The Triangle Physician April 2012

april

2 012

Cancer Centers of North Carolina Meet the Women who Care for Women with Cancer

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

Also in This Issue

Electroconvulsive Therapy Inflation-Proof Investments

Protecta XT TM

CRT-D and DR ICDs with SmartShock Technology TM

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

Brief Statement: Protecta™ CRT-D/DR ICDs Indications Protecta/Protecta XT implantable cardioverter defibrillators (ICDs) and CRT-D ICDs are indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias.

Protecta/Protecta XT (CRT-D) ICDs are also indicated the reduction of the symptoms of moderate to severe heart failure (NYHA Functional Class III or IV) in those patients who remain symptomatic despite stable, optimal medical therapy and have a left ventricular ejection fraction ≤ 35% and a prolonged QRS duration. Atrial rhythm management features such as Atrial Rate Stabilization (ARS), Atrial Preference Pacing (APP), and Post Mode Switch Overdrive Pacing (PMOP) are indicated for the suppression of atrial tachyarrhythmias in ICD-indicated patients with atrial septal lead placement and an ICD indication.

Additional Protecta/Protecta XT System Notes: The use of the device has not been demonstrated to decrease the morbidity related to atrial tachyarrhythmias.

• The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 17%, and in terminating device classified atrial fibrillation (AF) was found to be 16.8%, in the VT/AT patient population studied.

• The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 11.7%, and in terminating device classified atrial fibrillation (AF) was found to 18.2% in the AF-only patient population studied.

Additional Protecta XT DR System Notes: The ICD features of the device function the same as other approved Medtronic marketreleased ICDs. • Due to the addition of the OptiVol® diagnostic feature, the device indications are limited to the NYHA Functional Class II/III heart failure patients who are indicated for an ICD. • The clinical value of the OptiVol fluid monitoring diagnostic feature has not been assessed in those patients who do not have fluid retention related symptoms due to heart failure.

Contraindications Protecta/Protecta XT CRT-ICDs are contraindicated for patients experiencing tachyarrhythmias with transient or reversible causes including, but not limited to, the following: acute myocardial infarction, drug intoxication, drowning, electric shock, electrolyte imbalance, hypoxia, or sepsis. The devices are also contraindicated for patients who have a unipolar pacemaker implanted, patients with incessant VT or VF, or patients whose primary disorder is chronic atrial tachyarrhythmia with no concomitant VT or VF. Warnings and Precautions ICDs: Changes in a patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage. Do not place transthoracic defibrillation paddles directly over the device. Additionally, for CRT-ICDs, certain programming and device operations may not provide cardiac resynchronization.

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

Potential Complications Potential complications include, but are not limited to, acceleration of ventricular tachycardia, air embolism, bleeding, body rejection phenomena which includes local tissue reaction, cardiac dissection, cardiac perforation, cardiac tamponade, chronic nerve damage, constrictive pericarditis, death, device migration, endocarditis, erosion, excessive fibrotic tissue growth, extrusion, fibrillation or other arrhythmias, fluid accumulation, formation of hematomas/seromas or cysts, heart block, heart wall or vein wall rupture, hemothorax, infection, keloid formation, lead abrasion and discontinuity, lead migration/dislodgement, mortality due to inability to deliver therapy, muscle and/or nerve stimulation, myocardial damage, myocardial irritability, myopotential sensing, pericardial effusion, pericardial rub, pneumothorax, poor connection of the lead to the device, which may lead to oversensing, undersensing, or a loss of therapy, threshold elevation, thrombosis, thrombotic embolism, tissue necrosis, valve damage (particularly in fragile hearts), venous occlusion, venous perforation, lead insulation failure or conductor or electrode fracture.

See the device manual for detailed information regarding the implant procedure, indications, contraindications, warnings, precautions, and potential complications/ adverse events. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com.

Caution: Federal law (USA) restricts these devices to sale by or on the order of a physician.

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

UC201204700 EN © Medtronic, Inc. 2012. Minneapolis, MN. All Rights Reserved. Printed in USA. 02/2012

NOW with DF4 Connector System

JOHNSTON HE ALTH

Contents

COVER STORY

6

Cancer Centers of North Carolina

Meet the Women Who Care for Women with Cancer

April 2012

Vol. 3, Issue 4

FEATURES

13

Psychiatry

Electroconvulsive Therapy Advances in Treatment of Depression

16

DEPARTMENTS 13 Duke Research News

Your Financial Rx

The Keys to Inflation-Proofing Your Portfolio

Contributed by the Duke University

Financial planner Paul Pittman offers

School of Medicine, a Q&A with Dr. Sarah

suggestions for sound investments to

Hollingsworth Lisanby explores this fast-

protect oneself as the threat of runaway

acting therapy.

inflation looms.

Discovery May Lessen Chemo Side Effects

14 Duke Research News Genetic Variation Found in Eat Asians Found to Explain Resistance to Cancer Drugs

18 Duke Research News Deafening Affects Vocal Nerve Cells Within Hours

21 News

- Women’s Imaging Center has Walk-In Service, Extended Hours - Quest Names Top Performing Hospital

22 UNC Feature COVER PHOTO: CCNC’s female physicians are: (from left) Margaret Deutsch, M.D. Maha A. Elkordy, M.D. Jennifer Rubatt, M.D.

24 UNC Research News

Elizabeth E. Campbell, M.D. Monica B. Jones, M.D. M.S., F.A.C.O.G., F.A.C.S. Photo by Jacoby Photography.

Luella Love: New Lungs for a New Life

- Benefits of Varenicline May Balance Risks - Protein Complex Affects Cells’ Ability to Move and Respond

25 Duke Research News

Drug Helps Purge Hidden HIV Virus

26 UNC Feature Patient Perspective: From Caring for Others to Caring for Herself

28 News

2

The Triangle Physician

- Welcome to the Area - $7 Million Invested in ED Upgrades

The Magazine for Healthcare Professionals.

Did You Know?

We mail to over 9,000 MDs, PAs, administrators, and hospital staff in 18 counties in the greater Triangle area.

Not to each practice but to each MD or PA personally.

We are a totally LOCAL magazine designed primarily for MD referrals.

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

Counties: Alamance, Chatham, Durham, Franklin, Granville, Harnett, Johnston, Lee, Moore, Nash, Orange, Person, Sampson, Vance, Wake, Warren, Wayne, and Wilson Counties Person

Northampton

Warren

Granville

Swain

Cherokee

Orange

Guilford

Davie

Alexander Iredell

Mcdowell

Forsyth

Burke

Alamance Davidson

Henderson

nia

ylva

s Tran

Stanly

Gaston

Montgomery

Bertie Nash

Richmond Anson

The Triad Physician Magazine

Greene

Dare

Hyde

Craven Pamlico

Cumberland

Jones Sampson Duplin

Scotland

The Triangle Physician Magazine

Beaufort

Wayne Lenoir

Hoke

Cities: Raleigh Durham Chapel Hill Smithfield Roxboro Henderson Louisburg Clinton Pine Hurst Siler City

Martin

Pitt

Johnston Harnett

Moore

n

Washington Tyrrell

Mecklenburg

Union

Edgecombe

de

Wilson

Lee Cabarrus

Cleveland

Durham

Chatham

Lincoln

Rutherford Polk

Halifax

Franklin

Wake

Randolph

Rowan

Catawba

Haywood

Jackson Macon

Clay

Caldwell

Yancey

Buncombe

Graham

Yadkin

m

n wa

ell ch Mit

Madison

Wilkes

o Ch

Watauga Avery

Ca

Gates Hertford

k an ot s an qu uim rq Pe

Vance

ck tu

Caswell

ri ur

Rockingham

Stokes

s Pa

Surry

C

Alleghany Ashe

Robeson

Onslow

Carteret

Bladen Pender

The Eastern Physician Magazine FUTURE The Western Physician Magazine The Eastern and The Triangle Physician Magazines

New Hanover

Columbus

Brunswick

The Triad and The Triangle Physician Magazines

Local physician specialists and other professionals, affiliated with local businesses and organizations, contribute all editorials or columns about their respective specialty or profession.

• We list all new MDs and PAs each month who are licensed by the NC Medical Board • We list any New MD or PA who comes to the area • We list any MD or PA who is new to your practice • We List any new practice • We List any practice that has relocated or a new office

• We list any new or updated website • We list any events for your practice or charities • We list any CMEs • We list local hospital news • Local charity ads or article are FREE • Images for all of the above are appreciated

And we do this all for FREE We also profile MDs, practices or companies that want to get “in front” of MDs • 1 page article includes 1 image and text • 2 page article includes 2 images and text • 4 page article includes 4 images and text • 8 page article includes 8 images and text

We also provide PDFs and digital editions of the whole magazine or just your article.

Long-term advertising is always the best way to increase reader awareness of your practice and unique patient care brand.

If you would like to promote your company with The Triangle Physician, please contact us

Paget@TrianglePhysician.com or info@TrianglePhysician.com

april 2012

3

From the Editor

From the Editor

Amazing Women Understanding a patient’s struggles is key to compassionate care and paramount at Cancer Centers of North Carolina, our cover story this month.

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

Clearly, this is a large practice with some of the region’s brightest oncology specialists.

Here, the great array of specialist minds work in concert to provide the best possible care based on the patient’s condition, lifestyle and desires. Thanks to medical advances, the focus is squarely on quality of an extended life, which the practice refers to as “survivorship.”

While the practice treats men and women with cancer, the focus of this story is on the amazing women within CCNC. They comprise more than a quarter of the medical staff.

They include three medical oncologists and two gynecologic oncologists, not to mention

Editor Heidi Ketler, APR

heidi@trianglephysician.com

Contributing Editors Sarah Hollingsworth Lisanby, M.D. Paul J. Pittman, C.F.P. John D. Long, M.D. Photography Mark Jacoby

mark@jacobyphoto.com

the female nurse practitioners and physician assistants.

Creative Director Joseph Dally

The practice appreciates that women confront cancer, like most challenges, in ways that

Advertising Sales Carolyn Walters carolyn@trianglephysician.com

are unique to men. Studies indicate women tend to do more research about their disease and ask more detailed questions. Their concerns more often focus on family care, and

jdally@newdallydesign.com

News and Columns Please send to info@trianglephysician.com

there are unique body-image issues.

“Breast navigators” help patients manage what can be an overwhelming wealth of information. Hereditary screening and counseling are available as part of the care

The Triangle Physician is published by: New Dally Design 9611 Ravenscroft Ln NW, Concord, NC 28027

Cancer Society program for women undergoing cancer treatment

Subscription Rates: $48.00 per year $6.95 per issue

Also in this issue of The Triangle Physician, geriatric psychiatrist Sarah Hollingsworth

Advertising rates on request Bulk rate postage paid Greensboro, NC 27401

continuum, and the practice hosts Look Good, Feel Better, the quarterly American

Lisanby answers questions about electroconvulsive therapy. Financial planner Paul Pittman returns with suggestions for proactive, inflation-proof investing. A number of interesting advances also are featured in the news.

