A p r i l / M ay 2 0 12
Carteret General Hospital Robotic Arm Technology for Joint Replacement
T H E MA G A Z I N E F O R H E AL T H C AR E PR O F E S S I O N AL S
Also in This Issue Acute Pancreatitis Marketing Missteps
R A L E I G H , N C • M AY 5 , 2 0 1 2
Walking to raise funds for research to ﬁnd treatments and a cure for neuroﬁbromatosis (NF)
Saturday, May 5, 2012 8:00 AM - Check in/Registration
9:00 AM - Welcome, Group Picture, Walk Begins
LOCATION Lake Benson Park 921 Buffalo Rd., Garner, NC, 27529 REGISTRATION
Register online at: http://www.nfwalk.org Have any questions? Contact Heather Wray at firstname.lastname@example.org or 919-414-4569.
Join Us for Rafﬂe, Food, and Fun for the Entire Family!
If you are in a position to help us underwrite the cost of this event in support of the children and adults who suffer from NF or you are unable to walk but would like to make a donation please visit www.ctf.org/walk. Please make checks payable to “Children’s Tumor Foundation” and turn in at event or mail to Children’s Tumor Foundation, 95 Pine Street, 16th Floor, New York, NY 10005.
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No Place Like Home Carteret General Hospital is working with area specialists to bring the benefits of less-invasive technological advances close to home. Two recent examples are featured in this issue of The Eastern Physician. The RIO Robotic Arm Interactive Orthopedic System for knee and hip joint-replacement surgeries is now offered at Carteret General, and performed by Dr. Thomas E. Bates, medical director of Carolinas Center for Joint and Spine; and Dr. Jeffrey K. Moore of Moore Orthopedics & Sports Medicine. Carteret General also has brought to the region endoscopic retrograde cholangiopancreatography, or ERCP, for safely removing gallstones lodged in the bile duct. Dr. John Baillie of Carteret Medical Group is
T H E MA G A Z I N E F O R H E AL T H C AR E PR O F E S S I O N AL S
the only gastroenterologist in Morehead City and one of only a few in the state to offer ERCP. Turn to pages 4 and 6, respectively, to read more about these advances, including how they work and
Editor Heidi Ketler, APR
who might benefit. Once again, resident marketing specialist Amanda Kanaan gives quick, straight-forward advice on avoiding marketing missteps. Her first tip is to avoid do-it-yourself marketing. Also, consider this bit of advice: there is no other publication with the reach of The Eastern Physician – more than 6,000 physicians, doctors of osteopathic medicine, physician assistants, nurse practitioners, administrators and staff. So if you want to reach the home market, your news and advertising on these pages is the way to do it.
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General Hospital Robotic Arm Technology for Joint Replacement
DEPARTMENTS 8 Wound Care
The Case for Specialized Wound Care
10 Your Financial Rx The Keys to Inflation-Proofing Your Portfolio
$57 Million Investment Represents Largest Expansion in Nash’s History
An Advanced Approach to Acute Pancreatitis Dr. John Baillie brings endoscopic retrograde cholangiopancreatography to Morehead City.
12 Practice News
7 Marketing Doctor’s Five Major Marketing Missteps Amanda Kanaan offers advice on marketing missteps that can sabotage practice success.
Coastal Carolina Cardiology Joins Vidant Medical Group
Welcome and upcoming events
Cover Image: From left, Jeffrey K. Moore, M.D.; Thomas E. Bates, M.D., A.A.O.S.; Robert E. Coles, M.D., A.A.O.S.; and Gary Wertman, M.D., D.O.
The Eastern Physician
Photography Bill Goode Photography Creative Director Joseph Dally
With respect and gratitude,
Contributing Editors Beth Anne Atkins John Duda, M.D. Amanda Kanaan Paul Pittman, C.F.P.
Subscription Rates: $48.00 per year/$6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401 Every precaution is taken to insure the accuracy of the articles published. The Eastern Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinion expressed or facts supplied by its authors are not the responsibility of The Eastern Physician. However, The Eastern Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Eastern Physician.
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Commercial • Engagement • Wedding • Children • Family • Maternity • Babies • Seniors april/may 2012 3
Robotic Arm Technology for Joint Replacement As one of the first in the state to offer
of each patient’s unique bone structure,”
According to Dr. Bates, the MAKOplasty
robotic arm technology, Carteret General
says Thomas E. Bates, M.D., A.A.O.S.,
procedure is four to six times more
Hospital is leading the way in robotically
medical director of Carolinas Center for
accurate for hip replacement and two to
assisted orthopedic surgery – literally. The
Joint and Spine, and an expert in adult joint
three times more accurate for the knee
robotic arm, known as the RIO Robotic
reconstruction and sports medicine.
than traditional surgery.
Arm Interactive Orthopedic System, uses computer-assisted technology to guide
Improved Accuracy and Precision
The highly advanced RIO System allows
surgeons to perform minimally invasive
MAKOplasty, provides reproducible results
joint surgery with greater consistency
and improved outcomes of total hip and
and better alignment through a guidance
“It’s like a GPS for joint surgery, allowing for
partial knee replacement surgery through
system that cannot be duplicated manually.
better alignment by providing a 3-D image
“This technology gives me the opportunity
to perform surgery with the precision and accuracy that not even the most experienced of surgeons can accomplish,” says Dr. Jeffrey K. Moore, M.D., of Moore Orthopedics & Sports Medicine who has performed more than 2,000 joint replacements over the course of 25 years.
