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october

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The Triangle Physician T H E

M A G A Z I N E

F O R

H E A L T H

C A R E

P R O F E S S I O N A L S

Meet Dr. Thomas Weber Jr. Changing the Face of Pain Management Across the Triangle

Also in This Issue Ways not to say “You’re fired!”

Endometriosis studies raise hope

Dermatologist explores bane of rashes


T


6

COVER STORY

Meet Dr. Thomas Weber Jr.

Changing the Face of Pain Management Across the Triangle o c t o b e r 2 0 17

Vol. 8, Issue 9

FEATURES

8

DEPARTMENTS 11 Dermatology

Practice Management

Dos and Don’ts for Handling Disciplinary Action Margie Satinsky explores ways to minimize the need for disciplinary action.

10

Causes and Types of Skin Rashes

14 Research News Poliovirus Triggers Innate Immune Response in Glioblastoma Therapy

15 News

Welcome to the Area

Women’s Health

Exciting Options for Women with Endometriosis

The Triangle Physician

Andrea Lukes describes the life-impacting condition of endometriosis and informs about promising studies.

T H E

M A G A Z I N E

F O R

H E A L T H C A R E

P R O F E S S I O N A L S

On the Cover: Dr. Thomas Weber Jr. of Midtown Pain and Spine Management Clinic specializes in the placement of spinal cord stimulators, with a special eye on maintaining his zero-overdose record.

october 2017

1

Category

Table of Contents


From the Publisher

Dermatology

Pain and Addiction Free Dr. Thomas Weber Jr. of the new Midtown

Gynecologic-obstetrician Andrea Lukes

Pain and Spine Clinic, our cover story this

writes about endometriosis, its primary

month, knows a lot about acute pain and

symptoms, the causes of the pain, risk

even offers to make special arrangements to

reduction and clinical trials that offer hope

provide needed relief.

of effective treatment. Practice management consultant Margie Satinsky gives dos

In addition to his osteopathic medicine

and don’ts that can minimize the angst

degree, a residency in anesthesia and a

associated with disciplinary action.

fellowship in pain medicine, he served in Baghdad as a chief of anesthesia, treating

Incorporating The Triangle Physician into

wounded soldiers and civilians.

your marketing mix is advised if your goal is to reach the more than 9,000 Triangle

Dr. Weber uses all forms of pain

medical professionals. The process for

management and has had zero reported

inquiry is painless. Simply send an email

overdoses. He prefers non-surgical and

to info@trianglephysician.com. A regular

interventional pain treatment to pain

advertising schedule is advised for the

medication. Patient-satisfaction testimonials

best results – referrals, which are a real

reflect treatment effectiveness.

endorphin booster!

This month dermatologist Gregory

With gratitude,

Wilmoth reviews skin conditions and the

Publisher

characteristic physical and emotional discomfort that accompany them.

John Teague

The Triangle Physician T H E

M A G A Z I N E

F O R

H E A L T H C A R E

P R O F E S S I O N A L S

Publisher - John Teague John@TTP2LC.com

Creative Director - Joseph Dally jdally13@gmail.com

Contributing Editors Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Margie Satinsky, M.B.A. Gregory J. Wilmoth, M.D.

News and Columns Please send to info@trianglephysician.com

Advertising Sales info@trianglephysician.com

2

The Triangle Physician

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. 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.


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Meet Dr. Thomas Changing the Face of Pain Management Across the Triangle

Weber Jr.

F

or acute and chronic pain sufferers, the answer to your pain may be closer than you think. In September, the Triangle’s new “boutique” pain management clinic officially opened its doors. Midtown Pain and Spine Clinic, founded and run by Thomas J.

Weber Jr., D.O., is changing the face of pain management across the Triangle and North Carolina and putting a stop to the opioid epidemic one patient at a time. Introducing Dr. Weber Dr. Weber, who enlisted in the United States Army at age 18 and earned his doctor of osteopathic medicine from the Kirksville College of Osteopathic Medicine. Upon graduation, he completed an internship at the Dwight D. Eisenhower Army Medical Center and his residency in anesthesia at the National Capital Consortium, Walter Reed National Military Medical Center. Following his residency, Dr. Weber was deployed to Baghdad, where at the age of 29 he was elected chief of anesthesia and worked as a combat support doctor. “I performed one of my first epidurals post-residency on an Iraqi woman who was giving birth,” shared Dr. Weber. “During my time in Baghdad, I treated the wounded soldiers, and civilians caught in a war zone. It was in this theater where my passion for pain management truly began.”

