o c t o b e r 2 0 11
Cary Internal Medicine & The Diabetes Center Excellence in Diabetes, Heart and Stroke Care
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 Lawrence Marks, M.D., Appointed Oncology Research Professorship Mammograpy: Making Sense of Mixed Messages MRI Is Important Adjunct in Breast Cancer Screening
Add a pinch of spice,
a hint of laughter,
and a correct diagnosis,
and you’ll get Robert.
Robert suffered from unexplained fainting spells. His physicians couldn’t figure out why. To find answers, they implanted a Reveal® Insertable Cardiac Monitor (ICM) to see if his spells were heart rhythm related.
The Reveal ICM is a long-term heart monitor that may help you rule in or rule out an abnormal heart rhythm as the cause of unexplained fainting spells. In Robert’s case, they were, and now he has a pacemaker. Possible risks associated with the implant of a Reveal Insertable Cardiac Monitor include, but are not limited to, infection at the surgical site, device migration, erosion of the device through the skin and/or sensitivity to the device material. Results may not be typical for every patient.
Brief Statement Indications 9529 Reveal® XT and 9528 Reveal® DX Insertable Cardiac Monitors – The Reveal XT and Reveal DX Insertable Cardiac Monitors are implantable patient-activated and automatically activated monitoring systems that record subcutaneous ECG and are indicated in the following cases: • patients with clinical syndromes or situations at increased risk of cardiac arrhythmias; • patients who experience transient symptoms such as dizziness, palpitation, syncope, and chest pain, that may suggest a cardiac arrhythmia. 9539 Reveal® XT and 9538 Reveal® Patient Assistants – The Reveal XT and Reveal Patient Assistants are intended for unsupervised patient use away from a hospital or clinic. The Patient Assistant activates one or more of the data management features in the Reveal Insertable Cardiac Monitor: • To verify whether the implanted device has detected a suspected arrhythmia or device related event. (Model 9539 only); • To initiate recording of cardiac event data in the implanted device memory. Contraindications: There are no known contraindications for the implant of the Reveal XT or Reveal DX Insertable Cardiac Monitors. However, the patient’s particular medical condition may dictate whether or not a subcutaneous, chronically implanted device can be tolerated. Warnings/Precautions: 9529 Reveal XT and 9528 Reveal DX Insertable Cardiac Monitors – Patients with the Reveal XT or Reveal DX Insertable Cardiac Monitor should avoid sources of diathermy, high sources of radiation, electrosurgical cautery, external defibrillation, lithotripsy, therapeutic ultrasound and radiofrequency ablation to avoid electrical reset of the device, and/or inappropriate sensing. MRI scans should be performed only in a specified MR environment under specified conditions as described in the device manual. 9539 Reveal XT and 9538 Reveal Patient Assistants – Operation of the Model 9539 or 9538 Patient Assistant near sources of electromagnetic interference, such as cellular phones, computer monitors, etc., may adversely affect the performance of this device. Potential Complications: Potential complications include, but are not limited to, device rejection phenomena (including local tissue reaction), device migration, infection, and erosion through the skin. See the device manual for detailed information regarding the implant procedure, indications, contraindications, warnings, precautions, and potential complications/adverse events. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.
UC201003796 EN © Medtronic, Inc. 2009. Minneapolis, MN. All Rights Reserved. Printed in USA. 11/2009
For more information, visit www.fainting.com.
JOHNSTON HE ALTH
Cary Internal Medicine & The Diabetes Center
Excellence in Diabetes, Heart and Stroke Care
o c t o b e r 2 011
Vol. 2, Issue 10
Mammography: Making Sense of Mixed Messages
DEPARTMENTS 14 Radiology
Your Financial Rx
Putting Paul in the Hot Seat Paul Pittman chats about his role models,
Dr. Jennifer Van Vickle points to recent
thinking outside of the box and “post-
studies that prove annual mammography
modern” financial planning.
beginning at age 40 saves lives.
MRI Is Important Adjunct in Breast Cancer Screening
18 WakeMed News Physician Network Grows; New Executives Named
19 Rex Health Care News Cary Surgery Center Earns Accreditation
UNC Hospital News 20 Country’s First Inpatient Perinatal Psychiatry Unit Opens
20 Scientist to Study Post-Mastectomy Breast Reconstruction Decision Making
21 New Nanoparticle for Cancer Therapy; Cost-effective Infection-Control
22 24-Week Treatment for Hepatitis C Is Effective, Reduces Side Effect Exposure
23 Dr. Lawrence Marks Is Appointed to an Oncology Research Professorship
Duke Research News 24 Cost-effective Use of Breast Cancer MRI; Exercise and Arthritis
25 Study Reveals New Understanding of Cholesterol’s Role in Bone Loss
26 Nurse Transition Program to Evaluate Safety and Outcomes
27 Women’s Wellness Cover Image: From left, Dr. Prashant K. Patel, Dr. Amrita Parikh and Dr. Vijay K. Juneja form the internal medicine team at Cary Internal Medicine & The Diabetes Center. Jim Shaw Photography.
The Triangle Physician
Women’s Wellness Center Offers Opportunities for Clinical Research
Experience makes good medicine accurate
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From the Editor
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
Type 2 diabetes is deadly and pervasive, yet largely preventable through healthy diet and regular exercise. Once diagnosed, diabetes management is doable, but difficult at best. Among those on the forefront of diabetes prevention and management in the RaleighDurham region is the health care team of Cary Internal Medicine & The Diabetes Center, our cover story this month. Together, with diabetes educators and dieticians, the physicians guide patient-centered teams to effect proper self-care practices. Dr. Prashant Patel also has taken a lead in advancing diabetes awareness locally. When learning all that’s involved to manage diabetes – the necessary self care and major lifestyle changes – those with type 2 can only wish they had fixed their unhealthy habits sooner. It would have been so much easier. That’s the message they didn’t hear or didn’t want to hear. What if that message could inspire the appropriate response? Think of the lives, hardship and money that could be saved. Breast cancer is as yet unpreventable, but radiologists are refining imaging methods for early detection. In this issue, Dr. Carmelo Gullotto discusses the benefits of magnetic
Editor Heidi Ketler, APR
Contributing Editors Carmelo Gullotto, M.D. Paul J. Pittman, C.F.P. Jennifer S. Van Vickle, M.D. Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G Photography Jim Shaw Photography email@example.com Creative Director Joseph Dally
Advertising Sales Carolyn Walters firstname.lastname@example.org Natalie Snapp email@example.com News and Columns Please send to firstname.lastname@example.org
resonance imaging in combination with mammography and ultrasound. Just as powerful is public awareness of the importance of early detection. So thanks to Dr. Jennifer Van Vickle for an article that can help us set the record straight about mammography. Money is always top of mind, so returning is our resident financial planner, Paul Pittman. This month, his column is presented in a question-and-answer format that offers a story on thinking outside the box and a heads up about the new “post-modern” investment strategy. The October issue of The Triangle Physicians is a great read, with important insight, news and information. You are encouraged to join our list of contributors and advertisers, who are reaching more than 9,000 physicians, physician assistants and health care administrators. With that kind of readership, you can only wonder, what if… ? As always, our gratitude for all you do!
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 Internal Medicine & The Diabetes Center Excellence in Diabetes, Heart and Stroke Care C
ary Internal Medicine & The Diabetes
physicians in Wake County to be recognized
diabetes to reduce complications has always
Center is a full-service internal medicine
by the National Committee for Quality
been central to our practice,” says Dr. Patel.
practice, specializing in the treatment and
Assurance for meeting the highest standard
management of diabetes, heart disease,
in diabetes care in 2004. They also earned
Drs. Patel and Juneja acquired Cary Internal
stroke and women’s health.
NCQA recognition for excellence in heart/
Medicine & The Diabetes Center at 103
Blaines Court, after its founder, Fred C.
Leading the practice are Prashant K. Patel,
Oliver, M.D., retired in 2000. Having been “Diabetes is, as yet, incurable, but it is
established in 1979, the medical practice is
who have long recognized the connection
manageable with aggressive lifestyle changes
the oldest in Cary. Amrita Parikh, M.D., joined
between diabetes and complications that
and medication. Because diabetes and pre-
the practice in 2006. All three physicians are
can lead to heart disease and stroke. Through
diabetes are associated with the myriad
certified with the American Board of Internal
their proactive, patient-centered approach to
health problems that internists treat, helping
Medicine and members of the American
diabetes management, they became the first
patients effectively manage diabetes and pre-
College of Physicians.
PHOTO BY JIM SHAW PHOTOGRAPHY
M.D., F.A.C.P., and Vijay K. Juneja, M.D.,
Dr. Amrita Parikh (left) answers patient Joti Pallan’s women’s health questions.
The Triangle Physician
Cary Internal Medicine offers a full range of
third is undiagnosed and untreated.)
medical services, including routine physical
•T ype 2 diabetes accounts for 95
and gynecologic examinations. Patients
percent of all diabetes cases.
have in-office access to the latest diagnostic
vascular) complications. Unlike patients with type 1 diabetes, the majority of patients with type 2 do not need insulin to survive.
•A pproximately 20.6 million Americans
tests and treatments, such as: • Cardiovascular risk assessment, using treadmill stress testing,
age 20 and older, or 9.6 percent of the
population, have diabetes.
Education Program, heart disease and stroke
•A mong those age 65 and older 10.9
electrocardiograms and lipid profiles; • Pulmonary function testing, using spirometry, and nebulizer treatments; skin tag, wart and mole removal, biopsies and laceration repairs;
accounted for about 65 percent of deaths in
million, or 26.9 percent are diagnosed
people with diabetes in 2002. Adults with
diabetes had heart disease death rates two
•O f those younger than 20,
• Minor surgical procedures, such as
to four times higher than adults without
approximately 215,000 have diabetes
diabetes. Their risk for stroke also was two to
(type 1 or type 2).
four times higher.
