N ov e m b e r / D e c e m b e r 2 013
Spine & Scoliosis Specialists Multidisciplinary Practice Provides Leading-Edge Treatment for Complex and Simple Spine Conditions
Also in This Issue Use of Radioactive Iodine Circumcision Update
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Editor’s Note
Embracing Immediacy Often patients with a painful spine injury must wait days or weeks until a specialist is able to see them. Spine & Scoliosis Specialists – this month’s featured practice – can eliminate that agonizing wait with its Acute Spine Injury Clinic, which offers evaluations the same day or within 24 hours of an injury. Spine & Scoliosis Specialists is dedicated to treating any type of back problem – from minor to complex – with specialists in surgical, nonsurgical and rehabilitative care and the full complement of diagnostic and treatment expertise, technology and services. Their early
Editor Heidi Ketler, APR
treatment offers to not only bring pain relief sooner, but to increase the chances of a correct diagnosis so appropriate treatment can begin sooner. This increases the likelihood of better long-term results and decreases the need for emergency room visits. This issue of The Triad Physician also features a number of contributors, whose articles
Contributing Editors June DeLugas Bill Evans, M.P.H., M.C.H.E.S., C.H.C. Amanda Kanaan Michael J. Thomas, M.D., Ph.D. John S. Wiener, M.D., F.A.A.P., F.A.C.S.
enlighten on a diverse array of relevant health care topics. Thanks to all for making this a great issue.
Photography - Kendal Murphy Creative Director - Joseph Dally
Urologist John Wiener reviews the changing medical opinion of circumcision, which is currently favored by the American Academy of Pediatrics. Endocrinologist Michael Thomas discusses the clinical use of radioactive iodine. Bill Evans explains the skillset of the health education specialist, an emerging health care role that supports improved relationships in the new Accountable Care Organization environment. Practice marketing specialist Amanda
Contact Information for Marketing, Media & News: Faye Tuttle Email: Faye@TriadPhysician.com Phone: 336.399.1140
Kanaan shares what’s trending in web design. And interior designer June DeLugas offers insight into the importance of lighting function and ambiance. The fast approach of Dec. 31 generally creates a sense of urgency for finishing the year in a strong position financially. Most of us also are thinking about goals for making the year
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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.
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Heidi Ketler
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.
Editor
2
The Triad Physician
Category
COVER STORY
4
Spine & Scoliosis Specialists Multidisciplinary Practice Provides Leading-Edge Treatment for Complex and Simple Spine Conditions
november/december 2013
FEATURES
8
Endocrinology
What’s New with Radioactive Iodine?
Vol. 2, Issue 3
DEPARTMENTS 7 Practice Marketing Competing for Patients Online: Three of the Latest Web Design Trends
Dr. Michael Thomas describes the use of this byproduct of nuclear
11 Interior Design
fission in the treatment of hyperthyroidism and thyroid cancer.
Express Style and Define Ambience Through Light Fixtures
10
Urology
Circumcision Update Dr. John Wiener discusses the ongoing controversy surrounding this American practice and the lack of medical evidence for or against it.
12 Health Care Reform Help! Support Is Available to Guide Change in Skillset and Mindset
13 News
- Welcome to the Area - Events
COVER PHOTO: The medical staff at Spine & Scoliosis Specialists includes (left to right): Ruben Torrealba, M.D., Colleen Mahar, PA-C, Thomas R. Saullo, M.D., Max W. Cohen, M.D., Jennifer Czinsky, PA-C, and Bradley Hicks, PA-C.
NOVEMBER/DECEMBER 2013
3
Cover Story Category
Spine & Scoliosis Specialists, Greensboro Multidisciplinary Practice Provides Leading-Edge Treatment for Complex and Simple Spine Conditions Spine & Scoliosis Specialists is the Piedmont
where people can go for any type of back
“Our goal is to help patients – without
Triad’s only medical practice devoted
problem – from minor muscle strains to
surgery if possible – and we’re successful
exclusively to spine care, offering the latest,
ruptured discs to scoliosis,” says Max W.
in doing so most of the time,” says Dr.
most technologically advanced treatment,
Cohen, M.D., F.A.A.O.S., who founded
Cohen. “Only 10 percent of our patients
delivered by fellowship-trained physicians.
Spine & Scoliosis Specialists in 2007.
typically undergo surgery. The remainder are
helped
through
nonsurgical
The mission of Spine & Scoliosis
Spine & Scoliosis Specialists is known
alternatives. One of the most gratifying
Specialists is to provide advanced spine
for its commitment to leading-edge
aspects of our work at Spine & Scoliosis
care that relieves pain, improves mobility
techniques, as well as its emphasis on
Specialists is hearing patients tell us
and enhances patients’ quality of life. The
patient-centered care. Often the practice
they are now pain-free as a result of their
multidisciplinary medical team treats
can help patients who have been told that
treatment.”
both complex and simple back and neck
nothing can be done for a complex spine
injuries and conditions.
problem. Spine & Scoliosis Specialists
Highly Trained Medical Team
has earned a reputation regionally for
The medical staff, composed of three
excellence and draws patients from
physicians and three physician assistants,
across the southeast.
