Womenâ€™s Wellness Clinic
Excellence in Gynecology 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
Also in This Issue
ACL Reconstruction Roth IRA Conversion
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
JOHNSTON HE ALTH
Women’s Wellness Clinic Excellence in Gynecology
m ay 2 012
Vol. 3, Issue 5
Advancing Approach for Achieving Successful ACL Reconstruction
DEPARTMENTS 9 Marketing Physician Outreach Is Cost-Effective Way to Boost Relationships, Referrals
Fragility Fractures and Bone Health: Are We Making Any Progress?
Dr. Andre Grant explains why emphasis
Dr. Douglas Dirschl suggests adopting
has been placed on improving single-
model programs to improve a downward
bundle ACL reconstruction.
trend in the United States.
COVER PHOTO: Standing (from left) are Janet Figueroa-Davis, Tara Whitted, Juliette Eck and Atiya Sherwani.. Sitting are Andrea Lukes, M.D., (left) and Amy Stanfield, M.D. Photo by Jacoby Photography.
10 Your Financial RX
Weigh Factors in Roth IRA Conversion
18 Duke Research News
Only a Few Cell Can Make Heart Muscle
19 Duke Research News Team Converts Scar Tissue Into Heart Muscle Without Stem Cells
20 Duke Research News Genes May Explain Why Some Turn Their Noses Up at Meat
21 Rex Hospital News Rex Healthcare Is Only One Named to Becker’s Hospital Review in Triangle
21 Durham Regional News
New Chief Medical Officer Appointed
22 UNC News
- Nanoparticle Carriers May Offer New Hope for Failed Cancer Drug - Supercharged Protein Rescues Cells, Reduces Damage from Heart Attack
23 UNC News UNC Physicians Inducted as Fellows in American College of Radiology
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From the Editor
From the Editor
The Joy of Health Care After reading this month’s cover story on the Women’s Wellness Clinic, one gets the sense that obstetric gynecologists Andrea Lukes and Amy Stanfield reap considerable
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
joy from their professional lives. The guiding principle of this women’s health care practice: “It is a privilege to care for women.” The genuine nature of this claim is reflected in everything from involvement in clinical research through Carolina Women’s Research and Wellness Clinic and the pursuit of clinical excellence in minimally invasive procedures to the myriad of women’s health services offered and even the flexible office hours. Dr. Stanfield’s expertise in integrative medicine enables the practice to advise on a wider range of medically appropriate treatment alternatives. These women also strive for balance. They have grown their practice, while staying independent, inviting and flexible, and while being fully engaged in raising their families. As proof of the latter, I called Dr. Lukes one snow day a couple of years ago and caught
Editor Heidi Ketler, APR
Contributing Editors Douglas R. Dirschl, M.D. Andre C. Grant, M.D. Jack Inge, M.D. Amanda Kanaan Paul J. Pittman, C.F.P. Photography Mark Jacoby Creative Director Joseph Dally
her sled riding with her kids!
Advertising Sales Carolyn Walters firstname.lastname@example.org
Also contributing to this issue of The Triangle Physician are gynecologist Jack Ing, who
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applauds marvelous advances possible with robotic surgery, and orthopedic surgeons Douglas Dirschl and Andre Grant. Dr. Dirschl discusses the need for physicians to embrace proper and ongoing management of patients who sustain fragility fractures. Dr. Grant reviews the evolution of anterior cruciate ligament reconstruction and the new definition of success brought on by long-term research findings. Marketing specialist Amanda Kanaan and certified financial planner Paul Pittman return this month with practice management advice. Ms. Kanaan discusses the value of a physician liaison as part of the health care team. Mr. Pittman weighs the pros and cons of converting a traditional IRA to a Roth IRA. We always welcome news and information of interest to the Triangle medical community, as well as your advertising. If the Triangle medical community is your market, The Triangle Physician is your best medium. Get creative, run on a consistent basis and you’re likely to be overjoyed by the response. With great appreciation for all you do,
Heidi Ketler Editor
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The Triangle Physician
Women’s Wellness Clinic Excellence in Gynecology By Rory Cullen
Perhaps the most striking thing about the
Rest assured – form does not sacrifice
Figueroa-Davis, the office staff holds true
Women’s Wellness Clinic is how un-clinical
function. The clinic is at the cutting edge
to their guiding principle: “it is a privilege
of medical technology, boasting devices
to care for women.” Patients spending just
and procedures that are revolutionizing gy-
an hour or two in the clinic recognize the
The clinic is one of a cluster of private
necological practice. Treatments that once
heartfelt sentiment behind these words.
medical practices located in a lone, proud
took days to recover from are performed
building off of Highway 54, near Fayetteville
within an office setting, with greater safety
Road. Surrounded by trees and open
and effectiveness than ever before. Thanks
This drive to provide exceptional care
fields, it’s a far cry from the downtown
to its constant, energetic participation in
is best exemplified, perhaps, by the two
bustle and traffic that plague so many
a variety of clinical research studies, the
physicians at the clinic’s head. Andrea
university clinics. Airy, open architecture
clinic remains at the forefront of modern,
Lukes, M.D., M.H.Sc., F.A.C.O.G., and Amy
eschews the traditional white in favor of
minimally invasive and complete gyneco-
Stanfield, M.D., F.A.C.O.G, are both board
soft greens, blues and browns. In place
logic health care.
certified in obstetrics/gynecology and
of anatomical diagrams, hand-painted
highly engaged in women’s health.
landscapes decorate the walls. Flowers are
The staff of the Women’s Wellness Clinic
a prominent theme, too, nestled in picture
recapitulates this dichotomy of compassion
Dr. Lukes earned a combined medical
frames or vases. Examination tables seem
and quality. They number seven, all
degree and master’s degree in statistics
out of place next to plush couches and
women, and radiate a genuine know-
at Duke University before completing
stylish décor that could have come from
your-name warmth and friendliness. With
her ob/gyn residency at the University
the folds of a real estate brochure.
direction from the office manager, Janet
of North Carolina in 1998. She returned to Duke University Medical Center and began her career in earnest, co-founding the Women’s Hemostasis and Thrombosis Clinic to respond to the needs of women with bleeding and clotting disorders. Her research at Duke collaborated with the National Institute of Health (NIH) and the Center for Disease Control (CDC) and received the sponsorship of private industry. After 10 successful years at Duke, Dr. Lukes left to fulfill a longtime dream and found Carolina Women’s Research and Wellness Clinic. In addition to the satisfaction that comes from providing the best of care to women in the Triangle, Dr. Lukes enjoys greater freedom to pursue her passion for clinical research, focusing on the most important topics in gynecology.
Juliette Eck, R.N., takes a blood sample.
The Triangle Physician
She is aided in this endeavor by Dr. Stanfield. A graduate of UNC School of Medicine, Dr. Stanfield began her residency in 1998 at the Carolinas Medical Center in Charlotte, N.C. She followed this with private practice in Chapel Hill, opening her doors in 2002. After many successful years she chose to broaden her knowledge, pursuing a prestigious fellowship in integrative medicine under the esteemed Andrew Weil, M.D., at the University of Arizona. Finishing in 2009, Dr. Stanfield began a comprehensive integrative health program through the Women’s Wellness Clinic. Integrative health combines the very best of traditional medicine with the latest and most efficacious alternative methods, em-
Andrea Lukes, M.D., (left) and Atiya Sherwani discuss details for upcoming clinical trials.
phasizing the mutual interactions of physical health, mind, spirit and community on
ing of the pressures and time constraints
dometrial biopsy and who has completed
overall wellness. As CWRWC director of
faced by working moms has been funda-
childbearing, these advanced procedures
integrative medicine, Dr. Stanfield man-
mental in their approach to gynecological
– astoundingly – can be completed quickly
ages research and clinical efforts in this
practice. The clinic maintains a light at-
within the clinic and satisfy 95 percent of
specialized field, while incorporating her
mosphere and open schedules, ensuring
patients, reducing or eliminating heavy pe-
expertise into her daily practice.
