F e b rua ry / M a rc h 2 015
Duke Triangle Heart Associates
Specialty Clinic Values Sense of Community Along with Quality Care
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Also in This Issue
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COVER STORY
6
Duke Triangle Heart Associates Specialty Clinic Values Sense of Community Along with Quality Care
F e b r u a r y / m a r c h 2 0 15
FEATURES
10
Practice Management
Strategic Business Planning Critical for Success in Challenging Market Margie Satinsky explains the necessary components and desired outcomes – enhanced financial performance among them. .
14
Vol. 6, Issue 2
DEPARTMENTS 12 Gastroenterology
15 Rex Healthcare News
Meditation and the Quest to Reduce Stress and Improve Quality of Life
Steve Burriss Is Named Interim President
16 Duke News
- Califf Named Deputy FDA Commissioner - Raleigh Neurology Associates Enrolls 100th Patient in Study to End MS
18 UNC Research News
Women’s Health
Doctor-Patient Communication II: Observations on an Effective Approach
Genomic Changes of Head and Neck Tumor-HPV Link Identified
19 UNC News
Horizons Treatment Program Awarded $1 million Challenge Grant
20 UNC News
Partnership with Women’s Group in Greensville to Control IVF Costs
Dr. Andrea Lukes explores the personal and
20 News
professional journey that has led her to embrace
Welcome to the Area
meditation as a valuable life tool. COVER PHOTO: Members of the medical staff at Triangle Heart Associates are, from left: (front row) Elizabeth Henke, M.D.; Deborah Smith, F.N.P.-C.; John Stewart Jones, D.O; Jennifer Peifer, P.A.-C.; Michael Komada, M.D.; and (back row) Robin Mathews, M.D.; Matthew Brennan, M.D.; Timothy Donahue, M.D.; Eric Moore, M.D.; and Benjamin Conway, M.D.
2
The Triangle Physician
Ten years ago, Durwood Stephenson returned from vacation feeling great. He had enjoyed playing a lot of tennis and was running a mile each day. He went to a scheduled physical checkup with his family doctor, who suggested that it might be good, at his age, to have a stress test just as a precautionary measure. The morning after the stress test at Johnston Health, his cardiologist called him and said he needed to have a catheterization immediately. The heart catheterization revealed that, in spite of his active, healthy lifestyle, he had four major blockages - damage related to his having diabetes. This mandated a quadruple bypass surgery followed by intensive cardiac rehabilitation.
“I am grateful for my doctor being so proactive, even when I saw no need for concern,” says Durwood. “All of my doctors agreed that, if I had not been moved in this direction, I would very likely have had a fatal heart attack within four months - I might never have known Ava, my four-year-old granddaughter! I am also thankful that Johnston Health had such an excellent cardiopulmonary rehab program so close to home. I took their directions and advice to heart and gave my best to their prescribed treatment. We were able to really turn things around. Their cardiac rehab and my hard work accomplished my goals. I feel great. I am back, active and living life to its fullest - and enjoying its sweetness!”
Healing Neighbors.
It’s What We Do. It’s Who We Are!
www.johnstonhealth.org
CLAYTON 2138 NC Hwy. 42 W.
919-585-8000
SMITHFIELD 509 N. Bright Leaf Blvd.
919-934-8171
From the Editor
Celebrating Connections
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
This month we spotlight matters of the heart within Triangle Heart Associates, a well-established practice that counts as a measure of its success a strong connection with the surrounding community. Today, Triangle Heart Associates also celebrates its connection with the premier Duke Heart Center, further strengthening its continued presence in a changing health care era.
Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Douglas Drossman, M.D. Margie Satinsky, M.B.A. Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.
Read more about Triangle Heart Associates, its multidisciplinary range of diagnostic and treatment services and its accomplished medical staff on page 6.
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In this February issue, three contributors return to reinforce their
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News and Columns Please send to info@trianglephysician.com
Obstetrician gynecologist Andrea Lukes writes about the power of meditation as a way to minimize stress. Gastroenterologist Douglas Drossman offers a more effective physician-patient dialogue in contrast to the one he shared in the last issue of The Triangle Physician. Practice management consultant Margie Satinsky gives guidance on successful business planning to maximize opportunities and minimize risks. The Triangle Physician also celebrates community connections. Each issue reaches more than 9,000 Triangle medical professionals, making it a costeffective vehicle for sharing news and insight â&#x20AC;&#x201C; at no charge! Imagine the impact of a cover story on your practice and advertising that reinforces the qualities that distinguish you within the medical community. Rates are competitive. For more information and to submit editorial content and advertising, contact
The Triangle Physician is published by: New Dally Design Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
Every precaution is taken to insure the accuracy of the articles published. The 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.
info@trianglephysician.com.
All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography.
With great appreciation for all you do,
Any copyrights are waived by the advertiser.
Heidi Ketler
No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.
Editor
4
The Triangle Physician
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Cover Story
Duke Triangle Heart Associates Specialty Clinic Values Sense of Community Along with Quality Care Along with diverse and patient-centered physicians and state-of-the-art testing, Duke Triangle Health Associates is proud of its sense of community. Add convenient locations to the mix and you’ve got a winning formula for longevity. These distinct qualities help explain why in more than 35 years and amid a changing health care climate, Triangle Heart has sustained its position as a leading practice that patients rely on. Triangle Heart Associates provides state-ofthe-art cardiac care to help heart patients lead longer, healthier lives.
The private diagnostic department waiting room has a welcome, reassuring feel.
“We are dedicated to making sure that pa-
“Every day, I feel fortunate that I get to
and deal with the hassles of parking and ev-
tients have the most positive health care
work with such a broadly talented team of
erything else that entails, when we’re able
experience possible,” says heart rhythm
providers that we have here,” says Dr. Do-
to offer the same services here.”
specialist Tim Donahue, M.D.
nahue. “We’ve tried to align our growing team of physicians, so that we are able to
One of the region’s long-standing practices,
Ever-expanding and evolving, Triangle
provide a comprehensive approach in all
Triangle Heart Associates also takes special
Heart Associates has been comfortably
facets of cardiac care.”
care to preserve its community practice feel, while maintaining the ties to the nation-
growing into its custom, two-year-old clinic
ally known Duke University Health Systems.
in Croasdaile Commons, a Duke Health
Triangle Heart’s outpatient cardiac testing
Systems complex located just north of I-85
department is easily accessible, making
and NC-147 on Hillandale Road in Durham.
it ideal for patients. Outpatient testing in-
“The physicians and staff are proud to be in
In close proximity to both Duke Regional
cludes transthoracic echocardiography and
the Duke family, but we’ve always wanted to
Hospital (formerly Durham Regional Hospi-
all forms of stress testing, such as nuclear
convey a small, personal clinic atmosphere
tal) and Duke University Hospital, Triangle
cardiac imaging. Both the echocardiogra-
that Triangle Heart Associates has been
Heart is conveniently located for patients
phy and nuclear imaging laboratories have
known for all these years,” says Elizabeth
from all corners of the Triangle.
maintained IAC (Intersocietal Accreditation
Henke, M.D., a partner with the practice for
Commission) status.
nearly 30 years.
gists at Triangle Heart Associates – a part of
“We’re proud to offer multiple imaging op-
Complementary Cardiac Services
Duke Heart Center – delivers high-quality,
tions to continually evaluate our existing pa-
Triangle Heart Associates specialists offer
comprehensive evaluation and treatment
tient group and to newly diagnose cardiac
offers complete diagnostic and manage-
services to patients with a broad range of
issues for local referring physicians,” says
ment services and the most advanced
cardiovascular conditions.
