a p r i l 2 012
Carolina Urological Associates, P. A.
High-Caliber, Diverse Expertise Improves Quality of Life Also in This Issue Contraception Education Sight-Improving Surgery
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Editor’s Note Woman to Woman The American Urological Association estimates that a shocking one in three women experience stress urinary incontinence. It is reasoned that the embarrassing nature of the condition is a major barrier to proper diagnosis and treatment. As a result, many choose to live with a condition that can be very isolating. Making the decision to seek care easier for women suffering from SUI are Drs. Elizabeth Albertson and Laura Foster, the Triad’s only female urologists. They are featured in our cover story on Carolina Urological Associates, P.A., this month. The article relates not only the diverse expertise of all of the physicians within the practice, but also their intense compassion and focus on solving sensitive genitourinary conditions. Dr. Albertson was named one of Business North Carolina magazine’s “Best Doctors” in November 2009. Dr. Foster shares her career-influencing experience as a resident who witnessed the quality-of-life transformation following treatment of one woman struggling with serious symptoms. Like erectile dysfunction, SUI is not openly discussed in public or even with a health care provider. To facilitate communication – woman to woman, or otherwise – AUA is conducting “It’s Time to Talk about SUI,” a campaign with numerous resources, including an online interactive assessment tool at www.urologyhealth.org. This issue of The Triad Physician also features obstetric-gynecologist Eleanor Greene,
Editor Heidi Ketler, APR Contributing Editors June DeLugas Eleanor Greene, M.D., M.P.H. Andrew T. Hearn, M.D. Takashi Hirata, M.D. Becca Jones John D. Long, M.D. Scott Richardson Photography Anna Paschal Photography Creative Director Joseph Dally Contact Information for Marketing, Media & News: Angie Griffin angie@triadphysician.com 336-509-2209
who shares her concern about the failure rates of birth control, citing the need for better access to effective contraception. Family physician Takashi Hirata urges physicians to recommend the human papillomavirus vaccine for girls and women age nine to 26 to reduce the risk of cervical cancer. Vascular surgeon Andrew Hearn discusses the incidence of varicose veins in men and women and the importance of treatment. Wellness coordinator Becca Jones offers intriguing insight into the influence of a physician’s health and lifestyle choices on her or his recommendations to patients. On the lifestyle front, interior designer June DeLugas offers guidance on remodeling to increase the value of one’s home. You, too, are invited to contribute news and commentary of importance to the Triad medical community. Also, consider the marketing value of advertising on our pages. Every month, we reach more than 6,000 Triad physicians, physician assistants, nurse practitioners, administrators and hospital staff. With great appreciation and respect,
Heidi Ketler Editor
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The Triad Physician
News and Columns Please send to info@triadphysician.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 Triad 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 Tirad Physician. However, The Triad 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 Triad Physician.
Category
Contents
COVER STORY
6
Carolina Urological Associates, P. A.
High-Caliber, Diverse Expertise Improves Quality of Life
april 2012
Vol. 1, Issue 3
FEATURES
8
Women’s Health
Taking “a Shot” at Cervical Cancer Dr. Takashi Hirata urges physicians to help parents understand the value of the human papillomavirus vaccine in preventing cancer.
17
DEPARTMENTS
20 News - “Miracle Man” Grateful for
9 Women’s Health Contraception and Family Planning: An Essential Part of Women’s Health
Heart Care
- HighPoint’s Moore Named CFO of Year
21 News
10 Vascular Surgery
CMEs, welcome, relocation
Vanquishing Varicose Veins
12 Lifestyle Is Remodeling the Prescription for Increasing the Value of Your Home?
13 Wellness Healer, Heal Thyself
Marketing
Is Your Online Presence Like a Billboard in the Desert? Marketing specialist Scott Richardson
14 Duke Research News Genetic Variation in East Asians Found to Explain Resistance to Cancer Drugs
18 News Forsyth Medical Center and Lowes
offers advice on developing an online
Foods to Open New Learning Lab for
presence that attracts potential patients.
Rehabilitation Patients
april 2012
3
Category On the Cover
Carolina Urological Associates, P.A.
High-Caliber, Diverse Expertise Improves Quality of Life By Vicki L. Friedman
A visit to Carolina Urological Associates,
University. She received her certification
someone’s life for the good significantly,”
P.A., can be a life-altering experience.
from the American Board of Urology in
Dr. Foster says. “Patients walk in with a
1999. Business North Carolina magazine
problem. We solve that problem, and when
Patients can expect modern, specialized
recognized Dr. Albertson as one of its
they walk out, we have made a huge impact
urologic care and compassionate individu-
“Best Doctors” in November 2009. Dr.
on their lives.”
alized attention at the leading urology prac-
Albertson has also been consistently listed
tice in Winston-Salem and Forsyth County.
in Best Doctors in America, from 2007
CUA’s main practice, occupying 24,000
CUA is also home to the only two female
through 2011, by her peers as one of the
square feet, is located in Kimel Park – Win-
urologists in the Triad.
top clinicians in her area of expertise.
ston-Salem’s premier medical office complex. CUA also maintains a Kernersville
Elizabeth Albertson, M.D., F.A.C.S., and
Dr. Foster earned her medical degree at the
office that is open five days a week and sat-
Laura Foster, M.D., are two of the most
University of North Carolina Chapel Hill,
ellite offices in Mocksville, Elkin and King.
respected urologists in a field dominated by
where she completed her residency. She
men. Both specialize in the diagnosis and
was certified by the American Board of
The practice was formed in 2001 through
therapeutic treatment of female urological
Urology in 2003. Both physicians are mem-
the merger of three urology practices in
disorders, ranging from incontinence to
bers of the Society of Women in Urology.
Winston-Salem: Maplewood Urological Associates, Lyndhurst Urological Associates
pelvic prolapse to voiding dysfunction to stone disease.
Drs. Albertson and Foster are accustomed
and Salem Urological.
to finding solutions for urological problems Dr. Albertson received her medical
that patients often fear cannot be solved.
