j u ly 2 0 11
Rex Heart & Vascular Specialists
Multidisciplinary Excellence in Cardiology
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Also in This Issue PET/CT and Melanoma Staging Disability Insurance
Introducing Consulta® CRT-P now with Proactive Heart Failure Management
I N N O V A T I O N Consulta CRT-P Leading Edge Innovation for Proactive Heart Failure Management
S O P H I S T I C A T I O N Exclusive OptiVol® Fluid Status Monitoring and remote care with CareLink® Network
N O C O M P R O M I S E Programming Flexibility
S I M P L I C I T Y Completely Automatic
Brief Statement Medtronic Consulta® CRT-P System Indications: The Consulta CRT-P System is indicated for NYHA Functional Class III or IV patients who remain symptomatic despite stable, optimal medical therapy, and have a left ventricular ejection fraction of ≤ 35% and a prolonged QRS duration. Rate adaptive pacing is provided for those patients developing a bradycardia indication who might benefit from increased pacing rates concurrent with increases in activity. Dual chamber and atrial tracking modes are indicated for patients who may benefit from maintenance of AV synchrony. Antitachycardia pacing (ATP) is indicated for termination of atrial tachyarrythmias in patients with one or more of the above pacing indications. Atrial rhythm management features such as Atrial Rate Stabilization (ARS) and Post Mode Switch Overdrive Pacing (PMOP) are indicated for the suppression of atrial tachyarrhythmias in patients with atrial septal lead placement and one or more of the above pacing indications. Contraindications: The Consulta CRT-P system is contraindicated for: • Concomitant implant with another bradycardia device • Concomitant implant with an implantable cardioverter defibrillator. There are no known contraindications for the use of pacing as a therapeutic modality to control heart rate. The patient’s age and medical condition, however, may dictate the particular pacing system, mode of operation, and implant procedure used by the physician. • Rate-responsive modes may be contraindicated in those patients who cannot tolerate pacing rates above the programmed Lower Rate • Dual chamber sequential pacing is contraindicated in patients with chronic or persistent supraventricular tachycardias, including atrial fibrillation or flutter • Asynchronous pacing is contraindicated in the presence (or likelihood) of competition between paced and intrinsic rhythms • Single chamber atrial pacing is contraindicated in patients with an AV conduction disturbance • ATP therapy is contraindicated in patients with an accessory antegrade pathway. Warnings and Precautions: • Changes in a patient’s disease and/or medications may alter the efficacy of the device’s
programmed parameters • Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage • Do not place transthoracic defibrillation paddles directly over the device • Certain programming and device operations may not provide cardiac resynchronization. Potential Complications: Potential complications include, but are not limited to, rejection phenomena, erosion through the skin, muscle or nerve stimulation, oversensing, failure to detect and/or terminate tachyarrhythmia episodes, acceleration of ventricular tachycardia, and surgical complications such as hematoma, infection, inflammation, and thrombosis. See the device manuals for detailed information regarding the implant procedure, indications, contraindications, warnings, precautions, and potential complications/adverse events. Medtronic CareLink® Monitor/CareLink® Network Intended Use: The CareLink Monitor and the CareLink Network are indicated for use in the transfer of patient data from some Medtronic implantable cardiac devices based on physical instructions and as described in the product manual. These products are not a substitute for appropriate medical attention in the event of an emergency and should only be used as directed by a physician. Contraindications: There are no contraindications for the CareLink Monitor. Warnings and Precautions: The CareLink Monitor must only be used for interrogating compatible Medtronic implantable devices. The CareLink Monitor is intended for use within the prescribing country. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts these devices to sale by or on the order of a physician.
www.medtronic.com World Headquarters Medtronic, Inc. 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA Tel: (763) 514-4000 Fax: (763) 514-4879 Medtronic USA, Inc. Toll-free: 1 (800) 328-2518 (24-hour technical support for physicians and medical professionals)
UC201105940 EN © Medtronic, Inc. 2011. Minneapolis, MN. All Rights Reserved. Printed in USA. 03/2011
Changes in a patient’s disease and/or medications may alter the efficacy of a device’s programmed parameters or related features.
Rex Heart & Vascular Specialists Multidisciplinary Excellence in Cardiology
j u ly 2 011
Vol. 2, Issue 7
DEPARTMENTS 14 Your Financial Rx The Dissection of
PET/CT Is Useful in Melanoma Staging and Restaging
Folate Supplement Recommended with Birth Control Use
Dr. William Way Jr. explains the value
Dr. Andrea Lukes urges greater awareness
of PET/CT in determining the spread of
about the importance of taking folate
melanoma and deep, local lesions to help
supplements in women who are on birth
guide treatment decisions.
18 Radiology Ultrasound and Laser Technology Are Key to Treating Venous Insufficiency
18 Neurology Overview: Diabetic Neuropathy
20 WakeMed News Broadcaster contributes $100,000 to Kids Kampaign
21 Rex News New cardiologist joins Garner specialty practice
23 UNC News Ob/Gyn Accolades and Achievements
24 News Welcome, new partnership and clinical trials
Cover Image: Dr. James Zidar, president of Rex Heart & Vascular Specialists.
The Triangle Physician
JOHNSTON HE ALTH
From the Editor
Health Care Tectonics 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
The Triangle health care landscape is in an active state of shifting strategic alliances. In this issue of The Triangle Physician, we get an introduction to one of the newest specialty practices to emerge, Rex Heart & Vascular Specialists, led by cardiologist James Zidar. It was clear when the practice opened last fall that Rex Healthcare leaders were making good on their plans to create a specialty cardiology practice to raise their heart and vascular program to the next level. Their careful selection process resulted in a comprehensive medical team with impressive credentials. The cardiologists, some of whom were recruited from within the Triangle, are recognized not only for their skill and leadership in advancing medical science, but their compassion and dedication to patient
Editor Heidi Ketler, APR
Contributing Editors Eithne Burke, M.D. John Grant Buttram, M.D. Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G Cynthia Payne, M.D. Paul Pittman, C.F.P. Henry Tellez, M.D.
Photography Jim Shaw Photography email@example.com
New this month in The Triangle Physician is radiologist William Way Jr., who provides
Creative Director Joseph Dally
an overview of positron emission tomography/computerized tomography in melanoma
of ultrasound and laser technology in treating venous insufficiency.
Advertising Sales Carolyn Walters firstname.lastname@example.org Natalie Snapp email@example.com
Neurologist Henry Tellez returns with an article on diabetic neuropathy. Gynecologist
News and Columns Please send to firstname.lastname@example.org
staging and restaging. Radiologist Jason Harris makes a debut with his article on the role
Andrea Lukes writes about the importance of educating patients on the benefits of folate supplementation before conception. On fiscal health, certified financial planner Paul Pittman returns with another wellreasoned article, this one on the value of disability insurance for high-income earners. As the Darwinian side of Triangle health care plays out in an era of active realignment, perhaps itâ€™s time to consider adding The Triangle Physician to your marketing mix. The only magazine for health care professionals in the greater Triangle area, it is mailed to approximately 9,000 medical professionals. With this exclusive reach, it can be a costeffective tool for reinforcing your brand and your competitive edge. With deep gratitude for all you do,
Heidi Ketler Editor
The Triangle Physician is published by New Dally Design 9611 Ravenscroft Ln NW, Concord, NC 28027 Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401 Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinion expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. However, 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.
The Triangle Physician
On the Cover
Rex Heart & Vascular Specialists
Multidisciplinary Excellence in Cardiology Rex Heart & Vascular Specialists is an
is a team of accomplished, board-certified
interventional cardiology. Dr. Mohit Pasi
extension of Rex Healthcare and its
cardiologists, who offer general cardiology
also is board certified in nuclear cardiology
commitment to quality cardiovascular care,
services, in addition to a complementary
and echocardiography. Dr. Mobarek is
increasing access to top-ranked cardiologists
board certified in electrophysiology and
and the latest technology throughout Wake
involvement in device development for the
cardiovascular medicine, with a special
County and beyond.
management of coronary and peripheral
interest in stress echocardiography. Dr.
vascular disease keep them on the cutting
Smith is board certified in internal medicine
and vascular medicine. He is a registered
“We are dedicated to saving patient lives, by
treating and preventing heart and vascular
disease, with compassionate, excellent care
The physicians at Rex Heart & Vascular
medical ultrasonographer. Dr. Usher is
when and where it is most needed,” says
Specialists are: George L. Adams, M.D.,
board certified in internal medicine and
James P. Zidar, M.D., F.A.C.C., F.S.C.A.I.,
H.M.S., F.A.C.C.; Sameh K. Mobarek,
Rex Heart & Vascular Specialists president.