Stewart Jones, D.O. “The patients really ap-
technology available.
The experienced team of eight cardiolo-
preciate not having to go in to the hospital
6
The Triangle Physician
Here is a list of consultative, interventional
“We offer both medical and invasive (abla-
maintains an active public health research
and preventive cardiology services offered:
tion) management of cardiac arrhythmias.
career to help advance the care of patients
• Noninvasive cardiovascular imaging,
We also implant and manage all available
with both coronary and valvular heart dis-
including echocardiogram, stress
types of pacemakers and defibrillators,”
ease, including grant funding from the Unit-
echocardiogram, nuclear imaging and
says Dr. Donahue, who specializes in car-
ed States Food and Drug Administration,
coronary computed tomography*
diac electrophysiology. “All of our invasive
the Patient Centered Outcomes Research
• Exercise stress testing
procedures are done in the Electrophysiol-
Initiative and the Burroughs-Wellcome
• Diagnostic cardiac catheterization*
ogy Laboratory at Duke Regional Hospital.”
Fund. He is board certified in cardiovascular medicine.
• Balloon angioplasty and stent placement* • Monitoring of patients taking warfarin
Meet Triangle Heart
• Implantation* and management of pace-
Associates Physicians
Benjamin J. Conway, M.D., Cardiologist
The Triangle Heart Associates medical team
Maintaining a full-time practice in consulta-
• Electrophysiologic testing and ablation
encompasses a broad range of specialized
tive cardiology and cardiovascular imaging,
• Risk-factor monitoring
expertise to assure high-quality, compre-
Dr. Conway enjoys working closely with his
• Guidance with lifestyle modification
hensive evaluation and treatment for cardio-
patients to understand their cardiovascular
vascular conditions.
condition, so they can manage it with clarity
makers and defibrillators
and confidence. He also finds time to nour-
*All surgical procedures are conducted at Duke Regional Hospital.
J. Matthew Brennan, M.D., M.P.H.
ish a passion for medical informatics and
Interventional Cardiologist
has been closely involved in the deploy-
These are the cardiovascular conditions for
Dr. Brennan’s practice focuses on the care
ment of Duke Maestro Care, the system’s im-
which Triangle Heart provides evaluation
of patients with complex coronary artery
plementation of the Epic Electronic Health
and management:
disease and those with valvular heart dis-
Record. Dr. Conway is board certified in
• Acute and chronic coronary artery
ease. As a Duke-trained interventional car-
cardiovascular disease, nuclear cardiology
diologist, Dr. Brennan incorporates both
and echocardiography. He finished his resi-
• Congestive heart failure
cutting-edge radial and femoral techniques
dency at Brown University in Providence,
• Valvular heart disease
for the care of his patients. He is dedicated
R.I., and his cardiology fellowship at Maine
• Cardiac rhythm and conduction distur-
to the belief that while the cornerstone of
Medical Center in Portland, Maine.
disease
bances
21st century cardiovascular care must be
• Peripheral vascular disease
grounded in a solid understanding of mod-
Timothy P. Donahue, M.D.
• Peripheral artery disease
ern evidence and technologies – every pa-
Electrophysiologist
• Heart disease in women
tient is unique, and each patient’s treatment
Joining the practice six years ago, Dr. Do-
• Lipid management
plan should reflect that individuality. In ad-
nahue specializes in cardiac electrophysi-
dition to his clinical practice, Dr. Brennan
ology. His scope of practice includes the diagnosis and treatment of all types of heart rhythm disorders, including atrial fibrillation, supraventricular tachycardia (SVT) and ventricular tachycardia. “We offer both medical and invasive (ablation) management of cardiac arrhythmias. We also implant and manage all available types of pacemakers and defibrillators. All invasive procedures are done in the Electrophysiology Laboratory at Duke Regional Hospital.” Elizabeth Henke, M.D., Cardiologist For the last three decades Dr. Henke has served the community as a consultant cardiologist. She is one of a few women in the field of cardiology, and she did her original
The Triangle Heart Associates’ diagnostic department is equipped with the latest technology, including this nuclear cardiology SPECT (single-photon emission-computed tomography) gamma camera.
training in Britain. She completed a residency in internal medicine and a fellowship in February/March 2015
7
and policy. He is working to help the clinic navigate an ever-changing health care environment while maintaining a practice that is highly focused on patients and their needs. Jennifer Peifer, P.A.-C. Physician Assistant Jennifer Pfeifer enjoys assisting patients with both the primary prevention of cardiovascular disease and with the chronic management of cardiovascular disease. Deborah D. Smith, F.N.P.-C. The practice nursing station is where a dynamic array of patient care and operational functions is performed.
Nurse Practitioner Deborah Smith has been practicing nursing
genetics at the University of North Carolina
ship at the Wake Forest University School
for more than 25 years in cardiology, critical
at Chapel Hill, followed by a fellowship in
of Medicine in 2004. Dr. Komada is board
care and emergency medicine. She focused
cardiology at Duke. Her areas of interest in-
certified in cardiovascular disease, interven-
on community-oriented practice at UNC,
clude general cardiology and echocardiog-
tional cardiology and nuclear cardiology.
where she received her family nurse prac-
raphy, as well as the manifestation and treat-
titioner master degree. She has published Robin Mathews, M.D., Cardiologist
several articles and book chapters on acute
Dr. Mathews completed his residency and
coronary syndromes. She has a passion for
J. Stewart Jones, D.O.
cardiology fellowship at the State University
empowering her patients as active partners
Interventional Cardiologist
of New York prior to relocating to Durham
in their cardiovascular health.
Dr. Jones chooses a holistic approach to
to pursue training as an American Heart As-
cardiovascular care. He’s a Michigan State
sociation cardiovascular outcomes fellow
Physician Referrals Are Welcome
College of Osteopathic Medicine graduate
at Duke University. He is a general cardi-
Patients also enjoy free, onsite parking and
with continued cardiovascular training as
ologist with experience in management of
attentive, customer-focused office staff.
a heart failure/transplant fellow at the Uni-
acute and chronic cardiovascular condi-
Hours of operation are Monday through
versity of Pittsburgh, as a general cardiolo-
tions, such as prevention. In addition to his
Thursday, 8:30 a.m. to 5 p.m.; and Friday,
gist at the University of Missouri at Kansas
clinical practice, he maintains an interest in
8:30 a.m. to 4 p.m. To make an appointment,
City St. Luke’s Hospital and as an interven-
cardiovascular outcomes in acute coronary
call (919) 220-5510. If necessary, patients are
tional fellow at the Iowa Heart Center in Des
syndrome and health policy. Dr. Mathews
asked to cancel or reschedule their appoint-
Moines, Iowa. He has extensive experience
is board certified in cardiovascular disease
ment at least 24 hours in advance.
in cardiac catheterization, angioplasty/stent
and nuclear cardiology.
ment of cardiac disease in women.
procedures, peripheral vascular disease
Triangle Heart is connected to Duke’s state-
management, hypertension/high choles-
Eric S. Moore, M.D., M.B.A., M.P.H.
of-the-art electronic medical records sys-
terol risk factor modification and nuclear
Cardiologist
tem, which coordinates care for Duke-affil-
cardiology and interventions. Dr. Jones is
Dr. Moore joined Triangle Heart seven years
iated practices. Patients also have access to
board certified in general cardiology and in
ago after finishing his fellowship at Virginia
Duke MyChart, an online patient portal that
nuclear cardiology. At Duke Regional Hos-
Commonwealth University. His areas of in-
allows them to see their test results, request
pital, he serves as chair of medicine and the
terest include echocardiography and nucle-
prescription refills, schedule appointments
Hospital Peer Review Committee.
ar cardiology, but his greatest interest lies in
and communicate with their Duke provider.
direct interaction with patients. He strives to Michael R. Komada, M.D.
teach his patients about cardiovascular dis-
Triangle Heart Associates’ medical records
Interventional Cardiologist
ease, so they can understand their therapy
can be reached at (919) 220-6536. The front
Dr. Komada graduated from Wake Forest
and be active participants in the manage-
desk number is (919) 317-1553.