includes specialists in surgical, nonsurgi-
“We
not
only
provide
specialized
diagnosis and care, but also are a place
cal and rehabilitative care. Together, they offer a full complement of spine services onsite at 2105 Braxton Lane, Suite 101, in Greensboro and at a new office that opened in December 2013 at 4590 Premier Drive in High Point. Dr. Cohen is a board-certified orthopaedic surgeon and the only Triad physician with double fellowship training in spine and scoliosis surgery. He completed his training at Cornell University’s prestigious Hospital for Special Surgery, the topranked orthopaedics hospital in the U.S., according to U.S. News & World Report. He specializes in complex spinal disorders, including scoliosis in children and adults. He has extensive experience in performing minimally invasive surgery, disc replacement, complex multi-level scoliosis surgery and revision surgery. Dr. Max W. Cohen (left) and Dr. Ruben Torrealba perform navigation-guided spine surgery using the O-Arm. They are the only spine surgeons in Guilford County using this technology, which allows for more precise placement of implants in patients with severe spinal deformities.
4
The Triad Physician
Ruben Torrealba, M.D., who joined Spine & Scoliosis Specialists in November, is
a board-certified orthopaedic surgeon
studies, a diagnosis and, if needed, a pain-
who completed his fellowship training
relieving injection – all in the same day.
in spine surgery at Twin Cities Spine Center in Minnesota, renowned for
Spine & Scoliosis Specialists has the lat-
training physicians and treating patients
est diagnostic equipment onsite, includ-
from around the world. Dr. Torrealba
ing magnetic resonance imaging, digital
specializes in minimally invasive surgery
X-rays, fluoroscopy and ultrasound.
and treats simple and complex spinal disorders, including spondylolisthesis,
“Because we do imaging in-house, pa-
herniated discs, spinal stenosis, fractures
tients in pain can undergo scans faster
and degenerative spinal disorders. He is
and more conveniently than would be
fluent in both Spanish and English.
possible at an outside imaging center,” says Dr. Cohen.
Thomas R. Saullo, M.D., is a board-certified specialist in physical medicine and
“In addition, our spine-specific MRI imag-
rehabilitation who completed fellowship
ing ensures that we receive precise infor-
training in interventional spine care in
mation required for accurate diagnosis.
Richmond, VA, with Michael DePalma,
The MRI images are immediately avail-
M.D., a leading interventional spine spe-
able on our computerized PACS (picture
cialist who teaches a rigorous, evidence-
archive computer system) for our doctors
based, algorithmic approach to diagnos-
to review. This eliminates delays in treat-
ing and treating painful spinal disorders.
ment.”
Dr. Saullo, who also has a degree in physical therapy, brings a comprehensive, non-
The onsite fluoroscopy suite includes
surgical approach to the treatment of pa-
sophisticated imaging equipment, which
tients with spine problems.
Dr. Saullo uses to guide spinal injections and perform other procedures. He can
Diagnosis and Treatment the Same Day
perform
Spine & Scoliosis Specialists offers patients
injections,
the advantage of receiving complete care
(SI) joint injections, kypohoplasty and
onsite. Many patients who are in pain can
implants of spinal cord stimulator trials in
receive a physical examination, imaging
the office.
diagnostic
and
therapeutic
epidural steroid injections, facet joint nerve
blocks,
sacroiliac
Acute Spine Injury Clinic Offers Fast Treatment Spine & Scoliosis Specialists offers an Acute Spine Injury Clinic at both of its locations. Physicians may refer patients with acute spine injuries or conditions to the clinic for evaluation within 24 hours or, in most cases, the same day. “That’s one of the things that differentiates us from a lot of spine specialists,” says Max W. Cohen, M.D., F.A.A.O.S., the founder of Spine & Scoliosis Specialists. “We are willing to see patients the same day or within 24 hours of referral. As a result, we can arrive at a correct diagnosis and start appropriate treatment, which keeps many patients out of emergency rooms. We believe we can provide treatment that leads to better results when the patient is seen sooner, rather than later.” To refer a patient to the Acute Spine Injury Clinic, call Spine & Scoliosis Specialists at 336-333-6306 and request an appointment in the Acute Spine Injury Clinic. Advanced Surgical Techniques When surgery is needed for a spinal injury or condition, Spine & Scoliosis Specialists surgeons perform leading-edge techniques using state-of-the-art technology. Surgery to correct scoliosis in children and adults is a specialty. Many surgeons do not perform scoliosis surgery when the curvature is large or the patient has other spine conditions in addition to scoliosis. With their advanced training, the surgeons at Spine & Scoliosis Specialists have both the skill and the willingness to perform complex surgeries designed to correct difficult curvatures. Patients sometimes travel great distances to
Dr. Ruben Torrealba (left) and Dr. Max W. Cohen discuss a patient’s case.
be evaluated at Spine & Scoliosis Specialists. NOVEMBER/DECEMBER 2013
5
Spine & Scoliosis Specialists surgeons have extensive training in minimally invasive surgery and are the only surgeons in Guilford County who perform navigationguided spine surgery using a state-of-theart, GPS-like system called the O-Arm. “It allows for more precise placement of implants in patients with severe deformities of the spine,” Dr. Cohen says.