4

The Triangle Physician


Dr. Weber discusses a potential spinal cord stimulator with a patient When Dr. Weber returned from his tour, he was asked to open a pain management clinic at Fort Bragg. “I was told we had the budget for a pain management clinic, and it needed to be used. So I began seeing patients and using an empty operating room for my procedures. I had no staff, no nurse, no P.A. It was just me.” Dr. Weber began with a small number of patients that quickly grew, as members of the Green Beret and Delta Force began coming to Dr. Weber for treatment. Soon, he was performing 10 spinal cord stimulation procedures a month. With more than 2,500 patient encounters under his belt, and his practice growing at a rapid pace, Dr. Weber was able to bring in support staff and create a full-fledged pain management clinic. As a lieutenant colonel, Dr. Weber resigned from the Army after 12 years of active duty. He then decided to further his training in pain management by completing a fellowship in pain medicine at Wake Forest University. “Although I had treated nearly 5000 patients and was already board certified through the American Board of Anesthesiology in both general anesthesiology and pain medicine, I felt the fellowship was necessary for my personal and professional growth,” said Dr. Weber. “I was used to treating soldiers, and the fellowship really helped me to become well rounded in my practice.” Today, Dr. Weber still sees patients who he began treating during his fellowship. Because Dr. Weber centers his practice on his patients, they drive from across the state to seek his expertise.

october 2017

5


“One of my greatest joys is getting to know my patients on a personal level. I have some patients I have been treating for five years or more. I know them, I know their families and this knowledge helps me to better manage their pain,” said Dr. Weber. After completing his fellowship, Dr. Weber joined Duke Hospital in Durham, where he once again opened a pain clinic from scratch. As one of the highest producing anesthesiologists at Duke, Dr. Weber had approximately 2,000 patients come through his clinic. After nearly five years with Duke, Dr. Weber felt the calling to open his own practice, so Midtown Pain and Spine Clinic was born. Introducing Midtown Pain and Spine Clinic Dr. Weber and Midtown Pain and Spine Clinic offer a collaborative, comprehensive and patient-centered approach to caring for patients who are living with pain. Through the use of image-guided spine intervention, which offers precise diagnostic capabilities, Dr. Weber is able to provide patients relief from their symptoms. “My goal as a pain management physician is to minimize side effects and maximize benefits,” said Dr. Weber. With patients ranging in age from 16 to 85 years old, Dr. Weber treats a variety of patients from a variety of backgrounds. “There is no age that is too old,” said Dr. Weber, “Although I can’t fix Father Time, I can help patients enjoy their life without feeling his affects.”

6

The Triangle Physician

Dr. Weber and staff members (from left), Kasey Renuart, RT(R), Amy Redmond, Alissa Moody, Dr. Weber.


As a part of his patient-centered approach, acute pain patients with a physician referral can be seen as soon as the same day or next day. “I will come in early, I will stay late,” said Dr. Weber. “I don’t ever want a patient to have to wait months on end to be seen. My goal is to see a referred patient as soon as possible, and I will do everything in my power to make that happen.” Midtown Pain and Spine Clinic offers treatment for back pain, neck pain and other painful conditions, using scientifically proven and advanced non-surgical and interventional pain treatments, such as epidural steroid injections, intrathecal therapy and percutaneous disc decompression. However, Dr. Weber’s true passion lies with spinal cord stimulation. “Through the use of spinal cord stimulation, I have been able to give patients their life back. The immediate relief they experience after the procedure is gratifying,” said Dr. Weber. “With the opioid epidemic growing, I like giving patients an alternative to pain relief without the side effects or chance for addiction.” At a recent appointment with Dr. Weber one patient commented on “how Dr. Weber has truly changed her life. Before I saw Dr. Weber I was in severe pain and did not know which direction I would be able to turn, but he was able to place a temporary spinal cord stimulator on a trial basis. It helped, as did the permanent implant very soon thereafter. I am now living my life without pain and most importantly without the use of high-dose narcotics.” An Alternative to Opioids “Although the opioid epidemic has been gaining attention in recent years, it has been around since the early 2000s,” said Dr. Weber. “When I was running the pain clinic at Fort Bragg, we treated nearly 27,000 patients and had zero overdoses. When I was at Duke, I treated close to 20,000 patients during a five-year timespan with zero overdoses.” Although prescription management is part of the services offered by Dr. Weber, he prefers to treat his patients using the most advanced, state-of-the-art pain management treatment options that eliminate the