University School of Medicine in 1993. He
ment of their chronic conditions. He also
completed his internal medicine residency
holds a master of business administration
Triangle Heart Associates is located at
at the University of Virginia Hospitals in 1996
degree and a master of public health de-
1821 Hillandale Road, Suite 25C, in
and his cardiovascular medicine fellow-
gree focusing on health care organization
Durham 27704.
8
The Triangle Physician
www.kendallmurphyphotography.com kendall@kendallmurphyphotography.com Maternity
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Business Professionals
6/10/14 9:24 PM
Practice Management
Strategic Business Planning Critical for Success in a Challenging Market
By Margie Satinsky, M.B.A.
The business of medicine is more chal-
force members to collaborate in set-
lenging than ever. Throughout the coun-
ting the practice’s future direction.
try, physicians are experiencing organi-
• It allows the practice to set priorities.
zational changes in the delivery system,
Everything can’t be done simultane-
reimbursement for demonstrated value
ously, so determine a sensible order.
rather than quantity of care, enhanced
• Clarity of focus can improve patient
technology and an ever-changing regula-
care.
tory environment. Strategic business plan-
• By no means the least important rea-
ning is more important than ever. Here’s
son, strategic business planning offers
our advice on why it’s important and how
the potential for enhanced financial
to do it successfully.
performance.
Margie Satinsky is president of Satinsky Consulting L.L.C., a Durham consulting firm that specializes in medical practice management. She’s the author of numerous books and articles, including Medical Practice Management in the 21st Century. For more information, visit www.satinskyconsulting.com. • Values: What’s important to your prac-
Why bother with strategic
How does the strategic business
business planning?
planning process work?
tice, and do you deliver care, interact
Imagine building a house without a blue-
The strategic business planning process
with patients and colleagues and man-
print or taking a family vacation without a
is straightforward, regardless of whether
age your workforce in ways that are
destination. Your practice is no different.
you are a medical practice or a corner
consistent with those values?
Without a formal process to identify your
store. Start with an honest assessment of
• Goals: What are the practice’s specific
mission, values, goals, projects, timing,
all aspects of your current practice by ask-
goals with respect to organization and
barriers, opportunities and strategies, you
ing these types of questions of all owners,
management, financial management,
are likely to miss good opportunities and
senior managers, and other workforce
human resources, marketing, informa-
make serious and expensive mistakes.
members:
tion technology, operations, quality
• Mission: Is your mission statement
initiatives and compliance? Have the
What are the potential benefits of
current, and does it accurately reflect
owners and senior managers reached
strategic business planning?
the practice’s direction for the next
consensus on those goals? What prog-
A well-structured strategic business plan-
5-10 years?
ress have you made/not made toward
ning process can help your practice in many ways. • It provides clear direction, preventing the haphazard occurrence of activities that may actually work against each other. • It creates a blueprint for consistent practice growth and development. • It offers an opportunity for practice owners, managers and other work-
10
The Triangle Physician
Following the interviews and data gather-
who will participate in the process. For
• Projects: Within each category listed
ing, direct the consultant to aggregate the
example, we spent many more hours
under goals, what projects are on your
responses to the questions. Schedule an
working with an eight-physician cardiol-
to-do list, and in what priority order?
off-site strategic planning retreat (either
ogy practice considering acquisition by
What’s the estimated cost of each proj-
one half day or an entire day).
a health care system than we did with a
reaching the goals?
four-person internal medicine practice
ect? Do workforce members have the ability and time to do what’s on your
Following the retreat, ask the consultant
wrestling with ways to improve access to
list?
to summarize the results for the practice.
patient care.
egies for each project: Be honest
What’s the cost of strategic
The more important question about cost
about the hurdles, opportunities and
business planning?
is what’s the cost of not engaging in stra-
ways to get where you want to go. Two
The cost for externally facilitated strategic
tegic business planning? It might be far
barriers that often impede progress
business planning depends on the size of
more than what you would pay to have it
are lack of staff time to do a project or
the practice and the number of people
done!
• Barriers, opportunities and strat-
lack of internal skill to do something that’s not been done before.
Who should be involved in a strategic business planning process? We recommend strong internal involvement and external facilitation by an experienced professional. Internally, greater involvement by owners, senior managers and other workforce members is likely to result in better buy-in to the end result. External facilitation has many advantages over internal facilitation. In any practice there are likely to be differences of opinion, and someone outside the organization can best guide the discussion. An experienced external facilitator can also bring to the table lessons learned from other similar engagements. What are typical steps in strategic business planning that is facilitated by an external consultant? Assuming your practice has decided to engage an external consultant, begin by clarifying the scope of the engagement. Next, collaborate with the consultant to develop a standard list of questions that can be asked of key individuals in face-toface or telephone interviews. Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
February/March 2015
11
Gastroenterology
Doctor-Patient Communication, Part 2:
Observations on Ineffective Approach To conclude this two-part series, we will dis-
out to eat, and I just got this job, and I’m just
cuss a more effective approach to the same
worried. At home, I just don’t feel I’m doing a
physician-patient encounter.
good job there either. My kids are great, you know, they help out and all but … I just don’t
Situation
know. ”
Ms. Simpson is a 38-year-old woman with
Doctor: “I can really see how this is affecting
several years of abdominal pain and bowel
your life.”
difficulties. Blood studies, barium enema and
Patient: “Sometimes I feel like no one under-
computed tomography have been negative.
stands.”
She has been on numerous medications, in-
Doctor: “It’s got to be hard when people don’t
cluding antispasmodics, fiber, probiotics and
really understand what you’re going through.
antibiotics without benefit. She is depressed
So what do you think is going on? ”
and frustrated and asks her doctor for a sec-
Patient: “I don’t know. I have been reading
ond opinion.
on the Internet, and it seems there are other people that have the same symptoms, and
New Physician Interview
they call it ‘irritable bowel syndrome.’”
Doctor: “Hi, Ms. Simpson, I’m Dr. Drossman.
Doctor: “Yes, irritable bowel is a possibility,
How can I help you?”
and if that’s what you have, I want to be sure
Patient: “Well, I came back from vacation,
you get the right information. You know, there
and I got a flare up of whatever it is I have…
is a lot of research going on now to help find
stomach pain, nausea, diarrhea, fatigue. I just
better ways to treat that condition. So these are
got this new promotion at work to floor super-
one of the things we’d be thinking about. We
visor, and then all this happened.
want to do some other tests and then we can take it from there. Well, this has certainly been
“It started with the muscle ache and then fa-
helpful. So what I’d like to do is a physical ex-
tigue, and then I started getting queasy and
amination, and then we’ll come back and take
having pain. It was worse after I ate. It was kind
it from there.”
of like a stomach virus. I felt warm. I didn’t take
By Douglas Drossman, M.D.
