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
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.

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
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
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

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
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
UC201004100 EN © Medtronic, Inc. 2011. Minneapolis, MN. All Rights Reserved. Printed in USA. 02/2011
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.

www.medtronic.com

World Headquarters Medtronic USA, Inc. Patient Line:

Medtronic, Inc. Toll-free: 1 (800) 328-2518 Tel: 1 (800) 551-5544
710 Medtronic Parkway (24-hour technical support 7:00 am to 6:00 pm CT M-F
Minneapolis, MN 55432-5604 for physicians and medical Fax: (763) 514-1855
professionals)
USA 24-hour information available
Tel: (763) 514-4000 on www.medtronic.com
Fax: (763) 514-4879
We help you get back to your life
After a disabling illness or injury, are led by a board-certified
all you want to do is get back to rehabilitation physician. Other team
your life—as quickly as possible. members include nurse practitioners,
rehabilitation nurses, physical
Durham Rehabilitation Institute at
therapists, speech therapists, and
Durham Regional Hospital helps you
others dedicated to providing
regain your independence with care
personalized care to meet each
delivered in a warm, compassionate
patient’s needs.
environment.
Top-rated rehabilitation care with the
Durham Rehabilitation Institute is
convenience of a community hospital:
an award-winning facility that
this is Durham Regional Hospital.
provides comprehensive, state-of-
the-art care. Treatment programs For physician referrals, call 919-470-7226.

durhamregional.org

8114
 Contents

COVER STORY

6
M ay 2 011
Cary Orthopaedic & Sports Medicine
Thrives on a Tradition of Excellence
Vol. 2, Issue 5

FEATURES DEPARTMENTS

10
LASIK
Ophthalmology 21
Raleigh Radiology’s
Radiology
11 Orthopedics
Total Ankle Replacement Is Revolu-
tionizing Care of Ankle Arthritis

Advances Benefit the Military
Dr. Dean Dornic explains how the military
has embraced advances in laser-assisted in
situ keratomileus.
12 Your Financial Rx
Reduce Your Investment Pain Threshold
Musculoskeletal Team
Offers Image-Guided Pain 14 Sleep Medicine
Sleep Apnea Requires Specialized
Management Attention
Dr. Jeffrey Browne gives an overview of the 16 Orthopedics
pain management uses and methods of Double Bundle Technique Improves
Anterior Cruciate Ligament Outcomes
image-guided injections.
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 replace-
ment, and Hospital of Choice Award

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

27 News
Upcoming events, welcome, new offices
and clinical trials
2 The Triangle Physician
JOHNSTON
HE ALTH
 From the Editor

Spring into Health

It’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 Editor
and physical therapists, such as those at Cary Orthopaedic Sports Medicine and Spine Heidi Ketler, APR heidi@trianglephysician.com

Specialists. This finely tuned team is standing by to provide early and proper diagnosis
Contributing Editors
so patients can get back to the games of life faster, more fully and with less pain. Ker Boyce, M.D., F.A.C.C., F.A.C.P.
Jeffrey Browne, M.D
Giridhar Chintalapudi, M.D.
Weight management increases in importance as the weather warms. Overweight Dean Dornic, M.D.
and obesity comprise a national problem. Its toll on human life weighs heavy on the Mark Galland, M.D.
Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G
economy. And despite all the marvels of modern medicine, data suggests overweight
Selene G. Parekh, M.D., M.B.A.
and obesity are increasing. A beacon of hope is the Medi-Weightloss Clinic. Its regimen Paul Pittman, C.F.P.
that includes ongoing counseling and medical supervision is possibly the surest,
Photography
healthiest approach to long-term weight management. Jim Shaw Photography jimshawphoto@earthlink.net

Creative Director
Also on the orthopedic front, Dr. Mark Galland reviews how a new double-bundle surgical
Joseph Dally jdally@newdallydesign.com
technique improves anterior cruciate ligament outcomes. Dr. Selene Parekh focuses on the
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 The Triangle Physician is published by
New Dally Design
planner Paul Pittman talks about avoiding the very real pain felt when investment returns 9611 Ravenscroft Ln NW, Concord, NC 28027
are poor. Dr. Jeffrey Browne explains image-guided pain management.
Subscription Rates:
$48.00 per year
The Triangle Physician welcomes two new contributors. Dr. Dean Dornic writes about $6.95 per issue
the benefits of laser-assisted in situ keratomileus (LASIK) surgery to the military. Dr.
Advertising rates on request
Giridhar Chintalapudi (aka Dr. Chin) reviews the diagnosis and treatment of sleep apnea. Bulk rate postage paid Greensboro, NC 27401

Every precaution is taken to insure the accuracy of

Spring also is a great time to evaluate your practice marketing strategies. If you haven’t
the articles published. The Triangle Physician can
done so already, incorporating The Triangle Physician into the mix makes a lot of sense. not be held responsible for the opinions expressed
Consider that it is the only publication of its kind, dedicated to the Triangle medical or facts supplied by its authors.

profession. Opinion expressed or facts supplied by its authors

are not the responsibility of The Triangle Physician.
However, The Triangle Physician makes no warrant
Our sincere gratitude for all you do. Happy spring!
to the accuracy or reliability of this information.

All advertiser and manufacturer supplied photog-

Heidi Ketler
Editor
raphy will receive no compensation for the use of
submitted photography.

Any copyrights are waived by the advertiser.

