Gary L. Munn, MD
Anthony J. Caterine, MD Maria R. Urbano, MD
Patients will always remember how we make them feel. And at EVMS Medical Group we want to make them feel better. We understand that for so many patients, a trip to the doctor is stressful — especially when they’re sick or hurt, or worried about a potential diagnosis. So how can we make a positive change?
It begins with the patient experience. We are dedicating ourselves to improving quality of care across each and every point of patient contact, from the very first hello. We’re expanding the lines of communication, placing even more value on kindness and compassion. Yet it’s more than simply being nice. It’s a conscious focus on shifting our entire culture. By working together as a team, we can provide each patient with the best — and most personalized — healthcare experience. Because above all, we’re here to treat our patients well.
The knowledge to treat you better.
Learn more at EVMSMedicalGroup.com.
Summer 2016 VOLUME IV, ISSUE II
40 Active Aging 41 Increasing Patient Engagement in Your Practice 42 New Age in Oncology Care 44 Why Conventional Laparoscopic Surgery is Becoming Obsolete
DEPARTMENTS 4 Publisher’s letter
6 Physician Advisory Board 22 Medical Update: A Telemedicine Update
12 Diagnosing mental disorders……a timeline of how far we’ve come 16 Anthony J. Caterine, MD 18 Gary L. Munn, MD 20 Maria R. Urbano, MD
8 Good Deeds: Jessica Delong, MD 10 Advanced Practice Providers: Lucy Kooiman, MSA 46 In the News 50 Welcome to the Community
26 If it’s Good Enough for Astronauts
54 Awards and Accolades
27 Physical Therapy for Overactive Bladder
30 Neuromodulation Provides Relief for Patients with Chronic Back Pain
32 Acute Care Therapy at EVMS
34 Mental Health Services in Virginia – Where Are We Now?
35 Mindfulness as a Treatment for Chronic Pain 36 Strategies to Maintain a Small, Independent Practice 38 Companion Diagnostics and Colorectal Cancer
Taking Nominations for the Summer 2016 edition We are looking for physician leaders who specialize in
DERMATOLOGY Deadline for Nomination Submissions
Nomination forms are available on www.hrphysician.com (click nominate tab) or by emailing a request to email@example.com Spring 2016 Hampton Roads Physician | 3
WELCOME TO THE Holly Barlow
ccording to the National Alliance on Mental Health and the National Institutes of Health, approximately 21.4 percent of American adults experience mental illness in a given year. One in 25 experiences a serious mental illness that substantially interferes with or limits major activities. Young Americans, described as ages 13-18, experience severe mental disorders at some point in their lives at a rate of 21.4 percent. Younger children – those from eight to 15 – fare somewhat better, with 13 percent suffering severe mental illness. Schizophrenia affects 1.1 percent of adults in the United States, which 2.6 percent live with bipolar disorder. Sixteen million – or 6.9 percent – of adults had at least one major depressive episode in the past year, and fully 18.1 percent experienced an anxiety disorder, such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias. Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5 percent had a co-occurring mental illness. These statistics are even more ominous than they seem at first. According to a 2014 study by the Kaiser Family Foundation, the US has only about half the mental health professionals it needs. It’s equally true in Virginia, where there are shortages of physicians in many of the remote areas of the Commonwealth. There’s been increasing focus on Virginia’s psychiatric services since the November 2014 high profile suicide of Austin Deeds, after stabbing his father, then Senator Creigh Deeds.
A publication for
and about the local medical community
Spring 2016, Volume IV/Issue II
Recognizing the achievements of the local medical community Publisher Holly Barlow Editor Bobbie Fisher Physician Advisory Board (see page 6) Magazine Layout and Design Desert Moon Graphics Published by Publishing, LLC
4 | www.hrphysician.com
In a September 15, 2015 article in the Pharma & Healthcare section of forbes.com, contributor Bruce Japsen reported on the national shortage of psychiatrists, stating “Several state legislatures and members of Congress are looking for ways to get more doctors-in-training to choose psychiatry as a profession.” In his article, Japsen quoted Charles Ingoglia, vice president at the National Council for Behavioral Health, who told the Associated Press that “I’m not aware of any part of the country where it is easy for our members to find psychiatrists.” Telepsychiatry may very well be part of the solution for Virginia as well, as for the other states. For instance, soon – and in some cases now – patients with acute behavioral issues who present at an emergency department with no psychiatrist on staff, can be offered a telepsychiatric consult and referral. With increasing of such teleconsulting, patients in the larger metropolitan areas as well as those in outlying areas will surely benefit – as will society at large. In this issue, Hampton Roads Physician profiles three of the area’s leading behavioral health experts; and we talk with several local experts who explain the possibilities telemedicine is studying and delivering, which improve the quality of health care in the community. Our Summer edition will focus on Dermatology. We are looking for nominations of the top physicians in this specialty. Please contact us or visit our website for more info. More details are also available on the Table of Contents page.
Emeritus and Voting Board Jon M. Adleberg, MD Anthony M. Bevilacqua, DO Silvina M. Bocca, MD, PhD, HCLD Mary A Burns, MD, FACOG, FPMRS Jeffrey R. Carlson, MD Kevaghn P. Fair, DO Bryan Fox, MD Margaret Gaglione, MD, FACP Emmeline C. Gasink MD, FAAFP, CMD Jerry L. Nadler, MD, FAHA, MACP, FACE Paa-Kofi Obeng, DO Michael J Petruschak MD Richard G. Rento II, MD Michael Schwartz MD JohnM. Shutack, MD I. Phillip Snider, DO Deepak Talreja, MD, FACC, FSCAI Jyoti Upadhyay, MD, FAAP, FACS Christopher J. Walshe, MD Elizabeth Yeu, MD
Contact Information 757-237-1106 firstname.lastname@example.org Hampton Roads Physician is published by DocDirect Publishing, LLC, 7445 N. Shore Rd., Norfolk, VA 23505 Phone: 757-237-1106. This publication may not be reproduced in part or in whole without the express written permission of DocDirect Publishing, LLC. Published four times a year, Hampton Roads Physician provides a wide variety of the most current, accurate and useful information busy doctors and health care providers want and need. Cover stories concentrate on one branch of medicine, featuring profiles of practitioners in that specialty. Featured physicians are chosen by the advisory board through a nomination process involving fellow physicians and public relations directors from local hospitals and practices. Although every precaution is taken to ensure accuracy of published materials, DocDirect Publishing, LLC cannot be held responsible for opinions expressed or facts supplied by its authors. Visit Us Online
B O A R D A D V I S O R Y P H Y S I C I A N
2016 ADVISORY BOARD
Their input will help guide the editorial content, format, and direction of the magazine. Along with our Emeritus Board, they will select our featured physicians. Alfred Abuhamad, MD Obstetrics & Gynecology Dr. Abuhamad serves as the Vice Dean for Clinical Affairs and the Mason C. Andrews Professor and Chair, Department of Obstetrics and Gynecology at EVMS. He is Board certified in Obstetrics & Gynecology and Maternal-Fetal Medicine. He is the current president of the Society of Ultrasound in Medical Education, and the National Council of Safety in Womenâ€™s Healthcare and past president of the American Institute of Ultrasound in Medicine.
O.T. Adcock, Jr., RPh, MD
Jennifer Miles-Thomas, MD, FPM-RS Urology Dr. Miles-Thomas is a urologist with The DevineJordan Center for Reconstructive Surgery and Pelvic Health-a division of Urology of Virginia, an Assistant Professor in the Department of Urology at EVMS, and the Medical Director for the Pelvic Health Center at Chesapeake Regional Medical Center. Dr. MilesThomas is Board certified and fellowship trained in urology. She is also Board certified in female pelvic medicine and reconstructive surgery.
Hesed Mugaisi, MD
Registered Pharmacist and Physician, Board certified in Family Medicine in practice in Hampton for 32 years. Currently serves as Associate Medical Director and Service Line Chief for Primary Care and Access for Riverside Medical Group.
Dr. Mugaisi is a Board certified family medicine physician with Bon Secours Suffolk Primary Care. He acquired his bachelor of medicine and bachelor of surgery from the University of Nairobi in Nairobi, Kenya and completed his family medicine residency at Group Health Family Medicine Residency Program affiliated with University of Washington in Seattle, WA.
John W. Aldridge, MD, FAAOS
Jennifer F. Pagador, MD
Orthopaedic Surgeon Dr. John Aldridge is Board certified orthopaedic surgeon with Hampton Roads Orthopaedics & Sports Medicine. He specializes in minimally invasive muscle sparing spinal surgery and total joint replacement surgery. Dr. Aldridge practices at both the Newport News and Williamsburg office locations of HROSM. In addition to his many interests in the field of orthopaedics, he also serves as a Lieutenant Colonel in the United States Army Reserves.
Brian L. Johnson, MD
Family, Bariatric and Age Management Medicine Dr. Pagador is Medical Director of Seriously Weight Loss, LLC and Attending Physician at Revita Medical Wellness, specializing in medical weight loss and hormone optimization. Dr. Pagador is Board certified in family medicine.
Michael M. Romash, MD
Dermatology Dr. Johnson is the founder of The Virginia Dermatology & Skin Cancer Center. He is a Fellow of the American Academy of Dermatology, American College of Mohs Surgery, and the American Society of Dermatologic Surgery. His emphasis is on the treatment of skin cancer using the Mohs Micrographic surgical technique, an advanced surgical procedure for the treatment of skin cancers.
Orthopaedic Surgeon A Board certified lower extremity specialist practicing for over 30 years, Dr. Michael Romash is a Fellow of the prestigious American Orthopaedic Association and known as a pioneer in his field. Author of numerous medical journal articles and chapters in text books about foot and ankle surgery, he has developed treatments commonly used for various heel fractures.
Mark W. McFarland, DO
Lynne A. Skaryak, MD
Orthopaedic Spine Surgery Dr. McFarland practices at the Orthopaedic & Spine Center in Newport News and is Board certified In Orthopaedic Surgery and Fellowship trained in Spine Surgery.
Thoracic Surgery Dr. Skaryak is Director of Thoracic Surgery and Co-Director of Thoracic and Lung Health at Chesapeake Regional Medical Center. She is Board certified in Thoracic Surgery.
Visit our website to see all members of the Emeritus Board: hrphysician.com 6 | www.hrphysician.com
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Robert A. Frazier, Jr., M.D.
Kevaghn P. Fair, D.O.
Michael T. Ryan, D.O.
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DELONG, MD Urology of Virginia
n addition to a lifelong desire to help people by becoming a doctor, Jessica DeLong got the travel bug when she was young – which explains her double major in Biology and Spanish (UVA ’07). She did a semester abroad in Costa Rica, immersing herself in the language and culture. In medical school at EVMS and residency at the Lahey Clinic, followed by a fellowship in adult and pediatric reconstructive urology at EVMS, she found a career that could give her the opportunity to realize both of her passions. She wasted no time pursing them: “When I finished my fellowship, I wanted to have an international focus, so before beginning formal practice, I took six months to travel and do medical work abroad,” Dr. DeLong says. “I initially intended to go to West Africa, but with the outbreak of the ebola virus, my plans were cancelled.” Instead, she spent two months in China (where she studied Mandarin), and later traveled to Ho Chi Minh City to work with IVUMed partners on reconstructive urology. “Within reconstructive urology, we can do such a variety of procedures, helping men and women, adults and kids alike,” she says. “We have great technology here, but many of these surgeries can be done with extremely limited equipment, which makes them very translatable.” She’s been in such basic operating suites often, lately working in the Dominican Republic, where the need is great. “There aren’t any surgeons trained to do reconstructive urology in the DR,” she explains. “For many of our male patients who have been unable to work due to urethral trauma, we can get them back to being productive members of society by repairing their injuries; and for women, we treat everything from female prolapse to incontinence
or congenital anomaly. Many of these patients have experienced years of disability prior to our evaluation.” She’s been invited back to Shanghai to collaborate with surgeons there on female reconstructive work. It’s especially exciting, she says, because “I’ve wanted to develop a relationship with a hospital there because of the opportunity to do collaborative research. They treat a huge number of people, and I thought that if we could get our institutions together we could really do some good research.” But for the most part, she’ll concentrate her efforts in the Dominican Republic for the near future, both because there’s such a huge need, and because, she says, “the DR is the perfect location to try to set up a program; they have the infrastructure in order to be able to benefit from additional training. With my colleague Dr. Ramón Virasoro, we are establishing a Reconstructive Urology fellowship in the DR, which will be the first surgical fellowship in the Caribbean. We’ve had tremendous support and close collaboration with Dr. Charles Horton and Physicians for Peace, and have identified our first urology fellow candidate, who’ll come on board on July 1st.” Built into the program is a model of sustainability. Dr. DeLong explains: “If we’re successful in the Dominican Republic, the program will be translatable to other resource-poor health care environments. We’re going to be training fellows, and once those fellows have graduated, they’ll perpetuate that program, so the idea is that within five years, they will be self-sufficient.” Which will leave her free to identify other places to go, other patients to treat, and other surgeons to train. And of course, other languages to learn and cultures to explore.
