m ay 2 0 11
Cary Orthopaedic & Sports Medicine
Thrives on a Tradition of Excellence 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
LASIK in the Military Image-guided Pain Relief
FDA-Approved for MRI Use The First and Only Pacing System to Break the Image Barrier Introducing the Revo MRITM Pacing System engineered with SureScan® Technology – the only pacing system to provide proven cardiac care that’s designed to be used safely with MRI.
Brief Statement The Revo MRI™ SureScan® pacing system is MR Conditional and as such is designed to allow patients to undergo MRI under the specified conditions for use. Indications The Revo MRI SureScan Model RVDR01 IPG is indicated for use as a system consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI® SureScan 5086MRI leads. A complete system is required for use in the MRI environment. The Revo MRI SureScan Model RVDR01 IPG is indicated for the following: • Rate adaptive pacing in patients who may benefit from increased pacing rates concurrent with increases in activity • Accepted patient conditions warranting chronic cardiac pacing include: – Symptomatic paroxysmal or permanent second- or third-degree AV block – Symptomatic bilateral bundle branch block – Symptomatic paroxysmal or transient sinus node dysfunctions with or without associated AV conduction disorders – Bradycardia-tachycardia syndrome to prevent symptomatic bradycardia or some forms of symptomatic tachyarrhythmias The device is also indicated for dual chamber and atrial tracking modes in patients who may benefit from maintenance of AV synchrony. Dual chamber modes are specifically indicated for treatment of conduction disorders that require restoration of both rate and AV synchrony, which include: • Various degrees of AV block to maintain the atrial contribution to cardiac output • VVI intolerance (for example, pacemaker syndrome) in the presence of persistent sinus rhythm
Antitachycardia pacing (ATP) is indicated for termination of atrial tachyarrhythmias in bradycardia patients with one or more of the above pacing indications. Atrial rhythm management features such as Atrial Rate Stabilization (ARS), Atrial Preference Pacing (APP), and Post Mode Switch Overdrive Pacing (PMOP) are indicated for the suppression of atrial tachyarrhythmias in bradycardia patients with atrial septal lead placement and one or more of the above pacing indications. The device has been designed for the MRI environment when used with the specified MR Conditions of Use. Contraindications The device is contraindicated for: • Implantation with unipolar pacing leads • Concomitant implantation with another bradycardia device • Concomitant implantation 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 implantation 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 • Single chamber atrial pacing is contraindicated in patients with an AV conduction disturbance • ATP therapy is contraindicated in patients with an accessory antegrade pathway
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)
Patient Line: Tel: 1 (800) 551-5544 7:00 am to 6:00 pm CT M-F Fax: (763) 514-1855 24-hour information available on www.medtronic.com
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. Use of the device should not change the application of established anticoagulation protocols. Do not scan the following patients: • Patients who do not have a complete Revo MRI SureScan pacing system, consisting of a SureScan device and two SureScan leads • Patients who have previously implanted devices, or broken or intermittent leads • Patients who have a lead impedance value of < 200 Ω or > 1,500 Ω • Patients with a Revo MRI SureScan pacing system implanted in sites other than the left and right pectoral region • Patients positioned such that the isocenter (center of MRI bore) is inferior to C1 vertebra and superior to the T12 vertebra See the device manuals before performing an MRI Scan for detailed information regarding the implant procedure, indications, MRI conditions of use, contraindications, warnings, precautions, and potential complications/ adverse events. For further information, call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.
UC201004100 EN © Medtronic, Inc. 2011. Minneapolis, MN. All Rights Reserved. Printed in USA. 02/2011
The Revo MRI SureScan pacing system is MR Conditional designed to allow patients to undergo MRI under the specified conditions for use. A complete system, consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI® SureScan leads is required for use in the MRI environment.
We help you get back to your life After a disabling illness or injury, all you want to do is get back to your lifeâ€”as quickly as possible. Durham Rehabilitation Institute at Durham Regional Hospital helps you regain your independence with care delivered in a warm, compassionate environment. Durham Rehabilitation Institute is an award-winning facility that provides comprehensive, state-ofthe-art care. Treatment programs
are led by a board-certified rehabilitation physician. Other team members include nurse practitioners, rehabilitation nurses, physical therapists, speech therapists, and others dedicated to providing personalized care to meet each patientâ€™s needs. Top-rated rehabilitation care with the convenience of a community hospital: this is Durham Regional Hospital. For physician referrals, call 919-470-7226.
Cary Orthopaedic & Sports Medicine Thrives on a Tradition of Excellence
M ay 2 011
Vol. 2, Issue 5
LASIK Advances Benefit the Military Dr. Dean Dornic explains how the military has embraced advances in laser-assisted in situ keratomileus.
DEPARTMENTS 11 Orthopedics Radiology
Raleigh Radiology’s Musculoskeletal Team Offers Image-Guided Pain Management Dr. Jeffrey Browne gives an overview of the pain management uses and methods of image-guided injections.
Total Ankle Replacement Is Revolutionizing Care of Ankle Arthritis
12 Your Financial Rx Reduce Your Investment Pain Threshold
14 Sleep Medicine Sleep Apnea Requires Specialized Attention
16 Orthopedics Double Bundle Technique Improves Anterior Cruciate Ligament Outcomes
18 Cardiology Atrial Fibrillation: A Perspective on Treatment Evolution
22 Women’s Health New Findings in Losing Weight
24 WakeMed News County’s fifth hospital, new Brier Creek Healthplex and more
26 GHS News Distinction for knee and hip replacement, and Hospital of Choice Award
27 Durham Regional News U.S. News Best Hospital ranking
27 News 2
Upcoming events, welcome, new offices and clinical trials The Triangle Physician
JOHNSTON HE ALTH
From the Editor
Spring into Health Itâ€™s spring, a time to sweep out the cobwebs, which for many means self reflection about our health and lifestyle.
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
Outdoor activity ramps up and body mechanics become a focus. Watching our back and every part of our musculoskeletal being in times of injury are orthopedic specialists and physical therapists, such as those at Cary Orthopaedic Sports Medicine and Spine Specialists. This finely tuned team is standing by to provide early and proper diagnosis so patients can get back to the games of life faster, more fully and with less pain. Weight management increases in importance as the weather warms. Overweight and obesity comprise a national problem. Its toll on human life weighs heavy on the economy. And despite all the marvels of modern medicine, data suggests overweight and obesity are increasing. A beacon of hope is the Medi-Weightloss Clinic. Its regimen that includes ongoing counseling and medical supervision is possibly the surest,
Editor Heidi Ketler, APR
Contributing Editors Ker Boyce, M.D., F.A.C.C., F.A.C.P. Jeffrey Browne, M.D Giridhar Chintalapudi, M.D. Dean Dornic, M.D. Mark Galland, M.D. Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G Selene G. Parekh, M.D., M.B.A. Paul Pittman, C.F.P.
healthiest approach to long-term weight management.
Photography Jim Shaw Photography firstname.lastname@example.org
Also on the orthopedic front, Dr. Mark Galland reviews how a new double-bundle surgical
Creative Director Joseph Dally
technique improves anterior cruciate ligament outcomes. Dr. Selene Parekh focuses on the
improvements in total ankle replacement in the treatment of ankle arthritis.
Advertising Sales Carolyn Walters email@example.com
Dr. Andrea Lukes enters the weight management discussion with an overview of the use
News and Columns Please send to firstname.lastname@example.org
of phentermine to suppress appetite. In this issue we get several points of view on pain management. Certified financial planner Paul Pittman talks about avoiding the very real pain felt when investment returns are poor. Dr. Jeffrey Browne explains image-guided pain management. The Triangle Physician welcomes two new contributors. Dr. Dean Dornic writes about the benefits of laser-assisted in situ keratomileus (LASIK) surgery to the military. Dr. Giridhar Chintalapudi (aka Dr. Chin) reviews the diagnosis and treatment of sleep apnea. Spring also is a great time to evaluate your practice marketing strategies. If you havenâ€™t done so already, incorporating The Triangle Physician into the mix makes a lot of sense. Consider that it is the only publication of its kind, dedicated to the Triangle medical profession. Our sincere gratitude for all you do. Happy spring!
Heidi Ketler Editor
The Triangle Physician
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.
On the Cover
Cary Orthopaedic & Sports Medicine Thrives on a Tradition of Excellence By Heidi Ketler
Known as a hotbed of athletic activity, the
All nine orthopedic surgeons are fellowship
The practice now encompasses Cary Ortho-
Greater Raleigh and Triangle region experi-
trained. In addition to general orthopedics
paedic Spine Specialists, offering a total ap-
ences its share of sports-related injuries. For
and sports medicine, the range of specializa-
proach to spine care. Garner Orthopaedic
29 years Cary Orthopaedic & Sports Medi-
tion includes arthroscopic and reconstruc-
Sports Medicine & Spine Specialists pro-
cine Specialists has been filling the need for
tive surgery, total joint replacement and
vides a similar offering to that community
high quality diagnosis and treatment of these
minimally invasive spine surgery.
and surrounding counties. All three ortho-
injuries and many other orthopaedic related conditions.
paedic locations have a dedicated PerforCary Orthopaedic Sports Medicine and
mance Physical Therapy facility on site.
