The Triangle Physician May 2011 by TTPLLC

m ay 2 0 11

Cary Orthopaedic & Sports Medicine

Thrives on a Tradition of Excellence 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

LASIK in the Military Image-guided Pain Relief

FDA-Approved for MRI Use The First and Only Pacing System to Break the Image Barrier Introducing the Revo MRITM Pacing System engineered with SureScan® Technology – the only pacing system to provide proven cardiac care that’s designed to be used safely with MRI.

www.medtronic.com

Brief Statement The Revo MRI™ SureScan® pacing system is MR Conditional and as such is designed to allow patients to undergo MRI under the specified conditions for use. Indications The Revo MRI SureScan Model RVDR01 IPG is indicated for use as a system consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI® SureScan 5086MRI leads. A complete system is required for use in the MRI environment. The Revo MRI SureScan Model RVDR01 IPG is indicated for the following: • Rate adaptive pacing in patients who may benefit from increased pacing rates concurrent with increases in activity • Accepted patient conditions warranting chronic cardiac pacing include: – Symptomatic paroxysmal or permanent second- or third-degree AV block – Symptomatic bilateral bundle branch block – Symptomatic paroxysmal or transient sinus node dysfunctions with or without associated AV conduction disorders – Bradycardia-tachycardia syndrome to prevent symptomatic bradycardia or some forms of symptomatic tachyarrhythmias The device is also indicated for dual chamber and atrial tracking modes in patients who may benefit from maintenance of AV synchrony. Dual chamber modes are specifically indicated for treatment of conduction disorders that require restoration of both rate and AV synchrony, which include: • Various degrees of AV block to maintain the atrial contribution to cardiac output • VVI intolerance (for example, pacemaker syndrome) in the presence of persistent sinus rhythm

Antitachycardia pacing (ATP) is indicated for termination of atrial tachyarrhythmias in bradycardia patients with one or more of the above pacing indications. 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 bradycardia patients with atrial septal lead placement and one or more of the above pacing indications. The device has been designed for the MRI environment when used with the specified MR Conditions of Use. Contraindications The device is contraindicated for: • Implantation with unipolar pacing leads • Concomitant implantation with another bradycardia device • Concomitant implantation with an implantable cardioverter defibrillator There are no known contraindications for the use of pacing as a therapeutic modality to control heart rate. The patient’s age and medical condition, however, may dictate the particular pacing system, mode of operation, and implantation procedure used by the physician. • Rate responsive modes may be contraindicated in those patients who cannot tolerate pacing rates above the programmed Lower Rate • Dual chamber sequential pacing is contraindicated in patients with chronic or persistent supraventricular tachycardias, including atrial fibrillation or flutter • Single chamber atrial pacing is contraindicated in patients with an AV conduction disturbance • ATP therapy is contraindicated in patients with an accessory antegrade pathway

www.medtronic.com World Headquarters Medtronic, Inc. 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA Tel: (763) 514-4000 Fax: (763) 514-4879

Medtronic USA, Inc. Toll-free: 1 (800) 328-2518 (24-hour technical support for physicians and medical professionals)

Patient Line: Tel: 1 (800) 551-5544 7:00 am to 6:00 pm CT M-F Fax: (763) 514-1855 24-hour information available on www.medtronic.com

Warnings and Precautions 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. Use of the device should not change the application of established anticoagulation protocols. Do not scan the following patients: • Patients who do not have a complete Revo MRI SureScan pacing system, consisting of a SureScan device and two SureScan leads • Patients who have previously implanted devices, or broken or intermittent leads • Patients who have a lead impedance value of < 200 Ω or > 1,500 Ω • Patients with a Revo MRI SureScan pacing system implanted in sites other than the left and right pectoral region • Patients positioned such that the isocenter (center of MRI bore) is inferior to C1 vertebra and superior to the T12 vertebra See the device manuals before performing an MRI Scan for detailed information regarding the implant procedure, indications, MRI conditions of use, contraindications, warnings, precautions, and potential complications/ adverse events. For further information, call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.

The Revo MRI SureScan pacing system is MR Conditional designed to allow patients to undergo MRI under the specified conditions for use. A complete system, consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI® SureScan leads is required for use in the MRI environment.

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Contents

COVER STORY

Cary Orthopaedic & Sports Medicine Thrives on a Tradition of Excellence

M ay 2 011

Vol. 2, Issue 5

FEATURES

Ophthalmology

LASIK Advances Benefit the Military Dr. Dean Dornic explains how the military has embraced advances in laser-assisted in situ keratomileus.

DEPARTMENTS 11 Orthopedics Radiology

Raleigh Radiology’s Musculoskeletal Team Offers Image-Guided Pain Management Dr. Jeffrey Browne gives an overview of the pain management uses and methods of image-guided injections.

Total Ankle Replacement Is Revolutionizing Care of Ankle Arthritis

12 Your Financial Rx Reduce Your Investment Pain Threshold

14 Sleep Medicine Sleep Apnea Requires Specialized Attention

16 Orthopedics Double Bundle Technique Improves Anterior Cruciate Ligament Outcomes

18 Cardiology Atrial Fibrillation: A Perspective on Treatment Evolution

22 Women’s Health New Findings in Losing Weight

24 WakeMed News County’s fifth hospital, new Brier Creek Healthplex and more

26 GHS News Distinction for knee and hip replacement, and Hospital of Choice Award

27 Durham Regional News U.S. News Best Hospital ranking

27 News 2

Upcoming events, welcome, new offices and clinical trials The Triangle Physician

JOHNSTON HE ALTH

From the Editor

Spring into Health Itâ&#x20AC;&#x2122;s spring, a time to sweep out the cobwebs, which for many means self reflection about our health and lifestyle.

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

Outdoor activity ramps up and body mechanics become a focus. Watching our back and every part of our musculoskeletal being in times of injury are orthopedic specialists and physical therapists, such as those at Cary Orthopaedic Sports Medicine and Spine Specialists. This finely tuned team is standing by to provide early and proper diagnosis so patients can get back to the games of life faster, more fully and with less pain. Weight management increases in importance as the weather warms. Overweight and obesity comprise a national problem. Its toll on human life weighs heavy on the economy. And despite all the marvels of modern medicine, data suggests overweight and obesity are increasing. A beacon of hope is the Medi-Weightloss Clinic. Its regimen that includes ongoing counseling and medical supervision is possibly the surest,

Editor Heidi Ketler, APR

heidi@trianglephysician.com

Contributing Editors Ker Boyce, M.D., F.A.C.C., F.A.C.P. Jeffrey Browne, M.D Giridhar Chintalapudi, M.D. Dean Dornic, M.D. Mark Galland, M.D. Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G Selene G. Parekh, M.D., M.B.A. Paul Pittman, C.F.P.

healthiest approach to long-term weight management.

Photography Jim Shaw Photography jimshawphoto@earthlink.net

Also on the orthopedic front, Dr. Mark Galland reviews how a new double-bundle surgical

Creative Director Joseph Dally

technique improves anterior cruciate ligament outcomes. Dr. Selene Parekh focuses on the

jdally@newdallydesign.com

improvements in total ankle replacement in the treatment of ankle arthritis.

Advertising Sales Carolyn Walters carolyn@trianglephysician.com

Dr. Andrea Lukes enters the weight management discussion with an overview of the use

News and Columns Please send to info@trianglephysician.com

of phentermine to suppress appetite. In this issue we get several points of view on pain management. Certified financial planner Paul Pittman talks about avoiding the very real pain felt when investment returns are poor. Dr. Jeffrey Browne explains image-guided pain management. The Triangle Physician welcomes two new contributors. Dr. Dean Dornic writes about the benefits of laser-assisted in situ keratomileus (LASIK) surgery to the military. Dr. Giridhar Chintalapudi (aka Dr. Chin) reviews the diagnosis and treatment of sleep apnea. Spring also is a great time to evaluate your practice marketing strategies. If you havenâ&#x20AC;&#x2122;t done so already, incorporating The Triangle Physician into the mix makes a lot of sense. Consider that it is the only publication of its kind, dedicated to the Triangle medical profession. Our sincere gratitude for all you do. Happy spring!

Heidi Ketler Editor

The Triangle Physician

The Triangle Physician is published by New Dally Design 9611 Ravenscroft Ln NW, Concord, NC 28027 Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401 Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinion expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. However, The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.

On the Cover

Cary Orthopaedic & Sports Medicine Thrives on a Tradition of Excellence By Heidi Ketler

Known as a hotbed of athletic activity, the

All nine orthopedic surgeons are fellowship

The practice now encompasses Cary Ortho-

Greater Raleigh and Triangle region experi-

trained. In addition to general orthopedics

paedic Spine Specialists, offering a total ap-

ences its share of sports-related injuries. For

and sports medicine, the range of specializa-

proach to spine care. Garner Orthopaedic

29 years Cary Orthopaedic & Sports Medi-

tion includes arthroscopic and reconstruc-

Sports Medicine & Spine Specialists pro-

cine Specialists has been filling the need for

tive surgery, total joint replacement and

vides a similar offering to that community

high quality diagnosis and treatment of these

minimally invasive spine surgery.

and surrounding counties. All three ortho-

injuries and many other orthopaedic related conditions.

paedic locations have a dedicated PerforCary Orthopaedic Sports Medicine and

mance Physical Therapy facility on site.