If you know physicians who are performing good deeds – great or small – who you would like to see highlighted in this publication, please submit information on our website – www.hrphysician.com – or call our editor, Bobbie Fisher, at 757.773.7550. 8 | www.hrphysician.com
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A D VA N C E D P R A C T I C E PROVIDERS
LUCY KOOIMAN, MSA
Administrative Director, Behavioral Health Bon Secours Maryview Medical Center
hen Lucy Kooiman was in the BSN program at Norfolk State University (2008, summa cum laude), she was frequently scolded by her teachers for spending too much time with her hospital patients. But she wanted to hear how they were doing, and to know how they came to be came to be so sick. Mostly, she wanted to help them learn what they could do differently when they got home, so they wouldn’t have to return to the hospital. “One teacher told me I’d never make it in nursing if I kept asking patients all those questions,” she remembers. “They told me to do a head-to-toe assessment, get it over with and move on to the next patient. But I wanted to talk with these people, hold their hands if they needed me to, and help them if I could. Unfortunately, in most hospital nursing, time constraints make it very hard to do that.” It was different when she took the rotation for behavioral medicine, where talking and listening to her patients was not just permitted, but her principal task. She found she had a natural affinity for these patients, and a profound desire to help them.
Throughout college and graduate school (Central Michigan University, 2008), she sought employment (and volunteer opportunities) that would allow her to serve the un- and underserved populations suffering from mental health conditions. She worked with virtually every demographic: as a counselor at the YWCA Women in Crisis Center, as a geriatric psychiatric nurse with Diamond Health Corporation, as the night nurse supervisor at a 120-bed private psychiatric residential facility for adolescents, as the charge nurse in Maryview’s child and adolescent unit, and as nurse manager for Behavioral Health at Maryview Medical Center. In 2011, she undertook the interim directorship of Behavioral Health, and was named permanent Administrative Director in 2012. In that capacity, Kooiman has overseen the development and implementation of business operations for the 54-bed inpatient unit, which includes supervision nearly 100 employees, from RNs to social workers, therapists, mental health technicians, crisis workers and clerical personnel. She manages the departmental budget, identifies and grows new community partnerships and deals with contract physicians. Even with all of her administrative responsibilities, Kooiman is still keenly interested in the outcomes of individual patients. “The majority of our patients are disadvantaged in a number of ways,” she explains. “It goes beyond their illness: they have socioeconomic challenges, they’re homeless. They have no voice.” She makes sure that every patient leaves better off than when he or she was admitted, right down to ensuring they are properly dressed. “We have a closet here, where we keep donated clothing that we can give to those patients who need it. Often they come in in disarray, but we want them to leave with pride and dignity.” Kooiman describes with pride a recent accomplishment: a grant was written that enabled Maryview to provide a dedicated nurse practitioner to do mental health assessments for clinic patients. “So many people who are dealing with serious illness aren’t aware that they also have depression or anxiety,” she says. “This will help us treat these patients’ mental and physical health conditions.” And while she doesn’t have as much time for hands-on bedside patient care as she used to, Kooiman can still be found on the floor if the need arises, donning gloves to assist with whatever needs to be done. As she says, “Once you’re a nurse, you never stop being a nurse. The priority is always taking care of patients.”
If you work with or know a Physician Assistant or Nurse Practitioner you’d like us to consider, please visit our website – www.hrphysician.com – or call our editor, Bobbie Fisher, at 757.773.7550. 10 | www.hrphysician.com
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Dr. Cal Robinson oﬀers evidence-based psychological therapies to patients suﬀering from chronic pain, where patient well-being is the top priority. In May, Dr. Robinson will be the ﬁrst physician in the United States to oﬀer the Mindfulness-Based Chronic Pain Management (MBCPM™) Program to chronic pain patients. This program was developed by Dr. Jackie Garner-Nix, renowned physician and chronic pain consultant at St. Michael’s Hospital in Toronto Canada, who also serves as adjunct faculty in the Department of Anesthesiology at the University of Toronto. If you have patients with ﬁbromyalgia, sleep disorders, stress/anxiety or chronic, non-cancer related pain, please call Dr. Robinson to refer or for more information.
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Diagnosing Mental Disorders… …a timeline of how far we’ve come In early American culture, mental illness was thought to be caused by moral or spiritual failings, and punishment and shame were often handed down to the mentally ill and their families. 12 | www.hrphysician.com
hroughout history, mental illness has been stigmatized, un-, under- and overdiagnosed, and simply misunderstood, too often resulting in crude, cruel and horrific treatment of those who suffered. Trephination, or trepanning, is one of the earliest diagnostic tools used to explain mental illness. Prehistoric skulls and cave art dating back as far as 6500 BCE reveal surgical drilling of holes in skulls to allow the release of evil spirits within. Around 2700 BCE, the Chinese medicine identified the yin and yang, positive and negative bodily forces, claiming that an imbalance in these forces resulted in both physical and mental illness. Papyri from 1900 BCE declared that women with mental illness had a wandering uterus (later named ‘hysteria’). Egyptian and Greek practitioners believed making women smell strong substances would guide their uteri back into proper location. In the fifth and sixth centuries before the Common Era, it was easy for physicians to fall back on the whims of the gods: only godly displeasure could account for such abnormal behavior. It wasn’t until the time of Hippocrates that mental illness first became an object of scientific speculation. Around 400, he posited the theory that either
a deficiency or excess of one of the ‘humors’ (blood, yellow bile, black bile, and phlegm) was responsible for physical and mental illness. Hippocrates classified mental illness into one of four categories – epilepsy, mania, melancholia, and brain fever – and like other prominent physicians and philosophers of his time, he did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior. That belief reemerged and evolved later. For example, Hindu tradition attributed psychological disorders to sorcery and witchcraft. During the Middle Ages, people believed mental illness was caused by evil spirits or demons. People were subjected to whipping, bloodletting, purges, and once again, to trepanning. Eventually, a common treatment for people with mental illness involved placing them in asylums or ‘madhouses.’ The most (in)famous of these asylums was the Priory of the New Order of St. Mary of Bethlem, which was founded in London 1247 during the reign of Henry III. Known then and still today by its nickname, ‘Bedlam,’ the hospital remains in operation, Europe’s oldest extant psychiatric hospital. In early American culture, mental illness was likewise thought to be caused by moral or spiritual failings, and punishment and shame were often handed down to the mentally ill and their families. As the population grew and certain areas became more densely settled, mental illness became a social issue, and institutions were established to handle the needs of such individuals collectively. In 1752, the Quakers in Philadelphia made the first organized effort to care for the mentally ill, but not utilizing the gentle care their name evokes today. When they opened the Pennsylvania Hospital in Philadelphia, they provided rooms in the basement to house a small number of mentally ill patients – complete with shackles attached to the walls.
In Virginia, in 1773, when the need to provide care for the mentally ill became apparent, the legislature provided funds to build a small hospital in Williamsburg – Eastern State, the first psychiatric hospital in the Commonwealth. Today, the hospital sits on 500 acres and consists of two patient care buildings, caring for 300 patients. In 1774, the Madhouses Act created the first legal framework for regulating madhouses in Great Britain. Before the Act, the mentally ill were either kept in the family home or placed in private houses, whose owners were paid a fee by the Crown. These houses had little to no medical supervision, inviting mistreatment of the truly mentally disturbed, and virtual incarceration of those who were not (often put there as an expediency by a relative.) The Act put an end to such practices by requiring annual licensing and inspections by the Royal College of Physicians.
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Spring 2016 Hampton Roads Physician | 13
The nineteenth century saw reformers who sought to create hospitals that treated patients humanely and attempted to cure them. These reformers saw mental illness as the result of an underlying psychological disorder that needed to get diagnosed according to its symptoms, and could become cured through treatment. One such reformer was Dorothea Dix, an author and teacher, whose efforts helped create dozens of new institutions across the United States and Europe, changing perceptions of both the mentally ill and even some prisoners. In 1812, Benjamin Rush (often called “The Father of American Psychiatry” and a signer of the Declaration of Independence) wrote the first systematic textbook on mental diseases in America, entitled Medical Inquiries and Observations upon Diseases of the Mind. The book went into five editions through 1835 and served as the major such textbook for almost 50 years. Other volumes followed, authored by pioneers in the field like Sigmund Freud, Victor Frankl, Anna Freud, Carl Jung, Fritz Perls and others. Today, the field of treating patients with psychiatric disorders is guided by a different book, The Diagnostic and Statistical Manual (DSM.) The DSM is published by the American Psychiatric Association, offering a common language and standard criteria for the classification of mental disorders. It is now in its fifth edition, DSM-5, published on May 18, 2013.
Fortunately for the 26.2 percent of adult Americans who suffer from a diagnosable mental disorder in a given year, today’s practitioners – like our cover doctors Maria Urbano at EVMS, Anthony Caterine at Riverside and Dr. Munn at Naval Medical Center Portsmouth – have a wealth of reliable medical knowledge and years of hands-on experience to rely on in treating the individuals who suffer these conditions. They are offering hope to patients and their families alike, and helping eliminate the stigma that has so unfairly attached to them throughout the centuries. Resources: “Diagnosing Mental Illness in Ancient Greece and Rome,” Julie Beck, The Atlantic, Jan. 23, 2014. “History of Mental Illness,” Ingrid G. Farreras, Hood College, abstract of a learning module of the Noba Project. www.nih.gov www.esh.dbhds.virginia.gov www.psychiatry.org
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ANTHONY J. CATERINE, MD Consultation and Geriatric Psychiatrist Riverside Health System
nthony Caterine says he always knew he wanted to be a doctor: “My father was a surgeon, so I was interested in medicine early on.” He recognized early on that people seemed comfortable talking to him (he was elected president of his junior and senior classes in high school), and he chose psychiatry because he excelled in it in medical school (Stritch School of Medicine, Loyola University, ’88.) He completed his residency in psychiatry 16 | www.hrphysician.com
at Shand’s Teaching Hospital in Gainesville Florida in 1992. He also took specialized training in forensic psychiatry under Dr. George Barnard at the University of Florida. Dr. Barnard, he notes, was one of the Forensic Psychiatrists who evaluated Aileen Wuornos, the serial killer from Florida who was portrayed in the movie “Monster.” Dr. Caterine conducted 194 forensic psychiatric evaluations, and provided expert testimony in 30 court cases.
