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Wake Radiology Cary An imaging force in the Triangle

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


Every 5 Seconds we help improve another life

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


55 Board-certified subspecialized radiologists | 18 Triangle Locations Evening and weekend hours for many services | MRI 7 days a week Physician decision support

With This Many Choices, The Answer Is Easy. Neuroradiology Sports Imaging Pediatric Imaging Oncologic Imaging Diagnostic Imaging Interventional Radiology Advanced Breast Imaging

Advanced Imaging With Providers And Patients In Mind. With 55 board-certified, subspecialty trained radiologists at 18 convenient Triangle locations, Wake Radiology gives you and your patients many choices in imaging. We provide advanced comprehensive radiology services coupled with subspecialty expertise to give your patients a high level of care. So—the next time imaging is needed think of Wake Radiology. If you are not certain what imaging route to take, simply call our radiologists. They are available by phone for physician decision support and welcome the opportunity to assist you. When it comes to individualized provider and patient care, convenience, and subspecialized imaging the choice is easy.

Š2011 Wake Raleigh. All rights reserved. Radiology saves lives.

Wake Radiology. Excellent decision. WAKE RADIOLOGY EXTENDED HOURS Screening Mammogram: Evenings & Saturdays CT, Ultrasound & Routine Radiology: Saturdays MRI: 7 days a week

WAKE RADIOLOGY EXPRESS SCHEDULING Centralized Scheduling: 919-232-4700 Chapel Hill Scheduling: 919-942-3196

wakerad.com


Contents

COVER STORY

6

Wake Radiology Expands Imaging Services in Cary Office Strengthens Quality of Care in the Triangle

January 2012

Vol. 3, Issue 1

FEATURES

12

Your Financial Rx

Insult to Injury

16

17 Duke News Wound Management

Paul Pittman advises investors to look

Early, Aggressive Treatment of Diabetic Ulcers Can Save Foot

out for overlapping holdings that can

Dr. Michael Kerzner offers clinical findings

increase costs without increasing

that underscore need for immediate and

returns.

specialized treatment of foot ulcers.

However much you value wildlife conservation in North Carolina,

DEC NC

11

1234

quadruple it.

That’s right! Your conservation effort is increased by a 3-to-1 matching gift. So, when you are one of the first to display the new North Carolina Wildlife Habitat Foundation NCDMV license tag, your $10 tag contribution to the organization becomes $40 in lands preserved. The all-volunteer North Carolina Wildlife fe Habitat Foundation assists in acquisition, on, management, and protection of land in North Carolina for the conservation of habitats needed to preserve wildlife

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The Triangle Physician

DEPARTMENTS

right here in the Old North State. Conservation education efforts are preparing future generations to sustain your concern for the lands we protect today. At www.ncwhf.org, download the license tag application and see the good works in process. pp Your new tag shows your support and your n contribution is put to work…times four. co

www.ncwhf.org w

Research identifies dangerous microbes in premature babies; Duke and Durham County Embark on Diabetes Initiative

18 Rex News Grants to Support Community Nonprofits

19 Business So You Have a Nice Website…Now What?

20 News Appointments, partnerships, accolades, expansions and welcome


JOHNSTON MEDIC AL CENTER Clayton A Healthier tomorrow begins today

JOHNSTON MEDIC AL CENTER Clayton

A H e a lt h i e r tom or r o w b e g i n s today


From the Editor

From the Editor

On a Mighty Mission 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

Wake Radiology in Cary is a force to be reckoned with, especially if the opponent is cancer or injury. Its mighty arsenal includes 55 board-certified radiologists and the most advanced imaging technologies available. With all the wonders of medical technology, they also are mindful of the power of basic human caring. Our cover story on this thriving practice offers great insight into the present realm of medical possibility. In this month’s issue of The Triangle Physician, the focus also is on diabetes, and Dr. Michael Kerzner writes on the need for early, aggressive treatment of diabetic food ulcers. You also will read about a Duke initiative to improve outcomes for diabetic patients in Durham County. In other news from Duke, researchers have embarked on a study of the role of dangerous

Editor Heidi Ketler, APR

heidi@trianglephysician.com

Contributing Editors Michael S. Kerzner, D.P.M. Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G. Paul Pittman, C.F.P. Amanda Kanaan Photography Jim Shaw Photography jimshawphoto@earthlink.net Creative Director Joseph Dally

jdally@newdallydesign.com

microbes found in low-birthweight babies.

Advertising Sales Carolyn Walters carolyn@trianglephysician.com

Returning to begin the new year with The Triangle Physician is financial planning expert

News and Columns Please send to info@trianglephysician.com

Paul Pittman, always full of valuable insight and cautionary advice. Dr. Andrea Lukes gives us an overview of a treatment for age spots, best pursued in the winter months. Also in this issue, Rex Healthcare announces its annual call for community grant requests. Last year alone, Rex awarded more than $500,000 to 80 nonprofits across the Triangle. And Cirques des Sciences, a fund raiser for Morehead Planetarium and Science Center is coming.

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

Thanks to all who have contributed to a great start for The Triangle Physician in 2012. Best wishes to all those on a mighty medical mission for a great 2012! With deep gratitude and respect,

Heidi Ketler Editor

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.

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The Triangle Physician


Category On the Cover

Wake Radiology Expands Imaging Services in Cary Office Strengthens Quality of Care in the Triangle Wake Radiology continues to lead the way in advanced patient care in the Triangle and surrounding areas with its Comprehensive Imaging Center in Cary. Opened in 1998, Wake Radiology Cary located at 300 Ashville Avenue has undergone numerous expansions, renovations and modality upgrades to better serve the area’s growing specialized medical community and its patient base.