Inside, 10 physicians offer a diverse range of specializations from female urology
degree from the University of Virginia and completed her residency at the Bowman
“It’s rewarding to work in a field that
to urological oncology to treatment
Gray School of Medicine at Wake Forest
allows you to do something that changes
of kidney stones to benign prostate hyperplasia, or benign enlargement of the prostate. Patients who are seen for a female urological problem have seamless, immediate access to an expanded level of appropriate medical expertise. Because of the diversity in training and special interests, the urologists at CUA are able to care for all patients, both new and established, with referrals within the group to the urologist with the expertise and specialized skills and training to best treat the medical condition. In addition to Drs. Albertson and Foster, David Cook, M.D., C.P.I., and Morris Friedman, M.D., specialize in urologic oncology and men’s health; Aubrey Evans,
CUA Urodynamic Lab, Dr. Elizabeth Albertson and Liz Sink, LPN
4
The Triad Physician
M.D., in laparoscopic and robotic surgery
of the prostate, kidney and bladder and
site urodynamic testing, a procedure that
erectile dysfunction; Wynn Newsome,
examines how well the bladder, sphincters
M.D., and David Kunkle, M.D., in general
and urethra are storing and releasing urine,
urology; Slade Hubbard, M.D., in laparo-
helps to confirm the diagnosis.
scopic and robotic surgery; Fred McPhail III, M.D., in minimally invasive urologic and
“Confirming diagnosis is key,” Dr. Albertson
laser procedures; and Fred Reid, M.D., in
says. “I’ve had so many patients complain-
stone disease and BPH.
ing of one problem when, after testing, we find they actually have a different problem.”
All the physicians in the practice participate in urological clinical trials that allow them
In addition to a state-of-the-art lab on
to spearhead various research, giving
site, nurses Maggie Pitts, R.N. and Liz
patients the option to participate in some
Sink, L.P.N., have specialized training in
of the latest advances in urologic care.
urodynamics. Their experience in the field raises patients’ comfort levels during
Getting Past the Embarrassment
testing and ensures that patients receive
Often women never make that initial trip
the most comprehensive evaluations.
to a urologist, embarrassed by discussion of topics that include urinary incontinence
“Our nurses are wonderful,” Dr. Albertson
or pelvic prolapse. Recurrent bladder
says. “They help facilitate getting a true
infections and pelvic pain also often
picture of the patient’s problem.”
Dr. Laura Foster reviewing patient’s electronic medical record
urinary retention or significant symptoms of urinary frequency, this therapy works
trouble female patients.
Latest Technologies for Urinary Incontinence
by sending mild electrical pulses to the
“Women appreciate having a conversation with a female doctor about problems that
Most women are familiar with the
The sacral nerve controls the bladder and
are not always easy to discuss with a male
symptoms of stress urinary incontinence
surrounding muscles that manage urinary
physician,” Dr. Albertson says.
due to exercise, frequency and inability to
function, and the electrical stimulation may
make it to the bathroom on time. Men also
eliminate or severely reduce the urge to go.
sacral nerve located in the lower back.
Women experience urinary incontinence – or
can suffer from incontinence, particularly
the leakage of urine – twice as much as men.
after prostate surgery or in relation to BPH.
“It’s like a pacemaker for your bladder,”
CUA offers many alternatives for handling
Dr. Foster says. “It’s really the same battery
“I tell patients this is a very common prob-
some of the most troublesome bladder
that people have for pacemakers for their
lem that affects 35 million Americans, men
control problems.
heart. Many patients achieve completely satisfying results from this procedure. We
and women,” Dr. Albertson says. “People don’t talk about it enough. Incontinence is
Minimally Invasive
a major quality-of-life issue.”
Surgical Techniques
can do the testing for it in our office.”
Patients suffering from stress incontinence
Botox: Not Just for Wrinkles
Depending on the type of incontinence,
will benefit the most from surgical
Botox was approved in the summer of
CUA offers several options for treatment,
correction. Procedures for stress urinary
2011 for neurologic bladder problems
including behavioral therapy, medical
incontinence can be done on an outpatient
causing incontinence. Patients who have
therapy using oral medications or surgical
basis. The most successful therapies for
struggled with other therapies often have
therapy, with a wide range of minimally
stress urinary incontinence are urethral
immediate relief of their symptoms after
invasive techniques available.
sling and urethral bulking agents.
Botox injections.
“People are always concerned that the
“Patients generally recover quickly,” Dr.
“Most patients finally find relief from their
only treatment option for them is surgery,”
Albertson says. “They often experience
problems after using Botox,” Dr. Albertson
Dr. Albertson says. “But we find that for
immediate relief.”
says. “It’s a very simple and successful procedure that can be done in our office.”
urinary incontinence, we only operate on three patients out of 10.” Proper diagnosis is the first step, and on-
InterStim Therapy: A Pacemaker for the Bladder
Robotics Surgery
Designed to treat urinary urge incontinence,
For male patients, CUA specializes in the
april 2012
5
da Vinci robotic prostatectomy, a minimally invasive way to remove
Dr. Foster remembers when she initially realized the difference
the prostate gland, seminal vesicles and sometimes lymph nodes
she could make as a urologist. During her residency, she met a
when curing prostate cancer.
woman carrying an oversized pocketbook filled with diapers and changes of clothing. The patient’s car was lined with trash bags due
As opposed to making one large incision through the abdomen,
to severe urinary incontinence.
the da Vinci robotic approach uses six small slits that do not cut the muscle. Then instruments can be inserted into the abdomen along
“I watched the urologist that day do a simple procedure that
with a camera that enlarges the view to 12 times the magnification.
changed her life and changed my life, too,” Dr. Foster says. “I love
The da Vinci robot holds the laparoscopic instruments and camera,
being able to make that kind of a difference in someone’s life.”
improving precision of a procedure. Dr. Albertson says being so specialized allows her to stay current CUA urologists skilled in this procedure are Drs. Cook, Evans,
on the latest treatments that can improve a woman’s quality of life
Hubbard, Kunkle and McPhail.
often after only one office visit.
“Robotics allows our doctors to treat prostate and renal disease,
“I really like taking care of women and helping them find solutions
including benign and cancerous conditions minimally invasively,”
to their bladder problems,” she says. “People around the state will
Dr. Foster says. “That means turning a hospital stay into one night,
search out Carolina Urological Associates, and especially a female
whereas it used to be three or four. Your time returning to work and
urologist, because of the committed, advanced care that is our
family is much faster.”
specialty.”
