s e p t e m b e r 2 0 11
Duke Musculoskeletal Center Opens in the Heart of the Triangle
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 Shoulder Pain Road to Recovery Thyroid Cancer and Ultrasound
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Contents
COVER STORY
6
New Duke Musculoskeletal Center Opens in the Heart of the Triangle
s e p t e m b e r 2 011
FEATURES
16
Orthopedics
Vol. 2, Issue 9
18
DEPARTMENTS 14 Your Financial Rx 3 Most-Asked Investment Questions
Radiology
Achieving Success in Treating Shoulder Pain and Injuries
Imaging in the Diagnosis of Thyroid Nodules
Dr. Raymond Carroll reviews the types of
Dr. Michael Kwong explains the
shoulder injuries that can occur during
characteristics of thyroid malignancies
athletic play, and the necessary imaging
and recommendations for ultrasound and
and treatment.
nuclear medicine scans.
21 Women’s Health Recognizing the Realities of Miscarriages
22 Orthopedics Healthy Training Habits for Young, Female Volleyball Athletes
24 UNC Research News Molecular Delivery Truck Successfully Delivers Gene Therapy Cocktail.
25 UNC Research News National Cancer Institute Awards $19.3 Million and Prostate Cancer Foundation Awards $1 Million
26 Franklin Regional News Medical Center Earns National Accreditation
27 WakeMed News Children’s Hospital Accepted for NACHRI Accreditation and First Triangle Smartphone App Unveiled for Consumers. Cover Image: Duke Orthopaedics’ (from left) David Attarian, M.D., vice chairman of clinical operations; James Nunley, M.D., chairman of the Department of Orthopaedic Surgery; and David Ruch, M.D., director of hand and upper extremity, stand in front of the new Page Road facility. Jim Shaw Photography.
2
The Triangle Physician
28 News Welcome to the Area and For Your Health
JOHNSTON HE ALTH
From the Editor
Reflections of Team Spirit 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
Who doesn’t love fall? If not for the approach of autumn’s harvest and color, then certainly for the fall football season! There seems a universal appeal for enjoying the cooler temps and, perhaps, making more of an effort to be physically active. For those on the field, cheering from the stands, in the yard raking leaves, the Raleigh Triangle is covered in case of musculoskeletal injury by world-class orthopedic specialists whose mission is to keep us moving and active. One of the very best is Duke Orthopaedics, ranked sixth by U.S. News & World Report. It is now operating as a “musculoskeletal institute,” with numerous centers of excellence, from a new headquarters – Duke Medical Plaza Page Road. And that’s our cover story this month. The facility’s splendid façade is a reflection of all that is possible in the realm of orthopedic care, including exceptional operational efficiencies and “five-star” customer service amenities available within. Having its remarkable orthopedic specialists on one’s team is a definite advantage. This issue of The Triangle Physician offers a seasonal look at sports medicine. In it, we welcome orthopedic surgeon Kevin P. Speer. Dr. Speer reinforces the essentials for preventing injury in young female volleyball athletes that are so often overlooked by parents and coaches. Orthopedic surgeon Raymond Carroll reviews the kinds of athletic
Editor Heidi Ketler, APR
heidi@trianglephysician.com
Contributing Editors Raymond M. Carroll, M.D. Michael D. Kwong, M.D. Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G Paul J. Pittman, C.F.P. Kevin P. Speer, M.D. Photography Jim Shaw Photography jimshawphoto@earthlink.net Creative Director Joseph Dally
jdally@newdallydesign.com
Advertising Sales Carolyn Walters carolyn@trianglephysician.com Natalie Snapp natalie@trianglephysician.com News and Columns Please send to info@trianglephysician.com
shoulder injuries, and the necessary imaging and treatment. Another new contributor, radiologist Michael Kwong explains the characteristics of thyroid malignancies and recommendations for ultrasound and nuclear medicine scans. Obstetrician/gynecologist Andrea Lukes discusses the role of the physician in identifying female patients who are at risk for miscarriage. And this month, certified financial planner Paul Pittman answers his clients’ top three financial planning questions. Go team! Thanks to our dedicated contributing editors and valued advertisers, we have another great issue! You, too, are invited to contribute articles that will enlighten Triangle Physician readers on subjects of medical interest. Also, don’t forget that your advertising dollars are well spent with this magazine, which goes to the more than 8,000 physicians, physician assistants, nurse practitioners and hospital administrators throughout the Raleigh-Durham medical Triangle. As always, our gratitude for all you do!
Heidi Ketler Editor
4
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
New Duke
Musculoskeletal Center
Opens in the Heart of the Triangle “We are hoping to take our overall patient experience to a much higher level (at Duke Medical Plaza Page Road), while still providing our Duke Orthopaedic world-class care.” – David E. Attarian, M.D., Vice Chairman, Duke Orthopaedics Clinical Operations
D
care to patients of all ages and physical ability. Care emphasizes health promotion and wellness, function restoration, prevention of complications and maintenance of optimal patient response through patient and family education. The new Duke Medical Plaza Page Road ambulatory center links the expertise of specialists in orthopedic surgery, radiology, physical therapy, occupational therapy
uke Health System has a new primary
in the United States by U.S. News & World
and orthopedic nursing to ensure patients
outpatient orthopedic presence in
Report.
receive the most appropriate and responsive
the heart of the North Carolina Research
treatment. It is the largest of the Duke
Triangle. It’s the state-of-the-art Duke Medical
Underlying the specialized care is the
Orthopaedic locations, with more patient
Plaza Page Road, providing unprecedented
Duke Orthopaedics mission to provide
services in one location. It is equipped with
access to world-class care, ranked sixth
compassionate, cost-effective, high-quality
the most advanced surgical, medical and radiological equipment.
PHOTO BY JIM SHAW PHOTOGRAPHY
Duke
Medical
Plaza
Page
Road
is
conveniently located off of Page Road at 4709 Creekstone Drive in Durham. The facility’s allglass exterior offers picturesque views of an idyllic wooded setting within a metropolitan area. “It is in a center of population growth for the Triangle area, just off I-40 and 54, close to RDU (Raleigh/Durham International Airport), surrounded by restaurants and hotels,” says James A. Nunley II, M.D., M.S., who is chair of Duke Orthopaedics. The new facility has 36 exam rooms grouped into individual pods of four private rooms. It comes complete with onsite imaging and physical
therapy/occupational
therapy.
Appointments within 24 hours are available for new and urgent patients. Patients also benefit from a preoperative screening Samuel Wellman, M.D., of the Duke Total Joint Center explains treatment options for a Duke Medical Plaza Page Road patient.
6
The Triangle Physician
clinic, which eliminates the need for a trip to the main Duke campus. A state-of-the-art
imaging center is planned, beginning with
and David S. Ruch, M.D., both of whom are
care, foot and ankle care and non-operative
mobile magnetic resonance imaging in the
seeing patients at Duke Medical Plaza Page
spine care. Patients have direct access to
next several months.
Road.
Duke Orthopaedics’ comprehensive services
“It’s quite an improvement over our previous
“We are hoping to take our overall patient
that require subspecialty physicians in
(main campus) location that was built in
experience to a much higher level (at
oncology, pediatrics and trauma.
1932, and (it) has been incredibly well
Duke Medical Plaza Page Road), while still
received,” says Dr. Nunley. “Patients love that
providing our Duke Orthopaedic world-
The Duke Orthopaedics team includes
there is free parking, and it’s easy to get to,
class care,” says David E. Attarian, M.D.,
doctors,
right off the freeway. It’s something new that
vice chairman of Duke Orthopaedics
specialists, sports medicine specialists, non-
the patients like and that works really well for
clinical operations. “All of our cutting-edge
operative spine specialists, subspecialty
the physicians.”
services can be accessed at the Page Road
physician assistants, nurse practitioners,
site. Best Doctors crosses all services, as
physician
assistants,
Advancing Orthopedic Care
does same-day/next-day appointment. FIFA
registered
physical
Duke Orthpaedics’ top-ranked specialists
(Medical Centres of Excellence) applies
occupational therapists. All work together
are leaders in research, clinical services
to sports medicine. Our physicians have
to ensure patients receive the best possible
and education. They are sought across the
pioneered a number of orthopedic surgical
care in a timely manner.
country and around the world to treat the
breakthroughs, such as free vascularized
most difficult cases for patients who have
fibular graft surgery. The foot and ankle
The physicians use the latest onsite
run out of options.
team performs the most replacements in the
diagnostic techniques to uncover the cause
nation and is the world’s most experienced.”
of musculoskeletal pain. Tests may include
in these distinct areas of care, except those
They have pioneered a number of orthopedic
surgeons,
family
medicine
residents,
nurses,
therapists
and
blood tests, X-rays, fluoroscopy, ultrasound,
vascularized fibular graft surgery for young
A Musculoskeletal Institute with Centers of Excellence
patients who have avascular necrosis,
Referred to as a “musculoskeletal institute,”
causing their hip bones to deteriorate. The
Duke Medical Plaza Page Road is comprised
After diagnosis, the physician works with
condition can occur in all ages when blood
of centers of excellence for sports medicine,
the patient to devise a treatment plan that
flow to a bone is interrupted as a result of
total joint care, hand and upper extremity
best suits his or her needs, and the surgeon
surgical breakthroughs, including the free
stress radiography, computed-tomography scan and MRI.
a joint injury, narrowed or clogged blood vessels (from fat or sickle cell anemia) or from excessive pressure inside the bone (caused by conditions like Legg-CalvePerthes disease or Gaucher’s disease). It primarily affects shoulder, knee and hip joints. In free vascularized fibular graft surgery, Duke surgeons remove the dead bone from the hip and replace it with healthy bone and a new blood supply, preserving the native hip joint. For young patients, it eliminates the need for multiple lifetime joint replacements, each of which has a lifespan of about 15 years. Since development of free vascularized fibular graft surgery by Dr. James Urbaniak in 1979, the Duke team has performed more than 2,500 of these procedures. It currently is performed by Samuel S. Wellman, M.D.,
Academic and other meetings are conducted in this Duke Orthopaedics conference room.