He began his career in a standard, inpatient/outpatient practice, being interested in both aspects. But as he got further into his career, he realized he had an affinity for working with patients in the more acute hospital setting. He had joined a practice in the Midwest, but found himself gravitating more and more toward treating dual diagnosis patients, with acute physical and psychiatric problems. In 2002, Dr. Caterine took advantage of the opportunity to move to Virginia to work on a medical psychiatric unit, part of the Riverside Health System. “These patients were too medically ill to be in a regular psychiatric hospital,” he says, “but they still required intensive psychiatric treatment.” When that unit closed, Dr. Caterine remained within the Riverside system. “Riverside has a very large, comprehensive lifelong health program,” he says. “They have a focused geriatric practice, with twelve nursing facilities as part of the system. They knew I was Board certified in Geriatric Psychiatry, so they asked me to start doing psychiatric consults there initially, while I continued doing consults at the general hospital.” He moved over to the lifelong health division, and since 2005, has confined his work to consults at several Riverside Hospitals and the various nursing facilities. “The biggest change for me in the last couple of years has been telemedicine,” Dr. Caterine says. “I used to literally drive to all of the nursing facilities, which are all over the place. One year I logged more than 10,000 miles! Such an inefficient use of my time with so many patients needing treatment, patients I couldn’t physically get to.” Today, through telemedicine, he’s able to do consultations at Riverside’s Tappahannock, Gloucester and Eastern Shore hospitals as well as the nursing facilities in similar areas. “With telemedicine, I can schedule my time, but can also do consults the same day they are asked, if indicated,” he notes. His interest in and compassion for the concerns of severely ill and psychiatric elderly patients is reflected in the research he has done and the many presentations he has given, particularly in the areas of depression, bipolar disorders, geropsychiatry and geriatric psychopharmacology. He was recognized by J. C. Penney’s Partners in Peace Award for Contributions to Senior Strength Program Center for the Prevention of Abuse in 1997. As a geriatric psychiatrist, Dr. Caterine believes passionately that society has a responsibility to better prepare for the number of people who will need treatment for dementia. “People are living longer and longer, and as we know, Alzheimer’s is a disease of aging. By the time these people are 85, they’ll have a 30-40 percent chance of developing Alzheimer’s. And the risk keeps going up after that.” With the Baby Boomers entering ages associated with dementia, there is going to be a significant increase in people with dementia. He sees these patients every day and many are happy and coping well. “But some are not,” he cautions, “and they can be very difficult to take care of. If we don’t think about this and plan, these people are going to fill up our ERs, hospitals, and then – because they will have nowhere else to go – the younger people who need treatment in those settings will have a harder time getting the treatment they need.” Dr. Caterine enjoys finding novel ways to assess patients’ ability to engage with him, as a sign of possible depression or apathy. Lately, he’s been asking, “Who are you voting for president this year?” He finds it telling that many are replying, “No one.” Winter 2016 Hampton Roads Physician | 17
GARY L. MUNN, MD CAPT, MC, USN [Ret]
Adult Inpatient Psychiatry Naval Medical Center Portsmouth
ary Munn was commissioned an ensign in the United States Navy in June, 1976, upon graduation from the U.S. Naval Academy. He found an easy rapport with the sailors he supervised as a division officer: “They’d come to me for counseling,” he says, “and I had insights into some of the tragedies in their lives. I wanted to be able to help them.” He earned his medical degree at New York Medical College in Valhalla, New York, in 1988, and completed both his internship and residency in psychiatry at Naval Medical Center Portsmouth. During a long and storied career in the United States Navy, Dr. Munn had a number of experiences that provided him the opportunity to make significant contributions to the advancement of military medicine. From 1992-1995, while assigned to U.S. Naval Hospital Sigonella, Dr. Munn served as both Mental Health Department Head and Chairman of the Bioethics Review and Medical Records Review Committees, as well as the psychiatric advisor to the Family Advocacy Case Review Committee. In 1995, he deployed to the Baltic Sea for BALTOPS 1995, aboard USS OLIVER HAZARD PERRY, to demonstrate shipboard medicine capacity to representatives of the former Soviet Bloc nations. Returning to Portsmouth in 1995, he served in numerous positions in inpatient and Emergency Psychiatry. In 1997, he deployed to Roosevelt Roads, Puerto Rico aboard USS BATAAN in support of recovery and clean-up efforts following Hurricane Georges. A year later, he was sent to U.S. Naval Hospital Guam, where he ensured continuance of the mission by providing interim psychiatric coverage during a shortage. He went on to serve on the 2nd Fleet Service Support Group platform at Camp Lejeune, where he trained staff to identify and manage Combat Stress. He was named Head of the Psychiatry Department in 2001. In 2003, he received the call to deploy with BRAVO Surgical Co to Kuwait and Iraq, where he served as the Officer in Charge of the Combat Stress Platoon. Under his leadership, his team had a 100 percent return-to-duty rate. Later in 2003, Dr., Munn was transferred to National Naval Medical Center, Bethesda as the Department Head for Adult Inpatient Behavioral Health. In 2004, he was awarded the H. James Sears Award for Excellence in Navy Psychiatry. In 2007, he was recognized as the Naval Medical Center Portsmouth Psychiatry Residency Teacher of the Year. Dr. Munn returned to Kuwait in 2007 as the Officer in Charge of COSTNAV [Combat and Operational Stress Team, Navy], supervising the provision of mental health care at four remote bases. After completing his tour overseas, Dr. Munn returned to serve on the psychiatric wards at Naval Medical Center Portsmouth, where he also expanded the ECT Services. Dr. Munn retired from the Navy in 2008, but says, “I was really blessed as I was approaching retirement. A company with a contract opening at Portsmouth 18 | www.hrphysician.com
Naval Hospital offered me a position. I was able to start work as a contractor the day after I retired.” He practices exclusively at Naval Medical Center Portsmouth, while holding associate professorships in clinical psychiatry and behavioral sciences at Eastern Virginia Medical School and the Uniformed Services University. His years of experience in military inpatient psychiatry are unparalleled. Dr. Munn and his colleagues at Naval Medical Center Portsmouth also support the airmen at Langley Air Force Base, soldiers at Ft. Eustis and Ft. Story, and Coast Guardsmen locally and in Elizabeth City. He adds, “we get referrals from around the world – the entire eastern half of the United States as well as Europe and Africa. Whenever service members are in need of inpatient psychiatric treatment, Portsmouth is generally where they come.” Practicing psychiatry in the military is gratifying, Dr. Munn says, because “we’re not operating under the constraints of insurance companies, or answering to third party payers. We’re able to provide the care to our service members and veterans in ways we feel most appropriate, and we have the support of the command and the Congress and federal government to do just that.” However, he acknowledges, the practice of military psychiatry has also gotten more complex over the years. “We’ve always
had to balance having to understand the needs of the military in addition to the emotional and medical needs of the service member,” he explains, “and doing our best to not compromise between the two, but to carve a new path so the needs of both are best met.” These servicemen and women are fighting a war on two fronts, with an all-volunteer force, and Dr. Munn is treating soldiers and sailors who are making their fourth, fifth or sixth deployments. “It’s tough on the service members and their families, and mental health services are in high demand within the department of defense,” Dr. Munn says. Not surprisingly, between 2007 and 2015, Dr. Munn received more and more inpatient psychiatric referrals related to substance abuse disorders. He helped establish the Substance Abuse and Detoxification Unit at Naval Medical Center Portsmouth. The demands on service members seem greater than they’ve ever been, he notes, “But whereas psychiatry used to be the ‘stepchildren’ of military medicine – last in line to be considered for budgetary issues – now the value of military mental health is absolutely recognized, and there are plenty of resources being directed toward us. We can take the best care of our beneficiaries.” Spring 2016 Hampton Roads Physician | 19
Maria R. Urbano, Eastern Virginia Medical School Department of Psychiatry
hinking she might pursue a career in either teaching or pharmacy, Maria Urbano earned a degree in biology at Pennsylvania’s Shippensburg University after deciding against pharmacy, which led to a job doing research – on geraniums. “Tissue cultures,” she explains. “We were looking for better ways to grow geraniums.” Having enjoyed the research aspect of her undergraduate degree, she enrolled in Michigan State University to earn a master’s in microbiology. She again found herself working with plants, this time looking at nitrogen fixation on clover plants. It was interesting work, she says, “but I knew I didn’t want to spend my days working in a lab, with only a research assistant for company. I was really missing people.” She left Michigan State with more than a master’s degree: it was there that she befriended several medical students (including one very special friend), and began to envision a career in medicine for herself. “It seemed like the perfect way to combine my love of science and my need to be with people,” she says. She applied to EVMS, and earned her medical degree in 1983. Dr. Urbano thought she wanted to practice family medicine, right up until she did a rotation in psychiatry. “We did it at the Naval Hospital in Portsmouth,” she explains. “We didn’t have a resident or an intern, so it was the students and the attending. We had the opportunity to do much more than we would have ordinarily and really got to know the patients. I knew I had found my specialty.” She completed a residency in psychiatry in 1987, and was Board certified in 1988. As for that special friend she met in Michigan – Tom Manser – he remained in Michigan for his internship, but moved to Virginia for his residency at EVMS, and to propose. Today, Dr. Manser is Chief of the General Medicine Division at EVMS. Dr. Urbano completed one year of internal medicine residency before starting her psychiatry residency. “It wasn’t unusual back then to enter psychiatry in the second year,” she says. “But after that first year, I realized it wasn’t what I wanted to be doing. I kept remembering something one of my favorite professors told me: ‘your goal is to get the patient’s story.’ And it’s true: by getting patients to tell their stories, you learn about their lives, and then you can find ways to create effective interventions to help them.” Dr. Urbano acknowledges that there can be many layers of stories before a patient gets to the real story, depending on their problem. “People have a lot of defenses,” she says. “From a psychological perspective, the goal of the defenses is to keep emotional conflicts hidden away from consciousness, so they don’t disturb you too much. But they end up causing anxiety or anger or sadness, so it takes time to go back and find what the root cause of the feelings was.” In practice, Dr. Urbano says, we learn to ask the questions that help patients develop their stories. Her tradition is psychodynamic psychotherapy, the oldest of the modern therapies. “It’s associated with Freud,” Dr. Urbano explains. “It’s helping patients look at relationships from childhood and learning how those relationships affect their current abilities as adults to form (and maintain) their own relationships.” The goal, she says, is that when patients learn to explore both past events and feelings, they can connect them to their current life situations, which can result in changes in personality or behavior. Then they can make better choices, or have more 20 | www.hrphysician.com
MD options in the present. When she’s not counseling patients, Dr. Urbano is teaching (she’s a full professor at EVMS), publishing (she’s led or been secondary author of a number of medical publications), participating in funded and unfunded research and training grants, or giving presentations both locally and across the country. Many of these activities are based on the topic of Autism Spectrum Disorder. “When Dr. (Stephen)Deutsch MD, PhD came to EVMS in 2009 as our chairman, he was doing research in autism,” Dr. Urbano says. “I was interested because there are individuals with ASD in my family. At the time, very little attention was being paid specifically to the older adolescent/young adult ASD population.” Dr. Deutsch was working with a strain of mice that don’t interact as normal mice do – just as people with autism often avoid social contact with other people. “He had tested a tuberculosis drug that had been found to change social behavior in these mice,” Dr. Urbano explains. “We received a grant from the Hampton Roads Community Foundation to fund the study on young adults with autism. The drug (D-cycloserine) was shown to be effective in improving stereotypic symptoms and increasing social behaviors in older adolescents and young adults with ASD. It was also safe and well tolerated. It was very exciting.” It also represents a professional frustration. “One of the challenges we face in studying autism is finding the resources to pursue scientific avenues that we have evidentiary reason to believe will be fruitful,” she says. “In academic research, it always comes down to a question of resources. It’s particularly vexing because we’re dealing with such young patients, the adolescents and young adults, at a critical time in their lives.” Spring 2016 Hampton Roads Physician | 21
MEDICAL U P D A T E
Bringing the Specialist to the Bedside:
A TELEMEDICINE UPDATE …what many patients still don’t know By Bobbie Fisher
any people consider telemedicine to be a relatively new concept, whereas it might be argued that the practice actually began the first time a physician returned a patient’s phone call and said, “Take two aspirin and call me in the morning.” And while phone conversations with doctors – rather than inhome or in-office visits – quickly became widely accepted, many patients have persisted in viewing other telemedical advances with some skepticism. As recently as July of 2015, medical magazines were publishing articles with titles like American public still skeptical about telemedicine (July 15, 2015 | Eric Wicklund - Editor, mHealthNews), citing surveys and studies that indicated that while consumers were growing more comfortable with certain aspect of telemedicine, they were wary of seeing a doctor or getting a diagnosis online. In fact, one study of 504 22 | www.hrphysician.com
American adults, conducted by internet marketing company TechnologyAdvice, indicated that some 75 percent either didn’t trust a diagnosis delivered through telemedicine, or would give it less weight than one made by a doctor in person. It’s very likely that skepticism stems from a lack of understanding of the breadth of care made possible by telemedicine – or even what the term itself means.
Telemedicine is here to stay. The opportunities to expand its reach into the everyday practice of medicine are incalculable.
Telemedicine Defined. “Most people accept the simple definition of telemedicine as providing health care over a distance,” says Jeffrey Forman, MD, a pulmonology and critical care medicine physician with Bayview Physicians Group, who recently completed a Masters of Health Care Delivery Sciences program at Dartmouth College, where he did a Jeffrey Forman, MD focused, longitudinal project on mobile health technology. “It’s important to make a clear distinction between telemedicine, mobile health and remote patient monitoring,” he says. “There’s a difference that patients should understand.” Telemedicine communication can be from physician to physician, from patient to physician, or from a remote physician to an onsite doctor and patient, often involving a live video connection like Facetime or Skype. “Mobile health technology,” Dr. Forman continues, “involves employing a mobile device like an iPhone or iPad, to provide pertinent medical information to a provider. Think of a patient sending information about his blood sugar to his physician, who can then treat it appropriately.” Remote sensing refers to setting up actual monitoring devices in patients’ homes. These will monitor heart rates, blood pressures, O2 saturations, and other data, which is John R. Baker, MD then sent to the provider.
additional tests, begin appropriate treatment and arrange for transfer if needed. “These experts have broadened their inclusion category,” Dr. Baker says. “They also identify those patients who may need to go on to very specialized surgeries, those who need not only medication for their strokes, but who also need emergency surgery to remove a blood Wolfgang Leesch, MD clot or repair an aneurysm.” Neurointerventionalist Wolfgang Leesch, MD and his colleagues with Riverside Neurovascular Specialists can log onto a link to the outlying hospitals in the Riverside Health System – in Gloucester and Tappahannock and on the Eastern Shore – to evaluate suspected stroke patients. “Because there’s no test that provides hard evidence that someone has had a stroke,” Dr. Leesch explains, “there are two components to telestroke: telemedicine and teleradiology. We need to look at radiological images to determine if there is bleeding in the brain. CT scans are online and can be examined by a radiologist. Then we can determine if the patient needs the clot busting TPA drug. But it takes the trained eye of a neurointerventionalist to make that determination, and to direct the subsequent care of these critically ill patients.” Essentially, Dr. Leesch says, “teleneurology has the potential to place a stroke neurologist, an interventionalist, and a
Leveling the Playing Field for Every Patient in an Acute Care Setting. Hampton Roads is the home of large, state-of-the-art hospitals and hospital systems. Acutely ill patients in this metropolitan area of Southeastern Virginia have almost immediate access to specialized medical services in nearly every field of medicine. Many areas of the Commonwealth are not so fortunate, reflecting the majority of the country: “In fact, more than half of the hospitals in the U.S. have fewer than 100 beds,” says John R. Baker, MD, a neurointerventional surgeon and Director of the Bon Secours Neurovascular Center. “In acute care, it’s always a matter of how quickly a specialist can get to the patient. Telemedicine allows us to bring specialized medical care to patients in these smaller hospitals.” For example, a critical access hospital in a small, rural area may not have the resources to employ a full-time intensivist and other specialists to deal with acute stroke patients. A patient presenting with weakness on one side, or in the leg, might otherwise have to wait to be transported to a larger facility sometimes hundreds of miles away for diagnosis and treatment, but using a teleneurology service, the emergency room physician can immediately consult with a neurologist who can evaluate the patient, observing and asking questions, live and in real time. The neurologist can then order
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neurosurgeon at every rural hospital” – not just in Virginia, but all over the world.
