October
2 012
Advanced Pain Consultants Improving the Quality of Life for Patients with Chronic Pain
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
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Delivering Bad News Social Media
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Contents
COVER STORY
6 ocotober
Neurostimulation:
The Pacemaker for Pain
Improving the Quality of Life for Patients with Chronic Pain
2012
Vol. 3, Issue 9
FEATURES
14
Marketing
Three Reasons Why Practices Should Consider Social Media Amanda Kanaan outlines considerations for practices as they explore ways to enhance patient-physician relationships.
15
DEPARTMENTS
Breaking Bad News to Patients Is an Art to be Mastered
17 Your Financial Rx Are You a Pessimist or an Optimist?
18 Recovery Breast Cancer Survivors Benefit from the Ripple Effect of Fly-Fishing Retreat
Dr. Neeraj Agrawal discusses ways to deliver unwelcome news to reduce the stress on patient, family and physician, alike. COVER PHOTO: Sonia Pasi, M.D., of Advanced Pain Consultants is board certified in neurology and interventional pain medicine. She offers spinal cord stimulator treatment for chronic pain in patients who meet eligibility criteria.
2
Pretty In Pink on the Move
20 Duke News Medical Ethics
The Triangle Physician
Fills Need for Primary Care in Fuquay-Varina
15 Women’s Health
- Cancer Research Yields Unexpected New Method to Produce Nylon - Policy Provides Ethical Foundation for Managing Critical Drug Shortages
23 News
mission Quality Measures Recognition
24 UNC News
- Hospital Performs Its First Single-Incision Robotic Surgery - Wake Specialty Physicians
-S cientists Identify Genetic
Causes of Most Common Form of Breast Cancer
25 UNC News
-G enetically Engineered
Models Better Predict Pharmacodynamic Response
27 News
-M ission: Lifeline Recog-
nizes Heart Attack Care
22 News
-H ospitals Earn Joint Com-
28 News
- Welcome to the Area and upcoming events
Nash County
Wendell
Wake County 401
231
96
Garner
42E
Wilson County
Clayton
42W
Fuquay-Varina
70
70
96
Kenly
95
42W
70
40
Micro Selma
McGee’s Crossroads
95
Smithfield
70 Four Oaks
Harnett County Coats
40 Benson
Erwin Dunn
95
Princeton
95
Johnston County 40
Wayne County
95
LADIES NIGHT OUT
Passport to Health
Sampson County
JOHNSTON HE ALTH
A H e a lt h i e r Tom or r o w b e g i n s today
From the Editor
From the Editor
Freedom From Pain
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
According to a 2011 Institute of Medicine of the National Academies, about 116 million Americans live with chronic pain, which is associated with increased rates of depression and anxiety, sleep disturbance and insomnia, and decreased physical activity due to fear of exacerbating pain. All can greatly impact the quality of one’s life
Editor Heidi Ketler, APR
heidi@trianglephysician.com
and contribute to higher health care costs.
Contributing Editors Neeraj Agrawal, M.D. Amanda Kanaan Paul Pittman, C.F.P.
In this month’s cover story, “Neurostimulation: The Pacemaker for Pain,” we learn
Photography Mark Jacoby
from Dr. Sonia Pasi of Advanced Pain Consultants about the use of the spinal cord stimulator (SCS) in the pursuit pain-free living. In many cases, the technology
Creative Director Joseph Dally
succeeds, while reducing dependence on pain medication.
Advertising Sales
mark@jacobyphoto.com
jdally@newdallydesign.com
Paget Lassiter
Also in this issue of The Triangle Physician, we hear from oncologist Neeraj Agrawal, who presents an important discussion on the delicate role of the physician in presenting unwelcome news to the patient and family.
Resident contributors return to share insights on practice management issues. Amanda Kanaan’s overview of social media helps clarify its appropriateness and usefulness. Financial planning guru Paul Pittman reviews points made by science writer Matt Ridley in his book The Rationale Optimist.
And as always, a reminder of the value of The Triangle Physician as a cost-effective – if not pain free – practice referral tool. Simply submit your news and insight at no cost and/or advertise at our affordable rates to reach more than 9,000 throughout the Triangle medical community. With gratitude and respect,
Heidi Ketler Editor
paget@trianglephysiciancom 704-677-6886 News and Columns Please send to info@trianglephysician.com
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. 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.
4
The Triangle Physician
Cover
Neurostimulation:
The Pacemaker for Pain Improving the Quality of Life for Patients with Chronic Pain By Amanda Kanaan
Dr. Sonia Pasi of Advanced Pain Consul-
Other uses of neurostimulation include
According to Dr. Pasi, here are the most
tants is improving patients’ quality of life
cortical stimulation for patients with in-
common questions referring physicians
with a unique neurostimulator device
tractable facial pain conditions such as tri-
have when learning about the spinal cord
deemed the “pacemaker for pain”. Most
geminal neuralgia; deep brain stimulation
stimulator (SCS) system and how it might
widely used for patients suffering from
to help Parkinson’s patients suffering from
benefit their patients.
various chronic pain disorders, the spinal
tremors and dystonia; and vagal nerve
cord stimulator (SCS) is an effective solu-
stimulation for epilepsy patients.
What is a spinal cord stimulator (SCS)?
through traditional therapies. “The stimu-
“Spinal cord stimulation has been help-
Spinal cord stimulation relies on low volt-
lator can help reduce patients’ dependence
ing patients manage their chronic pain for
age electrical pulses of the spinal nerves to
on pain medication and return them to a
decades, but many physicians are unaware
interrupt the pain signal sent to the brain.
more active lifestyle,” says Dr. Pasi, board
that the treatment even exists let alone the
By blocking the feeling of pain, patients can
certified in neurology and interventional
impact it can have on improving their pa-
potentially reduce or eliminate the need for
pain medicine.
tient’s quality of life,” says Dr. Pasi.
pain medications and return to comfort-
tion for patients who have not found relief
able, productive lives. Utilizing electrical stimulation similar to a pacemaker, SCS has been called the “pacemaker for pain”.
How does it work? An SCS is a device that is surgically placed under the skin to send a mild electrical current to the spinal cord. A small wire carries the pulse to the nerve fibers of the spinal cord and when turned on, feels like a mild tingling in the area afflicted by pain. The electrical current interrupts the pain signal from reaching the brain and thus reduces the amount of pain felt by the patient. Patients are able to adjust the SCS system’s level of intensity through a transmitter device that can program the various electrical settings (amplitude, frequency, pulse width, and polarity). Patients have the ability to select the best setting for managing their pain as it changes throughout the day. The transmitter allows patients to turn the stimulation up or down, just like you Sucessful Trial with Spinal Cord Stimulator leads placed under fluoroscopic guidance in the lower thoracic spine to control both chronic lower back and bilateral leg pain simultaneously.
6
The Triangle Physician
would turn the volume up or down on a TV remote control. In fact, many refer to
Debbie Howard a patient of Dr. Pasi’s shares her joy and happiness being pain free after a successful trial followed by implantation of SCS for management of her chronic lower back and leg pain. In addition to improving her quality of life she is able to manage her chronic with out medications now.
the transmitter device as a “remote control
tients are then taught how to use a remote
sedated and local anesthesia is injected
for pain”.
control which allows them to turn the ther-
where the small incisions are to be made.
apy on and off and increase or decrease the
The leads are placed in the epidural space
intensity of the stimulation.
above the spinal cord and secured with su-
The SCS device is manufactured by three major
companies:
Boston
Scientific,
Medtronic and ANS.
tures. The surgeon will decide how many Once the stimulator is turned on, patients
leads and the number of electrodes to im-
can experience instant relief. After a one
plant.
How is the procedure performed?
week trial phase, patients follow up with their physician to evaluate if the trial was
The patient is then awakened during the
Phase One: Trial Phase
successful or not. According to clinical
procedure to help the surgeon determine
SCS implantation is performed in two
studies, a trial is considered successful if
how well the stimulation covers the pain
phases. In phase one, patients must under-
the patient experiences a pain reduction of
pattern. Once the leads are in place, seda-
go a trial to see if the device decreases their
more than 50 percent.
tion is given again. An extension wire is
level of pain. “There are not many treat-
then passed under the skin from the spine
ment options that give patients the abil-
Phase Two: Implantation
around the torso to the abdomen or but-
ity to test drive them before they commit.
If phase one is successful, patients are
tock where the generator will be implanted
With SCS, patients get the benefit of testing
scheduled for surgery to permanently
superficially in the fatty tissue.
the device prior to making a decision about
implant the device (known as phase two
surgery,” says Dr. Pasi.
of treatment). Permanent implantation is
Patients are discharged the same day and
usually performed by a neurosurgeon in
the pulse generator is programmed before
During the SCS trial phase, a lead(s) is
a hospital or surgical center setting. Al-
they leave. Approximately ten days after
implanted temporarily in the space above
though it is called permanent, treatment
the procedure the patient returns to the of-
the spinal cord through an outpatient pro-
can be discontinued at any time and the
fice to remove the sutures or staples. Pro-
cedure that takes about an hour. The leads
device safely removed.
gramming of the pulse generator can be
are connected to an External Trial Stimulator (ETS) which are worn on a soft belt. Pa-
adjusted at this time if needed. Prior to the procedure, the patient is lightly
octoBER 2012
7
• Spinal nerve injury pain such as arachnoiditis or nerve root injury
For others, it can mean a reduction in the amount of pain medication.
