October 21, 2018

Pain Management

What is a Physiatrist?
By Rita Boslet, MBA, FACMPE

Physical Medicine and Rehabilitation physicians or “Physiatrists” work to improve the wellbeing of patients experiencing a decrease in quality of life because of a pain limiting condition or disabling disorder, often with amazing results. Physiatrists are experts at diagnosis and treatment of pain, as well as the evaluation of function. They focus on nerve, muscle and bone and their interrelationships that determine function or pain responses. Physiatrists often treat patients with acute work or vehicular injuries, sports injuries, adults suffering from low back pain, headache, neurological disorders and arthritis. The goal is to enable patients to return to full function through non-surgical methods.

Often, interventional procedures, such as epidural injections, can provide long-lasting pain relief. Relief of pain allows the patient to resume some normal activity and begin strengthening exercises which will lead to improved recovery. Treatment always includes specific explanation as to potential causes of the symptoms and a discussion of ways to prevent future injury.

A physical medicine-based practice will not use narcotic pain medication as a front line measure. Often, a patient with chronic pain currently treated with narcotics will be referred. This patient may be denied evaluation, due to obvious narcotic addiction or dependence after chart review. Accurate assessment of a patient’s pain cannot be done while the patient is taking significant doses of narcotic pain medications and studies have shown that narcotic medications can worsen, rather than lessen pain in some cases. A Physical Medicine and Rehabilitation specialist is trained to diagnose and treat pain, not addiction. However, after a patient has been weaned from narcotics, the evaluation and treatment process may begin. When narcotics have been prescribed for a short term, the patient may be accepted for treatment. The patient must realize that the narcotics are temporary and the goal is the discontinuation of medication and the restoration of maximum function.

Pain management does not guarantee complete pain cessation, only progress toward a comfortable, active and optimal lifestyle. Hard work and persistence is required in combination with a team approach by patient, physician and therapist.

Specialized treatment modalities used by a Physiatrist can include: epidural blocks, selective nerve root blocks, prolo therapy and platelet rich plasma injections (PRP), radio frequency denervation, discography and intradiscal injection, spinal cord stimulator trials, diagnostic musculoskeletal ultrasounds, ultrasound guided injections, image guided intra-articular hip injections, electrodiagnostic testing, physical therapy, electrostatic therapy, therapeutic massage and more.

If a problem is in early stages, prompt treatment is essential to prevent the unintended slide into chronic pain. Appropriate diagnosis and treatment leads to correcting the harmful activity, breaking the pain cycle, and hopefully, restoration of normal function and a fulfilling lifestyle.

Rita Boslet, MBA, FACMPE is the Practice Administrator for APM Spine and Sports Physicians. APMSpineAndSports.com

 

 

Medical Professional Spotlight

Recognizing Outstanding Nurse Practitioners and Physician Assistants in Hampton Roads
Valerie LeGrone, MSN, ANP-BC, CNOR

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(L-R) Dr. Mark A. Fontana, Bariatric Clinical Director, Dr. Caren D. Beasley, Medical Bariatrician, Valerie LeGrone, Nurse Practitioner, Dr. Stephen D. Wohlgemuth, Bariatric Medical Director

Valerie LeGrone is very much a team player. As an adult nurse practitioner at Sentara Comprehensive Weight Loss Solutions, she’s part of the multidisciplinary effort to help patients lose weight, and keep it off. “This is the perfect job for me,” she says. “I’m able to incorporate my lifelong interest in nutrition and passion for exercise into my work with our patients.” Indeed, her education, experience and passions have prepared her well for her demanding work schedule.

LeGrone earned her BSN in 1991 at the University of Pennsylvania as part of a US Navy program. Upon graduation, she was commissioned as an Ensign, stationed at Bethesda Naval Hospital. She was co-assigned to the USNS COMFORT, and had the opportunity to experience deployment during Operation Uphold Democracy in Haiti. “We had 12 operating rooms with the ability to strap down tables in rough seas,” she says. “It was wonderful training. Everything I did in my Navy career led to my role as a nurse practitioner and prepared me for what I’m doing now.”

