouser, Deborah Salomon
Contributing Photographers Don McKenzie, Mike Martin
Board of Directors FirstHealth of the Carolinas Mr. Alex Bowness, Chair Mr. Julian King, Vice Chair Robert Bahner Jr., M.D. Mr. H. Edward Barnes Jr. David Bruton, M.D. Mr. James H. Bulthuis Mr. David L. Burns David M. Cowherd, M.D. John N. Ellis, M.D. Walter S. Fasolak, D.O. Mr. David J Kilarski Mrs. Carolyn D. Helms
Mrs. Anna G. Hollers Mr. John M. May Dr. Susan R. Purser Bruce S. Solomon, D.O. John S. Stevenson, M.D. William L. Stewart, M.D. Stephen A. Szabo, M.D. Mr. Robert E. Tweed Mr. David Woronoff
Corporate Officers Chief Executive Officer, FirstHealth of the Carolinas
. . . .
Mr. David J. Kilarski
1. . . CEO message 4. . . FHC news 6. . . Calendar 7. . . Support groups 24. . . New providers 26. . . Letters
Features
8. . . . . Pain
Chief Financial Officer, FirstHealth of the Carolinas . . . . . Mrs. Lynn S. DeJaco Chief Information Officer, FirstHealth of the Carolinas. . . . . . . . . . . . . . . . . . . . . . . . . . Mr. David B. Dillehunt Vice President, Human Resources, FirstHealth of the Carolinas. . . . . . . . . . . . . . . . . . . . . . . . . . Mr. Daniel F. Biediger Vice President, Finance, FirstHealth of the Carolinas. . . . Mr. Jeffrey A. Casey Vice President, Quality, FirstHealth of the Carolinas. . . . . . . . . . . . . . . . . . . . . . . . . . Mrs. Cindy McNeill-McDonald President, FirstHealth Richmond Memorial Hospital . . . Mr. John J. Jackson President, FirstCarolinaCare Insurance Company. . . . . . . Mr. Kenneth J. Lewis President, Foundation of FirstHealth . . . . . . . . . . . . . . . . . . Mrs. Kathleen Stockham President, FirstHealth Montgomery Memorial Hospital. . . . Mrs. Beth Walker The not-for-profit FirstHealth of the Carolinas is headquartered in Pinehurst, N.C., and is composed of Moore Regional Hospital, Montgomery Memorial Hospital, Richmond Memorial Hospital (a division of Moore Regional Hospital), the Foundation of FirstHealth, FirstCarolinaCare Insurance Company, and Regional Health Services. Comments on FirstHealth of the Carolinas magazine or changes of address should be directed to bbouser@firsthealth.org or to (910) 715-4278.
FirstHealth of the Carolinas is published three times a year by Krames StayWell 407 Norwalk St. Greensboro, NC 27407 (336) 547-8970 President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William G. Moore Senior Staff Accountant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Kelly Carter Š Copyright 2011 by Krames StayWell, an operating company of StayWell/MediMedia USA, and FirstHealth of the Carolinas, Inc. No part of this publication may be reproduced or transmitted in any form or by any means without written permission from Krames StayWell. Articles in this publication are written by professional journalists who strive to present reliable, up-to-date health information. However, personal decisions regarding health, finance, exercise and other matters should be made only after consultation with the reader’s physician or professional adviser. All editorial rights reserved. Opinions expressed herein are not necessarily those of Krames StayWell or FirstHealth of the Carolinas. Models are used for illustrative purposes only.
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22 . . . A nurse at the helm(s)
O David J. Kilarski
named new CEO of FirstHealth of the Carolinas
n Nov. 1, FirstHealth of the Carolinas welcomed a new chief executive officer, only the second in its 16-year history, when David J. Kilarski succeeded retiring CEO Charles T. Frock. The 55-year-old Kilarski was most recently president and CEO of two Ohio health system hospitals within the Cleveland Clinic Health System: South Pointe Hospital in Warrensville Heights and Marymount Hospital and Marymount Health Care Systems in Garfield Heights. He has more than 20 years of health executive experience including leadership roles in community hospitals, academic medical centers and multi-hospital systems. Before moving into an executive level position in 1989, he served in pharmacy leadership positions for hospitals in Illinois and Texas. “I see a bright future for FirstHealth of the Carolinas,” Kilarski says. “The organization has positioned itself throughout the years as an innovative quality health system. The physicians I have already had the opportunity to meet are first class and interested in working together to continue to bring superior medical care to the community.” According to Alex Bowness, chair of FirstHealth’s Board of Directors, the reputation and success the organization achieved under Frock’s leadership allowed it to attract “a top-notch group” of candidates to succeed him. “Our outstanding physicians, the dedicated staff and volunteers, including support of the Foundation and the entire community were also key in making this opportunity attractive,” Bowness says. During his tenure as president and chief executive officer, Kilarski was instrumental in leading the two Cleveland Clinic hospitals to national recognition. While there, he had responsibility for operations with combined net operating revenue of $330 million and 2,500 full-time employees. “Dave was the unanimous choice for the CEO position,” Bowness says. “His extensive experience made him an ideal candidate to lead FirstHealth in our ever-changing and challenging health care environment. “He has a proven track record building trust and teamwork among leadership, working well with employed and partner physicians, improving operating margins, increasing employee satisfaction and ensuring each patient receives the highest level of quality of care. The board is confident he has the vision and passion to take FirstHealth to the next level in delivering the best patient care.” Kilarski earned his M.S. degree from Ohio State University and his bachelor’s degree from the University of Illinois. He began his career at St. John’s Hospital in Springfield, Ill., and is a Fellow of the American College of Health Care Executives.
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Nursing programs earn second Magnet recognition FirstHealth Moore Regional Hospital and affiliated nursing programs have earned their second four-year recognition as a Magnet® Nursing Hospital. Moore Regional received its first Magnet recognition in 2006. The 2011 redesignation also includes FirstHealth Richmond Memorial Hospital (a division of Moore Regional) as well as FirstHealth’s school nurse, community health and Cardiac Rehab programs. Only 386 hospitals worldwide and 21 hospitals in North Carolina currently hold the Magnet recognition, which was developed by the American Nurses Credentialing Center to recognize health care organizations that provide nursing excellence.
School Health Centers get HRSA grant The FirstHealth Montgomery County School Health Centers have received a $499,988 grant from the federal Health Resources and Services Administration (HRSA). The money will be used to rebuild the centers while incorporating telehealth and videoconferencing technology into their operation. School Health Centers are located at West Middle School in Mt. Gilead and East Middle School in Biscoe, and their services are available to all children enrolled in Montgomery County’s public schools. Seventyeight percent of the children served by the program are either uninsured or covered by Medicaid or N.C. Health Choice.
FirstHealth, Scotland Memorial partner in joint venture FirstHealth of the Carolinas and Scotland Memorial Hospital in Laurinburg have partnered in a joint venture to provide diagnostic cardiology procedures and interventional vascular services in Scotland County. The Scotland Cardiovascular Center opened in September on the Scotland Memorial Hospital campus. Physicians affiliated with the center include cardiologists Matthew Block, M.D., and Jide Lawal, M.D., and vascular surgeon Clinton Atkinson, M.D. FirstHealth provided start-up technical and operational support for the new venture and continues to provide nursing and technical staffing as well as patient scheduling and Joint Commission compliance services. An open house for the new operation will be held Thursday, Nov. 17, from 5 to 6:30 p.m. IN HOKE FOR HOKE—Teens from Hoke County High School’s TRU (Tobacco Reality Unfiltered) organization rode on the FirstHealth of the Carolinas float during a Sept. 15 parade that was part of Hoke County’s 2011 Turkey Festival celebration. FirstHealth, which participated in various Turkey Festival events as a gold sponsor, also had Mobile Health and CCT vehicles in the parade. FirstHealth Community Health Services facilitates the Hoke County High TRU group.