•A bout 79 million Americans over age
• Bone density testing; and
20 (50 percent of adults age 65 and
Obesity and age are major risk factors for
• Vision testing.
older) have pre-diabetes.
diabetes. Abdominal obesity is an indicator of insulin resistance. The abdominal fat is
Medical care is expedited and convenience
Type 1 diabetes can occur at any age, most
thought to prohibit insulin from converting
is enhanced by onsite laboratory services.
commonly in juveniles but also in adults,
sugar, starches and other food into energy needed for daily life.
“Diabetes is, as yet, incurable, but it is manageable with aggressive lifestyle changes and medication. Because diabetes and prediabetes are associated with the myriad health problems that internists treat, helping patients effectively manage diabetes and pre-diabetes to reduce complications has always been central to our practice.” – Prashant Patel, M.D., F.A.C.P.
“The epidemic of obesity in America and our aging population, coupled with lack of awareness, assure the incidence of diabetes will increase,” says Dr. Patel. NDEP estimates the total number of people with diabetes in the United States will be 30.3 million in 2030, which will place the United States third in global prevalence, after India and China. “If recent trends in diabetes and pre-diabetes prevalence rates continue linearly over the next 50 years, future changes in the size and demographic characteristics of the U.S.
State of Diabetes in Nation a Concern
especially in their late 30s and early 40s.
population will lead to dramatic increases
Unlike people with type 2 diabetes, those
in the number of Americans with, or at risk
The statistics for diabetes are grim. Diabetes
with type 1 generally are not obese. The
for, diabetes,” says Dr. Juneja. “The current
– a group of diseases marked by high levels
distinguishing characteristic of a patient with
increase in the number of new cases in
of blood glucose resulting from defects in
type 1 diabetes is that ketosis and eventually
people age 40 to 59 raises the need for
insulin production, insulin action or both –
ketoacidosis develop if insulin is withdrawn.
interventions focused on this segment of the
ranks seventh as the leading cause of death
Therefore, these patients are dependent on
by disease in the United States. According
to the Centers for Disease Control and
NDEP estimated the cost of diabetes in 2010
Prevention, the risk for death among people
Type 2 diabetes comprises an array of
at $174 billion. The total includes direct
with diabetes is about twice that of people of
dysfunctions resulting from the combination
medical costs ($116 billion) and indirect
similar age who do not have diabetes.
costs ($58 billion), those associated with
inadequate insulin secretion. Its disorders
loss of work, disability and premature
death. After adjusting for population age
• Diabetes affects 25.8 million people in
and associated with microvascular (i.e.,
and gender differences, the average medical
the United States, or 8.3 percent of the
retinal, renal, possibly neuropathic) and
expenditures among people with diagnosed
population. (Of that total, about one-
macrovascular (i.e., coronary, peripheral
diabetes were 2.3 times higher than what
Its 2011 fact sheet also reports:
over time), blood pressure and low-density lipoprotein cholesterol values – collectively known as the “ABCs” of diabetes. A1c values and self-monitoring of blood glucose (SMBG) guide therapy for achieving glycemic targets and minimizing the risk of complications. The self-care plan takes into consideration the patient’s age, school or work schedule, physical activity, eating patterns, social situation and cultural factors, and presence of complications of diabetes or other medical conditions. While
Program (NDEP) study in 2007 found an acceptance of the importance of maintaining individual ABC goals among physicians, a significant number of them recognized their patients were not reaching their goals. Successful
teaching the ABCs, says Dr. Patel. “The didactic approach is to teach the relevant information about the ABCs and provide recommendations to patient care. The approach that empowers patients with knowledge and understanding of the ABCs within the context of personalized goalsetting, skill-building and one’s daily roles is Dr. Prashant Patel (right) explains the features of an insulin pump with patient Ronald Herschkorn.
the most effective,” he says.
expenditures would be in the absence of
individualized care for patients with pre-
At The Diabetes Center, patients have an
diabetes and diabetes is based on proven
integrated health care team that includes
models and backed by years of experience,
a certified diabetes educator, a dietician,
“Treatment costs for people with diabetes are
says Dr. Patel. “Our practice is uniquely
the referring physician and other health
more than double those for people without
positioned to meet the growing need.”
care providers, as necessary. The team is
diabetes, mainly because of the high costs associated with complications,” says Dr. Juneja. Cardiovascular disease remains the most costly complication of type 2 diabetes.
coordinated by Drs. Patel and Juneja.
Diabetes Management Is Patient-Centered and Goal-Oriented The
“The therapeutic alliance works closely with the patient to develop attainable goals diabetes
for metabolic control, improved lipid levels
The positive news is that diabetes can be
management is patient understanding and
and reduced blood pressure,” says Dr. Patel.
prevented or delayed. “Lifestyle changes
self-care practices that empower him or her
“It is a collaborative process in which the
and ongoing management of both type 1
to make day-to-day and often hour-to-hour
diabetes educator helps the patients gain the
and type 2 diabetes can also prevent many
knowledge and problem-solving and coping
complications associated with the disease,”
skills needed to successfully self-manage the Patients must have a working knowledge of
says Dr. Juneja.
disease and its related conditions.”
the three key metabolic markers: hemoglobin The
The Triangle Physician
A1c (a measure of average blood sugar levels
“Our practice is unique in that we effectively
“Primary prevention remains an important area of focus for us. There needs to be more communication about pre-diabetes and the power of diabetes prevention with patients, as well as other health care professionals.” – Prashant Patel, M.D., F.A.C.P. manage diabetes in adults from A to Z,
month. Now my readings are consistently
beginning with diagnosis,” says Dr. Juneja.
between 100 to 130. I wish I had been referred sooner!”
Patient Frankie Lemons was referred by her serious hypoglycemic episodes resulting in
Medication Management and Monitoring
Oral diabetes medication is often prescribed
hospitalization. “When I was diagnosed with
The Diabetes Center physicians have the
for type 2 patients whose bodies still
type 2 diabetes, I believed oral medication
specialized understanding to prescribe
produce some insulin. When beta-cell failure
would be enough to manage my blood sugar
injectable insulin, oral pills and medication
develops, insulin injections are required
swings. Now, I have a better understanding
and prescribed either in combination with
of the impact of diet and lifestyle on my
weight control, as needed and to best
diabetes. I have focused on the proper
suit the patient. “There are many forms of
adjustments and haven’t been to the hospital
medication, and the type selected is based
Advanced care using a continuous glucose
since. I feel I have gotten my life back, and I
on a body’s response to it and the patient’s
monitoring system is prescribed for patients
am so grateful.”
ability to monitor and self-administer,” says
with diabetes that is difficult to control.
“Studies have shown the benefits of using
internist to The Diabetes Center after several
diabetes pills or alone.
a CGM (continuous glucose meter), even
“I was referred by my family physician to The Diabetes Center because of wide variations
Insulin is the only medication that can be
in people with good blood sugar control,”
in my glucose levels, from the 40s to 500s,”
used to control the increases in blood sugar
says Dr. Patel. “The patients spent more time
says Ronald Hershkorn, a patient with type
that occur with type 1 diabetes. For those
every day within their target glucose range,
2 diabetes. “The staff and physicians helped
with type 2, insulin may be used alone or
had lower A1c levels and fewer low blood
me get started on the insulin pump, and
in combination with diabetes pills or other
I have had amazing results in less than a
medications. New CGM technology has enhanced comfort and convenience, minimizing user error in calculations and leading to greater patient compliance. Since continuous monitors are not as accurate as the standard meters, patients are advised to use a standard meter one or two times a day to confirm their CGM reading.
Lifestyle Changes and Weight Loss The Diabetes Prevention Program, a large study of people at high risk for diabetes funded by the National Institute of Diabetes and Digestive and Kidney Diseases, showed lifestyle intervention to lose weight and increase physical activity reduced diabetes
“If recent trends in diabetes and pre-diabetes prevalence rates continue linearly over the next 50 years, future changes in the size and demographic characteristics of the U.S. population will lead to dramatic increases in the number of Americans with, or at risk for, diabetes.” – Vijay Juneja, M.D.
Before people develop type 2 diabetes, they almost always have pre-diabetes – blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as diabetes. In studies, the rate of progression has ranged from an average of three years to 10 years. NDEP reported in 2008 that a survey found only 25 percent of those at high risk for diabetes believed they were at risk. In addition, only a small percentage (9 percent) of the population at risk for developing diabetes had been told by their physician.
incidence, especially among adults age 60
problems, says Dr. Patel. The combination
and older. It also found lifestyle intervention
of conditions in metabolic syndrome – high
It is estimated that about one-third of the U.S.
to be more cost effective than medications in
blood pressure, elevated insulin levels,
population has pre-diabetes, but is unaware
people with type 2 diabetes.
excess body fat around the waist and
of it. Symptoms can be subtle – such as
abnormal cholesterol levels – increase the
excessive urination, thirst, itching, difficulties
risk of heart disease, stroke and diabetes.
concentrating, weight loss – or absent.
Early Intervention Can Turn Back the Clock
Statistics show that people with pre-diabetes
the support of a network of health care professionals, have the greatest effect
“Primary prevention remains an important
compared to people with normal blood
managing their diabetes,” says Dr. Patel.
area of focus for us,” says Dr. Patel, “There
glucose. “Those with pre-diabetes may
“Those who pursue aggressive lifestyle changes, such as losing weight, exercising and quitting smoking, in addition to
have a 1.5-fold risk of cardiovascular disease
needs to be more communication about
already be experiencing long-term damage
This treatment approach also can delay
pre-diabetes and the power of diabetes
to the body, especially the heart and
or prevent the development of metabolic
prevention with patients, as well as other
circulatory system,” says Dr. Patel.
health care professionals.”