Passion for the Field
Carolina Urological Associates’ main office is located at
Though few women seek careers in urology, Drs. Albertson and
140 Kimel Park Road in
Foster cannot imagine a more rewarding field of medicine. Both
Winston-Salem, N.C.
share a commitment to women’s health issues in addition to a
For appointments, call
passion for solving urological problems.
(336) 245-2100. Visit CUA online at www.cuaws.com.
For patients, family members, a GREAT program As part of its “We’re here for your life” mindset, the Cancer Centers of North Carolina pays attention to future cancer risks, not only for its patients but for their loved ones as well. It’s Hereditary Cancer and High Risk Clinic allows CCNC to continue to explore an individuals’ risk for future malignancies, or that risk for their family members. Through the US Oncology GREAT initiative (Genetic Risk Evaluation and Therapy), participating oncologists and nurse practitioners pursue specialty training in high-risk, hereditary and genetic cancer syndromes, and maintain active and current training in this field. They can help patients and families sort through the various types of risk for cancers that do exist — some inherited and some “acquired,” such as age of child bearing or exposure to certain substances. Not all inherited syndromes can be “tested for,” but among those that can, CCNC offers confidential and supportive education and information, not just about the tests which exist, but also about the long-term implications of such tests, for a patient’s future and for that of her family. That enables patients to explore a variety of risk-reducing options for management. Providers help advise patients, present options and follow them over the years to ensure that the appropriate diagnostic evaluations — both in terms of tests themselves and the frequency of these tests — are followed closely. For instance, women for whom certain risk factors exist should have oncea-year rather than every-three-year colonoscopies, which is a recognized and insurance-approved standard of care. Likewise, some women should be getting MRI’s regularly instead of simply mammograms.
Dr. Laura Foster discussing treatment options with patient
6
The Triad Physician
The Cancer Centers can advise and help orchestrate such care. And where appropriate, its specialty-trained gynecologic oncologists can perform riskreducing gynecologic surgeries to favorably impact long-term survival for both breast and ovarian malignancies.
Cover Story Doctors
Carolina Urological Associates, P.A.
Elizabeth Albertson, M.D.
David O. Cook, M.D.
Aubrey J. Evans, M.D.
Laura C. Foster, M.D.
R. Morris Friedman, M.D.
J. Slade Hubbard, M.D.
David A. Kunkle, M.D.
E. Frederick McPhail, III, M.D.
Carolina Urological Associates Our main office is located at 140 Kimel Park Road in Winston-Salem, N.C. For appointments, call
(336) 245-2100. Visit CUA online at www.cuaws.com. George B. Newsome, M.D.
C. Frederic Reid, M.D.
april 2012
7
Women’s Health
Taking “a Shot” at
Cervical Cancer
By Takashi Hirata, M.D.
If you are a health care professional who
With one series of shots, you can help
is treating preteen or teenage patients,
protect your female patients against HPV
one vaccination you may want to consider
and significantly reduce their risk of
recommending at future checkups is the
developing cervical cancer.
human papillomavirus vaccine. There are more than 100 types of HPV, A virus that is easily spread by skin-
and about 40 of these can cause genital
to-skin contact during sexual activity,
warts and precancerous changes. Some
papillomavirus (HPV) is the leading cause
parents understand that the HPV vaccine
of cervical cancer in women. About 20
is for STD prevention, but they don’t realize
million people are currently infected with
that it is also a cancer-prevention vaccine.
This vaccine is safe and effective and can help eliminate both STD and cancer risks for our preteen and teenage patients.
Dr. Takashi Hirata is medical director of Medical Associates of Davie at Hillsdale (www. madhillsdale.com) and consulting physician for the Davie County Breast and Cervical Cancer Control Program (BCCCP). Medical Associates of Davie at Hillsdale is located at 121 Medical Drive, Advance, N.C., 27006. Dr. Hirata can be reached at (336) 998-9060 or thirata@novanthealth.org.
period, and your patients should receive all three shots to ensure the vaccine will be effective. The most common side effect is soreness or reddening of the skin where the shot is given.
HPV in the United States, mostly young
Therefore, it is imperative that we explain all
people in their late teens and early 20s.
the benefits the HPV vaccine can provide.
The HPV vaccine isn’t just for women.
And because it often has no
This vaccine is safe and effective and can
Gardasil, which has been shown to also
symptoms, many people do
help eliminate both STD and cancer risks
protect against the HPV types that cause
for our preteen and teenage patients.
most genital warts, also is approved for
not know they have
males ages nine to 26.
the disease. Two vaccines, Cervarix and Gardasil, are approved by the United States Food and
The best time to administer the HPV vac-
Drug Administration to guard against the
cine is at age 11 or 12, when most children
HPV strains that can cause cervical
are getting other vaccinations. These shots
cancer, and both have
should be given before a person is sexu-
been recommended
ally active for their full effectiveness, but I
for girls and women
would still recommend that people who
ages nine to 26.
are sexually active get the vaccine, too.
The vaccination
Even if a patient has had an abnormal Pap
is given as a
smear or other concern that may be re-
series of three
lated to HPV, this vaccine may protect her
shots
from other, different types of HPV.
a
8
The Triad Physician
over
six-month
Women’s Health
Contraception, Family Planning and Women’s Health By Eleanor E. Greene, MD, MPH
The number of con-
use. When used properly, pills are highly
has been propelled back to the national
traceptive
options
effective with perfect use failures reported
arena for debate again after 50 years when
available to women
at 0.1%. Because of imperfect use of pills,
many thought this discussion was settled.
in the United States
real use failures rates are in the 5-8% range.
Access to and use of contraception is not
has increased dra-
In fact, of nearly three million unintended
for political debate, but is a very personal
matically in the past
pregnancies per year occurring in the
decision that should be made by a woman
50 years. Before the
United States, over half or 53% were using a
and her doctor.
1960’s, primitive barrier methods, withdraw-
contraceptive method. Use of safe effective contraception for
al, and periodic abstinence were all that women had to delay or prevent pregnancy.