that patients are seen promptly and have
riods and even improving post menstrual
plenty of time for questions. Furthermore,
syndrome symptoms. Dr. Stanfield sums it
Together, Drs. Lukes and Stanfield make
many of their treatment options are aimed
up: “These in-office endometrial ablations
at minimizing convalescence. “One day, in
are a minimally invasive procedure that
and out,” says Janet Figueroa-Davis.
provide an alternative to hormone medica-
other’s strengths beautifully. Under their
tions and/or a hysterectomy.”
leadership, CWRWC has continued to grow and now includes collaborating physicians
Heavy menstrual bleeding (HMB) is
across North Carolina, all of whom are
one of the most common gynecological
Continuing the line of technological
supporting an ever-increasing number of
problems addressed at the Wellness Clinic,
wonders is the MyoSure® device, designed
studies, trials, and research projects.
affecting as many as one in four women.
for the surgical removal of polyps and
“Heavy periods can impact a woman’s
uterine fibroids. Polyps are lesions in the
The Women’s Wellness Clinic (the private
daily activities, from soiling clothing and
endometrium, while uterine fibroids arise
practice associated with CWRWC) has
embarrassment, avoiding social and family
from the myometrium, the layer of tissue
grown too, although Drs. Lukes and
events, missing work and more,” says Dr.
underlying the endometrium. Both can
Stanfield are careful to balance the
Lukes. After determining the etiology of the
contribute to heavy bleeding.
competing needs of an expanding practice
symptoms, the Wellness Clinic presents a
with a friendly, relatable atmosphere.
wide array of treatment options to the
The MyoSure device allows a physician to
They’re committed to keeping the practice
patient, explained with compassion and
remove polyps or fibroids in a single, easy
independent and small to maintain a
candidness. “Many women do not realize
procedure. The 6.25-millimeter hystero-
high quality of care. “You can see people
the variety of treatments now available,”
scope gives the physician direct visualiza-
for years and get to know them,” says Dr.
says Dr. Lukes.
tion during the procedure with a minimum of cervical dilation. Like the ablation treat-
Stanfield. “I enjoy seeing so many different These include endometrial ablation proce-
ments above, it can be completed quickly
dures, such as NovaSure® (www.novasure.
and in-office with minimal discomfort, and
com), which ablates, or removes, the en-
it only requires oral anesthesia. “This is
Dr. Lukes and Dr. Stanfield also are both
dometrium (the lining of the uterus). Avail-
cutting-edge, safe and effective gynecol-
busy mothers of four, and their understand-
able to any woman who has a normal en-
ogy,” says Dr. Lukes.
patients. It’s been a good fit.”
Sherwani, the director of research at the clinic, is involved in six different projects. The clinic participates in trials from Phase 1 (experimental drugs administered to a small pool of patients) through Phase 4 (post-marketing studies to follow up on a drug’s side effects and optimal use), and Ms. Sherwani remarks that many patients at Women’s Wellness Clinic are enthusiastic about participation. “Many girls and women enjoy being a part of innovative and leading research,” she says. “We only choose clinical trials that our physicians believe in,” she continues. “I have worked at other clinical institutes, but I think our current staff and location are the best around.” Amy Stanfield, M.D., (left) and Tara Whitted review a patient’s chart.
The medical community seems to agree: Dr. Lukes has provided expert opinion to
Women seeking permanent birth con-
muscles that cause them. Treatment takes
the FDA in recent hearings about birth
trol will find similarly innovative proce-
just 10 to 20 minutes. Products from the
control medication and has presented at
dures at the Women’s Wellness Clinic.
SkinCeuticals and Glytone lines also are
the Nurse Practitioners in Women’s Health
In place of traditional bilateral tubal liga-
conference, and before the American Congress/College of Obstetricians and
tion surgeries, options such as ESSURE® (www.essure.com) and ADIANA (www.
“We began offering these treatments
Gynecologists (ACOG), the National Medi-
adiana.com) utilize micro-inserts (as small
because our staff wanted to have the
cal Association (NMA), the Association
as a grain of rice) placed in the fallopian
treatments themselves,” says Dr. Lukes.
of Advanced Gynecologic Laparoscopists
tubes. These create a physical barrier, pre-
“The majority of women we see want to
(AAGL) and the American Society for
venting sperm from reaching the egg. The
have hair removal or treatment for wrinkles
Reproductive Medicine (ASRM). Dr. Stan-
procedure takes 10-15 minutes and is eas-
and age spots. Beauty certainly comes
field has been published in a number of
ily done in-clinic. “Both options offer reli-
from within, but sometimes removing an
journals, offering her expert insight in the
able but permanent birth control,” says Dr.
age spot helps as well.”
emerging field of integrative medicine.
Other services provided by the clinic
Despite the lofty accolades and pressures
include screening for breast or ovarian
of research, Drs. Lukes and Stanfield
The clinic also offers advanced aesthetic
cancer, fertility and sexual dysfunction
haven’t lost themselves in ivory towers.
treatments for hair removal via the nearly
treatment, pap smears and hormone
Throughout the clinic, they maintain a keen
pain-free Alma laser (www.painfreehairfree.
replacement therapy for menopause.
focus on their ultimate goal: to provide the
Lukes. “Women must be sure they’re done having children.”
best care for women. The Patients’ Choice
com). Hair treated with the laser will never regrow, and the laser can be calibrated
Award (an online physician rating service
for all skin types. Although it takes four
Since its founding, CWRWC has been in-
at www.patientschoice.org) testifies to the
to six treatments to render the target area
volved in more than 30 clinical studies, cov-
compassion of the Women’s Wellness Clin-
completely hair-free, there is no recovery
ering an enormous range of gynecological
ic. Even more telling are the handwritten
time, and patients may resume normal
issues, from contraception to migraines.
thank-you notes, carefully enshrined upon
The frequency with which the practice pur-
the practice’s aquamarine walls.
sues clinical trials has been rapid enough A variation of Botox, Dysport® is offered
to prompt an audit from the Food and Drug
To learn more about the Women’s
to reduce the appearance of frown lines
Administration (FDA) – which the clinic
Wellness Clinic, visit www.cwrwc.com
by blocking nerve impulses to the facial
passed with flying colors! Even now, Atiya
or call (919) 251-9225.
The Triangle Physician
Physician Outreach is Cost-Effective Way to Boost Relationships & Referrals By Amanda Kanaan
As a physician, you can’t be everywhere
As a physician, you can relate to the fact
at once. From a clinical perspective, you
that referring doctors prefer to send patients
help ease this burden by hiring nurse
to practices they have relationships with.
practitioners or physician assistants as an
In some ways when you refer a patient to
extension of your care. From a marketing
another doctor, you are putting your own
perspective, hiring a physician liaison helps
reputation at stake by endorsing that doctor’s
expand your outreach in the community by
skills and services. Patients will either thank
building and maintaining relationships with
you or complain to you for doing so. By
referring doctors on your behalf.
referring to practices you already have an established relationship with, you reduce the
From private practices to major hospital
chances these patients will come back in the
systems, health care providers have long
form of a complaint.
Amanda Kanaan is a medical marketing specialist whose company, WhiteCoat Designs, provides Physician Outreach services, Medical Website Design, Search Engine Optimization (SEO), Social Media Management and Marketing Consulting to private practices and healthcare organizations. Ms. Kanaan
relied on the assistance of a physician liaison
can be reached by e-mail to amanda@
to strengthen their practice’s reputation,
Hiring a physician liaison isn’t for everyone.
uncover opportunities, collect valuable
It primarily benefits specialists and sub-
feedback and ultimately increase new patient
specialists who heavily rely on referrals to
fuel their practice.