Dr. Vijay Juneja and patient Frankie Lemons review the results of her continuous glucose monitoring.
The Triangle Physician
than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain,” says Dr. Parikh. Cary Internal Medicine physicians also monitor women for diabetes after they have experienced gestational diabetes. “Blood sugar usually returns to normal soon after delivery for most women with gestational diabetes, but the risk of developing type 2 diabetes in the future remains,” says Dr. Parikh. “It is estimated that half of women with gestational diabetes will develop diabetes within 10 to 15 years.”
Advocate for Patients and Physicians pre-diabetes,
“As with men, women’s most common heart
Dr. Patel has embraced a mission of patient
intervening early can actually turn back
attack symptom is chest pain or discomfort.
advocacy and medical stewardship.
the clock and return elevated blood
But women are somewhat more likely
glucose levels to the normal range,” says Dr. Patel. Studies have shown that those
with pre-diabetes can prevent or delay the
development of type 2 diabetes by up to 58 percent through changes to their lifestyle that include modest weight loss and regular exercise.
Dr. Patel advises that testing for pre-diabetes
in patients with risk factors for diabetes begin at age 12 in children who are overweight and be repeated every three years.
Women’s Health, Heart and Diabetes The physicians with Cary Internal Medicine & The Diabetes Center are keenly aware of
the issues surrounding women’s health, particularly cardiovascular disease, the leading cause of death in women. Although heart disease is sometimes thought of as a “man’s disease,” it kills about the same number of women and men each year in the U. S. Unfortunately, 36 percent of women in a 2005 Centers for Disease Control and Prevention survey did not perceive themselves to be at risk for heart disease.
1. This 90°, soft cannula infusion set combines ease of use with maximum comfort. The Quick-serter® may be used to easily and comfortably insert the cannula under your skin. 2. The Quick-serter is the insertion device for the Quick-set. The Quick-serter insertion device makes insertions quick, easy, and virtually painless. 3. The Paradigm Revel Insulin Pump lets you customize your insulin delivery to fit your lifestyle and leave the hassle of insulin injections behind. The Revel Insulin Pump comes CGM ready, so when you want to add a transmitter and glucose sensor to your Revel Insulin Pump, you can have the added protection from lows and highs 4. CareLink® USB upload device wirelessly sends data from your MiniMed Paradigm® Insulin Pump to CareLink® Personal software. 5. A compatible glucose meter is included with all new insulin pump orders which automatically sends your test results wirelessly to your Paradigm® Revel™ Insulin Pump. This helps reduce the number of button pushes and data entry mistakes, making insulin pump therapy more convenient and accurate.
From left, Angela Allen, Dawn Howdyshell and April Richardson are medical assistants at Cary Internal Medicine & The Diabetes Center.
He is frequently featured in the local media to help
raise awareness of diabetes prevention and early
Wainwright to the Quality, Access, Value Committee
detection. He has been involved in guiding health
and most recently the Acute Care Services Committee,
care policy in Washington, D.C., as a member of the
also referred to as the CON committee. In the fall of
Leadership Council for Improving Cardiovascular
2009, he was invited to serve on the Legislative Cabinet
Care, and in North Carolina, as a member of American
of the North Carolina Medical Society.
Diabetes Association Leadership Council. He also served on the physician’s advisory board of a major
This year, Dr. Patel was honored to be selected for the
North Carolina health insurance company.
“Physician Profile” by the editorial board of The Wake
Dr. Prashant K. Patel
County Physician magazine. He also was selected as Dr. Patel is a founding member of the Triangle Indian-
a 2012 scholar of the North Carolina Medical Society
American Physicians Society (TIPS), which began
in 2006, and of the North Carolina Indian-American Political Action Committee.
Physician Consultation and Referral Cary Internal Medicine & The Diabetes Center offers
In these capacities, he led a team of 10 physicians to
consultation services on diabetes for physicians who
the halls of Congress Oct. 8, 2009, when they met with
are in a position to detect diabetes early – namely
six North Carolina congressional leaders in the House
family physicians, pediatricians and primary care
and Senate about health care reform. In particular, they
physicians, such as internists and gynecologists.
Dr. Vijay K. Juneja
discussed a permanent fix to the flawed sustainable growth rate formula and effective tort reform.
Referrals also are welcome.
On Jan. 1, 2010, Dr. Patel was awarded a fellowship
Contact Cary Internal Medicine & The Diabetes Center
by the American College of Physicians. On March 1,
at (919) 467-6125 or visit www.caryinternalmedicine.
2010, he was appointed by Gov. Beverly Perdue to the
com. Dr. Patel also suggests the website
State Health Coordinating Council (SHCC). He was
betterdiabetescare.nigh.gov for more information.
then appointed by SHCC Chairman and the honorable
The Triangle Physician
Dr. Amrita Parikh
Making Sense of Mixed Messages By Jennifer S. Van Vickle, M.D.
The American Cancer Society recommends yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.
uring the past two years women have been barraged with mixed messages about mammography. The traditional recommendation of yearly mammography beginning at age 40 was thrown into question when the United States Preventive Services Task Force published recommendations in 2009. This left many women and health care providers confused about who should have mammograms, how often and when. Fortunately, the information isn’t as confusing as it seems. Numerous studies have shown
that mammography saves lives. The most recent information comes from the Swedish Two-County Trial. The study is the longest running prospective randomized controlled study of mammography ever conducted. The study included 133,065 women ages 45 to 74 and published initial results 10 years after the beginning of the study. The 10-year data showed a significant reduction in breast cancer mortality. The data published this summer include 29 years of follow-up and show that the benefit has doubled. This is consistent with other prospective studies. The combined data
of multiple prospective studies shows that mammography saves lives. The U.S. Preventive Services Task Force agrees that mammography saves lives. What the task force focuses on is tradeoffs related to a woman’s age, overall health and risk of having breast cancer. Since younger women are less likely to have breast cancer than older women, young women are more likely to have unnecessary call-back mammograms or biopsies that are benign. On the other
hand, older women may be more likely to have a positive callback or biopsy, but to be in poor health. As a result, diagnosing and treating the cancer may or may not prolong their lives. When informed and involved in the decision, most younger women prefer to take these issues in stride for the possibility that mammography may save their life. For women in poor health, discussion with their health care provider is important in deciding whether screening mammograms make sense for them.
Dr. Jennifer Van Vickle has been a women’s imaging and abdominal imaging radiologist with Raleigh Radiology since 2002. She also is medical director of ultrasound at Rex Hospital. Dr. Van Vickle earned her bachelor’s degree from the University of Chicago and master’s degree in theology, followed by her medical degree from Duke University. She completed an internship in internal medicine, a residency in diagnostic radiology and a fellowship in abdominal imaging and mammography at Duke University Medical Center. Areas of expertise include breast imaging, breast intervention, and abdominal and pelvic imaging, using computed tomography, ultrasound and magnetic resonance imaging.
These issues are taken into consideration by the American Cancer Society in its mammography guidelines. The American Cancer Society recommends yearly mammograms starting at age 40 and continuing for as long as a woman is in good health. One concern is that confusion about this information will dissuade women who may benefit from mammograms from getting them because they are anxious, have busy schedules or have trouble making financial ends meet. It is important to make decisions about screening mammograms based on a realistic perspective about mammography’s benefits, rather than these obstacles. Raleigh Radiology offers: • Extended morning, evening and weekend mammography hours. • Online and call-in scheduling • Rapid reporting to minimize the length of time women wait for their results. • Ultrasound-guided biopsies with rapid turn-around times. • Free screening mammograms to uninsured on National Mammography Day each October. • Self-pay discounts. • Educational materials to help women understand screening and self-breast exam. October 2011
MRI Is Important Adjunct in
Breast Cancer Screening By Carmelo Gullotto, M.D.
agnetic resonance imaging (MRI)
scar and recurrent breast cancer in
Recent literature has demonstrated that
of the breasts is the most accurate
patients who have already been treated
in BRCA1 and BRCA2 carriers annual
for breast cancer.
surveillance with breast MRI is associated
imaging method to detect and stage breast cancer. Used in conjunction with
• Evaluating response to cancer treatment.
with a significant reduction in the incidence
mammography and ultrasound, breast MRI
• Identifying cancer not detected by
of advanced-stage breast cancers. In the
can solve diagnostic dilemmas and uncover
mammography in high-risk patients.
cohort of 1,275 women evaluated by Warner
et al, the group of patients in the breast MRI
Breast MRI can be helpful in these situations:
For certain women at high risk for breast
group had a significantly greater incidence
of being diagnosed with ductal carcinoma
recommends annual breast MRI screenings
in situ and stage 1 breast cancer. While
breasts (as often found in younger
as an adjunct to screening mammography.
the group that did not undergo annual
women) when mammography and
Among them are women who have a greater
screening, breast MRI had a significantly
ultrasound fail to detect or characterize
than 20 percent calculated lifetime risk of
higher incidence of a diagnosis of stage 2 to
a palpable abnormality.
breast cancer (average lifetime risk in the
stage 4 breast cancer. These data confirm the
• Determining the extent of a known
United States is 12-13 percent) as defined by
ability of breast MRI to detect breast cancer
cancer and evaluating for possible
a risk calculator such as the Gail model. Also
at its earlier stages when it is potentially
occult disease in the contralateral
included in this group are those who have
BRCA1 and BRCA2 gene mutations and those
mammographically. MRI is the most
with a first-degree relative who is a BRCA gene
Patients for whom the ACS states that
sensitive and specific imaging method
carrier. Typically patients in this high-risk group
there is currently insufficient evidence to
for local staging of breast cancer.
undergo alternating breast MRI and screening
recommend for or against screening breast
mammograms at six-month intervals.