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First in Quality 650 Number of robotic surgeries performed at Moore Regional Hospital as of October 2011
John Caliri
Fitness director speaks at WHO meeting John Caliri, director of the FirstHealth Centers for Health & Fitness, spoke to a gathering of the World Health Organization (WHO) in New York City in September. During a WHO Wellness Week event hosted by Technogym, a producer of fitness and wellness equipment, Caliri focused on the effect that lifestyle change can have on non-communicable diseases such as cardiovascular disease and cancer. He especially noted FirstHealth’s success with its Exercise Is Medicine (EIM) program. EIM partners physicians in the FirstHealth service area with the Centers for Health & Fitness in an effort to help patients make the necessary lifestyle changes to improve their health. More than 130 physicians from 16 different medical specialties currently refer patients to the program that includes a free exercise assessment by a professional exercise trainer and a free twoweek membership to the Center for Health & Fitness of the patient’s choice. www.firsthealth.org/fitness
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How high patients rated their experience at Reid Heart Center on a scale of 1-10 in August 2011
28
Average wait-time in minutes to see a physician at the Emergency Department at Richmond Memorial Hospital in August 2011
92.1
Average ranking patients gave Moore Regional and Richmond Memorial inpatient nurses on a scale of 100 on September 2011 HCAHPS surveys
344
Number of MRIs performed at Montgomery Memorial Hospital in the past 12 months
85
Percentage of patients in August 2011 who said they would definitely recommend Moore Regional or Richmond Memorial (Note: Montgomery Memorial was not surveyed)
750
Number of active monthly users of FirstHealth’s Cancer Facebook page as of September 2011
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November Bodies in Motion Lecture: “Ouch, My Aching Joints!” The Basics of Joint Replacement Wednesday, Nov. 9 5:30 p.m. Conference Center FirstHealth Moore Regional Hospital Diabetes Health Fair Saturday, Nov. 12 9 a.m. to noon FirstHealth Specialty Centers Building Memorial Drive and Page Road Pinehurst Counseling Tips for Clergy Monday, Nov. 14 6 p.m. FirstHealth Raeford Center 313 Teal Road Raeford Kelly Frye, LRT/CTRS, of FirstHealth Behavioral Services, will conduct this community education program. Open House Scotland Cardiovascular Center Thursday, Nov. 17 5 p.m. Scotland Memorial Hospital The Scotland Cardiovascular Center is a joint venture between FirstHealth of the Carolinas and Scotland Memorial Hospital. Business After Hours Thursday, Nov. 17 5:30 p.m. Hospital Cafeteria FirstHealth Richmond Memorial Hospital FirstHealth Richmond Memorial Hospital will host the Richmond County Chamber of Commerce Business After Hours. The evening will feature a Thanksgiving meal and program. Shoe Sale and Computerized Foot Analysis Friday, Nov. 18 9 a.m. to 7 p.m. Saturday, Nov. 19 8 a.m. to noon FirstHealth Center for Health & FitnessPinehurst
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2011 Turkey Trot Saturday, Nov. 19 8:30 a.m. Cannon Park Highway 211 Pinehurst The FirstHealth Center for Health & Fitness-Pinehurst has partnered with Pinehurst Parks and Recreation to provide a new venue and a new event for the 31st annual running of this Moore County favorite. Events will begin at 8:30 a.m. with a one-mile fun run. A HalfMarathon will begin at 9 a.m. and will be followed by 5K and 10K races at 9:30 a.m. New this year is a Youth Turkey Trot Half-Marathon. For more details, visit the event website at www.firsthealth.org/turkeytrot, where you can download a registration form and view the new course routes. Registration is also available at www. active.com.
December 20th Annual Light Up a Life Ceremony Thursday, Dec. 1 5 p.m. FirstHealth Hospice & Palliative Care Campus 251 Campground Road (off Highway 15-501) Pinehurst Montgomery Memorial Hospital Auxiliary Christmas Love Light Tree Ceremony Tuesday, Dec. 6 6:15 p.m. Main Entrance FirstHealth Montgomery Memorial Hospital
Holly Day Camp for Kids Saturday, Dec. 10 1 to 4:30 p.m. FirstHealth Center for Health & FitnessPinehurst Various activities for children ages 15 months to 12 years Cost: 1 child—$20 members/$25 community. Each additional sibling—$15 members/$20 community FirstHealth Moore Regional Hospital Auxiliary Holiday Ball Saturday, Dec. 10 7 p.m. Carolina Hotel Ballroom Pinehurst Supporting the FirstHealth Dental Care Centers.
January H.E.L.P. (Healing Experience for Those Living with Pain) Begins Thursday, Jan. 12, 2012 2 p.m. Specialty Centers Building FirstHealth Moore Regional Hospital A 12-week program that helps participants take charge of their pain. Please register by Dec. 21. Participation in the H.E.L.P. program is covered by most insurance policies. Bodies in Motion Lecture: “Arthritis Is a Pain” Thursday, Jan. 12, 2012 5:30 p.m. Conference Center FirstHealth Moore Regional Hospital
February Bodies in Motion Lecture: “Life Is Not a Spectator Sport” Wednesday, Feb. 15, 2012 5:30 p.m. Conference Center FirstHealth Moore Regional Hospital
Unless otherwise noted, there is no charge for these programs. For more information or to register, please call (800) 213-3284 or visit our website at www.firsthealth.org/calendar.
Bariatric 6 p.m., third Monday of each month, Renaissance Room, Pinehurst Surgical, 5 FirstVillage Drive, Pinehurst. Better Breathers—A support group that teaches individuals with chronic obstructive pulmonary disease (COPD) and their families how to live with lung disease. • Montgomery County: 12:30 p.m., second Monday of each month, September through May, Community Health Building, 443 Wood St., Troy. • Moore County: 10 a.m., third Tuesday of each month, except June through August, Conference Center, FirstHealth Moore Regional Hospital. Breast Cancer Support Group 7 p.m., second Monday of the month, except July and August, Conference Center, FirstHealth Moore Regional Hospital. Cancer Support Group 2 p.m., every Tuesday, Sun Room, Cancer Center, FirstHealth Moore Regional Hospital. Cancer Survivors Support Group 11 a.m., second Tuesday of the month, Sun Room, Cancer Center, FirstHealth Moore Regional Hospital. CODA 7 p.m., every Monday, Conference Center, FirstHealth Moore Regional Hospital. Fibromyalgia Support Group 7 p.m., second Tuesday of each month, except December, Outpatient Center Conference Room, FirstHealth Moore Regional Hospital, 238 Page Road, Pinehurst. FirstQuit Support Group—A group for people who have quit or are trying to quit tobacco. • Hoke County: noon, second and fourth Monday of each month, FirstHealth Family Care Center-Raeford, 313 Teal Drive, Raeford. • Moore County: noon, every Thursday, FirstHealth Taylortown Building, 181-C Westgate Drive, West End.
Richmond County: 5 p.m., every Thursday, Conference Dining Room, FirstHealth Richmond Memorial Hospital, 925 S. Long Drive, Rockingham. Lupus Support Group 4 p.m., third Sunday of each month, except June and July, Conference Center, FirstHealth Moore Regional Hospital. NAMI-MC (National Alliance on Mental Illness-Moore County) 7 p.m., first Monday of each month, Community Classroom, FirstHealth Specialty Centers Building, 35 Memorial Drive, Pinehurst. Post-Deployment Group—For individuals with postdeployment symptoms. 11 a.m., every Monday, FirstHealth Behavioral Services, FirstHealth Specialty Centers Building, 35 Memorial Drive, Pinehurst. Post-Polio Support Group 10 a.m., first Saturday of each month, Conference Center, FirstHealth Moore Regional Hospital.
Unless otherwise noted, support groups meet in the Conference Center of FirstHealth Moore Regional Hospital, corner of Highway 211 and Page Road, Pinehurst. For more information on any of these groups, please call (800) 213-3284.