Finally, you are invited to inform, delight, even amaze readers of this magazine with your practice news and medical perspective. Also consider the advertising reach to more than 9,000 physicians, physician assistants, administrators and hospital staff in 18 counties surrounding the greater Triangle.

With great appreciation,

Heidi Ketler Editor

4

The Triangle Physician

Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors.

Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician.

The Triangle 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 Triangle Physician.

Cover

Cancer Centers of North Carolina Meet the Women Who Care for Women with Cancer

By Paul V. Brown

At Cancer Centers of North Carolina,

nurses, a clinical trial program, progressive

Experts in Medical Oncology

the physicians recognize the impact of a

laboratory

radiation

CCNC has several of the Triangle’s most

cancer diagnosis. While a diagnosis can

services. Collectively, CCNC’s oncologists

experienced and highly regarded board-

be shocking, progress in understanding

have more than 300 years of experience

certified medical oncologists. The three

cancer on a cellular, genetic and molecular

and treat most forms of cancer.

female medical oncologists are Elizabeth

and

recognized

level and the development of more targeted

E. Campbell, M.D., Margaret A. Deutsch,

therapies have shifted our perspective.

The physicians and staff at CCNC pride

We no longer view cancer as a “death

themselves on their commitment to the

sentence,” but in many cases, more as a

comprehensive care of the cancer patient

Medical oncologists consider the current

chronic disease that can be managed for

as a whole, not just the cancer as a disease.

standard options and state-of-the-art clini-

long periods of time, allowing longevity

All personnel are mindful of the entire

cal trials, while working with the patients’

and quality of life. Today, there is ever more

treatment process. More than a quarter of

values and preferences for care. They

reason to be optimistic when faced with a

CCNC’s 19 doctors are female.

plan and administer treatment, evaluate

cancer diagnosis.

M.D., and Maha A. Elkordy, M.D., M.P.H.

and monitor programs and follow patients Multidisciplinary services are offered

through their illness and recovery. By hav-

An independent cancer treatment center,

throughout six CCNC locations – in Raleigh,

ing regular consultations with each other,

Cancer Centers of North Carolina (CCNC)

North Raleigh, Cary, Dunn and Clayton – so

the oncologists can follow patients to maxi-

addresses most forms of the disease in

a woman (or man, for that matter) doesn’t

mize benefit and minimize risk. They work cooperatively to evaluate family history,

With five female physicians, Cancer Centers of North Carolina offers compassionate, multidisciplinary care to women (and men) with a cancer diagnosis

lifestyle and health care history in order to identify patients at high risk for other forms of cancer.

Dr. Elizabeth Campbell earned her medical

both women and men, with a full comple-

have to waste precious energy driving

degree from Duke University, where she

ment of cancer-fighting tools. The practice

across town or across the region for a

graduated with honors. She completed her

provides a full spectrum of clinical ser-

particular service. CCNC physicians work

residency and a fellowship in hematology

vices, as well as dynamic support services,

with Rex Hospital, Duke Raleigh Hospital,

and oncology at the University of North

from yoga to nutrition and social work to

WakeMed Raleigh Campus, WakeMed Cary

Carolina at Chapel Hill, where she was

support groups. Its focus is on beating can-

Hospital, Johnston Health and Harnett

selected as chief resident.

cer – “survivorship,” as the staff puts it.

Health Medical Center.

More than 30 years old, Cancer Centers

Each CCNC center is designed to be con-

oncology and internal medicine. Here,

of North Carolina has a long history

venient for patients and their families. The

her focus has been on breast cancer and

and deep roots in the Triangle. The

ample, onsite parking means there are no

other malignancies affecting women and

practice was founded in 1979 as Raleigh

hassles with long walks and parking decks.

men and more recently on cancer risk

Hematology Oncology. Today, it is a full-

And a peaceful atmosphere and tasteful in-

assessment and management, including

service oncology center that, in addition

teriors make their offices places where it’s

evaluation and management of hereditary

to its specialty-trained physicians, includes

easier to relax and reflect.

cancer syndromes.

Dr. Campbell is board certified in medical

physician extenders, oncology certified

6

The Triangle Physician

Dr. Campbell has served on a number

She echoes one of CCNC’s themes, “We’re

community in some fashion to help those

of

boards,

here for your life,” and adds, “We are here,

who are much less fortunate than we are

including those of Susan G. Komen for the

as well, for the life of their families and their

in terms of their health,” says Dr. Deutsch.

Cure, Wake Health Services and Triangle

children. So many of our women patients

Pastoral Counseling, as well as the editorial

are as concerned about the implications

Dr. Deutsch attended the University of Wis-

board of the local magazine Touched

of their cancer for their children: ‘Will my

consin-Madison and obtained her medical

by Cancer. She also is a member of the

kids now get cancer because I’ve had it?’

degree from the Medical College of Wis-

American Society of Clinical Oncology.

We’re here to help them know just what

consin. She completed her residency in

health-related

community

those risks really are and what can be done

internal medicine at Michael Reese Hospi-

Dr. Campbell serves on the US Oncology

to modulate or reduce them. That’s what

tal and Medical Center in Chicago and her

Network GREAT (Genetics Risk Evaluation

I would want for my own life and family

fellowship in hematology and oncology at

and

– somebody looking out for me and my

Duke University. She is board certified in

family 20 years or more into the future.

internal medicine and oncology.

“Our team approach to diagnosis, our

Dr. Deutsch chaired the Cancer Care

extensive treatment options and our

Committee and the Medical Executive

She also was awarded a National Public

vast array of support services provide

Committee of WakeMed Health & Hospitals

Radio Silver Medal of Excellence for a

a rich milieu of options for optimal and

in Raleigh, where she also has served as

radio project on women and AIDS and

individualized therapy for our patients.

medical staff president. Her certifications

won special recognition for a WUNC-

All of these make CCNC the type of really

include the National Board of Medical

FM program called “Beauticians and

special place it is,” Dr. Campbell says.

Examiners and the American Board of

Treatment

Program)

Executive

Committee and is a member of the GREAT Education Committee, with Dr. Elkordy and Dr. Rubatt.

Internal Medicine, and she is a member of

Mammography Outreach.”

Another CCNC physician who donates her

the American Society of Clinical Oncology.

“The day-to-day management of the person

time to charitable activities in the com-

in front of us is paramount; but of course,

munity is Dr. Margaret Deutsch, who this

Dr. Maha Elkordy has served patients

when the treatment is completed, nobody

year agreed to participate in the Woman of

and the community at CCNC for 15 years.

wants to have a relapse. Here at CCNC,

the Year campaign, a 10-week fund-raising

Graduating magna cum laude from North

we are committed to risk management

event for the Leukemia and Lymphoma So-

Carolina State University, Dr. Elkordy went

and hereditary screening and counseling

ciety. “Our unique position in the commu-

on to get her master’s in public health from

that help patients avoid recurrences

nity allows us to witness and understand

the University of North Carolina School of

and future cancers, as well as help them

the struggle of our patients with cancer to

Public Health in Chapel Hill. Afterward,

offer unprecedented protection to their

survive one day at a time as they grapple

she obtained her medical degree at the

families,” says Dr. Campbell.

with their illness, treatment and recovery.

UNC School of Medicine. She continued

It is imperative that we give back to the

her Atlantic Coast Conference allegiance

At CCNC, medical oncologists, gynecologic oncologists, mid-level providers and breast navigators frequently participate in multidisciplinary conferences to discuss patients and their treatments.

april 2012

7

sive medical credentials and patient-centered outlook. “I felt that they were a compassionate center. All of the physicians have very strong academic ties, and they are very well read in the field. But it’s not just our physicians. Everyone, from the medical assistants to the personnel on our front desk, is very compassionate and understands the struggles that cancer patients go through.”

Dr. Rubatt earned her medical degree from the Medical College of Wisconsin and completed her residency in obstetrics and gynecology at the Medical College of Virginia in Richmond, Va. Her fellowship in gynecologic oncology was at Magee-Women’s Hospital of University of Pittsburgh Medical Center in Pittsburgh, Pa. Dr. Monica Jones’ first career choice was to Dr. Elizabeth Campbell visits with a patient who is receiving chemotherapy at CCNC Macon Pond.

be a cardiothoracic surgeon. She decided on gynecologic oncology during her resi-

(go Wolfpack, go Tarheels!), attending

psychosocial, speaks to the importance of

dency, after seeing a woman wheeled into

Duke University, where she completed her

rallying all available resources to assure

the emergency room “with heavy bleeding

fellowship in hematology and oncology.

the best cancer-related outcomes.”

from a cervical cancer.” The patient was

She is board certified in internal medicine and medical oncology.

unaware of her condition.

The medical oncologist is often the central care manager for the oncology patient,

“It moved me to wonder why some women

Before CCNC, Dr. Elkordy worked in

and as such she frequently coordinates

wait for this to be so far along before they

Duke’s Bone Marrow Transplant Program

care with other essential disciplines, such

get help,” Dr. Jones says. “The other thing

and served on the university’s department

as radiation oncology and gynecologic

I wanted to understand was why these

of medicine staff. She is a member of the

oncology. Being able to do so under a

cancers happen and how to treat them.”

American Societies of Hematology and

single umbrella of coordinated care is

Clinical Oncology.

something CCNC delivers.

Dr. Elkordy has been named one of America’s Most Compassionate Doctors and was

Compassionate Multidisciplinary Care

recently honored for the third time as Pa-

Monica B. Jones, M.D., M.S., F.A.C.O.G.,

obstetrics and gynecology. Her clinical

tient’s Choice Physician for providing out-

F.A.C.S.;

M.D.,

interests include aggressive debulking

standing care to her patients.

are gynecologic oncologists at CCNC.

surgery for ovarian cancer. Since coming

Gynecologic oncologists treat women

to Raleigh, Dr. Jones has established a

She calls cancer a multidisciplinary disease

diagnosed with cancer of the female

robotic gynecologic oncology surgery

that is best treated using a multidisciplinary

reproductive tract. The more well-known

program and performed more than 300

approach. “For women, in particular, we

disorders are cervical, ovarian and uterine

robotic-assisted procedures.

want to bring layers of service,” she says.

cancers, but other forms treated by

“Delivering state-of-the-science oncologic

gynecologic oncologists are vulvar and

“Shortly after my arrival at CCNC, I devel-

care is at the core of what we do at Cancer

endometrial cancers, trophoblastic disease

oped a gynecologic oncology multidisci-

Centers of North Carolina. Doing so,

and complex pelvic surgery.

plinary conference attended by medical,

A graduate of the University of Cincinnati Medical School and fellowship trained at

and

Jennifer

Rubatt,

the Mayo Clinic, Dr. Jones is board certified in gynecologic oncology and general

through a multi-pronged model, which

radiation and gynecologic oncologists. A

touches upon patient genetic factors, tumor

Dr. Jennifer Rubatt says she joined CCNC in

pathologist and mid-level providers also

biology, patient health, both physical and

2011, because she was drawn to its impres-

participate in this conference, enriching

8

The Triangle Physician

our review of all of the patients’ clinical ma-

“CCNC has the latest in biologic and

cologists for evaluation as a possible candi-

terial and enhancing the development of a

molecular treatments, and partial as

date for high dose rate brachytherapy, also

comprehensive treatment plan for all gyne-

well as whole breast radiotherapy, high-

referred to as accelerated partial breast

cologic oncology patients,” says Dr. Jones.

