The Triangle Physician March 2012 taylor Retina Center by TTPLLC

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Taylor Retina Center Focused on Early Diagnosis and Treatment Advances

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

Financial Planning Mindset The PSA Concern

Protecta XT TM

CRT-D and DR ICDs with SmartShock Technology TM

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

Brief Statement: Protecta™ CRT-D/DR ICDs Indications Protecta/Protecta XT implantable cardioverter defibrillators (ICDs) and CRT-D ICDs are indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias. Protecta/Protecta XT (CRT-D) ICDs are also indicated the reduction of the symptoms of moderate to severe heart failure (NYHA Functional Class III or IV) in those patients who remain symptomatic despite stable, optimal medical therapy and have a left ventricular ejection fraction ≤ 35% and a prolonged QRS duration. Atrial rhythm management features such as Atrial Rate Stabilization (ARS), Atrial Preference Pacing (APP), and Post Mode Switch Overdrive Pacing (PMOP) are indicated for the suppression of atrial tachyarrhythmias in ICD-indicated patients with atrial septal lead placement and an ICD indication. Additional Protecta/Protecta XT System Notes: The use of the device has not been demonstrated to decrease the morbidity related to atrial tachyarrhythmias. • The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 17%, and in terminating device classified atrial fibrillation (AF) was found to be 16.8%, in the VT/AT patient population studied. • The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 11.7%, and in terminating device classified atrial fibrillation (AF) was found to 18.2% in the AF-only patient population studied.

Additional Protecta XT DR System Notes: The ICD features of the device function the same as other approved Medtronic marketreleased ICDs. • Due to the addition of the OptiVol® diagnostic feature, the device indications are limited to the NYHA Functional Class II/III heart failure patients who are indicated for an ICD. • The clinical value of the OptiVol fluid monitoring diagnostic feature has not been assessed in those patients who do not have fluid retention related symptoms due to heart failure. Contraindications Protecta/Protecta XT CRT-ICDs are contraindicated for patients experiencing tachyarrhythmias with transient or reversible causes including, but not limited to, the following: acute myocardial infarction, drug intoxication, drowning, electric shock, electrolyte imbalance, hypoxia, or sepsis. The devices are also contraindicated for patients who have a unipolar pacemaker implanted, patients with incessant VT or VF, or patients whose primary disorder is chronic atrial tachyarrhythmia with no concomitant VT or VF. Warnings and Precautions ICDs: Changes in a patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage. Do not place transthoracic defibrillation paddles directly over the device. Additionally, for CRT-ICDs, certain programming and device operations may not provide cardiac resynchronization.

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

Potential Complications Potential complications include, but are not limited to, acceleration of ventricular tachycardia, air embolism, bleeding, body rejection phenomena which includes local tissue reaction, cardiac dissection, cardiac perforation, cardiac tamponade, chronic nerve damage, constrictive pericarditis, death, device migration, endocarditis, erosion, excessive fibrotic tissue growth, extrusion, fibrillation or other arrhythmias, fluid accumulation, formation of hematomas/seromas or cysts, heart block, heart wall or vein wall rupture, hemothorax, infection, keloid formation, lead abrasion and discontinuity, lead migration/dislodgement, mortality due to inability to deliver therapy, muscle and/or nerve stimulation, myocardial damage, myocardial irritability, myopotential sensing, pericardial effusion, pericardial rub, pneumothorax, poor connection of the lead to the device, which may lead to oversensing, undersensing, or a loss of therapy, threshold elevation, thrombosis, thrombotic embolism, tissue necrosis, valve damage (particularly in fragile hearts), venous occlusion, venous perforation, lead insulation failure or conductor or electrode fracture. See the device manual for detailed information regarding the implant procedure, indications, contraindications, warnings, precautions, and potential complications/ adverse events. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts these devices to sale by or on the order of a physician.

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

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Contents

COVER STORY

Taylor Retina Center Focused on Early Diagnosis and Treatment Advances

march 2012

Vol. 3, Issue 3

FEATURES

Your Financial Rx

Saving for Retirement Should Be Mandatory Mindset

DEPARTMENTS 14 Women’s Health

Physical Trainers Help Motivate Client to Reap Exercise Benefits

18 Practice Marketing

Urology

Branding 101: Image Is Everything

20 UNC Research News

PSA Testing & Prostate Cancer in African-American Men

Financial planner Paul Pittman cites

Concerned about draft recommendations

evidence that supports the need to rethink

to end PSA practice, Dr. Judd Moul sug-

retirement planning and adopt more

gests an approach using baseline PSA and

regimented savings.

risk stratification.

- Statin Therapy May Have Added Benefits - Findings Suggest Bone Density Test Less Often for Some Older Women

22 UNC News

- Real-time Flourescent Imaging Guides Kidney Cancer Surgery - Tar Heels and Coca-Cola Team Up to Fight Cancer

22 WakeMed News

$5 Million Pledge Achieves Neonatal Fund-Raising Goal

However much you value wildlife conservation in North Carolina,

DEC NC

1234

24 Duke Research News Cancer Drugs Help Hardest Cases of Pompe Cases

25 Duke Research News Multidisciplinary Approach Draws High-Risk Prostate Cancer Patients

quadruple it.

26 Duke News That’s right! Your conservation effort is increased by a 3-to-1 matching gift. So, when you are one of the first to display the new North Carolina Wildlife Habitat Foundation NCDMV license tag, your $10 tag contribution to the organization becomes $40 in lands preserved. The all-volunteer North Carolina Wildlife fe Habitat Foundation assists in acquisition, on, management, and protection of land in North Carolina for the conservation of habitats needed to preserve wildlife

right here in the Old North State. Conservation education efforts are preparing future generations to sustain your concern for the lands we protect today. At www.ncwhf.org, download the license tag application and see the good works in process. pp Your new tag shows your support and your n contribution is put to work…times four. co

www.ncwhf.org w

Durham Regional Renovations Under Way

26 Practice News

Cary Cardiology Joins WakeMed Group

27 Community Service

- The North Carolina Chapter of the Children’s Tumor Network - Run for Horse Park Fun and Cancer Awareness

28 News

Welcome New Physicians

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March 2012

From the Editor

Sight-Saving Advances Just within the past decade, advances in ophthalmology are making it possible for retina

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

specialists to prevent and, in many more cases, reverse blindness. Yet, the Centers for Disease Control reports that only half of those at high risk of serious vision loss – an estimated 300,000-plus in the United States – have visited an eye doctor in the past 12 months. This is frequently the result of lack of mobility and awareness. This month The Triangle Physician cover story features The Taylor Retina Center and its retina surgeons – Jeffrey Taylor, Nitin Gupta and Carey Pate – who are working to minimize the obstacles to sight-saving retina care. Satellite offices are making specialized care more accessible to those in rural communities. Clinical trials through the Macular Degeneration Institute of North Carolina will assure access to the latest diagnostic approaches and therapies. Outreach to the public and medical community is increasing awareness of the importance of ophthalmology and prevention and early intervention. We also are fortunate to have in this issue a number of contributors who share their insights. Urologist Judd Moul discusses the reasons behind his grave concern about the

Editor Heidi Ketler, APR

heidi@trianglephysician.com

Contributing Editors Amanda Kanaan Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G. Judd W. Moul, M.D., F.A.C.S. Paul J. Pittman, C.F.P. Photography Mark Jacoby Creative Director Joseph Dally

mark@jacobyphoto.com

jdally@newdallydesign.com

Advertising Sales Carolyn Walters carolyn@trianglephysician.com News and Columns Please send to info@trianglephysician.com

draft guidelines on prostate specific antigen blood test for prostate released in 2011 by the United States Preventive Services Task Force. In the practice management arena, marketing specialist Amanda Kanaan explains the importance of branding and offers tips on building a powerful brand. Paul Pittman, our resident certified financial planner, offers sound arguments for a retirement mindset focused on saving. Dr. Andrea Lukes also returns to recommend a personal trainer for women who need extra motivation to exercise regularly. We thank all our columnists and advertisers, alike, for their contributions to a great issue. Our other readers are invited to contribute. Your message will reach about 9000 physicians, physician assistants, nurse practitioners and hospital administrators, and the editorial calendar on page 27 can give you added foresight. With gratitude for all you do,

Heidi Ketler Editor

The Triangle Physician

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Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.

Cover

Retinal Disorders on the Rise

The Taylor Retina Center

Focused on Early Diagnosis and Treatment Advances

common

considered the foremost expert in macular

Today, the Taylor Center is one of the area’s

retina diseases threaten to take

degeneration, diabetic retinopathy, retinal

few retina-only medical practices. Five sat-

away the vision of many North

detachments, macular puckers, holes and

ellite offices are located across the state in

Carolinians – macular degeneration and

many other diseases that affect the retina

Wilson, Greenville, Smithfield, Erwin/Dunn,

diabetic retinopathy.

and vitreous.

and New Bern. “We have expanded the

The incidence of both is expected to more

The Taylor Retina Center has been

is a real need for retina physicians,” says Dr.

than double in the next few decades,

providing this level of expertise to the

Taylor. “Many of our patients are elderly and

and with that will come an increase in

Triangle region and eastern North Carolina

have difficulties traveling to doctor’s offices

irreversible blindness, especially among

for nearly 30 years. Jeffrey S. Taylor,

in the Triangle. So we bring our specialized

those who do not access early and effective

M.D., founded what is now known as the

expertise and technology closer to them,

medical intervention.

Taylor Retinal Center as the region’s first

helping improve their livelihood and qual-

increasingly

practice to serve outlying areas, where there

private retina practice in 1983. He quickly

ity of life. Retinal scanners and lasers have

diagnostic

established a reputation for his pioneering

become more portable, allowing specialty

modalities and therapies have been

spirit, compassionate care and his “patient

care to be delivered to more patients than

developed over the past decade to combat

always comes first” philosophy. This core

ever before.”

some of the severe diseases that primarily

value is a cornerstone of the practice and

affect the retina. One’s best defense is

is emphasized daily.

