April 2, 2020

The Power of Nonsurgical Approaches for Damaged Shoulders

By Thomas E. Fithian, MD, FAAOS

 

Patients with common shoulder disorders often assume they’ll require surgery to ease pain and improve stiffness, weakness and range of motion. Yet conservative measures – particularly exercise rehabilitation and physical therapy – often can provide amazing benefits. 

In many cases of rotator cuff injuries, shoulder instability, and shoulder arthritis, there is no harm in delaying a trip to the operating room in favor of trying a nonsurgical approach. 

The most frequent cause of shoulder pain is a rotator cuff disorder, generally seen in patients over 40. That includes full- or partial-thickness tears, tendinitis, and bursitis and impingement, all of which can interfere significantly with daily life.

As I’ve seen in my practice, research increasingly has indicated that for select patients, a combination of physical therapy, anti-inflammatory medications and possibly cortisone injections can delay or even eliminate the need for surgery.  

One influential study was a Vanderbilt-led, multicenter examination of atraumatic full-thickness tears. The research, published in the Journal of Shoulder and Elbow Surgery in 2013, found exercise rehabilitation was an effective therapy in approximately 75 percent of patients followed for up to two years. 

Physical therapy targets both the rotator cuff and small but important muscles around the shoulder blade, as well as core abdominal and lower back muscles. These exercises aim to improve joint mechanics and function and help compensate for damaged tendons. 

Therapists teach range of motion, isometric, scapular stabilization and resistance exercises, as well as offer tips on posture, sleep positions, safe lifting and carrying techniques, and how to use heat, ice and anti-inflammatories for pain. 

Most patients can learn enough in a few in-office sessions – sometimes just one – to continue therapy at home. If they don’t get relief, cortisone injections often are beneficial once an orthopaedist pinpoints the precise source of pain. 

On a personal note, my own recurrent bouts of rotator cuff tendonitis have always responded to at-home exercises, allowing me to avoid injections or surgery. 

Shoulder instability and dislocation, often found in younger patients and athletes, also frequently can be resolved by strengthening muscles around the joint. Exercises can be tailored to individual patients, such as baseball pitchers working to regain arm strength. 

Arthritis in the shoulder, meanwhile, is much less likely to progress as rapidly as it does in weightbearing joints such as the knee and hip. Arthritic shoulders tend to be very responsive to cortisone injections, sometimes given as infrequently as once a year. I am not surprised if these patients go the rest of their lives without requiring a total joint replacement. 

I have been a conservative surgeon throughout my 35 years of practice, but raising awareness of these methods is especially important to me now: in March, I stopped performing surgery to have a more flexible schedule. However, I am NOT retired! On the contrary, I expect to stay busy with diagnostics and nonsurgical treatments for upper extremity problems. 

Should my patients require surgery, of course, referral to a colleague would be simple. Yet as our specialty continues to discover more about the most effective treatments for joint disorders, I predict conservative approaches will only gain ground.

Dr. Fithian is a fellowship trained shoulder specialist with Hampton Roads Orthopaedics Spine & Sports Medicine. hrosm.com

Detecting and Treating Thyroid Nodules

By Cheryl D. Almirante, MD, FACE, ECNU, CCD

 

Thyroid nodules are extremely common. In fact, by age 60 about half of all people have a thyroid nodule that can be found either through palpation or with imaging. Although the condition is predominately benign, it is important to facilitate necessary assessment of each patient in order to rule out thyroid cancer. Treatment of patients with thyroid nodules can be complex in nature. In such cases, evaluation by an endocrinologist is important to ensure appropriate work-up, treatment, and monitoring. 

People with thyroid nodules are at greater risk for developing thyroid cancer if they have a history of high radiation dose exposure, are older than 40 years of age, and/or have a family history of thyroid cancer. 

Patients with thyroid nodules are mostly asymptomatic. Nodules are commonly detected on routine physical examination or incidentally discovered on radiological procedures such as MRI or CAT scan. In other instances, patients present with a sensation of a lump in their necks and complain of persistent neck pain, problems with swallowing, and hoarseness. 

