s e p t e m b e r 2 0 11
CarolinaEast
Leads Region in Advanced Electrophysiology Care T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
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INTRODUCING The Magazine for Healthcare Professionals. All health care professionals and health related businesses have a new outlet for a direct publication that targets up to 6000 physicians, PAs, NPs, medical centers and related health care professionals. The regional physician publication is coming to the Eastern Region of North Carolina! DF Marketing Consulting and Associates will be handling the advertisements for the publication in the following counties:
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Editor’s Note At Your Service! The Eastern Physician magazine is the newest member of the thriving eastern North Carolina medical community, dedicated to fulfilling a specialized niche – disseminating news among medical professionals within this region. Specifically, your market includes more than 6,000 physicians, physician assistants, nurse practitioners, office administrators and hospital staff in the cities of Greenville, Wilmington, Goldsboro, New Ben, Fayetteville, Southern Pines, Pine Hurst, Rocky Mount, Wilson, Washington, Morehead City and Elizabeth City, and numerous surrounding counties. This first issue of The Eastern Physician is a condensed version of things to come. The cover story is an introduction to CarolinaEast Heart Center electrophysiologists Christopher J. Hudson and Angela M. Park. Going forward, this lead article will be an in-depth portrayal of the driving forces within a practice or hospital and the
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Editor Heidi Ketler, APR Contributing Editors Paul J. Pittman, C.F.P. Satish Mathan, M.D. Henry Tellez, M.D.
unique qualities – the individuals, expertise and technology – that define it. Each feature will be accompanied by a cover photo and a number of photos throughout.
Photography Bill Goode Photography
Each month, The Eastern Physician will satisfy the medical community’s need to know, with news and
Creative Director Joseph Dally
information that you and your colleagues may contribute. We accept editorials and press releases on medical advances, individual accomplishments and appointments, new construction, expansion or relocation, and other related matters. Eastern Physician also lists new physicians and physicians assistants, along with information on upcoming events and clinical trials. Yes, advertising is our lifeblood. So The Eastern Physician offers an exceptional opportunity for branding within an exclusive market at competitive rates. We encourage you to contact us at info@easternphysician.com. We will provide an editorial calendar of what’s to come, so you can plan your advertising and article contributions to reinforce your brand within specific medical specialties. To be sure, The Eastern Physician is designed to earn your trust and respect as a valuable news and information source. We are delighted to continue a proud print-publishing tradition and appreciate your support. It’s a privilege to be at your service!
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Heidi Ketler
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Contents
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.
Editor
4 Cover Carolina East Leads region in advanced electrophysiology care
6 Your Financial Rx Putting Paul in the hot seat
8 Radiology Article Utering fibroid embolization is a safe minimally invasive therapy
10 Neurology Overview of diabetic neuropathy
12 News Welcome to the Area
2
The Triangle Physician
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3
Cover
CarolinaEast
Leads Region in Advanced Electrophysiology Care Cardiac
arrhythmias
are
at
Advances in cardiac ablation make it possible
defibrillators (ICD); 3-D mapping; and
CarolinaEast Health System by a team
for CarolinaEast electrophysiologists to control
radiofrequency
of
cardiac
symptoms of AF in 75-80 percent of paroxysmal
abnormal rhythms.
support staff, who are skilled in the use of
AF patients and 60 percent of persistent AF
medications and catheter-based procedures
patients, according to Angela M. Park, M.D.,
The breadth of CarolinaEast’s heart care
for complex and simple ablations, as well as
F.A.C.C., of CarolinaEast Heart Center.
expanded in April 2009 with the addition
electrophysiologists
managed and
device implantation.
and
cryoablation
for
of CarolinaEast Heart Center. Prior to In addition to cardiac ablation, CarolinaEast
Christopher J. Hudson, M.D., F.A.C.C., F.