Sandhills Ostomy Association 3 p.m., first Sunday of each month, except June through September, Conference Center, FirstHealth, Moore Regional Hospital. Stroke Club 10:30 a.m., second Saturday of each month, Conference Center, FirstHealth Moore Regional Hospital. Susan Sharpe Cancer Support Group (Richmond) 6:30 p.m., fourth Thursday of each month, except June through August, Conference Dining Room, FirstHealth Richmond Memorial Hospital, 925 South Long Drive, Rockingham. Zipper Club—For individuals who have had open-heart surgery. 7 p.m., fourth Tuesday of each month, except December, Conference Center, FirstHealth Moore Regional Hospital.
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“The greatest evil is physical pain.” Saint Augustine, early Christian philosopher and theologian
“Illness is the doctor to whom we pay most heed; to kindness, to knowledge, we make promise only; pain we obey.” Marcel Proust, French author
8 Fall 2011
10 M.I.L.D. relief for lower back pain 11 RMH Orthopaedics 12 Foot pain 13 Wrist and hand pain 14 Pain from sports injuries 15 Joint pain 15 Back pain 16 Weight-loss and pain 17 Pain and weight-loss with bariatric surgery 17 Pain and weight-loss with Exercise Is Medicine 18 Pinpointing pain 19 Surgery with less pain 20 Post-surgical pain 21 Smoking and pain
Believe it or not, pain has a purpose. Without it, you could seriously hurt yourself or have a medical problem and not even know it. A sensation that is triggered in the nervous system, pain can be sharp or dull, constant or intermittent. Pain that goes on for weeks, months or years is called chronic. It may have a diagnosable cause, such as arthritis, or a cause that is unknown. Depending on the cause, there are many ways—from over-the-counter medications to surgery—to treat pain.
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A M.I.L.D. patient’s story relief for lower back pain
Retired nurse Anita Abatemarco found herself putting some of her long-unused professional skills back into use during her husband’s final illness last year. Turning and lifting her beloved Rocco took a toll on her lower back, though, and it wasn’t long before the tiny 79-year-old was holding onto furniture to get around her Pinehurst home— especially in the morning when the pain was more severe. Nothing, not even three epidural injections, seemed to help. “I had absolutely no relief from the pain,” Abatemarco says. Abatemarco’s pain, which began in her pelvis and radiated down her right leg and into her ankle, was so acute that she was immediately interested when Paul Kuzma, M.D., told her about the M.I.L.D. procedure. She had the procedure early this year and has been very pleased with the results. “When you have that pain, you don’t want it to ever come back,” she says. “I’m grateful for this procedure. I really am.”
Paul Kuzma, M.D., of the FirstHealth Back & Neck Pain Center and Pinehurst Anesthesia Associates, is one of only a handful of North Carolina specialists to be trained in the M.I.L.D. treatment for lumbar spinal stenosis (LSS), a painful condition caused by a narrowing in the spinal canal due to bone or tissue growth. M.I.L.D. (Minimally Invasive Lumbar Decompression) removes a primary cause of the probPaul Kuzma, M.D. lem for which more than 1.2 million patients are treated each year. The procedure has been proven safe and effective in several studies. With LSS, pressure increases on the nerves that go through it to the legs as the space for the spinal canal shrinks. This causes pain and numbness or weakness in the lower back, buttocks, legs and feet that can worsen when the patient is walking or standing or improve when the patient bends forward, sits or lies down. People with LSS commonly complain of difficulty walking even short distances, and do so—in advanced cases—with a characteristic stoop. Patients most likely to benefit from the M.I.L.D. treatment are usuWith X-ray guidance, Dr. Kuzma uses miniature instruments ally in their 60s, 70s and 80s. introduced through a needle about the size of a pencil to Most have tried a variety of other remove the ligament and bone pieces causing the pain. As therapies (physical therapy, acupuncture, chiropractics) or symptom the matter is removed, the size of the spinal canal increases management (medication, epidural and the pressure on the nerves is relieved. steroid injections and pain pumps) The patient goes home the same day with a bandage on without success. his/her back. “When I see patients, they’ve usually been through quite a lot by “The results have been really good,” Dr. Kuzma says. “We the time we get to this discussion,” can’t address everything that causes spinal stenosis, but we says Paul Kuzma, M.D. “Those who can address some of it.” are most likely to benefit from this
Who can benefit?
For more information on the M.I.L.D. procedure for lumbar spinal stenosis or the FirstHealth Back & Neck Pain Center, call (800) 213-3284 toll-free.
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procedure are those who want to be active, but are limited by back and leg pain or heaviness when they start to walk.”
Oh, my aching wrist, back, knee, hip, foot … The worst pain, a philosopher said, is the pain a person experiences at the moment. Pain is powerful: Ancient Greeks created Algea, the spirit of pain, also Poine, pain’s goddess. Hippocrates treated pain with willow bark containing salicylic acid (aspirin). Pain emanates from all parts of the body and, in most cases, signals a problem. Athletes and older adults know all about orthopaedic pain. “As people age, their ligaments and tendons don’t have the elasticity, so these injuries are more common and take longer to heal, because blood supply isn’t as good,” says Kurt Wohlrab, M.D., of Pinehurst Surgical and FirstHealth Richmond Medical Group–Orthopaedics. Orthopaedic surgeons often sub-specialize in wrist, back, ankle, hip, knee and foot pain, or wherever a joint, muscle, ligament, tendon or bone is involved. Treatments are similar.
FirstHealth’s Orthopaedic and Joint Replacement “Bodies in Motion”lecture series will highlight various causes of joint pain and their surgical treatment options. n
“Ouch, My Aching Joints!” The Basics of Joint Replacement Wednesday, Nov. 9
n “Arthritis
Is a Pain” Thursday, Jan. 12, 2012
Orthopaedics care close to home for Richmond residents Patricia Craven worked at FirstHealth Richmond Memorial Hospital for 18 years, first as a ward secretary and then as a nurse on Labor & Delivery. She loved her work and still loves the hospital. “I always go to Richmond Memorial,” she says. John R. Moore IV, M.D.
Both of Craven’s knees have been surgically replaced, and she had hip replacement surgery in June of this year. The last two surgeries were done at Richmond Memorial, where convenience as well as quality was a factor for Craven, who lives in Hamlet. “It’s wonderful,” she says of her Richmond County care. “I wouldn’t trade it for anything in the world. It makes everything easier.” When she has an office visit, Craven now sees orthopaedic surgeon John R. Moore IV, M.D., at FirstHealth Richmond Medical Group – Orthopaedics (809 S. Long Drive, Suite K) on the Richmond Memorial Hospital campus. When Dr. Moore isn’t available, Craven knows she can rely on physician assistant Kevin Slater, P.A.-C., for help. “Kevin is great,” she says. “If you get in trouble, he’ll see you most any time, which is nice.” A Pinehurst Surgical and FirstHealth of the Carolinas partnership, FirstHealth Richmond Medical Group – Orthopaedics provides a complete range of treatments for a variety of conditions—from sports injuries to full and partial joint replacements. The goal of this orthopaedic team is to help Richmond County residents with bone, joint and muscle problems maximize their quality of life and level of function in a safe and efficient manner that is close to home.
n “Life
In addition to Dr. Moore and Slater, the providers at the office include David Casey, M.D.; Ward Oakley, M.D.; David Strom, M.D.; and Kurt Wohlrab, M.D.
Each program will begin at 5:30 p.m. in the Conference Center at FirstHealth Moore Regional Hospital and will include a sampling of joint-healthy hors d’oeuvres.
“I’m very satisfied with the office here,” says Craven. “I think it’s wonderful.”
Is Not a Spectator Sport” (sports injuries) Wednesday, Feb. 15, 2012
Call (800) 213-3284 to register or for more information.