For smaller practices, this concept may seem
It is an ongoing commitment that takes time
easier (such as script pads that can be faxed
daunting considering the costs involved with
to achieve results. Much like dating, you won’t
in for scheduling) and using your liaison to
hiring another full-time employee. However,
be in a relationship with someone after just
uncover and fix internal issues.
many medical marketing agencies now offer
one or two dates. It may take multiple visits to
physician liaison services on a contract
convince a practice to try your services, and
The key to a successful physician outreach
basis, making it feasible and much more
when they do, it has to be a good experience
program is listening. Liaisons shouldn’t just
affordable for specialists to pursue this
in order for the referrals to continue.
walk into offices, tell the staff about your
whitecoat-designs.com, phone at (919)714-9885 or on the web at www.whitecoat-designs.com.
practice, drop off some brochures and walk Physician liaisons help build new referring
out. Their role is to listen, find opportunities to
In marketing, if you’re not saying it then
relationships. They also are essential in
strengthen relationships and then nurture those
you’re not doing it. That means that if you are
maintaining those relationships by ensuring
relationships into consistent referral patterns.
not out communicating the benefits of your
the referring office has a smooth experience
practice to the referring community, then it’s
and by rectifying any negative feedback on
Although many doctors hesitate hiring a liai-
safe to assume no one knows. I work with
behalf of either the referring office and/or
son, because they feel the concept of sales
many physicians who think because their
has no place in their practice, the truth is
practice has been in existence for more than
liaisons act more as customer service repre-
15 years their reputation speaks for itself.
The key to a successful physician outreach
sentatives. When used effectively, liaisons are
While reputation is important, doctors are
strategy is to bring value to your relationship
the furthest thing from a traditional sales rep.
often astonished when liaisons report back
with referring physicians. Ways to legitimately
that many referring physicians are not only
add value include offering a monthly or
Overall, physician liaisons are often an afford-
unfamiliar with their services, but don’t even
quarterly newsletter containing ongoing
able and valuable tool in winning over your
know they exist.
education about your specialty, creating
peers and gaining valuable new patient refer-
tools that make referral coordinators’ lives
rals to fuel your practice.
Your Financial Rx
Weigh Factors in
Roth IRA Conversion By Paul J. Pittman, C.F.P.
Thinking about converting to a Roth Individual Retirement Account?
Form 8606, which details the non-taxable portion of your IRA.
Recharacterization A recharacterization will undo a Roth conversion. It has been called the “doover option,” which can be exercised any time before the due date of your income tax return for the year of the conversion,
While many people will make that decision
more from their heart than head, one important question to ask yourself is, how
For example, recharacterizations for 2010
long can you keep your money in a Roth
could be made through Oct. 15, 2011. One
of the most common reasons to reverse a
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. Send an e-mail to receive Mr. Pittman’s Weekly Market Commentary.
conversion is that the portfolio’s value has If you decide to convert, here are some
declined after the conversion to a Roth IRA.
Next, consider establishing multiple Roth IRA accounts if you are converting a large
other factors and strategies that will help First, establish a new Roth IRA to hold
amount of money. If you have multiple as-
each year’s conversion amount separate
set classes in one Roth IRA, the tax effect
from any of your existing Roth IRAs. This
of losses and gains are proportional to
Income limits prevent many people from
will make it easier to identify the funds
the account. But if you maintain multiple
making tax-deductible contributions to a
being recharacterized. If the funds are
Roth IRAs, each with a single asset class
traditional retirement account. However,
(examples: United States large caps, do-
as of April 15, 2010, you have been able to
process can become more complicated.
you now and in the future.
contribute to a non-deductible traditional IRA, in anticipation of converting that traditional IRA later, in 2010. In 2009, the maximum permitted contribution to a nondeductible IRA was $5,000, or $6,000 if you were 50 or older at year-end. The IRS says when calculating the taxable and non-taxable amounts of a conversion, all of your traditional IRAs, including SEP (simplified employee pension plan) and simple IRAs, must be included. Here’s the bottom line: You cannot just withdraw or convert the non-deductible fund and pay no income tax, even if the non-deductible IRA contributions were kept in a separate IRA. Any year you make non-deductible contributions, you must file
The Triangle Physician
mestic small caps, foreign stocks, emerg-
ing market stocks, commodities, etc.), you
gross income will reduce their eligibility
If you are eligible, the advantage of
can pick and choose recharacterizations to
for college financial aid and scholarships.
converting for the tax year of 2009 is that tax rates are known. The big uncertainty is what
take advantage of the tax break. Another important tax consideration is
will tax rates be in the future? That is why
For example, let’s assume you have
that you must make sure you have funds
many taxpayers will pay the tax in 2010 as
$500,000 in your retirement account. You
available in a non-retirement account to pay
opposed to splitting the income tax on the
decide to convert $100,000 and set up four
the taxes that will be due on conversion.
conversion between 2011 and 2012 tax years.
can keep the best performers as Roth IRAs
It is important to work with your tax
Restrictions, penalties and taxes may
and recharacterize the laggards back to
adviser to evaluate all the results of a Roth
apply. Unless certain criteria are met, Roth
IRA conversion and see if they will differ
IRA owners must be 59½ or older and have
if the conversion is shifted from one year
held the IRA for five years before tax-free
withdrawals are permitted.
accounts, $25,000 in each account. You
However, there is another strategy to consider in this situation. “Instead, convert $500,000 to five separate accounts of $100,000. Basically, you will keep the best one and recharacterize the other four accounts,” says Barry Picker, certified public accountant of Picker, Weinberg & Auerbach CPAs P.C. This also will give you the flexibility to convert more money, if it makes sense to do so. The downside of this strategy, however, is that it involves a lot of paperwork, and you need to keep detailed records. Still, the multiple Roth IRAs don’t have to remain segregated forever. Once the converted Roth IRAs are beyond the recharacterization deadline, they can be merged into one account.
Tax Bracket Strategy What tax bracket were you in for 2010 and where will you be in the year of the conversion? In choosing the “optimum” amount to convert to a Roth IRA, you would most likely convert an amount that would be taxed at a rate equal to or less than your projected future tax rate. For example, if you are in the lowest tax bracket, your strategy may require a series of partial conversions each year to remain in the 15 percent federal tax bracket. Be aware! Various deductions and credits, such as medical expenses and the child tax credit, may be impacted. Parents of students may find that increasing adjusted
Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
Advancing Approach for Achieving
Successful ACL Reconstruction By Andre C. Grant, M.D.
Anterior cruciate ligament injuries have long been a problem for the young athlete and have, at times, ended careers. Because of the this, anterior cruciate ligament reconstruction has been the standard for athletes whose sights were set on their sporting longevity. What we have realized is that the long-term health of the athlete’s knee extends way beyond their athletic careers. For years we have performed anterior cruciate ligament (ACL) reconstruction to provide knee stability when performing the highlevel activities required in sports. The ACL is the main ligament that provides stability in the anteroposterior direction, as well as in rotation. Since it is the primary stabilizer for the knee, a wellfunctioning ACL is necessary for jumping, cutting, twisting and
Double-bundle ACL anatomy
turning activities,. Therefore, most orthopedic surgeons will recommend ACL reconstruction in young athletic individuals to
Thanks to long-term outcome studies, we have become aware of
restore knee stability and return to play.
the detriment to the knee with a lack of rotational stability. When the kinematics of the knee are not restored completely, associated
For many years, a single-bundle reconstruction of the ACL has been
injuries to the knee occur, including injuries to the cartilage,
the “gold standard” approach. Historically, restoring an “isometric”
meniscus and associated ligaments. This may eventually play a
point for the new ACL has been the goal. Through research and
large part in the development of debilitating knee arthritis. This is
clinical outcome data, we know that this is a successful technique
certainly the case with ACL-deficient knees treated non-operatively.
in the short term, allowing athletes to return to their previous level of play, providing them with restoration of kinematics in the
Given this discovery, techniques have been developed over the
anteroposterior direction. Recent evidence, however, shows that
last decade to better restore ACL kinematics with reconstructive
this may not be restoring the rotational stability to the knee.
surgery. The most notable of these being the double-bundle ACL reconstruction technique. The native ACL is made up of two bundles of fibers that run together, connecting the two main bones of the knee – the anteromedial bundle and the posterior lateral bundle. Both have a separate function. Traditional single-bundle ACL reconstruction attempted to replicate the function of both of these bundles by restoring the isometric point of the ligament as a whole. The double-bundle technique attempts to restore the anatomic footprint of each bundle and reconstructs them individually. This has been shown to restore knee kinematics in the short term, but it is not yet known if this
Anatomic versus non-anatomic
The Triangle Physician
has long-term benefit in preventing early degeneration of the knee.