• Chest wall pain from intercostal neuralgia • Phantom limb pain syndrome
In the future, will there be additional indi-
• Post herpetic neuralgia pain
cations for SCS treatment in the U.S. other
• Chronic pelvic pain from intisticial
than chronic pain?
cystitis • Other indications widely used in Eu-
Yes, in Europe the device has been indi-
rope are peripheral vascular disease and
cated for broader uses, such as to treat
intractable angina
peripheral vascular disease by improving circulation and chronic pain. Dr. Pasi also
Patients may be a candidate for SCS if
hopes to use the treatment for intractable
they meet the following criteria:
angina and peripheral nerve stimulation in
• Conservative therapies have failed
the future.
• The source of pain has been verified • The patient would not benefit from additional surgery • No serious dependence on pain medication or other drugs • No depression or other psychiatric conditions that may contribute to the pain • No other medical conditions that would A Pacemaker for Chronic Pain -showing a completely implantable small battery and thin wire called lead.
prohibit implantation
What are the pros and cons of spinal cord stimulation? Pros of SCS • Trial of device prior to committing to implantation • Procedure is reversible • Implant is non-destructive to the nerves • Treatment is long-term and cost-effective (North, 2007)
Is it FDA approved? SCS is approved by the U.S. Food and Drug
Cons of SCS
What type of patient is a good candidate?
Administration (FDA) for the manage-
• For safety reasons the device cannot be
ment of chronic pain in the back, neck,
turned on while driving, but it may be
Before determining if SCS treatment is an
arms, or legs. It is a safe treatment that has
used several hours prior to driving in
option, patients must be thoroughly evalu-
been used by doctors to manage chronic
order to provide residual relief.
ated by a pain specialist. The doctor will
pain for more than 40 years.
acceptable. (a new version of the device
want to review the patient’s previous treatments including medications, physical ther-
• MRIs are prohibited, but CAT scans are
Does insurance cover it?
allows for head MRIs)
apy, injections, and surgeries. “Spinal cord
SCS is a cost-effective treatment that is
• Battery life is limited (lasts an average of
stimulation is not for everyone. The key is to
covered by Medicare, most major health
5 years with maximum life of 11 years)
properly select patients before pursuing the
insurance plans, and workers’ compensa-
trial. Patients who have chronic nerve pain
tion programs.
What are the results? The results of spinal cord stimulation treat-
or fail conservative therapy should be good
What are the goals of SCS treatment?
ment vary greatly depending on the pa-
Types of patients who may benefit from
The goals of SCS treatment are to help pa-
to carefully select proper candidates and
SCS treatment:
tients better function during normal activ-
have patients undergo a trial phase to en-
• Patients who have chronic pain from
ities, return to work, and fully participate
sure SCS treatment is a feasible option.
(RSD) reflex sympathetic dystrophy
in family and community life. Although re-
or CRPS
lief will vary for each person, even a small
“I feel like I’ve been given my life back,”
amount of pain reduction can be signifi-
says Debbie Howard of Raleigh who re-
cant if it helps patients to be more produc-
veals that SCS allowed her to reduce her
tive with less pain.
pain medications by more than 50 percent.
candidates,” says Pasi.
• Back or neck pain from failed back or neck surgery syndrome • Radiating neuropathic pain in back
Howard, who has been out of work for 22
or neck • Legs or arm pain from peripheral neuropathy
8
The Triangle Physician
tient’s condition. This is why it’s important
For some patients, SCS works so well that
years due to chronic pain, says “I had al-
they are able to go off all pain medications.
most given up hope before I met Dr. Pasi.”
Diagnosed with fibromyalgia and osteoar-
who was thrilled just to be able to walk up
roscopy in her office, as well as, more ad-
thritis of the spine, Howard is now able to
and down the aisles of her local supermar-
vanced treatments such as radiofrequency
perform activities she hasn’t been able to
ket again.
nerve ablation, spinal cord stimulation (SCS), and intrathecal pain pumps.
in years. “Until you are active again, you the little things like walking to the mailbox
SCS: A Safe, Cost-Effective Option for Chronic Pain Sufferers
and being able to drive that have made a
Spinal cord stimulation is a safe, cost-ef-
big difference,” says Howard who reports
fective and long-term treatment option for
that her friends can even tell a difference
patients who have not found relief through
in her voice.
traditional therapies (Kumar, et al., 2007).
don’t know what you’ve been missing. It’s
Journals Cited
Janet Teague of Greensboro is another pa-
seen SCS give patients back a quality of life
tient of Dr. Pasi’s with a similar story. “I re-
they thought was no longer possible,” says
member the exact day, December 9, 2010,
Dr. Pasi.
• Kumar, K., & al., e. (2007). Spinal cord stimulation versus conventional medical management for neuropathic pain: A multicentre randomized controlled trial. Pain Journal 132, 179-288. • North, R. B. (2007). ( Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost-effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery, 61:361-369.
walk,” says Teague who suffered from back
Dr. Pasi’s practice, Advanced Pain Consul-
If you believe your patient might be a good
pain for years. After trying every treatment
tants, is located in Raleigh and provides a
candidate for SCS, please contact Dr. Pasi at:
possible, nothing worked.
multidisciplinary and state-of-the-art ap-
Advanced Pain Consultants
proach to chronic pain management. Dr.
Sonia Pasi, M.D., board certified in neurology and interventional pain medicine 3948 Browning Place, Suite 109 Raleigh, NC 27609 Office: (919) 510-7901 Fax: (919) 510-7902 www.apcpaincare.com
“For those who are good candidates, I’ve
when I woke up and realized that I couldn’t
Teague, who is still in the trial phase of
Pasi is fellowship trained in interventional
the SCS procedure, says the device is al-
pain management from Duke University
ready making a big difference. “All of my
Medical Center and is also board certified
co-workers, friends and family noticed an
in neurology. Dr. Pasi offers a number of
immediate difference in me,” says Teague
minimally invasive procedures under fluo-
A Team Approach :(left to right )Olivia ,Sylvia Dr.Pasi (middle), Mike and Reyna. “Key to sucesss for SCS is the accurate diagnosis and selection of patients,“ says Dr.Pasi
octoBER 2012
9
Marketing
Three Reasons Why Doctors Should Consider
Social Media
By Amanda Kanaan
Physicians are eager to embrace new ad-
those people (94 percent) turn to Face-
vances in medical technologies, but as a
book. Additionally, they found
whole they tend to be late adopters when
that Americans using
it comes to progressive communication
social media for
tools, such as social media.
health care are affluent,
and
Although health care is innately social,
on average, 41
policies, like the Health Insurance Porta-
years of age.
bility and Accountability Act (HIPAA), have caused, what I believe to be an un-
It’s clear that social me-
healthy fear among physicians to interact
dia is not a fleeting trend, and patients
with patients outside of the office.
find it to be a valuable resource for health
rethink their social media strategy to not
care information and interaction. So now
just focus on marketing but on an overall
Whether you cite HIPAA, a lack of time or
the real question is, “what’s the advantage
business strategy to improve outcomes and
limited computer skills as reasons for not
for doctors?”
lower the cost of providing care.
Three Advantages of Social Media for Doctors
The physician-patient relationship is a
major opportunities to use social media to your advantage.
1. Cost-Effective Marketing
the opportunity for both to speak, listen,
While there are many advantages to so-
understand and learn from one another.
Are Patients Really Using Social Media?
cial media, one of the major benefits is
Embrace the opportunity to educate and
the ability to attract new patients. Social
interact with your patients to help better
First, let’s take a look at the numbers when
media acts like a megaphone, amplifying
manage their conditions and coordinate
it comes to patient interaction online. Ac-
your message across various channels and
care. Just be careful to never give personal
cording to a 2012 study by Pricewater-
potentially reaching those who may have
medical advice or reveal patients’ private
houseCoopers, a survey of more than 1,000
no idea who you are. This is especially ef-
health information online. Think of your
adults in the United States revealed:
pursuing social media, there’s a strong possibility you could be missing out on three
two-way street, and social media provides
fective when it comes to patient testimo-
online interactions as communicating
• One third of consumers now use social
nials and connecting with other referring
with your patient population as a whole in
media sites for health-related activities;
doctors online. It’s a powerful branding
order to avoid HIPAA concerns.