September 2011
7
The
Duke
sports
medicine
program
encompasses women’s sports, pediatric sports, sports psychology, primary care/ non-orthopedic-related medical care and rheumatology care. Duke Women’s Sports Medicine Program, led by Alison Toth, M.D., is one of only two such programs in the nation. Since 2001, it has become a worldclass program that concentrates on the needs of female athletes, both high level and recreational, and manages them throughout their lifespan. The sports medicine physicians at Duke Medical Plaza Page Road are these same From left: Phyllis Martin, P.R.M.O.; Jessie Mathers, P.T.; and Christopher Fiander, P.T., of Duke Physical Therapy are part of a comprehensive physical therapy/occupational therapy clinic at Page Road.
high-caliber
specialists,
offering
great
expertise in diagnosing and treating the full range of sports and activity-related injuries,
remains committed to managing the patient’s
of aging or disuse that affects the ability to
including joint strains and sprains, bone
care through to recovery.
participate in sports or exercise or simply
fractures, and tendonitis and bursitis caused
maintain an active lifestyle.
by chronic misuse or overuse.
conservative treatments. When surgery is
The practice also has worldwide distinction
The full spectrum of surgical procedures
required, the physician recommends joint-
as one of two FIFA Medical Centres
range from arthroscopic ankle surgery
replacement prosthesis, as appropriate, and
of Excellence in the United States that
to procedures that free frozen shoulders.
a customized rehabilitation program.
provides a level of care found at only 12
It encompasses all aspects of the knee
similar programs around the world. The
and shoulder, including arthroscopic and
The first clinical approach is to use
reconstructive surgery and surgical repair of
“All of our cutting-edge services can be accessed at the Page Road site. Best Doctors crosses all services, as does same-day/ next-day appointment. FIFA (Medical Centres of Excellence) applies to sports medicine. Our physicians have pioneered a number of orthopedic surgical breakthroughs, such as free vascularized fibular graft surgery. The foot and ankle team performs the most replacements in the nation and is the world’s most experienced.” – David E. Attarian, M.D., Vice Chairman, Duke Orthopaedics Clinical Operations
rotator cuff tears. The Duke sports medicine program also offers treatment for medical illnesses related to sports activity, such as asthma, concussions drome,
and
post-concussion
mononucleosis,
syn-
athletic-induced
amenorrhea and overtraining syndrome. Its seasonal Saturday Injury Clinics are designed to provide expert care to weekend warriors, including young people injured in Friday night games. Blake R. Boggess, D.O., (Best Doctor
The following is an overview of the Duke
FIFA (Fédération Internationale de Football
ranked in 2007-2012) is the sports medicine
Medical Plaza Page Road Centers of
Association) medical center program was
specialist at Duke Medical Plaza Page Road.
Excellence.
created in 2005 to give players a resource for expert care in the form of prevention,
Total Joint Care
Sports Medicine
treatment and rehabilitation. They also work
Each year, surgeons at the Duke Total Joint
Duke Orthopaedics has a 70-year history as a
to educate and train the next generation of
Center perform more than 1,500 hip and
national leader in treating conditions caused
clinical specialists and scientists who are
knee replacements on patients ranging from
by injury, disease or the normal process
committed to football medicine.
young adults to senior citizens. Specialized
8
The Triangle Physician
expertise also extends to shoulders, elbows,
total ankle replacements, also known as total
Orthopaedics’ patients receive the most
wrists, thumbs, ankles and other joints.
ankle arthroplasty. Every year, they perform
cutting-edge technology performed by the
the most replacement procedures in the
most experienced surgeons.
Expertise in adult reconstruction and
nation, ensuring patients receive care from
access to cutting-edge technology, including
some of the most experienced and qualified
Foot and ankle treatments range from
computer-assisted
surgeons in the world, says Dr. Nunley.
conservative
surgery
and
patient-
specific devices, ensure patients receive
non-surgical
management,
including casting, bracing and orthotics;
the best care possible. A wide range of
In total ankle replacement surgery, the
minimally invasive procedures, such as
techniques, including vascularized bone
surgeon uses advanced prosthetic designs
steroid injections, PRP (platelet-rich plasma
grafting, arthroscopy of the hip and knee,
that accurately mimic the human ankle and
injections) and arthroscopy; and surgical
partial joint replacements and osteotomy
improved surgical techniques that allow for
correction, such as ankle reconstruction and
(correcting deformed bones), are used to
more precise alignment of the implant. The
ligament reconstruction.
delay the need for an artificial joint. Many of
Duke team has experience with all ankle
these techniques were pioneered at Duke.
prostheses currently approved for use in the
The foot and ankle team at Duke Medical
When these techniques don’t work to prevent
United States, including INBONE, SaltoTalaris
Plaza Page Road is comprised of Samuel
joint
and STAR.
B. Adams Jr., M.D.; Mark E. Easley, M.D.
replacement,
surgeons
offer
the
Duke most
Orthopaedic advanced
replacement procedures available.
(Best Doctor ranked in 2007-2012); James A. The surgeons are actively involved in clinical
Nunley II, M.D., M.S., (Best Doctor ranked
trials and research that tests new prostheses
in 1996-2012); and James K. DeOrio, M.D.
David E. Attarian, M.D. (Best Doctor
and devices, such as the original clinical
ranked in 1996-2012); Michael P. Bolognesi,
research for the STAR replacement. They
Hand and Upper Extremity
M.D.; and Samuel S. Wellman, M.D., are
write articles and text books related to foot
Duke
the total joint specialists at Duke Medical
and ankle surgery operative procedures and
art techniques to diagnose and treat
Plaza Page Road.
travel the country teaching other surgeons
all conditions from the shoulder to the
ankle replacements procedures. The active
fingertips. When bone fractures and ligament
Foot and Ankle
pursuit of new and better ways to treat
tears require surgery, Duke surgeons offer
Duke Orthopaedics is a national leader in
foot and ankle conditions ensures Duke
minimally invasive techniques, such as
Orthopaedics
uses
state-of-the-
Andre Grant, M.D., (left) and Blake Boggess, M.D., (right) of Duke sports medicine flank their nursing staff.
September 2011
9
General Orthopedics Duke’s general orthopedists are trained across all disciplines and implement care for the entire spectrum of bone, joint and muscle injuries and disorders – from arthritis, to fractures, sprains and dislocations, to joint pain and tendonitis. They
have
access
to
leading-edge
technologies and treatments, and are experts at employing these approaches. Treatments include: •M edical management of musculoskeletal pain; •N on-surgical techniques, including casting and bracing, orthotics and platelet-richplasma injections for tendonitis; • S urgical
procedures,
including
arthroscopy, reconstructive surgery, and tendon and ligament repair surgery; and •P hysical and occupational therapy and rehabilitation. Tonya Tolley, R.N., and Fraser Leversedge, M.D., of Duke’s Hand and Upper Extremity Center review patient files.
Samuel D. Stanley, M.D., is the general orthopedist at Duke Medical Plaza Page Road.
arthroscopy
and
arthroscopic-assisted
Non-operative Spine Care Non-operative spine care specialists at Duke
Onsite Physical and Occupational Therapy
Medical Plaza Page Road treat patients with
Duke’s licensed physical and occupational
Condition-specific therapies for elbows
debilitating back pain and disorders of the
therapists are dedicated to excellence in
include injections, fracture repair, ligament
spine.
the science and art of rehabilitation for all
fracture repair, when possible.
or tendon repair or reconstruction, elbow
patients, whether they are injured athletes,
arthroscopy and elbow replacement surgery.
The treatment team may include pain
patients who have undergone operations,
Wrist and forearm treatments range from
management, occupational medicine and
victims of traumatic injury or individuals
microsurgery and thumb-joint replacement
rehabilitation experts, in addition to nurses
with development disorders.
surgery to non-surgical treatments for
who are specially trained to care for patients
tendonitis and arthritis. Nerve damage
with spinal surgeries.
treatment options include minimally invasive
A number of physical therapists are board certified in either sports medicine or
techniques for nerve decompression and
Non-operative spine care covers a range of
orthopedics. A few have dual licenses in
microvascular surgery, nerve grafts and
conditions, from Ankylosing spondylitis and
physical therapy and athletic training.
nerve repair.
basilar invagination (cranial settling) to low
Grant E. Garrigues, M.D., is the shoulder
back and neck pain, myelopathy, fractures
The physical therapy team specializes in
and spondylosis.
assessment and treatment of musculoskeletal
and elbow specialist at Duke Medical Plaza
injuries. They include:
Page Road. Diane M. Allen, M.D.; Richard
Anand B. Joshi, M.D., M.H.A., and Gloria
D. Goldner, M.D. (Best Doctor ranked in
G. Liu, M.D., M.S., (Best Doctor ranked
as shoulder instability or rotator cuff
2003-2012); Fraser J. Leversedge, M.D.;
in 2007-2008) are the non-operative spine
disorders;
and David S. Ruch, M.D. (Best Doctor
specialists at Duke Medical Plaza Page Road.