Physician Referrals Spine & Scoliosis Specialists welcomes referrals from physicians for evaluation of spinal conditions, diseases and injuries. To refer a patient or discuss a case with one of its spine specialists, visit www.TriadSpine.com or call (336) 333-6306. Referring physicians may send MRIs and other imaging studies (if available) with the patient and fax patient medical records to (336) 458-3681. Spine & Scoliosis Specialists has two locations: 2105 Braxton Lane, Suite 101, Greensboro 27408 and 4590 Premier Drive, High Point 27265.
The surgeons at Spine & Scoliosis Specialists often see scoliosis patients who have been unable to get help elsewhere for extreme curvatures. Dr. Max Cohen corrected this patient’s 80-degree curvature (before surgery) to 15 degrees (after surgery).
Dr. Thomas R. Saullo uses fluoroscopic guidance to administer a pain-relieving injection to a patient in Spine & Scoliosis Specialists’ onsite fluoroscopy suite.
6
The Triad Physician
Competing for Patients Online
Practice Marketing
Three of the Latest Web Design Trends By Amanda Kanaan
If you’ve ever had a patient present in your
by creating “responsive” websites. This
office with a self-diagnosis from WebMD,
allows your website to adapt to any de-
then you know firsthand the impact of
vice – from smartphones to tablets (ipads,
the internet on health care. Patients are
etc.) to computers. A responsive website
not only searching for conditions online,
automatically responds and adapts to any
they’re also comparing doctors.
size device, resulting in a better user experience. This also makes your website much more likely to convert visitors into patients.
2. Patient Interaction Websites should be more than a pretty online brochure. There are plenty of interactive tools you can integrate to keep patients on your website longer. This is good
Amanda Kanaan is the founder and president of WhiteCoat Designs – a medical marketing agency providing doctors with medical website design, search engine optimization (SEO), mobile and responsive websites, social media management, graphic design, physician liaison services, and more. To contact Ms. Kanaan or to learn more about WhiteCoat Designs, visit www.whitecoat-designs.com.
not only for search engine optimization Your website has just seven seconds to
(SEO) purposes but also to bring value to
information (PHI) online and rightfully
your relationship with the patient.
so. However, there are now companies that specialize in meeting Health Insur-
make an impression on patients or they’re on to the next link in Google. Patients will
One example is the symptom checker.
ance Portability and Accountability Act
also use your website to compare you to
Another is a dosage calculator for parents
compliance regulations for online interac-
your competitors, and will actually choose
to calculate their children’s medications
tions. This makes it possible for patients
a provider based on the design, functional-
online – a great tool for pediatric websites.
to reveal the reason for their appointment when making a request through your web-
ity and messaging of a website. With that in mind, here are three of the latest website
There are plenty of companies that offer
site. It also allows patient registration pa-
design trends to help you stand out online.
affordable online tools that allow patients
perwork to be filled out online.
to use your website as a resource for re-
1. Responsive Design
searching a condition. After all, wouldn’t
These benefits not only make your prac-
More than half of all smartphone owners
you rather a patient come to your website
tice more efficient, but they are also
have used their phone to look up health
to look up a symptom rather than relying
something patients appreciate. Sixty-five
or medical information. Mobile websites
on WebMD?
percent of patients are willing to switch to a physician who engages them using
make browsing the desktop version of your site much easier and faster for pa-
The benefit is that it drives more traffic to
digital communications. Research shows
tients. Since users’ search behaviors are
your website. It also positions you as the
that patients want to interact online. So by
different on mobile devices versus desk-
expert in your specialty, meaning anytime
giving patients what they want, you can
top computers, having a mobile website
a patient has a concern, you are top of
help your website standout among the
is a necessity, if you want to improve the
mind.
competition.
online experience for patients.
3. HIPAA Forms
Source: Pew Research Center, Pew Inter-
However, website designers are now tak-
Medical providers are extremely ner-
net & American Life Project (2011)
ing this thought process one step further
vous about collecting protected health NOVEMBER/DECEMBER 2013
7
Endocrinology
What’s New with
Radioactive Iodine? By Michael J. Thomas, M.D., Ph.D.
Radioiodine (I-131), first discovered in
A normal adult thyroid RAIU is between
1938, is a nuclear fission byproduct of
10-30 percent at 24 hours. Patients with
uranium. In the early 1940s, radioiodine
Graves’ disease often have a markedly
was used to study thyroid physiology,
elevated RAIU, whereas patients with
and by the late 1940s it was used to treat
thyroiditis typically have extremely low
hyperthyroidism and thyroid cancer. So,
RAIU measurements (due to lack of
remarkably, I-131 has been used clinically
iodine uptake in injured thyroid tissue).
for the past 70 years. RAIU can be influenced by dietary iodine and
intake (e.g. vitamins and fish oil capsules),
a
iodinated computed tomography contrast
precursor to thyroid hormone, thus
dye and anti-thyroid medications, so it is
trapping the iodine in the gland. With the
necessary to perform RAIU measurements
exception of the salivary glands, very little
several days (sometimes weeks) after
iodine is absorbed elsewhere in the body,
these factors are discontinued or avoided.
and unincorporated iodine is quickly
RAIU measurements are inexpensive and
excreted in the urine, with much smaller
can be performed in the office setting.
