october
2 017
The Triangle Physician T H E
M A G A Z I N E
F O R
H E A L T H
C A R E
P R O F E S S I O N A L S
Meet Dr. Thomas Weber Jr. Changing the Face of Pain Management Across the Triangle
Also in This Issue Ways not to say “You’re fired!”
Endometriosis studies raise hope
Dermatologist explores bane of rashes
T
6
COVER STORY
Meet Dr. Thomas Weber Jr.
Changing the Face of Pain Management Across the Triangle o c t o b e r 2 0 17
Vol. 8, Issue 9
FEATURES
8
DEPARTMENTS 11 Dermatology
Practice Management
Dos and Don’ts for Handling Disciplinary Action Margie Satinsky explores ways to minimize the need for disciplinary action.
10
Causes and Types of Skin Rashes
14 Research News Poliovirus Triggers Innate Immune Response in Glioblastoma Therapy
15 News
Welcome to the Area
Women’s Health
Exciting Options for Women with Endometriosis
The Triangle Physician
Andrea Lukes describes the life-impacting condition of endometriosis and informs about promising studies.
T H E
M A G A Z I N E
F O R
H E A L T H C A R E
P R O F E S S I O N A L S
On the Cover: Dr. Thomas Weber Jr. of Midtown Pain and Spine Management Clinic specializes in the placement of spinal cord stimulators, with a special eye on maintaining his zero-overdose record.
october 2017
1
Category
Table of Contents
From the Publisher
Dermatology
Pain and Addiction Free Dr. Thomas Weber Jr. of the new Midtown
Gynecologic-obstetrician Andrea Lukes
Pain and Spine Clinic, our cover story this
writes about endometriosis, its primary
month, knows a lot about acute pain and
symptoms, the causes of the pain, risk
even offers to make special arrangements to
reduction and clinical trials that offer hope
provide needed relief.
of effective treatment. Practice management consultant Margie Satinsky gives dos
In addition to his osteopathic medicine
and don’ts that can minimize the angst
degree, a residency in anesthesia and a
associated with disciplinary action.
fellowship in pain medicine, he served in Baghdad as a chief of anesthesia, treating
Incorporating The Triangle Physician into
wounded soldiers and civilians.
your marketing mix is advised if your goal is to reach the more than 9,000 Triangle
Dr. Weber uses all forms of pain
medical professionals. The process for
management and has had zero reported
inquiry is painless. Simply send an email
overdoses. He prefers non-surgical and
to info@trianglephysician.com. A regular
interventional pain treatment to pain
advertising schedule is advised for the
medication. Patient-satisfaction testimonials
best results – referrals, which are a real
reflect treatment effectiveness.
endorphin booster!
This month dermatologist Gregory
With gratitude,
Wilmoth reviews skin conditions and the
Publisher
characteristic physical and emotional discomfort that accompany them.
John Teague
The Triangle Physician T H E
M A G A Z I N E
F O R
H E A L T H C A R E
P R O F E S S I O N A L S
Publisher - John Teague John@TTP2LC.com
Creative Director - Joseph Dally jdally13@gmail.com
Contributing Editors Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Margie Satinsky, M.B.A. Gregory J. Wilmoth, M.D.
News and Columns Please send to info@trianglephysician.com
Advertising Sales info@trianglephysician.com
2
The Triangle Physician
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. 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.
We’ve Taken Screening To Another Dimension!
3-D
MAMMOGRAPHY
“With 3-D mammography, we are able to see
tissue better than ever before - detecting small cancers at an earlier stage and also decreasing stressful false positives. We are excited about what offering this, close to home in Smithfield & Clayton, means for women, families and physicians.” Dr. Cary Bizzell Radiologist Johnston Health
Screening Saves
! s e v Li
www.johnstonhealth.org
Meet Dr. Thomas Changing the Face of Pain Management Across the Triangle
Weber Jr.
F
or acute and chronic pain sufferers, the answer to your pain may be closer than you think. In September, the Triangle’s new “boutique” pain management clinic officially opened its doors. Midtown Pain and Spine Clinic, founded and run by Thomas J.
Weber Jr., D.O., is changing the face of pain management across the Triangle and North Carolina and putting a stop to the opioid epidemic one patient at a time. Introducing Dr. Weber Dr. Weber, who enlisted in the United States Army at age 18 and earned his doctor of osteopathic medicine from the Kirksville College of Osteopathic Medicine. Upon graduation, he completed an internship at the Dwight D. Eisenhower Army Medical Center and his residency in anesthesia at the National Capital Consortium, Walter Reed National Military Medical Center. Following his residency, Dr. Weber was deployed to Baghdad, where at the age of 29 he was elected chief of anesthesia and worked as a combat support doctor. “I performed one of my first epidurals post-residency on an Iraqi woman who was giving birth,” shared Dr. Weber. “During my time in Baghdad, I treated the wounded soldiers, and civilians caught in a war zone. It was in this theater where my passion for pain management truly began.”