Spine Specialists is distinguished by its tradiSince opening its doors in 1982, Cary Or-
tion of excellence that ensures every initial
Teamwork a Practice Hallmark
thopaedic has grown with the community
patient encounter begins with an orthopae-
“Excellence in Sports medicine and Ortho-
to offer a comprehensive range of surgical,
dic physician evaluation. “A hallmark of this
pedics requires that we’re all on the same
non-surgical and rehabilitative services. The
practice is continually striving to provide
page to meet patient goals as quickly and
practice is comprised of a team of orthopae-
early and proper diagnosis which can help
safely as possible,” says Douglas L. Golle-
dic sports medicine and spine-specialized
prevent prolonged difficulties and provide
hon, M.D., senior partner. “To ensure the
surgeons, physiatrists and physical thera-
the greatest value for the health care dollar
very best outcome ideally we involve the
pists at three separate locations.
spent,” says Michael Mazzella, Cary Ortho-
physician, parents, the athletic trainer and
paedic Chief Operating Officer.
coach as part of the team focused on return-
PHOTO BY BRYAN REGAN PHOTOGRAPHY
ing that athlete back to the desired level of activity. “
Sports Medicine Expertise Over the years, Cary Orthopaedic Sports Medicine and Spine Specialists services to patients has represented the Triangle’s wide world of sports, from the Carolina Hurricanes, Carolina RailHawks and Carolina Ballet to scholastic athletes, recreational weekend warriors and elite triathletes. “This is a very diverse athletic market, not just for professional sports,” says Susan McArdle, Cary Orthopaedic Business Manager. “We see everything from acute injuries to arthritis that may be manifested in the older recreational athlete.” Patients seek out Cary Orthopaedic Sports Medicine and Spine Specialists for the levDr. Andersen provides diagnosis and treatment of an injured wrist
The Triangle Physician
el of care that provides enhanced freedom
order to withstand the repetitive stresses of
of movement without pain for all types of
musculoskeletal problems. “Our patient’s goals can be as diverse as walking down
Most orthopaedists recommend a minimum
the driveway to get the newspaper to the
of six months of progressive physical ther-
highest level of training to qualify for a ca-
apy before returning to competitive sports.
reer in professional athletics,” says Doug-
ACL rehabilitation involves a progression of
las J. Martini, M.D. “Even if a patient is not
therapeutic and sport-specific activities. The
a high-level athlete or a recreational or
experienced physical therapist makes the
scholastic athlete, we treat them all with
best determination as to whether or not the
the same high level of expertise and ex-
patient is able to safely progress.
Approach to Arthritic Joints Knee ligament reconstructive surgery
Osteoarthritis is a common, progressive and
Injury to the anterior cruciate ligament, or
at the knee, hip and shoulder. The first line
ACL, is common among the high-level ath-
of treatment for osteoarthritis aims to relieve
letes and the recreationally active popula-
pain with nonsteroidal anti-inflammatory
tion. This ligament serves as the primary
drugs, along with physical therapy, applica-
tive overhead activities. “Those susceptible
restraint to forward and pivoting motion of
tions of a topical analgesic and injections of
to overuse-related problems are athletes
the shin bone. An ACL tear can be a debili-
who engage in repetitive overhead arm
debilitating disease that occurs commonly
Dr. Carroll evaluates for a rotator cuff injury
movements, like throwing. Degenerative
tating sports injury. Viscosupplementation is commonly used
changes in the shoulder may contribute to
With the appropriate diagnosis and treat-
to treat chronic osteoarthritis of the knee if
the problem in active older adults,” says Ray-
ment approach, “the prognosis for recov-
conservative treatments fail. It involves the
mond M. Carroll, M.D.
ery is excellent,” says William K. Andersen,
injection of gel-like substances (hyaluro-
M.D. Surgical reconstruction of a torn ACL
nates) into the knee joint to supplement the
Most patients experience pain relief and im-
is usually recommended for patients who
viscous properties of synovial fluid. The pa-
proved shoulder function through non-sur-
are less than 25 years old, regardless of ac-
tient will receive three to five injections over
gical treatment, including anti-inflammatory
tivity level, because they tend to have prob-
the course of several weeks. Positive effects
medicine and strengthening exercises. Sur-
lems with instability and frequent episodes
can last several months.
gery may be considered if a rotator cuff tear is acute and painful, if it is in the dominant
of the knee giving way. Given the advances in ACL reconstruction and the accelerated
Shoulder Injuries and Treatment
arm of the active individual or if maximum
approach to rehabilitation, this surgical pro-
A rotator cuff injury may result from a trau-
overhead arm strength is required for work
cedure is often recommended to a wider
matic event or develop gradually with repeti-
active patient population than in the past. Preoperatively, “it is important to regain motion in the knee as soon as possible after injury to prevent stiffness and secondary problems,” says Dr. Andersen. “Resolution of swelling and stiffness prior to ACL reconstruction surgery improves post-operative joint function.” A torn ACL must be entirely removed and a new one reconstructed. The new ligament is positioned within the knee with screws or other fixation devices. The reconstructed ligament then has to heal in this position in Dr. Armour performs specific orthopaedic maneuvers to assess the extent of a knee injury
Proactive Approach to Recovery Cary Orthopaedic & Sports Medicine
Spine Specialists Center Offers
Specialists’ rehabilitation service, PER-
“Dedicated Care for the Spine”
FORMANCE Physical Therapy, provides highly trained and experienced physical therapists to guide patients through “prehabilitation” in the weeks leading up to surgery. Pain and loss of strength and function can spiral preoperatively and can prolong a successful post-operative outcome. The goal of physical therapy preoperatively is to regain the patient’s range of motion, reduce pain and swelling, and enhance basic strength, setting the stage for a quicker comeback. Therapy pre- or post-operatively allows for
Given the prevalence and variance of neck and back pain in our society, Cary Orthopaedic Spine Specialists has put together a dedicated medical team providing advanced non-surgical and surgical options to treat the sources of pain. Neck pain is typically caused by poor posture at work while seated in front of a computer or during recreational activities, according to Sameer Mathur, M.D. “Fortunately, associated problems are not serious in approximately 80 percent of cases and can be treated non-surgically through a tailored physical therapy program or spinal injections.” When symptoms don’t improve after two or three months of conservative treatment, surgery may be a solution.
accelerated recovery. “So, they’re a step ahead of the game,” says Marc Capannola, Clinical Director of PERFORMANCE, adding, “Patients also get a mental lift knowing they will be able to be active sooner.” PERFORMANCE Physical Therapy also provides an important therapeutic tool called the SwimEx. “This aquatic therapy approach to rehabilitation allows for quicker initiation of the rehabilitation program for a patient who is not ready to do an activity on a hard surface but may be able to do it in the water,” says Mr. Capannola.
Physician Referrals Cary Orthopaedic accepts referrals from all physicians, regardless of specialty or hospital affiliation. For more information, visit the practice at www.caryortho.com or call (919) 467-4992.
Sports Medicine Specialists: Douglas L. Gollehon, M.D. Brian T. Szura, M.D. Douglas J. Martini, M.D. William K. Andersen, M.D. Derek L. Reinke, M.D. Mark A. Curzan, M.D. Raymond M. Carroll, MD. Edouard F. Armour, M.D.
The Triangle Physician
Traditional surgical treatment for a degenerative or herniated disk, one of the most common problems, is cervical diskectomy and fusion. In select patients, a new surgical procedure can be performed without fusion. Similar to total knee and hip replacement, the degenerated cervical disk can be replaced with an artificial implant that replicates the function of the diskjoint complex. This allows the neck to maintain motion and prevents adjacent-level arthritis.
ment includes bed rest, pain control and physical therapy. If that approach is unsuccessful kyphoplasty is a minimally invasive treatment option. Through two small incisions at the level of the fracture, cement is introduced into the vertebral body to reinforce it. This is done under local anesthesia, and patients experience immediate pain relief in the recovery room. Most often surgery is not necessary. If surgery is determined to be the best option, Cary Orthopaedic Spine Specialists will first consider minimally invasive alternatives that produce equal or better results than traditional surgery. Cary Orthopaedic Spine Specialists’ physiatrists are experienced in the use of fluoroscopic-guided epidural joint injections to treat chronic back pain. The treatment applies a numbing agent and anti-inflammatory on or near the inflamed nerve. Additional procedures available in this comprehensive spine center are nerve conduction and EMG (electromyogram) studies. Acupuncture also is offered for pain relief or resolution and may serve as a reasonable alternative to longterm narcotic analgesics.
Approximately two-thirds of adults suffer from low back pain at some time in their lives. Common causes include myofascial dysfunction, degeneration of the disc or facet joints, spondylolisthesis, spinal stenosis and compression fractures.
Spine-Focused Physical Therapy The physical therapists at the Spine Center are completely focused on the spine and specially trained in manual therapy techniques. Patients also learn proper lifting and moving techniques, and are guided on maintaining proper body mechanics.
Spinal stenosis occurs when there is narrowing of the spine, resulting in compression of the spinal nerves. The traditional surgical approach involves wide lumbar decompression and possible fusion. Patients are in the hospital for several days and may suffer from chronic back pain.
Physician Referrals Cary Orthopaedic Spine Specialists accepts direct referrals for neck and back problems requiring evaluation, management, surgical treatment, physical therapy and/or interventional spinal injections.
The minimally invasive X-STOP procedure revolutionized the treatment for spinal stenosis. It is placed between the spinous processes to prevent extension of the spine. The outpatient procedure is performed under local anesthesia. Recovery and return to normal activity is much quicker.
Compression fracture of the vertebral body is common in older adults. Conservative treat-
Orthopaedic Spine Surgeon Sameer Mathur M.D., Physiatry Team: Scott S. Sanitate, M.D. Gary L. Smoot, M.D. Chris Lin, M.D. Nicole P. Bullock, M.D.