• 40 percent of consumers have sought
tool in enhancing the reach of your repu-
out reviews of treatments, physicians
tation. Facebook now even offers analyt-
3. Competitive Edge
and other patient experiences;
ics for your page so you can monitor the
Social media is an extremely powerful
• 45 percent of consumers say informa-
impact you’re having online and analyze
platform that allows physicians to position
tion from social media sources would
what type of content resonates best with
themselves as an expert in their specialty.
affect their decisions; and
patients. This makes the ROI much more
For example, maybe a doctor wants to po-
trackable.
sition himself/herself as an expert in ro-
• 73 percent would welcome social media-based tools for such things as
botic surgery within the ob/gyn specialty.
making an appointment or asking a
2. Patient-Centered Relationships
While their peers sit on the sidelines, doc-
question.
The reason patients are eager to connect
tors have an opportunity to take a leader-
with their doctors online isn’t so they can
ship role and put themselves ahead of the
A separate survey by the National Research
see where you went to dinner on Saturday
competition. Now is the time to build up
Corp. reported that more than 40 percent
night. They want to use social media as a
your social media network online and
of respondents rely on social networking
tool to better manage their health. This
show your patients that you are not only
for health information, and nearly all of
is prompting health care organizations to
a leader in your specialty but also in terms
10
The Triangle Physician
Amanda Kanaan is the president and founder of WhiteCoat Designs, a North Carolinabased marketing agency catering specifically to physicians. WhiteCoat Designs offers doctors affordable marketing solutions to help them grow their practices. Services include website design, search engine optimization (SEO), social media management, online reputation monitoring, brochure and collateral design, branding makeovers and physician liaison services to build patient referrals. Ms. Kanaan can be reached at amanda@whitecoat-designs.com or (919) 714-9885. To learn more, visit www.whitecoat-designs.com.
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Although social media may not be an option for all practices, the advantages of participating are at least worth considering. Negative reviews will happen whether you like them or not. The good news is that social media at least gives you the opportunity to be part of the conversation and show off your customer-service skills. If you decide to pursue social media, you need to ensure you have the time to interact consistently and if not, who you are going to trust to manage your page for you. Also, it is strongly advised – even by AMA – to put social media policies in place. This ensures all members of your practice understand what type of behavior is acceptable on your social media sites. The policy also should be easily accessed by patients. Start the Conversation Have an opinion on social media for health care? Want to ask Amanda Kanaan a question about getting started with social media? Send her a message on Facebook at / whitecoatdesigns or on Twitter @whitecoatdesign.
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octoBER 2012
11
Medical Ethics
Breaking Bad News to Patients Is an
Art to be Mastered By Neeraj Agrawal, M.D.
As clinicians, we all will be bearers of bad
about their illness. Avoiding the discussion
in accordance with the individual’s needs
news for our patients, and preparing our-
or sugar coating it can potentially expose
and desires, helping the patient handle its
selves for this task will not only help us
patients to unnecessary, ineffective and
emotional fallout and finally forming a
serve our patients better but help reduce
potentially harmful treatments and add to
plan of action for the future. It is extremely
our own emotional stress. Whether it is a
high end-of-life health care costs. Lack of
important that adequate time be allocated,
new life-threatening diagnosis or the wors-
formal training and inadequate mentoring
so the clinician can address all of these
ening of an existing disease process, the
are cited as the main barriers to effective
important steps during the interaction. A
failure of a treatment plan or the discus-
communication with our patients when
comprehensive interaction should prepare
sion to terminate curative treatments are
bad news has to be given. Providers of-
the patient for the news, deliver it and then
potentially life-altering for our patients.
ten feel ill equipped to handle patient and
bring closure by discussing a plan to move
We find these situations contrary to our
family emotions, such as anger and blame,
forward.
own focus on helping our patients feel bet-
making it difficult to tell the complete truth
ter. Some of us are left with a feeling that
without being negative.
It helps when family members and other stakeholders, such as nurses and social
we have failed the patient, and this in turn can lead to a defensive response. There is
Breaking bad news is an art that involves
workers, are invited to be present if the
no question that this is one of the most un-
both the use of verbal and nonverbal skills
patient so wishes. The setting should be
pleasant tasks in a work day and can lead to
and can be envisioned as a stepwise proce-
private, and seating such that you are fac-
frustration and early burnout.
dure. Several guidelines and recommenda-
ing the patient, making it possible for the
tions have been published, and it has been
doctor and patient to draw cues from the
While we are bound by ethical and legal
shown in many studies that structured
other’s expressions and body language. It is
obligations to provide full and complete in-
training does improve clinical skills in this
my personal opinion that a telephone con-
formation to our patients, it is also shown
critical area. Broadly the goals of a bad-
versation or an electronic communication
that a large majority of patients, even
news interview should include assessing
are not suited for such a complex and nu-
those from different cultural backgrounds,
the readiness and capacity of the patient
anced task.
would much rather be told the full truth
to receive the news, providing the news While patients and families often have a premonition about what is coming, it is none the less important at the start of the discussion to first assess the patient’s understanding of their current clinical situation, their expectations and their capacity to comprehend the information that will be provided. This also will help determine if the patient is using coping mechanisms, such as denial or wishful thinking. Not all patients are ready and not everyone wants to be told everything, and we need to be sure that the patient does wish to be given the information and has the ability to process it. In some situations, families of vari-
12
The Triangle Physician
Dr. Neeraj Agrawal of Cancer Centers of North Carolina is board certified in medical oncology and hematology. He completed his residency at the Medical Center of Central Massachusetts and a fellowship with Cleveland Clinic Foundation. Dr. Agrawal has published and presented promising results of clinical trials in the treatment of lung cancer and myeloma. He is involved in clinical trials for breast, lung and colon cancers. He also has co-authored chapters in textbooks and is involved in the training of residents during their clinical rotation at WakeMed Health & Hospitals. Dr. Agrawal donates his time to the WakeMed cancer clinic to help with the care of indigent patients. His primary office is located in North Raleigh, and he has a satellite office one day a week in Dunn. He follows his patients admitted at Rex Healthcare, WakeMed and Duke Raleigh hospitals. Call (919) 470-5243.
pursue aggressive palliation can surely be
plan to move forward. While it is possible
offered even in the toughest of situations
that the patients and families will block out
when there are no curative options and the
everything after they receive the bad news
prognosis is bleak.
and we may have to repeat this part of the discussion at a later time when the patient
Having delivered the news, it is now essen-
is in a more receptive frame of mind, it is
tial that we address the emotional impact
still essential that bad news is not delivered
on the patient whether it is shock, silence,
in isolation and that the patient leaves with
tears or anger. Words and phrases that con-
a feeling that there is a plan for the future.
vey empathy and validation will reduce the
Even in the darkest of moments, the hu-
patient’s isolation, and sometimes it helps
man mind has an immense capacity to fo-
to share with the patient your own disap-
cus on the positive, and planning for the
pointment in the outcome. Lastly a bad-
future helps the patient regain a sense of
news discussion is incomplete without a
purpose.
ous cultural backgrounds may request that the patient be spared being told bad news. While we still must continue to maintain our commitment to patient autonomy, it is also important that we try to understand the family’s concerns and approach the discussion in a way that is sensitive to the patient’s own desires. Foreshadowing the bad news with visual and verbal cues will help dampen the shock. It conditions the mind, so the news will be less likely to come as an unexpected blow. As is true with all patient communications, the relevant information must be given in a way consistent with patient’s background and educational level. While it is important to be honest and comprehensive, it is also important to be sensitive. Overly negative statements, such as “we can do nothing more,” are inaccurate and create in the patient a sense of abandonment. At the very least, a promise to
Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
octoBER 2012
13
We’re Proud To Be Named A Best Hospital. We’re Even Prouder To Be Right Here In Durham.
Durham Regional Named One Of
U.S. News & World Report’s Best Hospitals. #5 in North Carolina. #3 in the Triangle.* In an area known for
great medical care, we’re proud to be named among the elite hospitals in North Carolina and the Triangle by U.S. News & World Report. We’re even prouder to deliver excellence to our patients and our community, because to us, they’re always #1. *Durham Regional Hospital ranked fifth out of 147 North Carolina Hospitals and third out of 19 Triangle hospitals.
Women’s Health
Pretty In Pink On the Move The following is the latest news from the
In Pink Foundation: “Beyond the Ribbon
Services, is the two-year breast cancer
Pretty In Pink Foundation:
Blend” and “Champion Blend.”
survivor behind it all, and she couldn’t be
Provider Partnerships Form After Expansion into News Brunswick County
Each one-pound bag costs $12, plus ship-
Carting keep ringing, with folks wanting
ping. Proceeds for these two blends – after
their own pink trash receptacle.
Pretty In Pink Foundation has formed
coffee, bag, label and
a
labor – benefit Pretty
happier. The telephones at Coastal Ladies
number
of
health
care
provider
partnerships in New Brunswick County
covering the cost of the
In Pink Foundation.
following its announcement of a formal expansion there in April.
