September/october
2018
The Triangle Physician T H E
M A G A Z I N E
F O R
H E A L T H
C A R E
P R O F E S S I O N A L S
Prostate Cancer Treatment Experts Offering HIFU – A Cutting-Edge, Non-Invasive Treatment with Low Risk of Side Effects
Also in This Issue New Birth Control Options for Women (and Men)
Effective Use of Social Media to Promote Your Practice
Finding a Mohs Surgeon
Table of Contents s epte m b e r / o ct o b e r 2 0 1 8
2
Vol. 9, Issue 4
Prostate Cancer Treatment Experts
Offering HIFU – A Cutting-Edge, Non-Invasive Treatment with Low Risk of Side Effects
FEATURES
6 8 11
Women’s Health
New Birth Control Options for Women (and Men)
Physician Advocacy
DEPARTMENTS
Effective Use of Social Media to Promote Your Practice
9 News Newest Data Shows Childhood Obesity Continues to Increase
Dermatology
12 News
Finding a Mohs Surgeon
Welcome to the Area
On the Cover: (From left to right) Dr. William Kizer, Dr. Frank Tortora and Dr. Mark Jalkut (Not pictured: Dr. Daniel Khera-McRackan) offer a new non-invasive prostate cancer treatment called HIFU with the Sonablate device.
The Triangle Physician T H E
M A G A Z I N E
F O R
H E A L T H
C A R E
P R O F E S S I O N A L S
Copy Editor - Melanie Coughlin melanie.s.coughlin@gmail.com
Creative Director - Joseph Dally jdally13@gmail.com
Contributing Editors Andrea S. Lukes, MD, MHSc, FACOG Margie Satinsky, M.B.A. Gregory J. Wilmoth, M.D.
News and Columns Please send to info@trianglephysician.com. Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
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Every precaution is taken to ensure the accuracy of the articles published. The Triangle Physician cannot be held responsible for the opinions expressed or facts supplied by its authors. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.
September/october 2018
1
Cover Story
Prostate Cancer Treatment Experts
Offering HIFU – A Cutting-Edge, Non-Invasive Treatment with Low Risk of Side Effects
MD; and Willian Kizer, MD. While HIFU was approved for prostate tissue ablation in the US in October 2015, many of these physicians have been working with HIFU patients outside the US for more than 10 years. “While still considered ‘new’ by
While prostate cancer is a fairly common
What is HIFU for Prostate Cancer?
some urologists, I have been working
disease among men in the US, with about
HIFU in a one-time, out-patient procedure
with HIFU patients since 2008 and have
1 in 9 men being diagnosed in his lifetime,
that uses ultrasound energy to heat and
been very impressed by the outcomes
it is also one that usually is very treatable,
destroy tissue in the prostate. It is radia-
and experiences of my patients,” said Dr.
especially if diagnosed early.
tion-free, and studies show that the risk of
Tortora. “As I see it, there are two major
Expert physicians at Associated
side effects such as erectile dysfunction
advantages to the HIFU treatment for
Urologists of North Carolina have part-
and urinary incontinence are significantly
prostate cancer. First, there is minimal
nered with HIFU Prostate Services to
lower with HIFU than with surgery (radi-
change to a person’s lifestyle. For exam-
offer their prostate cancer patients a cut-
cal prostatectomy) or radiation.
ple, there is very little erectile dysfunction
ting-edge, non-invasive prostate cancer
The urologists offering HIFU in the
and no urinary incontinence. Secondly, it
treatment called HIFU, or high intensity
Triangle area include Frank Tortora, MD;
leaves all options on the table if recur-
focused ultrasound.
Dan Khera-McRackan, MD; Mark Jalkut,
rence should occur.”
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The Triangle Physician
How Does HIFU Work? HIFU is delivered using a medical device called the Sonablate, which is made up of a computer console, a transrectal probe and chilling unit. The probe contains transducers that emit ultrasound energy, providing an image of the prostate, but can also be focused to a central point where the temperature is raised rapidly which causes cell destruction. This works the same way as sunlight that is focused to burn a hole in a leaf. During HIFU, the Sonablate software allows doctors to get a real-time image of the prostate and plan exactly where they want to deliver HIFU energy, thus destroying the targeted tissue. The doctor also receives immediate feedback to confirm the targeted
ing of the efficacy of treatment. Because there
prostatic tissue has been eliminated.
is less collateral damage to the tissue around
“HIFU is a non-invasive treatment that
the prostate, HIFU with Sonablate gives us
destroys cancer cells in the prostate with
the ability to cure prostate cancer in men
thermal energy. It is an ideal treatment for
with lower rates of impotence and without
men with prostate cancer detected early and
any significant risk of incontinence. Further-
likely to be confined to the prostate, said Dr.
more, it preserves future treatment options
Jalkut. “The Sonablate technology allows us
should they become necessary.”