A

help diagnose injury and disease in the most responsible manner utilizing X-ray, CT, ultrasound, nuclear medicine, MRI, PETCT, digital mammography, BSGI and other therapies through minimally invasive interventional radiology. In one location, Wake Radiology Cary offers services grouped according to the needs of patients and their physicians: interventional services; dedicated, state-

s the Triangle’s largest radiology

encompasses excellent medicine coupled

of-the-art comprehensive breast services;

group, our 55 board-certified and

with careful attention to patients’ conve-

diagnostic imaging services including MRI;

subspecialized radiologists perform more

nience, comfort, and peace of mind. Our

and PET·CT services.

than 650,000-plus procedures annually.

subspecialized radiologists utilize the ad-

Wake Radiology’s approach to imaging

vanced imaging technologies in Cary to

March 2010   –  PET·CT staging and restaging   –  August 2010

PET-CT’s wide ranging applications PET-CT technology represents one of the most powerful tools in nuclear medicine imaging, and Wake Radiology’s subspecialty trained radiologists are experts at integrating multi-modality exams and clinical information to give a definitive answer. David Schulz, MD, one of the five dedicated PET-CT imagers at Wake Radiology explains, “PET-CT scans provide both metabolic and structural information, rather than merely detecting that a ‘mass’ or ‘lesion’ is present. PET is useful for initial treatment planning, treatment monitoring, restaging, and detection of suspected recurrence of numerous neoplasms, including but not limited to the most deadly cancers: lung, colon, and breast. Moreover, PET can often identify cancerous cells in many cases before traditional imaging such as CT or MRI.” Paramjeet Singh, MD of Cancer Centers of NC says, “PET-CT is an integral part of my practice. I use it for initial diagnosis and it has proven

PET·CT images of 57-year-old female with metastatic breast cancer. First PET-CT in March 2010 (left images, top and bottom) show the conglomerate of adjacent nodes. After cancer therapies, on the follow-up PET-CT in August 2010, the conglomerate of adjacent nodes clearly decreased in both size and number.

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The Triangle Physician

essential in the follow-up and evaluation of treatment plans. Wake Radiology’s PET-CT imaging specialists are always just a phone


call away if I need to review findings or consult with them on a difficult case. The use of PET-CT has made an impact on my patient’s care for the better and has been a great help to me as a physician. “In addition to oncology applications, PET also has proven utility for neurological applications such as identifying refractory seizure foci and the differential diagnosis of frontotemporal dementia and Alzheimer’s disease. We are also excited about some new PET compounds aimed at detecting the plaques seen in the brains of patients with Alzheimer’s disease, potentially facilitating earlier diagnosis. The first of these compounds may achieve final FDA approv-

Postcontrast projection image of both breasts, as if looking upwards from the patient’s feet, demonstrating a large breast cancer in the breast on the left of the image. The breast on the right is normal.

al as soon as spring 2012, and we look forward to providing this specialized service

existing services, and it will also allow re-

Breast MRI is well established as the most

as it becomes available.”

ferring physicians to access MRI expertise

sensitive and specific method for early

and services in Cary that once were only

detection of breast cancers, and is recom-

The equipment, a Siemens Biograph True-

available at Wake Radiology’s Raleigh MRI

mended as an annual surveillance test for

Point PET-CT scanner, provides distinct

Center in Raleigh.” Some of the new ser-

patients with high Gail Model risk of breast

advantages over either PET (positron

vices offered include:

cancer by the National Cancer Institute (NCI). A woman can easily calculate her

emission tomography) or CT (computed tomography) alone. Since November 2008,

Breast MRI

Gail Model risk in a few minutes using the

patients desiring dedicated subspecialty

Wake Radiology has garnered well-known

Breast Cancer Risk Calculator link on the

trained PET-CT reads have not needed to

regional accolades for its exceptionally

Wake Radiology website, wakerad.com. If

travel to UNC, Duke, or Rex hospitals for

high quality breast MRI program. After

the Gail Model risk exceeds 20 percent,

their PET-CT scans. The decreased travel

having performed more than 4,000 breast

most insurers will cover the cost of an an-

time, easy registration, and short wait times

MRIs in our Raleigh location, we now have

nual breast MRI. This is also true for any

have all helped to make this process as

expanded the service to the Cary office

woman who has undergone genetic testing

convenient as possible for hundreds of pa-

to complete the imaging spectrum of the

and is found to be BRCA (breast cancer

tients. At Wake Radiology PET-CT Services,

Comprehensive Breast Imaging Center.

genome) positive. In addition, for those patients who have undergone lumpec-

patients will experience fast, personalized service and a warm, tranquil atmosphere.

Nancy Crowley, MD, of Tolnitch Surgical

tomy and radiation for prior breast cancer,

Wake Radiology’s PET-CT service is a joint

Associates has been utilizing Wake Radi-

Breast MRI is the most specific method for

venture with WakeMed.

ology’s BMRI services since its launch in

excluding disease recurrence in the op-

2005 “This is a well-respected program that

erative site. Mammograms and ultrasounds

New Short Bore Magnet -

combines exceptional patient care with

are much less specific for this scenario.

Expanding Services

concise reporting that’s available via PACS

and Quality

(Picture Archive Communications System)

MR Enterography

In 2010 a fixed MRI was added to Cary’s

within hours after the study is completed.

Many patients suffer for years with Crohn’s

extensive list of imaging modalities. Now

Their rapid turnaround in scheduling and

disease, which predominantly affects the

Wake Radiology is replacing the Siemens

reporting also benefits my patients who

small bowel (ileum, jejunum, and duode-

Essenza with a Siemens Avanto 1.5T MRI

are understandably anxious to learn the

num), but can affect any segment of the

unit to expand the broad range of services

outcome.” Dr. Crowley continues, “The ex-

GI tract. These patients commonly require

offered in one location. G. Glenn Coates,

pansion of services into Wake Radiology’s

lifelong imaging surveillance of disease ac-

MS, MD, director of body MRI, says, “The

Cary location will add an extra level of con-

tivity, which in the past has been conduct-

new magnet will allow additional compre-

venience for the women of Wake County.”

ed with CT almost exclusively. Due to the risks involved in chronic CT surveillance

hensive services that nicely complement

January 2012

7


Images from abnormal pre/post contrast MR Enterography demonstrating acute upon chronic crohn’s disease.

Fluid sensitive MRGI

Motion independent, steady-state fluid sensitive images

Arterial phase bowel perfusion

Delaed phase bowel perfusion

from accumulated exposure to imaging ra-

under control. Many fantastic advances in

studies, even on the weekends. In addition,

diation, methods were developed to allow

cancer therapy have resulted in patients liv-

this allows review of any complex study be-

MRI (which uses no radiation) to replace

ing many years past their cancer diagnosis.

fore the patient’s study is completed.

CT as the imaging method for determining

In the past, required surveillance imaging

disease activity and response to medical

was exclusively performed with CT. How-

For claustrophobic patients, our extensive

therapy.

ever, with patients now living much lon-

on-site presence allows us to give intra-

ger past their cancer diagnosis date, the

venous sedation, making the experience

MR enterography (MRE), a study specifi-

radiation exposure of many surveillance

more comfortable, with higher image qual-

cally designed for Crohn’s disease patients,

CTs has become a topic of great concern

ity than can be afforded on lower quality

will now be available at the Cary Office. This

in the medical community. As such, meth-

equipment, including ‘open magnets.’ The

will allow regional Crohn’s patients greater

ods have been developed to allow MRI to

end result is that the source of pain is more

options and convenience for their required

replace CT for lifelong surveillance imag-

accurately determined, and the extent of

lifelong imaging surveillance needs.

ing needs. Cancer survivors can now have

injury is described in greater detail.”

body MRIs instead of CTs to assess the sta“I value the relationship I have with the body

tus of their cancer.