dose conformal radiation options for the

irradiation. Surgeons will insert a multi-

gynecologic patients and some of the best

channel breast catheter into the lumpec-

Both she and Dr. Rubatt have a special clini-

radiation therapists in the business,” says

tomy cavity through a small incision. This

cal interest in fertility-sparing approaches to

Dr. Campbell. “We are experts in molecular

specialized procedure allows the radiation

gynecologic cancers and routinely partner

and hormonal managements of cancer,

oncologist to insert into the biopsy cavity

with reproductive endocrine specialists to

and while radiation is currently limited

a radiation dose that conforms to the size

coordinate the care of women faced with

to two locations, the practice has that

and shape of the area to be treated.

infertility and a gynecologic malignancy.

high degree of medical and gynecologic

“Surgery alone is insufficient for most gyne-

expertise at each of its six practice sites of

Brachytherapy in this setting involves just

service.”

two treatments per day over five days, compared to the usual six-week course

cologic cancers. We know that multimodal therapy, including surgery, chemotherapy

The practice’s computerized tomography

of breast cancer radiation treatment.

and radiation, helps patients live longer,”

(CT) scanner finds the center of a tumor so

This partial breast treatment and shorter

explains Dr. Jones.

the team can begin to formulate an optimal

timeframe minimizes radiation exposure

treatment plan. The treatment planning sys-

to healthy tissue and offers greater

CCNC gynecologic oncologists collaborate

tem called Pinnacle determines the ideal

convenience than traditional radiation

and work closely with the practice’s three

way to wrap the radiation dose around the

treatment for breast cancer. The company

radiation oncology physicians to offer pa-

tumor. The dose is delivered on a Varian du-

that developed the SAVI® accelerated

tients with cervical and endometrial can-

al-energy linear accelerator, using the most

partial breast irradiation technology has

cers high dose rate (HDR) brachytherapy.

precise form of therapy, called intensity-

recognized the Cancer Centers of North

This is a highly specialized procedure to

modulated radiation therapy, or IMRT.

Carolina as a “Center of Excellence.”

the tumor while limiting exposure to the

When appropriate, breast cancer patients

At any given time, CCNC is participating

surrounding tissues. Another advanced

are referred to the practice’s radiation on-

in approximately 25 clinical trials. That

®

deliver a high dose of radiation directly to

procedure available to patients with some ovarian cancers is intraperitoneal chemo-

Dr. Margaret Deutsch reviews information with a CCNC patient.

therapy. It, too, means fewer drugs and less radiation exposure to healthy tissue.

The two gynecologic oncology physicians also stress the necessity of working closely with their medical oncology colleagues.

Some cancers are part of hereditary cancer syndromes, so a patient who contracts breast cancer, for instance, may be at risk for a gynecologic malignancy.

State-of-the-Science Treatments and Technology When radiation is indicated, CCNC’s radiation oncologists, medical physicists and dosimetrists are called in. They use advanced computerized treatment systems and state-of-the-art technology to deliver internal and external radiation to

cancerous

cells.

Treatments

are

customized to each patient and delivered with pinpoint accuracy.

april 2012

9

CCNC delivers coordinated care. Here, gynecologic oncologist Dr. Jennifer Rubatt (left) meets with radiation oncologist Dr. John F. Reilly Jr. and medical oncologist Dr. Maha A. Elkordy to discuss a patient and her treatment.

range of trials provides oncologists with

hours for referral patients and referral

specific disease, with 9.7 percent of

additional treatment tools. It gives patients

surgeries are built into the calendars of

women calling it their top fear – a gaping

access to the most cutting-edge treatments.

cancer center’s physicians. Emergencies

discrepancy. Women fear breast cancer

For a patient who has exhausted treatments

are standard in medicine, but CCNC hits

so much because it can strike women

for her form of cancer, a new clinical trial

the 24-48 hour and one- to two-week targets

of all ages and cost many families their

may be another option.

98 to 99 percent of the time, Ms. Keyes says.

grandmothers, mothers, daughters, sisters

Beyond collaborating with each other,

“If you just found out that you have cancer,

CCNC oncologists work closely with

you don’t want to wait,” she says. Neither

Women have unique needs and even

referring physicians. Dr. Rubatt notes that

do they want to go through the experience

ask different kinds of questions after a

CCNC doctors write letters to referring

and treatment by themselves. The staff at

cancer diagnosis. Usually the manager of

physicians

patient’s

CCNC encourages patients to join support

the household, they tend to worry about

diagnosis and treatment plan. That’s

groups and has formed a number of

who will care for the family during their

critical, too, since a chemotherapy drug

such groups, which provide information,

treatment and recovery. Cancer raises

may interfere with other medications for

guidance and an understanding of living

body-image issues, such as hair loss and

such conditions as diabetes or her high

through cancer.

loss of a breast. Dr. Rubatt observes that

and wives.

detailing

their

women tend to research their disease more

blood pressure.

Dedicated to the Fight

closely, and ask more detailed treatment

Referring physicians and their patients

Many women fear breast cancer even

questions than do men.

also appreciate scheduling that allows a

if they never contract it. A 2005 survey

new patient to see an oncologist within 24

commissioned by the Society for Women’s

Breast cancer is the most common form of

to 48 hours, according to Chastity Keyes,

Health Research found that 22 percent of

the disease in women, but it is also the most

oncology liaison. If surgery is required by

women say breast cancer was the single

treatable. Medical oncologists commonly

a gynecologic oncologist, it is generally

disease they most feared. All cancer

treat breast cancer in its earliest form in the

scheduled one to two weeks from the initial

responses totaled a whopping 57 percent.

breast, when it reaches lymph nodes and if

consultation, Ms. Keyes says. Appointment

Heart disease was the second most feared

and when it becomes metastatic.

10

The Triangle Physician

Nurses called “breast navigators” are

Barringer says. “We later switched the title

referrals.

among the key supports that CCNC

to the current, navigator. I like the change

A visit to the Cancer Centers shows how

provides women diagnosed with breast

of the title to a navigator, as it describes

the practice thinks hard about the comfort

cancer. Understanding that treatment can

the aspect of getting someone from Point

and convenience of patients. Each facility

involve a number of oncology providers

A – being dealt the breast cancer card and

has:

and diagnostic and treatment options, the

of knowing little-to-nothing about what to

• Onsite laboratory services

breast navigator helps patients manage

expect – to Point B – completing treatment

• Onsite infusion

what can be an overwhelming amount of

and what that looks like for her/him. No

• Financial counselors

information.

matter the twist or turns, ups or downs in

• A resource room

the patient journey, they know that they

• Wig collection

As breast navigators, Dawn Barringer, R.N.,

can pick up the phone and call me. We are

• A coffee bar

B.S.N., C.B.C.N., Anne Shook, R.N., and

there from the point of diagnosis, teach the

• Children’s area

Lorie Robertson, R.N., coordinate patient

chemotherapy class and coordinate care

treatments and evaluations, explain the

with the other providers. We also answer

Cancer

different options and act as a source of

surgical and radiation questions,” says Ms.

oncology rehabilitation through Activcare

support. The navigator role has had such

Barringer.

provides patient assistance in maintaining

Centers

of

North

Carolina’s

or improving fitness during and after

a positive impact on patients at the Macon Pond CCNC that the service was expanded

Oncology social worker Cynthia von der

cancer treatment. Additionally, CCNC

recently to the Cary and Dunn practices.

Lehr, M.S.W., assists patients at all of the

hosts a quarterly “Look Good Feel Better”

CCNC locations, by addressing quality-of-

program for women undergoing cancer

Ms. Barringer, who has nearly two decades

life aspects – physical, emotional, social,

treatments, a program of the American

of oncology experience, helped develop

spiritual, even financial – that come with

Cancer Society. A registered dietician

the program at CCNC four years ago, when

cancer diagnosis. Her special expertise

provides private nutritional consultations,

she came to the practice. “We started off

comes in the form of education, advocacy,

and yoga classes are offered at the Macon

with my title as a care coordinator,” Ms.

supportive counseling, resources and

Pond location.

Members of CCNC’s gynecologic oncology team are: (from left) B. Elayne Cohen, P.A.-C.; Monica B. Jones, M.D., M.S., F.A.C.O.G., F.A.C.S.; Jennifer Rubatt, M.D.; and Cynthia Hanes, N.P.

april 2012

11

Long History and Deep Roots in the Triangle

Western Wake Medical Center. Dr. Rubatt

Rose, Donegan, Kritz and Eisenbeis see

also sees patients in this office one day a

patients.

Cancer Centers of North Carolina founder

week.

Cancer Centers of North Carolina is

William R. Berry, M.D., works in the Macon Pond Road facility, along with Drs. Monica

Later that year, CCNC opened the North

affiliated with US Oncology Network, one

Jones, Elizabeth Campbell and Jennifer

Raleigh practice at 10010 Falls of Neuse,

of the nation’s largest community-based

Rubatt; and Roy Cromartie, M.D.; Alan

Suite 203. Neeraj Agrawal, M.D., and Shaun

cancer treatment and research networks.

Kritz, M.D.; Stephen J. Tremont, M.D.; Virgil

C. Donegan, M.D., along with Dr. Margaret

The affiliation unites CCNC with more

L. Rose, M.D.; and Mark Yoffe, M.D. Scott D.

Deutsch, are the medical oncologists. Dr.

than 1,000 physicians and 10,000 cancer

Meredith, M.D., is the practice’s ear nose

Meredith and Dr. Jones also work onsite.

professionals. Those professionals care for more than 850,000 cancer patients in

and throat oncologist, and John F. Reilly, M.D.; Andrew Kennedy, M.D., F.A.C.R.O.,

In 2003, CCNC made its first expansion

more than 540 locations and more than 80

and Scott L. Sailer, M.D., are the radiation

outside of Wake County by opening its

integrated cancer centers throughout the

oncologists.

Dunn practice in Harnett County. Drs.

U.S.

Agrawal, Campbell, Cromartie, Tremont By 2000, CCNC had opened two new

and Yoffe are the medical oncologists at

US Oncology Research is the nation’s

practices in Wake County. In February

this site, located at 805-C Tilgman Drive,

largest

1999, the Cary practice began operations.

near Harnett Health Hospital.

network, specializing in Phase I through

community-based

research

Phase IV oncology clinical trials. The

Charles F. Eisenbeis, M.D., Ph.D., and P.J. Singh, M.D., along with Dr. Maha Elkordy,

Just four years later, in February 2007,

investigator- and sponsor-initiated trials

are the medical oncologists at this site,

CCNC opened a practice in Clayton at 555

bring innovative therapies to patients in

located in the medical park adjacent to

Medical Park Place, Suite 201-B, where Drs.

local communities across the nation.