Dr. Frank Tortora uses the Sonablate software to image, target and treat prostate cancer as well as to monitor changes in the prostate tissue in real time.
to fine-tune each man’s procedure such that the treatment plan can be customized and
Fewer Side Effects
personalized for each man considering the
The Sonablate has special features that allow
size and shape of his prostate along with the
physicians to visualize the exact location of
extent of his cancer and the level of risk each
the nerves near the prostate that are respon-
cancer carries. It allows for real-time monitor-
sible for helping maintain sexual function. Transducers in the probe of the Sonablate deliver ultrasound energy to the prostate while leaving healthy tissue around the prostate unharmed.
september/october 2018
3
Since doctors have the ability to see these nerve bundles, they can avoid them and therefore, men have lower risk of erectile dysfunction. Additionally, studies have shown that men who have HIFU for prostate cancer are less likely to have issues with urinary incontinence, or the ability to control their bladders. “HIFU is extremely well tolerated and compared to other treatments and has very minimal side effects. For a patient to qualify, the cancer would have to be a low- or moderate-risk tumor that is completely localized to the prostate, said Dr. Khera-McRackan. “Often we can treat only the part of the prostate that is cancerous and spare the rest; this is called focal HIFU. In that case, there are even fewer side effects.” Recovery After HIFU HIFU is an outpatient procedure which typically last one to three hours depending on the size of the prostate. After a brief recovery at the treatment center, patients return home to recover more comfortably and often return to their normal lifestyle after a few days. “Patients return home the same day of the procedure
The Sonablate HIFU System includes a console, monitor, transrectal probe and chilling unit.
and are able to go out to eat for dinner that evening. HIFU really isn’t a huge disruption to their normal life,” said Dr. Kizer. “There really is minimal change to a patient’s lifestyle with HIFU. This is drastically different than other more traditional options for prostate cancer, such as a radical prostatectomy which will require recovery overnight in a hospital and a few weeks before patients can return to their normal lifestyle.” Additionally, unlike with radiation and surgery, if for some reason there is a recurrence of prostate cancer, HIFU does not exclude patients from having any other treatments. This also means that, while not common, HIFU may be repeated if necessary. If a man chooses to have HIFU, he is not limiting himself down the road to pursue other treatment options. Who Qualifies for HIFU? While only a physician can determine if a patient qualifies for HIFU or not, typically men with
4
The Triangle Physician
a prostate gland of less than 40 grams with localized prostate cancer (tumor has not spread outside of the prostate gland) may be candidates for HIFU. The other information that physicians usually look at to determine if a patient qualifies for HIFU is a PSA of 20 or less and a Gleason score of 7 or less. “We offer patients all types of treatments – from surgery and radiation to HIFU – Not all prostate cancer is lethal, but not all prostate cancer is slow growing either. The treatment is extremely individual depending on the person and the type and extent of disease he has,” said Dr. Tortora. Anyone interested in HIFU for localized prostate cancer should speak with a doctor about his specific diagnosis and whether or not it would be a good treatment option in his case.
and treat only the tumor.
Effectiveness of HIFU
the United Kingdom on 625 men with pros-
Studies show that HIFU has rates of efficacy similar to other treatments for prostate cancer but with less risk for side effects such as incontinence and erectile dysfunction. “HIFU is a great option in specific circumstances; it has a lower risk of side effects and, for the right patients, can be just as effective as those ‘gold standard’ treatments,” said Dr. McRackan. Focal HIFU Focal therapy, often referred to as a “male lumpectomy,” is a general term for a variety of non-invasive techniques for destroying small tumors inside the prostate while leaving the gland intact and sparing most of its normal tissue. Advanced imaging techniques allow doctors to pinpoint exactly where in the prostate the tumor is located. By utilizing multiparametric MRI and UroNav fusion biopsies, doctors are able to target the tumor within the prostate, leaving healthy tissue unharmed. Focal therapy with Sonablate HIFU technology creates a small, precise lesion. This
A paper was published from a study in
Dr. William Kizer and Dr. Mark Jalkut review a Sonablate HIFU prostate cancer treatment on the monitor.
tate cancer treated with Focal HIFU in the prestigious journal European Urology*, reporting outstanding five-year results in terms of disease control and side effect profile. The study shows that after 1-2 years, 97% of men were continent, and after 2-3 years 98% of men had no issues with incontinence. The study also indicated that erections sufficient for penetration were maintained in 85% of men who were able to achieve an erection sufficient for penetration prior to focal HIFU. Overall survival rate after focal HIFU was reported at 99%. Where is HIFU Available? HIFU is currently available at several different locations in the greater Raleigh-Durham area including Rex Surgery Center, WakeMed Cary Hospital and North Carolina Specialty Hospital. Anyone interested in learning more about HIFU or speaking with a physician should contact HIFU Prostate Services at 1-877-884-HIFU (4438.)
targets the tumor within the prostate, leaving
*A Multicentre Study of five-year Outcomes Follow-
the surrounding tissue unharmed. Experi-
ing Focal Therapy in Treating Clinically Significant
enced physicians use software to merge MRI
Non-Metastatic Prostate Cancer. European Urology.
and real-time images of the prostate to locate
June 27, 2018.
september/october 2018
5
Women’s Health
New Birth Control Options for Women (and MEN!) By Andrea S. Lukes, MD, MHSc, FACOG
Andrea S. Lukes, MD, MHSc, FACOG, founded the Women’s Wellness Clinic (private practice) and the Carolina Women’s Research and Wellness Clinic (research center) which are both located in Durham, NC. Dr. Lukes received a combined medical degree and master’s degree in statistics from Duke University and completed her residency at the University of North Carolina School of Medicine. Her areas of expertise is in women’s health, including heavy menstrual bleeding, uterine fibroids, endometriosis, contraception, menopause and migraines. Most recently, Dr. Lukes was hired as the Chief Medical Officer of Health Decisions CRO which is specialized within women’s health. The Women’s Wellness Clinic is accepting new patients, 919-251-9223, www.cwrwc.com
6
The Triangle Physician
Contraception allows individuals control over
able donut-shaped ring. The ring is is non-biode-
the timing of pregnancy and can prevent unin-
gradable and flexible. A woman places it within
tended pregnancies. Health care providers play
the vagina for 3 weeks then removes it for one
an important role in educating and counseling
week to allow for withdrawal bleeding, so this
women and their partners on available choices of
is the older version in terms of regimen (21/7).