CarolinaEast Health System is one of only a
Health System electrophysiologists perform
H. R.S., joining the practice this past April,
few health care providers in eastern North
ventricular tachycardia ablation, typical
Dr. Park had been serving North Carolina’s
Carolina that is performing complex ablation
reentry ablation for atrial flutter and
eastern seaboard since 2006.
procedures to treat atrial fibrillation (AF). AF
atrioventricular nodal reentry tachycardia
is one of the most common arrhythmias, yet
(AVNRT), as well as simple ablations. The
Drs. Park and Hudson specialize in
historically has been one of the most difficult
electrophysiology lab is equipped to perform
arrhythmia
to treat. If left untreated, AF increases the risk
tilt-table testing; device implants, including
pacemakers, internal defibrillators, heart
of heart failure and stroke.
pacemaker,
resynchronization
failure devices and ablations. Both are board
therapy (CRT) and implantable cardioverter-
certified in internal medicine, cardiology
cardiac
management,
including
and cardiac electrophysiology. Dr. Park earned her medical degree from Case Western Reserve University School of Medicine in Cleveland, Ohio, in 1995. Her post-graduate training at Cedar Sinai Medical Center in Los Angeles included a residency in internal medicine and fellowships in cardiology and cardiac electrophysiology. Dr. Hudson earned his medical degree from Brody School of Medicine at East Carolina University in 2002. He completed his residency in internal medicine at Carolinas Medical Center in Charlotte and fellowships in clinical cardiac electrophysiology and general cardiology from the University of Florida in Gainesville. CarolinaEast Heart Care offices are located in New Bern and Morehead City. For more Angela M. Park, M.D., F.A.C.C. , Michael Latonte, and Christopher J. Hudson, M.D., F.A.C.C., F.H.R.S., using NAVX 3D mapping and cardiac stimulator to evaluate cardiac arrhythmia.
4
The Triangle Physician
information, call (252) 635-6777 or visit www. heartcentereast.com.
Your Financial Rx
Putting Paul in the Hot Seat By The Triangle Physician
Because markets are inefficient, you have to combine non-correlating assets, as well as defensive positioning and active management. It’s not a buy-and-hold kind of world out there anymore.
would give me a great sense of satisfaction. I now feel as if I am making something good out of what my parents went through. TTP: What has been your biggest surprise in working with physicians? Paul: Physicians are caregivers and healers, but they are also business owners. I used to be surprised by their resourcefulness, but not any more. One outstanding example
This month, The Triangle Physician is going
gave me the desire and conviction to work
is a urologist in Cary, Dr. Marc Benevides.
to turn the tables a bit and interview Paul
with families to help them achieve financial
Not only is he a spectacular physician on
Pittman, a certified financial planner and
peace of mind. I don’t want other people to
the cutting edge of his specialty and a great
regular contributor to this column.
go through the struggle my family did, and
person, but he is also an extremely astute
I don’t want other people to lose what they
businessman.
TTP: Paul, you have been writing
already have. He once old me that as the check signer
your Financial Rx column for many years now. Aside from all of the great
TTP: It sounds like very hard lessons
for his practice he would be astonished by
information you have passed on, what
to learn, and your parents must have
the amount paid for medical supplies. After
makes you different from all of the
been good teachers.
further investigation, he was “horrified.” He could not believe what his practice was
financial advisors out there? Paul: Terrific teachers and great role
paying for catheters, gauze, urine strips and
Paul: I know there are many out there
models for me on how to live life. As I
such.
who physicians could work with, but I
watched my parents during those tough
truly believe in what we’re doing here
years, it became apparent to me that they
(The Preferred Client Group), and that
were very clear on two things. First, taking
what we stand for is unique. Let me share
care of family was their No. 1 priority. They
something with you. When I was 17, my
made sure we had basic material needs
father was laid off from a long career and
taken care of and then they surrounded
found himself unemployed at age 56. Not
us with love. Second, they knew what they
many companies were looking to hire a
valued and what they cherished, and they
56 year old. My mother had a full-time job,
lived those values.
but they struggled to work and raise three kids. Money was always tight. We lived from
Because of my parents’ experience, I
paycheck to paycheck. But through their
realized that my passion was to help people
love and hard work, we made it.
financially. If I could, through thoughtful financial planning, help people multiply
The story has a happy ending, but that
their current savings and earnings, as well
experience left an indelible mark on me. It
as protect what they already have, then that
6
The Triangle Physician
Paul Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 459-4171 and paul.pittman@pcgnc.com.