Iodine
is
incorporated
actively into
transported thyroglobulin,
amounts excreted in stool, saliva and perspiration. Two radioisotopes of iodine
A radioiodine thyroid scan generates an
are used clinically: I-131 (half-life 8.02
image of the iodine that is actively trapped
days), which is used mostly for therapy;
in the thyroid, revealing areas of increased
and I-123 (half-life 13 hours), which is a
or decreased absorption. In the past,
very low-energy gamma-emitter useful for
thyroid scans were sometimes performed
diagnostic and imaging studies.
to determine whether a thyroid nodule
Dr. Michael Thomas of Carolina Endocrine P.A. graduated from the School of Medicine at West Virginia University in Morgantown, with a doctor of medicine and doctor of philosophy in pharmacology and toxicology. He completed his post-graduate medical training at Barnes Hospital at Washington University in St. Louis, including his internship, residency and fellowship in endocrinology. Dr. Thomas was previously a faculty member in endocrinology/medicine at Washington University, the University of Iowa and the University of North Carolina at Chapel Hill. He established Carolina Endocrine in the summer of 2005. Board certified in internal medicine and endocrinology, Dr. Thomas is licensed to perform endocrine nuclear medicine procedures and therapies at Carolina Endocrine. He is a fellow of the American College of Endocrinology (FACE) and has completed endocrine certification in neck ultrasound (ECNU). For more information and patient referrals and appointments call (919) 571-3661 or visit the practice website at carolinaendocrine.com.
was “hot,” a nodule that absorbed a lot of (RAIU)
radioiodine; or “cold,” a nodule that did
other tissues (e.g. MIBG; iodine-131-
measurement determines how much
not absorb any radioiodine. Nearly all hot
meta-iodobenzylguanidine,
iodine the thyroid gland absorbs during
nodules are benign, but “cold” nodules
that
a several-hour period. It is useful to
carry about a 20 percent risk of malignancy
medullary [chromaffin] tissue, to identify
determine the underlying cause of thyroid
and should be further evaluated.
pheochromocytomas).
therapeutic management decisions based
The advent of ultrasound and fine needle
Radioiodine has been extensively studied
on the result.
aspiration (FNA) biopsy have obviated
under a variety of different thyroid disease
the need for some thyroid scans, except
situations, doses and ages. Studies extend
The procedure is straightforward: the
in the diagnosis of toxic multinodular
back to the 1950s.
patient ingests a known amount of
goiter or toxic adenoma.
A
radioiodine
uptake
is
concentrated
an into
agent adrenal
dysfunction, and it can be used to guide
radioiodine and then returns 24 hours
For “low” doses of radioiodine used to
later to have the amount of radiation in
Another type of imaging study is a “whole
treat hyperthyroidism (e.g. 10-30 mCi), the
his thyroid measured. A device similar
body scan,” which is obtained before
risk of malignancies appears negligible
to a Geiger counter measures the levels
or after I-131 therapy in patients who
in most studies and meta-analyses.
in the neck area. The amount of radiation
have undergone total thyroidectomy for
However, there is heightened concern
is divided by the known starting amount
thyroid cancer. Other nuclear medicine
about the routine use of radioiodine in
of radioiodine, giving the percent uptake.
scans also employ I-131 in imaging
pre-adolescents, so caution is advised
8
The Triad Physician
iodine used to treat thyroid cancer, with
References
fewer side effects, but no apparent outcome
Sisson, J.C., et al Radiation Safety in
differences. There are more side effects
the Treatment of Patients with Thyroid
with higher doses of radioiodine therapy,
Diseases by Radioiodine 131I: Practice
including nausea, vomiting and sialoadeni-
Recommendations
tis (swelling of the salivary glands), which
Thyroid Association. Thyroid 21(4):335-
can lead to pain and dry mouth (xerosto-
346, 2011
of
the
American
mia), as well as alterations in test sensation and excessive tearing (epiphora). At high
For more information and patient referrals
doses of radioiodine, there is an increased
and appointments call (919) 571-3661 or
risk of secondary malignancies, including
visit carolinaendocrine.com.
with radioiodine use in the pediatric
salivary gland, stomach, bladder and he-
population, and never used in pregnancy.
matologic malignancies, though these are very uncommon.
