Hampton Roads Physician Winter 2017 by Hampton Roads Physician Magazine

Winter 2017

www.hrphysician.com

Honoring Physicians Who Specialize In:

Left to right: WILLIAM A. DELACEY, MD, DEEPAK R. TALREJA, MD and JOHN E. BRUSH, JR., MD

Patients will always remember how we make them feel. And at EVMS Medical Group we want to make them feel better. We understand that for so many patients, a trip to the doctor is stressful — especially when they’re sick or hurt, or worried about a potential diagnosis. So how can we make a positive change?

It begins with the patient experience. We are dedicating ourselves to improving quality of care across each and every point of patient contact, from the very first hello. We’re expanding the lines of communication, placing even more value on kindness and compassion. Yet it’s more than simply being nice. It’s a conscious focus on shifting our entire culture. By working together as a team, we can provide each patient with the best — and most personalized — healthcare experience. Because above all, we’re here to treat our patients well.

The knowledge to treat you better.

Learn more at EVMSMedicalGroup.com.

contents Winter 2017 VOLUME V, ISSUE I

35 What to do If You Are Accused of Patent Infringment 38 Helping Paraplegics Walk Again DEPARTMENTS 4 Publisherâ&#x20AC;&#x2122;s Letter 16 Good Deeds: Ian Persaud, MD, MPH 18 Advanced Practice Providers: Sally Carr, NP-C 22 Medical Update: Colorectal Cancer 36 Understanding Your Patient

FEATURES 6 Heart Disease

40 In the News

10 John E. Brush, Jr., MD 12 William A. DeLacey, MD 14 Deepak R. Talreja, MD

46 Welcome to the Community 49 Awards and Accolades 50 Physician Advisory Board

20 Finding Solutions for Cervical Whiplash 30 Stereotactic Radiosurgery Offers Cutting-Edge Precision in the Battle Against Cancer

32 How Colon Cancer Treatment Redefined Preventable Blindness Worldwide 34 Rotator Cuff Repair

Taking Nominations for the Spring 2017 edition We are looking for physician leaders who specialize in

OPHTHALMOLOGY Deadline for Nomination Submissions

OPHTHALMOLOGY

February 23

Nomination forms are available on www.hrphysician.com (click nominate tab) or by emailing a request to holly@hrphysician.com WInter 2017 Hampton Roads Physician | 3

WELCOME TO THE WINTER 2017 EDITION CELEBRATING OUR 5TH ANNIVERSARY! Holly Barlow

Bobbie Fisher Editor

Publisher

ith this issue, Hampton Roads Physician enters not just a New Year, but also our fifth year of publication. At the beginning of any new year, it seems appropriate to thank all of you who have been our readers and supporters since our first issue, with special gratitude to those physicians who have written articles and shared their expertise with our readers. This magazine has been enriched by your participation. The new year also seems a good time to reflect on our vision when we started the magazine, and to restate that vision to new readers. As the Welcome section of each issue illustrates, Hampton Roads is home to a vibrant medical community that continually attracts new physicians. It’s that fact that inspired this magazine: we believe the level of medical care available in Hampton Roads is second to none, and it’s been our mission from the first to recognize and honor the achievements of the local medical community, and to present them with professionalism

Physician H

A publication for

Winter 2017 Volume V, Issue I

Recognizing the achievements of the local medical community Publisher: Holly Barlow Editor: Bobbie Fisher Cover photos by Sigmon Taylor Photography Physician Advisory Board (see page 50)

Published by Publishing, LLC Emeritus and Voting Board Alfred Abuhamad, MD O.T. Adcock, Jr., RPh, MD Jon M. Adleberg, MD

4 | www.hrphysician.com

We’re looking forward to another year of presenting comprehensive articles on topics of interest, and hope you’ll continue to share your ideas, suggestions and comments with us. Please bear in mind that our ultimate goal is to be a useful resource to our readers. PLEASE ALSO REMEMBER that Hampton Roads Physician is an advertisersupported publication. As such, the practices, hospital systems and other businesses whose ads appear in the magazine are what make it possible for us to continue to publish. You can reach us at any time with questions, comments or suggestions. Holly Barlow, Publisher: 757.237.1106 holly@hrphysician.com Bobbie Fisher, Editor: 757.773.7550 bobbie@hrphysician.com Fax: 757.222.1345 hrphysician.com

and about the local medical community

Magazine Layout and Design Desert Moon Graphics

and editorial integrity. Our featured specialty at the beginning of this new year is cardiology, and we are delighted to honor Dr. John Brush, Dr. William DeLacey and Dr. Deepak Talreja, who appear on the cover, and whose work is highlighted in their individual profiles within the magazine. Our medical update is the ongoing battle to stop colorectal cancer. We’re already working on the Spring issue: our cover story and featured physicians will be from the field of ophthalmology, while our medical update will address the emerging field of preventive medicine. From the website of the American College of Preventive Medicine: “Preventive medicine is … a unique medical specialty recognized by the American Board of Medical Specialties (ABMS). Preventive medicine focuses on the health of individuals, communities, and defined populations. Its goal is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death. . .”

John W. Aldridge, MD, FAAOS Anthony M. Bevilacqua, DO Silvina M. Bocca, MD, PhD, HCLD Mary A Burns, MD, FACOG, FPMRS Jeffrey R. Carlson, MD Kevaghn P. Fair, DO Bryan Fox, MD Margaret Gaglione, MD, FACP Emmeline C. Gasink MD, FAAFP, CMD Mark W. McFarland, D.O. Jennifer Miles-Thomas, MD, FPM-RS Jerry L. Nadler, MD, FAHA, MACP, FACE Paa-Kofi Obeng, DO Jennifer F. Pagador, MD Richard G. Rento II, MD Michael M Romash MD Michael Schwartz MD John M. Shutack, MD I. Phillip Snider, DO Deepak Talreja, MD, FACC, FSCAI Jyoti Upadhyay, MD, FAAP, FACS Christopher J. Walshe, MD, FACOG, FACS, FPMRS Elizabeth Yeu, MD

Contact Information 757-237-1106 holly@hrphysician.com Hampton Roads Physician is published by DocDirect Publishing, LLC, 1263 Manchester Ave., Norfolk, VA 23508 Phone: 757-237-1106. This publication may not be reproduced in part or in whole without the express written permission of DocDirect Publishing, LLC. Published four times a year, Hampton Roads Physician provides a wide variety of the most current, accurate and useful information busy doctors and health care providers want and need. Cover stories concentrate on one branch of medicine, featuring profiles of practitioners in that specialty. Featured physicians are chosen by the advisory board through a nomination process involving fellow physicians and public relations directors from local hospitals and practices. Although every precaution is taken to ensure accuracy of published materials, DocDirect Publishing, LLC cannot be held responsible for opinions expressed or facts supplied by its authors. Visit Us Online

HEART DISEASE ADVANCES NOTWITHSTANDING, STILL THE NO. 1 KILLER OF MEN AND WOMEN

610 thousand Americans die of heart disease every year, 17 million worldwide popping up on Facebook, Instagram and all social media, imploring the year to cease and desist.

And that was before December. December 2016 served as an even more profound reminder that heart disease still claims the lives of one in every four Americans. The very month itself is considered a risk factor for cardiac death. A December 12, 2016 article in the AHA/ ASA Newsroom states: Although researchers don’t know exactly why heart attacks are more common around (the winter) holidays, they note a number of possible reasons, including changes in diet and alcohol consumption during the holidays; stress from family

his image, already iconic, now sadly serves as a devastating reminder of the number of deaths that 2016 will be remembered for. The actors who played Princess Leia and R2D2 – Carrie Fisher and Kenny Baker, respectively – were two of the many, many others who lost their lives last year: famous faces, as well as family members and friends from our own lives. Bowie. Rickman. Frey. Scalia. Boutros-Ghali. Shandling. Prince. Ali. Wiesel. Wilder. Palmer. By Autumn, 2016 had become so notable for the number of deaths, memes were

6 | www.hrphysician.com

interactions, strained finances, travel and entertaining; respiratory problems from burning wood; and not paying attention to the signs and symptoms of a heart attack. December 2016 was no exception. On December 13th, actor Alan Thicke, age 68, died of a ruptured aorta while playing hockey with his son. Four days later, Dr. Henry Heimlich, 95, the surgeon who invented the technique to save choking victims, died of a heart attack. On December 18th, actress Zsa Zsa Gabor died of heart failure. And on December 27th, actress, Princess Leia portrayer

In 2010, the American Heart Association set a strategic goal of reducing death and disability from cardiovascular disease and strokes by 20 percent while improving the cardiovascular health of all Americans by 20 percent by the year 2020. and author Carrie Fisher, 60, died after suffering a heart attack days before. The next day, her 84-year old mother, Debbie Reynolds, died, her last words being “I want to be with Carrie.” Her death was attributed to a stroke, although many wondered whether she might have died of a broken heart. It’s not that far-fetched. According to the American Heart Association, Broken heart syndrome, also called stress-induced cardiomyopathy or takotsubo cardiomyopathy, can strike even if you’re healthy… Women are more likely than men to experience the sudden, intense chest pain – the reaction to a surge of stress hormones — that can be caused by an emotionally stressful event. It could be the death of a loved one or even a divorce, breakup or physical separation, betrayal or romantic rejection. It could even happen after a good shock. Whether caused by stressinduced cardiomyopathy, family genetics or otherwise, heart disease statistics are increasingly grim. In 2010, the American Heart Association set a strategic goal of reducing death and disability from cardiovascular disease and strokes by 20 percent while improving the cardiovascular health of all Americans by 20 percent by the year 2020. Yet on the January 4, 2017 edition of Dr. Fred Feit’s radio program, Heart to Heart, AHA CEO Nancy Brown revealed

that 2016 was the first year in which death rates from heart disease have not gone down, but in fact have ticked up slightly, according to the CDC. “As we sit here today, fewer than 1% of all Americans are in ideal cardiovascular health,” Brown told listeners. She acknowledged the challenge, saying, “We have a lot of work to do to encourage people to live their best life by controlling their risk factors and focusing on health behaviors.” Whatever the etiology, women are especially at risk. In 2004, the American Heart Association saw that as a challenge, and responded with its Go Red For Women campaign. That year, cardiovascular disease was claiming the lives of nearly half a million American women each year, but, the AHA says, “women were not paying attention,” even dismissing it as a disease of older men. To dispel the myths and raise

THANK YOU! The doctors and staff at Allergy & Asthma Specialists extend a

heartfelt thank you to all the physicians and staffs in Hampton Roads who refer their patients to us for allergy and asthma health care. We never lose sight of the fact that your referral is accompanied with a trust in us.

Dr. Gary Moss

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WInter 2017 Hampton Roads Physician | 7

Whether caused by stress-induced cardiomyopathy, family genetics or otherwise, heart disease statistics are increasingly grim. awareness of heart disease and stroke as the number one killer of women, the AHA created a passionate, emotional, social initiative designed to empower women to take charge of their heart health – Go Red For Women. In her December 30th message on the AHA website, Nancy Brown encouraged those saddened by the deaths of Carrie Fisher and Debbie Reynolds, and all those who lost their lives to heart disease in 2016, “to make our national conversation a personal one, to spark important, difficult interactions that help more people understand the threat these diseases pose. In our mourning, let’s embrace some teachable moments.” The statistics are especially frustrating for specialists like the three heart specialists who are featured in this issue of Hampton Roads Physician, because they know that cardiovascular diseases are largely preventable. Simple common sense tenets like managing blood pressure, controlling cholesterol, reducing blood sugar, getting and

staying active, eating better, losing excess weight and not smoking could significantly reduce the rate of heart disease in the US, and lessen the number of deaths. As Nancy Brown noted, that day may be a long time coming. Until it does, the good news for the people of Hampton Roads is that the level of cardiac care in this community is second to none. Fellowship trained Dr. John Brush, Dr. William DeLacey and Dr. Deepak Talreja represent distinct areas of specialty care for heart patients – cardiac research, interventional cardiology and cardiac electrophysiology – and were chosen to be featured from among a number of highly skilled and well-respected practitioners. We may well have been overwhelmed at the end of 2016 at the number of lives lost, but as AHA CEO Nancy Brown reminds us, “the dawning of a new year offers the hope of better days ahead.” To which we say, hopefully, healthier days, as well. 

We Are Seeing Patients In A Whole New Light. Imaging at Chesapeake Regional Healthcare represents a dedicated team ready to deliver technology and services to fit any need or schedule. We offer both patient-centered care and safe, convenient reporting through EPIC, our electronic health record system. We are nationally accredited by the American College of Radiology in MRI and ultrasound. The Breast Center at Chesapeake Regional Healthcare is an American College of Radiology Breast Center of Excellence and also received the Women’s Choice Award for America’s Best Breast Center four years in a row.