Fortunately,

many

novel

early intervention by a retina specialist,

Over the years, the practice has continued to grow, and the Taylor Retina Center invited Nitin Gupta, M.D., M.P.H., in 2008, and J. Carey Pate, M.D., in 2011 to join Dr. Taylor in continuing his mission to reduce severe vision loss in our region. All three surgeons are board-certified ophthalmologists and fellowship trained to provide comprehensive retina care and special expertise in the management of the diabetic retinopathy, macular degeneration and retinal detachment. “Retina disease can severely threaten vision. While not all eye conditions are curable, one’s best chance for preserving vision is to be seen immediately by a retina specialist,” says Dr. Gupta. “Our specialized focus assures patients receive the best

Dr. Jeffrey Taylor administers an intravitreal injection of avastin.

The Triangle Physician

possible care at each of our locations.”

Dr. Carey Pate examines the retina and macula using a slit lamp and 90 diopter lens.

Diseases of the Retina

The two most common retina diseases in

While the exact cause of AMD is being

As the population ages, the incidence of

the United States are age-related macular de-

studied, it is known that different genetic

eye disease is increasing. According to the

generation (AMD) and diabetic retinopathy

and age-related factors lead to an

National Eye Institute, about 3.3 million

(DR). According to the Centers for Disease

accelerated aging process in the eye.

Americans age 40 and over are blind or

Control, AMD is the leading cause of central

Known risk factors include:

have low vision. This is about 1 in every 28

vision loss in Americans age 60 and older,

• Age

people. Without increased prevention and

while diabetes is the leading cause of blind-

• Family history of macular degeneration

early intervention, that number could be

ness in younger adults.

• Race • Smoking

5.5 million by 2020. Age-related Macular Degeneration

• Cardiovascular diseases

The retina is important to vision. It is a

According to the Centers for Disease

• Poor nutrition

multi-layered, light-sensitive tissue lining

Control (CDC), an estimated 1.8 million

• Obesity

the inner surface of the eye. The clear

Americans are affected by AMD, and an

• Excessive ultraviolet sunlight exposure

cornea and lens of the eye focus light

additional 7.3 million with large drusen

on the retina, similar to film in a camera,

(yellow or white deposits under the

Those with AMD should monitor their vision

creating a detailed image of the visual

retina) are at substantial risk of developing

daily with an Amsler Grid. Any changes on

world. When light strikes the retina, highly

AMD. The number of people with AMD is

the grid may signify progression to “wet”

specialized rod and cone photoreceptors

estimated to reach 2.95 million in 2020.

macular degeneration and require an urgent eye exam. “Wet” refers to the fluid

start a chain of chemical and electrical events that create a nerve impulse. These

A painless condition, AMD affects the central

that leaks from fragile, new blood vessels

are sent through the fibers of the optic

retina (macula), which is responsible for

growing beneath the retina. This causes

nerve to the brain, where it is perceived as

the clear vision required to read or drive.

distortion of objects, visible dark spots and

sight.

Although it usually affects both eyes, the

blurred central vision.

eyes can be affected differently.

March 2012

Dr. Nitin Gupta examines the peripheral retina with an indirect headset and 20 diopter lens.

While there is no cure for macular

Other medications, such as Lucentis

including green leafy vegetables, omega-3

degeneration, the exudative, or “wet”

(ranibizumab) and Eylea (aflibercept), are

fatty acids and fish, may be beneficial, as

form, can be treated in an effort to stop

also treatment options for patients affected

well. Newer supplements, such as lutein

the bleeding and fluid leakage. The most

by wet macular degeneration. “Unlike

and xeozanthin, are being studied in large

commonly used treatment in the United

earlier treatments, which slowed the rate

clinical trials. According to Dr. Pate, “while

States is an ocular injection of Avastin

at which patients went blind, both of these

these supplements are likely beneficial

(bevacizumab), a drug developed to

drugs stop vision loss for most patients

in some patients, smoking cessation

prevent blood vessel growth in cancerous

and in some way actually improve many

and improvement in diet are critical to

tumors. Patients may receive an ocular

patients’ vision,” says Dr. Gupta. “This is

minimizing one’s risk of developing sight-

injection once a month until the leakage

especially good news for those who were

threatening AMD.”

subsides and then as needed, thereafter.

able to drive prior to an episode of wet AMD. There is hope that after treatment,

Diabetic Retinopathy

Dr. Taylor recognized the potential benefits

many of them will be able to regain

Diabetic retinopathy is the leading cause of

of Avastin therapy for AMD early on, and is

enough vision to return to driving and

blindness in American adults. According

the first retina specialist to use intravitreal

other activities. The key to saving vision,

to the CDC, an estimated 4.1 million and

Avastin in North Carolina. “At that time,

however, is early detection and prompt

899,000 are affected by retinopathy and

Avastin was something special, and I felt

referral to a retina specialist.”

vision-threatening retinopathy, respectively.

my patients who had no other alternatives.

Vitamin combinations of zinc, antioxidants,

Everyone with diabetes, type 1 and type

I was amazed at the visual improvement

vitamin E, vitamin C and beta-carotene have

2 is at risk for diabetic eye disease. The

in the first patient I treated with an Avastin

been shown to reduce the risk of developing

longer an individual has diabetes, the

injection,” says Dr. Taylor.

advanced AMD. Eating a healthy diet,

greater the risk.

that it had the potential to save vision in

The Triangle Physician

“People with diabetic retinopathy can

to bleed. “Novel drug therapies, such as

Comprehensive Sight-Saving

reduce their risk of blindness by 95 percent

Avastin, are safely injected with a tiny

Advances

with timely treatment and appropriate

needle into the eye in an almost painless

Drs. Pate, Gupta and Taylor have extensive

follow-up care,” says Dr. Gupta. “Better

fashion,” says Dr. Pate.

experience

managing

complex

eye

diseases with ocular injections, laser and

control of blood sugar, blood pressure and blood cholesterol levels slows the onset and

“Lasers can greatly reduce the chance

vitreoretinal surgery. In fact, both Drs.

progression of retinopathy and reduces the

of severe vision loss and should be

Pate and Gupta have been awarded the

need for sight-saving laser surgery.”

considered early in the course of the

prestigious Rhett Buckler Award for retina

disease, rather than after vision loss has

surgery by the American Society of Retina

DR typically affects both eyes. It is

already occurred,” he says. “That is why

Specialists.

characterized by progressive damage to

regular, comprehensive, dilated eye exams

the blood vessels of the retina, which can

are important for diabetic patients.”

Vitreoretinal surgery can be beneficial for retinal detachment, macular pucker,

lead to the accumulation of fluid in the retina, called macular edema. Vision loss

When DR becomes severe, the abnormal

macular

hole,

may be mild to severe depending on the

blood vessels can hemorrhage into the

complications from cataract surgery and

amount of leakage. The most severe form

vitreous and cause scar tissue on the

a variety of other severe eye diseases that

is proliferative retinopathy, marked by the

retina. If the scar tissue becomes severe,

can affect the retina, macula and vitreous.

growth of delicate new blood vessels that

it can lead to a tractional detachment of

rupture easily and cause scar tissue and

the retina and even total blindness. At this

Macular Hole and

vitreous hemorrhage.

stage of the disease, surgery is often the

Macular Pucker

best option to attempt to restore lost vision.

Macular

Ocular injections and laser treatment offer

This surgery, referred to as a “vitrectomy,”

happen spontaneously as part of the

the best chance to save vision before the

is an outpatient surgery performed at the

aging process. Severe eye trauma and

fragile, new blood vessels have started

hospital.

other pathologic eye conditions also may

holes

vitreous

and

hemorrhage,

puckers

usually

Janet Delahunty, ophthalmic technician, performs an ocular computed tomography (OCT) scan of the retina.

March 2012

lead to these sight-threatening conditions.

notes, “it is imperative that patients are

Taylor. “Many patients live in areas located

Macular puckers and holes are often

referred in an emergent manner. The

far from a retina specialist. They frequently

repaired with vitrectomy surgery and some

earlier they receive surgery, the more likely

are unable to drive themselves and rely on

combination of a gas bubble and special

they are to recover vision.”

family members or friends. We have been able to establish satellite clinics in at-need

positioning. Because of recent advances in medical technology, Retina Surgery

Patients Always Come First

areas to better serve our patients and the

has become increasingly successful and

“Accessibility of care has become more and

community.”

rewarding for patients and surgeons alike.

more important, especially in the day of specialized care,” says Dr. Taylor. “Most of

Retinal Detachment

our patients are high risk for vision loss and

Although a detached retina can happen

any delays in treatment are unacceptable.”

Earlier this month, the Taylor Retina Center opened its new Raleigh office at 1101

to anyone, those with high myopia, a posterior vitreous detachment or trauma

Existing

with

Dresser Court. The facility is located off of

are at increased risk. Sight-saving repair

urgent eye problems can expect to get an

Wake Forest Road in a quiet neighborhood

requires surgery, using some combination

appointment at the Taylor Retina Center

close to the beltway. There is ample

of a scleral buckle, vitrectomy or gas

right away, and often on the same day they

parking beside the office. Power doors

bubble. A scleral buckle is a tiny silicone

call. “It’s not uncommon for us to stay late

accommodate patients in walkers and

band attached to the outside of the eye

or work weekends for emergencies. It’s a

wheelchairs. Nearly 10,000 square feet

to gently push the eye’s wall against the

pretty regular thing, actually, and all of the

allow for spacious exam, treatment and

detached retina. A temporary gas bubble

doctors buy into that.”

imaging rooms. “Patient feedback over the

patients

and

referrals

last few months has been very exciting.

helps the eye heal before dissolving on its own. “Despite the high success rates

“To treat the patient first, we must make it

They love the convenience and amenities

of retinal reattachment surgery,” Dr. Pate

convenient for them to get to us,” says Dr.

of our new office,” says Dr. Gupta. “And

Dr. Carey Pate describes the photographic findings to a patient with macular disease.

The Triangle Physician

we’re happy to do what we can to make the lives of our patients a little easier.” “Our respect for patients is well known, especially to those with chronic diseases who come to our offices frequently. They know we treat our patients like family,” Dr. Pate says. “The common thread through the years has been the consistency in the way we provide care here every day. We address our patients’ concerns using the best medical science and technology available to improve retinal conditions in a caring and compassionate way,” says Dr. Gupta. “This ultimately gives our patients the best chance at improving their vision.”