Ponderosa Roasting is a small-batch opera-
According to a PIPF news release, partner-
tion whose mission is
ships with several Brunswick County phy-
to help individuals in
sicians, surgeons, oncologists, radiologists
need through select
and medical centers include work with:
blends. The Coffee with
• Brunswick Surgical Associates
a Cause menu on its
• Brunswick Women’s Center
website
• First Med
the company’s commit-
• Family Medical Supply
ment to giving back to
• South Atlantic Radiology
the world community.
underscores
• Satellite offices with Wilmington Owner Cheyl Guildner embraced this
Shortly after completing her cancer
mission after spending more than a
treatments, Ms. Buffalino and her husband,
Also PIPF is working with Brunswick Nov-
decade designing and selling coffee
Chris Buffalino, were developing a business
ant Medical Center to develop and expand
roasters through her company Renegade
plan to provide competitive pricing for the
medical and support services for those diag-
Roasters. She then entered the roasting
disposal of trash – solid waste, liquid waste
nosed with breast cancer in the community,
side with Ponderosa Roasting Coffee Co.
and recyclables. About the same time, Ms.
and Brunswick County Health Department
Its specially crafted Renegade Roaster was
Buffalino became active in the new Pretty
and its Breast and Cervical Cancer Preven-
the winner of the Autodesk Designer of the
In Pink Foundation office that had recently
tion Treatment (BCCPT) program to pro-
Month in January 2009 for inventions and
opened in Wilmington.
vide those patients with support needs.
is used daily to roast the special Ponderosa
headquarters.
Roasting blends.
Today, Coastal Ladies Carting also donates
Throughout North Carolina, about $24 mil-
a percentage of each customer’s monthly
lion worth of services – including surgery,
For coffee samples or more information,
invoice to Pretty In Pink Foundation.
chemotherapy and radiation therapy – was
visit www.ponderosaroasting.com or con-
So each time the Coastal Ladies Carting
given by the medical community through
tact Ponderosa Roasting at (619) 519-5103.
telephone rings with a new customer
PIPF at no cost to 457 patients, according to Joy Wade, a PIPF program director.
signing on, another donation is made to
Trash Collector Goes Pink
provide life-saving services to those with
Pink trash dumpsters, pink carts and
breast cancer.
The organization’s headquarters are in Raleigh,
pink recycling bins have been popping up
with offices in Charlotte and Wilmington.
throughout Wilmington and New Hanover
Coastal Ladies Carting even provides
County. Every day, pink trash trucks come
free office space for the Wilmington
Designer Coffee Blend to Raise Funds
along and empty their contents.
regional office, which comes with internet,
Ponderosa Roasting in El Cajon, Calif., has
Kelly Buffalino, owner of Coastal Ladies
reception services, along with the free use
developed two blends of coffee for Pretty
Carting Recycling & Trash Collection
of pink trash receptacles
conference room, WiFi, kitchen and
octoBER 2012
15
JOHNSTON
HOME CARE & HOSPICE
A Service of Johnston Health
Your Financial Rx
Are You A Pessimist or an Optimist?
By Paul J. Pittman, C.F.P.
Have you ever met a happy pessimist?
did in 1970. • Global trade enriches our lives. By 9
There’s a widespread perception that
a.m., I have shaved with an American
congenital pessimists – we all know a
razor, eaten bread made with French
few – are realists, imbued with superior
wheat and spread with New Zealand
intellect, historical insight and prescience.
butter and Spanish marmalade, brewed
Conversely, optimists are often perceived
tea from Sri Lanka, dressed in clothes
as Pollyannaish, naive, ignorant of the
made from Indian cotton and Australian
facts, indulging in wishful thinking or
wool, put on shoes of Chinese leather and
trying to sell you something.
Malaysian rubber and read a newspaper printed on Finnish paper with Chinese
In his book The Rational Optimist, science
ink. I have consumed miniscule fractions
writer Matt Ridley believes the world has
of the labor of hundreds of people. This
never been better and will get even better.
is the magic of trade and specialization.
Here are some of his thoughts worth
Self-sufficiency is poverty.
considering:
Paul Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 459-4171 and paul. pittman@pcgnc.com. Send an e-mail to receive Mr. Pittman’s Weekly Market Commentary.
• Great ideas keep coming. The more we • Poverty is nose-diving. The rich get richer,
prosper, the more we can prosper. The
• Optimists are right. For 200 years,
but the poor do even better. Between
more we invent, the more inventions
pessimists have had all the headlines
1980 and 2000, the
even though optimists
poor doubled their
have
consumption.
The
more often. There is
Chinese are 10 times
immense vested interest
richer and live about
in pessimism. No charity
25 years longer than
ever raised money by
they did 50 years ago.
saying things are getting
Nigerians are twice
better.
as rich and live nine
ever got the front page
more years on average.
writing a story about how
The percentage of the
disaster was now less
world’s people living
likely. Pressure groups
been
No
right
far
journalist
and their customers in
in absolute poverty has dropped by more than half. The
become possible. The world of things
the media search even the most cheerful
United Nations estimates poverty was
is often subject to diminishing returns.
statistics for glimmers of doom. Don’t be
reduced more in the past 50 years than in
The world of ideas is not. The ever-
browbeaten – dare to be an optimist!
the previous 500 years.
changing exchange of ideas causes the ever-increasing rate of innovation in
You will have your own perceptions as to
• The environment is better than you think.
the modern world. There isn’t even a
whether the market pessimists or optimists
In the United States, rivers, lakes, seas
theoretical possibility of exhausting
have been more right than wrong. If you
and air are getting cleaner all the time. A
our supplies of ideas, discoveries and
look back at the stock market during the
car today emits less pollution traveling at
inventions.
last 50 years, the optimists win.
full speed than a parked car (with leaks)
octoBER 2012
17
Recovery
Breast Cancer Survivors Benefit from
the Ripple
Effect of Fly-Fishing Retreat “My retreat in Colorado was the shining light in my breast cancer journey.” – 2012 participant of Casting for Recovery
Thanks to advances in treatment, more
concerns, while they learn a skill that offers
women are surviving a diagnosis of breast
therapeutic physical and mental benefits.
cancer, and this has led to increased national interest in understanding how to
A 2010 American Cancer Society report
improve their long-term quality of life.
entitled Cancer Survivorship Research: Recovery and Beyond featured 18 studies
of their own experience and bond with
According to the National Cancer Institute,
that evaluated exercise’s impact on qual-
other women in similar circumstances, ac-
of the approximate 2.6 million women alive
ity of life among breast cancer survivors.
cording to the press advisory.
in the United States with a history of breast
Twelve noted a positive impact. Of four
cancer in January 2008, more than half were
studies on anxiety, three reported signifi-
A 2005 issue of Journal of Advanced Nursing
diagnosed fewer than 10 years earlier.
cant improvements.
(Vol. 51, Issue 5, Sept. 2005) addressed the
The issue for women diagnosed with breast
Fly-fishing instruction is a form of exercise
breast cancer continue to experience infor-
cancer isn’t solely about survival, according
that addresses areas of the body affected by
mational and emotional needs during their
to Casting for Recovery Executive Director
radiation and/or surgery in the treatment
long-term survivorship. However, women’s
Lori Simon. It includes managing the dis-
of breast cancer, according to the press ad-
needs are often unmet by oncology teams
ease, while pursuing life and engaging in
visory. The motion is similar to exercises
and they have to find other sources of sup-
the full range of possible activities.
prescribed by surgeons.
port, such as self-help groups.”
“A woman must address the fact that be-
Counseling, medical education and other
However, according to the advisory, on
yond treatment there are still challenges
services also are components of CFR,
average 70 percent of CFR participants do
in balancing life and recovery and in com-
which is available to participants at no cost.
not belong to a support group.
in relationships with others,” said Ms. Si-
Not Just Fly Fishing
Helping to Overcome the Issues
mon. “When Casting for Recovery began
While fly fishing is on the Casting for Re-
Findings from a 2011 study of CFR retreats
(in 1997), many organizations focused on
covery agenda, helping survivors discover
in five states and post-retreat surveys dem-
research and advocacy but there was very
possibilities within themselves is at the
onstrate the program’s ability to reduce
little attention to quality-of-life issues and
core of its mission.
and/or identify emotional distress and
benefits of self-help support. “Survivors of
ing to terms with changes in her body and
the benefit of physical activity.”
quality of life issues in breast cancer surviThe two and a half days of instruction and
vors, according to the advisory.
Casting for Recovery (CFR) is an innova-
facilitated small-group activities are con-
tive national quality-of-life program for
ducted by trained volunteers. During this
The 2011 study was designed to evaluate the
women of any age or stage of breast can-
time, participants have an opportunity to
effects on emotional distress in breast can-
cer treatment and recovery. Its mission has
overcome feelings of helplessness, learn to
cer survivors. Participants completed the
been to help these women explore their
take care of themselves, reflect on the value
National Comprehensive Cancer Network
18
The Triangle Physician
(NCCN) Distress screening tool prior to and
Casting for Recovery has conducted 414
The organization depends on donations
two to six weeks after their CFR retreats.
retreats nationally since its founding and
from individuals, foundations and corpo-
served more than 5,100 breast cancer
rations. Corporate supporters currently
The study found these to be the 10 top
survivors. It also has inspired similar pro-
include The Hartford, UnderArmour and
concerns of participants:
grams for men with cancer, wounded vet-
L.L. Bean.