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JOHN E. BRUSH, JR., MD

Sentara Cardiology Specialists

r. John Brush can’t remember the moment he decided to be a physician. “I just always wanted to be a doctor,” he says. “I had a natural inclination to science and math, and an interest in understanding how things work.” Dr. Brush earned his medical degree from the University of Virginia in 1980, and completed his internship and residency at the University of Vermont School of Medicine, followed by a fellowship in cardiology at Yale University School of Medicine. He began his career as a staff cardiologist in the Cardiology Branch of the National Heart, Lung and Blood Institute at NIH, and later served as staff physician in the Cardiac Catheterization Lab at the University Hospital in Boston. In 1992, Dr. Brush moved to Hampton Roads to accept a position with Cardiology Consultants, which became part of Sentara Cardiology Specialists in 2012. Throughout his career, Dr. Brush has maintained a close involvement with the American College of Cardiology, an international organization with over 48,000 members. He has served on several committees, including the Board of Trustees. It was his involvement with one of these committees that led to the project he calls one of his proudest accomplishments: the Doorto-Balloon Alliance for Quality, or the D2B project. He explains: “When I started as an intern, we treated heart attack patients by putting them in the coronary care unit and watching them, and 10 | www.hrphysician.com

when complications arose, we took care of them. But we had no way to take care of the primary problem.” Which was, of course, that their arteries were clogged and their heart muscle wasn’t getting enough blood and oxygen. “About 20 years ago, we started taking these patients to the cath lab. Our national guidelines said we should be able to get these patients to the lab and get an artery open with a balloon catheter within 90 minutes of their time of arrival – hence, door-to-balloon time.” Unfortunately, until 10 years ago, across the country, only about 45 percent of patients had a door-to-balloon time of less than 90 minutes. “In 2006, when I was chair of the ACC’s quality improvement committee, we decided to work on this,” Dr. Brush says. “I worked with a Yale colleague, Dr. Harlan Krumholz, and we devised a more efficient communications plan, eliminating wasted time and missed phone calls, that enabled us to significantly reduce door-to-balloon time. The percentage of patients who got from door to balloon in less than 90 minutes increased from 45 to 95.” The success of the project is born out in a November 30, 2016 article in Cardiology Magazine, entitled “Door-to-Balloon 10 Years Later: Successful Model Sets the Stage for the Next Generation of ACC’s QI Programs,” which states Launched in November 2006, the program involved over 1,000 hospitals and changed the proportion of patients with

D2B times less than 90 minutes …. From 2005 to 2010, the median time to percutaneous coronary intervention was reduced by 30 percent, from 94 to 64 minutes. …there is evidence that these improvements have saved lives. A second point of pride for Dr. Brush is the book he wrote and illustrated in 2015, The Science of the Art of Medicine. “It’s about how doctors think,” he explains. “I got interested in this when I was working with the ACC’s quality improvement committee – I started thinking, what’s the fundamental quality problem? Why do doctors err? Why do we make mistakes? I started doing some reading and stumbled on the field of cognitive psychology, which examines how people make decisions. Also, I was increasingly involved with Eastern Virginia Medical School, teaching internal medicine residents the art of clinical reasoning. “Doctors make decisions all day long,” he continues, “and the fundamental problem in medicine is there’s a lot of uncertainty. We’re just scratching the surface of our understanding of biomedical science. When patients present with symptoms, we don’t always know what it is at first – sometimes we never know. There are levels of uncertainty and variability that we deal with. We deal with it through reasoning.” The Science of the Art of Medicine deconstructs the process of clinical reasoning. Dr. Brush initially offered his book for free to Internet readers, intending it primarily for trainees, students, residents and fellows – and physicians as well. It was well received – even garnering a good review from Oxford University – and soon, readers across the world were demanding printed copies. Dr. Brush worked with a publisher in Richmond, Virginia to produce a printed book, which along with the iBook has to date sold more than 4,000 copies. It is widely assigned as supplementary reading for students as they go through their training. As a result of the success of his book, and the many other papers and articles he has authored, Dr. Brush has been invited to lecture at several universities and medical centers across the country. He was also asked to write the chapter on clinical reasoning in Braunwald’s Heart Disease, the definitive cardiology textbook. He’s already on to his next exploration: observational research, which he calls the other side of the clinical reasoning coin. “I’m very fortunate in that Sentara has given me some protected time to work on it,” he says. “It’s an opportunity to build bridges between Sentara and EVMS and do some original research projects. It’s just getting off the ground, but I’m excited about where this could lead.” In fact, Dr. Brush says, he finds his work as fascinating today as when he was as a student: “At 62, I’m learning more on a daily basis than I ever have in my whole career.”  WInter 2017 Hampton Roads Physician | 11

WILLIAM A. DELACEY, MD Sentara Cardiology Specialists

ad it not been for a case of vertigo, William DeLacey might have become a Navy fighter pilot rather than a prominent cardiologist specializing in electrophysiology. Right out of college (Duke ’78), he was heavily recruited for Aviation Candidate School, but both he and the Navy soon realized he’d never be able to fly a jet. “Had I persisted,” he says, “I probably would have wound up as a big smoking hole in the ground.”

became a surrogate father and mentor. It was his guidance that drew me to medicine.” The Navy gave him a commission and put him through Georgetown University School of Medicine on a scholarship. Dr. DeLacey stayed in the Navy for 12 years. He completed his internship in Internal Medicine at National Naval Medical Canter in Bethesda, followed by a year with the active service force aboard a supply ship as Photos by Sigmon Taylor Photography part of the 6th Fleet. He returned to Bethesda to complete his residency in Internal Medicine, before spending the next three years at the Naval Hospital at Camp LeJeune, North Carolina – where he had the opportunity to treat Marines as well as many Navy fighter pilots. During his tenure at Camp LeJeune, Dr. DeLacey served as Chief of the Medical Staff of the Naval Hospital, and as President of the Medical Society. He also developed a keen interest in cardiology. In 1989, he returned to Bethesda once again, this time to pursue a fellowship in Cardiovascular Diseases. During that time, he says, he discovered he really enjoyed working with patients and implanting pacemakers. “That’s what led me to electrophysiology,” he remembers. “I loved the surgery part of it; and I find cardiology the most surgical of the medical specialties – we do surgery and medicine both.” The Navy sent him to the University of Virginia in 1991, to study cardiac electrophysiology with Dr. John DiMarco, the man Dr. DeLacey calls “probably the smartest person I’ve ever met.” In 1992, the Navy brought Dr. DeLacey and his family to the Naval Medical Center in Portsmouth. “The Navy was very good to me and to my Instead, he pursued a wish just as strong as the urge to fly. “I family,” he says, “but by 1994, it was time to get out.” They was always interested in science,” Dr. DeLacey says. “My father stayed in Hampton Roads because they liked the area, and he died when I was very young, and his physician, Dr. Scanlon, joined the practice at Lakeview Medical Center. In 2009, Dr. 12 | www.hrphysician.com

Over the course of his career, Dr. DeLacey has seen tremendous advances in cardiology. DeLacey’s wife passed away, and he describes the ensuing three years as challenging. But in 2012, he joined Sentara Cardiology Specialists, which he calls “definitely a big plus.” In 2014, Dr. DeLacey remarried, and now lives in Hampton. He currently divides his time between the Southside and the Peninsula, and has recently begun working at Sentara Williamsburg Regional Medical Center, as well as at Sentara CarePlex Hospital in Hampton. He also serves as President of the Medical Staff at Sentara Obici Hospital. He credits his time with the service for nurturing the sense of leadership that has been one of the hallmarks of his career. The Navy also instilled in him an intense appreciation for the value of teamwork. “The days of the doctor walking around as the dictator are gone – thankfully. As physicians, we may be at the top rung, but there are 50 people below us who make it happen. We can’t function without the advanced care practitioners, nurses, technicians – everybody on the ladder,” he says, “especially in the intricate and precise work of cardiac electrophysiology. You have to have a good team. My Navy training helped me understand that.” Over the course of his career, Dr. DeLacey has seen tremendous advances in cardiology. “When I first started implanting some of the more sophisticated pacemakers, it could take five or six hours.

It was tortuous,” he remembers. “Now with biventricular and three-wire pacing, we can do it in a couple of hours. That’s the way medical technology evolves: the science is there, and then the engineers get involved and make it user friendly.” Similarly, he says, procedures to implant defibrillators, which once required lengthy, open surgery, can now be done in about an hour. Dr. DeLacey believes much of the future of cardiac care, as in much of medicine, lies in gene therapy. “It’s coming. It’s definitely the future,” he says. “We’re just in the beginning phases of learning about the human genome sequence. It’s still in its infancy, but I’m fully certain that in 20 or 25 years, there’ll be gene therapy for all kinds of things: genetic diseases, heart attacks, arrhythmias. For example, I envision someone coming with a heart attack, and we inject genes inside them and it repairs the damage. And that’s during our children’s lifetimes.” In addition, Dr. DeLacey is involved in a project with IBM at Sentara Heart, teaching the iconic computer Watson to read echocardiograms. “Watson itself doesn’t know anything,” he explains, “but once you teach it, it knows it forever. I believe Watson – or something like Watson – is going to be involved in medicine in a good way.” Dr. DeLacey remains proud of his Navy service. “It was a very good experience for me,” he says. “I think people who have been in the service tend to have a different perspective. And it brought me here.”  WInter 2017 Hampton Roads Physician | 13

DEEPAK R. Bayview Cardiovascular Associates

oming from a medical family – his father practiced medicine in Hampton Roads for 40 years and was named the Physician of the Year in 2016 by the Krueger Foundation – the question wasn’t whether Deepak Talreja would become a physician, but rather what specialty he would pursue. “From childhood on, I’d go on hospital rounds with my father,” he says. “My sister, Reena Talreja, is a local OB/GYN and my mother is a nurse. We don’t know how to do anything else.” He completed the family portrait by marrying a pediatrician, Dr. Hyeon Choi. A 1993 graduate of the University of Virginia with a Bachelor’s in Biology and a minor in Philosophy, Dr. Talreja remained in Charlottesville for Medical School. After completing his internship and residency at Vanderbilt, he headed to the Mayo Clinic for a cardiovascular fellowship, which he completed in 2003, and a fellowship in interventional cardiology in 2004. He chose cardiology as he realized his passion lay with the heart. It may even have been a legacy: his father trained at the Cleveland Clinic in cardiology. About his chosen field, Dr. Talreja says, “We know the heart well as an organ, with its fascinating plumbing, mechanical parts and electrical systems. We can fix a lot of what goes wrong with it, putting in stents, replacing valves or fixing electrical problems. We can make a difference and save people’s lives in real time. It’s so exciting.” A particular area of excitement has been the development of fully percutaneously implantable valves. “For the last 30 years, if someone had a severe narrowing of an aortic valve, the only way to treat it was to open the chest, cut out the old valve, replace it with new one,” Dr. Talreja says. “But now, with the introduction of transcatheter aortic valve replacement – TAVR – we can implant a valve inside the body without ever opening the chest. Through a small arterial line in the leg, we pass the valve in, and often in less time than it took to do the full operation, we achieve similar results.” The procedure has been a boon for heart patients, including the elderly: TAVR is now routinely done on otherwise healthy 80 and 90 year-olds, who are home in a few days, scar-free. At the opposite end of the spectrum, Dr. Talreja says, are developments in prevention, one in particular that shows promise. About 12 years ago, a genetic abnormality was identified in Caucasian and African American populations in the United States: a deficiency of PCSK9, an enzyme made by most, but lacking in some people. “When it was discovered that these people have LDL levels of 10 to 30 mg/dL, and they’re not developing vascular disease, everybody tried to find a way to replicate that,” Dr. Talreja says. “Unfortunately, there’s no drug that will do that, but monoclonal antibodies have been developed, which harness a person’s immune system, much the same way that the body creates an antibody to a virus.” The potential is tremendous: “These humanized antibodies can be injected into the patient once or twice a month, and bring cholesterol down by over 50 percent. We had the opportunity to participate in studies with these agents and now they are available for clinical use.” In fact in March of 2017, he says, “there are new studies coming out that we hope will show they further reduce heart attack, stroke and death. The preliminary data is very favorable.” These advances – and “our ability to prolong and extend both quality and length of life” – are remarkable, but Dr. Talreja sees a bit of a hard road ahead from the 14 | www.hrphysician.com

TALREJA, MD medical ethical standpoint. “It takes great intellectual maturity and wisdom as a people to understand when to use it, how to use it, how to distribute it fairly,” he emphasizes. “We’re clearly spending too much on medical care. Our costs are going to have to go down; prevention will be a huge part of this.” For that to happen, it will mean people practicing healthfulness, and especially eating right, Dr. Talreja knows. He conducted a 2014 study that monitored the cholesterol changes in 400 people across the region, on various diets – Paleo, Vegan, Mediterranean and Dash. Researchers from the University of Virginia, Cleveland Clinic and the University of Alabama asked to follow these patients, all of whom were enthusiastic, most vowing never to return to their unhealthy habits. Thus far, only about a third have reverted. These findings were presented at the November 2015

meeting of the National Lipid Society and 2016 Cardiac Research Therapies meeting showing the effects of different diets on cholesterol levels. “As a nation, we have to engage in prevention,” Dr. Talreja believes. “It’s the future of cardiology, as well as health care as a whole. Get people to eat healthy and quit smoking. Encourage them to exercise. That’s what will save us.” Until that day comes, Dr. Talreja enjoys practicing in his hometown. He was torn when asked to remain on the faculty at the Mayo Clinic after his training, but feeling the pull of returning to Hampton Roads, he says, “My kids are growing up with their grandparents and family close by. Now I’m taking care of many of my old high school friends and even some of my teachers – I could never imagine an honor that great.” 