M.D., F.A.C.C.; Deepak Pasi, M.D., F.R.C.P.,
“People in outlying areas often present with
F.A.C.C., F.S.C.A.I., F.A.A.C.; Mohit Pasi,
In August, Rex Healthcare will welcome
more advanced disease, because access to
M.D., F.A.C.C., F.S.C.A.I.; S. Wayne Smith,
Robert R. Mendes, M.D., a vascular
primary care is less available.”
M.D.; and Bruce W. Usher Jr., M.D., F.A.C.C.
surgeon, who will practice at Rex Vascular
Dr. Zidar is fellowship trained in cardiology
Drs. Adams, Deepak Pasi and Mohit Pasi
and interventional cardiology. Joining him
are board certified in cardiology and
Surgical Specialists further rounding out Rex’s expertise in heart and vascular care.
PHOTO BY BRIAN STRICKLAND
Members of the Rex Vascular Surgical Specialists nursing team are board-certified nurse practitioners with advanced degrees. They are Priya Kos, R.N., M.S.N., A.N.P.B.C.; Pamela T. Thompson, R.N., M.S.N., A.N.P.-B.C.; and Tracey Wright, R.N., B.S.N., M.S.N., F.N.P.-B.C. From expert surgeons and cardiologists to highly-trained nurses, “Our heart and vascular team provides exceptional care in the most critical medical conditions,” said Dr. Zidar. “We make available less-invasive diagnostic and interventional technologies to optimize clinical outcomes for our patients.” Several management initiatives are aligned with Rex Healthcare, such as providing more efficient care, according to Dr. Zidar. Rex has chosen a new vendor (Fugi) for vascular Dr. Zidar discusses patient test results.
The Triangle Physician
imaging and storage, and designed state-of-
Clinical team members at Rex Hospital’s Heart and Vascular Services.
the-art cardiac and vascular catheterization
average rating in the country. Medicare
labs with Philips Medical Systems. The
quality rankings in the last two years show
The practice works closely with the UNC
health system has combined peripheral
that Rex placed first in heart attack survival
endovascular skills with a comprehensive
rates among Triangle hospitals. It also was
Mounsey, M.D., B.M., B.Ch., Ph.D., M.R.C.P.,
wound clinic, led by Rex Surgical Specialists
the first hospital in the Triangle to be a
F.A.C.C., who is a professor and director
in two locations to offer comprehensive
nationally recognized chest pain center by
of electrophysiology. “He is a very skilled
services for the most aggressive vascular
the Society of Chest Pain Centers (SCPC) in
electrophysiologist who performs complex
disease. “The creation of our specialty
2005. In 2011 Rex was accredited for the third
electrical ablations in the left atrium that are
practice was a way to take Rex cardiovascular
time. To become an Accredited Chest Pain
not performed in Raleigh,” Dr. Zidar says.
services to the next level,” says Dr. Zidar. Rex
Center, Rex Healthcare engaged in rigorous
Heart & Vascular Specialists has offices at Rex
evaluation by SCPC for its ability to assess,
A new mission for the Rex heart and
Healthcare’s main campus in Raleigh, as well
diagnose and treat patients who may be
vascular program is the clinical education
as Rex facilities in Cary, Wakefield and Garner.
experiencing a heart attack.
and training of the senior cardiology fellows
Rex Healthcare’s leadership in cardiology
Rex Heart & Vascular Specialists also is
in the cardiac catheterization labs with Drs.
is well-established. Recently, it became
partnering with the University of North
Zidar, Pasi and Adams to gain exposure to,
one of three hospitals in North Carolina
Carolina (UNC) Health Care Center for Heart
and experience with, complex coronary
to be named among the 50 best hospitals
and Vascular Care to broaden its expertise
and vascular intervention. Physicians at Rex
in America by Becker’s Hospital Review.
even further. “By having this network of
Heart & Vascular Specialists also are actively
Specifically, the hospital was recognized for
physicians, we’re providing excellent patient
involved in the development of regional
its ongoing commitment to patient needs
care,” says Dr. Zidar. “We can leverage our
systems of care for the treatment of ST-
and investment in innovations.
close working relationships with the UNC
elevation myocardial infarction and critical
faculty to bring to Raleigh quaternary services
limb ischemia. Dr. Adams has been working
In 2009, Rex Healthcare was rated best for
– advanced heart failure care, cardiac
closely with local EMS teams on this effort.
heart attack survival in Wake County by
transplantation and left ventricular assist
Hospital Compare, with the only above-
devices (LVADs) – for our sickest patients.”
from UNC. Currently, two fellows are working
Cardiologists Sam Mobarek, M.D., and Mohit Pasi, M.D., of Rex Heart & Vascular Specialists.
Most of these patients have the common risk
Advanced Skill in Treating PAD
Rex Heart & Vascular Specialists is a single
factors of hypertension, dyslipidemia and
“Minimally invasive medical technology to
source for multidisciplinary cardiovascular
treat peripheral artery disease and restore
care, from prevention and diagnosis to
blood flow below the knee and prevent
treatment and rehabilitation. This is of
Interventional cardiology and electrophys-
limb loss is more successful than ever,”
particular benefit to patients with multiple
says Dr. Zidar. It is a specialty area of Rex
Heart & Vascular, and Dr. George Adams
is recognized as a leader in this rapidly
required more than one cardiovascular
specialist. For these patients at Rex Heart
on staff. He follows a large population of
& Vascular Specialists, the continuity of
pacemaker and defibrillator patients. “It
care is managed within one practice by one
makes sense for us to be involved on both
The high prevalence of peripheral artery
fronts,” says Dr. Zidar.
disease (PAD) and increased risk for other
“There is a lot of overlap” between the
Electrophysiology services at Rex Heart
about symptoms or PAD’s seriousness
disciplines of cardiac and vascular disease,
& Vascular Specialists include invasive
create an urgent need for vigilance among
says Dr. Zidar. “We see many patients over
and noninvasive treatment of cardiac
physicians to identify at-risk patients, says Dr.
65 who have both coronary and peripheral
arrhythmias, such as catheter ablation of
Zidar. Yet, PAD often goes undiagnosed.
artery disease. We focus on primary
prevention when we can catch the disease
fibrillation, and pacer and defibrillator
According to American College of Cardiology
process early and secondary prevention
implantation and lead extraction.
(ACC)/American Heart Association (AHA)
when we encounter more advanced disease.
guidelines, physicians should consider
conditions, combined with low awareness
The Triangle Physician
From left to right: Mohit Pasi, M.D., James Zidar, M.D., Priya Kos, R.N., A.N.P., Bruce Usher, Jr., M.D., Deepak Pasi, M.D., Pam Thompson, R.N., A.N.P., Sameh Mobarek, M.D., S. Wayne Smith, M.D., Tracey Wright, R.N. and George Adams, M.D.
referring the following patients for PAD
Success in Treating Problem Wounds
based procedure used to modify plaque in
When surgery is necessary to restore
the smaller arteries above and below the
• Diabetics less than 50 years old with at
blood flow in patients with critical limb
knee, before reopening them using balloon
least one other risk factor – smoking,
ischemia below the knee, peripheral
angioplasty. It is designed to reduce the risk
hypertension or abnormal cholesterol;
vascular interventions increasingly include
of dissecting or tearing the vessel.
• Age 50 to 69 with a history of smoking or
revascularization of the leg or foot using
laser, orbital and directional atherectomy.
• Age 70 years and older;
closely with the Rex Wound Healing
• Leg symptoms with exertion (suggestive of claudication) or ischemic rest pain; • Adults with abnormal lower extremity pulse examination; and • Adults
Rex Heart & Vascular Specialists works
Among the most experienced and skillful
Center, whose arsenal to treat PAD includes
in the use of this cutting-edge technology
hyperbaric oxygen therapy (HBOT). “We
is Dr. Adams, who has a special interest
have excellent synergy with the Rex Wound
in amputation prevention in the most
Healing Center,” says Dr. Zidar.
complex cases. Atherectomy is a catheter-
coronary, carotid or renal artery disease. ACC/AHA individuals
extremity PAD be identified using the anklebrachial index, or ABI. The painless, noninvasive screening compares the blood pressure in the ankles with the blood pressure in the arms. Treatment for PAD focuses on reducing symptoms
progression of the disease. In most cases, lifestyle changes, exercise and claudication medications are enough to slow PAD or reverse its symptoms. Cardiologist James Zidar performs a procedure in Rex Hospital Cath Lab.