1) Worry/fears/nervousness
erans and organizations operating in New
2) Fatigue
Zealand, Canada and the United Kingdom.
3) Memory/concentration
For more information, visit www.castingforrecovery.org.
4) Sadness/depression 5) Sleep 6) Appearance 7) Financial/insurance 8) Dealing with partner/children 9) Sexual 10) Loss of interest in usual interests. The 2011 study found, however, a significant decrease in the distress score after experiencing the retreat – from 4.02 prior to the retreat to 2.93 post-retreat. Ninety-one percent of respondents felt more aware and accepting of themselves, felt better able to cope and learned something new about living with breast cancer after participating in a retreat.
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octoBER 2012
19
Duke News
Cancer Research Yields Unexpected New Method to Produce Nylon In their quest for a cancer cure, researchers
similarities between cancer research tech-
They were right. The functional mutation
at the Duke Cancer Institute made a seren-
niques and biochemical engineering. Both
observed in cancer could be constructively
dipitous discovery – a molecule necessary
fields rely on enzymes, which are mol-
applied to other closely related enzymes,
for cheaper and greener ways to produce
ecules that convert one small chemical to
creating a beneficial outcome – in this case
nylon.
another. Enzymes play a major role in both
the missing link that could enable adipic
healthy tissues and in tumors, but they are
acid production from cheap sugars. The
The finding, described in the Sept. 23 is-
also used to convert organic matter into
next step will be to scale up the overall
sue of the journal Nature Chemical Biol-
synthetic materials, such as adipic acid.
adipic acid production process, which remains a considerable undertaking.
ogy, arose from an intriguing notion that some of the genetic and chemical changes
One of the most promising approaches
in cancer tumors might be harnessed for
being studied today for environmentally
“It’s exciting that sequencing cancer ge-
beneficial uses.
friendly adipic acid production uses a
nomes can help us to discover new enzyme
series of enzymes as an assembly line to
activities,” Dr. Reitman said. “Even genetic
“In our lab, we study genetic changes that
convert cheap sugars into adipic acid.
changes that occur in only a few patients
cause healthy tissues to go bad and grow
However, one critical enzyme in the series
could reveal useful new enzyme functions
into tumors. The goal of this research is
called a 2-hydroxyadipate dehydrogenase
that were not obvious before.”
to understand how the tumors develop
has never been produced, leaving a miss-
in order to design better treatments,” said
ing link in the assembly line.
Medical research that can be applied broadly to solve other significant issues of
Zachary J. Reitman, Ph.D., an associate in research at Duke and lead author of the
This is where the cancer research comes
the day “is the result of a cancer researcher
study. “As it turns out, a bit of information
in. In 2008 and 2009, Duke researchers,
thinking outside the box,” said Dr. Yan, a
we learned in that process paves the way
including senior author of the study Hai
professor in the Duke Department of Pa-
for a better method to produce nylon.”
Yan, M.D., Ph.D., identified a genetic mu-
thology. “Not only is this discovery excit-
tation in glioblastomas and other brain tu-
ing, it reaffirms the commitment we should
Nylon is a ubiquitous material, used in
mors that alters the function of an enzyme
be making to science and to encouraging
carpeting, upholstery, auto parts, apparel
known as an isocitrate dehydrogenase.
young people to pursue science.”
its production is adipic acid, which is one
Dr. Reitman and colleagues had a hunch
In addition to Drs. Reitman and Yan, study
of the most widely used chemicals in the
that the genetic mutation seen in cancer
authors include Bryan D. Choi, Ivan Spaso-
world. Currently, adipic acid is produced
might trigger a similar functional change
jevic, Darell D. Bigner and John H. Samp-
from fossil fuel, and the pollution released
to a closely related enzyme found in yeast
son. The work was supported with funds
from the refinement process is a leading
and bacteria (homoisocitrate dehydroge-
from the National Institutes of Health (R01
contributor to global warming.
nase), which would create the elusive 2-hy-
CA1403160). The authors are listed on a
droxyadipate dehydrogenase necessary for
patent that is pending related to the mu-
“green” adipic acid production.
tated enzymes.
and other products. A key component for
Dr. Reitman said he and colleagues delved into the adipic acid problem based on
Policy Provides Ethical Foundation for Managing Critical Drug Shortages Hospitals and health systems faced with
fairness, researchers at Duke University
day, Sept. 24, in the archives of Internal
ongoing shortages of key drugs for cancer
Medical Center reported.
Medicine, the Duke team outlined a policy adopted at Duke Medical Center that es-
and other diseases should develop firm rationing policies based on transparency and
20
The Triangle Physician
In a special article published online Mon-
tablished clear-cut rules for apportioning
Duke News waste. In certain critical-shortage situa-
scarce drugs using a hierarchy of clinical
or (a patient) says they’d like to be a major
need and effectiveness.
donor? Does that person step to the front
tions, Duke also had rules giving prior-
of the line? Our policy says no – all patients
ity to existing patients, new patients from
are treated equal.”
the immediate referral region and patients
Built on similar models that govern some
who could be cured by the drug.
organ donations, the Duke approach was written by the hospital’s ethics committee
While each shortage was unique, Dr. Ro-
and adopted by hospital leadership in 2011
soff said having the policy provided a
Dr. Rosoff said Duke’s experience could be
as shortages of critical drugs occurred
uniform approach to managing different
instructive to most other institutions, but
regularly.
situations. When drugs were flagged as
noted the hospital benefitted from having
running low, hospital officials immediately
a compounding pharmacy, which enabled
In recent years, the United States Food
responded by taking inventory of remain-
it to produce many scarce drugs when raw
and Drug Administration has announced
ing stock, determining when and how ad-
materials were available. He said that ca-
hundreds of supply problems for lifesav-
ditional supplies might become available,
pacity created additional ethical dilemmas,
ing chemotherapy agents, pain medica-
reducing waste and paring back on usage.
requiring strong communication and cooperation with surrounding hospitals.
tions, antibiotics and other drugs. Dozens of pharmaceuticals are on the shortage list
One tactic was to restrict scarce drugs for
at any given time, forcing doctors to switch
FDA-approved uses, or in circumstances
“We had to make some difficult decisions,
patients to alternatives, delay treatments or
with firm, scientific evidence of benefit. As
most of which we foresaw in the creation
cut dosages.
a result, a chemotherapy agent approved
of the policy,” Dr. Rosoff said. “There have
solely for breast cancer could not be used
been several issues we thought could hap-
“There’s no reason to believe things will get
“off label” for other types of cancers un-
pen, but haven’t happened yet, so in that
better and, in fact, they may get worse, so
less there was strong published evidence to
sense, it’s been very gratifying.” In addi-
hospitals will have to deal with some very
support it.
tion to Dr. Rosoff, authors included Kuldip R. Patel; Ann Scates; Gene Rhea; Paul W.
dicey issues,” said Philip M. Rosoff, M.D., M.A., director of clinical ethics at Duke
Hospital officials also strategically sched-
Bush; and Joseph A. Govert. The study did
and lead author of the study. “For that
uled patients who needed the same drugs
not receive external funding.
reason, it’s important to establish and fol-
on the same day, pooling the small leftover
low an ethically defensible policy for how
NEWSOURCE-JUN10:Heidi 8/5/10 12:57 amounts in single-vial containers to reduce
PM
Page 1
scarce resources are rationed.” In their article describing the development and implementation of the Duke Medical
Do They Like What They See?
Center policy, Dr. Rosoff and co-authors outlined five essential components: • Rules were transparent and open to re-
Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.
view both internally and externally; • The policy and its rationale were relevant, clinically necessary and clearly stated; • Patients and doctors had a path for appeal;
Our services range from consultation, to design, to creation and implementation of strategic plans.
• Rules were followed and enforced by all and for all; • No patient or doctor was allowed special consideration. Dr. Rosoff said fairness was an especially important component of the policy. “One of the issues that arises is the question of so-called ‘special people,’” Dr. Ro-
newsource & Associates 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.
soff said. “What if a major donor comes in
octoBER 2012
21
Durham Regional News
Hospital Performs Its First Single-Incision Robotic Surgery Durham Regional Hospital is expanding
surgeon who performed the cholecystec-
Most people who require gallbladder
its surgical options by offering single-inci-
tomy. “We are excited to be a leader in the
removal are candidates for the robotic
sion surgery using the da Vinci Si surgical
surgical field, but are most excited for the
single-incision surgery. According to the
robot.
benefits it offers our patients.”