Physicians’ Own Pharmacy, a physician-
diversification, but it is very important. I am
owned medical supply company. Any
not just talking about owning some stocks,
physician interested in saving overhead
some bonds and some treasuries; I am
at no expense to quality can become a
referring to philosophical diversification.
member shareholder. Details are available
If the economy and markets have told
at popmedical.com.
us anything over the last 10 or so years, it is to incorporate different investment
Physicians have relinquished so much
philosophies in your investments.
control of so many aspects of their practices to insurance companies, vendors, etc., this
Modern portfolio theory sees the markets
is one way to regain an element of that
as efficient. This may have been the case in
control and expense. And it’s one example
the past, but not anymore. We now utilize
of how physicians are thinking outside
what we refer to as post-modern portfolio
of the box when it comes to running the
theory, because we see the markets as
business side of their practice.
inefficient. This means you have to combine non-correlating assets, as well as defensive
So he decided to do something about it.
TTP: Interesting story. We
positioning and active management. It’s
He found that many of the established
sometimes forget that physicians are
not a buy-and-hold kind of world out there
United States manufacturers were willing
businesspeople, too. Any investment
anymore.
to deal with him directly, that products his
advice you’d like to give our readers in
practice already used could be obtained at
this economy?
TTP: Paul, thank you for your time and insight. We will continue this
a significantly reduced price. Interestingly enough, it didn’t stop there. The desire to
Paul: Absolutely! One of the most over-
save on overhead in his office morphed into
used terms in the investment business is
interview in next month’s issue.
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
September 2011
7
Radiology Article
Uterine Fibroid Embolization
Dr. Satish Mathan is medical director for interventional services at Rex Hospital and Raleigh Radiology. The vascular and interventional radiologist earned his bachelor of science degree from the University of California at Santa Barbara and his medical degree from the Medical College of Wisconsin. He completed an internship at Santa Clara Valley Medical Center in San Jose, Calif., and was a chief resident at the University of North Carolina Hospitals, Chapel Hill. He completed a fellowship in vascular and interventional radiology at UNC Hospitals.
Is Safe Minimally Invasive Therapy By Satish Mathan, M.D.
Treatment of symptomatic fibroids by UFE appears to be safe, technically feasible with standard equipment and easily tolerated. Most patients experience significant symptomatic improvement within a few weeks. Fibroids are a very common and oftendiagnosed
women’s
health
symptomatic uterine fibroids.
condition.
Uterine fibroids are the most common
The UFE procedure typically takes between
pelvic mass in women in the United States
one and two hours. Pelvic angiogram
with prevalence as high as 40 percent in
is performed with both uterine arteries
some areas. Only one-quarter seek medical
selectively catheterized and embolized via
vascular injury. With regard to radiation,
attention, most commonly for irregular
one arterial access. Typically, embolization
the overall dose to the pelvic organs is
bleeding, extremely heavy menses, with or
is
Tris
higher than most diagnostic tests, but well
without anemia, pelvic pain, and pressure
acrylic
(TAGM)
within acceptable range, with maximum
on the bladder and other organs.
particles. These occlude the arterioles and
dose reduction techniques used during the
preferentially devitalize the fibroids, while
procedure.
performed
with
gelatin
submillimeter
microspheres
Traditionally, treatment of symptomatic
sparing the uterus.