Cardiologists James Zidar and Deepak Pasi collaborate on clinical issues.
designed to capture debris that may be
and any health problems that may have
Through its work in clinical trials, Rex
released during the procedure and reduce
occurred since hospitalization or the last
the chance of stroke) in the treatment of
improvements made in medical science.
obstructive (blocked) carotid artery disease.
The following are current studies available at Rex.
The CHOICE Study is for patients with carotid
The AMPLIFY Study evaluates the effects of
artery blockages who are considered high-
an investigational blood thinner, apixaban, in
risk surgical patients. This study is designed
The objective of the ALERTS Pivotal Study is
preventing venous thromboembolic (VTE)
to assess the outcomes of stenting with distal
to provide an assessment of the safety and
recurrence (the formation or presence
protection in the treatment of obstructive
effectiveness of the AngelMed Guardian
of a blood clot) or death in patients with
(blocked) carotid artery disease. In addition,
System. The AngelMed Guardian System
deep vein thrombosis (DVT) or pulmonary
this study will assess clinical outcomes
is designed to track significant changes in
embolism (PE) over six months.
for possible extension of the Centers for Medicare and Medicaid Services (CMS)
the heartâ€™s electrical signal and then alert patients to seek medical attention.
coverage to a broader group of patients.
The TRANSLATE Study is for patients who
have had a heart attack and were treated
For more information, visit the
The SAPPHIRE Registry study is for patients
with a procedure to open blocked blood
Rex Heart & Vascular Specialists at
with carotid artery blockages who are
flow in the heart and placed on clot-
www.rexheartvascular.com or call
considered to be high-risk surgical patients.
preventing medications. This study will
(919) 784-5600 for the Raleigh/Garner
It is designed to assess the outcomes of
collect information about symptoms that
offices, (919) 387-3260 for the Cary office or
stenting with distal protection (a tiny filter
may have related to the heart, medications
(919) 570-7590 for the Wakefield office.
The Triangle Physician
Is Highly Useful in Melanoma Staging and Restaging By William G. Way Jr., M.D.
PET/CT serves to answer the two big questions: Has the tumor already spread beyond the loco-regional lymph nodes, and is there a second primary skin tumor we didnâ€™t know was there?
extends from the lower part of the brain down to the mid-thighs. Melanoma, on the other hand, occurs not only on the trunk, proximal extremities, and head and neck, but also on the peripheral extremities and, in particular, the sun-exposed areas. Not long ago, for instance, I evaluated a patient with a melanoma on the foot. Since the skin, in essence, is one large organ, and melanoma can occur anywhere on the skin, we perform
While the worldwide incidence of many
melanoma becomes invasive, it has a
cancers has been decreasing, the incidence
tendency to spread first to loco-regional
of melanoma of the skin, unfortunately, is
lymph nodes and then throughout the
While PET/CT is capable of detecting
on the rise. In the United States, according
metastatic disease in the draining regional
to the World Health Organization, the
a full-body scan on these patients.
lymph nodes, such as those behind the
incidence of malignant melanoma has
PET/CTâ€™s usefulness comes not from
knee, in the groin or in the axilla, its
increased an average of 4 percent every year
screening for the disease, but rather for
primary value in the setting of malignant
since the early 1970s.1 Early detection and
detecting more widespread disease once
melanoma is in the detection of more
accurate staging are vital to determining,
metastatic loco-regional nodal disease is
widespread metastases in sites, such as the
without delay, the most effective treatment
confirmed. The exception might be for
lungs, bones or liver. Because these tumors
for the patient. PET/CT (positron emission
a deep and/or aggressive local lesions
tend to be very hypermetabolic, they
tomography/computerized tomography) is
where positive loco-regional lymph nodes
often are very easy to detect. Thus, PET/
an extremely useful test for the evaluation of
were expected but none were found, since
CT serves to answer the two big questions:
patients with malignant melanoma because
it is possible for this disease to skip these
Has the tumor already spread beyond the
the tumor tends to be very hypermetabolic,
lymph nodes and metastasize directly to
loco-regional lymph nodes, and is there a
thus allowing for ready detection of
the brain, bone, lung, liver, etc. Thus, PET/
clinically occult sites of disease.
CT plays a very important role in the initial staging of malignant metastatic melanoma
Melanoma can be a very aggressive disease.
and in helping guide decisions for the most
In one study of patients diagnosed with a
single melanoma, their risk of developing a second primary melanoma was increased
The unique procedure that we perform for
roughly 200 times over that of the general
malignant melanoma is to scan the patient
population. That study also showed that
from the top of his or her head all the way
for patients diagnosed with melanoma,
to the toes. This is a more comprehensive
most second melanomas occurred within
scan than our standard PET/CT scan
two years of the first.2 When a malignant
for other malignancies, which generally
The Triangle Physician
PET/CT image consisting of coronal whole-body CT image (A), PET image with CT attenuation correction (B).
Dr. William Way Jr. is a body imaging radiologist and PET/CT (positron emission tomography/ computerized tomography) imaging specialist. He serves as chief medical officer and medical director for imaging at Wake Radiology, Raleigh. His expertise is in cross-sectional body imaging, and his special clinical interests include PET, CT, nuclear medicine and ultrasonography. Dr. Way, who joined Wake Radiology in 1992, is board certified by the American Board of Radiology and the National Board of Medical Examiners. A native of Winchester, Va., he is a graduate of the University of Virginia School of Medicine. He completed his internship at Denver Presbyterian Hospital in Denver, Colo., and residency at the Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Mo. He then completed a fellowship in cross-sectional imaging at the University of Michigan Medical Center in Ann Arbor, Mich. He is a member of the American College of Radiology, the Radiologic Society of North Carolina, the North Carolina Medical Society and the Wake County Medical Society.
previously diagnosed with locally or
staging of melanoma when it is initially
regionally advanced disease, as it allows
diagnosed and that allows for the early
for the early detection of recurrent disease
detection of recurrent disease at remote
at more remote locations. These patients
and often clinically unsuspected locations.
often will undergo periodic PET followup, since they are at increased risk for the
World Health Organization. WHO - Health
subsequent development of widespread
Effects of UV Radiation. Web. 2010. Accessed at
metastatic disease. In this circumstance,
a whole-body PET scan serves as a single examination to search the entire body for evidence of disease recurrence.
Burden, AD, Vestey, JP, et al. Multiple Primary Melanoma:
Implications. Journal article. 1994. BMJ 376-309.
In summary, PET/CT is a very sensitive
imaging study that facilitates accurate
second primary skin tumor we didn’t know was there? There could be another primary melanoma, for example, in an armpit or hidden by hair on the scalp, that might have escaped detection despite a very thorough physical examination by the patient’s referring physician. PET/CT also can be used to direct where and what to biopsy for definitive diagnosis in the setting of widespread metastatic disease. In one instance, for example, several unexpected tumors were discovered on PET/CT in addition to the primary tumor that was initially detected in the patient’s eye at the time of an ophthalmology exam. In this particular case, we were able to direct the referring physician to the site that would be safest and most appropriate to biopsy in order to properly diagnose and stage the patient. PET/CT’s unique ability to detect clinically occult tumors is equally important with regard to ongoing surveillance of patients Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
Your Financial RX
The Dissection of
Disability Insurance By Paul Pittman, C.F.P.
Since last month, I have had several e-mails
important as retaining more of your assets
asking questions about disability insurance.
from fees and taxes! Even if you don’t have
This type of insurance is critical for
an immediate need for disability income
physicians for a variety of reasons. As a high-
insurance, having it can give you some
wage earner who depends on a completely
sound mind and body, protection of income is a major component of a sound
Some experts argue that disability income
financial plan. If you were unable to work
insurance is the most important type
for an extended period of time due to an
of insurance you can own, even more
injury or illness, how long would you be
important than homeowner’s, auto or even
able to pay your bills and meet your daily
life insurance. I wouldn’t say that it is more
insurance policies. Employer-sponsored
living expenses? Do you know how much
important, but rather it is an integral part of
policies, or “group” policies, are relatively
income you would receive from outside
a sound financial plan. Disability insurance
inexpensive to purchase and generally
sources and for how long?
protects one of your most valuable assets:
remain in effect as long as the individual continues to work for the business.
Protection of your income and lifestyle is as important as retaining more of your assets from fees and taxes.