Dr. Douglas Drossman graduated from Albert Einstein College of Medicine and was a medical resident and gastroenterology fellow at the University of North Carolina. He was trained in psychosomatic (biopsychosocial) medicine at the University of Rochester and recently retired after 35 years as professor of medicine and psychiatry at UNC, where he currently holds an adjunct appointment. Dr. Drossman is president of the Rome Foundation (www.theromefoundation.org) and of the Drossman Center for the Education and Practice of Biopsychosocial Care (www. drossmancenter.com). His areas of research and teaching involve the functional GI disorders, psychosocial aspects of GI illness and enhancing communication skills to improve the patient-provider relationship. Drossman Gastroenterology P.L.L.C. (www. drossmancenter.com) specializes in patients with difficult-to-diagnose gastrointestinal disorders and in the management GI disorders, in particular severe functional GI disorders. The office is located at Chapel Hill Doctors, 55 Vilcom Center Drive, Suite 110 in Chapel Hill. Appointments can be made by calling (919) 929-7990.
So, while we are working on your symptoms,
my temperature, so I don’t know for sure, but it
After the Physical Exam
I’d like to have Dr. Johnson, who is a colleague
definitely felt like it was getting worse.
Doctor: “I can see that you’ve had two exten-
of mine and a psychologist, help you develop
sive medical evaluations, and between that
coping strategies to help you get back to a
“I went to see Dr. Jones, and I asked him what
your symptoms haven’t changed any. So from
more normal lifestyle. ”
he could do to help me. He thought I should
our medical evaluation, I do believe you have
Patient: “But you’ll still see me too, right?”
see you.”
irritable bowel syndrome. I’d like to work on
Doctor: “Yes, of course. Dr. Johnson will be
Doctor: “Tell me more about the symptoms,
managing your symptoms rather than doing
part of our health care team, and we’ll focus
like what makes it better or worse?”
other tests that may not be necessary.”
more on the medical management.
Patient: “Well it’s definitely better after a bow-
Patient: “So, what do we do?”
el movement, and it’s worse after I eat or when
Doctor: “Well there is no magic pill, I think
In that regard, you’ve been on a lot of medi-
I’m upset. I’m really starting to worry about
you know that, but we can work on this. I can
cines that haven’t been very effective. I think
this.”
see that these symptoms have had more ef-
we should consider something that might
Doctor: “I see.”
fects than just the pain. This affected your qual-
work a little bit better for you. It’s a type of anti-
Patient: “I don’t feel like I can work out or go
ity of life, your relationship with others.
depressant that helps with pain.”
12
The Triangle Physician
NEWSOURCE-JUN10:Heidi
8/5/10
12:57 PM
Page 1
Patient: “Do you think I’m depressed?” Doctor: “What are your thoughts about that?” Patient: “Well… maybe, because of the symptoms? Doctor: “Well, you know medications have different effects. Aspirin, for example, can
Do They Like What They See?
be used to treat pain, but it also can prevent Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.
a heart attack. Antidepressants are similar in that in addition to treating depression, they can actually act as pain modulators. They can block pain signals going from the gut to the brain. In blocking the pain, they can raise your
Our services range from consultation, to design, to creation and implementation of strategic plans.
pain threshold. That’s in addition to, helping with depressive symptoms, if you are having those as well. “But whatever you decide, we’ll be working together on this to modulate your symptoms and get you to a better place.” Patient: “Okay. I’ll give it a try. Thanks, doc-
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strate effective communication skills. The interview method was facilitative; the doctor gave the patient the opportunity to tell her story in her own way. He expressed empathy for her concerns and validated her beliefs. Education was provided as part of the dialog, as he asked for the patient’s ideas. The doctor listened actively; his questions and responses were based on what the patient said rather than any personal agenda. After the physical exam, the doctor summarized his observations, affirmed the diagnosis of irritable bowel syndrome, and recommended the psychologist as part of a team approach to care. He recommended the antidepressant as a way to treat the pain and he offered to work collaboratively and with an interest to continue the care in a partner-like relationship.
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Women’s Health
Meditation
and the Quest to Reduce Stress and Improve Quality of Life
By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.
I truly feel that being a physician is a privi-
to pray and focus on words that may bring
lege. It has allowed me to help many wom-
them closer to their god.
en, but I have learned so much from my patients.
Recently, I have come to admire a woman that I first met as a patient. As I listened to
For one thing, individuals respond so dif-
her during our first encounter, I realized
ferently to the many stresses in life. Be-
that Amanda May has an approach to life
cause of this, I have seen a spectrum of
that I value. She is both a yoga and medi-
ways to respond to stresses in life. Some
tation teacher. Learn more on her website
individuals ignore and shut out stresses,
kundalinibliss.com.
while others focus on the stress to the point that it overwhelms them.
As she purports on her website, she desires to help others bring the wisdom of
I was recently reminded of the importance
yoga, meditation and mindfulness into
of meditation when my sisters and I cared
a busy lifestyle. This can increase one’s
for our aunt who died from endometrial
peace, joy, vitality and health. I agree with
cancer. The practice of meditation can
Amanda that each of us can find wisdom,
help restore balance when life events chal-
peace and joy within ourselves.
lenge you. Amanda teaches meditation and yoga Meditation is of value to many different
classes locally and is working with
cultures worldwide. The meaning of medi-
Y.O.G.A. for Youth, a non-profit organiza-
tation is “continued or extended thought,
tion that provides local, at-risk youth with
reflection, contemplation” or “devout reli-
tools for self-discovery that “foster hope,
gious contemplation or spiritual introspec-
discipline and respect for self, others and
tion,” according to dictionary.com. Through
community.”
meditation, an individual can make a conscious effort to change how the mind works.
After earning her bachelor’s degree in religion from Duke University (1988), Dr. Andrea Lukes pursued a combined medical degree and master’s degree in statistics from Duke (1994). Then, she completed her ob/gyn residency at the University of North Carolina (1998). During her 10 years on faculty at Duke University, she cofounded and served as the director of gynecology for the Women’s Hemostasis and Thrombosis Clinic. She left her academic position (2007) to begin Carolina Women’s Research and Wellness Center. She and partner Amy Stanfield, M.D., F.A.C.O.G., head the Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals. Call (919) 251-9223 or visit www.cwrwc.com.
someone whom I respect and admire beyond measure. Although Catholic, she has
She also works with Communities in
meditated for many years.
Schools, a dropout prevention organizaMy first introduction to meditation was
tion, committed to surrounding local at-
Her emphasis regarding meditation is to
through Catholicism. The prayer beads or
risk students with a community of support,
keep it simple. As she explains, she uses
rosary of Roman Catholics has 54 beads
empowering them to stay in school and
meditation to “help quiet her thoughts.”
plus an extra five.
achieve in life. Specific outcomes include
Her preference is to do meditation in the
an increased level of physical fitness, in-
early morning by lighting a candle and
Prayer beads are used in many religions
creased ability to focus and concentrate
then focusing on her breathing and pay-
to help focus meditation. In Islam, the mis-
and increased stress-management tech-
ing attention to whatever thoughts come
baha has 99 beads and the tasbih has 33
niques in order to circumvent and reverse
to mind. Today, the simple act of lighting a
beads. The Hindus use a string of 108 or 27
problems.
candle centers her.
prayer beads as well. One does not need
Another patient, Pia Lapidus, has been a
Pia was introduced to meditation in the late
prayer beads to meditate, but it allows one
long-time and dear friend of mine. She is
1970s through a body scan visualization
beads. Both the Buddhists and Sikhs have
14
The Triangle Physician
Women’s Health technique to improve her performance as
daily life to train both her mind and body.
practice meditation is nurse practitioner
a competitive athlete. She played competi-
She describes being lost in her thoughts
Lindsay Wojciechowski, a lead consultant
tive tennis and was All Ivy at Princeton, and
and reflections during morning runs. This
to our Women’s Wellness Clinic. She has
impressively the No. 1 junior tennis player
focused time to herself allows her to mind-
been practicing meditation to help focus
in Asia. (She is from the Philippines.) She
fully and happily devote the rest of her day
her thoughts and become more mindful.
competed several times at Wimbledon as a
to her family, her full-time job, her friends
junior tennis player.
and those she encounters in her daily life.