American College of Surgeons, surgery is
A surgical team at Durham Regional per-
Potential benefits of robotic single-incision
formed their first single-incision chole-
surgery include minimal scarring, minimal
cystectomy (removal of the gallbladder)
pain, less blood loss, shorter hospital stay
Durham Regional offers various types of
with robotic assistance in August. The
and a faster recovery.
robot-assisted surgeries. In addition to
the recommended treatment for gallstones and non-functioning gallbladders.
gallbladder removal, surgeons at Durham
patient’s gallbladder was removed through an incision of approximately 1 inch in the
During the procedure, the surgeon sits at
Regional perform robot-assisted surgery in
belly button. The surgery was performed in
a console, viewing a three-dimensional,
urology, gynecology, weight-loss surgery
about one hour with a hospital stay of less
high-definition image of the patient’s anat-
and other general surgery procedures. The
than 24 hours.
omy. The surgeon uses controls to move
hospital also offers a wide range of mini-
the instrument arms and camera. In real-
mally invasive conventional laparoscopic
“Neither robotic surgery nor single-inci-
time, the system translates the surgeon’s
surgeries.
sion surgery is new, but combining the two
hand, wrist and finger movements into
is the next step in the evolution of surgical
more precise movements of the miniatur-
For information, visit durhamregional.org/
offerings,” says Dana Portenier, M.D., the
ized instruments inside the patient.
robotics.
Wake Specialty News
Wake Specialty Physicians Fills Need for Primary Care in Fuquay-Varina Wake Specialty Physicians - Fuquay-Vari-
ties we serve.”
medicine, including obstetrics, pediatrics
na Primary Care is a new WakeMed Health & Hospitals practice in Fuquay-Varina.
broad experience in all aspects of family
Dr. Kessler spent 10 years as a practicing
and internal medicine.
family medicine doctor in Ohio and as a Ioanna Z. Giatis Kessler, D.O., F.A.C.O.F.P.,
staff member in the Department of Fam-
In addition to treating the needs of chil-
and Amber Whited, D.O., are offering
ily Medicine at South Pointe Hospital, a
dren and adults, Wake Specialty Physicians
comprehensive family medicine services
Cleveland Clinic hospital also in Ohio.
- Fuquay-Varina will provide chronic-
for adults, adolescents and pediatric (new-
Board certified by the American College of
disease management for such problems
born and up) patients in the new office lo-
Osteopathy Family Physicians (ACOFP),
as high blood pressure, diabetes and high
cated at 231 North Judd Parkway.
Dr. Kessler is also a fellow of ACOFP and
cholesterol. The practice also will offer
has served as a clinical professor of fam-
preventive physical exams, vaccinations,
“People are better stewards of their health
ily medicine at universities in Kentucky,
dermatological care and women’s health
when they have access to high-quality care
Pennsylvania and Ohio.
services, including annual gynecological checkups, hormone management and
in their communities,” said Susan Weaver, M.D., WakeMed executive vice president
Dr. Whited is board certified in family
pregnancy tests and counseling. Same-day
of physician practices and medical affairs.
medicine and joined Wake Specialty Phy-
appointments and 24/7 physician coverage
“There is currently an unmet need for pri-
sicians - Fuquay-Varina Primary Care after
are also available.
mary care services in Fuquay-Varina, and
completing her family medicine residency
WakeMed is committed to delivering ex-
at Southwest Washington Medical Center
To schedule an appointment,
pert, compassionate care to the communi-
in Vancouver, Wash. There, she gained
call (919) 235-6410.
22
The Triangle Physician
News
Hospitals Earn Joint Commission Quality Measures Recognition Five of the region’s hospitals have been named among
sessment. Each accountability
use of evidence-based clinical processes for
measure represents an
heart attack, heart failure, pneumonia and
evidence-based prac-
620 nationwide for
surgical care.
tice, for example,
exemplary performance on specific
giving aspirin at
In addition to being included in the Joint
quality measures
arrival for heart
Commission’s Improving America’s Hospi-
in 2011. They
attack patients
tals annual report, the Top Performers on
are: Duke Uni-
and giving an-
Key Quality Measures will be recognized
versity Hospital
tibiotics
one
on the Joint Commission’s Quality Check
hour before sur-
website at qualitycheck.org. The Top Per-
and
Durham
former program will also be featured in
gery.
Regional Hospital
October’s Joint Commission: The Source
in Durham, Duke These five hospitals
Raleigh Hospital and
were recognized for their
Rex Healthcare in Raleigh
and November’s Joint Commission Perspectives.
and Granville Health System in Oxford.
The Triangle Physician 2013 Editorial Calendar
The Joint Commission’s Top Performers on Key Quality Measures placed in the top 18 percent of the 3,376 eligible hospitals in the United States that report performance data to the nation’s leading accreditor of health care organizations. To earn the designation, a hospital must achieve a score of 95 percent or above for its composite performance score and on each individual area that comprises its as-
January Glaucoma Wound Management Accounting
May Arthritis Women’s Health Medical Billing
September Atrial Fibrillation Urology Web Design
February Asthma and Allergies Heart Disease Consulting for your Practice
June Men’s Health Vascular Diseases Medical Collections
October Cancer in Women COPD - Lung Health Medical Software - EMR
March Nutrition Sleep Disorders Legal
July Imaging Technologies Psoriasis Medical Insurance
November Alzheimer’s Disease Diabetes Financial Planning
April Autism Irritable Bowel Syndrome IT Services
August Orthopedics Gastroenterology Medical Real Estate
December Pain Management Spine Disorders Practice Management
Cary Endocrine & Diabetes Center, P.A.
CEDC provides diagnosis and treatment for patients with hormonal and metabolic disorders including: diabetes, lipid disorders, PCOS, thyroid disorders, osteoporosis and other bone disorders, pituitary disorders, adrenal disorders, and sex hormone disorders.
Celebrating our first year in Cary!
Sung-Eun Yoo, MD
Endocrinologist Diplomat, American Board of Endocrinology, Diabetes and Metabolism Diplomat, American Board of Internal Medicine Endocrine Certification in Neck Ultrasound (ECNU) Certification in the International Society for Clinical Densitometry (ISCD)
On-Site Services: • Thyroid, parathyroid and neck ultrasound • Ultrasound guided FNA • DEXA bone density scans and interpretation • Osteoporosis therapy • Comprehensive diabetes management including diabetes education, insulin pump therapy, and continuous glucose monitoring • LabCorp in-house Introducing Jeanne Hutson, NP-C Board Certified in Advanced Diabetes Management
Cary Endocrine & Diabetes Center, P.A. • 103 Parkway Office Court, Suite 202 • Cary, NC 27518 • 919-378-2332 • www.caryendocrine.com
octoBER 2012
23
UNC News
Scientists Identify Genetic Causes of Most Common Form of Breast Cancer A team of scientists with The Cancer Ge-
“In particular, we now have a much better
ual genes were associated with the luminal
nome Atlas program reports its genetic
picture of the genetic causes of the most
A subtype. Some of these mutations may
characterization of 800 breast tumors, in-
common form of breast cancer, namely
be directly targetable by a drug(s) that is
cluding finding some of the genetic causes
estrogen-receptor positive/luminal A dis-
in clinical development, possibly offering
of the most common forms of breast can-
ease. We also found a stunning similar-
new options for many patients.
cer, providing clues for new therapeutic
ity between basal-like breast cancers and
targets and identifying a molecular simi-
ovarian cancers.”
In addition, the TCGA team compared basal-like breast tumors (also known as triple-
larity between one sub-type of breast can“This study has now provided a near com-
negative breast cancers) with high-grade
plete framework for the genetic causes of
serous ovarian tumors and found many
Their findings, which offer a more compre-
breast cancer, which will significantly im-
similarities at the molecular level, suggest-
hensive understanding of the mechanisms
pact clinical medicine in the coming years
ing a related origin and similar therapeutic
behind each sub-type of breast cancer, are
as these genetic markers are evaluated as
opportunities. These data also suggest that
reported in the September 23 online edi-
possible markers of therapeutic respon-
basal-like breast cancer should be consid-
tion of the journal Nature.
siveness.”
ered a different disease than ER-positive/
cer and ovarian cancer.
luminal breast cancer, and in fact, both The researchers, including a large
basal-like breast cancer and ovar-
group from the University of
ian cancer were more similar to
North Carolina School of Medi-
each other than either was to ER-
cine, analyzed tumors using two
positive/luminal breast cancer.
basic approaches. The first used an unbiased and genome-wide ap-
“Cancer is, of course, a complex
proach. The second was within the
disease that includes many types
context of four previously known
of alterations, and thus, no one
molecular sub-types of breast can-
technology can identify all of
cer: HER2-enriched, luminal A,
these alterations. However, by us-
luminal B and basal-like.
ing such a diverse and powerful Dr. Perou is the May Goldman Shaw dis-
set of technologies in a coordinated fash-
Both approaches arrived at the same con-
tinguished professor of molecular oncol-
ion, we were able to identify the vast ma-
clusions, which suggest that even when
ogy and a member of UNC Lineberger
jority of these alterations,” said Dr. Perou.
