TEP_Sept2011_PROOF3

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CarolinaEast

Leads Region in Advanced Electrophysiology Care T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S

Every 5 Seconds we help improve another life

Working in partnership with physicians for over 50 years to bring the beneďŹ ts of biomedical technology to patients around the world.

INTRODUCING The Magazine for Healthcare Professionals.

All health care professionals and health related businesses have a new outlet for a direct publication that targets up to 6000 physicians, PAs, NPs, medical centers and related health care professionals. The regional physician publication is coming to the Eastern Region of North Carolina! DF Marketing Consulting and Associates will be handling the advertisements for the publication in the following counties:

The Eastern Physician T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S

Counties: Beaufort, Bertie, Bladen, Brunswick, Camden, Cartert, Chowan, Columbus, Craven, Cumberland, Currituck, Dare, Duplin, Edgecomb, Gates, Greene, Halifax, Hertford, Hoke, Hyde, Jones, Lenoir, Martin, Montgomery, Moore, Nash, New Hanover, North Hampton, Onslow, Pamlico, Pasquotank, Pender, Perquiams, Pitt, Richmond, Robeson, Sampson, Scotland, Tyrrell, Washington, Wayne, Wilson Cities: Greenville, Wilmington, Goldsboro, New Bern, Fayetteville, Southern Pines, Pine Hurst, Rocky Mount, Wilson, Washington, Morehead City, Elizabeth City

DF MARKETING CONSULTING AND ASSOCIATES – 1-919-267-4296 If you’re looking for referrals from other Health Care Professionals, our publication will reach them. We directly mail our publication to up to 6000 Physicians, PAs, NPs, and Medical Groups in the Eastern Region of North Carolina!

We are seeking EDITORIALS for our First Issue in August 2011!

Ask us about our FREE INITIAL CONSULTATION! We offer ad development, graphic design assistance, individualized- personal photos, head shots, and a full service photo shoot for a nominal fee.

Want to be a featured doctor or clinic with up to 8 pages of advertising space with a personalized brochure spread?

We can do that also.

For any assistance or questions you may have contact: David Frank at 919-924-3751 or email at David@EasternPhysician.com Kyle Blatchley at 910-992-1592 or email at Kyle@EasternPhysician.com

“YOUR HAPPINESS IS OUR PRIORITY!” 423 Cameron Woods Drive, Apex, North Carolina 27523

Editor’s Note At Your Service!

The Eastern Physician magazine is the newest member of the thriving eastern North Carolina medical community, dedicated to fulfilling a specialized niche – disseminating news among medical professionals within this region.

Specifically, your market includes more than 6,000 physicians, physician assistants, nurse practitioners, office administrators and hospital staff in the cities of Greenville, Wilmington, Goldsboro, New Ben, Fayetteville, Southern Pines, Pine Hurst, Rocky Mount, Wilson, Washington, Morehead City and Elizabeth City, and numerous surrounding counties.

This first issue of The Eastern Physician is a condensed version of things to come. The cover story is an introduction to CarolinaEast Heart Center electrophysiologists Christopher J. Hudson and Angela M. Park. Going forward, this lead article will be an in-depth portrayal of the driving forces within a practice or hospital and the

T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S

Editor Heidi Ketler, APR Contributing Editors Paul J. Pittman, C.F.P. Satish Mathan, M.D. Henry Tellez, M.D.

unique qualities – the individuals, expertise and technology – that define it. Each feature will be accompanied by a cover photo and a number of photos throughout.

Photography Bill Goode Photography

Each month, The Eastern Physician will satisfy the medical community’s need to know, with news and

Creative Director Joseph Dally

information that you and your colleagues may contribute. We accept editorials and press releases on medical advances, individual accomplishments and appointments, new construction, expansion or relocation, and other related matters. Eastern Physician also lists new physicians and physicians assistants, along with information on upcoming events and clinical trials.

Yes, advertising is our lifeblood. So The Eastern Physician offers an exceptional opportunity for branding within an exclusive market at competitive rates. We encourage you to contact us at info@easternphysician.com. We will provide an editorial calendar of what’s to come, so you can plan your advertising and article contributions to reinforce your brand within specific medical specialties.

To be sure, The Eastern Physician is designed to earn your trust and respect as a valuable news and information source. We are delighted to continue a proud print-publishing tradition and appreciate your support.

It’s a privilege to be at your service!

Advertising Sales David Frank david@easternphysician.com Kyle Blatchley kyle@easternphysician.com News and Columns Please send to info@easternphysician.com Subscription Rates: $48.00 per year/$6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401

Heidi Ketler

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.