Neeraj Agrawal, M.D. Medical Oncology/ Hematology

William R. Berry, M.D. Medical Oncology/ Hematology

Elizabeth E. Campbell, M.D. Medical Oncology/ Hematology

Roy Cromartie, M.D. Medical Oncology/ Hematology

Margaret A. Deutsch, M.D. Medical Oncology/ Hematology

Shaun C. Donegan, M.D. Medical Oncology/ Hematology

Charles F. Eisenbeis, M.D., Ph.D. Medical Oncology/ Hematology

Maha A. Elkordy, M.D. Medical Oncology/ Hematology

Monica B. Jones, M.D. Gynecologic Oncology

Andrew S. Kennedy, M.D., F.A.C.R.O. Radiation Oncology

Alan D. Kritz, M.D. Medical Oncology/ Hematology

Scott D. Meredith, M.D. ENT Oncology

John F. Reilly, Jr., M.D. Radiation Oncology

Virgil L. Rose, M.D. Medical Oncology/ Hematology

Jennifer Rubatt, M.D. Gynecologic Oncology

Scott L. Sailer, M.D. Radiation Oncology

Paramjeet Singh, M.D. Medical Oncology/ Hematology

Stephen J. Tremont, M.D. Medical Oncology/ Hematology

Mark Yoffe, M.D. Medical Oncology/ Hematology

12

The Triangle Physician

Duke Research News

Discovery May Lessen Chemo Side Effects A team of researchers at Duke University

need as much of the drug to get it into

The next step will be to try to understand

has determined the structure of a key

the tumor cells efficiently,” Dr. Lee said.

which features of the transporter confer

molecule that can carry chemotherapy

“Knowing the shape of the transporters

the ability to recognize certain chemo

and anti-viral drugs into cells, which

will let scientists design drugs that are

drugs and ultimately to design drugs that

could help to create more effective drugs

recognized well by this transporter.”

can easily enter the cells.

Because the drugs enter healthy cells as

This work won Dr. Lee the National

“Knowing the structure and properties

well as tumor cells, giving a lower dose

Institute of General Medical Sciences

of the transporter molecule may be

of drug that targets tumor tissue would

Award,

the key to changing the way that some

be the best scenario, said Dr. Lee, who is

Biophysical Society meeting in February.

chemotherapies, for example, could work

also a member of the Duke Ion Channel

in the body to prevent tumor growth,”

Research Unit. “Healthy cells don’t divide

The work was funded by the McKnight

said senior author Seok-Yong Lee, Ph.D.,

as often as tumor cells, so lowering the

Endowment Fund for Neuroscience,

assistant professor of biochemistry at

amount of drug given overall would be an

the Alfred P. Sloan Foundation, the

Duke.

effective approach to killing tumors while

Klingenstein

protecting patients.”

Foundation, the Basil O’Connor Starter

with fewer effects to healthy tissue.

nucleoside

transporter,

he

Fund,

received

the

at

the

Mallinckrodt

Scholar Research Award from the March

The transporter molecule, called a concentrative

which

The

researchers from

studied Vibrio

transporter cholera,

a

of Dimes Foundation, and the National Institutes

of

Health

Director’s

New

works by moving nucleosides, the building

molecules

blocks of DNA and RNA, from the outside

comma-shaped bacterium. The bacterial

Innovator Award, in addition to start-up

to the inside of cells. It also transports

transporter serves as a good model

funds from the Duke University Medical

nucleoside-like chemo drugs through cell

system for studying human transporters,

Center.

membranes. Once inside the cells, the

because they share similar amino acid

nucleoside-like drugs are modified into

sequences. They found that both the

Other authors include Zachary Lee

nucleotides that are incorporated into

human and bacterial transporter use a

Johnson and Cheom-Gil Cheong also of

DNA in ways that prevent tumor cells from

sodium gradient to import nucleosides

the Department of Biochemistry and the

dividing and functioning.

and drugs into the cells.

Ion Channel Research Unit.

“We discovered the structure of the transporter molecule, and now we believe it is possible to improve nucleoside drugs to be better recognized by a particular form of the transporter molecule that resides in certain types of tissue,” Dr. Lee said.

However much you value wildlife conservation in North Carolina,

DEC NC

11

1234

quadruple it.

“Now we know the transporter molecule has three forms, which recognize different drugs and reside in different tissues.”

The team determined the chemical and physical principles a transporter molecule uses to recognize the nucleosides, “so if you can improve the interactions between

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.

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

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

the transporter and the drug, you won’t

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

These precisely targeted drugs shut down

benefit from these tyrosine kinase inhibitor

scientists at Duke-NUS (National University

molecular pathways that keep these cancers

drugs.

of Singapore) Graduate Medical School has

flourishing and include TKIs for treating CML,

identified the reason why some patients fail

and the form of NSCLC with EGFR genetic

“Because we could determine in cells how

to respond to some of the most successful

mutations.

the BIM gene variant caused TKI resistance, we were able to devise a strategy to over-

cancer drugs.

Now the team at Duke-NUS Graduate

come it,” said S. Tiong Ong, M.B.B.Ch., senior

Tyrosine kinase inhibitor (TKI) drugs

Medical School in Singapore, working with

author of the study and associate professor

work effectively in most patients to fight

the Genome Institute of Singapore (GIS),

in the Cancer and Stem Cell Biology Signa-

certain blood cell cancers, such as chronic

Singapore General Hospital and the National

ture Research Programme at Duke-NUS and

myelogenous leukemia (CML) and non-small-

Cancer Centre Singapore, has discovered

Division of Medical Oncology, Department of

cell lung cancers (NSCLC) with mutations in

that there is a common variation in the

Medicine, at Duke University Medical Center.

the EGFR gene.

BIM gene in people of east Asian descent that contributes to some patients’ failure to

“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

14

The Triangle Physician

Asian population. By contrast, no people of

additional researchers and teams from the

Chin); the Yong Loo Lin School of Medicine,

European or African ancestry were found to

Duke-NUS Graduate Medical School, Genome

National University of Singapore (Dr. Seet Ju

have this gene variant.

Institute of Singapore (Dr. Yijun Ruan and Dr.

Ee); the University of Bonn, Germany (Dr.

Axel Hillmer), Singapore General Hospital

Markus Nöthen); the University of Malaya

“While it’s interesting to learn about this eth-

(Dr. Charles Chuah) and National Cancer

(Dr. Veera Nadarajan); and the University of

nic difference for the mutation, the greater

Centre Singapore (Dr. Darren Wan-Teck Lim).

Tokyo, Japan (Dr. Hiroyuki Mano).

principle may apply for other populations,”

In addition, the investigators also received

The study was supported by grants from the

said Patrick Casey, Ph.D., senior vice dean for

important contributions from Akita University

National Medical Research Council (NMRC)

research at Duke-NUS, and James B. Duke,

Graduate School of Medicine, Japan (Dr.

of Singapore; Biomedical Research Council

professor of pharmacology and cancer biol-

Naoto Takahashi); the Cancer Science

(BMRC) of A*STAR, Singapore; Genome

ogy. “There may well be other, yet to be dis-

Institute of Singapore (Dr. Ross Soo); the

Institute of Singapore; Singapore General

covered gene variations that account for drug

National University Cancer Institute of

Hospital; and two NMRC Clinician Scientist

resistance in different world populations.

Singapore (Drs. Liang Piu Koh and Tan Min

Awards to Drs. Ong and Chuah.

significance of the finding is that the same

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 and EGFR non-smallcell lung cancer patients per year will carry 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 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 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.”

The major contributors to the study include

Womens Wellness half vertical.indd 1

12/21/2009 4:29:23 PM

april 2012

15

Psychiatry

Q&A:

Electroconvulsive Therapy Advances in Treatment of Depression

By Sarah Hollingsworth Lisanby, M.D.

What is ECT?

ECT can be a life-saving treatment.

identify any special risks that anesthesia may pose for them. Unless the person has

Electroconvulsive therapy (ECT) refers to the most effective and rapidly acting

What are the benefits of ECT?

a very serious medical illness, the risk of

treatment that we have today for severe

ECT often quickly resolves the symptoms

life-threatening side effects is extremely

depression and other conditions, and is

of major depression, including depressed

rare.

used throughout the world.

mood, lack of interest, appetite and weight disturbance, sleep disturbance, feelings of

The common risks of the seizure include

An approved medical treatment, ECT

hopelessness and helplessness, loss of self

difficulty with memory (amnesia), as well

involves using electricity to produce a

esteem and thoughts of suicide.

as temporary headache or muscle aching.

The types of memories that can be affected

brief seizure in a person under general anesthesia, while the person receiving the

Remission, which is the likelihood of

include memories of the past (retrograde

treatment is asleep. The seizure usually

having complete resolution of symptoms,

amnesia) and the ability to remember new

lasts about a minute or less, and body

is reported to range from 70 percent to

information (anterograde amnesia).

movement is very little because of a strong

90 percent with ECT. Remission rates for

muscle relaxant medication that is given

medication are typically around 20 percent

Many patients experience some degree

following the anesthetic drug.

to 30 percent.

of anterograde amnesia, but this typically

ECT is given two to three times per

ECT can also be used in other conditions

People receiving ECT can experience

week, usually for six to 12 treatments. It

when other treatments are not sufficiently

varying amounts of retrograde amnesia.

is performed by medical physicians (a

effective. Bipolar disorder, schizophrenia,

Retrograde amnesia typically deals with

psychiatrist and an anesthesiologist), with

Parkinson’s disease, and treatment resistant

events that occurred close in time to the

assistance from nurses and other medical

epilepsy are examples of those conditions.

ECT, but it can extend further into the past.

disappears soon after the ECT course ends.

The amount of memory effect depends to

staff.

What are the risks of ECT?

a large extent on the type of ECT received.

This form of treatment is recommended

Nearly all medical procedures have a risk

when a severe clinical depression is not

of side effects. In the case of ECT, the risks

Right unilateral ECT, which stimulates the

responding to other treatments, such as

relate to the anesthesia and to the seizure.

right side of the head, has less risk of memory loss than bilateral ECT, which stimu-

psychotherapy and medications, or when there is a need for a rapid response, such

The risks of anesthesia are relatively low,

lates both sides of the head. Ultrabrief-

as when there is a high risk of suicide or

because ECT involves a very brief period

pulse ECT, which uses a very small amount

the depression itself is threatening the

of anesthesia, typically lasting less than 10

of electricity, has less risk of memory loss

health of the person. Because it is rapidly

minutes. Before undergoing ECT, patients

than earlier types of ECT treatment.

effective, even when other treatments fail,

are evaluated by the anesthesiologist to

16

The Triangle Physician

Dr. Sarah Hollingsworth Lisanby is a geriatric psychiatrist and professor and chair of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine.

Does ECT damage the brain?

No. Careful studies using sensitive brain-imaging measures in people receiving ECT, and precise anatomical measurements in animal research studies have repeatedly demonstrated that ECT does not damage the brain.