DEDICATED BREAST CENTER Focused on lowering patient anxiety

MRI specialists at Wake Radiology, tremendously,” states Kittu Parekh, MD, digestive

Musculoskeletal MRI

Since Wake Radiology introduced compre-

health care. “Having this cutting-edge equip-

MRI is a powerful tool in assessing bone

hensive breast imaging services in 2007,

ment at Raleigh MRI and now in Cary, com-

and joint disease, ranging from sports in-

the area’s first center dedicated exclusively

bined with the expertise of their subspecial-

juries to early stages of arthritis. “Our up-

to women’s imaging has become well

ty body MRI radiologists, allows physicians

graded MRI in our Cary office allows us to

known for its personalized care. Compre-

options when it comes to imaging patients

implement state of the art protocols with

hensive breast services in Cary is staffed by

with Crohn’s disease and minimizes long-

the highest image quality. This allows us to

technologists and radiologists with exper-

term exposure.” Dr. Parekh continues, “It is

take full advantage of our musculoskeletal

tise in mammography, ultrasound, and in-

through a continued collaboration with GI

expertise,” states Nik Wasudev, MSK Imag-

terventional breast diagnostic procedures.

doctors and other physicians that the MRE

ing specialist. “Wake Radiology has the

The office specializes in digital screening

program has improved the quality of life for

largest and most experienced team of radi-

and diagnostic mammograms, ultrasound-

patients with this disease.”

ologists who have done a dedicated bone

guided breast biopsies, and stereotactic

and joint fellowship in our region. More-

(mammogram-guided) biopsies. The cen-

Cancer Surveillance Body MRI

over, one or more of our musculoskeletal

ter offers the area’s only breast-specific

Just as Crohn’s disease patients require

experts is now working seven days a week,

gamma imaging (BSGI), a nuclear medi-

lifelong imaging surveillance of disease

with on-site coverage Saturday and Sunday

cine study that shows malignant cells very

activity, many cancer survivors (cured

in our Cary office. We therefore have the

clearly. Bone densitometry also is available

or in remission) require lifelong imaging

ability to perform advanced studies such

in this dedicated women’s services area.

surveillance to determine if cancer is still

as MR arthrograms and contrast-enhanced

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The Triangle Physician


Susan Kennedy, MD, a breast imaging radiologist, says, “Our emphasis is on patient convenience. We believe that they shouldn’t have to wait an inordinate amount of time for an examination; their time is important, too. For instance, the average duration of a patient visit for a digital screening mammogram in our Cary office is 13 minutes. “We perform digital screening mammograms on asymptomatic patients without a significant previous history every day. We then read these studies in a separate read-

Susan Kennedy, MD, consults with patient after diagnostic mammogram.

ing area, with optimal viewing conditions, without distractions, in order to be able to

“If a biopsy is needed,” she says, “it can

way to screen them, because if it is nega-

find subtle abnormalities that could indi-

often be scheduled within a day. So the

tive, the chances of their having breast can-

cate breast cancer.

whole process, including a biopsy and pa-

cer are very low. We also use it for difficult

thology results, is often completed within

clinical problems or patients who have

“We also perform diagnostic digital mam-

a week — that’s very reassuring to our pa-

hard to evaluate breasts — such as those

mograms at our Cary facility for patients

tients. Our office workflow is designed to

with dense tissue or lumps,” says Dr. Bird.

who have had an abnormal screening mam-

minimize the amount time patients are in a

mogram. The process is optimized to dimin-

state of apprehension.”

Overall, Dr. Kennedy says, “We are all very proud of our facility. We treat our patients

ish patient anxiety and inconvenience.” “Wake Radiology adopted BSGI,” explains

like family, with decency and respect, and

Dr. Kennedy continues, “For those patients

Dr. Richard Bird, FACR, “because the

make sure they are appropriately informed

with abnormal screening mammograms,

modality offered excellent promise as a

about their particular situation. We also be-

we call them ourselves to let them know

problem-solving tool.” BSGI is a nuclear

lieve the patient’s feelings are paramount

they need to return for a diagnostic mam-

medicine study that traces a tiny dose of

and that convenience matters so we offer

mogram and usually are able to schedule

a radioactive pharmaceutical to detect if

extended evening and Saturday screening

the patient for that study within the next 24

there is a metabolically active area, which

mammography appointments. We are truly

hours. All of our patients who have a diag-

can be a sign of cancer.

efficient, so our patients are not spending extra time in our waiting room. Dr. Ken-

nostic mammogram meet with one of our breast imaging specialists for their results

“This is useful for screening women who

nedy adds, “We’re always available to help

before leaving the office, so there is no

may have a somewhat increased risk for

the referring providers and accommodate

anxiety about the unknown.

breast cancer but do not meet the criteria

their requests. Wake Radiology’s compre-

to screen with breast MRI. This is another

hensive breast services in Cary and nine of our other breast imaging centers are proud to have received the American College of Radiology’s (ACR) designation of “Breast Imaging Centers of Excellence.” INNOVATIVE SACROPLASTY IS LATEST ADVANCE FOR INTERVENTIONAL SERVICES Wake Radiology’s Interventional Services has been the Triangle area’s only practice to offer sacroplasty, an innovative treatment for osteoporosis insufficiency frac-

These are a few of the mammography technologists of Wake Radiology. All techs are certified by the American Registry of Radiologic Technologists.

tures of the sacrum, which are extremely painful and afflict many elderly patients. January 2012

9


This procedure is the latest example of Wake Radiology’s

can to make these important services available on an out-patient basis.

quest “to advance patient pain relief using the latest in mini-

Contrast is also offered on weekends and the office is staffed by a radi-

mally invasive procedures as an alternative to surgery, that

ologist. The added benefit for providers is that our imaging reports are

involves lengthy recovery time,” says Carroll C. Overton, MD,

available via the Wake Radiology PACS system or on your fax machine

director of interventional services.

hours after the exam is complete. The Cary office is staffed weekdays with a PET-CT radiologist, an interventional radiologist, a MSK radiolo-

“Unlike spinal compression fractures, where patients can at

gist and up to two breast imaging radiologists. All subspecialized imag-

least gain a little bit of relief by sitting or lying down, with a

ing is read at various offices through our PACS system and our radiolo-

sacral fracture, they can’t sit and find pain relief. Sacroplasty

gists are available for physician decision support whenever needed.

has been tremendously helpful to our patients. Heretofore, we didn’t have anything to offer for this pain.” Sacroplasty is similar to vertebroplasty, the injection of special cement into the bone with the use of X-ray to guide the needle, and to Balloon Kyphoplasty, in which a balloon-like device is inserted to lift a crushed vertebra so that bone cement can then fill the void. Sacroplasty, Dr. Overton explains, “is an innovative way of doing basically a vertebroplasty in the sacrum. This is an extension of a procedure from one anatomic part to another.”

