The Eastern Physician March 2012 by TTPLLC

Category

Protecta XT TM

CRT-D and DR ICDs with SmartShock Technology TM

With Protecta, 98% of ICD patients are free of inappropriate shocks at 1 year and 92% at 5 years.*1

Brief Statement: Protecta™ CRT-D/DR ICDs Indications Protecta/Protecta XT implantable cardioverter defibrillators (ICDs) and CRT-D ICDs are indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias. Protecta/Protecta XT (CRT-D) ICDs are also indicated the reduction of the symptoms of moderate to severe heart failure (NYHA Functional Class III or IV) in those patients who remain symptomatic despite stable, optimal medical therapy and have a left ventricular ejection fraction ≤ 35% and a prolonged QRS duration. Atrial rhythm management features such as Atrial Rate Stabilization (ARS), Atrial Preference Pacing (APP), and Post Mode Switch Overdrive Pacing (PMOP) are indicated for the suppression of atrial tachyarrhythmias in ICD-indicated patients with atrial septal lead placement and an ICD indication. Additional Protecta/Protecta XT System Notes: The use of the device has not been demonstrated to decrease the morbidity related to atrial tachyarrhythmias. • The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 17%, and in terminating device classified atrial fibrillation (AF) was found to be 16.8%, in the VT/AT patient population studied. • The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 11.7%, and in terminating device classified atrial fibrillation (AF) was found to 18.2% in the AF-only patient population studied.

Additional Protecta XT DR System Notes: The ICD features of the device function the same as other approved Medtronic marketreleased ICDs. • Due to the addition of the OptiVol® diagnostic feature, the device indications are limited to the NYHA Functional Class II/III heart failure patients who are indicated for an ICD. • The clinical value of the OptiVol fluid monitoring diagnostic feature has not been assessed in those patients who do not have fluid retention related symptoms due to heart failure. Contraindications Protecta/Protecta XT CRT-ICDs are contraindicated for patients experiencing tachyarrhythmias with transient or reversible causes including, but not limited to, the following: acute myocardial infarction, drug intoxication, drowning, electric shock, electrolyte imbalance, hypoxia, or sepsis. The devices are also contraindicated for patients who have a unipolar pacemaker implanted, patients with incessant VT or VF, or patients whose primary disorder is chronic atrial tachyarrhythmia with no concomitant VT or VF. Warnings and Precautions ICDs: Changes in a patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage. Do not place transthoracic defibrillation paddles directly over the device. Additionally, for CRT-ICDs, certain programming and device operations may not provide cardiac resynchronization.

www.medtronic.com * Primary prevention patient programmed for detection rate cut off at 188 bpm. 2 The Eastern Physician

Potential Complications Potential complications include, but are not limited to, acceleration of ventricular tachycardia, air embolism, bleeding, body rejection phenomena which includes local tissue reaction, cardiac dissection, cardiac perforation, cardiac tamponade, chronic nerve damage, constrictive pericarditis, death, device migration, endocarditis, erosion, excessive fibrotic tissue growth, extrusion, fibrillation or other arrhythmias, fluid accumulation, formation of hematomas/seromas or cysts, heart block, heart wall or vein wall rupture, hemothorax, infection, keloid formation, lead abrasion and discontinuity, lead migration/dislodgement, mortality due to inability to deliver therapy, muscle and/or nerve stimulation, myocardial damage, myocardial irritability, myopotential sensing, pericardial effusion, pericardial rub, pneumothorax, poor connection of the lead to the device, which may lead to oversensing, undersensing, or a loss of therapy, threshold elevation, thrombosis, thrombotic embolism, tissue necrosis, valve damage (particularly in fragile hearts), venous occlusion, venous perforation, lead insulation failure or conductor or electrode fracture. See the device manual for detailed information regarding the implant procedure, indications, contraindications, warnings, precautions, and potential complications/ adverse events. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts these devices to sale by or on the order of a physician.

Changes in a patient’s disease and/or medications may alter the efficacy of a device’s programmed parameters or related features.

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Editor’s Note

Experienced in Matters of the Heart Kinston Cardiology Associates has been serving eastern North Carolina for nearly two decades. Today, it is the predominant cardiology practice in the region. As reported in this month’s cover story, the practice founder, cardiologist Alan Kirollos, and his partner, Dr. Stephanie Martin, have great expertise in all aspects of diagnosis and treatment of heart disease. Their practice exemplifies those bringing to the region the best medical science has to offer. Their compassion is underscored by 24-7 availability. Equally important is their counsel on prevention and risk reduction. This issue of The Eastern Physician also focuses on urology. Urologist Scott Lisson reviews the benefits of surgical robotics, particularly for prostatectomy and nephrectomy. Drs. Hsiao Lai, Basema Dibas and Guillermo Hidalgo contributed an article on the complexities of pediatric nephrology. Inside, you’ll also read the latest news from a variety of health care providers. We appreciate all contributions of news and perspective relative to the region’s medical community. We also invite you to consider the value of advertising directly to more than 6,000 physicians, physician assistants, nurse practitioners, office administrators and hospital staff throughout eastern North Carolina. Please refer to the editorial calendar on page 17 to guide your placement of editorial and/or advertising. With respect and gratitude,

4 Cover

Kinston Cardiology

Associates

A Leader in Cardiology

7 News New Hanover Regional Medical Center Wins Two Heart Care Awards

12 Community Service Special Olympics Awards FirstHealth for Adult Healthy Eating Program

14 News

8 Urology Pediatric Nephrology Disorders Are a Growing Concern in Eastern North Carolina Drs. Basema Dibas, Guillermo Hidalgo and Hsiao Lai review pediatric nephrology advances of and the expanding practice at East Carolina University.

14 Urology Prostatectomy and Nephrectomy Benefit from Surgical Robotics Dr. Scott Lisson reviews the technical components of a robotic laparoscopic system and the patient benefits in select urologic procedures.

The Eastern Physician

Contributing Editors Basema Dibas, M.D. Guillermo Hidalgo, M.D. Hsiao L. Lai, M.D. Scott W. Lisson, M.D. Photography Bill Goode Photography

Advertising Sales David Frank david@easternphysician.com Kyle Blatchley kyle@easternphysician.com

Editor

FEATURES

Editor Heidi Ketler, APR

Creative Director Joseph Dally

Heidi Ketler Contents

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

Nash Health Board Names New Officers; New Pacemaker Technology Gives Patients an MRI Option

16 News SRMC Recognizes Certified Nurses Day; Toxicologist Joins ECU Physicians

17 News Welcome; Golf Classic to Benefit Young Patients Cover Image: Stephanie Martin, M.D., and Alan Kirollos, M.D., of Kinston Cardiology Associates are respected for their expertise and compassionate care.