Spine Specialists is distinguished by its tradiSince opening its doors in 1982, Cary Or-

tion of excellence that ensures every initial

Teamwork a Practice Hallmark

thopaedic has grown with the community

patient encounter begins with an orthopae-

“Excellence in Sports medicine and Ortho-

to offer a comprehensive range of surgical,

dic physician evaluation. “A hallmark of this

pedics requires that we’re all on the same

non-surgical and rehabilitative services. The

practice is continually striving to provide

page to meet patient goals as quickly and

practice is comprised of a team of orthopae-

early and proper diagnosis which can help

safely as possible,” says Douglas L. Golle-

dic sports medicine and spine-specialized

prevent prolonged difficulties and provide

hon, M.D., senior partner. “To ensure the

surgeons, physiatrists and physical thera-

the greatest value for the health care dollar

very best outcome ideally we involve the

pists at three separate locations.

spent,” says Michael Mazzella, Cary Ortho-

physician, parents, the athletic trainer and

paedic Chief Operating Officer.

coach as part of the team focused on return-

PHOTO BY BRYAN REGAN PHOTOGRAPHY

ing that athlete back to the desired level of activity. “

Sports Medicine Expertise Over the years, Cary Orthopaedic Sports Medicine and Spine Specialists services to patients has represented the Triangle’s wide world of sports, from the Carolina Hurricanes, Carolina RailHawks and Carolina Ballet to scholastic athletes, recreational weekend warriors and elite triathletes. “This is a very diverse athletic market, not just for professional sports,” says Susan McArdle, Cary Orthopaedic Business Manager. “We see everything from acute injuries to arthritis that may be manifested in the older recreational athlete.” Patients seek out Cary Orthopaedic Sports Medicine and Spine Specialists for the levDr. Andersen provides diagnosis and treatment of an injured wrist

The Triangle Physician

el of care that provides enhanced freedom

order to withstand the repetitive stresses of

of movement without pain for all types of

sports activities.

musculoskeletal problems. “Our patient’s goals can be as diverse as walking down

Most orthopaedists recommend a minimum

the driveway to get the newspaper to the

of six months of progressive physical ther-

highest level of training to qualify for a ca-

apy before returning to competitive sports.

reer in professional athletics,” says Doug-

ACL rehabilitation involves a progression of

las J. Martini, M.D. “Even if a patient is not

therapeutic and sport-specific activities. The

a high-level athlete or a recreational or

experienced physical therapist makes the

scholastic athlete, we treat them all with

best determination as to whether or not the

the same high level of expertise and ex-

patient is able to safely progress.

pectation.”

Approach to Arthritic Joints Knee ligament reconstructive surgery

Osteoarthritis is a common, progressive and

Injury to the anterior cruciate ligament, or

at the knee, hip and shoulder. The first line

ACL, is common among the high-level ath-

of treatment for osteoarthritis aims to relieve

letes and the recreationally active popula-

pain with nonsteroidal anti-inflammatory

tion. This ligament serves as the primary

drugs, along with physical therapy, applica-

tive overhead activities. “Those susceptible

restraint to forward and pivoting motion of

tions of a topical analgesic and injections of

to overuse-related problems are athletes

the shin bone. An ACL tear can be a debili-

a corticosteroid.

who engage in repetitive overhead arm

debilitating disease that occurs commonly

Dr. Carroll evaluates for a rotator cuff injury

movements, like throwing. Degenerative

tating sports injury. Viscosupplementation is commonly used

changes in the shoulder may contribute to

With the appropriate diagnosis and treat-

to treat chronic osteoarthritis of the knee if

the problem in active older adults,” says Ray-

ment approach, “the prognosis for recov-

conservative treatments fail. It involves the

mond M. Carroll, M.D.

ery is excellent,” says William K. Andersen,

injection of gel-like substances (hyaluro-

M.D. Surgical reconstruction of a torn ACL

nates) into the knee joint to supplement the

Most patients experience pain relief and im-

is usually recommended for patients who

viscous properties of synovial fluid. The pa-

proved shoulder function through non-sur-

are less than 25 years old, regardless of ac-

tient will receive three to five injections over

gical treatment, including anti-inflammatory

tivity level, because they tend to have prob-

the course of several weeks. Positive effects

medicine and strengthening exercises. Sur-

lems with instability and frequent episodes

can last several months.

gery may be considered if a rotator cuff tear is acute and painful, if it is in the dominant

of the knee giving way. Given the advances in ACL reconstruction and the accelerated

Shoulder Injuries and Treatment

arm of the active individual or if maximum

approach to rehabilitation, this surgical pro-

A rotator cuff injury may result from a trau-

overhead arm strength is required for work

cedure is often recommended to a wider

matic event or develop gradually with repeti-

or sports.

active patient population than in the past. Preoperatively, “it is important to regain motion in the knee as soon as possible after injury to prevent stiffness and secondary problems,” says Dr. Andersen. “Resolution of swelling and stiffness prior to ACL reconstruction surgery improves post-operative joint function.” A torn ACL must be entirely removed and a new one reconstructed. The new ligament is positioned within the knee with screws or other fixation devices. The reconstructed ligament then has to heal in this position in Dr. Armour performs specific orthopaedic maneuvers to assess the extent of a knee injury

MAY 2011

Proactive Approach to Recovery Cary Orthopaedic & Sports Medicine

Spine Specialists Center Offers

Specialists’ rehabilitation service, PER-

“Dedicated Care for the Spine”

FORMANCE Physical Therapy, provides highly trained and experienced physical therapists to guide patients through “prehabilitation” in the weeks leading up to surgery. Pain and loss of strength and function can spiral preoperatively and can prolong a successful post-operative outcome. The goal of physical therapy preoperatively is to regain the patient’s range of motion, reduce pain and swelling, and enhance basic strength, setting the stage for a quicker comeback. Therapy pre- or post-operatively allows for

Given the prevalence and variance of neck and back pain in our society, Cary Orthopaedic Spine Specialists has put together a dedicated medical team providing advanced non-surgical and surgical options to treat the sources of pain. Neck pain is typically caused by poor posture at work while seated in front of a computer or during recreational activities, according to Sameer Mathur, M.D. “Fortunately, associated problems are not serious in approximately 80 percent of cases and can be treated non-surgically through a tailored physical therapy program or spinal injections.” When symptoms don’t improve after two or three months of conservative treatment, surgery may be a solution.

accelerated recovery. “So, they’re a step ahead of the game,” says Marc Capannola, Clinical Director of PERFORMANCE, adding, “Patients also get a mental lift knowing they will be able to be active sooner.” PERFORMANCE Physical Therapy also provides an important therapeutic tool called the SwimEx. “This aquatic therapy approach to rehabilitation allows for quicker initiation of the rehabilitation program for a patient who is not ready to do an activity on a hard surface but may be able to do it in the water,” says Mr. Capannola.

Physician Referrals Cary Orthopaedic accepts referrals from all physicians, regardless of specialty or hospital affiliation. For more information, visit the practice at www.caryortho.com or call (919) 467-4992.

Sports Medicine Specialists: Douglas L. Gollehon, M.D. Brian T. Szura, M.D. Douglas J. Martini, M.D. William K. Andersen, M.D. Derek L. Reinke, M.D. Mark A. Curzan, M.D. Raymond M. Carroll, MD. Edouard F. Armour, M.D.

The Triangle Physician

Traditional surgical treatment for a degenerative or herniated disk, one of the most common problems, is cervical diskectomy and fusion. In select patients, a new surgical procedure can be performed without fusion. Similar to total knee and hip replacement, the degenerated cervical disk can be replaced with an artificial implant that replicates the function of the diskjoint complex. This allows the neck to maintain motion and prevents adjacent-level arthritis.

ment includes bed rest, pain control and physical therapy. If that approach is unsuccessful kyphoplasty is a minimally invasive treatment option. Through two small incisions at the level of the fracture, cement is introduced into the vertebral body to reinforce it. This is done under local anesthesia, and patients experience immediate pain relief in the recovery room. Most often surgery is not necessary. If surgery is determined to be the best option, Cary Orthopaedic Spine Specialists will first consider minimally invasive alternatives that produce equal or better results than traditional surgery. Cary Orthopaedic Spine Specialists’ physiatrists are experienced in the use of fluoroscopic-guided epidural joint injections to treat chronic back pain. The treatment applies a numbing agent and anti-inflammatory on or near the inflamed nerve. Additional procedures available in this comprehensive spine center are nerve conduction and EMG (electromyogram) studies. Acupuncture also is offered for pain relief or resolution and may serve as a reasonable alternative to longterm narcotic analgesics.

Approximately two-thirds of adults suffer from low back pain at some time in their lives. Common causes include myofascial dysfunction, degeneration of the disc or facet joints, spondylolisthesis, spinal stenosis and compression fractures.

Spine-Focused Physical Therapy The physical therapists at the Spine Center are completely focused on the spine and specially trained in manual therapy techniques. Patients also learn proper lifting and moving techniques, and are guided on maintaining proper body mechanics.

Spinal stenosis occurs when there is narrowing of the spine, resulting in compression of the spinal nerves. The traditional surgical approach involves wide lumbar decompression and possible fusion. Patients are in the hospital for several days and may suffer from chronic back pain.

Physician Referrals Cary Orthopaedic Spine Specialists accepts direct referrals for neck and back problems requiring evaluation, management, surgical treatment, physical therapy and/or interventional spinal injections.

The minimally invasive X-STOP procedure revolutionized the treatment for spinal stenosis. It is placed between the spinous processes to prevent extension of the spine. The outpatient procedure is performed under local anesthesia. Recovery and return to normal activity is much quicker.

Spine Specialists

Compression fracture of the vertebral body is common in older adults. Conservative treat-

Orthopaedic Spine Surgeon Sameer Mathur M.D., Physiatry Team: Scott S. Sanitate, M.D. Gary L. Smoot, M.D. Chris Lin, M.D. Nicole P. Bullock, M.D.

Nutrition Article

Help End

Childhood Obesity Within a Generation By National Dairy Council

America’s children are fatter, weaker and more sedentary than ever before. In fact: • 33 percent of American children and adolescents are overweight • 17 percent of children ages 2 to 19 are obese • Only 14 percent of teens consume three servings of milk per day • Only 2 percent of school age children consume the recommended servings from all the major food groups

What’s contributing to this onslaught of childhood obesity? First, distorted portion sizes mean that our children are overeating foods and beverages high in calories, fat and sodium, but low in key nutrients. In addition, today’s working families eat more meals away from home. Did you know that the average fast food meal contains more saturated fat than the American Heart Association recommends we consume in two days? Finally, children ages 8 to 13 spend nearly six hours in front of TV and computer screens each day instead of being physically active. These three primary factors have caused the percentage of overweight children and adolescents to triple in the past 40 years.

and development,” said Dr. Cathy Wood, pediatrician, Montgomery, Ala. The new 2010 Dietary Guidelines notes it is especially important to establish the habit of drinking milk in young children, as those who consume milk at an early age are more likely to do so as adults. The Dietary Guidelines encourages all Americans to consume more low-fat dairy foods for better bone health and recommends 2 cups for children 2 to 3 years, 2.5 cups for children 4 to 8 years, and 3 cups for those 9 years and older. Next, take a short assessment of the number of meals eaten away from home. Most restaurant portions are oversized for children and adults alike. Research shows that when larger portions are served, both adults and children eat more, despite fullness, and load up on extra calories. Physicians should encourage parents to prepare and eat more nutrient-rich meals at home. Tammy Beasley, registered dietitian and author of Rev It Up Fitness, said kids tend to eat more fruits, vegetables and low-fat dairy foods at meals shared with their parents. “Family meals