This fact tells us that there is a need for
women contribute significantly to im-
Today, women can choose from a variety
more effective intervention. That interven-
provements in women’s health, reduced
of hormonal oral contraceptives, intrauter-
tion must include improved education in
maternal mortality, and healthier babies that
ine systems, injectable contraceptives,
contraceptive
Preadolescent
we experience in the United States today.
implants, a vaginal ring, the contraceptive
males and females must be knowledgeable
After considering risks associated with
patch, and hysteroscopic devices inserted
on the benefits of abstinence, the need to
contraceptive use, the risk of a pregnancy
in the fallopian tubes. In addition, there are
delay the onset of sexual activity and how
related complications far outweighs the
multiple types of condoms, the diaphragm,
to protect themselves from unplanned
risks of using contraception. Hal Lawrence,
and cervical caps. This expanded pool of
pregnancies and sexually transmitted dis-
the Executive Vice President of the
possibilities has increased the likelihood of
eases. Safe, effective contraceptive methods
American Congress of Obstetricians and
a successful contraceptive experience for
should be accessible to all sexually active
Gynecologists said it best when he recently
women.
individuals who do not desire conception.
noted that decades of clinical and medical
Almost all of the research and new product
Yes, today we have far more contraceptive
scientific evidence show that contraception
development has been directed toward
choices. But in spite of this fact, still half
is a basic part of women’s healthcare and
female contraception. Although a male
of the pregnancies that occur each year
is critical to achieving healthy families.
pill has been talked about and researched
in the United States are unintended or
Also noted was that In 1999, the Centers for
for decades, we still have no birth control
unplanned. Healthcare professionals have
Disease Control declared family planning
pill for men. However, recent trials for
the responsibility of helping identify the
one of the 10 greatest public health
a contraceptive injection for men were
best method for an individual or a couple
achievements of the twentieth century,
completed and if approved by FDA may
and educating them on proper use.
realizing that the ability to time and space
methods.
guidelines based on the best available
children reduces fetal, infant, and maternal
become available soon. Finally, because of the provision in the
mortality and morbidity by preventing
In the United States taking oral contraceptive
Affordable Care Act designed to ensure
unintended and high-risk pregnancies.
pills is the most popular form of reversible
that women have access to certain
contraception. For most healthy women the
preventive health measures by eliminating
pill is safe, effective, and relatively easy to
co pays for contraception, contraception
april 2012
9
Vascular Surgery
Vanquishing
Varicose Veins By Andrew T. Hearn, M.D.
Varicose veins afflict as many as 50 percent
and pool. The term for this condition is
patients safe, quick, in-office procedures,
of women and 35 percent of men in the
called “venous reflux.”
with a rapid return to normal activities.
“road maps” of veins in the legs to bulging,
For many years, surgeons have treated
When the patient presents with the
ropelike veins; heavy, aching, swollen legs;
the condition of venous reflux and
complaint of varicose veins, a thorough
changes in the appearance and texture of
painful varicose veins with vein stripping,
history and physical examination is begun.
the skin; and lower-extremity skin ulcers
an uncomfortable operative procedure
To supplement the clinical findings, a
that are difficult to heal.
that requires general anesthesia and a
venous duplex scan is obtained. This study
prolonged recovery period, which often
is a combination of ultrasound imaging
results in unsightly scarring.
with Doppler interrogation. The venous
United States. Symptoms range from visible
The significant problems with varicose
duplex scan provides detailed evaluation
veins often develop when small oneway valves inside the veins fail to close
In the last few years therapies have changed
of the anatomy, as well as the function
properly, allowing blood to flow backward
radically and modern approaches offer
of the veins and valves. The information acquired determines the type of therapy recommended. In the very early stages, varicose veins can benefit from conservative approaches, such as exercise, which improves the calf muscle pump function. Also, leg elevation, with the foot at or above the heart level, and the use of support stockings, which provide between 20-30 mm Hg compression, can alleviate leg discomfort. Sclerotherapy treats small spider veins and medium-size varicose veins that are visible on the surface of the skin. This procedure utilizes agents that are caustic to the unwanted veins and sclerose the varicosities into invisible threads. In the past, a painful solution of hypertonic saline was often used. Newer solutions, such as Polidocanol and Sotradecol, provide excellent resolution of surface veins with minimal pain and low incidence of pigmentation. For larger, diseased veins a minimally invasive endovenous ablation procedure that treats the problem veins from within is utilized. The procedure is performed in the of-
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The Triad Physician
Dr. Andrew Hearn is a boardcertified vascular surgeon with special training in vascular disease. He is the medical director and founding partner at Carolina Vascular & Vein Specialists in Burlington, N.C. Dr. Hearn holds additional board certification with the American College of Phlebology and is a registered vascular technologist. For more information visit www.carolina-vascular. com or Dr. Hearn can be contacted by phone at (336) 585-1869 or by e-mail to carolinavascularandvein@gmail.com.
fice, takes less than one hour, and requires only local anesthesia and no incision. An endovenous ablation entails a delicate laser or radiofrequency fiber being introduced via a catheter into a refluxing, diseased vein. The laser or radiofrequency energy gently heats the vessel wall, contracting and permanently closing or ablating the vein. The body redirects venous blood flow to healthy functional veins, thus relieving the patient of symptoms of chronic venous insufficiency. The patient can immediately walk away from the procedure and may return to normal functional activities in one or two days. A follow-up venous duplex study is done within a week after treatment to ensure the problem vein has closed successfully and no deep venous thrombosis has occurred. The risk of DVT from the procedure is approximately 0.2 percent. Within a month, the surface veins that were fed by the treated vessel mostly disappear. If they persist, follow-up sclerotherapy can be prescribed to restore a more healthy appearance.  With today’s modern treatments, there is no reason for anyone to suffer the embarrassment, pain or health-related concerns that results from varicose veins.
april 2012
11
Lifestyle
Is Remodeling the Prescription for Increasing the
Value of Your Home?