News and Columns Please send to info@easternphysician.com Subscription Rates: $48.00 per year/$6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401 Every precaution is taken to insure the accuracy of the articles published. The Eastern Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinion expressed or facts supplied by its authors are not the responsibility of The Eastern Physician. However, The Eastern Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Eastern Physician.

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March 2012

Cover Story

Kinston Cardiology Associates A Leader in Cardiology By Margaret Barchine

Despite significant advances in detecting and treating heart disease, more than 1 million Americans suffer heart attacks every year. This statistic, coupled with compassion, propels Alan Kirollos, M.D., Stephanie Martin, M.D., and the staff of Kinston Cardiology Associates to diagnose and treat heart disease, with a focus on the most effective, least invasive technologies and techniques available. The cardiologists also are experienced in more invasive approaches, if those are deemed necessary. Kinston Cardiology Associates has been serving high-risk patients and those with known heart disease in Lenoir, Green, Jones and surrounding counties for nearly two decades. Today it is the predominant cardiology practice in the region. “We evaluate patients who may be experiencing symptoms of heart disease, such as chest pain, shortness of breath, irregular heartbeat or syncope. The patient may feel light headed or dizzy,” says Dr. Kirollos, who is president of Kinston Cardiology Associates.

Some patients have no initial outward symptoms and may be referred by their physician after detection of a heart murmur or abnormal electrocardiogram during an exam for an unrelated condition. Kinston Cardiology Associates provides patients with access to a comprehensive range of diagnostic technologies to critically examine the condition and performance of the heart and its vessels. Noninvasive tests include: exercise stress testing; and nuclear or stress echocardiography; electrocardiogram; echocardiogram, including transesophageal echocardiogram; and cardiac computed tomography. The cardiologists at Kinston Cardiology Associates also are skilled at minimally invasive heart catheterization and pacemaker and internal defibrillator insertion, as needed. “We have available the newest pacemakers that unlike the old pacemakers allow the patient to have an MRI (magnetic resonance imaging),” Dr. Kirollos says.

Dr. Kirollos and Kim Johnson, L.P.N., monitor a patient’s heart rate, blood pressure and oxygen uptake during an exercise stress test.

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Kinston Cardiology Associates physicians and staff pride themselves on delivering high quality care in a friendly and compassionate atmosphere. Dr. Kirollos is available to see patients, as needed, 24 hours a day, seven days a week in the office or at Lenoir Memorial Hospital. Always grateful, patients sometimes extend written thanks for the care they receive. One patient wrote, “Thank you. You saved my life.” Another patient noted that she would not permit another cardiologist to perform a procedure before consulting with Dr. Kirollos. A patient who was admitted to an out-of-town hospital expressed this sentiment, “I wish you were here to take care of me… .”

Heart Disease Examined Studies have shown that heart disease is the leading cause of death for men and women in the United States. Conditions may include coronary artery disease, heart attack, congestive heart failure and congenital heart disease. Smoking, high cholesterol, high blood pressure, an unhealthy weight and lack of exercise increase the risks. Genetics may predispose certain individuals to heart disease, which may be aggravated by various other risk factors, such as diet. “People generally think of a heart attack, when they hear of heart disease; but many conditions, such as coronary artery disease, cardiomyopathy, arrhythmia and heart failure, can cause chest pain, palpitations or shortness of breath,” says Dr. Kirollos.

These symptoms should not be ignored. The longer treatment is postponed, the greater the risk of heart damage, which could ultimately lead to death. Heart attack A heart attack occurs when there is a sudden interruption in the heart’s blood supply caused by a blockage in the coronary arteries, which carry blood to the heart muscle. This lack of blood flow quickly damages the heart muscle, causing tissue to die. Immediate emergency intervention has dramatically helped reduce the number of deaths from heart attacks. Heart attack symptoms may not always be severe. They can include pain or pressure in the chest, discomfort that spreads to the back, jaw, throat or arm, and feelings of nausea, indigestion or heartburn. Weakness, anxiety, shortness of breath and rapid or irregular heartbeats also may be experienced. Women don’t always feel chest pain with a heart attack. They are also more likely than men to have heartburn, loss of appetite, tiredness or weakness, coughing and heart flutters. Coronary artery disease Coronary artery disease, or CAD, is the prelude to a heart attack. This occurs when a sticky plaque builds inside the coronary arteries, causing it to become smaller and restricting blood flow. Angina or recurring chest pains are early signs of CAD. But sometimes the outward symptoms are too subtle to be detected or to raise the necessary concern that would compel a patient to consult a physician. “Unfortunately, many people don’t know they have CAD until they experience a heart attack,” says Kinston Cardiology’s Dr. Stephanie Martin. Heart Failure There are widely held public misconceptions about heart failure. Some people confuse it with other cardiac-related illnesses, such as myocardial infarction or cardiac arrest, both of which can cause heart failure.

Dr. Kirollos and Donna Mann, a certified echocardiology sonographer, perform a cardiac ultrasound.

In reality, heart failure causes the heart to work harder to meet the body’s demands. Unable to achieve that aim, blood may back up in other areas of the body, such as the lungs, liver, gastrointestinal tract, arms and legs. Heart failure is typically a chronic condition. Early symptoms may be too mild to affect everyday life, yet it is possible that long-term treatment can keep symptoms under control. Patients with heart failure may develop shortness of breath, fatigue, or swelling in ankles, feet, legs, and abdomen. Sudden Cardiac Death Similar to, but not the same as, a heart attack, sudden cardiac death (SCD) accounts for half of all heart disease deaths in the United States. SCD occurs when the heart beats irregularly and dangerously fast. The heart’s pumping chambers do not pump blood out to the body, which if not returned to a regular rhythm, can cause death. Arrhythmia When electrical impulses become erratic, the heart may race, slow down, or quiver. This arrhythmia usually passes quickly, but some types diminish the heart’s efficiency, which stresses the body’s ability to function properly. Patients should be advised to inform their physician when they notice their heart is beating abnormally. Cardiomyopathy Cardiomyopathy involves changes in the

heart muscle that may interfere with its ability to pump effectively. High blood pressure, heart valve disease and heart failure are chronic conditions that result from cardiomyopathy. Congential Heart Defects Congenital heart conditions are present at birth, but may not be detected until an individual reaches adulthood. The condition can manifest as a leaky heart valve, malformations in the walls that separate the heart chambers or other heart problems. These conditions do not always require treatment. According to Dr. Kirollos, after examining a patient for any type of heart disease, further imaging procedures may be needed for additional diagnosis. He adds that early intervention can reduce the risk of permanent damage or death. Diagnostic Technologies “At Kinston Cardiology, we evaluate the patient during a thorough cardiac physical examination, and if needed, we perform other tests like echocardiogram (ultrasound of the heart), stress test, monitoring the heart rhythm and ultrasound of the arteries to detect blockages before it causes problems,” says Dr. Kirollos.

