a u g u s t 2 0 11
Vickers Clinic
Internal Medicine Practice Delivers Patient-focused, Compassionate Care
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Also in This Issue Targeting Musculoskeletal Pain Osteoporosis and Imaging Accuracy
Dream Big. Working in partnership with physicians for over 50 years to bring the benefits of biomedical technology to patients around the world.
There are about 5,000 hospitals in the United States.
And only 1 of those is located in North Carolina. Only 140 of them landed a spot on the 2011 U.S.News & World Report rankings of “America’s Best Hospitals.”
Just 17 of those made the Honor Roll— for excellence across many specialties.
“America’s Best Hospitals” Duke University Medical Center Durham, NC
Isn’t it nice to know that one is close to you? 90 percent of the Triangle lives within 12 miles of a Duke Medicine location. Find one near you and learn more about our top-ranked care—including highly ranked specialty services in geriatrics, pulmonology, orthopedics, heart care, ophthalmology, neurosciences, urology, gynecology, kidney disorders, cancer, and more—at dukehealth.org, or by calling 888-ASK-DUKE.
*Duke University Medical Center is ranked #9 on U.S.News & World Report’s Honor Roll of America’s Best Hospitals for 2011. Locations data based on ZIP codes within a 12-mile radius for all Duke Medicine locations.
Contents
COVER STORY
6
Vickers Clinic
Internal Medicine Practice Delivers
Patient-focused, Compassionate Care
au g u s t 2 011
Vol. 2, Issue 8
FEATURES
10
Physical Medicine and Rehabilitation
Evaluation of Musculoskeletal Pain Requires Special Expertise
DEPARTMENTS 14 Neurology Overview: Restless Leg Syndrome
15 Rex News New Pulmonary Specialists
12
Practice Opens
Radiology
16 Women’s Health Yes, Alma Hair Removal Is Painless and Effective
18 Your Financial Rx
Dr. Cary Smoot discusses the role of
Accuracy in Bone Mineral Density Imaging Is Key to Osteoporosis Diagnosis
neuromuscular medicine in the effective
Dr. Joseph Melamed gives specifics
New Physician Joins Rex
evaluation and treatment of back pain.
about the use of dual-energy X-ray
Thoracic Specialists
absorptiometry (DXA) to determine T-scores and FRAX scores.
Plan Like There Is No Tomorrow
20 Practice News
UNC News 22 New HIV Prevention Study Data Indicate Benefit of cART Treatment 23 Study Suggests “Trial Effect” Diminishes as HIV Treatment Improves 24 Contributions to The Cancer Genome Atlas and bone-loss experiment on space shuttle 27 Clinical Trial of Molecular Therapy for Muscular Dystrophy Yields Significant Positive Results
26 Clinical Trials Ovulation and ovarian activity, stomach ulcers, infectious disease
28 News Cover Image: Dr. Juan Alva, M.D., F.A.C.P., A.G.A.F., founder and medical director of Vickers Clinic P.C.
Listing of new physicians and
Jim Shaw Photography.
physician assistants
2
The Triangle Physician
JOHNSTON HE ALTH
From the Editor
Practices Great and Small 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
It is refreshing to learn how solo medical practices, like Vickers Clinic in Durham – our cover story this month – exist by filling important niches in the uber-competitive medical triangle. Since 1982, this internal medicine practice operated by Dr. Juan Alva has been a beacon to those of lesser means who come for quality, compassionate care. As you will learn, it’s been a long journey for the native of Mexico, who demonstrated perseverance at an early age and parlayed his brilliance into becoming a physician and a United States citizen. It certainly is a testament to the human spirit, and our region has been a beneficiary. The Triangle Physician also welcomes radiologist Joseph Melamed, who discusses the importance of specialized expertise when it comes to accurate assessment of osteoporosis using advanced imaging techniques. Likewise, Dr. Gary Smoot makes his
Editor Heidi Ketler, APR
heidi@trianglephysician.com
Contributing Editors Eithne Burke, M.D. John Grant Buttram, M.D. Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G Cynthia Payne, M.D. Paul Pittman, C.F.P. Henry Tellez, M.D. Photography Jim Shaw Photography jimshawphoto@earthlink.net Creative Director Joseph Dally
jdally@newdallydesign.com
physical rehabilitation and pain management.
Advertising Sales Carolyn Walters carolyn@trianglephysician.com Natalie Snapp natalie@trianglephysician.com
This month, gynecologist Andrea Lukes answers frequently asked questions about laser
News and Columns Please send to info@trianglephysician.com
debut with an article about the subtleties of back pain and the value of certification in
hair removal. Neurologist Henry Tellez addresses restless leg syndrome and methods for alleviating the discomfort. Our resident financial planning expert, Paul Pittman, tells it like it is – no time like the present to get one’s affairs in order. Inside this issue, you’ll also read fantastic news from our medical schools, demonstrating that this region is leading the way in the race to find cures to such diseases as HIV and AIDS. Thanks to all of our contributing editors and advertisers. With so much vital information going to such a distinguished audience, who wouldn’t want to have a presence – great and small – in every issue of The Triangle Physician! To you, our readers, our deepest appreciation for all you do.
Heidi Ketler Editor
The Triangle Physician is published by New Dally Design 9611 Ravenscroft Ln NW, Concord, NC 28027 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. Opinion expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. However, 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
On the Cover
Vickers Clinic
Internal Medicine Practice Delivers Patient-focused, Compassionate Care “Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life – the poetry of the commonplace, of the ordinary man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their griefs.” – Sir William Osler
V
along with diagnostic and therapeutic colonoscopies and upper endoscopies, and cardiac exercise stress testing. In addition to being a fellow of the American College of Physicians, Dr. Alva is board certified in internal medicine and in gastroenterology, and he is a fellow of the American Gastroenterology Association. He also has special expertise in cardiology. Throughout the years, Dr. Alva’s internal medicine practice has expanded to 1,700 square feet and includes three examination
ickers Clinic P.A. stands proudly at
of Mexico, has delivered a special brand
rooms, an endoscopy suite, a graded cardiac
609 William Vickers Ave. as the only
of ethically and ethnically based care that
exercise stress-tolerance testing room, and a
embraces compassion and family values.
large reception area and waiting room. It also
Hispanically owned and operated medical practice in Durham. Since opening its doors
is equipped with a laboratory that delivers
Sept. 8, 1982, Juan Jose Alva, M.D., F.A.C.P.,
The full spectrum of internal medicine
A.G.A.F., a Johns Hopkins-educated native
services is offered at Vickers Clinic,
results within minutes.
PHOTO BY JIM SHAW PHOTOGRAPHY
Dr. Alva’s wife of 48 years, Elsa Alva, has been a partner in the clinic, overseeing business affairs. A native of Buenos Aires, Argentina, Elsa Alva’s intercultural awareness has been instrumental in advancing the practice mission to better help patients, says Dr. Alva. “To be aware of a patient’s culture shows empathy. You have to speak the language and put yourself in their shoes. I think Latin American immigrants feel more comfortable knowing we come from their background,” he says. Vickers Clinic welcomes all patients, regardless of ethnicity, religion or ability to pay.
The Journey of a Physician from Ciudad Juarez, Chihuahua, Mexico Dr. Juan Alva, a fellow of the American Gastroenterology Association, readies the Vickers Clinic endoscopy suite for a colonoscopy.
6
The Triangle Physician
Juan Alva and his younger brother, Jose Alva, were raised in a Mexican border town
by their mother, Maria Alva. Their father had
and a medical degree from La Facultad
essential, and he became proficient in stress
died when Juan was 4.
de Ciencias Médicas de la Universidad
testing.
Nacional de la Plata in 1969. That year he In those days, Ciudad Juarez was not as
opened a private practice in Buenos Aires
Ultimately, Dr. Alva was decorated with
notorious as it is today, according to Dr. Alva.
and conducted original research on Chagas
the Armed Forces Reserve Medal, National
However, after graduating from Rosaura
disease, an endemic trypanosomiasis of
Defense Services Medal, Army Reserve
Zapata grammar school, Maria urged her
southern Brazil and northern Argentina.
Components Achievement Medal and U.S.
sons to attend high school in neighboring
Army Commendation Medal. His military
El Paso, Texas. In preparation, both boys
Both the practice and research project
experience and references also led him to
attended night school at an English academy
ended abruptly during severe political and
a position as gastroenterology consultant
in Ciudad Juarez.
economic unrest. Dr. Alva made calls to
for the Fayetteville Veterans Administration
Burroughs Wellcome & Co. (now part of
Medical Center (1991-1993).
After graduating from El Paso Technical
GlaxoSmithKline) and was offered a job
Institute at age 16, Juan Alva attended the
in Research Triangle Park, North Carolina.