Pia continues to use meditation in her
Another woman who is beginning to
I strongly recommend to my patients and friends that this very old practice can improve one’s quality of life.
Rex Healthcare News
Steve Burriss Is Named Interim President
Steve Burris
Steve Burriss, chief operating officer of Rex
executive leadership committee for Light the Night Walk, the board of
Healthcare, was named interim president. This
directors for the Cary Chamber of Commerce and the Healthcare Works
appointment follows the announcement that David
Coalition. He currently serves as the 2015 March of Dimes’ Triangle
Strong, president, is leaving to serve Orlando
March for Babies chairman and on the board of directors for the Greater
Health as its president and chief executive officer.
Raleigh Chamber of Commerce and the North Carolina Symphony.
“We are thrilled to have someone with Steve’s
Mr. Burriss earned a bachelor of science degree in business and a
ability, leadership and knowledge of Rex and our
master in business administration from Marshall University. He lives in
community lead our organization,” said Robert S. Thomas, chairman
Raleigh with his wife, Tina, and has two children in college.
of the Rex Board of Trustees. “The board has great confidence in Steve and the executive team to execute Rex’s initiatives currently under way, and future strategy and plans.” Mr. Burriss, 48, has served as chief operating officer at Rex Healthcare, an affiliate of UNC Health Care, since April 2012. He oversees all operations at the 660-bed organization, at six locations in Wake County, with more than 5,600 co-workers. Prior to his role as chief operating officer, Mr. Burriss served as senior
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vice president of operations and ambulatory services, managing a variety of areas, including Rex Cancer Center, heart and vascular
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services, physician services and ambulatory services. Under Mr. Burriss’ leadership, Rex added three new health campuses, two jointventure surgery centers and more than 150 physicians. Mr. Burriss joined Rex Healthcare in 1998 as director of human resources and was later promoted to vice president of human resources. He was named
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a “COO to Know” by Becker’s Hospital Review in 2013 and received recognition from the Triangle Business Journal as “40 Under 40.” During his tenure, Rex was highlighted as one of the Top 50 Hospitals in the U.S. by Becker’s Hospital Review. Mr. Burriss actively volunteers throughout the Triangle community.
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He served on the executive leadership team for the American Heart Association, the board for the Leukemia and Lymphoma Society, the
February/March 2015
15
Duke Research News
Califf Named Deputy FDA Commissioner Robert Califf, M.D., vice
ing for over 30 years with the many bright
During his career, Dr. Califf has led many
chancellor of clinical
and dedicated people in the Duke family
landmark clinical studies, and he is a na-
and translational re-
to help shape the future of medicine and
tionally and internationally recognized
search at Duke Univer-
public health.”
expert in cardiovascular medicine, health outcomes research, health care quality
sity School of Medicine and a global leader in
As deputy commissioner of the FDA, Dr.
cardiovascular
and clinical research.
medi-
Califf will provide executive leadership to
cine, clinical and trans-
the agency’s Center for Drug Evaluation
Dr. Califf has been a pioneer in the grow-
lational research and medical economics,
and Research, the Center for Biologics
ing field of translational research, which is
has been named deputy commissioner for
Evaluation and Research, the Center for
key to ensuring that advances in science
medical products and tobacco at the Unit-
Devices and Radiological Health and the
translate into medical care. He also has
ed States Food and Drug Administration.
Center for Tobacco Products.
played a pivotal role in the development
Dr. Califf begins his appointment at the
Dr. Califf will oversee the Office of Spe-
Centered Outcomes Research Network,
end of February.
cial Medical Programs in the Office of
which is designed to enhance the quality
Robert Califf, M.D.
and leadership of the national Patient-
the Commissioner, playing a critical role
and relevance of clinical evidence that is
“Dr. Califf has been a transformational
in providing high-level advice and policy
used to guide health decisions.
leader at Duke for 33 years, always work-
direction for the federal agency’s medical
ing to improve research and clinical care
product and tobacco priorities. He also
Dr. Califf was a member of the Institute of
to benefit patients at Duke and around
will manage crosscutting clinical, scientif-
Medicine (IOM) committees that recom-
the world,” said Nancy C. Andrews, M.D.,
ic and regulatory initiatives in several key
mended Medicare coverage of clinical tri-
Ph.D., dean of the Duke University School
areas, including orphan drugs, pediatric
als and the removal of the dietary supple-
of Medicine. “Recognized at Duke and
science and the agency’s advisory com-
ment ephedra from the market, and of the
among his colleagues nationally as a vi-
mittee system.
IOM’s Committee on Identifying and Preventing Medication Errors. He is currently
sionary committed to ensuring the safety and health of our global community, Dr.
At Duke, Dr. Califf has had many signifi-
a member of the IOM Policy Committee
Califf will bring a passionate commitment
cant roles. In addition to vice chancellor
and liaison to the Forum in Drug Discov-
to his new role with the FDA, just as he
of clinical and translational research, he
ery, Development and Translation.
has to his many roles at Duke.”
is currently director of the Duke Translational Medicine Institute and professor of
In addition, he has past experience with
“I am delighted to accept this role with
medicine in the Division of Cardiology at
the FDA serving as a member of the Car-
the FDA to work with its leaders and the
the Duke University School of Medicine.
diorenal Advisory Panel and on the Sci-
broader government agencies to improve
Dr. Califf previously served as the found-
ence Board’s Subcommittee on Science
public health by advancing the safety
ing director of the Duke Clinical Research
and Technology that reviewed the FDA in
and effectiveness of medical products,”
Institute, a premier academic research or-
2007, producing a report entitled “FDA Sci-
Dr. Califf said. “This position will allow
ganization, and is one of the top 10 most-
ence and Mission at Risk.”
me the opportunity to apply the insights
cited medical authors with over 1,200
I have gained from my experience work-
peer-reviewed publications.
Raleigh Neurology Associates Enrolls 100th Patient in Study to End MS Raleigh Neurology Associates recently
Carolina Research Campus in Kannapolis,
Raleigh Neurology partnered with Duke in
reached the 100-patient milestone for the
N.C., that is working to end multiple scle-
July 2014 to help recruit 1,000 people with
MURDOCK Multiple Sclerosis Study, a long-
rosis.
multiple sclerosis and 100 people with pri-
term research project based at the North
16
The Triangle Physician
mary progressive MS.
Duke Research News Simon Gregory, Ph.D.,
Although scientists have known about
3456. In the Durham area, call Ms. Maichle
is principal investiga-
multiple sclerosis for centuries, research-
at (919) 695-6413. In the Charlotte area,
tor for the MURDOCK
ers still do not understand how the disease
call (704) 250-5861 or visit www.murdock-
(Measurement to Un-
progresses and why certain people re-
study.org. This is not a drug study, so par-
derstand the Reclas-
spond to treatment while others do not. Dr.
ticipants will not receive any form of treat-
sification of Disease in
Gregory’s team wants to generate biomark-
ment. Enrollment takes about 90 minutes,
Cabarrus/Kannapolis)
ers – measurable molecular indicators in
and volunteers are compensated.