The following is a review of available diagnostic technologies. Electrocardiogram One form of non-invasive testing is the electrocardiogram (EKG or ECG). It is a painless test where electrodes are placed on the skin to record the heart’s activity. The March 2012

heal damage to the cardiovascular system. Lifestyle changes also can make a big difference in improving one’s heart condition. They include quitting smoking, exercising for 30 minutes most days of the week, eating a heart-healthy diet, maintaining a healthy weight and getting regular blood pressure, cholesterol and diabetes screenings.

test provides information about a patient’s heart rhythm, which may also reveal damage to the heart muscle, as well as unusual conditions, such as an enlarged heart. The results can also be compared to future EKGs to track changes in the condition of the heart. Stress test Stress tests measure whether the heart muscle is receiving an adequate supply of blood. In an exercise stress test, patients walk on a treadmill or ride a stationary bike. The intensity of the exertion is safely adjusted to increase the difficulty of the exercise. As this happens, a medical technician is closely monitoring the patient’s EKG, heart rate and blood pressure. Holter Monitor A portable Holter heart rhythm recorder is used to measure heart performance when a heart rhythm problem is suspected. It is worn by a patient over a period of one to two days. The Holter monitor records a snapshot of the heart’s continuous electrical activity throughout the day and night. “In addition to a patient wearing the monitor, we ask them to keep a log of the activities they do and to note any symptoms and when they occur,” says Dr. Martin. X-ray A chest X-ray may be used to identify abnormalities of the heart, lungs and chest bones. Ultrasound The ultrasound waves generated by an echocardiogram examine the chambers and valves of the heart. This test is useful

The Eastern Physician

for diagnosing and evaluating many types of heart disease, as well as treatment effectiveness. Cardiac Computed Tomography Cardiac computed tomography, or cardiac CT, looks at detailed three-dimensional images of the heart and its blood vessels. This test is useful for evaluating plaque buildup in the coronary arteries and heart valve problems.

“In addition to treating the disease, we educate our patients – especially those who are at increased risk – about preventative measures,” says Dr. Kirollos. “Communicating with our patients plays an integral part in helping them to successfully recover from heart-related health problems.” Dr. Kirollos urges patients to be mindful of what they eat. “Whole grains, vegetables, legumes and fruits help keep the heart healthy. In addition, plant oils, walnuts, other nuts and seeds help improve cholesterol levels.” He adds that fish is an excellent source of heart-healthy protein.

Meet the Cardiologists Cardiac Catheterization Cardiac catheterization is a minimally invasive procedure that involves guiding a catheter through a blood vessel in a patient’s arm or leg to the coronary arteries. Injected dye is shown on X-ray, enabling the doctor to determine the extent and severity of any blockages. The condition may then be treated using angioplasty or stenting during this procedure. Treatment Strategies and Prevention “Medications may be used to treat the heart condition or to prevent progression of problems,” says Dr. Kirollos. “If needed, we perform invasive cardiac procedures, such as cardiac catheterization, pacemaker placement and internal defibrillator placement.”

Dr. Kirollos’ medical interests include general, non-invasive cardiology, diagnostic cardiac catheterization, pacemaker and internal defibrillator placement and follow-up. He is board certified in cardiovascular diseases, internal medicine and nuclear cardiology. He also is certified by the North American Society of Pacing and Electrophysiology for competence in pacemaker and cardioverter defibrillator implantation. Dr. Kirollos completed his residency in internal medicine at Loyola University and Hines Veterans Administration Medical Center. His fellowship was in cardiology at the University of Virginia and Salem Veterans Administration Medical Center. Dr. Martin specializes in non-invasive cardiology, particularly diagnostic catheterization, including transesophageal echocardiogram; transthoracic echocardiogram, with stress echo (treadmill or pharmacologic); nuclear cardiology; cardiac computed tomography; and interpretation of carotid ultrasound.

“We invite cardiac patients to discuss their cardiac rehab program with us,” says Dr. Martin. “Patients develop the will to change their lifestyle through the program.”

Dr. Martin began her medical training at the University of North Carolina School of Medicine in Chapel Hill. She completed her residency at the University of North Carolina Hospitals and her cardiology fellowship at Emory University in Atlanta, Ga.

Scientific studies have proven that eating well and taking supplements have positive influences on the human body’s ability to

Dr. Martin and Dr. Kirollos are certified by the American Board of Internal Medicine and the American Board of Internal Medicine-Cardiovascular Disease.

News

New Hanover Regional Medical Center Wins Two Heart Care Awards NHRMC was considered on nine qual-

For more information, visit www.nhrmc.org/

ity measures, including whether eligible pa-

heart.

tients were given reperfusion therapy, whether patients were given aspirin on arrival, and

Action Registry–GWTG is a partnership

whether patients who smoke were given

between the American College of Cardiology

smoking cessation counseling on discharge.

Foundation

and the American Heart

Association with partnering support from the

ew Hanover Regional Medical Center’s commitment to providing exceptional heart attack care has

been recognized with two prestigious awards from the American Cardiology Foundation and the American Heart Association. New Hanover Regional Medical Center (NHRMC) was one of only 167 hospitals in the nation to win the American College of

Cardiology

Foundation’s

National

Cardiovascular Data Registry (NCDR) Action Registry-Get with the Guidelines (GWTG) Gold Performance Achievement Award. The American College of Cardiology Foundation award recognizes NHRMC success in implementing a higher standard of care for heart attack patients. According to a news release, the award signifies that NHRMC’s Heart Center has reached an aggressive goal of treating these patients to standard levels of care outlined by the American College of Cardiology/American Heart Association.

NHRMC also won the American Heart

American College of Emergency Physicians,

Association’s Mission: Lifeline Bronze Quality

Society of Chest Pain Centers and the Society

Achievement Award for its commitment and

of Hospital Medicine. Action Registry-GWTG

success in implementing higher standards

empowers health care provider teams

that effectively improve the survival and

to consistently treat heart attack patients

care of STEMI (ST Elevation Myocardial

according to the most current, science-based

Infarction) patients.

guidelines. It also establishes a national standard for understanding and improving

NHRMC’s Code STEMI program works with

the quality, safety and outcomes of care

paramedics and hospitals throughout the

provided for patients with coronary artery

region to identify when someone is having

disease, specifically high-risk STEMI and

a STEMI heart attack so the emergency and

non-STEMI patients.

cardiac team at NHRMC can be readied to provide quick intervention in the cardiac

The American Heart Association’s Mission:

catheterization lab. The national benchmark

Lifeline program helps hospitals and

for getting STEMI patients to intervention is

emergency

90 minutes. The average time at NHRMC’s

systems of care that follow proven standards

Heart Center is 44 minutes.

and procedures for STEMI patients. The

medical

services

develop

program works by mobilizing teams across NHRMC’s Heart Center is home to 29

the continuum of care to implement

cardiologists

American

and

three

cardiovascular

Heart

Association/American

surgeons, who perform more than 550

College of Cardiology clinical treatment

surgical procedures and 12,000 diagnostic

guidelines. For more information, visit www.

procedures each year. The NHRMC Heart

heart.org/missionlifeline and www.heart.