• Differentiating between post surgical
Local staging breast MRI: Mammographically detected invasive ductal carcinoma was identified in the left breast (yellow arrow). Right breast lesion was seen on MRI but was mammographically occult (red arrow). Subsequent MRI-guided biopsy of the right breast lesion yielded invasive ductal carcinoma.
The Triangle Physician
High-risk screening breast MRI: Chronic seroma from a prior procedure was identified (yellow arrow). An area of suspicious enhancement was mammographically occult (red arrow). Subsequent MRI-guided biopsy yielded high-grade ductal carcinoma in situ.
Dr. Carmelo Gullotto is a body imaging radiologist and breast magnetic resonance imaging specialist, board certified in diagnostic radiology by the American Board of Radiology. He has been with Wake Radiology since 2004. Special clinical interests are abdominal imaging and MRI. A native of Syracuse, N.Y., Dr. Gullotto is a graduate of Duke University School of Medicine in Durham, where he was a resident in diagnostic radiology and a fellow in abdominal imaging. He is a member of the Radiological Society of North America, North Carolina Medical Society and the Wake County Medical Society.
Do They Like What They See? Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations. Our services range from consultation, to design, to creation and implementation of strategic plans.
• Patients with a 15-20 percent lifetime risk of breast cancer • Patients with a personal history of
newsource & Associates
lobular carcinoma in situ, atypical lobular or atypical ductal hyperplasia • Patients with a personal history of breast cancer
Call (540) 650-3686 or send inquiries to email@example.com.
In summary, in the appropriate patient
Our network of smart, creative, award-winning specialists serves the health care industry throughout the Mid-Atlantic.
Maybe it’s happiness in a child’s eyes. Whatever the desired outcomes, count on us to ensure your key messages have the 20/20 clarity to deliver.
population, breast MRI is a useful adjunct to screening mammography in the detection of breast cancer, a problem solver for diagnostic dilemmas not fully evaluated by mammography and ultrasound, and useful in evaluating extent of disease in patients with newly diagnosed breast cancer. Citations “American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography,” published in the March/April 2007 CA: A Cancer Journal for Clinicians (Vol. 57, No 2: 75-89). First author: Debbie Saslow, Ph.D., American Cancer Society. “MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer,” published in the March 29, 2007 New England Journal of Medicine (Vol. 356, No 13: 1295-1303). First author: Constance D. Lehman, M.D., Ph.D., University of Washington Medical Center, Seattle. “Prospective Study of Breast Cancer Incidence in Women With a BRCA 1 or BRCA 2 Mutation Under Surveillance With and Without Magnetic Resonance Imaging,” published in the May 2011 Journal of Clinical Oncology (Vol. 29, No 13: 1652-1654). First author: E Warner, Sunnybrook Odette Cancer Centre, Women’s College Research Institute, Ontario.
Managing your patients’ health is your life’s work. Managing physicians’ wealth is mine. 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® President and Managing Director 919-459-4171 firstname.lastname@example.org www.pcgnc.com Securities offered through LPL Financial Member NASD/SIPC Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers
Your Financial RX
Putting Paul in the Hot Seat By The Triangle Physician
Because markets are inefficient, you have to combine non-correlating assets, as well as defensive positioning and active management. It’s not a buy-and-hold kind of world out there anymore.
would give me a great sense of satisfaction. I now feel as if I am making something good out of what my parents went through. TTP: What has been your biggest surprise in working with physicians? Paul: Physicians are caregivers and healers, but they are also business owners. I used to be surprised by their resourcefulness, but not any more. One outstanding example
This month, The Triangle Physician is going
gave me the desire and conviction to work
is a urologist in Cary, Dr. Marc Benevides.
to turn the tables a bit and interview Paul
with families to help them achieve financial
Not only is he a spectacular physician on
Pittman, a certified financial planner and
peace of mind. I don’t want other people to
the cutting edge of his specialty and a great
regular contributor to this column.
go through the struggle my family did, and
person, but he is also an extremely astute
I don’t want other people to lose what they
TTP: Paul, you have been writing
your Financial Rx column for many
He once old me that as the check signer
years now. Aside from all of the great
TTP: It sounds like very hard lessons to
for his practice he would be astonished by
information you have passed on, what
learn, and your parents must have been
the amount paid for medical supplies. After
makes you different from all of the
further investigation, he was “horrified.” He
financial advisors out there?
could not believe what his practice was Paul: Terrific teachers and great role models
paying for catheters, gauze, urine strips and
Paul: I know there are many out there who
for me on how to live life. As I watched my
physicians could work with, but I truly believe
parents during those tough years, it became
in what we’re doing here (The Preferred
apparent to me that they were very clear
Client Group), and that what we stand for is
on two things. First, taking care of family
unique. Let me share something with you.
was their No. 1 priority. They made sure we
When I was 17, my father was laid off from a
had basic material needs taken care of and
long career and found himself unemployed
then they surrounded us with love. Second,
at age 56. Not many companies were looking
they knew what they valued and what they
to hire a 56 year old. My mother had a full-
cherished, and they lived those values.
time job, but they struggled to work and raise three kids. Money was always tight. We lived
Because of my parents’ experience, I
from paycheck to paycheck. But through
realized that my passion was to help people
their love and hard work, we made it.
financially. If I could, through thoughtful financial planning, help people multiply
The story has a happy ending, but that
their current savings and earnings, as well
experience left an indelible mark on me. It
as protect what they already have, then that
The Triangle Physician
Paul J. Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 459-4171 and email@example.com.
some bonds and some treasuries; I am
theory, because we see the markets as
referring to philosophical diversification.
inefficient. This means you have to combine
If the economy and markets have told
non-correlating assets, as well as defensive
us anything over the last 10 or so years,
positioning and active management. It’s
it is to incorporate different investment
not a buy-and-hold kind of world out there
philosophies in your investments.
Modern portfolio theory sees the markets
TTP: Paul, thank you for your time and
as efficient. This may have been the case in
insight. We will continue this interview
the past, but not anymore. We now utilize
in next month’s issue.
what we refer to as post-modern portfolio
So he decided to do something about it. He found that many of the established United States manufacturers were willing to deal with him directly, that products his practice already used could be obtained at a significantly reduced price. Interestingly enough, it didn’t stop there. The desire to save on overhead in his office morphed into Physicians’ Own Pharmacy, a physicianowned medical supply company. Any physician interested in saving overhead at no expense to quality can become a member shareholder. Details are available at popmedical.com. Physicians have relinquished so much control of so many aspects of their practices to insurance companies, vendors, etc., this is one way to regain an element of that control and expense. And it’s one example of how physicians are thinking outside of the box when it comes to running the business side of their practice. TTP: Interesting story. We sometimes forget that physicians are businesspeople, too. Any investment advice you’d like to give our readers in this economy? Paul: Absolutely! One of the most overused terms in the investment business is diversification, but it is very important. I am not just talking about owning some stocks, Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
Physician Network Grows The WakeMed Physician Practices network
Madan, M.D., who brings 25 years of family
access, supporting a team of directors,
continues to expand access in Wake County,
managers and staff.
Accent Urgent Care centers in Raleigh and
Several new physicians will join WakeMed’s
Mr. Harrington will oversee all aspects of
Cary and new primary care practices in
existing primary care practices this fall. The
the revenue cycle, including continued
north Raleigh and Apex. New physicians
following physicians joined this summer:
process improvements undertaken during
most recently with the acquisition of two
also are being added in the existing Brier
the past two years. Additionally, he will be
Creek and downtown Raleigh primary care
Amy Erickson, D.O., joined Brier Creek
tasked with managing health care reform
Medical Group in August as a board-certified
implementation related to revenue cycle,
family medicine physician with experience
and adjusting processes and procedures to
The urgent care centers joined the WakeMed
in private practice and in the United States
accommodate system growth.
Physician Practices network Oct. 1. The
Air Force. Dr. Erickson earned her medical
Cary location is adjacent to WakeMed
degree in osteopathic medicine from the
“Mr. Harrington was selected from a wide
Cary Hospital and the Raleigh location is
University of New England College of
range of well-qualified candidates for
near the corner of Blue Ridge and Harden
Osteopathic Medicine, Biddeford, Maine,
his depth and breadth of experience in
roads. Accent Urgent Care serves adults
and completed her residency in family
outstanding health care organizations. His
and children of all ages seven days a week,
practice at Albany Medical College.
broad financial and revenue cycle expertise
with more than a dozen providers, including physicians and physician assistants.
will help us negotiate highly competitive Brian Klausner, M.D., is board certified in
managed care contracts and prepare for
internal medicine, and joined City Center
anticipated changes related to health care
WakeMed also acquired North Wake Internal
Medical Group in downtown Raleigh in
reform. We are looking forward to welcoming
Medicine, a well-established primary care
September. Dr. Klausner received his
him into the WakeMed family,” said William
practice in north Raleigh, which will add to
medical degree from Georgetown University
K. Atkinson II, Ph.D., president and chief
its physician network Susheel Atree, M.D.;
School of Medicine and completed his
Behnaz Atree, M.D.; and Rosa Messer,
residency in internal medicine at University
M.D., effective Nov. 1. The practice at
of Chicago Hospitals.
WakeMed North Healthplex will be relocated
Mr. Harrington has more than 25 years of experience in health care finance. Most
to the adjacent Physicians Office Pavilion
VP of Revenue Cycle Named
recently, he served as vice president of
at North Healthplex to accommodate the
Effective Oct. 17, Dudley Harrington will
managed care and revenue cycle for MCG
expansion of North Healthplex into a full-
assume the role of WakeMed Health &
Health Inc., in Augusta, Ga. MCG Health
service women’s hospital.