I-131 therapy is usually outpatient, and recipients are instructed to follow some basic hygiene and safety precautions for varying lengths of time following therapy. The side effects of low-dose radioiodine are minimal: some patients experience minor thyroid pain that usually responds to analgesics. Rates of post-procedural hypothyroidism vary in terms of their onset, depending on the dose of radioiodine given and the underlying cause of hyperthyroidism: the majority of patients with Graves’ disease develop hypothyroidism within several months, whereas a smaller percentage of patients with toxic multinodular or toxic adenomas develop hypothyroidism (1025 percent) over a longer period of time. Once the hypothyroidism develops, it usually requires lifelong thyroid hormone replacement therapy. Higher doses of radioiodine (30-200 mCi) are often used to treat high-risk papillary or follicular thyroid cancer. There is no evidence
that
radioiodine
treatment
will decrease the risk of recurrence or improve longevity in low-risk patients. Radioiodine therapy is administered to outpatients when TSH (thyroid stimulating hormone) levels are elevated (either using recombinant human TSH or thyroid hormone withdrawal). In the past decade, there has been a remarkable reduction in the doses of radioNOVEMBER/DECEMBER 2013
9
Urology
Circumcision Update By John S. Wiener, M.D., F.A.A.P., F.A.C.S.
Circumcision has been practiced for
Changing Recommendations
more than 10,000 years in cultures around
A close look at the limited evidence for
the globe; however, the circumcision of
or against circumcision led the American
newborn boys was limited to the Jewish
Academy of Pediatrics (AAP) to issue its
culture until recent times. In the late 19th
first statement on the practice in 1975:
century, medical experts in America and
“There is no absolute medical indication
Britain began to extol the virtues of the in-
for routine circumcision of the newborn.”
fant circumcision.
Yet, only 14 years later, the AAP amended its guidelines, noting some health benefits
Dr. John Wiener is an associate professor of surgery (urology) and pediatrics at Duke University Medical Center. He is head of the section of pediatric urology and vice chief and associate resident director in the division of urologic surgery. He can be reached at (919) 684-6994 or john. wiener@duke.edu.
In 1914, Abraham Wolburst wrote in the
without recommending routine circumci-
Journal of the American Medical Associa-
sion. Circumcision was found to confer
tion that circumcision was “a great aid to
a nearly 10-fold decrease in urinary tract
could be significantly reduced with appro-
cleanliness,” and a “prophylaxis against a
infections (UTIs) in infant boys, but UTIs
priate measures.
variety of venereal diseases,” and it led to
are rare and occur in only 1 percent of un-
a “diminished tendency to masturbation,”
circumcised boys.
Circumcision, as with any surgical procedure, is not without risks. Death was a very
which supposedly led to physical and
rare but noted risk, but this has essentially been eliminated with antimicrobials (when rarely needed) and treatment for bleeding disorders (which could be tragically discovered after circumcision in hemophiliacs.) In addition to bleeding and infection, other complications include injury to the penis and urethra, as well as poor cosmetic appearance which may require later surgical revision. There remains controversy over the hypothesis that circumcision impairs penile sensation and sexual satisfaction without a clear answer. Based on these data, no medical organization in the world currently recommends newborn circumcision. North Carolina, along with at least 16 other states, denied moral decline. “It is the moral duty of ev-
Penile cancer essentially does not occur
Medicaid coverage for routine newborn cir-
ery physician to encourage circumcision
in males circumcised at birth, but this is
cumcision beginning in 2001. As a result of
in the young.”
an exceedingly rare cancer in the U.S.,
this and additional factors, the prevalence
even among uncircumcised men. In 1999,
of newborn male circumcision in the U.S.
With increasing medical support, new-
the AAP again revised its guidelines to
today has declined to 31-79 percent, de-
born circumcision grew from an uncom-
promote discussion of the risks and ben-
pending upon regional variations. Another
mon practice to 33 percent of male births
efits of circumcision with expecting/new
factor behind this decline is increased im-
in the United States by 1930. As hospital
parents but still did not recommend the
migration of individuals from areas and cul-
births became the norm, newborn male
practice routinely. They did recommend
tures where circumcision is not the norm.
circumcision became nearly universal by
procedural analgesia, as several studies
the 1970s.
confirmed that the pain of the procedure
10
The Triad Physician
In the last decade, three randomized con-
Interior Design trolled trials from sub-Saharan Africa demonstrated a statistically significant reduction in HIV sero-conversion of 53 percent, in aggregate, in circumcised young men engaging in heterosexual sex. These and other studies also noted a more modest reduction in transmission of other sexually transmitted infections, most notably, human papillomavirus.
Express Style and Define Ambience through Light Fixtures By June DeLugas
With these findings, the AAP again revised
As a medical professional, you are aware
its recommendation in 2012, stating that
of the importance of lighting in interiors.
“the preventative health benefits… outweigh
Medical offices require direct light in
risks of the procedure.” They did not recom-
exam rooms and work spaces, most
mend routine circumcision of all newborn
often overhead fluorescent fixtures.
males but did state that the data are suf-
Reception areas and waiting rooms
ficient “to justify access to this procedure
provide the opportunity to introduce
for families choosing it and to warrant third-
more attractive lighting options in the
party payment for circumcision.” This policy
form of lamps and pendant fixtures,
statement was endorsed by the American
maybe even a chandelier. When it
College of Obstetricians and Gynecologists.
comes to the home, however, lighting options are almost limitless.