Center is the only hospital in southeastern

org/quality.

North Carolina to perform heart surgery.

March 2012

Urology

Pediatric Nephrology

Disorders Are Growing Concern in Eastern North Carolina By Hsiao L. Lai, M.D.; Basema Dibas, M.D.; and Guillermo Hidalgo, M.D.

Pediatric patients with nephrologic disor-

inherited or developmental disorders to-

ders are a unique population with com-

ward an increasing proportion of children

plex medical needs who often require

referred for primary hypertension, renal

specialized dietary, social, financial and

hyperfiltration and metabolic syndrome.

educational support services.

These children are at much higher risk of developing diabetes and progressive

Many of these patients have underlying

renal disease.

developmental or genetic disorders, in

Dr. Guillermo Hidalgo, Dr. Hsiao Lai and Dr. Basema Dibas are pediatric nephrology specialists with ECU. Dr. Hidalgo is a boardcertified pediatrician and associate professor. He can be reached at (252) 744-5437 or hidalgog@ecu.edu. Dr. Lai is board certified in internal medicine, pediatrics, nephrology and pediatric nephrology and an assistant professor. She can be reached at (252) 744-2545. Dr. Dibas is board certified in pediatrics and a clinical assistant professor. She can be reached at (252) 744-5437.

addition to their kidney disease, which

Eastern North Carolina has a particularly

warrant multidisciplinary care. In the

high burden of diabetes, hypertension

past, dysplastic and developmental dis-

and obesity. This affects not only the

betes in the 22-40 year-old age group are

orders of the kidney and urogenital tract

adult

increasingly

accelerating, while stable or declining in

were the leading causes of kidney disease

these disorders are being discovered in

all other age groups, aside from patients

that progressed to end-stage renal disease

adolescents and school-age children.

75 years or older.

According to the National Health and Nu-

The true prevalence of patients with

Recently, the spectrum of pediatric renal

tritional Examination Survey (NHANES),

kidney disease is unknown. Because of

disease has changed from predominantly

the rates of incident ESRD related to dia-

this, it is difficult to accurately estimate

population,

but

(ESRD).

how many of these individuals progress to advanced stages of chronic kidney disease (CKD) or to kidney failure. Young patients with kidney disease suffer high morbidity and mortality, especially if there is a delay in disease detection. Fortunately, new standardized equations for

estimation

kidney

function

in children is allowing the medical community to better detect and monitor early kidney disease in a more uniform fashion. Pediatric nephrology in eastern North Carolina has been a presence since 1983. Between 1983 and 2003, there was a sustained patient base of about 800 patients. Although in general pediatricaged patients comprise only about

The Eastern Physician

0.1 percent of persons requiring dialysis

and one part-time nephrologist to three

community pediatricians and developing

for end-stage renal disease, the number of

full-time and one part-time nephrologist.

collaborations with clinicians in general

young patients with chronic nephrologic disorders is likely much higher.

pediatrics,

cardiology,

endocrinology

The pediatric nephrology community has

and maternal-fetal medicine, along with

made significant advances in the diagnosis

allied health services, to provide the

For a period between 2003 and 2008, the

and early detection of kidney disease

integrated, yet specialized care that these

pediatric nephrology presence in eastern

during the past decade. Widespread use

patients require. In addition, ECU is

North Carolina was intermittent, and many

of prenatal ultrasound has allowed many

participating in multicenter research trials

patients had to travel more than 75 miles

more cases of obstructive, dysplastic

to advance understanding, prevention

to access specialized care.

and cystic kidney disorders even before

and management for pediatric patients

patients are born. Advances in genetic

with nephrologic disorders.

In 2010, the United States Department

testing and understanding of disease

of Health and Human Services put forth

factors have allowed us to identify children

Active patient recruitment is currently

the Healthy People 2020 national health

at risk for problems leading to chronic

under way for patients with CKD, newly

objectives, of which one of 28 focus areas

kidney disease, such as vesicoureteral

diagnosed nephrotic syndromes and

was “reducing new cases of CKD and

reflux, glomerular disorders, renal tubular

atypical hemolytic uremic syndrome or

its complications, disability, death and

disorders and stone disease, and have

thrombotic thrombocytopenic purpura.

economic costs.”

allowed refinement of management of

Collaborations with adult nephrologists

these patients.

are also in place to improve the transition

Bringing back specialized nephrologic

of care for the adolescent patient into the

care and related services for this region’s

Pitt County Memorial Hospital and ECU

adult medical setting. Dialysis services

pediatric population has been a focus of

is dedicated to providing high quality,

for children who develop acute or

the Pediatric Department at East Carolina

accessible, integrated care to pediatric

chronic kidney failure, along with kidney

University (ECU) and Pitt County Memorial

patients with kidney disease. In an effort

transplantation, are now conducted at

Hospital. In the past five months the

to facilitate care, the Pediatric Nephrology

ECU.

program has expanded from one full-time

Division at ECU is reaching out to

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March 2012

Urology

Prostatectomy and Nephrectomy Benefit from

Surgical Robotics By Scott W. Lisson, M.D.

The age of minimally invasive surgery

disease can be accomplished using this

is upon us. Surgeons of all different

technique.

specialties around the world are doing

Dr. Scott Lisson earned his medical doctorate Al-

the majority of their work via a minimally

The da Vinci Surgical System is a state-

pha Omega Alpha

invasive approach.

of-the-art medical robotics platform that

and Magna Cum

consists of a surgeonâ&#x20AC;&#x2122;s console and

Laude from the

The minimally invasive surgical (MIS)

a patient side cart, with three to four

Boston University

technique may vary from surgeon to

interactive robotic arms controlled by

School of Medicine in Boston, Mass.

surgeon or within specialties, however the

the surgeon from the console. One arm

He completed a surgical internship

goals of MIS are the same for each case:

houses the dual-lens laparoscope that

at the University of Chicago Medical

achieve outcomes that are identical to

provides full stereoscopic vision from

Center in Chicago, Ill., and a residency

or improvements on the traditional open

the console; the remainder of the arms

approach, reduce patient morbidity (pain,

control the routine laparoscopic surgical

blood loss), reduce hospital length of stay

instruments.

and improve cosmesis. The operating surgeon works from a Robotic-assisted

College of Medicine in Jacksonville, Fla. He is a diplomate of the American Board of Urology. Dr. Lisson is a partner at Rocky Mount Urology Associates and an attending urologic surgeon at

surgery

seated position at the console, gazing into

is one such approach that has gained

an ergonomically engineered headpiece

Mount, N.C. He can be reached at

widespread acceptance and utilization

that projects a high-resolution three-

swl@rockymounturology.com or

in the urologic community within the

dimensional image of the surgical field.