Meanwhile, on Nov. 18, 1988, Dr. Alva obtained
University of Texas at El Paso, where he
After 11 years in Buenos Aires, Dr. Alva and
his U.S. citizenship. “I did all my studies
earned his bachelor’s degree in biology at
his family returned to North Carolina, where
in the U.S.A. since high school and had
age 19. He went on to earn his a medical
he worked as project leader for Allopurinol
distinguished post-graduate education and
degree at age 23 at the St. Louis University
research (1976-1979). He then accepted
was elected president of the Johns Hopkins
School of Medicine in Saint Louis, Mo.,
a position as chief of medicine at John
Alumni Association for North Carolina for
and conducted his post-graduate work at
Umstead Hospital in Butner, N.C., (1979-
two years. In addition, I was elected a Fellow
University of Oklahoma Hospitals (1960-
1982).
of the American College of Physicians and a
1962) and Johns Hopkins (1962-1965).
Fellow of the American Gastroenterological Dr. Alva went on to serve as a lieutenant
Association,” says Dr. Alva.
Interestingly, Dr. Alva’s younger brother was
colonel in the U.S. Army Reserve at Womack
accepted at age 17 into Guadalajara Medical
Army Medical Center-Fort Bragg (1982-1992).
In February 2005, Dr. Alva was inducted into
School, the most prestigious medical school
It was during the start of Desert Shield/
the University of North Carolina, Chapel Hill
in Mexico. Jose Alva graduated at age 21,
Desert Storm, when swift deployment of
Eugene S. Mayer Community Service Honor
obtained advanced credentials in neonatal
800,000 troops to Riyadh, Saudi Arabia, was
Society. He was recognized “For outstanding
care and has long had a thriving pediatric practice in El Paso.
Buenos Aires and Desert Storm Detours In 1965, the United States Department of State advised Dr. Juan Alva that his visa was about to expire. So he, his wife and daughter moved to Buenos Aires, where he had accepted a position with Merck Co., “setting up clinical trials in the Argentine republic, and returning to New York on a yearly basis to present my results.” While in Buenos Aires, Dr. Alva served as a gastroenterologist at Los Institutos Nacionales de la Salud, Instituto Nacional de la Gastroenterologia (1965-1967) and at El Instituto para la Investigación Médica de la Universidad Nacional de Buenos Aires (1967-1976). He earned a bachelor’s degree from El Colegio Nacional de la Plata in 1968
Vickers Clinic medical assistant Dawn Arnold prepares a patient for a colonoscopy.
august 2011
7
dedication to community service and for
treating patients with compassion and a
not change our values, morals or ethics,” he
the best qualities of caring for the health
positive attitude improves recovery. Even
says.
of citizens throughout North Carolina, the
when a patient has a fatal illness, a physician
United States and the world.”
should not abandon that patient; you work
Neither society is associated with the
with them and always with the sense of
American Osler Society, whose membership
Five years later, Dr. Alva was inducted into the
optimism, at least to make their suffering
is limited, according to Dr. Alva. Rather, they
Sociedad Argentina de Humanismo Medico
more bearable. That’s an Oslerian principle,”
are part of an Oslerian network anchored
as an honorary international member by
says Dr. Alva.
by the Osler Center for Clinical Excellence
the dean of the faculty of medicine of the University of Buenos Aires.
at Johns Hopkins, which was established As current secretary/treasurer of the Osler
decades ago to train physicians in the
Society of North Carolina, Dr. Alva is actively
basic elements of a sound doctor-patient
Upholding Osler Legacy of Humanistic Medicine
involved in efforts to create more Osler
relationship.
Dr. Alva emulates in his own practice the
Alva founded the Osler Society of North
This fall, Dr. Alva and Elsa Alva plan to travel
pioneering medical principles espoused by
Carolina (oslernc.org), and in 2010 he co-
to Honolulu, Hawaii, to support development
Sir William Osler.
founded the Osler Club of Buenos Aires. The
of an Osler Society at the John A. Burns
501(c)3 Osler Society of North Carolina has
School of Medicine at the University of
15 members and meets on an ad hoc basis.
Hawaii at Manoa.
medicine” and credited with advancing the
Both were created to promote the legacy of
Pursuit of Lifelong Learning
role of physician as teacher/researcher/
Sir William Osler, and membership is open
Dr. Alva embraces lifelong learning, which is
pathologist. He was a prolific writer, and
to all medical professionals interested in
integral to the Oslerian movement.
the textbook The Principles and Practice of
humanistic medicine, “which is important
Medicine was among his many important
in this age of technological innovation,”
“Lifelong learning also is a premise of
medical works. He also was the first chair
Dr. Alva says. “The role of the physician is
Hippocrates and the great physicians. If
of medicine of The Johns Hopkins Hospital.
changing in a highly technological medical
you don’t keep up with medical science,
environment that is capable of dealing with
you quickly fall behind. It should be a part
multiple medical problems. But we should
of every physician’s life, because being a
Sir William Osler (1849-1919) is sometimes
societies around the globe. In 2005, Dr.
referred to as the “father of modern
“Multiple psychiatric studies show that
physician is not just a job, it’s a calling, a vocation,” says Dr. Alva. Since his return to private practice, Dr. Alva has been in an ideal position to pursue his interest in gastroenterology and cardiology. He is a regular participant of cardiology rounds Tuesday evenings at Duke University Medical, just a six-minute drive from Vickers Clinic. He is a clinical assistant professor of medicine at the University of North Carolina at Chapel Hill since 1976. He also opens Vickers Clinic on a monthly basis to medical students and provides instruction. Because of the location and availability of two endoscopy rooms, colonoscopies and upper endoscopies at Vickers Clinic require only a copay and are scheduled within three Elsa Alva, left, and Dawn Arnold assist Dr. Alva at Vickers Clinic.
8
The Triangle Physician
to four days.
Physical Medicine and Rehabilitation
Evaluation of
Musculoskeletal Pain
Requires Special Expertise By Gary L. Smoot, M.D.
Comprehensive management of spinal
abnormalities
conditions from the acute to the chronic
abnormalities on imaging studies are not
focused
should be the goal in treating patients
always the source of the pain generator.
medications, acupuncture, physical therapy,
with
aging.
However,
with musculoskeletal pain. Functional
The diagnosis then allows for specific treatment
using
education,
neuromuscular massage, radiofrequency
evaluation by an experienced physician
Physicians who are board-certified in
neuroablation, spinal cord stimulation,
that keeps abreast of the most recent
physical
surgery and interventional procedures.
research is critical to proper diagnosis and
(PM&R) are trained in neuromusculoskeletal
treatment. Treatment should begin with an
medicine. They perform electrodiagnostic
Steroid Injection for Herniated Disk
accurate diagnosis by obtaining a thorough
(EDX) testing to assess the function of the
Herniated discs are a common reason for
history, performing a detailed physical
neuromuscular system. This determines the
referral. Focal herniated nucleus pulposus
examination, reviewing all test results and
site of pathology, ranging from the spinal
can impinge on the spinal nerve resulting
obtaining additional testing if indicated.
nerve being compressed to a peripheral
in radiculopathy. Injectional therapy is used
medicine
and
rehabilitation
etiology such as carpal tunnel syndrome.
for the treatment of this condition, if other
This becomes more important as a
EDX testing complements such imaging
forms of conservative care have not been
patient ages. Multiple imaging studies
studies as magnetic resonance imaging
effective.
have documented increasing structural
(MRI) that provide the structural analysis.
Dr. Gary Smoot in the Cary Orthopaedic Spine Specialists fluoroscopy suite.
10
The Triangle Physician
Dr. Gary L. Smoot practices at Cary Orthopaedic Spine Specialists. He is a diplomate of the American Association of Physical Medicine and Rehabilitation, American Society of Interventional Pain Physicians and the International Spine Intervention Society. The Ohio native attended Ohio State University for his undergraduate and medical degrees. His internship and residency in physical medicine and rehabilitation (PM&R) was completed at the University of Texas Health Science Center in San Antonio, Texas, in 1991. Dr. Smoot moved to Raleigh in 1991. He has 20 years of experience in interventional spine care and electrodiagnostic medicine. He is board certified in PM&R and pain medicine. Dr. Smoot is affiliated with Cary Orthopaedic Spine Specialists and can be contacted at (919)297-0000 or by visiting www.caryortho.com.
vital signs are monitored before, during and after the procedure to ensure medical stability. All possible precautions are observed in order to provide maximum safety to the patient. Patients remain under observation for 15-20 minutes after the procedure, and they are always instructed to have a family member or friend drive them home.
