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Category

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

april/may 2012

1


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 hwray@nc.rr.com 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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Editor’s Note

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.

Heidi Ketler

Advertising Sales Paget@EasternPhysician.com Info@EasternPhysician.com

Editor

News and Columns Please send to info@easternphysician.com

4  Cover

Carteret

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

FEATURES

12 News

6 Gastroenterology

$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

13 News

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.

2

The Eastern Physician

Photography Bill Goode Photography Creative Director Joseph Dally

With respect and gratitude,

Contents

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


Cover Story

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

physicians

The

as

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

enhanced

“This technology gives me the opportunity

during

joint-replacement

surgery.

procedure

itself,

accuracy

and

known

precision.

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

4

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 Result

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

feeling knee

Osteoarthritis (OA) is the most common total

hip

form of arthritis and a leading cause

rates

are

of disability worldwide, according to

of

the

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

osteoarthritis

complications by equipping the surgeon

disease at earlier stages and through less-

with unparalleled accuracy in component

invasive techniques.

For

patients

replacement markedly

undergoing the

success

improved.

Two

and

degenerative

placement.

joint

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.

april/may 2012

5


Gastroenterology

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

6

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. “Before, 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,� 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.


Marketing

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

Marketing.

whose com-

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-

pany, WhiteCoat

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

online review.

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.

March 2012

7


Wound Care

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

healing factors.

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

I

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

working

with

an

established

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,

8

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

8/5/10

12:57 PM

Page 1

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.

Healogics

was

formed

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 hketler@verizon.net.

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.

april/may 2012

9


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. pittman@pcgnc.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

discounted price.

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,

security.

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

Consider These

Cash or Minimal Interest Savings

potential to appreciate.

Real Assets – Think “valuable” and “finite

Accounts – Storing money in savings

quantity.”

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.

10

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

hearing.

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

laser-powered

of speech,” said senior

they were able to determine

author Richard Mooney,

that

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

microscope,

deafening

triggered

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

across.

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

munication Disorders.

april/may 2012

11


News

$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

General

Hospital’s

Emergency

Care

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

Center.

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

as possible.”

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.

Practice News

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.

mid-level

Health.

12

The Eastern Physician

providers,

specializing

in

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

april/may 2012

13


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

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