Dr. Andre Grant earned his medical degree from Howard University College of Medicine. After his internship at Johns Hopkins Medical Center, he completed his residency in orthopedic surgery at the University of Colorado under the mentorship of several leaders in sports medicine. He later finished a sports medicine fellowship at Union Memorial Hospital in Baltimore, Md., where he was the assistant team physician for the Washington Nationals and Baltimore Ravens, as well as other professional organizations, colleges and high schools in the area. His love for sports medicine developed as a varsity football player at Dartmouth College. As assistant professor of orthopaedic surgery at Duke University, Dr. Grant regularly gives presentations on sports medicine injuries and prevention to his peers and for community groups. His areas of clinical interest include anatomical ACL reconstruction and shoulder and knee reconstruction. He is one of only a few fellowship-trained sports medicine physicians at Duke Raleigh Hospital. To contact Dr. Grant, call (919) 862-5093.
been shown to be significantly different. This seems like a simple concept, but for years nonanatomical single-bundle ACL reconstruction was the mainstay, resulting in satisfactory outcomes in the short term. Also, the outcome measures used to evaluate these older techniques were subjective and did not tell the entire story. Only now has there been a paradigm
What is known is that it is technically
lacked rotational stability, allowing the
shift in the current techniques, as we
demanding, time consuming and costly
knee to experience chronic injury.
surgeons have become more critical in evaluating success when it comes to ACL
overall, when compared to traditional, instrumentation
reconstruction. This has led to an evolution
have been developed to restore the native
in the way we treat patients to improve
What this has led to is the “idea” of
footprint of the ACL using a single-bundle
improving the techniques of the single-
ACL graft to restore the kinematics of the
bundle reconstruction. For years we were
knee. The anatomical ACL reconstruction
Anatomical single-bundle ACL reconstruc-
delighted with the results of restoring
technique places the graft exactly where
tion will inevitably become the gold stan-
the “isometric point” of the ACL, but
it should be, thus replicating the natural
dard of the future for ACL surgery, as we de-
the resultant reconstruction was not
function of the knee. This is technically
velop new ways to enhance our techniques
restoring the footprint of the native ACL.
less demanding and more cost effective
and instrumentation, as well as develop
Patients were able to return to play and
when compared to double-bundle ACL
more precise tools to critically redefine
be successful, but in the long term these
reconstruction, and objective outcome
what it is to have a successful outcome as
knees were continuing to have pain and
measures and patient satisfaction have not
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Fragility Fractures and Bone Health:
Are We Making Any Progress? By Douglas R. Dirschl, M.D.
In 2012, more than two million individuals
This lack of commitment to secondary
in the United States will sustain a fragility
fracture prevention is a major failing of
fracture. This is more than three times the
U.S. health care and leads to increased
number who will sustain a heart attack and
expenditures, morbidity and mortality.
more than seven times the number who
There are, however, a few model programs
will be diagnosed with breast cancer.
that identify fragility fracture patients and ensure appropriate management through a
The most powerful predictor for sustaining
fracture liaison service (FLS).
a fragility fracture is the existence of a prior fracture. For example, nearly half of
The Kaiser Permanente Healthy Bones
hip fracture patients have previously had
program utilizes nurse care managers
another fragility fracture.
to test and treat all patients over 50 who have sustained a fracture. In three years,
Appropriate intervention in patients when
this program reduced hip fractures by
they sustain a fragility fracture can prevent
38 percent in the population managed,
these future fractures.
preventing 970 hip fractures in calendar year 2007 among 3.2 million southern
In 2004, the U.S. surgeon general published
California members. If a similar program
a report on the nation’s bone health,
were implemented across the country,
citing numerous population studies that
more than 100,000 hip fractures would be
indicated only one in five fragility fracture
prevented and $3 billion saved each year.
patients received appropriate evaluation
Douglas R. Dirschl is professor and chairman of the University of North Carolina Department of Orthopaedics. He specializes in orthopedic traumatology, general orthopedics and fragility fractures and bone health. Dr. Dirschl has served on numerous national committees in the areas of research, education, evaluation and professionalism. He has served as chairman of the American Orthopaedic Association Critical Issues Committee and as creator and chair of the AOA Orthopaedic Institute of Medicine Council and the AOA Own the Bone program. He served as the 124th president of the AOA from June 2011 to June 2012. Dr. Dirschl may be contacted at (919) 9669072 or at firstname.lastname@example.org. The UNC Orthopaedics website is www. med.unc.edu/ortho.
their physicians – and by everyone they The American Orthopaedic Association’s
encounter during their care – that it is
Own the Bone program is a web-based,
medically necessary they undergo an
This data prompted many groups, health
evaluation by the Healthy Bones team.
care institutions and physicians to focus
gram that provides participating sites all
on impacting this national public health
the necessary tools to evaluate, educate
This, too, is what we need to do in each of
issue. After nearly a decade of effort on
and treat patients for low bone mass fol-
our medical practices. Every patient over
bone health and fragility fracture, however,
lowing a fragility fracture. The program has
age 50 we encounter who has sustained a
it appears little progress has been made.
expanded rapidly in its two years of exis-
fracture should be informed they should
tence to nearly 90 sites in 38 states and has
undergo an evaluation for their bone
impacted more than 5,000 patients.
health, that such an evaluation is medically
and treatment following fracture.
A just-completed study of more than
80,000 women who sustained a fragility
necessary (just as is having their blood
fracture between 2000 and 2009 found
The key factor that makes for a successful
pressure or mammogram) and that they
that the treatment rate is still only about 20
FLS program – and the key factor that is
may benefit from treatment with calcium,
percent. Shockingly, the treatment rate has
missing in most U.S. medical communities
vitamin D and/or prescription medications.
decreased each year between 2001 and
– is a mandate that all fracture patients over
We can – and should – improve the health
age 50 undergo evaluation and treatment.
of these patients, reduce their risk of future
For example, Kaiser patients are told by
fractures and save money.
The Triangle Physician
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Quiet Room at Duke Cancer Center Cancer Care As It Should Be.
By Jack Inge, M.D.
Imagine a time when surgery will be done with robots; nobody
abdominal hysterectomy was as primitive as a limb amputation?
will have to have large abdominal incisions, people will go home shortly after surgery and resume their normal activities in days
The robot has vision capabilities that far exceed the human
not weeks. We will think it was barbaric that our ancestors had
eye. With the robot I can see in three-dimensional vision, high
to have large painful incisions for the same procedure we now
definition, 1080i pixels and 10 times magnification! We watch
perform through dime-sized incisions. I take great pleasure in
football games in high definition, why not operate with the best
announcing that the future is now.
Today we have the ability to make open hysterectomies with large
Of course, there always will be skeptics with any new technology,
abdominal incisions extinct. Nearly 150 years ago during the civil
just like there was when the car was invented. In the beginning,
war we practiced the barbaric procedure of limb amputation
people were reluctant to adopt the new technology. Where are
for gun shot wounds. Will we soon look back and think that an
the horses now? Laparoscopic surgery, the predecessor to the robot, was a wonderful invention, but it too has its limitations. It’s been around since the ’80s but decades later we still have a 50 percent open hysterectomy rate. Since adopting the robot I have experienced a 0 percent open abdominal rate in my last 300 cases. This is due, in part, to the robot’s wristed instruments that rotate 540 degree and allow the surgeon the ability to maneuver and reach spaces we never could with traditional non-wristed laparoscopic instruments. We’ve removed uteruses as big as a watermelons through a dimesized incision. There are a few talented laparoscopists in the country who would ask why I don’t use a laparoscope anymore. I would simply tell them the same reason I don’t ride my horse to work! No matter what problem presents itself, I can handle it better with a robot. I have had countless cases that could never have been completed with a laparoscope. It’s hard to predict which cases will be difficult; with the aid of the robot you never underestimate your opponent. This year several studies showed that robot hysterectomy patients experience less pain when compared to other modalities, such as laparoscopy and vaginal hysterectomies. This is, in part, because the robotic arms move around an axis at the skin, so there is never any tension or pressure on the skin.