America’s children are overweight, but what’s even more alarming is that they are undernourished in calcium, vitamin D, potassium and fiber, key vitamins and minerals that they need to grow into healthy adults. Feeling helpless? Don’t. Ending the childhood obesity and nutrition crisis within a generation is possible, and with these three counseling tips, physicians and other health professionals can help move the needle.

have long-lasting health and social benefits,” she said. “Children learn by modeling themselves after their parents, including food behaviors. Eating together lets parents show their children by example how to choose nutrient-rich foods, know when they are full and try new foods.” Lastly, physicians should encourage families to put muscles in motion for at least 60 minutes daily and engage children in more play time and less screen time. Many schools have eliminated physical education, recess and exercise to increase time spent in class, but programs are being introduced to help combat the lack of physical activity in schools. One school-based program that is gaining momentum nationwide is Fuel Up to Play 60, a nutrition and physical fitness initiative created by the National Dairy Council and the National Football League and supported by the U.S. Department of Agriculture, along with 13 national health organizations including the American Academy of Pediatrics. Now in more than 12,000 schools across the Southeast, Fuel Up to Play 60 empowers youths in grades four through 10 to take action and motivate their peers to improve nutrition and physical activity in school and at home. “Fuel Up to Play 60 is making a difference with our students,” said Manny Barocco, Director of Athletics, Health and Physical Education, Jefferson Parish, La. “It mixes competition, fun and nutrition to help students win the biggest prize of all – a healthy future.”

First, review the beverage basics with families. The American Academy of Pediatrics recommends low-fat or fat-free white or flavored milk, water and 4 to 6 ounces of 100 percent fruit juice daily for children ages 1 to 6. “When sodas, sweet tea or sports drinks replace milk in the diet, it’s hard for children to get the calcium and vitamin D they need for bone growth

Childhood obesity is a problem as serious as it is solvable, so talk to your patients and their parents to help bring the statistics down. Together, physicians, dietitians, parents, teachers and communities can end this alarming epidemic. It’s serious. It’s solvable. It’s time.

MAY 2011

Opthalmology

LASIK

Advances Benefit Military’s Effectiveness By Dean Dornic, M.D.

The United States armed forces have embraced LASIK as a way to make troops “combat ready.” During the first three months of the Iraq

now allows LASIK in all aviators, including

Acceptance of the new and improved

war in 2003, the military airlifted 60 service

those in high-performance aircraft.

LASIK eye surgery by the Department of

members out of the region because of

Defense has helped make our troops better

severe corneal ulcers caused by contact

Although the most common types of laser

lens wear. The military now forbids contact

eye surgery can cost between $2,500 and

lenses because of the risks associated

$5,000 for both eyes at a private doctor,

with dusty and dirty conditions. And

active military personnel can now receive

while contact lens wear can be dangerous

LASIK free at one of 25 Warfighter Refractive

in combat situations, eyeglasses can be

Eye Surgery Program centers.

and safer.

impractical. Even if the glasses don’t break, they often can hinder soldiers on missions.

Since its introduction to the Armed Forces

The spectacles can fog up, fall off or make

in 2000, more than 300,000 refractive

putting on a gas mask a cumbersome and

surgery procedures have been performed

time-consuming task when seconds matter.

at military hospitals, and more than 45 studies have been conducted to determine

Many people want to get laser eye surgery

the safety and efficacy of laser vision

so they can be free of the hassles of glasses

correction among military personnel.

or contacts. But many service members deploying to Iraq and Afghanistan are

The Navy is currently undertaking a study

rushing to get it done for much different

on Naval aviators. To date, more than

reasons. They are getting the surgery

200 aviators have been enrolled in the

because it could save their life.

study. The results of the study have been outstanding. Aviators were able to return to

Over the years, vision correction technology

flight status within four weeks after LASIK.

has evolved such that LASIK (laser-assisted

Patient satisfaction has been excellent.

in situ keratomileus) has proven to be a

One hundred percent were able to achieve

safe and effective procedure. This has led

20/20 levels of vision. There were no

to a growing acceptance of LASIK in the

complaints of significant glare, halos, haze

military.

or sharpness of vision. Ninety-eight percent felt that LASIK helped their effectiveness

The United States armed forces have

as a naval aviator and 98 percent indicated

embraced LASIK as a way to make troops

they would definitely recommend LASIK to

“combat ready.” Laser vision correction

their fellow aviators.

has been allowed for all aspects of military service, including aviation, special

Innovations,

operations and support personnel. It also is

wavefront-guided technology, have made

approved for NASA astronauts. The Air Force

the LASIK procedure better and safer.

The Triangle Physician

such

blade-free

and

Dr. Dean Dornic is founder and medical director of the Laser Eye Center of Carolina. A board-certified, fellowship-trained vision correction specialist, he has more than 15 years of surgical experience and has performed thousands of successful LASIK procedures. He was selected as one of “America’s Top Ophthalmologists” by Consumer’s Research Council of America and was named a LASIK Gold surgeon – an honor bestowed upon the top 50 LASIK surgeons nationwide by Sightpath Medical. Dr. Dornic has lectured at international meetings and trained other surgeons on LASIK. For more information, visit www.visionauthorities.com.

Orthopedics

Total Ankle Replacement Is Revolutionizing Care of Ankle Arthritis

By Selene G. Parekh, M.D., M.B.A.

The third-generation implants require smaller bone cuts, are more anatomical and better able to restore natural ankle motion. Ankle arthritis is a chronic condition that

of motion. The third-generation implants

causes substantial pain, disability and loss in

require smaller bone cuts, are more

quality of life. In fact, a recent study published

anatomical and better able to restore

in 2008 demonstrated end-stage ankle arthritis

natural ankle motion.

to be as debilitating as hip arthritis. The ideal candidate for a TAR suffers from Until recently, conservative options, such as

post-traumatic ankle arthritis or rheumatoid

injections, bracing and anti-inflammatories,

arthritis, is less than 250 pounds and is 50

have been used to delay surgery. When

years of age or older with little or no major

surgery was needed, the best option was

ankle deformity. However, this is changing

a surgical ankle fusion. This would relieve

as orthopedic foot and ankle surgeons gain

pain, but unfortunately, leave patients

more experience with these implants and

with a loss of motion in the ankle, a limp,

techniques. Depending on the specifics of

and make the knee and subtalar joints

a patient, TAR surgery is being performed at

susceptible to arthritic changes. These

an earlier age, with greater deformities and

issues have made clinicians, orthopedic

with a larger body mass index.

and physical exam, followed by weightbearing radiographs. At times, a computed tomography scan may be needed to provide more anatomical details. Based on these findings, treatment options are reviewed with the patient. If a patient is a candidate for a TAR, a medical clearance and dental

surgeons, researchers and ankle implant companies seek other solutions.

Dr. Selene G. Parekh is an associate professor of orthopedic surgery at the North Carolina Orthopaedic Clinic and Duke University, Department of Orthopaedic Surgery. His research and clinical interests include total ankle replacements, foot and ankle injuries of athletes, minimally invasive foot and ankle trauma surgery, tendon injuries of the foot and ankle, and the adoption and development of novel technologies in foot and ankle surgery. Dr. Parekh has been an active speaker at regional, national and international meetings, helping to teach other orthopedic surgeons about novel techniques for the care of foot and ankle patients.

The evaluation of a patient with ankle arthritis begins with a thorough history

Total ankle replacement (TAR) has been

evaluation to eliminate a possible source of infection are requested. The surgery for TAR requires an overnight

available in the United States since the

stay. The patient is made non-weight bearing

1970s. The earlier generations of ankle

for four to six weeks. Thereafter, intense

replacements were plagued with failures.

physical therapy is required to gait train and

However, the most recent, third-generation

strengthen the ankle. Most patients note a

implants have overcome many of the

tremendous improvement in their quality of

shortcomings of these earlier implants.

life, being able to perform activities, such as walking, yoga, golf and swimming, which

This has renewed the interest in TAR.

they may have lost for years.

Currently in the United States, there are three TAR systems available: the STAR, the

Total ankle replacements are revolutionizing

Salto and the Inbone. These implants have

the care of ankle arthritis. Pain relief,

been available in Europe for years, with

preservation of adjacent joints, restoration

promising medium- and long-term results.

of ankle motion and a more normal gait

In the U.S., the Inbone was approved in

are some of the benefits of third-generation

2005, the Salto in 2006 and the STAR in 2009.

TAR procedures. Patients should be made aware of this treatment option, as it holds the

The goals of TAR surgeries are to reduce

promise of transforming their quality of life.

pain, while preserving a natural range

MAY 2011

Your Financial RX

Reduce Your Investment

Pain Pain Threshold Threshold By Paul Pittman, C.F.P.

Did you know 94 percent of all active money managers under-perform their respective indexes? Are you in the 94 herd or the elite 6?

The same way opening your investment statements might be doing to you right now.

Is the decimal point causing pain? Are you experiencing any pain right now? On a scale of 1 to 10, what is your current

“Are you having any pain today? On a scale

so small I was going to be able to pass it on

of 1 to 10, what is your current pain level?”

my own. Sure enough, 12 hours later, I heard the unmistakable “clink” in my urine screen.

level? What I have witnessed in 24 years in this business is that something as small as a

The nurse asked me these questions during my last few doctor visits. Thank goodness, I

If this wasn’t a 10, then I can only hope

decimal point can raise an investor’s pain

have not had any pain for quite awhile, but

that a 10 involves blacking out. I had been

level immediately to a 10. Usually the source

it makes me wonder: What is a level 1? What

on painkillers that could have stopped that

of pain is not the decimal point, but the

is a level 10?

charging rhino in his tracks, and the stone

location of that decimal point.

wasn’t much bigger than a decimal point on I have had a physician tell me that I was going

this page.

“Pressure” must be the buzzword for “this is

How could something so small bring a

a 5 on the pain scale.” (By the way, using the

rough and tough six-foot man to the ground?

word “pressure” instead of “pain” doesn’t minimize the experience.) Anyway, back to my question on what each level means. I have experienced what I can only imagine was a 10. I had a kidney stone rear it’s ugly head during my daughter’s dance recital. It was my first, and I was sure that a rhino had rammed his horn into my back. I went from a 0 to a 10 in about 30 minutes. My wife took me to the emergency room, and thank goodness it was closer than the gun shop. As I writhed on the floor of the ER, the triage nurse said it was probably a kidney stone. I was certain that it was the size of a Buick. But I was one of the lucky ones; mine was

The Triangle Physician

Your broker might be telling you that this is “pressure.” Now we all understand this term

to feel some “pressure” during a procedure.

much better.