4
The Triangle Physician
Dr. Weber discusses a potential spinal cord stimulator with a patient When Dr. Weber returned from his tour, he was asked to open a pain management clinic at Fort Bragg. “I was told we had the budget for a pain management clinic, and it needed to be used. So I began seeing patients and using an empty operating room for my procedures. I had no staff, no nurse, no P.A. It was just me.” Dr. Weber began with a small number of patients that quickly grew, as members of the Green Beret and Delta Force began coming to Dr. Weber for treatment. Soon, he was performing 10 spinal cord stimulation procedures a month. With more than 2,500 patient encounters under his belt, and his practice growing at a rapid pace, Dr. Weber was able to bring in support staff and create a full-fledged pain management clinic. As a lieutenant colonel, Dr. Weber resigned from the Army after 12 years of active duty. He then decided to further his training in pain management by completing a fellowship in pain medicine at Wake Forest University. “Although I had treated nearly 5000 patients and was already board certified through the American Board of Anesthesiology in both general anesthesiology and pain medicine, I felt the fellowship was necessary for my personal and professional growth,” said Dr. Weber. “I was used to treating soldiers, and the fellowship really helped me to become well rounded in my practice.” Today, Dr. Weber still sees patients who he began treating during his fellowship. Because Dr. Weber centers his practice on his patients, they drive from across the state to seek his expertise.
october 2017
5
“One of my greatest joys is getting to know my patients on a personal level. I have some patients I have been treating for five years or more. I know them, I know their families and this knowledge helps me to better manage their pain,” said Dr. Weber. After completing his fellowship, Dr. Weber joined Duke Hospital in Durham, where he once again opened a pain clinic from scratch. As one of the highest producing anesthesiologists at Duke, Dr. Weber had approximately 2,000 patients come through his clinic. After nearly five years with Duke, Dr. Weber felt the calling to open his own practice, so Midtown Pain and Spine Clinic was born. Introducing Midtown Pain and Spine Clinic Dr. Weber and Midtown Pain and Spine Clinic offer a collaborative, comprehensive and patient-centered approach to caring for patients who are living with pain. Through the use of image-guided spine intervention, which offers precise diagnostic capabilities, Dr. Weber is able to provide patients relief from their symptoms. “My goal as a pain management physician is to minimize side effects and maximize benefits,” said Dr. Weber. With patients ranging in age from 16 to 85 years old, Dr. Weber treats a variety of patients from a variety of backgrounds. “There is no age that is too old,” said Dr. Weber, “Although I can’t fix Father Time, I can help patients enjoy their life without feeling his affects.”
6
The Triangle Physician
Dr. Weber and staff members (from left), Kasey Renuart, RT(R), Amy Redmond, Alissa Moody, Dr. Weber.
As a part of his patient-centered approach, acute pain patients with a physician referral can be seen as soon as the same day or next day. “I will come in early, I will stay late,” said Dr. Weber. “I don’t ever want a patient to have to wait months on end to be seen. My goal is to see a referred patient as soon as possible, and I will do everything in my power to make that happen.” Midtown Pain and Spine Clinic offers treatment for back pain, neck pain and other painful conditions, using scientifically proven and advanced non-surgical and interventional pain treatments, such as epidural steroid injections, intrathecal therapy and percutaneous disc decompression. However, Dr. Weber’s true passion lies with spinal cord stimulation. “Through the use of spinal cord stimulation, I have been able to give patients their life back. The immediate relief they experience after the procedure is gratifying,” said Dr. Weber. “With the opioid epidemic growing, I like giving patients an alternative to pain relief without the side effects or chance for addiction.” At a recent appointment with Dr. Weber one patient commented on “how Dr. Weber has truly changed her life. Before I saw Dr. Weber I was in severe pain and did not know which direction I would be able to turn, but he was able to place a temporary spinal cord stimulator on a trial basis. It helped, as did the permanent implant very soon thereafter. I am now living my life without pain and most importantly without the use of high-dose narcotics.” An Alternative to Opioids “Although the opioid epidemic has been gaining attention in recent years, it has been around since the early 2000s,” said Dr. Weber. “When I was running the pain clinic at Fort Bragg, we treated nearly 27,000 patients and had zero overdoses. When I was at Duke, I treated close to 20,000 patients during a five-year timespan with zero overdoses.” Although prescription management is part of the services offered by Dr. Weber, he prefers to treat his patients using the most advanced, state-of-the-art pain management treatment options that eliminate the
“My goal as a
need for pain medication. Dr. Weber has placed hundreds of spinal cord stimulators in eligible patients, who have
pain management
completed a five-to-seven-day trial using a temporary stimulator. Following the trial, Dr. Weber
physician is to
evaluates the patient for improvements in activities of daily living, as well as the pain source
minimize side effects
and level. If the results are promising, the procedure is performed using X-ray and an epidural
and maximize
needle to target the T8 or T9 vertebra, where the stimulator leads are placed.