The Triangle Physician
Dr. Jack Inge is a Raleigh native who is in private practice at MidCarolina Obstetrics & Gynecology. He is currently an epicenter surgeon and teaches robot surgery to physicians from all over the country. There are less than 25 epicenters in the United States designated to teach robot surgery. Contact Mid-Carolina Ob/Gyn at (919) 781-5510 or email@example.com or visit www. carolinarobot.com.
Page 1 Duke Research News
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At a lecture recently, a physician asked me why he should bother learning this
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new technology when he could simply make a large incision the way he has for years. Patients don’t know the difference, he said.
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out loud? I wonder, if he ever needs his prostate removed, will he ask for a simple large incision or will he request a robotic procedure. To me one of the greatest things about the robot is how the patients respond post
Managing your patients’ health is your life’s work. Managing physicians’ wealth is mine.
operatively. I always ask patients what they did after surgery, and the stories never cease to amaze me. They are always excited to tell me of their post-operative accomplishments. I was recently referred a collage student who was told she would have to have a large incision for her procedure. She was supposed to compete in a college Division II volleyball tournament in two weeks. With the aid of the robot, we performed her surgery with three dime-
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Duke Research News
Only a Few Cells Can Make Heart Muscle Just a handful of cells in the embryo are
(heart muscle cells) in the growing
simply thicken in place, but instead there
all that’s needed to form the outer layer
animal can give rise to the thousands
was a network of cells that enveloped the
of pumping heart muscle in an adult
of cardiomyocytes that form the wall of
ventricle in a wave. It was as if a cell at your
the cardiac ventricle,” said Vikas Gupta,
shoulder grew a thin layer of new cells
lead author, who is in the Duke Medical
down your arm surface.”
Researchers at Duke University Medical
Scientist Training Program for medical and
Center used zebrafish embryos and careful
Mr. Gupta said this opens an area for investigation to see whether or not a
employment of a new technique that allows for up to 90 color labels on different
Mr. Gupta found that about eight single
process like this repeats in the hearts of
cells to track individual cells and cell lines
cells contributed to forming the major type
mammals and perhaps in other internal
as the heart formed.
of heart muscle in the wall of the zebrafish
heart – and just one or two cells could The scientists were surprised by how
create anywhere from 30-70 percent of the
Dr. Poss said the cell clones appear to
few cells went into making a critical
entire ventricular surface.
have the ability to cover as much of the ventricular surface as possible before
organ structure, and they suspect other organs may form in a similar fashion, said
“Clonal dominance like this is a property
other cells start appearing and growing at
Kenneth Poss, Ph.D., professor in the Duke
of some types of stem cells, and it’s a new
Department of Cell Biology and Howard
concept in how to form an organ during
Hughes Medical Institute.
development,” Dr. Poss said.
“Our suspicion is that the muscle cells that initiate large clones are not much different
The study appears online April 25 in
Another surprise was the way the patches
from other muscle cells – they just get to
of cloned cells formed muscle.
the surface of the heart first,” Dr. Poss said.
“The most surprising aspect of this work is
“It was completely unexpected,” Mr.
to the egg first, among all the millions of
that a very small number of cardiomyocytes
Gupta said. “I thought the wall would
possible sperm cells.
They used the analogy of a sperm getting
Dr. Poss said the manner in which these muscle cells envelope the heart could lead to new therapies. “Researchers may be able to channel this developmental process to help damaged hearts or failing hearts to grow muscle that will reinforce the ventricular walls,” he said. “Someone who’s had a heart attack would want this ability to generate new muscle to cover a scar naturally, and it’s attractive to think that the help might come from a small number of muscle cells within a population.” The color-label technique was originally developed by other biologists and was Growth of the zebrafish heart from embryo to adult is tracked using colored cardiac muscle clones, each containing many cellular progeny of a single cardiac muscle cell. Here, a large clone of green cardiac muscle cells (top) expands over the surface of many smaller clones in a growing heart. Credit: Vikas Gupta, Duke University Medical Center.
The Triangle Physician
critical to allowing the researchers to track heart cell populations.
Duke Research News “You can label individual cells very early
Dr. Poss said it makes sense that this
Funding for the study came from a National
in an embryo with a permanent color, and
growth process works by a gradual layering
Heart, Lung and Blood Institute Medical
those cells and their progeny will keep that
process, especially for the heart.
Scientist Training Program supplement. Dr. Poss is an early career scientist of the
color,” Dr. Poss said. “You can learn what an individual cardiomyocyte did and its
“It’s speculative, but for the heart to main-
Howard Hughes Medical Institute. This
neighbor and that cell’s neighbor and so
tain circulation in a relatively slowly grow-
work also was supported by grants from
on, until you’ve covered much of the whole
ing animal, a process like this to build the
the American Heart Association.
ventricle of the developing zebrafish.”
heart might be a way of gradually increasing its circulatory strength to keep up.”
Team Converts Scar Tissue Into Heart Muscle Without Stem Cells Scientists at Duke University Medical Cen-
combination, the microRNAs were delivered
“It’s an exciting stage for reprogramming
ter have shown the ability to turn scar tis-
into scar tissue cells called fibroblasts, which
science,” said Tilanthi M. Jayawardena,
sue that forms after a heart attack into heart
develop after a heart attack and impair the
Ph.D., first author of the study. “It’s a very
muscle cells using a new process that elim-
organ’s ability to pump blood.
young field, and we’re all learning what it means to switch a cell’s fate. We believe
inates the need for stem cell transplant. Once deployed, the microRNAs repro-
we’ve uncovered a way for it to be done,
The study, published online April 26 in the
grammed fibroblasts to become cells re-
and that it has a lot of potential.”
journal Circulation Research, used mol-
sembling the cardiomyocytes that make
ecules called microRNAs to trigger the
up heart muscle. The Duke team not only
The approach will now be tested in larger
cardiac tissue conversion in a lab dish and,
proved this concept in the laboratory, but
animals. Dr. Dzau said therapies could be de-
for the first time, in a living mouse, demon-
also demonstrated that the cell conversion
veloped within a decade if additional studies
strating the potential of a simpler process
could occur inside the body of a mouse –
advance in larger animals and humans.
for tissue regeneration.
a major requirement for regenerative medicine to become a potential therapy.
“We have proven the concept,” Dr. Dzau said. “This is the very early stage, and we
If additional studies confirm the approach in human cells, it could lead to a new way
“This is one of the exciting things about
have only shown that it is doable in an ani-
for treating many of the 23 million people
our study,” said Maria Mirotsou, Ph.D., as-
mal model. Although that’s a very big step,
worldwide who suffer heart failure, which
sistant professor of cardiology at Duke and
we’re not there yet for humans.”
is often caused by scar tissue that develops
a senior author of the study. “We were able
after a heart attack. The approach could
to achieve this tissue conversion in the
In addition to Drs. Dzau, Mirotsou and Jay-
also have benefit beyond heart disease.
heart with these microRNAs, which may
awardena, study authors include: Bakytbek
be more practical for direct delivery into
Egemnazarov; Elizabeth A. Finch; Lunan
“This is a significant finding with many
cells and allow for possible development
Zhang; Kumar Pandya; J. Alan Payne; Zhip-
therapeutic implications,” said Victor J.
of therapies without using genetic methods
ing Zhang; and Paul Rosenberg.
Dzau, M.D. The senior author on the study
or transplantation of stem cells.” Funding for the study was provided by the
is James B. Duke professor of medicine and chancellor of health affairs at Duke
The researchers said using microRNA for
National Heart, Lung and Blood Institute;
University. “If you can do this in the heart,
tissue regeneration has several potential
the Edna and Fred L. Mandel Jr. Founda-
you can do it in the brain, the kidneys and
advantages over genetic methods or trans-
tion; and the Foundation Leducq. Dr. Mirot-
other tissues. This is a whole new way of
plantation of stem cells, which have been
sou is supported by the American Heart
difficult to manage inside the body. Nota-
Association National Scientist Develop-
bly, the microRNA process eliminates tech-
ment Award, and Rosenberg is supported
To initiate the regeneration, Dr. Dzau’s team
nical problems, such as genetic alterations,
by the National Institutes of Health.
used microRNAs, which are molecules that
while also avoiding the ethical dilemmas
serve as master regulators controlling the ac-
posed by stem cells.