Paul J. Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 459-4171 and paul.pittman@pcgnc.com.

How does the movement of the decimal

This is not to say that owning these posi-

pain and accept what is shoveled at you.

tions is a bad thing, but owning them several

Take the time, break the chain, find out

times is. It raises your risk level many times

what is right for you and your family! It is

over. True allocation is broad, covers many

too important to keep on doing what you

asset classes, styles and countries, but most

have always done and expect a different

importantly, it is designed specifically for

outcome.

you. Your investment profile, risk tolerance and goals are as individual as your

Did you know 94 percent of all active money

fingerprint.

managers under-perform their respective indexes? Are you in the 94 herd or the elite 6?

Here again, I strongly advise you to find a qualified person to help you develop your

Until next month, good health and

personal allocation. Do not live with your

happiness.

point affect your stress level, your emotions, your retirement, your child’s education? All of these items should be fully taken into account when you develop your Investment Policy Statement in the very beginning. Do you have clear and concise steps to lower the pain level, or are you just trying to live with the pain? Pain in the investment world not only brings doubt and fear into play, but can also seriously derail a sound financial plan. What you do not want is for this pain to create a knee-jerk reaction. This is when pain breeds panic, and panic develops into bad decision-making. Pain does crazy things to emotions. If you are properly allocated, then secular bear markets shouldn’t shoot your pain level to a 10 and create bad decisions. Look back over one of my previous articles on proper allocation to better understand this concept. (If you cannot locate it, I am happy to e-mail it to you.)

Is overlap killing your allocation? I’ll wager that right now you have a large degree of “overlapping” in your portfolio. Overlapping is a killer of proper allocation. This is where you own certain positions more than once and probably many times in a standard, brokerage-firm allocation. You may very well own Cisco Systems or Coca-Cola or General Electric, three or four or five times in your portfolio! Womens Wellness half vertical.indd 1

12/21/2009 4:29:23 PM

MAY 2011

Sleep Medicine Category

Sleep Apnea Requires Specialized Attention By Giridhar Chintalapudi, M.D.

Doctors usually can’t detect the condition during routine office visits. Also, there are no blood tests for the condition. Most people who have sleep apnea don’t know they have it because it only occurs during sleep.

One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses. You’re asleep when the snoring or gasping happens. You likely won’t know that you’re having problems breathing or be able

About 70 million Americans suffer from

oxygen causes the brain to send a signal for

to judge how severe the problem is. Your

a sleep problem and nearly 60 percent of

you to wake up, so you open up the airway

family members or bed partner often will

them have a long-term disorder. Even though

in your throat and start breathing again. If

notice these problems before you do.

sleep problems are very common, they are

you have sleep apnea, this cycle may repeat

very often undiagnosed and untreated. One

as often as 50 or more times an hour.

of the most common sleep problems is

Other signs and symptoms of sleep apnea may include: morning headaches; memory

sleep apnea. It is estimated that 4 percent of

The frequent drops in oxygen level and

or learning problems and not being able to

middle-aged men and 2 percent of middle-

reduced sleep quality trigger the release of

concentrate; feeling irritable, depressed, or

aged women suffer from sleep apnea.

stress hormones. These compounds raise

having mood swings or personality changes;

heart rate and increase your risk of high blood

urination at night; and a dry throat when you

In sleep apnea, you have one or more pauses

pressure, heart attack, stroke and arrhythmias

wake up.

in breathing while you sleep. You often move

(irregular heartbeats). The hormones also

out of deep sleep and into light sleep when

raise the risk of, or worsen, heart failure

your breathing pauses or becomes shallow.

Another common sign is fighting sleepiness during the day, at work or while driving.

This results in poor sleep quality that makes you

Untreated sleep apnea also can lead to

You may find yourself rapidly falling asleep

tired during the day. Sleep apnea is one of the

changes in how your body uses energy.

during the quiet moments of the day when

leading causes of excessive daytime sleepiness.

These changes increase your risk of obesity

you’re not active.

and diabetes. Doctors usually can’t detect the condition during routine office visits. Also, there are no blood tests for the condition. Most people who have sleep apnea don’t know they have it because it only occurs during sleep. A family member and/or bed partner may first notice the signs of sleep apnea.

Sleep Apnea Can Contribute to Serious Medical Conditions During normal sleep, throat muscles relax. When this happens, if there is too little room inside your throat or too much tissue pressing on the outside of your throat, your airway can become blocked. This blockage stops the movement of air, and the amount of oxygen in your blood drops. The drop in

The Triangle Physician

Dr. Giridhar Chintalapudi (“Dr. Chin”) earned his medical degree from Kurnool Medical College, India. Before moving to the United States, he worked in United Kingdom for five years, with special interest in neuropsychiatry. He completed his internship and residency at State University of New York, Stony Brook. He is board certified in general neurology, vascular neurology and sleep medicine. He also is a board member of North Carolina Academy of Sleep Medicine. In addition to being active in private practice, he also is involved in teaching both neurology and sleep medicine. Dr. Chin can be reached at 919-708-5008.

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If a patient has problems breathing during sleep, even if he doesn’t have daytime sleepiness, he should talk with his doctor. Janet Clayton, CCIM 919.420.1581 janet.clayton@tlgcre.com

Treatment Can Restore Regular Breathing Doctors diagnose sleep apnea based on

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medical and family histories, a physical exam and results from sleep studies. Usually, your primary care doctor evaluates your symptoms first. He or she then decides whether you need to see a sleep specialist for diagnosis and treatment. A sleep study is

Managing your patients’ health is your life’s work. Managing physicians’ wealth is mine.

the most accurate test for diagnosing sleep apnea. It records what happens with your breathing while you sleep. The goals of treating sleep apnea are to restore regular breathing during sleep and relieve symptoms, such as loud snoring and daytime sleepiness. Lifestyle changes, mouthpieces, breathing devices and surgery may be used. Medicines typically aren’t used to treat the condition.

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®

Treatment may improve other medical

President and Managing Director

problems linked to sleep apnea, such as

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

high blood pressure. Treatment also can reduce your risk of heart disease, stroke and diabetes. If a patient has sleep apnea, he should talk with his doctor or sleep specialist about the treatment options that will work best.

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MAY 2011

Orthopedics

Double-Bundle Technique

Improves Anterior Cruciate Ligament Outcomes By Mark Galland, M.D.

The double-bundle technique is much more technically demanding to perform, but there is little doubt that one day it will be “The Standard.” Treatment of a once devastating knee injury

and feelings of instability even after successful

has evolved! In the all-too-recent past, tearing

surgery and rehabilitation. Still, others are

one’s anterior cruciate ligament meant the

unable to return to their previous levels of

end of an active lifestyle and certainly the

activity, and once-promising athletic careers

end of many promising athletic careers.

are ended. Moreover, knees reconstructed

New advances in surgical technique and an

with the traditional single-bundle technique

enhanced understanding of the anatomy of

may be more prone to re-injury and often

the ligament have improved the prognosis for

develop arthritis many years later.

A dissection depicting the double-bundle nature of the native ACL (the medial femoral condyle has been removed). Reproduced from: Fu F. Femoral insertion site of the anterior cruciate ligament (letter to the editor; http://www.ejbjs.org.) Journal of Bone and Joint Surgery American, May 24, 2005.

accomplish part of the goal – which is to

athletes suffering this once-devastating injury.

stabilize the knee and preserve the joint from degenerative arthritis.

The anterior cruciate ligament (ACL) is a ligament located in the middle of the knee

The newest and most progressive surgical

that connects the femur to the tibia. It is

technique for ACL reconstruction is called

a critical ligament that stabilizes the knee

the anatomic double-bundle technique and

during sports and physical activity. The

is superior to the single-bundle technique

ACL is usually injured during a pivoting

in many ways.

or cutting motion and can occur with or without contact.

Early results suggest that the anatomic double-bundle technique decreases the

ACL injuries have become more common

likelihood and severity of the post-surgical

as participation in sports has increased.

problems associated with traditional single-

As a result, ACL reconstructive surgery is

bundle technique, while increasing overall

now one of the most common orthopedic procedures.

ACL Reconstruction Single Bundle technique. Reproduced from: Vangsness CT. ACL Reconstruction Orthopaedic Procedures, 2010.

New advances have greatly improved the surgical technique of ACL reconstruction. Traditionally

ACL

reconstruction

knee stability. In addition, the knee is more likely to regain normal range of motion as compared to knees treated non-operatively or with the traditional single-bundle technique.

The latest research may explain these uninspiring results. Through extensive

This success is accomplished in the double-

has

laboratory analysis, we have learned that

bundle technique by accurately replacing

focused on reconstruction of a single strand

the ACL is composed of two separate

and restoring the native ACL.

or “bundle” of fibers. The results have been

and

largely successful in restoring knee stability

Each functions independently and in

Currently only a select few surgeons are

and returning athletes to play.

concert. Knowing this, it is reasonable to

trained in and are performing this ground-

conclude that reconstruction of only one

breaking technique. It is much more

portion (and ignoring the other) will only

technically demanding to perform, but there

Unfortunately, many still experience some pain

The Triangle Physician

distinct

portions,

“bundles.”

Women’s Health Diabetes May

The Triangle Physician Orthopaedics Allergies 2011 Editorial Calendar

Dr. Mark Galland of Orthopaedic Specialists of North Carolina is a board-certified orthopedic surgeon, specializing in sports medicine and practicing in Wake Forest and North Raleigh. He serves as team physician and orthopedic consultant for the Carolina Mudcats, the AA affiliate of the Cincinnati Reds, as well as several area high schools and colleges. Dr. Galland is a recognized expert in knee injuries and doublebundle ACL reconstruction. He can be reached at (919) 562-9410 or by visiting www.orthonc. com or www.drmarkgalland.com.

June Vision Neurology July Imaging Technologies Interventional Radiology August Infectious Diseases Pediatrics

is little doubt that, one day, this doublebundle technique will be “The Standard.” We have entered a new era in sports medicine.