No part of this publication can be reproduced or

transmitted in any form or by any means without
the written permission from The Triangle Physician.
4 The Triangle Physician
 On the Cover
Cary Orthopaedic
& Sports Medicine
Thrives on a Tradition of Excellence
By Heidi Ketler
Known as a hotbed of athletic activity, the
Greater Raleigh and Triangle region experi-
ences its share of sports-related injuries. For
29 years Cary Orthopaedic & Sports Medi-
cine Specialists has been filling the need for
high quality diagnosis and treatment of these
injuries and many other orthopaedic related
conditions.
Since opening its doors in 1982, Cary Or-
thopaedic has grown with the community
to offer a comprehensive range of surgical,
non-surgical and rehabilitative services. The
practice is comprised of a team of orthopae-
dic sports medicine and spine-specialized
surgeons, physiatrists and physical thera-
pists at three separate locations.
PHOTO BY BRYAN REGAN PHOTOGRAPHY
Dr. Andersen provides diagnosis and treatment of an injured wrist
6 The Triangle Physician
All nine orthopedic surgeons are fellowship
trained. In addition to general orthopedics
and sports medicine, the range of specializa-
tion includes arthroscopic and reconstruc-
tive surgery, total joint replacement and
minimally invasive spine surgery.
Cary Orthopaedic Sports Medicine and
Spine Specialists is distinguished by its tradi-
tion of excellence that ensures every initial
patient encounter begins with an orthopae-
dic physician evaluation. “A hallmark of this
practice is continually striving to provide
early and proper diagnosis which can help
prevent prolonged difficulties and provide
the greatest value for the health care dollar
spent,” says Michael Mazzella, Cary Ortho-
paedic Chief Operating Officer.
The practice now encompasses Cary Ortho-
paedic Spine Specialists, offering a total ap-
proach to spine care. Garner Orthopaedic
Sports Medicine & Spine Specialists pro-
vides a similar offering to that community
and surrounding counties. All three ortho-
paedic locations have a dedicated Perfor-
mance Physical Therapy facility on site.
Teamwork a Practice Hallmark
“Excellence in Sports medicine and Ortho-
pedics requires that we’re all on the same
page to meet patient goals as quickly and
safely as possible,” says Douglas L. Golle-
hon, M.D., senior partner. “To ensure the
very best outcome ideally we involve the
physician, parents, the athletic trainer and
coach as part of the team focused on return-
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 Hurri-
canes, Carolina RailHawks and Carolina Bal-
let to scholastic athletes, recreational week-
end warriors and elite triathletes.
“This is a very diverse athletic market, not
just for professional sports,” says Susan
McArdle, Cary Orthopaedic Business Man-
ager. “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 lev-
el of care that provides enhanced freedom
of movement without pain for all types of
musculoskeletal problems. “Our patient’s
goals can be as diverse as walking down
the driveway to get the newspaper to the
highest level of training to qualify for a ca-
reer in professional athletics,” says Doug-
las J. Martini, M.D. “Even if a patient is not
a high-level athlete or a recreational or
scholastic athlete, we treat them all with
the same high level of expertise and ex-
pectation.”
Knee ligament
reconstructive surgery
Injury to the anterior cruciate ligament, or
ACL, is common among the high-level ath-
letes and the recreationally active popula-
tion. This ligament serves as the primary
restraint to forward and pivoting motion of
the shin bone. An ACL tear can be a debili-
tating sports injury.
With the appropriate diagnosis and treat-
ment approach, “the prognosis for recov-
ery is excellent,” says William K. Andersen,
M.D. Surgical reconstruction of a torn ACL
is usually recommended for patients who
are less than 25 years old, regardless of ac-
tivity level, because they tend to have prob-
lems with instability and frequent episodes
of the knee giving way. Given the advances
in ACL reconstruction and the accelerated
approach to rehabilitation, this surgical pro-
cedure is often recommended to a wider
active patient population than in the past.
Preoperatively, “it is important to regain mo-
tion 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 recon-
struction 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
order to withstand the repetitive stresses of
sports activities.
Most orthopaedists recommend a minimum
of six months of progressive physical ther-
apy before returning to competitive sports.
ACL rehabilitation involves a progression of
therapeutic and sport-specific activities. The
experienced physical therapist makes the
best determination as to whether or not the
patient is able to safely progress.
Approach to Arthritic Joints
Osteoarthritis is a common, progressive and
debilitating disease that occurs commonly
at the knee, hip and shoulder. The first line
of treatment for osteoarthritis aims to relieve Dr. Carroll evaluates for a rotator cuff injury
pain with nonsteroidal anti-inflammatory
drugs, along with physical therapy, applica- tive overhead activities. “Those susceptible
tions of a topical analgesic and injections of to overuse-related problems are athletes
a corticosteroid. who engage in repetitive overhead arm
movements, like throwing. Degenerative
Viscosupplementation is commonly used changes in the shoulder may contribute to
to treat chronic osteoarthritis of the knee if the problem in active older adults,” says Ray-
conservative treatments fail. It involves the mond M. Carroll, M.D.
injection of gel-like substances (hyaluro-
nates) into the knee joint to supplement the Most patients experience pain relief and im-
viscous properties of synovial fluid. The pa- proved shoulder function through non-sur-
tient will receive three to five injections over gical treatment, including anti-inflammatory
the course of several weeks. Positive effects medicine and strengthening exercises. Sur-
can last several months. gery may be considered if a rotator cuff tear
is acute and painful, if it is in the dominant
Shoulder Injuries and Treatment arm of the active individual or if maximum
A rotator cuff injury may result from a trau- overhead arm strength is required for work
matic event or develop gradually with repeti- or sports.
Dr. Armour performs specific orthopaedic maneuvers to assess the extent of a knee injury
MAY 2011 7
Proactive Approach to Recovery
Cary Orthopaedic & Sports Medicine
Specialists’ rehabilitation service, PER-
FORMANCE Physical Therapy, provides
highly trained and experienced physical
therapists to guide patients through “pre-
habilitation” 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, re-
duce pain and swelling, and enhance ba-
sic strength, setting the stage for a quicker
comeback.
Therapy pre- or post-operatively allows for
accelerated recovery. “So, they’re a step
ahead of the game,” says Marc Capannola,
Clinical Director of PERFORMANCE, add-
ing, “Patients also get a mental lift know-
ing 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 quick-
er initiation of the rehabilitation program
for a patient who is not ready to do an ac-
tivity 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.
8 The Triangle Physician
Spine Specialists Center Offers
“Dedicated Care for the Spine”
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 surgi-
cal 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-sur-
gically through a tailored physical therapy pro-
gram or spinal injections.”
When symptoms don’t improve after two or
three months of conservative treatment, sur-
gery may be a solution.
Traditional surgical treatment for a degenera-
tive 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 disk-
joint complex. This allows the neck to maintain
motion and prevents adjacent-level arthritis.
Approximately two-thirds of adults suffer from
low back pain at some time in their lives. Com-
mon causes include myofascial dysfunction,
degeneration of the disc or facet joints, spon-
dylolisthesis, spinal stenosis and compression
fractures.
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 possi-
ble fusion. Patients are in the hospital for sever-
al days and may suffer from chronic back pain.
The minimally invasive X-STOP procedure revo-
lutionized 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.
Compression fracture of the vertebral body is
common in older adults. Conservative treat-
ment includes bed rest, pain control and physi-
cal 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 un-
der 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 Or-
thopaedic 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-guid-
ed 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 compre-
hensive 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 long-
term narcotic analgesics.
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 tech-
niques, and are guided on maintaining proper
body mechanics.
Physician Referrals
Cary Orthopaedic Spine Specialists accepts
direct referrals for neck and back problems
requiring evaluation, management, surgical
treatment, physical therapy and/or interven-
tional spinal injections.
Spine Specialists
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.

Help End
Childhood
Within a Generation
Obesity
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.
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.
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
By National Dairy Council
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
Nutrition Article
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.”
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 9
 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
war in 2003, the military airlifted 60 service
members out of the region because of
severe corneal ulcers caused by contact
lens wear. The military now forbids contact
lenses because of the risks associated
with dusty and dirty conditions. And
while contact lens wear can be dangerous
in combat situations, eyeglasses can be
impractical. Even if the glasses don’t break,
they often can hinder soldiers on missions.
The spectacles can fog up, fall off or make
putting on a gas mask a cumbersome and
time-consuming task when seconds matter.
Many people want to get laser eye surgery
so they can be free of the hassles of glasses
or contacts. But many service members
deploying to Iraq and Afghanistan are
rushing to get it done for much different
reasons. They are getting the surgery
because it could save their life.
Over the years, vision correction technology
has evolved such that LASIK (laser-assisted
in situ keratomileus) has proven to be a
safe and effective procedure. This has led
to a growing acceptance of LASIK in the
military.
The United States armed forces have
embraced LASIK as a way to make troops
“combat ready.” Laser vision correction
has been allowed for all aspects of
military service, including aviation, special
operations and support personnel. It also is
approved for NASA astronauts. The Air Force
10 The Triangle Physician
now allows LASIK in all aviators, including Acceptance of the new and improved
those in high-performance aircraft. LASIK eye surgery by the Department of
Defense has helped make our troops better
Although the most common types of laser and safer.
eye surgery can cost between $2,500 and
$5,000 for both eyes at a private doctor,
active military personnel can now receive
LASIK free at one of 25 Warfighter Refractive
Eye Surgery Program centers.
Since its introduction to the Armed Forces
in 2000, more than 300,000 refractive
surgery procedures have been performed
at military hospitals, and more than 45
studies have been conducted to determine
the safety and efficacy of laser vision
correction among military personnel.
The Navy is currently undertaking a study
on Naval aviators. To date, more than
200 aviators have been enrolled in the
study. The results of the study have been
outstanding. Aviators were able to return to
flight status within four weeks after LASIK.
Patient satisfaction has been excellent.
One hundred percent were able to achieve Dr. Dean Dornic is founder and medical
20/20 levels of vision. There were no director of the Laser Eye Center of Carolina.
A board-certified, fellowship-trained vision
complaints of significant glare, halos, haze
correction specialist, he has more than
or sharpness of vision. Ninety-eight percent 15 years of surgical experience and has
felt that LASIK helped their effectiveness performed thousands of successful LASIK
procedures. He was selected as one
as a naval aviator and 98 percent indicated of “America’s Top Ophthalmologists” by
they would definitely recommend LASIK to Consumer’s Research Council of America and
was named a LASIK Gold surgeon – an honor
their fellow aviators.
bestowed upon the top 50 LASIK surgeons
nationwide by Sightpath Medical. Dr. Dornic
Innovations, such as blade-free and has lectured at international meetings and
trained other surgeons on LASIK. For more
wavefront-guided technology, have made information, visit www.visionauthorities.com.
the LASIK procedure better and safer.