Telemedicine in the ICU. In 2000, Sentara started the eICU, which uses remote telemonitoring of ICU beds, the first hospital system in the country to do so. “In our eICU, localized specialists monitor patients Michael G. Charles, MD 24 hours a day, seven days a week,” says Michael G. Charles, MD, Medical Director for Clinical Effectiveness with Sentara Medical Group. “We have more than 100 beds now, and recently expanded to Sentara Obici Hospital.” The physician in charge sits across from computer monitors that receive information from the ICU – EKG data, oxygen levels, lab data, reports from nurses and even some video feeds. The physician reviews the data and instructs nurses on when to adjust medications, ventilator settings, etc., just as the physician would do in person. However, instead of doing so in person in one hospital, these telemedicine practitioners are monitoring ICU patients in hospitals across the Sentara system. “When you’re in an ICU, you’re constantly looking at monitors and receiving information,” Dr. Charles says. “It’s very amenable to telemedicine.” But, he emphasizes, “There is still a physician present to respond to emergency situations. It won’t eliminate the need for an in-person doctor in the hospital.”
their tremors, and compare with all previous videos. These specialists can make adjustments to medications and order any other modalities they believe necessary. “By interacting with teleneurologists,” Dr. Baker explains, “these patients can be evaluated for mental status, even Alzheimer’s, without having to travel outside their home area. They can go to their doctor’s office or a hospital or remote clinic.”
Teledermatology – a Growing Subspecialty.
“In dermatology,” says Abby S. Van Voorhees, MD, Chair of the Department of Dermatology and Residency Director at Eastern Virginia Medical School, “there are two kind of telemedicine that are being developed in parallel.” One, she explains, is what many patients do spontaneously: Abby S. Van Voorhees, MD store and forward. They take cell phone pictures of a rash or a growth, and then show them to someone. “We don’t encourage people to send photos phone-to-phone, because it’s not HIPAA compliant,” she notes, “but the social media-savvy public has adopted this approach.” But a primary care physician might well take a photo of a patient’s rash or growth and send it to a dermatologist, who can then give advice or be reassuring. “We can say something looks worrisome and needs further testing or assessment,” Dr. Van Voorhees says, “or that it doesn’t appear to be of great concern.” The other kind of teledermatology is less common. “It’s Telemedicine in Chronic Care Settings. real time telemedicine,” Dr. Van Voorhees explains, “where the “Clinics have begun using these services for patients with primary care physician links the patient by video directly to the Parkinson’s or other movement disorders as well,” Dr. Baker dermatologist, who views the presentation at that exact moment says. Teleneurologists can watch patients on the video, review and can confer with the patient. The dermatologist can then direct treatment, or give advice to the primary in real time.” The EVMS teledermatology department has been very involved in telemedicine at the Veterans Affairs Hospital. “We provide service for a large catchment area of veterans’ hospitals for the THANK YOU! The doctors and staff at Allergy & Asthma Specialists extend a entire region,” Dr. Van Voorhees heartfelt thank you to all the physicians and staffs in Hampton Roads who refer their patients to us for allergy and asthma health care. We never lose says. “It eliminates the need sight of the fact that your referral is accompanied with a trust in us. for veterans to have to travel all the way to Hampton to be seen. Arrangements can be made for biopsies to be done in their local hospitals, and guidance can be provided to their treating physician to ensure they receive the proper additional care.” Dr. Gary Moss Dr. Greg Pendell Dr. Craig Koenig June Raehll Lisa Deafenbaugh FNP-BC PA-C It’s also been an effective We make it as easy as possible on the patient and referring physician by ACCEPTING MOST INSURANCES. learning and teaching tool at EVMS, an added advantage for Virginia Beach (757) 481-4383 • Chesapeake (757) 547-7702 • Norfolk (757) 583-4382 medical students and trainees. www.allergydocs.net
24 | www.hrphysician.com
Expanding telemedicine to other specialties. There has been increasing interest in the Commonwealth in providing mental health services to remote areas. “There is a shortage of psychiatrists in many of these rural areas,” Dr. Charles notes. “We’re looking at telemedicine to help with consults. For instance, if a patient comes in to an emergency room in one of Virginia’s most rural areas, a teleconsult can be arranged with a psychiatrist, who could monitor one or more different emergency departments for behavior health emergencies. Fortunately, those don’t occur too frequently, but when they do, this would allow one psychiatrist essentially to take care of many patients in outlying hospitals.” The idea is in its infancy, Dr. Charles says, but it’s being carefully studied.
The Bottom Line. Telemedicine is here to stay. The opportunities to expand its reach into the everyday practice of medicine are incalculable. But it’s not – nor can it be – a replacement for a caring, well trained physician. And it’s not going to help every patient. As Dr. Forman explains, the key to many of these remote technologies being successful is the analytics behind them. “You need a system that analyzes the data and can filter it so that triggers are made when things go wrong,” he says. “As we get more and more data, these analytics will help us filter out and determine which patients are on the cusp of having a problem for which we can intervene, before it results in a visit to the emergency room or a hospitalization. The key is setting up a command and control center, with trained medical personnel looking at the data and communicating with the attending physician to give appropriate medical advice.” Ultimately, it isn’t technology that helps people. It is medicine that helps people.
Electronic House Calls, Patient Portals, Mobile Medicine – What Patients Really Think. “One of the models of teleconsultation is a large group of specialists who do consults anywhere in the country,” Dr. Baker says. “The next person in the queue takes the next call. You might get a quicker response, but that person doesn’t necessarily know your patients or your particular system. You can also have a smaller, localized group of six or seven experts, rather than 300, and you can develop a rapport with them.” As for the patients themselves, they’re seeing the specialist on a video, so it’s not a detached voice coming out of a speaker. “It’s done very professionally, and most patients realize they’re getting more comprehensive care.” “For many dermatology patients, telemedicine is a big plus,” Dr. Van Voorhees says. “It spares them having to make an extra visit to the doctor’s office.” Dr. Charles agrees: “Patients want care that’s convenient and fast. They’re already tuned into the technology. The new generation that’s coming up isn’t going to sit around for two hours in a waiting room.”
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f it’s good enough for Astronauts, it must be good enough for all of us!
By Alan L. Wagner, MD, FACS
eing able to determine how someone’s health is when that someone is far away requires knowing what to measure, how to measure it, and how to get that information where it needs to go. Our first American astronaut, John Glenn, had his blood pressure and heart rate measured in space during that inaugural flight, and ever since that time, we on the ground have been slowly adapting that technology to help those in need. As an early member of the American Telemedicine Association, having established one of America’s first diabetic eye disease remote monitoring programs with the Strelitz Diabetes Institutes, and leading a team that developed a system for remote premature baby eye examinations to prevent blindness at CHKD, I can attest to the growing importance of telemedicine. For patients over the age of 25, diabetes is the leading cause of blindness. All the evidence points to using regular examinations of the inside of the eye to find early diabetic changes, and stop them in their tracks. We used to examine patients with our own eyes, or use bulky cameras to take pictures of the inside of the eye, using film that had to be developed. Now the world has
been turned on its head: there are robot cameras that do a fine job of taking these very important pictures. Even a clip-on adapter for a cell phone camera can take a pretty good picture of the inside of the eye. It’s great to get these pictures, but of course, it’s all about interpreting the images that matters, and giving that information back to patients and their healthcare team. Every day, our practice reviews dozens of images taken elsewhere to help patients from far away. High blood pressure and heart disease require regular check-ins as well, and patients can’t always easily get to their doctors’ office or clinic for monitoring. Telemedicine enables us to offer patients in remote locations the opportunity to have these tests done locally, rather than having to travel. Using the same technology they use to have food delivered, they can deliver valuable information to their physicians. These aren’t just conveniences for patients; they also help keep the cost of healthcare under control by minimizing the cumulative
Alan L. Wagner, MD, FACS founded the Wagner Macula & Retina Center in 1987. He completed medical school at Vanderbilt University School of Medicine, residency at EVMS and a fellowship at Weill Cornell University Medical Center. wagnerretina.com
26 | www.hrphysician.com
financial impact of time lost from work due to extensive travel. Of course, keeping the cost of healthcare under control also requires having the right people in place to diagnose and prescribe care. Telemedicine enables us to deliver this broad spectrum of affordable care, wherever our patients might be. We salute and support our colleagues who join us in adapting cutting edge technology to bring personalized and affordable care to all those in need, wherever they may live.
Physical Therapy for Overactive Bladder…
…a vital tool for urologists and their patients By Erin Glace, MSPT, PRPC, BCB-PMD
significantly reducing the number of nighttime visits to the bathroom. Other applications of electrical stimulation are available, based on the patient’s needs and lifestyle. Pelvic muscle exercise and many of the treatments provided by pelvic floor physical therapists have been recommended by the American Urological Association as a first line of treatment; thus many urologists are referring their patients for physical therapy before attempting more invasive treatments. Overactive bladder, which affects 30 percent of American men and as much as 40 percent of women, can be a vexing, disruptive condition. Physical therapists, working in concert with urologists, can provide effective, compassionate care for these sufferers.
Erin Glace, MSPT, PRPC, BCBPMD is the Director of Physical Therapy and Urodynamics at Urology of Virginia Physical Therapy Department. www.urologyofva.net
ore and more urologists are referring their patients with bladder symptoms to physical therapists, with excellent results. In physical therapy, patients learn how to properly use their pelvic floor muscles to help retrain their bladder; they learn about foods and drinks that may be contributing to the problem, as well as some simple behavioral strategies to help control their bladder frequency and urgency. In a specialized pelvic floor physical therapy practice, the patient’s pelvic floor muscles are assessed, using state-of-theart equipment, enabling the therapist to determine what is contributing to bladder problems. Some patients may need to strengthen their pelvic floor muscles and learn strategies to inhibit unwanted bladder contractions, while others may need to learn to release their pelvic floor muscles to more completely empty their bladder.
Pelvic muscle exercise and many of the treatments provided by pelvic floor physical therapists have been recommended by the American Urological Association as a first line of treatment. Trained therapists provide neuromodulation, a painless electrical stimulation treatment that can help calm an overactive bladder or help build strength and sensation in the patient’s pelvic floor muscles. Percutaneous Tibial Nerve Stimulation, or PTNS, has been found to be effective for patients with nocturia,
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Neuromodulation Provides Relief for Patients with Chronic Back Pain …adapted from the technology behind pacemakers, spinal cord stimulation is reducing and even eliminating pain. By Michael Ingraham, MD Sports Medicine & Orthopaedic Center
n pain medicine, the most common complaint we hear in an average day – and we hear it every day – is back pain. It’s not surprising, given that more than 80 percent of the population will experience back pain at least once during their lives. Most recover within a few months. Unfortunately, for those who do not, back pain can become a chronic condition that renders even the simplest daily task insurmountable, causing tremendous disruption in their lives and their families’ lives. In appropriate cases, neuromodulation – or spinal cord stimulation – has been shown to provide significant relief from chronic back and leg pain in as many as 85 percent of patients. The typical candidate is a patient who presents with a history of long-standing back and leg pain: a classic sciatica presentation. The patient has failed conservative management, may have undergone surgery(ies), but the pain has not resolved with traditional treatment, including opioid medication. After assessing the patient’s receptiveness to the concept of neuromodulation, we do a five-day nonsurgical trial to determine if the technique will be effective. This involves numbing the patient’s skin, and through two small needles, we pass a catheter into the epidural space. We then stimulate the spinal cord, blocking some of the pain signals coming from the brain. Thus, rather than pain, the patient feels a slight tingling – or in the best case scenario, nothing at all. The trial procedure takes less than an hour, and the patient can go home after the leads are placed. If the trial is successful, and the patient enjoys relief from pain, we can then repeat the process, this time implanting a small battery under the skin, akin to that used in pacemakers, to power the stimulator. The different models available allow us to customize both the procedure and the kind of device we implant. Some patients don’t like to charge their devices, and thus prefer a permanent battery, which must be replaced after three to five years. Some of the
more technologically savvy like the ability to change the settings throughout the day, increasing or decreasing stimulation in response to their symptoms. As the technology has become more sophisticated, we’ve developed new and innovative ways of using these devices, and many patients who had all but given up hope are experiencing as great as a 70 percent reduction in their pain. In two recent randomized controlled trials of patients with predominant leg pain, spinal cord stimulation was found to be more effective than reoperation and conventional medical management. It’s also been demonstrated to be more effective in treating persistent sciatic pain after spine surgery, often eliminating the need for reoperation. Additionally, in a conventional medical management study, more subjects randomized to spinal cord stimulation had a significant reduction in leg pain. Today, rather than waiting until all other treatments have failed, neuromodulation is beginning to be introduced earlier into the algorithm. We’re starting to offer it earlier and earlier, as new research proves it to be an ever more viable option.