“My goal as a

need for pain medication. Dr. Weber has placed hundreds of spinal cord stimulators in eligible patients, who have

pain management

completed a five-to-seven-day trial using a temporary stimulator. Following the trial, Dr. Weber

physician is to

evaluates the patient for improvements in activities of daily living, as well as the pain source

minimize side effects

and level. If the results are promising, the procedure is performed using X-ray and an epidural

and maximize

needle to target the T8 or T9 vertebra, where the stimulator leads are placed.

benefits”

Visit Midtown Pain and Spine Clinic In addition to helping his patients achieve their pain goals, Dr. Weber is passionate about educating his patients on the dangers associated with opioids. “I have been referring patients to Dr. Weber for many years,” said Dr. Tim Garner of Raleigh Neurosurgical Clinic Inc. “Not only does he work new patients into his schedule immediately, I trust that he will provide the pain relief they are seeking for the best possible outcome for improved quality of life. He is one of the best.” Those struggling with pain, including pain associated with failed back surgery, complex regional pain syndrome (CRPS), or other painful conditions may contact Midtown Pain and Spine Clinic to schedule an appointment by calling (919) 277-9845. More information is available at www.midtownpainspine.com.

october 2017

7


Physician Advocacy

Dos and Don’ts for Handling

Disciplinary Action By Margie Satinsky, M.B.A.

Regardless of the care taken during the hiring

Margie Satinsky is president of Satinsky Consulting L.L.C., a Durham consulting firm that specializes in medical practice management. She has helped many physicians start new practices, assess the wisdom of affiliating with a larger health care system and improve their current practices. Ms. Satinsky is the author of numerous books and articles, including Medical Practice Management in the 21st Century.

• Investigate the circumstances thoroughly by

warrant disciplinary action against employees. In

interviewing participants and witnesses and

spite of your best efforts to collaborate with your

by taking written statements. Make sure exam-

employees in setting and achieving goals, some

ine the problem from multiple perspectives

people won’t achieve the desired level of com-

before moving ahead.

petence. Others will deliberately or inadvertently

• If the facts warrant disciplinary action, disci-

break important rules that you have established,

pline the employee when the violation first

documented and communicated.

occurs or upon completion of your investi-

Here are tips for dealing with situations that warrant disciplinary action. Next month we’ll address departures from your practice, focusing particularly on the “employment at will” practice in North Carolina.

disciplinary action (other than discharge) is correction, not punishment. • Make disciplinary write-ups comprehensive by: (1) Applying progressive employee disIncorporating prior action(s) taken; and by (3) Notifying the employee of likely action if future violations occur. Retain all disciplinary write-ups for at least two years. • Develop and consistently apply a system for progressive disciplinary action. Well-managed practices maintain a log of all disciplinary actions in order to ensure consistency and avoid risking the accusation that the reaction to one misdemeanour is inconsistent

Positive Steps to Take

The Triangle Physician

gation. Inform the employee that the goal of

cipline for the same or similar conduct; (2)

For more information, visit www.satinskyconsulting.com.

8

investigation of the problem.

process, all employers encounter situations that

with the reaction to another.

• Clarify expectations at the outset rather

• Know when to take immediate action. Not all

than after a problem arises by: (1) Develop-

problems carry the same weight. Situations

ing and maintaining specific written work

like theft or some other type of fraud demand

rules regarding such topics as attendance,

immediate action.

dress code, confidentiality requirements,

• Take special precautions if the employee is

telephone etiquette and use of social media;

a member of a union. If a union is involved

(2) Documenting the work rules in an official

and an employee requests that a union rep-

employee manual; and by (3) Reinforcing the

resentative attend an investigative interview,

message with posted signage and explana-

allow the employee the opportunity to have

tions during staff and one-on-one meetings.