Contents

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.

Editor

4 Cover Carolina East Leads region in advanced electrophysiology care

6 Your Financial Rx Putting Paul in the hot seat

8 Radiology Article Utering fibroid embolization is a safe minimally invasive therapy

10 Neurology Overview of diabetic neuropathy

12 News Welcome to the Area

2

The Triangle Physician

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.

Prostate Cancer

•E

Cities: Greenville, Wilmington, Goldsboro, New B

Mount, Wilson, Washington, Morehead City, Elizab •C

October Breast Cancer Neurosurgery 2011 Editorial Calendar

•E

for Healthcare Professionals.

•C The Magazine for Hea

en, Brunswick, Camden, Cartert, Chowan, Columbus, Craven, plin ,Edgecomb ,Gates, Greene, Halifax, Hertford, Hoke, Hyde, Jones, e, Nash, New Hanover, North Hampton, Onslow, Pamlico, Pasquotank, d, Robeson, Sampson, Scotland, Tyrrell, Washington, Wayne, Wilson

Urology •P Counties:Endocrinology Beaufort, Bertie, Bladen, Brunswick, C

oldsboro, New Ben, Fayetteville, Southern Pines, Pine Hurst, Rocky head City, Elizabeth City

Cities: Greenville, Wilmington, Goldsboro, New B PainCardiology Management

Mailing to over 6,000 MDs, DOs, PAs, NPs, Offica November

PAs, NPs, Office Administrators, and Hospital Staff

January

Cumberland,Alzheimer’s Currituck, Dare, Duplin ,Edgecomb1, Glaucoma Lenoir, Martin, Montgomery, Moore, Nash, New Ha Pender, Perquiams, Pitt, Richmond, Robeson, Sam December

February

Lung Safety

dar The magazine for the healthcare professional in Eastern, NC Monthly publication-12 issues per year Mailed to 6,000 MDs, PAs, and NPs- Your Referring Base Area- Eastern, NC -Elizabeth City to Wilmington, From Goldsboro to Beaufort and includes the Sandhill ( Southern Pines)

en al

Totally local Local MDs contribute the editorials Article are written about local MDs and their practices Monthly Local News Section TOTALLY FREE Listings

ies rds

s

y

Dece

March 2012 Editorial Calendar Digestive Health Care Men’s Health January Diabetes April Banking Women’s Health Diabetes February Heart Disease in Women May Accounting for Medical Orthopaedics Practices Allergies

March June Men’s Health Vision Vision Neurology New Medical Devices July Imaging April Technologies Women’s Health Interventional Radiology Marketing Your Services August May Infectious Diseases Orthopedics Pediatrics Medical Insurance September SportsJune Medicine Neurology Prostate Cancer Sleep Apnea October July Breast Cancer New Imaging Technologies Neurosurgery Electronic Medical Records November August Urology Digestive Disease Alzheimer’s Computer Technologies December September Pain Management Sports Medicine Sleep Disorder Physical Therapy

Local professional write informative editorials

es

Imp

Mount, Wilson, Washington, Elizab Sleep DisorderMorehead City, Close

Announcement of all new MDs and PAs every month Announcement of any new website Announcement of any new practices Announcement of any MD moving to a new practice Announcement of any practice moving to a new location or branch Announcement of events – charity, open house Announcement of CMEs Listing for Clinical Trials

Advertise your practice to over 6,000 MDs, PAs, and NPs Profile your practice or a new MD in your practice

Eastern Physician’s Services • New MDs in the area - can include a head shot, free service • MD that has changed practices, free service • New or relocated practice, free service • New or changed Web Site, free service • Events - listing of any event you are having, free service • CMEs - listing of CMEs in the area, free service • Editorials - in conjunction with the editorial calendar • Clinical Trials- listing of your Clinical Trials see sample PDF, This is a paid service $50 per month with a 3 month minimum • Profiles of new or existing doctors or practices Price depends upon 1, 2, 4, 6, or 8 page count

Important Info

Close dates are the 1st of the Preceding month. ie: January will close on December 1st. For more information, please contact info@EasternPhysician.com

•N

•M

•N

•N

•E

•C

•E

•C •a N

•P M 1 •N

•N

Imp •E

Close •C Dece

October Breast Cancer Reconstructive Surgery

•E

November Urology Robotic Surgery

•P 1

•C a

Imp

December Pain Management September 2011

Close Dece

3

Cover

CarolinaEast

Leads Region in Advanced Electrophysiology Care Cardiac

arrhythmias

are

at

Advances in cardiac ablation make it possible

defibrillators (ICD); 3-D mapping; and

CarolinaEast Health System by a team

for CarolinaEast electrophysiologists to control

radiofrequency

of

cardiac

symptoms of AF in 75-80 percent of paroxysmal

abnormal rhythms.