An Institute Dedicated to Macular Degeneration The Taylor Retina Center specialists are amplifying their role in advancing prevention, diagnosis and treatment with development of the Macular Degeneration Institute of North Carolina. “Many of our patients remember their parents being told nothing can be done to help their vision,” says Dr. Gupta. “Just 10 years ago there was no effective treatment for macular degeneration. Today, retina physicians are improving vision in about half of our patients with wet macular degeneration, whereas before we were only able to prevent vision from going from bad to worse. It is an additional source of comfort that the latest treatment options are now offered in more convenient locations for patients in eastern North Carolina.” “Patients who are seen at the Taylor Retina Center will have access to powerful emerging therapies for treatment of their retina disease,” says Dr. Pate. “With the immense amount of research and development on both the wet and dry forms of AMD, we anticipate many future breakthroughs in management of this potentially devastating disease.” True to its preventive spirit, the Taylor Retina Center was the first practice in North Carolina to use genetic testing to determine a person’s risk of being among the 20 percent whose macular degeneration will evolve into advanced stages, when sight can be lost. “It’s better, by far, to identify the disease in its earliest stage when treatment can minimize the risks and preserve vision, rather than when the patient is already experiencing vision loss,” Dr. Pate says.

Education Emphasizes Importance of Eye Care “Ongoing research offers hope for saving sight, but progress needs to be made in prevention and early intervention,” says Dr. Pate. “The greatest challenge we face is education of at-risk patients: those with macular degeneration, diabetes, retinal detachment and a host of other retinal diseases.”

Photos 1-6, fluorescein angiography, 7-8, color photographs, and 9-14, optical coherence tomography (OCT). All are of macular degeneration.

March 2012

Outspoken proponents, the Taylor Retina Center physicians’ outreach extends into the medical and general communities. They present lectures for visually impaired individuals and participate in health fairs. They also speak before their colleagues in educational forums across the state.

Meet the Physicians Dr. Jeffrey Taylor graduated from the University of Illinois College of Medicine as its James Scholar in 1977. He completed his internship at Butterworth Hospital in Grand Rapids, Mich., and his ophthalmology residency at Manhattan Eye Ear

“Physicians need to be able to explain the importance of eye care so their patients ‘get it,’ because if a patient doesn’t understand their condition, they may not follow up on treatment and monitoring the way they should,” says Dr. Gupta. “It’s really heartbreaking, because eye diseases that rob a person’s sight are often preventable and manageable, with the proper care.”

and Throat Hospital in New York, where he served as chief resident. Dr. Taylor’s specialty training in vitreoretinal surgery was completed with Retina Associates at the Massachusetts Eye and Ear Infirmary, Harvard Medical School in Boston. Dr. Nitin Gupta graduated from the Brody School of Medicine at East Carolina University in 2002 and completed his residency

“Patients of the Taylor Retinal Center have been grateful for the expanded access to a practice that is very well-regarded in the medical community and a new state-of-the-art facility in Raleigh that offers the latest technology and expertise in treating retinal disease,” says Dr. Gupta. For more information on the Taylor Retina Center call (919) 878-4060, send an e-mail to contactus@ taylorretinacenter.com or visit www.TaylorRetinaCenter.com.

in ophthalmology at the Medical College of Georgia. He graduated from the prestigious Macular Degeneration Institute with Retina Associates of Kentucky and completed a two-year surgical vitreoretinal fellowship at the University of Kentucky in Lexington. Dr. Carey Pate graduated from Baylor College of Medicine in Houston, Texas, in 2005. He completed an internship in transitional surgery and a residency in ophthalmology at the University of Kentucky, followed by a dual, two-year fellowship in vitreoretinal surgery at the University of Kentucky and Retina Associates of Kentucky.

The Taylor Retina Center is located at 1101 Dresser Court, just north of I-440 on Wake Forest Road in Raleigh.

The Triangle Physician

Your Financial Rx

Saving for Retirement Should Be Mandatory Mindset By Paul Pittman, C.F.P.

In a world where retirement seems ever

professionals who explained the funda-

elusive, what are your expectations and

mentals of asset allocation, goal setting,

what are you doing to achieve them?

debt, etc. Those workers who attended had volunteered to learn more about their

Most nations today are coming to grips with

financial situation and, therefore, were

the same economic forces: an aging and

somewhat motivated. After the sessions,

growing population of seniors, a shrinking

100 percent of the participants said they

workforce in proportion to the number of

were going to increase contributions to

retirees, slower economic growth and in-

their 401(k) plans – just 14 percent actually

creased longevity.

did so.

Retirement policies internationally are be-

The solution, he suggested, is an automatic

ginning to reflect this reality. Throughout

enrollment plan.

Western Europe, the official retirement age

Paul Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 4594171 and paul.pittman@pcgnc.com. Send an e-mail to receive Mr. Pittman’s Weekly Market Commentary.

is rising. France’s employment minister

When the default option at one company

(IRA) legislation. Under the proposal, em-

recently announced plans to raise the na-

was participation in the 401(k) plan, and

ployers with at least 10 employees would

tion’s legal retirement age to 62 (up from

workers had to affirmatively opt out, partici-

be required to offer workers’ retirement

age 60) and to increase the number of

pation rates grew to nearly 100 percent. The

savings options through payroll deduc-

working years required to claim a pension

upfront cost of filling out paperwork and

tions, and those who don’t sign up would

to 41.5 (up from 40 years).

making decisions had been removed from

be automatically enrolled in a plan.

the equation, and a hassle-factor cost of optSpain is increasing its retirement age from

ing out had been added to the other side.

Whether you are already contributing to a retirement plan or not, think about set-

65 to 67 by 2013; the Dutch will do the same by 2025. By 2029, Germans will have to

When the company set the default at put-

ting up your own savings plan. Regardless

work until 67 to claim the government pen-

ting 2 percent of each worker’s salary into

of your age, an automatic deduction from

sion, up from age 65. For hopeful retirees,

the plan, almost 100 percent of the workers

your checking account each month to an

the only way to deal with this demographi-

made 2 percent contributions. When the

investment of your choice will increase

cally driven dilemma may be to work lon-

default was raised, the workers passively

your nest egg in retirement. Avoid the

ger and save more money in a disciplined

accepted the contribution of up to 15 per-

temptation to touch these monies and set

manner.

cent with comparable employer matches.

a goal to increase the percentage you save

Remarkably, the corporate policy had a 97

each year.

David Laibson, a behavioral economist at

percent employee approval rating. In a world where retirement seems ever

Harvard, believes education and incentives are surprisingly ineffective ways to get

This is not a new concept. Australia has

elusive, what are your expectations and

people to do things in their own best inter-

come up with a solution to savings ad-

what are you doing to achieve them?

ests. He studied the behavior of employees

equacy by making a 9 percent employer

at several large companies, each of which

contribution to individual retirement-like

If you would like to receive my Weekly Mar-

offered a generous match on all contribu-

plans compulsory. The mandated high rate

ket Commentary e-mail, contact me at paul.

tions to their 401(k) plans. Thousands of

of savings has had the effect of providing

pittman@pcgnc.com. You will not receive

workers older than age 59½ were not par-

Australians with a much thicker asset cush-

any other correspondence from us. The

ticipating in those plans even though they

ion than most Americans have.

Weekly Market Commentary comes out every Monday afternoon.

were leaving money on the table. Currently, Congress is working on a draft of Workers attended seminars by financial

automatic Individual Retirement Account

Until next month, good health and happiness. March 2012

Women’s Health

hysical rainers Help Motivate Clients to Reap Exercise Benefits By Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G.

The advantages of regular exercise, such

muscle-strengthening exercises to guard

the end of the day.” Each of these are valid

as stress reduction, weight loss and a

against loss of bone mass, particularly in

and compelling reasons, but given the

higher metabolism, are familiar to nearly

postmenopausal women.

enormous preventive benefits of consistent fitness, we encourage women to seek out

everyone. But a growing body of research suggests that an active lifestyle confers a

The list goes on: regular exercise is

myriad of other benefits.

correlated with a lower incidence of stroke,

ways to maintain a regular exercise routine.

Alzhiemer’s disease, high blood pressure,

One solution is to get in touch with a per-

For example, a study out of Appalachian

type 2 diabetes and depression. And study

sonal trainer who has great undersanding

State University’s Human Performance

after study shows that the advantage lies in

of fitness and motivational skills. Terry

Lab showed that even a moderate fitness

exercise itself, rather than merely in having

Starr, a certified personal trainer with more

regimen can improve the body’s immune

a healthy body mass index. Overweight or

than 20 years of experience, comes to

response and lower the duration and

not, a sedentary lifestyle carries greater risk

mind. Terry customizes workout programs

severity of the common cold or the flu

of eventual medical trouble than an active

to fit each individual’s lifestyle, whether it’s

by as much as 25 percent, compared

one.

in the home or at the gym.

“A lot of people have this misconception that they have to be out of breath. It’s the amount of time you spend that burns the fat. Thirty minutes to an hour each day is a lot of gain.”

No stranger to long, busy days focused on career and her own children, Terry has developed several creative ways to squeeze helpful fitness habits into a packed schedule. “If you’re doing phone work or even talking to a friend for 15 or 30 minutes, walk around,” she says. “Walking

(Nieman

All of these emerging benefits highlight

is better than sitting or eating or watching

2005). Research done by investigators

the need to ensure women are getting

TV. Always be moving.”

at Harvard Medical School showed that

the exercise needed to stay healthy. Many

women who exercise regularly reduce

women do not get regular exercise or any

The goal is to raise the heart rate. Long

their risk of breast cancer by 20 percent

exercise at all. My colleague, Amy Stanfield,

runs or bike rides may be commonly

to 30 percent, and benefit from up to 50

M.D., F.A.C.O.G., and I hear many reasons

associated with keeping fit, but plenty

percent lower mortality rates if diagnosed

from patients we see at the Women’s

of other activities work just as well. Salsa

(Holmes 2005). Further, recommendations

Wellness Clinic: “I just don’t have time,”

dancing, tennis, yoga or gardening are all

developed by the Department of Health

“I’m so busy after work running around

good options that can be fun, social events,

and Human Services include twice-weekly

with my children” or “I’m so exhausted at

to boot. Terry recommends that her clients

sedentary

individuals

The Triangle Physician

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 Thombosis 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.

chose an activity they like. “If you can shop that fast, go for it!”