A primary care physician can determine if there is hyperfunctioning or hypofunctioning of the thyroid gland. The initial laboratory test performed may include the thyroid-stimulating hormone (TSH). The most common condition is Hashimoto’s thyroiditis, which is a cause of hypothyroidism and increases the risk of development of thyroid nodules. Additionally, iodine deficiency, although currently rare in the United States, is known to cause thyroid nodules.

When a nodule is found, specialized testing such as thyroid ultrasonography and fine needle aspiration biopsy is necessary for a comprehensive diagnosis to determine malignancy. This can be performed by an endocrinologist with an Endocrine Certification in Neck Ultrasound (ECNU).  This designation signifies a commitment to clinical excellence and quality evaluations for patients with thyroid and parathyroid conditions, through both diagnostic ultrasound and biopsies. The endocrinologist conducts real-time imaging of the patient’s thyroid gland and surrounding neck structures and, if necessary, performs a fine needle aspiration biopsy under ultrasound. If needed, biopsies can be performed at the same appointment. 

Caring for patients with thyroid nodules requires a close collaboration between primary care physicians and endocrinologists. Together, they can improve patient outcomes, longevity, and overall quality of life.

Dr. Almirante is a Board certified, fellowship trained endocrinologist at TPMG Newport News Endocrinology. She has extensive experience with treatment of thyroid nodules, hyperthyroidism, hypothyroidism, diabetes, and osteoporosis. mytpmg.com

Lesser Known Treatment Options for Urinary Incontinence

By Jennifer Miles-Thomas, MD, FPMRS

 

Anyone who watches television has seen an explosion in commercials for medications to treat urinary incontinence. However, therapy options for patients who don’t respond to these drugs remain much less familiar. 

Multiple types of incontinence affect millions of Americans every year, with a higher prevalence in women. Risk factors for the two most common forms, stress and urge incontinence, include age, pregnancy and childbirth, obesity, and diet and activity levels. 

In the past, physicians have prescribed a pill to virtually everyone suffering from leakage, frequent urination, bladder-emptying problems or lack of bladder control, a constellation of symptoms referred to as overactive bladder. 

But as we have learned more about the various causes of incontinence, several new modalities have appeared. For instance, we know FDA-approved medications won’t be effective for stress incontinence, as that involves a weakening of the urinary sphincter and pelvic floor muscles. 

For all patients, the first step is typically introducing pelvic floor exercises and lifestyle changes that can reduce bladder irritation. Many foods and beverages have higher acidity levels that can trigger bladder contractions; a short list includes coffee, soda, cheeses, nuts and lemons. 

Patients also should stay well hydrated to dilute those acidity levels. While people assume that drinking more water will force them to urinate more often, they’re more likely to maintain control by avoiding dehydration. 

Should behavioral modifications and two types of medications fail to relieve symptoms, we can perform urodynamic testing to better pinpoint root causes and rule out issues such as undiagnosed infections or bladder tumors. 

This procedure places tiny sensors inside the bladder via slim catheters – smaller than the inside of a pencil – to measure nerve and muscle function, flow rates and pressure in and around the bladder. 

Several “third line” treatments can significantly improve quality of life when medications fail, and they are usually covered by insurance:

• Percutaneous tibial nerve stimulation (PTNS): This form of neuromodulation involves inserting a fine needle electrode into the ankle – like acupuncture – site of a nerve that runs to the sacral nerve plexus that regulates bladder and pelvic floor function. This delivers adjustable pulses that can decrease bladder contractions, although patients won’t feel anything inside the bladder. Treatments are weekly, about 20 minutes apiece, for three months. By eight to 10 weeks, most patients see a significant benefit.  

• Sacral Neuromodulation: An electrical stimulation therapy that implants a programmable, battery-operated device – similar to a pacemaker – just beneath skin in the buttocks. This stimulates sacral nerves leading directly to the bladder, again aiming to slow contractions. It often works for five to seven years and can be removed or replaced; it is also invisible to others (and doesn’t set off metal detectors!).