Childhood Obesity Within a Generation By National Dairy Council
America’s children are fatter, weaker and more sedentary than ever before. In fact: • 33 percent of American children and adolescents are overweight • 17 percent of children ages 2 to 19 are obese • Only 14 percent of teens consume three servings of milk per day • Only 2 percent of school age children consume the recommended servings from all the major food groups
What’s contributing to this onslaught of childhood obesity? First, distorted portion sizes mean that our children are overeating foods and beverages high in calories, fat and sodium, but low in key nutrients. In addition, today’s working families eat more meals away from home. Did you know that the average fast food meal contains more saturated fat than the American Heart Association recommends we consume in two days? Finally, children ages 8 to 13 spend nearly six hours in front of TV and computer screens each day instead of being physically active. These three primary factors have caused the percentage of overweight children and adolescents to triple in the past 40 years.
and development,” said Dr. Cathy Wood, pediatrician, Montgomery, Ala. The new 2010 Dietary Guidelines notes it is especially important to establish the habit of drinking milk in young children, as those who consume milk at an early age are more likely to do so as adults. The Dietary Guidelines encourages all Americans to consume more low-fat dairy foods for better bone health and recommends 2 cups for children 2 to 3 years, 2.5 cups for children 4 to 8 years, and 3 cups for those 9 years and older. Next, take a short assessment of the number of meals eaten away from home. Most restaurant portions are oversized for children and adults alike. Research shows that when larger portions are served, both adults and children eat more, despite fullness, and load up on extra calories. Physicians should encourage parents to prepare and eat more nutrient-rich meals at home. Tammy Beasley, registered dietitian and author of Rev It Up Fitness, said kids tend to eat more fruits, vegetables and low-fat dairy foods at meals shared with their parents. “Family meals
America’s children are overweight, but what’s even more alarming is that they are undernourished in calcium, vitamin D, potassium and fiber, key vitamins and minerals that they need to grow into healthy adults. Feeling helpless? Don’t. Ending the childhood obesity and nutrition crisis within a generation is possible, and with these three counseling tips, physicians and other health professionals can help move the needle.
have long-lasting health and social benefits,” she said. “Children learn by modeling themselves after their parents, including food behaviors. Eating together lets parents show their children by example how to choose nutrient-rich foods, know when they are full and try new foods.” Lastly, physicians should encourage families to put muscles in motion for at least 60 minutes daily and engage children in more play time and less screen time. Many schools have eliminated physical education, recess and exercise to increase time spent in class, but programs are being introduced to help combat the lack of physical activity in schools. One school-based program that is gaining momentum nationwide is Fuel Up to Play 60, a nutrition and physical fitness initiative created by the National Dairy Council and the National Football League and supported by the U.S. Department of Agriculture, along with 13 national health organizations including the American Academy of Pediatrics. Now in more than 12,000 schools across the Southeast, Fuel Up to Play 60 empowers youths in grades four through 10 to take action and motivate their peers to improve nutrition and physical activity in school and at home. “Fuel Up to Play 60 is making a difference with our students,” said Manny Barocco, Director of Athletics, Health and Physical Education, Jefferson Parish, La. “It mixes competition, fun and nutrition to help students win the biggest prize of all – a healthy future.”
First, review the beverage basics with families. The American Academy of Pediatrics recommends low-fat or fat-free white or flavored milk, water and 4 to 6 ounces of 100 percent fruit juice daily for children ages 1 to 6. “When sodas, sweet tea or sports drinks replace milk in the diet, it’s hard for children to get the calcium and vitamin D they need for bone growth
Childhood obesity is a problem as serious as it is solvable, so talk to your patients and their parents to help bring the statistics down. Together, physicians, dietitians, parents, teachers and communities can end this alarming epidemic. It’s serious. It’s solvable. It’s time.
Advances Benefit Military’s Effectiveness By Dean Dornic, M.D.
The United States armed forces have embraced LASIK as a way to make troops “combat ready.” During the first three months of the Iraq
now allows LASIK in all aviators, including
Acceptance of the new and improved
war in 2003, the military airlifted 60 service
those in high-performance aircraft.
LASIK eye surgery by the Department of
members out of the region because of
Defense has helped make our troops better
severe corneal ulcers caused by contact
Although the most common types of laser
lens wear. The military now forbids contact
eye surgery can cost between $2,500 and
lenses because of the risks associated
$5,000 for both eyes at a private doctor,
with dusty and dirty conditions. And
active military personnel can now receive
while contact lens wear can be dangerous
LASIK free at one of 25 Warfighter Refractive
in combat situations, eyeglasses can be
Eye Surgery Program centers.
impractical. Even if the glasses don’t break, they often can hinder soldiers on missions.
Since its introduction to the Armed Forces
The spectacles can fog up, fall off or make
in 2000, more than 300,000 refractive
putting on a gas mask a cumbersome and
surgery procedures have been performed
time-consuming task when seconds matter.
at military hospitals, and more than 45 studies have been conducted to determine
Many people want to get laser eye surgery
the safety and efficacy of laser vision
so they can be free of the hassles of glasses
correction among military personnel.
or contacts. But many service members deploying to Iraq and Afghanistan are
The Navy is currently undertaking a study
rushing to get it done for much different
on Naval aviators. To date, more than
reasons. They are getting the surgery
200 aviators have been enrolled in the
because it could save their life.
study. The results of the study have been outstanding. Aviators were able to return to
Over the years, vision correction technology
flight status within four weeks after LASIK.
has evolved such that LASIK (laser-assisted
Patient satisfaction has been excellent.
in situ keratomileus) has proven to be a
One hundred percent were able to achieve
safe and effective procedure. This has led
20/20 levels of vision. There were no
to a growing acceptance of LASIK in the
complaints of significant glare, halos, haze
or sharpness of vision. Ninety-eight percent felt that LASIK helped their effectiveness
The United States armed forces have
as a naval aviator and 98 percent indicated
embraced LASIK as a way to make troops
they would definitely recommend LASIK to
“combat ready.” Laser vision correction
their fellow aviators.
has been allowed for all aspects of military service, including aviation, special
operations and support personnel. It also is
wavefront-guided technology, have made
approved for NASA astronauts. The Air Force
the LASIK procedure better and safer.
The Triangle Physician
Dr. Dean Dornic is founder and medical director of the Laser Eye Center of Carolina. A board-certified, fellowship-trained vision correction specialist, he has more than 15 years of surgical experience and has performed thousands of successful LASIK procedures. He was selected as one of “America’s Top Ophthalmologists” by Consumer’s Research Council of America and was named a LASIK Gold surgeon – an honor bestowed upon the top 50 LASIK surgeons nationwide by Sightpath Medical. Dr. Dornic has lectured at international meetings and trained other surgeons on LASIK. For more information, visit www.visionauthorities.com.
Total Ankle Replacement Is Revolutionizing Care of Ankle Arthritis
By Selene G. Parekh, M.D., M.B.A.
The third-generation implants require smaller bone cuts, are more anatomical and better able to restore natural ankle motion. Ankle arthritis is a chronic condition that
of motion. The third-generation implants
causes substantial pain, disability and loss in
require smaller bone cuts, are more
quality of life. In fact, a recent study published
anatomical and better able to restore
in 2008 demonstrated end-stage ankle arthritis
natural ankle motion.
to be as debilitating as hip arthritis. The ideal candidate for a TAR suffers from Until recently, conservative options, such as
post-traumatic ankle arthritis or rheumatoid
injections, bracing and anti-inflammatories,
arthritis, is less than 250 pounds and is 50
have been used to delay surgery. When
years of age or older with little or no major
surgery was needed, the best option was
ankle deformity. However, this is changing
a surgical ankle fusion. This would relieve
as orthopedic foot and ankle surgeons gain
pain, but unfortunately, leave patients
more experience with these implants and
with a loss of motion in the ankle, a limp,
techniques. Depending on the specifics of
and make the knee and subtalar joints
a patient, TAR surgery is being performed at
susceptible to arthritic changes. These
an earlier age, with greater deformities and
issues have made clinicians, orthopedic
with a larger body mass index.
and physical exam, followed by weightbearing radiographs. At times, a computed tomography scan may be needed to provide more anatomical details. Based on these findings, treatment options are reviewed with the patient. If a patient is a candidate for a TAR, a medical clearance and dental
surgeons, researchers and ankle implant companies seek other solutions.
Dr. Selene G. Parekh is an associate professor of orthopedic surgery at the North Carolina Orthopaedic Clinic and Duke University, Department of Orthopaedic Surgery. His research and clinical interests include total ankle replacements, foot and ankle injuries of athletes, minimally invasive foot and ankle trauma surgery, tendon injuries of the foot and ankle, and the adoption and development of novel technologies in foot and ankle surgery. Dr. Parekh has been an active speaker at regional, national and international meetings, helping to teach other orthopedic surgeons about novel techniques for the care of foot and ankle patients.
The evaluation of a patient with ankle arthritis begins with a thorough history
Total ankle replacement (TAR) has been
evaluation to eliminate a possible source of infection are requested. The surgery for TAR requires an overnight
available in the United States since the
stay. The patient is made non-weight bearing
1970s. The earlier generations of ankle
for four to six weeks. Thereafter, intense
replacements were plagued with failures.
physical therapy is required to gait train and
However, the most recent, third-generation
strengthen the ankle. Most patients note a
implants have overcome many of the
tremendous improvement in their quality of
shortcomings of these earlier implants.
life, being able to perform activities, such as walking, yoga, golf and swimming, which
This has renewed the interest in TAR.
they may have lost for years.
Currently in the United States, there are three TAR systems available: the STAR, the
Total ankle replacements are revolutionizing
Salto and the Inbone. These implants have
the care of ankle arthritis. Pain relief,
been available in Europe for years, with
preservation of adjacent joints, restoration
promising medium- and long-term results.
of ankle motion and a more normal gait
In the U.S., the Inbone was approved in
are some of the benefits of third-generation
2005, the Salto in 2006 and the STAR in 2009.
TAR procedures. Patients should be made aware of this treatment option, as it holds the
The goals of TAR surgeries are to reduce
promise of transforming their quality of life.
pain, while preserving a natural range
Your Financial RX
Reduce Your Investment
Pain Pain Threshold Threshold By Paul Pittman, C.F.P.
Did you know 94 percent of all active money managers under-perform their respective indexes? Are you in the 94 herd or the elite 6?
The same way opening your investment statements might be doing to you right now.