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

x Improved patient outcomes

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

x NO inventory to purchase

Toll Free 855-4POPMED www.POPMedical.com

Fitness doesn’t have to be exhausting or take hours away from your day. “A lot of people have this misconception that they have to be out of breath,” says Terry. “It’s the amount of time you spend that burns the fat. Thirty minutes to an hour each day is a lot of gain.” A long, brisk walk doesn’t stress your joints or tire you out and gives you all the benefits of a short run.” Many women find it difficult to get started, and that’s where a trainer can help the most. The good news is that once fitness routines become habitual, it may be hard to stop, and the benefits accrue quickly. “Look in the mirror after one or two months,” Terry says, “and you won’t want to go back.” For more information, contact Terry Starr

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®

at (919) 427-2497.

President and Managing Director

References

919-459-4171 paul.pittman@pcgnc.com www.pcgnc.com

Nieman DC, Henson DA, Austin MD, Brown VA. The immune response to a 30-minute walk. Med Sci Sports Exerc 37:57-62, 2005. Journal of the American Medical Association (Vol. 293, No. 20: 2479-2486). Michelle Holmes, MD, Harvard Medical School and Brigham and Women’s Hospital in Boston.

Securities offered through LPL Financial Member NASD/SIPC Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers

March 2012

Urology

PSA Testing & Prostate Cancer in African-American Men By Judd W. Moul, M.D., F.A.C.S.

As a cancer specialist in North Carolina

of his annual physical! Unfortunately, this

next five years and is told to return at age

working exclusively in the area of prostate

confusion may cause many doctors to stop

45 for a repeat PSA. At age 45, the same

cancer, I am scared. I am worried that the

recommending PSA to their patients and

rules apply, and those still with a PSA less

latest controversy surrounding the prostate

may further keep fewer African-American

than 1.0 are told to return at age 50.

specific antigen blood test to screen for

men from getting tested. However, for a man with a PSA greater

prostate cancer will erase the progress we have made in lessening the disparity

The AUA and the NCCN have published

than 1.0 ng/ml, he is told to be checked

for prostate cancer seen between black

guidelines that use PSA in a novel way

annually, as he is at slightly higher risk for

and white men. I am worried that primary

(1,2). All men, including African Ameri-

future prostate cancer. If a younger man

care doctors and providers will ignore the

cans, are encouraged to get a baseline PSA

between age 40-50 has a PSA of 2.5 ng/ml

American Urological Association and the

test at age 40. This baseline number is a

or greater, he is told to see a urologist for

National Comprehensive Cancer Center

tool for risk assessing individual man for

possible prostate biopsy to rule out early

guidelines calling for a baseline PSA test at

future testing.

stage prostate cancer or to be followed more closely by the specialist, using the

age 40 (1,2). Specifically, if a man has a baseline PSA

changes over time in the PSA as a guide for

Getting a baseline PSA is especially

value of 1.0 ng/ml or less at age 40, he is

further work up (6-8).

important for African-American men, who

at very low risk of prostate cancer over the

tend to get prostate cancer at younger ages than Caucasian men and may have more to lose if the disease is not detected in an early curable state (3,4). In 2011, the United States Preventive Services

Task

Force

released

draft

guidelines stating that PSA screening did not reduce prostate cancer mortality as reported from the currently available randomized trials and suggested that doctors stop performing the PSA test (5). This caused a firestorm, as many groups and individuals have disagreed with the task force and have re-emphasized the value of PSA (1,2). Ironically, soon after this government panel called to curtail PSA, President Obama, likely the most famous African-American male in the world, had a PSA test as part

The Triangle Physician

Dr. Moul is the James H. Semans, M.D., professor of surgery and director of the Duke Prostate Center, Duke Cancer Institute, Duke University Medical Center. Prior to joining Duke, he was professor of surgery at the Uniformed Services University of the Health Sciences in Bethesda, Md., and an attending urologic oncologist at the Walter Reed Army Medical Center in Washington, D.C. In addition, he was director of the Center for Prostate Disease Research, a Congress-mandated research program of the Department of Defense based at USUHS and WRAMC. Dr. Moul completed his urologic oncology fellowship at Duke University and graduated summa cum laude from Pennsylvania State University. He earned his medical degree from Jefferson Medical College. Dr Moul was awarded 2009 National Physician of the Year for the dedication, talent and skill that served to improve the lives of countless thousands of people worldwide. In 2006, he was named chairman of the newly founded American Urological Association Foundation Education Council. Other honors have included selection as a 1994 fellow for the American Urological Association/European Association of Urology International Academic Exchange Program; the 1995 American Medical Association Young Physicians Section Community Service Award for his national involvement in prostate cancer patient support groups; and the 1996 Sir Henry Welcome Research Medal and Prize from the Association of Military Surgeons of the United States. Dr. Moul can be reached by calling (919) 684-5057 or by e-mail to judd.moul@duke.edu.

age. In 1994, I led the U.S. Army team

References

showing that African-American men, in

1) Gomella LG, Liu XS, Trabulsi EJ, Kelly WK, Myers R, Showalter T, Dicker A, Wender R. Screening for prostate cancer: the current evidence and guidelines controversy. Can J Urol. 2011 Oct;18(5):5875-83. PubMed PMID: 22018148.

general, had higher PSA values. We then developed specific guidelines to help fine tune PSA testing in this high-risk group (9,10). Over the years between the mid 1990s and now, more men were tested and there was a tremendous stage migration. In other words, in the pre-PSA era, about 20-25 percent of men (black and white) presented

with

incurable

metastatic

disease. Over the last 5-10 years, the rate of metastatic disease at first presentation has dropped to less than 5 percent. If we now are going to face a backlash against PSA testing as a result of the USPSTF, I am afraid we may see a return to the bad old days, when a quarter of men presented with incurable bony metastatic prostate cancer and faced a much shortened life expectancy. For AfricanAmerican men, who generally present at a younger age, we may go from now seeing men in the mid-40s to late-50s having a mild- to moderate-elevated PSA and an early-detected, curable prostate cancer to a man showing up in the mid-to-late-50s to mid-60s with metastatic disease and a dismal prognosis. In summary, please be skeptical of the USPTF draft recommendations. Instead of abandoning PSA, consider using the test more intelligently by encouraging all men in your practice to have a baseline PSA at age 40 (11). Then use this value to fine tune your further ordering of the test in that individual.

Using baseline PSA as a risk stratification

For high-risk African-American men, be

tool in young men rather than mass

aware that the disease more commonly

screening every year makes more sense

strikes younger men. These men have

and can save money. Most men will only

more to lose if prostate cancer is missed

need testing infrequently and the small

and they then present later, but still young,

proportion with a higher baseline PSA can

with advanced disease.

2) Kazzazi A, Momtahen S, Bruhn A, Hemani M, Ramaswamy K, Djavan B. New findings in localized and advanced prostate cancer: AUA 2011 review. Can J Urol. 2011 Jun;18(3):5683-8. Review. PubMed PMID: 21703040. 3) Sridhar G, Masho SW, Adera T, Ramakrishnan V, Roberts JD. Do African-American men have lower survival from prostate cancer compared with white men? A meta-analysis. Am J Menâ&#x20AC;&#x2122;s Health. 2010 Sep;4(3):189-206. Epub 2010 May 18. Review. PubMed PMID: 20483872. 4) Barocas DA, Penson DF. Racial variation in the pattern and quality of care for prostate cancer in the USA: mind the gap. BJU Int. 2010 Aug;106(3):322-8. Epub 2010 Jun 14. Review. PubMed PMID: 20553251; PubMed Central PMCID: PMC2910169. 5) Lin K, Croswell JM, Koenig H, Lam C, Maltz A. Prostate-Specific Antigen-Based Screening for Prostate Cancer: An Evidence Update for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Oct. Available from http://www.ncbi.nlm.nih.gov/books/ NBK82303/ PubMed PMID: 22171385. 6) Crawford ED, Moul JW, Rove KO, Pettaway CA, Lamerato LE, Hughes A. Prostate-specific antigen 1.54.0 ng/ml: a diagnostic challenge and danger zone. BJU Int. 2011 Dec;108(11):1743-9. doi: 10.1111/j.1464410X.2011.10224.x. Epub 2011 Jun 28. PubMed PMID: 21711431. 7) Tang P, Du W, Xie K, Fu J, Chen H, Yang W, Moul JW. Characteristics of baseline PSA and PSA velocity in young men without prostate cancer: Racial differences. Prostate. 2012 Feb 1;72(2):173-80. doi:10.1002/ pros.21418. Epub 2011 May 2. PubMed PMID: 21538426. 8) Tang P, Sun L, Uhlman MA, Polascik TJ, Freedland SJ, Moul JW. Baseline PSA as a predictor of prostate cancer-specific mortality over the past 2 decades: Duke University experience. Cancer. 2010 Oct 15;116(20):4711-7. PubMed PMID: 20589748. 9) Moul JW, Sesterhenn IA, Connelly RR, Douglas T, Srivastava S, Mostofi FK, McLeod DG. Prostatespecific antigen values at the time of prostate cancer diagnosis in African-American men. JAMA. 1995 Oct 25;274(16):1277-81. PubMed PMID: 7563532. 10) Morgan TO, Jacobsen SJ, McCarthy WF, Jacobson DJ, McLeod DG, Moul JW. Age-specific reference ranges for prostate-specific antigen in black men. N Engl J Med. 1996 Aug 1;335(5):304-10. PubMed PMID: 8663870. 11) Scales CD Jr, Antonelli J, Curtis LH, Schulman KA, Moul JW. Prostate-specific antigen screening among young men in the United States. Cancer. 2008 Sep 15;113(6):1315-23. PubMed PMID: 18696715.

be followed in a more intelligent manner. We know African-American men are at higher risk for prostate cancer at a younger

March 2012

Practice Marketing

Branding 101: Image Isn’t Is Everything By Amanda Kanaan

What comes to mind when you think of

Identify your claim to fame. Start by

industry giants such as Walmart or Nike?

identifying some of your practice’s best

You may positively associate Walmart with

traits. It could be your depth of experience

low prices or perhaps you’ve had a negative

in the field, the technology you use, the

experience with long checkout lines. For Nike

fact that you offer evening and weekend

you may picture that famous swoosh logo

appointments

or even be reminded of the infamous Tiger

combination of these differentiators. Most

Woods debacle. For better or for worse, both

importantly, stay true to who you are. Don’t

of these brands elicit some type of emotional

try and pretend to be something you are

response when you hear their names.

not. Consumers will quickly recognize this

(convenience)

as false advertising, and it will do more The same goes for medical practices and

harm than good.