support staff, who are skilled in the use of

AF patients and 60 percent of persistent AF

medications and catheter-based procedures

patients, according to Angela M. Park, M.D.,

The breadth of CarolinaEast’s heart care

for complex and simple ablations, as well as

F.A.C.C., of CarolinaEast Heart Center.

expanded in April 2009 with the addition

electrophysiologists

managed and

device implantation.

and

cryoablation

for

of CarolinaEast Heart Center. Prior to In addition to cardiac ablation, CarolinaEast

Christopher J. Hudson, M.D., F.A.C.C., F.

CarolinaEast Health System is one of only a

Health System electrophysiologists perform

H. R.S., joining the practice this past April,

few health care providers in eastern North

ventricular tachycardia ablation, typical

Dr. Park had been serving North Carolina’s

Carolina that is performing complex ablation

reentry ablation for atrial flutter and

eastern seaboard since 2006.

procedures to treat atrial fibrillation (AF). AF

atrioventricular nodal reentry tachycardia

is one of the most common arrhythmias, yet

(AVNRT), as well as simple ablations. The

Drs. Park and Hudson specialize in

historically has been one of the most difficult

electrophysiology lab is equipped to perform

arrhythmia

to treat. If left untreated, AF increases the risk

tilt-table testing; device implants, including

pacemakers, internal defibrillators, heart

of heart failure and stroke.

pacemaker,

resynchronization

failure devices and ablations. Both are board

therapy (CRT) and implantable cardioverter-

certified in internal medicine, cardiology

cardiac

management,

including

and cardiac electrophysiology.

Dr. Park earned her medical degree from Case Western Reserve University School of Medicine in Cleveland, Ohio, in 1995. Her post-graduate training at Cedar Sinai Medical Center in Los Angeles included a residency in internal medicine and fellowships in cardiology and cardiac electrophysiology.

Dr. Hudson earned his medical degree from Brody School of Medicine at East Carolina University in 2002. He completed his residency in internal medicine at Carolinas Medical Center in Charlotte and fellowships in clinical cardiac electrophysiology and general cardiology from the University of Florida in Gainesville.

CarolinaEast Heart Care offices are located in New Bern and Morehead City. For more Angela M. Park, M.D., F.A.C.C. , Michael Latonte, and Christopher J. Hudson, M.D., F.A.C.C., F.H.R.S., using NAVX 3D mapping and cardiac stimulator to evaluate cardiac arrhythmia.

4

The Triangle Physician

information, call (252) 635-6777 or visit www. heartcentereast.com.

Your Financial Rx

Putting Paul in the Hot Seat

By The Triangle Physician

Because markets are inefficient, you have to combine non-correlating assets, as well as defensive positioning and active management. It’s not a buy-and-hold kind of world out there anymore.

would give me a great sense of satisfaction.

I now feel as if I am making something good out of what my parents went through.

TTP: What has been your biggest surprise in working with physicians?

Paul: Physicians are caregivers and healers, but they are also business owners. I used to be surprised by their resourcefulness, but not any more. One outstanding example

This month, The Triangle Physician is going

gave me the desire and conviction to work

is a urologist in Cary, Dr. Marc Benevides.

to turn the tables a bit and interview Paul

with families to help them achieve financial

Not only is he a spectacular physician on

Pittman, a certified financial planner and

peace of mind. I don’t want other people to

the cutting edge of his specialty and a great

regular contributor to this column.

go through the struggle my family did, and

person, but he is also an extremely astute

I don’t want other people to lose what they

businessman.

TTP: Paul, you have been writing

already have.

He once old me that as the check signer

your Financial Rx column for many years now. Aside from all of the great

TTP: It sounds like very hard lessons

for his practice he would be astonished by

information you have passed on, what

to learn, and your parents must have

the amount paid for medical supplies. After

makes you different from all of the

been good teachers.

further investigation, he was “horrified.”

He could not believe what his practice was

financial advisors out there?