contraception. Many factors can influence which
This ring, however, lasts for one year, providing
contraceptive is used: effectiveness, side effects,
thirteen 28-day menstrual cycles. The device does
prevention of sexually transmitted infections, ac-
not require refrigeration prior to using (the NU-
cess, convenience and in some cases noncontra-
VARING does require refrigeration). This newer
ceptive benefits.
ring, ANNOVERATM, will be available within the
Although versions of the male condom have
US in 2019.
been around for centuries, the birth control pill
The hormones within ANNOVERATM include
was introduced into the US in 1960. Since that
a ‘new’ progestin called Nestorone® (segester-
time, the type of hormone used has changed with
one acetate) and a widely used estrogen (ethinyl
more varieties of progestin than estrogen. Also,
estradiol). Similar to the pill, patch, and shorter
the regimen or days of active hormones versus
acting vaginal ring, the mechanism of action for
placebo pills has changed. Initially there were
ANNOVERATM is by preventing ovulation (or the
only 21/7 regimens (21 active pills and 7 placebo
release of an egg by the ovary). Similar to other
pills). Now there are several options which allow
combined hormone contraception (CHC) it has
for no placebo pills or continuous active pills, ver-
a black box warning stating that females over 35
sus 24/4, 26/2 and more.
years old who smoke should not use ANNOVER-
One convenient method that was recently ap-
ATM. Cigarette smoking increases the risk of seri-
proved by the U.S. FDA is ANNOVERATM . This
ous cardiovascular events from CHC use. Further,
is a new vaginal ring that provides one year of
it has not been adequately evaluated in females
contraception. ANNOVERATM is a combined
with a body mass index of 30 kg/m2 or greater.
hormonal contraceptive (has both an estrogen
The research which led up to the approval
and a progestin) that is delivered through a reus-
of ANNOVERATM was through the Contracep-
lead, but also the fundamental work of
Another development within contra-
The CCTN was established in 1996 and
organizing large scale phase three clini-
ception is a new ‘birth control APP’ called
supports research on both male and fe-
cal trials”.
Natural Cycles which was approved by
male contraception. The CCTN is man-
Health Decisions has also coordinat-
the FDA just recently in August 2018. It
aged through the National Institute of
ed large-scale phase three studies within
prevents pregnancy through tracking a
Child Health and Human Development
male contraception as well. Currently
woman’s body temperature and her men-
(NICHD) Division of Intramural Popula-
there are no hormonal contraceptive op-
strual cycle. The reliability of this APP in
tion Health Research. The statistical and
tions for men (remember the condom is
preventing pregnancy is not as good as
clinical coordinating center the the CCTN
not hormonal). As highlighted in Time
ANNOVERATM or other hormonal op-
is through Health Decisions. Health De-
Magazine (June 18th, 2018) the CCTN
tions, but it is a method that can prevent
cisions has worked with the CCTN since
began a study using a gel contraceptive
pregnancy and allow for family planning.
its inception in 1996. Health Decisions is
for men. Over 400 couples in six differ-
The new development within contra-
a clinical research organization which fo-
ent countries will enroll 400 couples.
ception for individuals is exciting. Health
cused on women’s health (www.health-
According to Clint Dart, enrollment will
care providers who counsel women and
decisions.com). I joined Health Deci-
likely begin in October, 2018, and take
men on contraception will have even
sions as the chief medical officer in 2018
approximately 12 months to complete
more options in the next several years.
and have been fortunate to learn more
enrollment. The gel which will be used
Our role at the Women’s Wellness Clinic
about the work done by the CCTN.
by men actually uses the same progestin
is to make sure we provide the most up-
The principal investigator at Health
Nestorone® that is contained within AN-
to-date information to the women we see.
Decisions for the CCTN research is Clint
NOVERATM but also a synthetic testoster-
Dr. Kristen Feldman who joined the staff at
Dart, who leads the statistical analysis. Mr
one. The mechanism of action in men is
the Women’s Wellness Clinic is an expert
Dart is the Senior Director of Biostatistics
through blocking the testes from making
within contraception and notes that she
and Programming at Health Decisions.
enough testosterone to produce sperm.
likes “offering all options to patients and
His expertise has helped with on-going
Given this produces side effects, some
then helping an individual make best deci-
research in contraception for both wom-
testosterone is added back through the
sion based on her own health and needs
en and men.
gel to minimize the side effects.
regarding contraception”.