Is the decimal point causing pain? Are you experiencing any pain right now? On a scale of 1 to 10, what is your current
“Are you having any pain today? On a scale
so small I was going to be able to pass it on
of 1 to 10, what is your current pain level?”
my own. Sure enough, 12 hours later, I heard the unmistakable “clink” in my urine screen.
level? What I have witnessed in 24 years in this business is that something as small as a
The nurse asked me these questions during my last few doctor visits. Thank goodness, I
If this wasn’t a 10, then I can only hope
decimal point can raise an investor’s pain
have not had any pain for quite awhile, but
that a 10 involves blacking out. I had been
level immediately to a 10. Usually the source
it makes me wonder: What is a level 1? What
on painkillers that could have stopped that
of pain is not the decimal point, but the
is a level 10?
charging rhino in his tracks, and the stone
location of that decimal point.
wasn’t much bigger than a decimal point on I have had a physician tell me that I was going
“Pressure” must be the buzzword for “this is
How could something so small bring a
a 5 on the pain scale.” (By the way, using the
rough and tough six-foot man to the ground?
word “pressure” instead of “pain” doesn’t minimize the experience.) Anyway, back to my question on what each level means. I have experienced what I can only imagine was a 10. I had a kidney stone rear it’s ugly head during my daughter’s dance recital. It was my first, and I was sure that a rhino had rammed his horn into my back. I went from a 0 to a 10 in about 30 minutes. My wife took me to the emergency room, and thank goodness it was closer than the gun shop. As I writhed on the floor of the ER, the triage nurse said it was probably a kidney stone. I was certain that it was the size of a Buick. But I was one of the lucky ones; mine was
The Triangle Physician
Your broker might be telling you that this is “pressure.” Now we all understand this term
to feel some “pressure” during a procedure.
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.
How does the movement of the decimal
This is not to say that owning these posi-
pain and accept what is shoveled at you.
tions is a bad thing, but owning them several
Take the time, break the chain, find out
times is. It raises your risk level many times
what is right for you and your family! It is
over. True allocation is broad, covers many
too important to keep on doing what you
asset classes, styles and countries, but most
have always done and expect a different
importantly, it is designed specifically for
you. Your investment profile, risk tolerance and goals are as individual as your
Did you know 94 percent of all active money
managers under-perform their respective indexes? Are you in the 94 herd or the elite 6?
Here again, I strongly advise you to find a qualified person to help you develop your
Until next month, good health and
personal allocation. Do not live with your
point affect your stress level, your emotions, your retirement, your child’s education? All of these items should be fully taken into account when you develop your Investment Policy Statement in the very beginning. Do you have clear and concise steps to lower the pain level, or are you just trying to live with the pain? Pain in the investment world not only brings doubt and fear into play, but can also seriously derail a sound financial plan. What you do not want is for this pain to create a knee-jerk reaction. This is when pain breeds panic, and panic develops into bad decision-making. Pain does crazy things to emotions. If you are properly allocated, then secular bear markets shouldn’t shoot your pain level to a 10 and create bad decisions. Look back over one of my previous articles on proper allocation to better understand this concept. (If you cannot locate it, I am happy to e-mail it to you.)
Is overlap killing your allocation? I’ll wager that right now you have a large degree of “overlapping” in your portfolio. Overlapping is a killer of proper allocation. This is where you own certain positions more than once and probably many times in a standard, brokerage-firm allocation. You may very well own Cisco Systems or Coca-Cola or General Electric, three or four or five times in your portfolio! Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
Sleep Medicine Category
Sleep Apnea Requires Specialized Attention By Giridhar Chintalapudi, M.D.
Doctors usually can’t detect the condition during routine office visits. Also, there are no blood tests for the condition. Most people who have sleep apnea don’t know they have it because it only occurs during sleep.
One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses. You’re asleep when the snoring or gasping happens. You likely won’t know that you’re having problems breathing or be able
About 70 million Americans suffer from
oxygen causes the brain to send a signal for
to judge how severe the problem is. Your
a sleep problem and nearly 60 percent of
you to wake up, so you open up the airway
family members or bed partner often will
them have a long-term disorder. Even though
in your throat and start breathing again. If
notice these problems before you do.
sleep problems are very common, they are
you have sleep apnea, this cycle may repeat
very often undiagnosed and untreated. One
as often as 50 or more times an hour.
of the most common sleep problems is
Other signs and symptoms of sleep apnea may include: morning headaches; memory
sleep apnea. It is estimated that 4 percent of
The frequent drops in oxygen level and
or learning problems and not being able to
middle-aged men and 2 percent of middle-
reduced sleep quality trigger the release of
concentrate; feeling irritable, depressed, or
aged women suffer from sleep apnea.
stress hormones. These compounds raise
having mood swings or personality changes;
heart rate and increase your risk of high blood
urination at night; and a dry throat when you
In sleep apnea, you have one or more pauses
pressure, heart attack, stroke and arrhythmias
in breathing while you sleep. You often move
(irregular heartbeats). The hormones also
out of deep sleep and into light sleep when
raise the risk of, or worsen, heart failure
your breathing pauses or becomes shallow.
Another common sign is fighting sleepiness during the day, at work or while driving.
This results in poor sleep quality that makes you
Untreated sleep apnea also can lead to
You may find yourself rapidly falling asleep
tired during the day. Sleep apnea is one of the
changes in how your body uses energy.
during the quiet moments of the day when
leading causes of excessive daytime sleepiness.
These changes increase your risk of obesity
you’re not active.
and diabetes. Doctors usually can’t detect the condition during routine office visits. Also, there are no blood tests for the condition. Most people who have sleep apnea don’t know they have it because it only occurs during sleep. A family member and/or bed partner may first notice the signs of sleep apnea.
Sleep Apnea Can Contribute to Serious Medical Conditions During normal sleep, throat muscles relax. When this happens, if there is too little room inside your throat or too much tissue pressing on the outside of your throat, your airway can become blocked. This blockage stops the movement of air, and the amount of oxygen in your blood drops. The drop in
The Triangle Physician
Dr. Giridhar Chintalapudi (“Dr. Chin”) earned his medical degree from Kurnool Medical College, India. Before moving to the United States, he worked in United Kingdom for five years, with special interest in neuropsychiatry. He completed his internship and residency at State University of New York, Stony Brook. He is board certified in general neurology, vascular neurology and sleep medicine. He also is a board member of North Carolina Academy of Sleep Medicine. In addition to being active in private practice, he also is involved in teaching both neurology and sleep medicine. Dr. Chin can be reached at 919-708-5008.
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Medical Space Available in Rex Hospital Vicinity
If a patient has problems breathing during sleep, even if he doesn’t have daytime sleepiness, he should talk with his doctor. Janet Clayton, CCIM 919.420.1581 firstname.lastname@example.org
Treatment Can Restore Regular Breathing Doctors diagnose sleep apnea based on
Independently Owned & Operated
medical and family histories, a physical exam and results from sleep studies. Usually, your primary care doctor evaluates your symptoms first. He or she then decides whether you need to see a sleep specialist for diagnosis and treatment. A sleep study is
Managing your patients’ health is your life’s work. Managing physicians’ wealth is mine.
the most accurate test for diagnosing sleep apnea. It records what happens with your breathing while you sleep. The goals of treating sleep apnea are to restore regular breathing during sleep and relieve symptoms, such as loud snoring and daytime sleepiness. Lifestyle changes, mouthpieces, breathing devices and surgery may be used. Medicines typically aren’t used to treat the condition.
Financial Rx for Physicians: • • • • •
Aiding Wealth Creation, Preservation and Protection Business Management Tax-strategies Liability Protection Asset Preservation
Trust your wealthcare to a specialist. The Preferred ClienT GrouP Paul J. Pittman CFP®
Treatment may improve other medical
President and Managing Director
problems linked to sleep apnea, such as
919-459-4171 email@example.com www.pcgnc.com
high blood pressure. Treatment also can reduce your risk of heart disease, stroke and diabetes. If a patient has sleep apnea, he should talk with his doctor or sleep specialist about the treatment options that will work best.
Securities offered through LPL Financial Member NASD/SIPC Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers
Improves Anterior Cruciate Ligament Outcomes By Mark Galland, M.D.
The double-bundle technique is much more technically demanding to perform, but there is little doubt that one day it will be “The Standard.” Treatment of a once devastating knee injury
and feelings of instability even after successful
has evolved! In the all-too-recent past, tearing
surgery and rehabilitation. Still, others are
one’s anterior cruciate ligament meant the
unable to return to their previous levels of
end of an active lifestyle and certainly the
activity, and once-promising athletic careers
end of many promising athletic careers.
are ended. Moreover, knees reconstructed
New advances in surgical technique and an
with the traditional single-bundle technique
enhanced understanding of the anatomy of
may be more prone to re-injury and often
the ligament have improved the prognosis for
develop arthritis many years later.
A dissection depicting the double-bundle nature of the native ACL (the medial femoral condyle has been removed). Reproduced from: Fu F. Femoral insertion site of the anterior cruciate ligament (letter to the editor; http://www.ejbjs.org.) Journal of Bone and Joint Surgery American, May 24, 2005.
accomplish part of the goal – which is to
athletes suffering this once-devastating injury.
stabilize the knee and preserve the joint from degenerative arthritis.
The anterior cruciate ligament (ACL) is a ligament located in the middle of the knee
The newest and most progressive surgical
that connects the femur to the tibia. It is
technique for ACL reconstruction is called
a critical ligament that stabilizes the knee
the anatomic double-bundle technique and
during sports and physical activity. The
is superior to the single-bundle technique
ACL is usually injured during a pivoting
in many ways.
or cutting motion and can occur with or without contact.
Early results suggest that the anatomic double-bundle technique decreases the
ACL injuries have become more common
likelihood and severity of the post-surgical
as participation in sports has increased.
problems associated with traditional single-
As a result, ACL reconstructive surgery is
bundle technique, while increasing overall
now one of the most common orthopedic procedures.
ACL Reconstruction Single Bundle technique. Reproduced from: Vangsness CT. ACL Reconstruction Orthopaedic Procedures, 2010.
New advances have greatly improved the surgical technique of ACL reconstruction. Traditionally
knee stability. In addition, the knee is more likely to regain normal range of motion as compared to knees treated non-operatively or with the traditional single-bundle technique.