R A L E I G H , N C • M AY 5 , 2 0 1 2

Saturday, May 5, 2012 8:00 AM - Check in/Registration

•

9:00 AM - Welcome, Group Picture, Walk Begins

LOCATION

How has ECT been modernized over the years?

Lake Benson Park 921 Buffalo Rd., Garner, NC, 27529

Medical advances have dramatically improved ECT,

REGISTRATION

increasing its safety. These advances include general

Register online at: http://www.nfwalk.org

anesthesia, the switch to safer types of electrical stimulation and the use of right unilateral electrode placement.

When is ECT the right treatment?

Walking to raise funds for research to find treatments and a cure for neurofibromatosis (NF)

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!

ECT is indicated for severe clinical depression or bipolar disorder, and other conditions. It is typically used when depression is very severe or has lasted for a long time and not gotten better with psychotherapy and medications.

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.

Sometimes a change in medication dosage or a switch in medication will be effective for depression, but when it is not, there may be a role for ECT. Certain types of depression, such as psychotic depression, or catatonic symptoms predict better response to ECT. Older age also predicts better response to ECT. Is ECT effective for older adults?

There is evidence that older people actually respond better to ECT than those who are younger. The Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine currently is investigating the use of ECT in seniors to understand how best to maintain remission after a successful course of ECT. Currently, relapse is a significant issue for patients who see improvement in their depression after treatment, so this study is important in learning how we can provide longlasting improvement and prevent relapse in depressed individuals. Effective relapse prevention strategies after ECT are critical to prolonging remission, and that is precisely what we are examining in this study.

For more information or to request an appointment at the Duke Brain Stimulation and Neurophysiology Center, call (919) 681-0603.

april 2012

17

Duke Research News

Deafening Affects Vocal Nerve Cells Within Hours Portions of a songbird’s brain that control

Dr. Mooney said.

learning and initiating motor sequences, including the complex vocal sequences that

how it sings have been shown to decay within 24 hours of the animal losing its

“I will go out on a limb and say that I think

hearing.

similar changes also occur in human brains

make up birdsong and speech.

after hearing loss, specifically in Broca’s

Although other studies had looked at the

The findings, by researchers at Duke Uni-

area, a part of the human brain that plays

effects of deafening on neurons in audi-

versity Medical Center, show that deafness

an important role in generating speech and

tory brain areas, this is the first time that

penetrates much more rapidly and deeply

that also receives inputs from the auditory

scientists have been able to watch how

into the brain than previously thought. As

system,” Dr. Mooney said.

deafening affects connections between nerve cells in a vocal motor area of the

the size and strength of nerve cell connections visibly changed

brain in a living animal, said

under

microscope,

Katie Tschida, Ph.D., a post-

researchers could even

doctoral research associate in

predict which songbirds

Dr. Mooney’s laboratory who

would have worse songs in

led the study.

a

coming days.

Using a protein isolated from “When hearing was lost,

jellyfish that can make song-

we saw rapid changes in

bird nerve cells glow bright

motor areas in that control

green when viewed under a

song, the bird’s equivalent

laser-powered

of speech,” said senior

they were able to determine

author Richard Mooney,

that deafening triggered rapid

Ph.D., professor of neu-

changes to the tiny connec-

robiology at Duke. “This

tions between nerve cells,

microscope,

called synapses, which are

study provided a laser-like

only one thousandth of a millimeter across.

focus on what happens in the living song-

About 30 million Americans are hard of

bird brain, narrowed down to the particular

hearing or deaf. This study could shed light

cell type involved.”

on why and how some people’s speech

“I was very surprised that the weakening

changes as their hearing starts to decline,

of connections between nerve cells was

Dr. Mooney said.

visible and emerged so rapidly – over the

The study was published in the online jour-

course of days these changes allowed us to

nal Neuron March 7.

“Our vocal system depends on the audi-

predict which birds’ songs would fall apart

Like humans, songbirds depend on hear-

tory system being able to create intelligible

most dramatically,” Dr. Tschida said. “Con-

ing to learn their mating songs – males that

speech. When people suffer profound

sidering that we were only tracking a hand-

sing poorly don’t attract mates, so hearing

hearing loss, their speech often becomes

ful of neurons in each bird, I never thought

a song, learning it and singing correctly are

hoarse, garbled and harder to understand,

we’d get information specific enough to

all critical for songbird survival. Songbirds

so not only do they have trouble hearing,

predict such a thing.”

also resemble humans and differ from

they often can’t speak fluently any more,”

most other animals in that their songs fall

Dr. Mooney said.

The research was supported by the National Science Foundation and the National

apart when they lose their hearing, and this feature makes them an ideal organism

The nerve cells that showed changes after

Institute on Deafness and Other Communi-

to study how hearing loss may affect the

deafening send signals to the basal gan-

cation Disorders.

parts of the brain that control vocalization,

glia, a part of the brain that plays a role in

18

The Triangle Physician

hope was part of your treatment plan?

Welcome to the new Cancer Center at Duke. A place where treatment revolves around the patient and the level of comfort is just as high as the quality of care. A place where all the what ifs about cancer care become what is... dukecancerinstitute.org

Quiet Room at Duke Cancer Center Cancer Care As It Should Be.

Your Financial Rx

The Keys to Inflation Proofing Your Portfolio

By Paul J. Pittman, C.F.P.

If you are like me, for years, even before the

supply, while demand for them is

economic seizure we experienced at the

soaring worldwide, especially in Asia.

end of 2008, you were probably wondering when the low interest rates and all of the

Treasury Inflation Protected Securities

“easy money” policies were going to result

(TIPS) – These bond yields are tied to

in inflation. Then, after the 2008 economic

the Consumer Price Index (CPI) and will

seizure, we witnessed the extreme become

increase or decrease as the CPI changes. In

even more extreme. Money printing

general, if the things cost more, these pay

significantly increased, the bank lending

more and vice versa.

rates dropped to zero, and again, if you are

Paul Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally soughtafter speaker, humorist and writer. Mr. Pittman can be reached at (919) 459-4171 and paul. pittman@pcgnc.com. Send an e-mail to receive Mr. Pittman’s Weekly Market Commentary.

like me, you probably asked, is this not the

Stocks and the Indexes – While inflation

exact thing that creates inflation?

may cause stocks to suffer in the short term if

Long-Term Bonds – Inflation has a lot

things like cost of goods sold and borrowing

to do with bond rates and since rates are

Yet, despite all of the blatant catalysts,

increase for businesses over the long term,

relatively low, we run the risk that rates

the inflation rate has been anything but

stocks tend to keep your money growing

will rise. That is bad for the current value

alarming... but wait. Are we not hearing

ahead of inflation. Stocks for the Long Run

of long-term bonds. You can think of it this

that our biggest bond buyer, China, is wary

author Jeremy Siegel points out that stock

way, if new bonds are being issued that

of our over-use of debt? Are we not just a

returns historically have been immune to

pay higher rates than the ones you own, no

couple of interest rate upticks away from

the inflation rate over long stretches of time.

one would want to buy yours except at a

concluding that, “the inflationary spiral we

Although rising prices could crimp profits

discounted price.

have been hearing about has begun?” Will

in the short term, Siegel argues that compa-

there be a day of reckoning for devaluing

nies – eventually – can pass on those costs

Finally, inflation-proofing your portfolio

our currency? Will runaway inflation

to consumers, making inflation a wash for

comes down to being invested in a

become our nation’s biggest challenge?

stock market returns. Please note that this is

diversified mix of assets that have a high

a generalization. There is no way to guaran-

probability of either keeping pace or

If runaway inflation occurs, how can we

tee or predict the volatility and performance

appreciating at a faster rate than inflation.

best protect ourselves against it? Let’s face

of any specific security.

While cash reserves are vital for short-term financial security, the threat of inflation

it, we do not know for sure that it is coming,

Steer Clear of These

gives a good reason to keep long-term

Cash or Minimal Interest Savings

money invested in assets that have the

Consider These

Accounts – Storing money in savings

potential to appreciate.

Real Assets – Think “valuable” and “finite

accounts or, even worse, cash, is a losing

quantity.”

proposition during high inflationary times.

The opinions voiced in this material are

• Real Estate – For instance, there is a

Just think about how much cheaper things

for general information only and are not

finite amount of coastal real estate. The

like bread, stamps and medical insurance

intended to provide specific advice or

ocean makes sure that this remains a

were 10 to 15 years ago. If your money

recommendations for any individual. To

very “finite quantity.”

was under the mattress during that time,

determine which investment(s) may be

• Precious Metals and Raw Materials –

it definitely would not buy what it used to

appropriate for you, consult your financial

For instance, electric car batteries need

buy. On the other hand, if it was invested

advisor prior to investing. All performance

silver and palladium, but these metals

in appreciating assets and it averaged an

referenced is historical and is no guarantee

can’t be mass produced. They are

annual rate of 7 percent, it would have

of future results. All indices are unmanaged

expensive and difficult to find in nature.

approximately doubled over a 10-year

and cannot be invested into directly. The

The fact is, most natural resources and

period (not including taxes or fees).

market for all securities is subject to risk

but it sure would not be a surprise.

life’s basic necessities are in short

20

The Triangle Physician

and loss of principal is possible.

News

Morrisville Women’s Imaging Center Has Walk-In Service, Extended Hours The Wake Radiology Women’s Imaging

that have achieved high practice standards

earned the industry’s premier accredita-

Center in Morrisville is the group’s first

in image quality, personnel qualifications,

tions. All seven Wake Radiology women’s

Morrisville location and focuses on digital

facility equipment, quality control proce-

imaging offices in Raleigh, Cary, Chapel

screening mammography and bone den-

dures and quality assurance programs.

Hill, Wake Forest, Garner and Morrisville are BICOE-designated centers. Together

sity screening.

The Morrisville office is also an Interna-

they are fully accredited in mammogra-

The center features walk-in appointments

tional Society of Clinical Densitometry-

phy, stereotactic breast biopsy, breast

and extended hours to accommodate ear-

accredited facility. Certification is awarded

ultrasound and ultrasound-guided breast

ly morning and evening exams. Located at

to imaging centers specializing in skeletal

biopsy. Wake Radiology also has one of

1101 Grace Park Drive, Morrisville 27560,

assessment that provide the highest level

the largest and most advanced DXA (dual-

the office is a central location for women

of testing and adhere to the standards de-

energy X-ray absorptiometry) programs in

who travel to Research Triangle Park or live

termined by the multidisciplinary interna-

the southeast, offering testing at eight sites

in the western part of the county.

tional society of radiologists, obstetricians,

in the Triangle.

gynecologists and endocrinologists. All Office hours are:

exams are performed by technologists

Screening mammograms at the Morris-

• Monday from 10 a.m. to 7 p.m.

certified by the American Registry of Ra-

ville location are available without an ap-

• Tuesday, Wednesday and Friday from

diologic Technologists, with additional

pointment during office hours; however

specialty certification by the ISCD. Bone

appointments can be made in advance by

density tests are interpreted by subspe-

calling (919) 232-4700. While women do

cialty trained musculoskeletal radiologists

not need a physician referral for this yearly

who are also certified by ISCD.

exam, they must have visited their primary

7:15 a.m. to 3:45 p.m.