By June DeLugas
Many homeowners are opting to remodel
Many remodeling projects take up more
their current homes rather than selling
time and money than homeowners
or moving. The focus has turned from
expect. Make sure you have plenty of
building a dream home to creating a
time between the completion date of
dream home out of an existing one.
your remodeling project and important events, such as weddings, and remember
As our lives become more and more
that remodeling does not mean cutting
fast-paced, we opt to create a safe haven
corners, it means making an investment
where we can relax and entertain friends
in your home. The most popular rooms to
and family, without having to travel.
remodel are bathrooms and kitchens. You
Today’s homeowners seek specific areas
will get more return for your investment
designed for specific purposes. Home
when you remodel these two rooms.
theatres, bonus rooms, craft rooms,
June DeLugas is a well-known designer who owns a firm located in Clemmons, N.C. She is known for creating awardwinning homes that reflect the special relationship she develops with each client. Her retail showroom and design firm is open Monday through Friday between 10 a.m. and 5:30 p.m. or on Saturdays by appointment. You also can visit her website or blog online at junedelugasinteriors.com.
home offices, exercise rooms and spa-like
Next time you are at an event in someone’s
Reports for information on appliances you
bathrooms create environments to meet
home, notice the places of importance.
are thinking of purchasing.
the needs of every family member.
Upon entering, you get the feel of the home as you pass through the foyer.
When you’ve hired a professional to
The next stop for guests at one point of
guide you, share your ideas, style and
the visit is the powder room. Last but not
color preferences, they can advise you
least, most gatherings always wind up in
accordingly. You can expect a drawing or
the kitchen. These are the areas you may
presentation representing the “after” of
want to focus on when considering your
your project. A professional will guide you
remodel.
through the process of selecting colors, granite, floors and other furnishings
The
perfect
remodeling
prescription project
for
contains
any
necessary for completing the room.
many
While remodeling can increase the
elements. It is important that you think
Once
comfort and value of your home, it is
about the purpose for the remodel and
made, a professional can assist you in
important to have realistic expectations
the style of the room and how it works
scheduling the necessary contractors
and be well informed before taking on a
with the rest of your home. Contact a
and subcontractors needed for the job.
large project. Keep in mind the adage that
professional to help you plan and prepare
If you take this remodeling prescription
“nothing worthwhile is ever easy or free.”
the project every step of the way. You
as suggested you will find your home
might consider checking out Consumer
updated and more valuable than before.
12
The Triad Physician
your
selections
have
been
Wellness
Healer, Heal Thyself By Becca Jones
We care for our patients, we care for our
of sleep is linked to obesity, diabetes and
families, we care for our colleagues – but
heart disease. Turn off the TV and the iPad,
what about caring for ourselves? This is
put down that book and add that hour
more than just a personal health issue. The
back into your sleep time.
Centers for Disease Control presented a study at the recent American Heart Asso-
Drink more water. Not getting enough
ciation meeting that found physicians with
can cause headaches, sap your energy and
good health habits are more likely to rec-
impact digestion. Drink a glass first thing in
ommend lifestyle changes to their patients.
the morning and then often throughout the day. Replace those empty-calorie sodas
Researchers
asked
1,000
physicians
about their lifestyles and if they would
you drink and you are on your way to
Becca Jones is the wellness coordinator for Cone Health. She has 10 years of experience in worksite wellness. She holds a master’s degree in health promotion from the University of Alabama and a bachelor’s degree in exercise science from the University of North Carolina at Wilmington.
weight loss.
recommend lifestyle changes to patients
Balanced diet. You barely have time to sit,
with high blood pressure. Physicians who
Exercise. Just like you tell patients – 30
much less think about a healthy lunch or
exercised at least once a week or didn’t
minutes a day, three days a week. If you
snack. So think about it ahead of time and
smoke, for example, were twice as likely
wait until you have the time, it will never
bring it with you. Having something with
to urge a patient to reduce sodium, eat
happen. Make the time to exercise, just
you makes it less likely you will grab the
healthy, lose weight or exercise as those
like any other priority. Write it into your
doughnut or visit the vending machine.
who did not maintain healthy habits.
weekly schedule with all of your other
Make sure you include a wide variety of
appointments. When the inevitable conflict
foods, including fruits, vegetables and
arises, reschedule it for as soon as you can.
grains. You want five or more servings of
So how do you lead a healthier lifestyle with long hours, endless demands on
fruits and vegetables a week.
your time and the stress of mounting paperwork
and
declining
Laugh. It de-stresses
reimbursements? I won’t
the body, boosts your
say it is easy, but start
immune
with five simple steps. (I
improves
system your
and mood.
bet you have heard these
Smile. Read the comics.
before, but we all need to
Look up David Letterman’s
recommit ourselves now
Top 10 lists. When you hear
and again. Why not now?):
people laughing in the office,
1. Get plenty of good
walk over and ask them why. Tell
quality sleep.
a joke or just do something silly.
2. Drink more water.
Share embarrassing moments and
3. Exercise regularly.
learn to laugh at yourself. Regular
4. Eat a balanced diet.
humor can lift the mood of the
5. Laugh every day. Humor
entire office.
is good for the soul.
Being a caregiver is a big part of who you are – just don’t
Sleep. You need seven
leave your name off of the
to eight hours a night.
list of those requiring care. You may just
Not getting that means
end up healthier, happier and an even
more than a bad mood
better practitioner to the people you
and headaches. Lack
care for.
april 2012
13
Duke Research News
Genetic Variation in East Asians Found to Explain Resistance to Cancer Drugs By John D. Long, M.D.
A multinational research team led by scientists at Duke-NUS (National
Now the team at Duke-NUS Graduate Medical School in Singapore,
University of Singapore) Graduate Medical School has identified
working with the Genome Institute of Singapore (GIS), Singapore
the reason why some patients fail to respond to some of the most
General Hospital and the National Cancer Centre Singapore, has
successful cancer drugs.
discovered that there is a common variation in the BIM gene in people of east Asian descent that contributes to some patients’ failure to
Tyrosine kinase inhibitor (TKI) drugs work effectively in most patients
benefit from these tyrosine kinase inhibitor drugs.
to fight certain blood cell cancers, such as chronic myelogenous leukemia (CML) and non-small-cell lung cancers (NSCLC) with
“Because we could determine in cells how the BIM gene variant
mutations in the EGFR gene.
caused TKI resistance, we were able to devise a strategy to overcome it,” said S. Tiong Ong, M.B.B.Ch., senior author of the study and
These precisely targeted drugs shut down molecular pathways that
associate professor in the Cancer and Stem Cell Biology Signature
keep these cancers flourishing and include TKIs for treating CML, and
Research Programme at Duke-NUS and Division of Medical Oncology,
the form of NSCLC with EGFR genetic mutations.