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Foot pain Feet are where the rubber meets the road. Like tires, they show wear and tear. According to David Strom, M.D., of Pinehurst Surgical and FirstHealth Richmond Medical Group–Orthopaedics, the heel is the number one cause of foot pain. Plantar fasciitis, which is usually responsible for heel pain, affects 70 percent of the population over a lifetime, Dr. Strom says. The pain, which resembles walking on nails, can last for years and results from altered mechanics causing inflammation. Stretching exercises help, and antiinflammatory medications may be of benefit. “A cortisone shot is often a better option,” Dr. Strom says. Orthotics, heel cushions and specific stretching exercises may help. Occasionally, the pain will disappear spontaneously. Foot pain caused by arthritis is treated with anti-inflammatory drugs or with surgery to fuse joints with screws and plates. Bunions, bony bumps on the joint at the base of the big toe, are hereditary, Dr. Strom says. Treatment includes roomier shoes, perhaps with orthotics, or surgery. Any shoe that concentrates body weight on the ball of the foot or squeezes toes into an unnatural position is likely to make the fashionista’s feet ache. Dr. Strom calls extreme shoe styles (platform toes, stiletto heels) “great for ankle injuries and my business.” A ruptured Achilles tendon (base of ankle) causes a sudden, intense pain that quickly subsides. Surgery is usually the best treatment. Neuropathy (diabetic and otherwise) produces nerve pain or numbness in the feet that waxes and wanes. Ingrown toenails may be prevented by correct trimming and wearing wider shoes, Dr. Strom says. Seek professional help if the toenail becomes infected, inflamed and painful.
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David Strom, M.D.
Wrist and hand pain “Common Hand and Wrist Disorders” n
Thursday, Dec. 1 5:30 p.m. FirstHealth Outpatient Rehab–Aviemore Clinic 12 Aviemore Drive, Pinehurst
Learn about carpal tunnel syndrome, trigger finger, tendonitis, rheumatoid arthritis and the latest techniques used for the treatment of hand and wrist disorders. Speakers will be Glen Subin, M.D., orthopaedic surgeon; and Holly Pandich, OTR/L. The lecture is free, and light refreshments will be served. For more information, call (800) 213-3284.
The carpal tunnel is a narrow conduit at the base of the hand. The median nerve passes through this rigid tunnel on its way from the forearm to the palm side of the thumb and fingers (excluding the pinky). Compression of the nerve sheath causes inflammation, therefore pain, says Glen Subin, M.D., of Mid-South Orthopaedic Clinic. The condition is common but not exclusive to typists, musicians and other professions that require repetitive hand movements. Dr. Subin treats a dozen other causes, including gout, cysts, aging, pregnancy and “idiopathic” or unknown. The first sign is numbness and tingling. “This goes away when they shake the hand,” Dr. Subin says. The syndrome may progress to a burning, aching pain that worsens if not treated. Simple actions like turning newspaper pages become difficult. “This clumsiness can become permanent,” says Dr. Subin. “You can lose nerve fibers that don’t (regenerate). Surgical treatment prevents nerve death.” Surgery relieves pressure by increasing the size of the canal by 33 percent, but surgery is a last resort. Less-invasive treatments include wrist splints, antiinflammatory drugs and cortisone injections. Carpal tunnel syndrome pain can be unrelenting and of varying intensity. Some people are helped by pain medication.
Glen Subin, M.D.
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pain from
Kurt Wohlrab, M.D., who specializes in sports medicine, claims the whole body as his playing field, treating all ages, many bones, even more joints, tendons and cartilages injured in physical activity. “Pain is not necessarily a sign you have to stop doing something,” he says. “In sports medicine, we get people back to active lifestyles.” However, Dr. Wohlrab continues, pain is the body’s way of expressing a need—perhaps for an adjusted golf swing or an altered gait. The cause of pain is determined by examinations and imaging that rule out injuries and other causes. Dr. Wohlrab sees golfer’s elbow and runner’s knee pain even in an older population. For best results, the underlying cause is treated in an active mode, such as physical therapy. “If your elbow is sore and you stop using the arm, then you’ll get a frozen shoulder,” Dr. Wohlrab says. Cortisone injections and anti-inflammatory drugs diminish pain and keep people moving. Cortisone masks pain and lets the body do the healing, Dr. Wohlrab says, but cortisone is not always a long-term solution. Narcotics are used short-term for post-surgical discomfort. Pain resulting from a fracture can be considerable and resistant to analgesics when swelling occurs within the cast. Orthopaedic pain is subjective and individualized, as are pain thresholds. “Figuring that out is the art of pain medication,” Dr. Wohlrab says.
Kurt Wohlrab, M.D.
Heather MacMillan of Pinehurst, triathlete and FirstHealth Orthopaedic and Joint Replacement patient. Read her story at www.firsthealth.org/ortho.
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Joint Pain Arthritis causes painful swelling and inflammation in joints, particularly knees, hips, ankles and shoulders, says Jason Guevara, M.D., of Pinehurst Hip and Knee Center. Obesity and smoking contribute to arthritis, which takes several forms, including rheumatoid and osteoarthritis. “Motion is lotion; rest is rust,” Dr. Guevara says, meaning a used joint is not likely to stiffen. Jason Guevara, M.D. Strengthening muscles around a joint through physical therapy will keep it functioning better with less discomfort. Glucosamine (sugar and ammonia), a widely advertised remedy for arthritis, has zero effect, in Dr. Guevara’s opinion. “It’s more of a placebo,” he says. Here, as elsewhere, a cortisone injection usually helps. A series of Synvisc (synthetic oil) shots is intended to lubricate the joint and alleviate pain. Joint pain caused by swelling from trauma is lessened with ice, wraps and anti-inflammatories such as Advil and Aleve. If conservative treatment fails, patients with debilitating pain may choose partial or complete joint replacement surgery, “a good option,” Dr. Guevara says, with new all-metal or all-ceramic parts. Recovery from partial hip and knee replacements is quick, he says. Ankles are more difficult.
Roy Jackson of Vass, golfer and FirstHealth Orthopaedic and Joint Replacement patient. Read his story at www.firsthealth.org/ortho.
Back Pain Eighty percent of Americans will experience disabling back pain some time during their life, says James Rice, M.D., of Sandhills James Rice, M.D. Orthopaedic and Spine Center. Some is mechanical; some is age-related. Trauma, a pinched nerve or a ruptured disc cause sudden, acute pain. Arthritis in the spine may be treated with disease-modifying medications such as Embrel. A cortisone injection resolves other causes. Narcotic pain medication creates a “bad syndrome,” Dr. Rice says. “The fewer pills the better.” Dr. Rice advises a good exercise program and physical therapy. A diagnosis to determine the cause of pain includes the patient’s personal and family history, risk factors, onset of pain, and what makes it better or worse. “Smoking is a risk factor for back pain, because it decreases the blood supply,” Dr. Rice says. “The body can’t repair itself as quickly.” Back strains, often from a pulled muscle, usually respond to ice or heat (try both, Dr. Rice says) and ibuprofen. Protracted bed rest results in weakness. Instead, restrict heavy activity and stay mobile, he says. Pain radiating from the back down the leg may be caused by a pinched nerve. Here, as always, an ounce of prevention pays off: A healthy diet, frequent exercise, no smoking and weight control help keep the car out of the shop and running better and longer. www.firsthealth.org
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FREE INFORMATION SESSIONS
on the weight-loss surgery program at FirstHealth Moore Regional Hospital are held at 6 p.m. the first Thursday and the third Monday of each month in the Renaissance Room of Pinehurst Surgical, 5 Village Drive, FirstVillage Campus, Pinehurst. For more information, call (800) 213-3284.
