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Women’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


Contents

COVER STORY

6

Women’s Wellness Clinic Excellence in Gynecology

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Vol. 3, Issue 5

FEATURES

12

Orthopedic Surgery

Advancing Approach for Achieving Successful ACL Reconstruction

14

DEPARTMENTS 9 Marketing Physician Outreach Is Cost-Effective Way to Boost Relationships, Referrals

Orthopedic Surgery

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

24 News

2

The Triangle Physician

Upcoming events and welcome


The Magazine for Healthcare Professionals.

Did You Know? We mail to over 9,000 MDs, PAs, administrators, and hospital staff in 18 counties in the greater Triangle area. Not to each practice but to each MD or PA personally. We are a totally LOCAL magazine designed primarily for MD referrals.

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: Alamance, Chatham, Durham, Franklin, Granville, Harnett, Johnston, Lee, Moore, Nash, Orange, Person, Sampson, Vance, Wake, Warren, Wayne, and Wilson Counties Person

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nia

ylva

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The Triad Physician Magazine

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n wa

ell ch Mit

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k an ot s an qu uim rq Pe

Vance

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The Eastern Physician Magazine FUTURE The Western Physician Magazine The Eastern and The Triangle Physician Magazines

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Local physician specialists and other professionals, affiliated with local businesses and organizations, contribute all editorials or columns about their respective specialty or profession. • We list all new MDs and PAs each month who are licensed by the NC Medical Board • We list any New MD or PA who comes to the area • We list any MD or PA who is new to your practice • We List any new practice • We List any practice that has relocated or a new office

• We list any new or updated website • We list any events for your practice or charities • We list any CMEs • We list local hospital news • Local charity ads or article are FREE • Images for all of the above are appreciated

And we do this all for FREE We also profile MDs, practices or companies that want to get “in front” of MDs • 1 page article includes 1 image and text • 2 page article includes 2 images and text • 4 page article includes 4 images and text • 8 page article includes 8 images and text

We also provide PDFs and digital editions of the whole magazine or just your article. Long-term advertising is always the best way to increase reader awareness of your practice and unique patient care brand.

If you would like to promote your company with The Triangle Physician, please contact us

Paget@TrianglePhysician.com or info@TrianglePhysician.com

may 2012

3


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

heidi@trianglephysician.com

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

mark@jacobyphoto.com

jdally@newdallydesign.com

her sled riding with her kids!

Advertising Sales Carolyn Walters carolyn@trianglephysician.com

Also contributing to this issue of The Triangle Physician are gynecologist Jack Ing, who

News and Columns Please send to info@trianglephysician.com

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

The Triangle Physician is published by: New Dally Design 9611 Ravenscroft Ln NW, Concord, NC 28027 Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401

Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.

4

The Triangle Physician


Cover

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

it seems.

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

Expert Care

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.

6

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

quite

at minimizing convalescence. “One day, in

are a minimally invasive procedure that

and out,” says Janet Figueroa-Davis.

provide an alternative to hormone medica-

a

team,

complementing

each

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

Innovative Treatment

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.”

may 2012

7


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-

offered.

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

Continuing Excellence

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

activities immediately.

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.

8

The Triangle Physician


Marketing

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

referrals.

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

marketing strategy.

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

the patient.

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.

may 2012

9


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

including extensions.

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

IRA?

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

Non-deductible Contributions

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,

commingled,

(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

10

The Triangle Physician

the

recharacterization

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

traditional IRAs.

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

to another.

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

may 2012

11


Orthopedic Surgery

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

12

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

their outcomes.

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

a patient.

single-bundle techniques.

New

techniques

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may 2012

13


Orthopedic Surgery

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 dirschld@med.unc.edu. 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

evidence-based,

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

quality-assurance

pro-

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

2010!

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.

14

The Triangle Physician


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Gynecology

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.

optics possible?

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.

16

The Triangle Physician


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8/5/10

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 info@midcarolinaobgyn.com or visit www. carolinarobot.com.

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17


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

zebrafish.

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

doctorate degrees.

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

organs.

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

the surface.

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

Nature.

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.

18

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

regenerating tissue.”

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

may 2012

19


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-

said.

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

Egelandsdal said.

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

turies.

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.

20

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

ment Center.

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

at Rex.”

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

since

the philosophy and mission of Durham

2002.

In

addition

to

serving

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

to

promote

clinical

College of Healthcare Executives.

care

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

Regional’s

and two daughters.

Hospital May 1.

administration,

medical the

staff,

hospital

Durham

County

may 2012

21


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

approach.

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

drug

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

failed

to

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’

wortmannin,

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

fectiveness.

nanoparticle

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.

Current

nanomedicine

clinical

research

development

due

delivery

is

a

Additionally,

breakthrough

Wang explained.

as

well

as

look

into

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.

Fund.

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

defensive systems.

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-

22

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,

system.”

“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

chemotherapy.

follow-up revealed no detrimental effects.

drugs are known to break down FAK,

The press advisory said the researchers

Some

chemotherapy

leaving patients’ hearts more vulnerable

then adjusted their formula to create a

to damage.

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 News

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

Radiology.

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

the

can bestow on a radiologist, radiation

Radiology. Dr. Fordham completed her

Philadelphia and fellowships in body

oncologist

undergraduate

molecular

imaging at Hahnemann Medical Center

recognition as a fellow of the American

biology at Wellesley College and earned

in Philadelphia and in neuroradiology at

College

her medical degree at the Tufts University

Duke University.

of

or

medical

Radiology.

physicist ACR

is

fellows

demonstrate a history of service to the

degree

in

Osteopathic

Medical

Center

of

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.

radiation

oncologists,

interventional

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

services.

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.

may 2012

23


News Upcoming Event

Welcome to the Area

Physicians

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

June 4

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. ®

TM

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

July

New Imaging Technologies Electronic Medical Records

August

Digestive Disease – Computer Technologies

September

Sports Medicine – Physical Therapy

October

Breast Cancer – Reconstructive Surgery

November

Urology – Robotic Surgery

December

Pain Management

24

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

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

Physician Assistants

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: 252-243-7049

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.

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