Michael Ingraham, MD is a fellowship trained pain medicine physician, who will join Sports Medicine & Orthopaedic Center in August 2016. He completed his internship at Harvard University/Beth Israel Deaconess Medical Center, and his residency in physical medicine and rehabilitation at Georgetown University/National Rehabilitation Hospital. He did his fellowship in pain medicine at the University of Virginia School of Medicine. smoc-pt.com
30 | www.hrphysician.com
The surgeons of the EVMS Acute Care Surgery service are (L-R) LD Britt, MD MPH; Jessica R. Burgess, MD; Timothy J. Novosel, MD and Leonard J. Weireter, Jr., MD (seated) Jay N. Collins, MD (inset) Rebecca C. Britt, MD
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cute Care Surgery is an evolving specialty that arose following a 2005 survey conducted by the American College of Surgeons. The survey demonstrated that trauma and critical care surgeons were increasingly responsible for emergency surgical care; in fact, nearly 75 percent of emergency departments identified inadequate oncall specialty coverage. A 2006 Institute of Medicine report on the future of emergency care confirmed the national shortage of on-call specialists. In 2007, recognizing the growing and disturbing trend, Eastern Virginia Medical School established the Acute Care Surgery service at Sentara Norfolk General Hospital. Today, Acute Care Surgery (ACS) consists of five full-time EVMS surgeons, all Board certified and fellowship trained in trauma, emergency general surgery and critical care medicine. 32 | www.hrphysician.com
Trauma accounts for only a portion of the work these surgeons do. Jay N. Collins, MD, a member of the ACS team, explains: “We are available every day of the year, and every hour of the day, for any kind of surgical emergency people might have. Whether for common diseases like appendicitis, diverticulitis or gallstone problems, or more complex cases involving perforations and serious infections of the abdomen, bowel obstructions of both the small and large intestines, and cancers that perforate into the abdomen, the team is immediately available.” These conditions are unrelated to trauma, but each is serious and each can be potentially life threatening in its own right. Each represents no less dramatic a medical catastrophe, requiring no less a skilled, expert specialist. In a typical scenario, a patient might experience abdominal pain and sit around the house, resting, hoping Promotional Feature
these patients may be very ill post-operatively, requiring mechanical ventilation, medications to maintain blood pressure if in septic shock, and careful monitoring. They are admitted to the ICU by their ACS surgeon, and treated by the ACS team until discharge. In addition to caring for the patients who go directly to Sentara Norfolk General’s emergency room, the EVMS Acute Care Surgery service has established relationships with several freestanding emergency rooms throughout Hampton Roads and on the Eastern Shore. The smaller community hospitals in the area often refer their patients with complicated medical problems – such as smokers with COPD, a history of multiple heart attacks, pulmonary emboli or transplants – to ACS as well, recognizing the experience of surgeons who work in a tertiary care hospital. That experience is vast and comprehensive: with referrals from virtually every physician, hospital system and private practice in the community, the surgeons of Acute Care Surgery at EVMS evaluate as many as 1,200 patients every year. EVMS Brickhouse Professor and Chair of Surgery LD Britt, MD, MPH, author of the name “Acute Care Surgery”, served as Editor-in-Chief for the first textbook on the subject, Acute Care Surgery Principles and Practice, and later was the senior editor for the second textbook, Acute Care Surgery. The follow-up edition is currently in progress.
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it will pass. But when symptoms don’t resolve, these patients arrive at the emergency room with fever, weakness, dizziness, hyperventilation and, by that time, often in need of urgent medical care. “When they come to Sentara Norfolk General,” Dr. Collins says, “they undergo an exam and are given blood tests, x-rays, CT scans if needed, and we are immediately contacted by the ER physicians. Any time of the day or night, one of us is on site, ready to examine and evaluate these patients, and if necessary, take them to the operating room without delay to correct their problems.” Fortunately, not everyone who is seen by ACS requires surgery immediately. It’s as important to know when to operate as it is to know when not to, Dr. Collins emphasizes. In some instances, with very complicated cases, e.g., a patient with a cardiac or lung diseases who presents with appendicitis, the surgeons may choose to administer antibiotics initially and then monitor the patient carefully. ACS surgeons may consult with the patient’s specialist(s), but if during the course of treatment the patient worsens, it is the ACS surgeons, who have been continuously watching the patient, who make the determination that the time has come for surgery. When they do need surgery, one of the benefits for patients of Acute Care Surgery is that they remain under the direct care of these five surgeons throughout their entire hospitalization. Some of
Spring 2016 Hampton Roads Physician | 33
MENTAL HEALTH SERVICES IN VIRGINIA
Where Are We Now
By Bonnie P. Lane, Attorney at Law Goodman Allen Donnelly PLLC
he sufficiency of Virginia’s behavioral health laws has been thrust into the spotlight due to two tragic events: the shooting at Virginia Tech in 2007, and the November 2013 attack on Senator Creigh Deeds by his mentally ill son. The Senator’s son was sent home after a psychiatric bed was unable to be located; he subsequently attacked his father and then committed suicide. The Legislature responded to the demands for substantial changes to the existing structure of the mental health system to include some positive changes to the laws regarding emergency custody orders (ECO) and temporary detention orders (TDO). Currently, the time period in which a person can be held under an ECO extends to eight hours. Each person taken into emergency custody receives a written summary of the emergency custody procedures and the statutory protections associated with those procedures. Additionally, patients brought to hospitals under an ECO who also qualify for a TDO no longer can be released when the ECO expires simply because a facility cannot be located. The state psychiatric facility in the region where the patient is located is the TDO facility of last resort and the patient must be admitted there if no other facility can be located to accept the patient. The time period for holding PATIENTS under a TDO has also been extended from 48 to 72 hours before THEY MUST BE discharged or ATTEND an involuntary commitment hearing. A statewide web-based psychiatric bed registry has been created to help locate available beds. These changes come as an effort to reduce the number of individuals at risk of causing harm to either themselves or others, and who are in need of hospitalization or medical treatment from being released without getting the help they need. In many instances, this can lead to those individuals committing serious offenses and ending up in the criminal justice system. In 2015, 25.29 percent of the female Virginia inmate population, and 13.63 percent of the male population, was diagnosed as mentally ill. 46.82 percent of the mentally ill population and 7.87 percent of the general population were diagnosed with a serious mental illness. 34 | www.hrphysician.com
The Center for Behavioral Health and Justice has been established to achieve greater behavioral health and justice coordination across public and private sectors. There is no state-funded mental health treatment program operating within jails, and private contractors provide the most significant portion of mental health treatment in jails. Community Service Boards only have a statutory requirement to evaluate inmates for whom a TDO is being sought, with no obligation to provide treatment. The Department of Behavioral Health Developmental Services has waiting lists for individuals coming from jails. The Legislature continues to work to improve the system. The Center for Behavioral Health and Justice has been established to achieve greater behavioral health and justice coordination across public and private sectors. Joint Subcommittees and task forces are also working to institute additional statutory and regulatory changes, hopefully in the near future.
Bonnie P. Lane is an attorney at the Norfolk office of Goodman Allen Donnelly PLLC, and focuses her practice primarily on medical malpractice defense litigation and healthcare issues. www.goodmanallen.com
MINDFULNESS as a Treatment for Chronic Pain By F. Cal Robinson, PsyD
he rigors of contemporary life have left scores of people unwell in mind and body. For many, modern medical and psychological treatments haven’t satisfactorily addressed their need for health, peace and well-being. Thus, we’re witnessing a return to ancient and tested practices, including holistic health care, plant-based diets, naturopathic medications, meditation and mindfulness. Mindfulness has been featured in the news lately, on TV, radio talk shows and magazines, and social media. What is it that’s generating so much buzz? How are business leaders using mindfulness to improve the lives of those with whom they interact, as well as to sharpen their own focus, leadership and relationship in the marketplace? Why are physicians and psychologists recommending it for their patients as an effective adjunct/alternative to medications or surgery? For starters, it works and the proven results are based on sound science. It’s an effective treatment methodology for any number of behavioral health issues – anxiety, restlessness, depression, OCD, substance abuse and eating disorders. It’s shown to relieve stress, lower blood pressure, treat heart disease, lessen chronic pain, improve sleep and help with gastrointestinal issues. In business, those who practice mindfulness see an improvement in focus, concentration, problem-solving and conflict resolution ability. Overall, it contributes to improved life quality by decreasing worry and stress over the “what-ifs”. Mindfulness is the practice of focusing attention on the “now,” or the present, with purpose and non-judgmental acceptance. Thoughts and feelings are allowed to wash over a person’s consciousness freely, but without the nagging reminders or value judgments we tend to assign to each thought. Most wisdom traditions have a prayer or meditative component for a reason, and mindfulness is a reflection of that; it slows the mind and allows peaceful focus and contemplation on the larger issues of life. I use mindfulness to treat many cognitive issues, but my main focus is patients with chronic, intractable pain, most of whom spend a majority of time trying to either avoid, discount or alleviate their pain. This leads to a life unfulfilled, as pain becomes the sole focus. Patients may ignore family, friends, work and their values as they search for relief. They may seek stronger medications and substances or undergo multiple surgeries to make the pain go away. It can be a horrible existence. Mindfulness training can help by getting the patient to focus on the pain and accept it as a part of life, rather than wasting energy avoiding it. This doesn’t mean resigning oneself to pain. Rather, it means being with the pain and ending the struggle with it. By harnessing its natural healing power, we “re-train” the brain through mindfulness meditation. Meditation practices are shown to smooth the brain patterns of those with chronic pain.
Over time, this reduction becomes hard-wired, resulting in less experienced pain. Clinical trials have shown a pain reduction of 57 percent by those who practice; very skilled meditators can reduce pain around 90 percent. I am profoundly amazed at the capacity our brains have for learning and adapting to pain. The results I see in my own practice are gratifying for me and life-changing for my patients.
Dr. Robinson is a Board certified medical psychologist. He joined Orthopaedic & Spine Center in August 2015. Dr. Robinson received his Doctor of Psychology from the Forest Institute of Professional Psychology. osc-ortho.com
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Spring 2016 Hampton Roads Physician | 35
STRATEGIES TO MAINTAIN A SMALL, INDEPENDENT PRACTICE
Are they real? And do they work? By Christopher L. Graff, JD, CPA
maller independent practices, consisting of only a few physicians, are increasingly rare. In today’s healthcare environment, sub-specialist physicians who have no or limited hospital duties tend to be more successful in maintaining their independence, e.g., ophthalmologists and dermatologists, as they are able to see large numbers of patients. Unfortunately, many other practices, particularly primary care practices like family medicine and internal medicine, often have more difficulty seeing the number of patients necessary to succeed in private practice. To achieve median compensation for their sub-specialties, primary care providers typically have to see 25 or more patients a day, which was difficult even before the advent of the ACA EHR requirements. Many small to mid-size practices have accumulated so much debt associated with meeting these requirements that the only way they have been able to survive was to become part of a larger group or to add a concierge component to their practices.
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Although the integration of the hospitalist model into many hospital systems has taken some pressure off smaller practices because their doctors no longer have to round in the hospitals, this model can cut both ways. Many physicians, especially those who have grown up participating in a call rotation, find it difficult to back away from the hospital environment. They tend to lose a lot of collegiality with other physicians; they feel stuck in the office; and they are often dissatisfied having to deal with the pressure of getting their numbers up. More often than not, though, private practices tend to find it more profitable not to be in the hospital. The physicians who make that choice often end up spending more time with their families, developing their hobbies, and getting more sleep (see our cover story for the importance of that!). They also tend to make as much, or more, money – I have yet to have any clients who left the hospital and did not end up doing better on their own from a financial standpoint. However, leaving the hospital is still a big adjustment. Physicians will generally have to see more patients, and if that option is not palatable to them, non-physician providers can contribute to a successful outpatient practice. If physician owners can comfortably add non-physician providers (“NPPs”) without believing that they need to micromanage them, NPPs
can bring in additional revenue and allow the physician owners to either maintain their existing practice at their traditional pace and/or allow the physician owners to become even more efficient with their practice as a whole. To survive in today’s environment, physicians need to be creative and learn to rely on others to maintain and to grow their practices. Although selling out to a larger group or to a hospital system seems like an easy way out from a financial perspective, the lack of control over a physician’s practice can prove to be a greater cost to the more entrepreneurial-minded physician than the financial security generally associated with these larger, more corporate-minded healthcare systems.