(252) 443-1080.

past five years; the majority of major

The surgeon maneuvers the side cartâ&#x20AC;&#x2122;s

urologic cases for malignant and benign

laparoscopic instruments via two foot

laparoscopic

in urologic surgery at the Mayo Clinic

The Eastern Physician

Nash Health Care Systems in Rocky

pedals and two master hand controls.

renal tissue as possible has become a priority for urologic surgeons managing renal tumors as radical nephrectomy leads to a higher incidence of renal insufficiency vs. partial nephrectomy. However,

technical

limitations

performing minimally invasive partial nephrectomy truncated its routine use. Robot-assisted

laparoscopic

partial

nephrectomy (RApNx) has emerged in the last two to three years as a viable minimally invasive option to the traditional open

partial

nephrectomy.

Small

laparoscopic port sites lead to less postoperative discomfort when compared to a flank or subcostal incision. The joint-wristed design of the da Vinci laparoscopic

instruments

allow

for

precise, efficient, and accurate renal reconstruction following tumor excision that mimics the open technique. This technical advancement has precluded the need for intra-operative renal hypothermia to extend cold ischemia times. As with The da Vinci System scales, filters and

Blood loss is significantly less with

prostatectomy, oncologic outcomes in

translates the surgeonâ&#x20AC;&#x2122;s hand movements

RALP and transfusion rates are typically

select cases using the robot-assisted

into

less

approach are comparable to open partial

precise

micro-movements

than

percent.

Visualization

nephrectomy.

the laparoscopic instruments. These

deep in the pelvis is superior, which

specifically

instruments

translates to improved nerve-sparing

feature a jointed-wrist design that exceeds

techniques to preserve potency in select

In summary, the da Vinci Surgical

the natural range of motion of the

candidates. RALP also employs a running

System provides urologic surgeons with

human hand; motion scaling and tremor

vesicourethral anastamosis, which is

superior 3D laparoscopic visualization,

reduction further interpret and refine the

watertight and only requires five to seven

enhanced dexterity, improved precision

surgeonâ&#x20AC;&#x2122;s hand movements.

days of urethral catheter drainage vs. the

and ergonomic comfort while operating

engineered

traditional 14 days with an open approach.

Applicable Urological Procedures

Oncologic outcomes are comparable to

regions, such as deep in the pelvis or in

potentially

challenging

anatomic

Robot-assisted laparoscopic prostatectomy

the open technique.

the retroperitoneum. Prostatectomy and partial nephrectomy are two examples

(RALP) has become the most commonly performed surgical approach to the malig-

Nephron-sparing surgery has become the

of surgical procedures that employ this

nant prostate gland and has several advantag-

standard of care for select renal tumors up

technology to the benefit of our patients.

es over the traditional open prostatectomy.

to 7 cm in size. Preserving as much normal

March 2012

Community Service

Special Olympics Awards FirstHealth for

Adult Healthy Eating Program Sallie Beth Johnson

FirstHealth Commu-

FirstHealth’s involvement with Special

To adapt the FirstHealth program for

nity Health Services

Olympics began in September 2007 with

individuals with intellectual disabilities,

recently was awarded

a call from Sandhills Community College

Ms.

“Outstanding Corpo-

(SCC) about preventive health classes for

guidance from the Office on Disability and

ration” by the Special

the school’s Project Succeed program for

Health at the University of North Carolina

Olympics North Caro-

developmentally disabled adults.

at Chapel Hill. She and Community Health

lina for its part in a healthy choices pro-

Johnson

sought

resources

and

Administrative Director Chris Miller met

gram designed for adults with intellectual

During a meeting with an SCC compensa-

with the program’s manager, who told

disabilities.

tory education instructor, Ms. Johnson ob-

them about national and state data showing

served some of the poor nutrition choices

health disparities in the field of disabilities.

Moore County Special Olympics coordina-

that Project Succeed students were making

tor Robin Sheffield nominated FirstHealth

during break times.

for the award, calling particular attention

“We learned about People-First Language, adaptable fitness equipment and sample

to the personal contributions of Commu-

“I realized the need to offer our Healthy

nutrition and physical activity curriculums

nity Health Services health educator Sallie

Eating Every Day class,” she said. “Since

from the field’s leaders, including the

Beth Johnson.

we are dedicated to reaching those

Department of Disability and Human

most in need of services, I knew we

Development at the University of Illinois at

“Sallie Beth has done this on her own time

couldn’t overlook this population and

Chicago,” Ms. Johnson said.

and her own accord,” Ms. Sheffield said.

the enthusiastic interest from Project

“It wasn’t something we asked her to do.

Succeed.”

She’s awesome, and the kids love her.”

The Eastern Physician

By winter/spring 2008, FirstHealth had begun to pilot an adapted Healthy Eating

Every Day class for SCC’s Project Succeed

coaches and families; expanding its healthy

Practices to Eliminate Tobacco-Related

students.

living classes to other programs serving

Disparities: The Power of Communities,” in

people with intellectual disabilities; and

New Orleans, April 17-18.

FirstHealth’s

interest

this

newly

discovered population took a new turn

developing an ongoing relationship with Moore County Special Olympics.

For her, the Special Olympics partnership

as Ms. Johnson began to investigate the

has become personal. “Serving as a

various programs provided by Special

In addition to the healthy living classes

Healthy Athletes clinical director has

Olympics. One was Healthy Athletes,

it offers to athletes and the CPR training

been one of my most rewarding volunteer

which helps athletes improve their training

it provides to coaches and volunteers,

experiences,” she says. “It is a feel-good

and competition by focusing on overall

FirstHealth contributes to Special Olympics

role. It gives me access several times a

health and fitness.

by encouraging its employees to volunteer,

year to events and people that truly lift the

donating water to events, and promoting

spirits. It’s a joy to work with my volunteers

“It was serendipity,” Ms. Johnson says.

and supporting Special Olympics activities

and interact with the athletes. Smiles,

“They were in the process of recruiting

in the community.

laughs and positive energy are contagious

health promotion volunteers and looking

at Special Olympics games.”

for a new health promotion clinical direc-

In October 2011, FirstHealth Community

tor. I volunteered at the Special Olympics

Health Services presented its work with

Fall Tournament 2008 to get an idea of the

the Special Olympics population at the

program and received first-hand interac-

American Public Health Association’s

tion with the athletes, learned strategies

annual meeting in Washington, D.C., Ms.

to ask assessment questions and received

Johnson is a presenter for the Promising

guidance on health education activities in

Practices 2012 Conference, “Promising

Those interested in helping with Special Olympics (volunteering or making donations) may call Robin Sheffield at (910) 690-5869. For more information on the various services provided by FirstHealth Community Health Services, call (877) 342-2255.