June DeLugas, an interior designer in Clemmons, is known for creating awardwinning homes that reflect the special relationships she develops with each client. Her retail showroom and design firm is open Monday through Friday from 10 a.m. to 5:30 p.m. and on Saturdays by appointment. You also can visit her website and blog online at junedelugasinteriors.com.
What to Tell Parents Parents of newborn boys should be coun-
Whether building a new home or updat-
part of any design project cannot be
seled to the potential benefits of circum-
ing a current home, light fixtures are an
underestimated. The world of lighting
cision, as well as its risks. This conversa-
important aspect of interior design that
is a dynamic one with legally mandated
tion should begin long before delivery.
should not be left to the last minute.
changes occurring as we make the
The newborn penis undergoes a growth
Light fixtures can define the style of a
planet a friendlier place, making light
spurt and may quickly become too large
home and affect the overall ambience
bulbs look like corkscrews. The use
to safely remove the foreskin; hence, most
of the space. Replacing outdated light
of energy-efficient LED lighting is
practitioners limit the procedure to the first
fixtures in the home is an easy way to
becoming more popular and affordable
month of life. After that age, circumcision is
achieve a whole new look without ma-
every year.
typically performed in the operating room
jor
under general anesthesia, incurring addi-
Homeowners are al-
tional risks and significantly greater costs.
ways excited about the
construction.
new
options
For families opting to keep the foreskin
that are available
intact, proper penile hygiene should be
to them for lighting,
taught. “Physiologic phimosis” is present
whether they are
in nearly all infants but typically resolves in
replacing bathroom
most boys by age three and will likely con-
vanity
tinue to resolve spontaneously by puberty
adding a fabulous
in the remainder. Lack of resolution or oc-
dining room chan-
currence of UTIs, balanitis or ballooning
delier.
lights,
or
with urination may prompt therapy with steroid creams, which have shown high
While the lighting portion of the budget
When thinking about updating your
success rates. The ideal age to begin regu-
might need to be robust, it is well worth
lighting, go beyond the functionality of
lar retraction and cleaning is not clear, but,
the investment. When it comes to
fluorescents, and see what you can find
if possible, it is best done at an early age
“form meets function,” nothing could
to express your style and personality in
so that the boy learns this as a regular part
be truer of lighting. From ambient to
your home or office.
of bathing.
task to accent lighting, this critical NOVEMBER/DECEMBER 2013
11
Health Care Reform
Help! Support Is Available to
Guide Change in Skillset and Mindset By Bill Evans, M.P.H., M.C.H.E.S., C.H.C.
At the University of North Carolina at
change in physician practice settings.
Greensboro we have met with several senior leaders in major health systems around
Health
the state during the past few months, and
grounding in behavioral theory with
education
specialists
offer
they all say the same thing, “Help! We can’t
a social-ecological approach to one’s
solve today’s problems with yesterday’s
health. They recognize the effects of an
tools, with a new reimbursement structure
individual’s relationships with family and
through the Affordable Care Act.”
friends; affiliations with institutions, such as the workplace and places of worship;
Bill Evans is an assistant professor in the Department of Public Health Education at the University of North Carolina-Greensboro. For practices interested in health coach training, he can be reached at wmevans@uncg.edu or (336) 334-3796.
When I speak to physicians and nurses in
and their broader community, such as
Patient Centered Medical Homes, they are
organizations; and the laws or policies
physician assistants, nurse practitioners,
striving to meet the new demands of “pay
that affect their lives, such as whether
nurse navigators, nurses, certified medical
for performance” and are working to retool
sidewalks are in their neighborhoods.
assistants, social workers, etc.) on new
their approach to practice. But there is a
skills that will help patients reach optimal
common conclusion they have all come
For once, the incentives are aligned to
to: “We don’t yet have the skills to change
include such a skillset on the medical team.
behavior.” Therein lies the multimillion-
But at UNCG, we recognize that the supply
It starts with the co-creation of an alliance
dollar misstatement.
of health education specialists in this new
with the patient and being grounded in
role is low, so we are working diligently to
the application of behavioral theory. If the
outcomes.
someone’s
train our undergraduates, master in public
relationship with and accountability to the
behavior. Think about when someone has
health students and even doctoral students
patient isn’t there, practices will have little
told you that you have to do something.
for this new role in medical settings.
success.