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
causes substantial pain, disability and loss in
quality of life. In fact, a recent study published
in 2008 demonstrated end-stage ankle arthritis
to be as debilitating as hip arthritis.
Until recently, conservative options, such as
injections, bracing and anti-inflammatories,
have been used to delay surgery. When
surgery was needed, the best option was
a surgical ankle fusion. This would relieve
pain, but unfortunately, leave patients
with a loss of motion in the ankle, a limp,
and make the knee and subtalar joints
susceptible to arthritic changes. These
issues have made clinicians, orthopedic
surgeons, researchers and ankle implant
companies seek other solutions.
Total ankle replacement (TAR) has been
available in the United States since the
1970s. The earlier generations of ankle
replacements were plagued with failures.
However, the most recent, third-generation
implants have overcome many of the
shortcomings of these earlier implants.
This has renewed the interest in TAR.
Currently in the United States, there are
three TAR systems available: the STAR, the
Salto and the Inbone. These implants have
been available in Europe for years, with
promising medium- and long-term results.
In the U.S., the Inbone was approved in
2005, the Salto in 2006 and the STAR in 2009.
The goals of TAR surgeries are to reduce
pain, while preserving a natural range
Orthopedics
Dr. Selene G. Parekh is
an associate professor
of orthopedic surgery
at the North Carolina
Orthopaedic Clinic
and Duke University,
Department of
Orthopaedic Surgery.
of motion. The third-generation implants His research and
clinical interests include total ankle replacements,
require smaller bone cuts, are more
foot and ankle injuries of athletes, minimally
anatomical and better able to restore invasive foot and ankle trauma surgery, tendon
natural ankle motion. 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
The ideal candidate for a TAR suffers from
speaker at regional, national and international
post-traumatic ankle arthritis or rheumatoid meetings, helping to teach other orthopedic
arthritis, is less than 250 pounds and is 50 surgeons about novel techniques for the care of
foot and ankle patients.
years of age or older with little or no major
ankle deformity. However, this is changing
and physical exam, followed by weight-
as orthopedic foot and ankle surgeons gain
bearing radiographs. At times, a computed
more experience with these implants and
tomography scan may be needed to provide
techniques. Depending on the specifics of
more anatomical details. Based on these
a patient, TAR surgery is being performed at
findings, treatment options are reviewed
an earlier age, with greater deformities and
with the patient. If a patient is a candidate
with a larger body mass index.
for a TAR, a medical clearance and dental
evaluation to eliminate a possible source of
The evaluation of a patient with ankle
infection are requested.
arthritis begins with a thorough history
The surgery for TAR requires an overnight
stay. The patient is made non-weight bearing
for four to six weeks. Thereafter, intense
physical therapy is required to gait train and
strengthen the ankle. Most patients note a
tremendous improvement in their quality of
life, being able to perform activities, such
as walking, yoga, golf and swimming, which
they may have lost for years.
Total ankle replacements are revolutionizing
the care of ankle arthritis. Pain relief,
preservation of adjacent joints, restoration
of ankle motion and a more normal gait
are some of the benefits of third-generation
TAR procedures. Patients should be made
aware of this treatment option, as it holds the
promise of transforming their quality of life.
MAY 2011 11
 Your Financial RX

Reduce Your Investment

Pain Threshold
Pain 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?
“Are you having any pain today? On a scale
of 1 to 10, what is your current pain level?”
The nurse asked me these questions during
my last few doctor visits. Thank goodness, I
have not had any pain for quite awhile, but
it makes me wonder: What is a level 1? What
is a level 10?
I have had a physician tell me that I was going
to feel some “pressure” during a procedure.
“Pressure” must be the buzzword for “this is
a 5 on the pain scale.” (By the way, using the
word “pressure” instead of “pain” doesn’t
minimize the experience.)
so small I was going to be able to pass it on
my own. Sure enough, 12 hours later, I heard
the unmistakable “clink” in my urine screen.
If this wasn’t a 10, then I can only hope
that a 10 involves blacking out. I had been
on painkillers that could have stopped that
charging rhino in his tracks, and the stone
wasn’t much bigger than a decimal point on
this page.
How could something so small bring a
rough and tough six-foot man to the ground?
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
level?
What I have witnessed in 24 years in this
business is that something as small as a
decimal point can raise an investor’s pain
level immediately to a 10. Usually the source
of pain is not the decimal point, but the
location of that decimal point.
Your broker might be telling you that this is
“pressure.” Now we all understand this term
much better.

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

12 The Triangle Physician

 This is not to say that owning these posi- pain and accept what is shoveled at you.
Paul J. Pittman is a
Certified Financial tions is a bad thing, but owning them several Take the time, break the chain, find out
Planner™ with The times is. It raises your risk level many times what is right for you and your family! It is
Preferred Client
Group, a financial over. True allocation is broad, covers many too important to keep on doing what you
consulting firm for asset classes, styles and countries, but most have always done and expect a different
physicians in Cary,
importantly, it is designed specifically for outcome.
N.C. He has more
than 25 years of you. Your investment profile, risk tolerance
experience in the and goals are as individual as your Did you know 94 percent of all active money
financial industry and is passionate about
investor education. He is also a nationally fingerprint. mangers under-perform their respective
sought-after speaker, humorist and writer. indexes? Are you in the 94 herd or the elite 6?
Mr. Pittman can be reached at (919) 459-4171
Here again, I strongly advise you to find a
and paul.pittman@pcgnc.com.
qualified person to help you develop your Until next month, good health and
personal allocation. Do not live with your happiness.
How does the movement of the decimal
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 13
 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.
About 70 million Americans suffer from
a sleep problem and nearly 60 percent of
them have a long-term disorder. Even though
sleep problems are very common, they are
very often undiagnosed and untreated. One
of the most common sleep problems is
sleep apnea. It is estimated that 4 percent of
middle-aged men and 2 percent of middle-
aged women suffer from sleep apnea.
In sleep apnea, you have one or more pauses
in breathing while you sleep. You often move
out of deep sleep and into light sleep when
your breathing pauses or becomes shallow.
This results in poor sleep quality that makes you
tired during the day. Sleep apnea is one of the
leading causes of excessive daytime sleepiness.
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.
oxygen causes the brain to send a signal for
you to wake up, so you open up the airway
in your throat and start breathing again. If
you have sleep apnea, this cycle may repeat
as often as 50 or more times an hour.
The frequent drops in oxygen level and
reduced sleep quality trigger the release of
stress hormones. These compounds raise
heart rate and increase your risk of high blood
pressure, heart attack, stroke and arrhythmias
(irregular heartbeats). The hormones also
raise the risk of, or worsen, heart failure
Untreated sleep apnea also can lead to
changes in how your body uses energy.
These changes increase your risk of obesity
and diabetes.
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
to judge how severe the problem is. Your
family members or bed partner often will
notice these problems before you do.
Other signs and symptoms of sleep apnea
may include: morning headaches; memory
or learning problems and not being able to
concentrate; feeling irritable, depressed, or
having mood swings or personality changes;
urination at night; and a dry throat when you
wake up.
Another common sign is fighting sleepiness
during the day, at work or while driving.
You may find yourself rapidly falling asleep
during the quiet moments of the day when
you’re not active.