The latest research may explain these uninspiring results. Through extensive
This success is accomplished in the double-
laboratory analysis, we have learned that
bundle technique by accurately replacing
focused on reconstruction of a single strand
the ACL is composed of two separate
and restoring the native ACL.
or “bundle” of fibers. The results have been
largely successful in restoring knee stability
Each functions independently and in
Currently only a select few surgeons are
and returning athletes to play.
concert. Knowing this, it is reasonable to
trained in and are performing this ground-
conclude that reconstruction of only one
breaking technique. It is much more
portion (and ignoring the other) will only
technically demanding to perform, but there
Unfortunately, many still experience some pain
The Triangle Physician
Women’s Health Diabetes May
The Triangle Physician Orthopaedics Allergies 2011 Editorial Calendar
Dr. Mark Galland of Orthopaedic Specialists of North Carolina is a board-certified orthopedic surgeon, specializing in sports medicine and practicing in Wake Forest and North Raleigh. He serves as team physician and orthopedic consultant for the Carolina Mudcats, the AA affiliate of the Cincinnati Reds, as well as several area high schools and colleges. Dr. Galland is a recognized expert in knee injuries and doublebundle ACL reconstruction. He can be reached at (919) 562-9410 or by visiting www.orthonc. com or www.drmarkgalland.com.
June Vision Neurology July Imaging Technologies Interventional Radiology August Infectious Diseases Pediatrics
is little doubt that, one day, this doublebundle technique will be “The Standard.” We have entered a new era in sports medicine.
Schematic shows double-bundle ACL reconstruction. Reproduced from: Casagranda BC, Maxwell NJ, Kavanagh EC, Towers JD, Shen W, Fu FH. Normal Appearance and Complications of Double-Bundle and Selective-Bundle Anterior Cruciate Ligament Reconstructions Using Optimal MRI Techniques. American Journal of Radiology. 2009; 192:1407-1415.
structures in the knee to a near normal state.
knee to its normal state. When suffering
You can resume your life of physical activity
a major knee injury such as an ACL tear,
and sport participation with the confidence
surgeons who perform the anatomic
that your knee is structurally sound.
double-bundle technique may restore the
September Sports Medicine Prostate Cancer
October Breast Cancer Neurosurgery
potentially devastating injury may now have a reconstructive surgery to truly restore the
November Urology Alzheimer’s
December Pain Management Sleep Disorder
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
A Perspective on Treatment Evolution By Ker Boyce, M.D., F.A.C.C., F.A.C.P.
Today, new catheter ablation devices are in development. Other energy sources are being evaluated. Hybrid procedures are being developed and refined. A new class of agents targeting the IKur channels are in development. Atrial fibrillation is the most common rhythm
That has changed in the last two decades,
disorder resulting in hospitalization. With the
as we have seen a phenomenal growth in
increasing population and the aging of the
our understanding of its pathophysiology.
baby boomers, it is becoming more prevalent
Michel Haissaguerre’s group first reported
in every cardiologist’s practice.
the recording of pulmonary vein potentials in 1998. This quickly led to the concept that
Atrial fibrillation (AF) was probably first
paroxysmal AF is often triggered by ectopic
described by the Chinese emperor physician
atrial tachycardias that commonly arise
Huang Ti in his classic medical treatise about
from one or more of the pulmonary veins.
2000 BC. The first modern description of AF
Persistent/permanent AF is usually associated
is credited to William Harvey in 1628, with
with enlarged atria and myocardial fibrosis,
his observations of animal hearts. Willem
which supports multiple wavelets.
Einthoven published the first echocardiogram recording of AF in 1906, calling it “pulsus
New Treatment Frontier
inequalis et irregularis.”
This progress in understanding has led
Dr. Ker Boyce earned his bachelor of science in chemistry from the Georgia Institute of Technology at age 18. After graduating with his medical degree from Emory University School of Medicine, he completed an internal medical residency at Emory. He then went on active duty in the United States Navy, serving first as a naval flight surgeon and force medical officer in support of the U.S. Antarctic Research Program. He then completed his cardiology fellowship at Naval Medical Center San Diego and his electrophysiology fellowship at the University of California San Diego. Dr. Boyce then returned and joined the faculty of the Naval Medical Center San Diego, eventually becoming the division chief and fellowship program director. In 1999, Dr. Boyce transferred to the U.S. Naval Reserve and entered private practice. He started the electrophysiology program at FirstHealth Moore Regional Hospital. He continued to serve in the Navy, mentoring the electrophysiology program at Naval Hospital Portsmouth and serving as an advisor to the Naval Aerospace Medical Institute until his retirement from the Navy in 2006.
to new options for therapy. The treatment of AF still has three goals: prevention of
amiodarone, to name a few. Most recently
administering digitalis leaf to patients with
dronedarone was released. Unfortunately, no
heart failure. He noted that those with an
ventricular rate control and rhythm control to
agent works well, and not all are appropriate
irregular pulse would improve and their pulse
restore a sinus mechanism.
for every patient due to coexisting conditions.
1914 reported the use of quinine for AF after
Numerous studies have been completed
The current frontier of AF management is
a Dutch sailor told him how his palpitations
showing the benefit of warfarin in AF.
nonpharmacologic treatment of AF to restore
improved while taking quinine for malaria.
The recent release of dabigatran, a direct
sinus rhythm. This was first done by James
Walter Frey later reported that quinine’s
thrombin inhibitor, now offers an alternative.
Cox with his cut-and-sew Maze operation in
stereoisomer, quinidine, was more effective.
Rate control is usually accomplished with
1987. It evolved into the Maze III procedure
verapamil, dilitiazem and/or betablockers.
by 1992. This surgery works well but is open
Atrial fibrillation was often categorized
A nonpharmacologic alternative is AV
chest/open heart. It is difficult to perform as
junction ablation and permanent pacemaker
a concomitant procedure to other cardiac
surgery. For these reasons, it has not been
would become steady. Karel Wenckebach in
(now permanent) for clinical purposes.
However, for most of the next century, our understanding and treatment of AF did not
relegated to medications. There are numerous
agents such quinidine, flecainide, sotalol, and
percutaneous ablation techniques. There was
The Triangle Physician
a rapid evolution from targeting potentials inside the pulmonary veins, to pulmonary vein isolation, to antral isolation. This has been aided by the development of 3-D mapping systems, importing of cardiac computed tomography or magnetic resonance studies, irrigated-tip radiofrequency catheters and robotics. Despite these advances, the overall success rate for patients with paroxysmal AF for a single ablation procedure is in the range of 6070 percent. It is less successful for the persistent AF patient with an enlarged left atrium. In the March 2011 issue of The Triangle Physician, there was an article on a new hybrid AF procedure. This work was pioneered by Dr. Andy Kiser at FirstHealth Moore Regional Hospital in Pinehurst. Dr. Kiser started with an open-chest approach to assess the epicardial ablation device and to develop a lesion set. He then developed a minimally invasive approach through the pericardium. In collaboration with electrophysiologists, a hybrid approach was subsequently developed. The surgeon begins the ablation procedure epicardially, and then the electrophysiologist completes the various lines and tests for pulmonary vein isolation endocardially. With Dr. Kiserâ€™s return to his alma mater, this work will be continued at the University of North Carolina at Chapel Hill. So what does the future hold? New catheter
ablation devices are in development. Some use balloons to deliver a circumferential ablation around each pulmonary vein ostium. Other energy sources are being evaluated. Hybrid procedures are being developed and refined. A new class of agents targeting the IKur channels, found
Do They Like What They See?
predominantly in atrial myocardium, are in
Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.
development. And what does this mean for patients? Each patient is different. Some are asymptomatic
Our services range from consultation, to design, to creation and implementation of strategic plans.
and only require anticoagulation. A few only need a little more rate control. Many are devastated with AF and require restoration of sinus rhythm. With so many treatments now available, it is imperative that the treating physician be aware of the risks and benefits of each, and then tailor therapy to each patient.
newsource & Associates
In the meantime, my kudos to all the researchers, basic science and clinical, who are continuing to explore new frontiers in
Call (540) 650-3686 or send inquiries to firstname.lastname@example.org.
Our network of smart, creative, award-winning specialists serves the health care industry throughout the Mid-Atlantic.
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INTRODUCING The Magazine for Healthcare Professionals. All health care professionals and health related businesses have a new outlet for a direct publication that targets up to 6000 physicians, PAs, NPs, medical centers and related health care professionals. The regional physician publication is coming to the Eastern Region of North Carolina! DF Marketing Consulting and Associates will be handling the advertisements for the publication in the following counties:
The Eastern Physician T H E M AG A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Counties: Beaufort, Bertie, Bladen, Brunswick, Camden, Cartert, Chowan, Columbus, Craven, Cumberland, Currituck, Dare, Duplin, Edgecomb, Gates, Greene, Halifax, Hertford, Hoke, Hyde, Jones, Lenoir, Martin, Montgomery, Moore, Nash, New Hanover, North Hampton, Onslow, Pamlico, Pasquotank, Pender, Perquiams, Pitt, Richmond, Robeson, Sampson, Scotland, Tyrrell, Washington, Wayne, Wilson Cities: Greenville, Wilmington, Goldsboro, New Ben, Fayetteville, Southern Pines, Pine Hurst, Rocky Mount, Wilson, Washington, Morehead City, Elizabeth City
DF MARKETING CONSULTING AND ASSOCIATES – 1-919-267-4296 If you’re looking for referrals from other Health Care Professionals, our publication will reach them. We directly mail our publication to up to 6000 Physicians, PAs, NPs, and Medical Groups in the Eastern Region of North Carolina! We are seeking EDITORIALS for our First Issue in July 2011! Ask us about our FREE INITIAL CONSULTATION! We offer ad development, graphic design assistance, individualized- personal photos, head shots, and a full service photo shoot for a nominal fee. Want to be a featured doctor or clinic with up to 8 pages of advertising space with a personalized brochure spread? We can do that also. For any assistance or questions you may have contact: David Frank at 919-924-3751 or email at David@EasternPhysician.com Kyle Blatchley at 910-992-1592 or email at Kyle@EasternPhysician.com
“YOUR HAPPINESS IS OUR PRIORITY!” 423 Cameron Woods Drive, Apex, North Carolina 27523
Raleigh Radiology’s Musculoskeletal Team Offers Image Guided Pain Management By Jeffrey Browne, M.D.