WR Physician Decision Support Body Imaging Hotline - 919-453-1127 Body MRI Hotline - 919-788-7978 Breast Imaigng Hotline - 919-233-5338 x 2123 Breast MRI Hotline - 919-788-7978 Interventional Radiology Hotline - 919-854-2180 Musculoskeleton Imaging Hotline - 919-782-4830 Neuroradiology Hotline - 919-676-5090 Pediatric Imaging Hotline - 919-782-4830 PET·CT Hotline - 919-233-7280

Results have been excellent. “Ninety percent of our patients get complete relief. Half of them get relief the day of their procedure, and the other half get progressive resolution of their symptoms over the next week.” Carole Drake – Express Scheduler

The service’s eight board-certified interventional radiologists provide a host of additional advanced procedures, including

Wake radiology EXPRESS SCHEDULING

treatment for arterial vascular disease, uterine artery/fibroid

STREAMLINE YOUR SCHEDULING

embolization, cancer therapies, advanced vein therapies,

Wake Radiology offers two way to expedite your scheduling process,

varicoceles and male infertility, dialysis access management,

Express Scheduling, requires only one call or fax to order any service, or

venous access procedures, and vertebroplasty and Balloon

schedule online via the Wake Radiology Scheduler’s Portal. Scheduling

Kyphoplasty for chronic back pain management.

has never been easier using our secure online link. As an additional feature, Wake Radiology Express Schedulers will contact referring

Another service offered in the interventional suite in Cary is

physicians’ patients to coordinate the best date, time, and location for their

vein therapies for varicose and spider veins, treatments that

procedures. Contact a Wake Radiology Referral Services Manager at 919-

are increasingly important for both women and men. Wake Ra-

218-2795 to find out how your office can register for online scheduling.

diology offers free consultations and emphasizes that skilled

WR Express Scheduling … 919-232-4700

vascular and interventional radiologists provide the highest level of patient care to help eliminate complications. Many insurance plans now cover the treatments. Patients may request a free consultation online at wakerad.com. We’re here when you and your patients need us Many of Wake Radiology’s offices including Cary are now offering evening and weekend appointments for screening mammography, CT, ultrasound (excluding vascular procedures), and X-ray. MRI service is available seven days a week in Cary with an MSK radiologist on site. We understand how busy patients are and how difficult it can be to take time away from work for diagnostic imaging so we are doing all that we

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The Triangle Physician

Wake Radiology Cary | 300 Ashville Avenue | Cary, NC 27518 Diagnostic Imaging | Breast Imaging & Biopsy | PET·CT | MRI Interventional Radiology 919-233-5338 wakerad.com


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9193


Insult to Injury Your Financial Rx

By By Paul Pittman, C.F.P.

“The firm made money, and the broker made money, so two out of three ain’t bad.”

are even more profitable for the financial institution. The old adage is “The firm made money, and the broker made money, so two out of three ain’t bad.” There are some brokers out there who do a good job of guiding clients’ financial lives, but for the great majority, their arsenal

I was recently interviewed for an article

Who do you think pays for advertising,

is still limited to retail products. Buying

in a national financial newspaper, and the

commissions, salaries, bonuses, payroll,

or owning an investment product with a

writer asked me, “What are some of the

overhead and all of the other expenses

3 percent expense ratio is like having a

stumbling blocks that individual investors

an investment company incurs? You might

racehorse with a 300-pound jockey. They

face going forward with a personal

have read in the news in the past that

may finish the race, but are not the smartest

financial recovery plan?”

Goldman Sachs paid out staggering year-

or the most efficient way to compete.

end bonuses to their employees. Your This was an easy question. There are two

If your fees are in the 3 percent range, and

investment dollars paid for that.

you have $1 million in investments, then

huge problems out there that stand to hamper any sort of true recovery in an

As my readers already know, I am not a

you are paying $30,000 a year just to own

investment portfolio. These two show up

fan of retail investment products. They

those investments. I believe that is about

after the battle has been waged and the

are for the uninformed. Mutual fund fees

$15,000 too much. Take that $15,000 a

returns are in. They are the equivalent of

sometimes run in excess of 3 percent a

year, compound it over the next 20 years

bayoneting the wounded.

year. Variable annuities run even higher. I

at 8 percent, and you see that fees can be

refer to these fees as a thief in the night,

costing you more than $700,000 in potential

robbing you of your returns.

growth!

with them, and there are many ways you

Fees are truly the silent killer in your

This is why I refer to fees as the silent

can be charged. There can be upfront

portfolio. Most financial institutions make

killer. What you don’t know can hurt you.

sales charges, or “loads.” There can be

money by hiring a sales force, or brokers,

When you consider a financial advisor, you

ongoing charges, such as management

to sell firm-recommended investment

should be hiring that person to enhance

expenses, 12b-1 fees, bid/ask spreads, also

products

These

your financial position and to guide you

redemption, trading and “wrap” charges.

products are very profitable to the firm.

to your goals, not to sell you fee-laden

“In-house,” or firm-sponsored products,

products.

Fees: The Silent Killer All investments have fees associated

12

The Triangle Physician

to

their

customers.


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.