Thorough Follow Up for Customized Care Reassessment one or two weeks after each injection is crucial and should always be performed.
The epidural steroid injection addresses the inflammatory
During follow up, results of the injection are discussed. Patients
component of the pathology. Decreased inflammation can prevent
rate the initial relief of the injection, percent of relief, duration of
further damage and hopefully result in resolution of the symptoms
improvement and whether they continue to improve after the
and full recovery.
injection. This allows the physician to further customize the need for additional injections, the location of additional injections and
There are three standard approaches for epidural injections: caudal,
the medication to be utilized for the additional injection. All these
interlaminar and transforaminal. The most specific approach to
factors need to be assessed and recorded to provide optimum care
delivery of medication to the area is transforaminal. This places the
for the patient.
needle in as close proximity as is safely possible to the area of the herniated disc compressing the nerve root. This will deliver the most
The physical medicine and rehabilitation physician’s goal should
concentrated dosage of medication to the site of the pain generator.
always be to provide the best care using the most recent research coupled with experience to attain the best patient outcome.
Flouroscopy Suite Epidural steroid injections are performed under fluoroscopy either in the physician’s office or hospital out-patient facility. Prior to any interventional procedure under fluoroscopy the patient is carefully screened for any medications that may adversely affect the safety of the procedure. Intravenous access is established and
An image of a transforaminal epidural injection, the most specific approach to delivery of medication to an area of the spine, in the treatment of a herniated disk. It shows the needle tip (NT) in close proximity to the L5 spinal nerve and the extension tubing (ET) containing the contrast agent. The arrowheads indicate the spread of contrast into the epidural space.
august 2011
11
Radiology
Accuracy in
Bone Mineral Density Imaging
Is Key to Osteoporosis Diagnosis By By Joseph W. Melamed, M.D., CCD
Current
estimates
from
the
National
New
pharmacologic
advances
in
The World Health Organization international
Osteoporosis Foundation indicate that 10
the
with
reference standard for the diagnosis of
million Americans have osteoporosis and
bisphosphonates and other classes of
osteoporosis is a BMD measurement in the
34 million more are at risk for developing
drugs have made diagnosing the disease
femoral neck that is 2.5 standard deviations
it. Although 80 percent of those who are
all the more important. Central dual-
or more below the mean for the young
affected are women, the disease is so
energy X-ray absorptiometry (central DXA),
adult population. BMD measurements from
prevalent that men are also frequently
which evaluates bone mineral density,
DXA scans are expressed as “T-scores” that
diagnosed. The annual cost of treating
is considered the gold standard test for
reflect the number of standard deviations
osteoporosis-related fractures was $19 billion
diagnosing osteoporosis.
away from the young adult mean.
by the year 2025. In spite of the asymptomatic
A DXA scan produces an image using two
A T-score of -2.5 or lower in the total hip,
nature of the disease, it can have serious
distinct wavelengths of X-rays, enabling an
femoral neck, lumbar spine or forearm
consequences; the one-year mortality for
accurate estimation of bone mineral density
allows the diagnosis of osteoporosis to be
patients over the age of 50 who sustain an
(BMD) for the region scanned. Regions of
made in a post-menopausal woman or a
osteoporotic hip fracture is 24 percent.
interest (ROI) that are measured include
man over the age of 50. A T-score between
treatment
of
osteoporosis
in 1995 and is expected to rise to $25.3 billion
the lumbar spine (L1-L4), the hips (total
-1.0 and -2.5 is termed “Osteopenia.” For
disease
hip and femoral neck sub-regions) and the
younger patients the BMD is compared
characterized by diminished bone mass
forearm (33 percent radius sub-region). In
to the age-matched mean database, and a
resulting in structurally weak, porous
children, the lumbar spine (L1-L4), and the
“Z-score” is calculated. A Z-score of -2.0 or
bones that are more likely to fracture.
total body (less head) are measured. The
less is termed “below the expected range
Osteoporosis-related fractures can occur in
effective radiation dose for DXA is about
for age,” but the diagnosis of osteoporosis
any bone but are most common in the hip,
0.001 mSv, which is equivalent to about 3
cannot be made in those patients without
spine and wrist.
hours of natural background radiation.
additional clinical information.
Osteoporosis
is
a
systemic
Here is an example of FRAX score, fracture risk assessment, results for a postmenopausal woman with osteopenia.
12
The Triangle Physician
Dr. Joseph Melamed joined Wake Radiology in 1996. He is a native of New York City and a graduate of Yale University School of Medicine in New Haven, Conn. At Duke University Medical Center in Durham, he completed his residency and a fellowship in musculoskeletal radiology. Dr. Melamed is chairman of the Department of Radiology at Maria Parham Medical Center in Henderson and chairman of the Department of Radiology at Franklin Regional Medical Center in Louisburg. His special clinical interests include bone densitometry and musculoskeletal imaging. He is board certified in diagnostic radiology by the American Board of Radiology and also is a certified clinical densitometrist. Dr. Melamed is a member of the Radiological Society of North America, the American Roentgen Society and the International Society of Clinical Densitometry.
Ten-year fracture risk can be estimated using a combination of clinical information and BMD to generate a fracture risk assessment, or FRAX, score that is useful in determining the need for treatment in patients who fall into the “osteopenic” category. In 2010 the International Society of Clinical Densitometry (ISCD) and the International Osteoporosis
Foundation
issued
joint
recommendations for the use of the FRAX fracture risk assessment tool in clinical practice.
The
Foundation
National
recommends
Osteoporosis considering
drug therapy for patients with osteoporosis based on clinical or morphometric hip or
is the site certification offered by the ISCD,
vertebral low trauma fracture, T-score of
which indicates that all technologists and
-2.5 or less, or FRAX score of greater than
clinicians have obtained certification and
3 percent for the hip or greater than 20
that the facility has met additional rigorous
percent for any major osteoporotic fracture.
criteria and follows ISCD guidelines.
to assess response to treatment, but must
Careful quality control is critical in the
References
be made using the same machine or with
performance and interpretation of DXA
a machine of the same manufacturer
studies.
that has been correctly cross calibrated.
of
Radiologic
Technologists
Serial measurements are only valid if the
the
International
Society
technologist performing the scan has
Densitometry (ISCD) both offer special
obtained his/her least significant change,
DXA certification for technologists, and
or LSC, precision values on that machine
the ISCD also offers a certified clinical
by performing a series of double studies.
densitometrist designation to qualified
1. The International Society of Clinical Densitometry and International Osteoporosis Foundation Position Development Conference on Interpretation and Use of FRAX in Clinical Practice, November 2010, Bucharest, Romania. 2. http://www.radiologyinfo.org/en/safety/index. cfm?pg=sfty_xray 3. http://www.nof.org/node/40 4. http://www.iscd.org/Visitors/positions/
Serial BMD measurements can be made
The
American
Association of
and Clinical
clinicians. The highest level of certification
OfficialPositionsText.cfm
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1120 SE Cary Pkwy, Cary, NC 27518
919-467-4992 Fax 919-481-9607 Fax 919-481-9607
1005 Vandora Springs Rd., Garner, NC 27529
919-779-3861 Fax 919-779-3234
www.caryortho.com
Fax 919-779-3234 august 2011
13
Neurology
Overview:
Restless Leg Syndrome By Henry Tellez, M.D.
Dr. Henry Tellez is in private practice with Sandhills Neurologists PA. He earned his medical degree from Valley University, Colombia. He then completed his internship and neurology residency at Saint Louis University School of Medicine, Missouri. This was followed by a fellowship in nerve conduction (nerve conduction velocity/ electromyography) studies and neuromuscular diseases at the University of North Carolina, Chapel Hill. Dr. Tellez is board certified in general neurology, neuromuscular medicine and vascular neurology by the American Board of Medical Specialties.
Restless leg syndrome is not dangerous or life threatening, and it is not a sign of a serious disorder. However, the discomfort and sleep disruption it causes can greatly affect quality of life. Restless leg syndrome is a disorder in
at night when lying down or sometimes
Examination and testing may be used to rule
which there is an urge or need to move the
during the day when sitting for long periods
out other disorders with similar symptoms.
legs to stop unpleasant sensations. It affects
of time.
up to 10 percent of the population, mostly
There is no known cure for RLS. Treatment
middle-aged and older adults. Stress makes
A sensation often described as creeping,
is aimed at reducing stress and helping the
it worse.
crawling, aching, pulling, searing, tingling
muscles relax. Warm baths, gentle stretching
or bubbling in the upper leg, feet or
exercises, massage and eliminating caffeine
The cause of restless leg syndrome (RLS)
sometimes arms may last for one hour
may help. Patients with iron deficiency
is not known in most patients. It may occur
or longer. Those with RLS may feel an
should receive iron supplements.
more often in patients with peripheral
irresistible urge to walk or move their
neuropathy,
chronic
kidney
legs, which almost always relieves the
Low doses of pramipexole or ropinirole
Parkinson’s
disease,
pregnancy,
disease, iron
discomfort. Most patients have rhythmic
(Requip) can be very effective at controlling
deficiency and use of certain medications. A
leg movements during sleep hours, called
symptoms in some people. The second
form of RLS may be passed down in families.
periodic limb movement disorder (PLMD).
line of drugs includes Sinemet (an anti-
This may be a factor when symptoms start
All of these symptoms often disturb sleep.