• Thursday from 7:15 a.m. to 3:15 p.m.

The Morrisville center has earned the

care physician within the last 24 months.

Breast Imaging Center of Excellence by the American College of Radiology. This

The new Morrisville imaging center joins

designation is awarded to imaging centers

the other Wake Radiology offices that have

Quest Names Top Performing Hospital Alamance Regional Medical Center is one

mortalities, and safely reduced the cost of

improve patient safety while reducing the

of four hospitals in North Carolina to be

care for each patient’s hospitalization, ac-

cost of care and readmissions.”

named a 2011 Top Performing Hospital in a

cording to a QUEST press release.

In the last 30 months, hospitals participating

national health care collaborative. The Premier health care alliance’s national QUEST

“By collaborating with other hospitals to

in the QUEST collaborative reportedly

collaborative has identified 123 hospitals

share our patient outcomes and best care

have reduced health care spending by

nationwide, including Alamance Regional,

practices, we are able to enhance the care

$2.85 billion through the delivery of high-

that achieved care outcomes that earned a

we provide to patients while also taking

quality, evidence-based care. Collaborative

Top Performance award.

a leadership role in driving better results

members also have a 5 percent lower

within the health care industry,” says John

mortality rate than hospitals who are not

The QUEST Top Performing hospitals in-

Currin, president and chief executive of-

participating in the collaborative.

creased delivery of evidence-based care,

ficer, Alamance Regional. “Participating

saved lives by reducing avoidable hospital

in the QUEST program is also helping us

april 2012

21

UNC Feature

Luella Love New Lungs for a New Life Contributed by the UNC School of Medicine If Luella Love believed in lucky numbers,

“I’m a long-time organ donor myself, and

her recovery, but Ms. Love sees them as

she would pick 11.

I had real mixed emotions when I prayed

distant bumps in the road.

for new lungs,” Ms. Love said. “Never will “I got my new lungs on Nov. 11, 2011,

I forget that my getting a second chance

“Often the steroids and anti-inflammatory

during a surgery that started at 11 p.m.,”

at life means someone lost theirs. Still, I

drugs that transplant patients must take

said Ms. Love, 48, of Concord, N.C. “I don’t

wanted the call that there were lungs for

make them less sensitive to pain, and it’s

believe in lucky numbers, but I do believe

me.”

sometimes hard to diagnose when there are post-transplant infections or issues,”

in God.” The call came early on Nov. 11 and during

Dr. Haithcock said. “Still, she’s really done

Ms. Love, a petite Indiana native who

a 14-hour surgery, Benjamin E. Haithcock,

great, and I fully expect to see her on a

has lived in North Carolina seven years,

M.D., assistant professor of surgery at

track or running a 5K soon.”

was born with cystic fibrosis (CF), a

the University of North Carolina School

life-shortening inherited disease that

of Medicine and lead lung transplant

Ms. Love expects that soon, too. Her

causes abnormally thick, sticky mucus

surgeon at the UNC Center for Transplant

diligence in all post-transplant therapies

to build up in the breathing passages and

Care, transplanted the new lungs into Ms.

rivals

in the pancreas, resulting in breathing

Love’s chest. Fifteen to 20 lung transplants

because she sees time that she didn’t

difficulties and related digestive system

are performed at UNC Hospitals each

expect to have stretch before her.

issues. At Ms. Love’s birth, life expectancy

year.

her

pre-transplant

dedication,

“Before the transplant, my best day

for CF patients hovered in the teens.

“I will always remember Dr. Haithcock

would be someone else’s bad day,” Ms.

“I was diagnosed at 18 months old, and

telling me my new lungs were pristine and

Love said, remembering the difficulty

my mother was told I wouldn’t live to

the perfect size for my small frame,” Ms.

breathing when not even exerting herself,

see kindergarten,” Ms. Love said. “My

Love said. “When the time is right, I want

the digestive issues, some bladder- and

mother died of lung cancer in 1996, and I

to thank the family of the donor for their

bowel-control issues. “I’m free of all that

celebrated my 48th birthday days after my

loved one’s priceless gift.”

now. And I have time.

Dr. Haithcock credits Ms. Love’s diligence

“I want to ramp up my advocacy for organ

with pre-transplant physical therapy with

donation. I want to work with support

getting her back in the game of life.

groups for CF patients, because I know

transplant. My new chance at life feels like a miracle to me.”

Despite CF, Ms. Love had never excused

what it’s like not to have that. I want to be

herself from life. She ran five miles – morning and evening – in her 20s. When

“Our lung transplant patients are required

there to hold someone’s hand when they

she could no longer run, she walked. She

to be up and moving around as much

need it most. I want to learn to dance, to

worked in customer relations for a bank

as possible,” Dr. Haithcock said. “Luella

run – yes, a 5K – and to learn to crochet.”

until chronic respiratory and digestive

followed those instructions to the letter,

issues requiring hospitalizations signaled

and it shows. Four to six hours after

Learning to crochet helped pass the time

that CF was winning. By May of last year

transplant, she was raring to go, the

during Ms. Love’s required 90 to 100 days

her body was showing signs of shutting

breathing tube came out and she was

post-transplant stay at SECU (State Em-

down.

walking.”

ployees’ Credit Union) Family House, the

She prayed for new lungs, reluctantly.

Unexpected gallbladder and liver issues

minutes away from UNC Hospitals that

required additional surgery and extended

provides comfortable, convenient and af-

40-bedroom hospital hospitality house

22

The Triangle Physician

WakeMed News fordable housing for seriously ill adult patients and their family member caregivers.

Transplant patients are monitored closely for signs of organ rejection and other complications and have multiple therapies weekly to help their minds and bodies adjust to the new normal. A shuttle takes patients to and from the hospital regularly, and emergency transport is arranged as needed.

“As excited as I am about going home, I am sad about leaving family house,” Ms. Love said, as she headed home to Concord March 1. “I’m treated like family here, with love and respect. I know without this place my recovery would have been slower. The food provided by volunteers is always excellent, and the after-dinner entertainment is always nice. There are places for solitude and places for coming

In-Office Pharmacy Program POP Medical provides physicians with the ability to fill prescriptions in their own office, increasing practice revenues and offering great convenience to patients. Using the turn-key Pharmacy Dispensing Solution, the practice is furnished with prepackaged medication and may offer it to the patient for the patient’s copay.

Benefits include: x Same co-pay as pharmacy

x Improved patient outcomes

x Additional revenue stream for practice x Seamless and efficient turn-key operation

x NO inventory to purchase

Toll Free 855-4POPMED www.POPMedical.com

together. I have to figure out a way to give back for all they’ve given me.”

Ms. Love was joined at family house by her sister, Crystal, from Indiana, who has stayed by her side since the transplant.

“Crystal is a blessing to me,” Ms. Love said. “She’s lifted me, bathed me, done my laundry, organized my very large pillbox, gone with me to every appointment and helped me think, and she’s taught me to crochet.

“She’s missed her sons’ birthdays, and Thanksgiving, Christmas and New Year’s with her husband and their family. She

Managing your patients’ health is your life’s work.

Managing physicians’ wealth is mine.

Financial Rx for Physicians: •

• • • •

Aiding Wealth Creation, Preservation and Protection Business Management Tax-strategies Liability Protection Asset Preservation

misses them greatly, and I can’t thank her

Trust your wealthcare to a specialist.

enough for what she’s done for me. She’s

The Preferred ClienT GrouP Paul J. Pittman CFP®

been a little bit of everything to me, and at the end of the day, she’s still my sister.”

For organ donor information, contact Carolina Donor Services, the federally designated organ procurement organization serving 6.1 million people in 79 counties in North Carolina and Danville, Va., at www.carolinadonorservices.org or (919) 489-8404.

President and Managing Director 919-459-4171 paul.pittman@pcgnc.com www.pcgnc.com Securities offered through LPL Financial Member NASD/SIPC

Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers

april 2012

23

UNC Research News

Benefits of Varenicline May Balance Risks The United States Food and Drug

Drs. Kistler and Goldstein calculated the

varenicline use should be weighed against

Administration has approved the smoking

potential short-term risks and longer term

known health outcomes from cessation.

cessation

varenicline

benefits, giving providers and patients a

This analysis allows us to have a more

(Chantix) as an effective aide in helping

more meaningful way to base decisions.

meaningful conversation with patients.”

people quit smoking, including those

For instance, they calculate that if the

with cardiovascular disease. It cautions,

research

cardiovascular

The bottom line for clinicians, assuming

however, that varenicline may also be

events and varenicline was true, then

an elevated odds of adverse cardiovascu-

associated with a small, increased risk of

one additional woman has an adverse

lar events with varenicline as published,

certain cardiovascular adverse events in

cardiovascular event over a year for every

is that just more than approximately four

patients with cardiovascular disease.

345 women who take varenicline. They

additional lives are saved over 10 years at

also calculate the benefit of smoking

a cost of approximately three additional

Some researchers have suggested that

cessation with varenicline on mortality,

adverse cardiovascular events that occur

varenicline shouldn’t be used at all

showing that one additional life is saved

in the first year.

because of these potential increased

over 10 years for every 238 people who

cardiovascular risks. But Christine E.

take a course of varenicline.

medication

on

adverse

“These calculations should help clinicians to avoid throwing the baby out with the

Kistler, M.D., M.A.Sc., and Adam Goldstein,

bathwater,” said Dr. Kistler.

M.D., M.P.H., physician-researchers at the

“We believe this information will allow

University of North Carolina at Chapel Hill

clinicians to appropriately and adequately

School of Medicine, believe that a new

describe the risk and benefit of varenicline

This commentary received no external

analysis of potential risks against proven

use in terms of adverse cardiovascular

funding or support. Dr. Kistler has an

health outcomes provides more complete

events and mortality reduction, terms that

institutional career development award

data for such decisions.

patients and their doctors more readily

from the Agency for Healthcare Research

understand,” said Dr. Kistler, lead author

and Quality. Dr. Goldstein has an

of the commentary.

unrestricted educational grant from Pfizer

In a commentary published online March 15

through the UNC School of Medicine

by the journal Nicotine & Tobacco Research, show

to support development of inpatient

significantly

tobacco cessation programs, and he

more people quit smoking than would

has participated on advisory boards for

they discuss ways clinicians can better have

“Randomized

controlled

conversations about the balance between

that

any potential short-term increased risk of adverse cardiovascular events compared to

quit without the medication” said Dr.

Boehringer and Pfizer Pharmaceuticals.

the overall long-term reduction in the risk of

Goldstein, director of tobacco cessation

death that results from smoking cessation

programs in the UNC Department of

and use of the drug.

Family Medicine. “Any increased risks of

varenicline

helps

trials

Protein Complex Affects Cells’ Ability to Move and Respond In a paper published today in the journal

system response, to learning and brain

thought previously that cells could simply

Cell, a team from the University of North

development, wound healing and – when it

not survive without it. Thanks to Norman

Carolina at Chapel Hill has explained for

goes wrong – in cancer.