True diversification in a portfolio does

down to is performance, specifically, net

not have redundancy or overlapping.

performance. Remember my mantra: It’s

Without proper diversification, you (or

Not What You Make, It’s What You Keep!

your advisor) are basically gambling and

Repeat that to yourself every time you

speculating with your money. Make sure

review your portfolio.

you cover several different asset classes, sectors and countries. If you can mix in

Find a financial professional that is

an asset class that is non-correlating with

credentialed, experienced, unbiased and

about 10 percent of your portfolio, you can

unencumbered by a financial institution. A

actually lower your risk level even more.

quick analysis by this person can show you not only the weak parts of your financial

Now you can see, at least partially, why

plan, but also how much of your money

I believe fees and redundancy are the

you are leaving on the table.

biggest drag on a portfolio. What it all boils

Redundancy: A Real Drag I see this almost as frequently as I do high fees. On a regular basis someone will come into my office and show me a statement where they own four or five mutual funds or a firm-sponsored mutual fund allocation program, and they will ask if they are well diversified. For starters, it is important to be aware of the investment firms’ sources of revenue. They may be collecting fees from the investor and from the fund companies allowed in their investment programs. (Yes, sometimes the financial institutions get paid from both sides. So diversification sometimes means a diverse source of revenue for the house!) When I analyze the holdings of these funds, which is the only real way to test diversification, I see the top five stocks in each of the funds is basically the same. This means you may own GE, or IBM, or GM, or Home Depot, or others, five different times! This is called redundancy, or overlapping. Owning mutual funds and individual stocks together can make your overlapping problem multiply. You have to know exactly what you own. When you have significant overlapping, the risk of your portfolio rises, but the potential return does not necessarily rise with it. Womens Wellness half vertical.indd 1

12/21/2009 4:29:23 PM

January 2012

13


Women’s Health

Winter is the Time to Treat

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

Although being outside has enormous health benefits, the skin endures sun damage that can result in “age spots.” Birth control pills and pregnancy can worsen them for woman. Fortunately, there are safe treatments that can reduce their visible effect, and winter is the best time to utilize them. The Alma Laser effectively treats pigmented and vascular lesions, using advanced fluorescent technology (AFT). The pulsed light of AFT is absorbed by the target areas (age spots, rosacea, erythema, melasma, small blood vessels) without damaging healthy skin. Pigmented

lesions

respond

because

the light energy heats the melanin in the lesion and causes it to fragment. The melanin fragments are then absorbed by the body and eliminated. By providing

Daily Regimen for Healing

properties and is now recognized as

smooth, consistent light pulses, the energy

Before women apply their makeup in the

a pigment-regulating and penetration-

delivered to the skin is gentle and effective.

morning, we recommend the following

enhancing agent.

In terms of vascular lesions, the light

regimen:

selectively heats and closes off the blood

• Wash face in the morning and apply an

vessels, reducing the lesions.

antioxidant serum. • Wait 1-2 minutes and apply a hydrating

After laser treatment, patients should avoid

sunscreen.

This serum has anticancer, antifungal, antibacterial,

antiviral

and

anti-

inflammatory bioactivities. It also contains vitamin C and ferulic acid, which helps

long exposure in the sun (easier to do in

After reviewing many available options, we

prevent and treat damage at every level of

the winter) and keep the skin well hydrated

offer the exclusive SkinCeuticals brands.

the skin.

with lotions. Most treatments do not need

The two top serums include Phloretin CF

anesthesia, but a topical anesthetic allows

and CE Ferulic.

us to treat the entire face – providing an

Phloretin CF is recommended for hyperpigmentation, erythema, uneven skin tone,

even treatment. Doing this once or twice

Phloretin CF is derived from apples and the

loss of elasticity, mottled appearance and

a year will help keep the skin looking

root bark of fruit trees. Phloretin is a broad-

photodamaged skin. This is best suited for

younger.

spectrum molecule that has antioxidant

women with normal or oily skin.

14

The Triangle Physician


CE Ferrulic is a topical antioxidant that provides eight times the natural skin’s photoaging protection. It was actually a three-time winner for best serum and received the 2009 Allure (women’s magazine) Best of Beauty Editors’ Choice Awards. Ingredients in CE Ferrulic include vitamins C and E; ferulic acid, which is a plant-based antioxidant; 15 percent pure L-ascorbic acid; and 1 percent alpha tocopherol. The serum is recommended for rosacea, fine lines and wrinkles, erythema,

hyperpigmentation

and

photoaged or photodamaged skin. It is better suited for women with normal or

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dry skin.

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step that we recommend as a “must” for daily skin care. Not many realize that over-the-counter brands do not provide the same type of protection available through physician offices.

Securities offered through LPL Financial Member NASD/SIPC Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers

The SkinCeutical sun defense creams are optimal for daily use. We recommend the following: • Daily Sun Defense SPF 20 • Ultimate UV Defense SPF 30 • Sport UV Defense SPF 45 • Sheer Physical UV Defense SPF 50 These sunscreens are superior because they offer both a chemical block against UVA and UVB rays, and provide a physical block, with a transparent zinc oxide. These are ideal of all skin types because they are both PABA free and oil free. Women often find that feeling their best can involve small steps in good skin care. During these winter months, we are offering discounts. We also work in collaboration with aesthetic specialist Eileen Slutsky, RN/BSN, and plastic surgeon Cynthia L. Diehl, M.D., for those with a need for more extensive therapies.

January 2012

15


Wound Management

Early, Aggressive Treatment of

Diabetic Ulcers Can Save Foot By Michael S. Kerzner, D.P.M.

Nearly 24,000,000 Americans have diabetes,

continued damage to the involved area;

with 15 percent developing foot ulcers each

treatment of any infection; good blood sugar

year. This results in 60,000 amputations

control; proper nutrition; and evaluation for

annually. Durham County, North Carolina,

possible peripheral arterial disease or other

has the third highest amputation rate in

diseases or illnesses.

the diabetic population based on statistics published through Medicare.

Delaying treatment can be a serious error, and diabetics need to be careful when trying

Part of the problem is diabetics have

to treat the wound themselves. Cleansing

decreased feeling in their feet and often do

wounds with some products can be too harsh

not realize they have an ulcer or wound. In

and can damage tissue. Allowing wounds to

addition, patients and families often do not

get too dry or too wet can slow healing and

know how quickly diabetic foot ulcers can

cause other complications. Patient’s should

break down, become infected and spread

always be encouraged to check with their

into deep tissue.

doctor on any home treatment.

Michael S. Kerzner, DPM, is the attending podiatrist at the Wound Management Institute at Duke University Medical Center. He is a board-certified podiatric physician with many years of experience in limb salvage and reconstruction. Dr. Kerzner earned his doctor of podiatric medicine from Temple University School of Podiatric Medicine in Pennsylvania.

improvement within the first four weeks healed greater than 63 percent of the time

In cases that are slow to heal or getting worse, it

within the following three months.

is important to seek advanced treatment from a

Advanced

comprehensive wound care center.

regular

treatment

options

include:

specialized dressings to promote healing; and

aggressive

debridement;

application of a total contact cast; and use of negative pressure wound treatment devices,

It has been shown that early recognition

While standard treatment is important, it

bioengineered skin substitute and hyperbaric

of foot ulcers is a very important factor in

doesn’t always work. Studies show only 25

oxygen treatment for selected wounds.

preventing amputation and loss of limbs.

percent of diabetic ulcers will heal within

For this reason, it is recommended that

three months, despite the best of care. In

The goal of treatment is always

diabetics have their feet checked every visit

cases that are slow to heal or getting worse, it

the prevention of amputation,

to the primary care doctor, endocrinologist

is important to seek advanced treatment from

preservation of function

or podiatrist.

a comprehensive wound care center.

and maintaining

If an ulcer is found, there is standard

Recent data suggests that if a diabetic foot

treatment available that’s best provided by

ulcer does not show greater than 50 percent

a wound care physician. The treatment may

improvement after the first four weeks of

include debridement (removing unhealthy

appropriate management, then less than 9

tissue); application of dressings to keep the

percent will heal within the following three

wound moist and encourage the body’s own

months. The same study revealed that those

healing process (autolytic debridement);

wounds treated with advanced treatment

use of special shoes and boots to prevent

modalities showing greater than 50 percent

quality of life.