Parkinson’s
at a younger age. The abnormal gene has
Symptoms also can make it difficult to sit
pregabalin
not yet been clearly identified.
during air or car travel, or through classes
clonazepam. However, these medications
or meetings.
may cause daytime sleepiness. Low doses
The condition can result in a decreased
medication), or
tranquilizers,
gabapentin, such
as
of narcotics also may sometimes relieve
quality of sleep (insomnia). This lack of
There is no specific examination for restless
sleep can lead to daytime sleepiness,
leg syndrome. The health care provider
anxiety or depression, and confusion or
will not usually find any abnormalities,
Restless leg syndrome is not dangerous or
slowed thought processes.
unless the patient also has peripheral nerve
life threatening, and it is not usually a sign of
RLS symptoms.
disease. Blood tests (complete blood count
a serious disorder. However, the discomfort
RLS leads to uncomfortable sensations
and serum ferritin) may be done to rule
and sleep disruption it causes can greatly
in the lower legs that are eased with leg
out iron deficiency anemia, which in rare
affect quality of life.
movement. These sensations usually occur
cases can occur with restless leg syndrome.
14
The Triangle Physician
Rex News
New Pulmonary Specialists Practice Opens Rex
Healthcare
has
launched
Rex
Pulmonary Specialists on its main campus in Raleigh. Through its partnership with UNC Health Care System, Rex Pulmonary Specialists began seeing Wake County patients May 11. Pulmonologist M. Patricia Rivera, M.D., leads the practice.
M. Patricia Rivera, M.D.
“The launch of Rex Pulmonary Specialists and the addition of Dr. Rivera to our Raleigh staff will allow Rex Healthcare to offer a more comprehensive approach to the diagnosis and treatment of lung cancer,” said David Strong, president of Rex Healthcare. “Dr. Rivera is a highly qualified physician whose passion for medicine and research is only surpassed by her dedication to patients. Our patients with respiratory ailments will greatly benefit from her expertise and care.” Dr. Rivera has more than 20 years of experience in pulmonary medicine and is an associate professor of Medicine at the University of North Carolina at Chapel Hill. She earned her fellowship from Memorial Sloan-Kettering Cancer Center in New York, N.Y., and has special research interest in care of patients with lung cancer and immunocompromised hosts, fluorescence bronchoscopy and molecular characterization of abnormal bronchial lesions, and novel approaches for early detection of lung cancer in highrisk patients. At Rex, Dr. Rivera will work closely with Rex Thoracic Specialists and the Rex Cancer Center to focus on caring for local patients with lung cancer. Appointments may be made by calling (919) 784-5650. For more information, visit www.rexhealth.com. Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
august 2011
15
Women’s Health
Yes, Alma Hair Removal Is Painless and Effective By Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G.
One of the most common questions among
those few follicles not treated, but this is
women interested in laser hair removal at
infrequent and for only a few hairs.
Women’s Wellness Clinic is why several treatments are needed.
Women are routinely surprised to learn that there is no recovery time with Alma
The reason is that laser hair removal treats
Laser Pain-Free, Hair-Free, which is the
only actively growing, or anagen, hair, and
hair removal system used at Women’s
only a fraction of hair is actively growing at
Wellness Clinic. After treatments, women
one particular time. There are four stages of
can immediately return to work, school or
hair growth:
normal activities. Not only is the procedure
1) Early anagen (early hair growth),
easy, but the treated area looks great.
2) Anagen (active hair growth), 3) Catagen (regression),
The Pain-Free, Hair-Free laser can be
4) Telogen (resting, not growing).
adjusted to treat all skin types. Adjustments are made according to the standardized
After earning her bachelor’s degree in religion from Duke University (1988), Dr. Andrea Lukes pursued a combined medical degree and master’s degree in statistics from Duke (1994). Then, she completed her ob/gyn residency at the University of North Carolina (1998). During her 10 years on faculty at Duke University, she co-founded and served as the director of gynecology for the Women’s Hemostasis and Thrombosis Clinic. She left her academic position in 2007 to begin Carolina Women’s Research and Wellness Center, and to become founder and chair of the Ob/Gyn Alliance. She and partner Amy Stanfield, M.D., F.A.C.O.G., head Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals for management of heavy menstrual bleeding. Call (919) 251-9223 or visit www.cwrwc.com.
Anagen hair accounts for approximately 20
Fitzpatrick skin type classification. It is
percent to 30 percent of the hair removed
performed with increasing regularity at
during each treatment. After four to six
Women’s Wellness Clinic, as knowledge
treatments, the area should be free from hair.
about the benefits increases.
Patients also want to know if their hair will
To
ever grow back. The answer is, hair treated
Women’s Wellness Clinic at (919) 251-9223.
with laser in the anagen phase cannot
Consultations are free. Those who reference
regrow. Some women may need touch-
this article in The Triangle Physician will
Also for more information, visit
up treatments every two years or so due
receive a discount on the Alma Laser hair
www.painfreehairfree.com.
to hormonal changes or regrowth from
removal procedure.
16
The Triangle Physician
schedule
an
appointment,
call
august 2011
17
Your Financial RX
Plan Like There Is No Tomorrow By Paul Pittman, C.F.P.
“…Now is the time for some liposuction on your financial affairs… There might be an MI brewing right now…”
tomorrow, and at the same time, planning like we are going to live forever. With any planning, having to prepare for our own mortality can be a painful task, but is a necessary step. If you have prepared diligently, then your wishes can be carried
I get asked very often when I think the
but when it comes to knowing net worth,
out in the manner you choose should you
markets are going to improve. If I am doing
these same people shrug their shoulders.
get run over by the proverbial bus on your
my job properly, I don’t get asked that by
It is very important to know net worth,
way home. Think of this as controlling your
a client very often because I strive to keep
because it is the only real manner in which
assets from the grave.
them informed. Consistent contact is the
to judge how well you are doing over time.
key to a client-Financial Coach relationship
Preparation can also avoid unnecessary
and does wonders for one’s comfort zone.
A quick tally of your assets, minus your
taxes and probate costs. Most people would
We have been in turbulent markets for some
liabilities and debts, will give you a clearer
rather leave assets to the cousins that they
time, but better days are ahead if you are in
look at your financial picture. Net worth
never hear from or their favorite charity
the right places.
also can indicate whether your estate may
versus voluntarily donating to the IRS.
be subject to federal taxes upon your death That being said, now is the time for some
and what you can expect to pass on to your
First and foremost, physicians are health
liposuction on your financial affairs. That’s
beneficiaries.
care professionals. You are also business
right, remove the fat! It is clogging the heart
owners. It took years of hard work to get
of your financial life. There may be an MI
where you are now, but I have noticed
brewing right now in your financial plan.
that few have the time, patience or the knowledge of how to run, grow and protect
This fat can come in the form of risk,
a busy medical practice.
fees, liability or even complacency. It can be trimmed by taking some
Physicians are motivated to protect
proactive steps to improve your
their wealth and way of life. In my
financial health.
experience, physicians not only want to protect what they have built but also
If you have been reading my
expand it as well, and this all boils down
columns over the years, you have
to performance. Since many physicians
no doubt read my mantra: “It is not
have investments, and some quite large,
what you make, it is what you keep!”
the biggest drain on performance is fees.
“Keep” means what you take home, after fees, expenses and taxes. Wealth accumulation
I equate fees to a thief in the night. Many
and preservation is all about the net.
fees are disclosed, but hidden. What As the medical field is all too aware,
you can’t see can hurt you. You should
Many of my physician clients can quickly
tomorrow is not promised. In the financial
obtain a cost-analysis on all of your assets.
recall their annual income, the value of
coaching and planning industry, we have
Remember the mantra: “It is not what you
their home and other financial numbers,
the unique job of planning like there is no
make, but what you keep.”
18
The Triangle Physician
NEWSOURCE-JUN10:Heidi
Paul J. 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) 4594171 and paul.pittman@pcgnc.com.
8/5/10
12:57 PM
Do They Like What They See? Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations. Our services range from consultation, to design, to creation and implementation of strategic plans.