Department of Medicine, at Duke University Medical Center. “A novel class of drugs called the BH3-mimetics provided the answer,” Mr. Ong said. “When the BH3 drugs were added to the TKI therapy in experiments conducted on cancer cells with the BIM gene variant, we were able to overcome the resistance conferred by the gene. Our next step will be to bring this to clinical trials with patients.” “We used a genome-wide sequencing approach to specifically look for structural changes in the DNA of patient samples. This helped in the discovery of the east Asian BIM gene variant. What’s more gratifying is that this collaboration validates the use of basic genomic technology to make clinically important discoveries,” said Yijun Ruan, Ph.D., a co-senior author of this study and associate director for Genome Technology and Biology at GIS. The study was published online in Nature Medicine on March 18. If the drug combination does override TKI resistance in people, this will be good news for those with the BIM gene variant, which occurs in about 15 percent of the typical east Asian population. By contrast, no people of European or African ancestry were found to have this gene variant. “While it’s interesting to learn about this ethnic difference for the mutation, the greater significance of the finding is that the same principle may apply for other populations,” said Patrick Casey, Ph.D., senior vice dean for research at Duke-NUS, and James B. Duke, professor of pharmacology and cancer biology. “There may well
14
The Triad Physician
be other, yet to be discovered gene variations that account for drug resistance in different world populations. These findings underscore the importance of learning all we can about cancer pathways, mutations and treatments that work for different types of individuals. This is how we can personalize cancer treatment and, ultimately, control cancer.” “We estimate that about 14,000 newly diagnosed east Asian CML
Legal Expertise, Health Care Knowledge Principal Karen McKeithen Schaede, a registered nurse for 10 years, brings in-depth understanding of health care to the practice of law.
and EGFR non-small-cell lung cancer patients per year will carry
Our staff can assist you with: • Medical Practice Formation • Physician Employment • Medical Practice Sale, Acquisition or Consolidation • Medical Joint Ventures • Medical Staff Disputes • HIPAA Issues • Corporate Compliance • Contract Disputes • Employment and Labor Law
the gene variant,” Mr. Ong said. “Notably, EGFR NSCLC is much more common in east Asia, and accounts for about 50 percent of all non-small-cell lung cancers in east Asia, compared to only 10 percent in the west.” The researchers found that drug resistance occurred because of impaired production of BH3-containing forms of the BIM protein. They confirmed that restoring BIM gene function with the BH3 drugs worked to overcome TKI resistance in both types of cancer. “BH3-mimetic drugs are already being studied in clinical trials in
1175 Revolution Mill Drive Studio 7A Greensboro, NC 27405 Fax: (888) 392-2707 karen@shadylaw.net www.shadylaw.net
combination with chemotherapy, and we are hopeful that BH3 drugs in combination with TKIs can actually overcome this form of TKI resistance in patients with CML and EGFR non-small-cell lung cancer,” Mr. Ong said. “We are working closely with GIS and
336-288-4055
the commercialization arm of the Agency for Science, Technology & Research (A*STAR), to develop a clinical test for the BIM gene variant, so that we can take our discovery quickly to the patient.”
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The major contributors to the study include additional researchers and teams from the Duke-NUS Graduate Medical School, Genome Institute of Singapore (Dr. Yijun Ruan and Dr. Axel Hillmer), Singapore General Hospital (Dr. Charles Chuah) and National Cancer Centre Singapore (Dr. Darren Wan-Teck Lim). In addition, the investigators also received important contributions from Akita University Graduate School of Medicine, Japan (Dr. Naoto Takahashi); the Cancer Science Institute of Singapore (Dr. Ross Soo); the National University Cancer Institute of Singapore (Drs. Liang Piu Koh and Tan Min Chin); the Yong Loo Lin School
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of Medicine, National University of Singapore (Dr. Seet Ju Ee); the University of Bonn, Germany (Dr. Markus Nöthen); the University of Malaya (Dr. Veera Nadarajan); and the University of Tokyo, Japan (Dr. Hiroyuki Mano). The study was supported by grants from the National Medical Research Council (NMRC) of Singapore; Biomedical Research Council (BMRC) of A*STAR, Singapore; Genome Institute of Singapore; Singapore General Hospital; and two NMRC Clinician Scientist Awards to Drs. Ong and Chuah.
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Check out our video! 2575 Old Glory Drive Clemmons - 336.778.1030 - www.junedelugasinteriors.com
april 2012
15
News
Is Your Online Presence Like a
Billboard in the Desert?
By Scott Richardson
As traditional advertising dollars, such as
your practice can assist.
yellow pages, continue to migrate online, medical practices are confronted with
Having first-page visibility for these
many nontraditional questions:
searches needs to be the foundation of your online marketing strategy. The two
1. How do I attract potential new
primary methods for first-page visibility
patients to my website? 2. W hat is more important, search
include SEO and SEM. Search engine
engine optimization or search
optimization, or SEO in layman terms,
engine marketing?
is making sure your website is searchengine friendly. The goal with SEO is to
Ask 100 online marketing experts their
get your website to the top of the organic,
opinion and you will probably get 110
“non-paid,” section for as many keyword
different opinions. One thing that all 100
searches as possible. Search engine
will agree upon is that doing nothing to
marketing, or SEM, is simply meant to take
actively promote your practice online is
the guess work out of the formulas and
not an option.
pay for placement on as many keywords as possible. One common analogy is, SEO
Having a website without promotion is
is like building a house over time and SEM
like paying for a billboard in the desert. It
is like buying the home already built.
may make you feel good that your family
Scott Richardson has been a small business marketing professional for more than 20 years. Having consulted thousands of businesses over his career, he has seen the recent dramatic shift in advertising strategies. Mr. Richardson studied marketing at Michigan State University. Afterward, he started his career with Ameritech Publishing, now at&t Advertising Solutions. After 17 years with at&t, he accepted a position with ReachLocal, an internet marketing company based in Woodland Hills, Calif. For the last three years, Mr. Richardson has consulted businesses throughout the Carolinas, assisting with their online strategies. For more information, visit www. reachlocal.com or contact Mr. Richardson at scott.richardson@reachlocal.com or (704) 451-0098.