given the tremendous genetic diversity of
Comprehensive Cancer Center. Katherine Hoadley, Ph.D., study co-au-
breast cancers, four main subtypes were observed. This study is also the first to in-
Among the many discoveries include find-
thor, explained. “Our ability to compare
tegrate information from six analytic tech-
ings of some of the likely genetic causes of
and integrate data from RNA, microRNA,
nologies, thus providing new insights into
the estrogen-receptor positive luminal A
mutations, protein, DNA methylation and
these previously defined disease subtypes.
subtype. Luminal A tumors are the num-
DNA copy number gave us a multitude of
ber one cause of breast cancer deaths in
insights about breast cancer. In particular,
“Through the use of multiple different
the United States, accounting for approxi-
highlighting how distinct basal-like breast
technologies, we were able to collect the
mately 40 percent, and finding the genetic
cancers are from all other breast cancers on
most complete picture of breast cancer
drivers of this subtype is of paramount im-
all data types. These findings suggest that
diversity ever,” said Charles Perou, Ph.D.,
portance.
basal-like breast cancer, while arising in the same anatomical location, is potentially
corresponding author of the paper. “These
a completely different disease.”
studies have important implications for all
The Cancer Genome Atlas (TCGA) team
breast cancer patients and confirm a large
found that the mutation diversity within
number of our previous findings.
this group was the greatest and that even
Dr. Perou described UNC’s role on the
specific types of mutations within individ-
TCGA breast cancer project as “extensive,
24
The Triangle Physician
UNC News including generating the RNA expression
TCGA is a groundbreaking effort to genet-
lion in grants to fund this research. TCGA
data, performing integrated data analyses
ically characterize the entire genome of 20
is funded jointly by the National Cancer
and playing a major role in the writing of
different cancer types, involving scientists
Institute and the National Human Genome
the paper and crafting of the new hypoth-
from around the world. UNC Lineberger
Research Institute, both part of the Nation-
eses coming from this work.”
was one of the original consortium mem-
al Institutes of Health.
bers and will receive more than $20 mil-
Genetically Engineered Models Better Predict Pharmacodynamic Response first time, we were able to compare these
New cancer drugs must be thoroughly tested in preclinical models, often in mice, be-
The collaborative study, which appears in
various laboratory techniques used in
fore they can be offered to cancer patients
The Oncologist, brought together a set of
countless labs and the pharmaceutical in-
for the first time in Phase I clinical trials.
unique resources available at UNC to de-
dustry to evaluate how carboplatin was
Key components of this process include
termine which preclinical models best pre-
delivered to the tumor and compare it to
pharmacokinetic and pharmacodynamic
dict delivery of carboplatin to melanoma
actual human data. None of these labora-
studies, which evaluate how the drug acts
tumors in patients.
tory models are perfect, but the genetically engineered model is the best in terms of
on a living organism. These studies measure the pharmacologic response and the
“We have a unique opportunity to evalu-
predicting the amount of drug that is de-
duration and magnitude of response ob-
ate an important factor in the treatment of
livered to the tumor in human patients,”
served relative to the concentration of the
solid tumors because of the outstanding
Dr. Zamboni said.
drug at an active site in the organism.
collaborative nature and novel resources at “We know that laboratory models are im-
UNC,” said Dr. Zamboni.
perfectly predictive of human response
A new comparison of four different methodologies for pharmacokinetic and phar-
“We have used a pharmacokinetics testing
and if the tumor models don’t predict de-
macodynamic testing of the anti-melano-
method called microdialysis, which uses
livery, they are most likely not an optimal
ma agent carboplatin demonstrates that
a tiny probe to take samples that measure
research tools,” he said.
genetically engineered mouse models
serial drug concentrations in a tumor over
provide tumor delivery of drug most com-
time,” he said. “We plan to use this method
Dr. Sharpless added, “We are continually
parable to the response seen in melanoma
to advance pharmacology studies of anti-
looking for ways to build better laboratory
patients.
cancer agents in tumors and tissues of pa-
models so that new therapies move from
tients and to evaluate the tumor delivery of
the lab to the patient as quickly and safely as
“These studies are critically important in
nanoparticles and other classes of delivery
possible. This study provides valuable vali-
the case of small-molecule cancer drugs,
agents.”
dation that genetically engineered models can help us accomplish this objective.”
which often have systemic side effects and can be toxic at high concentrations,” said
The study team used the resources of the
Ned Sharpless, M.D., Wellcome distin-
preclinical Phase I unit at UNC Lineberger
Other members of the research team in-
guished professor of cancer research and
to compare how pharmacokenetic levels
clude Austin Combest, Pharm.D., M.B.A.,
study co-author.
vary in several preclinical tumor models,
Katie Sandison, B.S., Suzan Hanna, M.S.,
including a genetically engineered model,
of UNC Eshelman School of Pharmacy;
The study was led by Bill Zamboni,
a model where tumor cells are transplanted
UNC Lineberger researchers Patric Rob-
Pharm.D., Ph.D., associate professor of
to the appropriate part of the body (called
erts, Ph.D., Pharm.D., Patric Dillon, M.D.,
pharmacotherapy and experimental thera-
an orthotopic syngeneic transplant, or
and Charlene Ross; Beth Zamboni, M.S., of
peutics at the UNC Eshelman School of
OST), and a xenograft model, where hu-
Carlow University (Pittsburgh, Pa.); Sohr-
Pharmacy and a member of UNC Line-
man tumor tissue is transplanted.
ab Habibi, Ph.D., of the UNC Department of Chemistry; and Markus Muller, M.D.;
berger Comprehensive Cancer Center; and Dr. Sharpless, who is also associate direc-
“Because carboplatin is widely used, we
and Martin Brunner, M.D., of Vienna Uni-
tor for translational research at UNC Line-
have good data on how the drug works
versity Hospital (Austria).
berger.
pharmacokenetically in humans. For the
octoBER 2012
25
The Magazine for Healthcare Professionals.
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The Triangle Physician Magazine
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ylva
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m
n wa
ell ch Mit
Madison
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o Ch
Watauga Avery
Ca
Gates
k an ot s an qu uim rq Pe
Vance
ck tu
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ri ur
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The Eastern Physician Magazine FUTURE The Western Physician Magazine The Eastern and The Triangle Physician Magazines
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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.
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info@TrianglePhysician.com 26
The Triangle Physician
News
Mission: Lifeline Award Recognizes Heart Attack Care Three hospitals in the region have earned
Hospitals recognized in the gold category
In 2011, Durham Regional received the
the American Heart Association Mission:
are recognized for at least 24 months of 85
Bronze
Lifeline Silver Receiving Quality Achieve-
percent or higher composite adherence to
Bronze represented one quarter of meet-
ment Award for their exceptional standard
all STEMI receiving center performance
ing or exceeding quality measures. By re-
of care for heart attack patients.
achievement indicators and 75 percent or
ceiving silver, Durham Regional achieved
higher compliance on all STEMI receiv-
four quarters (or one year) of consecutively
University of North Carolina Hospital in
ing center quality measures to improve the
meeting all the goals outlined by the AHA,
Chapel Hill is recognized as a “Gold Re-
quality of care for STEMI patients.
with the focus on first medical contact to
Quality
Achievement
Award.
angioplasty in less than 90 minutes, ac-
ceiving” hospital. Durham Regional Hospital in Durham is recognized as a “Silver
Those in the silver category are recognized
cording to a Durham Regional Hospital
Receiving” hospital, and Duke University
for at least 12 months of 85 percent or
press advisory.
Hospital in Durham as a “Bronze Receiv-
higher composite adherence to all STEMI
ing” hospital.
receiving center performance achieve-
“Durham Regional is dedicated to provid-
ment indicators and 75 percent or higher
ing timely, expert care to our heart attack
According to an American Heart Associa-
compliance on all STEMI receiving center
patients,” said Michael Komada, M.D.,
tion (AHA) press advisory, each year in the
quality measures to improve the quality of
cardiologist at Durham Regional Hospital.
United States, nearly 300,000 people have
care for STEMI patients.
“This takes a team and great collaboration across many departments within the hos-
a STEMI, or ST-segment elevation myocardial infarction, the most severe form
Bronze “Receiving” hospitals are recog-
pital, as well as with local EMS and other
of heart attack. A STEMI occurs when a
nized for at least 90 days of 85 percent or
facilities. We are excited to be recognized
blood clot completely blocks an artery to
higher composite adherence to all STEMI
for our achievements, and I am proud of
the heart. To prevent death, it’s critical to
receiving center performance achieve-
our dedication to continuous improve-
immediately restore blood flow, either by
ment indicators and 75 percent or higher
ment in cardiac care.”
surgically opening the blocked vessel or by
compliance on all STEMI receiving center
giving clot-busting medication.
quality measures to improve the quality of
For more information, visit heart.org/mis-
care for STEMI patients.
sionlifeline and heart.org/quality.
Hospitals involved in Mission: Lifeline are part of a system that makes sure STEMI patients get the right care they need as quickly as possible. Mission: Lifeline focuses on improving the system of care for these patients and at the same time improving care for all heart attack patients. STEMI “Receiving” hospitals meet high standards of performance in quick and appropriate treatment of STEMI patients to open the blocked artery. Before discharge, patients start aggressive risk-reduction therapies, such as cholesterol-lowering drugs, aspirin, ACE inhibitors and betablockers, and they receive smoking cessation counseling if needed. Hospitals must adhere to these guidelines-based measures at a set level for a designated period of time
However much you value wildlife conservation in North Carolina,
DEC NC
11
1234
quadruple it.