Photos by Sigmon Taylor Photography

WInter 2017 Hampton Roads Physician | 15

GOOD DEEDS

Throughout Hampton Roads, there are physicians who regularly volunteer their time, knowledge, training and experience to individuals and organizations in this community, in the nation and throughout the world. They do so quietly, without fanfare, and often without reward or recognition of any kind. Hampton Roads Physician is pleased to acknowledge these physicians by sharing their good deeds with our readers.

Ian Persaud, MD, MPH Medical Director of Cardiology & Specialty Care JenCare Medical Centers

hen Dr. Ian Persaud came to Hampton Roads in 2013 to join JenCare Medical Centers, he brought with him a history of volunteerism and service that extended far beyond the borders of the Brooklyn community, where he was a fellow at State University of New York Downstate Medical Center. Throughout his fellowship, he participated in many of the local and international outreach activities and missions of the Brooklyn Tabernacle and the International Presbyterian Church. It was only natural, therefore, that he would seek out volunteer and outreach opportunities when he came to Hampton Roads. These he has found in a number of places. Since June of 2014, he has been an active member of the Soup Kitchen Ministry at First Presbyterian Church in the Ghent section of Norfolk. “I really love to cook,” Dr. Persaud says, “it’s a real stress reliever.” But more importantly, he says, it’s an opportunity to meet people living in the community who, whether just down on their luck or truly impoverished, have interesting stories to tell. And it’s an opportunity to help them. Dr. Persaud also participates in the Church’s Video Mission Ministry. “This was something I got interested in during my fellowship,” he says. “I worked with the inmates at Riker’s Island. In New York, many of the families lived close by, so they could visit the inmates regularly. But locally, many of the inmates’ families are eight hours away or more, so it’s impractical to visit.” The Video Ministry works with prisons to facilitate on-screen conferences between inmates and their families, much like a Skype session. “There are inmates who haven’t laid eyes on their family members in years,” Dr. Persaud says.

“Allowing them to have that connection can be very emotional at times, but always gratifying.” Dr. Persaud also devotes time at the HOPES Clinic, supervising and teaching the medical students who volunteer there. HOPES, which stands for Health Outreach Partnership of EVMS Students, has served uninsured citizens of Norfolk with long term and specialty care since its founding in 2011. Until recently, there wasn’t a cardiac clinic at HOPES, and many of the patients who regularly use the clinic have sought attention from area emergency rooms for chest pain, heart failure, or other cardiac conditions. “Once these patients leave the ER, it’s hard for them to get the necessary follow-up studies like echocardiograms or EKGs,” Dr. Persaud explains. “So we’ve been identifying the subset of these patients with multiple admissions for heart failure or uncontrolled blood pressure who have been coming to the HOPES clinic, to get them into a specialty clinic, where we can manage them more closely, even doing echocardiogram studies so they don’t have to go elsewhere.” Dr. Persaud will serve as Medical Director of the Cardiac Specialty Care Clinic, which he anticipated would be fully operational in January 2017. In all of his community service work, Dr. Persaud likes having time with individuals who might otherwise pass under the radar – to give them some much needed attention. Whether he’s cooking and serving meals with the soup kitchen ministry, facilitating family video conferences for prisoners, or supervising students who are providing much needed medical care to underserved members of the community, he says, “It’s nice to have a specific skill set that allows me to help them in a particular way.”

If you know physicians who are performing good deeds – great or small – who you would like to see highlighted in this publication, please submit information on our website – www.hrphysician.com – or call our editor, Bobbie Fisher, at 757.773.7550. 16 | www.hrphysician.com

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medical center for heart care, and Virginia’s only nationally ranked heart program, Sentara Heart Hospital continues to be the choice for heart care in the Mid-Atlantic region and beyond. Thank you to our devoted team of Sentara Heart physicians, nurses and clinical teams for your ongoing

49 states, Washington D.C., Puerto Rico, Virgin Islands, Australia, Canada and the United Kingdom have selected Sentara Heart Hospital for their care.

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A D VA N C E D P R A C T I C E PROVIDERS

It is an honor to highlight local Nurse Practitioners and Physician Assistants as they are increasingly invaluable members of the healthcare industry. We congratulate Sally Carr, NP-C.

SALLY CARR, NP-C

hree years ago, after nearly thirty-five years in obstetrics and gynecology – first as a nurse and later as a Certified Nurse Practitioner – Sally Carr knew it was time for a change. She saw a notice on one of the professional websites she frequented, advertising for a bariatric NP. “I didn’t really know what that meant,” Carr remembers now, “but the ad mentioned dealing with bioidentical hormones in the female patient, and I had been doing that for 30 years, so I thought I’d apply and at least talk with the physician.” When Dr. Jennifer Pagador, the founder and medical director of Seriously Weight Loss, reviewed Carr’s resume, she immediately contacted her for an interview. The physician was so impressed at the interview, she offered Carr the position of Bariatric Nurse Practitioner. Carr accepted, and found a second career equally satisfying in terms of helping a population of patients with very specific health issues and and needs. Helping people with health needs has always been at the forefront of Carr’s career decisions. As a high school student with a decided interest in the sciences, she worked in a pharmacy in her small town of Pittsboro, North Carolina. She attended pharmacy school, but after two years, she realized that “organic chemistry was never going to be my friend.” She decided to apply the two years toward a Bachelor of Science in Nursing. She completed her final two years and earned her BS from Atlantic Christian (now Barton) College. She worked as a staff nurse at New Hanover Memorial Hospital in Wilmington, as well as at what was then Obici Memorial Hospital. Just as she was realizing she didn’t care for the constantly changing shifts and weekend work, a fellow nurse suggested they investigate the nurse practitioner program that was coming to Hampton Institute. They attended the lecture

and decided to apply. Carr graduated in 1982 as a Certified OB/GYN Nurse Practitioner, and worked in the field exclusively until 2013, when she noticed Dr. Pagador’s ad. The two practices – OB/GYN and bariatric – both involve dealing with bioidentical hormones, but otherwise, Carr’s daily routine is far different working with Dr. Pagador’s Seriously Weight Loss patients. Where she spent most of her days doing complete physical exams and ordering tests for obstetric and gynecology patients, today she spends more of her one-on-one time with patients counseling them. “Now I mostly give dietary counseling, encouraging physical activity,” she says. “Where I was used to standing a lot, and going constantly, now I’m spending time sitting and talking with patients, reviewing how their diet is going, how their exercise regimen is going, how much they’re sleeping, how much stress there is in their lives.” Patients do have blood tests, and Carr works to help them improve their numbers. And because Seriously Weight Loss is a medically managed office, patients are administered an EKG. “Some of the medications we use can affect the heart,” Carr says, “so we have to ensure they’re not going to cause any more problems. Some patients rarely get EKGs, so we’ve even picked up some problems they weren’t aware of. We refer them for appropriate care before admitting them to the program.” The best part of the switch to bariatric practice, Carr says, is that her work is “more rewarding, because these patients actually want to hear what I have to say.” She explains: “I talked to patients for years and years about health and nutrition, trying to encourage them to lose weight, to become healthier, and nobody listened to me. Today, my patients listen. And in return, they regain their health.” 

If you work with or know a Physician Assistant or Nurse Practitioner you’d like us to consider, please visit our website – www.hrphysician.com – or call our editor, Bobbie Fisher, at 757.773.7550. 18 | www.hrphysician.com

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FINDING SOLUTIONS FOR CERVICAL WHIPLASH By Scott Bradley, MD, Hampton Roads Orthopaedics & Sports Medicine

lthough cervical whiplash is a common injury, the condition is often misdiagnosed and overlooked in patients who might suffer frustrating or debilitating symptoms for months or years. With specialized training, advanced diagnostic equipment and tailored therapies, we can offer a range of treatment options to erase or ease mild to severe pain. Whiplash injuries occur with rapid acceleration and deceleration of the head, most often during car accidents. That force can stretch and tear muscles, liga-

20 | www.hrphysician.com

ments and joints between the vertebrae of the neck. Studies have shown more than 80 percent of people in a car accident sustain some degree of whiplash, while crashes at speeds of as little as five miles per hour can induce a cervical injury. Symptoms can appear weeks or months after an accident. While mild cases might present with minor neck discomfort and stiffness, moderate to severe cases may include multiple complaints, including headache, dizziness, vision changes, tinnitus and pain or numbness in the neck,

shoulder, arm or jaw. Without relief, these patients also are at risk for developing depression, anxiety and insomnia. Unfortunately, cervical whiplash injuries can be difficult to diagnose because damage to structures in the neck may not appear on imaging tests, and because reported pain may be located away from the neck. By the time many patients reach us, they have consulted with multiple doctors in emergency room and community settings. Frequently, they have received ineffective medication or been told there is nothing physically wrong with them; some have been dismissed as drug-seekers. By listening closely to clinical symptoms, we often can match pain in a certain area of the body to a specific structure in the neck. In many cases, pain arises from the facet joints, small synovial joints between and behind adjacent

vertebrae that provide spinal column stability and allow for proper movement. Generally, our treatment plans begin with conservative approaches such as anti-inflammatory medications, muscle relaxants and application of heat or ice, along with physical therapy and stretches to loosen and repair shocked muscles. Precise medication management and individualized exercise regimens can relieve many mild cases of whiplash. For patients with moderate to severe injuries, we can offer advanced diagnostic tests such as nuclear medicine studies and discuss more aggressive therapies. Our goal is to address the source of each person’s pain – not mask it temporarily

or rely on a single-angle treatment. Options include epidural steroid injections or facet joint injections to reduce inflammation. Another promising treatment is radiofrequency ablation (RFA), which burns the nerves that enervate damaged joints. RFA has the potential to block pain for eight to 10 months, giving muscles time to reset and freeing patients to participate fully in physical therapy. The improvements we see can have a major quality-of-life impact. Many patients greet us with smiles, hugs and joyful stories of finally returning to their regular activities. With patience and persistence, we can find solutions for cervical whiplash. 

Dr. Bradley is Board certified in Physical Medicine and Rehabilitation and specializes in disorders of the spine, musculoskeletal system and acute sports-related injuries. He will join Hampton Roads Orthopaedic & Sports Medicine in February 2017, practicing at the New Town office in Williamsburg. www.hrosm.com.

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MEDICAL U P D A T E

COLORECTAL

CANCER 22 | www.hrphysician.com

espite advances made in the diagnosis and treatment of colorectal cancer, the disease continues to maintain its hold as the second leading cause of cancer-related deaths in the United States, and the third most common cancer in both men and women. Unfortunately, the statistics are even worse in Hampton Roads. Bruce Waldholtz, MD, a gastroenterologist with Gastroenterology & Liver Specialists of Tidewater, cites a 2015 study published by epidemiologist Rebecca Siegel, MPH in Cancer Epidemiology, Biomarkers & Prevention, reporting that the Eastern Virginia/ Northeast North Carolina region is one of three hot spots in the United States for colorectal cancer, with a nine percent higher mortality rate than the rest of the country. And yet it remains a fact that half of all U.S. colon cancer deaths a year could be prevented if everyone 50 and older were screened. And even when not prevented, colon cancer in its early stages is highly curable, with a five-year survival rate of 90 percent. However, only 39 percent of colon cancers are detected at this stage. The main reason, of course, is that people aren’t getting screened. “Colon cancer screening right now is at about 50 to 55 percent,” says Marybeth Hughes, MD, Chief of the Division of Surgical Oncology at EVMS. “It’s woefully inadequate.” So inadequate, in fact, that the National Colorectal Cancer Roundtable has launched the “80% by 2018” initiative.