• Botox injections: Guided by a cystoscope, physicians administer 100 to 300 units of Botox into the bladder after numbing the wall to relax the muscle and block some nerves that generate contractions. It typically lasts for six months.  

Patients who have suffered embarrassing symptoms for years – whether leakage or frequent dashes to the restroom – have found great relief with these treatments. I encourage others to discuss these issues with your primary doctor and if you have tried medications without benefit, consult a urologist.

Dr. Miles-Thomas, a urologist, is Board certified in Female Pelvic Medicine and Reconstructive Surgery. She serves as President of Urology of Virginia. urologyofva.net

Compliance 101: When do you need a Business Associate Agreement?

By Erica Pero

 

Under HIPAA and HITECH, when “covered entities” and “business associates” share patient information (PHI), there must be a Business Associate Agreement (BAA) between the two. Think of BAAs like the baton used in a relay race – without it, everyone would be running separate races.

Covered Entities are companies that provide healthcare to patients, such as doctors, dentists, chiropractors, medical transport companies, home healthcare agencies, pharmacies, etc. They receive PHI directly from patients.

Business Associates are companies that perform services for Covered Entities, such as medical billing companies, software vendors, collection agencies, accountants, etc. They receive PHI from the Covered Entity.

Business Associates may also share PHI with other Business Associates. Along the chain of contractors, one is either an upstream contractor (closer to the Covered Entity) or a downstream contractor (farther from the Covered Entity). BAAs contain information that requires each party to take reasonable measures to protect PHI. (This is why BAAs are your friend. Really.)

EACH LINK IN THE CHAIN OF CONTRACTORS MUST BE SUPPORTED BY A BAA.

(… Pause to let that sink in…)

Without a Business Associate Agreement in place for each link of the chain, you’re leaving yourself open to liability. It’s a simple document required by the federal government. Make sure you protect yourself and PHI!!

Erica Pero, an attorney with Pero Law, focuses her practice on health law. She helps healthcare professionals navigate the complexities of running a business in today’s healthcare industry. Pero Law is a lean law firm committed to excellent customer service and exceptional legal representation. perolaw.com 

Preparing for a Lawsuit

By Douglas E. Penner

So, you have been served with a lawsuit. You knew medical malpractice lawsuits were possible. You have heard tales about other healthcare providers being sued or seen attorneys advertising about verdicts against health care providers. You knew it could happen to you, but you never thought that it would. You certainly never anticipated such a wide range of emotions in response – everything from apprehension and anxiety to frustration and anger to denial and withdrawal, and perhaps sympathy for the patient or even pity for yourself. None of these responses is unusual.

Soon after receiving the lawsuit, you meet with your attorney. After introductions, you discuss the healthcare that is the basis of the lawsuit and maybe a little bit about the life of a lawsuit. The meeting usually ends with an ominous instruction: “Do not discuss the lawsuit or anything about the underlying circumstances with anyone other than your attorneys”. This is very good advice. Communications with your attorneys are privileged so there can be open and candid discussion of the case. Communications outside the presence of your attorneys are discoverable and could lead to depositions of those individuals by the patient’s attorney, in order to investigate whether you said anything inconsistent with your deposition testimony. However, not discussing the situation can cause isolation and intensify the emotions you are already experiencing.   

Here are a few tips to help manage your emotions and foster a better relationship with your attorney:

First, openly discuss your emotional reaction to being sued. Attorneys are generally very good listeners and have probably had a past client who has felt the same as you. It can be very beneficial to take the time and have the willingness to discuss how you are feeling with your attorney.

Second, make sure you have a good understanding about your role on the “team” while preparing a defense to allegations. Knowing your role, what is expected of you and when you will be needed to contribute will lessen your anxiety. If you disengage and isolate yourself from the lawsuit and your attorney, you are defeating your ability to defend yourself and lessening the likelihood of prevailing in the lawsuit. Your full cooperation, and equipping your attorney with as much of your expertise as possible, will improve your chances of success. By providing your expert insight, your attorney will be better prepared to navigate the defense strategy and retain experts who will view the case like you do. Also, be sure to share any concerns about the care you provided, as this is important information for your attorney. 