and friends comment on your cool, new
Surfing: This group is simply online
site or that you were the first in your
without
competitive field to have a live website,
destination site. This is a great opportunity
users, 200-plus Twitter users, the Pinterest
but your results are probably negligible.
to build your brand at a very low-cost
user, etc. Depending on your practice
per-thousand impression compared to
size, your ability to gain followers will
traditional advertising mediums.
dictate your success levels on social
A very straightforward approach to understanding
what
consumers
a
true
purpose
or
single
media marketing.
are
doing online and how to attract them is
Commonly known as banner ads, many
to consider three simple “conversations.”
small businesses view this form of
Although not generally considered a
Consumers – including potential new
marketing as intrusive or cost prohibitive.
strong return on investment (ROI) tool,
patients – are doing one of these three
Truthfully though, this is a very subtle form
your social media presence is often a
online at any given time: searching,
of brand awareness, unless the message
first impression of your practice. Simply
surfing or socializing.
vehicle are pop-up videos or something
building your page is not enough in most
similar. When done properly in a regional
cases, you want to be able to portray
Searching: These consumers are ac-
format, reaching these “surfers” can
yourself as an industry expert, and
tively looking for the solution to a prob-
actually be much more affordable than
relevant content marketing will help you
lem. “They are buyers looking for the sell-
you think. There are also many options
accomplish this.
ers.” This is the low-lying fruit, the people
that allow you to behaviorally target your
that have typed their problem into the box
audience, meaning the audience most in
To summarize, don’t have that billboard
of their favorite search engine in hopes of
need of your product or service.
in the desert. Make sure you are actively pursuing methods to drive traffic to your
finding the answer. Their answer might be an appointment to a local physician or
Socializing: I think we all know what
a comforting voice that will explain how
this is. Yes, the 800 million-plus Facebook
website.
april 2012
17
News
Forsyth Medical Center and Lowes Foods Open New Learning Lab for Rehabilitation Patients Patients Will Shop in a Realistic Grocery Store as Part of Rehab Therapy Forsyth Medical Center and Lowes Foods are excited to announce the opening of the Life Learning Lab at the hospital’s rehabilitation center, a virtual grocery store where rehab patients will be able to develop their cognitive and physical abilities in a safe environment. The Lowes Foods Life Learning Lab, the only one of its kind in the Triad, is designed to be a mini grocery store complete with various types of shelving, frozen food cases, a bakery section, grocery carts, a check-out line with a cash register, an ATM machine donated by Allegacy and a computer for on-line ordering. different aspects of rehab. Physical and
daily activities of life, such as balance
Therapists will incorporate the learning
occupational therapists will focus on
and endurance, money handling, object
lab into patients’ therapy to improve all
helping patients with the physical and
recognition and problem solving. And
18
The Triad Physician
News
R A L E I G H , N C • M AY 5 , 2 0 1 2
Walking to raise funds for research to find treatments and a cure for neurofibromatosis (NF)
Saturday, May 5, 2012 8:00 AM - Check in/Registration
•
9:00 AM - Welcome, Group Picture, Walk Begins
LOCATION
Lake Benson Park 921 Buffalo Rd., Garner, NC, 27529
speech therapists will focus on communication, thinking
REGISTRATION
and memory skills. The hospital’s dieticians also plan to
Register online at: http://www.nfwalk.org
use the lab to help teach healthy eating habits and how to read food labels to identify which foods are best for the patient.
Have any questions? Contact Heather Wray at hwray@nc.rr.com or 919-414-4569.
Join Us for Raffle, Food, and Fun for the Entire Family!
“From writing a grocery list to gathering the items and going through the check-out, this lab gives us the ability to work with patients who need to develop not only physical skills, but cognitive and decision-making skills as well,” said Lynn Watkins, project manager for post
If you are in a position to help us underwrite the cost of this event in support of the children and adults who suffer from NF or you are unable to walk but would like to make a donation please visit www.ctf.org/walk. Please make checks payable to “Children’s Tumor Foundation” and turn in at event or mail to Children’s Tumor Foundation, 95 Pine Street, 16th Floor, New York, NY 10005.
acute services, Forsyth Medical Center. “Currently we take patients who are well enough out into community grocery stores to practice these skills, but this is a much safer and protected environment. We owe a sincere thank you to Lowes Foods for helping us design this space and for donating all of the supplies.” Steve Hall, president of Lowes Foods says, “Lowes Foods has been a member of Winston-Salem for many years, headquartered here with a number of stores in the market. As a member of the community we are pleased to have the opportunity to partner with Forsyth Medical Centerin updating and improving their rehabilitation facility. Getting brain trauma patients on their feet and back into the community as quickly as possible is our mutual goal. Grocery shopping is essential to everyone and now we have a place for patients to acquire the skills needed to be self supporting again. As a family-owned North Carolina-based company we could not be more proud to have been a small part of this effort.” Forsyth RehabilitationCenter’s inpatient rehabilitation facility sees close to 1,000 patients a year. It has been accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) for its Adult Inpatient Rehabilitation Programs and its Inpatient Rehabilitation Stroke Specialty Program.
april 2012
19
News
“Miracle Man”
Grateful for Heart Care Hilario Cordova marked the first anniver-
your great hospital with its incredible doc-
“I believe in God,” said Mr. Cordova. “He
sary of his life-saving heart catheterization
tors and nurses and everybody behind the
wanted to leave me here for a reason.” Mr.
and triple bypass operation. That day one
scenes. Words cannot express the grati-
Cordova’s story is one of many featured in
year ago, he was driving to work when he
tude I feel.”
the Cone Health 2011 Clinical Outcomes and Program Report.
experienced extreme chest pain. He had a complete blockage in the left main coro-
Tracy Cordova with her “miracle man,” Hilario Cordova, after quick-response, life-saving heart care.