As noted by Clint Dart, the phase 3 pivotal clinical studies which led up to the approval for ANNOVERATM included
MOHS MICROGRAPHIC SURGERY • EXCISIONAL SURGERY • CRYOSURGERY
2,265 females enrolled in multicenter trials. Most of the females (67.1%) were from the United States with the remaining being from the Dominican Republic, Brazil, Chile, Finland, Hungary, Sweden, and Australia. The mean age was 26.7% years and the mean BMI was 24.1 kg/m2 (range 16.0 – 41.5). The Pearl Index (PI) was 2.98 per 100 woman-years of ANNOVERA use (95% Confidence Interval 2.13, 4.06). Led by Clint Dart, statisticians at Health Decisions did the analysis of this data which led to approval by the FDA. Mr. Dart explains that “there were three open labeled studies which led up to the approval for ANNOVERATM . The
SHE WANTED SOMEONE TO TAKE HER SERIOUSLY I R E F E R R E D H E R T O S O U T H E R N D E R M AT O L O G Y
impressive group of principal investigaFOR THE MOST ADVANCED SKIN CANCER TREATMENTS, REFER YOUR PATIENTS TODAY!
tors within the CCTN are mostly academic institutions with the US. The staff at HD is focused on women’s health but supports the network in a number of ways, including the statistical analysis which I
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tive Clinical Trials Network (CCTN).
Category Physician Advocacy
Effective Use of Social Media to Promote Your Practice, Part 2 By Margie Satinsky, M.B.A.
This article is the second of a two-part series on the effective use of social media to promote your practice. The first article, which appeared in the 2018 May/June edition of Triangle Physician, contained an introduction and two recommendations. This article contains two more important suggestions.
the physician and asks a specific question about his/her personal condition. The provider responds, disclosing PHI that should not be shared or viewed by anyone other than the patient. Here’s another situation that occurs frequently and that may be a HIPAA violation. Patients often like the convenience of websites such as www.
Margie Satinsky, MBA, is President of Satinsky Consulting, LLC, a Durham, NC consulting firm, that specializes in medical practice management. She’s the author of numerous books and articles, including Medical Practice Management in the 21st Century. For additional information, go to www. satinskyconsulting. com. Nancy MacCreery, MBA, is President of Broad Reach Marketing Services, a Cary, NC company, that specializes in market strategy, digital campaigns, market research and customer engagement. For additional information, go to www.broadreachmarketingservices.com. Alice Saunders, President of Trisecta, is a marketing consultant and writer. For additional information, go www.trisecta.com.
8
The Triangle Physician
Use Social Media Safely to Avoid
caringbridge.com or www.carepages.com to
Inappropriate Disclosures of Protected
communicate with family and friends when they
Health Information (PHI)
are ill or in the hospital. People sign up to be
The theory behind social media is that partici-
part of a group that receives blog posts on the
pants voluntarily consent to contribute social
patient’s condition. All too often, health care pro-
and personal data to a social media electronic
viders comment on the condition and treatment,
storage system. Depending on the type of social
mistakenly assuming that the blog post is equiva-
media, there may be ways to restrict access to
lent to patient authorization to reveal PHI.
some of that information so not all users can see
Still another common situation arises when
it. Medical practices that use social media are not
someone posts a negative comment about a
exempt from HIPAA. As Covered Entities, they
provider and/or practice. In many instances, the
are obligated to protect the use and disclosure of
individual physician or practice has a knee-jerk
protected health information (PHI) and to honor
reaction and counters the comment as quickly
the specific patient rights that are identified in the
as possible. Often the provider discloses PHI
Privacy Rule as amended by the HITECH Act of
without even thinking about the potential HIPAA
2009 and the 2013 Omnibus Final Rule.
violation.
Let’s examine some real-life situations that
Social media and HIPAA are related but not
we’ve seen with clients. A patient and provider
incompatible. Providers, not patients, are respon-
are Facebook friends. The patient reaches out to
sible for maintaining HIPAA compliance. The saf-
Select the Appropriate Option(s)
time to learn new skills, you may be better
through a secure patient portal. However,
for Maintaining Your Social Media
served by outsourcing the responsibility
if you expect to enter into social media
Presence
to a qualified professional.
“friendships,” require patients to sign a
Many practices make the mistake of del-
If you do decide to outsource the respon-
written authorization regarding online
egating the responsibility for developing
sibility, here are questions to ask of the indi-
disclosure before entering into the online
and maintaining social media to an enthu-
viduals/companies that you are considering:
relationship. Even with the patient’s writ-
siastic workforce member. When a solid
• What do you know about health care
ten authorization, review what you post,
strategy is in place and if that individual
making sure not to use or disclose PHI
understands the big picture – i.e. all that
• How well do you understand HIPAA?
without proper prior authorization. For
we’ve mentioned above – the decision to
• With what social media platforms do
additional guidance, read the Federation
select an internal person may be appro-
you have professional experience?
of State Medical Boards’ Model Policy
priate. But if the individual assuming the
Guidelines for the Appropriate Use of
responsibility for social media doesn’t
Media and Social Networking in Medical
understand the context into which social
• What reports will you send me?
Practice
media must be put and doesn’t have the
• How do you measure success?
(http://www.fsmb.org/Media/
Default/PDF/FSMB/Advocacy/pub-social-media-guidelines.pdf).
practices?
• What is your process for planning and content development?
Visit this link to learn more about getting more from your social media: http://www.broadreachmarketingservices.com/blog/seven-steps-to-get-more-our-of-your-social-media-efforts.