80% by 2018 – An Ambitious But Achievable Goal Hundreds of organizations and care providers across the country have committed to substantially reducing colorectal cancer as a major public health problem for those 50 and older (45 for African Americans).These organizations are working toward the shared goal of 80 percent of adults aged 50 and older being regularly screened for colorectal cancer by 2018. The initiative is led by the American Cancer Society (ACS), the Centers for Disease Control and Prevention

Brian Billings, MD

David Z. Chang, MD

(CDC) with the NCCR. The 80% by 2018 website states that “If we can achieve 80% by 2018, 277,000 cases and 203,000 colorectal cancer deaths would be prevented by 2030.” All of the physicians interviewed for this article believe it’s an achievable goal, and all are involved in the initiative. “Bon Secours received a grant from NIH, which we used to hire personnel to visit primary care physicians’ offices and go through patient charts to identify those who need colonoscopy,” says Joseph Frenkel, MD, a colorectal surgeon with Bon Secours Maryview Medical Center, “and then trying to navigate them to a gastroenterologist or colorectal specialist for that screening.” Similarly, reports Sentara Cancer Network colorectal surgeon William Rudolph, MD, “Sentara Medical Group physicians are leveraging the power of the electronic medical record to proactively trigger screening reminders.” “We do a lot of outreach on 80% by 18, monthly lectures, speaking with church and civic groups and the like,” says Brian Billings, MD, a colorectal surgeon with Riverside Health System. “We’ll screen any appropriate patient who comes through our doors.” The initiative is aimed not just at the general public, Dr. Hughes says, “but also at primary care physicians. When patients come in for regular checkups – cholesterol, blood pressure, etc. – or indeed, for any office visit, these physicians should be asking about colonoscopy, and urging their eligible patients to schedule them.” The gold standard for screening, of course, is colonoscopy, which unfortunately many patients simply refuse for a variety of reasons, not the least of which is the prep. It’s the number one complaint patients have. “We’re better with preps than we used to be,” says Dr. Billings. “We’re using Miralax, a low volume prep that’s easily tolerated.” And it may soon get more palatable, Dr. Waldholtz explains: a Boston-based company, ColonaryConcepts, is developing bowel-cleaning food bars and drinks that taste more like fruit smoothies

Joseph Frenkel, MD

Marybeth Hughes, MD

Winter 2017 Hampton Roads Physician | 23

Ray Ramirez, MD

William Rudolph, MD

and chocolate. “These have shown good results thus far,” Dr. Waldholtz says. “They’re not commercially available yet, but ColonaryConcepts is scheduled to begin phase 3 trials in early 2017, so we might see them enter the market by 2018.”

Noncolonoscopy Screenings Fifteen years ago, virtual colonography was introduced, looking for a less invasive way to diagnose patients, and select out those who actually needed the full colonoscopy for follow up. While effective at finding polyps a centimeter or greater, it can’t determine which are simply polyps and which are cancer. Another problem with colonography is that it was developed “in an era when we weren’t really looking at flat polyps,” Dr. Billings says. “These are subtle, and easily missed by the CT. But for patients whose anatomy won’t allow colonoscopy, or who can’t tolerate it, there is an application for virtual

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colonography.” The newest iterations of screening tests include the Fecal Immunochemical Test (FIT) and stool DNA tests. These are attractive to patients because they can be done at home, and while better than no screening at all, both of these can miss many polyps and some cancers. The FIT test can produce false positive test results. In both cases, if the results are abnormal, Bruce Waldholtz, MD colonoscopy screening is indicated. Dr. Frenkel explains, “The biggest problem with these tests is they’re just not as accurate or therapeutic as colonoscopy. They’re good at ruling out cancer, and for someone who can’t have a colonoscopy, that’s promising. So there’s a place for them with very elderly or highly comorbid patients, but beyond that, I don’t use them.” “These screening tests are better than the stool tests we’ve had in the past,” says Ray Ramirez, MD, a colon and rectal surgeon with Chesapeake Surgical Specialists. “But they are not indicated for people with a history of polyps or a first degree relative with a history of colon cancer.” These newer screening tests are included in the recently published Recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer, which again confirm the primacy of the colonoscopy, Dr. Hughes says. The new guidelines have expanded, she says: “If you have a first degree family member,

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you should have your first screening when you are 10 years younger than that relative was diagnosed. For instance, if your sister got colon cancer at 45, your colonoscopies should start when you are 35.” “It’s true that a DNA or FIT test is better than nothing,” Dr. Rudolph says, but cautions, “These tests are adequate at picking up cancers – we’re talking about 70 to 90 percent sensitivity – but advanced adenomas, precancerous polyps, aren’t picked up by the standard DNA test. And getting the polyps out before they turn into cancers has made a huge impact.” David Z. Chang, MD, a medical oncologist with Virginia Oncology Associates, confirms. “With screening colonoscopy, when polyps are found, we can actually prevent cancer by taking out the polyp. Even if it is cancer, it’s very curable in its early stages. For example, in Stage I, 95 percent of patients can

be cured by surgery alone. Unfortunately, without screening colonoscopy, by the time people present with symptoms and come to see surgical oncologists, they likely already have cancer, likely beyond Stage I.”

Genetic Tests

“There are colon cancers that act differently,” Dr. Hughes says. “Some are well differentiated, some poorly. And there are other markers, like BRAF, KRAS mutations that can help us guide the biologic behavior of these tumors.” Knowing that wouldn’t dictate the type of surgery performed, she adds. A lot of that information is gleaned after the specimen is removed. “We’re also looking at micro-satellite instability, in the subset of patients who have problems with their repair genes. In these patients, when a cell divides, it makes a mistake, and the four repair genes that we look at are compromised, so these patients are at higher risk for another cancer. They don’t respond as well to chemotherapy.” “The discovery of micro-satellite instability in colorectal tumors has increased our awareness of the diversity of colorectal cancers,” Dr. Chang adds, A Division of “and their implications for specialized management of patients, for example, using the modern immunotherapy.” There are other genetic abnormalities that can occur as well, Dr. Rudolph notes, including Lynch Syndrome and familial polyposis. “We have standard genetic tests, looking for these conditions,” he says. “In fact, for three years, nearly 100 percent of cancer specimens obtained from Sentara’s colonoscopy or surgery patients have undergone testing,” giving patients’ family members the opportunity to be tested and seek treatment. For example, if a family member tests positive for Lynch Syndrome, one of the options is either to screen the colon on a yearly basis, or to have a partial colectomy. And some women, if they are beyond childbearing years, may choose to undergo prophylactic Michael Sperling, MD Bruce Waldholtz, MD Douglas Howerton, MD oophorectomy or hysterectomy. Gary Payman, MD Scott Yagel, MD Alex Williams, MD “We’re starting to see some of the Paul Ricketts, MD fruits of our genetic work,” Dr. Billings says, “and really starting to understand Two Convenient Locations: the genetic mutations that are driving Norfolk, Chesapeake these tumors. So the future is going (757) 627-6416 (757) 436-3285 to see us more and more tailoring 400 Gresham Drive, Suite 303 113 Gainsborough Square, Suite 202 therapy to individuals.” Tumors are Norfolk, VA 23507 Chesapeake, VA 23320 different, he explains, some slow growing and easy to treat, while others are very aggressive and fast. “We can’t www.GI-MDs.com really tell the difference between them, Providing comprehensive GI healthcare since 1971! other than that some patients do well and some poorly. Now we’re starting

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Colonoscopy Saves Lives!

26 | www.hrphysician.com

to be able to take these tumors apart genetically, and look for markers that can tell us if the patient has an aggressive tumor.”

Colorectal Surgeries The procedure the surgeon chooses depends on where the tumor is, each patient’s unique presentation and anatomy, whether there have been multiple prior surgeries, and other conditions, including obesity. For Stage I, II and even III, surgery is always an essential part of treatment, Dr. Chang says. And staging determines the prognosis. “In Stage IV, when cancer has spread to other organs like the liver or lungs, it has traditionally not been curable. But today, chemotherapy has become so effective that we are sometimes able to shrink cancer in the liver to allow surgery to remove it. Looking at the data from M. D. Anderson and other institutes, between 40 and 60 percent of these patients can become long-term survivors after liver metastasis resection, basically cured and living relatively comfortable lives.” Among the most significant advances in the field of colorectal cancer are the new surgical techniques that are being employed today, and especially those being contemplated. “It’s acceptable to do an open colon with an old-fashioned incision,” Dr. Hughes says, “although more surgeons are doing laparoscopic colectomies, which make it easier on the patient to recover. More and more minimally invasive procedures will be done in the future.” Nationally, only about a third of colon cancer surgery is now being

done minimally invasive, adds Dr. Ramirez, who teaches the technique to residents and surgeons several times a year. “That, to me, is one area where we can improve, because of the many benefits to the patient.” Today, some surgeons believe robotic surgery affords better visualization in the pelvis, especially in men with their smaller pelvises, because the magnification on the camera is better than laparoscopic, especially for low rectal surgery. Robotic surgery solves one of the persistent problems with traditional laparoscopic surgery, says Dr. Rudolph, who performs robotic colorectal procedures at his home base at Sentara Virginia Beach General Hospital, and also at Bon Secours DePaul Medical Center, both of which house a daVinci Xi® system. “The generation of the Xi robot at DePaul was specifically designed – in part, at least – for colorectal surgery,” Dr. Frenkel says, “because unlike some of the other surgeries that are done robotically, colorectal surgeons sometimes need to be in more than one corner of the abdominal cavity. For example, in a patient having rectal cancer surgery, we may need to remove a portion of their sigmoid colon. It was difficult for the older robot to go into different areas because of the way it was built. With the newer Xi, we can go to different areas more easily. I love the greater visualization and the ease it allows me to dissect the rectum.” That matters, he adds, because in rectal cancer surgery, the quality of the dissection is extremely important as it relates to patient outcomes oncologically. “Fine movements and the ability to dissect very precisely just aren’t possible with straight laparoscopy,” Dr. Rudolph explains. “It’s like using chopsticks.” But with the daVinci

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robot, he says, “we have fully articulated motions with our instruments, allowing us to get into areas we normally wouldn’t be able to get into, with precision we normally wouldn’t have.” Since employing the Xi, Dr. Rudolph confirms that robotic surgery has improved his patients’ recovery, significantly reduced hospital stays and lessened complications. Dr. Frenkel, a proponent of single incision surgery, has recently begun doing surgeries robotically as well, and agrees wholeheartedly. And with the recent installation of a new daVinci Xi® system at Bon Secours Maryview Medical Center, there is now a third location where surgeons can perform the procedure.

What’s Next? Colorectal Cancer Treatment 5-10-15 Years From Now. Colorectal cancer is being studied across the country with a view toward prevention and cure. An ongoing local research project is an Alliance trial: N1048, looking at patients with rectal cancer who are candidates for curative intent sphinctersparing surgery – without high risk features such as tumor encroaching upon the mesorectal fascia or distal tumors. “The biggest hope I have in terms of treating colon cancer is immunotherapy,” says Dr. Chang. “It’s been around for many years, but becoming more popular recently as we see more effective immunotherapy agents approved for various cancers, e.g., melanoma, lung cancer, kidney cancer, bladder cancer, etc. However, other than for micro satellite instable colon cancer, immunotherapy hasn’t been as effective in most colon cancer because of the cancer’s different biology. It’s being studied extensively, and I foresee that in 10 years, immunotherapy will be used for colon cancer. We’re also seeing encouraging results for cancer control from radioembolization in patients whose colon cancer has spread to the liver.” “There are major advances in the way we treat rectal cancer,” Dr. Rudolph says, “one is the idea that we can treat it locally, or transanally.” Dr. Rudolph emphasizes that transanal surgery is not the standard of care in the United States – yet – but explains: “Normally what we worry about with colorectal cancer is ensuring that we get an adequate sampling of lymph nodes, to ensure that the cancer staging is complete and that there is no residual cancer left. Particularly in rectal cancer, there’s a high risk of recurrence. Because of this, for many rectal cancers we give preoperative chemotherapy and radiation therapy, followed by resection through the abdomen. In some countries, they are now taking out the cancers locally through the anus, sparing patients a very big surgery and possible colostomy. Although we do not have large randomized studies at this point to be able to make this approach the standard of care in the US, in the future this may be a tremendous advantage to our patients.” Preliminary results outside of the United States are good, but it won’t be available in the US until sufficient data is accrued to ensure equivalency between a transabdominal and a transanal resection. There are several trials going on in America, but it will take a while to accrue the data. Perhaps the most dramatic potential change in the treatment of colorectal cancer is the advent of the transanal total mesorectal excision. “The pioneers in our field are working on ways to do the entire rectal cancer surgery from the anal area,” Dr. Frenkel says, “removing both the tumor

STOP COLON CANCER

and the surrounding lymph nodes, just as it would be done transabdominally. Many people feel that, as opposed to rectal dissection from the abdomen, which can be challenging when you’re dealing with the prostate or the vagina and uterus, that dissection might become the standard. We’re only a couple of years into this now, but it’s on the horizon.”