Athletes

suffering

once

Schematic shows double-bundle ACL reconstruction. Reproduced from: Casagranda BC, Maxwell NJ, Kavanagh EC, Towers JD, Shen W, Fu FH. Normal Appearance and Complications of Double-Bundle and Selective-Bundle Anterior Cruciate Ligament Reconstructions Using Optimal MRI Techniques. American Journal of Radiology. 2009; 192:1407-1415.

structures in the knee to a near normal state.

knee to its normal state. When suffering

You can resume your life of physical activity

a major knee injury such as an ACL tear,

and sport participation with the confidence

surgeons who perform the anatomic

that your knee is structurally sound.

double-bundle technique may restore the

•

September Sports Medicine Prostate Cancer

•

October Breast Cancer Neurosurgery

•

potentially devastating injury may now have a reconstructive surgery to truly restore the

•

November Urology Alzheimer’s

•

December Pain Management Sleep Disorder

Clo Dec

SANDHILLS SLEEP DISORDERS CENTER

Dr. H. Tellez, MD Board Certified Neuromuscular Medicine Board Certified Neurology

Dr. G. Chin, (Chintapudi) MD, DABSM Board Certified Sleep Medicine Board Certified Neurology

Our Priority Is Your Sleep! The Specialities • Sleep Apnea • Sleep Studies • Memory Disorder • Brain/Spine MRI • Gait Problem • EEG • Neuropathy, ie: CTS • NCV- EMG Laboratory

888-614-7420 295 Olmstead Blvd., Suite 12 Pinehurst, NC 28374 (910) 235-0595

• www.SNSleepSolutions.com 112 Dennis Drive Sanford, NC 27331 (919) 708-5008

609 Attain Street, Unit 101 Fuquay-Varina, NC 27526 (919) 552-8917

MAY 2011

Cardiology

Atrial Fibrillation

A Perspective on Treatment Evolution By Ker Boyce, M.D., F.A.C.C., F.A.C.P.

Today, new catheter ablation devices are in development. Other energy sources are being evaluated. Hybrid procedures are being developed and refined. A new class of agents targeting the IKur channels are in development. Atrial fibrillation is the most common rhythm

That has changed in the last two decades,

disorder resulting in hospitalization. With the

as we have seen a phenomenal growth in

increasing population and the aging of the

our understanding of its pathophysiology.

baby boomers, it is becoming more prevalent

Michel Haissaguerre’s group first reported

in every cardiologist’s practice.

the recording of pulmonary vein potentials in 1998. This quickly led to the concept that

Atrial fibrillation (AF) was probably first

paroxysmal AF is often triggered by ectopic

described by the Chinese emperor physician

atrial tachycardias that commonly arise

Huang Ti in his classic medical treatise about

from one or more of the pulmonary veins.

2000 BC. The first modern description of AF

Persistent/permanent AF is usually associated

is credited to William Harvey in 1628, with

with enlarged atria and myocardial fibrosis,

his observations of animal hearts. Willem

which supports multiple wavelets.

Einthoven published the first echocardiogram recording of AF in 1906, calling it “pulsus

New Treatment Frontier

inequalis et irregularis.”

This progress in understanding has led

Dr. Ker Boyce earned his bachelor of science in chemistry from the Georgia Institute of Technology at age 18. After graduating with his medical degree from Emory University School of Medicine, he completed an internal medical residency at Emory. He then went on active duty in the United States Navy, serving first as a naval flight surgeon and force medical officer in support of the U.S. Antarctic Research Program. He then completed his cardiology fellowship at Naval Medical Center San Diego and his electrophysiology fellowship at the University of California San Diego. Dr. Boyce then returned and joined the faculty of the Naval Medical Center San Diego, eventually becoming the division chief and fellowship program director. In 1999, Dr. Boyce transferred to the U.S. Naval Reserve and entered private practice. He started the electrophysiology program at FirstHealth Moore Regional Hospital. He continued to serve in the Navy, mentoring the electrophysiology program at Naval Hospital Portsmouth and serving as an advisor to the Naval Aerospace Medical Institute until his retirement from the Navy in 2006.

to new options for therapy. The treatment of AF still has three goals: prevention of

amiodarone, to name a few. Most recently

administering digitalis leaf to patients with

thromboembolism

anticoagulation,

dronedarone was released. Unfortunately, no

heart failure. He noted that those with an

ventricular rate control and rhythm control to

agent works well, and not all are appropriate

irregular pulse would improve and their pulse

restore a sinus mechanism.

for every patient due to coexisting conditions.

1914 reported the use of quinine for AF after

Numerous studies have been completed

The current frontier of AF management is

a Dutch sailor told him how his palpitations

showing the benefit of warfarin in AF.

nonpharmacologic treatment of AF to restore

improved while taking quinine for malaria.

The recent release of dabigatran, a direct

sinus rhythm. This was first done by James

Walter Frey later reported that quinine’s

thrombin inhibitor, now offers an alternative.

Cox with his cut-and-sew Maze operation in

stereoisomer, quinidine, was more effective.

Rate control is usually accomplished with

1987. It evolved into the Maze III procedure

verapamil, dilitiazem and/or betablockers.

by 1992. This surgery works well but is open

Atrial fibrillation was often categorized

A nonpharmacologic alternative is AV

chest/open heart. It is difficult to perform as

junction ablation and permanent pacemaker

a concomitant procedure to other cardiac

implantation.

surgery. For these reasons, it has not been

William

Withering

reported

1785

would become steady. Karel Wenckebach in

paroxysmal,

persistent

chronic

(now permanent) for clinical purposes.

widely adopted.

However, for most of the next century, our understanding and treatment of AF did not

Rhythm

change significantly.

relegated to medications. There are numerous

Electrophysiologists

agents such quinidine, flecainide, sotalol, and

percutaneous ablation techniques. There was

The Triangle Physician

control

has

historically

been later

developed

a rapid evolution from targeting potentials inside the pulmonary veins, to pulmonary vein isolation, to antral isolation. This has been aided by the development of 3-D mapping systems, importing of cardiac computed tomography or magnetic resonance studies, irrigated-tip radiofrequency catheters and robotics. Despite these advances, the overall success rate for patients with paroxysmal AF for a single ablation procedure is in the range of 6070 percent. It is less successful for the persistent AF patient with an enlarged left atrium. In the March 2011 issue of The Triangle Physician, there was an article on a new hybrid AF procedure. This work was pioneered by Dr. Andy Kiser at FirstHealth Moore Regional Hospital in Pinehurst. Dr. Kiser started with an open-chest approach to assess the epicardial ablation device and to develop a lesion set. He then developed a minimally invasive approach through the pericardium. In collaboration with electrophysiologists, a hybrid approach was subsequently developed. The surgeon begins the ablation procedure epicardially, and then the electrophysiologist completes the various lines and tests for pulmonary vein isolation endocardially. With Dr. Kiserâ&#x20AC;&#x2122;s return to his alma mater, this work will be continued at the University of North Carolina at Chapel Hill. So what does the future hold? New catheter

NEWSOURCE-JUN10:Heidi

8/5/10

12:57 PM

Page 1

ablation devices are in development. Some use balloons to deliver a circumferential ablation around each pulmonary vein ostium. Other energy sources are being evaluated. Hybrid procedures are being developed and refined. A new class of agents targeting the IKur channels, found

Do They Like What They See?

predominantly in atrial myocardium, are in

Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.

development. And what does this mean for patients? Each patient is different. Some are asymptomatic

Our services range from consultation, to design, to creation and implementation of strategic plans.

and only require anticoagulation. A few only need a little more rate control. Many are devastated with AF and require restoration of sinus rhythm. With so many treatments now available, it is imperative that the treating physician be aware of the risks and benefits of each, and then tailor therapy to each patient.

newsource & Associates

In the meantime, my kudos to all the researchers, basic science and clinical, who are continuing to explore new frontiers in

Call (540) 650-3686 or send inquiries to hketler@verizon.net.

atrial fibrillation.

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MAY 2011

INTRODUCING The Magazine for Healthcare Professionals. All health care professionals and health related businesses have a new outlet for a direct publication that targets up to 6000 physicians, PAs, NPs, medical centers and related health care professionals. The regional physician publication is coming to the Eastern Region of North Carolina! DF Marketing Consulting and Associates will be handling the advertisements for the publication in the following counties:

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DF MARKETING CONSULTING AND ASSOCIATES – 1-919-267-4296 If you’re looking for referrals from other Health Care Professionals, our publication will reach them. We directly mail our publication to up to 6000 Physicians, PAs, NPs, and Medical Groups in the Eastern Region of North Carolina! We are seeking EDITORIALS for our First Issue in July 2011! Ask us about our FREE INITIAL CONSULTATION! We offer ad development, graphic design assistance, individualized- personal photos, head shots, and a full service photo shoot for a nominal fee. Want to be a featured doctor or clinic with up to 8 pages of advertising space with a personalized brochure spread? We can do that also. For any assistance or questions you may have contact: David Frank at 919-924-3751 or email at David@EasternPhysician.com Kyle Blatchley at 910-992-1592 or email at Kyle@EasternPhysician.com

“YOUR HAPPINESS IS OUR PRIORITY!” 423 Cameron Woods Drive, Apex, North Carolina 27523

Radiology Article

Raleigh Radiology’s Musculoskeletal Team Offers Image Guided Pain Management By Jeffrey Browne, M.D.

When a local mail courier’s hip pain became

Common indications for CT or fluoroscopic-

Complications are infrequent, but patients

so debilitating that he could no longer perform

guided procedures include:

should be aware of signs of infection at the

his job, he discussed his options with his

• Extremity (upper, lower, ankle, foot) joint

injection site. An allergic reaction to steroid injection or iodinated contrast is rare and often

injection for pain or arthritis

physician. His arthritis would eventually require hip replacement, but he was not quite ready for

• Joint aspirations

mild. Since the corticosteroid can take five to

the operation. He was an ideal candidate for

• Shoulder brisement for adhesive capsulitis

seven days to reach maximum effectiveness,

fluoroscopic-guided hip joint injection, and

• Sacroiliac joint injections

his results were very gratifying. He was able to return to work within a week and his pain was

Ultrasound is a very effective

markedly improved.

modality when soft tissue or fluid is the region of interest.