Christopher L. Graff, JD, CPA has worked for The Medical Management Consulting Group, Inc. since 1994, received his bachelor’s degree from the College of William and Mary in 1991, received his law degree from Widener University School of Law in 1994, is licensed in VA and PA, and became a CPA in 2000. mmcgonline.com
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Spring 2016 Hampton Roads Physician | 37
COMPANION DIAGNOSTICS and COLORECTAL
CANCER By Michael Schwartz, MD
he goal of personalizing cancer treatments by targeting molecular alterations in tumors has seen rapid advances in the past 20 years. Knowledge of the mechanisms associated with cancer initiation and progression has recently improved with the increasing use of molecular techniques, enabling identification of alterations in cancer cells and subsequent development of therapeutic agents targeting these alterations. Central to the drive for personalized medicine is the need to develop specific diagnostic tests that facilitate identification of patients who are most likely to respond to a given treatment. Such tests have been referred to as â€œcompanion diagnosticsâ€? (CDx), and can play an essential role in outcome prediction as well as therapy monitoring. The lifetime risk for colorectal carcinoma (CRC) is about five percent in developed countries. New molecular testing
Companion diagnostics are continuing to evolve in CRC, where they are becoming an essential tool for selecting the most appropriate personalized therapeutic treatment.
guidelines are currently being developed. Per the draft guideline, all patients with CRC being considered for treatment with the EGFR inhibitors cetuximab and panitumumab should undergo extended RAS mutational testing to predict their response to the drugs. The draft guideline calls for extended mutational analysis that includes KRAS and NRAS codons 12 and 13 of exon 2, codons 59 and 61 of exon 3, and codons 117 and 146 of exon 4. Studies have shown that patients who had mutations in KRAS exons 2, 3 and 4 and in NRAS exon 2 and 3 do not benefit from anti-EGFR therapy and could suffer from those agents. The guidelines are expected to recommend BRAF V600 mutation analysis in conjunction with deficient DNA mismatch repair/ microsatellite instability (dMMR/MSI) testing for patients with metastatic colorectal carcinoma, and dMMR/MSI testing in all patients for prognostic stratification and identification of Lynch syndrome. The final guideline should be published in the near future. For CRCs, TNM stage remains the best predictor of survival after resection and the key determinant of patient management. Nevertheless, stage-independent variability in clinical outcome is sometimes observed and likely due to molecular heterogeneity. This is particularly important in early stage CRC where patients can be potentially cured by surgery alone, and only a proportion derive benefit from adjuvant chemotherapy. For these patients, identification of prognostic molecular markers to supplement conventional staging can change management and outcomes. For example, CRCs with dMMR and MSI have a better stageadjusted survival compared to proficient MMR or microsatellite stable tumors. In addition, most studies indicate that patients
Taking Nominations for the Summer 2016 edition We are looking for physician leaders who specialize in
DERMATOLOGY Deadline for Nomination Submissions
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Nomination forms are available on www.hrphysician.com (click nominate tab) or by emailing a request to firstname.lastname@example.org
associated with a lower rate of five-year disease-free survival than CDX2 positive tumors. Furthermore, the rate of five-year diseasefree survival was higher among patients with stage II CDX2negative tumors who were treated with adjuvant chemotherapy than among patients who were not treated with adjuvant chemotherapy. Companion diagnostics are continuing to evolve in CRC, where they are becoming an essential tool for selecting the most appropriate personalized therapeutic treatment. ď€ź
Immunohistochemical staining patterns of MSI tumout. (A) H&E of tumor. (B) Strong positive internal control of normal glandular epithelium. (C) Negative staining for MLH1. We emphasise the importance of a positive internal control (stromal cells and lymphocytes). (D) Positive immunohistochemical staining for MSH2 with nuclear staining in both tumput and stromal cells.
with stage II dMMR CRCs do not benefit from 5FU based chemotherapy and can be treated by surgery alone. A recent article (N Engl J Med 2016;374:211-222) identified a subgroup of patients with stage II colon cancer who appeared to benefit from adjuvant chemotherapy. In this study, those whose CRC lacked nuclear expression of CDX2 (a master regulator of intestinal development) by immunohistochemistry were
Dr. Schwartz attended medical school at SUNY Upstate Medical University in Syracuse, NY and completed his residency in combined Anatomic and Clinical Pathology at the University of Pittsburgh Medical Center where he was Chief Resident and later a staff pathologist. He is a member of Peninsula Pathology Associates and works at Riverside Regional Medical Center in Newport News. ppapathology.com
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Spring 2016 Hampton Roads Physician | 39
By Lori Sprott, ACE-CPT
t’s no secret that exercise is important for maintaining health and wellness, regardless of age. The National Institute on Aging has published its Exercise & Physical Activity guide, highlighting what staying active means and the benefits of continuing to move. Physical activity for older adults, according to the Institute, can range from running and playing sports to comfortable walks to doing household chores, depending on their health and current fitness level. For people who have been athletic much of their lives, finding themselves ‘aging athletes’ can feel like facing the end of the activities they love, and that often leads older adults to untie their running shoes or hiking boots permanently, when things feel too painful or strenuous.
40 | www.hrphysician.com
According to the President’s Council on Fitness, Sports & Nutrition, only 35-44 percent of adults 75 years or older are physically active, while only 28-34 percent of adults ages 65-75 remain active. There are a number of reasons why; most commonly arthritis creeps in, making once fun activities like golf, tennis, walking or running uncomfortable. But there are ways to tackle these issues, starting with attacking the problem before it grows. A surprising factor that can contribute to arthritis pain is loss of balance. As patients compensate for pain, balance and ambulation can be affected, which often only brings more pain, instability, and uncertainty. This gradual shift may be subtle and go unnoticed. A physical therapist or personal trainer can perform functional movement screening to assess instabilities, balance issues and areas of discomfort. How patients perform in unilateral and balance exercise screenings can reveal a lot about the stability of their hips, ankles, knees, shoulders, elbows and wrists. Patients often seek treatment for knee pain, but assessment reveals the cause of the discomfort to be an altered gait from hip instability. Crafting appropriate exercises and therapies to strengthen those areas can improve the form of the movement and slowly help patients rebuild their comfort and confidence. There are several non-invasive exercises and therapies to help improve balance, motor skills, and muscle tone in areas that have become painful or unstable due to aging. Strength training, balance work, conditioning, cardio aerobic training and refining fine motor skill reactions go a long way to helping older patients reach their athletic goals. Such training should be tailored to patients’ health, specific problems, goals for activity and fitness level. Not all older adults will be able to continue running 5K races, while others will. For some, the goal will be to walk comfortably around the neighborhood or safely play with grandchildren. Others will shoot to return to golf or tennis. Slowing down is part of aging, but it needn’t mean the end of an active life. The most important thing older adults can do is stay on top of those early aches, pains, and stiff joints. It’s important to take action early to avoid having to give up favorite activities, whether running, walking, swimming or playing golf.
According to the President’s Council on Fitness, Sports & Nutrition, only 35-44 percent of adults 75 years or older are physically active, while only 28-34 percent of adults ages 65-75 remain active.
Lori Sprott joined Tidewater Performance, a division of Tidewater Physical Therapy, in 2011. She earned a BS in Exercise Science from Virginia Tech. She is a certified Ace personal trainer, and a certified USA swim coach. tpti.com
Increasing Patient Engagement in Your Practice
any patients want to be involved in managing their health care. Empowering patients to schedule their own appointments and manage correspondence, refills, and prior authorizations can lead to higher levels of patient engagement and satisfaction. Patient engagement initiatives have been found to reduce hospital visits, decrease morbidity and mortality rates, improve treatment adherence, and reduce costs. How can your practice attain higher levels of patient engagement? The answer lies in how your practice incorporates technology into its day-to-day operations. Technology can play a major role in helping medical practices improve patient engagement levels.
Off-site Monitoring Devices that allow patients to monitor information related to their medical conditions and relay the data electronically can foster greater understanding among patients about how lifestyle decisions impact their health. Engaged patients may be more likely to comply with medical treatments.
Technology Is Key Incorporating a technology-based infrastructure to handle David M. Limroth, CPA R. Paul Speece, CPA Nicole J. Wood-Sabo, CPA, MS a variety of typically labor-intensive tasks can help increase Copyright 2015 by DST. All rights reserved. patient engagement. Not every patient will respond favorably The general information in this publication is not intended to be nor to conducting health care interactions online, but patients should it be treated as tax, legal, or accounting advice. Additional issues could exist that would affect the tax treatment of a specific who are already comfortable with technology will likely transaction and, therefore, taxpayers should seek advice from an embrace the opportunity. Areas where utilizing technology independent tax advisor based on their particular circumstances may be beneficial include: before acting on any information presented. This information is not intended to be nor can it be used by any taxpayer for the purpose of Online scheduling. Appointment cancellations can impact avoiding tax penalties both a practice’s schedule and its revenues. Giving patients the convenience of scheduling their own appointments online may lead to lower no-show rates. Check-in. Allowing patients to use kiosks or tablet computers to enter 757.627.2624 SanitaryLinen.com personal information and other relevant data before their scheduled appointment can help expedite and streamline the check-in process and increase efficiency levels throughout the practice. Providing first class healthcare textile rental services to Online care. Many time-consuming Hampton Roads. Mention this ad for an exclusive service offer. routine interactions, such as data collection, can be performed more efficiently online. Portals designed to allow patients to view test results and ask questions related to their care save time and increase patient satisfaction levels. Your Local Linen, Mat & Uniform Rental Service
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Spring 2016 Hampton Roads Physician | 41
A NEW AGE IN ONCOLOGY CARE… …antibodies are allowing the immune system to destroy cancer cells. By Paul Conkling, MD Virginia Oncology Associates
n March 6th, President Jimmy Carter stood before one of the Sunday school classes he teaches in Plains, Georgia, and shared a remarkable piece of information. He announced that he no longer needed treatment for cancer – less than seven months after revealing he had been diagnosed with melanoma that had metastasized to his brain. For oncologists, the news was less of a surprise than a confirmation. The President had been treated for his
aggressive cancer with a new drug, pembrolizimab (Keytruda), which was approved not long before his diagnosis. Pembrolizimab is an example of a group of new therapies – checkpoint inhibitors, or antibodies that modulate the immune system, allowing the immune system to do a better job of finding and killing cancer cells. We’ve known for at least 25 years that certain cells in the immune system (T cells) have the ability to infiltrate into tumors and kill cancer cells. These T cells develop receptors
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We’ve known for at least 25 years that certain cells in the immune system (T cells) have the ability to infiltrate into tumors and kill cancer cells. that are unique to the particular cancer cell; they attach to the cancer cell and literally punch a hole in the cell, killing it. However, while the process has worked well in the test tube, that success hasn’t translated to human beings in real time – until now. In the last five or six years, because of improved molecular genetic techniques, we have a better understanding of why it hasn’t worked: it’s because of a set of proteins called PD-1 and PDL-1, which work together to protect or hide the tumor cell from the T cell, so the cancer cell has in effect masked itself from the normal immune system, preventing the T cells from entering and killing the tumor cell. There are now a number of pharmaceutical companies that are producing a variety of anti-PD-1 and anti-PDL-1 antibodies. We’re using these therapies every day now, some as part of clinical trials, and some commercially. Two of these antibodies are currently approved by the FDA: pembrolizimab, which President Carter used, and nivolumab (Opdivo.) The FDA approval is for just three diseases: non-small cell lung cancer, metastatic melanoma and renal cell carcinoma. It’s very likely, however, that these two drugs will soon be approved to treat cancer of the urinary bladder, squamous cell carcinoma of the larynx or tongue, stomach and esophageal cancers, triple negative breast cancer and ovarian cancer. A word of caution: these therapies, while more effective than anything we’ve seen for the last few decades, don’t work for everyone. But when they do, they produce very dramatic responses – and from what we’ve observed, very durable, long-term responses. We are at the dawn of a new age in oncology care, with so many new avenues of treatment being developed, giving us new ways to treat disease. It’s a very exciting time.
Paul Conkling, MD is a graduate of Dartmouth College and the Ohio State University College of Medicine. He is involved in Hematology/Oncology research and currently serves as the coordinator for the Clinical Oncology Research Program at Sentara Hospitals in Norfolk, Virginia. He is a consulting associate for the Department of Medicine at Duke University, as well as a Clinical Assistant Professor at Eastern Virginia Medical School. virginiacancer.com
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Spring 2016 Hampton Roads Physician | 43
WHY CONVENTIONAL LAPAROSCOPIC SURGERY IS BECOMING OBSOLETE…
…and why it should.
By Charles P Williams, MD, FACS, Bon Secours Surgical Specialists
hen laparoscopic surgery was introduced more than 25 years ago, it was heralded as a major advancement in the field of patient care. With video camera assistance and thin instrumentation, surgeons could perform certain procedures with incisions of no more than half an inch, rather than the much larger incisions required in open procedures. It marked a definite change in the way surgery was performed, promising patients far less post-operative pain, shorter hospitalizations, much quicker recovery time, and an earlier return to daily life. Today, in more and more operating suites in major medical centers, conventional laparoscopic surgery is becoming a thing of the past. The reasons are simple: robotic assisted laparoscopic
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surgery affords the surgeon far greater visualization of the surgical field, and the improved instrumentation available for use in robotic procedures provides a nearly 360-degree range of motion that the surgeon cannot achieve with standard laparoscopic instruments. The higher resolution of images and the flexion, extension and rotation of these instruments makes a huge difference when we’re dissecting. The advantages to our patients are obvious: with improved visualization, especially in cases where there’s a lot of scarring and adhesions, the ability to move the instruments where we need them to go significantly reduces the need to have to resort to an open procedure in midsurgery. We can reduce the risk of some of the morbidities that occur in surgery, such as seromas and hematomas, or injury to surrounding organs and vessels, because we can visualize the finer structures better, allowing us greater opportunity to keep them out of the surgical field. We can more easily visualize the vessels properly in a dissection versus cutting through them and discovering later that the vessel was retracted and started to bleed. There are advantages to the surgeon, as well. We’re no longer at the bedside, having to contort and twist into some unnatural positions to get the cases completed; rather, we’re sitting in a comfortable and more ergonomically appropriate position at a console. There’s far less wear and tear on the surgeon’s body, improving our ability to focus on the very delicate work we’re doing. We can work smarter, and therefore work a little more, without the fatigue that besets a standing and twisting surgeon – especially one who’s doing cases back to back, all day long. General surgeons and specialists alike recognize that the robot is a helpful tool. The systems and the platform continue to advance, resulting in greatly improved capabilities. One of the most exciting recent advances, especially for colon resection cases, bariatric and pancreatic surgeries, is the ability of the newer robotic devices to staple. It’s a much needed development for these very difficult cases. Unfortunately, in most places (here and elsewhere), what’s lagging behind
is the availability of the technology. We have surgeons lined up who want to use system because they recognize its profound benefits. Essentially, any surgery that can be performed laparoscopically can be done better and quicker by using the robotic system.