benefits”
Visit Midtown Pain and Spine Clinic In addition to helping his patients achieve their pain goals, Dr. Weber is passionate about educating his patients on the dangers associated with opioids. “I have been referring patients to Dr. Weber for many years,” said Dr. Tim Garner of Raleigh Neurosurgical Clinic Inc. “Not only does he work new patients into his schedule immediately, I trust that he will provide the pain relief they are seeking for the best possible outcome for improved quality of life. He is one of the best.” Those struggling with pain, including pain associated with failed back surgery, complex regional pain syndrome (CRPS), or other painful conditions may contact Midtown Pain and Spine Clinic to schedule an appointment by calling (919) 277-9845. More information is available at www.midtownpainspine.com.
october 2017
7
Physician Advocacy
Dos and Don’ts for Handling
Disciplinary Action By Margie Satinsky, M.B.A.
Regardless of the care taken during the hiring
Margie Satinsky is president of Satinsky Consulting L.L.C., a Durham consulting firm that specializes in medical practice management. She has helped many physicians start new practices, assess the wisdom of affiliating with a larger health care system and improve their current practices. Ms. Satinsky is the author of numerous books and articles, including Medical Practice Management in the 21st Century.
• Investigate the circumstances thoroughly by
warrant disciplinary action against employees. In
interviewing participants and witnesses and
spite of your best efforts to collaborate with your
by taking written statements. Make sure exam-
employees in setting and achieving goals, some
ine the problem from multiple perspectives
people won’t achieve the desired level of com-
before moving ahead.
petence. Others will deliberately or inadvertently
• If the facts warrant disciplinary action, disci-
break important rules that you have established,
pline the employee when the violation first
documented and communicated.
occurs or upon completion of your investi-
Here are tips for dealing with situations that warrant disciplinary action. Next month we’ll address departures from your practice, focusing particularly on the “employment at will” practice in North Carolina.
disciplinary action (other than discharge) is correction, not punishment. • Make disciplinary write-ups comprehensive by: (1) Applying progressive employee disIncorporating prior action(s) taken; and by (3) Notifying the employee of likely action if future violations occur. Retain all disciplinary write-ups for at least two years. • Develop and consistently apply a system for progressive disciplinary action. Well-managed practices maintain a log of all disciplinary actions in order to ensure consistency and avoid risking the accusation that the reaction to one misdemeanour is inconsistent
Positive Steps to Take
The Triangle Physician
gation. Inform the employee that the goal of
cipline for the same or similar conduct; (2)
For more information, visit www.satinskyconsulting.com.
8
investigation of the problem.
process, all employers encounter situations that
with the reaction to another.
• Clarify expectations at the outset rather
• Know when to take immediate action. Not all
than after a problem arises by: (1) Develop-
problems carry the same weight. Situations
ing and maintaining specific written work
like theft or some other type of fraud demand
rules regarding such topics as attendance,
immediate action.
dress code, confidentiality requirements,
• Take special precautions if the employee is
telephone etiquette and use of social media;
a member of a union. If a union is involved
(2) Documenting the work rules in an official
and an employee requests that a union rep-
employee manual; and by (3) Reinforcing the
resentative attend an investigative interview,
message with posted signage and explana-
allow the employee the opportunity to have
tions during staff and one-on-one meetings.