When a local mail courier’s hip pain became
Common indications for CT or fluoroscopic-
Complications are infrequent, but patients
so debilitating that he could no longer perform
guided procedures include:
should be aware of signs of infection at the
his job, he discussed his options with his
• Extremity (upper, lower, ankle, foot) joint
injection site. An allergic reaction to steroid injection or iodinated contrast is rare and often
injection for pain or arthritis
physician. His arthritis would eventually require hip replacement, but he was not quite ready for
• Joint aspirations
mild. Since the corticosteroid can take five to
the operation. He was an ideal candidate for
• Shoulder brisement for adhesive capsulitis
seven days to reach maximum effectiveness,
fluoroscopic-guided hip joint injection, and
• Sacroiliac joint injections
his results were very gratifying. He was able to return to work within a week and his pain was
Ultrasound is a very effective
modality when soft tissue or fluid is the region of interest.
Whether an athlete or everyday patient, the team
of seven subspecialty-trained musculoskeletal
radiologists at Raleigh Radiology has you
include aspiration of fluid for
covered for your interventional needs.
analysis, bursitis, treatment of
calcific tendinitis, drainage or When conservative management of your
patient’s joint or tendon pathology fails or if
cysts, Baker’s cysts, hematomas,
the cause of pain is uncertain, an image-guided
and abscesses. In many cases
injection of a short-acting anesthetic and long-
acting corticosteroid is very useful in managing
calcifications can be aspirated
from the tendon or bursa prior
to the injection of steroids, The injections can be used to:
a procedure referred to as
• Delay or eliminate need for surgery
Dr. Jeffrey Browne is a musculoskeletal radiologist at Raleigh Radiology and medical director of computed tomography for Rex Hospital. He graduated from the University of Connecticut School of Medicine and completed an internship at St. Raphael’s Hospital in New Haven, Conn. He completed his residency and a fellowship in musculoskeletal radiology Duke University Medical Center. Dr. Brown is a member of the American College of Radiology, Radiological Society of North America and American Roetgen Ray Society. He joined Raleigh Radiology in 2008.
• Diagnose cause or site of pain • Control pain in non-operative patients
The duration of the pain relief varies
we ask patients to avoid excessive activity
• Offer pain relief quicker than conservative
depending on the severity and reversibility
that could potentially prohibit the steroid from
of the patients’ condition, as well as other
reaching its full potential effect.
factors. In the case of arthritis, the steroid will Fluoroscopic-, ultrasound- and computed
reduce the inflammation; however, it will not
Our team of MSK radiologists offer these
tomography (CT)-guided injections increase
reverse the condition. If therapeutic effect is
injections at three convenient locations within
the precision of these procedures by confirming
achieved, a maximum of four injections per
Raleigh: Our Blue Ridge and Cedarhurst
correct needle placement. After administering
year can be performed. Patients are asked to
outpatient offices and at Rex Hospital. To
a local anesthetic, the needle is directed to the
assess changes in their pain shortly after their
schedule a joint injection, call our Blue Ridge
site of interest, using minimal or no radiation
injection and report the effectiveness to their
facility at 781-1437 or Cedarhurst at 877-5400.
exposure. If a joint is the target, a small amount
physician. Pain relief immediately following the
For more information, go to our website at
of contrast is injected during fluoroscopy to
procedure is diagnostic of a problem at the site
confirm intra-articular position. A combination
of a long-acting anesthetic and an intermediateto-long-acting corticosteroid are then injected.
Before arriving for the procedure, patients are
The anesthetic can provide immediate pain
requested to inform the staff if they are diabetic,
relief lasting four to six hours and also confirm
taking blood thinners or have had previous
the site of pain. The corticosteroid begins
reactions to iodinated contrast. Prior to the
to work approximately one to two days after
injection, a radiologist will question the patient
injection, reaching its maximum effectiveness
about his or her symptoms and correlate them
within five to seven days.
with any imaging findings.
Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 2007 10:7-111. Silbergleit R, Mehta BA, Sanders WP and Talati SJ. Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics 2001 21:927-39. Dussault RG, Kaplan PA, Anderson MW. Fluoroscopyguided sacroiliac joint injections. Radiology 2000 214:273-6.
New Findings in Losing Weight By Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G.
The alarming fact is that approximately
than the placebo group, which had a weight
percent of people taking fenfluramine,
two thirds of Americans are overweight or
loss of 1.4 kg, or 3.1 pounds.
or dexfenfluramine, had abnormal valve
obese. So when a study on the effects of a
combined drug (low-dose phentermine plus
At one year, this study showed that weight
topiramate) on excess weight and associated
loss of 10 percent or greater at one year was
The FDA did not ask manufacturers to remove
comorbidities was published in Lancet in
seen in 7 percent of the placebo group, in
phentermine from the market. Phentermine
April, health care providers took note.
37 percent of the low-dose group and in 48
works on the hypothalamus portion of
percent of the high-dose group. This was a
the brain to release norepinephrine (a
Although not yet approved by the Food and
statistically significant difference for both
neurotransmitter that signals a fight-or-
Drug Administration, the findings of the
doses, compared to placebo.
flight response, reducing hunger). The
CONQUER1 study showed significant weight
most common side effects are dry mouth,
loss. Upon FDA approval, the combined
insomnia, dizziness, mild increase in blood
drug will be marketed as Qnexa.
associated with obesity improved in those
pressure (rarely more severe) and heart rate.
treated with the combined drug. Specifically,
Monitoring blood pressure in important.
In the CONQUER trial, two doses of
there were significant reductions in systolic
blood pressure, diastolic blood pressure
The precise mechanism of action for
compared in overweight/obese subjects
topiramate is not clear, but theories suggest
as an adjunct to diet and lifestyle changes.
energy expenditure increases with reduced
The term “overweight” refers to a body mass
fasting glucose and total cholesterol. For
caloric intake, reduced salivary enzyme
index (BMI) greater or equal to 25 but less
most of the risk factors, the improvement
activity, reduced leptin and corticosteroid
than 30. Obesity refers to a BMI of greater or
was more in the higher dose group.
concentrations, and potential reduction in
equal to 30.
serum glucose and insulin concentrations. Of concern are the adverse events associated
Although not yet approved by the Food and Drug Administration, the findings of the CONQUER study showed significant weight loss.
with topiramate, including parasthesias, memory
fatigue, insomnia, difficulty concentrating, and dizziness.
Local Treatment Using Phentermine Adults evaluated in the study had a BMI
Taking Note of Side Effects
More than 300 patients have been treated
between 27-45 kg/m2, and two or more
Phentermine was first approved by the
using the drug phentermine through a
FDA as an appetite-suppressing drug back
limited program at Women’s Wellness Clinic.
in 1959. At one point it was combined
or obstructive sleep apnea. Of the 2,487
subjects, 994 were assigned to placebo (979
dexfenfluramine) and called Fen-Phen.
The medication is used for three to six months to suppress appetite. When patients start this program, they are told of a remote
analyzed), 498 to 7.5 mg phentermine plus 46 mg topiramate (488 analyzed), and 995 to
Eventually, dangerous side effects surfaced
chance of pulmonary hypertension is
15.0 mg phentermine plus 92 mg topiramate
in Fen-Phen users, with 24 cases of heart
valve disease, as well as cases of pulmonary hypertension. Some individuals died from
It is recommended by the FDA that
At the lower dose, the mean weight loss was
the effects of Fen-Phen. Following these
phentermine be used short-term (up to
8.1 kg, or 17.8 pounds. At the higher dose
reports, fenfluramine (or dexfenfluramine)
12 weeks), while incorporating healthy
the mean weight loss was 10.2 kg, or 22.4
was taken off of the market voluntarily.
dieting and exercise. In our experience and
pounds. These were both statistically higher
through discussions with peers, if weight
The Triangle Physician
After earning her bachelor’s degree in religion from Duke University (1988), Dr. Andrea Lukes pursued a combined medical degree and master’s degree in statistics from Duke (1994). Then, she completed her ob/gyn residency at the University of North Carolina (1998). During her 10 years on faculty at Duke University, she co-founded and served as the director of gynecology for the Women’s Hemostasis and Thombosis Clinic. She left her academic position in 2007 to begin Carolina Women’s Research and Wellness Center, and to become founder and chair of the Ob/ Gyn Alliance. She and partner Amy Stanfield, M.D., F.A.C.O.G., head Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals for management of heavy menstrual bleeding. Call (919) 251-9223 or visit www.cwrwc.com.
equal to 25) or obese (BMI greater or equal to 30), effective regimens for weight loss are
and www.mypyramid.com. • Exercise! – This is so important to do for
important to help individuals lose weight.
weight loss and weight control. • Be mindful of the food you are eating,
While effective medications are available, there is basic information providers should
both in terms of quality and quantity. • Do not multitask when you are eating, and
emphasize to their patients, including the following:
chew your foods well. • Give yourself a pantry and refrigerator/
• Healthy lifestyle changes in diet and
freezer makeover – Get rid of the foods
exercise should be emphasized.
that tempt you.
• In order to lose one pound in a week, you
• Do not eat late at night.
must have a deficit of 3,500 calories in that week (500 calories per day for 7 days).
As new developments in weight loss emerge,
• Do not consume less than 1,200 calories
Women’s Wellness Center staff weighs the
per day to avoid slowing down your
risks and benefits. Call (919) 251-9223 for
available appointments and support with
• Eat less and more often to boost metabolism. Try to consume five to six small meals during the day, beginning with
loss continues through 12 weeks, then
breakfast, within 45 minutes of walking.
continuation through 16 weeks is tolerated.
• Keep a food journal – potentially an online version that will keep a calorie count for
you. For example: www.thedailyplate.