•E lbow
and
shoulder
injuries,
such
• J oint problems, such as injuries to ankle
ranked in 2003-2012), are the Duke hand and
ligaments, as well as knee ligaments and
upper extremity specialists there.
cartilage;
10
The Triangle Physician
• Muscle strains, tendon injuries and overuse injuries; • Osteoarthritis; • Clinical and surgical treatment, including rotator cuff repair, shoulder labral repair, shoulder reconstruction, elbow tendon repair, elbow ligament reconstruction, elbow arthroscopy, anterior cruciate ligament (ACL) reconstruction surgery, lateral
collateral
repair,
posterior
ligament cruciate
(LCL) ligament
(PCL) reconstruction and total knee replacement; and • Injury-prevention and sports-performance training incorporating the latest research from The Michael W. Krzyzewski Human Performance
Research
Laboratory
(K-Lab) and the Duke Sports Performance Program. Patients can schedule a physical therapy appointment on the same day as their doctor visit at the clinic.
Multi-specialty Duke Eye Center Opens The new Duke Eye Center at Page Road began offering convenient access to the full complement of specialized ophthalmology services Aug. 29.
“Many patients find it more convenient to visit our satellite locations, rather than navigating through the medical center facility to find us there,” says Dr. Epstein.
The state-of-the-art facility is the ninth satellite of Duke Eye Center, which is ranked seventh by U.S. News & World Report.
The new 8,500-square-foot satellite is sharing its location at 4709 Creekstone Drive in Durham with Duke Orthopaedics. Duke Medical Plaza Page Road is a striking 60,000-square-foot, free-standing facility that offers ample parking and two covered driveup lanes.
“Patients who suffer from retinal diseases and glaucoma can come to the new location and have every test done that they could at our main eye center,” says Dr. David Epstein, chairman of ophthalmology in the Duke University School of Medicine and chairman of the Duke Eye Center. Seven specialists will offer the range of eye care specialties at this location, including: • Glaucoma • Cornea • Retinal diseases • Oculoplastics, and reconstructive and cosmetic surgeries • Cataracts • LASIK/refractive surgery consultations
5-Star Patient Service It doesn’t take long for patients at Duke Medical Plaza Page Road to recognize their convenience and comfort are top priorities.
Located off of I-40 in the center of the Research Triangle Park, it is in close proximity to hotels, restaurants and the airport. It is particularly convenient for employees of surrounding businesses, as well as the orthopedic patients who also may receive care at the eye center. Duke Eye Center at Page Road patients are guaranteed an appointment within a week of their call. Appointments can be made by calling (919) 681-3937. For more information visit www.dukeeye.org.
Did you know! The number of older Americans getting help for fading eyesight almost tripled from 1997 to 2007, as the nation aged and treatment improved.
A view of the Duke Medical Plaza Page Road campus.
September 2011
11
Appointments with a Duke orthopedic
Patients may call (888) ASK-DUKE (275-3853)
8 a.m. to 4:30 p.m. For more information, visit
provider are available within 24 hours of
to schedule an appointment. Appointments
www.DukeHealth.org/orthopaedics.
calling for new patients. Duke Orthopaedics
are available from Monday through Friday,
and Duke Urgent Care have partnered to guarantee same-day/next-day appointments for urgent care patients, also. It’s all by design. Multiple committees have been engaged in planning and implementing “five-star� customer service goals at Page Road, and they will continue to review them, according to Dr. Attarian.
Samuel B. Adams Jr., MD Management of all disorders of the foot and ankle, treatment of osteochondral lesions of the talus, total ankle replacement, orthobiologic applications to foot and ankle surgery including stem cells therapies and platelet rich plasma
Anand B. Joshi, MD, MHA Non-operative, interventional care of neck and back pain, optimize functional outcome through rehabilitation, electrodiagnostics, and minimally invasive, percutaneous spine procedures
David E. Attarian, MD Joint-replacement surgery (primary and revision, hip and knee), arthroscopic surgery (knee)
Gloria G. Liu, MD, MS Non-operative management of spine problems, including spine epidural steroid injection, radiofrequency ablation, neuropathic pain, spasticity, acupuncture, BOTOX injections, and EMG/NCS testing
The Page Road location is easy to access and surrounded by popular shopping, restaurant and hotel destinations. Upon arrival, patients
Blake R. Boggess, DO Sports medicine, care of athletes of all ages, nonoperative orthopedics, minor-fracture management, musculoskeletal ultrasound, chronic tendonopathies, plateletrich plasma (PRP) injections
can be dropped off under a covered drive at the front entrance. Courtesy concierge service is available, and there is ample, free onsite parking. In the waiting areas, patients can enjoy expansive picturesque view of the Duke Medical Plaza Page Road grounds or watch their favorite programming on the flat-screen televisions. Patients are invited to use the complimentary beverage stations. They can
Michael P. Bolognesi, MD Total hip and knee replacement; revision total hip and knee replacement; computer-assisted orthopedic surgery; unicompartmental knee replacement; minimally invasive hip and knee replacement; patella femoral-joint and gender-specific arthroplasty James K. DeOrio, MD Lower-extremity reconstruction, especially total ankle replacements and all other procedures involving hind foot, midfoot, and forefoot deformities
make the most of their wait by accessing an Internet kiosk and free WiFi. Patients may not immediately put their
Fraser J. Leversedge, MD Hand, upper-extremity, and microvascular surgery; clinical conditions affecting the upperextremity distal to the shoulder, including trauma, arthritis, nerve/ tendon repair and reconstruction; pediatric/congenital disorders, sports injuries, and post-traumatic reconstruction Richard C. Mather III , MD Sports medicine and all types of athletic injuries, hip arthroscopy, femoroacetabular impingement, labral tears of the hip, arthroscopy of the shoulder and knee, rotator cuff tears, shoulder instability, cartilage restoration, ACL and meniscus tears, platelet rich plasma, throwing injuries James A. Nunley II , MD, MS Foot and ankle surgery, arthritis and sports injuries of the foot and ankle, ankle replacement
finger on it, but the improved patient flow and traffic patterns within the clinic
Mark E. Easley, MD Total ankle replacement; sports medicine of the foot and ankle; ankle arthroscopy; tendon repairs for foot and ankle; cartilage repair/reconstruction of the ankle; adult foot and ankle reconstruction; sports injuries of the foot
make their visit extra efficient and timely. They
also
appreciate
onsite
imaging,
physical/occupational therapy and surgical scheduling. and ankle
With the opening of Duke Medical Plaza Page Road, patients and referring physicians are advised that Duke Orthopedic clinics are no longer operating at 10950 Chapel Hill Road in Morrisville and 6301 Herndon Road at Southpoint. Those patients will be transferred to the new location. Additionally, urgent care centers at Morrisville and Southpoint are transferring urgent orthopedic patients to Medical Plaza Page Road during regular work hours for same-day appointments.
12
The Triangle Physician
Grant E. Garrigues, MD Arthroscopic, joint replacement, and reconstructive surgery of the shoulder and elbow; treatment of rotator cuff tears, labral/Bankart/SLAP tears, impingement syndrome, cartilage defects, arthritis, instability, stiffness, nerve compression, throwing athletes, and traumatic injuries Andre Grant, MD Sports medicine, joint replacement, gender-specific knee replacement, fracture care, carpal tunnel and trigger-finger release, shoulder and knee reconstruction, including arthroscopic rotator cuff and labral repair, cartilage restoration and all-inside ACL reconstruction
David S. Ruch, MD All aspects of upper-limb surgery including microscopic and minimally invasive techniques of treating degenerative and traumatic conditions; research interests in nerve injuries, fractures of the wrist and elbow, tendon injuries and arthritis; avascular necrosis of the hand and elbow; avascular necrosis of the hip; free vascularized fibular bone grafting Samuel D. Stanley, MD General orthopaedics including joint replacement, sports medicine, hand and foot, trauma, and general pediatrics
Samuel S. Wellman, MD Surgical treatment of degenerative and inflammatory conditions of the hip and knee, including hip and knee replacement, partial knee replacement, revision of hip and knee replacements, surgical treatment of avascular necrosis of the hip
Your Financial RX
3 Most-Asked
Investment Questions By Paul Pittman, C.F.P.
Many owners and partners are looking for larger tax deductions and accelerated retirement savings. Cash balance plans may be the perfect solution for them.
their own accounts. In LaRue, however, the Supreme Court limited it’s prior decision in Russell to defined benefit plans, explaining the Russell decision did not apply to individual account plans, like 401(k) plans, which dominate the retirement landscape today. The case is likely to generate a significant increase in 401(k) plan litigation.
Every month, I get several calls and e-mails
flow. Can your cash flow handle the debt
from readers asking questions about their
payment?
One way to limit the infinite and personal fiduciary liability to a company, its owners,
specific financial situation. I am always glad to answer any questions, but I thought that I
The other side of the coin is the emotional
and board members is to consult a qualified
would pass on the three top questions I get
one. Is the debt keeping you up at night?
adviser to review and oversee the plan,
and my answers.