My advice is to work with trusted financial professionals that specialize in the area of a physician’s practice. This means that the accountant, the attorney and the financial
newsource & Associates
advisor all have to be on the same page and have an intimate knowledge of what it takes to have a successful, growing practice. When assembling this team,
Page 1
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.
remember that these people work for you and should be concerned with one thing – taking care of you. Anyone can sell you an investment product and send out statements, but it takes a specialist to lead and coach you. It is my experience that simple “I love you” wills, with a hodgepodge of retail investment products, does not make a sound fiscal and financial plan. Planning is an ongoing and ever-changing process. It is not an inoculation. I use the analogy of a piano tuner. This is a constant, gradual process, not a one-time fix. Finances are not usually the most important aspects of our lives. You should hyperconcentrate on this several times a year, take care of them and then get back to wherever your passion lies, be that healing, curing, teaching a child how to throw a mean curve-ball or whittling that pesky handicap into the single digits. Until next month, good health and happiness.
august 2011
19
Practice News
New Surgeon Joins Rex Thoracic Specialists Practice Expands in Raleigh to Meet Growing Community Needs Thoracic
surgeon
Richard M. Gillespie has
joined
area as we all work together to provide the
Rex Pulmonary Specialists and Rex Cancer
best possible care for our patients.”
Center, to diagnose and treat lung cancer
Rex
and other thoracic cancers. In addition,
Thoracic Specialists.
Gillespie completed his cardiovascular
he will work closely with community
and thoracic surgery fellowship at the
physicians to diagnose and treat diseases of
“Dr. Gillespie will
Sanger Heart & Vascular Institute of
the lungs, chest and esophagus.
be a great addition
Carolina’s Medical Center in Charlotte and
to Rex Thoracic Specialists as we expand
has additional experience in both trauma
Rex Thoracic Specialists is located at the
to accommodate the growing needs in
surgery and emergency medicine. He is
medical office building on the main Rex
our community,” said Alden M. Parsons,
board certified in thoracic surgery and the
campus in Raleigh at 2800 Blue Ridge Road,
M.D., medical director of Rex Thoracic
fundamentals of laparoscopic surgery.
suite 201. For more information, call (919)
Specialists. “His expertise is an asset to
784-5650 or visit rexhealth.com.rexthoracic.
our care team here at Rex and the many
At Rex, Dr. Gillespie will work closely with
physicians we partner with throughout our
Dr. Parsons, as well as the physicians of
SANDHILLS SLEEP DISORDERS CENTER
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Dr. G. Chin, (Chintapudi) MD, DABSM Board Certified Sleep Medicine Board Certified Neurology
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20
The Triangle Physician
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609 Attain Street, Unit 101 Fuquay-Varina, NC 27526 (919) 552-8917
INTRODUCING The Magazine for Healthcare Professionals. All health care professionals and health related businesses have a new outlet for a direct publication that targets up to 6000 physicians, PAs, NPs, medical centers and related health care professionals. The regional physician publication is coming to the Eastern Region of North Carolina! DF Marketing Consulting and Associates will be handling the advertisements for the publication in the following counties:
UNC News
The Eastern Physician T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Counties: Beaufort, Bertie, Bladen, Brunswick, Camden, Cartert, Chowan, Columbus, Craven, Cumberland, Currituck, Dare, Duplin, Edgecomb, Gates, Greene, Halifax, Hertford, Hoke, Hyde, Jones, Lenoir, Martin, Montgomery, Moore, Nash, New Hanover, North Hampton, Onslow, Pamlico, Pasquotank, Pender, Perquiams, Pitt, Richmond, Robeson, Sampson, Scotland, Tyrrell, Washington, Wayne, Wilson Cities: Greenville, Wilmington, Goldsboro, New Bern, Fayetteville, Southern Pines, Pine Hurst, Rocky Mount, Wilson, Washington, Morehead City, Elizabeth City
DF MARKETING CONSULTING AND ASSOCIATES – 1-919-267-4296 If you’re looking for referrals from other Health Care Professionals, our publication will reach them. We directly mail our publication to up to 6000 Physicians, PAs, NPs, and Medical Groups in the Eastern Region of North Carolina! We are seeking EDITORIALS for our First Issue in August 2011! Ask us about our FREE INITIAL CONSULTATION! We offer ad development, graphic design assistance, individualized- personal photos, head shots, and a full service photo shoot for a nominal fee. Want to be a featured doctor or clinic with up to 8 pages of advertising space with a personalized brochure spread? We can do that also. For any assistance or questions you may have contact: David Frank at 919-924-3751 or email at David@EasternPhysician.com Kyle Blatchley at 910-992-1592 or email at Kyle@EasternPhysician.com
“YOUR HAPPINESS IS OUR PRIORITY!” 423 Cameron Woods Drive, Apex, North Carolina 27523
UNC News
New HIV Prevention Study Data Indicate Benefit of cART Treatment Researchers from the University of North
where the virus from the originally-infected
suggests potential impact on adherence
Carolina at Chapel Hill School of Medicine
partner was confirmed by genetic analysis
when infected individuals areinformed that
presented detailed data from the landmark
to be the source of infection in the newly
their cART also may benefit their partner.
HIV Prevention Trials Network 052 study
infected sexual partner. Of these 29 linked
at the 6th International AIDS Society
infections, only one infection occurred in
Results of HPTN 052 were already being
Conference on HIV Pathogenesis, Treatment
the early cART arm. Based on the latest
considered in policy recommendations.
and Prevention in Rome last month. The
analyses, this one transmission most likely
At a joint press conference by the HPTN,
HIV Prevention Trials Network (HPTN) 052
occurred close to the time the couple
the World Health Organization (WHO),
study found that early treatment of people
enrolled in the study and before HIV viral
the National Institutes of Health and the
infected with the human immunodeficiency
replication could have been suppressed by
International AIDS Society, the WHO
virus (HIV) with combination antiretroviral
cART in the infected participant.
introduced
progress
in
developing
therapy (cART) led to a 96 percent
guidance for couples where one partner
reduction in transmission of the virus to
is HIV-infected and the other is not
their uninfected partners.
(serodiscordant). According to the WHO, in African countries with the highest HIV rates,
The presentation of results included new
close to half of the HIV-infected adults in
data indicating that the protective benefit
stable relationships have an HIV-uninfected
of early cART treatment may be even
partner, and more than half of new adult
stronger than initially reported. “This study
infections occur within such couples.
represents the culmination of many years of work, and we are thrilled by its success and
“HPTN 052 is the first randomized clinical
by the opportunity to share these data with
trial to indicate definitively that an HIV-
our colleagues and the public,” said Myron
infected individual can reduce sexual
Cohen, M.D., J. Herbert Bate Distinguished
transmission of HIV to an uninfected partner
Professor of Medicine at UNC and principal
by beginning antiretroviral therapy sooner,”
investigator of the study.
said Cohen, who also directs the Institute The new analyses also provide more insight
of Global Health & Infectious Diseases at
HPTN 052, which is funded by the National
as to how early initiation of cART benefits
UNC. “We could not be more pleased that
Institute of Allergy and Infectious Diseases,
the HIV-infected person. Individuals who
the WHO is considering these findings in
part of the National Institutes of Health,
were put on early cART maintained higher
its work on guidance for serodiscordant
was designed to evaluate whether early
absolute CD4 counts than those in the
couples.”
versus delayed use of cART by HIV-infected
delayed arm, who received treatment when
individuals would reduce transmission of
their CD4 counts fell below 250 cells/mm≥
The initial trial results were published
HIV to their uninfected partners and benefit
or an AIDS-related event occurred. Early
July 18 in The New England Journal of
the HIV-infected individuals as well. During
cART also was associated with a 41 percent
Medicine. In addition to Dr. Cohen, the
the course of the study, 39 participants
reduction in HIV-related illnesses or death,
other UNC authors on the study are Mina
who had been HIV-uninfected at the start
a direct benefit for the HIV-infected partner.
Hosseinipour, M.D.; Irving Hoffman, P.A.;
of the study became infected with HIV.
The reliable suppression of HIV among HIV-
and Joseph Eron, M.D.
Of those, 29 were linked transmissions,
infected people in the early treatment arm
22
The Triangle Physician
UNC News
Study Suggests “Trial Effect” diminishes as HIV Treatment Improves A new study by investigators from the
side effects), and the change in attitude
the current HAART period argues that the
University of North Carolina at Chapel Hill
toward HIV, which has come to be seen by
efficacy demonstrated in clinical trials is
School of Medicine has confirmed the
many as a chronic, but treatable infection,
likely to predict the effectiveness of the
existence of a “trial effect” in clinical trials
may be among the explanations for the
therapy in broader treatment populations.
for treatment of human immunodeficiency
lack of demonstrable trial effect in the later
Clinicians and public health officials may
virus and also shows that effect diminishes
period.
have increased confidence that treatment
over time.
guidelines based on clinical trial data are “This is the first study to clearly demonstrate
relevant to routine clinical care.