a union steward present. If no union is in-

• Identify problems as soon as you observe

volved and an employee requests that a co-

them. If minor or major violations occur,

worker be allowed to attend an investigative

share your concerns with your employee,

interview, allow the employee the opportu-

reiterate the expectations, document the dis-

nity to have a co-worker present as a witness

cussion and explain that the next step is an

and advisor to the employee, but not as a


direct participant. • S eek advice from an external consultant and/or legal counsel sooner rather than later. Make sure you are aware of both the antidiscrimination and labor laws that apply to all aspects of employment, not only disciplinary action. Although disciplinary action does not always result in termination of employment, understand your options early in the process rather than at the eleventh hour. Traps to Avoid • When an employee isn’t up to par, it’s tempting to criticize right away. Avoid giving oral discipline without documenting your action and placing the information in the appropriate file. •D  on’t file disciplinary action

Do you have lower abdominal pain due to

Endometriosis? Women’s Wellness is currently conducting a clinical research study and (Company Name) Clinic is currently conducting a clinical research study and is isininneed needofofqualified qualifiedvolunteers. volunteers.To Toqualify, qualify,you youmust mustbe beaawoman woman between between Endometriosis. the ages of of18-65 18-65 who whohas haslower lowerabdominal abdominalpain pain the ages duedue to to Endometriosis. Compensation up to is available for study-related time and travel. Compensation up$840 to $XXX is available for study-related time and travel. The Women’s Wellness Clinic offers Radiant Research or Clinical Research many opportunities for you to Advantage or Comprehensive Clinical participate in clinical trials. In addition Development Logo and Tagline Here. to the endometriosis study, there Radiant Tagline: We Can’t Do It Without are trials on birth control, migraines, YOU! CRA Tagline: Enhancing bacterial Patient Care urinary tract infections, Through Clinical Research. CCD Tagline: vaginosis, and heavy periods. Call The Proof is in more the Performance. 919–251–92234 information.

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slips without first obtaining the

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witness to the discipline. •D  on’t apply different disciplinary actions for the same or similar conduct by different employees

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• Ads may be used in newspapers, fliers, posters, mailings, public transportation, or outdoor advertising. without a valid reason. • Ad may appear white on black or black on white or color. •D  on’t discipline or discharge an • Compensation in ad will match compensation listed in IRB approved consent form. employee without a thorough • Ad may be used in its entirety for website posting or e-mail communication. investigation and thorough –When possible, all internet website postings will fall under the “Research Opportunities” heading shou documentation. be one, but may also fall under the “Employment Opportunities” heading should there not be a relevan •D  on’t discipline or discharge an on a given website. If there is not a relevant “Research” heading, the following disclaimer will be option employee without first allowing the study related text: the person being disciplined or “Please note that the following is not an employment opportunity but an opportunity to participate in discharged the opportunity research to explain trial.” Notice: Radiant Research Inc. and Clinical Research Advantage retains all exclusive rights. All content, form an his/her position. protectedanunder U.S. and Foreign copyright laws. No portions of this document may be reproduced or used •D  on’t disciplineare or discharge without express employee for violation ofthe a rule that written consent of Radiant Research, Inc. the employer failed to communicate or any employee is deemed to know. •D  on’t rely on your memory to remember employee violations. Document everything. •D  on’t discriminate based on age, gender, race, religion or other protected characteristics when determining discipline or discharge.

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october 2017

9


Women’s Health

Dermatology

Exciting Options for Women with

Endometriosis By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.

Endometriosis is found in approximately 7

States Food and Drug Administration trials in-

percent of women who have no symptoms, but

clude treatments with GnRH antagonists, a se-

up to 50 percent of women who have infertility

lective progesterone receptor modulator and a

and up to 70 percent of women who have pelvic

selective dopamine (D2) receptor agonist. Call (919) 251-9223 for more information

pain.