Study and associate
the body – that would allow researchers
professor at the Duke
to reclassify MS and lead to the develop-
Duke launched the MURDOCK Study in
Molecular Physiology Institute at Duke
ment of tests that physicians would use to
2007 with a $35 million gift from David H.
University School of Medicine. He and his
diagnose the disease and determine which
Murdock, founder and developer of the
team are working to identify the genetic un-
treatments are best based on a patient’s ge-
North Carolina Research Campus and
derpinnings of complex diseases like MS
netic profile.
chairman of Dole Foods. The MS study is
Simon Gregory, Ph.D.
one of several sub-studies of MURDOCK,
and understand disease development and progression at the molecular level.
Dr. Gregory’s work in genetics opened up
which aims to enroll 50,000 people in a
a new field of research into how the IL7R
community registry to identify links across
While Duke recruits MS patients at several
gene contributes to the development of MS
major diseases and disorders and find
locations in North Carolina, Raleigh Neu-
after he and his collaborators identified the
ways to treat and even defeat some of to-
rology is the only independent enrollment
gene’s association with the disease, forming
day’s leading causes of illness and death.
site for the MURDOCK Study and enrolls
the basis of ongoing study to understand the
The MURDOCK Study researchers are
between six and eight patients per week.
mechanism and signaling of IL7R.
working to improve treatments for heart disease, obesity, osteoarthritis, hepatitis C,
Together, Raleigh Neurology and Sarah
To learn more or start the enrollment pro-
osteoarthritis and Alzheimer’s, as well as
Maichle, the Duke clinical research coor-
cess, call Raleigh Neurology at (919) 782-
multiple sclerosis.
dinator who oversees enrollment of people with MS at the Duke
55 Vilcom Center Drive Boyd Hall, Suite 110 Chapel Hill, NC 27514
Drossman Gastroenterology PLLC a patient-centered gastroenterology practice focusing on patients with difficult to diagnose and manage functional GI and motility disorders. The office is located within the multidisciplinary health care center, Chapel Hill Doctors. Dr. Douglas Drossman is joined by physician’s assistant, Kellie Bunn, PA-C. Appointments are scheduled on Tuesday and Wednesday and most laboratory studies are available.
919.929.7990
www.drossmangastroenterology.com
Center for Living Campus in Durham, have recruited more than 200 study participants. Sarah Maichle
Total enrollment has
reached 659 people with multiple sclerosis and eight people with primary progressive MS. Volunteers contribute small samples of blood and urine and complete two questionnaires related to medical history, demographics and MS diagnosis.
Drossman Gastroenterology
Without a cure or diagnostic test, multiple sclerosis remains a mysterious and unpredictable disease affecting as many as 400,000 people in the United States who suffer symptoms ranging from numbness and tingling to blindness and paralysis. When someone has MS, his or her own immune system directs an abnormal response against the central nervous system.
February/March 2015
17
UNC Research News
Genomic Changes of Head and Neck Tumor-HPV Link Identified A study co-led by a University of North Carolina Lineberger Comprehensive Cancer Center researcher has identified genomic changes in head and neck cancers linked to the sexually transmitted disease HPV. This is the latest finding of a collaborative scientific effort designed to map out the genomic changes driving cancer. The Cancer Genome Atlas (TCGA) researchers analyzed the genomes of 279 head and neck cancer tumors. They identified subtypes of head and neck cancer based on their genomic characteristics, changes in smoking-related tumors, as well as genomic differences in head and neck cancer tumors linked to HPV, the most commonly sexually transmitted disease in the United States. The findings were published online Wednesday in the journal Nature. Researchers hope the findings will help lead to potential new therapies and the identification of markers that can help identify patients likely to respond to a particular therapy, as well as help direct the best course of treatment for patients. “The rapid increase in HPV-related head and neck cancers, noticeably in oropharyngeal tumors, has created an even greater sense of urgency in the field,” D. Neil Hayes, said D. Neil Hayes, M.D., M.P.H. M.D., M.P.H., senior author of the study report, an associate professor of medicine at the UNC School of Medicine and a member of UNC Lineberger. Oropharyngeal cancer starts in the oropharynx, which is the part of the throat behind the mouth. “We’re uncovering differences between tumors with and without HPV infection, and these new data are allowing us to rethink how we approach head and neck cancers.” Smoking and alcohol use are main risk fac-
18
The Triangle Physician
TCGA researchers have uncovered new details about the potential role of the human papillomavirus in head and neck cancer. HPV-related head and neck cancers have been growing in number. Credit: Ernesto del Aguila, National Human Genome Research Institute.
tors for head and neck cancer, according to the National Cancer Institute (NCI). But studies have shown that HPV-linked oropharyngeal cancer cases are on the rise. About 9,000 new oropharyngeal cancer cases are estimated to have been caused by HPV in the United States each year, according to the Centers for Disease Control and Prevention. Comparatively, there were an estimated 55,000 new cases last year of all types of head and neck cancer, which include tumors of the mouth, throat, voice box, nasal cavity and salivary gland.1 In North Carolina, there were 1,850 new cases of head and neck cancer in 2012, which was up about 3 percent from 2011.2 In the HPV positive tumors in their sample, they found tumors with deletions and mutations of a gene called TRAF3, which is involved in anti-viral response. The researchers also found alterations of the FGFR3 gene and mutations in the PIK3CA gene in HPVpositive tumors, which also are found in a much broader set of mutations in smokingrelated tumors.
PIK3CA has already been shown to be associated with HPV, Dr. Hayes said, but he said they showed the link clearly in their study. And the study found that while the EGFR (epidermal growth factor receptor) gene is frequently altered in HPV-negative tumors in smokers, it is rarely abnormal in HPVpositive tumors. They found that many of the head and neck cancer tumors in the study had alterations in a group of genes for certain growth factor receptors such as EGFR and FGFR, signaling molecules and cell division regulation. “So this is a set of alterations that, at some level, many people think are drug-able,” Dr. Hayes said. He called attention to the study’s findings for one gene in particular, CCND1, that’s involved in cell division regulation. Dr. Hayes said the gene is involved in a drug-able pathway, and a potential drug is in development for it. In addition to helping understand genomic changes in head and neck cancer, Dr. Hayes said the study’s findings may help further
UNC Research News the understanding of other cancer types. And while Dr. Hayes said TCGA efforts have helped create a “parts list” of genomic alternations in a range of cancers, he said there are cancer types for which more genomic mapping is needed. “Just like in a car manual, you need to know what kind of car you have and what the parts are to know how to put it back together,” he said. “We really have built a parts manual for what’s broken in cancer so that we can start addressing it in a logical and a real way.”
The Cancer Genome Atlas is supported and managed by the NCI and the National Human Genome Research Institute. The TCGA network includes researchers at institutions around the country and globe.
The study was funded by grants from NIH, the Bobby F. Garrett Cancer Foundation and NIDCD (National Institute on Deafness and Other Communication Disorders) Intramural Projects.
As a national leader in TCGA, UNC Lineberger scientists have been involved in multiple, individual tissue type studies as well as the largest, most diverse tumor genetic analysis ever conducted to date. UNC has done RNA sequencing work for those projects, among other contributions.