fibroids
or
In the perioperative or early postoperative
A small series show a 38 percent pregnancy
has
been
myomectomy,
and
hysterectomy
recently
course, patients may develop pelvic pain
rate after UFE for those patients trying
endometrial ablation. Oral contraceptive
more
and nausea/vomiting. Therefore, they are
to get pregnant. Women seeking future
pills,
intrauterine
admitted under the care of the interventional
childbearing are generally screened and
devices and GnRH, or gonadotrophin-
hormonal-impregnated
radiology service for overnight observation
counseled to consider other treatment
releasing hormone, antagonists have also
and pain control with PCA (patient-
options. For them, myomectomy is the
been used for nonsurgical management.
controlled anesthesia). As soon as patients
preferred treatment at this time. However, if
are tolerating oral intake, oral narcotic and
the fibroids are too large or numerous that a
The first U.S. experience with uterine
nonsteroidal anti-inflammatory drugs are
myomectomy may result in a hysterectomy,
fibroid embolization (UFE) was reported in
started, and patients are home the next
UFE may still be advised.
1997 from the University of California, Los
day and back to work the next week.
Angeles, with seven of nine patients having
Most series report average technical success
significant clinical improvement. Since that
Abdominal pain typically is the worst
rates for myomectomy of about 98 percent.
time, numerous well-constructed clinical
within the first few days, and tapers off by
A 90 percent rate of clinical success means
studies in the radiology and obstetric/
the third to fifth day. Risks are minimal, but
patients have a significant enough decrease
gynecology literature have validated the use
include infection, hematoma, nontarget
in their bleeding or mass-effect symptoms
of UFE as a viable option for treatment of
embolization
that they require no further treatment.
8
The Triangle Physician
and
angiographic-related
Despite a high rate of symptomatic relief, most patients have only modest (50 percent to 75 percent) volume reductions. In summary, the treatment of symptomatic fibroids by UFE appears to be safe, technically
feasible
with
standard
equipment and easily tolerated. Most patients experience significant symptomatic improvement within a few weeks. Raleigh Radiology was the first to offer this procedure within the Triangle and has been
Managing your patients’ health is your life’s work. Managing physicians’ wealth is mine. Financial Rx for Physicians: • • • • •
Aiding Wealth Creation, Preservation and Protection Business Management Tax-strategies Liability Protection Asset Preservation
providing this service for more than 10
Trust your wealthcare to a specialist.
years. Prior to a Raleigh Radiology consult,
The Preferred ClienT GrouP Paul J. Pittman CFP®
patients with known or suspected fibroids will need magnetic resonance imaging taken of their pelvis with and without contrast to better delineate the location of the fibroids and vascularity. UFE consults can be scheduled at Raleigh Radiology’s Interventional Services Clinic at the Blue Ridge facility by calling (919) 781-1437 or at Rex Hospital by calling (919) 784-3419.
President and Managing Director 919-459-4171 paul.pittman@pcgnc.com www.pcgnc.com Securities offered through LPL Financial Member NASD/SIPC
Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers
SANDHILLS SLEEP DISORDERS CENTER
Dr. H. Tellez, MD Board Certified Neuromuscular Medicine Board Certified Neurology
Dr. G. Chin, (Chintapudi) MD, DABSM Board Certified Sleep Medicine Board Certified Neurology
Our Priority Is Your Sleep! The Specialities • Sleep Apnea • Sleep Studies • Memory Disorder • Brain/Spine MRI • Gait Problem • EEG • Neuropathy, ie: CTS • NCV- EMG Laboratory
888-614-7420 • www.SNSleepSolutions.com 295 Olmstead Blvd., Suite 12 Pinehurst, NC 28374 (910) 235-0595
102 Dennis Drive Sanford, NC 27331 (919) 708-5008
609 Attain Street, Unit 101 Fuquay-Varina, NC 27526 (919) 552-8917
September 2011
9
Neurology
Overview: Diabetic Neuropathy By Henry Tellez, M.D.