Both of these factors warrant consideration
and advise the participants. Is someone
in keeping debt or paying it off. A simple
counseling your employees now? Consider
1) What should I do about my
cash-flow analysis will give you a clear
consulting with an accredited investment
school loan debt?
answer.
fiduciary.
heart of all financial planning. Debt is the
2) We have a retirement plan
3) I am in my late 50s and I don’t
biggest obstacle to creating and maintaining
for our employees. Do I, as the
feel I have put away enough
wealth. Many people make a lot of money,
business owner, have any liability
money for my retirement. Is there
but also have a lot of debt and spend a lot
with this plan?
anything I can do to make up for
of money.
The short answer is this: Yes.
lost time?
First of all, this question goes to the very
Yes. If you already have a qualified Remember my mantra. It’s not what you
In the case of LaRue v. DeWolff, the U.S.
retirement plan, such as a 401(k), you also
make, it’s what you keep! True financial
Supreme Court unanimously held that
can start a cash balance plan.
responsibility involves the simple act of
participants in 401(k)s and other defined
spending less than you make. The next step
contribution plans can sue for investment
is to maximize the money that you are not
losses incurred in their individual accounts
spending. Debt keeps you from stockpiling
as a result of a fiduciary’s breach of duty.
more of your income for later use.
Mr. LaRue sued his former employer for investment losses that resulted in an alleged
That being said, education debt usually
failure to respond appropriately to requests
carries a low interest rate. The last several
for investment changes.
people that I spoke with had interest rates on their student loans around 3 percent. If
A prior Supreme Court decision (Russell v.
you can put your money into an investment
Mass Mutual) seemed to state that a claim
paying more than that, then the better use
for losses due to a fiduciary breach could
of your money is to carry the debt. You
be brought only by the plan as a whole, and
also need to take into account your cash
not by individual participants for losses in
14
The Triangle Physician
Paul J. Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 4594171 and paul.pittman@pcgnc.com.
the participant, the higher the amount
Treasury Bonds, which has hovered around
is. The reason for this difference is that
5 percent in recent years.
an older person has fewer years to save toward the approximate $2.5 million lump
When participants terminate employment,
sum that is allowed in a cash balance plan.
they are eligible to receive the vested
Subject to IRS limits, the actual contribution
portion of their account balance. As an
is determined by a formula specified in
example, if you were born in 1950, you can
the plan document. It can be either a
defer $150,261 into a cash balance plan
percentage of pay or a flat dollar amount.
plus $20,500 into your 401(k) for a total of $170,761 for that year!
The rate of return is guaranteed and is independent of the plan’s investment
Most advisers are not aware of the cash
performance. That rate changes each year
balance plan. Find someone who is and
but usually is equal to the yield on 30-year
have a discussion to see if it is right for you.
A cash balance plan is a type of retirement plan that belongs to the same general class of plans known as qualified plans. A 401(k) is a qualified plan. These plans “qualify” for tax deferral and creditor protection under ERISA
(Employee
Retirement
Income
Security Act). In a cash balance plan, each participant has an account that resembles those in a 401(k) or profit sharing plan. Those accounts are maintained by the plan actuary, who generates annual participant statements The account grows annually in two ways: first, a contribution, and second, an interest credit, which is guaranteed rather than being dependent on the plan’s investment performance. Many owners and partners are looking for larger tax deductions and accelerated
retirement
savings.
Cash
balance plans may be the perfect solution for them. 2006 legislation encouraged more and more
professionals
and
successful
business owners to adopt this type of plan. A cash balance plan is a defined benefit plan that specifies both the contribution to be credited to each participant and the investment earnings to be credited based on those contributions. Contributions are age-dependent. The older Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
September 2011
15
Orthopedics
Achieving Success in
Treating Shoulder Pain and Injuries By Raymond M. Carroll, M.D.
S
houlder
pain
is
a
common
presenting symptom for athletes of all ages and activity levels, and
often is within the shoulder girdle, which includes the scapula, clavicle and proximal humerus, and their associated joints and soft tissues.
Athletes who follow a treatment plan that involves rest or modifying activities, and who comply with appropriate rehabilitation can expect to recover from a painful shoulder condition. Although many people associate shoulder injuries with throwing and collision sports, such as baseball or football, shoulder problems are seen in many athletes of other sports, such as the martial arts, racket sports, wrestling and swimming. In general, painful shoulder conditions in the athlete can be broken down into two broad categories: traumatic and atraumatic. Traumatic shoulder injuries typically occur in contact sports, but can occur with any sport where the shoulder is involved in collision, excessive force or extreme motions. Common shoulder injuries that occur with direct force to the outside of the shoulder include acromioclavicular joint sprains (shoulder separations) and Dr. Raymond Carroll evaluates a patient’s rotator cuff injury.
16
The Triangle Physician
clavicle fractures. These injuries are
Dr. Raymond M. Carroll, M.D., is a board-certified orthopaedic surgeon who is fellowship trained in shoulder surgery and has a subspecialty certificate in sports medicine. He is a graduate of the University of North Carolina at Chapel Hill and UNC School of Medicine. Dr. Carroll joined Cary Orthopaedic & Sports Medicine Specialists in 2006. His interests include arthroscopic shoulder surgery, shoulder replacement surgery and sports medicine. Dr. Carroll can be reached at (919) 467-4992. For more information go to www. caryortho.com.
commonly seen in football players who take direct blows to the outside of the shoulder and in cyclists who are thrown over the handlebars of their bicycles. Injuries that involve excessive force or extreme motions include shoulder dislocations, labral tears and rotator cuff injuries and are often seen in wrestling, basketball and the martial arts. Traumatic shoulder injuries are often easily diagnosed with a good history of present illness and physical examination. Standard
tears. These injuries are often a result of
the diagnosis and severity. Many of these
repetitive microtrauma over time rather than
injuries resolve with the initial treatment.
acute injuries. When the shoulder pain persists despite In younger athletes, atraumatic injuries are
initial treatment, advanced imaging, such as
related mainly to overuse which results
magnetic resonance imaging or ultrasound,
in muscle weakness and, subsequently,
may be indicated. Shoulder radiographs
worsening biomechanics which lead to
are commonly ordered prior to advanced
painful shoulder conditions. In the older
imaging, but are often noncontributory, as
athlete, muscle imbalance and/or weakness
soft tissues are not visualized on radiographs.
can result in painful shoulder conditions with little or no provocation. This situation is most
Most painful shoulder conditions in the
common in middle-aged athletes who are just
athlete can be diagnosed and treated
starting a new exercise regimen and using
efficiently. The goal of treatment in most
muscles that have been otherwise dormant.
cases is a resumption of normal activities without restriction. Successful treatment
The diagnosis of atraumatic shoulder pain
is dependent on compliance with the
is often made with history and physical
treatment plan.
examination. Often, radiographs are not necessary for initial evaluation. Initial
Athletes who fail to rest or modify their
treatment of atraumatic injuries includes rest
activities as part of the treatment plan are at
from the provocative activity, heat therapy,
increased risk for chronic injury. In addition,
nonsteriodal anti-inflammatory medication
athletes who return to activity without
and physical therapy. Initial treatment can
appropriate rehabilitation are at increased
last up to six to eight weeks, depending on
risk for recurrent injury.
shoulder radiographs (AP, outlet or Y view, and axillary views) are typically adequate to definitively diagnose these injuries. Soft tissue injuries to the labrum or rotator cuff may necessitate magnetic resonance imaging for definitive diagnosis. Initial treatment includes sling immobilization, rest, ice and nonsteroidal antiinflammatory medication. Injury-specific treatment is based on the severity of the injury, and surgical treatment is often appropriate with more severe injuries. Physical therapy is crucial to ultimate recovery of mobility and strength in many of these injuries. Atraumatic shoulder injuries are common in tennis players, golfers, swimmers, volleyball players and weightlifters, but can occur with any athletic endeavor. Atraumatic shoulder injuries are typically overuse injuries, such as seen in overhead throwing athletes. Classic atraumatic injuries, such as those seen in baseball pitchers, include rotator cuff injuries, labral tears and proximal biceps
September 2011
17
Raidiology
Imaging
in the Diagnosis of Thyroid Nodules By Michael D. Kwong, M.D.
An estimated 37,000 cases of thyroid cancer are diagnosed each year and the rate seems to be increasing.
The imaging evaluation of thyroid nodules following physical exam and laboratory studies should start with a thyroid ultrasound. This high-resolution evaluation will allow characterization of the nodule size, morphology, echogenicity, internal vascularity and presence of a “halo” sign, assessment of microcalcifications, and characterization of the borders. Sometimes the ultrasound can show characteristically benign findings, such as a comet tail artifact arising from echogenic foci, which is indicative of the colloid crystals of benign nodules. A cystic lesion and multiplicity of nodules are more
Thyroid nodules are very common and often are incidental findings
favorable signs, but thyroid cancers can occur in all nodules.
on chest computed tomography scans, cervical spine magnetic resonance imaging scans or carotid ultrasounds. These are usually asymptomatic, not palpable on exam, and the chronicity or stability
Type Of Thyroid Malignancy
is unknown. These can be cystic or solid, and often multiple nodules
Characteristics
Papillary thyroid cancer
The papillary type of thyroid cancer is the most common, making up about 80 percent of all thyroid cancer diagnoses. Papillary thyroid cancer can occur at any age, but is most commonly diagnosed in people ages 30 to 50.