Postsurgical Innovation A new post-operative protocol being introduced throughout the country is ERAS, Dr. Ramirez says. “It stands for Enhanced Recovery After Surgery, and the goal is to minimize postoperative pain without the use of narcotics. The actual prep for surgery is totally different.” It’s a very involved prep, Dr. Billings notes, that includes having the patient drink a carbohydrate rich drink the night before and the morning of the surgery. “The patient is given a spinal injection before surgery, and nonnarcotic pain medicine during and immediately after surgery.” The NIH website defines the key principles of the ERAS protocol as “pre-operative counseling, preoperative nutrition, avoidance of perioperative fasting and carbohydrate loading up to two hours preoperatively,” and calls ERAS “an important focus of perioperative management after colorectal surgery.”

The Bottom Line Colon and rectal cancers, while not 100 percent preventable, can be treated when detected early, and for that to happen, patients are going to have to make screening – at the age appropriate to their particular medical profile – a priority. And physicians are going to have to even more aggressively prevail upon their patients to take this life-saving step. “Don’t fear the scope,” Dr. Hughes urges patients. “It saves lives.” And if they won’t have a colonoscopy? As Dr. Waldholtz says, quoting the American Cancer Society, “The best test is the one that gets done.”  WInter 2017 Hampton Roads Physician | 29

World Class Weaponry Stereotactic Radiosurgery offers cutting-edge precision in the battle against cancer By Biral S. Amin, MD

tereotactic Radiosurgery has changed the outlook for many cancer patients once at a high risk of complications from radiation treatment â&#x20AC;&#x201C; or with little chance of recovery at all. Two remarkable systems at the Radiosurgery Center, the Leksell Gamma Knife and Synergy S, can deliver high doses of radiation to abnormal tissues in the brain and body in an extremely precise manner. These non-invasive therapies increase the concentration of radiation we can deliver to unhealthy tissue yet spare surrounding healthy tissue from damage. With no incisions involved, they also limit blood loss and pain, promote quicker healing and offer new hope to patients who have undergone previous cancer treatments without The Gamma Knife success. The Gamma Knife simultaneously aims 194 powerful beams of cobalt radiation at a single site inside the brain. The outpatient procedure has evolved into the gold standard for treatment of metastatic brain tumors and also can target primary small primary tumors, arteriovenous malformations (AVM), trigeminal neuralgia (TN), vestibular neuroma (VN) and other benign conditions. As a result, patients who once faced grueling open surgery, lengthy hospital stays and taxing recovery periods can return almost immediately to their pretreatment activities. They also demonstrate improved long-term cognitive function compared to those who undergo whole-brain radiation. Synergy S, meanwhile, can be effective on cancers throughout the body, including the lung, breast, prostate, pancreas, spine and liver, as well as on brain tumors not accessible by the Gamma Knife. The system pairs a linear accelerator with real-time visualization of internal structures, including soft tissues, in a three-dimensional format. The combination allows surgeons to blast cancerous growths and lesions with incredible accuracy, even if tumors or organs shift during radiation treatment. 30 | www.hrphysician.com

Synergy S can help patients who are not surgical candidates and/or have difficult-to-reach cancers such as tiny lung tumors or a small metastasis away from the original disease site. By dramatically narrowing the treatment field, the system also benefits patients who have had previous doses of conventional radiation that have already impacted nearby tissues. Stereotactic Radiation has constantly evolved since its initial introduction in 1951. In the last five years alone, we have made significant progress in our ability to immobilize patients during treatment; pinpoint, map and track cancers; and instantly switch radiation beams on and off based on even the most incremental tumor movement during surgery.

Synergy S

This innovative technology, made possible by a partnership between Riverside Health System, the University of Virginia Health System and Chesapeake Regional Medical Center, will continue to change the lives of cancer patients in Hampton Roads well into the future. ď&#x20AC;ź Dr. Amin practices at the Radiosurgery Center at Riverside Regional Medical Center in Newport News. He is Board certified by the American Board of Radiation/Radiation Oncology and treats all cancer sites, with a special interest in head and neck tumors and prostate brachytherapy. riversideonline.com/cancer

How Colon Cancer Treatment Redefined Preventable Blindness Worldwide Kapil G. Kapoor, MD, Wagner Macula and Retina Center

n 2013, a group of prominent historians were surveyed and asked to compile a list of the greatest breakthroughs of all time. While some items on the list were clearly revolutionary – such as electricity (#2) and the Internet (#9) others seemed humdrum by comparison (paper at #6!), but clearly chosen for the ripple effects they would have on history and society. If we similarly compiled a list of the greatest breakthroughs in retinal medicine, we would need go no further than the topic of colon cancer to unveil one of the true gems. Perhaps the single most dramatic therapeutic change in retinal medicine had its origins in colorectal cancer treatment. In 2004, the FDA approved bevacizumab (Avastin) for the treatment of metastatic colon cancer. Bevacizumab is a humanized monoclonal antibody that inhibits vascular endothelial growth factor (VEGF) by shrinking blood vessels. Bevacizumab proved a potent chemotherapeutic adjunct, inducing tumor regression by inhibiting growth of the very blood vessels tumors critically rely on for their own growth. New blood vessel growth is a significant source of pathology in retinal disease, most notably in wet age-related macular degeneration (AMD). With advancing age, the retinal basement membrane degenerates, and a lack of oxygen and nutrients signals development of new blood vessels. Rather than recruiting oxygen and improving the nutrient stores, these new blood vessels, or choroidal neovascular membranes, break through the retinal surface and leak blood and fluid into the retinal layers, often resulting in a severe disruption of central vision. This quickly compounds when we realize how quickly wet AMD can lead to legal blindness, and how prevalent AMD is – affecting over 20 million Americans! Just over a decade ago, the only reasonable treatment for these blood vessels was laser treatment that often just slowed blood vessel growth, with ineffectual lasting effect. There was no known way to reverse vision loss – all treatment focused on preventing or slowing the inevitable vision loss. Anti-VEGF heralded an entire new era, with impressive results. Randomized controlled trials have revealed that nearly half of patients are able to significantly reverse vision loss, improving vision by at least three lines on the eye chart. Additionally, approximately 95 percent can successfully prevent further significant loss of vision – a huge improvement!

32 | www.hrphysician.com

It soon became apparent that this treatment would work in several other cancers by inhibiting VEGF, thus gaining multiple other FDA approvals. Similarly, in retinal medicine, bevacizumab and its cohort of other anti-VEGF teammates have expanded their scope to a range of retinal pathologies, prominently diabetic retinopathy and retinal vascular occlusions – that similarly produce new blood vessels intent on stealing vision.

In 2004, the FDA approved bevacizumab (Avastin) for the treatment of metastatic colon cancer. Whereas wet AMD was a nearly irreversible source of vision loss a decade ago, it now has superb treatments that can keep patients with wet AMD driving, reading, and continuing their day-to-day activities for years! It’s easy to take our present outcomes for granted, and even easier to forget the critical need for continued innovation. Research and development have always been the foundation of progress in medicine, the cornerstone upon which we expand our patient outcomes. The jump from using anti-VEGF in colorectal cancer to using it in the eye was one of those breakthrough moments. The very next innovation may be developing as we speak. Currently, multiple clinical trials are ongoing at our research center, investigating treatments across a breadth of retinal pathology, notably the dry and wet forms of age-related macular degeneration and diabetic retinopathy – the leading causes of blindness in adults in the United States today. These innovative treatments no longer require a trek out of town, and we look forward to your collaboration in expanding and communicating the availability of these research opportunities to your patients and colleagues.

Kapil G. Kapoor, MD is a Board certified ophthalmologist specializing in vitreoretinal surgery. wagnerretina.com

A surgery team just for kids. Children’s Hospital of The King’s Daughters offers the most comprehensive pediatric surgical care for children in Hampton Roads, northeastern North Carolina and Virginia’s Eastern Shore.

CHKD’s state-of-the art facilities include a new cardiac catheterization lab and cardiac operating suite at our main hospital in Norfolk and two CHKD Health and Surgery Centers in Newport News and Virginia Beach for outpatient surgery.

In addition to general pediatric surgery, we offer care in five pediatric subspecialties including cardiac surgery, neurosurgery, orthopedic surgery, plastic surgery and urology. Our team also includes more than 20 pediatric anesthesiologists and dozens of OR nurses.

More than 20 pediatric surgeons. More than 13,000 surgeries last year. And more than 50 years of experience in pediatric surgical care. That’s what makes CHKD more than a hospital.

Our surgeons have pioneered non-invasive techniques for the correction of chest wall abnormalities at our worldrenowned Nuss Center, and our craniofacial reconstruction program is proud to be the American home of the international charity Operation Smile. Our multidisciplinary spine team includes orthopedic and neurosurgeons and is a regional leader in spine surgery for children and adolescents.

Learn more at CHKD.org.

OUR SURGERY TEAM Cardiac Surgery

James Gangemi, MD

Neurosurgery

John Birknes, MD Joseph Dilustro, MD Gary Tye, MD

General Surgery

Frazier Frantz, MD Robert Kelly, MD Ann Kuhn, MD Margaret McGuire, MD Robert Obermeyer, MD

Orthopedics/ Sports Medicine

Marc Cardelia, MD Allison Crepeau, MD Cara Novick, MD Jeremy Saller, MD Sheldon St. Clair, MD Carl St. Remy, MD Allison Tenfelde, MD

Plastic Surgery

George Hoerr, MD Jesus (Gil B.) Inciong, MD

Urology

Charles Horton, MD Jyoti Upadhyay, MD Louis Wojcik, MD

ROTATOR CUFF REPAIR: Advances in non-surgical care and the operating room benefit patients of all ages By Samuel Brown, MD

ffective repair of rotator cuff tears is frequently possible in most patients, no matter how major their injury or advanced their age. However, the best results depend on prompt and accurate diagnosis, effective use of non-invasive therapies or surgery, and carefully managed rehabilitation. Specialized care can help almost all patients return to their favorite activities and avoid long term shoulder pain and arthritis.

or normal wear-and-tear of age. They are often preceded by a condition called shoulder impingement syndrome, which is compression of the rotator cuff in the narrow subacromial space. One common misconception is that everyone with a rotator cuff “tear” requires surgery. In fact, many patients with partial tears or worn, fraying areas of a tendon can improve without surgery. Non-steroidal anti-inflammatory medications, strengthening exercises and physical therapy may help. Others with more serious tears will benefit from arthroscopic surgery, One common misconception is that everyone a minimally-invasive outpatient procedure. Full-thickness tears, in which the tendon is torn away with a rotator cuff “tear” requires surgery. from the bone, are more significant. New suture anchors Tears of the rotator cuff – a group of four muscles and their and techniques have reduced surgical times, minimized the rate tendons that converge at the greater tuberosity of the humerus of complications and allowed us to fix injuries once considered in the shoulder – are extremely common. Tears can be acute “untreatable”. or degenerative, caused by falls, repetitive stresses in athletics The rehabilitation period remains significant, requiring gradual but steady strengthening without risking another tear. Physical therapy may range from six to eight weeks up to two to three months, depending on a patient’s injury and age. Since Traditional & High-Tech Artificial Limbs each individual is different, long-term success is best achieved Custom Orthopedic Bracing & Splints with close coordination between a surgeon and physical therapy Custom Foot Orthotics team. Every case is different. Sports Medicine Bracing American Board Certified Clinicians Early diagnosis and intervention is critical. Symptoms of rotator cuff injury include night pain and pain with activity; discomfort when raising or lowering the arm, weakness when lifting or rotating the arm and a grinding sensation with shoulder movement also may occur. If left untreated, damage can progress to adhesive capsulitis, or frozen shoulder syndrome, which is marked by extreme stiffness and pain, limited range of motion and the development of scar tissue that complicates any future attempt at repair and rehabilitation. Unrepaired patients also might suffer from cuff tear arthropathy, a debilitating form of shoulder arthritis. As a result, we encourage primary care physicians to refer patients of all ages – not just the young or athletic – to a specialist. Even patients in their 80s and 90s can see a dramatic improvement in their daily lives with proper care. Our philosophy is that a patient doesn’t have to be a professional athlete to be treated like one! Dr. Brown is an Orthopaedic Surgeon and specialist in Sports Medicine, with fellowship training in shoulder disorder. He is one of the original members of Sports Medicine & Orthopaedic Center, Inc., and recently became President of the Southern Orthopaedic Association. smoc-pt.com 34 | www.hrphysician.com

What To Do If You Are Accused of Patent Infringment By Matthew R. Osenga – Goodman Allen Donnelly, PLLC

eing accused of patent infringement is serious and can have grave consequences. You could be liable for damages, including lost profits or reasonable royalties - maybe even attorneys’ fees or treble damages. You could even be subject to an injunction. There are, however, a number of defenses to such an accusation.