Benefits for the Patient For patients with midstage osteoarthritis that has not damaged the entire joint, the MAKOplasty partial knee replacement is an ideal option. It allows for replacement of the medial, lateral or patellofemoral compartment of the knee while keeping the rest of the joint intact. This results in a more natural-feeling knee: preservation of the cruciate ligaments restores natural knee motion and rotation, while preservation of bone stock makes further surgery less complicated in the younger patient with arthritis. The RIO System enables accurate compoDr. Thomas Bates, Dr. Gary Wertman, and Dr. Robert Coles of Carolinas Center for Surgery
The Eastern Physician
nent placement, preservation of normal
Cup position specifically is crucial in
Good candidates for the MAKOplasty par-
regards to wear rates and hip-replacement
tial knee replacement are those who suffer
longevity. “With MAKOplasty, the cup is put
from knee pain triggered by activity, usual-
in the ‘safe zone’ 100 percent of the time
ly in the inner knee and/or under the knee
so you know the alignment is correct,” says
cap. These patients also may experience
Dr. Bates. He points to a Boston study of
startup knee pain or stiffness, when activi-
1,800 patients that showed the cup was
ties are initiated from a sitting position. Af-
placed in the ‘safe zone’ only 50 percent of
ter failing to respond to non-surgical treat-
the time without the technology.
ments or nonsteroidal anti-inflammatory medication, the MAKOplasty partial knee
How It Works
replacement may be an ideal option.
The RIO System works through computer-
Dr. Jeffrey Moore, Orthopedic Surgeon
knee kinematics and soft-tissue balancing.
assisted technology that guides the
Candidates for MAKOplasty total hip ar-
surgeon based on the patient’s own
throplasty suffer from inflammatory or non-
unique bone structure. A simple computed
inflammatory degenerative joint disease
tomography scan allows the computer
(DJD), which causes debilitating hip pain
to generate a three-dimensional virtual
that cannot be successfully treated through
view of the patient’s bone surface. This
non-surgical techniques. The various types
interactive image is correlated with the
of DJD include osteoarthritis, post-traumat-
surgical plan pre-programmed by the
ic arthritis, rheumatoid arthritis, avascular
physician, enabling an ideal collaboration
necrosis and hip dysplasia.
between surgeon and technology.
The perfection of these three components dramatically decreases the most common
The computer and surgeon work together
The MAKOplasty partial knee and total hip
causes of failure in unicompartmental and
to match up real anatomy with virtual
replacement results in restored mobility
bicompartmental knee replacements.
anatomy in order to determine implant
and the quicker return to a quality, active
positioning. As the surgeon uses the
lifestyle for patients. “It’s very rewarding to
“At just one week, I see patients at a
robotic arm, auditory and visual feedback
see how well patients are doing and how
point of recovery that normally takes six
limits the bone preparation to the diseased
quickly they are getting back to normal
weeks to reach with traditional total knee
areas and guides the surgeon in making
activities,” says Dr. Bates.
replacement,” says Dr. Bates. Along with
real-time adjustments. Improved accuracy of the component
a faster recovery, other potential patient benefits of MAKOplasty as compared to
This results in more optimal implant
placement and enhanced precision of the
total knee surgery include:
positioning and placement for each
procedure itself allow for reproducible,
• Reduced pain
individual patient. “We always welcome
optimal outcomes that eliminate certain
• Minimal hospitalization
new technology as it’s this new technology
complications associated with traditional
• Less implant wear and loosening
that allows me to do a better job for my
joint replacement surgery. “The more
• Smaller scar
patients,” says Dr. Moore.
efficient and successful we are, the happier our patients are,” says Dr. Moore.
• Better motion and a more natural-
Who Is a Good Candidate
Osteoarthritis (OA) is the most common total
form of arthritis and a leading cause
of disability worldwide, according to
the American Academy of Orthopedic
most common complications of hip
Surgeons. With the RIO System, surgeons
replacement are dislocation and leg-length
have the opportunity to treat knee
inequality. MAKOplasty eliminates these
complications by equipping the surgeon
disease at earlier stages and through less-
with unparalleled accuracy in component
For more information regarding the MAKOplasty partial knee or total hip surgery, contact the Carolinas Center for Joint and Spine at (252) 808-6673 or visit Carteret General online at www.carteretgeneral.com. To reach Dr. Robert Coles, Dr. Gary Wertman, or Dr. Thomas Bates of the Carolinas Center for Joint and Spine please call (252) 247-2101 or www.cc4surgery.com. To contact Dr. Jeffrey Moore of Moore Orthopedics & Sports Medicine call (252) 808-3100 or www.mooresportsmed.com.