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

14 The Triangle Physician

 Dr. Giridhar
Chintalapudi (“Dr. Leasing Opportunity with Ownership Potential
Chin”) earned his
medical degree from Wesvill Medical & Professional Center
Kurnool Medical 2304 Wesvill Court Raleigh, NC 27607
College, India.
Before moving to
the United States, Medical Space Available in Rex Hospital Vicinity
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.

If a patient has problems breathing during

sleep, even if he doesn’t have daytime
sleepiness, he should talk with his doctor.

Treatment Can Restore Janet Clayton, CCIM

919.420.1581
Regular Breathing janet.clayton@tlgcre.com
Doctors diagnose sleep apnea based on Independently Owned & Operated

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
Managing your patients’ health is your life’s work.
for diagnosis and treatment. A sleep study is Managing physicians’ wealth is mine.
the most accurate test for diagnosing sleep
apnea. It records what happens with your Financial Rx for Physicians:
breathing while you sleep. • Aiding Wealth Creation, Preservation
and Protection
The goals of treating sleep apnea are to • Business Management
restore regular breathing during sleep and • Tax-strategies
relieve symptoms, such as loud snoring • Liability Protection
and daytime sleepiness. Lifestyle changes, • Asset Preservation
mouthpieces, breathing devices and surgery
Trust your wealthcare to a specialist.
may be used. Medicines typically aren’t used
to treat the condition. 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
high blood pressure. Treatment also can paul.pittman@pcgnc.com
www.pcgnc.com
reduce your risk of heart disease, stroke
and diabetes. If a patient has sleep apnea, Securities offered through
LPL Financial
he should talk with his doctor or sleep
Member NASD/SIPC
specialist about the treatment options that
will work best. Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers

MAY 2011 15
 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
has evolved! In the all-too-recent past, tearing
one’s anterior cruciate ligament meant the
end of an active lifestyle and certainly the
end of many promising athletic careers.
New advances in surgical technique and an
enhanced understanding of the anatomy of
the ligament have improved the prognosis for
athletes suffering this once-devastating injury.
The anterior cruciate ligament (ACL) is a
ligament located in the middle of the knee
that connects the femur to the tibia. It is
a critical ligament that stabilizes the knee
during sports and physical activity. The
ACL is usually injured during a pivoting
or cutting motion and can occur with or
without contact.
ACL injuries have become more common
as participation in sports has increased.
As a result, ACL reconstructive surgery is
now one of the most common orthopedic
procedures.
New advances have greatly improved the
surgical technique of ACL reconstruction.
Traditionally ACL reconstruction has
focused on reconstruction of a single strand
or “bundle” of fibers. The results have been
largely successful in restoring knee stability
and returning athletes to play.
Unfortunately, many still experience some pain
16 The Triangle Physician
and feelings of instability even after successful
surgery and rehabilitation. Still, others are
unable to return to their previous levels of
activity, and once-promising athletic careers
are ended. Moreover, knees reconstructed
with the traditional single-bundle technique
may be more prone to re-injury and often
develop arthritis many years later.
ACL Reconstruction Single Bundle technique.
Reproduced from: Vangsness CT. ACL
Reconstruction Orthopaedic Procedures, 2010.
The latest research may explain these
uninspiring results. Through extensive
laboratory analysis, we have learned that
the ACL is composed of two separate
and distinct portions, or “bundles.”
Each functions independently and in
concert. Knowing this, it is reasonable to
conclude that reconstruction of only one
portion (and ignoring the other) will only
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
stabilize the knee and preserve the joint
from degenerative arthritis.
The newest and most progressive surgical
technique for ACL reconstruction is called
the anatomic double-bundle technique and
is superior to the single-bundle technique
in many ways.
Early results suggest that the anatomic
double-bundle technique decreases the
likelihood and severity of the post-surgical
problems associated with traditional single-
bundle technique, while increasing overall
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.
This success is accomplished in the double-
bundle technique by accurately replacing
and restoring the native ACL.
Currently only a select few surgeons are
trained in and are performing this ground-
breaking technique. It is much more
technically demanding to perform, but there
 Women’s Health
Diabetes

May
Dr. Mark Galland of The Triangle Physician
Orthopaedics
Orthopaedic Specialists
of North Carolina is
2011 Editorial Calendar
Allergies
a board-certified
June
orthopedic surgeon,
specializing in sports Vision
medicine and practicing Neurology
in Wake Forest and
North Raleigh. He serves July
as team physician and orthopedic consultant Imaging Technologies
for the Carolina Mudcats, the AA affiliate of Interventional Radiology
the Cincinnati Reds, as well as several area
high schools and colleges. Dr. Galland is a August
recognized expert in knee injuries and double-
Infectious Diseases •
bundle ACL reconstruction. He can be reached
at (919) 562-9410 or by visiting www.orthonc. Pediatrics •
com or www.drmarkgalland.com.
September •
Sports Medicine •
is little doubt that, one day, this double-
Schematic shows double-bundle ACL reconstruction. Prostate Cancer
bundle technique will be “The Standard.” Reproduced from: Casagranda BC, Maxwell NJ, •
Kavanagh EC, Towers JD, Shen W, Fu FH. Normal
Appearance and Complications of Double-Bundle
October •
We have entered a new era in sports and Selective-Bundle Anterior Cruciate Ligament Breast Cancer •
Reconstructions Using Optimal MRI Techniques. Neurosurgery
medicine. Athletes suffering a once American Journal of Radiology. 2009; 192:1407-1415. •
potentially devastating injury may now have November
a reconstructive surgery to truly restore the structures in the knee to a near normal state. Urology •
knee to its normal state. When suffering You can resume your life of physical activity Alzheimer’s
a major knee injury such as an ACL tear, and sport participation with the confidence December
surgeons who perform the anatomic that your knee is structurally sound. Pain Management Im
double-bundle technique may restore the Sleep Disorder Clo
Dec