Hospitals vice president of revenue cycle,
is a not-for-profit corporation supporting
responsible for managing its $1 billion in net
the research and education mission of the
Medical College of Georgia by operating a
WakeMed Physician Practices established Wake Specialty Physicians-Apex Medical
478-bed medical center, 154-bed children’s
Group, a new family medicine practice
In this role, Mr. Harrington will lead patient
medical center, sports medicine center,
June 1. The practice is located in WakeMed
financial services, reimbursement/managed
ambulatory care center and radiation
Apex Healthplex and features Ragini
care and the administrative arm of patient
The Triangle Physician
WakeMed News Prior to MCG Health, he was director of
she managed the financial and operational
“Pandora was offered the permanent position
managed care services for McLeod Health
audit functions for the system and was
because of her perpetual professionalism,
Inc., in Florence, S.C., and previously was
the key contact on the Health Insurance
integrity, trustworthiness and exceptional
in the same position with Carolinas Hospital
Portability and Accountability Act and
performance during her long tenure at
System in Florence.
WakeMed,” said William K. Atkinson II, Ph.D., president and chief executive officer.
Mr. Harrington earned a bachelor’s degree in
Last year, Ms. Holloway was named interim
“Pandora has significant audit experience
science, with a concentration in accounting,
executive director of corporate compliance
and will work closely with WakeMed’s full
and master’s in business administration from
and chief compliance officer, responsible for
leadership team to adhere to and strengthen
Francis Marion University. He is also a fellow
all compliance-related activities, including
our corporate compliance policies.”
of the Healthcare Financial Management
compliance with the requirements in
contractual agreements with the Centers for
Ms. Holloway holds a master’s degree in
Medicare and Medicaid Services and the
business administration, which she earned
Department of Health and Human Services,
from Pfeiffer University, and is certified in
Office of the Inspector General.
health care compliance and as an internal
Compliance Officer Accepts Permanent Post Pandora
auditor. She also is a guest lecturer with the Ms. Holloway is responsible for helping
University of North Carolina School of Public
the organization stay abreast of laws and
Health, recipient of the WakeMed Circle of
regulations, communicating changes and
Quality Service award and a member of the
Ms. Holloway has been a WakeMed
providing education related to compliance
Garner Chamber of Commerce Board of
employee since 1982, serving the system
matters. She also will identify challenges and
for the majority of this time as director of
work to strengthen corporate compliance
compliance and audit services. In this role,
across the system.
Rex Health Care News
Cary Surgery Center Earns Accreditation
The Triangle Physician 2011/12 Editorial Calendar November
Urology – Alzheimer’s
Rex Surgery Center of Cary L.L.C. has earned a one-
“I am proud of our team for their flexibility and
year term of accreditation from the Accreditation
hard work that it took to receive this accreditation,”
Association for Ambulatory Health Care Inc.
said Cindy Vincent, R.N., M.S.N., director of Rex
Pain Management – Sleep Disorder
Diabetes – Banking
Heart Disease in Women Accounting for Medical Practices
Surgery Center of Cary.
Rex Hospital’s surgical services have long been the leading choice for Wake County residents, with
During the last fiscal year, Rex Surgery Center
more than 34,000 procedures performed last year.
physicians performed more than 3,000 outpatient surgeries in gynecology; plastic surgery; ear
Men’s Health – Vision New Medical Devices
Women’s Health Marketing Your Services
Accreditation was achieved through participation
nose and throat; orthopedics; urology; podiatry;
Orthopedics – Medical Insurance
in the Early Option Survey Program, a voluntary
and other general clinical areas at the centrally
Neurology – Sleep Apnea
process that enables an organization to measure
located, state-of-the-art facility. Rex Surgery Center
of Cary partnered with 25 surgeons in February to
against nationally recognized standards. The
transition to a freestanding surgery center.
New Imaging Technologies Electronic Medical Records
Digestive Disease Computer Technologies
accreditation process involves self-assessment
by the organization, as well as a thorough review
by the Accreditation Association for Ambulatory
symbol that an organization is committed to
Health Care Inc. (AAAHC) surveyors, who have
providing high-quality health care and that it has
extensive experience in the ambulatory health
demonstrated that commitment by measuring up
to the nationally recognized high standards.
Sports Medicine – Physical Therapy
Breast Cancer Reconstructive Surgery
Urology – Robotic Surgery
UNC Hospital News
Country’s First Inpatient Perinatal Psychiatry Unit Opens The University of North Carolina Department
programming for women during pregnancy
of Psychiatry and the UNC Women’s Mood
and postpartum. Services include:
Disorders Program have opened a five-bed unit for women with moderate to severe post-partum depression (PPD), the first of its kind in the country.
positive mother-baby interaction
• Individualized assessment and treatment
patient rooms refrigeration and freezer storage •L actation, nutrition and ob-gyn
•B iofeedback therapy
5 percent of which will need specialized
•M other-infant attachment therapy;
•F amily and partner-assisted
consultants For general information about our Women’s
Neurosciences Hospital will offer specialized
•H ospital-grade breast pumps,
psycho-educational, art and
Ten to 15 percent of women will have PPD,
units, the new unit within the North Carolina
•G liders for pumping and nursing in
plans with a multidisciplinary team •G roup therapies, including behavioral, mindfulness
Modeled after European mom-and-baby
•E xtended visiting hours to maximize
Mood Disorders Program, call (919) 966-9640.
•T herapeutic yoga geared for pregnancy and postpartum women
To make referrals to the inpatient program, call the UNC Psychiatry Admissions Office at
•P rotected sleep times
Scientist to Study Post-Mastectomy Breast Reconstruction Decision Making A UNC School of Medicine physician/
patients’ decisions. “Deciding about breast
years to understand consumers’ preferences
scientist has received a five-year grant
reconstruction requires a patient to predict
about purchasing decisions. We will use it
award to examine patients’ decision-making
how she would feel after the procedure,
to better understand women’s preferences
process about breast reconstruction and the
a process called ‘affective forecasting.’
about breast reconstruction. We also plan to
effects of reconstruction on quality of life and
evaluate the ability of breast cancer patients
shown that people have difficulty making
to predict how they will feel after surgery,
accurate predictions about how they will
which is so critical to decision making, yet
The $862,700 career development award
feel, tending to overestimate the effects of
to Clara Lee, M.D., M.P.P., a plastic and
disease and treatments on their wellbeing
reconstructive surgeon, is from the National
and to underestimate their ability to adapt
The goal of the research is increased
Institutes of Health.
to change and the effects of other aspects of
awareness that “will eventually lead to more
patients receiving the treatments they prefer
Dr. Lee, an associate professor of surgery,
and ultimately to better quality of life for
explained, “The decision about whether
Dr. Lee is a member of UNC Lineberger
or not to have breast reconstruction
Comprehensive Cancer Center medical
should depend almost completely on a
staff. She is a recipient of a 2010 Lineberger
Dr. Lee will be mentored during the grant
patient’s personal preferences. And yet
Population Sciences Award, which enabled
period by Michael Pignone, M.D., M.P.H., a
we find that rates of breast reconstruction
her and her team to conduct some of the
professor of medicine, chief of the division of
in the United States vary greatly by race,
preliminary research that supports the NIH
general medicine and clinical epidemiology,
socioeconomic status and geography. In this
study, we will evaluate the decision-making
women with breast cancer.”
Comprehensive Cancer Center; and Peter
process and the quality of decisions about
The study is unique in several ways. One
Ubel, M.D., John O. Blackburn Professor of
is the use of a technique from marketing
Marketing, Fuqua School of Business, and
professor, Sanford School of Public Policy at
The research team also intends to study
according to Dr. Lee. “Market researchers
Duke University. Both are national experts in
some novel psychological aspects of
have been using conjoint analysis for many
medical decision making.
The Triangle Physician
UNC Hospital News
Investigation Reveals Potential of New Nanoparticle Design for Cancer Therapy A new type of nanoparticle developed
significant growth inhibition of pancreatic
are more easily targeted to tumors than most
in the laboratories at the University of
tumors, which are extremely difficult to treat.
existing particles. We need to thoroughly
North Carolina has shown potential for
The nanoparticle has two to three times the
determine the pharmacokinetics and other
more effective delivery of chemotherapy
therapeutic efficacy over oxaliplatin.
important properties of the PSQ particle in
to treat cancer. Wenbin Lin, Ph.D., Kenan
order to translate this particle platform to the
Distinguished Professor of Chemistry and
The nanoparticle is different from other
Pharmacy, and colleagues report their
nanoparticles in its high drug loading and
finding in the Sept. 14 issue of Angewandte
its ability to release chemotherapeutics in a
Other UNC scientists involved in the research
controlled fashion. The release of therapeutic
are graduate students Joseph Della Roca,
cargoes depends on the naturally occurring
B.S.; Rachel C. Huxford, M.S.; and Erica
molecules that are more abundant in many
chemistry journal. In laboratory studies, Dr. Lin and colleagues
developed and tested a new type of
This work is supported by 2010 funding
nanoparticle that can deliver larger amounts
Dr. Lin explained: “The polysilsesquioxane
of a drug and will not leak the drug as the
(PSQ) particle we have developed carries
particle circulates through the blood stream
extremely high loadings of oxaliplatin-
Partnerships and the Carolina Center of
on its way to the target.
based chemotherapeutics. The particles
Cancer Nanotechnology Excellence. The
are stable under normal physiological
12 partnerships and nine centers were
In the proof-of-concept experiments, they
conditions, but can be readily reduced to
designed to promote and support individual,
tested the nanoparticle’s ability to deliver
release the platin cargoes in highly reducing
circumscribed multi-disciplinary research
therapeutic doses of the chemotherapy drug
tumor microenvironments that have high
projects that will address major barriers
oxaliplatin to colon and pancreatic tumors.
concentrations of reducing agents. As a result,
and fundamental questions in cancer using
The oxaliplatin-based particles showed
they have very little background release and
innovative nanotechnology solutions.