the health promotion discipline – nutrition, physical activity, bone health, sun safety and tobacco-use/secondhand smoke prevention.” After committing to at least three years as clinical director for Special Olympics North Carolina, Ms. Johnson began recruiting and training (medical, public health, nursing and allied health) volunteers to conduct Global Health Assessment Screenings at spring, summer and fall tournaments. She also served as a Global Health volunteer at the 2009 World Winter Games in Boise, Idaho, helping with health screenings for 595 of more than 2,200 participating athletes from nearly 100 countries. Through Ms. Johnson’s efforts, FirstHealth Community Health Services has enhanced its recruitment and tobacco-prevention activities by offering carbon monoxide screenings to Special Olympics athletes,

March 2012

News

Board Elects New Officers Vincent C. Andracchio II was elected chairman of the Nash Health Care Board of Commissioners Vincent C. Andracchio II recently, replacing outgoing chairman Michael Bryant. The Honorable Robert A. Evans was named vice-chairman. Rosa A. Brodie, secretary; and Carl M. Daughtry, treasurer, were reappointed to their offices. The Nash Health Care Board of Commissioners is a 14-member volunteer board appointed by the Nash County Board of Commissioners. Each board member is appointed for one, three-year term. Commissioners may be reappointed to serve two additional terms, for a maximum of three terms. Andracchio, a native of Rocky Mount, earned his bachelor’s degree in business administration from Wake Forest University. He is the Chairman of the Board and CEO of Guardian Holdings Inc., a privately owned holding company in Rocky Mount. Mr. Andracchio has

served as trustee and chairman of the board for Rocky Mount Academy, trustee and chairman of the finance committee at North Carolina Wesleyan College and board member and president of the Lucy Ann Boddie Brewer Boys and Girls Club. Mr. Andracchio also serves on the advisory board of the Generation Cos. and of RBC Centura Bank. Mr. Evans has an extensive career based around his desire to serve the community. After earning his bachelor’s degree from the University of North CarolinaChapel Hill and his juris doctor degree from the University of Pennsylvania, Mr. Evans practiced law in a private practice for 22 years before becoming district court judge in 1999. He is currently the district attorney for Nash, Edgecombe and Wilson counties. He has served on the UNC Board of Visitors and the UNC Alumni Association Board of Directors. He was chairman of the Rocky Mount Zoning Board of Adjustment and 1993 board chairman of the Rocky Mount Area Chamber of Commerce.

Ms. Brodie of Rocky Mount earned her bachelor of science degree in natural sciences from Saint Augustine’s College and her master’s degree in science from Howard University in Washington, D.C. She served as an instructor in nursing education at Nash Community College from 1968-1992. In addition, she worked extensively with Nash-Rocky Mount Public Schools, both as a science teacher and a supervisor of science in target schools. She did post-graduate work at North Carolina State University, North Carolina Central University and East Carolina University. Mr. Daughtry, a native of Cumberland County, has an extensive history of service to the Nash County community. He was the director of the county department of social services. He earned his bachelor’s degree from East Carolina University and his master’s degree in social work from the University of North Carolina at Chapel Hill.

New Pacemaker Technology Gives Patients an MRI Option Electrophysiologists at FirstHealth Moore

being performed by electrophysiologists

Medtronic’s

Regional Hospital have begun implanting

Rodrigo Bolanos, M.D., of Pinehurst

the only MRI-friendly pacing system

pacing systems that are not affected by

Medical Clinic and Mark Landers, M.D., of

approved by the United States Food and

magnetic resonance imaging (MRI).

Pinehurst Cardiology Consultants.

Drug Administration. The new system is

Revo

MRI

SureScan

engineered with multiple safety features, “Until this new device, pa-

Pacemaker and MRI manufacturers have

including circuits that are immune to

tients with a pacemaker

typically instructed physicians not to

strong magnetic fields.

were unable to undergo

expose patients with pacemakers to MRI

an MRI exam,” said Ker

scans, because the magnetic field of an

Changing health care demographics have

Boyce, M.D., an electro-

MRI machine can disrupt a pacemaker’s

had an impact on the increasing need for

physiologist with Moore Regional and

electronic system, effectively shutting it

MRI-friendly pacemakers. According to

Pinehurst Medical Clinic.

down or unintentionally stimulating the

industry reports, patients over age 65 are

Dr. Ker Boyce

heart. Some studies also claim that heat

the primary users of MRIs and are twice as

Dr. Boyce performed the first MRI-friendly

generated in the pacing wires by the

likely to need an MRI as younger patients.

pacing system implant at Moore Regional

MRI magnetic and electrical fields could

in mid-2011. The procedures are now also

damage cardiac tissue.

The Eastern Physician

News The elderly also dominate the patient population most likely to need a pacemaker. Lacey

Moore,

M.D.,

radiologist

with Moore Regional and Pinehurst Radiology, said MRI-friendly pacing systems Dr. Lacey Moore

give

these

patients

the

opportunity for imaging exams that

previously were unavailable to them. Not all patients, especially those with certain medical conditions, are appropriate for the technology, according to Dr. Boyce. “Still about 50 percent of the patients who require pacemakers will be eligible.” Scans also are limited to specific areas of the body. A traditional pacing system costs the patient about $7,000, while the MRI-friendly system will add about $500 more. With health care’s increasing reliance on MRI technology as a dependable and efficient diagnostic tool, Dr. Moore expects traditional pacemakers to eventually be phased out in favor of the MRI-friendly systems.

Urgent Care Carolina Quick Care operates five urgent care clinics in Eastern North Carolina. Employees enjoy state of the art facilities, competitive compensation and excellent benefits. Carolina Quick Care is currently accepting applications and CV’s for the following clinical positions; Physicians, PA’s, Nurse Practitioners, LPNs, medical assistants, and Radiology Technicians. Please submit your resume to Brenda.cqc@embarqmail.com. www.carolinaquickcare.com • brenda@carolinaquickcare.com Wilson • Rocky Mount • Greenville • Kinston • Roanoke Rapids

March 2012

News

SRMC Recognizes Certified Nurses Day Southeastern Regional Medical Center

Quawanna

celebrated Certified Nurses Day March 19

Gail Lowery, Michelle

by honoring its board-certified nurses.

Lowery,

Locklear, Anthony

Wayne Martin, Michael The following nurses were recognized

Martin,

for their professionalism, leadership,

McAr t hur-Kear ney,

and commitment to excellence in patient

Ann McDonald, Gail

care: Tammara Abernathy-Jones, Angela

McPherson, Saundra

Allen, Barbara Allen, Kaye Allen, Aundrea

Meares,

Avila, Mary Baer, Teresa Barnes, Lizzie

Melvin, Melissa Memoli, Holly Metzeroff,

like health care in general, has become

Ann Batten, Eugenia Bishop, Lisa Blake,

Crystal Moore, Elizabeth Moore, Peggy

increasingly complex. While a registered

Malina Brayboy, Arlene Britt, Bonnie Britt,

Newman, Tasha Nolley, Pamela Odum,

nursing license provides entry to general

Joni Britt, Melissa Britt, Christy Bullard,

Adaora Otubela, Caroline Oxendine,

nursing practice, the knowledge-intensive

Carrie Cain, Margie Cain, Lisa Campbell,

Emily Parnell, Gladys Paul, Suzanne

requirements of modern nursing require

Connie Canady, Deborah Cannon, Cynthia

Perry, Freda Pitman, James Pope, Allison

extensive education, as well as a strong

Carlyle, Antonia Clark, Loraine Collins,

Priest, Joyce Ransom, Kimberly Register,

personal commitment to excellence by

Michelle Cox, Denise Davis, Josephine

Amy Roberts, Toni Sampson, Maria Rita

the nurse.