Amanda Kanaan is a medical marketing specialist whose company, WhiteCoat Designs, provides website design, SEO and online marketing along with print design, and branding and messaging services to local private practices and health care organizations. Email Amanda at amanda@ whitecoat-designs.com, call at 919-714-9885 or visit the website at www.whitecoatdesigns.com.

have the greatest impact. (Remember that

even physicians themselves. When a patient hears your name what do you hope they

Get an outside opinion. Look to outside

your logo is the foundation of your brand,

say about you? More importantly, what are

sources to get additional opinions on the

so be sure it’s the right representation of

patients actually saying?

current reputation of your brand and how

your practice. Don’t make the emotional

to improve upon it. Don’t be afraid to ask

decision to keep your logo if it truly does

In its simplest form a brand is a set of

patients, as they will feel valued for their

not serve your practice well.)

promises to your customer (i.e. patients).

input and, in turn, become invested in

It is a direct representation of your practice

helping make your practice a success.

Get the word out. One of the most effective

and who you are as a physician, and sets an

Whether you hire a professional agency,

ways to promote your brand is through your

expectation of your services (whether good

coordinate a focus group or call on your

website. It’s a vital opportunity to establish

or bad). The act of brand building refers to

patients, your colleagues or even your

your brand and lead the conversation in

the deliberate and skillful effort to create

staff members, collecting other opinions

terms of the message you want patients

a desired perception in the mind of the

besides your own will give you a better

to hear. Your online presence should be

consumer. Building a brand for yourself and

understanding of your brand.

the most prominent part of your marketing strategy. Other useful online tools in

your practice helps differentiate you from your colleagues and answers the question

Choose a target demographic. Next re-

establishing your brand include social

“Why should I choose your practice?”

search and decide what patient demograph-

media outlets, e-newsletters and blogs. (Tip:

ic you would like to attract. The messaging

Connect your blog to your social media

Your brand is made up of everything patients

and imagery you use will vastly differ when

accounts

hear, see or experience in association with

creating a brand for an ob/gyn practice

uniform updates from one location.)

your practice. From your office décor to

targeting reproductive-age women versus

the look of your website, it’s all part of an

a sports medicine physician working with

Be patient. Even if you do everything

equation patients subconsciously utilize to

young athletes.

right, market penetration does not happen

(Facebook/Twitter)

send

overnight. It takes time to build a lasting

decipher who you are as a brand. Keep it consistent. Keeping your brand

brand. Resist the urge to constantly change

How to Build Your Brand

consistent will lead to faster and longer-

your message just because it doesn’t elicit a

To follow are the steps practice leaders can

lasting brand awareness. From your website

response within the first month. As I stated

take to build a brand that is representative of

to your brochures and everything else you

earlier, consistency is the key to a long-

your practice and meaningful to your target

produce in the community, maintain a

lasting brand.

patient population.

consistent message and image in order to

The Triangle Physician

UNC Research News

Statin Therapy May Have Added Benefits People with high cholesterol are at

Statins “only target the ‘bad and inducible

showed that simvastatin reduced levels

risk of heart attack and stroke because

tissue factor,’ not the good one used in

of oxidized low-density lipoprotein and

atherosclerotic plaques within their arteries

normal clotting, and therefore should not be

circulating tissue factor, which normalized

can rupture, triggering the formation of an

associated with the increased bleeding risk

coagulation

occlusive thrombus that cuts off the blood

that is a typical side effect of anticoagulant

cholesterol levels.

supply to their heart or brain.

drugs currently on the market.”

A study led by researchers from the

Dr. Mackman has studied tissue factor,

tissue factor expression on monocytes, and

University of North Carolina at Chapel

the number one initiator of clotting in the

this contributes to formation of an occlusive

Hill School of Medicine has identified

body, for 25 years. Tissue factor normally

thrombus after plaque rupture.

a molecular pathway that leads to this

resides outside of the blood vessels, only

abnormal blood clotting. The researchers

coming into contact with blood after an

“Though

then turned off the pathway using statins, a

injury, such as cutting your finger. However,

prescribed to lower cholesterol, some

popular class of cholesterol-lowering drugs.

it is expressed at high levels under certain

added benefits are its anti-inflammatory and

The study appears online in the Jan. 3 issue

abnormal conditions, such as inside

antithrombotic activities,” said Dr. Mackman.

of the Journal of Clinical Investigation.

atherosclerotic plaques, and gets turned

“In terms of drug development, I think we

on in a special subset of blood cells called

should be trying to better understand the

monocytes.

antithrombotic activities of statins, so we

without

altering

plasma

These results suggest oxidized LDL induces

“Statins

have

been

shown

have

statin

therapy

primarily

can develop safer antithrombotic drugs that

antithrombotic activity in several previous studies. However, I believe our study is

Dr. Mackman wondered if this was the cause

target the expression of inducible tissue

the first to elucidate how statins reduce

for the abnormal clotting seen in patients

factor.”

the activation of the blood-clotting process

with high cholesterol. To test his hypothesis,

independently

lipid-lowering

he and his colleagues analyzed humans,

This research was funded largely by the

activity,” said senior study author Nigel

monkeys and mice with high cholesterol.

National Heart, Lung and Blood Institute.

Mackman, Ph.D., F.A.H.A. Dr. Mackman is

All three groups also had elevated levels of

Most of the work was performed by A.

the John C. Parker distinguished professor

tissue factor.

Phillip Owens III, Ph.D. Study co-authors

their

from Dr. Mackman’s lab at UNC were Silvio

of hematology in the Department of Medicine and director of the UNC McAllister

Then the researchers treated the mice and

Antoniak, Ph.D.; Julie C. Williams; and

Heart Institute.

monkeys with simvastatin, a drug widely

Jianguo Wang, Ph.D.

used to treat high blood cholesterol. They

Findings Suggest Bone Density Test Less Often for Some Older Women The United States Preventive Services

M.D., M.P.H., of the University of North

women in the highest bone density ranges

Task

to develop osteoporosis.”

organizations

Carolina at Chapel Hill School of Medicine

have recommended that women ages

finds that women aged 67 years and older

65 and older be routinely screened for

with normal BMD scores may not need

“That was longer than we expected, and

osteoporosis using bone mineral density

screening again for 15 years.

it’s great news for this group of women,” Dr.

Force

and

other

Gourlay said.

screening. However, how often women should be screened is a topic that remains

“If a woman’s bone density at age 67 is

controversial and undecided, with no

very good, then she doesn’t need to be

Dr. Gourlay, an assistant professor in UNC’s

definitive scientific evidence to provide

re-screened in two years or three years,

Department of Family Medicine, presented

guidance.

because we’re not likely to see much

these results in a study published in the

change,” Dr. Gourlay said. “Our study found

Jan. 19 issue of the New England Journal of

it would take about 15 years for 10 percent of

Medicine.

Now a new study led by Margaret L. Gourlay,

The Triangle Physician

UNC Research News In the study, Dr. Gourlay and study co-

patient should be screened. It also suggests

research professors of biostatistics; Ryan

authors analyzed data from 4,957 women

that older postmenopausal women with

C. May, M.S., formerly a doctoral student in

aged 67 years and older that were collected

a T-score -2.0 and below will transition to

the UNC Gillings School of Global Public

as part of the longest-running osteoporosis

osteoporosis more rapidly, while women

Health; Chenxi Li, Ph.D., postdoctoral

study in the U.S., the Study of Osteoporotic

with T-scores higher than -2.0 may not

associate in the North Carolina Translational

Fractures. These women were enrolled

need screening again for five to 15 years,

and Clinical Sciences Institute; David F.

in the study from 1986 to 1988 when they

Dr. Gourlay said. “Doctors may adjust these

Ransohoff, M.D., professor of medicine; Li-

were 65 years or older, and had BMD

time intervals for a number of reasons, but

Yung Lui, M.A., M.S., of the California Pacific

testing starting about two years later. All had

our results offer an evidence-based starting

Medical Center Research Institute; Jane

BMD testing at least twice during the study

point for this clinical decision.”

A. Cauley of the University of Pittsburgh; and Kristine E. Ensrud, M.D., M.P.H., of the

period; some were tested up to five times over a period of 15 years.

Co-authors of the study are: Jason P. Fine,

Minneapolis Veterans Affairs Health Care

Sc.D., and John S. Preisser, Ph.D., both

System and the University of Minnesota.

For the analysis, women were categorized by BMD T-scores, which compare a person’s BMD to the expected bone density of a healthy young adult (about age 30). Women with osteoporosis (those with a T-score of -2.5 or lower) or past hip or clinical vertebral (spine) fractures were excluded because current guidelines recommend treatment for all women in those groups. Women who had already received treatment for osteoporosis were also excluded. The remaining women were placed in three groups according to their baseline BMD T-scores at the hip. The high-risk group was women with T-scores ranging from -2.49 to -2.00, while the moderate-risk group had T-scores from -1.99 to -1.50. The low-risk group included two T-score ranges: T-scores -1.49 to -1.01 and normal BMD (those with T-scores of -1.00 or higher). The researchers calculated estimated times for 10 percent of the women in each T-score group to transition to osteoporosis. For the high-risk group, the estimated time was 1.1 years, while it was about five years for the moderate-risk group and slightly over 15 years for the low-risk group. They found that in those same time periods, only 2 percent or less of women had hip or clinical vertebral fractures, which are the most important fractures doctors try to prevent by screening for osteoporosis. The study concluded that baseline BMD is the most important factor for doctors to consider in determining how often a

Womens Wellness half vertical.indd 1

12/21/2009 4:29:23 PM

March 2012

UNC News

Real-time Fluorescent Imaging Guides Kidney Cancer Surgery University of North Carolina Cancer

“When we are removing a tumor, there is

“Robotic surgery is often a good option

Care urologic surgeons Mathew Raynor,

always a concern about surgical margins,”

for patients. It is already very precise,

M.D., and Michael Woods, M.D., recently

said Dr. Woods. “The field of vision offered

minimally invasive, and healing times can

completed the first surgeries in the Triangle

by this technology may allow us to better

be faster,” said Dr. Raynor. “Any technology

using a new near-infrared fluorescence

identify the demarcation between normal

that may further enhance surgical precision

imaging-guided system with the da Vinci Si

tissue and cancerous tissue in the kidney.”

is a welcome tool.”