Finally, make clear to your attorney the manner of communication and the frequency of contact that will best serve your needs. For example, some doctors want to be constantly updated on every development in the case. Others prefer to have as little interruption to their practice and personal life as possible. Determine the communication that will best help you manage your emotions, but remember that you need to be available to your attorney.

Your attorney is your advocate, so good communication and exchange of information is in your best interest.

Douglas Penner is an attorney with the law firm of Goodman Allen Donnelly. He specializes in hospital risk management, medical malpractice defense, health care law, and State Board licensing and credentialing matters. www.goodmanallen.com

The Struggle of Transition for Military Doctors to Private Practice

By John Duerden, MD and Geoffrey Wright, MD

 

The transition from the military to the civilian lifestyle can be a difficult one. Because the military takes care of the hassle of figuring out the necessities of everyday living, such as insurance and housing, many veterans find it challenging to acclimate themselves once their military careers are over. 

Veteran physicians often experience this struggle as they transition from military hospitals to private practices. While the dedication to patient care and wellbeing always takes precedence, the internal factors tend to vary. 

During your military career, you won’t have to be concerned over a patient’s insurance or what your salary may be. The ability to practice pure medicine helps hone your skills and gives you more opportunity to give each patient more one-on-one time. However, the fear of deployment is always a concern, especially if you have a family. Deployments do give you the opportunity to solely focus on your craft, but, as they do with any military person, the stress they bring also inevitably affects you and your loved ones for long stretches of time. 

Military physicians work as a whole team, so you’re never working your hours alone. Schedules allow for another physician to work with you or be available at any time to assist. There’s a shared camaraderie amongst your peers. In the private sector, on the other hand, each physician tends to have varying schedules, which means you may not have that automatic support. There’s also a need to understand the business aspect of a private sector practice. With more competition, patients have multiple providers to choose from as compared to military hospitals, where they see whoever is available. Private physicians must market themselves to the public in order to gain awareness and build relationships with their potential clientele. 

Physician burnout can vary for private physicians and those in the military. Because your hours are set in the military, you have expectations for what your days will carry (except during deployments, when your constant focus is on your work). In the private field, you will operate longer daily. However, depending on your ability to handle stress, either field can weigh heavily on your day-to-day operations. 

For any physician transitioning from the military to a private practice, be prepared for the pace to be quicker, especially on the clinic side. You will need to understand not only insurance authorization and approvals, but peer-to-peer reviews. Figuring the type of practice in your preferred city – whether it’s private, hospital, or an academic setting – is important to narrow down where you end up practicing. 

Being in the military has helped veterans become better physicians. While deployments are stressful, they give you time and opportunity to work and build your skills under the direst situations. Your military background will help prepare you for the most complicated cases while practicing in the private sector. The best advice to prepare you for this transition is be ready to work towards reaching potential patients, understand the business of running a practice, and don’t expect the expected. Your background will be invaluable to your craft as a civilian physician.

John Duerden, MD

Geoffrey Wright, MD

John D. Duerden, MD is a Board certified Orthopaedic Surgeon, Foot and Ankle Specialist and Geoffrey Austin Wright, MD is a Board certified Orthopaedic Surgeon Joint Replacement Specialist with SMOC, Sports Medicine & Orthopaedic Center. smoc-pt.com

Post-Traumatic Reconstruction of the Foot and Ankle

By Joel D. Stewart, MD

 

Complex, traumatic injuries to the foot and ankle can present some of the greatest challenges to an orthopaedic surgeon. Due to their unique weight bearing role, feet and/or ankles that sustain crush injuries/open fracture traumas may never regain normal functional strength and motion.  

As a surgeon, I understand my patients’ desire to have a somewhat normal looking and semi-functioning foot, even after a mangling injury. I also understand their aversion to even the mention of amputation, even though it may be the best treatment option. If feasible, limb salvage becomes my primary goal; the return of limb function is secondary, and the cosmetic issues are tertiary. If we are successful in achieving our short-term goals, we then progress to the treatment of chronic, lifelong foot and ankle problems.