Study authors reported no conflicts of interest.
tivity of multiple genes. Tailored in a specific
Duke Research News
Genes May Explain Why Some Turn Their Noses Up at Meat If you don’t like the taste of pork, the rea-
The findings raise the possibility that more
Dr. Matsunami also speculated whether
son may be that your genes cause you to
consumers will dislike meat if castration is
meat inspectors with both copies of the
smell the meat more intensely, according
banned and more meat from noncastrated
functional variant, who presumably would
to a new study.
animals is sold, Dr. Matsunami said.
be more sensitive to higher levels of andro-
Duke University Medical Center scientists,
The study was published May 2 online in
working with colleagues in Norway, found
the PLoS One open-access journal.
stenone, might make different decisions in their jobs. The availability of the human genome has
that about 70 percent of people have two functional copies of a gene linked to an
A total of 23 subjects were recruited: 13 con-
provided the tools for revising sensory and
odor receptor that detects a compound
sumers and 10 professional sensory asses-
consumer science involving flavor percep-
in male mammals called androstenone,
sors. When all of the subjects were divided
tion, said co-author professor Bjørg Ege-
which is common in pork. People with one
into sensitive and insensitive cohorts, ac-
landsdal, Ph.D., of the Institute of Chemis-
or no functional copies of the gene can
cording to a smell test that was previously
try, Biotechnology and Food Science at the
tolerate the scent of androstenone much
devised, all of the androstenone-sensitive
University of Life Science in Ås, Norway.
better than those with two, the researchers
subjects had the RT/RT genotype, with two
“This could be very useful in product de-
copies of the functional RT gene.
velopment, to learn which flavor sensors
Hiroaki Matsunami, Ph.D., a Duke associ-
“I was surprised at how cleanly this ex-
research is needed, but we may be able to
ate professor of molecular genetics and
periment showed who smelled what,” Dr.
revise the way we recruit consumer groups
microbiology, had previously discovered
Matsunami said. “The results showed that
for evaluating product development,” Dr.
and described the genetics of the odor
people with two copies of the functional
receptor for androstenone (OR7D4). But
variant of the gene for that odor receptor
it wasn’t until a group of pork scientists in
thought that the meat smelled worse with
Another practical solution for meat pro-
Norway contacted him that he launched
higher levels of androstenone added.”
ducers would be to find other compounds
are correlated with which flavors. More
that are safe to ingest, but that might block
an experiment to learn more precisely at a genetic level how humans perceive the
For the experiment, the researchers added
the androstenone receptors to reduce that
smell of meat.
only biological levels of androstenone to
scent in meat.
existing pork meat, up to the limit of what The Norwegian team had practical reasons
might be found in male wild boars.
Other authors included researchers from the Norwegian Meat Research Centre in
for the study: It was concerned what might happen in Europe if a castration method
Dr. Matsunami said it would be fascinating
Oslo; the Institute of Chemistry, Biotechnol-
for swine was outlawed. Currently, female
to see results done on certain populations,
ogy and Food Science at the University of
pork meat and castrated male pork meat
including people in the Middle East, where
Life Sciences; the Nofima research group
are sold in Europe. The researchers were
pork has been omitted from diets for cen-
in Ås, Norway; and Monell Chemical Sens-
curious how consumers might respond to
es Center in Philadelphia.
“I would also like to know about odor-re-
Funding was provided by the Norwegian
The level of androstenone in noncastrated
ceptor variants in indigenous populations,
Research Council and the United States
pigs ranges up to 6.4 parts per million. In
such as people who live near the Arctic
National Institutes of Health (NIH) and an
Norway the level of androstenone in immu-
Circle and who never eat these meats.
NIH-Health Resources and Services Ad-
nocastrated (using hormones) pigs is from
What is their genotype?” Dr. Matsunami
ministration fellowship. No funding came
0.1-0.2 parts per million, and in surgically
said. Vegetarians as a group may also have
from pork or agricultural industries.
castrated pigs the rate approaches zero.
a genetic predisposition against the smell
meat from noncastrated males.
of meat, but all of these ideas need to be scientifically studied, he said.
The Triangle Physician
Rex Hospital News
Rex Healthcare Is Only One Named to Becker’s Hospital Review in Triangle Rex Healthcare was the only Triangle
that the passion of our co-workers, physi-
provides co-workers with a subsidized five-
health care organization recognized as one
cians and volunteers translates into ex-
star, onsite daycare at Rex Child Develop-
of the “100 Great Places to Work in Health-
cellent patient care,” said Rex President
care” by Becker’s Hospital Review and
David Strong. “We appreciate Becker’s for
Becker’s ASC Review.
recognizing our commitment to the more
Rex was the first hospital in the Triangle
than 5,300 people who are proud to work
to receive Magnet Recognition, placing
Rex nurses among the top 6 percent in the
The 2012 list was developed through nomi-
nation. Rex was named one of the top 100
nations and extensive research, and the organizations were chosen for their dem-
Rex offers employees discounts on enroll-
Best Places to Work in Healthcare by Mod-
onstrated excellence in providing robust
ment and monthly membership fees at
ern Healthcare magazine in 2008, 2009 and
benefits, wellness initiatives, professional
its four, soon-to-be five, wellness centers
2011, and was highlighted as one of the Top
development opportunities and atmo-
and provides discounts on health insur-
50 Hospitals in the U.S. by Becker’s Hospi-
spheres of employee unity and satisfaction.
ance premiums for those who participate
tal Review in 2011.
Rex Healthcare was chosen by a review
in the Rex “Taking Care of You” wellness
panel based on its efforts to provide high-
program. The hospital also has a range of
Read Becker’s full report online at www.
quality employee programs and benefits,
educational opportunities for its employ-
beckershospitalreview.com. For more in-
as well as previous industry recognition.
ees, including the Pathway for Advance-
formation about Rex, including career op-
ment in Clinical Excellence program and
portunities, visit rexhealth.com.
“Part of Rex’s mission is to be a top place
free courses through the Rex Center for
to work in the country, because we know
Leadership Excellence. Additionally, Rex
Durham Regional News
New Chief Medical Officer Appointed Dr. Griffith earned her medical doctor
Hospital Corporation governing board and
degree at the University of North Carolina
Duke University Health System (DUHS) to
and has been an emergency medicine
assure effective and efficient delivery of
physician at Durham Regional Hospital
high-quality patient care consistent with
the philosophy and mission of Durham
as president for Durham Regional’s
Regional and DUHS.
medical staff (2009-2010), she is currently president and a staff physician for Durham
Dr. Griffith is certified by the American
Emergency Physicians, the 23-provider
Board of Emergency Medicine, and is a
medical practice that staffs Durham
member of the North Carolina College of
Regional’s emergency department.
Emergency Physicians, American College of Emergency Physicians and American
As chief medical officer, Dr. Griffith continues
College of Healthcare Executives.
Barbara Griffith, M.D., began her post as
excellence in partnership with Durham
She resides in Durham with her husband
chief medical officer of Durham Regional
and two daughters.
Hospital May 1.
UNC Research News
Nanoparticle Carriers May Offer New Hope for Failed Cancer Drug has
be effective against cancer cells, but also
“Most research has focused on estab-
focused on the delivery of established
needs to have low toxicity, good stability
lished drugs. However, there is a large
and novel therapeutics. But a University
and good solubility. Many promising
number of these ‘forgotten’ drugs that
of North Carolina team is taking a different
drugs, such as wortmannin, failed clinical
can be revived and re-evaluated using
development because they failed one or
nanoparticle drug delivery. These drugs
more of these requirements. Nanoparticle
can provide new targets and offer new
They developed nanoparticle carriers to
strategies that previously didn’t exist,” Dr.
successfully deliver therapeutic doses
technology and has the ability to
of a cancer drug that had previously
overcome these limitations. Our study
is a proof of principle to demonstrate
The research team now will focus on
pharmacologic challenges. They report
that nanoparticles can renew the clinical
further development of the nanoparticle
their proof of principle findings in the April
potential of many of these ‘abandoned’
30 early online edition of Proceedings of
and ‘forgotten’ drugs,” said Andrew Z.
developing nanoparticle formulation of
the National Academy of Sciences.