In 2003, she earned her MSN in the Adult Nurse Practitioner program at the University of Texas at Arlington. She began her career with Sentara in 2006, working with palliative care patients at Sentara Leigh Hospital; and in 2009, joined the team at the Comprehensive Weight Loss Center.

Her day begins at Sentara Norfolk General, where bariatric surgeries are performed. “I round on patients in the hospital,” LeGrone says. “I watch their swallow studies to make sure there are no leaks, and I do all patient discharges.” When that work is completed, she returns to the Center to see patients at all stages of pre- and post-surgery care.

When she’s not actively working with patients, she assists with research projects between EVMS and the Center. “It’s fascinating,” she says, describing one current study that looks at the inflammatory markers in the blood of obese patients. “They’re hoping that eventually they’ll be able to draw blood samples that would indicate if someone had these inflammatory markers, which would identify them as being at higher risk for certain conditions, like diabetes or heart attack. We know that weight loss improves these inflammatory markers in patients and improves diseases like rheumatoid arthritis and gout.”

One of the aspects of the work she loves is counseling. “Had I not been a nurse practitioner, I probably would have been a dietician,” she says. “And I’ve always enjoyed exercise. So I really enjoy talking to these patients about diet, about nutrition and exercise. We know that a lot of them are eating for reasons other than hunger: stress, anxiety, monotony, or habit.” She has a variety of strategies to help these patients, but she’s also grateful that the Center has a psychologist on staff when patients need more structured counseling. She’s also realistic about exercise: “A lot of our patients have never exercised at all,” she says, “so we put together a program for them, focusing on what they can and will do. We have a small gym where they can start, with a certified exercise specialist.”

Ultimately, LeGrone says, the Center’s goal is for every patient to be successful with weight loss. “We have all the tools here to help them,” she says. One of the more high-tech tools is an infrared scanner that produces a 3-D image of the body. “It gives a totally accurate scan,” LeGrone says. Patients are scanned every three months, so they see exactly how many inches they’ve lost off their waists, hips, etc., giving them a better grasp of their progress.

“But our main tools are our world-class bariatrician and surgeons,” she says, “and a dedicated professional team that supports them. I truly believe we can be successful with every patient.”

Good Deeds

Honoring the Volunteer Service of
Dr. Roger H. Perry, Pediatrician

Dr-Perry-Good-DeedsDr. Roger Perry retired from the active practice of medicine in 1994, following a long and distinguished career. While a student at the University of Virginia (BA 1951; MD 1955), he was admitted into the prestigious Raven Society and a member of Alpha Omega Alpha Honor Medical Society. He completed both his internship and residency in Pediatrics at New York Hospital, Cornell University Medical Center in New York City.

During medical school, he signed up for the Berry Program. “You could sign up, and you were deferred until you finished your training,” Dr. Perry explains, “and then you’d go into one of the services for two years. That’s how I got into the Navy.” His service took him to the Submarine Base Hospital in Groton, Connecticut, where he practiced from 1958 to 1960.

Completing his Navy career, he moved to Ithaca, New York, where he started his private practice in 1960. He was on staff at Tompkins County Hospital, and served as President of the medical staff from 1980 to 1984. After thirty-four years of caring for the children in and around the community of Ithaca, he retired in 1994; and with his wife, moved to Newport News, so, he says, “We could be closer to our daughter and her family.”

After such a fulfilling career, many physicians are content to rest on well-deserved laurels, relaxing, enjoying leisure time with family and friends. Not so Dr. Perry: “I enjoyed my pediatric practice years,” he says, “and I didn’t want to give it up altogether. I figured volunteering would be a good way to keep active, but not be overwhelmed.”

Immediately after arriving in Newport News, Dr. Perry began asking around for opportunities. A neighbor told him about the Olde Towne Medical Center (there was no dental service at that time), and he arranged a meeting. “We had started out in 1993 just doing primary care,” says Dr. William J. Mann, Jr., the Center’s Executive Medical Director. “It had become obvious to us that we needed to offer pediatric care as well, just about the time Dr. Perry volunteered. It was heaven’s timing.”