Paul: Terrific teachers and great role

paying for catheters, gauze, urine strips and

Paul: I know there are many out there

models for me on how to live life. As I

such.

who physicians could work with, but I

watched my parents during those tough

truly believe in what we’re doing here

years, it became apparent to me that they

(The Preferred Client Group), and that

were very clear on two things. First, taking

what we stand for is unique. Let me share

care of family was their No. 1 priority. They

something with you. When I was 17, my

made sure we had basic material needs

father was laid off from a long career and

taken care of and then they surrounded

found himself unemployed at age 56. Not

us with love. Second, they knew what they

many companies were looking to hire a

valued and what they cherished, and they

56 year old. My mother had a full-time job,

lived those values.

but they struggled to work and raise three kids. Money was always tight. We lived from

Because of my parents’ experience, I

paycheck to paycheck. But through their

realized that my passion was to help people

love and hard work, we made it.

financially. If I could, through thoughtful financial planning, help people multiply

The story has a happy ending, but that

their current savings and earnings, as well

experience left an indelible mark on me. It

as protect what they already have, then that

6

The Triangle Physician

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 sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 459-4171 and paul.pittman@pcgnc.com.

Physicians’ Own Pharmacy, a physician-

diversification, but it is very important. I am

owned medical supply company. Any

not just talking about owning some stocks,

physician interested in saving overhead

some bonds and some treasuries; I am

at no expense to quality can become a

referring to philosophical diversification.

member shareholder. Details are available

If the economy and markets have told

at popmedical.com.

us anything over the last 10 or so years, it is to incorporate different investment

Physicians have relinquished so much

philosophies in your investments.

control of so many aspects of their practices to insurance companies, vendors, etc., this

Modern portfolio theory sees the markets

is one way to regain an element of that

as efficient. This may have been the case in

control and expense. And it’s one example

the past, but not anymore. We now utilize

of how physicians are thinking outside

what we refer to as post-modern portfolio

of the box when it comes to running the

theory, because we see the markets as

business side of their practice.

inefficient. This means you have to combine non-correlating assets, as well as defensive

So he decided to do something about it.

TTP: Interesting story. We

positioning and active management. It’s

He found that many of the established

sometimes forget that physicians are

not a buy-and-hold kind of world out there

United States manufacturers were willing

businesspeople, too. Any investment

anymore.

to deal with him directly, that products his

advice you’d like to give our readers in

practice already used could be obtained at

this economy?

TTP: Paul, thank you for your time and insight. We will continue this

a significantly reduced price. Interestingly enough, it didn’t stop there. The desire to

Paul: Absolutely! One of the most over-

save on overhead in his office morphed into

used terms in the investment business is

interview in next month’s issue.

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September 2011

7

Radiology Article

Uterine Fibroid Embolization

Dr. Satish Mathan is medical director for interventional services at Rex Hospital and Raleigh Radiology. The vascular and interventional radiologist earned his bachelor of science degree from the University of California at Santa Barbara and his medical degree from the Medical College of Wisconsin.

He completed an internship at Santa Clara Valley Medical Center in San Jose, Calif., and was a chief resident at the University of North Carolina Hospitals, Chapel Hill. He completed a fellowship in vascular and interventional radiology at UNC Hospitals.

Is Safe Minimally Invasive Therapy

By Satish Mathan, M.D.

Treatment of symptomatic fibroids by UFE appears to be safe, technically feasible with standard equipment and easily tolerated. Most patients experience significant symptomatic improvement within a few weeks.

Fibroids are a very common and oftendiagnosed

women’s

health

symptomatic uterine fibroids.

condition.

Uterine fibroids are the most common

The UFE procedure typically takes between

pelvic mass in women in the United States

one and two hours. Pelvic angiogram

with prevalence as high as 40 percent in

is performed with both uterine arteries

some areas. Only one-quarter seek medical

selectively catheterized and embolized via

vascular injury. With regard to radiation,

attention, most commonly for irregular

one arterial access. Typically, embolization

the overall dose to the pelvic organs is

bleeding, extremely heavy menses, with or

is

Tris

higher than most diagnostic tests, but well

without anemia, pelvic pain, and pressure

acrylic

(TAGM)

within acceptable range, with maximum

on the bladder and other organs.

particles. These occlude the arterioles and

dose reduction techniques used during the

preferentially devitalize the fibroids, while

procedure.

performed

with

gelatin

submillimeter

microspheres

Traditionally, treatment of symptomatic

sparing the uterus.

fibroids

or

In the perioperative or early postoperative

A small series show a 38 percent pregnancy

has

been

myomectomy,

and

hysterectomy

recently

course, patients may develop pelvic pain

rate after UFE for those patients trying

endometrial ablation. Oral contraceptive

more

and nausea/vomiting. Therefore, they are

to get pregnant. Women seeking future

pills,

intrauterine

admitted under the care of the interventional

childbearing are generally screened and

devices and GnRH, or gonadotrophin-

hormonal-impregnated

radiology service for overnight observation

counseled to consider other treatment

releasing hormone, antagonists have also

and pain control with PCA (patient-

options. For them, myomectomy is the

been used for nonsurgical management.