Wang, M.D., study senior author.
other abandoned drugs.
Wortmannin is a drug that was highly
“We found that the nanoparticle formu-
Other authors are (UNC) Shrirang Karve,
promising as a cancer drug, but its
lation of wortmannin decreased toxicity
Ph.D.; Michael Werner, Ph.D.; Rohit Sukumar,
successful preclinical studies did not
and increased stability, solubility and ef-
B.S.; Natalie Cummings, B.S.; Jonathan Copp,
translate into clinical efficacy because
B.S.; Edina Wang, B.S.; Manish Sethi, Ph.D.;
of challenges, such as high toxicity, low
wortmannin can improve the efficacy of
Chenxi Li, Ph.D.; and Ronald Chen, M.D.; and
stability and low solubility in the blood.
radiotherapy dramatically and is more ef-
(Harvard) Michael Pacold, M.D., Ph.D.
fective than the most commonly utilized “Drug development is a difficult and
chemotherapeutics,” said Dr. Wang, a
Funding for the work was provided by a
expensive process. For a cancer drug to
member of the UNC Lineberger Compre-
grant from the University Cancer Research
make it to clinical use, it not only has to
hensive Cancer Center.
Supercharged Protein Rescues Cells, Reduces Damage from Heart Attack Researchers from the University of North
heart cells during a heart attack,” said
“cry of a damsel in distress awakening her
Carolina at Chapel Hill reduced damage
Joan Taylor, Ph.D., associate professor
sleeping knight. If the gallant FAK arrives
from a heart attack by 50 percent by
in UNC’s department of pathology and
in time, it can save the cell and reduce
enhancing a protective protein found in
laboratory medicine. Dr. Taylor added that
permanent damage to the heart.”
mice and humans. The study, in which
the findings could lead to new treatment
mice were bred to make a supercharged
approaches for heart attacks and may
Dr. Taylor and her colleagues were in-
version of the protein focal adhesion
have broad implications for scientists
trigued by FAK’s protective abilities. “We
kinase, or FAK, appeared March 1
seeking to manipulate the body’s natural
thought if we could activate FAK to a great-
in the online edition of the journal
er extent, then we could better protect those heart cells,” said Dr. Taylor. Based
Arteriosclerosis, Thrombosis and Vascular Biology.
During a heart attack, oxygen-deprived
on their previous studies that defined the
heart cells emit signals that activate the
signals induced by FAK in heart cells, they
“This study shows that we can enhance
usually inert protein FAK. The author of a
reasoned that expression of FAK set to an
existing cell survival pathways to protect
press advisory liked the mechanism to the
“always-on” position would eventually suf-
The Triangle Physician
UNC Research News fer uncontrolled inflammation and heart
Mice with SuperFAK showed a much
said Dr. Taylor. “Negative feedback loops
failure. “Simply having more of a good
stronger FAK response during a heart
are important because they ‘reset’ the
thing isn’t always better,” said Dr. Taylor.
attack than mice with the natural protein,
“The dynamics of the protein’s activities
and three days later had about 50 percent
are important to appropriately transmit-
less heart damage, according to the press
The findings also may help researchers
ting those survival signals.”
release. Critically, SuperFAK deactivated
augment FAK in patients undergoing
at the appropriate time, so the eight-week
follow-up revealed no detrimental effects.
drugs are known to break down FAK,
The press advisory said the researchers
leaving patients’ hearts more vulnerable
then adjusted their formula to create a
new protein they called “SuperFAK.” To
The findings offer evidence that, rather
enhance its protective abilities without
than simply activating or de-activating
the harmful side effects, SuperFAK was
key proteins, researchers can benefit
Co-authors included Zhaokang Cheng,
primed for activation – ready to rush to
from a more nuanced approach that
Laura A. DiMichele, Zeenat S. Hakim,
the scene at the slightest provocation
taps into the body’s natural feedback
Mauricio Rojas and Christopher P. Mack.
from stressed heart cells – but remained
loops. “I think folks could use this idea to
The research was supported by grants
under the control of the mice’s natural
exploit mutations in other molecules – by
from the National Institutes of Health and
feedback systems that would shut it off
thinking about how to modify the protein
the American Heart Association.
when the crisis passed.
so that it can be under natural controls,”
UNC Physicians Inducted as Fellows in American College of Radiology Lynn Ansley Fordham, M.D., and Valerie
North America, the American Roentgen
The American Osteopathic College of
Jewells, D.O., were inducted as fellows in
Ray Society, the Society for Pediatric
the American College of Radiology during
Radiology, the American Institute of
the 89th ACR Annual Meeting and Chapter
Ultrasound in Medicine, the Society of
Dr. Jewells earned her doctor of osteopathic
Leadership Conference in Washington,
Radiologists in Ultrasound, the Society of
medicine from Philadelphia College of
D.C., last month.
Chairs of Radiology in Children’s Hospitals,
Osteopathic Medicine in Philadelphia,
the European Congress of Radiology
Pa. She completed her residency at
One of the highest honors the ACR
and the European Society of Pediatric
can bestow on a radiologist, radiation
Radiology. Dr. Fordham completed her
Philadelphia and fellowships in body
imaging at Hahnemann Medical Center
recognition as a fellow of the American
biology at Wellesley College and earned
in Philadelphia and in neuroradiology at
her medical degree at the Tufts University
demonstrate a history of service to the
School of Medicine. The ACR is a national non-profit association
college, organized radiology, teaching or research. Approximately 10 percent of ACR
Dr. Jewells is an associate professor of
serving more than 34,000 radiologists,
members achieve this distinction.
neuroradiology at UNC School of Medicine.
Her special interests include imaging of
radiologists, nuclear medicine physicians
Dr. Fordham is the chief of the Division
the head and neck, and research interests
and medical physicists with programs
of Pediatric Radiology at North Carolina
in imaging of multiple sclerosis using
focusing on the practice of radiology and
Children’s Hospital and an associate
diffusion tensor imaging and magnetic
the delivery of comprehensive health care
professor in the University of North
resonance spectroscopy. She is a member
Carolina School of Medicine, Department
of the American Society of Neuroradiology,
of Radiology. She is a member of the ACR,
The American Roentgen Ray Society, The
For more information, contact the American
the American Association for Women in
Radiological Society of North America,
College of Radiology at (703) 390-9822 or
Radiology, the Radiological Society of
The American College of Radiology and
visit www.acr.org or www.radiologyinfo.org.
News Upcoming Event
Welcome to the Area
Triangle Caregivers Conference June 19 / June 26
Hospice of Wake County, Alzheimers North Carolina and Guiding Lights are teaming up to present the fifth annul Triangle Caregivers Conference Tuesday, June 19 at The McKimmon Center in Raleigh and Tuesday, June 26 at Durham Convention Center in Durham. The format for both conferences will be identical. The conference will provide respite, resolution and resources for individuals who are caring for other adults. From 8 a.m. to 4 p.m., conference attendees will have the benefit of breakout sessions, lunch, vendor booths and pampering activities. Back this year is a virtual dementia tour. Cost is $5 for caregivers, $25 for professionals and $35 for professionals seeking three CEU credits.
Stephen D. DeMeo, DO
Pediatrics Duke University Division of Neonatology, Durham
Adam L Dore, DO
Internal Medicine Thurston Arthritis Research Center, Chapel Hill
Yasmina Laura Abajas, MD Pediatric Hematology-Oncology Univ of North Carolina Hosps - Department of Pediatric Hematology-Oncology Chapel Hill
Brian Douglas Alder, MD
Hillary Elizabeth Lockemer, MD
Pediatric Endocrinology Children’s Diabetes & Endocrinology, Raleigh
Andrew David McWilliams, MD
Hospitalist, Internal Medicine, Pediatrics University of North Carolina Hospitals, Chapel Hill
Mathew Robert Meeneghan, MD
Hematology and Oncology, Internal Medicine University of North Carolina Chapel Hill
To register, visit trianglecaregiversconference.com. For more information, call (919) 719-6765.