SANDHILLS SLEEP DISORDERS CENTER

Dr. G. Chin, (Chintapudi) MD, DABSM Dr. H. Tellez, MD

Board Certified Sleep Medicine Board Certified Neuromuscular Medicine
Board Certified Neurology 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 • www.SNSleepSolutions.com
295 Olmstead Blvd., Suite 12 112 Dennis Drive 609 Attain Street, Unit 101
Pinehurst, NC 28374 Sanford, NC 27331 Fuquay-Varina, NC 27526
(910) 235-0595 (919) 708-5008 (919) 552-8917

MAY 2011 17
 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
disorder resulting in hospitalization. With the
increasing population and the aging of the
baby boomers, it is becoming more prevalent
in every cardiologist’s practice.
Atrial fibrillation (AF) was probably first
described by the Chinese emperor physician
Huang Ti in his classic medical treatise about
2000 BC. The first modern description of AF
is credited to William Harvey in 1628, with
his observations of animal hearts. Willem
Einthoven published the first echocardiogram
recording of AF in 1906, calling it “pulsus
inequalis et irregularis.”
William Withering reported in 1785
administering digitalis leaf to patients with
heart failure. He noted that those with an
irregular pulse would improve and their pulse
would become steady. Karel Wenckebach in
1914 reported the use of quinine for AF after
a Dutch sailor told him how his palpitations
improved while taking quinine for malaria.
Walter Frey later reported that quinine’s
stereoisomer, quinidine, was more effective.
Atrial fibrillation was often categorized
as paroxysmal, persistent or chronic
(now permanent) for clinical purposes.
However, for most of the next century, our
understanding and treatment of AF did not
change significantly.
18 The Triangle Physician
That has changed in the last two decades,
as we have seen a phenomenal growth in
our understanding of its pathophysiology.
Michel Haissaguerre’s group first reported
the recording of pulmonary vein potentials
in 1998. This quickly led to the concept that
paroxysmal AF is often triggered by ectopic
atrial tachycardias that commonly arise
from one or more of the pulmonary veins.
Persistent/permanent AF is usually associated
with enlarged atria and myocardial fibrosis,
which supports multiple wavelets.
New Treatment Frontier
This progress in understanding has led
to new options for therapy. The treatment
of AF still has three goals: prevention of
thromboembolism by anticoagulation,
ventricular rate control and rhythm control to
restore a sinus mechanism.
Numerous studies have been completed
showing the benefit of warfarin in AF.
The recent release of dabigatran, a direct
thrombin inhibitor, now offers an alternative.
Rate control is usually accomplished with
verapamil, dilitiazem and/or betablockers.
A nonpharmacologic alternative is AV
junction ablation and permanent pacemaker
implantation.
Rhythm control has historically been
relegated to medications. There are numerous
agents such quinidine, flecainide, sotalol, and
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.
amiodarone, to name a few. Most recently
dronedarone was released. Unfortunately, no
agent works well, and not all are appropriate
for every patient due to coexisting conditions.
The current frontier of AF management is
nonpharmacologic treatment of AF to restore
sinus rhythm. This was first done by James
Cox with his cut-and-sew Maze operation in
1987. It evolved into the Maze III procedure
by 1992. This surgery works well but is open
chest/open heart. It is difficult to perform as
a concomitant procedure to other cardiac
surgery. For these reasons, it has not been
widely adopted.
Electrophysiologists later developed
percutaneous ablation techniques. There was
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 60-
70 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.
Kiser’s return to his alma mater, this work will be continued at the
University of North Carolina at Chapel Hill.

NEWSOURCE-JUN10:Heidi 8/5/10 12:57 PM Page 1

So what does the future hold? New catheter
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 Do They Like
developed and refined. A new class of What They See?
agents targeting the IKur channels, found
predominantly in atrial myocardium, are in Make sure you connect
development. with your key audiences
using strategic, cost-effective
advertising, marketing and public
And what does this mean for patients? Each relations.
patient is different. Some are asymptomatic
Our services range from consultation,
and only require anticoagulation. A few only
to design, to creation and
need a little more rate control. Many are implementation of strategic plans.
devastated with AF and require restoration
Our network of smart, creative,
of sinus rhythm. With so many treatments
award-winning specialists serves
now available, it is imperative that the treating the health care industry throughout

newsource
physician be aware of the risks and benefits of the Mid-Atlantic.
each, and then tailor therapy to each patient.
& Associates
Maybe it’s happiness in a child’s
In the meantime, my kudos to all the eyes. Whatever the desired
researchers, basic science and clinical, who outcomes, count on us to ensure
Call (540) 650-3686 or your key messages have the
are continuing to explore new frontiers in send inquiries to hketler@verizon.net. 20/20 clarity to deliver.
atrial fibrillation.

MAY 2011 19
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“YOUR HAPPINESS IS OUR PRIORITY!”