The term neuropathy is derived from the
Foot slapping and toe deterioration or
Greek word “neuron” (nerve) and the
frequent tripping may be early symptoms
English suffix “-pathy” (feeling, suffering).
of foot weakness. Symptoms of proximal extremity
weakness
include
difficulty
Neuropathies are characterized by a
climbing up and down stairs, difficulty
progressive failure of nerve fiber function. A
getting up from a seated or supine position,
generally established definition of diabetic
falling due to the knees giving way and
peripheral neuropathy is “the presence of
difficulty raising the arms above the
symptoms and/or signs of peripheral nerve
shoulders.
dysfunction in people with diabetes after exclusion of other causes.”
In the most common presentation of diabetic neuropathy with symmetrical
Dr. Henry Tellez is in private practice with Sandhills Neurologists PA. He obtained his medical degree from Valley University, Colombia. He then completed his internship and neurology residency at Saint Louis University, Miss. This was followed by a fellowship in nerve conduction (nerve conduction velocity/electromyography) studies and neuromuscular diseases at the University of North Carolina, Chapel Hill. Dr. Tellez is currently board certified in general neurology, neuromuscular medicine and vascular neurology by the American Board of Medical Specialties.
Neuropathies are the most common
sensorimotor symptoms, minor weakness
complication of diabetes mellitus (DM),
of the toes and feet may be seen. It is
affecting up to 50 percent of patients with
important to note that severe weakness is
Type 1 and Type 2 DM.
unusual and should prompt investigation
spine disorders) may generate poor urinary
into other causes, such as chronic
stream, feeling of incomplete bladder
The Symptoms
idiopathic demyelinating polyneuropathy
emptying and straining to void.
Diabetic neuropathy can present as a wide
(CIDP) or even vasculitis. Severe weakness
mixture of sensory, motor and autonomic
can be observed in asymmetrical diabetic
Sudomotor neuropathy may produce heat
symptoms. A well thought-out list of
neuropathy
intolerance, intense sweating the head,
symptoms can be used to help screen all
amyotrophy).
may
neck and trunk, with lack of sweat in the
diabetic patients for possible neuropathy.
occur along with sensory neuropathy
lower trunk/extremities, and gustatory
(sensorimotor neuropathy).
sweating.
These are subtle in onset and show a
Autonomic Symptoms
Etiology
stocking-and-glove distribution in the distal
Autonomic neuropathy may entail the
The factors important to the development
limbs. Sensory symptoms may be negative
cardiovascular,
and
of diabetic neuropathy are not understood
or positive, diffuse or focal. Negative
genitourinary systems, and the sweat
completely, and various hypotheses have
sensory symptoms include feelings of
glands. Patients with generalized autonomic
been proposed. It is commonly accepted to
numbness or deadness, which patients
neuropathies may report near syncope/
be a multifactorial problem.
may express as “wearing gloves or socks”
syncope.
syndromes Motor
(i.e.
diabetic
neuropathy
Sensory Symptoms
gastrointestinal
Development of symptoms depends on
or “walking on thick pads.” Loss of balance, especially in poorly lit environments or with
Gastrointestinal
neuropathy
many factors, such as total hyperglycemic
closed eyes, and painless injuries owed
may produce dysphagia, abdominal pain,
exposure and other risk factors, such as
to loss of sensation are frequent. Positive
nausea/vomiting,
elevated lipids, blood pressure, smoking,
symptoms may be described as burning,
incontinence, diarrhea and constipation.
high
prickling pain, tingling, electric shock – like
Cardiovascular
neurotoxic agents, such as ethanol and
feeling aching, tightness or hypersensitivity
may produce persistent sinus tachycardia,
to touch.
orthostatic hypotension, sinus arrhythmia
autonomic
malabsorption, autonomic
fecal
neuropathy
exposure
to
other
potentially
increased height.
and decreased heart variability in response
Genetic factors may also play a role.