Sharpless’ lab here at UNC, we were able to find a cell line where the protein can be

the first time how a long-studied protein complex affects cell migration and how

Jim Bear, Ph.D., principal investigator on

eliminated without loss of viability in order

external cues affect a cell’s ability to migrate.

the study, said, “The ARP 2/3 protein com-

to see what happens to cells.”

plex is – evolutionarily speaking – very old, Cell migration is one of life’s basic processes,

but very little is known about what hap-

The result, said Dr. Bear, was fascinating.

from development in the womb to immune

pens to cells when it is eliminated. It was

With the ARP 2/3 protein complex intact,

24

The Triangle Physician

UNC Research News cells migrate by forming a fan-shaped struc-

“fans” to respond to chemotactic cues. They

The study opens the way for a new frontier

ture, called a lamellipodia, at the leading

found that cells with lamellipodia “fans”

of investigation in the area of hapotaxis,

edge. The team found that eliminating this

and filopodia “fingers” (with and without

or behavioral clues that cells get from the

protein complex caused cells to switch to

the ARP 2/3 protein complex) respond

extracellular matrix. Also, said Dr. Bear, “We

making finger-shaped protrusions instead –

to

indistinguishably,

don’t understand chemotaxis as well as we

called filopodia. The cells with “fingers” on

although they move faster with lamellipodia.

thought. What are the forces in the cell that

chemotaxic

cues

respond to soluble cues?”

the leading edge move much more slowly than those with “fans.”

“The really interesting finding came when we looked at how each type of cell

Both areas of investigation could be

Dr. Bear, who is an associate professor of cell

responds to hapotactic cues,” said Dr. Bear.

important for future breakthroughs in areas

and developmental biology and a Howard

The team developed a new laboratory

requiring precisely controlled cell migratory

Hughes Medical Institute early career

technique that uses a microfluidic device to

behavior, including wound healing and

scientist, has focused his laboratory’s work

lay down a gradient of a surface molecules

tissue repair, cancer and cardiovascular

around how cell movement responds to

(or substrate) for the cells to “crawl” across

disease.

environmental cues. Once his team figured

in a way that could be measured in the lab.

out that loss of ARP 2/3 could change cells’

They could then look at whether the cells

Other members of the research team include

actual structure and movement, they went

could “sense” a gradient in the matrix. With

members of the Bear lab: Congying Wu,

on to look at how those changes affected

the ARP 2/3 protein complex, the cells

B.S., Sreeja Asokan, Ph.D., and Liz Haynes,

the ability of cells to respond to external

with “fans” on the leading edge followed

B.S.; as well as Matt Berginski, B.S., and

cues.

the gradient of the surface proteins in an

Shawn Gomez, Eng.Sc.D., from the UNC/

orderly, predictable fashion. Without it, the

North Carolina State University Biomedical

cells with “fingers” moved randomly.

Engineering program; and Norman E. (Ned)

“Cells sense a wide variety of soluble

Sharpless, Ph.D., and Jack Griffith, Ph.D.,

chemical cues through ‘chemotaxis’ – a process that is the basis behind many drugs

“This experiment – which was possible

from UNC Lineberger Comprehensive

that target cell behavior. They also respond

only with the help of many diverse UNC

Cancer Center. In addition, many of the

to attached cues from the surface that

colleagues, ranging from genetics to

imaging experiments were conducted in the

they are crawling upon – a much less well

biomedical engineering – finally tells us

UNC-Olympus Imaging Research Center, of

understood process called ‘haptotaxis,’”

what lamellipodia and the ARP 2/3 protein

which Dr. Bear is the director.

said Dr. Bear, who is also a member of UNC

complex do: help the cell respond to clues

Lineberger Comprehensive Cancer Center.

from the extracellular environment. It has

The research was funded by National

long been assumed that the protein was

Institutes of Health (Institute for General

So Dr. Bear’s team set out to test the widely

important for chemotaxis, but that is not the

Medicine) and the Howard Hughes Medical

held idea that the cells require lamellipodia

case.”

Institute.

Drug Helps Purge Hidden HIV Virus A team of researchers at the University

never fully eliminate the virus from the

demonstrate that the biological mechanism

of North Carolina at Chapel Hill have

cells and tissues it has infected.

that keeps the HIV virus hidden and unreachable by current antiviral therapies

successfully flushed latent HIV infection from hiding, with a drug used to treat

“Lifelong use of antiretroviral therapy is

can be targeted and interrupted in humans,

certain types of lymphoma.

problematic for many reasons, not least

providing new hope for a strategy to

among them are drug-resistance side

eradicate HIV completely.

Tackling latent HIV in the immune

effects and cost,” said David Margolis,

system is critical to finding a cure for

M.D., professor of medicine, microbiology

In a clinical trial, six HIV-infected men who

AIDS. The results were presented at the

and immunology and epidemiology at

were medically stable on anti-AIDS drugs,

19th Conference on Retroviruses and

the University of North Carolina at Chapel

received vorinostat, an oncology drug.

Opportunistic Infections in Seattle, Wash.

Hill. “We need to employ better long-term

Recent studies by Dr. Margolis and others

strategies, including a cure.”

have shown that vorinostat also attacks the enzymes that keep HIV hiding in certain

While current antiretroviral therapies can effectively control virus levels, they can

Dr. Margolis’ new study is the first to

CD4+ T cells, specialized immune system april 2012

25

UNC Research News cells that the virus uses to replicate. Within

latency, and suggests that we can build a

hours of receiving the vorinostat, all six

path that may lead to a cure.”

Awards (CTSA) program.

Other UNC authors on the paper include

patients had a significant increase in HIV RNA in these cells, evidence that the virus

The research conducted is part of a UNC-

Nanci Archin, Ph.D., Shailesh Choudary,

was being forced out of its hiding place.

led consortium, the Collaboratory of AIDS

Ph.D., Joann Kuruc, M.S.N., and Joseph

Researchers

(CARE),

Eron, M.D., of the medical school; Angela

“This proves for the first time that there are

funded by the National Institute of Allergy

Kashuba, Pharm.D. of the Eshelman School

ways to specifically treat viral latency, the

and Infectious Diseases. The consortium

of Pharmacy; and Michael Hudgens, Ph.D., of

first step towards curing HIV infection,” said

is administered by the North Carolina

the Gillings School of Global Public Health.

Dr. Margolis, who led the study. “It shows

Translational and Clinical Sciences (NC

that this class of drugs, HDAC inhibitors,

TraCS) Institute at UNC, one of 60 medical

Funding for this research was provided by

can attack persistent virus. Vorinostat may

research institutions in the U.S. working

the National Institutes of Health, Merck &

not be the magic bullet, but this success

to improve biomedical research through

Co., and the James B. Pendleton Charitable

shows us a new way to test drugs to target

the NIH Clinical and Translational Science

Trust.

for

Eradication

UNC Feature

Patient Perspective:

From Caring for Others to Caring for Herself

By Elizabeth Swaringen

Bernidene Uzzell has spent her entire life

bers were happy with the new direction, but

“We recommended that course of treatment

taking care of others. Stage IV colon cancer

they also knew better than to expend breath

because there is evidence to support pairing

made her take care of herself.

and energy trying to change Ms. Uzzell’s

a lower-dose of the oral chemotherapy with

mind.

radiation therapy to enhance the effects of radiation,” says Dr. Bernard, professor of

“It’s never been easy for me to ask for help, because I’ve always been focused on

“I had never felt sick, and I was feeling well,”

medicine in the Department of Medicine

helping others,” says Ms. Uzzell, 64, a retired

Ms. Uzzell says. “I’ve never eaten much

and the Division of Hematology and

career social worker, a wife, a mother of

meat, but mostly vegetables prepared with

Oncology. “Fortunately, she has had slow-

three and sibling to four from Kinston, N.C.

lots of herbs, garlic and onions. I’ve had top-

growing disease and did not complain of

“But, right now, it’s about me.”

of-the-line fitness equipment in my home,

symptoms. Colon cancer doesn’t always

and I walk a lot.

have the rapid downhill slide that some other cancers do.”

Ms. Uzzell was diagnosed in July 2008 after a colonoscopy, which she admits she was

“But this past summer, my body began

overdue in scheduling. Within a month, a

telling me something wasn’t quite right,”

The treatment is palliative, not curative, and

surgical resection of her ascending colon

she recalls. “That’s when we discovered the

is designed to allow Ms. Uzzell to live more

removed the diseased portion of her large

pelvic mass, and I knew chemotherapy and

comfortably and feel better overall, says

intestine. Post-surgery, oral chemotherapy

maybe more was in my future.”

Dr. Tepper, Hector MacLean distinguished professor of cancer research in the

began.

Under the care of Stephen A. Bernard, M.D.,

Department of Radiation Oncology.

After a few years, Ms. Uzzell, tired of the

and Joel E. Tepper, M.D., members of UNC

common side effects of conventional ther-

Lineberger Comprehensive Cancer Center,

“She’s not one to complain even though

apy, voluntarily stopped the chemotherapy

Ms. Uzzell resumed a lower dose of the

she was having some symptoms that would

and began alternative therapy that included

original chemotherapy in combination with

have given her every reason to,” Dr. Tepper

a lengthy list of herbs. Not all family mem-

20 days of radiation.

says. “Quite often palliative care is harder

26

The Triangle Physician

UNC News because it’s about striking the balance

the full story for fear that we won’t approve.

and a lot of other good people in my path.

between the treatment side effects versus

It’s in their own best interest of getting the

I’m blessed.”

the symptoms of the disease. It’s very

best care possible to be forthcoming.”

Still, Ms. Uzzell hasn’t totally stopped

individualized, with the patient taking an

reaching out to help others.

active role. She has a very good attitude and

While in Chapel Hill for the 20 days of

her background as a social worker is helpful

radiation, Ms. Uzzell stayed at SECU Family

to herself. She’s grateful for everything.”

House, the 40-bedroom hospital hospitality

“I went to a support group for colon cancer

house minutes away from UNC Hospitals

patients, and I now I tell everybody I see

Dr. Bernard agrees. “She’s a very enthusias-

that provides comfortable, convenient and

‘get off your rear, put yourself in gear and

tic individual, clearly active in her own care

affordable housing for seriously ill adult

get yourself in there for your colonoscopy.’”

and in living her life. She’s tolerating the

patients and their family-member caregivers.

Early detection makes a difference.

treatments well, and so far, so good.”

“This is my sanctuary, my refuge, my

Postscript: Nationally, the incidence of colon

Neither Dr. Bernard nor Dr. Tepper passed

place of healing,” Ms. Uzzell says. “I knew

cancer is dropping, due in large measure

judgment on Ms. Uzzell’s decision to

I needed to disconnect from those who’ve

to the use of colonoscopies starting at age

pursue alternative therapies, but reiterated

always depended on me to be there for

50 or earlier if there is a family history of

the importance of patients sharing their

them, if I was to do all I could for myself.

the disease. Colonoscopies can actually

use of them in combination or in lieu of

Family House has allowed me to do that. I

prevent cancer from forming by removing

conventional therapy.

feel my body mending.

pre-cancerous growths.