Trial effect is an umbrella term for the
a trial effect in HIV clinical trials, and
benefit experienced by study participants
this has important implications moving
The study was published in the July 13
simply by virtue of their participating in
forward,” Dr. Menezes said. Documentation
issue of the online journal PLoS ONE. Co-
a trial. It includes the benefit of newer
of a clinical trial effect should be considered
authors on the study were Joseph J. Eron,
and more effective treatments, the way
when interpreting the generalizability of
M.D.; William Miller, M.D.; David Wohl,
those treatments are delivered, increased
clinical trial results. At the same time, the
M.D.; Peter Leone, M.D.; and Ada Adimora,
care and follow up, and the patient’s own
fact that no trial effect was observed in
M.D., all of the UNC School of Medicine.
behavior change as a result of being under observation. “Trial effect is notoriously difficult to test,” said Prema Menezes, Ph.D., assistant professor of medicine at UNC and lead author of the study. “Our study used the objective finding of viral load supression to test our hypothesis,” she said. Researchers compared viral suppression among patients who began highly active antiretroviral therapy (HAART) in a clinical trial with patients who received HAART in routine clinical care in two different time periods, 1996-1999 and 2000-2006. They found clear evidence of a trial effect during the earlier period, but not during the later period. Patients in a clinical trial were about 33 percent more likely to show viral load suppression during the earlier period. Researchers offer that improvements to antiretroviral therapy (fewer pills and fewer
Managing your patients’ health is your life’s work. Managing physicians’ wealth is mine. Financial Rx for Physicians: • • • • •
Aiding Wealth Creation, Preservation and Protection Business Management Tax-strategies Liability Protection Asset Preservation
Trust your wealthcare to a specialist. The Preferred ClienT GrouP Paul J. Pittman CFP® President and Managing Director 919-459-4171 paul.pittman@pcgnc.com www.pcgnc.com Securities offered through LPL Financial Member NASD/SIPC Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers
august 2011
23
UNC News
The Cancer Genome Atlas Completes Detailed Ovarian Cancer Analysis As part of The Cancer Genome Atlas
The researchers confirmed that mutations
at treatments targeted to the specific biology
project, University of North Carolina
in the tumor suppressor gene TP53, are
of ovarian cancer,” said Dr. Hayes.
Lineberger Comprehensive Cancer Center
present in more than 96 percent of these
researchers have contributed to the most
cancers. Tumor suppressor genes produce
Investigators on the project also searched
comprehensive and integrated view of
proteins that normally prevent cancer
for existing drugs that might inhibit genes
cancer genes for any cancer type produced
formation. When the genes mutate and
that seem to play a role in ovarian cancer.
to date.
those protein functions are disrupted,
They identified 68 genes that could
tumors can form.
be targeted by existing Food and Drug
The UNC team, which includes Charles
Administration-approved, or experimental
Perou, Ph.D., professor of pathology
The team also found sets of genes
therapeutic, compounds. For example,
and laboratory medicine and genetics;
associated with different patient survival
poly (ADP-ribose) polymerase (PARP)
Neil Hayes, M.D., associate professor of
patterns, identifying a set of 108 genes
inhibitors, which have been tested in clinical
hematology/oncology; and Katie Hoadley,
associated with poor survival and 85 genes
trials at UNC and elsewhere, may be able to
Ph.D., research associate, completed the
associated with better survival. Overall, the
counteract a DNA repair gene observed in
microRNA and mRNA microarray analysis
five-year survival rate for ovarian cancer is
half of the ovarian tumors studied.
that contributed to the findings.
31 percent, meaning that there is an urgent
Ovarian serous adenocarcinoma tumors
need for a better understanding of, and
TCGA is jointly funded and managed by the
therapeutic targets for, the disease.
National Cancer Institute and the National
from 500 patients were examined and the
Human Genome Research Institute, both
analyses are reported in the June 30 issue of
“These are exactly the types of cancers for
part of the National Institutes of Health.
the journal Nature. Serous adenocarcinoma
which The Cancer Genome Atlas (TCGA)
As participants in TCGA, UNC Lineberger
accounts for about 85 percent of all ovarian
project can make a difference, providing the
scientists have also been involved in
cancer deaths.
resources and collaborative scientific power
findings related to subtypes of the brain
to establish new investigative avenues aimed
tumor glioblastoma and of lung cancers.
Bone-loss Prevention Experiment on the Last Space Shuttle Flight Researchers in the University of North
the department, painstakingly prepared
at the BioServe Space Technologies Center
Carolina at Chapel Hill/North Carolina State
an experiment aboard Atlantis aimed
with the University of Colorado, has been
University Joint Department of Biomedical
at revealing strategies to protect future
involved as an investigator in numerous
Engineering were at the Kennedy Space
astronauts from bone loss during extended
spaceflight studies.
Center for the final NASA launch of the STS-
exposure to micro-gravity. In addition to the human crew of this
135 space shuttle program July 8. Not only is this a milestone in the history
historic 12-day flight, Atlantis will be host
Ted
of space exploration, but also for Dr.
to 30 of its smallest passengers – mice –
Bateman, Ph.D., associate professor in
Bateman who, along with his collaborators
that might help humans one day travel far
The
24
UNC/NCSU
team,
The Triangle Physician
led
by
UNC News beyond the moon. These mice are integral
University. The study will explore how
In this final space shuttle experiment,
to Dr. Bateman’s research on bone and
weightlessness in space affects mouse
half of the space-flown mice were treated
muscle health in microgravity.
bone tissue at the molecular level, studying
with a novel agent that blocks the activity
the changes in protein expression by load-
of sclerostin. This experimental agent, a
sensing bone cells, called osteocytes.
sclerostin antibody, has been shown to
Rapid bone loss, an accelerated osteoporosis, results from removing gravitational
increase bone formation and bone mineral
loading. Such exposure will be unavoidable
density in ground-based mouse studies. A
for interplanetary missions such as a round-
different sclerostin antibody than the one
trip to Mars, explains Dr. Bateman. “We’ve
used for the space shuttle mouse study is
known for quite awhile, since the 1970s and
currently in clinical trials as a collaboration
the Skylab missions, that astronauts are going
between the biopharma companies Amgen
to lose bone on these extended missions,”
Inc. and UCB.
Dr. Bateman says. “Comprehensive work has been done to identify the amount of
The UNC scientist says that the sclerostin
loss – about 1-2 percent per month, which
Osteocytes are the bone cells primarily
clinical candidate antibody “may offer
is approximately five times the rate that
responsible for communicating changes in
a potential treatment for Earth-based
postmenopausal women lose bone here on
forces and loads to other cells that affect
osteoporosis as a novel way to increase
Earth.
bone mass and strength. Normally, these
bone formation and prevent fractures.”
cells send a signal in the form of a protein “And we know that this will cause a decline
called sclerostin to control bone formation.
in bone strength of approximately 3 percent
After the flight, the researchers will analyze the skeletons of the mice for changes in
per month. When astronauts return, the
“Though it has never been tested, we expect
bone strength and bone mineral density,
recovery is incomplete. On extended
that during spaceflight, with the removal of
in addition to looking for alterations in
missions, beyond six months up to three
gravitational loading, sclerostin levels will
bone cell activity and in the biochemical
years, such as on a Mars mission, this loss
increase significantly,” Dr. Bateman said.
communications used by these cells.
is going to be substantial.”
“We believe this increase in sclerostin signal may be a primary reason why bone
Funding for the research comes from
Along with his UNC/NCSU team, Dr.
formation is reduced in astronauts and
Amgen Inc.; the National Space Biomedical
Bateman’s project includes colleagues at
mice when they are in microgravity.”
Research Institute; and NASA’s Human
the University of Colorado and Harvard
Research Program, Johnson Space Center.
Scientists Describe New Protein’s Role in Immune Response to Pathogens The human immune system is a double-
how the immune system initially reacts to
Comprehensive Cancer Center, explained,
edged sword. While it is finely adapted to
a virus invader, as well as how a subgroup
“We knew that proteins called NLRs (NOD-
fighting potentially deadly viruses, such
of proteins plays a role in returning the
like receptors) control the immune system’s
as the H1N1 influenza, the mechanisms it
immune system to a normal surveillance
initial response to an invading pathogen,
uses to fight pathogens can have negative
function. Their pre-clinical findings were
such as influenza. However, we did not
effects, such as inflammatory disorders or
published in the June 24 online edition of
realize that a sub-group of these proteins
autoimmune diseases.