Medical Activity Defense One defense of particular importance to medical professionals is contained in § 287(c) of the Patent Act. This provision provides that no remedy shall apply to certain charges of patent infringement by listed medical professionals. Specifically, for qualifying activities, no damages, no injunction, no award of attorney’s fees, and no civil action for infringement are available to the patent owner. Like many provisions in the law, this defense was the result of a compromise, so it is important to study the various provisions and requirements to determine the parameters of the defense. The defense is available to “a medical practitioner’s performance of a medical activity” that would otherwise constitute an infringement. If the defense applies, the remedies for patent infringement do not apply against “the medical practitioner or against a related health care entity.” The first issue to consider is to whom this defense is available. The statute defines a medical practitioner as “any natural person who is licensed by a State to provide the medical activity . . . or who is acting under the direction of such person in the performance of the medical activity.” This definition seems to cover physicians, surgeons, nurses, and related health care practitioners. The statute also defines a related health care entity as “an entity with which the medical practitioner has a professional affiliation under which the medical practitioner performs the medical activity.” Examples include nursing homes, hospitals, universities, medical schools, HMOs, group medical practices, or medical clinics. The statute also defines professional affiliation as generally requiring some type of contractual or employment relationship, staff privilege or membership. Next, what type of medical activity falls within the defense? The statute defines medical activity as “performance of a medical or surgical procedure on a body,” but then makes several very big exclusions from the definition. The defense does not apply to methods of use of a patented machine, manufacture, or composition of matter; nor does the defense cover the practice of a process in violation of a biotechnology patent. The bottom line is that the defense applies to a relatively small number of patents directed to pure surgical or diagnostic pro-

cedures that are performed on a patient and that do not involve drugs or reagents to accomplish the result.

What Should You Do? If you are accused of infringing another party’s patent, it’s advisable to speak with a patent attorney, who can assist you in determining the types of defenses that may be available, as well as an appropriate response to the party making the accusation. The patent system can be a complicated and intricate experience. It is usually best to obtain advice from a patent attorney at an early stage in the process. Matt Osenga is a registered patent attorney with Goodman Allen Donnelly. His practice includes all aspects of patent prosecution before the US Patent & Trademark Office, as well as other aspects of patent law, including foreign patenting, patent infringement, and patent opinions. www.goodmanallen.com

Jennifer Pagador, MD Diplomate, American Board of Obesity Medicine

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WInter 2017 Hampton Roads Physician | 35

…a new column dedicated to easing the administrative burdens on physicians and their staffs

s the shift to value-based reimbursement continues, payers are more and more tying a portion of reimbursement to patient satisfaction scores, measurement of quality of care and the values it brings to the patient and ultimately to the health care system – all of which is requiring physicians and their staffs to place an even greater emphasis on understanding each patient’s unique personal and healthcare needs. Even in the era of savvy younger patients who readily access reliable medical information on the Internet and routinely monitor their own health through medical portals and practice 36 | www.hrphysician.com

websites, this can be an onerous task for physicians and their staffs. In the case of older patients, who can be notoriously poor historians, it’s even more of a time-consuming challenge for the physician to fully understand each patient’s personal profile. For a particular subset of this population, at least, the United States government is offering some much needed help. Dr. Scott Kruger of Virginia Oncology Associates, explains: “The biggest change that’s happening nationwide is the Oncology Care Model, or OCM project,” Dr. Kruger says. “There are roughly 195 oncology groups participating across the U.S. For the

first time, Medicare is giving us access to something they’ve never, ever given any group of doctors before: Medicare claims data.” In short, Medicare is letting these physicians know how many times their patients visit an emergency room or are admitted to the hospital, for whatever reason. “It’s a huge data base that we’ve never seen before,” Dr. Kruger says, “so I’m learning that some of our patients are going to the emergency department for non-oncology related reasons. Now I can look at whether that might have anything to do with our care, or with the medications we’re giving. Unfortunately, unless they tell us specifically, we don’t really know

There are a host of requirements to participate in the OCM, including ensuring a nurse navigator is available to each patient, and recruiting and training recordkeeping personnel. who our patients are seeing, why they’re seeing someone, or what they’re doing.” Essentially, Medicare wants OCM participants to make an oncology home for these people. They want to work with oncologists to see why patients are going to the hospital, why to the emergency room, and how oncologists can coordinate together with other caregivers to improve quality care. “Medicare is working with us to develop a new model of patient care,” Dr. Kruger says. There are a host of requirements to participate in the OCM, including ensuring a nurse navigator is available to each patient, and recruiting and training record-keeping personnel. But there too, Medicare is offering financial support.

OCM incorporates a two-part payment system for participating practices, creating incentives to improve the quality of care and furnish enhanced services for beneficiaries who undergo chemotherapy treatment for a cancer diagnosis. The two forms of payment include a per-beneficiary Monthly Enhanced Oncology Services (MEOS) payment for the duration of the episode and the potential for a performance-based payment for episodes of chemotherapy care. The $160 MEOS payment assists participating practices in effectively managing and coordinating care for oncology patients during episodes of care, while the potential for performance-based payment incentivizes practices to lower the total cost of care and improve care for

beneficiaries during treatment episodes. “Now, in addition to knowing the oncology piece of each patient’s care, we have access to information about heart disease, vascular disease, diabetes, and other conditions,” Dr. Kruger says. “This is giving us a much clearer snapshot of who each patient is. And when we understand the whole patient, we can decrease complications in those with major diseases. Knowing what’s going on can help us devise programs to help the patient access the health care system earlier, before complications come up.” The OCM project has only been in place since July, but Dr. Kruger notes, “I honestly think this is the medicine of the future.” 

More Sub-Specialty Care. When you need orthopedic treatment, it’s good to know an expert with a high level of training and skill is here to care for you. Some of our orthopedic sub-specialties include: • Total joint replacement • Shoulder • Hand

• Foot & ankle • Sports medicine • Trauma

Orthopedic Specialists

757-337-3366 riversideonline.com/ortho

EXPANDED OFFICE HOURS INCLUDES SATURDAY APPOINTMENTS WInter 2017 Hampton Roads Physician | 37

Helping Paraplegics Walk Again with Robotic Exoskeleton Systems By: John Robb, CPO, Reach Orthotic & Prosthetic Services

ou’ve probably seen it in the news: paraplegics standing upright and walking again with the aid of robotic exoskeleton systems. No longer the make believe flaunt of a science fiction movie, these real-life bionic devices have made their way into the everyday world of modern healthcare. And with the exoskeleton market expected to gain popularity across the globe, multiple vendors are joining in to offer their versions of the latest technology. Initially developed for military soldiers in the 1960s by the US armed forces and General Electric, exoskeleton technology is now available to the general population. This modern, wearable

technology is a marriage of computer systems and robotics, resulting in a powerful external structure for the human body. These bionic walking systems utilize a battery, motors and controls that allow wearers to replicate a wide range of movements, detecting and enhancing the user’s own abilities. Spinal cord injury patients may lose all or some of the muscle function in their lower extremities: these devices are secured externally along the lower back and lower extremities, providing movement to the hip, knee and ankle joints similar to normal ambulation. This allows paraplegics to stand up, walk and even climb stairs. Training is needed to learn skills and adapt to the device, and while exoskeletons fall short of normal function, the ongoing technology has a promising future. Exoskeletons are also extremely helpful in rehabilitation environments, where they provide patients with valuable exercise and therapy treatment options. Physical Therapists can utilize a broad range of parameters for each patient and make adjustments as training progresses.

The Benefits are Widespread: • Increases physical capabilities and independence • Offers support for standing, walking, and carrying objects • Can be utilized for rehabilitation of stroke or spinal cord injury • Provides mobility which can reduce the disabling effects of some diseases One of the biggest challenges facing designers of exoskeletons is the power supply. Power sources have to be light enough for the wearer to accommodate, and there are currently only a small number of power sources that can sustain a powered exoskeleton for more than a few hours. With any new technology there is a sizeable price tag, and this carries a hefty one: powered exoskeletons can cost $70,000 or more, and getting insurance coverage is challenging due to lack of long-term outcomes data. With more and more new players entering the market, the technology continues to advance and evidence of its benefits continues to be collected. In the meantime, we can expect to see more of this technology come off of the big screen and out into the marketplace. 

38 | www.hrphysician.com

Sentara Clinical Outcomes Reports: Results that Matter We know it’s important to you and your patients to make informed health care decisions. That’s why we are transparent about our results and outcomes every year – so that you can feel confident about who you partner with to provide quality care to patients. Our annual reports provide you with our current outcomes, quality improvements and patient stories. We believe trust is important when it comes to choosing your healthcare partner.

Take a look. On the web: sentara.com/annualreports

sentara.com/annualreports Your community, not-for-profit health partner

No web access? Call us for copies. 1-800-SENTARA (1-800-736-8272)

IN THE NEWS Bayview Physicians Group is pleased to announce the appointment of Dr. Jeffrey D. Forman to the role of Chief Medical Officer of Population Health. Dr. Forman will provide leadership and oversight of Bayview Physicians Groups Population Health Management Programs, which include several new initiatives designed to improve health outcomes for patients. He has been a physician in the Hampton Roads area for over 21 years and most recently served as Director of Hospitalist Medicine for Bayview Physicians Group. Bon Secours Hampton Roads Health System announces a new rehabilitation program now available to all cancer patients. The program was designed to help cancer patients deal with the challenges presented by a cancer diagnosis, before, throughout and after treatment. Patients participating in the program receive customized treatment plans that address a variety of cancer treatment-related symptoms, including pain, fatigue, joint stiffness, swelling, weakness, balance issues, bowel and bladder dysfunction, numbness, difficulty with speaking or swallowing, and more. These individualized treatments are coordinated around each patient’s chemotherapy, radiation and surgery schedules. Bon Secours Hampton Roads Health System is pleased to announce that construction has begun on the new Bon Secours Medical Plaza at Taylor Road Centre. An official groundbreaking

Thinking About Moving to a New Practice? Practice Opportunity for Full Time Provider Out Patient Opportunities • Full time

ceremony took place on December 12, 2016. The facility is scheduled for completion in the spring of 2017.

Joseph Oddis, CEO, Bon Secours Maryview Medical Center; Julie Kosiorek, Administrative Director, In Motion Physical Therapy; Sister Christine Webb, CBS; Chris Sanders, Robinson Development; Dr. Richard West, Vice Mayor, City of Chesapeake; Art Collins, Chair, Bon Secours Hampton Roads Board of Directors; Michael Kerner, CEO, Bon Secours Hampton Roads Health System; Mark Kuntz, Executive Director, Bon Secours Medical Group

Bon Secours Maryview Medical Center has earned re-certification for its Advanced Primary Stroke certification from The Joint Commission, the nation’s predominant accrediting body in health care. The two-year certification comes after a comprehensive on-site review in which Maryview was judged on its ability to meet strokerelated standards and requirements, including program management, the delivery of clinical care and performance improvement. The Bon Secours Hampton Roads Health System has announced the winners of the 2016 Dedicated Service Awards. They are Jonathan Compton, DPT; Suzette Henahan, CRN; Judith Mitnick, MS, RD, CDE, CSSD and Wendy Neal, BSN, RN. The award honors employees who have demonstrated their commitment to the core values of Bon Secours. Winners are chosen by a team of managers who base their decisions on how well nominees meet the selection criteria, which include support of the mission of Bon Secours, personal development, and accomplishments in activities reaching beyond the recipient’s basic job description.

• New housing opportunities readily available • Lab and X-Ray on site • Competitive compensation and benefit package Jonathan Compton, DPT

Suzette Henahan, CRN

Judith Mitnick, MS, RD, CDE, CSSD

Wendy Neal, BSN, RN

Please call Cathy Brown:

804-794-1155, Ext. 1155 Or email: cbrown@vaphysician.com Visit our website for more practice information vaphysicians.com/midlothian-family-practice-village/ 40 | www.hrphysician.com

Bon Secours Mary Immaculate Hospital’s senior development officer, Bruce LaLonde, was honored as a recipient of Flagship’s Still Serving Military Retiree and Veterans Award. LaLonde, a Portsmouth, VA resident, came to Bon Secours Mary Immaculate Hospital as the Senior Development Officer in December 2014.

Bon Secours DePaul Medical Center has been granted an additional three-year term of accreditation by the Intersocietal Accreditation Commission (IAC) in Vascular Testing. This latest accreditation awarded to Bon Secours DePaul demonstrates the facility’s ongoing commitment to providing quality patient care in vascular testing. Bon Secours DePaul Medical Center has received certification from DNV GL Healthcare as a Comprehensive Stroke Center, a prestigious designation that reflects the highest level of competence for treatment of patients who have experienced a serious stroke.

Bon Secours Hampton Roads Health System announces that Darlene Stephenson was selected by Inside Business for its 2016 Women in Business Achievement Award. Stephenson, CEO of Bon Secours Mary Immaculate Hospital, was honored for making a significant impact on the health care industry for more than 30 years. She received the award on December 12.

Are You an Independent Physician ?