Newest Data Shows Childhood Obesity Continues to Increase Across all ages, African-American and Hispanic Children Have Highest Rates Despite reports in recent years suggest-
The long-term trend is clearly that obesity
amination Survey (NHANES) in 2015-16, a
ing childhood obesity could be reaching
in children of all ages is increasing.”
large database updated every two years.
a plateau in some groups, the big picture
The data are based on body-mass in-
on obesity rates for children ages 2 to 19
dex (BMI) for 3,340 children participating
remains unfavorable.
in the National Health and Nutritional Ex-
Researchers examined data back to 1999 that includes 33,543 children. The researchers identified notable
Three decades of rising childhood obesity continued their upward trend in 2016 according to a new analysis from Duke Health researchers. The findings, which appear Feb. 26 in the journal Pediatrics, show 35.1 percent of children in the U.S. were overweight in 2016, a 4.7-percent increase compared to 2014. “About four years ago, there was evidence of a decline in obesity in preschoolers,” said Asheley Cockrell Skinner, Ph.D., lead author and associate professor of population health sciences, who is also a member of the Duke Clinical Research Institute (DCRI). “It appears any decline that may have been detected by looking at different snapshots in time or different data sets has reversed course.
september/october 2018
9
Duke Category News
est way to communicate with patients is
Duke News
spikes between 2014 and 2016 in obesity
overweight and Class II obesity (BMI that
in Asian-American children, the race or
for preschool boys, which rose from 8.5
is at least 120 percent above the 95th per-
ethnic group in whom rates were actually
percent to 14.2 percent, and girls aged 16
centile for age and sex) among Hispanic
lowest, at 23.2 percent.
to 19, whose rates of obesity jumped from
males.
35.6 percent to 47.9 percent.
Armstrong, who is also a pediatrician,
“Despite some previous reports, the
acknowledges the paper focuses on the
Boys and girls aged 16 to 19 had the
obesity epidemic has not abated,” said se-
problem of obesity rather than solutions,
highest rates of any age group in 2016,
nior author Sarah C. Armstrong, M.D., as-
and wanted to encourage families with di-
with 41.5 percent considered overweight,
sociate professor of pediatrics who is also
rect advice.
defined by the Centers for Disease Con-
a member of the DCRI. “This evidence is
“Although the latest trends show that
trol and Prevention (CDC) as having a BMI
important in keeping the spotlight shined
we haven’t figured out what works as a
at or above the 85th percentile for age and
on programs to support healthy changes.
population, we do know individual chang-
sex. Among these 16 to-19-year-olds, 4.5
Obesity is one of the most serious health
es can support families’ health,” Arm-
percent have Class III obesity, the highest
challenges facing children and is a predic-
strong said. “We know families can avoid
of three categories defined by the CDC.
tor for many other health problems. When
added sugar in beverages and food, get at
we see that leveling off, we can become
least an hour of activity a day, and incorpo-
complacent -- we can’t afford to do that.”
rate vegetables into every meal to improve
Both Class II and Class III are considered severe and are linked with greater risk of heart and metabolic health prob-
Skinner said the study has limitations,
WIRB 20141577
their health. Even if your child is a picky #13314497.0
BAY15001 lems, such as high blood pressure and on 1 cholesterol. 5 Across all age groups, African-Amer-
relying on two-year data that provides tion. But she said the NHANES database
Through projects at Duke Health, DCRI
ican and Hispanic children had higher
is a broader data source than sources for
and the Duke Center for Childhood Obe-
rates of overweight and all levels of obe-
studies that have found declines in obe-
sity Research, Armstrong and other Duke
sity, while Asian-American children had
sity rates among smaller or segmented
scientists are assessing the most effective
markedly lower rates. The most promi-
populations. The NHANES 2015-16 data
strategies to reduce obesity in children,
nent trend since 1999 is the increase in all
is also the first to include enough data to
including programs that offer at-risk chil-
levels of overweight for Hispanic girls, and
create a nationally representative sample
dren access to free medical care, partner-
snapshots in time across a wide popula-
eater and wants to eat the same vegetable every day, that is still a good choice.”
ships with municipal recreation programs across North Carolina, and even studying
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The Triangle Physician
children’s gut bacteria to determine how the gut microbiome is related to weight. In addition to Skinner and Armstrong, study authors include Sophie N. Ravanbakht and Eliana M. Perrin of Duke, and Joseph A. Skelton of Wake Forest University. The study received no outside funding, and authors had no conflicts of interest to disclose.
The Triangle Physician T H E M A G A Z I N E F O R H E A LT H CARE P R O F E S S I O N A L S
By Gregory J. Wilmoth, M.D. of Southern Dermatology & Skin Cancer Center
Hearing the words “skin cancer” come from a
certified dermatologist who performs Mohs sur-
medical professional’s mouth can be a terrifying
gery on a regular basis. The more experience
experience. However, there is a procedure that
the dermatologist has, the better prepared they
removes the skin cancer and allows us to get the
will be in the event of any complications.
highest cure rate of skin cancer while removing the least amount of tissue– Mohs surgery. Today, Mohs surgery has come to be known as the single most effective technique for remov-
Two organizations that provide training standards for Mohs surgery are the American Society for Mohs Surgery and American College of Mohs Surgery
ing both Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC), two of the most
Interview the Surgeon
common types of skin cancer.