The

the

The new technique incorporates a 3-D HD

The specially designed camera and

fluorescence enables them to better

camera that is mounted on one of the four

endoscopes allow Drs. Raynor and Woods

visualize blood flow in the kidney during

arms of the da Vinci Si surgical robot. In

and other UNC urologic surgeons to

surgery. They can then use a surgical

addition to standard real-time images of

capture real-time images of kidney tissue

technique called selective arterial clamping

the surgical field, the camera can switch to

and surrounding blood vessels by injecting

to assist in the removal of cancerous tissue

view the images of tissue and surrounding

a unique fluorescence dye that is activated

while sparing more normal tissue and

blood vessels illuminated by the special

by near-infrared light.

preventing damage to healthy parts of the

dye when exposed to near-infrared light.

Surgical System. surgeons

also

noted

that

kidney.

Tar Heels and Coca-Cola Team Up to Fight Cancer Coca-Cola put some fizz in the three-point

A representative of Coca-Cola presented a

doctors and scientists – are grateful for this

game of the University of North Carolina men’s

check to UNC Lineberger director Shelley

donation,” said Dr. Earp.

basketball team to help fight breast cancer.

Earp, M.D., before tip-off of the UNC vs. Clemson game Feb. 18.

For every three-point shot made during the

“The N.C. Cancer Hospital and UNC Lineberger faculty and staff care about

regular season, Coca-Cola donated $50 to

“As North Carolina’s public comprehensive

making cancer care better for patients. We

UNC Lineberger Comprehensive Cancer

cancer center, we are grateful for the

are proud to partner with Tar Heel Athletics

Center – up to a total of $10,000. At time

outstanding community support that UNC

to provide this support for carrying out the

of press realease, the Tar Heels’ 90 3-point

Lineberger receives from partners like

cancer center’s mission,” said Hager Rand,

shots netted $4,500 for cancer research and

Coca-Cola. Cancer research and treatment

president and chairman, Durham Coca-

treatment at UNC.

is a team effort and our star players –

Cola.

WakeMed News

$5 Million Pledge Achieves Neonatal Fund-Raising Goal William Charles Helton, M.D., and the

“Dr. Helton is one of the key physicians who

with the community. We are very grateful

Helton Family Foundation have pledged a

helped build WakeMed’s cardiovascular

for the trust and confidence Dr. Helton has

$5 million contribution toward the Just for

services from its infancy into the robust,

in WakeMed and for his generous financial

Kids Kampaign – the largest single gift in

leading program it is today. He is a talented

support,” said Bill Atkinson II, Ph.D.,

WakeMed Foundation’s history and one of

surgeon that has touched thousands of

M.P.H., M.P.A., WakeMed president and

the largest ever made to a hospital in Wake

hearts and lives and feels it is the duty of

chief executive officer.

County.

physicians to share their good fortunes

The Triangle Physician

WakeMed News “WakeMed is the safety net health care provider in our community, and I believe strongly in the mission of the health system and the outstanding work WakeMed is doing for our community. It is a great honor for me and my family to be able to give back in a meaningful way, and we are very pleased to be able to help grow access to children’s services in our community and the region,” said Dr. Helton.

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

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

The $20 million Just for Kids Kampaign provided $8.5 million toward the WakeMed Children’s Hospital – the first and only children’s hospital in Wake County, which opened in June 2010. The Children’s Hospital comprises 34,000 square feet of the new patient tower on the

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

•

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

LOCATION

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

WakeMed Raleigh Campus and features 45 beds – an

eight-bed pediatric intensive care unit, a 12-bed pediatric

Have any questions? Contact Heather Wray at hwray@nc.rr.com or 919-414-4569.

observation unit and a 25-bed pediatric inpatient unit – a Ronald McDonald family room, a teen room, a children’s

Join Us for Rafﬂe, Food, and Fun for the Entire Family!

play room and additional treatment and support facilities. The Just for Kids Kampaign also is supporting the expansion and renovation of WakeMed’s level IV neonatal intensive care unit and other comprehensive pediatric services. The WakeMed Raleigh Campus operates the

If you are in a position to help us underwrite the cost of this event in support of the children and adults who suffer from NF or you are unable to walk but would like to make a donation please visit www.ctf.org/walk. Please make checks payable to “Children’s Tumor Foundation” and turn in at event or mail to Children’s Tumor Foundation, 95 Pine Street, 16th Floor, New York, NY 10005.

only level IV NICU in Wake County, offering the highest level of neonatal intensive care to the region’s premature and critically ill newborns. The NICU is in the process of being expanded from 36 to 48 beds. In addition, it will offer enhanced facilities to provide more space for families and staff in the care of newborn babies. The $5 million gift helps complete the $20 million campaign. Previously in 2009, Dr. Helton donated $1 million to the WakeMed Foundation to establish an endowment for nursing education. He also committed an additional $500,000 in the form of a challenge grant to encourage others to contribute and increase the endowment to $2 million. The endowment just started paying out this year and offers scholarships for nursing students as well as nurses pursuing continuing education opportunities. Dr. Helton has been a cardiac surgeon with Carolina Cardiovascular Surgical Associates since 1978. The practice recently joined WakeMed Physician Practices and is now operating as Wake Specialty Physicians-Carolina Cardiovascular Surgical Associates. Dr. Helton has been a WakeMed Foundation board member since 2007 and has served on the finance committee for his entire tenure.

March 2012

Duke Research News

Cancer Drugs Help Hardest Pompe Cases The health of children with Pompe disease

infused,” said senior author Priya Kishnani,

members, but also for the team that cares

fails because of a missing enzyme, GAA,

M.D., professor of pediatrics and medical

for the children.”

that leads to dangerous sugar build-up,

genetics at Duke. “If you can get this

which affects muscles and movement. An

combination to people early, before they

The study examined four children, two who

enzyme replacement treatment pioneered

are infused with the enzyme, they will

had Pompe and had never been treated

at Duke University Medical Center has

likely have a very good response to the

and two who were treated, but were failing.

saved many lives, but some children

enzyme treatment. Once the body has

with Pompe disease produce an immune

been exposed to the enzyme treatment,

“We have made a difference in the lives of

reaction that blocks the benefits of the life-

the babies at risk are likely to mount

four patients at medical centers around the

saving enzyme treatment.

an immune response that blocks the

world,” Dr. Kishnani said. “All of them have

effectiveness of the infused enzyme.”

achieved new motor abilities, in distinct contrast with the relentless downhill course

Until recently, there has been no success in eliminating or suppressing this immune

The group at Duke earlier showed the

of patients who were unable to tolerate the

response.

role of the immune response in children

enzyme therapy and would otherwise have

with Pompe disease. Once this response

died.” Some of these children have now

with

occurred, children who were previously

been doing well for a number of years, Dr.

collaborators at other centers, has resulted

doing well failed to benefit from treatment

Kishnani said.

in successful enzyme replacement therapy

and died.

Now

research

led

Duke,

Other authors include Deeksha Bali and

for children who were predicted to have or who had the immune reaction blocking

The researchers in the current study,

Sarah P. Young of Division of Medical

the effects of the enzyme therapy. In the

spread out in centers at Children’s

Genetics, Duke Department of Pediatrics;

past, children with this immune response

Hospitals & Clinics of Minnesota, Medical

Laura E. Case of the Duke Division

died despite treatment.

College of Wisconsin/Children’s Hospital

of Physical Therapy, Department of

of Wisconsin, Sorka Medical Center in

Community and Family Medicine; Yoav

An article appearing in Genetics in

Israel and the Evelina Children’s Hospital

H. Messinger of Pediatric Hematology/

Medicine reports on research that has

in London, worked together to treat the

Oncology, and Nancy J. Mendelsohn and

shown a very low-dose combination of

at-risk babies with the chemotherapy

Rebecca Olson of Medical Genetics, at

medicines typically used to treat cancer

medicines at the time enzyme treatment

Children’s Hospitals & Clinics of Minnesota;

was successful in eliminating or preventing

started or shortly thereafter.

William Rhead, Amy White, Cara Wells and David Dimmock of the Division of Genetics,

the immune response. The team at Duke used genetic sequencing

Departments of Pediatrics, Medical College

The drugs were rituximab, methotrexate

to identify the children at risk of enzyme-

of Wisconsin and Children’s Hospital of

and

treatment failure. The experience of the

Wisconsin; Eli Hershkovitz of Pediatric

chemotherapeutic drugs and drugs to

Duke group allowed for identification of

Endocrinology & Metabolism Unit, Soroka

support the immune system. These drugs

these cases early.

Medical Center, Beer Sheva, Israel; Michael

gammaglobulins

–

mix

Champion of the Department of Inherited

were the right mix for children who had Pompe, and who were most likely weren’t

Dr. Kishnani said the stakes of failure are

Metabolic Disease, Evelina Children’s

going to benefit from the enzyme treatment

very high. “Until now, children with Pompe

Hospital, London, United Kingdom; Simon

because

who make antibodies to the enzyme

A. Jones of Genetic Medicine, Manchester

treatment die or are placed on invasive

Academic Health Science Centre, Central

ventilation by age 27 months,” she said. “It

Manchester University, Manchester, U.K.;

“The goal is to get the new combination

is very difficult for families, because some

and Amy S. Rosenberg of the Division of

therapy to the child who is at risk of

children who initially showed a benefit

Therapeutic Proteins, Center for Drug

rejecting the enzyme, before or at the

and were able to walk then started failing

Evaluation and Research, U.S. Food and

time the enzyme – recombinant human

once the immune response occurred. It is

Drug Administration, Bethesda, Maryland.

GAA (rhGAA), known as Myozyme – is

heartbreaking to watch, not only for family

their

anti-GAA

immune

response.

The Triangle Physician

Duke Research News Dr. Kishnani received research funding

from Genzyme and PTC Therapeutics, Leal

Several other authors received research

and honoraria from Genzyme, and is a

Foundation, families of SMA, and grant

funding or honoraria from or consult for

member of Pompe and Gaucher Disease

support from the National Skeletal Muscle

Genzyme.