Inexpensive Infection Control Measures Could Save Lives and Billions of Dollars University of North Carolina at Chapel
associated pneumonias and central line-
The first intervention was strict enforcement
Hill researchers have found that adopting
associated bloodstream infections involved
of standard hand hygiene practices on the
an inexpensive set of infection control
simple steps that lead to dramatic reductions
unit. All health care workers are expected
measures could potentially save many
in not only the targeted infections, but also
to wash their hands with soap and running
thousands of lives and billions of dollars.
mortality and costs,” said Bradford D. Harris,
water or an alcohol-based rub on entering
The study appears in the September 2011
M.D. Dr. Harris led the study while serving as
and leaving a patient’s room, before putting
issue of Health Affairs.
an associate professor of anesthesiology and
on and after removing gloves, and before and
pediatrics in the UNC School of Medicine.
after any task that involves touching potentially
At any given time, one of every 20 hospital
He is now a medical officer at the U.S. Food
contaminated surfaces or body fluids.
patients has a hospital-acquired infection,
and Drug Administration in Washington, D.C.
according to the US Department of Health
The second intervention was implementing
and Human Services. This leads to an
The study was conducted in the Pediatric
a bundle of measures aimed at preventing
estimated 99,000 deaths in the United States
Intensive Care Unit at North Carolina Children’s
ventilator-associated pneumonia. Examples
each year and up to $33 billion in preventable
Hospital, which is one of the five University of
included elevating the head of the patient’s
health care costs.
North Carolina Hospitals. The study tested
bed while the patient is receiving breathing
three interventions aimed at preventing and
assistance from a ventilator, giving the
reducing hospital-acquired infections.
patient daily breaks from sedation and then –
UNC Hospital News while the patient was unsedated – assessing
with central-line catheters still need them.
But adoption of the three interventions collectively could save this single hospital
whether or not the patient is ready to come off the ventilator, and providing daily oral
Results of the study showed that patients
unit an estimated $12 million a year, the
care (teeth brushing, mouth washes, etc.)
admitted after these interventions were
study found. If replicated nationwide, these
with a long-lasting antiseptic.
fully implemented were released from the
measures potentially could save thousands
hospital an average of two days earlier, their
of lives and billions of dollars each year.
hospital stay cost about $12,000 less and the
compliance with guidelines for the use
number of patient deaths were reduced by
UNC co-authors of the study are Cherissa
and maintenance of central-line catheters.
Hanson, M.D.; Claudia Christy, Tina Adams,
Andrew Banks and Tina Schade Willis, M.D.
impregnated with an antiseptic, using
The costs for implementing these measures
Matthew Maciejewski, Ph.D, an associate
were modest. Examples include roughly $21
professor at Duke University School of
whenever possible and performing two
a day for oral care kits and about 60 cents a
Medicine who, holds adjunct professor
assessments per day of whether patients
day for antiseptic patches and hand sanitizers.
appointments at UNC, is also a co-author.
24-Week Treatment for Hepatitis C Is Effective, Reduces Side Effect Exposure A new multinational study finds that a
treated with a combination of peginterferon alfa
therapy is just as effective as 48 weeks,” he
24-week treatment course for hepatitis C
and ribavirin, which is the current standard of
said. About two-thirds of the patients who
that adds telaprevir to peginterferon alfa
care. Nineteen of the patients in the study were
started with triple therapy were eligible for
and ribavirin is just as effective as a 48-week
enrolled at UNC Hospitals in Chapel Hill or at
shorter duration of treatment by clearing virus
regimen for many patients.
Medical Specialty Services in Greensboro, where
early in their treatment course.
UNC runs a hepatitis C practice in collaboration This is good news for up to four million
with the Moses Cone Health System.
people in the United States who suffer from
In addition, the study found uniformly high rates of sustained virologic response
this chronic liver disease, many of whom
All of the patients started the study by taking
regardless of the race or ethnicity of the
will undergo treatment for hepatitis C, said
all three drugs for 12 weeks. They stopped
patients, and no matter whether they had
Michael W. Fried, M.D. Dr. Fried is professor
taking telaprevir after week 12. Then patients
advanced fibrosis or cirrhosis of the liver.
of medicine at the University of North
who tested negative for the hepatitis C virus
Carolina at Chapel Hill, director of the UNC
were randomized to receive either 12 weeks
Side effects associated with telaprevir reported
Liver Center and a co-author of the Illuminate
or 36 weeks of additional treatment with
in the study include rash and anemia, but
study, published in the Sept. 15 issue of The
the other two drugs, peginterferon alfa and
in most cases these side effects were mild
New England Journal of Medicine.
ribavirin. One group received a total of 24
or moderate and could be managed by the
weeks of treatment while the other group was
patient’s physician, Dr. Fried said.
“The medications that we use to treat hepatitis
treated for 48 weeks.
C do have some side effects, and shortening
the duration of treatment shortens a patient’s
In the 24-week group, 92 percent of the
Pharmaceuticals and Tibotec. Vertex markets
exposure to these side effects,” Dr. Fried said.
patients ultimately achieved a sustained
telaprevir in the United States under the brand
virological response, meaning that the
name Incivek. Tibotec plans to market the
Lead author of the study, which was
hepatitis C virus remained undetectable in
drug in Europe.
conducted at 74 sites in Belgium, the
their blood after treatment was discontinued.
Netherlands and the U.S., was Kenneth E.
In the 48-week group, 88 percent achieved a
The U.S. Food and Drug Administration
Sherman, M.D., Ph.D., of the University of
sustained virological response. According to
approved Incivek on May 23 for the treatment
Cincinnati College of Medicine.
Dr. Fried, sustained virological response is
of chronic hepatitis C in combination with
analogous to cure of hepatitis C.
peginterferon alfa and ribavirin. Peginterferon
The study included 540 patients with chronic
alfa is marketed under the brand name
genotype 1 hepatitis C who had not previously
“These are very nearly identical results,
Pegasys, while ribavirin is sold as Copegus
been treated or who could not be successfully
showing that 24 weeks of treatment with triple
The Triangle Physician
UNC Hospital News
Lawrence Marks, M.D. Is Appointed to an Oncology Research Professorship Lawrence B. Marks, M.D., chairman of the
aimed at improving the therapeutic ratio of
and lectured about this sensitive issue and
University of North Carolina Department of
radiation therapy, largely through reducing
serves on several national panels addressing
Radiation Oncology, has been appointed the
the normal tissue effects of radiation. He
Dr. Sidney K. Simon Distinguished Professor
has conducted many prospective clinical
of Oncology Research at UNC-Chapel
trials to better understand radiation-induced
He is a member of the American Society of
Hill. The professorship, established by a
lung and heart injury for patients receiving
Radiation Oncology, the American Society
$500,000 gift from Wally (class of ’66) and Lil
radiation to the chest. He is currently
of Clinical Oncology and the recipient of
Loewenbaum of Austin, Texas, is named in
funded by grants received from the National
numerous awards and honors.
honor of Mr. Loewenbaum’s grandfather, Dr.
Institutes of Health to conduct studies to
Sidney K. Simon.
better understand the physiologic and
Prior to joining UNC as chair in 2008, Dr.
dose-related causes of radiation-induced
Marks was the Banks Anderson, Sr., M.D.,
Professor of Radiation Oncology at Duke
“Dr. Marks is a national and international leader in the area of radiation oncology
University, where he also directed the
with research spanning the basic-to-clinical
Dr. Marks is a national leader in studying
residency training program. He earned his
continuum. He is developing analyses and
the frequency and causes of “human-errors”
medical degree at the University of Rochester
trials which seek to maximize radiation
in the radiation oncology clinic. This work
and completed his residency in radiation
therapy’s effectiveness while minimizing
has led to the implementation of guidelines
medicine at Massachusetts General Hospital.
damage to healthy tissues. His work on
successfully reducing such errors, thereby
human factors in the radiation oncology
enhancing patient safety. He has published
clinic is receiving broad attention and is having a positive influence on patient safety across the United States,” said Shelley Earp, M.D., director of UNC Lineberger Comprehensive Cancer Center. “Dr. Marks is a thoughtful and energetic leader who has built UNC’s Department of Radiation Oncology into a thriving clinical and research enterprise that not only provides outstanding patient care but also trains therapists, dosimetrists and young physicians in this rapidly-evolving field,” said William L. Roper, M.D., M.P.H., dean of the UNC School of Medicine and chief executive officer of the UNC Health Care System. “The Loewenbaums’ support recognizes the need to enhance (Dr. Marks’) work improving the safety and effectiveness of radiation therapy, not only at UNC, but nationwide,” he added. Dr. Marks is a recognized expert in the treatment of patients with breast and lung cancer. The thrust of his work has been
Duke Research News
Breast Cancer MRI Could Benefit High-Risk Women Without Insurance Although a magnetic resonance imaging
For the Duke screening trial, a team of
Ford said that finding is important given the
screening can be expensive, it has been
“patient navigators” visited low-income
tendency of MRI screenings in the general
shown to be beneficial and cost effective
communities around Durham, where they
population to flag normal breast tissue as
for women at high risk of breast cancer who
identified women with no health insurance
suspect, leading to unnecessary worries and
have little or no insurance, researchers at
or limited policies and provided them with
Duke University Medical Center report.
information about breast cancer prevention and treatment. The patients were then
“MRI really should not be considered a
The researchers, who presented their
separated into two groups based on known
standard of care for routine breast cancer
findings at a health disparities conference
breast cancer risk factors, including close
screening because it is expensive and too
hosted by the American Association for
family members who had been diagnosed
sensitive,” Dr. Ford said. “But this study
Cancer Research in Washington, D.C., in
with the disease.
proves that if it is used in the right population,
September, said the findings could help
this test can be cost effective and lifesaving.”
ease breast cancer disparities among
Nearly 300 women – 33 percent African-
American – who met the criteria for high risk
Patient navigation was instrumental in
were given MRI screenings. The technology
ensuring that patients got the right screening
“Early detection and treatment of breast
is expensive, but can be more sensitive,
and follow-up. “We actually go out to
cancer in these high-risk women are
particularly among younger women who
different health fairs and community events,
important goals, particularly if we can find
have denser breast tissue that can pose a
identify women at Point 1 and then guide
a cost-effective way of achieving them,” said
challenge to mammography.
them through the process from that day
Anne C. Ford, M.D., assistant professor of
onward,” said Lamisha Banks, one of the
obstetrics and gynecology at Duke University
Another 299 women were considered
study navigators and co-authors. “We stick
Medical Center and lead author of the study.
normal risk, and got traditional, less costly
with them through treatment and beyond.”