Motor Symptoms
to deep breathing. Also, not unusual is near
Important
These may include distal, proximal or more
syncope upon changing positions from
mechanisms in the development of the
focal weakness. In the upper limbs, distal
recumbent to standing.
more common symmetrical forms of
contributing
biochemical
diabetic polyneuropathy likely include the
motor symptoms may consist of impaired fine-hand coordination and trouble with
Bladder neuropathy (which must be
polyol pathway, advanced glycation end
tasks, such as opening jars or turning keys.
entertained after exclusion of prostate or
products and oxidative stress.
10
The Triangle Physician
Risk Factors
diabetes diagnosis – because failure to
more localized pain or those in whom
Risk factors that are associated with more
diagnose diabetic polyneuropathy can
interactions with existing oral medications
severe symptoms include poor glucose
lead to serious consequences, including
is a concern.
control,
disability and amputation.
long
advanced
duration
age,
hypertension,
DM,
dyslipidemia,
of
Diabetic Gastroparesis
smoking, heavy alcohol intake, HLA-DR3/4
Consider any patient with clinical evidence
Erythromycin, cisapride, metoclopramide,
phenotype and tall height.
of diabetic peripheral neuropathy to be
MiraLax (polyethylene glycol 3350) are the
at risk for foot ulceration, and provide
most frequent medications used for this
Diagnosis
education on foot care. If necessary, refer
condition.
The diagnosis of diabetic neuropathy is
the patient to a podiatrist.
Erectile Dysfunction
based on the symptoms, their distribution Patients with diabetic peripheral neuropathy
Overall, erectile dysfunction from diabetic
require more frequent follow up, with
neuropathy is a very difficult condition to
Fasting plasma glucose and hemoglobin
particular attention to foot inspection and
treat. All other causes of impotence must
A1c are important laboratory screening
reinforcement of the need for regular self
be excluded. Once the diagnosis has been
tests for diabetic neuropathy. Other blood
care. Regular foot examinations and patient
confirmed, the oral agent sildenafil (Viagra)
test(s) to rule out Vitamin B12 deficiency
education about foot care have been shown
may be tried. Referral to a urologist is suggested.
and paraproteinemias (SIEP, or serum
in several studies to significantly reduce
immunoelectrophoresis)
rates of ulceration and even amputation.
and a detailed neuromuscular examination.
are
essential.
Orthostatic hypotension Increasing the dietary fluid and salt intake,
More specific blood work may be required depending on the clinical presentation
The importance of involving a neurologist
along with use of compression stockings,
(inflammatory conditions, paraneoplastic
(preferably with expertise in peripheral
may help. If these modalities do not
processes and others).
neuropathy) in the treatment of patients
improve symptoms, then medication (i.e.
with
midodrine) may help.
Multiple consensus panels recommend
diabetic
neuropathy
cannot
be
overemphasized.
Gustatory sweating
the inclusion of electrodiagnostic testing in the evaluation of diabetic neuropathy.
Glycemic Control
Glycopyrrolate can be used for the handling
A proper selection of electrophysiological
Of all treatments, tight and stable blood
of diabetic gustatory sweating. It is applied
tests includes both nerve conduction testing
sugar control is probably the most important
topically to the affected area and can give a
and needle electromyography (EMG). The
for slowing the progression of neuropathy.
marked reduction in sweating while eating
diagnosis is strongly supported when a nerve
Rapid changes from hypoglycemia to
a meal.
conduction
hyperglycemia have been suggested to
velocity/electromyography
bring and exacerbate neuropathic pain, so
Surgical Treatment
the stability of glycemic control may be as
This is indicated in patients with infected
The first part of the test involves measuring
important as the actual level of control in
foot ulcers when the infection cannot be
the rate of speed for electrical impulses as
relieving neuropathic pain.