You
can’t
easily
change
Your first reaction usually is resistance. In the meantime, we also recognize that
Peeling back the layers of the onion may
That is the issue we’re facing in moving
there are already clinical personnel in
bring some tears as practices work to
from a prescriptive model of medicine to
medical settings that simply need training
adjust to new patient care skills, but in the
a participatory approach, where centrally
and retraining to become better prepared
long run, there are rewards for everyone.
the patient has to find the means, motiva-
to help patients on their journey to
tion or inspiration to better manage their diabetes, congestive heart failure, lower their cholesterol or adhere to their medication schedule to maintain proper blood pressure ratios. In the Department of Public Health Education at UNCG, we recognized this a couple of years ago and started to facilitate trainings to begin to ramp up health
improved outcomes. So,
education specialists to accept new roles
we are also working to meet
in physician practice settings. We have
these demands around the
created training programs specifically
state by training existing
geared to emphasize patient behavioral
medical staff (physicians,
12
The Triad Physician
News Welcome to the Area
Physicians
Perry Scott Agbuya Jr., DO Pediatrics 332 W. Miller St. Salisbury
Joshua Heath Friedman, DO
Anesthesiology Wake Forest Univ Baptist Medical Center Winston-Salem
Edward Michael Johnson Jr., DO
Addiction Psychiatry; Addictionology or Addiction Medicine Grass Meadow Hospital Greensboro
Hannah Ross Kim, DO Family Medicine Lebauer Healthcare Greensboro
William Donald Andersen, MD
Surgery (general); Anesthesiology Wake Forest Univ Baptist Medical Center Winston-Salem
Sanam Baghshomali, MD Neurology Wake Forest Baptist Medical Center Winston-Salem
Lee Michael Bourgeois, MD
Psychiatry Wake Forest Univ Baptist Medical Center Winston-Salem
Thavij David Burapavong, MD Plastic Surgery High Point
Mateo Calderon-Arnulphi, MD Neurology Forsyth Comprehensive Neurology Winston Salem
Vidhya Chandramohan, MD
Endocrinology, Diabetes and Metabolism; Infectious Disease; Internal Medicine; Nephrology; Oncology; Pain Management; Pulmonary Disease; Rheumatology Wake Forest Univ Baptist Medical Center Winston-Salem
McNeil Lawrence Cronin, MD Anesthesiology - Critical Care Medicine, Pain Medicine 808 Cypress Street Greensboro
Nicholas Philip Doiron, MD
Anesthesiology Wake Forest School on Medicine Winston-Salem
Nkechinyere Emejuaiwe, MD Rheumatology, Internal Medicine Wake Forest Baptist Health Winston Salem
Justin Levi Farmer, MD
Anesthesiology; Critical Care Medicine; Pain Medicine Wake Forest Univ Baptist Medical Center Winston-Salem
Ashley Miriam Ferguson, MD
Pediatrics 322 W Miller Street Salisbury
Nitin Garg, MD
Tracy Nicole McLean, MD
Emily Ruth White, MD
Gary Glenn Nichols, PA
Ankit Garg, MD
Elizabeth Kaufman McNamara, MD
Matthew Charles Whitlock, MD
Laura Montgomery Orsban, PA
John Charles Gerancher III, MD
James John Morris, MD
Daniel Robert Green, MD
Ifeyinwa Nneka Nwankwor, MD
Abdominal Surgery; Vascular and Interventional Radiology Wake Forest University Winston-Salem Internal Medicine Cone Health Internal Medicine Greensboro Anesthesiology Pain Management PO Box 26851 Winston-Salem
Hospitalist; Internal Medicine; Cardiology; Cardiovascular Disease Wake Forest Univ Baptist Medical Center Winston-Salem
Patrick Hugh Harmon, MD
Psychiatry; Child Psychiatry Wake Forest Univ Baptist Medical Center Winston-Salem
Muhammad Khyzar Hayat Syed, MD Hospitalist; Internal Medicine Wake Forest Medical Center Winston-Salem
Akhil Sadanand Hegde, MD
Internal Medicine Cone Health Internal Medicine Greensboro
Dermatology 1143 Kenwood Street Winston-Salem
Thoracic Cardiovascular Surgery James J. Morris, MD High Point
Neonatal-Perinatal Medicine; Pediatrics WFU Neonatology Division Office Winston-Salem
Candace Yvonne Parker-Autry, MD
Obstetrics and Gynecology; Urological Surgery; Urology Wake Forest University Winston-Salem
Raina Mitelia Paul, MD
Pediatric - Emergency Medicine Wake Forest Baptist Medical Center Winston-Salem
General Practice; General Preventive Medicine; Internal Medicine Wake Forest Baptist Health Winston-Salem
Stephanie Renee Pierce, MD
Jackson Henley, MD
Anatomic Pathology and Clinical Pathology 1573 York Place Burlington
Emergency Medicine Wake Forest Univ Baptist Medical Center Winston-Salem
Scott David Humble, MD
Obstetrics and Gynecology Wake Forest Baptist Health Winston-Salem
James Bobbitt Powell, MD
Waqas Tariq Qureshi, MD
Anatomic and Clinical Pathology; Cytopathology 117 Poteat Lane Salisbury
Cardiology; Cardiovascular Disease, Internal Medicine Wake Forest Baptist Medical Center Winston-Salem