Registry Advisory Boards for Genzyme.

Research Center. He is also a consultant

Dr. Case also received research support

for the Genzyme registry advisory boards.

Multidisciplinary Approach Draws High-Risk Prostate Cancer Patients In choosing where they get treatment,

determine whether the multidisciplinary

prostate cancer patients tend to opt for a

approach could be a viable model of care

Dr. Stewart said that finding raises questions

major cancer center if they have severe

for hospitals and community doctors,

about access to multidisciplinary care for

disease, but stick closer to home for less

providing prostate cancer patients more

many prostate cancer patients. Poorer

complicated cases, even when offered a

standardized, less fragmented information.

men who lived more than 100 miles from

model of care that taps numerous experts.

Figuring out how patients are drawn to

the clinic were less inclined to travel for

the multidisciplinary model and who then

the evaluation and treatment in the model

The findings by Duke Cancer Institute

stays for treatment is an important step in

program, particularly if they weren’t referred

researchers, published in the January issue

expanding the services beyond big cancer

by a physician.

of the Journal of Urology, are the first large

centers. Judd W. Moul, M.D., senior author of the

analysis of the so-called multidisciplinary care strategy that gives prostate cancer

The Duke physicians studied two groups

study, said spreading the multidisciplinary

patients access to a surgeon, a medical

from 2005 to 2009, including 701 patients

approach beyond major hospitals and

oncologist and a radiation oncologist – all

who sought an evaluation at Duke’s

cancer centers remains a costly proposition

in a single visit. The care team then decides

multidisciplinary prostate cancer clinic, and

that could be an impediment to removing

as a group what’s best for the patient, easing

1,318 who accessed care in the hospital’s

barriers to care.

the bias for any one specialty.

traditional urology prostate cancer center or “From the patient perspective, it’s a

genitourinary oncology clinics.

wonderful opportunity to get an in-depth

Such multidisciplinary care has been common in Europe and is often used in the

In the multidisciplinary clinic, which is

education about the disease, but it’s difficult

United States for breast and lung cancers,

generally offered once a week, the men

for many health systems to do something

but it can be expensive and difficult to

seeking evaluations tended to be younger,

like this, considering the time commitment

structure outside of large, sophisticated

white, more affluent and live further away

of multiple cancer specialists needed at

hospitals.

than Duke’s typical prostate cancer patients.

the same time for the clinic,” Dr. Moul said.

Sixty-one percent of the men sought the

“In light of multitude new treatments that

The approach may be increasingly useful

clinic on their own, rather than through a

have been approved in the last two years

as prostate cancer patients now face

doctor who referred them because they

for advanced prostate cancer, it is critical

a complex array of treatment options,

had a difficult case. But those patients often

to embrace the multi-D concept so that

including

didn’t stick around to undergo treatment.

patients can become acclimated to the total

different

surgical

methods,

care team earlier in their disease course.”

radiation therapies, and active surveillance. About 42 percent of the multidisciplinary “Optimum management of prostate cancer

clinic patients took the expert advice and

W. Robert Lee, M.D., M.S., M. Ed., a

continues to be controversial and not well

then opted for treatment closer to home,

radiation oncologist and co-author of the

defined,” said lead author Suzanne B.

especially if they had low-risk disease.

study, agreed that new treatment choices have complicated the decision process for

Stewart, M.D., a urology resident in the Duke Prostate Center. “With so many options,

Those who actually got multidisciplinary

patients. “Prostate cancer is a disease with

it can leave patients with uncertainty and

care were sicker, and were demographically

many options for treatment,” Dr. Lee said. “It

distress.”

similar to typical Duke prostate cancer

is our hope that this format allows patients

patients – younger, black, lower income and

to make wise decisions on what treatment is

living nearby.

best for them.”

Dr. Stewart said the Duke team set out to

March 2012

Duke Research News The Duke team is now exploring whether

said Daniel J. George, M.D., director of

Ph.D.; Andrew J. Armstrong, M.D., M.Sc.;

patients fare better in multidisciplinary

genitourinary medical oncology.

Phillip G. Febbo, M.D.

the physicians who have participated

In addition to Drs. Stewart, Moul, Lee and

Funding for the study was provided by

in the multidisciplinary approach, the

George, study authors included: Lionel

the Committee for Urologic Research,

treatment model has already proved useful:

L. Bañez, M.D.; Cary N. Robertson, M.D.;

Education and Development at Duke

“What I’ve learned from practicing in our

Stephen J. Freedland, M.D.; Thomas J.

University. The study authors reported no

multidisciplinary environment has helped

Polascik, M.D.; Donghua Xie, M.D.; Bridget

conflicts of interest.

me make better decisions for my patients,”

F. Koontz, M.D.; Zeljko Vujaskovic, M.D.,

clinics than in regular care. For many of

Duke News

Durham Regional Renovations Under Way Durham Regional Hospital is investing

will be a new patient reception area, and all

more than $7 million to build a new

patient rooms will be upgraded with new

The emergency department project, which

emergency department entrance, create a

furniture and amenities.

is expected to be complete this summer,

separate outpatient entrance and renovate women’s services.

will create a new entrance with a distinct In late 2012, a dedicated area for outpatient

security screening and check-in area, along

services will open. Services will include

with a more patient-friendly waiting area.

“Our goal is to improve the hospital

radiology and imaging services and pre-

The project also includes the relocation

experience for our patients and their loved

operative testing.

of triage rooms around a single treatment

ones,” said Katie Galbraith, chief hospital

hub, as well as implementation of a new

operations and business development

“Our new outpatient entrance is designed

video surveillance system for enhanced

officer. “These renovations to our facility

to provide one-stop shopping for our

security.

will help us do that.”

patients,” Ms. Galbraith said. “It will feature its own, dedicated parking lot, so patients

Visit durhamregional.org/progress for the

Renovations to Women’s Services’ The

coming for an outpatient service, such as

latest construction updates.

Birth Place on the hospital’s fourth floor

a mammogram or CT scan, can park right

began this month. When finished, there

outside the entrance.”

Practice News

Cary Cardiology Joins WakeMed Group Cary Cardiology is joining Wake Specialty

physicians perform a wide spectrum of

will continue to operate from existing

Physicians May 1.

cardiac services, including: intravascular

offices in Cary, Dunn, Lillington and Benson, and all existing phone numbers,

ultrasound,

balloon

Wake Specialty Physicians-Cary Cardiology

intracoronary

stent

includes: Priyavadan M. Shah, M.D.; Dhiren

treatment of rhythm disorders, atrial

procedures will remain unchanged for

Shah, M.D.; Rama Garimella, M.D.; Pratik

fibrillation ablation, the diagnosis and

patients and referring physicians.

Desai, M.D.; Sunil Desai, M.D.; Joshua

management of peripheral artery disease,

Macomber, M.D.; and Pavlo Netrebko, and

stress testing, nuclear scanning and

WakeMed Health & Hospitals Physician

M.D.; and nurse practitioners Tina Jackson,

echocardiograms,

computed

Practices is the umbrella under which

Marianne Burger and Beverly Gregory.

tomography, implantation of pacemakers

Wake Specialty Physicians, WakeMed

and defibrillators, among others.

Faculty Physicians and Wake Orthopedics

Cary

Cardiology

has

been

The Triangle Physician

cardiac

the

serving

the Triangle for nearly 30 years. Its

angioplasty, placement,

contact

information

and

scheduling

operate. For more information, visit www. Wake Specialty Physicians-Cary Cardiology

wakemedphysicians.com.

News

The North Carolina Chapter of the Children’s Tumor Foundation Heather Wray is the North Carolina

families, but within the first few months of

chapter representative for the Children’s

existence the North Carolina Chapter of the

Tumor Foundation. In March 2009, her

Children’s Tumor Foundation had reached

oldest child Ethan was diagnosed with

out to both UNC and Duke hospitals;

neurofibromatosis type 1, at the age of six.

holding a patient symposium and a family

This changed the lives of the entire Wray

meet and greet.

family. Since becoming the chapter representative, Ms. Wray began seeking information and

Ms. Wray has helped coordinate two

support for this generally unknown, yet

NFWalks, raising over $64,000 for medical

very common disorder. One in every 3000

research needed to find a cure for NF. She

babies is born with this disorder every year.

has also attended the NF Forum for patients and their families that is held each year by

The Children’s Tumor Foundation offered

Children’s Tumor Foundation. There she

support, as well as, access to medical

has been able to forge relationships with

research being done to find a cure for this

other families and other chapter affiliates

spectrum disorder.

across the country.

Neurofibromatosis (NF) is a set of distinct

When Ms. Wray is not advocating for those

genetic disorders that cause tumors to

affected by NF, she enjoys spending time

grow along various types of nerves. NF

with her husband David and their three

can also affect the development of non-

children Ethan, Claire and Mary. She also

nervous tissues such as bones and skin.

enjoys teaching the 3 year old Sunday

Neurofibromatosis causes tumors to grow

School at Aversboro Road Baptist Church,

anywhere on or in the body.

in Garner North Carolina.

Upcoming Event Run for Horse Park Fun and Cancer Awareness On your mark, get set, go(!) to the Run for the Ribbons 5K and Family Fun 1K Saturday, April 7, at 9 a.m. and 10:30 a.m., respectively. Run for the Ribbons 5K and Family Fun 1K is a community fitness event that will kick off a colorful day of cancer awareness, survivor celebration and horse racing at the 61st Stoneybrook Steeplechase. Carolina Horse Park Foundation and the Moore Regional Hospital Foundation are partnering to raise awareness and proceeds for the MRH Foundation’s Cancer CARE Fund. Carolina Horse Park is located at 2814 Montrose Road, Raeford, N.C. 28376 To register, visit www.runfortheribbons5K. com or active.com.

The Triangle Physician 2012 Editorial Calendar

April

Women’s Health Marketing Your Services

May

Orthopedics – Medical Insurance

June

Ms. Wray knew that if she was seeking this

If you would like more information about

support and information that others would

the Children’s Tumor Foundation or how

be too. So she asked about starting a North

you can help make a difference, please

Carolina chapter. In 2010, the first informal

contact hwray@nc.rr.com or visit our

meeting was held and only included 3

website www.FightNF.org or www.CTF.org

Neurology – Sleep Apnea

July

New Imaging Technologies Electronic Medical Records

August

Digestive Disease Computer Technologies

Heather Wray with her son, Ethan.