An Advanced Approach to Acute Pancreatitis Like most gastroenterologists, John Baillie, M.B., Ch.B., F.R.C.P., F.A.C.G, of Carteret Medical Group sees patients suffering from acute pancreatitis. Unlike many other gastroenterologists, Dr. Baillie has a unique tool at his disposal to investigate and treat some causes of this potentially life-threatening condition. He is the only gastroenterologist in Morehead City, N.C., and one of a relatively small number in the state to offer endoscopic retrograde cholangiopancreatography (ERCP), an advanced endoscopic procedure in which he is an acknowledged expert. ERCP is a procedure that is part diagnostic and part therapeutic. The test combines the use of an endoscope with X-ray pictures to examine the tubes (ducts) that drain the liver, gallbladder and pancreas. ERCP can also treat certain problems found during the test. For instance, if a gallstone is present in the common bile duct, the doctor
can remove the stone with instruments inserted through the endoscope. ERCP is indicated for patients who suffer from acute pancreatitis caused by a migrating gallstone that fails to pass into the intestine (duodenum) and obstructs the shared outlet of the bile duct and pancreatic duct (ampulla of Vater). It is also used to investigate recurrent attacks of acute pancreatitis, some of which are due to mechanical issues, such as masses obstructing the pancreatic outflow (ampullary tumors), congenital abnormalities of pancreatic drainage and high pressure in the pancreatic duct sphincter. In the United States, more than 90 percent of acute pancreatitis cases are related to gallstones. ERCP is a minimally invasive procedure that allows an appropriately trained gastroenterologist to safely remove gallstones that lodge in the bile duct, the most common cause of acute pancreatitis. The majority of patients who suffer from gallstone pancreatitis are offered gallbladder removal (cholecystectomy, usually laparoscopic) when they have recovered from their illness. In patients who have stones obstructing the ampulla of Vater, a procedure called endoscopic sphincterotomy can be performed during ERCP to open the bile duct; the stones can then be removed using catheters with balloons or baskets attached. In the frail elderly and other patients considered high risk for surgery, endoscopic sphincterotomy alone allows present and future stones to pass into the intestine without obstruction.
Dr. John Baillie, Gastroenterologist at Carteret Medical Group
The Eastern Physician
Patients who develop acute pancreatitis from gallstone passage need to have their gallbladders removed, or ERCP with sphincterotomy if they cannot have surgery, as the problem is likely to recur. Patients who have stones in their bile ducts
after gallbladder removal require ERCP with sphincterotomy and duct clearance of stones or debris, which usually prevents any recurrence. The success rates of ERCP depend on the nature of the procedure (diagnostic vs. simple therapeutic vs. complex therapeutic), but an expert can generally achieve a success rate greater than 90 percent in complex cases and close to 100 percent in uncomplicated cases. Dr. Baillie, who has performed more than 7,000 ERCP procedures, is one of the most experienced experts in the state. â€œBefore, patients in the Morehead City area often had to travel to Duke University Medical Center in Durham, N.C., or the UNC Hospitals in Chapel Hill, N.C., to have complex ERCP performed. Now, many local patients can get these procedures done close to home,â€? says Dr. Baillie. Dr. John Baillie has almost 30 years of experience in managing gastrointestinal disorders, along with expertise in modern GI endoscopy. He joined the Carteret Medical Group staff after many years of service on the faculty of NC Baptist Hospital and Duke University Medical Center, where he was professor of medicine. He was recently recognized in the Best Doctors in America database and has been the recipient of the American Society for Gastrointestinal Endoscopy (ASGE) Master Endoscopist and Distinguished Educator Awards. Dr. Baillie currently directs gastroenterology services at Carteret Medical Group and is regularly consulted by outside physicians on difficult cases. Dr. Baillie may be contacted with questions or for a consult by calling Carteret Medical Group at (252) 648-8712 or Carteret General Hospital at (252) 808-6000. For more information, visit www.carteretmed.com.
Doctor’s Five Major Marketing Mishaps Anatomy. Physiology. Pharmacology. These
have incredible websites but no one can find
are all classes doctors take in medical school.
them because they haven’t been optimized
What’s not usually a part of the curriculum?
to rank well in the search engines.
Amanda Kanaan is a medical marketing specialist
Knowing how to market your practice can
3. Failing to Differentiate Your Practice
be just as essential to your success as un-
Making claims such as “we offer compas-
derstanding drug interactions. Avoid the five
sionate care” or “we provide experienced
major missteps below to create a marketing
specialists” will not differentiate your prac-
strategy that is relevant and effective.
tice, especially considering your competi-
tors probably say the same thing. In fact, it
Designs, provides medical website design, search engine optimization (SEO) and social media consulting, along with print design, branding and marketing services to local private
1. Creating a Do-It-Yourself Marketing Strategy
will only make it more difficult for patients
When doctors attempt to create and
be generic). Start by researching what claims
implement their own marketing strategy, they
your competitors make about their care and
face two major challenges, a lack of medical
then decide what sets you apart. Whatever
marketing training and a lack of time. The
you decide your differentiator will be, make
problem with inexperienced marketing is that
sure it is unique and you keep the messaging
you can quite easily create a strategy that is
consistent on every piece of marketing collat-
(It may be intimidating at first, but it’s a highly
expensive yet ineffective. In addition, doctors
eral you produce. Even your staff should be
effective way to communicate with patients.)
already have a full-time job taking care of
trained to talk with patients about your differ-
patients. Either the doctor, the patient or the
entiators. In order to create a powerful brand,
practice’s marketing efforts will suffer for it.
your messaging needs to infiltrate every part
5. Wasting Marketing Dollars on Bad Customer Service
It’s for these reasons that while doctors may
of your practice.