Reference 1-2: The Cancer Genome Atlas Research Network. Comprehensive genomic characterization of head and neck squamous cell carcinomas. Nature. online January 28, 2015. DOI: 10.1038/nature14129.
UNC News
Horizons Treatment Program Awarded $1 million Challenge Grant The University of North Carolina Horizons Program, a comprehensive substance abuse treatment program for pregnant and parenting women, has received a $1 million challenge grant that would enable the program to serve more women from North Carolina each year. The pledge of support comes from Oak Foundation, which will provide a $1 million grant contingent on UNC raising a matching $1 million in private donations by May 2015. The total would go toward the purchase of a new building in Carrboro.
allow us to expand our capacity to help heal the lives of more of North Carolina’s women and children affected by drug addiction.” Based in the UNC School of Medicine’s department of obstetrics and gynecology, Horizons was established in 1993 and has since helped almost 5,000 North Carolina women coping with substance-use disorders, including many scarred by abuse and violence. But need outstrips capacity, resulting in about one of every four women seeking help being referred to other programs.
“We would be able to double the number of women and families served each year and triple our ability to provide onsite daycare,” Dr. Jones said. A new building also would enable the program to provide on-site interactive training to local, national and international clinicians who are eager to learn about implementing the Horizons Program model, she said. A $3 million investment is required to realize the vision for a new facility. Meeting Oak Foundation’s challenge would cover a significant portion of that need.
Oak Foundation funds efforts that address social and environmental concerns, particularly those that have a major impact on the lives of the disadvantaged. Oak has its main administrative office in Geneva, Switzerland, and a presence in the United States and seven other countries: Belize, Bulgaria, Denmark, Ethiopia, India, the United Kingdom and Zimbabwe. “The generous donation from Oak Foundation provides funds that are transformational for UNC Horizons,” said Hendree Jones, Ph.D., executive director of Horizons. “Securing a permanent space for our program will
scheduled for completion in 2015.
That’s why Horizons Program aims to purchase a facility to increase both capacity and programming. Plans call for a 12,000-squarefoot space in Shelton Station, an approved mixed-use project in downtown Carrboro,
“We are proud to support UNC Horizons and believe that the new permanent home will enable it to provide a therapeutic and nurturing environment and continue its work, which is life changing, not only for women, but also for their children,” said Millie Brobston, a program officer with Oak Foundation. For information about making a donation to help meet the challenge, contact Tonya Taylor at (919) 962-9589 or taylortr@live.unc.edu. February/March 2015
19
UNC News
Partnership With Women’s Group in Greensville to Control IVF Costs The University of North Carolina Fertility Center and East Carolina University Women’s Physicians health care practices are forming a unique collaboration to better serve Greenville-area patients in need of in vitro fertilization and to help control treatment costs.
Hayslip Jr., M.D., professor and chair of obstetrics and gynecology at the Brody School of Medicine and IVF medical director at ECU Women’s Physicians.
tients. When we opened our new treatment center last year, we did so with the goal of reaching out to help even more patients in North Carolina and across the region,”
“UNC Fertility opened a new state-of-the-art lab just last year. It makes perfect sense for my patients to continue their in-office treatment here at ECU and then take advantage of UNC Fertility’s outstanding team and facility when it’s time for laboratory procedures. They get the best of both worlds – the convenience of day-to-day services in their own backyard as well as access to the latest technology at UNC Fertility.”
said Marc A. Fritz, M.D., practice director at UNC Fertility. “Most patients will only need to travel to see us two times during an IVF cycle – and we’re just 90 minutes away from Greenville, so it’s very manageable.”
Through their partnership, women in eastern North Carolina will be able to receive day-to-day in vitro fertilization (IVF) care and monitoring at ECU Women’s Physicians in Greenville and then travel to UNC Fertility Center’s lab in Raleigh for onsite lab procedures. ECU Women’s Physicians recently closed its IVF lab, due in part to state budget cuts, according to a press advisory. Maintaining the lab would have required significant pass-along price increases to their patients. IVF, which is one of many treatment options for couples in need of fertility assistance, is typically one of the most costly treatments due to the highly-specialized laboratory technology needed. “Running our own independent IVF lab was becoming increasingly expensive, and we did not want couples in Greenville to have to pay that price,” said Calvin “Cal”
Dr. Hayslip is the only board-certified reproductive endocrinologist in eastern North Carolina “We want to do everything we can to make IVF as affordable as possible for all pa-
“We are honored to have the opportunity to partner with ECU to provide advanced infertility services for their patients. We consider ourselves part of their team and already are working closely with Dr. Hayslip and other physicians to meet the needs of patients in the Greenville and surrounding communities,” Dr. Fritz said. “We look forward to building our relationship with ECU and to help build families for patients throughout eastern North Carolina.”
News Welcome to the Area
Physicians
Benjamin George Cobb, MD
Dhanesh Kumar Gupta, MD
Alyssa Nicole Heaton, MD
Lauren Marie Allen, MD
Anesthesiology
Anesthesiology
Emergency Medicine
UNC Department of Anesthesiology Chapel Hill
Duke University Medical Center Durham
University of North Carolina Hospitals Chapel Hill
Brittani Ann Hale, MD
Bryan Michael Hoag, MD
Anesthesiology
Diagnostic Radiology; Radiology
Anatomic and Clinical Pathology; PathologyForensic, Hematology, Medical Microbiology, Molecular Genetic
Duke University Hospitals Durham
Agustin Cornejo Esquerra, MD
Sonia Noreen Bains, MD
Duke University Hospitals Durham
Allergy and Immunology; Internal Medicine
Boice-Willis Clinic Rocky Mount
John Michael Baratta, MD Physical Medicine and Rehabilitation
University of North Carolina Hospitals Chapel Hill
20
The Triangle Physician
Maxillofacial Surgery; Reconstructive Surgery; Plastic Surgery; Plastic Surgery/Hand Surgery
Gregory Charles Gray, MD Preventive Medicine/Occupational; Public Health
Duke Medicine, Div of ID Durham
Duke University Hospitals Durham
University of North Carolina Hospitals Chapel Hill
Paul Richard Halweg, MD
Ulrike Hoffmann, MD
Anesthesiology
UNC Dept of Anesthesiology UNC Hospitals Chapel Hill