controlled medically. Jejunostomy can
(NCV/EMG) test is abnormal.
help patients with intractable gastroparesis.
they travel down a nerve. The second part of the test, EMG, is essential to exclude or detect
Pain Management
When impotence is a continual problem,
other conditions that might mimic neuropathy
Oral agents include antidepressants and
the patient may pursue the option of a
(lumbar radiculopathy, cervical radiculopathy,
anticonvulsant drugs. Usually, pregabalin
penile prosthesis. Charcot foot can be
tarsal tunnel syndrome and others).
is recommended for treatment of diabetic
treated with bracing or special boots. In
neuropathic
some cases, surgery is used to correct the
pain.
Yet,
physicians
deformity.
In the appropriate clinical setting, magnetic
should determine if the drug is clinically
resonance imaging of the cervical, thoracic
appropriate for their patients on a case-
and/or lumbar regions may help exclude
by-case
another cause for symptoms mimicking
antidepressants and sodium valproate
Physical and occupational therapy should
diabetic neuropathy.
should also be considered for diabetic
be considered when activities of daily living
neuropathy pain management.
are being compromised. It is quite essential
basis.
Gabapentin,
tricyclic
Rehabilitation
to prevent falls in patients with significant
Treatment The primary care physician needs to be
Topical
alert for the development of neuropathy –
transdermal lidocaine may be useful
therapy
with
capsaicin
or even its presence at the time of initial
in some patients, especially those with
or
sensory ataxia from underlying diabetic neuropathy.
September 2011
11
News Welcome to the Area
Physicians Robert Anthony Alcott, DO Family Medicine Southern Regional AHEC Fayetteville
Zachary Peter Englert, DO General Surgery Pitt County Memorial Hospital, GME Greenville
Robert Lawrence Turton, DO 2104 Auburn Lane Wilmington
Annetta Cheryl Alexander, MD
Pedro Hernandez, MD
Ramzy Husam Rimawi, MD
Hamlet
Pitt County Memorial Hospital, GME Greenville
Kerry Lynn Hollowell, MD General Surgery Pitt County Memorial Hospital Greenville
Karen Melinda Isaacs, MD
Ram Prasad Sapkota, MD
Nirav Manubhai Jasani, MD
Rodney Kevin Sessoms, MD
Pitt County Memorial Hospital, GME Greenville
Internal Medicine Sessoms Medical Practice Clinton
Jonathan Robert Maher, MD
Juan Aviles, MD
Catherine Jeanette Maxcey, MD
Crystal Cornelia Bowe, MD
Family Medicine Columbus Regional Medical Center Whiteville
Family Medicine New Hanover Regional Medical Center Wilmington
Internal Medicine, Pediatrics Pitt County Memorial Hospital Greenville
107 Airport Road, Kinston
Claude Roofian, MD
Dept of Orthopaedics Camp Lejeune
Pope Air Force Base Fort Bragg
Family Medicine Pitt County Memorial Hospital, GME Greenville
Marshall Scott Nickel, MD
Shazia Amber Choudry, MD
Iraj Nikfarjam, MD
Ft Bragg Dept of Family Medicine Fort Bragg
Cumberland Cardiology Fayetteville
Physician Assistants Shannon Michelle Billings, PA Carolina Skin Care Pinehurst
Robert Frederick DeLancy, PA Family Practice Aberdeen
Meghan Ann Driscoll, PA WAMC - Soldier Readiness Center Fort Bragg
Elizabeth Deibert Dryden, PA Newport
Christina Day Eakins, PA
Mark Fuller Sewell, MD
Wilmington
Womack Army Medical Center Fort Bragg
Christina Day Eakins, PA
Manu Sharma, MD Hope Mill Pediatrics Hope Mills
David Joseph Skarupa, MD