You can spend all the money in the world
to tell you apart from your peers (i.e. you’ll
believe they are saving money by serving as
practices and health care organizations. Ms. Kanaan can be reached by e-mail to amanda@whitecoat-designs. com, phone at (919)714-9885 or on the web at www.whitecoat-designs.com.
on marketing, but if your practice faces
the practice’s marketing department, in the
4. Forgetting Your Current Patients
customer service issues then you are
long run they may actually spend more.
New patients aren’t the only way to grow your
flushing dollars down the drain. Before
practice’s bottom line. It’s just as important to
you even begin to think about investing in
2. Neglecting New Mediums
market to current patients since they can be
marketing, you should first conduct mystery
Practices often neglect new mediums,
a valuable source of repeat business and pa-
shopping research. This involves hiring a
such as online marketing and social media,
tient referrals. If you’ve heard the saying “out
pretend patient to experience your practice
because they are not personally comfortable
of sight, out of mind” then you know that
from start to finish and provide an honest
with them. More than 80 percent of internet
ongoing communication is vital to building a
report on his findings. You need to know if
users look for health information online, 44
lasting relationship with your patients. Some
the phone operator was rude or the nurse
percent of which are specifically looking for
cost-effective ideas to maintain patient com-
was unfriendly. These are small issues that
a provider. Yet physicians who claim to offer
munications and stay top of mind include an
can make a big difference when enough
state-of-the-art treatments represent their
e-newsletter (simply collect patient e-mails at
patients feel uncomfortable and decide to
practices with websites that either haven’t
check-in or have a sign-up box on your web-
seek care elsewhere or worse, write a bad
been touched since the early 1990s or have
site), add a blog to your website, where you
lackluster messaging that fails to differentiate
can contribute short educational articles, or
their services. Even worse, some practices
take the leap into the world of social media.
The Case for Specialized Wound Care By John Duda, M.D.
Chronic Wounds Treated Venous ulcers Pressure ulcers Diabetic lower-extremity ulcers Arterial ulcer Surgical wounds and burns Osteoradionecrosis Soft-tissue radionecrosis Necrotizing infections Chronic refractory osteomyelitis Delayed radiation injury
injury, chronic infections and other skin-
being amputated due to diabetes every 30
seconds. Unfortunately, only about one third of diabetic amputees live longer than
Non-healing wounds of the diabetic foot,
five years – a survival rate equivalent to that
in particular, are considered one of the
of many cancers.
most significant complications of diabetes, representing a major worldwide medical,
Chronic wound management can present
social and economic burden. If not
many challenges for health care providers.
aggressively treated, these wounds can
And as many of us know, patients can be
lead to amputation.
their own worst enemies.
Eighty-five percent of diabetes-related am-
In an ideal world, patients and their
t wasn’t long ago that outpatient wound
putations are preceded by the appearance
caregivers take the necessary precautions,
management involved a lot of gauze pack-
of a foot ulcer. This equates to a lower limb
such as nutritional support or pressure
reduction to prevent the development of
ing, and transparent film and Bard Absorption Dressing was viewed as cutting edge. Fast forward a couple of decades, and those days seem quaint. Today, people are living longer and developing chronic conditions that can often result in serious complications, such as failure of the body’s wound-healing process. The usual culprits? Diabetes, arterial and vascular insufficiencies and diseases, complications of surgery and traumatic injuries, pressure ulcers, delayed radiation
Wound care centers that are managed by specialized wound care professionals, such as Diversified Clinical Services, promote best-in-class treatment and services, including: • Equipment: treatment chairs, HBO (hyperbaric oxygen) chambers, TCPo2 (transcutaneous partial pressure of oxygen) monitors • Clinical practice guidelines • Reimbursement support • Quality improvement initiatives • Clinical and management information systems • Educational materials for community physicians and patients
ulcers. When wounds persist, a specialized and holistic approach is required for healing. When
outpatient wound care center, such as Diversified Clinical Services, referring physicians partner in their patient’s treatment. They receive regular updates on healing progress and are notified when treatment is completed and their patients are healed. Over the years, the development of devices and dressings to more effectively assist with wound healing has worked in our favor. Hyperbaric oxygen therapy (HBOT) has been used to assist in wound healing for more than 40 years. Today, it is still considered to be an effective, noninvasive and painless treatment. The systemic delivery of oxygen through pressurized chambers helps heal the wound from the inside out. During HBOT, patients are monitored for increased concentration of oxygen in the blood near the wound. If the oxygen level is elevated,
The Eastern Physician
Dr. John Duda is the medical director of Carteret General Hospital’s new Wound Healing and Hyperbaric Center in Morehead City. Dr. Duda previously practiced emergency medicine at Carteret General Hospital for 10 years. He is a fellow of the American College of Emergency Physicians and has been board certified in emergency medicine since 1988. Dr. Duda’s work in emergency departments has exposed him to many types of acute and chronic wounds, as well as to the use of hyperbaric oxygen treatment of diving injuries and carbon monoxide poisoning. He has recently completed additional training in advanced wound care and the use of hyperbaric oxygen for non-healing wounds, bone infections and other medical indications for hyperbaric therapy. Dr. Duda can be reached at 3722 Bridges St., Morehead City, N.C., 28557, (252) 808-6450 or carteretgeneral.com.
the therapy is most likely beneficial to the patient.