Judy Bilicki has joined Bon Secours Hampton Roads Foundations as the new Vice President. She has worked in development for more than 20 years. Most recently, Bilicki worked for the Inova Health Foundation for eight years. Kathryn Funk, RN, BSN, CNRN, SCRN, has been honored by the March of Dimes as Nurse of the Year- Emergency. The March of Dimes Nurse of The Year Award is an awards event and fundraiser that brings together the health care community to recognize nursing excellence and achievements in research, education, quality patient care, innovation and leadership. Nurses are nominated by peers, nurse managers, supervisors, or the families that that they have impacted. In Virginia, 319 nurses were nominated for 18 categories.

Circa 1979

Medical Practice Specialists

(standing)

John G Corley III MBA, CPBC John@mmcgonline.com

Christopher L Graff JD, CPBC Chris@mmcgonline.com

• Healthcare Consulting Services • Tax Preparation & Planning • Budget Consulting & Analysis • Compensation Structures & Analysis

757.473.9226 (Complimentary initial Consultation) 154 Newtown Road, Suite B-4, Virginia Beach, Va. 23462 www.mmcgonline.com

WInter 2017 Hampton Roads Physician | 41

IN THE NEWS CellMax Life, the precision cancer testing company, now offers the CellMax-DNA Genetic Cancer Risk Test, which examines 98 genes across 24 hereditary cancers using its proprietary SMSEQ™ Platform. The CellMax-DNA Genetic Cancer Risk Test requires only a saliva sample. CellMax Life’s DNA test uses next generation sequencing to detect gene mutations known to increase lifetime cancer risk. The test surveys for increased genetic risk of 24 cancers, including Lung, Breast, Colorectal, Prostate, Stomach, Bladder, Pancreas, Kidney, Thyroid, Ovary and others. Chesapeake Regional Healthcare named Reese Jackson, JD, MHA, FACHE as President and Chief Executive Officer (CEO) effective December 1. Jackson is an accomplished health care strategist with more than two decades of progressive leadership experience in diverse health care settings and organizations across the country.

Chesapeake Regional Healthcare began offering 3D screening mammograms on January 1, for those whose insurance doesn’t cover the imaging, for $15, plus a $31 radiologist reading fee. CRH has the first mobile mammogram

42 | www.hrphysician.com

unit in the region with both 3D and 2D technology. The 40-foot unit is available for individual appointments and on-site customized screening days at businesses, churches, community centers and organizations. The Chas Foundation presented a $40,000 gift to Children’s Hospital of The King’s Daughters (CHKD) to support staff training and education for CHKD’s pediatric behavioral health program. CHKD offers outpatient pediatric behavioral health treatment at its health centers throughout the region in the same place they receive care for their physical health concerns.

(L-R) Karen Gershman, executive director of development at CHKD; Margaret Ballard, Beth Lloyd and Jane Steinhilber, The Chas Foundation board members; Stephanie Osler, director of behavioral health at CHKD, Tucker Corprew, founder and president of The Chas Foundation; and Beau Kirkwood, executive director of The Chas Foundation.

Children’s Hospital of The King’s Daughters opened the region’s third urgent care center exclusively for infants, children and teens at the new CHKD Health Center at Tech Center in Newport News. Researchers at the EVMS Leroy T. Canoles Jr. Cancer Research Center recently received a $2.1 million grant from the National Cancer Institute, to continue work on a breakthrough in the area of early detection of aggressive prostate cancer. The EVMS-led research team brings together internationally recognized translational research groups from the US and Canada. The Early Detection Research Network is a prestigious program administered by the Division of Cancer Prevention of the National Cancer Institute. The network supports the complete translational pipeline for cancer biomarker development with an emphasis toward getting new biomarkers into the clinic. The EVMS team will be part of the network’s Biomarker Development Laboratories, of which there are 15 across the country. Inocencio Albrincoles with Hope House Foundation has received the Direct Support Professional Award for Excellence by the Canadian National Association for the Dually Diagnosed. The award is given to an individual whose dedication, advocacy, compassion, competence, person-centered approaches and collaboration result in improved quality of life, health and wellness, and opportunities for people with intellectual disabilities and mental health needs. The award was presented at the NADD 33rd Annual Conference & Exhibit in Ontario. Wilford K. Gibson, MD, FACS, FAAOS performed the Hampton Roads region’s first outpatient anterior hip replacement procedure in September 2016. Gibson used the Mako™ Robotic Arm, a leading-edge technology from Stryker available at Chesapeake Regional Healthcare. The patient checked into the hospital for surgery at 7:30 a.m. and was discharged by 5:00 p.m. After just two weeks of in-home physical therapy and a week of outpatient therapy, the patient reported full range of motion with no limitations regarding daily activities.

Dr. Nelson Keller of HROSM Foot and Ankle Center has introduced MLS (Multiwave Locked System) Laser Technology to the Hampton Roads community. MLS Laser Therapy is a noninvasive, safe, and effective treatment modality which uses light to relieve pain, reduce inflammation, and to promote healing and soft tissue repair. The MLS Laser has breakthrough technology that uses a multiwave, fully robotic laser for faster healing and pain reduction. More than 90 percent of patients have experienced significant improvement in their symptoms.

Are you looking for a satisfying career and a life outside of work? Enjoy both to the fullest at Patient First. Opportunities are available in Virginia, Maryland, Pennsylvania, and New Jersey. Open 8 am to 10 pm, 365 days a year, Patient First is the leading urgent care and primary care provider in the mid-Atlantic with over 60 locations throughout Virginia, Maryland, Pennsylvania, and New Jersey. Patient First was founded by a physician and we understand the flexibility and freedom you want in both your career and personal life. If you are ready for a career with To learn more about fantastic career opportunities at Patient First, contact Patient First, please contact us. Recruitment Coordinator Eleanor Dowdy at (804) 822-4478 or Each physician enjoys: eleanor.dowdy@patientfirst.com or • Competitive Compensation visit prcareers.patientfirst.com. • Flexible Schedules • Personalized Benefits Packages • Generous Vacation & CME Allowances • Malpractice Insurance Coverage • Team-Oriented Workplace • Career Advancement Opportunities WInter 2017 Hampton Roads Physician | 43

IN THE NEWS HROSM Physical Therapy Center announces new Director, Marc Forrest, PT, MSPT, OCS, CEAS, Cert. SFMA. Forrest has been providing care in orthopaedic physical therapy and sports medicine to the Tidewater area since joining Hampton Roads Orthopaedics & Sports Medicine in July 2002.

Riverside Health Systems’ new medical campus in Onley, Virginia will be called Riverside Shore Health Services. The hospital will be open to patients beginning on February 25. The new $85 million Riverside Shore Health Services campus will include Riverside Shore Memorial Hospital, Riverside Shore Cancer Center and the Riverside medical offices for specialty physicians, as well as outpatient physical therapy. In the future, a primary and urgent care center in the current Riverside Shore Cancer Center in Nassawadox will round out Riverside’s facilities on the Eastern Shore.

Dr. Allen R. Jones Jr. of Newport News, CEO, Dominion Physical Therapy & Associates, Inc. has been elected President of the Virginia Board of Physical Therapy.

The Hospital Authority of Norfolk, the body which oversees Lake Taylor Transitional Care Hospital, elected new officers of the Board of Commissioners. Calvin A. Durham succeeds Anita O. Poston as Chair.

Riverside Health Systems is partnering with DNV GL – Healthcare to assure safety and quality. Seven Riverside hospitals are now accredited by DNV: Hampton Roads Specialty Hospital, Riverside Doctors’ Hospital Williamsburg, Riverside Regional Medical Center, Riverside Rehabilitation Institute, Riverside Shore Memorial Hospital, Riverside Tappahannock Hospital and Riverside Walter Reed Hospital. In addition, Riverside Regional Medical Center is accredited by DNV as a Comprehensive Stroke Center, and Riverside Doctors’ Hospital Williamsburg, Riverside Shore Memorial Hospital and Riverside Walter Reed Hospital are Primary Stoke Centers. Mark Duncan has been named Director of Government Relations by Riverside Health Systems, a new position that allows Duncan to act as a liaison between the health system, elected officials, business organizations and the community. Riverside, a not for profit health system, has a nearly a $1 billion direct impact on the economy - employing about 10,000 team members, purchasing goods and services for regular operating expenses, utilities, construction, taxes, donating charity care and more. The health system is the third largest in the state and in many of the localities where its hospitals are located, it is the largest employer of the region. 44 | www.hrphysician.com

Riverside Shore Cancer Center has received a Three-Year Accreditation with Commendation by the Commission on Cancer (CoC) of the American College of Surgeons. To earn voluntary CoC accreditation, a cancer program must meet or exceed 34 quality care standards, be evaluated every three years, and maintain specified levels of excellence in comprehensive patient-centered care. This ThreeYear Accreditation with Commendation is only awarded to a facility that exceeds requirements at the time of its triennial survey. Sports Medicine & Orthopedic Center (SMOC) opened a new type of orthopaedic center on October 31st in Chesapeake – one that integrated patient feedback for more services, easier access and more privacy. and has combined three of its offices into a state-of-theart center in Chesapeake. The new building includes a specific space for pain medicine, increasing SMOC’s ability to treat more patients on site. The SMOC practice was built on the foundation of expertise and is now serviced by over 120 physicians, physician assistants physical and occupational therapist and employees.

If you have News you would like to share with our readers in the Spring 2017 edition, please contact the publisher at 757-237-1106 or email: holly@hrphysician.com Deadline for submissions is March 28th.

WELCOME TO THE COMMUNITY

Obianuju Patience Abadi, MD has joined JenCare Medical Centers. Dr. Abadi received her medical degree from Windsor University School of Medicine, St. Kitts & Nevis. She completed both her internship and residency in family medicine at Sparrow/Michigan State University, and is in the process of completing her fellowship in Geriatric and Palliative Medicine at the University of Texas Health Science. She is Board certified in Family Medicine. Cassyanne Aguiar, MD has joined the rheumatology department at Children’s Hospital of The King’s Daughters. She received her medical degree from New York University School of Medicine and completed a residency in pediatrics at New York University Medical Center. She completed a fellowship in pediatric rheumatology at Hospital for Special Surgery/New York Presbyterian-Cornell in New York City and is Board certified in pediatric rheumatology. Imtiaz Ahmed, MD has joined Sentara Hospital Medicine Physicians at Sentara Princess Anne Hospital. Dr. Ahmed earned his medical degree from Medical University of Silesia and completed his residency at the University of Arkansas for Medical Sciences AHEC – West.

Yoseph Birku, MD has joined Sentara Infectious Disease Specialists in Suffolk. Dr. Birku earned his medical degree from Addis Ababa University. He completed his infectious disease fellowship at the University of Connecticut Health Center and his internal medicine residency at Aurora Medical Center. Jonathan Butler, MD PhD has joined Riverside Neurology Specialists in Newport News. Dr. Butler earned his medical degree at the Medical School of South Carolina, and completed both his residency and fellowship at Vanderbilt University. He is Board certified by the American Board of Psychiatry and Neurology. Vaishnavi Challapalli Sri, MD has joined Bayview Physicians Group, and is practicing at both Lakeview Internal Medicine and North Suffolk Family Medicine. Dr. Challapalli received her medical degree from Kakatiya Medical College, NTR University of Health Sciences in India. She completed her residency in Internal Medicine at EVMS and her Sleep Medicine fellowship at Ohio State University in Columbus, Ohio. Dr. Challapalli is Board certified in Internal Medicine. 46 | www.hrphysician.com

Douglas Dean, DO Assistant Professor has joined EVMS Physical Medicine & Rehabilitation. He received his medical degree from the Edward Via Virginia College of Osteopathic Medicine in Blacksburg, VA. He completed a Physical Medicine and Rehabilitation residency and fellowship at Eastern Virginia Medical School. Dr. Dean is Board certified by the American Board of Physical Medicine and Rehabilitation and Board Eligible in Pain Management. Sherif El-Mahdy, MD has joined Sentara Pulmonary, Critical Care & Sleep Specialists. Dr. El-Mahdy earned his medical degree from University of Alexandria. He completed his pulmonary and critical care fellowship at the University of Iowa, an internal medicine residency at St. John’s Hospital and an internal medicine residency at Michigan State University.

Gabrielle Johnson, MD has joined the Sentara Hospital Medicine Physicians team at Sentara CarePlex Hospital. Dr. Johnson earned her medical degree from Meharry Medical College School of Medicine and completed her fellowship and residency at the University of Virginia.

Steven J. Lewis, MD MPH has joined EVMS Family & Community Medicine. Dr. Lewis received his medical degree and Masters in Public Health from the University of Virginia Medical School, and a Family Medicine Residency at EVMS Portsmouth Family Medicine. Dr. Lewis is Board certified by the American Academy of Family Physicians.

Barbara Lis, MD has joined Sentara Family Medicine Physicians in Edinburgh. She earned her medical degree from Eastern Virginia Medical School. She completed her residency at the Riverside Family Medicine Residency Program.