Long term care of these patients almost always ensures that I will treat them for post-traumatic arthritis, tendon or ligamentous issues, non-union or all of the above, even when their acute medical care was handled expeditiously and appropriately. Pain reduction is vital, while stabilizing bones and joints, restoring functionality, and arresting further deformities. 

My team often works closely with Infectious Disease and Plastic Surgery to manage these complex injuries. If there is nerve damage, we may need to work with Neurology or Physical Medicine and Rehabilitation/Pain specialists to diagnose which nerves are damaged and determine options for management. If there was vessel damage, the patient may need bypass surgery or other vascular procedures.

The determination of nerve damage, alignment and infection are crucial to treatment option selection. Often, custom bracing can accommodate deformity and help with pain, but if there are wound healing issues or nerve damage, these can be difficult to manage. Skilled prosthetists and orthotists are key to make these non-operative options successful. 

If non-surgical options fail, limb realignment or tendon transfers should be considered. Arthrodesis remains the standard of care for treating post-traumatic arthritis, especially with soft tissue damage. It is important to accurately pinpoint the painful bony or joint abnormalities through diagnostic studies and selective anesthetic blocks to prevent fusion of non-symptomatic bones/joints. We have options for possible joint replacement for the ankle, but this is very dependent on soft tissue integrity and balancing of the limb and joint. 

If all other options are exhausted, amputation can provide the patient a better quality of life. The level of amputation, pre-injury activity level, and other co-morbidities can change how we manage prosthetics, sockets, and suspension systems. Managing patient expectations of what an amputation can and can’t do is critical. We see young military veterans doing amazing things on prosthetics, but an older, overweight, smoking diabetic may not get the same results. Finally, these are often work-related injuries and legal, economic and psychological issues can also play a role. 

In summary, the management of severe extremity trauma is a team effort. The orthopaedist, patient, family and multiple specialists must work cooperatively to return the patient to a relatively normal life and employment.

Dr. Joel Stewart is a fellowship trained foot and ankle specialist with an emphasis in Sports Medicine at Orthopaedic & Spine Center (OSC). osc-ortho.com

John T. Sinacori, MD, FACS, Laryngology,

Director of the Eastern Virginia Medical School Voice and Swallowing Center

 

For the past 18 years, Dr. John Sinacori has led the development of a comprehensive center for Hampton Roads patients with voice, airway or swallowing issues. 

The EVMS program offers the latest medical, surgical and multidisciplinary therapies for simple to complex problems. Laryngoscopes with digital chip technology and stroboscopy now can gather highly detailed views of the vocal folds and visualize vibration up to 700 times a second.   

Overall, Dr. Sinacori’s passion is raising awareness about the importance of vocal care. An estimated 40 percent of Americans rely heavily on their voices at work, including singers, actors, teachers, lawyers, ministers, broadcasters, and call center employees. 

“Many people ignore signs of voice strain or damage, or don’t realize that we can treat a wide range of pathologies,” he says. “People learn how to lift heavy objects to protect their backs, or wear earplugs to protect their hearing, but we rarely discuss how to protect our voice.” 

Dr. Sinacori, who completed a Laryngology Fellowship at Vanderbilt University Medical Center, has grown the EVMS Voice and Swallowing Center into a referral site for ENT specialists and primary care physicians throughout the region. The center handles about 4,000 adult and pediatric patient visits annually.

With new partner Benjamin J. Rubinstein, MD, who did a Laryngology Fellowship at Mount Sinai Hospital; Kamal R. Chemali, MD, an Autonomic Neurologist at the Sentara Music and Medicine Center trained at the Cleveland Clinic; and local speech pathologists, Dr. Sinacori tackles a long list of concerns, among them: 

• Performance voice care

• Benign vocal cord lesions

• Voice disorders related to aging

• Vocal cord paralysis 

• Vocal cord dysfunction or chronic cough

• Laryngeal cancer 

• Voice issues linked to neurological disorders such as spasmodic dysphonia or Parkinson’s disease 

• Airway stenosis and long-term tracheotomy use

• Swallowing dysfunction

• Transgender voice care and surgery

Dr. Sinacori works with all age groups. Teenage athletes, for example, are at risk for vocal cord dysfunction that causes shortness of breath during intense exercise, often misdiagnosed as asthma. Most can improve quickly working with a speech therapist. 