Dr. Charles P. Williams is a Board certified general surgeon with Bon Secours Surgical Specialists. He is a graduate of the University of North Carolina Chapel Hill School of Medicine. bshr.com
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Spectacular waterfront peninsula in Tabb school district. Pier, screened porch & privacy due to location at the end of lane.
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Spring 2016 Hampton Roads Physician | 45
IN THE NEWS
Dr. Richard Campana
American Addiction Treatment Center has opened a new location in Williamsburg. Locally owned and operated, AATC offers outpatient opioid treatment programs, specializing in the use of methadone and buprenorphine to interrupt the withdrawal syndrome of opioid dependent patients, utilizing a combined approach of individual and group counseling for patients suffering from addiction.
Bon Secours Mary Immaculate has opened two newly renovated surgical operating suites. With the help of community volunteers and business leaders with the Bon Secours Mary Immaculate Foundation, funds were raised for a video taping system that will allow other physicians to learn about the innovative procedures done at the hospital.
Bon Secours DePaul Medical Center’s Bariatric Surgical Center has been accredited as a Comprehensive Center under the Gregory F. Adams, MD, FACS Elizabeth Z. Barrett, MD, FACS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), a joint program of the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS). Bariatric surgeons Gregory F. Adams, MD, FACS, and Elizabeth Z. Barrett, MD, FACS have been designated verified surgeons by the ASMBS. The accredited center offers preoperative and postoperative care designed specifically for their severely obese patients. Bon Secours DePaul Medical Center in Norfolk and Bon Secours Mary Immaculate Hospital in Newport News have both achieved the Pathway to Excellence® designation by the American Nurses Credentialing Center (ANCC). To earn the distinction, organizations must successfully undergo a review process that documents foundational quality initiatives in creating a positive work environment, as defined by nurses and supported by research. These initiatives must be present in the facility’s practices, policies, and culture.
(L-R) Ann Andrews, Abbitt Realty; Bruce LaLonde, Bon Secours Mary Immaculate Foundation; Brian Gillette, Gillette Law Group; Darlene Stephenson, CEO, Bon Secours Mary Immaculate; Anthony Carter, MD, Orthopedic Surgeon with Hampton Roads Orthopedics and Sports Medicine; Scott Hurley, Bon Secours Hampton Roads Foundations; Ann Boorey, community volunteer; Lindsey Carney with Patten, Wornom, Hatten and Diamonstein, LC; and Nicole Talton, EVB.
Bon Secours DePaul Medical Center has added the da Vinci® Xi Surgical System to Surgical Robotics Capabilities. This next-generation robotic surgical system can be used across a wide spectrum of minimally invasive surgical procedures and has been optimized for highly complex, multi-quadrant surgeries. Seventeen surgeons are trained to provide Hampton Roads residents with more minimally invasive surgery options.
(L-R) Robert Squatrito, MD; Cherronte Princeton, CSA; Leah Gonzales, RN; Emily Thomson, DO; Saundra Digiovanni, RN; Mary Burns, MD; June Hill, RN; Raymond McCue, MD; Yassar Youssef, MD; Shirley Jones, Ted Hughes, MD; Heather Cummings, Michael Swins, ORT; Jonathan Wertz, and Shaun Wason, MD
46 | www.hrphysician.com
Scott Hurley, DMin, CFRE
Scott Hurley, DMin, CFRE has joined Bon Secours Hampton Roads Foundations as the new Vice President. Hurley has served in non-profit leadership positions for more than 30 years, most recently for the Christian Broadcasting Network. Hurley has also worked as a licensed nursing home administrator and has served as a national leader with Global Prayer Harvest.
David Wright, captain of the National League Champion New York Mets
Hometown hero David Wright, captain of the National League Champion New York Mets, hosted the sixth annual Vegas-style charity event for Children’s Hospital of The King’s Daughters on Friday, January 22, at the Virginia Beach Convention Center. Nearly 400 supporters raised a record $201,000 for CHKD, with Metal Tech as the title sponsor. Funds from past events have been used to renovate the hospital playroom and provide critical support for patient care.
The CHKD Center for Pediatric Sleep Medicine at the CHKD Health Center at Oakbrooke received program accreditation from the American Academy of Sleep Medicine (AASM). This accreditation is in addition to the previous accreditations earned by the Center for Pediatric Sleep Medicine locations at CHKD Health Center at Oyster Point in Newport News, and at the main hospital in Norfolk.
Hampton Roads Orthopaedics & Sports Medicine announces the launch of the Stem Cell Therapy Center located in Newport News. Drs. Jeremy Hoff and Kinjal Sohagia now offer state-of-theart regenerative medicine and stem cell therapies including Adipose Stem Cell Therapy and Platelet-Rich Plasma Therapy, providing many patients an alternative to invasive surgery.
Dr. Kinjal Sohagia and Dr. Jeremy Hoff
Children’s Hospital of The King’s Daughters opened the region’s second urgent care center exclusively for infants, children and teens on Wednesday, March 16th in Virginia Beach. The facility is home to several other signature services, including sports medicine; physical, occupational and speech therapy, X-ray services and lab services. EVMS scientists and scientists from the University of Arizona have deciphered the workings of a protein that plays a key role in regulating human heartbeats, which could lead to treatment for a potentially deadly condition that affects more than six million Americans. Vitold Galkin, PhD, Assistant Professor of Physiological Sciences, and Howard White, PhD, Professor of Physiological Sciences, are studying cardiac myosin binding protein C (cMyBP-C). Mutations in that protein can lead to sudden cardiac death in young adults and hypertrophic cardiomyopathy in older adults. The team of researchers showed for the first time that one part of cMyBP-C likely activates the heart’s contraction, while a second similar part has the opposite effect. EVMS and Virginia Wesleyan have signed an admission agreement that provides an enhanced opportunity for VWC students to earn graduate degrees in eight EVMS master’s programs. The new EVMS Early Assurance Program gives admission preference to VWC students interested in pursuing advanced degrees in the fields of Physician Assistant, Surgical Assisting, Contemporary Human Anatomy, Laboratory Animal Science, Pathologist Assistant, Art Therapy, Biotechnology and Public Health.
TOGETHER: A BETTER WAY TO FIGHT CANCER.
At Virginia Oncology Associates, we know each cancer is unique and so is every patient we treat. Our team of experienced physicians and staff is dedicated to providing advanced care, innovative technology and personalized treatment options. Virginia Oncology Associates is an affiliate of The US Oncology Network, one of the largest cancer treatment and research networks in the country. This affiliation enables us to bring the expertise of nearly 1,000 physicians nationwide to the delivery of our patients’ care. PENNINSULA (757) 873-9400 Hampton Newport News Williamsburg
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VirginiaCancer.com The US Oncology Network is supported by McKesson Specialty Health. © 2015 McKesson Specialty Health. All rights reserved.
Spring 2016 Hampton Roads Physician | 47
IN THE NEWS Lake Taylor Transitional Care Hospital has been recognized by the American Association of Respiratory Care (AARC) as a Quality Respiratory Care Provider in long-term care for 2016, the first time skilled nursing facilities, longterm acute care hospitals, and other long-term care facilities have been eligible for QRCP recognition. The AARC program’s purpose is to help consumers make choices about their health care by identifying facilities that provide access to respiratory therapists to deliver their care. Huntington Ingalls Industries (HII) in partnership with QuadMed, opened the HII Family Health Center on March 1, outside the gates of Newport News Shipbuilding. The 22,000-squarefoot health center will offer eligible shipyard employees and their families access to primary care, radiology, physical therapy, laboratory services and a pharmacy. The QuadMed care model is based on the patient-centered medical home philosophy and emphasizes patientprovider relationships, wellness, prevention and patient accountability in order to build a culture of health and wellness.
Serving the Bracing and Prosthetic Needs of Hampton Roads
Erin Lee, PA-C, with Orthopaedic & Spine Center, has been nominated for the Leukemia & Lymphoma Society’s Woman of the Year 2016 award, for her tireless and dedicated fund-raising efforts on behalf of this organization.
Erin Lee, PA-C
Dr. F. Cal Robinson
OSC Medical Psychologist, Dr. F. Cal Robinson, is the first physician in the United States to offer the Mindfulness-Based Chronic Pain Management (MBCPM™) Program in May 2016. The program was developed by Dr. Jackie Garner-Nix, a chronic pain consultant at St. Michael’s Hospital in Toronto Canada and adjunct faculty in the Department of Anesthesiology at the University of Toronto. Jennifer Pagador, MD, Medical Director of Seriously Weight Loss, LLC, recently passed the Board Exams in Obesity Medicine. She is now a Board certified/diplomate of the American Board of Obesity Medicine.
757-673-2000 Jennifer Pagador, MD
211 Bulifants Blvd. Suite B Williamsburg, VA
11747 Jefferson Ave Suite 5A Newport News, VA
7578 Hospital Dr Suite B-106 Gloucester, VA
4057 Taylor Road Suite P Chesapeake, VA
Hours: Mon – Thurs 8 am – 4:30 pm • Fri 8 am – 2 pm 48 | www.hrphysician.com
Riverside Regional Medical Center has been awarded a three-year accreditation, with commendations, from the Commission on Cancer (CoC), a division of the American College of Surgeons. Through the CoC, Riverside’s cancer program has access to reporting tools to aid in benchmarking and improving outcomes at its three accredited cancer facilities, as well as educational and training opportunities, development resources, and advocacy. The survey commended Riverside’s cancer program in seven different standards, indicating that RRMC satisfied and
exceeded each standard: Clinical Trial Accrual, Cancer Registrar Education, Public Reporting of Outcomes, College of American Pathologists Protocols, Nursing Care, Rapid Quality Reporting System Participation, Data Submission/Accuracy.
Virginia Eye Consultants is now accepting nominations for Looking Forward…Giving Back. This is the third year Virginia Eye Consultants’ surgeons will provide charitable eye procedures to members of the Hampton Roads community who are uninsured, underinsured or financially unable to pay. These procedures include cataract surgery, LASIK surgery, corneal transplants, glaucoma surgery and other treatments for trauma. Patients are selected through a nomination process and nominations will be accepted through Sunday, May 15, 2016 at midnight. Submissions can be made at any of Virginia Eye Consultants’ five locations or online at www.virginiaeyeconsultants.com.
Urology of Virginia has announced the completion of the new Paul F. Schellhammer Cancer center. The PFSCC opened at the beginning of January in a new three-story building on the campus of its existing office. The new cancer center is spacious and welcoming and allows for more efficient patient care.
If you have News you would like to share with our readers in the Summer edition, please contact the publisher at 757-237-1106 or email: email@example.com Deadline for submissions is June 28th.
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WELCOME TO THE COMMUNITY
Uosife Alfahd, MD has joined Virginia Orthopaedic & Spine Specialists. Dr. Alfahd attended Al Arab Medical University. He completed a residency in orthopaedic surgery and a fellowship in orthopaedic trauma and limb reconstructive surgery at University of Toronto. He is a member of the American Academy of Orthopaedic Surgery and serves as part of Libyan Doctors Relief in partnership with WAFA Relief and Doctors Without Borders. Jason Andre, MD, a Board certified general surgeon, has joined Bon Secours Vein and Vascular Specialists. Dr. Andre received his medical degree from Howard University College of Medicine in Washington, DC and completed his general surgery residency at Albert Einstein Medical Center in Philadelphia, PA. He also completed a fellowship in vascular surgery at Southern Illinois University School of Medicine. Dr. Andre is a member of the Society for Clinical Vascular Surgery, the Society of Vascular Surgery and St. John’s Hospital Clinical Performance Committee.
Stephen C. Brawley, PhD, MD has joined EVMS Portsmouth Family Medicine. Dr. Brawley relocated to Hampton Roads after recently retiring from the United States Navy where he was honored with Three Navy Commendation Medals and Two Navy Achievement Medals. A graduate of the US Naval Academy, Dr. Brawley received his medical degree from the University of Texas, Southwestern Medical School in Dallas Texas. He completed a family medicine residency at the Naval Hospital in Camp Lejeune, NC and a fellowship in Family Medicine Faculty Development at UNC in Chapel Hill, NC. Dr. Brawley received a PhD in Aeronautics at the Naval Post Graduate School in Monterey, CA as well as receiving the Admiral Wilkinson Fellowship Award in Aerospace at NASA Ames – Stanford, CA. Leila Bumanglag, MD has joined DePaul Medical Associates. Dr. Bumanglag is an internal medicine physician specializing in providing primary care to adults. She is a member of the American Medical Association and the American College of Physicians. Dr. Bumanglag received her medical degree from Far Eastern University in Quezon City, Philippines and completed her residency at Albert Einstein College of Medicine with Montefiore New Rochelle Hospital in New York.
More than 40 million Americans suffer from chronic sleep disorders every night. Many don’t even know it.