a union steward present. If no union is in-
• Identify problems as soon as you observe
volved and an employee requests that a co-
them. If minor or major violations occur,
worker be allowed to attend an investigative
share your concerns with your employee,
interview, allow the employee the opportu-
reiterate the expectations, document the dis-
nity to have a co-worker present as a witness
cussion and explain that the next step is an
and advisor to the employee, but not as a
direct participant. • S eek advice from an external consultant and/or legal counsel sooner rather than later. Make sure you are aware of both the antidiscrimination and labor laws that apply to all aspects of employment, not only disciplinary action. Although disciplinary action does not always result in termination of employment, understand your options early in the process rather than at the eleventh hour. Traps to Avoid • When an employee isn’t up to par, it’s tempting to criticize right away. Avoid giving oral discipline without documenting your action and placing the information in the appropriate file. •D on’t file disciplinary action
Do you have lower abdominal pain due to
Endometriosis? Women’s Wellness is currently conducting a clinical research study and (Company Name) Clinic is currently conducting a clinical research study and is isininneed needofofqualified qualifiedvolunteers. volunteers.To Toqualify, qualify,you youmust mustbe beaawoman woman between between Endometriosis. the ages of of18-65 18-65 who whohas haslower lowerabdominal abdominalpain pain the ages duedue to to Endometriosis. Compensation up to is available for study-related time and travel. Compensation up$840 to $XXX is available for study-related time and travel. The Women’s Wellness Clinic offers Radiant Research or Clinical Research many opportunities for you to Advantage or Comprehensive Clinical participate in clinical trials. In addition Development Logo and Tagline Here. to the endometriosis study, there Radiant Tagline: We Can’t Do It Without are trials on birth control, migraines, YOU! CRA Tagline: Enhancing bacterial Patient Care urinary tract infections, Through Clinical Research. CCD Tagline: vaginosis, and heavy periods. Call The Proof is in more the Performance. 919–251–92234 information.
Interested? Call 919-2519223 0-000-00-00000
249 NC Highway 54,Suite Suite 330 0000EStreet Name, 000, City, ST
slips without first obtaining the
Dur ham, NC 27713 www.companywebsite.com
signature(s) of the employee or a
www.cwrwc.com Find Us On Facebook
witness to the discipline. •D on’t apply different disciplinary actions for the same or similar conduct by different employees
BOTOX® COSMETIC • COOLSCULPTING® • FACIAL FILLERS • MICRODERMABRASION
• Ads may be used in newspapers, fliers, posters, mailings, public transportation, or outdoor advertising. without a valid reason. • Ad may appear white on black or black on white or color. •D on’t discipline or discharge an • Compensation in ad will match compensation listed in IRB approved consent form. employee without a thorough • Ad may be used in its entirety for website posting or e-mail communication. investigation and thorough –When possible, all internet website postings will fall under the “Research Opportunities” heading shou documentation. be one, but may also fall under the “Employment Opportunities” heading should there not be a relevan •D on’t discipline or discharge an on a given website. If there is not a relevant “Research” heading, the following disclaimer will be option employee without first allowing the study related text: the person being disciplined or “Please note that the following is not an employment opportunity but an opportunity to participate in discharged the opportunity research to explain trial.” Notice: Radiant Research Inc. and Clinical Research Advantage retains all exclusive rights. All content, form an his/her position. protectedanunder U.S. and Foreign copyright laws. No portions of this document may be reproduced or used •D on’t disciplineare or discharge without express employee for violation ofthe a rule that written consent of Radiant Research, Inc. the employer failed to communicate or any employee is deemed to know. •D on’t rely on your memory to remember employee violations. Document everything. •D on’t discriminate based on age, gender, race, religion or other protected characteristics when determining discipline or discharge.
HE WANTED HIS CONFIDENCE BACK
I R E F E R R E D H I M T O S O U T H E R N D E R M AT O L O G Y
THE SKIN RENEWAL CENTER AT S O U T H E R N D E R M AT O L O G Y
FOR THE MOST ADVANCED SKIN CARE TREATMENTS, REFER YOUR PATIENTS TODAY!
southernderm.com
919-863-0073
LASER HAIR REMOVAL • CLEAR + BRILLIANT® • THERMAGE®
DER17862_AD_Triangle Physician Ad CONFIDENSE 1/3.indd 1
• FRAXEL® DUAL
2/16/17 12:40 PM
october 2017
9
Women’s Health
Dermatology
Exciting Options for Women with
Endometriosis By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.
Endometriosis is found in approximately 7
States Food and Drug Administration trials in-
percent of women who have no symptoms, but
clude treatments with GnRH antagonists, a se-
up to 50 percent of women who have infertility
lective progesterone receptor modulator and a
and up to 70 percent of women who have pelvic
selective dopamine (D2) receptor agonist. Call (919) 251-9223 for more information
pain.