Follicular thyroid cancer
Follicular thyroid cancer also includes Hurthle cell cancer. Follicular thyroid cancer typically occurs in people older than 50.
Medullary thyroid cancer
Medullary thyroid cancer may be associated with inherited genetic syndromes that include tumors in other glands. Most medullary thyroid cancers are sporadic, meaning they aren’t associated with inherited genetic syndromes.
to ionizing radiation, including CT scans.
Anaplastic thyroid cancer
The anaplastic type of thyroid cancer is very rare, aggressive and very difficult to treat. Anaplastic thyroid cancer typically occurs in people age 60 or older.
Managing Thyroid Nodules
Thyroid lymphoma
Thyroid lymphoma begins in the immune system cells in the thyroid. Thyroid lymphoma is very rare. It occurs most often in adults age 70 or older.
Multiple nodules
Consider U/S-guided FNA of one or more nodules, with selection prioritized on basis of criteria (in order listed) for solitary nodule*
are present scattered throughout the gland. Most thyroid nodules are benign; however, approximately 10 percent of nodules are cancerous. This means an estimated 37,000 cases of thyroid cancer are diagnosed each year. In fact, the rate seems to be increasing. This may be due to the improved imaging that allows for earlier detection at a smaller size, increased awareness and vigilance of care providers, and possibly from increased exposure
When symptoms develop, they can include a new or enlarging palpable mass, dysphagia, odynophagia, hoarseness or changes to voice, or adjacent adenopathy.
The Society of Radiologists in Ultrasound convened a special panel of medical experts to address this topic and published a consensus conference statement in 2005 with these recommendations: Ultrasound Feature
Recommendation
Solitary nodule – microcalcifications
Strongly consider U/S-guided FNA if > 1 cm
Solid (or almost entirely solid) or coarse calcifications
Strongly consider U/S-guided FNA if 1.5 cm
Mixed solid and cystic or almost entirely cystic with solid mural component
Consider U/S-guided FNA if > 2 cm
None of the above, but substantial growth since prior U/S examination
Consider U/S-guided FNA
Almost entirely cystic and none of the above and no substantial growth (or no prior U/S)
U/S-guided FNA probably unnecessary
Multiple nodules
Consider U/S-guided FNA of one or more nodules, with selection prioritized on basis of criteria (in order listed) for solitary nodule*
18
The Triangle Physician
Dr. Michael Kwong, a vascular and interventional radiologist, joined Wake Radiology in 2003. He is a graduate of the Texas Academy of Mathematics and Science and attended college at the University of Texas at Austin. He earned his medical degree from the University of Texas Health Science Center at San Antonio and completed a diagnostic radiology residency at Boston University after an internal medicine internship in Columbus, Ohio. While in Boston, Dr. Kwong had a special interest and completed visiting fellowships in pediatric vascular and interventional radiology at Boston Children’s Hospital, and breast imaging and intervention at the Faulkner Sagoff Breast Center. He then went to the University of California San Diego where he completed a fellowship in vascular and interventional radiology. Dr. Kwong is a diplomate of the American Board of Radiology and a member of the Society of Interventional Radiology.
When a nodule is confirmed to be solid and has indeterminate characteristics, a nuclear medicine thyroid scan can be performed to assess whether the nodule is “hot,” “warm” or “cold.” A cold nodule would be more concerning for cancer, whereas a hot nodule is more likely a hyperfunctioning benign lesion. The ultrasound and nuclear medicine thyroid scan are complementary tests – one assesses the physical nature and the other assesses the physiological nature of a lesion. When more than one nodule meets the criteria for biopsy, typically the most concerning nodule is chosen for biopsy. Often in a
Job Opportunity An up-and-coming aesthetics spa in Durham, North Carolina is seeking a caring, Licensed Physician to serve as Medical Director to provide support and medical supervision. Primary responsibilities will be to INDIRECTLY supervise licensed midlevel practitioners and act as an in-house medical director. This position is flexible with scheduled days and hours.
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multinodular gland, one from each side is biopsied.
Compensation: Commensurate with experience and scope of responsibilities
Citations: Radiology 2005; 237:794-800 Management of Thyroid Nodules Detected at U/S: Society of Radiologists in Ultrasound Consensus Conference Statement. Mayo Clinic.com Health/thyroid cancer, Endocrineweb.com
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CARY ORTHOPAEDIC Sports Medicine Specialists Pain and injury can sideline your activities. Whether you’re training for a marathon, getting back to work or coaching little league, you can benefit from our 28 years of hands-on experience in diagnosis, treatment, and rehabilitation.
• Minimally Invasive Surgery • Gortex Casting • Intra-articular joint injections • On-Site Physical Therapy • Custom Orthotics
Our practice is unique. When you need care you will be seen by a board certified orthopedic surgeon.
1120 SE Cary Pkwy, Cary, NC 27518
919-467-4992 Fax 919-481-9607
1005 Vandora Springs Rd., Garner, NC 27529
919-779-3861 Fax 919-779-3234
www.caryortho.com
September 2011
19
Women’s Health
More hours. More imaging. More insight. With expanded outpatient hours to better serve our patients, Durham Regional Hospital is the place to refer your medical imaging needs. Durham Regional offers the latest imaging technology delivered by experienced staff to get your patients scanned and back to the things they enjoy most.
Expanded Hours: CT, MRI, and general X-Ray: Monday–Friday, 7:00 a.m. until 11:00 p.m. Ultrasound: Monday–Friday, 7:00 a.m. until 7:30 p.m. Mammography: Monday, Tuesday, Thursday, Friday, 7:30 a.m. until 6:00 p.m. Wednesday, 7:30 a.m. until 7:30 p.m. CT, MRI, and Ultrasound: Saturdays, 8:00 a.m. until noon. To schedule an appointment, call 919-470-5272 and ask for Durham Regional Hospital. Same day appointments are available. For additional information about Radiology services offered at Durham Regional, visit durhamregional.org.
8684
Women’s Health
Recognizing the Realities of
Miscarriages By Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G.
Many women do not realize that an
By far, the most common reason for
estimated 50 percent of all pregnancies are
a miscarriage is that a fetus did not
miscarried. The definition of a miscarriage
develop normally due to abnormal genes
is a loss of a pregnancy before 20 weeks
or
gestation. Although 50 percent is a high
spontaneous losses occur within the first 12
rate, only a fraction of these miscarriages
weeks of pregnancy with most (greater than
are “clinically diagnosed.” Experts estimate
60 percent) of those due to chromosome
that between 15-20 percent of known
abnormalities.
chromosomes.
Eighty
percent
of
pregnancies are miscarried. Even though miscarriages are common, they are difficult
Given this, one important aspect of helping
to experience.
women when they experience a miscarriage is reassurance that the cause is not due to
Given the difficulty a miscarriage can cause
something she did or did not due. Exercise,
women (emotionally and physically), health
intercourse, working, lifting or straining
care providers should know the potential
do not cause miscarriage. Health issues
risk factors and causes of miscarriage.
in women that may cause miscarriages include: uncontrolled diabetes, thyroid
The
most
common
risk
factor
for
miscarriage is age. Women older than
disease, infections, hormonal problems, or uterine or cervical problems.
age 35 have a higher risk of miscarriage compared to younger women. At age 35,
Although miscarriages are common, less
you have about a 20 percent risk, yet, at age
common is recurrent pregnancy loss (RPL).
40, the risk is about 40 percent. Those five
This is defined as having three or more
years double a woman’s risk. And at age
losses. If a woman has three pregnancy
45, the risk increases to approximately 80
losses, then she should be evaluated by a
percent.
specialist.
After earning her bachelor’s degree in religion from Duke University (1988), Dr. Andrea Lukes pursued a combined medical degree and master’s degree in statistics from Duke (1994). Then, she completed her ob/gyn residency at the University of North Carolina (1998). During her 10 years on faculty at Duke University, she co-founded and served as the director of gynecology for the Women’s Hemostasis and Thrombosis Clinic. She left her academic position in 2007 to begin Carolina Women’s Research and Wellness Center, and to become founder and chair of the Ob/Gyn Alliance. She and partner Amy Stanfield, M.D., F.A.C.O.G., head Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals for management of heavy menstrual bleeding. Call (919) 251-9223 or visit www.cwrwc.com.
• Immune factors, such as antiphospholipid Ab syndrome Because miscarriages can cause a great
The causes of this include the following
deal of emotional difficulties, it is important
categories (with brief explanations):
for health care providers to take a careful
• Genetic problems in parents or fetus
obstetrical history for signs of a medical
problem or risk factor, especially in women
• Uterine anomalies • Endocrine factors
who have had more than two pregnancies.
• Luteal phase deficiency –
We encourage primary care providers
insufficient
to refer to an obstetrician/gynecologist
progesterone
or reproductive endocrinologist when a woman has had three or more pregnancy
• Infection
losses. Further, if a woman is older or has
• Inherited thrombophilia – blood clots more often than normal
associated medical problems, then she should be referred even sooner.
due to such conditions as factor V Leiden or prothrombin mutation
September 2011
21
Sports Medicine
Young Female Volleyball Players
Injury Prevention Through Weight-training and Diet By Kevin P. Speer, M.D.