Manan Mehta, MD has joined a new practice, Bon Secours Medical Oncology. Dr. Mehta received his medical degree from South Gujarat University in India and completed his internal medicine residency at Charles Drew University of Medicine & Science in Los Angeles, California. He completed his hematology/oncology fellowship at the University of California, Los AngelesCedars Sinai Medical Center.

Alexandra S Mack, MD MPH has joined EVMS Family & Community Medicine. Dr. Mack received her medical degree from Tulane University School of Medicine in New Orleans, LA. She completed her Family Medicine Residency and Family Medicine-Obstetrics Fellowship at the University of Colorado Scholl of Medicine. She is Board certified by the American Academy of Family Physicians. Lindsey Moore, DO has joined the allergy and immunology department at Children’s Hospital of The King’s Daughters. Dr. Moore received her medical degree from New York Institute of Technology College of Osteopathic Medicine. She completed a pediatric residency at Naval Medical Center Portsmouth and a fellowship at the University of Mississippi. Dr. Moore is Board certified in pediatric allergy. Tara Nicolette, DO has joined Sentara Infectious Disease Specialists in Hampton. Dr. Nicolette earned her medical degree from the Virginia College of Osteopathic Medicine. She completed her fellowship at Eastern Virginia Medical School and her residency at Danville regional Medical Center.

Stuti Parikh, MD has joined Sentara Internal Medicine Physicians in Norfolk. Dr. Parikh earned her medical degree from Baroda Medical College and completed her residency at Coney Island Hospital. LaTonya Russell, MD has joined Sentara Pediatric Physicians in Edinburgh. Dr. Russell earned her medical degree from the University of Virginia and did her residency at the Medical College of VA Hospital – Virginia Commonwealth University Health System. Lisa Ulmer, PhD has joined the developmental pediatrics department at Children’s Hospital of The King’s Daughters. Dr. Ulmer earned her Ph.D. in clinical psychology from Virginia Commonwealth University. She completed a pre-doctoral internship at the University of Tennessee Health Science Center, and

a post-doctoral fellowship in early childhood at Nemours/A. I. duPont Hospital for Children. Lyzette Velazquez, MD has joined Riverside Neurology and Sleep Specialists. Dr. Velazquez earned her medical degree from the Ross University School of Medicine, and a psychiatry and internal medicine internship, followed by a neurology residency, at SUNY Downstate Medical Center in Brooklyn, New York. She completed fellowship training in neuromuscular disorders at the University of Southern California. Dr. Velazquez is Board certified by the American Board of Neurology and Psychiatry.

WHAT YOU’VE BUILT

IS WORTH PROTECTING.

MassMutual’s disability income insurance products help you protect your income in the event you become too ill or injured to work. And if you own a medical practice with two or more qualifying staff or professionals, you may be eligible for: • Unisex rates • Portable coverage • Rate discount • Non-cancellable, guaranteed continuable coverage to age 65 provided premiums are paid on time • Own occupation rider* Please contact me today to learn more! Robert P. Burke, CLU®, ChFC®, AEP General Agent MassMutual Commonwealth 222 Central Park Avenue, Suite 1100 Virginia Beach, VA 23462 757-490-9041 robertburke@financialguide.com www.massmutual.com/commonwealth LIFE INSURANCE + RETIREMENT/401(K) PLAN SERVICES + DISABILITY INCOME INSURANCE LONG TERM CARE INSURANCE + ANNUITIES

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WInter 2017 Hampton Roads Physician | 47

WELCOME TO THE COMMUNITY

Kevin Wolf, DO has joined Riverside Primary Care. Dr. Wolf earned his medical degree from the Philadelphia College of Osteopathic Medicine before completing a family medicine residency with Susquehanna Health in Williamsport, Pennsylvania. He is dual Board certified by the American Osteopathic Board of Family Physicians in osteopathy and allopathy.

Duncan Yoder, MD has joined the Sentara Vascular Specialists team. Dr. Yoder earned his medical degree from the University of Cincinnati College of Medicine. He completed his transplant surgery fellowship at the University of Nebraska and his general surgery residency at Washington Hospital Center â&#x20AC;&#x201C; Georgetown University

Welcome NPs and PAs

Catherine Adickes, NP Sentara Surgery Specialists at Sentara Obici Hospital

Benjamin Housley, PA Riverside Commonwealth Family Practice

Juanita Lee, NP Sentara Palliative Care Specialists

Laine Butler, PA Sentara Neurosurgery Specialists

Ashley Childers, PA Sentara Family Medicine Physicians in Virginia Beach.

Johnsie Hughes, FNP-C Sylvia Humrichouse, NP-C Nansemond Suffolk Family Sentara Neurology Specialists Practice, Bon Secours Hampton Roads Health System

Svetlana Mahan, PA Riverside Orthopedic, Sports Medicine & Physiatry Specialists

Patricia Robbins, NP Sentara Palliative Care Specialists team in Hampton

48 | www.hrphysician.com

Kathleen Mendoza, NP Riverside Gastroenterology Specialists

Samurdhi Roberts, PA Sentara Family Medicine Physicians

Megan Cobb, PA Riverside Vascular Surgery Specialists

Julianne Davis-Lowther, NP Riverside Pulmonary & Sleep Specialists

Robin Fulford, NP Sentara Comprehensive Weight Loss Solutions

Zachary Kaplan, PA Sentara Family Medicine Physicians

Marion Keeling, NP Sentara Family Medicine Physicians

Johnnie F. Lawrimore, NP Riverside Commonwealth Family Practice

Caitlin Mumford, PA-C Portsmouth Medical Associates, Bon Secours Hampton Roads Health System

Tina PeĂąalosa, PA Sentara Comprehensive Weight Loss Solutions

Clotilde Ramos, NP Sentara Palliative Care Specialists

Jacqueline Smola, PA Riverside Orthopedic, Sports Medicine & Physiatry Specialists

Ganna Spektor, PA-C Sentara Urgent Care

Courtney M. Taylor, NP Riverside Neurovascular Specialists

Awards Accolades

Celebrating the Accomplishments of Those Who have Received Major Honors

Surgeon L.D. Britt, MD, MPH has been elected to the National Academy of Medicine (NAM), becoming the first faculty member from Eastern Virginia Medical School (EVMS) to receive this distinction — considered one of the highest honors in the fields of health and medicine. Dr. Britt, the Edward J. Brickhouse Chair in Surgery, the Henry Ford Professor of Surgery and Professor and Chair of Surgery, also was the only physician from Virginia elected to NAM this year. His election places him in select company among the nation’s top medical and healthcare professionals. Within NAM’s 2,000 members elected over more than four decades, Dr. Britt is the first acute-care-specialty surgeon. Emmeline Gasink, MD, CMD, CWSP, with Riverside Health System, was among 10 leaders nationwide selected to participate in the fourth cohort of The Practice Change Leaders program, earning $45,000 to enhance leadership skills and implement a new aging program in the community.

Gasink serves as the Medical Director for Quality Assurance for the Lifelong Health Division of Riverside Health System and the Medical Director of Warwick Forest, one of three Riverside Health System Continuing Care Retirement Communities (CCRC). With the prestigious award, Dr. Gasink plans to integrate a coaching and assessment process, called Vitalize 360, to enhance well-being and improve the health of the older adult population at Warwick Forest, while focusing on their goals and what is most important to them. EVMS is one of only eight U.S. institutions chosen by the Association of American Medical Colleges (AAMC) to take part in a three-year workshop series, Building a Systems Approach to Community Health and Health Equity for Academic Medical Centers. The EVMS team will be led by Cynthia Romero, MD (MD ’93), a family physician and Director of the M. Foscue Brock Institute for Community and Global Health at EVMS.

Effective solutions

for your legal challenges. Our Firm offers experienced counsel in a wide range of legal services to the Health Care industry; from Risk Management, Medical Malpractice Defense, Licensing/Credentialing, Regulatory Matters, and Defense of Long Term Care & Nursing Facilities, to Business Transactions, Commercial Real Estate, and Intellectual Property. Meet our entire team at www.goodmanallen.com.

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WInter 2017 Hampton Roads Physician | 49

P H Y S I C I A N

A D V I S O R Y

B O A R D

We are Pleased to Introduce our

2017 ADVISORY BOARD

Anthony T. Carter, MD, FAAOS

Steven Pearman, MD

Orthopaedic Surgeon Board certified orthopaedic surgeon with Hampton Roads Orthopaedics & Sports Medicine. D. Carter specializes in minimally invasive joint replacement surgery of the hip and knee.

Family Medicine As a board-certified family medicine physician, Dr. Pearman practices at Sentara Family Medicine Physicians in Virginia Beach and also serves as Vice President & Senior Medical Director of Primary Care & Ambulatory Services of Sentara Medical Group.

Jessica DeLong, MD

Robin Poe-Zeigler, MD, FACOG

Reconstructive Urology Dr. DeLong practices in Virginia Beach at the Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, a Division of Urology of Virginia. She is Board certified in Urology and Fellowship trained in Adult and Pediatric Reconstructive Urology.

Reproductive Endocrinology and Infertility Practicing REI physician in Hampton Roads since 1993 and has owned her own practice since 1997. Currently serves as the Medical Director at the New Hope Center for Reproductive Medicine.

Susan B. Girois, MD, MPH, FACP

Merfake Semret, MD

Primary Care Board certified in Internal Medicine in practice in Hampton Roads for 5 years. Currently serves as Chief Medical Officer for JenCare Senior Medical Centers in Tidewater.

Nephrology Dr. Semret is a Board certified internist and nephrologist. Practices nephrology with Peninsula Kidney Associates in our Hampton, Newport News and Williamsburg offices. He also serves as the medical director at Davita Langley dialysis unit.

David Goss, MD

Barry Strasnick, MD

Orthopaedic Spine Surgery Dr. Goss practices at The Spine Center at Chesapeake, a Division of Sports Medicine and Orthopaedic Center. He is Board certified in Orthopaedic Surgery and Fellowship trained in Spinal Surgery.

Otolaryngology Board certified in Otolaryngology: Neurotology. Dr. Strasnick is Chair of EVMS Otolaryngology-Head & Neck Surgery, a physician leader in his specialty and past Medical Director of EVMS Medical Group

Robert R. Harding, MD

Raj N. Sureja, MD

Internal Medicine Board certified in Internal Medicine. He practices as a hospitalist at Riverside Doctorsâ&#x20AC;&#x2122; Hospital Williamsburg and serves as Chair of the Riverside Medical Group Board.

Pain Management Board certified and Fellowship-Trained Interventional Pain Management Physician, in practice since 2008. Senior Pain Management Partner at Orthopaedic & Spine Center in Newport News, VA.

Lauren James, MD

Richard Wertheimer, MD

Family Medicine Dr. James is the Lead Physician at Portsmouth Medical Associates of Bon Secours Maryview Medical Center. She is Board certified in Family Medicine.

Neurologist Dr. Wertheimer practices at Neurological Associates of Hampton Roads, Chesapeake Regional Medical Group. He is Board certified in neurology and electrodiagnosis, and fellowship trained in neuromuscular disease.

Visit our website to see all members of the Emeritus Board: hrphysician.com 50 | www.hrphysician.com

MEET OUR TEAM

Whatever treatment is needed – whether surgical or non-surgical – SMOC is a comprehensive, caring “one-stop shop” for orthopaedic issues from head to toe. Orthopaedic Care | Spine Care | Physical Therapy | Interventional Pain Medicine

CALL US TODAY TO SCHEDULE AN APPOINTMENT

757-547-5145

Chesapeake | Suffolk | North Suffolk

smoc-pt.com

S AY “ Y ES” TO

LIFE WITHOUT LIMITS

“I wouldn’t have a life without SMOC. Now I can say YES to a lot of things that I couldn’t do for a long time.” RON WEEKS - Spinal Cord Stimulator Patient

Read more about Ron Weeks’ success story at http://smoc-pt.com/about-us/patient-stories

Greg Franz, MD

Manan Mehta, MD

PERSONALIZED CANCER CARE Bon Secours Medical Oncology

comprehensive oncology care

Services provided

Bon Secours Medical Oncology offers experts in medical oncology

• Diagnosis & treatment of cancer and ongoing care

and hematology. Our board-certified physicians provide innovative medical therapies to individuals who have been diagnosed with cancer or blood disorders.

• Chemotherapy • Blood transfusions • Infusion therapies

Our partnership with Bon Secours Cancer Institute provides access to the entire continuum of cancer care including experts in diagnostics, medical oncology, surgery and radiation therapy. As a part of the multidisciplinary team, we are committed to providing comprehensive, personalized care every step of the way. For more information on our comprehensive care, call 757-278-2350.

Bon Secours Medical Oncology 757-278-2350 155 Kingsley Lane, Suite 150 Norfolk, VA 23505 7185 Harbour Towne Pkwy., Suite 105 Suffolk, VA 23435

Good Help to Those in Need® C A N C E R I NST I T U T E

B onSecours.com