724 Millspring Drive Durham
Thomas Michael Howard, MD Family Medicine - Sports Medicine
Apex
News Welcome to the Area Ehimemen Ojeabulu Iboaya, MD
Keith Johnson Robinson, MD
Rachel Lynn Chandler, PA
Elaine Del Castillo Matos, PA
Anesthesiology - Critical Care Medicine; Internal Medicine
Pediatric Pulmonology; Pediatrics
Urgent Care
University of North Carolina Hospitals Chapel Hill
FastMed Urgent Care of Clayton Clayton
Mansi Manjul Shah, MD
Saige Michelle Clark, PA
Abdominal Surgery; Colon and Rectal Surgery; Critical Care Surgery; General Surgery; Pediatric Surgery; Surgical Oncology; Vascular Surgery
Family Practice; Urgent Care
Abdominal Surgery; Cardiovascular Surgery; Colon and Rectal Surgery; Critical Care Surgery; Family Practice; Gastroenterology, Internal Medicine; Head and Neck Surgery; Orthopedic Surgery; Otolaryngic Allergy; Surgery; Thoracic Cardiovascular Surgery; Urological Surgery; Urology; Vascular Surgery
University of North Carolina Hospitals Chapel Hill
Dermatology; Family Medicine; Pediatrics; Psychiatry; Urgent Care
Duke Medical Center Durham
Nicole Jacobs, MD Child Psychiatry; Psychiatry
University of North Carolina Hospitals Chapel Hill
Sujai Jalaj, MD Gastroenterology, Internal Medicine
UNC Gastroenterology Chapel Hill
Joan Mary Jasien, MD
Cherrelle Smith-Ramsey, MD Pediatrics
University of North Carolina Hospitals Chapel Hill
Durham
Morrisville
Katherine Cole, PA Lillington
William Blake Conner, PA Emergency Medicine; Urgent Care
Raleigh
Neurodevelopmental Disabilities
Duke University Medical Center Durham
Jessica Kelly Stewart, MD
Owais Jeelani, MD
Duke University Hospitals Durham
Hospitalist; Internal Medicine
Chapel Hill
Shayna Dariene Jones, MD Obstetrics and Gynecology
Womenâ&#x20AC;&#x2122;s Care Center Pinehurst
Diagnostic Radiology; Vascular and Interventional Radiology
Nicholas Alan True, MD Emergency Medicine
University of North Carolina Hospitals Chapel Hill
Bethany Dawn Vallangeon, MD
Sarah Riley Cooper, PA Cardiology; Hospitalist; Surgery
Raleigh
Alexandra Frye Covington, PA Critical Care Surgery; Dermatology; Emergency Medicine - Sports Medicine; Family Medicine; Family Medicine - Sports Medicine; Family Practice; General Surgery; Urgent Care
Holly Springs
Anatomic and Clinical Pathology; Pathology - Molecular Genetic Pathology, Chemical, Immunopathology, Forensic, Hematology, Medical Examiner, Medical Microbiology, Pediatric; Pediatric - Allergy/Immunology
Christopher Britt Dominguez, PA
Gynecologic Surgery; Obstetrics and Gynecology
Duke University Hospitals Durham
Maghen Kathleen Eakle, PA
UNC Div of Advanced Laparoscopy & Pelvic Pain Chapel Hill
Michael David Weiland Jr., MD
Jennifer Renee Jutson, MD Anesthesiology; Pediatrics
Carrboro
Michelle Yee Louie, MD
Family Medicine; Family Practice; Family Practice/Sports Medicine
Southern Pines FastMed-Clayton
Clayton Pediatric Cardiology
Duke Childrenâ&#x20AC;&#x2122;s Hospital Durham
Robert Crews Edens, PA Family Medicine
Ophthalmology
Fuquay-Varina Primary Care Fuquay-Varina
Duke University Hospitals Durham
Carrie Anne Emory, PA
Varsha Manjunath, MD
Lauren Holly Mattingly, MD Anesthesiology
Duke University Hospital Durham
David Clinton McNabb, MD Orthopedic Surgery, Adult Reconstructive
Raleigh Orthopaedic Clinic Raleigh
Gregory Thomas Means, MD Cardiovascular Disease, Internal Medicine
University of North Carolina Hospitals Chapel Hill
Jacob Albert Misenheimer, MD Cardiovascular Disease, Internal Medicine
UNC Center for Heart & Vascular Chapel Hill
Arti Lalitkumar Pandya, MD Clinical Genetics (MD); Clinical Molecular Genetics; Pediatrics
UNC Pediatrics, Genetics & Metabolism Chapel Hill
Naseem Suleman Paruk, MD Family Medicine
Cary
Brian Robert Pisula, MD Emergency Medicine
University of North Carolina Hospitals Chapel Hill
Shanthi Sangeetha Ramesh, MD Obstetrics and Gynecology
University of North Carolina-Family Planning North Carolina
Physician Assistants Sandra Tiffany Alexander, PA Addiction Psychiatry; Addictionology or Addiction Medicine; General Practice; Pain Medicine; Psychiatry
Family Practice/Sports Medicine; General Surgery; Orthopedic Sports Medicine; Orthopedic Surgery; Urgent Care
Emergency Medicine; Family Medicine; General Practice; Hospitalist; Urgent Care
Cameron
Family Medicine; Family Practice; General Practice
Adam Benjamin Franks, PA
Macy Abigail Batts, PA Morrisville
4509 Bobwhite Trail Wilson
Seth William Pattan, PA Cardiology
Benson
Kyle Gilmore Pelligra, PA Raleigh
Benjamin Dent Pierce, PA Family Medicine - Adolescent Medicine, Geriatric Medicine; Family Practice; General Practice
Roxboro Family Medicine Roxboro
Kasey Ashcraft Ratliff, PA Family Medicine
Marshville
Tayyabah Rayyast, PA Hospitalist
Raleigh
Clayton
Cardiology
Richelle Bangi, PA
2639 Umstead Rd. Durham
Cardiology; Dermatology; Emergency Medicine; Family Medicine - Adolescent Medicine, Geriatric Medicine, Hospice and Palliative Medicine, Sports Medicine; Family Practice/Geriatric Medicine; General Practice; Internal Medicine; Nephrology, Orthopedic Surgery; Pediatrics; Urgent Care
Hospitalist
Brianne Hendrick Evans, PA
Emergency Medicine - Sports Medicine; Family Medicine - Sports Medicine; General Practice; Orthopedic Sports Medicine; Orthopedic Surgery; Urgent Care
Karyl Anne Noonan, PA
Mallory Lyn Eubanks, PA
Kristin Sue Ayers, PA
Lydia E Barrett, PA
Raleigh Neurosurgical Clinic Raleigh
Anastasia Dolgovskij Renz, PA
Duke University Hospital Durham
Buies Creek
Neurological Surgery, Critical Care
Raleigh
Raleigh Cary
Patricia Marie Nelson, PA
Ryan Allen Rodgers, PA Emergency Medicine; Urgent Care
Raleigh
Ashley Ronk, PA Family Medicine; Internal Medicine; Obstetrics and Gynecology; Orthopedic Surgery
Morrisville
Endocrinology, Internal Medicine
Raleigh
Katherine Emily Fryman, PA Diabetes; Emergency Medicine; Family Medicine; Family Practice; Geriatrics; Infectious Diseases, Internal Medicine; Orthopedic Sports Medicine; Pediatrics; Radiology; Urgent Care
Kaddijatou Sanyang, PA Young Adult Medicine; Adolescent Medicine; Family Practice; Hospitalist; Internal Medicine; Pediatrics
Raleigh
Barton Daniel Stearns, PA Emergency Medicine; Urgent Care
Raleigh
FastMed Urgent Care Clayton
Dawn Hines Gerrell, PA
Matthew Kyle Tucker, PA
Kenly
Emergency Medicine; Family Practice; Internal Medicine; Urgent Care
Orthopedic Sports Medicine; Orthopedic Surgery
BethAnne Berenice Harrison, PA
Garner
Cary Orthopaedic Cary
FastMed Urgent Care Garner
Molly Stapleton Calabria, PA
Vincent P. Keeney, PA
Elise Caceres-Mason, PA
Carrboro Family Medicine
Carrboro
Lora Michelle Calo, PA
Obstetrics and Gynecology; Urgent Care
Orthopedic Sports Medicine
Carolina Regional Orthopaedics Rocky Mount
Family Medicine - Adolescent Medicine; Family Medicine - Geriatric Medicine
Jessica Alicia Killmeier, PA
Vance Family Medicine Henderson
Cary
Lauren Richardson Webb, PA Emergency Medicine; Urgent Care
FastMed Urgent Care Clayton
Andrew Russell Zimmerman, PA Emergency Medicine; Surgery; Urgent Care
Raleigh
Emergency Medicine
February/March 2015
21
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