Whoever Said Counting Sheep Helps You Sleep
Should Be Put Out To Pasture. 50 CRH-011-16-sheepad_final.indd | www.hrphysician.com 1
You know a good night’s sleep is essential to good health. If your patients aren’t sleeping well at night, send them to Chesapeake Regional Healthcare for a sleep study. We’ll handle the rest. • The Sleep Centers at Chesapeake Regional Healthcare are fully accredited by the American Academy of Sleep Medicine. • We also have all of the necessary equipment for pediatric sleep studies and provide accommodations for parents to stay the night with their child. • For your convenience, appointments can be made in Chesapeake or at our Elizabeth City Sleep Center.
800 Battlefield Boulevard, North Chesapeake, VA 23320 • 757-312-6565 chesapeakeregional.com/sleep
1/15/16 9:49 AM
Catherine Davies, DO has joined Riverside Norge Internal Medicine and Pediatrics Center, following her completion of the VCU-Riverside Family Medicine Residency Program at Riverside Regional Medical Center. She earned her medical degree from the University of New England College of Osteopathic Medicine in Biddeford, Maine and is Board certified by the American Board of Family Medicine. Samantha Dewundara, MD, a glaucoma specialist and cataract surgeon, has joined Virginia Eye Consultants. Dr. Dewundara received her medical degree from the Wayne State University School of Medicine in Detroit, Michigan and completed an internship at St. John Hospital and Medical Center. She completed her ophthalmology residency at the Kresge Eye Institute in Detroit, and a glaucoma fellowship at Harvard Medical School at the Massachusetts Ear and Eye Infirmary. Nadege Gunn, MD, a Board certified gastroenterologist, has joined the Liver Institute of Virginia, part of the Bon Secours Hampton Roads Health System. A graduate of University of Florida Medical School, Dr. Gunn completed her internal medicine residency at Greenville Hospital System in South Carolina, and a fellowship in gastroenterology and hepatology at the San Antonio Military Medical Center in Texas. While serving in the United States Air Force, she earned the rank of Major and served as Chief of Gastroenterology at Elgin AFB in Florida.
Krystle Lappinen, MD has joined The Center for Womenâ€™s Health. Dr. Lappinen attended Eastern Virginia Medical School and completed her residency in obstetrics and gynecology at West Penn Allegheny Health System in Pittsburgh, Pennsylvania.
Claude Louis, MD has joined Riverside Mercury West. Dr. Louis earned his medical degree from Universite Notre Dame dâ€™Haiti in Port-au-Prince, Haiti. He completed his residency training at the Kansas University Medical Center, and is Board certified by the American Board of Family Medicine.
Jennifer Miles-Thomas, MD has rejoined the Williamsburg office of Urology of Virginia. She earned her medical degree from Northwestern University Feinberg School of Medicine, and served her general surgery internship at The Johns Hopkins Hospital, where she also completed her urology residency and fellowships in Female Urology and Endourology at The James Buchanan Brady Urological Institute.
James Henick, MD, a Board certified anesthesiologist and pain management physician, has joined Bon Secours Neuroscience Center for Pain Management. Dr. Henick received his medical degree from Tufts University in Boston, where he also completed his residency in anesthesiology. He also completed a fellowship in pain management at University of Virginia. He is a member of the American Society of Interventional Pain Physicians, American Society of Anesthesiologists and the International Anesthesia Research Society. He has served as a professor at the Uniformed Services University of the Health Sciences as well as a clinical instructor at the Air Force Institute of Technology. Joshua Langston, MD has joined Urology of Virginia. Dr. Langston completed medical school at the University of Texas Southwestern Medical School in Dallas, and did residency training at the University of North Carolina, Chapel Hill. He completed a fellowship in Andrology & Male Reconstructive Urology at the Institute of Urology in London, England.
Mellette PC serves the legal needs of health care clients so that they can focus on their primary mission of delivering high-quality patient care. Call Peter Mellette, Harrison Gibbs, Nathan Mortier, or Nicole Hartz for a consultation today.
(757) 259-9200 www.mellettepc.com
428 McLaws Circle, Suite 200, Williamsburg, VA 23185
Spring 2016 Hampton Roads Physician | 51
WELCOME TO THE COMMUNITY
Ranjana Mitra, MD has joined Sentara Medical Group as a hospitalist at Sentara Leigh Hospital. Dr. Mitra earned her medical degree from Royal College of Surgeons in Ireland. She completed her internal medicine residency at MedStar Franklin Square Medical Center and a general surgery residency at the University of Florida College of Medicine. She completed her internship at Our Lady of Lourdes Hospital in Ireland. M. Jawad Miran, DO has joined Chesapeake Regional Medical Group, a division of Chesapeake Regional Healthcare. Dr. Miran is board-certified in multiple specialties including obesity medicine, internal medicine and sleep medicine. Dr. Miran received his medical degree from the New York Institute of Technology at New York College of Osteopathic Medicine in Old Westbury, and completed a residency in internal medicine at the University of Medicine & Dentistry of New Jersey at Robert Wood Johnson University Hospital. He completed a sleep medicine fellowship at the New Jersey Neuroscience Institute at JFK Medical Center in Edison. Gary Zeevi, MD, FACC, FACP, has joined Sentara Medical Group at Sentara Cardiology Specialists in Norfolk. Dr. Zeevi completed his cardiac catheterization and interventional procedures fellowship at the Hospital of the University of Pennsylvania, where he also completed his cardiology fellowship and residency. Dr. Zeevi focuses on comprehensive, specialized care for patients suffering from any form of heart failure.
Dana Anaya, NP has joined the staff of Sentara Medical Group on the Sentara Surgery Specialists team at Sentara Leigh Hospital. Ms. Anaya earned her Masters in Nursing degree with an emphasis in Adult Gerontology from Virginia Commonwealth University.
Natalie Arnold, DNP has joined Sentara Medical Group at Sentara Family Medicine Physicians in Suffolk. She earned her Doctorate of Nursing Practice from Radford University.
52 | www.hrphysician.com
Tiffany Griffin, MPA, PA-C has joined the staff of Sentara Medical Group on the Sentara Vascular Specialists team at Sentara Norfolk General Hospital. She earned her Master of Physician Assistant Studies degree at Eastern Virginia Medical School.
Gabrielle Lanzetta, MSPAS RPA-C has joined Tidewater Orthopaedics Hand Center in November 2015, working with Board certified hand surgeons Dr. Campolattaro and Dr. Smerlis. She earned a Master of Science in Physician Assistant studies from Touro College and received the prestigious Maimonides Award. David Magnussen, PA-C has joined Atlantic Orthopaedic Specialists. He earned his Masters of Science Physician Assistant at Eastern Virginia Medical School and his Certificate of Added Qualification in Orthopaedic Surgery from the National Commission on Certification of Physicians Assistants. He will head the AOS OrthoNow after-hours clinic in Virginia Beach. Christine Ohlstein, NP has joined Sentara Medical Group with the Sentara Palliative Care Specialists team. She earned her Nursing Practitioner degree from Old Dominion University.
Teresa Patterson, FNP-C has joined Sentara Medical Group with the Sentara Hospital Medicine Physicians team at Sentara Virginia Beach General Hospital. Ms. Patterson earned her Master of Science in Nursing degree at Walden University.
Samantha Robertson, PA-C has joined the staff at Sentara Vascular Specialists. She earned her Physician Assistant degree at Lincoln Memorial University-DeBuck College of Osteopathic Medicine.
Demetra Tate, MPA, PA-C has joined the staff of Sentara Obici Hospital. Ms. Tate earned her Master of Physician Assistant Studies degree at Eastern Virginia Medical School.
OSC would like to welcome
Jasmie Swale, DPT
LaNeatra Hammond, LPTA.
Tidewater Physical Therapy would like to welcome Shaughanassee Williams, NP, a Nurse Practitioner and certified nurse midwife, has joined the staff at Western Branch OB/GYN in Chesapeake. She received her Master of Science in Nursing from Old Dominion University, and obtained her nurse midwifery certification from Shenandoah University in Winchester, Virginia. She is a member of the American College of Nurse Midwives, American Academy of Nurse Practitioners and Virginia Council of Nurse Practitioners.
Ryan Loberternos, PTA Battlefield
Richard Sieller, PT Gloucester Courthouse
Erin Silber, PT, DPT Ironbridge
Sabrina Letner, OTR/L, CHT, Redmill
Jon Antoine, PTA Williamsburg
Alyssa Brinkley, PTA Franklin
We would like to welcome your new physicians, NP’s and PA’s Please contact us at 757-237-1106 or email: firstname.lastname@example.org Deadline for submissions for the Summer edition is June 28th..
David M. Smith, MD
John C. Maddox, MD
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Why Choose PPA Pathologists? • Available to Consult with Physicians 24 Hours a Day, 365 Days a Year Theresa S. Emory, MD
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For a Complete List of Services, Please Visit: ppapathology.com email@example.com
Spring 2016 Hampton Roads Physician | 53
Celebrating the Accomplishments of Those Who have Received Major Honors J. Abbott Byrd, III, MD, FACS, FAAOS of Atlantic Orthopaedic Specialists has been selected to receive the Virginia Career Award on behalf of the Virginia Orthopaedic Society (VOS). This prestigious award recognizes Dr. Byrd’s major impact on practicing orthopaedic surgeons in the Commonwealth of Virginia, his noteworthy career achievements and service to his patients, and his enduring support of the Virginia Orthopaedic Society in its efforts to represent orthopaedic surgeons in the Commonwealth of Virginia. Dr. Byrd is known for his role in spinal implant development; he holds numerous patents on implant devices and developed Synergy Spinal Systems, which are distributed worldwide.
Alfred Abuhamad, MD, Mason C. Andrews Chair in Obstetrics and Gynecology, Professor and Chair of Obstetrics and Gynecology, and Vice Dean for Clinical Affairs at EVMS, has received a key award from the American Institute for Ultrasound in Medicine (AIUM). At the AIUM annual meeting in March in New York City, Dr. Abuhamad received the Joseph H. Holmes Clinical Pioneer Award in recognition of his career achievements in education, patient care and research. The award is presented annually to two individuals – one each from the clinical sciences and the basic sciences. Dr. Abuhamad is an internationally known expert in ultrasound.
Michael A. Campbell, MD, FAAOS, orthopaedic surgeon with Atlantic Orthopaedic Specialists, was honored by Inside Business as a Healthcare Hero for his contribution as a surgeon to improving health care. Dr. Campbell, subspecializing in Foot and Ankle Surgery, made history in 2015 when he performed a first of its kind procedure in the United States. He is a Healthcare Hero for the time he spent training on the new technology and then using it to greatly enhance the quality of life for his patient.
Jerry Nadler, MD, EVMS Vice Dean for Research and the Harry H. Mansbach Chair in Internal Medicine, has been named Virginia’s Outstanding Scientist for 2016. Governor Terry McAuliffe presented the award during a February 25th ceremony in Richmond. The prestigious recognition is part of the annual Virginia’s Outstanding STEM Awards, given by the Science Museum of Virginia. Dr. Nadler leads a team of researchers whose discoveries may lead to new treatments for the nearly 400 million people worldwide with diabetes and countless others who are pre-diabetic.
Abby Van Voorhees, MD, EVMS Chair of Dermatology, was honored by the American Academy of Dermatology with a Presidential Citation at its Academy’s Annual Meeting in Washington, DC, on March 3, 2016. Dr. Van Voorhees was chosen in recognition of her significant contributions and dedication to promoting excellence in psoriasis research. Over the past three decades, Dr. Van Voorhees has been active in clinical research in dermatology, particularly in issues related to the treatment of psoriasis, the most common autoimmune disease in the county.
54 | www.hrphysician.com
SAY “ YES”
TO LIFE WITHOUT LIMITS C ALL US TODAY TO SCHEDULE AN APPOINTMENT
Chesapeake | Suffolk | Belle Harbour
RONALD WEEKS :
Spinal Cord Stimulator
Because of SMOC, I’ve been able to “Say YES” to a lot of things, like going camping again and working in my workshop at home, that I couldn’t really do for a long time.
SMOC ANNOUNCES NEW CHESAPEAKE OFFICE OPENING IN 2016 The new location will accommodate orthopaedics, spine, pain management and physical therapy. Our new Chesapeake address is: 501 Discovery Drive, Chesapeake, VA 23320 | Located in the Oakbrooke Business & Technology Center
Bradley Prestidge, MD, MS radiation oncologist
MEET CANCERâ€™S WORST NIGHTMARE
Dr. Bradley Prestidge serves as the Bon Secours Cancer Instituteâ€™s regional medical director for radiation oncology. A world-renowned radiation oncologist with more than 24 years of experience, Dr. Prestidge is known for his expertise in brachytherapy for the treatment of breast, prostate, cervical and other cancers. Dr. Prestidge uses advanced treatment options to precisely target cancer, preserving healthy cells in the process. To learn more about how Dr. Prestidge can revolutionize cancer treatment for your patients, call 757-278-2200 or visit bshr.com/cancer. Bon Secours Oncology Specialists 155 Kingsley Lane, Suite 100 Norfolk, VA 23505
D E PAU L | M A RYV I EW | H A R BOU R V I EW
Published four times a year, Hampton Roads Physician provides a wide variety of the most current, accurate and useful information busy docto...
Published on Apr 21, 2016
Published four times a year, Hampton Roads Physician provides a wide variety of the most current, accurate and useful information busy docto...