In-Office Pharmacy Program POP Medical provides physicians with the ability to fill prescriptions in their own office, increasing practice revenues and offering great convenience to patients. Using the turn-key Pharmacy Dispensing Solution, the practice is furnished with prepackaged medication and may offer it to the patient for the patient’s copay. Benefits include: x Same co-pay as pharmacy
x Improved patient outcomes
x Additional revenue stream for practice x Seamless and efficient turn-key operation
x NO inventory to purchase
Toll Free 855-4POPMED www.POPMedical.com NEWSOURCE-JUN10:Heidi
A typical course of treatment involves about 90 minutes per day in a specialized chamber, five days per week, over a four-
Do They Like What They See?
to-six-week period. These treatments help reduce swelling, fight infection, build new blood vessels and ultimately produce healthy tissue.
Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.
In 2010 alone, Healogics effectively delivered more than 236,000 HBOT treatments.
Our services range from consultation, to design, to creation and implementation of strategic plans.
last month, when two of the nation’s largest wound center groups, Diversified Clinical Services and National Healing, joined forces. The combined companies offer greater opportunities for wound research, professional education, and evidence-based wound care.
newsource & Associates
As the prevalence, complexity and incidence of chronic wounds continue to increase, the need for specialized wound care expertise that employs an
Call (540) 650-3686 or send inquiries to firstname.lastname@example.org.
Our network of smart, creative, award-winning specialists serves the health care industry throughout the Mid-Atlantic.
Maybe it’s happiness in a child’s eyes. Whatever the desired outcomes, count on us to ensure your key messages have the 20/20 clarity to deliver.
evidence-based approach will rise.
Your Financial Rx
The Keys to Inflation Proofing Your Portfolio By Paul J. Pittman, C.F.P.
If you are like me, for years, even before the
supply, while demand for them is
economic seizure we experienced at the
soaring worldwide, especially in Asia.
end of 2008, you were probably wondering when the low interest rates and all of the
Treasury Inflation Protected Securities
“easy money” policies were going to result
(TIPS) – These bond yields are tied to
in inflation. Then, after the 2008 economic
the Consumer Price Index (CPI) and will
seizure, we witnessed the extreme become
increase or decrease as the CPI changes. In
even more extreme. Money printing
general, if the things cost more, these pay
significantly increased, the bank lending
more and vice versa.
rates dropped to zero, and again, if you are
Paul Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally soughtafter speaker, humorist and writer. Mr. Pittman can be reached at (919) 459-4171 and paul. email@example.com. Send an e-mail to receive Mr. Pittman’s Weekly Market Commentary.
like me, you probably asked, is this not the
Stocks and the Indexes – While inflation
exact thing that creates inflation?
may cause stocks to suffer in the short term
Long-Term Bonds – Inflation has a lot
if things like cost of goods sold and bor-
to do with bond rates and since rates are
Yet, despite all of the blatant catalysts,
rowing increase for businesses over the
relatively low, we run the risk that rates
the inflation rate has been anything but
long term, stocks tend to keep your money
will rise. That is bad for the current value
alarming... but wait. Are we not hearing
growing ahead of inflation. Stocks for the
of long-term bonds. You can think of it this
that our biggest bond buyer, China, is wary
Long Run author Jeremy Siegel points out
way, if new bonds are being issued that
of our over-use of debt? Are we not just a
that stock returns historically have been im-
pay higher rates than the ones you own, no
couple of interest rate upticks away from
mune to the inflation rate over long stretch-
one would want to buy yours except at a
concluding that, “the inflationary spiral we
es of time. Although rising prices could
have been hearing about has begun?” Will
crimp profits in the short term, Siegel ar-
there be a day of reckoning for devaluing
gues that companies – eventually – can
Finally, inflation-proofing your portfolio
our currency? Will runaway inflation
pass on those costs to consumers, making
comes down to being invested in a
become our nation’s biggest challenge?
inflation a wash for stock market returns.
diversified mix of assets that have a high
Please note that this is a generalization.
probability of either keeping pace or
If runaway inflation occurs, how can we
There is no way to guarantee or predict the
appreciating at a faster rate than inflation.
best protect ourselves against it? Let’s face
volatility and performance of any specific
While cash reserves are vital for short-term
it, we do not know for sure that it is coming,
financial security, the threat of inflation
but it sure would not be a surprise.
gives a good reason to keep long-term
Steer Clear of These
money invested in assets that have the
Cash or Minimal Interest Savings
potential to appreciate.