The Triangle Region has seen an enormous
accomplish this goal. This generally leads
protein to support their athletic efforts.
growth in popularity of adolescent female
to an unending yearly effort, leaving little,
Many times parents do not fully understand
volleyball over the past several years. This
if any, off season for these athletes. The
what their daughters need for healthy
has paralleled growth of the sport and
physical consequences of this perpetual
participation in the sport on an ongoing
interest both statewide and nationwide.
play compel the services of physicians,
basis.
particularly those who specialize in sports
medicine.
Sports medicine physicians who care
Girls volleyball is played in middle school and high school in the fall. However, school-
for these adolescent female volleyball
sponsored volleyball is generally dwarfed
The challenges of young female athletes
athletes can provide a tremendous service
by private, fee-based club volleyball in
within this sport are obvious. The nature
by emphasizing a few important strength-
sheer numbers, as well as competitive
of the sport lends itself to young girls,
building tenets to the athletes and their
level of play. The competitive club season
who are generally athletically lean and
parents.
generally
tall. Unfortunately, this age and body type
ranges
from
mid-November
through the end of June.
tend to have little developed strength.
Strength acquisition and weight lifting are crucial in preventing injury. Parents and the athletes themselves must be educated on the physical requirements of volleyball sport participation. Parents inherently understand the necessity of regular reinforcement and imposed effort. It is essential that parents understand the importance of strength training and strength acquisition in their daughters. They must be disarmed of the myths of muscle building in girls and also support the necessary dietary intake. Parents also want to see their child succeed. Injury prevention is key to gaining parental support for proper weight training and diet. Sports medicine physicians can emphasize
Many, if not most of, the adolescent
These girls have had little encouragement
what is necessary to prevent injury, or at
volleyball athletes aspire to play at higher
and instruction in weight lifting and the
least keep its occurrence to a minimal level.
levels in senior high school or beyond
importance of strength development.
And that is essential to success.
their volleyball play and the enthusiasm
Many teen athletes do not have diets that
Supervision
of their parents to support this effort
are adequate for their sport participation.
education is necessary. Without a strategy
pushes young girls harder and harder to
Few, if any, regularly consume enough daily
for strengthening, girls are vulnerable to
in college. This motivation to improve
22
The Triangle Physician
is
mandatory
and
Dr. Kevin Speer, an orthopedic surgeon and shoulder specialist with Southeastern Orthopedics Sports Medicine and Shoulder Center, graduated cum laude with a bachelor’s degree in chemistry from Indiana University in Bloomington, Ind., where he was a starter on the varsity football team. He was named to the National Football Foundation College Hall of Fame Top Eleven Scholar Athletes-Football in 1980 and was an NCAA Post-Graduate Scholarship Award winner in 1980. Dr. Speer earned his medical degree at Johns Hopkins University School of Medicine, completed a general surgery internship and residency and an orthopedic residency at Duke University Medical Center. He completed a sports medicine and shoulder fellowship at the Hospital for Special Surgery in New York City, under the direction of Dr. Russell Warren. Dr. Speer can be reached at (919) 2561511. For more information visit, www. SoutheasternOrthopedics.com.
many injuries. The two areas affected most
to consume 50 grams daily. It is important
by overuse stress injuries are the shoulder
that parent and player also understand the
and low back. Strengthening of the rotator
hydration demands of this sport.
cuff and the scapula stabilizers is critical. Physicians can do a great deal to assist Strength training of the core torso muscles
young women with their volleyball athletic
is equally important, if not more so. Most
play. Engaging the parents is most critical
expert observations support that core
because they need to understand the
conditioning is not only the most important
needs of their daughters. Commensurately,
element of injury prevention but also of
it is essential that the parents engage the
athletic play development.
volleyball coaches and clubs to ensure programs are in place to develop good
Stretching has an important role. Usually
habits for the prevention of injury and
young girls are quite limber in their
enable the ultimate enjoyment of the sport.
shoulders and need little effort there. The stretching emphasis should be on the
For interested physicians who want to
hamstrings, which are routinely tight in
understand more about the strengthening
the growing young female and can impact
and stretching that can help these athletes,
the kinetic chain adversely creating injury
Dr. Paul Salamh, P.T., D.P.T., has developed
vulnerability for both the low back and
programs
shoulder.
athletes. A photo-illustrated guide to one of
specifically
for
volleyball
his volleyball injury prevention programs, A balanced diet with adequate calories is
as well as his contact information, can be
important. The emphasis should be on
found at www.ShoulderCareCenter.com.
protein. These girls should be encouraged
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September 2011
23
UNC Research News
Molecular Delivery Truck Successfully Delivers Gene Therapy Cocktail In a kind of molecular gymnastics, scientists
This inherited condition is caused by
including the brain, lungs, heart and muscle.
at the University of North Carolina at Chapel
an abnormal AAT protein that is mainly
As a graduate student at the University of
Hill School of Medicine have devised a gene
produced by the liver. An estimated 1 out of
Florida in the early 1980s, his thesis project
therapy cocktail that has the potential to treat
every 2,500 people in the United States have
was understanding and developing AAV as
some inherited diseases associated with
the condition, which is often misdiagnosed
a vector for therapeutic genes. This work
“misfolded” proteins.
as asthma or smoking-related emphysema.
eventually led to development of AAV type-2
(See http://www.alpha1.org/.) Scarring of
as a viral vector, which has been used for gene
Like strings of beads attached end-to-end on a
healthy liver tissue (cirrhosis) also may
therapy trials in cystic fibrosis, hemophilia,
chain, a given sequence of a protein’s amino
affect infants as well as adults diagnosed
Parkinson’s disease, retinal disorders and
acids usually folds into a characteristic, three-
with the condition.
in several other settings, including the first
dimensional structure. When “misfolded,”
clinical trial of gene therapy for muscular
a mutant protein’s natural biological role
Studies suggest that a build-up in liver
may be compromised, sometimes with
cells of “misfolded” abnormal AAT is
implications for disease development.
responsible for alpha-1. It is thought that
“In essence, we engineered this sophisticated
the misfolded protein builds up in the
molecular Fed-Ex truck that delivers two
This is one of the challenging research
cellular endoplasmic reticulum, the part of
payloads
arenas chosen by R. Jude Samulski, Ph.D.,
the cell that manufactures proteins, and is
involves a genetic approach that disables the
director of the UNC Gene Therapy Center
unable to move out of the liver and into the
mutant protein so that it no longer causes
and a professor of pharmacology. “Among
bloodstream.
toxicity, and the other payload provides
the roughly 5,000 genetic disorders for which
dystrophy in the United States.
simultaneously.
One
payload
a new gene to replace the protein activity
the majority of genes have been mapped,
“Alpha-1 antitrypsin plays a very important
that is missing,” Samulski said. “In this way,
there’s a subset in which the mutant or
role in the health of the lungs, preventing
Chengwen packaged both strategies into the
misfolded protein by itself can cause disease
fluid build-up, protecting against infections,”
same vector, a single therapeutic approach
symptoms – this is in addition to the lack of a
Samulski said. “But in some individuals, the
that would resolve both problems.”
normal gene,” he says. “And that has added
protein mutation they’ve acquired actually
another layer of complication faced by the
creates additional toxicity in the liver. And
The researchers delivered the gene therapy
clinical research community when trying to
so, there’s a liver pathology in addition to the
cocktail via the bloodstream and targeted it to
develop and test new treatment approaches
lung damage. You have two complications
the liver. Once there, the replacement gene
to disorders that result from toxicity
going on, and not just one involving a lack
payload and the other payload for disabling
associated with cellular accumulation of
of alpha-1 antitrypsin’s protective role in the
the misfolded protein acted independently
misfolded proteins.”
airway.”
and successfully. The authors observed
Among these disorders are cystic fibrosis,
In the study, first- and co-corresponding
AAT along with a 13- to 30-fold increase” of
Huntington disease, amyotrophic lateral
author with Samulski, Chengwen Li, Ph.D.,
therapeutic AAT in the blood circulation.
sclerosis (ALS, or Lou Gehrig’s disease) and
research assistant professor of pediatrics,
Alzheimer’s disease.
conducted a series of gene therapy
“I believe we’ve validated a path to go forward
experiments using a mouse model of the
and test this cocktail cassette approach in a
The report published in the online “Early
alpha-1 disorder. All involved the adeno-
clinical trial,” Samulski said. “This general
Edition of the Proceedings of the National
associated virus (AAV) vector as a molecular
approach has potential application to other
Academy of Sciences” during the week
delivery truck.
diseases associated with misfolded proteins,
“over 90 percent knockdown of the mutant
of Aug. 15 revealed that the Samulski lab
such as Huntington’s disease and ALS,
has focused a gene therapy approach on a
Samulski, also a member of the UNC
protein deficiency that causes serious lung
Lineberger Comprehensive Cancer Center,
and liver disease in children and adults:
has long pioneered methodologies for
Other UNC coauthors are Pingjie Xiao,
alpha-1 antitrypsin (AAT) deficiency, or
using viruses to deliver genes effectively
Steven James Gray and Marc Scott Weinberg.
alpha-1.
and safely to various targets in the body,
24
The Triangle Physician
among others.”