423 Cameron Woods Drive, Apex, North Carolina 27523

Raleigh Radiology’s Musculoskeletal Team
Offers Image Guided Pain Management
By Jeffrey Browne, M.D.
When a local mail courier’s hip pain became
so debilitating that he could no longer perform
his job, he discussed his options with his
physician. His arthritis would eventually require
hip replacement, but he was not quite ready for
the operation. He was an ideal candidate for
fluoroscopic-guided hip joint injection, and
his results were very gratifying. He was able to
return to work within a week and his pain was
markedly improved.
Whether an athlete or everyday patient, the team
of seven subspecialty-trained musculoskeletal
radiologists at Raleigh Radiology has you
covered for your interventional needs.
When conservative management of your
patient’s joint or tendon pathology fails or if
the cause of pain is uncertain, an image-guided
injection of a short-acting anesthetic and long-
acting corticosteroid is very useful in managing
patients.
The injections can be used to:
• Delay or eliminate need for surgery
• Diagnose cause or site of pain
• Control pain in non-operative patients
• Offer pain relief quicker than conservative
measures
Fluoroscopic-, ultrasound- and computed
tomography (CT)-guided injections increase
the precision of these procedures by confirming
correct needle placement. After administering
a local anesthetic, the needle is directed to the
site of interest, using minimal or no radiation
exposure. If a joint is the target, a small amount
of contrast is injected during fluoroscopy to
confirm intra-articular position. A combination
of a long-acting anesthetic and an intermediate-
to-long-acting corticosteroid are then injected.
The anesthetic can provide immediate pain
relief lasting four to six hours and also confirm
the site of pain. The corticosteroid begins
to work approximately one to two days after
injection, reaching its maximum effectiveness
within five to seven days.
Radiology
Common indications for CT or fluoroscopic- Complications are infrequent, but patients
guided procedures include: should be aware of signs of infection at the
• Extremity (upper, lower, ankle, foot) joint injection site. An allergic reaction to steroid
injection for pain or arthritis injection or iodinated contrast is rare and often
• Joint aspirations mild. Since the corticosteroid can take five to
• Shoulder brisement for adhesive capsulitis seven days to reach maximum effectiveness,
• Sacroiliac joint injections
Ultrasound is a very effective
modality when soft tissue or
fluid is the region of interest.
Procedures that can be
performed under ultrasound
include aspiration of fluid for
analysis, bursitis, treatment of
calcific tendinitis, drainage or
decompression of ganglion
cysts, Baker’s cysts, hematomas,
Dr. Jeffrey Browne is a musculoskeletal radiologist at Raleigh
and abscesses. In many cases Radiology and medical director of computed tomography for Rex
of calcific tendinitis, the Hospital. He graduated from the University of Connecticut School of
calcifications can be aspirated Medicine and completed an internship at St. Raphael’s Hospital in
New Haven, Conn. He completed his residency and a fellowship in
from the tendon or bursa prior
musculoskeletal radiology Duke University Medical Center. Dr. Brown
to the injection of steroids, is a member of the American College of Radiology, Radiological
a procedure referred to as Society of North America and American Roetgen Ray Society. He
shoulder barbotage. joined Raleigh Radiology in 2008.
The duration of the pain relief varies we ask patients to avoid excessive activity
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.
factors. In the case of arthritis, the steroid will
reduce the inflammation; however, it will not Our team of MSK radiologists offer these
reverse the condition. If therapeutic effect is injections at three convenient locations within
achieved, a maximum of four injections per Raleigh: Our Blue Ridge and Cedarhurst
year can be performed. Patients are asked to outpatient offices and at Rex Hospital. To
assess changes in their pain shortly after their schedule a joint injection, call our Blue Ridge
injection and report the effectiveness to their facility at 781-1437 or Cedarhurst at 877-5400.
physician. Pain relief immediately following the For more information, go to our website at
procedure is diagnostic of a problem at the site www.raleighrad.com.
of injection.
References
Before arriving for the procedure, patients are Boswell MV, Trescot AM, Datta S, et al. Interventional
techniques: evidence-based practice guidelines in the
requested to inform the staff if they are diabetic, management of chronic spinal pain. Pain Physician
taking blood thinners or have had previous 2007 10:7-111.
reactions to iodinated contrast. Prior to the Silbergleit R, Mehta BA, Sanders WP and Talati SJ.
Imaging-guided injection techniques with fluoroscopy
injection, a radiologist will question the patient and CT for spinal pain management. Radiographics
about his or her symptoms and correlate them 2001 21:927-39.
with any imaging findings. Dussault RG, Kaplan PA, Anderson MW. Fluoroscopy-
guided sacroiliac joint injections. Radiology 2000
214:273-6.
MAY 2011 21
 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
two thirds of Americans are overweight or
obese. So when a study on the effects of a
combined drug (low-dose phentermine plus
topiramate) on excess weight and associated
comorbidities was published in Lancet in
April, health care providers took note.
Although not yet approved by the Food and
Drug Administration, the findings of the
CONQUER1 study showed significant weight
loss. Upon FDA approval, the combined
drug will be marketed as Qnexa.
In the CONQUER trial, two doses of
phentermine plus topiramate were
compared in overweight/obese subjects
as an adjunct to diet and lifestyle changes.
The term “overweight” refers to a body mass
index (BMI) greater or equal to 25 but less
than 30. Obesity refers to a BMI of greater or
equal to 30.
Although not yet approved by the Food and
Drug Administration, the findings of the
CONQUER study showed significant weight loss.
Adults evaluated in the study had a BMI
between 27-45 kg/m2, and two or more
comorbidities, including diabetes or
prediabetes, hypertension, dyslipidemia
or obstructive sleep apnea. Of the 2,487
subjects, 994 were assigned to placebo (979
analyzed), 498 to 7.5 mg phentermine plus
46 mg topiramate (488 analyzed), and 995 to
15.0 mg phentermine plus 92 mg topiramate
(981 analyzed).
At the lower dose, the mean weight loss was
8.1 kg, or 17.8 pounds. At the higher dose
the mean weight loss was 10.2 kg, or 22.4
pounds. These were both statistically higher
22 The Triangle Physician
than the placebo group, which had a weight
loss of 1.4 kg, or 3.1 pounds.
At one year, this study showed that weight
loss of 10 percent or greater at one year was
seen in 7 percent of the placebo group, in
37 percent of the low-dose group and in 48
percent of the high-dose group. This was a
statistically significant difference for both
doses, compared to placebo.
Further, the cardiometabolic issues
associated with obesity improved in those
treated with the combined drug. Specifically,
there were significant reductions in systolic
blood pressure, diastolic blood pressure
(high-dose group), triglycerides, high-
sensitivity C-reactive protein (hs-CRP),
fasting glucose and total cholesterol. For
most of the risk factors, the improvement
was more in the higher dose group.
Taking Note of Side Effects
Phentermine was first approved by the
FDA as an appetite-suppressing drug back
in 1959. At one point it was combined
with a medication (fenfluramine, or
dexfenfluramine) and called Fen-Phen.
Eventually, dangerous side effects surfaced
in Fen-Phen users, with 24 cases of heart
valve disease, as well as cases of pulmonary
hypertension. Some individuals died from
the effects of Fen-Phen. Following these
reports, fenfluramine (or dexfenfluramine)
was taken off of the market voluntarily.
Afterward, studies showed that 30
percent of people taking fenfluramine,
or dexfenfluramine, had abnormal valve
findings.
The FDA did not ask manufacturers to remove
phentermine from the market. Phentermine
works on the hypothalamus portion of
the brain to release norepinephrine (a
neurotransmitter that signals a fight-or-
flight response, reducing hunger). The
most common side effects are dry mouth,
insomnia, dizziness, mild increase in blood
pressure (rarely more severe) and heart rate.
Monitoring blood pressure in important.
The precise mechanism of action for
topiramate is not clear, but theories suggest
energy expenditure increases with reduced
caloric intake, reduced salivary enzyme
activity, reduced leptin and corticosteroid
concentrations, and potential reduction in
serum glucose and insulin concentrations.
Of concern are the adverse events associated
with topiramate, including parasthesias,
memory impairment, taste distortion,
fatigue, insomnia, difficulty concentrating,
and dizziness.
Local Treatment Using Phentermine
More than 300 patients have been treated
using the drug phentermine through a
limited program at Women’s Wellness Clinic.
The medication is used for three to six
months to suppress appetite. When patients
start this program, they are told of a remote
chance of pulmonary hypertension is
possible.
It is recommended by the FDA that
phentermine be used short-term (up to
12 weeks), while incorporating healthy
dieting and exercise. In our experience and
through discussions with peers, if weight

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.
loss continues through 12 weeks, then
continuation through 16 weeks is tolerated.
Weight-loss basics
Given that two-thirds of the United States
population is overweight (BMI greater or
equal to 25) or obese (BMI greater or equal
to 30), effective regimens for weight loss are
important to help individuals lose weight.
While effective medications are available,
there is basic information providers should
emphasize to their patients, including the
following:
• Healthy lifestyle changes in diet and
exercise should be emphasized.
• In order to lose one pound in a week, you
must have a deficit of 3,500 calories in that
week (500 calories per day for 7 days).
• Do not consume less than 1,200 calories
per day to avoid slowing down your
metabolism.
• Eat less and more often to boost
metabolism. Try to consume five to six
small meals during the day, beginning with
breakfast, within 45 minutes of walking.
• Keep a food journal – potentially an online
version that will keep a calorie count for
you. For example: www.thedailyplate.
com, www.calorieking.com, www.
sparkspeople.com, www.nutrihand.com
and www.mypyramid.com.
• Exercise! – This is so important to do for
weight loss and weight control.
• Be mindful of the food you are eating,
both in terms of quality and quantity.
• Do not multitask when you are eating, and
chew your foods well.
• Give yourself a pantry and refrigerator/
freezer makeover – Get rid of the foods
that tempt you.
• Do not eat late at night.
As new developments in weight loss emerge,
Women’s Wellness Center staff weighs the
risks and benefits. Call (919) 251-9223 for
available appointments and support with
helping patients to make healthy lifestyle
changes through weight loss.
References
1
Gadde KM, Allison DB, Ryan DH, et al. Effects of low-
dose, 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
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of habitats needed to preserve wildlife