Andrea S. Lukes, MD, MHSc, FACOG, founded the Women’s Wellness Clinic (private practice) and the Carolina Women’s Research and Wellness Clinic (research center) which are both located in Durham, NC. Dr. Lukes received a combined medical degree and master’s degree in statistics from Duke University and completed her residency at the University of North Carolina School of Medicine. Her areas of expertise is in women’s health, including heavy menstrual bleeding, uterine fibroids, endometriosis, contraception, menopause and migraines. Most recently, Dr. Lukes was hired as the Chief Medical Officer of Health Decisions CRO which is specialized within women’s health. The Women’s Wellness Clinic is accepting new patients, 919-251-9223, www.cwrwc.com
Often the current treatments for women with
and to schedule an appointment. Participating
moderate to severe pain from endometriosis are
in a clinical trial is voluntary but offers
not effective. Providers at the Women’s Wellness
reimbursement for participation and potentially
Clinic offer several upcoming clinical trials for
new and effective treatments for endometriosis.
women with endometriosis, as well as new and Table 1
effective medical treatments. Endometriosis is defined as ectopic
of Endometriosis?
of endometrial gland and stroma outside of the
• Nulliparity (no pregnancies)
uterine cavity. The two main symptoms include
• Prolonged exposure to endogenous
pain and infertility. The type of pain includes
estrogen
dysmenorrhea (pain during the menstrual
- Early menarche (before 13 years)
cycle),
dyspareunia
(pain
during
sexual
intercourse) and chronic pain. Recent science supports that estradiol fuels the different types of pain. Specifically estradiol induces COX-2, which in turn increases the production of prostaglandin E2 (PGE2). The PGE2 directly causes both pain and inflammation and leads to increased aromatase, which then increases local estradiol production. There are likely multifactorial causes of aberrant endocrine signaling, genetic factors and more. Known factors that increase the risk of endometriosis are listed in tables 1 and 2. Treatments for endometriosis are individualized and depend on symptoms (pain vs. infertility), as well as a woman’s desire for fertility. There are surgical options, but the available contraceptives, danazol, aromatase inhibitors and gonadotropin-releasing hormones. The providers at the Women’s Wellness Clinic are now enrolling women with endometriosis into several clinical trials. These United
The Triangle Physician
- Late menopause • Shorter menstrual cycles (less than 27 days) • Heavy menstrual bleeding • Mullerian anomalies • Exposure to diethylstilbestrol in utero • Height greater than 68 inches • Lower body mass index • High consumption of trans unsaturated fat
endometriosis that include: altered immunity,
medical treatments include NSAIDs, hormonal
10
What Increases the Risk
endometrium. In other words it is the presence
Table 2 What Decreases the Risk of Endometriosis? • Multiple births • Extended intervals of lactation • Late menarche (after age 14 years) • Increased consumption of long-chain omega-3 fatty acids • Being an African-American or Hispanic woman
Dermatology
Causes and Types of
Skin Rashes By Gregory J. Wilmoth, M.D.
Rashes come in many different forms, and
abdomen and back. It is not uncommon for the
causes and triggers vary widely. While medical
rash to appear in a small area at first, then grow
expertise is required to diagnose the root cause
larger over the course of several weeks. This rash
of a rash and determine a treatment plan, there
gets its nickname from the shape of the scars,
are some common signs that can help narrow
which resemble “Christmas trees.” Pityriasis ro-
down where a rash came from.
sea most often lasts six to eight weeks, but can
The word “rash” is generic and only refers
last much longer.
to a symptom. Most rashes are characterized by itching, inflammation and redness, or other dis-
Rosacea
coloration of the skin.
Rosacea is a chronic condition characterized by redness of the skin, particularly on the face. Ro-
Hives (Urticaria)
sacea “flares up” in connection with aggravating
Hives, or urticaria, is an outbreak of raised
factors, including certain foods, alcoholic bever-
bumpy red welts on the skin. The causes of hives
ages, strenuous exercise and extreme tempera-
can vary, and are often difficult to determine.
tures (hot or cold).
Autoimmune dysfunction often lies at the root of the problem, but food intolerances can also trig-
Poison Ivy/Poison Oak/Poison Sumac
ger hives, as well as stress and excess body heat.
These plants, well known for their three-leaf
Certain medications, insect bites and allergens
structure, contain an oily substance called uru-
have been linked to some cases of hives. Some
shiol, which causes a rash when it comes into
patients experience a one-time episode of hives,
direct contact with the skin. Treatment of these
where others may experience chronic hives.
rashes typically requires application of a topical steroid over a two-to-three-week period, until the
Shingles (Herpes Zoster)
rash subsides.