Andrea S. Lukes, MD, MHSc, FACOG, founded the Women’s Wellness Clinic (private practice) and the Carolina Women’s Research and Wellness Clinic (research center) which are both located in Durham, NC. Dr. Lukes received a combined medical degree and master’s degree in statistics from Duke University and completed her residency at the University of North Carolina School of Medicine. Her areas of expertise is in women’s health, including heavy menstrual bleeding, uterine fibroids, endometriosis, contraception, menopause and migraines. Most recently, Dr. Lukes was hired as the Chief Medical Officer of Health Decisions CRO which is specialized within women’s health. The Women’s Wellness Clinic is accepting new patients, 919-251-9223, www.cwrwc.com

Often the current treatments for women with

and to schedule an appointment. Participating

moderate to severe pain from endometriosis are

in a clinical trial is voluntary but offers

not effective. Providers at the Women’s Wellness

reimbursement for participation and potentially

Clinic offer several upcoming clinical trials for

new and effective treatments for endometriosis.

women with endometriosis, as well as new and Table 1

effective medical treatments. Endometriosis is defined as ectopic

of Endometriosis?

of endometrial gland and stroma outside of the

• Nulliparity (no pregnancies)

uterine cavity. The two main symptoms include

• Prolonged exposure to endogenous

pain and infertility. The type of pain includes

estrogen

dysmenorrhea (pain during the menstrual

- Early menarche (before 13 years)

cycle),

dyspareunia

(pain

during

sexual

intercourse) and chronic pain. Recent science supports that estradiol fuels the different types of pain. Specifically estradiol induces COX-2, which in turn increases the production of prostaglandin E2 (PGE2). The PGE2 directly causes both pain and inflammation and leads to increased aromatase, which then increases local estradiol production. There are likely multifactorial causes of aberrant endocrine signaling, genetic factors and more. Known factors that increase the risk of endometriosis are listed in tables 1 and 2. Treatments for endometriosis are individualized and depend on symptoms (pain vs. infertility), as well as a woman’s desire for fertility. There are surgical options, but the available contraceptives, danazol, aromatase inhibitors and gonadotropin-releasing hormones. The providers at the Women’s Wellness Clinic are now enrolling women with endometriosis into several clinical trials. These United

The Triangle Physician

- Late menopause • Shorter menstrual cycles (less than 27 days) • Heavy menstrual bleeding • Mullerian anomalies • Exposure to diethylstilbestrol in utero • Height greater than 68 inches • Lower body mass index • High consumption of trans unsaturated fat

endometriosis that include: altered immunity,

medical treatments include NSAIDs, hormonal

10

What Increases the Risk

endometrium. In other words it is the presence

Table 2 What Decreases the Risk of Endometriosis? • Multiple births • Extended intervals of lactation • Late menarche (after age 14 years) • Increased consumption of long-chain omega-3 fatty acids • Being an African-American or Hispanic woman


Dermatology

Causes and Types of

Skin Rashes By Gregory J. Wilmoth, M.D.

Rashes come in many different forms, and

abdomen and back. It is not uncommon for the

causes and triggers vary widely. While medical

rash to appear in a small area at first, then grow

expertise is required to diagnose the root cause

larger over the course of several weeks. This rash

of a rash and determine a treatment plan, there

gets its nickname from the shape of the scars,

are some common signs that can help narrow

which resemble “Christmas trees.” Pityriasis ro-

down where a rash came from.

sea most often lasts six to eight weeks, but can

The word “rash” is generic and only refers

last much longer.

to a symptom. Most rashes are characterized by itching, inflammation and redness, or other dis-

Rosacea

coloration of the skin.

Rosacea is a chronic condition characterized by redness of the skin, particularly on the face. Ro-

Hives (Urticaria)

sacea “flares up” in connection with aggravating

Hives, or urticaria, is an outbreak of raised

factors, including certain foods, alcoholic bever-

bumpy red welts on the skin. The causes of hives

ages, strenuous exercise and extreme tempera-

can vary, and are often difficult to determine.

tures (hot or cold).

Autoimmune dysfunction often lies at the root of the problem, but food intolerances can also trig-

Poison Ivy/Poison Oak/Poison Sumac

ger hives, as well as stress and excess body heat.

These plants, well known for their three-leaf

Certain medications, insect bites and allergens

structure, contain an oily substance called uru-

have been linked to some cases of hives. Some

shiol, which causes a rash when it comes into

patients experience a one-time episode of hives,

direct contact with the skin. Treatment of these

where others may experience chronic hives.

rashes typically requires application of a topical steroid over a two-to-three-week period, until the

Shingles (Herpes Zoster)

rash subsides.