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
to be eligible for the achievement awards.
octoBER 2012
27
News Welcome to the Area
Upcoming Events
Physicians
Kimberly Elaine Janssen, MD
Rebecca Victoria Taylor, MD
Kimberly Margaret Karrat, DO
Anatomic Pathology and Laboratory Medicine
Psychiatry
UNC Hospitals Pathology Dept Chapel Hill
University of North Carolina Hospitals Chapel Hill
Emily Louise Kingsley, MD
Amit Navin Vora, MD
Internal Medicine; Pediatrics
Cardiovascular Disease, Internal Medicine
Fuquay-Varina
University of North Carolina Hospitals Chapel Hill
Duke University Hospitals Durham
Ethan Martin Basch, MD
Lawrence Chunhao Ku, MD
Robert Maur Watt, MD
Neonatal-Perinatal Medicine; Pediatrics
Hospitalist; Internal Medicine
Duke University Hospitals Durham
First Health Hospitalist Service Pinehurst
Vikas Kumar, MD
Michael Yeung, MD
Anesthesiology
Cardiology
University of North Carolina Hospitals Chapel Hill
UNC Cardiology Chapel Hill
John Thomas Lemm, MD
Beatrice Guadalupe Zepeda, MD
Anesthesiology - Critical Care Medicine
Pediatrics; Critical Care Pediatrics
Duke University Hospitals Durham
Duke University Hospitals Durham
Physical Medicine and Rehabilitation
UNC at Chapel Hill
Ioanna Giatis Kessler, DO Family Medicine
Oncology, Internal Medicine
UNC Lineberger Cancer Center Chapel Hill
James Edward Bedford, MD Psychiatry
University of North Carolina Hospitals Chapel Hill
Robert Michael Bishop, MD Pediatric Cardiology; Pediatrics
Duke University Hospitals Durham
Stacy Lynn Boulton, MD Obstetrics and Gynecology
Wake Medical OB/GYN Raleigh
Anjana Chandran, MD Pediatrics
Lincoln Community Health Center Durham
Asa Lee Cordle, MD Psychiatry
University of North Carolina Hospitals Chapel Hill
Tejpal Singh Dhillon, MD Orthopedic Surgery
Sarah Stamps Lewis, MD Infectious Diseases, Internal Medicine
Duke University Hospitals Durham
Anton Lishmanov, MD Cardiovascular Disease, Internal Medicine
University of North Carolina Hospitals Chapel Hill
Carla Jane Luna, MD Allergy and Immunology; Internal Medicine
Allergy Partners of Pinehurst Pinehurst
Irvin Donald Milowe, MD
Raleigh
Child and Adolescent Psychiatry; Forensic Psychiatry
Heather Anne Dobbs, MD
Irvin D. Milowe, MD Durham
Anesthesiology
Duke University Hospitals Durham
Jennifer Dominguez, MD Anesthesiology
Duke University Hospitals Durham
Amber Ann Morris, MD Obstetrics and Gynecology
Aberdeen
Matthew William Payne, MD Family Medicine
Physician Assistants Roger Arguello, PA Cardiology; Cardiovascular Disease, Internal Medicine
105 Jones Ferry Rd., Carrboro
Ginger Morris Atkinson, PA Dermatology - Clinical & Laboratory, Pediatric
Blue Ridge Dermatology, Raleigh
Gerardina Bueti, PA Surgery
Duke University Medical Center Durham
Emily Anne Foster, PA Durham
Laura Renee Gleason, PA Emergency Medicine; Family Medicine; Family Practice; Urgent Care
Durham
Duke Primary Care Raleigh
Bailey Elizabeth Hardy, PA
Orthopedic Surgery, Musculoskeletal Oncology
Mustafa Saidi, MD
Triangle Medical Professionals Raleigh
Duke University Clinic Building Durham
Johnston Medical Center Smithfield
Jessica Ann Hope, PA
Scott Leonard Sanoff, MD
Heidi Jo Little, PA
William Curtis Eward, MD
Eleisha Danielle Flanagan, MD Abdominal Surgery; General Surgery
UNC Dept of Surgery Chapel Hill
Alia Lynell Fox, MD Pediatrics; Anesthesiology
Duke University Durham
Peter Nicholas Gottschalk, MD Emergency Medicine
Durham
Daniel William Handel, MD Dermatology; Hypnosis
Pittsboro
Albert Ramsey Harris, MD Plastic Surgery/Hand Surgery
Orthopaedic Specialists of NC Raleigh
Heather Ann Heaton, MD Emergency Medicine
University of North Carolina Hospitals
28
The Triangle Physician
Internal Medicine; Hospitalist
Internal Medicine - Nephrology
Duke University Medical Center Durham
Hanna Kelly Sanoff, MD Oncology, Internal Medicine
UNC Hematology/Oncology Chapel Hill
Jennifer Smith Segura, MD Child and Adolescent Psychiatry
Duke University Hospitals Durham
Nipa Doshi Shah, MD Pediatric - Transplant Hepatology, Allergy, Child Abuse, Developmental - Behavioral, Medical Toxicology, Neurodevelopmental Disabilities, Urology
Duke University Hospitals, Durham
Ryan Henry Sydnor, MD Radiology
Duke University Hospitals, Durham
General Surgery; Urology
Durham
Adolescent & Young Adult Medicine, Cardiovascular Disease, Internal Medicine, Dermatology, Diabetes, Endocrinology, Gastroenterology, Gynecology, Infectious Diseases, Nutrition, Urology
Eastern North Carolina Medical Group Rocky Mount
Anya Collieson Marshall, PA Family Practice; Gynecology; Pediatrics
MacGregor Family Physicians Cary
Look Good Feel Better Nov. 5, 5:30-7:30 p.m. Look Good Feel Better is a free American Cancer Society program that teaches women beauty techniques while they undergo chemotherapy and radiation treatments. Participants receive a free cosmetics kit and instruction by beauty professionals. Location: North Conference Room, Durham Regional Hospital Registration: Call (919) 470-7168
Diabetes Support Group for Adults Nov. 5, 6-7:30 p.m. This support group for those with diabetes and their guest is facilitated by certified diabetes educators to help participants manage their diabetes. November’s session will focus on recipes and strategies for enjoying the holidays. Location: Teer House, 4019 N. Roxboro Road, Durham 27704
Stroke Support Group Nov. 12, 1-2:30 p.m. The mission of this support group is to help educate the stroke survivor, caregiver and community about stroke prevention and stroke disabilities. This group meets the second Monday of each month. Location: Private Dining Room C, Durham Regional Hospital.
Good Neighbors, Good Health Health Education Seminar Nov. 13, 7 p.m. This free educational series is designed to help the community stay on top of important health issues. November’s seminar will be “Surgical Options for Breast Cancer Treatment,” presented by Aimee Mackie, M.D., Duke surgical oncologist at Durham Regional Hospital. Light refreshments will be provided. Location: Durham Regional Hospital auditorium Register for these events online at www.durhamregional.org/events or by calling (919) 403-4374, unless otherwise noted.
Jenna Elizabeth Partola, PA Family Medicine
Raleigh
Sarah Stout, PA General Surgery
Bariatric Specialists of NC, Cary
Brandon Lee Tingley, PA Orthopedic Surgery, Trauma
Wake Orthopaedics - Raleigh
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
“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).
The No-Excuse Mammogram Saturday and evening appointments where your patients live, work and play in the Triangle Annual screening mammograms at Wake Radiology take only 20 minutes, from check-in to exam completion. It‘s easy to schedule this important exam, because many of our nine breast imaging offices throughout the area are open evenings and Saturdays, and walk-ins are welcome at all locations. Wake Radiology is in-network with most insurance plans and offers financial assistance or payment plans to patients who need it. Wake Radiology is proud to be the only multi-site freestanding imaging provider in the Triangle to have earned the American College of Radiology’s Breast Imaging Centers of Excellence (BICOE) designation. This rigorous process demonstrates that every single breast imaging modality and breast interventional procedure at each Wake Radiology outpatient location is ACR accredited. Yearly mammograms are recommended for all women starting at age 40, and earlier if genetic risks exist. Your patients can call 919-232-4700 or go online to wakerad.com to schedule their annual digital screening mammogram today. Wake Radiology. Excellence in breast imaging.
Express Scheduling: 919-232-4700 Mon-Fri 7:30am-6:30pm Chapel Hill Scheduling: 919-942-3196 Mon-Fri 8:00am-5:00pm wakerad.com Nine convenient breast imaging locations in the Triangle Raleigh | West Raleigh | Northwest Raleigh | Chapel Hill | Cary Wake Forest | Garner | Morrisville | Fuquay-Varina
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