“Most of the medications we use as

“And I’ve never felt safer than in the hands of

For more information about the SECU

oncologists come from natural sources

Dr. Bernard and Dr. Tepper,” she says about

Family House at UNC Hospitals, visit

anyway, and there can be interactions if

the multi-disciplinary care for which UNC

secufamilyhouse.org.

alternative therapies are being used,” Dr.

Lineberger is known. “You usually hear

Bernard says. “Too often patients don’t tell us

people say that about God, but He put them NEWSOURCE-JUN10:Heidi

8/5/10

12:57 PM

Page 1

The Triangle Physician 2012 Editorial Calendar

May

Do They Like What They See?

Orthopedics – Medical Insurance

June

Neurology – Sleep Apnea

Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.

July

New Imaging Technologies Electronic Medical Records

August

Our services range from consultation, to design, to creation and implementation of strategic plans.

Digestive Disease Computer Technologies

September

Sports Medicine – Physical Therapy

October

Breast Cancer Reconstructive Surgery

newsource & Associates

November

Urology – Robotic Surgery

December

Pain Management

Call (540) 650-3686 or send inquiries to hketler@verizon.net.

Our network of smart, creative, award-winning specialists serves the health care industry throughout the Mid-Atlantic.

Maybe it’s happiness in a child’s eyes. Whatever the desired outcomes, count on us to ensure your key messages have the 20/20 clarity to deliver.

april 2012

27

News

$7 Million Invested in ED Upgrades Durham Regional Hospital is investing more than $7 million to build a new Emergency Department entrance, create a separate outpatient entrance and renovate women’s services.

“Our goal is to improve the hospital experience

Welcome to the Area

Physicians Stephen D. DeMeo, DO

Pediatrics Duke University Division of Neonatology, Durham

Adam L Dore, DO

Internal Medicine Thurston Arthritis Research Center, Chapel Hill

Yasmina Laura Abajas, MD Pediatric Hematology-Oncology Univ of North Carolina Hosps - Department of Pediatric Hematology-Oncology Chapel Hill

Brian Douglas Alder, MD

Hillary Elizabeth Lockemer, MD

Pediatric Endocrinology Children’s Diabetes & Endocrinology, Raleigh

Andrew David McWilliams, MD

Hospitalist, Internal Medicine, Pediatrics University of North Carolina Hospitals, Chapel Hill

Mathew Robert Meeneghan, MD

Hematology and Oncology, Internal Medicine University of North Carolina Chapel Hill

Jay Jeffrey Meyer, MD

Galbraith, chief hospital operations and business

Ophthalmology Duke University Hospitals Durham

development officer. “These renovations to our

Christopher Lee Alley, MD

Anthony Obiesie Okobi, MD

for our patients and their loved ones,” said Katie

facility will help us do that.”

Pathology Duke University Hospitals Durham

Renovations to women’s services (The Birth

Andrea Cyr Archibald, MD

Place) on the hospital’s fourth floor began this month. When finished, there will be a new patient reception area, and all patient rooms will be upgraded with new furniture and amenities.

In late 2012, a dedicated area for outpatient

Internal Medicine Duke University Hospitals Durham

Fernando J. Boschini, MD Radiology University of North Carolina Hospitals, Chapel Hill

Jeffrey Melson Clarke, MD

services and pre-operative testing, will open. “Our

Hematology and Oncology, Internal Medicine Duke University Hospitals Durham

new outpatient entrance is designed to provide

Alexis Anne Dieter, MD

services,

including

radiology

and

imaging

one-stop shopping for our patients,” Ms. Galbraith said.

Obstetrics and Gynecology Duke University Hospitals Durham

John Wesley French, MD

It will feature its own dedicated parking lot, so patients coming for an outpatient service, such as a mammogram or computed tomography scan, can park right outside the entrance. The area also includes a new pre-operative screening suite with six exam rooms, for completion of blood work and other tests prior to surgery.

The ED project, which is expected to be complete this summer, will create a new entrance with a distinct security screening and check-in area, along with a more patient-friendly waiting area.

The project also includes the relocation of triage rooms around a single treatment hub, as well as implementation of a new video surveillance system for enhanced security.

Visit durhamregional.org/progress for the latest construction

updates

Hospital.

28

The Triangle Physician

at

Durham

Regional

Ophthalmology Carolina Eye Associates Southern Pines

Natalee S. French, MD Pediatrics Sandhills Pediatrics Southern Pines

Elsje Harker, MD

Anesthesiology University of North Carolina Hospitals, Chapel Hill

Brian T. Kazienko, MD Cardiology, Vascular and Interventional Radiology VAC of Durham, Durham

Jason Paul Kimball, MD Hospitalist, Internal Medicine Eagle Hospital Physicians Henderson

Daniel Bryce Landi, MD

Pediatric: Allergy, Pulmonology, Gastroenterology, HematologyOncology, Infectious Diseases, Nephrology, Rheumatology, Cardiology, Critical Care Medicine Duke University Hospitals Durham

Ophthalmology Duke Eye Center, Durham

Durham

Himanshu Pravinchandra Parikh, MD Internal Medicine Himanshu P. Parikh, MD, PC Cary

Milton Bruce Shields, MD Ophthalmology Open Door Clinic, Burlington

John Matthew Sleesman, MD Raleigh

Lydia Li Ern Teh Snyder, MD

Pediatric Endocrinology; Pediatrics University of North Carolina Hospitals, Chapel Hill

Thomas John Sutton, MD Pediatrics Jeffers Mann & Artman Pediatric & Adolescent Medicine, Raleigh

Megan C. Swan, MD

Emergency Medicine - Hospice and Palliative Medicine Durham

Jennifer Orr Vincent, MD Pediatrics University of North Carolina Hospitals, Chapel Hill

Glenn Chung-Wing Yiu, MD

Caitlyn Molino Patrick, MD

Ophthalmology Duke Eye Center, Durham

Loren Del Mar Pena, MD

Physician Assistants

Internal Medicine University of North Carolina Hospitals, Chapel Hill

Pediatrics; Clinical Genetics (MD) Duke University Dept of Pediatrics, Durham

Kathryn Lynn Pepple, MD Ophthalmology Duke University Hospitals Durham

Nam-Kha Nguyen Pham, MD

Anesthesiology, Pain Medicine and Management Duke University Hospitals Durham

Feraz Najmi Rahman, MD

Kathryn M. Godly, PA

Addiction Medicine, Infectious Disease, Integrative Medicine Holly Springs

Kane Daniel Morgan, PA

Family Practice, Sports Medicine, Aerospace Medicine, Emergency Medicine Southern Pines

Jessica ONeill, PA

Nephrology, Internal Medicine, Geriatrics, Hospitalist, Family Medicine Raleigh

Radiology; Diagnostic, Vascular and Interventional Radiology University of North Carolina Hospitals, Chapel Hill

Therese Ann Piacente, PA

Jay Suman Raval, MD

Michael Don Vogele, PA

Blood Banking/Transfusion Medicine; Clinical Pathology University of North Carolina Department of Pathology Chapel Hill

Kristen Marie Rezak, MD

Plastic & Reconstructive Surgery Chapel Hill

Thomas J. Richard, MD Hematology/Oncology, Internal Medicine Southern Pines

Marian Alice Rollins-Raval, MD

Hematology Pathology, Anatomic and Clinical Pathology UNC Department of Pathology Chapel Hill

Cardiovascular Surgery Rex Cardiovascular Surgery Raleigh Vascular Surgery Durham VA Medical Center Durham

Richard Conrad Westmoreland, PA

Emergency Medicine; Family Medicine; Family Practice (and OMT) 245 Heather Lane Southern Pines

Brittany Walker White, PA Emergency Medicine, Sports Medicine, Family Practice, Orthopedic Surgery, Adult Reconstructive Triangle Orthopaedic Associates Durham

“More than a doctor.

Like a friend.”

We know it by heart.

Trust.

WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it.

We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution.

And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.

Cardiovascular Professionals in Johnston, Wayne and Wilson Counties Mateen Akhtar, MD, FACC Benjamin G. Atkeson, MD, FACC Kevin R. Campbell, MD, FACC Randy A.S. Cooper, MD, FACC Christian Gring, MD, FACC

Matthew A. Hook, MD, FACC Eric M. Janis, MD, FACC Diane E. Morris, ACNP Ravish Sachar, MD, FACC Nyla Thompson, PA-C

Waheed Akhtar, MD, FACC Malay Agrawal, MD, FACC Sunil Chand, MD, FACC Paul Perez-Navarro, MD, FACC Joel Schneider, MD, FACC

Cardiovascular Services Echocardiography Nuclear Cardiology Interventional Cardiology Carotid Artery Interventions Cardiac Catheterization Cardiac CT Angiography and Calcium Scoring Electrophysiology and Cardiac Arrhythmias Peripheral Vascular Interventions Pacemakers / Defibrillators Stress Tests Holter Monitoring Lipid and Anti-Coagulation Clinics Vascular Ultrasounds / AAA Screening

WHV Locations in Johnston, Wayne and Wilson Counties 910 Berkshire Road Smithfield, NC 27577

2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520

2605 Forest Hills Road South West Wilson, NC 27893

2400 Wayne Memorial Drive, Suite A Goldsboro, NC 27534

Phone: 919-989-7909 Fax: 919-989-3147

Phone: 919-359-0322 Fax: 919-359-0326

Phone: 252-243-7049

Phone: (919) 736-8655 Fax: (919) 734-6999

When it comes to your cardiovascular care – We know it by heart.

To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).

©2012 Wake Radiology. All rights reserved. Radiology saves lives.

Are Tired Legs Holding Your Patients Back?

Scan now to set up your vein therapy consultation with your smartphone.

To access, you may use any QR Reader App for your smartphone or iPod Touch (use AT&T Reader).

FREE CONSULTATIONS FOR MEN AND WOMEN

Think of the decisions your patients make in life based on how fatigued their legs are. Many men and women are affected by the discomfort and unsightly appearance of varicose veins; fortunately, advances in vein therapies allow us to offer your patients new choices and relief. Most of our treatments, including spider vein therapies, are minimally invasive or laser-based, have little or no downtime and are performed in our convenient outpatient setting.

Wake Radiology’s comprehensive approach to vein therapy is unlike others around. Our skilled interventional physicians have training and expertise in minimally invasive vein treatments, evaluating each patient personally and discussing the best treatment plan for their unique situation.

There are trails to be explored, beaches to be combed, and greenways to be enjoyed—so help your patients stop thinking about their tired legs and start thinking about what they want to do. Call us or go online to request a free consultation where we’ll help your patients determine how they can step back into great-feeling legs.

Wake Radiology. Making tired legs a thing of the past.

You or your patient can request a free consultation online today at wakerad.com Wake Radiology Cary | 300 Ashville Avenue, | Cary, NC 27518 | 919-854-2180 | wakerad.com