nary artery, often called a “widow maker” heart attack. Jonathan Berry, M.D., was the first to see him at Cone Health Heart and Vascular Center and said his condition was “completely incompatible with life.” Mr. Cordova “kept trying to die,” Dr. Berry said. Quick response by Dr. Berry, cardiothoracic surgeon Edward Gerhardt, M.D., and the entire Cone Health team saved Mr. Cordova’s life. Today, he is back to his fencebuilding business and enjoying time with his wife, Tracy Cordova, who calls him her “miracle man.” “I do credit Cone Health for saving my husband’s life,” Ms. Cordova said. “God worked it all out for him to be so close to
HighPoint Health System’s Moore Honored with Lifepoint “CFO of the Year” Award HighPoint Health System Chief Financial Officer Steve Moore was honored recently with LifePoint Hospitals’ CFO of the Year award. The award, presented annually to one of LifePoint’s nearly 50 hospital CFOs, celebrates leadership and operational excellence in 2011. Pictured, left to right: President of Operations Planning and Support Scott Raplee, Division CFO Jon Wall, HighPoint Health System CFO Steve Moore, Chairman and CEO Bill Carpenter, and President David Dill. “Steve is an effective leader with a calm demeanor and steady hand. Following the acquisition of HighPoint Health System by
20
The Triad Physician
News LifePoint Hospitals, Steve was instrumental in ensuring the
However much you value wildlife conservation in North Carolina,
successful transition of HighPoint to LifePoint’s operational systems,” said LifePoint Hospitals Division CFO Jon Wall,
DEC NC
11
1234
quadruple it.
who presented the award. “It is truly my pleasure to honor Steve through this important
That’s right! Your conservation effort is increased by a 3-to-1 matching gift. So, when you are one of the first to display the new North Carolina Wildlife Habitat Foundation NCDMV license tag, your $10 tag contribution to the organization becomes $40 in lands preserved.
award.” “Steve has put in many long hours during the past year and
The all-volunteer North Carolina Wildlife fe Habitat Foundation assists in acquisition, on, management, and protection of land in North Carolina for the conservation of habitats needed to preserve wildlife
I’m thrilled he has been recognized,” said HighPoint Health System CEO Mary Jo Lewis.
right here in the Old North State. Conservation education efforts are preparing future generations to sustain your concern for the lands we protect today. At www.ncwhf.org, download the license tag application and see the good works in process. pp Your new tag shows your support and your n contribution is put to work…times four. co
www.ncwhf.org w
Practice Relocation
Events AHEC Events Ahead Greensboro Area Health Education Center is offering the following continuing education events through June:
Total Family Care Relocates Office
April 17: The 11th Annual Key Issues in Trauma Management Conference Embassy Suites Hotel, 204 Centreport Drive, Greensboro.
May 22: 7th Annual Acute Stroke Treatment Update Deep River Event Center, 606 Millwood School Road, Greensboro.
Total Family Care, a Cornerstone Health Care practice, has moved to a new location at 1665 Westbrook Plaza Drive. The practice was formerly located at 3333 Brookview Hills Blvd. in Winston-Salem.
April 27: The John Lusk Cone Health Inaugural Oncology Symposium Cone Health Cancer Center on Wesley Long Campus, Greensboro.
June 01: Third Annual Bariatric Symposium Moses Cone Hospital, Greensboro.
Suzanne E. Hilton, M.D.; Aimee S. Lischke, M.D.; certified family nurse practitioner Nancy E. Frye, M.S.N., F.N. P.-C.; and certified physician assistant Gina Pasquale, P.A.C., are the providers at Total Family Care.
May 07: HIV Care in 2012: Trends in Clinical Care and Caring for Vulnerable Populations The Friday Center, Chapel Hill.
More information and online registration is available at www.gahec.org, or call the Greensboro AHEC customer service phone number at (336) 832-8025.
Welcome to the Area
Physicians Gerardo Enrique Arnaez Sommany Weber, DO
Wake Forest Univ Baptist Medical Center, Winston-Salem
Waseem Ghannam, MD
Hospitalist; Internal Medicine Wake Forest Univ Baptist Medical Center, Winston-Salem
Family Practice; Hospitalist Optimed Hospitalists, Statesville
Kavitta Baman Allem, MD Internal Medicine; Hospitalist Wake Forest Univ Baptist Medical Center, Winston-Salem
Orthopedic: Sports Medicine, Surgery, Hand Surgery Wake Forest Baptist Medical Center Winston-Salem
Robert David Becher, MD
Elizabeth Eby Halvorson, MD
General Surgery Wake Forest Univ Baptist Medical Center, Winston-Salem
Pediatrics; Hospitalist Wake Forest Univ Baptist Medical Center, Winston-Salem
Heather Marie Nettles Clark, MD
Sandra Davis Kaplan, MD
Psychiatry Wake Forest Univ Baptist Medical Center, Winston-Salem
Pain Medicine Winston-Salem
Michael A Codiga, MD
Anatomic Pathology, Clinical Pathology, Laboratory Medicine Wake Forest Univ Baptist Medical Center, Winston-Salem
Internal Medicine Winston-Salem
Thomas Lane Estes, MD Diagnostic Radiology
Benjamin Ray Graves, MD
Kyle Charles Mills, MD
Kristin Kucera Marcum, MD Otolaryngology Wake Forest Univ Baptist Medical Center, Winston-Salem
Jeffrey Edward Peacock, MD Anesthesiology Wake Forest Univ Baptist Medical Center, Winston-Salem
Milton Bruce Shields, MD Ophthalmology Open Door Clinic, Burlington
Charles Van Sikes, MD Adult Reconstructive; Orthopedic Surgery Wake Forest Univ Baptist Medical Center, Winston-Salem
Philip Peter Stapleton, MD Internal Medicine Winston-Salem
Physician Assistants Susannah M White, PA
The practice is accepting new patients, and appointments may be made by calling (336) 760-8380.
The Triad Physician 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
Winston-Salem
april 2012
21
CLEVELAND CLINIC
FORSYTH MEDICAL CENTER
Forsyth Medical Center is now affiliated with #1 ranked Cleveland Clinic. Forsyth Medical Center has been selected as the Triad region’s only affiliate heart hospital for the Cleveland Clinic — ranked #1 in the nation by U.S. News & World Report, 17 years in a row. This transforms our healthcare landscape forever. With Forsyth Medical Center and Cleveland Clinic working together, you have the best of the best on your side, with access to the most advanced research, programs, technologies and techniques in the world of cardiovascular medicine and surgery. Now there’s no need for you or your loved ones to travel for most cardiac care. Or to compromise. The #1 choice in cardiovascular care is right here for you.
www.forsythmedicalcenter.org/heart www.clevelandclinic.org/heart