UNC Research News
Study of African-American Breast Cancer Awarded $19.3 Million The National Cancer Institute has awarded
largest study of its type. Our aim is to explore
In a united effort, the investigators will
$19.3 million to a current five-year UNC
the potential biologic, environmental and
focus on subtypes of breast cancer,
Lineberger Comprehensive Cancer Center’s
epidemiologic causes of this difference
especially aggressive ones, and provide
Carolina Breast Cancer Study to investigate
in cancer incidence. Our previous studies
critical answers to improving treatment and
why African-American women under the
and those of our colleagues have suggested
reducing the risk of breast cancer among
age of 45 are more likely to be diagnosed
hypotheses that we will be investigating
young African-American women.
with aggressive types of breast cancer than
with this larger group of patients.”
are women of European ancestry.
Specific issues that will be addressed with this The grant will bring together breast cancer
multi-faceted approach will include genetic
Leading this study will be University of
cases from four ongoing studies – the
susceptibility; reproductive history, lactation
North Carolina scientist Robert Millikan,
Carolina Breast Cancer Study (CBCS),
and hormonal factors; body size, early life and
Ph.D., D.V.M. He is partnering with Christine
Women’s Circle of Health Study (WCHS),
adult physical activity, and gene/environment
Ambrose, Ph.D., professor of oncology
Black Women’s Health Study (BWHS) and
interactions; and other risk factors in relation
and chair of the department of cancer
Multiethnic Cohort Study (MCS) – and more
to breast cancer subtypes.
prevention and control, division of cancer
than 5,000 controls, or healthy women.
prevention and populations science, at
African-American women under age 45
Roswell Park Cancer Institute, and Julie R.
Shelley Earp, M.D., director of UNC
have a 76 percent five-year relative survival
Palmer, Sc.D., professor of epidemiology at
Lineberger, explained, “During the last
rate compared to young white women who
the Slone Epidemiology Center at Boston
decade
including
have an 88 percent survival rate (for the
University.
Charles Perou, Lisa Carey and Robert
years 2001-2007, the most recent years for
Millikan, have demonstrated that breast
which data are available).
Millikan,
a
Barbara
Sorenson
UNC
researchers,
Hulka
cancer is not one disease, but consists of
Distinguished Professor of Epidemiology
at least five different subtypes. Their work
The Carolina Breast Cancer Study Phases I
in the UNC Gillings School of Global Public
initiated the exploration of black/white
and II enrolled more than 2,300 women with
Health and a member of UNC Lineberger
differences in breast cancer subtypes. The
breast cancer and 2,000 controls between
Comprehensive Cancer Center, has directed
current study will assemble a population
1993-2001. Phase III of CBCS will be part of
the Carolina Breast Cancer Study for more
of African-American patients large enough
the funded study and will additionally look
than a decade. He explains, “This project
to thoroughly examine the range of risk
at the outcomes of breast cancer therapy
will collect data on more than 5,000 African-
factors and genes that could be associated
in North Carolina women, both African-
American women and, as such, will be the
with the different breast cancer subtypes.”
American and Caucasian.
Foundation awards $1 Million to Develop Nanoparticle Vaccine The Prostate Cancer Foundation (PCF)
and a local biotechnology company to
Awards are designed to support cross-
awarded the UNC-Beth Israel Deaconess
develop a nanoparticle vaccine for prostate
disciplinary teams of prostate cancer
Medical Center/Harvard-Johns Hopkins-
cancer. DeSimone is Chancellor’s Eminent
investigators who are focused on highly
Liquidia
a
Professor of Chemistry in the UNC College
innovative research with potential near-term
Challenge Award of $1 million, one of 10
Technologies
consortium
of Arts and Sciences and William R. Kenan
patient benefit. These awards are given to
such awards funded by the organization.
Jr. Distinguished Professor of Chemical
projects not yet funded by any government
Engineering
or foundation program.
University of North Carolina at Chapel Hill
at
North
Carolina
State
University.
researcher Joseph DeSimone, Ph.D., will partner with scientists at two universities
DeSimone’s cross-disciplinary team of Prostate Cancer Foundation Challenge
chemists and immunologists is developing a September 2011
25
UNC Research News new immunotherapy designed to efficiently
Nanotechnology Excellence, one of seven
DeSimone will work with UNC colleagues
deliver new agents to the body in order to
centers established by the National Cancer
Mary Napier, Ph.D., and Shaomin Tian,
stimulate a patient’s own immune system
Institute’s Alliance for Nanotechnology
Ph.D.; Martin Sanda, M.D., and M. Simo
to produce cancer-fighting agents and
in Cancer Program. He is also director of
Arredouani,
Ph.D.,
attack cancer cells. This work represents
UNC’s Institute for Advanced Materials, the
Deaconess
Medical
continued progress in immunotherapy for
Carolina Institute for Nanomedicine and
University; Charles Drake, M.D., Ph.D.,
cancer – a now-validated concept once
an adjunct member of Memorial Sloan-
from
thought to be impossible.
Kettering Cancer Center.
Jonathan Smith, Ph.D., chief scientific
Johns
from
Hopkins
Beth
Israel
Center/Harvard University;
and
officer at Liquidia Technologies. Located According to DeSimone, “UNC researchers,
“These newly funded programs form an
in Research Triangle Park, Liquidia focuses
in partnership with researchers at Liquidia,
excellent,
PCF-funded
on developing highly precise particle-
will focus on the particle fabrication and
research portfolio,” said Howard Soule,
based vaccines and therapeutics for the
optimization aspects of the project, which
Ph.D., executive vice president and chief
prevention and treatment of human disease.
will involve the development of particles,
science officer for PCF. “Joseph DeSimone
DeSimone founded Liquidia in 2004.
analytical evaluation and initial testing.” The
and his cross-investigational team including
UNC team will then work with collaborators
Martin Sanda, Simo Arredouani, and
The Prostate Cancer Foundation is the
at Harvard and John Hopkins to test the
Charles Drake have a goal of changing
world’s largest philanthropic source of
particles in validated models.
clinical practice and improving outcomes
support for accelerating the most promising
for
research for better treatments and cures for
patients
patient-centric
with
advanced
prostate
DeSimone is a member of UNC Lineberger
cancer. The Prostate Cancer Foundation is
Comprehensive Cancer Center and co-
delighted to fund this innovative work.”
prostate cancer.
director of the Carolina Center of Cancer
Franklin Regional News
Medical Center Earns National Accreditation Franklin Regional Medical Center has earned
and largest standards-setting and accrediting
The Joint Commission’s national Gold Seal
body in health care. The Joint Commission
of Approval for accreditation.
accreditation and certification is recognized
“In
nationwide as a symbol of quality that
accreditation, Franklin Regional Medical
The Gold Seal acknowledges when a hospital
reflects an organization’s commitment to
Center has demonstrated its commitment
demonstrates
Commission’s
meeting certain performance standards. It
to the highest level of care for its patients,”
standards for health care quality and safety.
is often seen as health care’s version of the
said Mark Pelletier, The Joint Commission’s
The accreditation award recognizes Franklin
Good Housekeeping Seal.
executive director of hospital programs and
The
Joint
Regional’s dedication to meeting The Joint Commission’s state-of-the-art standards.
patient safety and medication management. achieving
Joint
Commission
accreditation and certification services. The Joint Commission’s hospital standards
“Accreditation is a voluntary process and I
address important functions relating to
commend Franklin Regional for successfully
“We are extremely proud of achieving The
the care of patients and the management
undertaking this challenge to elevate its
Joint Commission accreditation. Only the
of hospitals. The standards are developed
standard of care and instill confidence in the
best health care organizations receive the
in consultation with health care experts,
community it serves.”
Gold Seal,” said Jason Proctor, president of
providers, such as physicians and nurses,
Franklin Regional. “This recognition shows
measurement experts and patients.
that we are making a significant investment
For more information on Franklin Regional, visit
www.FranklinRegional.org
or
call
in creating a culture of excellence here at
To achieve accreditation, Franklin Regional
(919) 496-5131. Follow Franklin Regional
Franklin. Our staff is concentrating on this
underwent an intense, unannounced on-site
on
every day.”
survey in 2011. A team of Joint Commission
franklinregional and Twitter at www.twitter.
surveyors evaluated Franklin for compliance
com/franklinrmc.
An independent, not-for-profit organization,
with standards of care in such areas as
The Joint Commission is the nation’s oldest
infection prevention and control, leadership,
26
The Triangle Physician
at
www.facebook.com/
WakeMed News
NACHRI Accepts Children’s Hospital for Accreditation
Hospital Unveils Triangle’s First Smartphone APP for Consumers
Created for iPhone and Android devices,
Insurance subsections offer users the
WakeMed Children’s Hospital has been
the app enables users to find the closest
ability to store physician phone numbers,
accepted as an associate member of the
WakeMed facilities and search more than
medications, photo of insurance cards and
National Association of Children’s Hospitals
1,000 physicians, in addition to inputting
other personal health information.
and Related Institutions (NACHRI).
personal health and insurance information,
WakeMed
Health
&
Hospitals
recently
The Doctor Finder feature allows users
introduced the first consumer-focused hospital
to search more than 1,000 physicians
smartphone app available in the Triangle.
representing nearly every specialty and subspecialty.
and staying abreast of hospital news.