Wilmington
Lisa Christine Gilligan, PA Morehead City
Carolyn Elaine Green, PA
ECU Physcians, Department of Surgery Greenville
Family Care Associates Troy
Fayetteville
Virginia Butler Taylor, MD
Sarah Jane Maloney, PA
Franklin Chinagorom Ohiagbaji, MD
Lenoir Orthopedics Kinston
Spring Lake
Dermatology Eastern Dermatology & Pathology Greenville
Lumberton
Chukwuemeka E Oji, MD
Chidebe Udeozo, MD Bladen Healthcare Elizabethtown
Albemarle Family Practice Elizabeth City
Tameru Dressie Demsie, MD
East Carolina Medical Associates Jacksonville
Stephen Arthur Parada, MD
Arul Vigg, MD
New Bern
Dept of the Army Fort Bragg
Tarboro Clinic Tarboro
Jeremy Wade Sexton, PA
Madhvi Hiren Patel, MD
Larry Irving Watson, MD
Nash General Hospital Rocky Mount
General Surgery Washington County Hospital Plymouth
Internal Medicine New Hanover Regional Medical Center Wilmington
Lya Carol Crichlow, MD
Fayetteville
Ira Nathaniel Doneson, MD Psychiatry Fayetteville
Humdum Pasha Durrani, MD Pitt County Memorial Hospital, GME Greenville
Roy Edward Ehrlich, MD Pinehurst
Sarah Lucille Gustafson, MD
Emilie Elks Pendley, MD Emergency Medicine Pitt County Memorial Hospital, GME Greenville
Emergency Medicine Pitt County Memorial Hospital, GME Greenville
Mia Farida Mediana Pingul, MD
Louis Karl Haase, MD
Laxman Raj Pokhrel, MD
Southern Pines
Kenneth William Harter, MD Cape Fear Valley Health System Fayetteville
Kristin DeVonne Hawkes, MD Fayetteville
12
The Triangle Physician
Pediatric Specialty Care Greenville
VA Medical Center Fayetteville
Francisco Jeronimo Ramirez, MD Womack Army Medical Center Fort Bragg
Aimee Elizabeth Widner, MD Physical Medicine and Rehabilitation Pitt County Memorial Hospital Greenville
Thamrah Rhoxana Wright, MD Roanoke Chowman Community Health Center Ahoskie
Sharon Elizabeth Nelson, PA
Leslie Elizabeth Prichard, PA
Western Carolina Emergency Physicians Albemarle
Larry Justain Sykes, PA Owen Drive Surgical Clinic Fayetteville
Kristen Danielle White, PA Ronaoke Chowan Hospital Ahoskie
Kristen Danielle White, PA Ronaoke Chowan Hospital Ahoskie
Kristen Danielle White, PA Ronaoke Chowan Hospital Ahoskie
“More than a doctor. Like a friend.”
Trust. WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it. We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution. And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.
Cardiovascular Professionals in Johnston County Mateen Akhtar, MD, FACC Benjamin G. Atkeson, MD, FACC Kevin R. Campbell, MD, FACC Randy A.S. Cooper, MD, FACC Christian Gring, MD, FACC
Matthew A. Hook, MD, FACC Eric M. Janis, MD, FACC Diane E. Morris, ACNP Ravish Sachar, MD, FACC Nyla Thompson, PA-C
WHV Locations in Johnston County 910 Berkshire Road Smithfield, NC 27577 Phone: 919-989-7909 Fax: 919-989-3147
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When it comes to your cardiovascular care – We know it by heart. To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).
We know it by heart. Cardiovascular Services Echocardiography Nuclear Cardiology Interventional Cardiology Carotid Artery Interventions Cardiac Catheterization Cardiac CT Angiography and Calcium Scoring Electrophysiology and Cardiac Arrhythmias Peripheral Vascular Interventions Pacemakers / Defibrillators Stress Tests Holter Monitoring Lipid and Anti-Coagulation Clinics Vascular Ultrasounds / AAA Screening