Many health care providers have been trained do
When looking for a provider to perform
surgery in different settings. Some providers under-
Mohs surgery, it’s important to do your home-
went training during their residency, while others
work. Patients will want a highly qualified der-
spent extra time after their residency on the train-
matologist to perform the procedure and will
ing. There are currently no specific requirements.
want them to:
In residency, dermatologists are routinely
• Be a board-certified dermatologist,
exposed to a wide variety of dermatological sur-
• Specialize in Mohs surgery,
gical procedures. They’re also trained to look at
• Accept their insurance ,
the skin and understand simple to complex re-
• Fully answer all questions as they arise and
construction of surgical defects. While a pathol-
• Have reconstruction expertise to repair
ogist may be on the team, most Mohs surgeons
Mohs defects.
wear two hats during the procedure– surgeon and pathologist. In general, dermatologists will
Asking Around
have more training in both cutaneous pathology
As basal cell carcinoma and squamous cell car-
and surgery than other health care providers.
cinoma are both incredibly common, chances
As the patient narrows down their list of pos-
are the patient will know someone who has in-
sible dermatologists, they should call each of-
teracted with a dermatologist who specializes
fice to schedule a consultation and meet with
in Mohs surgery. The patient should ask their
the dermatologist who would be performing the
friends, family and other health care providers
procedure. During this consultation, patients
they trust for recommendations.
should have a list of questions ready, such as:
There are surgeons who perform Mohs surgery exclusively and provide same-day reconstruction.
• Do you typically treat patients with the same skin concerns/problems as me? • How many Mohs surgeries do you perform a year? For how many years?
Research Credentials
• How frequently do you encounter compli-
Technically, any doctor who cuts into the skin
cations during this procedure?
and processes the tissue using the Mohs meth-
• How do you avoid complications?
od is performing Mohs surgery. While they may
• What do you do to fix any issues if a com-
be performing Mohs surgery, they may not be performing it well.
Dr. Gregory Wilmoth, a board-certified dermatologist at Southern Dermatology & Skin Cancer Center in Raleigh, specializes in Mohs surgery and skin cancer reconstruction, among other specialties. He earned his bachelor of science degree in chemistry from the University of North Carolina at Chapel Hill and his medical degree from Bowman Gray School of Medicine, Wake Forest University. He completed his internship at North Carolina Baptist Hospital and residency at Mayo Clinic, Rochester, Minn. Dr. Wilmoth is a fellow of the American Society for Mohs Surgery. He is a member of the American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Academy of Dermatology, American Medical Association and the North Carolina Medical Society.
plication does arise? While some dermatologists do complete a
Taking the time to research the doctor’s
fellowship training in Mohs surgeries, not all do,
credentials can go a long way to easing a wary
so it’s important to ask about any specialized
patient’s mind. Patients should look for a board-
training as well.
september/october 2018
11
Dermatology
Finding a Mohs Surgeon
News
Welcome to the Area
Physicians
Mahmoud Al Masry, MD
Mary McGowan Buckley, MD
Nicholas Christian DeVito, MD
Neurology
Pediatric Rheumatology; Pediatrics
Ophthalmology
UNC REX HOSPITAL Raleigh
Duke University Hospitals Durham
Hematology and Oncology, Internal Medicine
Guy Thomas Alexander, MD
Charles McGonegle Burns, MD
Diagnostic Radiology; Musculoskeletal Radiology; Neuroradiology; Nuclear Medicine; Nuclear Radiology; Pediatric Radiology; Therapeutic Radiology
Internal Medicine
Juliana Marie Dial, MD
Duke University Medical Center Durham
Pediatrics
Raleigh Radiology Raleigh
Cathleen Marie Dascenzo Bury, MD
Peter John Allen, MD
Duke University Hospital Durham
Jenna Marie Bottorff, DO Carolina Eye Associates, P.A. Southern Pines
George William Dignan, DO Anesthesiology
UNC - The Dept of Anesthesiology Chapel Hill
Richard Everett Gandee, DO Critical Care-Internal Medicine
UNC Dept of Neurology Neurocritical Care Chapel Hill
Adrienne Lynne Gentry, DO Obstetrics & Gynecologic - Surgery; Endocrinology/Infertility
UNC Fertility Center Raleigh
Anjni Patel Joiner, DO Emergency Medicine
Abdominal Surgery; Colon and Rectal Surgery; Surgical Oncology
Dept of Surgery Durham Head and Neck Surgery; Otorhinolaryngology; Rhinology
Marcus Allen Carden, MD
UNC Otolaryngology/Head & Neck Surgery Chapel Hill
Arthur David Kalman, DO