Real Assets – Think “valuable” and “finite
Accounts – Storing money in savings
accounts or, even worse, cash, is a losing
The opinions voiced in this material are
• Real Estate – For instance, there is a
proposition during high inflationary times.
for general information only and are not
finite amount of coastal real estate. The
Just think about how much cheaper things
intended to provide specific advice or
ocean makes sure that this remains a
like bread, stamps and medical insurance
recommendations for any individual. To
very “finite quantity.”
were 10 to 15 years ago. If your money
determine which investment(s) may be
• Precious Metals and Raw Materials –
was under the mattress during that time,
appropriate for you, consult your financial
For instance, electric car batteries need
it definitely would not buy what it used to
advisor prior to investing. All performance
silver and palladium, but these metals
buy. On the other hand, if it was invested
referenced is historical and is no guarantee
can’t be mass produced. They are
in appreciating assets and it averaged an
of future results. All indices are unmanaged
expensive and difficult to find in nature.
annual rate of 7 percent, it would have
and cannot be invested into directly. The
The fact is, most natural resources and
approximately doubled over a 10-year
market for all securities is subject to risk
life’s basic necessities are in short
period (not including taxes or fees).
and loss of principal is possible.
The Eastern Physician
Duke Research News
Deafening Affects Vocal Nerve Cells Within Hours Portions of a songbird’s brain that control
trol vocalization, Dr. Mooney said.
how it sings have been shown to decay
learning and initiating motor sequences, including the complex vocal sequences
within 24 hours of the animal losing its
“I will go out on a limb and say that I think
similar changes also occur in human
that make up birdsong and speech.
brains after hearing loss, specifically in
Although other studies had looked at the
The findings, by researchers at Duke Uni-
Broca’s area, a part of the human brain
effects of deafening on neurons in audi-
versity Medical Center, show that deaf-
that plays an important role in generating
tory brain areas, this is the first time that
ness penetrates much more rapidly and
speech and that also receives inputs from
scientists have been able to watch how
deeply into the brain than previously
the auditory system,” Dr. Mooney said.
deafening affects connections between
thought. As the size and strength of nerve
nerve cells in a vocal motor area of the
cell connections visibly
brain in a living animal, said
changed under a micro-
Katie Tschida, Ph.D., a post-
scope, researchers could
doctoral research associate
even predict which song-
in Dr. Mooney’s laboratory
birds would have worse
who led the study.
songs in coming days. Using a protein isolated from “When hearing was lost,
jellyfish that can make song-
we saw rapid changes in
bird nerve cells glow bright
motor areas that control
green when viewed under a
song, the bird’s equivalent
of speech,” said senior
they were able to determine
author Richard Mooney,
Ph.D., professor of neu-
rapid changes to the tiny
robiology at Duke. “This
connections between nerve
study provided a laser-like
cells, called synapses, which
focus on what happens in the living song-
About 30 million Americans are hard of
are only one thousandth of a millimeter
bird brain, narrowed down to the particu-
hearing or deaf. This study could shed
lar cell type involved.”
light on why and how some people’s
The study was published in the online
speech changes as their hearing starts to
“I was very surprised that the weakening
decline, Dr. Mooney said.
of connections between nerve cells was
journal Neuron March 7.
visible and emerged so rapidly – over the “Our vocal system depends on the audi-
course of days these changes allowed us
Like humans, songbirds depend on hear-
tory system being able to create intelligi-
to predict which birds’ songs would fall
ing to learn their mating songs – males
ble speech. When people suffer profound
apart most dramatically,” Dr. Tschida said.
that sing poorly don’t attract mates, so
hearing loss, their speech often becomes
“Considering that we were only tracking
hearing a song, learning it and singing
hoarse, garbled and harder to understand,
a handful of neurons in each bird, I nev-
correctly are all critical for songbird sur-
so not only do they have trouble hearing,
er thought we’d get information specific
vival. Songbirds also resemble humans
they often can’t speak fluently any more,”
enough to predict such a thing.”
and differ from most other animals in that
Dr. Mooney said.
their songs fall apart when they lose their
The research was supported by the Na-
hearing, and this feature makes them an
The nerve cells that showed changes after
tional Science Foundation and the Nation-
ideal organism to study how hearing loss
deafening send signals to the basal gan-
al Institute on Deafness and Other Com-
may affect the parts of the brain that con-
glia, a part of the brain that plays a role in
$57 Million Investment Represents Largest Expansion in Nash’s History More than 40 years ago, community
this is a historic occasion, ” said Vincent
leaders had a dream of combining existing
C. Andracchio II, chairman of the Nash
Center are under the age of 17 – nearly
health care services into one state-of-the-
Health Care Board of Commissioners.
double the amount of pediatric patients in
art medical center. This vision was shared
other North Carolina emergency rooms.
by a group of determined individuals as
This same determination and innovation
At Nash, this 20 percent equates to about
they surveyed a tobacco field off of a dirt
paved the way for Nash Health Care to be
13,000 children a year. The Nash Health
road in Rocky Mount. That dirt road would
one of the leaders in health care. Nash
Care Foundation has been instrumental in
eventually become Winstead Avenue, and
General Hospital was the first hospital
raising funding and community awareness
the dream would materialize and thrive as
in North Carolina to feature all-private
for creating a Pediatric Emergency Care
Nash General Hospital.
rooms. Nash Day Hospital was the first
freestanding hospital in North Carolina Four decades later, Nash Health Care
designed for outpatient surgery, he said.
continues to build on the same promise
“We celebrate today as an investment in our patients; we think our patients deserve
made by those community leaders: to
The building expansion will feature a total
the very best,” said Larry Chewning,
provide superior quality health care
of three new floors. The new emergency
president and chief executive officer of
locally, so patients do not have to leave
department will be located on the
Nash Health Care.
their hometown to receive innovative and
ground floor and the Nash Heart Center
technologically advanced treatments.
will occupy the second and third floors.