Even being moderately overweight puts stress on the hips, knees and lower back, and increases the likelihood of painful arthritis. The problem increases with the weight. “The heavier you are the more pressure you put on the structure when you move around,” says David W. Grantham, M.D., a bariatric surgeon with the surgical weight-loss program at FirstHealth Moore Regional Hospital. On the other hand, weight-loss surgery can help decrease back and joint pain by removing the source of stress to the affected area. Just how much and how soon depends on how much the problem has progressed, Dr. Grantham says. Even if a joint has deteriorated to the point that it needs to be replaced, weight-loss can improve the chance for a good surgical outcome and help prolong the life of the replacement joint. According to Raymond Washington Jr., M.D., medical director of the Moore Regional program, people who suffer from migraines have also been found to benefit from surgical weight-loss. While the exact cause is unknown, he says, it apparently involves the effect of the weight-loss on the endocrine system. As patients lose weight, they feel better and become more active, which aids the weight-loss process. “The surgery definitely makes a difference,” says Dr. Washington. “There’s definitely a correlation.” www.ncweightlosssurgery.org
Weight-loss surgery at FirstHealth The bariatric surgery program at FirstHealth Moore Regional Hospital offers indefinite follow-up under the direction of a weight-loss team that includes specially trained surgeons and a patient navigator/nutritionist who ensures that patients get timely care from the various health care services they require before and after surgery. “Our program is built on indefinite follow-up based on surgery, nutrition and education,” says Raymond G. Washington Jr., a general and bariatric surgeon and the program’s medical director. “Surgery is just one component of the program.” Dr. Washington and general and bariatric surgeon David W. Grantham, M.D., comprise Moore Regional’s weight-loss surgery team. Patient navigator Melissa Herman, R.D., LDN, CDE, is a registered dietitian who counsels patients about pre- and post-operative diet concerns, creates individualized patient diet plans, helps patients as they progress through the extensive bariatric process, and leads a monthly weight-loss support group. A unique component to the program involves a partnership with the FirstHealth Center for Health & Fitness-Pinehurst. Participating patients meet with a personal exercise trainer in the center’s Exercise Is Medicine program to develop an individualized exercise routine to help them become more fit before surgery and more physically active afterward. The program includes a free two-week fitness center membership as well as the free trainer evaluation.
David W. Grantham, M.D.
Raymond G. Washington, M.D.
Melissa Herman, R.D., LDN
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Pain and weight-loss … with
Exercise Is Medicine
As FirstHealth exercise technologist Jeff Moody II recalls, Dennis Morris had two goals in mind for his Exercise Is Medicine (EIM) program: to get back to work after surgery to correct a painful back injury and to fit into his favorite jeans. He has done both. A paramedic with Moore County EMS, Morris was working out at a non-FirstHealth gym when he noticed a loss of sensation in his arms and legs and some numbness from his waist down. Thinking he had pulled a muscle, he went home and went to bed only to wake up in “excruciating pain” about 2 a.m. Because he didn’t have the strength in his legs to change gears in his manual transmission vehicle, Morris drove the three-quarters of a mile to FirstHealth Montgomery Memorial Hospital in first gear. The Emergency Department physician on duty that night sent him to FirstHealth Moore Regional Hospital, where he had surgery to remove the spinal cord pressure caused by two herniated cervical discs. “I had immediate sensation back to my extremities,” says the 40-year-old Morris. Weak and needing help to regain the strength he had lost with his injury and the corrective surgery, Morris was referred for physical therapy and then, by his personal physician, Michael McLeod, M.D., of Troy Medical Services, to the EIM program at the Center for Health & Fitness-Pinehurst. “To get in physical shape was the ultimate goal and to regain my strength,” Morris says. To help Morris accomplish his goal, Moody prescribed an EIM exercise plan that began with upper- and lower-body resistance band exercises and then progressed after two weeks to free-motion strengthtraining equipment. Before long, Morris was ready to return to work—not just with Moore County EMS but also with the contract job that has him dodging paint balls and plastic pellets during tactical training exercises for law enforcement and the military. He also lost weight. Morris was happy just to be fit enough to achieve his back-to-work goal and resume his EMS and contract routine. The weight loss, he says, “was a bonus.” He now weighs 260 pounds (down from 320) and wears size 38 jeans.
Dennis Morris (left) lost weight and was able to regain the strength he needed to return to his job as a paramedic with Moore County EMS after working with exercise technologist Jeff Moody II in the Exercise Is Medicine program at the FirstHealth Center for Health & Fitness-Pinehurst.
What is EIM? Exercise Is Medicine (EIM) encourages health care providers to make exercise a part of their regular patient treatment plans. After discussing physical activity needs with a patient, the participating doctor refers the individual to the Center for Health & FitnessPinehurst for a free professional exercise assessment and treatment plan developed by a trained exercise technologist. Anyone, age 16 and up, who needs to start an exercise program to improve his/her health can participate in the EIM program—even those dealing with a chronic illness such as hypertension or diabetes or even cancer or heart disease. All that is required is physician referral. More than 130 physicians from 16 different medical specialties—including specialists at the FirstHealth Back & Neck Pain Center, currently refer patients to the EIM program. Although Exercise Is Medicine assessments and treatment plans are offered only at the FirstHealth Center for Health & Fitness-Pinehurst, participants can exercise at the location of their choice. For more information on the program, call (800) 213-3284.
www.firsthealth.org
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Pinpointing the source of pain
Physicians use various imaging technologies to pinpoint the source of pain caused by medical conditions. Which technology depends on a variety of factors including the location of the pain, the age and/or size of the patient, the amount of radiation dose and cost. Sometimes more than one technology could be appropriate. “Two or three modalities could be used to answer the same question,” says Ernest Samuel, director of Imaging Services at FirstHealth Moore Regional Hospital. “Sometimes it’s just a matter of deciding which modality is going to answer the question with the least amount of (radiation) exposure.” The most commonly used diagnostic technologies at FirstHealth of the Carolinas hospitals include CT, X-ray, nuclear medicine, MRI, PET and ultrasound. X-ray is probably the most familiar and the least expensive while ultrasound is quick and non-invasive. PET, CT, nuclear medicine and MRI usually have more specialized uses. Upgrades are constant with FirstHealth’s imaging technologies. A recent console upgrade to the 64-slice CT (computed tomography): A computer-aided X-ray procedure CT scanner at Moore Regional allows the machine to that combines many images to generate cross-sectional views (slices) and, if needed, three-dimensional images of the internal organs and produce quality exams while reducing patient radiastructures of the body. tion dose for certain cardiac procedures by as much
Imaging Glossary
as 78 percent and by 20 to 30 percent with other procedures, Samuel says. The area’s only true open bore MRI machine, which was placed into operation at FirstHealth’s Outpatient Imaging Clinic in Pinehurst late last year, provides the highest level of patient accommodation and acceptance for claustrophobic, obese, pediatric, elderly and infirm patients. The FirstHealth Raeford Center in Hoke County recently purchased a new digital X-ray system, and a digital X-ray system was placed in the Emergency Department at FirstHealth Montgomery Memorial Hospital earlier this year.
MRI (magnetic resonance imaging): Uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. Nuclear Medicine: Computer-aided cameras provide precise pictures of the area being imaged by detecting injected, inhaled or consumed radiopharmaceuticals as they move through the body. PET (positron emission tomography): Uses gamma ray signals given off by an injected radioactive element to measure the amount of metabolic activity at a site in the body. A computer reassembles the signals into images. Ultrasound (ultrasonography): Provides an inside view of soft tissues and body cavities without the use of radiation and invasive techniques. Special devices are used to bounce high-frequency sound waves off tissues, and the echoes are converted into pictures called sonograms. X-ray: Uses electromagnetic radiation to make images that have traditionally been recorded on film. Digital X-ray, which requires considerably less radiation exposure, is now used throughout the FirstHealth system.