controlled anesthesia). As soon as patients

preferred treatment at this time. However, if

are tolerating oral intake, oral narcotic and

the fibroids are too large or numerous that a

The first U.S. experience with uterine

nonsteroidal anti-inflammatory drugs are

myomectomy may result in a hysterectomy,

fibroid embolization (UFE) was reported in

started, and patients are home the next

UFE may still be advised.

1997 from the University of California, Los

day and back to work the next week.

Angeles, with seven of nine patients having

Most series report average technical success

significant clinical improvement. Since that

Abdominal pain typically is the worst

rates for myomectomy of about 98 percent.

time, numerous well-constructed clinical

within the first few days, and tapers off by

A 90 percent rate of clinical success means

studies in the radiology and obstetric/

the third to fifth day. Risks are minimal, but

patients have a significant enough decrease

gynecology literature have validated the use

include infection, hematoma, nontarget

in their bleeding or mass-effect symptoms

of UFE as a viable option for treatment of

embolization

that they require no further treatment.

8

The Triangle Physician

and

angiographic-related

Despite a high rate of symptomatic relief, most patients have only modest (50 percent to 75 percent) volume reductions.

In summary, the treatment of symptomatic fibroids by UFE appears to be safe, technically

feasible

with

standard

equipment and easily tolerated. Most patients experience significant symptomatic improvement within a few weeks.

Raleigh Radiology was the first to offer this procedure within the Triangle and has been

Managing your patients’ health is your life’s work.

Managing physicians’ wealth is mine.

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Aiding Wealth Creation, Preservation and Protection Business Management Tax-strategies Liability Protection Asset Preservation

providing this service for more than 10

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The Preferred ClienT GrouP Paul J. Pittman CFP®

patients with known or suspected fibroids will need magnetic resonance imaging taken of their pelvis with and without contrast to better delineate the location of the fibroids and vascularity. UFE consults can be scheduled at Raleigh Radiology’s Interventional Services Clinic at the Blue Ridge facility by calling (919) 781-1437 or at Rex Hospital by calling (919) 784-3419.

President and Managing Director 919-459-4171 paul.pittman@pcgnc.com www.pcgnc.com Securities offered through LPL Financial Member NASD/SIPC

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September 2011

9

Neurology

Overview: Diabetic Neuropathy

By Henry Tellez, M.D.

The term neuropathy is derived from the

Foot slapping and toe deterioration or

Greek word “neuron” (nerve) and the

frequent tripping may be early symptoms

English suffix “-pathy” (feeling, suffering).

of foot weakness. Symptoms of proximal extremity

weakness

include

difficulty

Neuropathies are characterized by a

climbing up and down stairs, difficulty

progressive failure of nerve fiber function. A

getting up from a seated or supine position,

generally established definition of diabetic

falling due to the knees giving way and

peripheral neuropathy is “the presence of

difficulty raising the arms above the

symptoms and/or signs of peripheral nerve

shoulders.

dysfunction in people with diabetes after exclusion of other causes.”

In the most common presentation of diabetic neuropathy with symmetrical

Dr. Henry Tellez is in private practice with Sandhills Neurologists PA. He obtained his medical degree from Valley University, Colombia.

He then completed his internship and neurology residency at Saint Louis University, Miss. This was followed by a fellowship in nerve conduction (nerve conduction velocity/electromyography) studies and neuromuscular diseases at the University of North Carolina, Chapel Hill. Dr. Tellez is currently board certified in general neurology, neuromuscular medicine and vascular neurology by the American Board of Medical Specialties.

Neuropathies are the most common

sensorimotor symptoms, minor weakness

complication of diabetes mellitus (DM),

of the toes and feet may be seen. It is

affecting up to 50 percent of patients with

important to note that severe weakness is

Type 1 and Type 2 DM.

unusual and should prompt investigation

spine disorders) may generate poor urinary

into other causes, such as chronic

stream, feeling of incomplete bladder

The Symptoms

idiopathic demyelinating polyneuropathy

emptying and straining to void.