September

Sports Medicine – Physical Therapy

October

Breast Cancer Reconstructive Surgery

November

Urology – Robotic Surgery

December

Pain Management

March 2012

News Welcome to the Area

Physicians Prateek Chaudhary, DO Rheumatology, Internal Medicine Duke University Hospitals Durham Heidi Jon Hartman, DO Diagnostic Radiology UNC Health Care System Chapel Hill Billie Candice Pack, DO Physical Medicine and ehabilitation Durham Audrey Ann Sova, DO Clayton Paula Clark Adkins, MD Pinehurst Maria Luiza Coutinho Albuquerque, MD GSK Safety Evaluation & Risk Management, Durham Nasrin Nadine Aldawoodi, MD Anesthesiology University of North Carolina Hospitals, Chapel Hill Lloyd M. Alderson, MD Neurology Brain Tumor Center at Duke Durham Alexander Christopher Allori, MD Plastic and Reconstructive Surgery Duke University Hospital Durham Andy Lee Anderson, MD Radiology Duke University Hospitals Durham

Andy Ki Chon, MD Diagnostic Radiology University of North Carolina Hospitals, Chapel Hill Stacy McLellan Cowherd, MD Internal Medicine University of North Carolina Hospitals, Chapel Hill Mani Ali Daneshmand, MD Thoracic Cardiovascular Surgery DUMC, Durham Melissa Ann Davis, MD Radiology University of North Carolina Hospitals, Chapel Hill Drew Edward Davis, MD Diagnostic Radiology Duke University Hospitals Durham Rose J. Eapen, MD Pediatric Otolaryngology Duke University Durham Krista Everett Evans, MD University of North Carolina Hospitals, Chapel Hill Nathan Holt Fedors, MD Musculoskeletal Radiology UNC School of Medicine Chapel Hill Francisco Andres Folgar, MD Ophthalmology Duke Eye Center, Durham Philip Austin Fong, MD Surgery - Surgical Critical Care University of North Carolina Hospitals, Chapel Hill Wen-Chi Foo, MD Duke University Hospitals Durham

Edward Lee Barnes, MD Internal Medicine University of North Carolina Hospitals, Chapel Hill

Eldesia LaBren Granger, MD Internal Medicine University of North Carolina Hospitals, Chapel Hill

Stephen Patrick Bergin, MD Hospitalist Duke University Hospitals Durham

Lauren Fritz Gratian, MD Internal Medicine Duke University Hospitals Durham

Joseph Brian Borawski, MD Emergency Medicine Duke University Hospitals Durham

Rasheeda Kamial Hall, MD Nephrology Duke University Hospitals Durham

Megan E. Brooks, MD Duke University Hospitals Durham

Robert Thomas Harris, MD Raleigh

Rebecca Casey Burke, MD Hospitalist Hospital Medicine Program, Duke University Hospital Durham Li-Fen Lien Chang, MD Radiation Oncology Federal Medical Center Butner George Rayburn Cheely, MD Hospitalist Hospital Medicine Programs Durham Rochelle C. Chijioke, MD Emergency Medicine University of North Carolina Hospitals, Chapel Hill

The Triangle Physician

Michael Emmanuel Herce, MD Internal Medicine UNC Infectious Diseases Clinic Chapel Hill Daniel Smith Higginson, MD 114 Little John Road Chapel Hill Jennifer Lynn Horan, MD Infectious Diseases, Internal Medicine Duke University Hospitals Durham Oksana Kantor, MD AA of NC, Raleigh

Christopher Raymond Kauffman, MD Radiology Duke University Hospitals Durham Georgia Lee Ketchum, MD Psychiatry University of North Carolina Hospitals, Chapel Hill Harrison Kibe, MD Anesthesiology University of North Carolina Hospitals, Chapel Hill Rebecca Adia Kuhns, MD Psychiatry University of North Carolina Hospitals, Chapel Hill Douglas Glen Larson, MD Diagnostic Radiology Duke University Hospitals Durham Timothy Dickey Mastro, MD Internal Medicine Durham Parthiv Suresh Mehta, MD Radiation Oncology Federal Medical Center Butner Ram Ron Miller, MD Geriatric Medicine GlaxoSmithKline Research Triangle Park Marica Liliana Moran, MD Pediatrics International Family Clinic Burlington Daisuke Francis Nonaka, MD Anesthesiology UNC Healthcare, Dept of Anesthesiology, Chapel Hill Lana Sue Oâ&#x20AC;&#x2122;Neal, MD Durham Stephen Philip Panyko, MD Psychiatry University of North Carolina Hospitals, Chapel Hill Christine Adele Piascik, MD Anesthesiology University of North Carolina Hospitals, Chapel Hill Jennifer Lynn Rochette, MD Pediatrics University of North Carolina Hospitals, Chapel Hill Pahresah L. Roomiany, MD University of North Carolina Hospitals, Chapel Hill Cody Candler Rowan, MD UNC Department of Anesthesiology, Chapel Hill Lance Atlas Roy, MD Anesthesiology - Pain Medicine Duke University Hospitals Durham Kenneth Joseph Sauve, MD Anesthesiology Duke University Hospitals Durham Jay William Schoenherr, MD Anesthesiology University of North Carolina Hospitals, Chapel Hill

Yogita Shah, MD Cary Angela Blotzer Smith, MD Urological Surgery University of North Carolina Hospitals, Chapel Hill Michael Louis Squire, MD Duke University Hospitals Durham Erin Marie Swanson, MD Obstetrics and Gynecology Raleigh OB/GYN Centre Raleigh Leonard Anthony Talbot, MD Anesthesiology Duke University Hospitals Durham Stephen Andrew Telloni, MD Internal Medicine University of North Carolina Hospitals, Chapel Hill Christopher M. Terry, MD Anesthesiology University of North Carolina Hospitals, Chapel Hill

Physician Assistants Todd Barton, PA

Vance Family Medicine Henderson

Christina Therese Baur, PA Clayton

Charles Wesley Bell, PA FastMed Urgent Care Garner

Jennifer Lynn Francis, PA Vance Family Medicine Henderson

Thomas C. Gaines, PA

Alamance Regional Medical Center, Burlington

Marisa Galavotti, PA Garner

Brian Thomas Garry, PA Franklin Regional Medical Center, Louisburg

Cheryl Theresa Huang, PA

Raleigh Neurosurgical Clinic Inc Raleigh

Hadley Ann Trotter, MD Emergency Medicine University of North Carolina Hospitals, Chapel Hill

Trudy Jo Kerlin, PA

Joseph David Tucker, MD Infectious Diseases, Internal Medicine UNC Infectious Diseases Division, Chapel Hill

Raleigh

Daniel W. Vande Lune, MD Orthopedic Surgery University Orthopaedics and Sports Medicine, Smithfield

Doctorâ&#x20AC;&#x2122;s Making Housecalls Durham

Nikta Khorram, PA Sarah K. Knoedler, PA Raleigh

Stacie E. Ledford, PA

Blue Ridge Family Physicians Raleigh

Young Ah Lee, PA Chapel Hill

Neeta Lakshmi Vora, MD Maternal and Fetal Medicine University of North Carolina School of Medicine Chapel Hill

Austin B. Lehmann, PA

Matthew W. Warren, MD Psychiatry Duke University Medical Center, Durham

Leigh Currin Matthews, PA

Joanne Wen, MD Ophthalmology Duke Eye Center, Durham Kelly Leigh West, MD Anatomic Pathology and Clinical Pathology Duke University Hospitals Durham

FastMed Urgent Care Garner

Jessica R Ling, PA Knightda Coats

Gina Elizabeth Mauldin, PA Duke Neurology of Raleigh Raleigh

Daniel McKearney, PA

Health Zone Medical Center Smithfield

Steve McKellar, PA Angier

Erica Michelle Rabe, PA

Samantha L. Wiegand, MD Obstetrics and Gynecology UNC Dept of Ob/Gyn Chapel Hill

FastMed Urgent Care Garner

Stephen W. Wilczynski, MD Hospitalist Durham

Callie Griffin Stegall, PA

Ostranda L. Williams, MD Pediatrics Duke University Hospitals Durham Seth Robert Yarboro, MD Orthopedic Surgery University of North Carolina Hospitals, Chapel Hill

Jennifer M. Sanchagrin, PA Raleigh Raleigh

Linda Marie Stiebris, PA Hillsborough

Valerie Denise Taylor, PA FirstHealth Raeford Center Raeford

Bradley F. Wolff, PA Apex

“More than a doctor. Like a friend.”

We know it by heart.

Trust. WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it. We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution. And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.

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

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

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

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

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

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

2605 Forest Hills Road South West Wilson, NC 27893

2400 Wayne Memorial Drive, Suite A Goldsboro, NC 27534

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

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

Phone: 252-243-7049

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

When it comes to your cardiovascular care – We know it by heart. To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).

55 Board-certified subspecialized radiologists | 18 Triangle Locations Evening and weekend hours for many services | MRI 7 days a week Physician decision support

With This Many Choices, The Answer Is Easy. Neuroradiology Sports Imaging Pediatric Imaging Oncologic Imaging Diagnostic Imaging Interventional Radiology Advanced Breast Imaging

Advanced Imaging With Providers And Patients In Mind. With 55 board-certified, subspecialty trained radiologists at 18 convenient Triangle locations, Wake Radiology gives you and your patients many choices in imaging. We provide advanced comprehensive radiology services coupled with subspecialty expertise to give your patients a high level of care. Soâ&#x20AC;&#x201D;the next time imaging is needed think of Wake Radiology. If you are not certain what imaging route to take, simply call our radiologists. They are available by phone for physician decision support and welcome the opportunity to assist you. When it comes to individualized provider and patient care, convenience, and subspecialized imaging the choice is easy.

Wake Radiology. Excellent decision. WAKE RADIOLOGY EXTENDED HOURS Screening Mammogram: Evenings & Saturdays CT, Ultrasound & Routine Radiology: Saturdays MRI: 7 days a week

WAKE RADIOLOGY EXPRESS SCHEDULING Centralized Scheduling: 919-232-4700 Chapel Hill Scheduling: 919-942-3196

wakerad.com