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Surgery with less pain … minimally invasive and robotic surgery
T
wenty-five years ago, typical gall bladder surgery would have meant a 5- to 7-inch abdominal incision, several days in the hospital and several weeks of recovery at home. That changed with the introduction of the laparoscopic cholecystectomy. These days, gall bladder surgery more often than not involves just several tiny incisions, mere fractions the size of the traditional open cut. Patients usually return to their normal activities within a week to 10 days, are sore for about a week and generally have much less discomfort than people who have had open surgery. According to Tom Kane, R.N., administrative director of Surgical Services at FirstHealth Moore Regional Hospital, the introduction of the laparoscopic (minimally invasive) cholecystectomy set a new standard for surgical procedures that is now used by almost every surgical service. “That’s when we started gaining momentum with minimally invasive surgery,” he says. In a minimally invasive endoscopic procedure, the surgeon gains access to the body through tiny ports and then uses a lighted optical instrument (the endoscope) to look inside. Images from cameras that are attached to the scope are displayed on monitors, and sharply pointed instruments called trocars allow the surgeon to introduce the surgical instruments into the surgical site. Advantages to minimally invasive surgery include less pain and scarring, a speedier recovery and decreased likelihood of post-surgical complications. Some procedures can even be done in an outpatient situation. “We want to be as minimally invasive to the patient as possible and cut the least amount of tissue as possible while getting the greatest visualization,” Kane says. Although the success of laparoscopic gall bladder surgeries claimed a big portion of the minimally invasive spotlight early on, gynecological surgeons were actually the first to push and develop minimally invasive surgery with laparoscopy for ectopic pregnancy and tubal ligations in the late 1970s. “Then general surgery took over,” Kane says “Once scopes got smaller and video support got better, most of the other services moved toward minimally invasive as well.” Orthopaedic surgeries are occasionally performed as minimally invasive procedures, and cardiothoracic procedures such as lung resections can
be done through scopes in the chest. Scopes also provide increased visualization for ENT (ear nose and www.firsthealth.org/robotics throat) specialists who work in very tightly enclosed spaces like the sinuses. “The term ‘minimally invasive’ is also used for procedures where a very small incision is made when compared to a more traditional surgical approach,” Kane says. “We may do spine surgery as ‘minimally invasive,’ which entails much smaller incisions.”
Robotic surgery
In a 21st century extension of minimally invasive activity, robotic surgery took minimally invasive surgery to yet another level. The flexible joints of the da Vinci Robotic Surgical System at Moore Regional Hospital serve as extensions of the surgeon’s wrists and fingers, mimicking gross motor movements and providing unprecedented access to remote parts of the body. Although completely in charge, the surgeon sits several feet away from the patient at a console from which he guides the movement of the surgical instruments at the end of the robotic arms. Movements are reduced to fractions of an inch, and 3-D images provide increased visualization and add depth perception. Tissue damage is minimal. At Moore Regional, urologists and gynecologists make use of robotic technology. Robotic-assisted prostatectomies allow urologists to remove cancerous prostate glands during nerve-sparing operations that can mean greater eradication of the cancer with maintenance of bladder control and potency. Gynecologists use the da Vinci for various procedures including pelvic reconstruction and laparoscopic hysterectomy. According to Kane, the increased use of minimally invasive procedures and the introduction of robotics to the surgical field have made traditionally very complex surgeries much less traumatic for the patient, decreasing pain and streamlining recovery. “The quicker we can get someone up and moving, the better off they are,” he says.
www.firsthealth.org
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Post-surgical pain A
side from the obvious anxieties they have about possible results, most people who are about to have surgery also worry about the pain they will experience afterward. Because surgery involves cutting through body tissue, a certain amount of postoperative pain is to be expected. How much depends on a number of factors, including the reason for and the location of the surgery. While the physician in charge of the patient’s care makes the decision on the type and dosage of pain medication that is to be administered, nurses play an important role in postoperative pain management, too. “Every nurse is taught that pain is individual to that patient,” says Karen Klish, R.N., clinical director of First Surgical, Outpatient and Pre-Admission Services at FirstHealth Moore Regional Hospital. “What might be tolerable to me might not be tolerable to someone else.” Postoperative pain management begins in the PACU (Post Anesthesia Care Unit), the area of the hospital once known as the Recovery Room, where the goal is to reduce or eliminate pain and discomfort with a minimum of side effects, according to Belinda Pope, R.N., PACU clinical director. Depending on the level of pain, medication can range from acetaminophen to lesser narcotics such as codeine to strong narcotics like morphine. Again, much depends on the level of pain and the patient’s tolerance for it, says Klish. “Pain is a very individual, specific and personal experience with each patient,” she says. “The goal is to keep patients as comfortable as possible, but they will have some post-op discomfort.”
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There are a variety of methods for medication delivery. PCA or patientcontrolled analgesia, which allows the patient to self-administer his/ her pain medication, is a popular postoperative pain control technique. Delivered via an electronically controlled infusion pump, the dose is set especially for the patient and programmed so that the patient cannot overdose. Because of their rapid effect, IV medications are more likely to be used in cases of severe or breakthrough pain. Medications that are administered by mouth take longer to act, but may remain active longer. According to Tammy Stafford, R.N., a clinical nurse leader in Outpatient Surgery at Moore Regional, a number of relatively simple measures can be used to make the postoperative patient more comfortable. They include elevation, relaxation techniques, pillow support, even ice or warm blankets. The distraction of a “support person” such as a parent or familiar caregiver is often helpful with pediatric patients, Stafford says, and a cold Popsicle can do wonders for a post-surgical sore throat. Patients also have a role in their pain management, and being in the best physical shape possible prior to surgery can have a significant effect. “Surgery is a big hit,” Klish says. “The more physical reserves a person has, the faster he or she is going to recover.” Patients who get up and move around as soon as possible after surgery not only feel better faster but also lessen their risk for certain postoperative complications. “Most surgical patients should be out of bed as soon as possible,” Klish says. “It hurts to get out of bed, but sometimes that’s the best medicine.”
Smoking and pain Most of the risks associated with smoking are well documented. They include increased risk of: n Coronary heart disease (by two to four times) n Stroke (by two to four times) n Lung cancer (by 23 times in men and 13 times in women) n Dying from chronic obstructive lung diseases, including chronic bronchitis and emphysema (by 12 to 13 times)
How to register for FirstQuit? If you would like to attend FirstHealth’s FirstQuit classes at the FirstHealth Back & Neck Pain Center, simply ask the center’s staff to register you. The Back & Neck Pain Center is located in the FirstHealth Specialty Centers Building, 35 Memorial Drive, Pinehurst. For more information, call (800) 213-3284.
There is another, somewhat lesser known risk of smoking: increased chronic pain. According to information published this summer in the American Journal of Medicine, people who smoke or who have smoked in the past are more likely to suffer from low back pain than people who have never smoked. Several studies have noted the link between smoking and low back pain. In one of the most recent, the University of Kentucky’s School of Public Health surveyed more than 6,000 women in the Kentucky Women’s Health Registry and found that smokers are significantly more likely to report chronic pain than nonsmokers. Smoking apparently contributes to the development of osteoporosis and the deterioration of spinal discs, making these painful medical conditions worse. It can also interfere with pain medication and increase pain sensitivity and perception. “This is just one of the many benefits of quitting smoking, as it is one of the best things you can do for your health,” says Cindy Laton, a certified tobacco treatment specialist with FirstHealth Community Health Services. FirstHealth of the Carolinas offers monthly FirstQuit tobacco-cessation classes at the FirstHealth Back & Neck Pain Center. Current and former tobacco users, as well as those who are trying to quit or are thinking about quitting, can also participate in a related FirstQuit support group. FirstQuit classes are led by certified tobacco treatment specialists, and include follow-up sessions and starter and follow-up supplies of tobaccocessation medications such as patches, gum and lozenges. www.firsthealth.org
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A nurse at the helm(s) By Deborah Salomon
C
arolyn Helms can skip from patient room to weight room to family room to boardroom without missing a beat. She is petite, focused, unflappable, devout and well-spoken. Helms vibrates with energy. As a health professional, Christian educator, pastor’s wife and mother, she multitasked before the concept had a name. She brings these attributes plus two to her position as chair of the FirstHealth Moore Regional Hospital Board of Trustees. She is the first woman and the first nurse in the position. Helms’ understanding exceeds the clinical, however. She believed in a holistic approach—physical, emotional, spiritual—to patient care long before the concept coalesced. Her admiration for the way Moore Regional implements this care has grown with her association with the institution. “I have witnessed small steps of progress—I’m excited about them,” she says. “It’s like losing weight. Small increments work better than a burst, which fizzles.” As a young woman in Chatham, Va., Helms gravitated to the sciences. A formative experience occurred when she was in nursing school at the Medical College of Virginia and caring for a woman with severe diabetes. The woman’s condition improved after she learned the importance of diet and exercise. She was released from the hospital, but soon relapsed. Helms encountered her during a subsequent hospitalization. “She went home to a deprived social/family situation,” says Helms, who believes that health care must include communication and empathy. “The lack of support, that made an impression on me. I believe we are spiritual beings. All our responses come from a ‘core.’” Learning about the growing hospice movement in the 1970s, Helms, armed with a bachelor’s degree in nursing and experience as a floor nurse in a 20-bed hospital, entered Southeastern Baptist Theological Seminary in Wake Forest. She met David Helms there.