Diabetic neuropathy can present as a wide

(CIDP) or even vasculitis. Severe weakness

mixture of sensory, motor and autonomic

can be observed in asymmetrical diabetic

Sudomotor neuropathy may produce heat

symptoms. A well thought-out list of

neuropathy

intolerance, intense sweating the head,

symptoms can be used to help screen all

amyotrophy).

may

neck and trunk, with lack of sweat in the

diabetic patients for possible neuropathy.

occur along with sensory neuropathy

lower trunk/extremities, and gustatory

(sensorimotor neuropathy).

sweating.

These are subtle in onset and show a

Autonomic Symptoms

Etiology

stocking-and-glove distribution in the distal

Autonomic neuropathy may entail the

The factors important to the development

limbs. Sensory symptoms may be negative

cardiovascular,

and

of diabetic neuropathy are not understood

or positive, diffuse or focal. Negative

genitourinary systems, and the sweat

completely, and various hypotheses have

sensory symptoms include feelings of

glands. Patients with generalized autonomic

been proposed. It is commonly accepted to

numbness or deadness, which patients

neuropathies may report near syncope/

be a multifactorial problem.

may express as “wearing gloves or socks”

syncope.

syndromes Motor

(i.e.

diabetic

neuropathy

Sensory Symptoms

gastrointestinal

Development of symptoms depends on

or “walking on thick pads.” Loss of balance, especially in poorly lit environments or with

Gastrointestinal

neuropathy

many factors, such as total hyperglycemic

closed eyes, and painless injuries owed

may produce dysphagia, abdominal pain,

exposure and other risk factors, such as

to loss of sensation are frequent. Positive

nausea/vomiting,

elevated lipids, blood pressure, smoking,

symptoms may be described as burning,

incontinence, diarrhea and constipation.

high

prickling pain, tingling, electric shock – like

Cardiovascular

neurotoxic agents, such as ethanol and

feeling aching, tightness or hypersensitivity

may produce persistent sinus tachycardia,

to touch.

orthostatic hypotension, sinus arrhythmia

autonomic

malabsorption, autonomic

fecal

neuropathy

exposure

to

other

potentially

increased height.

and decreased heart variability in response

Genetic factors may also play a role.

Motor Symptoms

to deep breathing. Also, not unusual is near

Important

These may include distal, proximal or more

syncope upon changing positions from

mechanisms in the development of the

focal weakness. In the upper limbs, distal

recumbent to standing.

more common symmetrical forms of

contributing

biochemical

diabetic polyneuropathy likely include the

motor symptoms may consist of impaired fine-hand coordination and trouble with

Bladder neuropathy (which must be

polyol pathway, advanced glycation end

tasks, such as opening jars or turning keys.

entertained after exclusion of prostate or

products and oxidative stress.

10

The Triangle Physician

Risk Factors

diabetes diagnosis – because failure to

more localized pain or those in whom

Risk factors that are associated with more

diagnose diabetic polyneuropathy can

interactions with existing oral medications

severe symptoms include poor glucose

lead to serious consequences, including

is a concern.

control,

disability and amputation.

long

advanced

duration

age,

hypertension,

DM,

dyslipidemia,

of

Diabetic Gastroparesis

smoking, heavy alcohol intake, HLA-DR3/4

Consider any patient with clinical evidence

Erythromycin, cisapride, metoclopramide,

phenotype and tall height.

of diabetic peripheral neuropathy to be

MiraLax (polyethylene glycol 3350) are the

at risk for foot ulceration, and provide

most frequent medications used for this

Diagnosis

education on foot care. If necessary, refer

condition.

The diagnosis of diabetic neuropathy is

the patient to a podiatrist.

Erectile Dysfunction

based on the symptoms, their distribution Patients with diabetic peripheral neuropathy

Overall, erectile dysfunction from diabetic

require more frequent follow up, with

neuropathy is a very difficult condition to

Fasting plasma glucose and hemoglobin

particular attention to foot inspection and

treat. All other causes of impotence must

A1c are important laboratory screening

reinforcement of the need for regular self

be excluded. Once the diagnosis has been

tests for diabetic neuropathy. Other blood

care. Regular foot examinations and patient

confirmed, the oral agent sildenafil (Viagra)

test(s) to rule out Vitamin B12 deficiency

education about foot care have been shown

may be tried. Referral to a urologist is suggested.

and paraproteinemias (SIEP, or serum

in several studies to significantly reduce

immunoelectrophoresis)

rates of ulceration and even amputation.

and a detailed neuromuscular examination.

are

essential.