However, there are significant limits on the benefits provided by group policies, so it is important to understand your spending needs. Private insurance policies are paid for by individuals and provide coverage when group policies don’t apply or don’t provide enough income. On one level, a
your ability to earn income. After all, it is
private policy is usually more expensive to
jeopardize any financial plan and can occur
this ability that enables you to have the
purchase than a group policy. However, a
at any time. Keeping that in mind, your best
lifestyle that you have, and you need to
private policy’s potential to provide much
defense may be a good offense. Look into
protect your net worth and the financial
greater benefits over time may make it
disability insurance as a defense against a
well-being of your family.
a smarter long-term choice. When you
consider that group policies often end up
financial meltdown. Many brokers and financial planners do
providing inadequate benefits, even those
Disability insurance replaces part of your
not even touch on the subject because
employees with group coverage should
income should you become unable to
they may see it as too complicated or too
consider purchasing a private policy to
work due to accident or illness. It provides
time-consuming. Many investment firms
fill the voids associated with group-only
you with income to meet your daily living
don’t want their agents to offer it because
expenses, such as mortgages, groceries,
of the liability it can bring on the firm. The
bottom line is this; it takes a specialist to
The manner in which an insurance
fully understand disability insurance, how
company defines “disability” can determine
Now, if you are like me, insurance is not
to structure it, finance it, and how (and
your eligibility to receive benefits should
high on the list of preferred topics, but it is
where) to own it.
you become disabled. Generally speaking, you want a policy with the most liberal
one of the main pieces of a sound financial plan. It all comes back to my mantra, “It’s
For most people, there are two main forms
definition of disability. There are three basic
not what you make, it’s what you keep.”
of disability income insurance to consider,
definitions of disability:
Protection of your income and lifestyle is as
employer-sponsored policies and private
The Triangle Physician
Paul J. 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 email@example.com.
Leasing Opportunity with Ownership Potential
Wesvill Medical & Professional Center 2304 Wesvill Court Raleigh, NC 27607
Built-Out Medical Space Available in Rex Hospital Vicinity
1) Own-Occupation. This is the most comprehensive definition of disability. It essentially states that you’re unable to perform the material and substantial duties of your own occupation. This is extremely important to physicians. Insurers generally
• Beautiful 6,131-SF Suite • 12 Exam Rooms • Extensive Window Line
consider your occupation as the job you were performing at the time of your disability. 2)
but less comprehensive than the “ownoccupation”
Janet Clayton, CCIM 919.420.1581 firstname.lastname@example.org Independently Owned & Operated
usually defines disability as sickness or injury that doesn’t allow you to perform the material and substantial duties of your own occupation and typically stipulates that you are not currently engaged in any other occupation. 3) Gainful Occupation. This is definitely the least desirable definition. These policies define disability as your inability to perform the material and substantial duties of any occupation that you are considered to be reasonably qualified for by way of your education, skills or training. As you can see, there are many important facets to disability income insurance, and I would recommend that you consult with a specialist in this field. As you are no doubt aware by now, I am a big proponent of getting the best advice and guidance from the most experienced and qualified advisor. Until next month, I wish you good physical health and good fiscal health.
Folate Supplement In Birth Control By Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G.
Despite evidence and official recommendations, a 2008 Gallop poll conducted by the March of Dimes showed that only 11 percent of women were aware that folate supplementation should begin prior to conception.
pills, followed by one week of placebo pills. At this point, the oral birth control pill is the most common form of birth control in the United States, compared to the intrauterine device (IUD), which is the most common form of birth control worldwide.
Birth Control Plus Folate Some of the newer birth control pills in the United States, specifically Beyaz and Safryl, launched this year, now offer folate supplementation within all 28 pills. Both
Early descriptions of birth control included
the Comstock Law in 1965 and ruled that
brands use levomefolate calcium (451
a gummy substance to cover the ‘mouth of
the private use of contraceptives was a
mcg), which is a synthetic folate that is
the womb’ (1850 B.C.). Honey and sodium
absorbed unchanged and is identical to L-5-
carbonate within the vagina, and a pessary
methytetrahydrofolate, the form of folate
from crocodile dung. Many advances have
The first birth control pill (Enovid) was
occurred since these initial choices. Just
approved in 1960. The initial pills had high
last year, the birth control pill celebrated its
doses of hormones and resulted in blood
There is a large body of evidence that
50th anniversary in the United States.
clots, strokes and depression. Since it first
folate supplementation prevents neural
that is ready to be used by the body.
tube defects. This evidence Initially
has resulted in the official
United States, the most
common forms of birth
Center for Disease Control,
control were withdrawal
the United States Preventive
and rhythm methods.
Task Force, and the American
Then in 1839, Charles
Congress of Obstetricians and
Gynecologists to recommend
the rubber condoms,
douching syringes and
for prevention of neural tube
the 19th century, the Comstock Law was enacted which made
emerged, the trend during the past 50 years
it illegal to send contraceptive devices
has been to lower the strength of estrogens
recommendations, a 2008 Gallop poll
and information (including educational
and offer different progestins. In addition,
conducted by the March of Dimes showed
information). Then early in the 1900s,
the initial pill had 21 days of active pill and
that only 11 percent of women were aware
Margaret Sanger opened the first birth
then seven days of placebo.
that folate supplementation should begin
control clinic in America, and in 1936 she
prior to conception2.
helped bring forth a legal case that allowed
More recently, birth control pills offer
physicians to legally mail birth control
24 days of active pills and four days of
Why is it important to take folic acid prior
devices and information throughout the
placebos, or the choice of having a period
to conception? The timing of neural tube
country. The Supreme Court overturned
“once a season,” with 12 weeks of active
closure is the answer. Within the first month
The Triangle Physician
after conception is when the neural tube closes – often before a woman realizes she is pregnant. Thus, health care providers must emphasize to reproductive-aged women that folate supplementation is important before conception. When we consider the birth control pill and the typical failure rate of 8 percent of all birth control pills, then the advantage of supplementing folate through the birth control pill makes sense. Further, given that after one month of stopping the pill, 21 percent of women will become pregnant; and that after three months from stopping the pill, 46 percent of women will become pregnant3 – again, the logic of folate supplementation within the birth control pill emerges. Folate supplementation is recommended for all women of reproductive age. Women who choose to take oral birth control pills now have two options that include folate supplementation (Beyaz and Safryl). In my opinion, in 15 to 20 years most birth control pills will include folate supplementation.
March of Dimes.
Cronin M et al. Obstet Gynecol. 2009;114:616-622.
SANDHILLS SLEEP DISORDERS CENTER
Dr. H. Tellez, MD Board Certified Neuromuscular Medicine Board Certified Neurology
Dr. G. Chin, (Chintapudi) MD, DABSM Board Certified Sleep Medicine Board Certified Neurology
Our Priority Is Your Sleep! The Specialities • Sleep Apnea • Sleep Studies • Memory Disorder • Brain/Spine MRI • Gait Problem • EEG • Neuropathy, ie: CTS • NCV- EMG Laboratory
888-614-7420 295 Olmstead Blvd., Suite 12 Pinehurst, NC 28374 (910) 235-0595
• www.SNSleepSolutions.com 112 Dennis Drive Sanford, NC 27331 (919) 708-5008
609 Attain Street, Unit 101 Fuquay-Varina, NC 27526 (919) 552-8917
Overview: Diabetic Neuropathy By Henry Tellez, M.D.
The term neuropathy is derived from the
Foot slapping and toe deterioration or
Greek word “neuron” (nerve) and the
frequent tripping may be early symptoms
English suffix “-pathy” (feeling, suffering).
of foot weakness. Symptoms of proximal extremity
Neuropathies are characterized by a
climbing up and down stairs, difficulty
progressive failure of nerve fiber function. A
getting up from a seated or supine position,
generally established definition of diabetic
falling due to the knees giving way and
peripheral neuropathy is “the presence of
difficulty raising the arms above the
symptoms and/or signs of peripheral nerve
dysfunction in people with diabetes after exclusion of other causes.”
In the most common presentation of diabetic neuropathy with symmetrical
Dr. Henry Tellez is in private practice with Sandhills Neurologists PA. He obtained his medical degree from Valley University, Colombia. He then completed his internship and neurology residency at Saint Louis University, Miss. This was followed by a fellowship in nerve conduction (nerve conduction velocity/electromyography) studies and neuromuscular diseases at the University of North Carolina, Chapel Hill. Dr. Tellez is currently board certified in general neurology, neuromuscular medicine and vascular neurology by the American Board of Medical Specialties.
Neuropathies are the most common
sensorimotor symptoms, minor weakness
complication of diabetes mellitus (DM),
of the toes and feet may be seen. It is
affecting up to 50 percent of patients with
important to note that severe weakness is
Type 1 and Type 2 DM.
unusual and should prompt investigation
spine disorders) may generate poor urinary
into other causes, such as chronic
stream, feeling of incomplete bladder
idiopathic demyelinating polyneuropathy
emptying and straining to void.