Health
Profile
and
My
The app also enables users to stay up to date on upcoming hospital events,
“Becoming a member of NACHRI is an important step for WakeMed Children’s,”
The WakeMed app is GPS enabled,
news and current events by following the
said Mark Piehl, M.D, medical director of
providing real-time identification of the
hospital’s blog, wakemedvoices.com, and
WakeMed Children’s Hospital. “The ability
nearest WakeMed Emergency Department
Facebook feeds. Emergency department
to share information with peers who, like us,
or facility. Turn-by-turn GPS directions are
wait times for the system’s five, soon- to-be
focus exclusively on children’s health care,
automatically generated from the user’s
six, emergency departments across Wake
is invaluable. Additionally, our advocacy
current location and touch-to-call phone
County will be added in the near future.
voice is much stronger in a group than it
numbers are listed for every facility. The
is alone. We are very excited to be a part of
app also includes hospital floor plans and
To download the app, visit the Android
this important national organization.”
campus maps for easier navigation.
Market, iTunes Store or visit wakemed.org.
WakeMed Children’s Hospital joins the foremost 242 children’s hospitals in the nation as a collective voice for health systems devoted to the well-being of children and their families. NACHRI associate
members
are
not-for-profit
medical institutions with a pediatric graduate education program affiliated with a medical school, a minimum daily pediatric census of 45 and recognition as a pediatric referral center. NACHRI provides members with a variety of opportunities to share best practices, benchmark performance, analyze data and
collaborate/network
with
other
members. According to a news release, these
collaborative
Managing your patients’ health is your life’s work. Managing physicians’ wealth is mine.
opportunities
can
provide invaluable support to WakeMed as it continues to enhance and expand children’s services. NACHRI also devotes significant resources to federal advocacy on issues that matter to children’s hospitals
Financial Rx for Physicians: • • • • •
Aiding Wealth Creation, Preservation and Protection Business Management Tax-strategies Liability Protection Asset Preservation
Trust your wealthcare to a specialist. The Preferred ClienT GrouP Paul J. Pittman CFP® President and Managing Director 919-459-4171 paul.pittman@pcgnc.com www.pcgnc.com Securities offered through LPL Financial Member NASD/SIPC
throughout the United States. Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers
august 2011
27
News Welcome to the Area
Physicians Melissa Tabor, DO Family Medicine Duke University Medical Center Durham
Thomas Kenneth Warcup, DO Chapel Hill
Beverly Parra Wilcher, DO Emergency Medicine Open Door Clinic Raleigh
Sasha Danielle Adams, MD UNC School of Medicine Chapel Hill
Obinna Ogochukwu Adibe, MD Dept of Surgery Div of Pediatric Surgery Durham
Adeel Ahmad, MD Duke University Hospitals Durham
Kristie Elizabeth Appelgren, MD Pediatrics Durham
For Your Health Laura Elaine Helton, MD
Andrew Phillip Stack, MD
Internal Medicine, Pediatrics Raleigh
Pediatrics Duke University Hospitals Durham
Eun-Sil Shelley Hwang, MD Duke University, Durham
Ahmed Mosharraf Khan, MD
Cary
Adrienne Christine Tounsel, MD
Paulette Andrea Green Kropf, MD
Thomas John Van De Ven, MD
Durham
Lyndon Byongkeun Lee, MD UNC Department of Ophthalmology Chapel Hill
Richard Charles Mather, MD Orthopedic Surgery Duke University Medical Center Durham
Kimberly Nicole Mims, MD Duke University Hospitals Durham
UNC Orthopaedics Chapel Hill
Stephanie Greer Norfolk, MD
Amber Leigh Bowman, MD Internal Medicine Duke University Hospitals Durham
Casey Tudor Chollet, MD
Pulmonary Disease and Critical Care, Internal Medicine Duke University Hospitals Durham
Okechukwu Emeka Nwoko, MD
Duke University Medical Center Durham
Orthopedic - Surgery of the Hand Duke University Hospitals Durham
Brian Joseph Colin, MD
Onajite Onaodowan, MD
Anesthesiology Duke University Hospitals Durham
Shannon Amber Covey, MD Pathology University of North Carolina Hospitals Chapel Hill
Melissa Anne Daubert, MD Durham
Andrea Renata Dean, MD Internal Medicine University of North Carolina Hospitals Chapel Hill
Kristin Lynn Donoghue, MD Cornerstone Pediatric & Adolescent Medicine Cary
Cauveh Erami, MD Pediatrics, Pediatric Cardiology Duke University Hospitals Durham
Ryan Jeffrey Fink, MD Anesthesiology Duke University Hospitals Durham
Stephanie Ann Fritch Lilla, MD Duke University Hospitals Durham
Allen Thomas Grady, MD Radiology University of North Carolina Hospitals Chapel Hill
Louis Karl Haase, MD Southern Pines
28
The Triangle Physician
Cary
Internal Medicine Duke University Hospitals Durham
Vinay Kumar Narotam, MD
Hitesh Avaiya, MD
Nandita Regmi Subedi, MD
4130 Garrett Road Durham
Madhvi Hiren Patel, MD Nash General Hospital Rocky Mount
Derek Brandon Pyles, MD Durham Regional Hospital Durham
Rachel Mary Reilly, MD Orthopedic Surgery Duke University Orthopaedics Durham
Amy Lynn Rezak, MD Division of Trauma and Critical Care Surgery Chapel Hill
Rodney Kevin Sessoms, MD Internal Medicine Sessoms Medical Practice Clinton
Abhay A Singh, MD Urology Duke University Hospitals Durham
Sarah Elizabeth Smithson, MD Chapel Hill
John Michael Solic, MD Orthopedic Surgery Triangle Orthopaedic Associates Durham
Deborah Vinson Spencer, MD University of North Carolina Chapel Hill
Duke Urgent Care - South Durham
Anesthesiology Duke University Hospitals Durham
Ida Janelle Wagner, MD University of North Carolina Hospitals Chapel Hill
Emma Rebecca Williams, MD Family Medicine Carrboro
Grant Richard Williams, MD Internal Medicine University of North Carolina Hospitals Chapel Hill
Free Prostate Cancer Screenings This year more than 240,000 men will be diagnosed with new cases of prostate cancer and more than 33,000 men will die from the disease, according to the National Cancer Institute. Yet, prostate cancer is treatable if diagnosed early, said Dr. Raj Pruthi, chief of urology at UNC Hospitals and a member of the UNC Lineberger Comprehensive Cancer Center. “A simple prostate exam and PSA blood screening can lead to early detection and treatment. It’s important to know your score.” UNC Health Care is offering free prostate cancer screenings from 1-6 p.m. on Wednesday, Sept. 21 and Thursday, Sept. 22 in the Urology Clinic on the second floor of N.C. Memorial Hospital, 101 Manning Drive, on the UNC-Chapel Hill campus.
Kimberly Woodward, MD Anatomic and Clinical Pathology University of North Carolina Hospitals Chapel Hill
Physician Assistants Tracelynn Jennings, PA WakeMed Faculty & Physicians Raleigh
Men who are 40 years old or older, or who have a family history of prostate cancer, may make an appointment in advance by calling (919) 966-1315. They may also walk in without an appointment on either day. Free parking will be provided for men who are screened.
“More than a doctor. Like a friend.”
Trust. WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it. We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution. And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.
Cardiovascular Professionals in Johnston County Mateen Akhtar, MD, FACC Benjamin G. Atkeson, MD, FACC Kevin R. Campbell, MD, FACC Randy A.S. Cooper, MD, FACC Christian Gring, MD, FACC
Matthew A. Hook, MD, FACC Eric M. Janis, MD, FACC Diane E. Morris, ACNP Ravish Sachar, MD, FACC Nyla Thompson, PA-C
WHV Locations in Johnston County 910 Berkshire Road Smithfield, NC 27577 Phone: 919-989-7909 Fax: 919-989-3147
2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520 Phone: 919-359-0322 Fax: 919-359-0326
When it comes to your cardiovascular care – We know it by heart. To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).
We know it by heart. Cardiovascular Services Echocardiography Nuclear Cardiology Interventional Cardiology Carotid Artery Interventions Cardiac Catheterization Cardiac CT Angiography and Calcium Scoring Electrophysiology and Cardiac Arrhythmias Peripheral Vascular Interventions Pacemakers / Defibrillators Stress Tests Holter Monitoring Lipid and Anti-Coagulation Clinics Vascular Ultrasounds / AAA Screening
©2011 Wake Radiology. All rights reserved. Radiology saves lives.
One More Day To Take Care of Yourself. Screening Mammograms on Saturdays. We understand that life can get hectic, and taking care of one’s self often gets pushed to the bottom of the list. Wake Radiology’s Breast Imaging Centers are committed to women’s wellness and want to make scheduling this important annual screening exam a little easier, so we now offer evening and Saturday appointments. Our board certified radiologists and highly trained registered technologists take time to accommodate the specific needs of each patient and look forward to serving the women of the Triangle with compassion and care.
Scan now to request a Screening mammogram with your smartphone.*
Your patient’s can call, go online 24/7, or use a smart phone to request a screening mammogram at a time that fits their busy schedule. They will find one of our nine Breast Imaging Centers close to where they live, work, and shop. Wake Radiology is the only multi-site outpatient imaging service provider in the Triangle to receive the American College of Radiology’s designation of Breast Imaging Centers of Excellence. Wake Radiology. Making healthcare more convenient. PROUDLY SUPPORTING THESE IMPORTANT ADVOCATES FOR WOMEN
*To access, use any QR Reader App for a smartphone or iPod Touch (use AT&T Reader).
CALL 1 NUMBER TO SCHEDULE AT THE LOCATION OF YOUR CHOICE | 919-232-4700 | wakerad.com