MAY 2011 23
 WakeMed News
WakeMed North to Become Wake
County’s Fifth Hospital
WakeMed Health & Hospitals will begin
expansion in fall 2011 of the existing
WakeMed North Healthplex into Wake
County’s fifth hospital – WakeMed North
Hospital.
With an anticipated opening date of
October 2013, WakeMed North Hospital
will be a 61-bed acute care hospital, with
a focus on inpatient women’s specialty
services, offering a full range of obstetric
and gynecological services, including
comprehensive preventive, diagnostic and
therapeutic care. The facility will continue to
serve men and children through the existing
emergency department, outpatient surgery,
imaging, lab and physician services already
offered at the facility.
“Since opening in 2002, WakeMed North
Healthplex’ consumer-driven volumes
have consistently outpaced projections,
demonstrating the great demand for health
care services in this community,” said Dr.
Bill Atkinson, WakeMed president and chief
executive officer.
Construction Commences
on Healthplex
Construction has begun on WakeMed Brier
Creek Healthplex located at the corner of
US-70 on T.W. Alexander Drive.
The facility will include the county’s third
24/7 full-service, stand-alone emergency de-
partment with 12 private treatment rooms. It
will be staffed by the same board-certified
physicians that serve WakeMed’s five addi-
tional emergency departments.
Laboratory and imaging services, including
computed tomography and X-ray, also will
24 The Triangle Physician
Currently WakeMed North
Healthplex offers a full-
service, 24/7 emergency
department, ambulatory
surgery center, imaging
and laboratory services
and a host of additional
clinical capabilities. The
campus also features
an 85,000-square-foot
medical office building.
“Transitioning to a hospital is the next logical
step, as the infrastructure is already in place
and the community has a critical mass of
262,000 residents living within a seven-mile
radius of the facility,” said Dr. Atkinson.
“While the hospital will initially open with a
women’s focus, our plan is for it to continue
to expand to meet the needs of women, men
and children, alike.”
Construction is expected to create 500
construction jobs. Hospital officials also said
the current 150 employees will be expanded
to about 442 full-time equivalent employees,
with an average salary of $48,760, by the
be available for emergency department pa-
tients and outpatient visits.
The facility, which will be owned, de-
veloped, and managed by Duke Realty,
will be 50,000 square feet, including a
26,000-square-foot emergency department
and 24,000 square feet of medical office
space.
Construction is slated to be completed by
November 2011 and the building will be op-
erational by January 2012. The project Cer-
second year of hospital operation. The cost
of the project is estimated to be nearly $62
million.
WakeMed received approval to add 41
licensed acute care beds to WakeMed
North Hospital in 2009. These beds were in
addition to the 20 acute care beds already
approved for relocation from WakeMed
Raleigh Campus, making the total bed count
for WakeMed North Hospital 61. The inpatient
beds will be constructed in an approximate
90,000-square-foot addition to the existing
North Healthplex.
tificate of Need was granted in September
2009 for $36 million. WakeMed’s total invest-
ment in the project is $14 million.
WakeMed Brier Creek Healthplex will ini-
tially employ 74 full-time employees and will
serve northwest Raleigh and Wake County.
It is located at 8001 T.W. Alexander Drive in
Brier Creek, less than one mile from I-540
and US-70. The complex sits on 12 acres, al-
lowing room for future development.
For more information, visit www.wakemed.org.
 WakeMed News

CON to Add Medical Office Space Available

101 Beds Physicians’ Office Pavilion at
WakeMed Health & Hospitals today 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 of
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
Janet Clayton, CCIM
Raleigh Campus and Cary Hospital to have 919.420.1581
occupancy rates at or above 90 percent if no janet.clayton@tlgcre.com
additional beds are opened at these facilities, Independently Owned & Operated

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, cost-
effectively and efficiently,” says Taylor.

MAY 2011 25
Granville Health System News
GHS Named Blue Distinction Center
for Knee and Hip Replacement
Granville Health System has been named
a Blue Distinction Center for Knee and Hip
Replacement.
Blue Distinction is a Blue Cross and Blue
Shield Association (BCBSA) program that
recognizes facilities that meet objective,
evidence-based thresholds for clinical
quality. These facilities have demonstrated
experience in offering comprehensive
inpatient knee and hip replacement
services, including total knee replacement
and total hip replacement.
BCBSA collaborated with expert physicians
and medical organizations to determine the
selection criteria for all Blue Distinction
programs. Candidates for Blue Distinction
Granville Health System in Top 10
of Most Customer-Friendly Hospitals
The American Alliance of Healthcare Pro-
viders named Granville Health System one
of the top 10 hospitals in the country in its
2011 Hospital of Choice Awards.
The award recognizes America’s “most cus-
tomer-friendly hospitals,” according to Ric
Vincent Parr, president of American Alli-
ance of Healthcare Providers (AAHCP). It is
“designed to find America’s most customer-
friendly hospitals based either on an exten-
sive application process, or by a review of
a facility’s public communication and staff
interaction with customers,” according to
an AAHCP press release.
Each year, AAHCP evaluates approxi-
26 The Triangle Physician
Centers for Knee and Hip Replacement must
present clinical-based evidence to establish
that they meet the selection criteria.
Examples of some of the criteria GHS met
include:
• An established acute care inpatient
facility, including intensive care,
emergency care, and a full range of
patient support services
• An established knee and hip
replacement program, performing
required annual volumes for certain
procedures
• An experienced knee and hip
replacement surgery team, including
surgeons with board certification,
subspecialty fellowship training, and
case volumes that meet selection
criteria
• Preoperative patient education
• Processes to support transitions of care
mately 400 hospitals for consideration of
this award. Approximately 100 hospitals
are recognized annually. The application
process requires a review of six principal
areas of consideration including standards
of conduct, performance management and
improvement, staff development and train-
ing, systems of communication, good citi-
zenship, and educational and promotional
consumer material.
“We are pleased to be chosen as one of the
top hospitals in the nation,” says L. Lee Is-
ley, Granville Health System chief executive
officer. “This award recognizes the high lev-
el of quality care provided by our dedicated
doctors, nurses and staff to the patients of
• Multidisciplinary teams and clinical
pathways to coordinate and streamline
care
• Use of an internal registry or database
to track patient outcomes over time
• Clinical outcomes for specific
procedures that meet objective
thresholds, such as complication rates
and length of stay.
“When it comes to spine surgery, and hip
and knee replacement, there is compelling
evidence that institutions with experience
that also adheres to their care protocols
deliver better outcomes,” said Don Bradley,
M.D., chief medical officer of Blue Cross
and Blue Shield of North Carolina. “We’re
providing that information to our members
to help them make informed choices about
where to receive care that’s proven to meet
national quality standards.”
Granville County and the surrounding ar-
eas. As we move forward, Granville Health
System will continue to invest further in the
hospital, supporting our commitment to de-
liver new medical programs, technologies
and expanded services to the community.”
Granville Health System ranked third after
first-place University of Kansas Hospital and
second-place UCLA Medical Center. The
Top 10 winners will have an opportunity to
compete for the Hospital of the Year Award,
to be announced this month.
Past Hospital of Choice Award recipients
include The Johns Hopkins Hospital, the
Mayo Clinic and the Cleveland Clinic.