Shingles is an extremely painful rash that can appear anywhere on the body. Shingles is caused

Psoriasis

by the varicella-zoster virus, the same virus that

Psoriasis stemming from an autoimmune disor-

causes the chicken pox. In patients who have

der comes in many different varieties affecting

contracted the chicken pox, the virus enters a

different areas of the body. Psoriasis consists of

dormant state. Shingles results from a reactiva-

red, scaly patches on the skin. During a psoriasis

tion of the virus. Shingles is more common in

flare, “scales” form as dead skin cells accumu-

adults over age of 60, particularly those with

late. These scaly areas often take on a gray or

weak immune systems. The rash typically leaves

silvery appearance.

behind blisters that form scar tissue. Some patients who suffer from shingles continue to expe-

Eczema (Atopic Dermatitis)

rience pain or itching long after the rash is gone,

Eczema refers to many different conditions result-

due to permanent nerve damage in the affected

ing in generally similar symptoms: patches of red

area.

and inflamed skin. Eczema is often linked to envi-

Dr. Gregory Wilmoth, a board-certified dermatologist at Southern Dermatology & Skin Cancer Center in Raleigh, specializes in Mohs surgery and skin cancer reconstruction, among other specialties. He earned his bachelor of science degree in chemistry from the University of North Carolina at Chapel Hill and his medical degree from Bowman Gray School of Medicine, Wake Forest University. He completed his internship at North Carolina Baptist Hospital and residency at Mayo Clinic, Rochester, Minn. Dr. Wilmoth is a fellow of the American Society for Mohs Surgery. He is a member of the American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Academy of Dermatology, American Medical Association and the North Carolina Medical Society.

ronmental allergens and chemical irritants. Some Christmas Tree Rash (Pityriasis Rosea)

patients with eczema have found that avoiding

Pityriasis rosea usually appears on the chest,

harsh soaps can bring a degree of relief, and it is

october 2017

11


Research News

sometimes necessary to test for allergic re-

In general, it is advisable to consult

although additional testing is sometimes

actions, especially in children. Treatments

a physician about any rash that persists

required. As any rash can potentially indi-

for eczema include topical creams and ste-

for more than a few days. A dermatolo-

cate a serious condition, early diagnosis

roids, and may sometimes require the use

gist can usually identify the specific type

is always best.

of antibiotics if the area becomes infected.

of rash through physical examination,

Poliovirus Triggers Innate Immune Response in Glioblastoma Therapy An investigational therapy using modified

but not the mechanistic details at this

macrophages. Dendritic cells then pres-

poliovirus to attack cancer tumors appears

level,” said co-senior author Matthias Gro-

ent the tumor to T cells to launch an im-

to unleash the body’s own capacity to fight

meier, M.D., a professor in the Duke De-

mune response. Once the immune system

malignancies by activating an inflamma-

partment of Neurosurgery who developed

is activated against the poliovirus-infected

tion process that counter’s the ability of

the therapy. “This is hugely important to

tumor, the cancer cells can no longer hide

cancer cells to evade the immune system.

us. Knowing the steps that occur to gener-

and they remain vulnerable to ongoing immune attack.

Describing this process in a paper

ate an immune response will enable us to

published Sept. 20 in the journal Science

rationally decide whether and what other

“Not only is poliovirus killing tumor

Translational Medicine, Duke Cancer Insti-

therapies make sense in combination with

cells, it is also infecting the antigen-present-

tute researchers provide the first published

poliovirus to improve patient survival.”

ing cells, which allows them to function in

insight into the workings of a therapy that

Gromeier, with expertise in cancer

such a way that they can now raise a T-cell

has shown promise in early clinical trials

biology, collaborated with fellow Duke re-

response that can recognize and infiltrate

searcher and co-senior author Smita Nair,

a tumor,” Nair said. “This is an encourag-

Ph.D., an immunologist and professor in

ing finding, because it means the polio-

the Department of Surgery. The research

virus stimulates an innate inflammatory

team elucidated how the poliovirus works

response.”

not only to attack cancer cells directly, but

Nair and Gromeier said further stud-

also to trigger a longer-lasting immune re-

ies will focus on the additional immune

sponse that appears to inhibit regrowth of

activity following exposure to the modified

the tumor.

virus.