Women in their 40s and 50s, meanwhile, may develop shortness of breath due to a narrowing in their windpipe. New management strategies, such as in-office steroid injections, help reduce the need for dilation surgeries under general anesthesia.   

Another effective procedure is the injection of filler materials to augment vocal folds and correct a weak voice caused by nerve damage, perhaps after thyroid surgery. Dr. Sinacori also employs lasers to remove lesions on vocal folds and has taken temporalis muscle grafts to regenerate scarred areas that limit vocal cord vibration. 

Moving forward, he is optimistic about advances in laser technologies and the use of photodynamic therapy to eliminate some lesions. The Voice Center also is conducting research on multiple new interventions for a variety of laryngological pathologies.

As Dr. Sinacori finishes his second decade of local practice, he hopes to build even stronger ties with professional voice organizations and support all regional and national talent performing in the area. The Voice Center offers the same technology and expertise as artists would find in a major city such as New York or Los Angeles, he notes.  

Everyone can protect their voice by taking small breaks from talking if possible, or softening or slowing speech for better breath support. A personal amplifier can also be a voice saver. Finally, Dr. Sinacori cautions people not to ignore symptoms such as hoarseness, a breaking or raspy voice, loss of vocal range, discomfort while speaking or swallowing, or chronic cough. 

“We can improve so many people’s quality of life, if they only seek help,” he says. “My mission is to keep raising awareness of all the options we have.”

Outstanding Achievements recognizes a local physician for accomplishments in the areas of education, medical innovations or introduction of new treatments and technologies to the region. It is our honor to recognize these accomplishments.

Please let us know if there is a physician who deserves recognition in this column.

My Favorite Charity

How My Service Dog Saved My Life
Help for Patients Suffering with PTSD Through K9s forWarriors

By Andrew Davis

I moved to Norfolk about six years ago after serving in the U.S. Army National Guard for 10 years. The adjustment wasn’t easy – the nights were the worst. My body knew I was exhausted, but my mind had other ideas. Every evening, I would go to bed knowing that in just a few hours’ time I would be forced awake by a nightmare. 

This became my nightly routine, and my daily routine became a combination of trying to stay awake and avoiding mistakes at work caused by a constant state of exhaustion.

Doctors prescribed medication to manage Post-Traumatic Stress Disorder (PTSD), but I was still suffering. I felt like I was digging myself deeper into a hole where I was constantly taking medicine while still experiencing drastic symptoms. 

At this point, I knew there had to be a different solution. My research led me to an organization that would change my life forever. 

K9s For Warriors is a non-profit that pairs service dogs with veterans living with military-related trauma. I remember feeling nervous to attend their training program, but my case of nerves melted away when I locked eyes with Lenny. 

Lenny, a golden retriever, was chosen to help with my unique symptoms.  There was an instant connection when I met him. In that moment, I was overcome by a sense of calm that I hadn’t felt since before my service. Without a doubt, Lenny has saved my life.

If I wake up at night, Lenny is right by my side to offer comfort. I’ve eased a lot of tension around my daily routine. Something as simple as going to the grocery story used to be daunting. I’d often feel a sense of urgency to leave the store without finishing my shopping. Now, if I begin to feel overwhelmed at the grocery store, Lenny comforts me until the moment passes. 

With Lenny, I have my life back. 

I hope more people can see the immense value that service dogs can have for veterans or anyone suffering from trauma. I feel better knowing I don’t have to worry about a public panic attack.

  1. I carry business cards for K9s For Warriors with me everywhere. Oftentimes when I meet veterans, I pass them a card when we shake hands. They won’t say anything when I do this, but they thank me with a look. They know I under-stand what they’re going through. 