Davis, Pauline Davis, Elizabeth Devine,

Santiago, Barbara Saunders, Allison Scott,

James Willard Dove, Beverly Duncan,

Mary Scott, Gina Stephens, Estella Rose

Southeastern Regional Medical Center

Wanda Faircloth, Deborah Ferguson, Lisa

Strickland, Deanna Taylor, Anita Thurman,

encourages national board certification

Floyd, Cynthia Gardner, Larry Green,

Joyce Usher, Teresa Vanderford, Linda

for all of its nurses. There are many nursing

Cynthia Guevara, Willie Sue Herndon,

Voigt, Ginny Volkman, Amy Williamson,

certification specialties, such as medical-

Renae Hester, Kenneth Bryan Hilbourn,

Kris Williamson, Charles Woolley, Marie

surgical, pediatric, pain management,

Heather

Wright and Julie Zaha.

cardiac vascular, oncology, hospice, case

Hinson,

Shannon

Huffman,

Cynthia

Annette

Pamela Jackson, Hae Jang, Jerotha

management, emergency nursing, critical

Johnson, Barbara Keith, Freda Kerr,

Board certification of nursing staff plays

Kenneth Kerr, Susan Kerr, Amy Kessenich,

an increasingly important role in the

Cynthia Kinlaw, Donna Kinlaw, Jennifer

assurance of high standards of care for

For more information about Southeastern

Lamb, Jeffrey Lane, Gina Locklear,

patients and their loved ones. Nursing,

Regional, visit www.srmc.org.

care and others.

Toxicologist Joins ECU Physicians Dr. Susan Miller

Susan Miller, M.D., a

She comes to Greenville from Drexel

Cooper University Hospital in Camden,

medical

University

N.J. She also has a bachelor’s degree in

toxicologist,

College

Medicine/

has joined the Brody

Hahnemann

School of Medicine at

Philadelphia, where she completed a

East Carolina University

fellowship in medical toxicology.

University

Hospital

and its group medical practice, ECU

bioengineering from the University of Pittsburgh. Board certified in emergency medicine,

Physicians, as clinical assistant professor

Dr. Miller earned her medical degree

Dr. Miller has special clinical interests in

and associate chief of toxicology with

from

University’s

toxicology, acute ingestions and other

the school’s Department of Emergency

Jefferson Medical College in Philadelphia

poisoning. She sees patients at the Pitt

Medicine.

and completed residency training in

County Memorial Hospital emergency

emergency medicine at the University of

department.

Thomas

Jefferson

Medicine and Dentistry of New Jersey/

The Eastern Physician

News Welcome to the Area

Physicians Kerry Elizabeth Agnello, DO Clark Health Clinic, Fort Bragg

Cresencio Duran, DO Family Medicine Southern Regional AHEC Fayetteville

Anthony Charles Geraci, DO Internal Medicine, Occupational Medicine Columbus Regional Healthcare System, Whiteville

Sarah Marie Gore, DO Obstetrics and Gynecology Pitt County Memorial Hospital, GME, Greenville

Justin Michael Markow, DO

Jeffrey Neal Faust, MD

Mary Eva Smyrnioudis, MD

Christopher Galgano, PA

Wilmington Health - Pediatrics Wilmington

Emergency Medicine Pitt County Memorial Hospital, GME Greenville

Cape Fear Valley Health System Fayetteville

Whitney Galloway Garren, PA

New Bern

John Thomas Stanton, MD

Monroe Urgent Care Monroe

Erin Welden, PA

Peggy Geimer, MD Novartis V&D Holly Springs

David Christopher Herman, MD Ophthalmology Vidant Health Greenville

Robert Paul Hinks, MD General Surgery Clinic Naval Hospital Camp Lejeune

Michael James Kiemeney, MD Emergency Medicine Pitt County Memorial Hospital, GME Greenville

Hematology and Oncology, Internal Medicine Wilmington Health PLLC Wilmington

Eugene Hong Kim, MD

Michael Shawn Neff, DO

Peter Kreishman, MD

Fayetteville Medical Home Fayetteville

Matthew Laurence Slane, DO Emergency Medicine WAMC, Fort Bragg

Joseph Corey Allen, MD Eastern Urological Associates Greenville

Phillip Andrew Austin, MD Family Medicine Pitt County Memorial Hospital, GME Greenville

Louisa Apongse Foyere Ayafor, MD Psychiatry Pitt County Memorial Hospital GME Greenville

Corinna Bartos, MD

Psychiatry Department of Behavioral Health Fort Bragg Surgery (general) Womack Army Medical Center Fort Bragg

Xia Li, MD

General Surgery ECU Brody School of Medicine Greenville

Rasheel Akbar Chowdhary, MD

Jacqueline Gobien, PA

Emergency Medicine Pitt County Memorial Hospital, GME Greenville

Michelle Christina Warren, MD Warren Oil Company Inc Dunn

Cody Adam Wingler, MD Family Medicine Greenville

New Hanover Regional Medical Center, Wilmington

Jason Robert Moore, MD NHCL Surgery Clinic Camp Lejeune ECU Div of Transplant Surgery Greenville Psychiatry Coastal Carolina Neuropsychiatric Center, Jacksonville

Tony Chieuvan Bui Nguyen, MD Family Medicine Pitt County Memorial Hospital GME Greenville

Mark Clifford Olesen, MD Preventive Medicine/OccupationalEnvironmental Medicine Hertford