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The two married and moved to Southern Pines, where he became pastor at First Baptist Church and she taught nursing at Sandhills Community College until the birth of their son in 1984. Helms returned to part-time nursing as a “Thursday girl” on a med-surg unit at Moore Regional, later working “Baylor,” a term for exhausting 12-hour weekend shifts. When Sandhills Hospice opened, she switched caps to work as a chaplain and then volunteered as a board member. Hospice proved a model for her brand of whole-person treatment. “I loved it,” she says. From hospice, Helms moved to serving on and later chairing, the Moore Regional Board’s Patient Care Committee, then to the board of trustees, where she learned that a hospital is a business with patient care the product. “I see the role of board member as the ultimate advocate,” she says. “This hospital has developed a strong awareness, a striving for up-front quality.” With a public that is better informed than ever before about health care, Helms says, hospital leaders must communicate more openly than in the past. Issues facing the current board include reimbursement procedures, health care reform and, her passion, patient care. She believes clinical experience enhances the board’s effectiveness just as a financier contributes to fiscal knowledge. “I certainly don’t feel like a pioneer,” as the first woman chair, she says. Helms was also the only woman on the search committee to find a replacement for retiring CEO Charles T. Frock. “A hospital has seasons,” she says. “Chuck has guided us through some very important seasons. I appreciate his vision.” Helms rises at dawn, works out at the FirstHealth Center for Health & Fitness, meditates, enjoys a good cup of coffee and meets the day with faith and enthusiasm. “Moore Regional Hospital takes being a community-oriented organization seriously,” she says. “The employees recognize their responsibility to lead and guide. It is a great honor to serve my community with them.”
www.firsthealth.org
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Cardiology
Cardiology
Stacey Hoiland, ANP
Dinah P. Welch, FNP
Pinehurst Medical Clinic Hospital Affiliation: Moore Regional Hospital Training: N.P., Duke University School of Nursing
Pinehurst Cardiology Consultants Hospital Affiliation: Moore Regional Hospital Training: N.P., University of Florida College of Nursing
Family Medicine
Family Medicine
Richard C. Wolonick, D.O.
Lu Caceres, P.A.-C
Board Certified
FirstHealth Family Care Center-Seven Lakes Training: D.O., Nova Southeastern University College of Osteopathic Medicine Internship/Residency: Malcolm Grow USAF Medical Center, Andrews Air Force Base, Md.
FirstHealth Jordan Clinic-Raeford Training: P.A., U.S. Army Physician Assistant School, Texas
Family Medicine
Hospitalist
Christopher McLaren, P.A.-C
Grant W. Jenkins, M.D.
FirstHealth Family Care Center-Raeford Training: P.A., Medical University of South Carolina
Board Certified
Hospitalist
Hospitalist
Shujaat Khan, M.D.
Marvin Lee III, M.D.
Board Certified
Board Certified
FirstHealth Hospitalist Service Hospital Affiliation: Moore Regional Hospital Training: M.D., Dow International Medical College, Pakistan Internship/Residency: Flushing Hospital and Medical Center, N.Y.
FirstHealth Hospitalist Service Hospital Affiliation: Moore Regional Hospital, Richmond Memorial Hospital Training: M.D., University of Florida Internship/Residency: Medical College of Georgia Hospital
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FirstHealth Hospitalist Service Hospital Affiliation: Moore Regional Hospital Training: M.D., University of Illinois-Urbana College of Medicine Internship/Residency: N.C. Baptist Hospital; St. Louis University School of Medicine
Hospitalist
Hospitalist
Tabinda Nazir, M.D.
Gabriel Silasi, M.D.
Board Certified
Board Certified
FirstHealth Hospitalist Service Hospital Affiliation: Moore Regional Hospital Training: M.D., Rawalpindi Medical College, Pakistan Internship/Residency: Ali Medical Center, Pakistan; Mount Sinai School of Medicine, N.Y.
FirstHealth Hospitalist Service Hospital Affiliation: Moore Regional Hospital, Richmond Memorial Hospital Training: M.D., Universitatea de Medicina Si Farmacie Victor Babes Internship/Residency: Metropolitan Hospital, N.Y.; Universitatea de Medicina Si Farmacie Victor Babes
Hospitalist
OB/GYN
Michael Nissen, FNP
Donald Jones, M.D., Ph.D.
FirstHealth Hospitalist Service Hospital Affiliation: Moore Regional Hospital Training: FNP, Kennesaw State University, Ga.
Board Certified
FirstHealth Richmond Medical Group– Women’s Center Hospital Affiliation: Richmond Memorial Hospital Training: M.D., Northeastern Ohio Universities Internship/Residency: Pitt County Memorial Hospital, N.C.
Pediatrics
Otolaryngology (Ear Nose and Throat)
Frederick Harrison Mabry III, M.D.
Waldemar Riefkohl, M.D.
Sandhills Pediatrics Hospital Affiliation: Moore Regional Hospital Training: M.D., Brody School of Medicine, East Carolina University, N.C. Internship/Residency: University of Virginia
Board Certified
Pinehurst Surgical Hospital Affiliation: Moore Regional Hospital Training: M.D., Temple University, Pa. Internship/Residency: Geisinger Medical Center, Pa.
Pediatrics Jennifer M. Mabry, M.D. Sandhills Pediatrics Hospital Affiliation: Moore Regional Hospital Training: M.D., Brody School of Medicine, East Carolina University, N.C. Internship/Residency: University of North Carolina at Chapel Hill
For a complete listing of FirstHealth of the Carolinas providers, visit the website at www.firsthealth.org/ physician. If you prefer a printed copy, call (800) 213-3284
www.firsthea0lth.org
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A “kind and encouraging staff� This is just a short note to advise how pleased I am about my improvement after 30 sessions of Pulmonary Rehab at FirstHealth. I am more capable of activity in and out of my home, and have learned enough to continue my exercise program at home. The pulmonary therapists, Jill Brown and Alyson Campbell, are very knowledgeable about so many aspects of lung disease and how better to handle it. They gave excellent instructions and addressed all my questions. I also appreciated the kind assistance of Chris Pevia, who kept encouraging me to set goals for myself when using the machines in order to improve my functioning. Not only was the staff kind and encouraging, but they were truly solicitous of all the patients. My rehab proved to be an enjoyable and very productive experience, and I am grateful.