Orthostatic hypotension Increasing the dietary fluid and salt intake,

More specific blood work may be required depending on the clinical presentation

The importance of involving a neurologist

along with use of compression stockings,

(inflammatory conditions, paraneoplastic

(preferably with expertise in peripheral

may help. If these modalities do not

processes and others).

neuropathy) in the treatment of patients

improve symptoms, then medication (i.e.

with

midodrine) may help.

Multiple consensus panels recommend

diabetic

neuropathy

cannot

be

overemphasized.

Gustatory sweating

the inclusion of electrodiagnostic testing in the evaluation of diabetic neuropathy.

Glycemic Control

Glycopyrrolate can be used for the handling

A proper selection of electrophysiological

Of all treatments, tight and stable blood

of diabetic gustatory sweating. It is applied

tests includes both nerve conduction testing

sugar control is probably the most important

topically to the affected area and can give a

and needle electromyography (EMG). The

for slowing the progression of neuropathy.

marked reduction in sweating while eating

diagnosis is strongly supported when a nerve

Rapid changes from hypoglycemia to

a meal.

conduction

hyperglycemia have been suggested to

velocity/electromyography

bring and exacerbate neuropathic pain, so

Surgical Treatment

the stability of glycemic control may be as

This is indicated in patients with infected

The first part of the test involves measuring

important as the actual level of control in

foot ulcers when the infection cannot be

the rate of speed for electrical impulses as

relieving neuropathic pain.

controlled medically. Jejunostomy can

(NCV/EMG) test is abnormal.

help patients with intractable gastroparesis.

they travel down a nerve. The second part of the test, EMG, is essential to exclude or detect

Pain Management

When impotence is a continual problem,

other conditions that might mimic neuropathy

Oral agents include antidepressants and

the patient may pursue the option of a

(lumbar radiculopathy, cervical radiculopathy,

anticonvulsant drugs. Usually, pregabalin

penile prosthesis. Charcot foot can be

tarsal tunnel syndrome and others).

is recommended for treatment of diabetic

treated with bracing or special boots. In

neuropathic

some cases, surgery is used to correct the

pain.

Yet,

physicians

deformity.

In the appropriate clinical setting, magnetic

should determine if the drug is clinically

resonance imaging of the cervical, thoracic

appropriate for their patients on a case-

and/or lumbar regions may help exclude

by-case

another cause for symptoms mimicking

antidepressants and sodium valproate

Physical and occupational therapy should

diabetic neuropathy.

should also be considered for diabetic

be considered when activities of daily living

neuropathy pain management.

are being compromised. It is quite essential

basis.

Gabapentin,

tricyclic

Rehabilitation

to prevent falls in patients with significant

Treatment The primary care physician needs to be

Topical

alert for the development of neuropathy –

transdermal lidocaine may be useful

therapy

with

capsaicin

or even its presence at the time of initial

in some patients, especially those with

or

sensory ataxia from underlying diabetic neuropathy.

September 2011

11

News Welcome to the Area

Physicians Robert Anthony Alcott, DO Family Medicine Southern Regional AHEC Fayetteville

Zachary Peter Englert, DO General Surgery Pitt County Memorial Hospital, GME Greenville

Robert Lawrence Turton, DO 2104 Auburn Lane Wilmington

Annetta Cheryl Alexander, MD

Pedro Hernandez, MD

Ramzy Husam Rimawi, MD

Hamlet

Pitt County Memorial Hospital, GME Greenville

Kerry Lynn Hollowell, MD General Surgery Pitt County Memorial Hospital Greenville