Whether an athlete or everyday patient, the team

Procedures

that

of seven subspecialty-trained musculoskeletal

performed

radiologists at Raleigh Radiology has you

include aspiration of fluid for

covered for your interventional needs.

analysis, bursitis, treatment of

under

can

ultrasound

calcific tendinitis, drainage or When conservative management of your

decompression

patient’s joint or tendon pathology fails or if

cysts, Baker’s cysts, hematomas,

the cause of pain is uncertain, an image-guided

and abscesses. In many cases

injection of a short-acting anesthetic and long-

acting corticosteroid is very useful in managing

calcifications can be aspirated

patients.

from the tendon or bursa prior

calcific

ganglion

tendinitis,

the

to the injection of steroids, The injections can be used to:

a procedure referred to as

• Delay or eliminate need for surgery

shoulder barbotage.

Dr. Jeffrey Browne is a musculoskeletal radiologist at Raleigh Radiology and medical director of computed tomography for Rex Hospital. He graduated from the University of Connecticut School of Medicine and completed an internship at St. Raphael’s Hospital in New Haven, Conn. He completed his residency and a fellowship in musculoskeletal radiology Duke University Medical Center. Dr. Brown is a member of the American College of Radiology, Radiological Society of North America and American Roetgen Ray Society. He joined Raleigh Radiology in 2008.

• Diagnose cause or site of pain • Control pain in non-operative patients

The duration of the pain relief varies

we ask patients to avoid excessive activity

• Offer pain relief quicker than conservative

depending on the severity and reversibility

that could potentially prohibit the steroid from

of the patients’ condition, as well as other

reaching its full potential effect.

measures

factors. In the case of arthritis, the steroid will Fluoroscopic-, ultrasound- and computed

reduce the inflammation; however, it will not

Our team of MSK radiologists offer these

tomography (CT)-guided injections increase

reverse the condition. If therapeutic effect is

injections at three convenient locations within

the precision of these procedures by confirming

achieved, a maximum of four injections per

Raleigh: Our Blue Ridge and Cedarhurst

correct needle placement. After administering

year can be performed. Patients are asked to

outpatient offices and at Rex Hospital. To

a local anesthetic, the needle is directed to the

assess changes in their pain shortly after their

schedule a joint injection, call our Blue Ridge

site of interest, using minimal or no radiation

injection and report the effectiveness to their

facility at 781-1437 or Cedarhurst at 877-5400.

exposure. If a joint is the target, a small amount

physician. Pain relief immediately following the

For more information, go to our website at

of contrast is injected during fluoroscopy to

procedure is diagnostic of a problem at the site

www.raleighrad.com.

confirm intra-articular position. A combination

of injection.

of a long-acting anesthetic and an intermediateto-long-acting corticosteroid are then injected.

Before arriving for the procedure, patients are

The anesthetic can provide immediate pain

requested to inform the staff if they are diabetic,

relief lasting four to six hours and also confirm

taking blood thinners or have had previous

the site of pain. The corticosteroid begins

reactions to iodinated contrast. Prior to the

to work approximately one to two days after

injection, a radiologist will question the patient

injection, reaching its maximum effectiveness

about his or her symptoms and correlate them

within five to seven days.

with any imaging findings.

References

Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 2007 10:7-111. Silbergleit R, Mehta BA, Sanders WP and Talati SJ. Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics 2001 21:927-39. Dussault RG, Kaplan PA, Anderson MW. Fluoroscopyguided sacroiliac joint injections. Radiology 2000 214:273-6.

MAY 2011

Women’s Health

Article Review:

New Findings in Losing Weight By Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G.

The alarming fact is that approximately

than the placebo group, which had a weight

percent of people taking fenfluramine,

two thirds of Americans are overweight or

loss of 1.4 kg, or 3.1 pounds.

or dexfenfluramine, had abnormal valve

obese. So when a study on the effects of a

findings.

combined drug (low-dose phentermine plus

At one year, this study showed that weight

topiramate) on excess weight and associated

loss of 10 percent or greater at one year was

The FDA did not ask manufacturers to remove

comorbidities was published in Lancet in

seen in 7 percent of the placebo group, in

phentermine from the market. Phentermine

April, health care providers took note.

37 percent of the low-dose group and in 48

works on the hypothalamus portion of

percent of the high-dose group. This was a

the brain to release norepinephrine (a

Although not yet approved by the Food and

statistically significant difference for both

neurotransmitter that signals a fight-or-

Drug Administration, the findings of the

doses, compared to placebo.

flight response, reducing hunger). The

CONQUER1 study showed significant weight

most common side effects are dry mouth,

loss. Upon FDA approval, the combined

Further,

issues

insomnia, dizziness, mild increase in blood

drug will be marketed as Qnexa.

associated with obesity improved in those

pressure (rarely more severe) and heart rate.

treated with the combined drug. Specifically,

Monitoring blood pressure in important.

the

cardiometabolic

In the CONQUER trial, two doses of

there were significant reductions in systolic

phentermine

plus

topiramate

were

blood pressure, diastolic blood pressure

The precise mechanism of action for

compared in overweight/obese subjects

(high-dose

group),

high-

topiramate is not clear, but theories suggest

as an adjunct to diet and lifestyle changes.

sensitivity

C-reactive

(hs-CRP),

energy expenditure increases with reduced

The term “overweight” refers to a body mass

fasting glucose and total cholesterol. For

caloric intake, reduced salivary enzyme

index (BMI) greater or equal to 25 but less

most of the risk factors, the improvement

activity, reduced leptin and corticosteroid

than 30. Obesity refers to a BMI of greater or

was more in the higher dose group.

concentrations, and potential reduction in

triglycerides, protein

equal to 30.

serum glucose and insulin concentrations. Of concern are the adverse events associated

Although not yet approved by the Food and Drug Administration, the findings of the CONQUER study showed significant weight loss.

with topiramate, including parasthesias, memory

impairment,

taste

distortion,

fatigue, insomnia, difficulty concentrating, and dizziness.

Local Treatment Using Phentermine Adults evaluated in the study had a BMI

Taking Note of Side Effects

More than 300 patients have been treated

between 27-45 kg/m2, and two or more

Phentermine was first approved by the

using the drug phentermine through a

comorbidities,

FDA as an appetite-suppressing drug back

limited program at Women’s Wellness Clinic.

dyslipidemia

in 1959. At one point it was combined

prediabetes,

including hypertension,

diabetes

or obstructive sleep apnea. Of the 2,487

with

subjects, 994 were assigned to placebo (979

dexfenfluramine) and called Fen-Phen.

medication

(fenfluramine,

The medication is used for three to six months to suppress appetite. When patients start this program, they are told of a remote

analyzed), 498 to 7.5 mg phentermine plus 46 mg topiramate (488 analyzed), and 995 to

Eventually, dangerous side effects surfaced

chance of pulmonary hypertension is

15.0 mg phentermine plus 92 mg topiramate

in Fen-Phen users, with 24 cases of heart

possible.

(981 analyzed).

valve disease, as well as cases of pulmonary hypertension. Some individuals died from

It is recommended by the FDA that

At the lower dose, the mean weight loss was

the effects of Fen-Phen. Following these

phentermine be used short-term (up to

8.1 kg, or 17.8 pounds. At the higher dose

reports, fenfluramine (or dexfenfluramine)

12 weeks), while incorporating healthy

the mean weight loss was 10.2 kg, or 22.4

was taken off of the market voluntarily.

dieting and exercise. In our experience and

pounds. These were both statistically higher

Afterward,

through discussions with peers, if weight

The Triangle Physician

studies

showed

that

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.

equal to 25) or obese (BMI greater or equal to 30), effective regimens for weight loss are

and www.mypyramid.com. • Exercise! – This is so important to do for

important to help individuals lose weight.

weight loss and weight control. • Be mindful of the food you are eating,

While effective medications are available, there is basic information providers should

both in terms of quality and quantity. • Do not multitask when you are eating, and

emphasize to their patients, including the following:

chew your foods well. • Give yourself a pantry and refrigerator/

• Healthy lifestyle changes in diet and

freezer makeover – Get rid of the foods

exercise should be emphasized.

that tempt you.

• In order to lose one pound in a week, you

• Do not eat late at night.

must have a deficit of 3,500 calories in that week (500 calories per day for 7 days).

As new developments in weight loss emerge,

• Do not consume less than 1,200 calories

Women’s Wellness Center staff weighs the

per day to avoid slowing down your

risks and benefits. Call (919) 251-9223 for

metabolism.

available appointments and support with

• Eat less and more often to boost metabolism. Try to consume five to six small meals during the day, beginning with

loss continues through 12 weeks, then

breakfast, within 45 minutes of walking.

continuation through 16 weeks is tolerated.

• Keep a food journal – potentially an online version that will keep a calorie count for

Weight-loss basics

you. For example: www.thedailyplate.

Given that two-thirds of the United States

com,

population is overweight (BMI greater or

sparkspeople.com, www.nutrihand.com

www.calorieking.com,

However much you value wildlife conservation in North Carolina,

www.

helping patients to make healthy lifestyle changes through weight loss.

References Gadde KM, Allison DB, Ryan DH, et al. Effects of lowdose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults CONQUER: A randomized, placebo-controlled, phase 3 study. Lancet 2011; DOI:10.1016/S0140-6736(11)60505-5. Available at http:// www.thelancet.com.

DEC NC

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MAY 2011

WakeMed News

WakeMed North to Become Wake County’s Fifth Hospital WakeMed Health & Hospitals will begin

Currently WakeMed North

expansion in fall 2011 of the existing

Healthplex offers a full-

WakeMed North Healthplex into Wake

service, 24/7 emergency

County’s fifth hospital – WakeMed North

department,

Hospital.

surgery center, imaging

ambulatory

and laboratory services With an anticipated opening date of

and a host of additional

October 2013, WakeMed North Hospital

clinical capabilities. The

will be a 61-bed acute care hospital, with

campus

a focus on inpatient women’s specialty

services, offering a full range of obstetric

medical office building.

and

gynecological

services,

also

features

85,000-square-foot

including

comprehensive preventive, diagnostic and

“Transitioning to a hospital is the next logical

second year of hospital operation. The cost

therapeutic care. The facility will continue to

step, as the infrastructure is already in place

of the project is estimated to be nearly $62

serve men and children through the existing

and the community has a critical mass of

million.

emergency department, outpatient surgery,

262,000 residents living within a seven-mile

imaging, lab and physician services already

radius of the facility,” said Dr. Atkinson.

WakeMed received approval to add 41

offered at the facility.