Diabetic neuropathy can present as a wide
(CIDP) or even vasculitis. Severe weakness
mixture of sensory, motor and autonomic
can be observed in asymmetrical diabetic
Sudomotor neuropathy may produce heat
symptoms. A well thought-out list of
intolerance, intense sweating the head,
symptoms can be used to help screen all
neck and trunk, with lack of sweat in the
diabetic patients for possible neuropathy.
occur along with sensory neuropathy
lower trunk/extremities, and gustatory
These are subtle in onset and show a
stocking-and-glove distribution in the distal
Autonomic neuropathy may entail the
The factors important to the development
limbs. Sensory symptoms may be negative
of diabetic neuropathy are not understood
or positive, diffuse or focal. Negative
genitourinary systems, and the sweat
completely, and various hypotheses have
sensory symptoms include feelings of
glands. Patients with generalized autonomic
been proposed. It is commonly accepted to
numbness or deadness, which patients
neuropathies may report near syncope/
be a multifactorial problem.
may express as “wearing gloves or socks”
Development of symptoms depends on
or “walking on thick pads.” Loss of balance, especially in poorly lit environments or with
many factors, such as total hyperglycemic
closed eyes, and painless injuries owed
may produce dysphagia, abdominal pain,
exposure and other risk factors, such as
to loss of sensation are frequent. Positive
elevated lipids, blood pressure, smoking,
symptoms may be described as burning,
incontinence, diarrhea and constipation.
prickling pain, tingling, electric shock – like
neurotoxic agents, such as ethanol and
feeling aching, tightness or hypersensitivity
may produce persistent sinus tachycardia,
orthostatic hypotension, sinus arrhythmia
and decreased heart variability in response
Genetic factors may also play a role.
to deep breathing. Also, not unusual is near
These may include distal, proximal or more
syncope upon changing positions from
mechanisms in the development of the
focal weakness. In the upper limbs, distal
recumbent to standing.
more common symmetrical forms of
diabetic polyneuropathy likely include the
motor symptoms may consist of impaired fine-hand coordination and trouble with
Bladder neuropathy (which must be
polyol pathway, advanced glycation end
tasks, such as opening jars or turning keys.
entertained after exclusion of prostate or
products and oxidative stress.
The Triangle Physician
diabetes diagnosis â€“ because failure to
more localized pain or those in whom
Risk factors that are associated with more
diagnose diabetic polyneuropathy can
interactions with existing oral medications
severe symptoms include poor glucose
lead to serious consequences, including
is a concern.
disability and amputation.
smoking, heavy alcohol intake, HLA-DR3/4
Consider any patient with clinical evidence
Erythromycin, cisapride, metoclopramide,
phenotype and tall height.
of diabetic peripheral neuropathy to be
MiraLax (polyethylene glycol 3350) are the
at risk for foot ulceration, and provide
most frequent medications used for this
education on foot care. If necessary, refer
The diagnosis of diabetic neuropathy is
the patient to a podiatrist.
based on the symptoms, their distribution Patients with diabetic peripheral neuropathy
Overall, erectile dysfunction from diabetic
require more frequent follow up, with
neuropathy is a very difficult condition to
Fasting plasma glucose and hemoglobin
particular attention to foot inspection and
treat. All other causes of impotence must
A1c are important laboratory screening
reinforcement of the need for regular self
be excluded. Once the diagnosis has been
tests for diabetic neuropathy. Other blood
care. Regular foot examinations and patient
confirmed, the oral agent sildenafil (Viagra)
test(s) to rule out Vitamin B12 deficiency
education about foot care have been shown
may be tried. Referral to a urologist is suggested.
and paraproteinemias (SIEP, or serum
in several studies to significantly reduce
rates of ulceration and even amputation.
and a detailed neuromuscular examination.
Orthostatic hypotension Increasing the dietary fluid and salt intake,
More specific blood work may be required depending on the clinical presentation
The importance of involving a neurologist
along with use of compression stockings,
(inflammatory conditions, paraneoplastic
(preferably with expertise in peripheral
may help. If these modalities do not
processes and others).
neuropathy) in the treatment of patients
improve symptoms, then medication (i.e.
midodrine) may help.
Multiple consensus panels recommend
the inclusion of electrodiagnostic testing in the evaluation of diabetic neuropathy.
Glycopyrrolate can be used for the handling
A proper selection of electrophysiological
Of all treatments, tight and stable blood
of diabetic gustatory sweating. It is applied
tests includes both nerve conduction testing
sugar control is probably the most important
topically to the affected area and can give a
and needle electromyography (EMG). The
for slowing the progression of neuropathy.
marked reduction in sweating while eating
diagnosis is strongly supported when a nerve
Rapid changes from hypoglycemia to
hyperglycemia have been suggested to
(NCV/EMG) test is abnormal.
bring and exacerbate neuropathic pain, so
the stability of glycemic control may be as
This is indicated in patients with infected
The first part of the test involves measuring
important as the actual level of control in
foot ulcers when the infection cannot be
the rate of speed for electrical impulses as
relieving neuropathic pain.
controlled medically. Jejunostomy can help patients with intractable gastroparesis.
they travel down a nerve. The second part of the test, EMG, is essential to exclude or detect
When impotence is a continual problem,
other conditions that might mimic neuropathy
Oral agents include antidepressants and
the patient may pursue the option of a
(lumbar radiculopathy, cervical radiculopathy,
anticonvulsant drugs. Usually, pregabalin
penile prosthesis. Charcot foot can be
tarsal tunnel syndrome and others).
is recommended for treatment of diabetic
treated with bracing or special boots. In
some cases, surgery is used to correct the
In the appropriate clinical setting, magnetic
should determine if the drug is clinically
resonance imaging of the cervical, thoracic
appropriate for their patients on a case-
and/or lumbar regions may help exclude
another cause for symptoms mimicking
antidepressants and sodium valproate
Physical and occupational therapy should
should also be considered for diabetic
be considered when activities of daily living
neuropathy pain management.
are being compromised. It is quite essential
to prevent falls in patients with significant
Treatment The primary care physician needs to be
alert for the development of neuropathy â€“
transdermal lidocaine may be useful
or even its presence at the time of initial
in some patients, especially those with
sensory ataxia from underlying diabetic neuropathy.
Block and Armstrong Join Executive Staff
to work closely with SAHA. The regional health care alliance was established in 2004 to develop and foster relationships among member hospitals in order to improve the quality of health care, with a focus on
Vicki Block, M.H.A., is joining WakeMed
member of the senior leadership team, she
quality and safety, cost savings, compliance,
Health & Hospitals as senior vice president
also will help shape the strategic direction
knowledge sharing and education.
and Raleigh campus administrator, and
of the health system.
Dale Armstrong as vice president of
WakeMed was a founding member of Block earned a master’s degree in hospital
SAHA, which today includes 15 hospitals
and health care administration from Xavier
representing 4,400 beds, 28,000 employees
Vicki Block, whose
University in Cincinnati, Ohio, and a
and an annual net revenue of $2.7 billion.
position will begin
bachelor of science degree in biology from
SAHA’s reach stretches from the coast
July 25, comes from
The University of Akron in Akron, Ohio.
through central piedmont North Carolina.
Moses Cone Health System, a five-hospi-
Dale Armstrong is
Mr. Armstrong earned his master’s degree in
tal, 1,168-bed system
joining WakeMed by
business administration from the University
with more than 7,000
Aug. 1. He is presently
of Georgia at Valdosta and his bachelor’s
employees, where she has served for five
chief executive officer
degree in medical technology from the
years as vice president of heart, vascular
of the Cary, N.C.,-
University of Maryland. He began his career
and imaging services. Ms. Block brings
as a medical lab technologist and then spent
more than 20 years of experience in health
several years overseeing lab operations
care operations, having been in leadership
Alliance (SAHA) and brings more than 20
for numerous hospitals in Georgia. Prior
roles at numerous well-renowned health
years of hospital and health care senior
to joining SAHA, Mr. Armstrong was the
systems across the state and country,
chief executive officer of several hospitals,
including The University of North Carolina
including Monroe Hospital in Bloomington,
Hospitals, Carolinas Healthcare and The
In his position as vice president of regional
Ind., Brynn Marr Behavioral Health System
operations with WakeMed, Mr. Armstrong
in Jacksonville, N.C., and most recently at
will focus on current and future linkages
Central Carolina Hospital in Sanford, N.C.