Cape Fear Heart Associates Wilmington

Amy Marie Horton, PA

Aubrey Lenore Wilson, PA

Wilmington

Edgewater Medical Center Lillington

Sarah Wistran Young, MD

Kip Phillips Jennings, PA

West End

Waynesborough Ophthalmology Goldsboro

Coastal Rehabilitation Medicine Wilmington

Leah Elaine Johnson, PA

Vanessa Marie Berwell, PA

Iadara Livier Martinez Miranda, MD

Rebecca Jones Westendorff, PA

East Carolina Heart Institute Greenville

Laura Ann Ivey, PA

Cardiovascular Disease Sanger Heart and Vascular Insitutute Monroe

Fayetteville

Virginia Jeanne Kearney, PA Jacksonville

Danielle Renee Lehman, PA Clark Health Clinic Fort Bragg

ECU Physicians Family Medicine Greenville

Michelle Jo Lilly, PA NextCare Urgent Care Wilmington

William Arnold Boehringer, PA Gary D. Waldman Dermatology Monroe

Jared Paul Litty, PA Cape Fear Valley Medical Center Fayetteville

Ashley Elizabeth Shearin Bragg, PA

Sarah Kay Rim Mabini, PA

Wilmington

Fayetteville

Cory Alan Briggs, PA Fayetteville

Rosemary Mantella, PA

Elizabeth Ann Essick Brookshire, PA

Kate Martis, PA

Hampstead

Southeastern Regional Med Ctr Lumberton

New Bern

Jared Tyler Cook, PA

Womack Army Medical Center Fort Bragg

Tamara Jennifer Mayberry, PA

Cape Fear Valley Emergency Dept Fayetteville

Abrons Family Practice & Urgent Care Wilmington

Cape Fear Valley Health System Fayetteville

Alexzandria Jill Messer, PA

Wilmington

Cape Fear Valley Hospital Fayetteville

Audrey Denise Eaves, PA

Sarah Beth Nace, PA

Cathryn Ann Patrice Dunty, PA

Bryan Christopher Patonay, MD Pathology Pitt County Memorial Hospital, GME Greenville

ECU Heart Institute of Medicine Greenville

107 N. Belvedere Dr. Hampstead

Christina Sue Elicson, PA

Maggi Castelloe Ormand, PA

Lyla Janeil Correoso -Thomas, MD

James Timothy Patrick, MD

Senior Health Associates, P. A. Wilmington

Active Wilmington

Dana Shumate Felts, PA

Anna Faison Pepper, PA

Hospice and Palliative Medicine Wilmington

Andrew Miller Courtwright, MD Internal Medicine NCHA-Hospitalist Group Wilmington

Saeed Payvar, MD Internal Medicine - Interventional Cardiology Greenville

Terezinha Machado Perritt, MD

Maria Victoria Moreno Cuttle, MD

Internal Medicine Fayetteville

Family Medicine Integrative Medical Associates Tryon

Hollis Moye Ray, MD

Cynthia Marie Downes, MD Emergency Medicine Pitt County Memorial Hospital, GME Greenville

Dana Joel Eilen, MD Cardiology Pitt County Memorial Hospital GME Greenville

Internal Medicine New Hanover Regional Medical Center, Wilmington

Aaron Mills Rubin, MD Womack Army Medical Center Fort Bragg

Karen Russell Schmidt, MD BSOM, Dept Pediatrics Greenville

Anne Marie Zeiler, PA First Care Medical Clinic Monroe

Event Golf Classic to Benefit Young Patients Cape Fear Valley Health Foundationâ&#x20AC;&#x2122;s Friends of Children will hold itâ&#x20AC;&#x2122;s 17th Annual Friends of Children Golf Classic at Highland Country Club Thursday, May 10, 2012. All proceeds will help children receiving care within Cape Fear Valley Health. For information on becoming a sponsor or to register, contact Sabrina Brooks at (910) 615-1449 or s broo@capefearvalley.com.

Welcome Matthew R. Paszek, MD Joined Rocky Mount Urology Associates Hometown: Rocky Mount, NC Undergrad: UNC- Chapel Hill, 1999 Med School: Brody School of Medicine at ECU, 2006 Internship/Residency: University of Kentucky Hospitals, 2011 Rocky Mount Urology Associates offers a full range of general urology services. www.rockymounturology.com

Tracey Marie McKinzie, PA

Caline Ann Daun, PA

Pulmonary Disease and Critical Care, Internal Medicine Pitt County Memorial Hospital Greenville

Neurology Morehead City

Jaclyn Elizabeth West, PA

Victor Anselmo Gomez, PA

Dermatology Pitt County Memorial Hospital, GME Greenville

Red Springs

LaFayette Clinic Fayetteville Harris Family Practice Laurinburg

Family Urgent Care Jacksonville

Caroline Felder Wooten, MD

Steven Michael Strocko, PA

Wilmington

Matthew Stephen Hyten, PA

Heather Marie Longin, MD

Andrew Bevan Morris, MD

Dustin Miguel Bermudez, MD

Michelle Marie Troendle, MD

Tamim Abdulhamid Alsaedi, PA

Michael William Bartoszek, MD

Emergency Medicine Womack Army Medical Center Fort Bragg

Greenville

Physician Assistants

Claire Morgan, MD

Brad Bruce Beckmann, MD

Justin Davis Ginsburg, PA

Internal Medicine Pitt County Memorial Hospital, GME Greenville

Internal Medicine Naval Hospital Camp Lejeune Womack Army Medical Center Fort Bragg

Emergency Medicine Pitt County Memorial Hospital, GME Greenville

Lindsay Yvonne Stagner, PA Greenville

Allergy Partners Greenville

The Carolinas Emergency Group, LLC Monroe

Ashley Fish, PA

Stephanie Ann Prenatt, PA

Lillington

Fayetteville

Shannah Leigh Fleck, PA

Bernadette Ann Raby, PA

Sun Coast Medical Jacksonville

Ramsey North Medical Clinic Fayetteville

Jessica Lynn Foley, PA

Christina Marie Ritter, PA

Johnston Pain Management Jacksonville

Wilmington

Kathryn Darby Robbins, PA

Ashley Virginia Fritz, PA

Port City Neurosurgery & Spine Wilmington

Womack Army Medical Center Fort Bragg

Leslie C Sexton, PA

Thomas Alan Furlong, PA

Greenville

Leo Jenkins Cancer Center Greenville

Natalie Barton Small, PA Methodist University Fayetteville

2012 Editorial Calendar May Orthopedics Medical Insurance June Neurology Sleep Apnea July New Imaging Technologies Electronic Medical Records August Digestive Disease Computer Technologies September Sports Medicine Physical Therapy October Breast Cancer Reconstructive Surgery November Urology Robotic Surgery December Pain Management March 2012

Duke Medicine in your neighborhood Calhoun D. Cunningham, MD, the newest member of Duke Otolaryngology of Raleigh, shares our commitment to providing high-quality specialty care in a convenient location. We look forward to continuing to serve Wake County’s ear, nose, and throat care needs. Comprehensive Diagnosis and Treatment:

Calhoun D. Cunningham, MD



Chronic ear infections



Acoustic neuromas and skull-base surgery



Hearing loss and cochlear implants



Dizziness and conditions affecting balance



Meniere disease

Our Team of ENT Specialists: Adam Becker, MD Seth Cohen, MD Matthew Ellison, MD Eileen Raynor, MD

Richard Scher, MD David Witsell, MD Charles Woodard, MD

Duke Otolaryngology of Raleigh 3480 Wake Forest Road, Suite 404 Raleigh, NC 27609 For an appointment, call 919-684-3834.

9362