16

The Triangle Physician


Duke News

Premature Babies Harbor Fewer, But More Dangerous Microbe Types One of the most comprehensive studies to

Seed, who is also with the Jean and George

giving babies probiotic substances to tip

date of the microbes living within extremely

Brumley Jr. Neonatal-Perinatal Research

the internal balance toward more favorable

low-birthweight infants found that hard-to-

Institute and the Duke Center for Microbial

bacteria, necessary for immunity and better

treat Candida fungus is often present, as well

Pathogenesis.

health.

Dr. Seed said while the study babies were

Dr. Seed stressed that certain bacteria and

Researchers at the Duke University Medical

colonized mainly by organisms found in

other microbes are helpful for growing ba-

Center and Nicholas School of the Environ-

stool specimens, in some cases Staphylo-

bies and their immune systems, so it is im-

ment looked at the microbes in 11 prema-

coccus epidermidis, a form of staph infec-

portant not to do any damage by creating an

ture infants and found much less diversity

tion, was abundant in many of the babies’

antiseptic environment.

than in full-term infants.

digestive tracts.

as some harmful bacteria and parasites.

“It’s a question of balance,” Dr. Seed said. “The babies’ guts were taken over by mi-

The bacteria and yeast in the premature

“As vulnerable as these babies are, we still

crobes we know are dangerous if they get

babies’ digestive tracts are known causes of

wouldn’t want to wipe out all of the bacteria,

into the blood,” said senior author Patrick

devastating infections in these babies. The

even all of the potentially harmful bacteria.”

Seed, M.D., Ph.D., assistant professor of pe-

gut seems to be a reservoir for some organ-

diatrics at Duke. “Even after the babies were

isms that form infections, Dr. Seed said. Pre-

Other authors include Mariam LaTuga, M.D.;

no longer on antibiotics, healthier bacteria

vious to this work, “we only knew the tip of

Michael Cotton, M.d., M.H.S.; Ronald Gold-

didn’t appear in the babies very quickly.

the iceberg,” he said.

berg, M.D.; and James Wynn, M.D., all of Duke Department of Pediatrics; and Chris-

This may be one reason why premature babies are so vulnerable to infections.” All of the premature children were placed

The researchers used genomic (DNA) typ-

topher Ellis and Robert Jackson of Duke’s

ing of the bacteria, fungi and parasites to

Nicholas School of the Environment. (Mr.

determine which types were present.

Jackson is also with the Biology Department and the Center on Global Change at Duke

on antibiotic treatments after birth, which

University).

would wipe out some types of bacteria and

It’s not clear if the newborns are picking up

yeast, but once they were off the antibiotics

these early infections from their mother’s

and taking food, the researchers expected

milk, blood or in other ways, or if the patho-

This research was supported by a pilot grant

to see more diversity of bacteria in the ba-

gens are from the environment surrounding

from the Duke Institute for Genome Sciences

bies’ developing digestive systems than they

the infants.

& Policy; the Duke Department of Pediatrics – Division of Perinatal-Neonatal Medicine;

found. The findings were published in PLoS One open-access journal on Dec. 8.

“It’s important to know where these patho-

the Jean and George Brumley Jr. Neonatal-

gens come from so that doctors can possi-

Perinatal Research Network; and the Center

Five infants had blood infections, while

bly manipulate the babies’ environment or

on Global Change, as well as support from

three had necrotizing enterocolitis, an infec-

their digestive systems,” Dr. Seed said. He

the Gerber and Hartwell Foundations.

tion-related death of bowel tissue, said Dr.

noted other studies had shown value for

Duke and Durham County Embark on Diabetes Initiative Improving health outcomes and quality of

versity of Michigan’s School of Natural Re-

“Attacking a complex problem like diabetes

life for Durham County residents with type

sources and Environment.

requires a committed team, resources, community engagement and alignment of health

2 diabetes are the twin goals of a bold collaborative effort spearheaded by Duke Uni-

The five-year program is supported by a

care and societal forces,” says Robert M. Cal-

versity Medical Center, the Durham County

$6.2 million grant the Bristol-Myers Squibb

iff, M.D., vice chancellor for clinical research

Health Department and the National Center

(BMS) Foundation’s national diabetes initia-

at Duke and leader of the steering commit-

for Geospatial Medicine, based at the Uni-

tive, Together on Diabetes.

tee for the Durham Diabetes Coalition.

January 2012

17


Duke Research News “We’re excited by this chance to build on

of a community. This powerful technology

and cancer – the leading causes of death

the vibrant relationships that already exist

allows researchers to visualize complex

in Durham. Only through community inter-

between Duke, the Durham Health Depart-

relationships between the locations of dia-

ventions like the Durham Diabetes Coali-

ment and other community stakeholders.

betes patients, patterns of health care and

tion can we really change the trends in new

Together, and with the support of the BMS

available social resources.

cases of diabetes and improve the care of persons with diabetes.”

Foundation, we will provide patients with diabetes and their health care providers

This information also is being used to ex-

with the tools they need to effectively man-

plore gaps in access to care and self-man-

The Durham Diabetes Coalition will em-

age their conditions and help them over-

agement resources, help patients connect

ploy a diabetes communication officer

come barriers to better health.”

with the community assets and identify in-

(DCO), who is responsible for designing

terventions that can result in better health

and implementing communication pro-

“Changing the course of the nation’s diabe-

outcomes, both for the individual and the

grams to provide relevant health and life-

tes epidemic requires radically new think-

neighborhood, as a whole. Geospatial data

style information to the community. The

ing and intensified collaborative action,”

also will be used to create a continuous

DCO also will develop community messag-

said Patricia M. Doykos, Ph.D., director of

feedback loop for improving the quality of

es and support programs to motivate resi-

the Bristol-Myers Squibb Foundation. “The

project efforts.

dents to participate in lifestyle initiatives as a group.

project is bringing both to everything, from how to account for the diverse drivers of

Diabetes affects nearly 25.8 million Ameri-

diabetes burden, to who can play a role, to

cans, or 8.3 percent of the country’s popu-

“We want this program to integrate health

what to do and how to measure whether it

lation. According to Gayle Harris, M.P.H.,

care all the way from the household and

is making a positive impact at the popula-

R.N., director of the Durham County Health

neighborhood to specialty clinics in order

tion level.”