Given that two-thirds of the United States
population is overweight (BMI greater or
However much you value wildlife conservation in North Carolina,
helping patients to make healthy lifestyle changes through weight loss.
References Gadde KM, Allison DB, Ryan DH, et al. Effects of lowdose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults CONQUER: A randomized, placebo-controlled, phase 3 study. Lancet 2011; DOI:10.1016/S0140-6736(11)60505-5. Available at http:// www.thelancet.com.
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
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
WakeMed North to Become Wake County’s Fifth Hospital WakeMed Health & Hospitals will begin
Currently WakeMed North
expansion in fall 2011 of the existing
Healthplex offers a full-
WakeMed North Healthplex into Wake
service, 24/7 emergency
County’s fifth hospital – WakeMed North
surgery center, imaging
and laboratory services With an anticipated opening date of
and a host of additional
October 2013, WakeMed North Hospital
clinical capabilities. The
will be a 61-bed acute care hospital, with
a focus on inpatient women’s specialty
services, offering a full range of obstetric
medical office building.
comprehensive preventive, diagnostic and
“Transitioning to a hospital is the next logical
second year of hospital operation. The cost
therapeutic care. The facility will continue to
step, as the infrastructure is already in place
of the project is estimated to be nearly $62
serve men and children through the existing
and the community has a critical mass of
emergency department, outpatient surgery,
262,000 residents living within a seven-mile
imaging, lab and physician services already
radius of the facility,” said Dr. Atkinson.
WakeMed received approval to add 41
offered at the facility.
“While the hospital will initially open with a
licensed acute care beds to WakeMed
women’s focus, our plan is for it to continue
North Hospital in 2009. These beds were in
“Since opening in 2002, WakeMed North
to expand to meet the needs of women, men
addition to the 20 acute care beds already
and children, alike.”
approved for relocation from WakeMed
Raleigh Campus, making the total bed count
have consistently outpaced projections, demonstrating the great demand for health
Construction is expected to create 500
for WakeMed North Hospital 61. The inpatient
care services in this community,” said Dr.
construction jobs. Hospital officials also said
beds will be constructed in an approximate
Bill Atkinson, WakeMed president and chief
the current 150 employees will be expanded
90,000-square-foot addition to the existing
to about 442 full-time equivalent employees,
with an average salary of $48,760, by the
Construction Commences on Healthplex Construction has begun on WakeMed Brier
be available for emergency department pa-
tificate of Need was granted in September
Creek Healthplex located at the corner of
tients and outpatient visits.
2009 for $36 million. WakeMed’s total invest-
US-70 on T.W. Alexander Drive.
ment in the project is $14 million. The facility, which will be owned, de-
The facility will include the county’s third
veloped, and managed by Duke Realty,
WakeMed Brier Creek Healthplex will ini-
24/7 full-service, stand-alone emergency de-
will be 50,000 square feet, including a
tially employ 74 full-time employees and will
partment with 12 private treatment rooms. It
26,000-square-foot emergency department
serve northwest Raleigh and Wake County.
will be staffed by the same board-certified
and 24,000 square feet of medical office
It is located at 8001 T.W. Alexander Drive in
physicians that serve WakeMed’s five addi-
Brier Creek, less than one mile from I-540
tional emergency departments.
and US-70. The complex sits on 12 acres, alConstruction is slated to be completed by
Laboratory and imaging services, including
November 2011 and the building will be op-
computed tomography and X-ray, also will
erational by January 2012. The project Cer-
The Triangle Physician
lowing room for future development. For more information, visit www.wakemed.org.
CON to Add 101 Beds WakeMed
Medical Office Space Available Physicians’ Office Pavilion at WakeMed North Healthplex
submitted two complementary Certificate of Need (CON) applications to add 101
Capture the High-Growth, Affluent North Raleigh Market!
beds in accordance with the bed-need allocation identified in North Carolina’s 2011 State Medical Facilities Plan. WakeMed is proposing to add 79 acute care beds to Raleigh Campus and 22 acute care beds to Cary Hospital. Both Raleigh Campus and Cary Hospital currently operate above the state’s CON performance
71.4 percent for hospitals the size of Cary Hospital and 75.2 percent for hospitals the size of Raleigh Campus. By 2015, growth coupled with an aging population, will cause occupancy rates at or above 90 percent if no
Janet Clayton, CCIM 919.420.1581 email@example.com
additional beds are opened at these facilities,
Independently Owned & Operated
Raleigh Campus and Cary Hospital to have
according to a press release. “WakeMed is the leading provider of inpatient health care services in Wake County – the second fastest-growing county in North Carolina. And, WakeMed’s high inpatient occupancy drove the allocation of 101 beds in North Carolina’s State Medical Facilities Plan,” said Stan Taylor, WakeMed vice president corporate planning. “Additionally, the other hospitals in Wake County currently have unutilized or under-utilized acute care beds and have not shown a good track record in providing the inpatient capacity that the community needs.” Wake County will have five hospitals, with the opening of WakeMed North Hospital in October 2013, and four stand-alone emergency departments. “Wake County does not need more hospitals. It needs to add more inpatient capacity in the county’s two busiest existing hospitals, leveraging existing infrastructure and support services already in place to add beds quickly, costeffectively and efficiently,” says Taylor.
Granville Health System News
GHS Named Blue Distinction Center for Knee and Hip Replacement Centers for Knee and Hip Replacement must
• Multidisciplinary teams and clinical
present clinical-based evidence to establish
pathways to coordinate and streamline
that they meet the selection criteria.
care • Use of an internal registry or database
Granville Health System has been named
Examples of some of the criteria GHS met
a Blue Distinction Center for Knee and Hip
• An established acute care inpatient
facility, Blue Distinction is a Blue Cross and Blue Shield Association (BCBSA) program that recognizes facilities that meet objective,
to track patient outcomes over time
emergency care, and a full range of
thresholds, such as complication rates and length of stay.
patient support services • An
“When it comes to spine surgery, and hip
evidence-based thresholds for clinical
and knee replacement, there is compelling
quality. These facilities have demonstrated
required annual volumes for certain
evidence that institutions with experience
that also adheres to their care protocols
experience in offering comprehensive
deliver better outcomes,” said Don Bradley,
services, including total knee replacement
replacement surgery team, including
M.D., chief medical officer of Blue Cross
and total hip replacement.
surgeons with board certification,
and Blue Shield of North Carolina. “We’re
subspecialty fellowship training, and
providing that information to our members
case volumes that meet selection
to help them make informed choices about
where to receive care that’s proven to meet
BCBSA collaborated with expert physicians and medical organizations to determine the
selection criteria for all Blue Distinction
• Preoperative patient education
programs. Candidates for Blue Distinction
• Processes to support transitions of care
national quality standards.”
Granville Health System in Top 10 of Most Customer-Friendly Hospitals The American Alliance of Healthcare Pro-
mately 400 hospitals for consideration of
Granville County and the surrounding ar-
viders named Granville Health System one
this award. Approximately 100 hospitals
eas. As we move forward, Granville Health
of the top 10 hospitals in the country in its
are recognized annually. The application
System will continue to invest further in the
2011 Hospital of Choice Awards.
process requires a review of six principal
hospital, supporting our commitment to de-
areas of consideration including standards
liver new medical programs, technologies
The award recognizes America’s “most cus-
of conduct, performance management and
and expanded services to the community.”
tomer-friendly hospitals,” according to Ric
improvement, staff development and train-
Vincent Parr, president of American Alli-
ing, systems of communication, good citi-
Granville Health System ranked third after
ance of Healthcare Providers (AAHCP). It is
zenship, and educational and promotional
first-place University of Kansas Hospital and
“designed to find America’s most customer-
second-place UCLA Medical Center. The
friendly hospitals based either on an exten-
Top 10 winners will have an opportunity to
sive application process, or by a review of
“We are pleased to be chosen as one of the
compete for the Hospital of the Year Award,
a facility’s public communication and staff
top hospitals in the nation,” says L. Lee Is-
to be announced this month.
interaction with customers,” according to
ley, Granville Health System chief executive
an AAHCP press release.
officer. “This award recognizes the high lev-
Past Hospital of Choice Award recipients
el of quality care provided by our dedicated
include The Johns Hopkins Hospital, the
doctors, nurses and staff to the patients of
Mayo Clinic and the Cleveland Clinic.
Each year, AAHCP evaluates approxi-
The Triangle Physician
Durham Regional News
U.S. News Ranks Durham Regional Fourth in Metro Area Durham Regional Hospital has been ranked
Durham Regional Hospital press release.
fourth out of 18 hospitals in Raleigh-Durham in U.S. News & World Report’s first-ever “Best Hos-
Patients and their families will have a far better
pitals” metro area rankings.
chance of finding a U.S. News-ranked hospital in their health insurance network and might not
The newly expanded U.S. News & World Report
have to travel to get care at a high-performing
rankings of hospitals in the 52 most-populous
hospital, according to the Durham Regional re-
metropolitan areas show that in three specialties
Durham Regional offers Raleigh-Durham highquality care. In those specialties, which include
“Durham Regional is honored to be recognized
kidney disorders, orthopedics and urology, its
for our treatment of kidney disorders, orthope-
performance puts it above most other hospitals
dics and urology,” said Kerry Watson, Durham
that are not nationally ranked.
Regional Hospital president. “This recognition reflects the dedication of our team of physi-
The new rankings recognize 622 hospitals in
cians, employees and volunteers who care for
or near major cities with a record of high per-
our patients every day.”
formance in key medical specialties. There are nearly 5,000 hospitals nationwide.