In her position as senior vice president
and the development of both day-to-
He is a fellow in the American College of
and Raleigh campus administrator with
day and long-term relationships with
Healthcare Executives and long-standing
WakeMed, Ms. Block will be responsible for
hospitals, physicians and other health care
member of Rotary International.
the overall administrative management and
organizations outside Wake County and
operations for the Raleigh campus. As a
across North Carolina. He will continue
$100,000 Contribution Made to Advance Children’s Health Care Capitol Broadcasting Co. Inc., through
campaign in WakeMed’s history, seeks to
The “hospital within a hospital,” located
its CBC/WRAL Community Fund, has
accomplish a number of health care goals
on the fourth floor of a new patient tower
contributed $100,000 to the initiative that will
for children and families in Wake County
at WakeMed’s Raleigh campus, expanded
expand and enhance children’s health care
and the surrounding region. The initial goal,
services at WakeMed Health & Hospitals.
to raise the first $8.5 million and open Wake
overcrowding due to area population
County’s first-ever children’s hospital, was
achieved last summer.
pediatric facility. The next phase of the
The WakeMed Foundation’s $20 million Just for Kids Kampaign, the largest fund-raising
The Triangle Physician
campaign will include a much needed
Hospital News expansion of WakeMed’s Level IV (highest
community and most importantly for our
in WakeMed’s history to be fully funded
level) Neonatal Intensive Care Unit (NICU),
children. Families in Wake County and
by community donations,” said Dr. Bill
for which WakeMed already has received
beyond will benefit from this impressive
Atkinson, WakeMed president and chief
new facility,” said James F. Goodmon,
executive officer. “Capital Broadcasting’s
president and chief executive officer of
generous donation is truly an investment in
Capitol Broadcasting Co.
our community’s children and families.”
throughout the Triangle area, the campaign
“As a result of the commitment and
Capitol Broadcasting Co. is a diversified
recently reached the $10 million milestone.
dedication of good corporate citizens
and leaders like Capital Broadcasting Co.
“The expansion of children’s health care
and Jim Goodmon, the children’s hospital
Charlotte, Wilmington and Durham, among
services at WakeMed is an asset to our
and NICU expansion are the first projects
other business interests.
Due to community generosity, including from diverse corporations and organizations
Cardiology Practice Adds New Physician and Garner Location Rex Healthcare recently expanded its
Rex Heart & Vascular Specialists offers
physician team at Rex Heart & Vascular
a comprehensive team of renowned
Specialists, with the addition of George
cardiologists at offices throughout Wake
For more information on Rex Healthcare,
Liell Adams, M.D., M.H.S., at a new practice
County, including Cary, Raleigh, Wakefield
visit www.rexhealth.com or call
location in Garner.
and now Garner. Rex is the only hospital
rating for heart attack survival.
in Wake County to earn an above-average “The addition of Dr. Adams and the new office allows us to provide the same comprehensive heart care to the Garner community that other patients around Wake County have come to expect,” said James Zidar, M.D., president, Rex Heart & Vascular Specialists. “His track record of providing quality, compassionate care makes him an excellent addition to our team and great start for the new practice.” Dr. Adams joins Rex Heart & Vascular Associates with more than 11 years of experience in cardiology and internal medicine. He earned his doctorate of medicine from East Carolina University, completed his residency at the University of Texas Southwestern, and achieved his master’s of health sciences in clinical research and his fellowship in cardiology from Duke University. Dr. Adams has received several honors, including an American College of Cardiology Young Investigator’s award. He also serves on the advisory board and selection committee for the North Carolina Albert Schweitzer Fellowship.
Managing your patients’ health is your life’s work. Managing physicians’ wealth is mine. Financial Rx for Physicians: • • • • •
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Trust your wealthcare to a specialist. The Preferred ClienT GrouP Paul J. Pittman CFP® President and Managing Director 919-459-4171 email@example.com www.pcgnc.com Securities offered through LPL Financial Member NASD/SIPC Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers
Ultrasound and Laser Technology Are Key to Treating Venous Insufficiency A significant number of patients with varicose veins suffer symptoms related to venous insufficiency, such as, aching leg pain, fatigue and/ or itching and swelling.
lower-extremity venous anatomy to establish the precise sources of venous insufficiency. Treatment usually involves techniques for eliminating the greater saphenous vein. As the primary superficial vein in the leg, dysfunction within this vein most often
Dr. Jason R. Harris, who joined Raleigh Radiology in 2008, has expertise in vascular and interventional and musculoskeletal radiology. He earned his bachelor of science degree at Brigham Young University and medical degree at Harvard Medical School. He completed his internship at Newton-Wellesley Hospital, Newton, Mass., and residency at Massachusetts General Hospital, Boston, Mass.; and a fellowship in vascular and interventional radiology at Duke University Medical Center. Dr. Harris is a member of the American College of Radiology, Society of Interventional Radiology.
results in varicosities and the symptoms of venous insufficiency.
Venous insufficiency affects an estimated 50
vein. Through a small puncture near the knee,
percent of men and women over the age of
Traditional treatment used to involve a surgical
the physician accesses and ablates the length
50 and 15 percent to 25 percent of all adults.
vein stripping or ligation procedure, using
of the greater saphenous vein from its origin.
general anesthesia. This procedure often Insufficiency results from a dysfunction
resulted in significant trauma to the leg and
All immediate postoperative care is usually
of valves that normally keeps the blood
required weeks, or even months, of recovery.
handled through the clinic. A follow-
moving in one direction toward the heart.
up exam allows the physician to ensure
As the valves fail, gravity causes blood to
Today, endovenous ablation has replaced
proper recovery and determine necessary
pool within the superficial veins of the
stripping and ligation to eliminate saphenous
management of the patientâ€™s varicose
legs, resulting in the thickening and bulging
disease. Adjuvant therapies might include
typical of varicosities.
procedure requires only a local anesthetic,
further ablation, ambulatory phlebectomy or
is performed as a same-day procedure in an
Varicose veins are much more than a
office setting and has a quick recovery time
cosmetic issue, as a significant number of
with a low risk of complications.
patients suffer from symptoms related to
Given the proven effectiveness of venous ablation, most insurance companies will
venous insufficiency. Symptoms may include
The entire procedure is performed using
cover the procedure, based on failed
aching leg pain, fatigue and/or itching and
ultrasound guidance, giving the physician
conservative therapy and medical necessity
swelling, all of which will typically increase
direct visualization of the greater saphenous
for symptom relief.
as the day progresses. The disease is usually progressive and will worsen with time. In later stages, venous insufficiency can lead to skin discoloration and even difficult-to-treat skin ulcers. The most common risk factors for venous insufficiency include age, family history, female gender and, especially, pregnancy. Diagnosis begins with a review of the patientâ€™s medical history and a physical exam, and is usually followed by ultrasound. A key component of diagnosis, ultrasound allows the physician to confirm valve dysfunction, determine if the patient is a candidate for laser therapy and map the
The Triangle Physician
The treatment of varicose veins is a natural extension of Raleigh Radiology, given ultrasoundâ€™s key role in both the diagnosis and treatment of lower extremity venous insufficiency. Related venous access procedures and applications of ultrasound for minimally invasive therapies have long been a part of its interventional practice. Pictured here, Dr. Jason Harris (center) stands with fellow Raleigh Radiology vascular and interventional radiologists Satish Mathan (left) and Mark Knelson.
OB/Gyn Accolades and Achievements Honors and Awards Dr. Champa Woodham was featured in the May 2011 edition of Ob.Gyn. News for her study entitled “Maternal 25(OH)D Levels and sFLT-1/PlGF Ratio Improves Predictability of Severe Preeclampsia in Early Pregnancy.” This research was selected for presentation in the fellows oral plenary session at the Society for Maternal-Fetal Medicine Annual Meeting in San Francisco, Calif., in February. Dr. Alison Stuebe was awarded an ECHO Pilot Grant for Alamance/UNC Breastfeeding Collaboration (ABC) Project. Dr. Stuebe is the principal investigator for the study, and Dr. Wanda Nicholson is the mentor. The 16-month grant is for $12,000. The 6th annual Society for Women’s Health Research Medtronic Prize for Scientific Contributions to Women’s Health was presented to Denniz Zolnoun M.D., M.P.H., associate professor in the Department of Obstetrics & Gynecology at the Society for Women’s Health Research (SWHR) annual gala dinner May 9.