Department, “One source estimates more

to provide people with the necessary tools

than 10 percent of Durham County resi-

to improve their outcomes,” says Dr. Califf.

During the planning phase, the coalition

dents have been diagnosed with diabetes

“We hope that Durham and the Diabetes

is employing geospatial mapping, which

and at least another 2 percent remain undi-

Coalition will serve as a model for similar

takes information related to disease and

agnosed. Diabetes is a significant risk fac-

diabetes management control interven-

health care and fits it to the physical map

tor for heart disease, stroke, kidney failure,

tions in communities across the country.”

Rex News

Grants to Support Community Nonprofits Rex Healthcare, which awarded more

opportunities to partner with local nonprofit

for more than 20 years. The donations have

than $500,000 in community grants to 80

organizations who share in our commitment

helped provide crucial health education to

nonprofits across the Triangle last year, is

to providing a healthier community for

combat problems, such as tobacco use and

accepting applications for its next round of

residents of Wake County.”

obesity among the youths of Wake County, said Ann Rollins, Poe Center executive

charitable giving. Many nonprofits have come to rely on Rex’s Rex’s

philanthropic

priorities

support

director.

ongoing community contributions. “We appreciate the long partnership and

health, human services, education and arts in this area. That includes worthy efforts in

“The gift from Rex supports everything we

collaboration we have with Rex,” Ms. Rollins

the communities, where Rex has medical

do, including our teacher leadership grants,”

said.

campuses, such as Apex, Cary, Garner, Holly

said Fran Carruthers, vice president of

Springs, Knightdale and Wakefield.

development at Wake Education Partnership.

The application deadline for new grants is

The nonprofit has received grants from Rex

Jan. 13. Grants will be awarded in June for

since 1996.

the fiscal year that starts July 1. For more

“Rex Healthcare maintains a strong belief in

information on the criteria or to apply, visit

being an active corporate citizen,” said Gwen Shaw-Deberry, Rex’s community relations

Rex also has contributed to the Alice Aycock

www.rexhealth.com/community and click

coordinator. “We continue to seek new

Poe Center for Health Education in Raleigh

on “Community Request Forms.”

18

The Triangle Physician


Business

So You Have a Nice Website…

Now What?

Why Every Practice Needs to Invest in Search Engine Optimization By Amanda Kanaan – White Coat Designs

The old adage of “if you build it, they will

“family doctor Raleigh”, Google evaluates

come” does not ring true when it comes

the millions of websites in existence and

to the online world. You may have spent

ranks them according to which equate to be

thousands building a fancy website with

the most relevant. They take into account a

all the bells and whistles, but that does not

number of factors, some of which include

mean anyone, besides you and your staff, will

how many times your website mentions a

actually visit your site.

specific keyword or phrase, how long your website has been in existence, how often

One of the most efficient and cost-effective

you update the site, and how many outside

ways to increase traffic to your website is

websites link back to your site.

through SEO (Search Engine Optimization).

Amanda Kanaan is a medical marketing specialist whose company, WhiteCoat Designs, provides website design, SEO and online marketing along with print design, and branding and messaging services to local private practices and health care organizations. Email Amanda at amanda@whitecoat-designs.com, call at 919-714-9885 or visit the website at www.whitecoat-designs.com.

Okay, so I realize that last thing medical

Since competition online is constantly

professionals need is another acronym to

growing, most agencies will charge a

remember, but this is one you may just want

monthly fee to continuously update and

to become familiar with – especially since it

monitor your SEO campaign. Just because

directly affects your bottom line.

you make it to #1 in Google does not mean

will take to rank (aka the more websites trying

you will stay there. Without continuous

to rank for your keyword, the harder it is and

The purpose of SEO is to increase the

efforts, your rankings can fall rather quickly.

longer it might take to gain your ranking).

number of visitors to your website by ranking

A successful SEO campaign is part science

high in search engines, such as Google,

and part skill of the SEO expert. Therefore, be

Try searching for a keyword or phrase you

Yahoo and Bing. This in turn of course leads

weary of agencies offering prices that are too

think your patients are using and see where

to increased exposure for your practice and

good to be true. Also be cautious of promises

your website ranks. I would also encourage

ultimately more new patient appointments

to rank your website in a certain position. No

you to research SEO articles online. I have

one can guarantee a particular

merely skimmed the surface when it comes

(granted that your website effectively sells your practice). With 85 percent of all website

page

rank

since

ultimately only the

to fully explaining the SEO concept and how you can use it to your advantage.

traffic

originating

search engines

from

search

t h e m s e lve s

Having a website and not optimizing it to

engines, SEO is

have control

be found in search engines is like printing

a vital part of any

of

business cards and never handing one out. It’s

online

algorithms.

marketing

the

a waste of an investment unless you take the extra step to ensure patients can easily find

strategy. While it’s easy to

your practice online. In today’s competitive

lose your rankings,

health care market, SEO is a powerful tool

it’s not so easy to gain

that allows you to cost-effectively compete

to decide what order in which they will

your positioning in the first place. The

with your colleagues and acquire the patient

display websites when you search for a

competitiveness of the keyword that you

volume you need to successfully grow your

specific keyword. Let’s say you search for

would like to rank for determines how long it

practice.

Search engines such as Google use a complex algorithm

January 2012

19


News

Campbell reappointed to Heart Rhythm panel

Region’s Doctors Make Best List

Physicians

Kevin R. Campbell, M.D., F.A.C.C., of Wake Heart and Vascular Associates has been appointed to a second, two-year term on the Continuing Medical Education Subcommittee of the Heart Rhythm Society.

The statewide Business North Carolina has released the 2012 Best Doctors list.

Cary

Welcome to the Area Aarthi Srinivasan Agaram, MD Eric James Benner, MD

Business North Carolina annually recognizes best practitioners under an agreement with Best Doctors Inc., a Boston company founded by physicians affiliated with Harvard Medical School.

Pediatrics Duke University Hospitals, Durham

Described as a global health company, Best Doctors is dedicated to helping people and their treating doctors get the right diagnosis and right treatment. It provides medical consultation services.