Karen Melinda Isaacs, MD

Ram Prasad Sapkota, MD

Nirav Manubhai Jasani, MD

Rodney Kevin Sessoms, MD

Pitt County Memorial Hospital, GME Greenville

Internal Medicine Sessoms Medical Practice Clinton

Jonathan Robert Maher, MD

Juan Aviles, MD

Catherine Jeanette Maxcey, MD

Crystal Cornelia Bowe, MD

Family Medicine Columbus Regional Medical Center Whiteville

Family Medicine New Hanover Regional Medical Center Wilmington

Internal Medicine, Pediatrics Pitt County Memorial Hospital Greenville

107 Airport Road, Kinston

Claude Roofian, MD

Dept of Orthopaedics Camp Lejeune

Pope Air Force Base Fort Bragg

Family Medicine Pitt County Memorial Hospital, GME Greenville

Marshall Scott Nickel, MD

Shazia Amber Choudry, MD

Iraj Nikfarjam, MD

Ft Bragg Dept of Family Medicine Fort Bragg

Cumberland Cardiology Fayetteville

Physician Assistants Shannon Michelle Billings, PA Carolina Skin Care Pinehurst

Robert Frederick DeLancy, PA Family Practice Aberdeen

Meghan Ann Driscoll, PA WAMC - Soldier Readiness Center Fort Bragg

Elizabeth Deibert Dryden, PA Newport

Christina Day Eakins, PA

Mark Fuller Sewell, MD

Wilmington

Womack Army Medical Center Fort Bragg

Christina Day Eakins, PA

Manu Sharma, MD Hope Mill Pediatrics Hope Mills

David Joseph Skarupa, MD

Wilmington

Lisa Christine Gilligan, PA Morehead City

Carolyn Elaine Green, PA

ECU Physcians, Department of Surgery Greenville

Family Care Associates Troy

Fayetteville

Virginia Butler Taylor, MD

Sarah Jane Maloney, PA

Franklin Chinagorom Ohiagbaji, MD

Lenoir Orthopedics Kinston

Spring Lake

Dermatology Eastern Dermatology & Pathology Greenville

Lumberton

Chukwuemeka E Oji, MD

Chidebe Udeozo, MD Bladen Healthcare Elizabethtown

Albemarle Family Practice Elizabeth City

Tameru Dressie Demsie, MD

East Carolina Medical Associates Jacksonville

Stephen Arthur Parada, MD

Arul Vigg, MD

New Bern

Dept of the Army Fort Bragg

Tarboro Clinic Tarboro

Jeremy Wade Sexton, PA

Madhvi Hiren Patel, MD

Larry Irving Watson, MD

Nash General Hospital Rocky Mount

General Surgery Washington County Hospital Plymouth

Internal Medicine New Hanover Regional Medical Center Wilmington

Lya Carol Crichlow, MD

Fayetteville

Ira Nathaniel Doneson, MD Psychiatry Fayetteville

Humdum Pasha Durrani, MD Pitt County Memorial Hospital, GME Greenville

Roy Edward Ehrlich, MD Pinehurst

Sarah Lucille Gustafson, MD

Emilie Elks Pendley, MD Emergency Medicine Pitt County Memorial Hospital, GME Greenville

Emergency Medicine Pitt County Memorial Hospital, GME Greenville

Mia Farida Mediana Pingul, MD

Louis Karl Haase, MD

Laxman Raj Pokhrel, MD

Southern Pines

Kenneth William Harter, MD Cape Fear Valley Health System Fayetteville

Kristin DeVonne Hawkes, MD Fayetteville

12

The Triangle Physician

Pediatric Specialty Care Greenville

VA Medical Center Fayetteville

Francisco Jeronimo Ramirez, MD Womack Army Medical Center Fort Bragg

Aimee Elizabeth Widner, MD Physical Medicine and Rehabilitation Pitt County Memorial Hospital Greenville

Thamrah Rhoxana Wright, MD Roanoke Chowman Community Health Center Ahoskie

Sharon Elizabeth Nelson, PA

Leslie Elizabeth Prichard, PA

Western Carolina Emergency Physicians Albemarle

Larry Justain Sykes, PA Owen Drive Surgical Clinic Fayetteville

Kristen Danielle White, PA Ronaoke Chowan Hospital Ahoskie

Kristen Danielle White, PA Ronaoke Chowan Hospital Ahoskie

Kristen Danielle White, PA Ronaoke Chowan Hospital Ahoskie

“More than a doctor.

Like a friend.”

Trust.

WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it.

We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution. And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.

Cardiovascular Professionals in Johnston County Mateen Akhtar, MD, FACC Benjamin G. Atkeson, MD, FACC Kevin R. Campbell, MD, FACC Randy A.S. Cooper, MD, FACC Christian Gring, MD, FACC

Matthew A. Hook, MD, FACC Eric M. Janis, MD, FACC Diane E. Morris, ACNP Ravish Sachar, MD, FACC Nyla Thompson, PA-C

WHV Locations in Johnston County 910 Berkshire Road Smithfield, NC 27577 Phone: 919-989-7909 Fax: 919-989-3147

2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520 Phone: 919-359-0322 Fax: 919-359-0326

When it comes to your cardiovascular care – We know it by heart.

To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).

We know it by heart.

Cardiovascular Services Echocardiography Nuclear Cardiology Interventional Cardiology Carotid Artery Interventions Cardiac Catheterization Cardiac CT Angiography and Calcium Scoring Electrophysiology and Cardiac Arrhythmias Peripheral Vascular Interventions Pacemakers / Defibrillators Stress Tests Holter Monitoring Lipid and Anti-Coagulation Clinics Vascular Ultrasounds / AAA Screening