Presentations by meetings American College of Obstetricians and Gynecologists’ Annual Clinical Meeting May 5-9, Washington, D.C. • Presidential Program: – “Misogyny and Women’s Health,” D.A. Grimes. • Poster Presentation – “Intrauterine Device Knowledge and Practices Among U.S. Obstetrics and Gynecology Residents, J. Tang, D. Bartz and R. Maurer. Gynecologic Oncology Robotic Symposium IGORS IV May 5-6, Washington, D.C. Dr. John F. Boggess served as program director and moderator for scientific session V in gynecologic oncology. In addition, he presented: • Live cadaveric dissection – “Abdominal/Pelvic Anatomy Through the Eyes of the Robot;” • Lecture – “Optimizing Robotic Approaches to Lymphadenectomy,” an interactive surgical tutorialbased session on para-aortic lymphadenectomy; • Lecture – “Optimizing Robotic Approaches to Hysterectomy and Beyond,” an interactive surgical tutorial-based session on radical trachelectomy;
• Lecture – “Optimizing RoboticAssisted Laparoscopy in Obese and Medically Compromised Patients: Tips and Tricks;” and • Surgical videos (see Dr. Rabbie K. Hanna below). Dr. Emma C. Rossi was an invited lecturer and presented “Sentinel Lymph Node Mapping Using RoboticallyAssisted Near Infrared Imaging and ICG for Endometrial and Cervical Cancer.” Dr. Rabbie K. Hanna presented these surgical videos: • Robotic-Assisted Pelvic Lymph Node Dissection During Pregnancy for Cervical Cancer,” Rabbie K. Hanna and John F. Boggess; and • “Robotic-Assisted Ureteroneocystotomy,” Rabbie K. Hanna and John F. Boggess.
Presentations by individuals Susan Nickel, C.N.M., “Safety in Pregnancy,” Triangle Association of Women’s Health Obstetric and Neonatal Nurse (AWHONN), May 2. Kathy Higgins, C.N.M., “Nutritional Supplements for Women,” UNC Wellness Center at Meadowmont, May 25. Dr. B.L. Robinson, C.A. Matthews, O.S. Palsson, E.J. Geller, M. Turner, B.A. Parnell, A.K. Crane, M.L. Jannelli, E.C. Wells, A.C. Connolly and W.W. Whitehead; poster presentation: “Influence of Stool Consistency, Urgency, and Obstetric History on Fecal Incontinence;” Digestive Disease Week, International GI Conference; May 7-10, Chicago, Ill. Dr. S.L. Young, “Progesterone Action on Human Endometrium: Clinical and Physiological Perspectives;” invited lecture at the 6th International Conference on the Female Reproductive Tract, May 20-23, Frauenworth, Germany. Dr. D. Zolnoun, “Biopsychosocial Correlates of Co-morbidity with IBS Among Women with Chronic Pelvic Pain;” invited oral presentation on overlapping conditions at the 9th International Symposium on Functional Gastrointestinal Disorders, April 7-10 , Milwaukee, Wis.
Publications G. Makrigiorgos, S. Santana, E. Sanchez, R. Sadacharan, A. Stuebe and Merewood A. “A National Website to Track Hospital Discontinuation of Formula Sample Pack Distribution: Accuracy of Self-report.” J Hum Lact. 2011 May;27(2):113-4. B. Parnell, W. Whitehead, E. Geller, J. Jannelli, and A.Connolly. “Overlapping Anal Sphincteroplasty: Impact of Suture Selection on Bowel Symptoms.” J. Repro Med. May/June 2011;56:187-191. R.F. Savaris, J.M. Groll, S.L. Young, F.J. DeMayo, J.W. Jeong, A.E. Hamilton, L.C. Giudice and B.A. Lessey. “Progesterone Resistance in PCOS Endometrium: A Microarray Analysis in Clomiphene Citrate-Treated and Artificial Menstrual Cycles.” J Clin Endocrinol Metab: 2011 96(6):1737-46. J.S. Sheffield, A. Hickman, J. Tang, K. Moss, A. Kourosh, N.M. Crawford and G.D. Wendel Jr. “Efficacy of an Accelerated Hepatitis B Vaccination Program During Pregnancy.” Obstet Gynecol. 2011 May;117(5):1130-5. Z. Zhang, D.A. Zolnoun, E.M. Francisco, J.K. Holden, R.G. Dennis and M. Tommerdahl. “Altered Central Sensitization in Subgroups of Women With Vulvodynia.” Clin J Pain. 2011 May 17. [Epub ahead of print]
From Twitter IN THE NEWS video: Rex On Call – “Rex, UNC Fighting Cancer Together.” Dr. Linda Van Le interviewed. http:// youtu.be/9slssg80EAQ. More Information for You - “Fibulin-5 and Pelvic Organ Prolapse.” http:// bit.ly/lO0tze. “Obesity and Pregnancy Complications – You Are Not Eating for Two,” references Dr. Allison Stuebe’s research. http://bit.ly/lqk806. “What’s an Obstetrician-Gynecologist to Do?” Editorial by Dr. Honor Wolfe, retweet @greenjrnl, June 2011 issue. http://bit.ly/f3XiHZ “What Vitamins Should I Take?” presentation by Kathy Higgins, C.N.M., at the UNC Wellness Center May 25. http://bit.ly/j9e6Mr. More Information for You – “HPV and Pap Tests.” http://bit.ly/iRdG8Z.
“Global Obesity and the Effect on Women’s Health,” by Dr. Nancy Chescheir, retweet @greenjrnl, May issue: http://bit.ly/kWE8ce. Trina Pugh shares her UNC midwifery story. http://bit.ly/jVgRD9. Dr. Nancy Chescheir’s responses to ACOG’s “Ask the Expert” questions about obesity and women’s health. http://bit.ly/lCVeuV. Dr. Jennifer Mersereau comments on recently published research about stress and fertility treatment. http:// on.fb.me/k1gYB9 Video: Joscelyne Brazile from Durham, N.C., shares her experience with UNC midwifery. http://youtu.be/ W1KXmouTcuE. New vaginal birth after cesarean (VBAC) guidelines. Who’s a candidate? http://bit.ly/jeytNO. “I set out to understand the nature of pain in gynecology... .” Read more of Dr. Denniz Zolnoun’s acceptance speech. http://bit.ly/luTuBd. IN THE NEWS: Dr. Denniz Zolnoun is the winner of the prestigious Society for Woman’s health Research Medtronic prize. http://bit.ly/kof32j. Do patients know enough about fertility preservation? http://1.usa. gov/hi9ncM and www.med.unc.edu/ fertilitypreservation. “It’s a Mother of a Day,” a blog by UNC OB/GYN alum Dr. Rink Murray about experiencing childless Mother’s Day. http://bit.ly/mCSCqa. Real Doctors, Real People: Featuring how Dr. John Steege applies surgical skills to woodworking. http://bit.ly/ hmbCvx. IN THE NEWS: “Misogyny Kills Women Around the Globe.” Dr. David Grimes presents. #ACOG2011. http://bit.ly/jua4S7. IN THE NEWS: “Making Strides.” Minority women as physicians. Dr. Alice Chuang is featured in this Medical Bulletin story. http://bit.ly/m4fwaJ. Video: UNC’s Dr. Catherine Matthews talks about urinary incontinence on the Rex Healthbreak. http://youtu.be/ wnpnruCNqfA. IN THE NEWS video: How misogyny hurts women’s health, by Dr. David Grimes. http://ow.ly/4LDE6. Retweet @acognews, #ACM2011.