Pulmonary Rehab patient Mary Ann Connelly (second from left) with Jill Brown, Alyson Campbell and Chris Pevia
Mary Ann Connelly Pinehurst
Competent professional therapists I am being treated for pulmonary fibrosis, and I am writing to inform you that I have had a significant improvement in my condition. Although it is chronic and cannot be corrected, it is being contained to a level I am able to live with. I feel this status of improvement in my breathing is very much the results of the work of Jill Brown and Alyson Campbell (of Pulmonary Rehab), two of the most competent and professional therapists I have seen. These two women have given me a great education in what this disease is and what can be done to improve my life. They are also the most dedicated people when it comes to taking care of their patients and show a great deal of thoughtfulness. These women teach by example and work very hard to motivate everyone and inspire us to work just as hard as they do. Their concern for our safety and
26 Fall 2011
improvement is obvious in the way they watch over us and help us to become the best we can. These inspirational women have helped me so much that I have gone from barely able to walk a short distance to being able to walk two miles at a time. I feel my continued participation in this program will improve my breathing and allow me to resume many outside activities that I have had to skip because I could not breathe well enough. I wish to thank you for providing this maintenance program and for providing these highly skilled and professional teachers to help me back to a more active and enjoyable lifestyle. Ralph P. McCormack West End
Community lucky to have MMH Physical Therapy team
Cardiac Rehab, special nurse renewed patient’s confidence
I am a 59-year-old horse trainer. I train standard-bred racehorses—trotters and pacers, and I live in Upstate New York. I have wintered in Pinehurst now for the last 10 years. I have finished the physical therapy series for my Last fall, I suffered a massive heart attack. I had 100 total knee replacement at FirstHealth percent blockage in one artery and Montgomery Memorial Hospital. 75 percent in another. I was told I Paula Covington (physical therapy was lucky to have survived, because assistant), Nancy Auman (physical it involved the infamous “widow therapist) and Andy Gillis (physical maker.” therapy assistant) were always on time After getting two stents at St. Just a note to compliment the for my appointments and taught me Elizabeth’s Cardiac Unit in Utica, Physical Therapy Department at the exercises and encouraged me in N.Y., I made my yearly move to FirstHealth Montgomery Memorial my efforts for rehab. Rehab secretary Pinehurst and commenced Cardiac Hospital. They are the most positive, Beverly Buie scheduled and rescheduled Rehab at FirstHealth Moore Regional upbeat, cordial people I have come my appointments as necessary to meet Hospital. I want to tell you I have across in a long time. They make you my needs. nothing but praise for your hospital, look forward to coming in. Andy Gillis As a construction manager for large your program and especially your (physical therapy assistant) worked projects, I have had the opportunity to staff. They gave me renewed with me and was great. view the work ethics of the modern-day confidence, instilled a sense of workforce close hand. You are very lucky accomplishment and discipline and Please pass this to them. to have a staff like that—that is, people also deep understanding in the turn who do their job cheerfully and without my life had taken. As a result, my Betsy Crisco complaint while keeping the client happy. career as a successful trainer-driver Biscoe On my eighth-week visit to my surgeon, here in New York is back on track Dr. Jason Guevara, his physician and I am once again doing what I assistant, Rob Keller, told me I was a poster child for knee love—winning races, training young trotters and competing replacement and my progress was about a month ahead of with other horsemen half my age. I am continuing my physical most patients. This would not have been possible without fitness program here at a local gym and staying loyal to my FirstHealth Montgomery’s PT team. Our community is lucky new diet. to have a facility like this in our area. I would specifically single out Denice Gibson, who was my R.N. and in charge of my case. Her dedication and personal Perry Price attention to my situation was a huge factor, and I can’t tell Mt. Gilead you how comforting it was to know three times a week I could see her and through her have constant contact with my cardiologist and professional advice concerning the many new drugs I was taking. Her cheerful, positive attitude was a godsend.
Compliments to a great team
Gaetan “Gates” Brunet Munnsville, N.Y.
www.firsthealth.org
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A “sublime example” to oath of healing
A note of sincere gratitude, albeit brief, for your stellar and compassionate care of my mom in her recent unscheduled visit to FirstHealth Moore Regional Hospital. She was suddenly stricken while in your fair city, and your immediate and professional attention to her is commendable. Thank you. The staff, physicians on call and other personnel directed to my mom’s emergency were of the utmost able and respectable posture. Your follow-up with her is equally meritable. Finally, simply thank you for your fealty and for your calling to the oath of healing. You are a sublime example. Dr. Kyles Y. Wallace Greensboro
Diamonds among Pinehurst jewels
Reid Heart Center staff gave its best
Please extend my sincerest thank you to all members of the staff at FirstHealth Moore Regional Hospital who cared for me. I was admitted through the Emergency Department and subsequently diagnosed and treated for atrial fibrillation. Everyone, from the point of admission to discharge, did their job with professionalism and care. Special attention is due Theresa Cranford, R.N., and Patricia Underwood, R.N., of the (3A Cardiology) nursing staff, and Drs. Daniel DiFrischia and David Cowherd. Pinehurst is known as a golfing jewel, but the people and facilities of FirstHealth Moore Regional Hospital are diamonds in my book.
From Easter Sunday until Mother’s Day 2011, my wife Dot was a patient at the Reid Heart Center in Pinehurst. Because she was critically—and fatally—ill following sudden cardiac arrest, our son Allen and I were with her for many long hours, as many as 24 to 36 hours at a time. During those hours, we watched intently as she was cared for by a large number of the FirstHealth staff and affiliates in a wide variety of specialties. Though it was not possible for me to remember all the names, I do remember this about every person who assisted her in any way: Every person served to the highest level of skill, lovingly, graciously, patiently, diligently and professionally. I am convinced that no patient anywhere in any hospital received better care than did Dot. I shall leave out some names, because I do not
James A. Walker Pinehurst
For more information on these or any of the services provided by FirstHealth of the Carolinas, please call (800) 213-3284.
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remember—some because I do not know, but I wish to call the roll of those who gave, I am certain, their best efforts to preserve her life: Drs. Thornton, Anderson, Boyce, Shepherd and Pritchett; nurses Pat, Stacey, Erika, Caron, Harry, Jerri and Mark; respiratory therapists Dallas and Brian; housekeepers Linda and Carolyn; front desk receptionist Derry; and others. Though the outcome for my “Buddy,” Allen’s “Mom,” and my daughter-in-law’s and grandchildren’s “Gran” was not what we desired, we are all confident that she came to the end of her life among caring persons who gave her everything that they had to give, and they gave willingly and lovingly. For this, we shall all be forever grateful. Robert A. “Bob” Nelson Raeford
FirstHealth Bariatric Center Are you ready to change your life and improve your health?
Let us help you begin your journey! FREE Weight-loss Surgery Information Sessions are held on the first Thursday and third Monday of every month (except holidays) at 6 p.m. in the Renaissance Room at Pinehurst Surgical, 5 FirstVillage Drive, FirstVillage Campus, Pinehurst.
Raymond Washington, M.D. Medical Director, FirstHealth Bariatric Center
Arrive 30 minutes prior to the beginning of the program to record weight and calculate body mass index. For more information or directions, please call (800) 213-3284 or visit us at www.ncweightlosssurgery.org
David Grantham, M.D. FirstHealth Bariatric Center
Melissa Herman, R.D., LDN, CDE Patient Navigator
www.ncweightlosssurgery.org 1031-80-11
NON-PROFIT U.S. POSTAGE PAID PERMIT NO. 4 LONG PRAIRIE, MN
155 Memorial Drive P.O. Box 3000 Pinehurst, NC 28374
Because we use a variety of sources for mailing, duplications sometimes occur. Please pass an extra copy along to a friend or neighbor.
www.firsthealth.org 861-80-11 Ad Wound/Diabetes Health Fair 2_ad 10/20/11 2:57 PM Page 1
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People living with diabetes face many challenges.
8/13/04 9:05:06 AM
The FirstHealth Wound Care & Hyperbaric Centers at Moore Regional Hospital and Richmond Memorial Hospital are specially equipped to treat diabetic wounds with Medicare-approved advanced treatments including hyperbaric oxygen therapy, which is proven to increase healing success.
ir s Hea9 lta.mh. -FNoaon Diabaye,te Nov. 12 •
Get back to doing the things you love. If you have a wound that has not healed, we have solutions. Our state-of-the-art wound care offers a comprehensive pathway of care.
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FirstHealth Specialty Cen
ters Building in Pineh
urst
For more information, call
(800) 213-3284
Call (910) 715-5901 in Moore County or (910) 417-3636 in Richmond County and find out how we can expand your treatment options.
861-80-11