Ophthalmology Duke University Hospitals Durham
Jay Jeffrey Meyer, MD
Look Good Feel Better®
Christopher Lee Alley, MD
Anthony Obiesie Okobi, MD
Durham Regional Hospital will offer Look Good Feel Better®, a free American Cancer Society program that teaches women beauty techniques while they undergo chemotherapy and radiation treatments. Participants receive a free cosmetics kit and instruction by beauty professionals. The seminar will be conducted from 5:30-7:30 p.m. in the North Conference Room at Durham Regional Hospital. To register, call (919) 470-7168.
Andrea Cyr Archibald, MD Internal Medicine Duke University Hospitals Durham
Fernando J. Boschini, MD
Meet the Robot June 7
Durham Regional Hospital will have the da Vinci Si Surgical System on hand at the Durham Bulls Athletic Park. Visitors will be able to test drive this newest robotic surgery technology, which allows our experienced surgeons to perform complex procedures through small incisions. For more information, visit durhamregional.org/events. ®
Monthly Stroke Support Group June 11
Durham Regional Hospital hosts a Stroke Support Group the second Monday of each month. The primary purpose of the support group is to educate the stroke survivor, caregiver and people in the local community about stroke prevention and stroke disabilities. The group will meet from 1-2:30 p.m. in Private Dining Room C at Durham Regional Hospital. Register online at www.durhamregional.org/events.
The Triangle Physician 2012 Editorial Calendar June
Neurology – Sleep Apnea
New Imaging Technologies Electronic Medical Records
Digestive Disease – Computer Technologies
Sports Medicine – Physical Therapy
Breast Cancer – Reconstructive Surgery
Urology – Robotic Surgery
Pathology Duke University Hospitals Durham
The Triangle Physician
Radiology University of North Carolina Hospitals, Chapel Hill
Jeffrey Melson Clarke, MD Hematology and Oncology, Internal Medicine Duke University Hospitals Durham
Alexis Anne Dieter, MD Obstetrics and Gynecology Duke University Hospitals Durham
John Wesley French, MD Ophthalmology Carolina Eye Associates Southern Pines
Natalee S. French, MD Pediatrics Sandhills Pediatrics Southern Pines
Elsje Harker, MD
Anesthesiology University of North Carolina Hospitals, Chapel Hill
Brian T. Kazienko, MD Cardiology, Vascular and Interventional Radiology VAC of Durham, Durham
Jason Paul Kimball, MD Hospitalist, Internal Medicine Eagle Hospital Physicians Henderson
Daniel Bryce Landi, MD
Pediatric: Allergy, Pulmonology, Gastroenterology, HematologyOncology, Infectious Diseases, Nephrology, Rheumatology, Cardiology, Critical Care Medicine Duke University Hospitals Durham
Ophthalmology Duke Eye Center, Durham
Himanshu Pravinchandra Parikh, MD Internal Medicine Himanshu P. Parikh, MD, PC Cary
Milton Bruce Shields, MD Ophthalmology Open Door Clinic, Burlington
John Matthew Sleesman, MD Raleigh
Lydia Li Ern Teh Snyder, MD
Pediatric Endocrinology; Pediatrics University of North Carolina Hospitals, Chapel Hill
Thomas John Sutton, MD Pediatrics Jeffers Mann & Artman Pediatric & Adolescent Medicine, Raleigh
Megan C. Swan, MD
Emergency Medicine - Hospice and Palliative Medicine Durham
Jennifer Orr Vincent, MD Pediatrics University of North Carolina Hospitals, Chapel Hill
Glenn Chung-Wing Yiu, MD
Caitlyn Molino Patrick, MD
Ophthalmology Duke Eye Center, Durham
Loren Del Mar Pena, MD
Internal Medicine University of North Carolina Hospitals, Chapel Hill
Pediatrics; Clinical Genetics (MD) Duke University Dept of Pediatrics, Durham
Kathryn Lynn Pepple, MD Ophthalmology Duke University Hospitals Durham
Nam-Kha Nguyen Pham, MD
Anesthesiology, Pain Medicine and Management Duke University Hospitals Durham
Feraz Najmi Rahman, MD
Kathryn M. Godly, PA
Addiction Medicine, Infectious Disease, Integrative Medicine Holly Springs
Kane Daniel Morgan, PA
Family Practice, Sports Medicine, Aerospace Medicine, Emergency Medicine Southern Pines
Jessica ONeill, PA
Nephrology, Internal Medicine, Geriatrics, Hospitalist, Family Medicine Raleigh
Radiology; Diagnostic, Vascular and Interventional Radiology University of North Carolina Hospitals, Chapel Hill
Therese Ann Piacente, PA
Jay Suman Raval, MD
Michael Don Vogele, PA
Blood Banking/Transfusion Medicine; Clinical Pathology University of North Carolina Department of Pathology Chapel Hill
Kristen Marie Rezak, MD
Plastic & Reconstructive Surgery Chapel Hill
Thomas J. Richard, MD Hematology/Oncology, Internal Medicine Southern Pines
Marian Alice Rollins-Raval, MD
Hematology Pathology, Anatomic and Clinical Pathology UNC Department of Pathology Chapel Hill
Cardiovascular Surgery Rex Cardiovascular Surgery Raleigh Vascular Surgery Durham VA Medical Center Durham
Richard Conrad Westmoreland, PA
Emergency Medicine; Family Medicine; Family Practice (and OMT) 245 Heather Lane Southern Pines
Brittany Walker White, PA Emergency Medicine, Sports Medicine, Family Practice, Orthopedic Surgery, Adult Reconstructive Triangle Orthopaedic Associates Durham
“More than a doctor. Like a friend.”
We know it by heart.
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, Wayne and Wilson Counties 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
Waheed Akhtar, MD, FACC Malay Agrawal, MD, FACC Sunil Chand, MD, FACC Paul Perez-Navarro, MD, FACC Joel Schneider, MD, FACC
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
WHV Locations in Johnston, Wayne and Wilson Counties 910 Berkshire Road Smithfield, NC 27577
2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520
2605 Forest Hills Road South West Wilson, NC 27893
2400 Wayne Memorial Drive, Suite A Goldsboro, NC 27534
Phone: 919-989-7909 Fax: 919-989-3147
Phone: 919-359-0322 Fax: 919-359-0326
Phone: (919) 736-8655 Fax: (919) 734-6999
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).
DIAGNOSTIC IMAGING | PEDIATRIC IMAGING | SPORTS IMAGING | NEURORADIOLOGY ADVANCED BREAST IMAGING | INTERVENTIONAL RADIOLOGY | ONCOLOGIC IMAGING
Since 1953, Wake Radiology has been a leader in diagnostic imaging in the Triangle and beyond. We bring to you and your patients the most advanced imaging technologies available, delivered with the reassurance and compassion that are at the heart of health and healing. We have 18 outpatient imaging locations throughout the Triangle—many offering studies on evenings and Saturdays, including screening mammography, CT, Ultrasound, and MRI exams. Wake Radiology’s 55 subspecialty trained radiologists diagnose injury and illness quickly, while working with you and your staff to ensure the best possible outcome. So, the next time your patients require medical imaging think of Wake Radiology, where outstanding imaging is backed by expertise, convenience, and compassion. Wake Radiology. Here when you and your patients need us. Wake Radiology is the only multi-site outpatient imaging service provider in the Triangle to receive the American College of Radiology’s designation of Breast Imaging Centers of Excellence. Scan now to request a Screening mammogram with your smartphone.
Express Scheduling 919-232-4700 | Chapel Hill Area Express Scheduling 919-942-3196 | wakerad.com
©2012 Wake Radiology. All rights reserved.
©2011 Wake Radiology. All rights reserved. Radiology saves lives.
Advanced Imaging For The Entire Family.
The Triangle Physician May 2012