To be ranked in its metro area, a hospital had to score in the top 25 percent among its peers in at
Duke University Medical Center and University
least one of 16 medical specialties.
of North Carolina Hospitals, respectively, ranked in the top three hospitals in the Raleigh-Durham
“All of these hospitals provide first-rate care for
metro area, according to the 2011 U.S. News Best
the majority of patients, even those with seri-
Hospitals metro ranking. Wake Medical Center
ous conditions or who need demanding proce-
ranked No. 3 in nine specialty areas, including
dures,” said Health Rankings Editor Avery Co-
kidney disorders, orthopedics and urology.
marow. “The new Best Hospitals metro rankings can tell you which hospitals are worth consider-
U.S. News created Best Hospitals more than
ing for most medical problems if you live in or
20 years ago to identify hospitals exceptionally
near a major metro area.”
skilled in handling the most difficult cases, such as brain tumors, typically considered inoper-
For the full list of metro area rankings visit
able, and delicate pancreatic procedures. Duke
and UNC also have achieved this U.S. News national ranking. The new metro area rankings are relevant to a
Upcoming Event National prosthetic expert to host clinic Ruben Preciado knows the power of a prosthetist. A below-knee amputee for three years, Preciado, 57, of Raleigh has forged a lifelong bond with nationally recognized prosthetist David R. Sickles, a certified prosthetist/orthotist and certified pedorthist with Peak Prosthetic Performance Clinic. Sickles and his team will share their expertise with Raleigh/Durham amputees and friends or family members, by providing free, no-risk, one-on-one prosthetic evaluations May 17-19, 8 a.m. to 8 p.m., behind the Duke Raleigh Hospital. Registration is required. Sickles has three decades of experience and service in the design, fit and manufacturing of prosthesis. He is the current chief operating officer of the Center for Orthotic and Prosthetic Care (COPC) of North Carolina and New York. He is director of the National Commission on Orthotic and Prosthetic Education (NCOPE) Accredited Residency Program at COPC of North Carolina and president-elect of the North Carolina Chapter of the American Academy of Orthotics and Prosthetics (AAOP). “The aim of Peak Prosthetic Performance Clinic is to provide anyone who has suffered a traumatic limb loss the chance to be heard, the chance to know what technology is available today and the ability to reach their peak prosthetic performance,” said Sickles, who is certified by the American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. (ABC). “From microprocessor-controlled knee units to vacuum-assisted suspension sockets, my team and I have coupled the latest technology with exceptional patient care for countless amputees on their path to independance.” To contact Sickles or to register for a complementary prosthetic evaluation, call (919) 821-5221 or (919) 684-2474. For more information on the Peak Prosthetic Performance Clinic, visit www.centeropcare.com.
much wider range of health care consumers. They are aimed primarily at consumers whose care may not demand the special expertise found only at a nationally ranked Best Hospital. The added centers boast a strong record of high performance for most conditions and procedures in one or more specialties, according to a
News Welcome to the Area
Physicians Tiffany Linn Reed, DO Internal Medicine, Geriatrics Duke University Hospitals, Durham
Robert Thomas Abbott, MD Duke Health, Durham
Kristen Elizabeth Amann, MD Internal Medicine, Pediatrics University of North Carolina Hospitals Chapel Hill
Mark Robert Anderson, MD Urological Surgery Duke University Hospitals, Durham
Alison Dawn Bartel, MD
Robert Aaron Lambert, MD
Kanecia Obie Zimmerman, MD
ECU Dept of Family Medicine, Greenville
Internal Medicine, Pediatrics Duke University Hospitals, Durham
Marshall Andrew Mazepa, MD Internal Medicine University of North Carolina Hospitals Chapel Hill
Hannah Imwold Messer, MD Physical Medicine and Rehabilitation University of North Carolina Hospitals Chapel Hill
Tiffany Lynn Morton, MD University of North Carolina Hospital Chapel Hill
Todd Brandon Nelson, MD
AGAPE Clinic, Washington
Dermatology Pitt County Memorial Hospital, Greenville
Raymond Mark Bernal, MD
Dana Michelle Neutze, MD
Duke Health - Division of Urology, Durham
Elizabeth Jane Brant, MD UNC Kidney Center, Chapel Hill
Michelle Richardson Brownstein, MD General Surgery UNC Department of General Surgery Chapel Hill
Long Bao Cao, MD
Family Practice University of North Carolina Hospitals Chapel Hill
Erica Lynn O’Neill, MD Obstetrics and Gynecology University of North Carolina Hospitals Chapel Hill
Andrew Fletcher Parker, MD
Emergency Medicine Duke University Hospitals, Durham
Devin Traer Caywood, MD
Jose Luis Piscoya, MD
Radiology Duke University Hospitals, Durham
Rebecca Jean Chancey, MD Pediatrics Duke University Hospitals, Durham
Matthew Alan Collins, MD Eastern Urological Associates, Greenville
Lauren Jamie Ehrlich, MD Diagnostic Radiology, Pediatric Radiology Duke University Hospitals, Durham
Amy Minchi Fang, MD
General Surgery Durham
Alison Schmidt Powell, MD Anesthesiology University of North Carolina Hospitals Chapel Hill
Shveta Shah Raju, MD Duke General Internal Medicine, Durham
Sarah Rodgers, MD Dermatology Duke University Hospitals, Durham
Duke Eye Center, Durham
David Hallmark Ryan, MD
Kasey Kincaid Fiorini, MD
Obstetrics and Gynecology University of North Carolina Hospitals Chapel Hill
Anesthesiology University of North Carolina Hospitals Chapel Hill
Justin Richard Scruggs, MD
UNC - Division of Cardiology, Chapel Hill
Physical Medicine and Rehabilitation University of North Carolina Hospitals Chapel Hill
Thomas Andrew Gebhard, MD
Frank William Shields, MD
Jillian Roxanna Foley, MD
Diagnostic Radiology Duke University Hospitals, Durham
Katherine Lynn Harlow, MD Emergency Medicine University of North Carolina Hospitals Chapel Hill
Johann Hsin-heng Hsu, MD UNC Chapel Hill, Chapel Hill
David Paul Johnson, MD
Diagnostic Radiology University of North Carolina Hospitals Chapel Hill
David Kristofer Sutton, MD Ophthalmology University of North Carolina Hospitals Chapel Hill
John Edward Thordsen, MD Retina Associates PC, Raleigh
Pediatrics Duke University Hospitals, Durham
Charles John Viviano, MD
Paul McPherson Johnson, MD
Edward Scott Vokoun, MD
Internal Medicine University of North Carolina Hospitals Chapel Hill
Shivanand P Lad, MD Duke University Medical Center, Durham
Duke Urology of Raleigh, Raleigh
Naval Hospital Camp LeJeun
De Benjamin Winter, MD
The Triangle Physician
Jessica Eleanor Elder, PA Goldsboro
William H Etheridge, PA Roanoke Chowan Hospital Emergency Dept Ahoskie
Erin Christina Jones, PA Dayspring Family Medicine Associates, Eden
Kristin Dermody Maggi, PA Sunset Beach
Charles Ryan Woodard, MD
Pain Medicine for Shingles
Wake Research Associates Wayne Harper, MD Pain after shingles? Has your shingles rash healed, yet you are still suffering from symptoms including burning, stabbing pain, sharpness or sensitivity? If so, you may have a condition called post-herpetic neuralgia, also known as PHN. We are conducting a clinical research study for people who have experienced these symptoms for at least nine months after the onset of their shingles rash.
Jessica Kristen Roberts, PA Atlantic Orthopedics, Wilmington
Kristina Marie Stover, PA Coastal Carolina Orthopaedic Surgeons Jacksonville
New Office Cary Gastroenterology Associates’ The new office is located at 555 Medical Park Place, Suite 108, inside the WakeMed Clayton Medical Park. All six of Cary Gastroenterology’s boardcertified physicians will treat patients at both the Cary and Clayton offices. Phone and fax numbers will be the same for both locations. To schedule an appointment at either office, call (919) 816-4948.
New Office Raleigh Orthopaedic Clinic The new office is located near Rex at 3633 Harden Road, Suite 100. In addition to providing complete orthopedic services, this office will serve as the Raleigh Orthopaedic Clinic Pediatric Center. On-site services will include: fellowship-trained pediatric orthopedic surgeons, digital X-ray and therapy services. The new location is an extension of our main Raleigh office, located at 3515 Glenwood Ave. Raleigh Orthopaedic Clinic (ROC) is Wake County’s largest and oldest orthopedic practice. The orthopedic surgeons are fellowship trained in their respective subspecialty areas, which include: foot and ankle, hand and wrist, spine, hip, shoulder and elbow surgery, total joint replacements, sports medicine and pediatric orthopaedic care. Ancillary services include physical therapy, magnetic resonance imaging, radiology, shock wave therapy, and orthotics and pedorthics.
This study will evaluate the effectiveness of an investigational medication for PHN. 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.
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.
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.
“We are very excited to be in this facility,” says Karl Stein, executive director of Raleigh Orthopaedic Clinic. “The Raleigh area is growing rapidly and we want to ensure easy access to our services for our patients.”
Study-related medical exams and study medication are provided at no cost, and compensation will be provided for time and travel.
Complete practice information is available at www.raleighortho.com.
For additional information and qualification criteria please call (919) 781-2514 or visit us online at www.wakeresearch.com.
Duke University Medical Center, Durham
Clinical Trials Do you have patients with any of these problems?
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.
The Easiest Imaging Order Is Now Online. ©2010 Wake Radiology. All rights reserved. Radiology Saves Lives.
Make life easier for your schedulers today!
As a referring provider, you can now place your imaging orders online with our new CMS-compliant provider portal. You or your schedulers can login and view each of our sub-specialty order forms to make ordering a breeze. The WR Provider Portal includes: • Fast ordering with auto-fill cells • Online CPT code lists for MR and CT exams for quick reference • Order logs showing archived orders and orders pending authorization • Quick access to all WR patient forms and location maps • Complete training available for your staff Get started today by calling our referral services staff at 919-788-7909. Wake Radiology. Making your life easier. Scan now to learn all about Wake Radiology. Download any QR Reader App for your Smartphone!
1 number to call, 17 locations serving the Triangle area. | Scheduling: 919-232-4700 | wakerad.com
The Triangle Physicain magazine is a local MD to MD referral magazine