Using human melanoma and breast

In addition to Gromeier and Nair,

cancer cell lines, and then validating the

study authors include Michael C. Brown,

findings in mouse models, the researchers

Eda K. Holl, David Boczkowski, Elena Do-

found that the modified poliovirus therapy

brikova, Mubeen Mosaheb, Vidya Chan-

starts by attaching to malignant cells, which

dramohan and Darell D. Bigner.

have an abundance of CD155 protein. The

The study received support the Public

CD155 protein is otherwise known as the

Health Services (CA197264, CA124756 and

poliovirus receptor. The modified virus

CA190991), the Department of Defense,

then begins to attack the tumor cells, di-

(W81XWH-16-1-0354); the Lefkofsky Family

in patients with recurrent glioblastoma, a

rectly killing many, but not all. This releases

Foundation, Hope & Gavin Wolfe, and the

lethal form of brain cancer. The modified

tumor antigens.

BLAST Glioblastoma Foundation.

Dr. Matthias Gromeier holds a sample of the modified poliovirus he developed that attacks glioblastoma brain tumor cells.

poliovirus received a breakthrough thera-

The second phase of assault is more

Nair and Gromeier, along with Brown,

py designation from the United States Food

complicated. By killing the cancer cells,

Chandramohan and Bigner, own intellectu-

and Drug Administration last year, expedit-

the modified poliovirus triggers an alarm

al property related to this research, which

ing research, according to a Duke press

within the immune system, alerting the

has been licensed to a Istari Oncology Inc.

advisory.

body’s defenses to go on the attack.

Gromeier and Bigner are cofounders and

“We have had a general understand-

This appears to occur when the modi-

ing of how the modified poliovirus works,

fied poliovirus infects dendritic cells and

12

The Triangle Physician

equity holders in the company.


News

Welcome to the Area

Physicians

Romin Bonakdar, MD

Nicole Michelle Fuerst, MD

Sriram Machineni, MD

Internal Medicine

Ophthalmology

Bariatric Medicine; Urgent Care

Pediatrics

UNC Hospitals Chapel Hill

Duke Eye Center Durham

UNC Hospitals Chapel Hill

Brian Conrad Brimmage, MD

Mark Joseph Gage, MD

Christine Standahl McClain, MD

Obstetrics & Gynecology - Surgery, Endocrinology/Infertility, Reproductive

Orthopedic Surgery, Trauma

Psychiatry

Katie Lyn Clouthier, DO UNC Chapel Hill Chapel Hill

Rodger Brent Cook, DO General Practice

Elm City

J. Richard Lee Evanson, DO Orthopedic Surgery; Orthopedic Surgery - Adult Reconstructive, Pediatric, Trauma , Ankle Foot, Hand Surgery

Duke Univ Dept of Orthopaedic Surgery Durham

James Edward Everhart, DO Internal Medicine

Duke University Medical Center Durham

Courtney Hudson Hinton, DO

Raleigh OB/Gyn Centre Raleigh

David Andrew Brown, MD Plastic & Reconstructive Surgery; Plastic Surgery; Plastic Surgery/Hand Surgery

Duke Plastic, Maxillofacial & Oral Surgery Durham

Anthony Bruno, MD Administrative Medicine; Orthopedic Surgery

Wayne Memorial Goldsboro

Megan Tien-Ling Chang, MD Pediatrics

614 W Main Street Durham

Briana Roberta Gibson, MD Anatomic and Clinical Pathology; Blood Banking/Transfusion Medicine

UNC Memorial Hospital Chapel Hill

Kevin McKenzie Gurysh, MD Emergency Medicine

Duke University Hospitals Durham

Steven Scott Harris, MD Diagnostic Radiology; Musculoskeletal Radiology; Neuroradiology; Nuclear Radiology; Pediatric Radiology; Therapeutic Radiology; Vascular and Interventional Radiology

Family Medicine; Family Practice

Durham

Avance Care Raleigh

Yeh-Chung Chang, MD Pediatric Infectious Diseases

Duke University Hospitals Durham

Steven James Jones, DO Family Medicine

DUMC Dept of Pediatrics Durham

James Pham Ho, MD

Sampson Regional Clinton

Sugong Chen, MD

Mark Andrew Kleman, DO

Abdominal Surgery; Bariatric Medicine; Colon and Rectal Surgery; Critical Care

UNC Division of Nephrology Chapel Hill

Duke Center for Metabolic & Weight Loss Surgery Durham

Aaron Isaac Loochtan, DO

Leslie Horn Clark, MD

Nephrology, Internal Medicine

Neurology

Duke University Hospitals Durham

Christina Renee MacRosty, DO Pulmonary Disease and Critical Care, Internal Medicine