Shingles is an extremely painful rash that can appear anywhere on the body. Shingles is caused
Psoriasis
by the varicella-zoster virus, the same virus that
Psoriasis stemming from an autoimmune disor-
causes the chicken pox. In patients who have
der comes in many different varieties affecting
contracted the chicken pox, the virus enters a
different areas of the body. Psoriasis consists of
dormant state. Shingles results from a reactiva-
red, scaly patches on the skin. During a psoriasis
tion of the virus. Shingles is more common in
flare, “scales” form as dead skin cells accumu-
adults over age of 60, particularly those with
late. These scaly areas often take on a gray or
weak immune systems. The rash typically leaves
silvery appearance.
behind blisters that form scar tissue. Some patients who suffer from shingles continue to expe-
Eczema (Atopic Dermatitis)
rience pain or itching long after the rash is gone,
Eczema refers to many different conditions result-
due to permanent nerve damage in the affected
ing in generally similar symptoms: patches of red
area.
and inflamed skin. Eczema is often linked to envi-
Dr. Gregory Wilmoth, a board-certified dermatologist at Southern Dermatology & Skin Cancer Center in Raleigh, specializes in Mohs surgery and skin cancer reconstruction, among other specialties. He earned his bachelor of science degree in chemistry from the University of North Carolina at Chapel Hill and his medical degree from Bowman Gray School of Medicine, Wake Forest University. He completed his internship at North Carolina Baptist Hospital and residency at Mayo Clinic, Rochester, Minn. Dr. Wilmoth is a fellow of the American Society for Mohs Surgery. He is a member of the American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Academy of Dermatology, American Medical Association and the North Carolina Medical Society.
ronmental allergens and chemical irritants. Some Christmas Tree Rash (Pityriasis Rosea)
patients with eczema have found that avoiding
Pityriasis rosea usually appears on the chest,
harsh soaps can bring a degree of relief, and it is
october 2017
11
Research News
sometimes necessary to test for allergic re-
In general, it is advisable to consult
although additional testing is sometimes
actions, especially in children. Treatments
a physician about any rash that persists
required. As any rash can potentially indi-
for eczema include topical creams and ste-
for more than a few days. A dermatolo-
cate a serious condition, early diagnosis
roids, and may sometimes require the use
gist can usually identify the specific type
is always best.
of antibiotics if the area becomes infected.
of rash through physical examination,
Poliovirus Triggers Innate Immune Response in Glioblastoma Therapy An investigational therapy using modified
but not the mechanistic details at this
macrophages. Dendritic cells then pres-
poliovirus to attack cancer tumors appears
level,” said co-senior author Matthias Gro-
ent the tumor to T cells to launch an im-
to unleash the body’s own capacity to fight
meier, M.D., a professor in the Duke De-
mune response. Once the immune system
malignancies by activating an inflamma-
partment of Neurosurgery who developed
is activated against the poliovirus-infected
tion process that counter’s the ability of
the therapy. “This is hugely important to
tumor, the cancer cells can no longer hide
cancer cells to evade the immune system.
us. Knowing the steps that occur to gener-
and they remain vulnerable to ongoing immune attack.
Describing this process in a paper
ate an immune response will enable us to
published Sept. 20 in the journal Science
rationally decide whether and what other
“Not only is poliovirus killing tumor
Translational Medicine, Duke Cancer Insti-
therapies make sense in combination with
cells, it is also infecting the antigen-present-
tute researchers provide the first published
poliovirus to improve patient survival.”
ing cells, which allows them to function in
insight into the workings of a therapy that
Gromeier, with expertise in cancer
such a way that they can now raise a T-cell
has shown promise in early clinical trials
biology, collaborated with fellow Duke re-
response that can recognize and infiltrate
searcher and co-senior author Smita Nair,
a tumor,” Nair said. “This is an encourag-
Ph.D., an immunologist and professor in
ing finding, because it means the polio-
the Department of Surgery. The research
virus stimulates an innate inflammatory
team elucidated how the poliovirus works
response.”
not only to attack cancer cells directly, but
Nair and Gromeier said further stud-
also to trigger a longer-lasting immune re-
ies will focus on the additional immune
sponse that appears to inhibit regrowth of
activity following exposure to the modified
the tumor.
virus.