Immunity.
actually functions to bring an overactive immune response back under control after
A new finding by University of North
Coy Allen, Ph.D., first author of the paper
the pathogen threat has been resolved. Our
Carolina scientists provides a window into
and a postdoctoral fellow at UNC Lineberger
study showed that a newly identified NLR
august 2011
25
Hospital News protein called NLRX1 is capable of shutting
“These findings are also relevant to cancer.
down an overreaction by the immune system
Several viruses are implicated in cancer,
during an influenza infection.”
including adenovirus, hepatitis C virus, EpsteinBarr virus and Kaposi’s sarcoma-associated
Dr. Allen continued, “We worked with influenza
herpesvirus. It is likely that NLRX1 may also
because the flu virus is an ongoing global health
mediate elements of the host immune response
concern that results in a significant number of
following onco-virus exposure,” said Dr. Allen.
deaths each year. In 2009-2010, a new influenza virus emerged and rapidly spread throughout
According to Dr. Allen, the next steps are to
the world, ultimately resulting in the first global
examine other NLR proteins to determine if they
influenza pandemic in over 40 years. As part of
too can act as an anti-inflammatory and to further
our studies, we partnered with the Centers for
describe how the NLRX1 protein shuts down the
Disease Control and Prevention and found that
immune response at the appropriate time.
NLRX1 also functions in controlling the immune response following 2009 H1N1 influenza virus
Other UNC authors are: Monika Schneider, UNC
infection.
graduate student; Yu Lei, Ph.D.; Beckley Davis, Ph.D.; Margaret Scull, Ph.D.; Denis Gris, Ph.D.;
In most cases, individuals who die from influenza
Kelly Roney, Ph.D.; Albert Zimmerman, Ph.D.;
virus infection suffer from a hyperactive immune
and Raymond Pickles, Ph.D. Additional authors
response to influenza. Thus, NLRX1 is one of
are Chris Moore, Ph.D., from Glaxosmithkline,
the mechanisms that dampen this hyperactive
Research Triangle Park, N.C.; John Bowzard,
immune response.
Ph.D.; Priya Rahjan, Ph.D.; and Suryaprakas Sambhara, Ph.D., from the influenza division,
Dr. Allen is a postdoctoral fellow in the
National
laboratory of Jenny Ting, Ph.D. Ting, UNC
Respiratory Diseases, Centers for Disease
Alumni Distinguished Professor of Microbiology
Control and Prevention, Atlanta, Ga.; and
and
Kathryn Monroe, University of California at
Immunology
and
director
of
the
inflammation center at UNC and, is a pioneer
Center
for
Immunization
and
Berkley graduate student.
in the understanding of the NLR family of proteins. She is co-leader of UNC Lineberger’s
Research funding was provided by grants from
immunology program and senior author of the
the National Institutes of Health and a National
Immunity paper.
Research Service Award.
Clinical Trials Do you have patients with any of these problems?
Ovulation and Ovarian Activity
Women’s Wellness Clinic Dr. Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. If you are a healthy female age 18-40 years with regular periods, then you may qualify for a research study on the effects of an investigational medication on ovulation and ovarian function. The research study procedures include: • physical exam • PAP smear • ultrasounds • blood draws • EKG Reimbursement up to $225 per week (for up to 20 weeks if you qualify). This study is being conducted by Dr. Andrea Lukes at the Women’s Wellness Clinic. Women’s Wellness Clinic is located by the Streets of SouthPoint. For more information call (919) 251-9223 or visit www.cwrwc.com.
Gastroenterology Stomach Ulcers Wake Research Associates Charles F. Barish, M.D.
Have you suffered from a heart attack or stroke and take 325 mg of aspirin daily to prevent another from occurring? If so, Wake Research is conducting a research study of an investigational medication that combines aspirin with a second medication to see if It can help prevent stomach ulcers. You’ll receive investigational medication and study-related exams at no cost and compensation up to $500 for time and travel. For additional information and qualification criteria please call (919) 781-2514 or visit us online at www.wakeresearch.com.
However much you value wildlife conservation in North Carolina,
DEC NC
11
1234
Wake Research Associates Charles F. Barish, M.D.
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
26
The Triangle Physician
General Medicine/ Infections
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
Do you have an upcoming hospitalization? You could be at risk of infection by Clostridium difficile (C.diff.), a bacteria that can cause severe gastrointestinal problems.You may qualify for this study if you are between 40 and 75 years old and have an upcoming hospitalization. Study-related medical exams and study medication are provided at no cost, and compensation will be provided for time and travel. For additional information and qualification criteria please call (919) 781-2514 or visit us online at www.wakeresearch.com.
UNC News
Clinical Trial of Molecular Therapy for Muscular Dystrophy Yields Significant Positive Results A molecular technique originally developed
a functional muscle protein and patients
They now plan to
at the University of North Carolina at Chapel
eventually lose their ability to walk and
expand their studies in
Hill has taken one step closer to becoming
breathe. In a milder form of the disease,
a next trial, increasing
a treatment for the devastating genetic
called Becker muscular dystrophy, the
both the dose and the
disease Duchenne muscular dystrophy.
genetic defect leads to one missed
duration of the treatment
component but leaves the rest intact,
to see if the approach has
The novel treatment uses strips of genetic
resulting in a muscle protein that is largely
clinical impact. In the future
code – called antisense oligonucleotides
functional and patients that can have a
the researchers would like to
– to restore the function of a defective
normal lifespan.
develop alternative formulations
dystrophin gene. In a study published
of the drug that can be
July 25, 2011 in the journal The Lancet,
In the current study, the researchers tested
administered subcutaneously,
researchers from the U.K., U.S. and Australia
a way to turn the lethal to the livable
like for diabetes, or perhaps even
demonstrated that a phase Ib/IIa trial of the
form of the illness by using antisense
in pill form. But Dr. Kole says even
approach restored production of the critical
oligonucleotides, strings of genetic lettering
the current approach holds great
muscle protein missing in patients with the
that can stick to and mask sections of
promise for the over 30,000 people
progressive neuromuscular condition.
code. The oligonucleotides cause the
who have the illness worldwide.
cell’s “splicing” machinery – responsible “When I first tried my approach in a test
for cutting and pasting the instructions
“If I get to see one child benefit
tube some twenty years ago, a reviewer
together – to skip a few paragraphs so the
from this treatment, it will be a
of my manuscript commented that it
reading frame is back on track and the rest
life as a scientist well spent,” said
was
of the dystrophin protein can be made as
Kole.
‘molecular
gymnastics
that
will
never amount to anything,’” said study author Ryszard Kole, PhD
instructed.
a professor
The research was funded in
of pharmacology who has taken a leave
To prove this concept, the scientists
part by the National
of absence from UNC to develop the
administered the treatment intraveneously
Institute of
technology
in
to 19 Duchenne muscular dystrophy
General
Bellevue, Washington. “Now we have
patients over the course of 12 weeks. They
Medical
evidence that it works, and in an illness that
found that the drug was well tolerated
Sciences and
has no other good therapeutic options.”
and appeared to increase the levels
the National
of dystrophin protein in a statistically
Heart, Lung and
Duchenne muscular dystrophy is a lethal
significant dose-dependent manner. The
Blood Institute.
disease that affects 1 in 3500 newborn boys.
best 3 responders showed an increase
In the disease, omissions or misprints in
following treatment of protein levels from
the letters of the dystrophin gene cause
2 percent to 18 percent, from 0.9 percent
its “reading frame” to shift, abbreviating
to 17 percent and from 0 percent to 7.7
the instructions for making the dystrophin
percent of normal muscle, respectively.