“By catching these tumors early, treatment
mammograms. Of the normal risk group, 40
may be less expensive than for advanced
percent were African-American.
In addition to Dr. Ford and Ms. Banks, study authors include: Xiomara Boyce, Stephanie
Among the normal-risk trial participants,
Robertson, Endya Frye, Nora Tolbert, Laurie
A problem that persists in the fight against
mammography detected one breast cancer
Lee, Gloria Broadwater and Victoria L.
breast cancer is the disparity in death
case. MRI screenings turned up seven
rates between blacks and whites. While
cancers in the high-risk group, demonstrating
African-American women are diagnosed
that a targeted use of MRI screenings could
Funding for the trial was provided by Susan G.
with the disease less often, they have a
offer an effective approach for high-risk
Komen for the Cure, Triangle Affiliate; Avon;
disproportionately higher death rate. Better
the National Breast Cancer Foundation; the
screening programs could help by catching
Breast Cancer Relief Foundation; and the
breast cancer tumors earlier, before they
The MRI screenings also had a lower rate
become lethal and spread.
of false positives than mammography. Dr.
Kate B. Reynolds Charitable Trust.
Exercise Eases Arthritis in Obese Mice Without Weight Loss Adding
The insight suggests that excess weight
Published Sept. 27 online in the journal w,
scientists at Duke University Medical Center
alone isn’t what causes the aches and pains
the findings are now being tested in people.
have found that physical activity improves
of osteoarthritis, despite the long-held notion
arthritis symptoms even among obese mice
that carrying extra pounds strains the joints
“What’s surprising is that exercise, without
that continue to chow down on a high-fat diet.
and leads to the inflammatory condition.
substantial weight loss, can be beneficial
The Triangle Physician
Duke Research News to the joints,” said Farshid Guilak, Ph.D.,
glucose poorly and had much higher blood
inflammatory molecules associated with
professor of orthopedic surgery at Duke and
levels of molecules that trigger the chronic
arthritis, but they lost their punch because
senior author of the study. “Ideally, it would
inflammation associated with osteoarthritis.
they could not organize into a force. “I
be best to be fit and lose a little weight, but
don’t want to say exercise is turning off that
this shows that exercise alone can improve
But when these animals got regular running
the health of your joints,” Dr. Guilak said.
wheel workouts, many of the harmful effects
inflammatory signal, it just impairs it.”
diminished – even though the mice ate the
The findings add to a growing body of
Even modest improvements could have a
same high-fat food and shed no weight.
research exploring fitness vs. fatness.
major impact if the findings are borne out
Glucose tolerance improved, while the
Ongoing studies at Duke and elsewhere
in people. The Arthritis Foundation reports
inflammatory response was disrupted among
are examining the role of diet, exercise and
that one in five adults in the United States
key signaling molecules called cytokines,
have been diagnosed with arthritis, and the
easing the development of arthritis.
annual cost of treating it and other rheumatic conditions has been tabbed at $128 billion.
“This shows that if you are obese, it’s better If the extra weight on the joints had been
to exercise,” Dr. Guilak said. “Sometimes
the cause of the arthritis, the researchers
pain can be a barrier to starting exercise,
Many cases of arthritis are associated
noted, exercise would have exacerbated the
but if you overcome it, in the long term, it’s
with obesity and inactivity, so the Duke
problem. Instead, it helped.
high-fat diet induces knee osteoarthritis, and
“We’re trying to understand the interaction of
In addition to Drs. Guilak and Griffin,
then whether exercise provides a protective
physical activity and obesity,” said Timothy
study authors included Janet L. Huebner,
M. Griffin, Ph.D., lead author of the study. Dr.
Virginia B. Kraus and Zhen Yan. The study
Griffin was formerly at Duke and is now at the
was supported by grants from the National
Using two sets of male mice – half fed a high-
Oklahoma Medical Research Foundation.
Institutes of Health and from the Arthritis
fat diet and the other fed regular food – the
“Even though there was the same amount of
researchers noted significant differences
body fat, the fat was different.”
researchers set out to determine whether a
among the two groups. The mice on the highfat food gained weight rapidly, processed
Dr. Griffin said the fat cells still produced
Study Reveals New Understanding of Cholesterol’s Role in Bone Loss Researchers at Duke University Medical
occurred independently of their ability to
“In the current study in mice, we showed
Center have found that high cholesterol
lower circulating cholesterol,” said Donald
that a high-cholesterol diet alone significantly
contributes to a loss of bone density by
McDonnell, Ph.D., chairman of the Duke
decreased bone quality,” said Erik Nelson,
blocking formation of new bone cells and
Department of Pharmacology and Cancer
Ph.D., a postdoctoral research associate in the
encouraging the activity of mechanisms
Biology. “The question was: Had scientists
McDonnell laboratory. However, they noted
responsible for breaking down bone.
that only when cholesterol was converted to
actually impacted bone biology? They hadn’t.
27-hydroxycholesterol did it negatively impact
The findings from studies on mice open new
When you hear hooves, think horses, not
possibilities for the treatment and prevention
zebras – look for a more obvious explanation.”
of osteoporosis and highlight a possible new
“We found that by binding to the estrogen
way that cholesterol-lowering statin drugs
Instead of focusing on cholesterol itself,
receptors, 27-hydroxycholesterol interferes
may improve bone health, according to a
with the positive actions of estrogens in
medical center press release.
breakdown product of cholesterol called
bone,” Dr. Nelson said. “We also found that
27-hydroxycholesterol and demonstrated that
a second class of proteins, liver X receptors,
“For years, people thought that the positive
this molecule actually inhibited the positive
were targets of 27-hydroxycholesterol in bone.
effects of statin drugs on bone mineral density
actions of estrogens on bone.
The combined actions of this byproduct of
Duke Research News cholesterol on the estrogen receptors and
were unclear,” Dr. McDonnell said. “These
Pharmacology and Cancer Biology; Xiaojuan
liver X receptors resulted in a doubly harmful
data not only provide an explanation for this
Wang and Diane Gesty-Palmer of the Duke
impact on bone.”
positive activity of estrogen but also highlight
Division of Endocrinology, Metabolism and
new approaches that can be used to treat this
Nutrition; Glenda Evans and Sundeep Khosla
of the Endocrine Research Unit of Mayo Clinic
They found that supplemental estrogen could improve bone density in mice with elevated
College of Medicine in Rochester, Minn.; and
27-hydroxycholesterol, noting that estrogens
Dr. Nelson said there are drugs that can
Michihisa Umetani of the Departments of
induced the expression of a protein called
artificially increase the amount of SHP, which
Pediatrics and Pharmacology, University of
“SHP” in developing bone cells that inhibited
stops this bone-loss process, so it may be
Texas Southwestern Medical Center in Dallas.
the negative activity of the liver X receptor.
possible to develop therapeutics that have a similar effect in humans.
Support for the work came from the National
Institutes of Health, the National Institute of
“In the meantime, the data we have generated
Diabetes and Digestive and Kidney Diseases,
27-hydroxycholesterol continued signaling
thus far suggest an unanticipated positive
the Arthritis Foundation and a Department of
through liver X receptor, which decreased the
activity of statins and add to the list of
Defense postdoctoral award.
amount of bone.
health benefits associated with lowering cholesterol,” Dr. McDonnell said.
“Although estrogens have been used for years for the treatment and prevention of post-
Other authors include Carolyn D. DuSell (now
menopausal osteoporosis, the mechanisms
with Genentech), Matthew K. Howe, Ryan
by which it accomplished its positive actions
D. Michalek and Jeffrey Rathmell of Duke
Nurse Transition Program to Evaluate Safety and Outcomes Durham Regional Hospital is one of 112
and confidence, prior research has not
Muir, R.N., M.S.N., nursing program manager
hospitals chosen by the National Council
examined actual patient outcomes. The
at Durham Regional Hospital. “This online
of State Boards of Nursing to participate in
data collected will measure actual patient
model of training suits our new nurses well.
an innovative, multi-state study to evaluate
outcomes, such as infection rates, patient
The topics are relevant to what they need,
safety and quality outcomes in nurse
falls, patient satisfaction, as well as new
and the support from their preceptors and
transition from school to practice.
nurse competencies, job satisfaction and job
managers gives them the confidence to
perform their best.”
(TTPS) follows newly licensed registered
Each new nurse is provided with online
The program lasts six months, though the
nurses hired to work at Durham Regional
training in addition to their duties on the
nurse has ongoing support for another six
and other hospital settings in Illinois, Ohio
unit. They report to a manager who provides
months. New nurses can choose whether
and North Carolina during their first year of
input and a preceptor who keeps a record
or not to enroll in the program. Currently, 49
of their training and offers assistance
Durham Regional nurses are participating.