3106 Hosp South Durham
Sara Kathryn Keller, DO Hospitalist; Internal Medicine
Duke Hospital Medicine Durham
Sheila Krishnan, DO
Internal Medicine; Pediatrics
Abdulaziz Saleh Alrasheed, MD
Rami Nayef Al-Rohil, MD
EmergeOrtho Durham
Robert Andrew Campbell, MD UNC Hospitals Chapel Hill
Duke University Medical Center Durham Physical Medicine & Rehab Neuromuscular and Pain Medicine
Emergency Medicine
Dermatopathology; Pathology
Hematology, Internal Medicine; Pediatric Hematology-Oncology
UNC School of Medicine Pediatric Hematology Oncology Chapel Hill
Maria Gabriela Castro, MD Family Medicine
General Surgery
UNC Div of Surgical Oncology Chapel Hill
Sommer Ebdlahad, MD Neurology
Duke University Hospitals Durham
Emily Marie Eichenberger, MD Infectious Diseases, Internal Medicine
Duke University Hospital Durham
Rami Raouf Eltaraboulsi, MD Internal Medicine; Pediatrics
Center for Aging and Health University of North Carolina at Chapel Hill Chapel Hill
Aaron Kyle Cecil, MD
John Anthony Engler, MD
Sacha Chanelle Baldeosingh, MD
Ananda Mishra Chowdhury, MD
Pediatrics
Internal Medicine
Pediatric - Emergency Medicine
UNC Hospitals Chapel Hill Administrative Medicine; Critical CareInternal Medicine; General Practice; Hospitalist; Pulmonary Disease
Division of Pulmonary Disease Chapel Hill
Annika Marie Barnett, MD Anesthesiology
Duke University School of Medicine Durham
Andrew Joseph Kubinski, DO Family Medicine - Sports Medicine
Duke University Medical Center Durham
Alissa Michelle Collins, MD
Duke University Hospitals Durham
Mari Mansfield Bentley, MD
Duke University Hospitals Durham
Family Medicine
Otorhinolaryngology
Critical Care - Internal Medicine; Hospitalist
A Preferred Women’s Health Center Raleigh
Central Carolina Hospital Sanford
Jason Jamier Bethea, MD
Louis John Michaelos II, DO Ophthalmology
Duke University Hospitals Durham
UNC Kittner Eye Center Chapel Hill
Anatomic Pathology; Blood Banking, Pathology; Clinical Pathology; Cytopathology; Dermatopathology
Shaily Pandey Bhatnagar, MD Dermatology
UNC Hospitals Chapel Hill
Amber Moss, DO
UNC Dermatology Chapel Hill
Jeremy Andrew Cypen, MD
Raleigh
Stephanie Michelle Downs-Canner, MD
Thurston Arthritis Research Center
Joshua Ryan Arenth, MD
Duke University Hospitals Durham
Family Medicine
Duke University Hospitals Durham
UNC Chapel Hill Chapel Hill
Pulmonary Disease and Critical Care, Internal Medicine
Steven Paul Michael, DO
Duke University Hospitals Durham
Neurology
Ana Corcimaru, MD Dermatology
Chapel Hill
Jennifer Michelle Crimmins, MD
Hospitalist; Internal Medicine
Neurological Surgery, Critical Care
Rex Neurosurgery and Spine Associates Raleigh
Brendan James Flanagan, MD Emergency Medicine Duke University Hospitals Durham
Gitanjali Madan Fleischman, MD Allergy; Facial Plastic Surgery; Maxillofacial Surgery; Neurotology; Otolaryngic Allergy; Otolaryngology; Otolaryngology - Sleep Medicine
UNC Hospitals Chapel Hill
Derrick Alwyn Fox, MD Internal Medicine; Neurology; Neuromuscular Medicine
Duke University Medical Center Durham
Lewis Watson George II, MD Diagnostic Radiology; Musculoskeletal Radiology; Neuroradiology; Nuclear Medicine; Pediatric Radiology; Vascular and Interventional Radiology
Hospitalist; Internal Medicine; Public Health
Durham Veterans Affairs Medical Center Durham
UNC Hospitals Chapel Hill
Duke Children’s Hospital & Health Center Durham
Duke Raleigh Hospital Raleigh
Stephanie Duggins Davis, MD
Hospitalist; Internal Medicine; Other; Psychiatry; Psychosomatic Medicine
Timothy Michael Brand, MD
Janice Seulgy Ahn, MD
Cardiovascular Surgery; Critical Care Surgery; Surgery; Surgical Oncology; Thoracic Cardiovascular Surgery
UNC Dept of Pediatrics Chapel Hill
Duke University Hospitals Durham
Clerio Francisco De Azevedo Filho, MD
John Daniel Hales III, MD
Katherine Jane Ryan, DO Pediatric Hematology-Oncology
Clinical Neuropathology; Pathology
Duke University Medical Center Dept of Pathology Durham
12
The Triangle Physician
Satasuk Joy Bhosai, MD
UNC Hospitals Chapel Hill
Pediatric Pulmonology; Pediatrics
Duke Cardiovascular Magnetic Response Ctr. Durham
Elizabeth Bronwen Gilbert, MD
Family Medicine - Sports Medicine; Family Practice
UNC Hospitals Chapel Hill
News
Welcome to the Area Emily Hanna, MD
Jeffrey Hamilton Howe, MD
Andrew Paul Landstrom, MD
David Mendez, MD
General Preventive Medicine
Diagnostic Radiology; Radiology; Vascular and Interventional Radiology
Pediatric Cardiology; Pediatrics
Family Medicine
Duke University Medical Center Durham
DUC Harps Mill Raleigh
Suh Hyun Lee, MD
Julia Antoinette Messina, MD
Emergency Medicine
Infectious Diseases, Internal Medicine
Duke University Hospitals Durham
Duke University Infectious Diseases Durham
Craig Ray Louer Jr., MD
Andrew Tyler Miller, MD