News Welcome to the Area
Triangle Physicians Julie Kristine Wood, DO Pediatrics Duke University Hospitals, Durham
Samuel Bruce Adams, MD Orthopedic Surgery Duke University Medical Center, Durham
Thomas John Bender, MD Duke Occupational & Environmental Medicine Durham
Thomas Joseph Bice, MD UNC Chapel Hill, Chapel Hill
Heather Carrick Braithwaite, MD Emergency Medicine Raleigh
Cheryl Ann Carlson, MD UNC Lineberger Comprehensive Cancer Center Chapel Hill
Khushbu Anirudhdha Chandarana, MD
Herman Aronov Naftel, MD
Timothy Michael Zagar, MD
Psychiatry University of North Carolina Hospitals Chapel Hill
Radiation Oncology University of North Carolina, Chapel Hill
Justin Eric Paulson, MD Juliessa Marta Pavon, MD Internal Medicine Duke University Hospitals, Durham
Sallie Robey Permar, MD
David Arthur Masneri Sr, DO Womack Army Medical Center, Fort Bragg
David Calvin Plitt, MD
Womack Army Medical Center, Fort Bragg
University of North Carolina Hospitals Chapel Hill
Robert Lee Young, DO
Julia Kristen Rauch, MD
Nephrology, Internal Medicine Wake Nephrology Associates, PA, Raleigh
Preeya Kshettry Gupta, MD
Benjamin Cohen Gersh, MD
Asher O Smith, MD Orthopedic - Surgery of the Hand Orthopedic Surgery Duke University Hospitals, Durham
Dana Marie Smith, MD Dept of Obstetrics and Gynecology Chapel Hill
Zebulon Zachary Spector, MD
Tobias Johannes Heye, MD
Eric Furman Strother, MD
Internal Medicine - Nephrology University of North Carolina Hospitals
Logan Leo Lechner, MD Obstetrics and Gynecology University of North Carolina Hospitals
Matthew Craig Lewis, MD
Anesthesiology Concentra, Durham
Kimberly Ann Putalik Talikoff, MD
Ronald James Viola, MD
Kristin Elinor Meade, MD Internal Medicine, Pediatrics Hospital Medicine Program, Duke University Hospitals, Durham
April Elizabeth Mendoza, MD UNC Chapel Hill, Dept of Surgery, Chapel Hill
The Triangle Physician
Neuro Rehabilitation, Merritt
Ashley Deane Kent, MD University Health Systems Physicians, Ahoskie
James Michael McGee, MD Emergency Medicine Womack Army Medical center, Fayetteville
Eleanor Louise Murray, MD Women’s Healthcare Associates, Jacksonville
John Livingston Powell, MD Gynecology/Oncology, Obstetrics and Gynecology 10 Crane Street, Wrightsville
BeachXiang Wang, MD 901 N. Winstead Avenue, Rocky Mount
Radiology Duke University Hospitals, Durham
Laura Wakil, MD Psychiatry University of North Carolina Hospitals Chapel Hill
Nicole Wilde, MD Internal Medicine University of North Carolina Hospitals Chapel Hill
Women’s Wellness Clinic Dr. Andrea Lukes
If you are a healthy female age 18-40 years with regular periods, then you may qualify for a research study on the effects of an investigational medication on ovulation and ovarian function. The research study procedures include: • physical exam • PAP smear • ultrasounds • blood draws • EKG Reimbursement up to $225 per week (for up to 20 weeks if you qualify). This study is being conducted by Dr. Andrea Lukes at the Women’s Wellness Clinic. Women’s Wellness Clinic is located by the Streets of SouthPoint. For more information call (919) 251-9223 or visit www.cwrwc.com.
Gastroenterology Stomach Ulcers Wake Research Associates Charles F. Barish, MD
Have you suffered from a heart attack or stroke and take 325 mg of aspirin daily to prevent another from occurring? If so, Wake Research is conducting a research study of an investigational medication that combines aspirin with a second medication to see if It can help prevent stomach ulcers. You’ll receive investigational medication and study-related exams at no cost and compensation up to $500 for time and travel. For additional information and qualification criteria please call (919) 781-2514 or visit us online at www.wakeresearch.com.
Colleen August, PA
Elizabeth Ann Thompson, MD
Thomas Clark Litzinger, MD
Emergency Medicine Duke University Hospitals, Durham
Catherine Mary Hagerty, MD
Columbus Internal Medicine, Whiteville
Lejla Vajzovic, MD
Douglas Alvin Lyssy, MD
Psychiatry, Family Practice Pitt County Memorial Hospital, Greenville
Cape Fear Valley Health System, Fayetteville
Pediatrics University of North Carolina Hospitals Chapel Hill
Ovulation and Ovarian Activity
Coastal Carolina Neonatology, Wilmington
Pediatrics Chapel Hill
Pediatrics University of North Carolina Hospitals
2530 Erwin Rd, Durham
Marc Thomas Bartman, MD Robert Michael DiGiuseppe, MD
Ophthalmology Duke University Eye Center, Durham
Louis-Philippe Laurin, MD
Emergency Medicine Pitt County Memorial Hospital, Greenville
Radiology University of North Carolina Hospitals Chapel Hill
Pediatrics University of North Carolina Hospitals Chapel Hill
Radiology Duke University Medical Center, Durham
Yousif Zaid Alkadhi, MD
Elizabeth Ann Russ, MD
Cardiovascular Surgery, Thoracic Surgery Duke University Medical Center, Durham
Karn Gupta, MD
ECEP II, P.A., Wilmington
Cape Fear Valley, Fayetteville
Daniel John Del Gaizo, MD
Division of Cardiovascular Medicine, Durham
Jeffery Wayne Van Den Broek, DO
Division of Infection Diseases, Durham
Jacob Niall Schroder, MD
Adam David DeVore, MD
Suzanne E Kimball, DO
Internal Medicine Duke University Hospitals, Durham
Duke University Hospital, Durham
Orthopedic Surgery UNC Hospitals Dept of Orthopaedics Chapel Hill
Gajarah Baseemah Ballard Peterson, MD
Matthew Palmer Rubach, MD
Andrei Cocieru, MD
381 Ruin Creek Road, Henderson
NC Inpatient Medicine Associates,PLLC New Bern
Sulene Liu Chi, MD
UNC Hospitals, Chapel Hill
Betsy L Loika, PA
Duke University Health System, Durham
2605 Blue Ridge Road, Raleigh
James Anders Christensen, MD
6509 Bakersfield Drive, Raleigh
UNC Pediatric Pulmonology, Chapel Hill
Internal Medicine University of North Carolina Hospitals Chapel Hill
Ophthalmology, Internal Medicine Duke University Medical Center, Durham
Ellen Beth Klaenhammer, PA
Clinical Trials Do you have patients with any of these problems?
Elizabeth Erin Bickell, PA Rita M Langworth, PA 5017 Songline St, Shallotte
Heather Shearin Page, PA Carolina Pediatrics, Wilmington
Medical Practice Partnership Effective May 9, Activcare Physical Therapy and Wellness One have combined their physical therapy and support teams, and will continue operating under the name Activcare Physical Therapy. Activcare is a privately held physical therapy practice with two locations in Raleigh and one in Fayetteville. For more information visit www.activcarept.com or call (919) 786-7434.
General Medicine/ Infections Wake Research Associates Charles F. Barish, MD
Do you have an upcoming hospitalization? You could be at risk of infection by Clostridium difficile (C.diff.), a bacteria that can cause severe gastrointestinal problems.You may qualify for this study if you are between 40 and 75 years old and have an upcoming hospitalization. Study-related medical exams and study medication are provided at no cost, and compensation will be provided for time and travel. For additional information and qualification criteria please call (919) 781-2514 or visit us online at www.wakeresearch.com.
Your LocaL cardioLogY ProfessionaLs in Johnston countY dedicated to QuaLitY, service, and integritY
Mateen Akhtar, MD, FACC
Benjamin G. Atkeson, MD, FACC
Christian N. Gring, MD, FACC
Matthew A. Hook, MD, FACC
Kevin Ray Campbell, MD, FACC
Eric M. Janis, MD, FACC
Randy Cooper, MD, FACC
Diane E. Morris, ACNP
Ravish Sachar, MD, FACC
Nyla Thompson, PA-C
2 Locations to serve our Patients Smithfield Heart & Vascular Associates 910 Berkshire Road Smithfield, NC 27577 Phone: 919-989-7909 Fax: 919-989-3147
Wake Heart & Vascular Associates 2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520 Phone: 919-359-0322 Fax: 919-359-0326
Coronary and Peripheral Vascular Interventions Pacemakers/Defibrillators Atrial Fibrillation Ablations Echocardiography Nuclear Cardiology Vascular Ultrasound Clinical Cardiology CT Coronary Angiography Stress Tests Holter Monitoring Cardiovascular Medicine Echocardiography Nuclear Cardiology Cardiac Catheterization
the highest QuaLitY cardiovascuLar care, cLose to home.
Little Is Big To Us.
BRENT A. TOWNSEND, MD | Pediatric Radiologist
CATHERINE B. LERNER, MD | Pediatric Radiologist
ÂŠ2011 Wake Radiology. All rights reserved. Radiology saves lives.
LAURA T. MEYER, MD | Pediatric Radiologist
Wake Radiology is the first radiology practice in Raleigh to open a dedicated pediatric outpatient imaging center. Four fellowship-trained, pediatric radiologists have created a child-friendly environment for your young patients who range from a few days of age to eighteen years old. Our pediatric radiologists are all subspecialty trained and are keenly aware of the unique challenges that your pediatric patients present. Because children are more sensitive to radiation than adults, we strive to use the smallest doses of radiation possible that will still provide diagnostic images and offer experienced guidance in selecting the most appropriate imaging modalities for your patient. Wake Radiology Pediatric Imaging. Deliverying the finest care for your smallest patients.
Wake Radiology Pediatric Imaging | 4301 Lake Boone Trail, Ste 100 | Raleigh, NC 27607 | Scheduling 919-232-4700 | wakerad.com