“We are proud to be here in Nash County,
The emergency department will have a
said Steve Lawler, president of Vidant
Nash Health Care recently broke ground
separate entrance and treatment area
Health. “We are proud to be a part of
on a new emergency department and
for pediatric patients and will be able to
this project to work together for the
heart center that will transform the
accommodate 90,000 patients a year. For
betterment of the community, allowing
hospital campus, representing the largest
comparison, the previous Emergency
patients to receive care as close to home
expansion since the hospital was built in
Care Center was built to accommodate
1971. The $57 million project is scheduled
40,000 patients a year, but actually treats
for completion in December 2013.
an estimated 65,000 patients a year. The
“We would like to thank each one of you.
new emergency department will have a
The Foundation exists to promote the
“This is an important and historic day.
total of 54 treatment areas, as compared to
health of our community. We are very
Today the story of our growth has
34 in the current Emergency Care Center.
thankful to be able to be here today,” said
another chapter. For our neighbors, for our children, and for all of us here today,
Norma Turnage, chairman of the Nash Twenty percent of the patients at Nash
Health Care Foundation.
Coastal Carolina Cardiology Joins Vidant Medical Group
By Beth Anne Atkins
Coastal Carolina Cardiology is now Vid-
Vidant Health is a network of interconnect-
Coastal Carolina Cardiology has been
ant Cardiology since joining Vidant Medi-
ed physician practices, more than 11,000
in existence since April 1999. The
cal Group, a multi-specialty physician
employees, 10 hospitals, home health and
practice has eight physicians and two
and provider group that is part of Vidant
hospice programs and wellness facilities.
The Eastern Physician
general and interventional cardiology,
News electrophysiology and peripheral vascular disease. “Our patients will be coming to the same location and seeing the same providers and staff they are used to seeing,” said Jerry Simpson, M.D., president of Vidant Cardiology. “By joining forces with Vidant Health, it ensures that this will be the case now and in the future. We are committed to finding a consistent and effective way to offer and deliver quality health care and look forward to doing so as part of Vidant Health.” With a staff of about 40 employees, the practice sees 63,000 patients in Ahoskie, Edenton, Greenville, Kenansville, the Outer Banks, Tarboro, Washington and Windsor. “We are excited to add such a quality practice to our network of physicians and providers,” said Travis Douglass, executive vice president and director of Vidant Medical Group. “We look forward to working together to provide more access to care in our region.” Vidant Cardiology is located at 850 W.H. Smith Blvd. in Greenville. Office hours are Monday through Friday 8 a.m. to 5 p.m. For more information, visit www.vidanthealth.com.
Welcome to the Area
Physicians Katie Porterfield Collins, D.O. Obstetrics and Gynecology Pitt County Memorial Hospital GME Greenville
Laura Patricia Diefendorf, M.D. Integrative Medicine, Pediatrics, Internal Medicine Pitt County Memorial Hospital, GME Greenville
Alison Brooke Freely, D.O. Family Medicine Fayetteville
John Wesley French, M.D. Ophthalmology Carolina Eye Associates Southern Pines
Melissa Erin Griffin, D.O. Family Medicine, Family Practice New Hanover Regional Medical Center, Wilmington
Natalee Sheppe French, M.D. Pediatrics Sandhills Pediatrics Southern Pines
Jigna Zatakia, D.O. Internal Medicine Pitt County Memorial Hospital Greenville
Darrell Edward Jones, M.D. Fort Bragg
Quara Tul Ain, M.D. Internal Medicine, Pediatrics Greenville William Doyle Atchley, M.D. Jacksonville Michael Lee Brooks, M.D. Internal Medicine Lumberton Medical Clinic Lumberton Rebekah Hughey Collymore, M.D. Adolescent Medicine, Pediatrics, Family Medicine, Geriatric Medicine, Integrative Medicine, Internal Medicine, Obstetrics and Gynecology, Pain Medicine Southern Regional AHEC Fayetteville
Whitney Nugent King, M.D. Pediatrics Cape Fear Pediatrics Wilmington Judy Kovell, M.D. Psychiatry Robinson Behavioral Health Clinic Fort Bragg John Joseph McPherson, M.D. Radiology Womack Army Medical Center Fort Bragg Alia Marie Iqbal O’Meara, M.D. Critical Care Pediatrics, Pediatrics Children’s Acute Care Fayetteville
Chris George Pappas, M.D. Sports Medicine, Family Medicine Womack Army Medical Center Fort Bragg Thomas Joseph Richard, M.D. Hematology/Oncology, Internal Medicine Southern Pines Adrian Ivan Sanders, M.D. Anesthesiology Leland John Alexander Thomas, M.D. Neurological Surgery Atlantic Neurosurgical and Spine Specialists Wilmington
Physician Assistants Angela Brewer Brooks, P.A. Emergency Medicine, Family Medicine Carolina Breast & Oncologic Surgery Greenville Michael Anthony Caruso, P.A. Family Medicine, Urgent Care Eastern Carolina Cardiovascular Elizabeth City Jeanie Marie Kittleson, P.A. Thoracic Cardiovascular Surgery East Carolina Heart Institute/UHSP Greenville
Kane Daniel Morgan, P.A. Family Practice/Sports Medicine, Aerospace Medicine, Emergency Medicine Southern Pines Jennifer Maline Scott, P.A. Family Medicine, General Practice Wade Family Medical Center, Wade Gary McCoy Toppin, P.A. Emergency Medicine, Family Medicine, Internal Medicine, Urgent Care, Geriatric Medicine Wilmington Richard Conrad Westmoreland, P.A. Emergency Medicine, Family Medicine, Family Practice (and OMT) Southern Pines
Event Free Weight-loss Surgery Information Session First Thursday and third Monday of every month at 6 p.m. Renaissance Room at Pinehurst Surgical 5 First Village Drive, Pinehurst, NC 28374 For more information call (800) 213-3284 or visit www.ncweightlosssurgery.org.