Orthopedic Surgery: Hand, Spine, Adult Reconstructive, Musculoskeletal Oncology, Pediatric; Sports Medicine
Diagnostic Radiology; Radiology
Carrboro
Olga Hardin, MD Allergy & Immunology; Internal Medicine
UNC Hospitals Chapel Hill
Durham
Jingquan Jia, MD
Mandy Nichole Hatfield, MD
Hematology and Oncology, Internal Medicine;
Neurology
UNC Hospitals Chapel Hill
Duke University Hospitals Durham
Eric Allen JohnBull, MD
Gabrielle Monet Hawkins, MD
Anesthesiology
Gynecology/Oncology; Obstetrics
Duke University Hospitals Durham
UNC HealthCare Chapel Hill
Jasmine Danielle Johnson, MD
Justin Thomas Low, MD
Abdominal Surgery; Obstetrics & Gynecologic Surgery
Neurology
UNC Hospitals Chapel Hill
Ashley Reynolds Helseth, MD
UNC Dept of OB-GYN Chapel Hill
Neuro-Oncology Fellowship Program Durham
Duke University Hospitals Durham
Andrea Anita Jordan Hayes, MD
Dorothy Anne Lowell, MD
James Taylor Herbert, MD
UNC Hospitals Chapel Hill
Child/Adolescent Neurology; Clinical Neurology, Neurophysiology; Neuromuscular Medicine; Pediatrics Neurodevelopmental Disabilities
Anesthesiology; Anesthesiology Critical Care Medicine
Duke University Hospitals Durham
John Hall Herndon, MD Neurology
UNC Hospitals Chapel Hill
Sarah Mabrey Heston, MD Pediatrics
Duke Pediatric Infectious Diseases Durham
Cory Michael Hines, MD
Abdominal Surgery; General Surgery; Pediatric Surgery; Surgical Oncology
Swarupa Kancherla, MD Ophthalmology
Raleigh Eye Center Raleigh
Atul Kapila, MD
Radiology
Duke University Hospitals Durham
Stephanie Treffert Lumpkin, MD General Surgery; Surgery
UNC Hospitals Chapel Hill
Gaurav Luther, MD
Family Medicine - Sports Medicine
UNC Hospitals Chapel Hill
Jharna Rakesh Patel, MD Hospice and Palliative Medicine; Internal Medicine
Cardiovascular Surgery; General Surgery; Thoracic Surgery
Abdominal Surgery; Urological Surgery; Urology
Durham
Wake Physician Practices Urology Raleigh
University of North Carolina, Pulmonary Division Chapel Hill
Shetal Arvind Patel, MD
Pediatric Cardiology
John-Paul Adriel Ceir King, MD
WakeMed Physicians Practices Pediatric Cardiology Raleigh
Diagnostic Radiology
Duke University Hospitals Durham
2599 Evans Rd Morrisville
Sneha Arun Mantri, MD
Anne Elizabeth West Honart, MD
Kevin Zachary Kinlaw, MD Hospitalist; Internal Medicine
Duke Health Movement Disorders Durham
Maternal and Fetal Medicine; Obstetrics and Gynecology
UNC Hospitals Chapel Hill
Anne Louise Marano, MD
1421 Barony Lake Way Raleigh
Neurology
Dermatology; Internal Medicine
Internal Medicine; Pulmonary Disease and Critical Care
Oncology, Internal Medicine
UNC School of Medicine, Division of Hematology and Oncology Chapel Hill
Michelle Vernali Pearlstein, MD Dermatology
UNC Hospitals Chapel Hill
Deborah Anne Phipps, MD Family Medicine; Obstetrics and Gynecology
Emergency Medicine
Duke University Hospitals Durham
Aycock Family Medicine Center Chapel Hill
Amanda M Korzep, MD Pinehurst
Stacey Ann Maskarinec, MD
Megan Elizabeth Pike, MD
Amanda May Korzep, MD
UNC Dermatology Chapel Hill
Mukesh Kumar, MD
Mohammed Merajul Hoque, MD
Cone Health Burlington
Diagnostic Radiology; Vascular and Interventional Radiology
Joseph Anto Kundukulam, MD
Duke University Hospitals Durham
Marcia Nicole NewbyGoodman, MD
Kunal Parimal Patel, MD
Molecular Genetic Pathology; Pathology, Immunopathology; Pathology-Medical Examiner
Anesthesiology Pain Management
UNC School of Medicine Chapel Hill
Matthew Delfino Lyons, MD
Shuhua Ma, MD
Christian Horazeck, MD
Nuclear Medicine
Jeffrey Edward Keenan, MD
Duke University Hospitals Durham
UNC Health Care Chapel Hill
Mitchel Alan Muhleman, MD
WakeOrtho Raleigh
Pediatrics
Dermatology
Duke Maternal Fetal Medicine Durham
Duke University Hospitals Durham
Stephen William Kenny, MD
William David Hoover III, MD
Maternal and Fetal Medicine; Obstetrics and Gynecology
Internal Medicine; Rheumatology
UNC Hospitals Chapel Hill
UNC Dept of Maternal-Fetal Medicine Chapel Hill
Courtney Jetun Mitchell, MD
Orthopedic - Surgery of the Hand; Orthopedic Surgery, Trauma
Emergency Medicine
Jason Griffith Ho, MD
Duke University Hospitals Durham
Hematology and Oncology, Internal Medicine
Anesthesiology - Pain Medicine; Anesthesiology Pain Management
Wake Spine and Pain Cary
Infectious Diseases, Internal Medicine
Hospitalist; Pediatrics
Duke University Hospitals Durham
Duke University Hospitals Durham
Jennifer Lynn McCauley, MD
Aaron Mark Pulsipher, MD
Internal Medicine; Pediatrics
Jennifer L McCauley, MD Chapel Hill
Austin Lee Roach McJunkins, MD Aerospace Medicine; General Medicine; Occupational Medicine
Seymour Johnson Flight Medicine Seymour Johnson Afb
Hospitalist; Internal Medicine; Pulmonary Disease and Critical Care
Duke University Hospital Durham
Milly Turakhia Rambhia, MD Anesthesiology
Duke University Dept of Anesthesiology Durham september/october 2018
13