Using human melanoma and breast
In addition to Gromeier and Nair,
cancer cell lines, and then validating the
study authors include Michael C. Brown,
findings in mouse models, the researchers
Eda K. Holl, David Boczkowski, Elena Do-
found that the modified poliovirus therapy
brikova, Mubeen Mosaheb, Vidya Chan-
starts by attaching to malignant cells, which
dramohan and Darell D. Bigner.
have an abundance of CD155 protein. The
The study received support the Public
CD155 protein is otherwise known as the
Health Services (CA197264, CA124756 and
poliovirus receptor. The modified virus
CA190991), the Department of Defense,
then begins to attack the tumor cells, di-
(W81XWH-16-1-0354); the Lefkofsky Family
in patients with recurrent glioblastoma, a
rectly killing many, but not all. This releases
Foundation, Hope & Gavin Wolfe, and the
lethal form of brain cancer. The modified
tumor antigens.
BLAST Glioblastoma Foundation.
Dr. Matthias Gromeier holds a sample of the modified poliovirus he developed that attacks glioblastoma brain tumor cells.
poliovirus received a breakthrough thera-
The second phase of assault is more
Nair and Gromeier, along with Brown,
py designation from the United States Food
complicated. By killing the cancer cells,
Chandramohan and Bigner, own intellectu-
and Drug Administration last year, expedit-
the modified poliovirus triggers an alarm
al property related to this research, which
ing research, according to a Duke press
within the immune system, alerting the
has been licensed to a Istari Oncology Inc.
advisory.
body’s defenses to go on the attack.
Gromeier and Bigner are cofounders and
“We have had a general understand-
This appears to occur when the modi-
ing of how the modified poliovirus works,
fied poliovirus infects dendritic cells and
12
The Triangle Physician
equity holders in the company.
News
Welcome to the Area
Physicians
Romin Bonakdar, MD
Nicole Michelle Fuerst, MD
Sriram Machineni, MD
Internal Medicine
Ophthalmology
Bariatric Medicine; Urgent Care
Pediatrics
UNC Hospitals Chapel Hill
Duke Eye Center Durham
UNC Hospitals Chapel Hill
Brian Conrad Brimmage, MD
Mark Joseph Gage, MD
Christine Standahl McClain, MD
Obstetrics & Gynecology - Surgery, Endocrinology/Infertility, Reproductive
Orthopedic Surgery, Trauma
Psychiatry
Katie Lyn Clouthier, DO UNC Chapel Hill Chapel Hill
Rodger Brent Cook, DO General Practice
Elm City
J. Richard Lee Evanson, DO Orthopedic Surgery; Orthopedic Surgery - Adult Reconstructive, Pediatric, Trauma , Ankle Foot, Hand Surgery
Duke Univ Dept of Orthopaedic Surgery Durham
James Edward Everhart, DO Internal Medicine
Duke University Medical Center Durham
Courtney Hudson Hinton, DO
Raleigh OB/Gyn Centre Raleigh
David Andrew Brown, MD Plastic & Reconstructive Surgery; Plastic Surgery; Plastic Surgery/Hand Surgery
Duke Plastic, Maxillofacial & Oral Surgery Durham
Anthony Bruno, MD Administrative Medicine; Orthopedic Surgery
Wayne Memorial Goldsboro
Megan Tien-Ling Chang, MD Pediatrics
614 W Main Street Durham
Briana Roberta Gibson, MD Anatomic and Clinical Pathology; Blood Banking/Transfusion Medicine
UNC Memorial Hospital Chapel Hill
Kevin McKenzie Gurysh, MD Emergency Medicine
Duke University Hospitals Durham
Steven Scott Harris, MD Diagnostic Radiology; Musculoskeletal Radiology; Neuroradiology; Nuclear Radiology; Pediatric Radiology; Therapeutic Radiology; Vascular and Interventional Radiology
Family Medicine; Family Practice
Durham
Avance Care Raleigh
Yeh-Chung Chang, MD Pediatric Infectious Diseases
Duke University Hospitals Durham
Steven James Jones, DO Family Medicine
DUMC Dept of Pediatrics Durham
James Pham Ho, MD
Sampson Regional Clinton
Sugong Chen, MD
Mark Andrew Kleman, DO
Abdominal Surgery; Bariatric Medicine; Colon and Rectal Surgery; Critical Care
UNC Division of Nephrology Chapel Hill
Duke Center for Metabolic & Weight Loss Surgery Durham
Aaron Isaac Loochtan, DO