Jeffrey Eric Carter, MD

Infectious Diseases, Internal Medicine Wilson Memorial Hospital

Goldsboro Heart Specialists recently extended eastward the medical footprint of Wake Heart and Vascular, a Raleigh-based cardiovascular practice.

Best Doctors itself was named this year to Inc. Magazine’s “Fastest-Growing Companies in America” list. A reported 116 percent revenue growth from 2007 through 2010, ($42,898,000 to $92,680,000, respectively) earned the company a slot on the top half of the respected list, considered the “gold standard of entrepreneurial success.”

Now, Wake Heart and Vascular (WHV) has a presence in 15 localities throughout central and eastern North Carolina.

Best Doctor listings by specialty are available by visiting: http://www.businessnc.com/index.php?src=gendocs& ref=BestDocs2011&category=BestDocs

William Glenn Filer, MD

The society is an international body that serves cardiac arrhythmia professionals and patients, and is the primary information resource on heart rhythm disorders. The subcommittee ensures that certain educational activities by the society meet the needs of society members and that all educational activities can be accredited.

Goldsboro Practice Joins Wake Heart Group

Frederick Douglas Burroughs, MD Pediatrics Knightdale General Surgery UNC Hospitals, Chapel Hill

Christopher Thomas Aboagye Da Costa, MD

Lawrence Anthony Dunn, MD Psychiatry Durham

Renata Gomes Ferreira, MD Anesthesiology Duke University Hospitals, Durham Physical Medicine and Rehabilitation UNC Hospitals, Chapel Hill

Amanda Coleman Guidon, MD

Goldsboro Heart Specialists, the practice of Waheed Akhtar, M.D., will remain at 2400 Wayne Memorial Drive in Goldsboro.

Rex Partners with Genome Project Rex Healthcare is collaborating with The International Genomics Consortium as a critical network Tissue Source Site. In this role, Rex will provide cancer tissue samples for analysis in The Cancer Genome Atlas project (TCGA), a historic National Institutes of Health (NIH) project. In addition, Rex will collect specific long-term clinical outcome data to facilitate research into the underlying cancer mechanisms. The International Genomics Consortium’s (IGC) Expression Project for Oncology (expO) has combined its network and mission with TCGA. The comprehensive, coordinated effort is working to accelerate the understanding of the molecular basis of cancer through the application of genome analysis technologies, including large-scale genome sequencing. Visit www.cancergenome.nih.gov for more information on TCGA and www.intgen.org for information on IGC.

WakeMed Expands Primary Care Access North Wake Internal Medicine and Susheel V. Atree, M.D.; Behnaz S. Atree, M.D.; and Rosa Messer, M.D., joined Wake Specialty Physicians as Wake Specialty Physicians – North Wake Internal Medicine. Dr. Susheel Atree and his wife, Dr. Behnaz Atree, opened North Wake Internal Medicine in WakeMed North Healthplex in 2004. Knightdale Family Practice and Anita Wilson, M.D., joined Wake Specialty Physicians as Wake Specialty Physicians – Knightdale Family Practice. Dr. Wilson has practiced at Knightdale Family Practice for the past year and previously worked as medical director for Solutions, a community support agency in Burlington, N.C., and Apex Family Medicine.

Neurology Duke University Medical Center Durham

Michael Barry Kastan, MD Duke Cancer Institute, Durham

Matthew William Luedke, MD Duke University Hospitals, Durham

Megha Kumudchandra Shah, MD Family Medicine Duke University Hospitals. Durham

Crystal Cenell Simpson, MD Nephrology, Internal Medicine Duke University Hospitals. Durham

Rebekah Ryanne Wu, MD Chapel Hill

Physician Assistants Justine R Barnes, PA Eastern ENT Sinus & Allergy Center, P.A. Goldsboro

Orlando Conty, M.D., joined Wake Specialty Physicians – Apex Medical Group, with experience in family medicine. Fluent in Spanish, Dr. Conty previously practiced at the Oregon Medical Group in Eugene, Ore.

Bambi Elayne Cohen, PA

Daphne J. Cates, M.D., joined Wake Specialty Physicians – Holly Springs Medical Center, with experience in family practice. Dr. Cates previously practiced at Vance Family Medicine in Henderson, N.C. She earned her medical degree from the University of Miami School of Medicine.

Aaron Christopher Kopp, PA

Cancer Center of North Carolina Raleigh

Kevin Scott Dendy, PA Triangle Orthopaedics, Durham Wake Med, Raleigh

Robert Allen Paul, PA Urgent Cares of America (NC), Inc. Clayton

Jan Maree Pixton, PA Southside Medical Center, Wilmington

All practices are accepting new patients and most major insurance plans. Details on all practices, locations and insurance plans can be found online at www.wakemedphysicians.com.

20

The Triangle Physician

Ainslee Elizabeth Smith, PA Raleigh

Ermelinda Xhemali, PA Durham


“More than a doctor. Like a friend.”

Trust. WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it. We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution. And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.

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

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

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

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

When it comes to your cardiovascular care – We know it by heart. To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).

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


Breast Cancer

WAKE AHEC AND WAKE RADIOLOGY PRESENT

Physicians in Emergency Medicine, Internal Medicine, Family Practice, Obstetrics and Gynecology as well as Physicians Assistants, Nurse Practitioners, Nurses and other healthcare providers involved in the care of women.

Diagnosis and Management Update

Saturday, March 17, 2012 | 7:15 AM to 2:30 PM

Embassy Suites Hotel Raleigh - Durham/Research Triangle 201 Harrison Oaks Boulevard | Cary, NC 27513

CREDITS This activity has been approved for AMA PRA Category 1 credit™ Wake AHEC CEU: 0.5 (5 contact hours)

PARTICIPANTS WILL LEARN HOW TO • Review a referral process based on clinical evaluation, ACS/ACR screening guidelines and ACR criteria • Evaluate current recommendations for completion axillary lymph node dissection for breast cancer after sentinel node biopsy • Recognize nomenclature used in breast pathology as it relates to breast cancer • Recognize the importance of using radiation to optimize the cure of breast cancer • Discuss progress in the treatment of breast cancer related to five molecular subtypes of breast cancer • Identify ways to refer patients to facilitate an interdisciplinary team approach

FOR MORE INFO AND TO REGISTER ONLINE VISIT www.wakeahec.org

ADA: Wake AHEC is fully committed to the principle of equal educational opportunities for all individuals and does not discriminate on the basis of any characteristic protected by federal or state law.

J O I N T L Y

S P O N S O R E D

B Y


January 2012  

The Triangle Physician January 2012

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