The NCSBN Transition to Practice Study
along the way. The five online transition TTPS will compare patient outcomes in
According to the NCSBN, health institutions
organizations that use the National Council
teamwork, patient-centered care, evidence-
with TTPS programs have seen a marked
of State Boards of Nursing (NCSBN)
based practice, quality improvement and
drop in attrition, along with improved patient
transition model with those organizations
informatics. Clinical reasoning and safety are
outcomes. This program’s goal is to create a
that use their own methods of transition.
integrated throughout each module.
consistent best practice method of training
new nurses that can be replicated across
programs have looked at retention rates, new
“The TTPS program is a wonderful addition
the country to ensure consistent quality of
nurse satisfaction, preceptor satisfaction
to the hands-on training and orientation our
care and to decrease turnover rates of new
and nurse’s perceptions of competence
new nurses already receive,” said Margaret
The Triangle Physician
Women’s Wellness Clinic
Opportunities for Clinical Research By Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G.
We continue to offer clinical research studies
The physicians at the Women’s Wellness
for our patients. Such opportunities include
monitor side effects, and to compare it to
Clinic offer personalized, evidence-based
FDA clinical trials. There are different types
commonly used treatments, and to collect
medical care for women. Providing clinical
of FDA clinical trials that we offer at the
information to allow the drug or treatment to
trials to our patients allows us to educate
Women’s Wellness Clinic include:
be used safely
patients and ourselves about the newest
Phase 4 trials: These are post marketing
technologies and medications for women’s
Phase 1 trials: Usually involves experi-
studies (done after approval of a drug) to
mental drug or treatment in a small group of
help delineate additional information on a
people (20-80) for the first time to evaluate
drug’s risks, benefits, and optimal use.
its safety, determine safe doses, and identify
One of our newest clinical trials is a Phase 1 study entitled: Clinical Research Study on
The types of studies done through the
Phase 2 trials: Experimental drug or
Women’s Wellness Clinic focus on women’s
treatment is given to larger group of people
health, including causes of heavy periods
Please call us at 919.251.9223 for
(100-300) to see if it is effective and to further
and treatments for heavy periods, PMS,
evaluate safety, doses, and side effects
migraines, ovarian function, birth control,
Phase 3 trails: Experimental drug or
menopause, vaginal atropy, and more.
Ovulation and Ovarian Activity.
treatment is given to large groups of people
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 • www.SNSleepSolutions.com 295 Olmstead Blvd., Suite 12 Pinehurst, NC 28374 (910) 235-0595
102 Dennis Drive Sanford, NC 27331 (919) 708-5008
609 Attain Street, Unit 101 Fuquay-Varina, NC 27526 (919) 552-8917
News Welcome to the Area
Physicians Michael Ryan Abern, MD Duke Urology Durham
Lea Lynne Bardy, MD Pathology University of North Carolina Hospitals Chapel Hill
Jose Fernando Bestard, MD
Jason Michael Kidd, MD
Sheena Harris, PA
Internal Medicine University of North Carolina Hospitals Chapel Hill
Alamance Regional Medical Center Burlington
Todd Kiefer, MD Internal Medicine, Cardiology Duke University Hospitals Durham
Brian Thomas Klausner, MD
Ashley Rosann Haskin, PA Durham
Rachel Holston, PA Durham Regional Hospital Durham
Wake Med City Center Clinic Raleigh
Nicole L Lane, PA
Holly Marie Biggs, MD
Anne Monica Lachiewicz, MD
Katherine Marie Mackin, PA
Internal Medicine University of North Carolina Hospitals Chapel Hill
Triangle Orthopaedic Associates Durham
Internal Medicine Duke University Hospitals Durham
Donald Lyle Budenz, MD University of North Carolina Chapel Hill
Emily A Evans-Hoeker, MD UNC Reproductive Endocrinology & Infertility Chapel Hill
Narges Farahi, MD UNC Dept of Family Medicine Chapel Hill
Iman Ghaderi, MD UNC Dept of GI Surgery Chapel Hill
Natasha Faye Harrison, MD University of North Carolina Hospitals Chapel Hill
Fletcher Lee Hartsell, MD Neurology University of North Carolina Hospitals Chapel Hill
Jun He, MD Psychiatry University of North Carolina Hospitals Chapel Hill
Ashley Rebekah Presar Hinson, MD Pediatrics Duke University Hospitals Durham
Jeffrey John Horvath, MD Radiology Duke University Hospitals Durham
Neva Margaret Howard, MD University of North Carolina Hospitals Chapel Hill
Ifeoma Jacqueline Igboeli, MD WakeMed Raleigh
Shalaka Dayarum Indulkar, MD Pediatric Neurology of North Carolina Cary
Daryhl Lindsay Johnson, MD Univ of North Carolina Dept. of Surgery Chapel Hill
Edmund Hilton Jooste, MD Department of Pediatric Anesthesiology Durham
Melissa Rahhyung Kang, MD Carrboro
Sujay Mansukhlal Kansagra, MD Pediatrics, Neurology University of North Carolina Hospitals Chapel Hill
The Triangle Physician
John Armand Mastrangelo, MD
Melissa Murfin, PA Elon University, Elon
Rebecca Yvonne Mumpower, MD
Sola Egberanmwen Ogunniyi, PA Raleigh
Matthew Gordon Rein, MD
Brenda Lee Quincy, PA Elon University, Elon
Internal Medicine Duke University Hospitals Durham
Kelli Renee Roe, PA
Yashica Yvonne Ruffin, MD
Brian Savage, PA
Deanna Mary Sasaki-Adams, MD
Danielle Shelley, PA
Neurological Surgery UNC Dept of Neurosurgery Chapel Hill
WakeMed Faculty Physicians Gen. Surgery & Trauma, Raleigh
Saif Lutfi Shafiq, MD Duke University Hospitals Durham
Michael James Shealy, MD Pathology Duke University Medical Center Durham
Usha Soundarapandian, MD Doctors Making Housecalls Durham
Bijoy Damodaran Thattaliyath, MD Duke University Hospitals Durham
Megan Aileen Webster, MD Psychiatry Psychiatric Associates of North Carolina Raleigh
Sara Elizabeth Wobker, MD Pathology University of North Carolina Hospitals Chapel Hill
Eric Hamilton Wright, MD Emergency Medicine University of North Carolina Hospitals Chapel Hill
Vijay Yerubandi, MD Duke University Hospitals Durham
Physician Assistants Shannon Michelle Billings, PA Carolina Skin Care Pinehurst
Kellie Ann Bunn, PA Raleigh
Detra Monteiz Yvonne Chambers, PA Durham
Duke University Medical Center, Durham
Jason Sonnenschein, PA Carrboro
Clinical Trials Do you have patients with any of these problems?
Ovulation and Ovarian Activity Women’s Wellness Clinic Dr. Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.
If you are a healthy female age 18-40 years with regular periods, then you may qualify for a research study on the effects of an investigational medication on ovulation and ovarian function. The research study procedures include: • physical exam • PAP smear • ultrasounds • blood draws • EKG Reimbursement up to $225 per week (for up to 20 weeks if you qualify). This study is being conducted by Dr. Andrea Lukes at the Women’s Wellness Clinic. Women’s Wellness Clinic is located by the Streets of SouthPoint. For more information call (919) 251-9223 or visit www.cwrwc.com.
“More than a doctor. Like a friend.”
Trust. WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it. We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution. And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.
Cardiovascular Professionals in Johnston County Mateen Akhtar, MD, FACC Benjamin G. Atkeson, MD, FACC Kevin R. Campbell, MD, FACC Randy A.S. Cooper, MD, FACC Christian Gring, MD, FACC
Matthew A. Hook, MD, FACC Eric M. Janis, MD, FACC Diane E. Morris, ACNP Ravish Sachar, MD, FACC Nyla Thompson, PA-C
WHV Locations in Johnston County 910 Berkshire Road Smithfield, NC 27577 Phone: 919-989-7909 Fax: 919-989-3147
2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520 Phone: 919-359-0322 Fax: 919-359-0326
When it comes to your cardiovascular care – We know it by heart. To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).
We know it by heart. Cardiovascular Services Echocardiography Nuclear Cardiology Interventional Cardiology Carotid Artery Interventions Cardiac Catheterization Cardiac CT Angiography and Calcium Scoring Electrophysiology and Cardiac Arrhythmias Peripheral Vascular Interventions Pacemakers / Defibrillators Stress Tests Holter Monitoring Lipid and Anti-Coagulation Clinics Vascular Ultrasounds / AAA Screening
©2011 Wake Radiology. All rights reserved. Radiology saves lives.
All For One — Fighting To Make A Difference.
Robin, survivor since 2006
One in every eight women will develop breast cancer in her lifetime, and we’re among the ones who are fighting back. We also have careers at Wake Radiology, where we put the power of imaging on your patient’s side: fellowship-trained radiologists, caring technologists that are ARRT certified, and state-of-the-art technology. We’re committed to helping patients make the most of these odds, starting with their annual screening mammogram, so we offer 8 convenient Triangle screening
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locations many with Saturday and evening appointments. At Wake Radiology, it’s all for one — in a fight we take very personally. Wake Radiology is the only multi-site outpatient imaging service provider in the Triangle to receive the American College of Radiology’s designation of Breast Imaging Centers of Excellence.
Wake Radiology salutes the grit, the grace, and the undaunted courage of every cancer survivor. Wake Radiology. Fighting for every One.
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The Triangle Physician October 2011 Serving about 9, 000 MDs, PAs, and NPs in the Triangle Area of North Carolina. If you have the need to g...