U.S. News Ranks
Durham Regional
Fourth in Metro Area
Durham Regional Hospital has been ranked
fourth out of 18 hospitals in Raleigh-Durham in
U.S. News & World Report’s first-ever “Best Hos-
pitals” metro area rankings.
The newly expanded U.S. News & World Report
rankings of hospitals in the 52 most-populous
metropolitan areas show that in three specialties
Durham Regional offers Raleigh-Durham high-
quality care. In those specialties, which include
kidney disorders, orthopedics and urology, its
performance puts it above most other hospitals
that are not nationally ranked.
The new rankings recognize 622 hospitals in
or near major cities with a record of high per-
formance in key medical specialties. There are
nearly 5,000 hospitals nationwide.
Duke University Medical Center and University
of North Carolina Hospitals, respectively, ranked
in the top three hospitals in the Raleigh-Durham
metro area, according to the 2011 U.S. News Best
Hospitals metro ranking. Wake Medical Center
ranked No. 3 in nine specialty areas, including
kidney disorders, orthopedics and urology.
U.S. News created Best Hospitals more than
20 years ago to identify hospitals exceptionally
skilled in handling the most difficult cases, such
as brain tumors, typically considered inoper-
able, and delicate pancreatic procedures. Duke
and UNC also have achieved this U.S. News na-
tional ranking.
The new metro area rankings are relevant to a
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 proce-
dures in one or more specialties, according to a
Durham Regional News
Durham Regional Hospital press release.
Patients and their families will have a far better
chance of finding a U.S. News-ranked hospital
in their health insurance network and might not
have to travel to get care at a high-performing
hospital, according to the Durham Regional re-
lease.
“Durham Regional is honored to be recognized
for our treatment of kidney disorders, orthope-
dics and urology,” said Kerry Watson, Durham
Regional Hospital president. “This recognition
reflects the dedication of our team of physi-
cians, employees and volunteers who care for
our patients every day.”
To be ranked in its metro area, a hospital had to
score in the top 25 percent among its peers in at
least one of 16 medical specialties.
“All of these hospitals provide first-rate care for
the majority of patients, even those with seri-
ous conditions or who need demanding proce-
dures,” said Health Rankings Editor Avery Co-
marow. “The new Best Hospitals metro rankings
can tell you which hospitals are worth consider-
ing for most medical problems if you live in or
near a major metro area.”
For the full list of metro area rankings visit
www.usnews.com/hospitals.
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 Ra-
leigh has forged a lifelong bond with
nationally recognized prosthetist
David R. Sickles, a certified prosthe-
tist/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 experi-
ence 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 direc-
tor of the National Commission on
Orthotic and Prosthetic Education
(NCOPE) Accredited Residency Pro-
gram 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 Perfor-
mance 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 perfor-
mance,” said Sickles, who is certified
by the American Board for Certifica-
tion 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 evalu-
ation, call (919) 821-5221 or (919)
684-2474. For more information on
the Peak Prosthetic Performance
Clinic, visit www.centeropcare.com.
MAY 2011 27

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
AGAPE Clinic, Washington
Raymond Mark Bernal, 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
ECU, Greenville
Devin Traer Caywood, 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
Duke Eye Center, Durham
Kasey Kincaid Fiorini, MD
Anesthesiology
University of North Carolina Hospitals
Chapel Hill
Jillian Roxanna Foley, MD
UNC - Division of Cardiology, Chapel Hill
Thomas Andrew Gebhard, 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
Pediatrics
Duke University Hospitals, Durham
Paul McPherson Johnson, MD
Internal Medicine
University of North Carolina Hospitals
Chapel Hill
Shivanand P Lad, MD
Duke University Medical Center, Durham
28 The Triangle Physician
News
Robert Aaron Lambert, MD
ECU Dept of Family Medicine, Greenville
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
Dermatology
Pitt County Memorial Hospital, Greenville
Dana Michelle Neutze, 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
Emergency Medicine
Duke University Hospitals, Durham
Jose Luis Piscoya, 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
David Hallmark Ryan, MD
Obstetrics and Gynecology
University of North Carolina Hospitals
Chapel Hill
Justin Richard Scruggs, MD
Physical Medicine and Rehabilitation
University of North Carolina Hospitals
Chapel Hill
Frank William Shields, 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
Charles John Viviano, MD
Duke Urology of Raleigh, Raleigh
Edward Scott Vokoun, MD
Naval Hospital Camp LeJeun
De Benjamin Winter, MD
ECEP, Wilmington
Charles Ryan Woodard, MD
Duke University Medical Center, Durham
Kanecia Obie Zimmerman, MD
Internal Medicine, Pediatrics
Duke University Hospitals, Durham
Physician
Assistants
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
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 board-
certified 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 fellow-
ship trained in their respective subspecialty
areas, which include: foot and ankle, hand
and wrist, spine, hip, shoulder and elbow
surgery, total joint replacements, sports med-
icine and pediatric orthopaedic care. Ancillary
services include physical therapy, magnetic
resonance imaging, radiology, shock wave
therapy, and orthotics and pedorthics.
“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.”
Complete practice information is available at
www.raleighortho.com.
Clinical Trials
Do you have patients with
any of these problems?
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 symp-
toms for at least nine months after the
onset of their shingles rash.
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 qualifica-
tion 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 medi-
cation to see if It can help prevent stom-
ach 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 qualifica-
tion 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 Clos-
tridium difficile (C.diff.), a bacteria that
can cause severe gastrointestinal prob-
lems.You may qualify for this study if you
are between 40 and 75 years old and have
an upcoming hospitalization.
Study-related medical exams and study
medication are provided at no cost, and
compensation will be provided for time
and travel.
For additional information and qualifica-
tion criteria please call (919) 781-2514 or
visit us online at www.wakeresearch.com.
 Your LocaL cardioLogY ProfessionaLs
in Johnston countY
dedicated to QuaLitY, service, and integritY

Mateen Benjamin G. Kevin Ray Randy

Akhtar, MD, FACC Atkeson, MD, FACC Campbell, MD, FACC Cooper, MD, FACC

Christian N. Matthew A. Eric M. Diane E.

Gring, MD, FACC Hook, MD, FACC Janis, MD, FACC Morris, ACNP

cardioLogY services
Coronary and Peripheral Vascular
Interventions
Pacemakers/Defibrillators
Atrial Fibrillation Ablations
Echocardiography
Nuclear Cardiology
Vascular Ultrasound
Clinical Cardiology
Ravish Nyla CT Coronary Angiography
Sachar, MD, FACC Thompson, PA-C Stress Tests
Holter Monitoring
Cardiovascular Medicine
2 Locations to serve our Patients Echocardiography
Smithfield Heart & Vascular Associates Wake Heart & Vascular Associates Nuclear Cardiology
910 Berkshire Road 2076 NC Hwy 42 West, Suite 100 Cardiac Catheterization
Smithfield, NC 27577 Clayton, NC 27520
Phone: 919-989-7909 Phone: 919-359-0322
Fax: 919-989-3147 Fax: 919-359-0326

the highest QuaLitY cardiovascuLar care, cLose to home.

 The Easiest Imaging
Order Is Now Online.
Make life easier for your schedulers today!

©2010 Wake Radiology. All rights reserved. Radiology Saves Lives.

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.

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