Bariatric Support Group First Thursday and third Monday of every month at 7 p.m. Renaissance Room at Pinehurst Surgical 5 First Village Drive, Pinehurst, NC 28374 For more information call (800) 213-3284 or visit www.ncweightlosssurgery
Protecta XT TM
CRT-D and DR ICDs with SmartShock Technology TM
With Protecta, 98% of ICD patients are free of inappropriate shocks at 1 year and 92% at 5 years.*1
Brief Statement: Protecta™ CRT-D/DR ICDs Indications Protecta/Protecta XT implantable cardioverter defibrillators (ICDs) and CRT-D ICDs are indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias. Protecta/Protecta XT (CRT-D) ICDs are also indicated the reduction of the symptoms of moderate to severe heart failure (NYHA Functional Class III or IV) in those patients who remain symptomatic despite stable, optimal medical therapy and have a left ventricular ejection fraction ≤ 35% and a prolonged QRS duration. Atrial rhythm management features such as Atrial Rate Stabilization (ARS), Atrial Preference Pacing (APP), and Post Mode Switch Overdrive Pacing (PMOP) are indicated for the suppression of atrial tachyarrhythmias in ICD-indicated patients with atrial septal lead placement and an ICD indication. Additional Protecta/Protecta XT System Notes: The use of the device has not been demonstrated to decrease the morbidity related to atrial tachyarrhythmias. • The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 17%, and in terminating device classified atrial fibrillation (AF) was found to be 16.8%, in the VT/AT patient population studied. • The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 11.7%, and in terminating device classified atrial fibrillation (AF) was found to 18.2% in the AF-only patient population studied.
Additional Protecta XT DR System Notes: The ICD features of the device function the same as other approved Medtronic marketreleased ICDs. • Due to the addition of the OptiVol® diagnostic feature, the device indications are limited to the NYHA Functional Class II/III heart failure patients who are indicated for an ICD. • The clinical value of the OptiVol fluid monitoring diagnostic feature has not been assessed in those patients who do not have fluid retention related symptoms due to heart failure. Contraindications Protecta/Protecta XT CRT-ICDs are contraindicated for patients experiencing tachyarrhythmias with transient or reversible causes including, but not limited to, the following: acute myocardial infarction, drug intoxication, drowning, electric shock, electrolyte imbalance, hypoxia, or sepsis. The devices are also contraindicated for patients who have a unipolar pacemaker implanted, patients with incessant VT or VF, or patients whose primary disorder is chronic atrial tachyarrhythmia with no concomitant VT or VF. Warnings and Precautions ICDs: Changes in a patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage. Do not place transthoracic defibrillation paddles directly over the device. Additionally, for CRT-ICDs, certain programming and device operations may not provide cardiac resynchronization.
www.medtronic.com * Primary prevention patient programmed for detection rate cut off at 188 bpm.
Potential Complications Potential complications include, but are not limited to, acceleration of ventricular tachycardia, air embolism, bleeding, body rejection phenomena which includes local tissue reaction, cardiac dissection, cardiac perforation, cardiac tamponade, chronic nerve damage, constrictive pericarditis, death, device migration, endocarditis, erosion, excessive fibrotic tissue growth, extrusion, fibrillation or other arrhythmias, fluid accumulation, formation of hematomas/seromas or cysts, heart block, heart wall or vein wall rupture, hemothorax, infection, keloid formation, lead abrasion and discontinuity, lead migration/dislodgement, mortality due to inability to deliver therapy, muscle and/or nerve stimulation, myocardial damage, myocardial irritability, myopotential sensing, pericardial effusion, pericardial rub, pneumothorax, poor connection of the lead to the device, which may lead to oversensing, undersensing, or a loss of therapy, threshold elevation, thrombosis, thrombotic embolism, tissue necrosis, valve damage (particularly in fragile hearts), venous occlusion, venous perforation, lead insulation failure or conductor or electrode fracture. See the device manual for detailed information regarding the implant procedure, indications, contraindications, warnings, precautions, and potential complications/ adverse events. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts these devices to sale by or on the order of a physician.
Changes in a patient’s disease and/or medications may alter the efficacy of a device’s programmed parameters or related features.
UC201204700 EN © Medtronic, Inc. 2012. Minneapolis, MN. All Rights Reserved. Printed in USA. 02/2012
NOW with DF4 Connector System
The Eastern Physician April-May 2012