“While the hospital will initially open with a

licensed acute care beds to WakeMed

women’s focus, our plan is for it to continue

North Hospital in 2009. These beds were in

“Since opening in 2002, WakeMed North

to expand to meet the needs of women, men

addition to the 20 acute care beds already

Healthplex’

and children, alike.”

approved for relocation from WakeMed

consumer-driven

volumes

Raleigh Campus, making the total bed count

have consistently outpaced projections, demonstrating the great demand for health

Construction is expected to create 500

for WakeMed North Hospital 61. The inpatient

care services in this community,” said Dr.

construction jobs. Hospital officials also said

beds will be constructed in an approximate

Bill Atkinson, WakeMed president and chief

the current 150 employees will be expanded

90,000-square-foot addition to the existing

executive officer.

to about 442 full-time equivalent employees,

North Healthplex.

with an average salary of $48,760, by the

Construction Commences on Healthplex Construction has begun on WakeMed Brier

be available for emergency department pa-

tificate of Need was granted in September

Creek Healthplex located at the corner of

tients and outpatient visits.

2009 for $36 million. WakeMed’s total invest-

US-70 on T.W. Alexander Drive.

ment in the project is $14 million. The facility, which will be owned, de-

The facility will include the county’s third

veloped, and managed by Duke Realty,

WakeMed Brier Creek Healthplex will ini-

24/7 full-service, stand-alone emergency de-

will be 50,000 square feet, including a

tially employ 74 full-time employees and will

partment with 12 private treatment rooms. It

26,000-square-foot emergency department

serve northwest Raleigh and Wake County.

will be staffed by the same board-certified

and 24,000 square feet of medical office

It is located at 8001 T.W. Alexander Drive in

physicians that serve WakeMed’s five addi-

space.

Brier Creek, less than one mile from I-540

tional emergency departments.

and US-70. The complex sits on 12 acres, alConstruction is slated to be completed by

Laboratory and imaging services, including

November 2011 and the building will be op-

computed tomography and X-ray, also will

erational by January 2012. The project Cer-

The Triangle Physician

lowing room for future development. For more information, visit www.wakemed.org.

WakeMed News

CON to Add 101 Beds WakeMed

Health

Hospitals

today

Medical Office Space Available Physicians’ Office Pavilion at WakeMed North Healthplex

submitted two complementary Certificate of Need (CON) applications to add 101

Capture the High-Growth, Affluent North Raleigh Market!

beds in accordance with the bed-need allocation identified in North Carolina’s 2011 State Medical Facilities Plan. WakeMed is proposing to add 79 acute care beds to Raleigh Campus and 22 acute care beds to Cary Hospital. Both Raleigh Campus and Cary Hospital currently operate above the state’s CON performance

occupancy

threshold

71.4 percent for hospitals the size of Cary Hospital and 75.2 percent for hospitals the size of Raleigh Campus. By 2015, growth coupled with an aging population, will cause occupancy rates at or above 90 percent if no

Janet Clayton, CCIM 919.420.1581 janet.clayton@tlgcre.com

additional beds are opened at these facilities,

Independently Owned & Operated

Raleigh Campus and Cary Hospital to have

according to a press release. “WakeMed is the leading provider of inpatient health care services in Wake County – the second fastest-growing county in North Carolina. And, WakeMed’s high inpatient occupancy drove the allocation of 101 beds in North Carolina’s State Medical Facilities Plan,” said Stan Taylor, WakeMed vice president corporate planning. “Additionally, the other hospitals in Wake County currently have unutilized or under-utilized acute care beds and have not shown a good track record in providing the inpatient capacity that the community needs.” Wake County will have five hospitals, with the opening of WakeMed North Hospital in October 2013, and four stand-alone emergency departments. “Wake County does not need more hospitals. It needs to add more inpatient capacity in the county’s two busiest existing hospitals, leveraging existing infrastructure and support services already in place to add beds quickly, costeffectively and efficiently,” says Taylor.

MAY 2011

Granville Health System News

GHS Named Blue Distinction Center for Knee and Hip Replacement Centers for Knee and Hip Replacement must

• Multidisciplinary teams and clinical

present clinical-based evidence to establish

pathways to coordinate and streamline

that they meet the selection criteria.

care • Use of an internal registry or database

Granville Health System has been named

Examples of some of the criteria GHS met

a Blue Distinction Center for Knee and Hip

include:

• Clinical

• An established acute care inpatient

Replacement.

facility, Blue Distinction is a Blue Cross and Blue Shield Association (BCBSA) program that recognizes facilities that meet objective,

to track patient outcomes over time

including

intensive

care,

emergency care, and a full range of

outcomes

procedures

that

for meet

specific objective

thresholds, such as complication rates and length of stay.

patient support services • An

established

knee

hip

“When it comes to spine surgery, and hip

evidence-based thresholds for clinical

replacement

performing

and knee replacement, there is compelling

quality. These facilities have demonstrated

required annual volumes for certain

evidence that institutions with experience

procedures

that also adheres to their care protocols

experience in offering comprehensive

hip

deliver better outcomes,” said Don Bradley,

services, including total knee replacement

replacement surgery team, including

M.D., chief medical officer of Blue Cross

and total hip replacement.

surgeons with board certification,

and Blue Shield of North Carolina. “We’re

subspecialty fellowship training, and

providing that information to our members

case volumes that meet selection

to help them make informed choices about

criteria

where to receive care that’s proven to meet

inpatient

knee

and

hip

replacement

BCBSA collaborated with expert physicians and medical organizations to determine the

• An

program,

and

experienced

knee

and

selection criteria for all Blue Distinction

• Preoperative patient education

programs. Candidates for Blue Distinction

• Processes to support transitions of care

national quality standards.”

Granville Health System in Top 10 of Most Customer-Friendly Hospitals The American Alliance of Healthcare Pro-

mately 400 hospitals for consideration of

Granville County and the surrounding ar-

viders named Granville Health System one

this award. Approximately 100 hospitals

eas. As we move forward, Granville Health

of the top 10 hospitals in the country in its

are recognized annually. The application

System will continue to invest further in the

2011 Hospital of Choice Awards.

process requires a review of six principal

hospital, supporting our commitment to de-

areas of consideration including standards

liver new medical programs, technologies

The award recognizes America’s “most cus-

of conduct, performance management and

and expanded services to the community.”

tomer-friendly hospitals,” according to Ric

improvement, staff development and train-

Vincent Parr, president of American Alli-

ing, systems of communication, good citi-

Granville Health System ranked third after

ance of Healthcare Providers (AAHCP). It is

zenship, and educational and promotional

first-place University of Kansas Hospital and

“designed to find America’s most customer-

consumer material.

second-place UCLA Medical Center. The

friendly hospitals based either on an exten-

Top 10 winners will have an opportunity to

sive application process, or by a review of

“We are pleased to be chosen as one of the

compete for the Hospital of the Year Award,

a facility’s public communication and staff

top hospitals in the nation,” says L. Lee Is-

to be announced this month.

interaction with customers,” according to

ley, Granville Health System chief executive

an AAHCP press release.

officer. “This award recognizes the high lev-

Past Hospital of Choice Award recipients

el of quality care provided by our dedicated

include The Johns Hopkins Hospital, the

doctors, nurses and staff to the patients of

Mayo Clinic and the Cleveland Clinic.

Each year, AAHCP evaluates approxi-

The Triangle Physician

Durham Regional News

U.S. News Ranks Durham Regional Fourth in Metro Area Durham Regional Hospital has been ranked

Durham Regional Hospital press release.

fourth out of 18 hospitals in Raleigh-Durham in U.S. News & World Report’s first-ever “Best Hos-

Patients and their families will have a far better

pitals” metro area rankings.

chance of finding a U.S. News-ranked hospital in their health insurance network and might not

The newly expanded U.S. News & World Report

have to travel to get care at a high-performing

rankings of hospitals in the 52 most-populous

hospital, according to the Durham Regional re-

metropolitan areas show that in three specialties

lease.

Durham Regional offers Raleigh-Durham highquality care. In those specialties, which include

“Durham Regional is honored to be recognized

kidney disorders, orthopedics and urology, its

for our treatment of kidney disorders, orthope-

performance puts it above most other hospitals

dics and urology,” said Kerry Watson, Durham

that are not nationally ranked.

Regional Hospital president. “This recognition reflects the dedication of our team of physi-

The new rankings recognize 622 hospitals in

cians, employees and volunteers who care for

or near major cities with a record of high per-

our patients every day.”

formance in key medical specialties. There are nearly 5,000 hospitals nationwide.

To be ranked in its metro area, a hospital had to score in the top 25 percent among its peers in at

Duke University Medical Center and University

least one of 16 medical specialties.

of North Carolina Hospitals, respectively, ranked in the top three hospitals in the Raleigh-Durham

“All of these hospitals provide first-rate care for

metro area, according to the 2011 U.S. News Best

the majority of patients, even those with seri-

Hospitals metro ranking. Wake Medical Center

ous conditions or who need demanding proce-

ranked No. 3 in nine specialty areas, including

dures,” said Health Rankings Editor Avery Co-

kidney disorders, orthopedics and urology.

marow. “The new Best Hospitals metro rankings can tell you which hospitals are worth consider-

U.S. News created Best Hospitals more than

ing for most medical problems if you live in or

20 years ago to identify hospitals exceptionally

near a major metro area.”

skilled in handling the most difficult cases, such as brain tumors, typically considered inoper-

For the full list of metro area rankings visit

able, and delicate pancreatic procedures. Duke

www.usnews.com/hospitals.

and UNC also have achieved this U.S. News national ranking. The new metro area rankings are relevant to a

Upcoming Event National prosthetic expert to host clinic Ruben Preciado knows the power of a prosthetist. A below-knee amputee for three years, Preciado, 57, of Raleigh has forged a lifelong bond with nationally recognized prosthetist David R. Sickles, a certified prosthetist/orthotist and certified pedorthist with Peak Prosthetic Performance Clinic. Sickles and his team will share their expertise with Raleigh/Durham amputees and friends or family members, by providing free, no-risk, one-on-one prosthetic evaluations May 17-19, 8 a.m. to 8 p.m., behind the Duke Raleigh Hospital. Registration is required. Sickles has three decades of experience and service in the design, fit and manufacturing of prosthesis. He is the current chief operating officer of the Center for Orthotic and Prosthetic Care (COPC) of North Carolina and New York. He is director of the National Commission on Orthotic and Prosthetic Education (NCOPE) Accredited Residency Program at COPC of North Carolina and president-elect of the North Carolina Chapter of the American Academy of Orthotics and Prosthetics (AAOP). “The aim of Peak Prosthetic Performance Clinic is to provide anyone who has suffered a traumatic limb loss the chance to be heard, the chance to know what technology is available today and the ability to reach their peak prosthetic performance,” said Sickles, who is certified by the American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. (ABC). “From microprocessor-controlled knee units to vacuum-assisted suspension sockets, my team and I have coupled the latest technology with exceptional patient care for countless amputees on their path to independance.” To contact Sickles or to register for a complementary prosthetic evaluation, call (919) 821-5221 or (919) 684-2474. For more information on the Peak Prosthetic Performance Clinic, visit www.centeropcare.com.