with
AVI
Biopharma,
protein. As a result, the cells fail to make
august 2011
27
The Magazine for
News
The Triangle Physician is bein Administers, and Hospitals in
Welcome to the Area
Physicians Shelley Rose McDonald, DO Duke Geriatrics Durham
Jennifer Elizabeth Holton, MD
Vikas Pathak, MD
Psychiatry Duke University Hospitals Durham
University of North Carolina Hospitals Chapel Hill
Physician Assistants Counties: Alamance, Chatham, Durham, Fra Laura Beth Bills, PA Person, Sampson, Vance, Wake, Warren, Way
Rupali Jagdish Prabhukhot, MD
Cities: Raleigh, Durham, Chapel Hill, Smithfi
Celeste Terese Campbell Jackson, MD
Raleigh
Family Medicine Grimesland
Internal Medicine Pitt County Memorial Hospital Greenville
Erik Mitchell Sasovetz, DO
Larry Ronald Jackson, MD
Fatima Adbulla Rangwala, MD
Internal Medicine Duke University Hospitals Durham
Internal Medicine Duke University Medical Center Durham
Neil Jain, MD
Brandi Nikcole Reeves, MD
Wake Emergency Physicians Raleigh
UNC Hematology & Oncology Fellowship Program Chapel Hill
Hamid Khalid Nazeer, DO
5th Battalion, 10th Marine Regiment Camp Lejeune
Christina Kay Anderson, MD Pediatrics Chapel Hill
Nicole Evangeline Aristy, MD Pediatrics Knox Clinic Wilmington
Bryan Laynes Balmadrid, MD Internal Medicine Gastroenterology, Internal Medicine Duke University Hospitals Durham
Divya Kumar Bappanad, MD Internal Medicine Duke University Hospitals Durham
Anna Hong Bordelon, MD Ophthalmology Duke Eye Center Durham
Ann Marie Buchanan, MD Pediatrics, Pediatric Infectious Diseases Duke University Hospitals Durham
Brian Andrew Casazza, MD UNC Dept. of PM&R Chapel Hill
Mesha McKinney Chadwick, MD Internal Medicine New Hanover Regional Medical Center Wilmington
Vincent Gerardo Champion, MD Diagnostic Radiology Camp Lejeune Naval Hospital Camp Lejeune
George Sadler Edwards, MD Orthopedic Surgery University of North Carolina Hospitals Chapel Hill
Brandon Fletcher, MD Family Medicine Pitt County Memorial Hospital, GME Greenville
Ashleigh Johnson Freeman, MD Maxton Family Practice Maxton
Jenee’ Jeri’ Gibson, MD Psychiatry, Child Psychiatry Pitt County Memorial Hospital Greenville
Nieraj Jain, MD Ophthalmology Duke University Eye Center Durham
Nagesh Hiremagalur Jayaram, MD Southeastern Medical Oncology Center Jacksonsville
Liangyong Jiang, MD Rheumatology, Internal Medicine University of North Carolina Hospitals Chapel Hill
Patricia Denise Jones, MD Internal Medicine, Pediatrics University of North Carolina Hospitals Chapel Hill
Khalid Mohammad Suleiman Saadah, MD
Lumberton
Candice Louise Hesse, PA January Tremont Medical Center Raleigh
Endocrinology Glaucoma Valeriya Romanovna Khodush, PA Vance Family Medicine Henderson
February
David James Kleczek, PA Cardiology
Jennifer Kolos, PA
Lung Safety
March Digestive Health Care Mary Candace Lee, PA Health EdgewaterMen’s Medical Center
Family Medicine Southern Regional AHEC Fayetteville
Durham
Matthew Christopher Smith, MD
Lillington
University of North Carolina Hospitals Chapel Hill
Bradley Glade April Mclaughlin, PA
Rebecca Leigh Smith, MD
Women’s Health Diabetes
NHCL Orthopaedics Camp Lejeune
Pediatrics Duke Children’s Hospital Durham
Kimberlee R Roche, PA
Duke Cardiology Durham
Chandramouleeswaran Srinivasan, MD
Orthopaedics Eileen Marie Sorge, PA
Prabhat Kumar, MD
Pediatric Cardiology Duke University Hospitals Durham
Carolina Endocrine, P.A. Raleigh
Joseph Michael Sroka, MD
Beverly Medical Center Raleigh
Michael Ryan Klein, MD
Internal Medicine, Cardiology UNC Center for Hear & Vascular Care Chapel Hill
UNC Hospitals, Chapel Hill
Jack Joseph Kuritzky, MD Internal Medicine Wake Faculty Physicians Raleigh
Sarah Brier Leonard, MD
Elaine Marie Sunderlin, MD Internal Medicine University of North Carolina Hospitals Chapel Hill
Pediatrics Pitt County Memorial Hospital Greenville
Raghuveer Vallabhaneni, MD
Laura Beth Lewandowski, MD
Ameeth Vedre, MD
Duke Medical Center Pediatric Rheumatology Durham
Duke Cardiovascular Magnetic Resonance Ctr Durham
Angela Renee Lipscomb-Hudson, MD
Juan Gualberto Verastegui, MD
Internal Medicine UNC Chapel Hill Chapel Hill
Internal Medicine Pitt County Memorial Hospital Greenville
Catherine Ann Lynch, MD
Yamini Vikas Virkud, MD
Duke University Medical Center Durham
Duke University Hospitals Durham
Eileen Katherine Maziarz, MD
Lidia Antonia Vognar, MD
Internal Medicine Duke University Medical Center Durham
Internal Medicine Durham
Mara Ann Monoski, MD
UNC Physicians and Associates Chapel Hill
Meshia Quinelle Waleh, MD
Morgan Eileen Mullaney, MD
Yvonne Susan Ngwe Weledji, MD
Duke Hospital Durham
Duke University Hospital Durham
Britni Fabacher Hebert, MD
Melchor Hernan Munoz, MD
Lisa Beth Williford, MD
Southern Piedmont Primary Care Monroe
Emergency Medicine University of North Carolina Hospitals Chapel Hill
The Triangle Physician
Scott Darron Fowler, PA
Allen Orthopedics 2011 Editorial Calendar
Jessica Marie Sloan, MD
Obstetrics and Gynecology Duke University Hospitals Durham
28
Fayetteville
Vance Family Medicine Henderson
Family Medicine Duke University Hospitals, Durham
Internal Medicine University of North Carolina Hospitals Chapel Hill
Brian Lee Burgemaster, PA
Pitt County Memorial Hospital, GME Greenville
505 Stonecroft Ln, Cary
Beverly Allen Gray, MD
Durham
Triangle Spine & Back Care Center Raleigh
May
Allergies
Pamela HeleneJune Steinberg, PA
Vision Neurology Michael John Straka, PA Elizabeth City
July Imaging Technologies Interventional Radiology Dennis James Wood, PA Sheila Rae Vance, PA Fort Bragg
Williamston
August The TriangleDiseases Physician Infectious 2011 Editorial Calendar Pediatrics September Sports Medicine Prostate Cancer October Breast Cancer Neurosurgery November Urology Alzheimer’s December Pain Management Sleep Disorder
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Your LocaL cardioLogY ProfessionaLs in Johnston countY dedicated to QuaLitY, service, and integritY
Mateen Akhtar, MD, FACC
Benjamin G. Atkeson, MD, FACC
Christian N. Gring, MD, FACC
Matthew A. Hook, MD, FACC
Kevin Ray Campbell, MD, FACC
Eric M. Janis, MD, FACC
Randy Cooper, MD, FACC
Diane E. Morris, ACNP
cardioLogY services
Ravish Sachar, MD, FACC
Nyla Thompson, PA-C
2 Locations to serve our Patients Smithfield Heart & Vascular Associates 910 Berkshire Road Smithfield, NC 27577 Phone: 919-989-7909 Fax: 919-989-3147
Wake Heart & Vascular Associates 2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520 Phone: 919-359-0322 Fax: 919-359-0326
Coronary and Peripheral Vascular Interventions Pacemakers/Defibrillators Atrial Fibrillation Ablations Echocardiography Nuclear Cardiology Vascular Ultrasound Clinical Cardiology CT Coronary Angiography Stress Tests Holter Monitoring Cardiovascular Medicine Echocardiography Nuclear Cardiology Cardiac Catheterization
the highest QuaLitY cardiovascuLar care, cLose to home.
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Are Tired Legs Holding Your Patients Back?
Scan now to set up your vein therapy consultation with your smartphone. To access, you may use any QR Reader App for your smartphone or iPod Touch (use AT&T Reader).
FREE CONSULTATIONS FOR MEN AND WOMEN
Think of the decisions your patients make in life based on how fatigued their legs are. Many men and women are affected by the discomfort and unsightly appearance of varicose veins; fortunately, advances in vein therapies allow us to offer your patients new choices and relief. Most of our treatments, including spider vein therapies, are minimally invasive or laser-based, have little or no downtime and are performed in our convenient outpatient setting. Wake Radiology’s comprehensive approach to vein therapy is unlike others around. Our skilled interventional physicians have training and expertise in minimally invasive vein treatments, evaluating each patient personally and discussing the best treatment plan for their unique situation. There are trails to be explored and beaches to be combed, and greenways to be enjoyed—so help your patients stop thinking about their tired legs and start thinking about what they want to do. Call us or go online to request a free consultation where we’ll help your patients determine how they can step back into great-feeling legs. Wake Radiology. Making tired legs a thing of the past.
You or your patient can request a free consultation online today at wakerad.com Wake Radiology Cary | 300 Ashville Avenue, | Cary, NC 27518 | 919-854-2180 | wakerad.com