2. I encourage people in the area to get involved if they can. K9s For Warriors offers opportunities to host a community event, sponsor a dog, or partner with businesses of all sizes. To learn more about the organization please visit K9sFor Warriors.org. 

I also want to thank my doctors and the people of Norfolk for being so welcoming to me and to Lenny. This community has truly benefited my recovery, and I’m so grateful to call Norfolk home.

Andrew Davis served as a lieutenant in the Texas Army National Guard from 2003-2012. Originally from Maine, Andrew moved to the Norfolk area almost six years ago and is proud to call Virginia home.

For more information or to schedule an eligibility appointment, visit gmcareclinic.com or call (804) 210-1368.   

My Favorite Charity

BEACH HEALTH CLINIC
Deepak R. Talreja,MD
Sentara Cardiology Specialists

Working with and volunteering at the Beach Health Clinic is a true joy for Dr. Deepak Talreja. His work with indigent patients at the free clinic reminds him exactly why he became a cardiologist – or simply a doctor in general. 

“We all love helping people and making a difference,” Dr. Talreja says. “It’s more like the old days of medicine, with less required paperwork and more time to focus on the most important factors in care: symptoms, medications and treatment plans. It’s a wonderful way to practice.” 

Founded in 1986 by physicians and concerned citizens, Beach Health Clinic offers comprehensive health care to uninsured Virginia Beach residents below 200 percent of the federal poverty level, or roughly $51,500 in income for a family of four.  

The nonprofit clinic is able to provide a high caliber of care thanks to dozens of dedicated medical volunteers, strong community support, and partnerships with pharmaceutical companies and local hospitals, particularly Sentara Healthcare facilities. 

“Our leaders have built an amazing infrastructure to ensure patients get what they need,” says Dr. Talreja, a volunteer for eight years and a member of the clinic’s Board of Directors for the past year. “Everyone puts their hearts and souls into it.” 

In fiscal 2018, the clinic provided more than $3.8 million in donated medical and dental care and medications on a budget of $249,126. Patient appointments included 764 visits to specialists, 201 to general practitioners, 150 to nurse practitioners and physician assistants, and 38 to psychologists.  

Beach Health Clinic is open Tuesday through Friday. Emphasizing preventive care and health education, the Holland Road site provides acute illness care, chronic condition management, and oral health services bolstered by the 2013 addition of a dental clinic. 

The program also has an on-site pharmacy and a medication assistance program to deliver free or low-cost drugs. Both prevent patients from foregoing potentially life-saving treatments to save money for food, rent and other necessities.

Along with flu shots and mammograms, specialty care includes cardiology, endocrinology, gynecology, internal medicine, neurology, orthopedics, pediatrics, physical therapy, podiatry and urology. Sentara often covers needed diagnostic tests. Some providers travel from outside Virginia Beach to help, such as dental hygiene students from Old Dominion University. 

“It’s a real community effort,” Dr. Talreja says, crediting Executive Director Susan Hellstrom and the board directed by Dr. Raymond Troiano, a neurologist, for their vision and energy. “So many people are willing to share their time.” 

Dr. Talreja encounters the same health concerns that as he does in private practice, from hypertension to complex arrythmias, diseases and malformations. Some patients come to him just once, while others have appointments on a regular basis. 

One older man he has treated for several years, for instance, has survived a heart attack that left him with only half his normal heart function, but he is doing well thanks to a defibrillator and stents. In another case, Dr. Talreja replaced a heart valve on a woman who had damage linked to a childhood bout with rheumatic fever.   

“The vast majority of these patients are very hardworking people who have fallen on tough times, or who just don’t have the income to afford good health care,” he says. “They are sweet, kind, grateful individuals and families.” 

For Dr. Talreja, the Beach Health Clinic also is a family affair. His father, a retired internal medicine specialist and cardiologist; his sister, an obstetrician/gynecologist; and his brother-in-law, a dentist, have served as volunteers as well.   

“What we all have in common – not just my family members, but all the volunteers – is that we really want to be there,” he says. “It’s both a privilege and a delight.”

To learn more, visit beachhealthclinic.org or call (757) 428-5601.