much wider range of health care consumers. They are aimed primarily at consumers whose care may not demand the special expertise found only at a nationally ranked Best Hospital. The added centers boast a strong record of high performance for most conditions and procedures in one or more specialties, according to a

MAY 2011

News Welcome to the Area

Physicians Tiffany Linn Reed, DO Internal Medicine, Geriatrics Duke University Hospitals, Durham

Robert Thomas Abbott, MD Duke Health, Durham

Kristen Elizabeth Amann, MD Internal Medicine, Pediatrics University of North Carolina Hospitals Chapel Hill

Mark Robert Anderson, MD Urological Surgery Duke University Hospitals, Durham

Alison Dawn Bartel, MD

Robert Aaron Lambert, MD

Kanecia Obie Zimmerman, MD

ECU Dept of Family Medicine, Greenville

Internal Medicine, Pediatrics Duke University Hospitals, Durham

Marshall Andrew Mazepa, MD Internal Medicine University of North Carolina Hospitals Chapel Hill

Hannah Imwold Messer, MD Physical Medicine and Rehabilitation University of North Carolina Hospitals Chapel Hill

Tiffany Lynn Morton, MD University of North Carolina Hospital Chapel Hill

Todd Brandon Nelson, MD

AGAPE Clinic, Washington

Dermatology Pitt County Memorial Hospital, Greenville

Raymond Mark Bernal, MD

Dana Michelle Neutze, MD

Duke Health - Division of Urology, Durham

Elizabeth Jane Brant, MD UNC Kidney Center, Chapel Hill

Michelle Richardson Brownstein, MD General Surgery UNC Department of General Surgery Chapel Hill

Long Bao Cao, MD

Family Practice University of North Carolina Hospitals Chapel Hill

Erica Lynn O’Neill, MD Obstetrics and Gynecology University of North Carolina Hospitals Chapel Hill

Andrew Fletcher Parker, MD

ECU, Greenville

Emergency Medicine Duke University Hospitals, Durham

Devin Traer Caywood, MD

Jose Luis Piscoya, MD

Radiology Duke University Hospitals, Durham

Rebecca Jean Chancey, MD Pediatrics Duke University Hospitals, Durham

Matthew Alan Collins, MD Eastern Urological Associates, Greenville

Lauren Jamie Ehrlich, MD Diagnostic Radiology, Pediatric Radiology Duke University Hospitals, Durham

Amy Minchi Fang, MD

General Surgery Durham

Alison Schmidt Powell, MD Anesthesiology University of North Carolina Hospitals Chapel Hill

Shveta Shah Raju, MD Duke General Internal Medicine, Durham

Sarah Rodgers, MD Dermatology Duke University Hospitals, Durham

Duke Eye Center, Durham

David Hallmark Ryan, MD

Kasey Kincaid Fiorini, MD

Obstetrics and Gynecology University of North Carolina Hospitals Chapel Hill

Anesthesiology University of North Carolina Hospitals Chapel Hill

Justin Richard Scruggs, MD

UNC - Division of Cardiology, Chapel Hill

Physical Medicine and Rehabilitation University of North Carolina Hospitals Chapel Hill

Thomas Andrew Gebhard, MD

Frank William Shields, MD

Jillian Roxanna Foley, MD

Diagnostic Radiology Duke University Hospitals, Durham

Katherine Lynn Harlow, MD Emergency Medicine University of North Carolina Hospitals Chapel Hill

Johann Hsin-heng Hsu, MD UNC Chapel Hill, Chapel Hill

David Paul Johnson, MD

Diagnostic Radiology University of North Carolina Hospitals Chapel Hill

David Kristofer Sutton, MD Ophthalmology University of North Carolina Hospitals Chapel Hill

John Edward Thordsen, MD Retina Associates PC, Raleigh

Pediatrics Duke University Hospitals, Durham

Charles John Viviano, MD

Paul McPherson Johnson, MD

Edward Scott Vokoun, MD

Internal Medicine University of North Carolina Hospitals Chapel Hill

Shivanand P Lad, MD Duke University Medical Center, Durham

Duke Urology of Raleigh, Raleigh

Naval Hospital Camp LeJeun

De Benjamin Winter, MD

The Triangle Physician

Jessica Eleanor Elder, PA Goldsboro

William H Etheridge, PA Roanoke Chowan Hospital Emergency Dept Ahoskie

Erin Christina Jones, PA Dayspring Family Medicine Associates, Eden

Kristin Dermody Maggi, PA Sunset Beach

Charles Ryan Woodard, MD

Pain Medicine for Shingles

Wake Research Associates Wayne Harper, MD Pain after shingles? Has your shingles rash healed, yet you are still suffering from symptoms including burning, stabbing pain, sharpness or sensitivity? If so, you may have a condition called post-herpetic neuralgia, also known as PHN. We are conducting a clinical research study for people who have experienced these symptoms for at least nine months after the onset of their shingles rash.

Jessica Kristen Roberts, PA Atlantic Orthopedics, Wilmington

Kristina Marie Stover, PA Coastal Carolina Orthopaedic Surgeons Jacksonville

New Office Cary Gastroenterology Associates’ The new office is located at 555 Medical Park Place, Suite 108, inside the WakeMed Clayton Medical Park. All six of Cary Gastroenterology’s boardcertified physicians will treat patients at both the Cary and Clayton offices. Phone and fax numbers will be the same for both locations. To schedule an appointment at either office, call (919) 816-4948.

New Office Raleigh Orthopaedic Clinic The new office is located near Rex at 3633 Harden Road, Suite 100. In addition to providing complete orthopedic services, this office will serve as the Raleigh Orthopaedic Clinic Pediatric Center. On-site services will include: fellowship-trained pediatric orthopedic surgeons, digital X-ray and therapy services. The new location is an extension of our main Raleigh office, located at 3515 Glenwood Ave. Raleigh Orthopaedic Clinic (ROC) is Wake County’s largest and oldest orthopedic practice. The orthopedic surgeons are fellowship trained in their respective subspecialty areas, which include: foot and ankle, hand and wrist, spine, hip, shoulder and elbow surgery, total joint replacements, sports medicine and pediatric orthopaedic care. Ancillary services include physical therapy, magnetic resonance imaging, radiology, shock wave therapy, and orthotics and pedorthics.

This study will evaluate the effectiveness of an investigational medication for PHN. Study-related medical exams and study medication are provided at no cost, and compensation will be provided for time and travel. For additional information and qualification criteria please call (919) 781-2514 or visit us online at www.wakeresearch.com.

Gastroenterology Stomach Ulcers

Wake Research Associates Charles F. Barish, MD Have you suffered from a heart attack or stroke and take 325 mg of aspirin daily to prevent another from occurring? If so, Wake Research is conducting a research study of an investigational medication that combines aspirin with a second medication to see if It can help prevent stomach ulcers. You’ll receive investigational medication and study-related exams at no cost and compensation up to $500 for time and travel. For additional information and qualification criteria please call (919) 781-2514 or visit us online at www.wakeresearch.com.

General Medicine/ Infections

Wake Research Associates Charles F. Barish, MD Do you have an upcoming hospitalization? You could be at risk of infection by Clostridium difficile (C.diff.), a bacteria that can cause severe gastrointestinal problems.You may qualify for this study if you are between 40 and 75 years old and have an upcoming hospitalization.

“We are very excited to be in this facility,” says Karl Stein, executive director of Raleigh Orthopaedic Clinic. “The Raleigh area is growing rapidly and we want to ensure easy access to our services for our patients.”

Study-related medical exams and study medication are provided at no cost, and compensation will be provided for time and travel.

Complete practice information is available at www.raleighortho.com.

For additional information and qualification criteria please call (919) 781-2514 or visit us online at www.wakeresearch.com.

ECEP, Wilmington

Duke University Medical Center, Durham

Physician Assistants

Clinical Trials Do you have patients with any of these problems?

Your LocaL cardioLogY ProfessionaLs in Johnston countY dedicated to QuaLitY, service, and integritY

Mateen Akhtar, MD, FACC

Benjamin G. Atkeson, MD, FACC

Christian N. Gring, MD, FACC

Matthew A. Hook, MD, FACC

Kevin Ray Campbell, MD, FACC

Eric M. Janis, MD, FACC

Randy Cooper, MD, FACC

Diane E. Morris, ACNP

cardioLogY services

Ravish Sachar, MD, FACC

Nyla Thompson, PA-C

2 Locations to serve our Patients Smithfield Heart & Vascular Associates 910 Berkshire Road Smithfield, NC 27577 Phone: 919-989-7909 Fax: 919-989-3147

Wake Heart & Vascular Associates 2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520 Phone: 919-359-0322 Fax: 919-359-0326

Coronary and Peripheral Vascular Interventions Pacemakers/Defibrillators Atrial Fibrillation Ablations Echocardiography Nuclear Cardiology Vascular Ultrasound Clinical Cardiology CT Coronary Angiography Stress Tests Holter Monitoring Cardiovascular Medicine Echocardiography Nuclear Cardiology Cardiac Catheterization

the highest QuaLitY cardiovascuLar care, cLose to home.

Make life easier for your schedulers today!

As a referring provider, you can now place your imaging orders online with our new CMS-compliant provider portal. You or your schedulers can login and view each of our sub-specialty order forms to make ordering a breeze. The WR Provider Portal includes: • Fast ordering with auto-fill cells • Online CPT code lists for MR and CT exams for quick reference • Order logs showing archived orders and orders pending authorization • Quick access to all WR patient forms and location maps • Complete training available for your staff Get started today by calling our referral services staff at 919-788-7909. Wake Radiology. Making your life easier. Scan now to learn all about Wake Radiology. Download any QR Reader App for your Smartphone!

1 number to call, 17 locations serving the Triangle area. | Scheduling: 919-232-4700 | wakerad.com