Hanumantha Rao Jogu, MD
Lindsey Anne Sachs, MD
Hospitalist Department of Internal Medicine,Section on Hospital Medicine Winston-Salem
Meghann Lee Kaiser, MD
Abdominal Surgery; Critical Care Surgery; General Surgery Wake Forest Univ Baptist Medical Center Winston-Salem
Jehanzeb Khan, MD
Sleep Medicine; Internal Medicine Wake Forest Univ Baptist Medical Center Winston-Salem
John Albert Lucas IV, MD
Family Practice/Sports Medicine Wake Forest Univ Baptist Medical Center Winston-Salem
Chaudry Nasir Majeed, MD Hospitalist 5362 Villas Drive Winston-Salem
Emily Myers Mann, MD
Family Medicine Southside United Health Center Winston-Salem
Kirk Stafford Sanders, MD Internal Medicine Pioneer Family Medical of Danbury Danbury
Katherine Rachel Schafer, MD
Infectious Diseases, Internal Medicine Winston-Salem
Louie Keith Scott, MD
Critical Care-Internal Medicine; Neurological Surgery Wake Forest University Winston-Salem
Ashley Lescanec Talbott, MD
Anesthesiology 1835 Brantley Street Winston-Salem
Andrew Holding Thornton, MD
Family Medicine Wake Forest Baptist Health Winston-Salem
Family Practice Wake Forest Univ Baptist Medical Center Winston-Salem
Christopher McAdams, MD
Erica Elise Valdez, MD
Diagnostic Radiology; General Practice; Vascular and Interventional Radiology Wake Forest Univ Baptist Medical Center Winston-Salem
Psychiatry Novant Health Psychiatric Medicine Winston-Salem
Pediatrics 969 Centenary Church Rd. Clemmons
Internal Medicine Greenway Health Care North Wilkesboro
Cardiology WFU Winston-Salem
Orthopedic Surgery, Trauma Winston Bone & Joint Winston-Salem
Roger Dale Page, PA
Physician Assistants
Lucy Pinson Barden, PA
Internal Medicine Cornerstone Internal Medicine at Jamestown Jamestown
Charles Jeffrey Beach, PA Urology Urology Partners Winston-Salem
Emergency Medicine; Anesthesiology 6209 Rascoe Road Burlington
David Allyn Scudder, PA
Emergency Medicine Forsyth Emergency Services PA Winston-Salem
Kelly Ray Taylor, PA Emergency Medicine FESPA Winston-Salem
Barbara Ann Mosley Bennett, PA
James Henry Tomlinson II, PA
Psychiatry Forsyth Medical Center Winston-Salem
Family Medicine Pleasant Garden Family Practice Pleasant Garden
John Anthony Carter, PA
John Jay Triplett Jr., PA
Nephrology, Internal Medicine; Family Medicine; General Surgery; Neurological Surgery, Critical Care; Neurological Surgery, Pediatric; Orthopedic, Hand Surgery; Plastic Surgery/Hand Surgery; Student Health; Vascular Surgery 5482 Heritage Oaks Lane Winston-Salem
Obstetrics and Gynecology Guilford County Health Dept Greensboro
Danielle Renee Caruso, PA
Occupational Medicine 4550 Greenfield Way Dr Winston-Salem
Family Practice; Orthopedic Surgery of the Spine; Pain Medicine; Urgent Care Carolina Pain Institute Winston-Salem
Paul Edward Craft, PA
Internal Medicine Cornerstone Internal Medicine at Jamestown Jamestown
Gale Lynn Harkness, PA
Family Practice; Family Medicine Community Care Center Winston-Salem
Dooley Lafayette Underwood III, PA
Orthopedic Surgery Greensboro Orthopaedics PA Greensboro
Wayne Winfred
Laura Marie Walls, PA
Pediatric Gastroenterology Brenner Children’s Hospital Winston-Salem
Cynthia Paige Ward, PA Emergency Medicine 681 Lichfield Road Winston-Salem
Karen Hill Wells, PA
Pediatrics 1083 Meadow Lark Drive Winston-Salem
Robert Henry Holliday Jr., PA Thoracic Cardiovascular Surgery WFUBMC Winston-Salem
George Ballard Ingle Jr., PA Emergency Medicine Forsyth Emergency Services, PA Winston-Salem
Phillip Antonio Kelley, PA
Emergency Medicine; Family Medicine; Urgent Care; Urology PrimeCare Highland Oaks Winston-Salem
Michael Kreitz Jr., PA
Family Medicine High Point Family Practice High Point
Scott David Long, PA
Family Medicine; Geriatric Medicine; Internal Medicine; Occupational Medicine; Pediatrics; Emergency Medicine; Urgent Care NextCare Urgent Care Burlington
Charles Andrew Martin, PA Internal Medicine; Occupational Medicine Dept of Veterans Affairs Winston-Salem
Events Road to Recovery Volunteer Driver Training Dec. 2, 10-11:30 a.m.
Every day thousands of cancer patients need a ride to treatment, but some may not have a way to get there. High Point Regional Health’s Road to Recovery program provides transportation to and from treatment for people who have cancer who do not have a ride or are unable to drive themselves. Volunteer drivers donate their time and the use of their cars so that patients can receive the lifesaving treatments they need. Location: Hayworth Cancer Center Resource Center, 302 Westwood Avenue, High Point 27262. Training also can be completed online. Contact: Wendy Martin, (336) 802-2704 or wmartin@ hprhs.com or visit www. highpointregional.com.
NOVEMBER/DECEMBER 2013
13