Leslie Horn Clark, MD
Nephrology, Internal Medicine
Neurology
Duke University Hospitals Durham
Christina Renee MacRosty, DO Pulmonary Disease and Critical Care, Internal Medicine
Neurological Surgery, Critical Care; Neurology; Radiology, Neuradiology; Vascular and Interventional Radiology
Univ of North Carolina Medical Ctr Chapel Hill
Eric Michael Holland, MD
Felipe De Araujo Andrade Medeiros, MD Duke Eye Center Durham
Julie Ellyn Mervak, MD Dermatology
UNC Dermatology Chapel Hill
Erin Kathleen Moran, MD Radiology
Duke University Medical Center Durham
Kimberly Carmen Munro, MD Obstetrics and Gynecology
Cary
Kim Graham Johnson, MD
Kathleen Marie Claus, MD Anesthesiology - Critical Care Medicine
Neurology; Psychiatry; Geriatric
Duke University Hospitals Durham
Karen Elizabeth Kimel-Scott, MD
Elena Jean Koepke, MD
Boice Willis Clinic, PA Rocky Mount
UNC Family Medicine Chapel Hill
William Thomas Atchley, MD
Kavi Krishna Devulapalli, MD Diagnostic Roentgenology Radiology; Vascular and Interventional Radiology
UNC Div of Pulmonary Diseases & Critical Care Medicine Chapel Hill
UNC Vascular and Interventional Radiology Chapel Hill
Bjorn Hackett Batdorf, MD
Damien Eugene Earl, MD
Duke Eye Center Durham
Goldsboro
University of North Carolina Hospitals Chapel Hill
Family Medicine; Family Practice; Hospitalist; Urgent Care
Ophthalmology
Orthopaedic Surgery
Duke University Hospitals Durham
Catherine Louw Coe, MD
Jay Berdia, MD
Joseph Timothy McLamb, MD
Abdominal Surgery; Gynecology; Gynecology/Oncology
Karen Denise Szymanski, DO
UNC Dept of Pathology & Laboratory Medicine Chapel Hill
Duke University Medical Center Durham
Robert Edward Olivo, MD
UNC Ambulatory Care Center Chapel Hill
Anatomic and Clinical Pathology; Hematology Pathology
Diagnostic Radiology
UNC Center for Heart & Vascular Chapel Hill
Duke University Medical Center Durham
Internal Medicine; Pulmonary Disease and Critical Care, Internal Medicine
Erin Colleen McCrum, MD
Cardiology; Cardiovascular Disease, Internal Medicine
UNC Hospitals Chapel Hill General Surgery; Plastic & Reconstructive Surgery; Plastic Surgery
UNC Hospitals Chapel Hill
Neurology
Duke University Hospitals Durham
Keisha Latoya French, MD Obstetrics & Gynecologic Surgery
NASH OB-GYN Associates, P.A. Rocky Mount
Marat Fudim, MD
Internal Medicine
Anesthesiology
Duke University Medical Center Durham
James Robert Lachman, MD Orthopedic Surgery; Orthopedic, Ankle Foot
Duke Orthopaedic Surgery Durham
Daniel Joseph Lattin, MD Ophthalmology; Pediatric Ophthalmology
Duke Eye Center Durham
Alexander Clayton Lemons, MD Orthopedic Surgery; Orthopedic Surgery of the Spine
Pinehurst Surgical Pinehurst
Cardiovascular Disease, Internal Medicine
Nephrology, Internal Medicine
Shannon Marie Page, MD Anesthesiology
Regional Anesthesia, PLLC Durham
Michael Benjamin Russell, MD Internal Medicine
Duke Hospital Durham
Teresa Danielle Samulski, MD Cytopathology; Pathology
UNC Chapel Hill Chapel Hill
Briana Lynn Scott, MD Hospitalist; Pediatrics
Duke University Hospitals Durham
Duke Urologic Surgery upcoming CME Conferences:
Duke Tuesday Urology Searle Conference Ctr. Duke University •November 7, 2017 •February 13, 2018 •July 2018 •November 6, 2018
https://surgery.duke.edu/ divisions/urology/cme
Duke University Hospitals Durham
october 2017
13
NO ONE SEES YOU LIKE WE DO. The way we see it, image is everything. So we specialize in everything imaging. From prevention and detection to diagnosis and intervention. All provided in 20 Triangle locations by more than 150 certiďŹ ed technologists and subspecialty radiologists. Every one of them with the unique ability to see beyond the patient to the person inside.
G
BO I
G MA
IN
DY
RO
I
MA G
NEU
IN G
VA
VE
IN
T
TH
-C
ERA
PET
PY
MRI
P E D I AT
ST IMAGING
RIC I M AGIN G
BREA
SC
R
PH
Y
U
LA
IM
AG
IN
G
ORT
HO PEDIC I M AGING
M
M AM
OG
RA
Be seen by people who specialize in you at WakeRad.com.