Neurological Surgery, Critical Care; Neurology; Radiology, Neuradiology; Vascular and Interventional Radiology

Univ of North Carolina Medical Ctr Chapel Hill

Eric Michael Holland, MD

Felipe De Araujo Andrade Medeiros, MD Duke Eye Center Durham

Julie Ellyn Mervak, MD Dermatology

UNC Dermatology Chapel Hill

Erin Kathleen Moran, MD Radiology

Duke University Medical Center Durham

Kimberly Carmen Munro, MD Obstetrics and Gynecology

Cary

Kim Graham Johnson, MD

Kathleen Marie Claus, MD Anesthesiology - Critical Care Medicine

Neurology; Psychiatry; Geriatric

Duke University Hospitals Durham

Karen Elizabeth Kimel-Scott, MD

Elena Jean Koepke, MD

Boice Willis Clinic, PA Rocky Mount

UNC Family Medicine Chapel Hill

William Thomas Atchley, MD

Kavi Krishna Devulapalli, MD Diagnostic Roentgenology Radiology; Vascular and Interventional Radiology

UNC Div of Pulmonary Diseases & Critical Care Medicine Chapel Hill

UNC Vascular and Interventional Radiology Chapel Hill

Bjorn Hackett Batdorf, MD

Damien Eugene Earl, MD

Duke Eye Center Durham

Goldsboro

University of North Carolina Hospitals Chapel Hill

Family Medicine; Family Practice; Hospitalist; Urgent Care

Ophthalmology

Orthopaedic Surgery

Duke University Hospitals Durham

Catherine Louw Coe, MD

Jay Berdia, MD

Joseph Timothy McLamb, MD

Abdominal Surgery; Gynecology; Gynecology/Oncology

Karen Denise Szymanski, DO

UNC Dept of Pathology & Laboratory Medicine Chapel Hill

Duke University Medical Center Durham

Robert Edward Olivo, MD

UNC Ambulatory Care Center Chapel Hill

Anatomic and Clinical Pathology; Hematology Pathology

Diagnostic Radiology

UNC Center for Heart & Vascular Chapel Hill

Duke University Medical Center Durham

Internal Medicine; Pulmonary Disease and Critical Care, Internal Medicine

Erin Colleen McCrum, MD

Cardiology; Cardiovascular Disease, Internal Medicine

UNC Hospitals Chapel Hill General Surgery; Plastic & Reconstructive Surgery; Plastic Surgery

UNC Hospitals Chapel Hill

Neurology

Duke University Hospitals Durham

Keisha Latoya French, MD Obstetrics & Gynecologic Surgery

NASH OB-GYN Associates, P.A. Rocky Mount

Marat Fudim, MD

Internal Medicine

Anesthesiology

Duke University Medical Center Durham

James Robert Lachman, MD Orthopedic Surgery; Orthopedic, Ankle Foot

Duke Orthopaedic Surgery Durham

Daniel Joseph Lattin, MD Ophthalmology; Pediatric Ophthalmology

Duke Eye Center Durham

Alexander Clayton Lemons, MD Orthopedic Surgery; Orthopedic Surgery of the Spine

Pinehurst Surgical Pinehurst

Cardiovascular Disease, Internal Medicine

Nephrology, Internal Medicine

Shannon Marie Page, MD Anesthesiology

Regional Anesthesia, PLLC Durham

Michael Benjamin Russell, MD Internal Medicine

Duke Hospital Durham

Teresa Danielle Samulski, MD Cytopathology; Pathology

UNC Chapel Hill Chapel Hill

Briana Lynn Scott, MD Hospitalist; Pediatrics

Duke University Hospitals Durham

Duke Urologic Surgery upcoming CME Conferences:

Duke Tuesday Urology Searle Conference Ctr. Duke University •November 7, 2017 •February 13, 2018 •July 2018 •November 6, 2018

https://surgery.duke.edu/ divisions/urology/cme

Duke University Hospitals Durham

october 2017

13


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The Triangle Physician October 2017

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The Triangle Physician October 2017

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