It was also a match made in heaven, Dr. Mann continues. Williamsburg has a large community of un- and underserved families, headed by men and women who earn their living as seasonal employees at local hotels, restaurants, theme parks and historic attractions. From May to December, during the heaviest tourist season, these workers have hourly jobs that offer no benefits. From December to May, they’re often without employment altogether, and thus without options for medical care. The Olde Towne Medical and Dental Center, which has expanded to include a full range of medical services (including geriatrics and prenatal care), that fills the void for these hard working individuals, who often lack basic English skills. In fact, Dr. Perry says, “We have a Spanish interpreter at the clinic, and all of our brochures are English and Spanish.”

“When Dr. Perry is here, he lights up the hearts of staff, children and parents,” a staff members says, while another describes Dr. Perry as a “fountain of knowledge and compassion. Working with him is a continuing learning opportunity.”

For Dr. Perry, it’s the opportunity to see children grow and develop. “I’ve always enjoyed well baby and well child work, and helping them along in their years of growing,” he says. The Olde Towne Medical and Dental Center offers him plenty of opportunities to do just that.

So will this good deeds doctor retire? “I’ll be here as long as the clinic will put up with me,” he says. Adds Dr. Mann, “As long as he’ll come, he’s welcome.”

 

The Legal Perspective

Moving to the Cloud
By G. Wythe Michael, Jr.

Over the past several years, many businesses have migrated essential software and business systems from company owned personal computers and servers to the “cloud.” In general, cloud computing refers to a network of remote computer servers hosted on the internet that store, manage, and process data. Typically, third party vendors provide both the software and the data storage capabilities – thereby allowing the business customer to access the information through any internet enabled computer. The healthcare industry is no exception to this trend, with practice groups using cloud-based services for billing, scheduling, medical records, telemedicine and for other uses.

Cloud computing offers several advantages over the traditional hardware/software model. These advantages can include lower costs (no need to purchase and maintain expensive servers or software), flexibility (users can pay for just the right amount of service and quickly make changes) and ease of use (the services can be accessed wherever an internet connection is available).

With these advantages, however, come risks – especially for healthcare providers. Certainly the biggest risk for practice groups using cloud-based services involves data breaches and other violations of HIPAA and the HITECH Act regulations. This is especially important given the numerous changes and requirements addressed in the Omnibus Final Rule issued by the Department of Health and Human Services in January, 2013 (with enforcement beginning effective September 23, 2013).

To address these risks, practice groups desiring to utilize cloud-based services should, as an initial matter, determine whether each vendor is capable of providing the service levels required by the practice and complying with applicable data security standards. This should include, among other things, an assessment of the vendor’s security infrastructure, the location(s) where the data will be stored, the vendor’s disaster recovery plans, the vendor’s service level capacity, the vendor’s financial capabilities, and a review of the vendor’s compliance history. These matters should be addressed during the initial negotiations with the vendor.

Second, practice groups should negotiate protective provisions into the agreement with the vendor. At a minimum, these protections should include the following:

• The agreement should require the vendor to adhere to specific service levels so that the practice group is assured that it will be able to access the services and data when needed.

• The agreement should require strict compliance with HIPAA and other applicable data and privacy security laws.

• The agreement should require the vendor to notify the practice of breaches of PHI and should describe the duties of the parties in the event of a breach.

• The agreement should require the vendor to return the practice’s data in a usable format upon the termination of the agreement.

• The agreement should require the vendor to protect and indemnify the practice for data breaches caused by the vendor.

Given the importance of the services provided, the critical information being stored and the potential risks, practice groups should ensure that their cloud vendors are capable of performing the required services and that the agreement with the vendor contains adequate protections for the practice. Accordingly, a review of the vendor agreement by an experienced attorney will be extremely valuable.

 

G. Wythe Michael, Jr. is an attorney with the law firm of Goodman, Allen & Filetti. Wythe regularly works with medical, dental and other professional service firms and understands the unique issues impacting these firms and their owners. Call 804-565-6811or visit their website goodmanallen.com

 

 

Key Choices for a Financially Successful Retirement

Establishing a retirement strategy and making decisions about income, liquidity, long term care and legacy may seem like a daunting task but it need not be. Consider the following key choices for less stress and more success.

Choose a knowledgeable financial professional to help you map out a course of action.
One of the most important choices to make is who may help you achieve retirement success. Consider someone with experience in helping others plan for retirement income and who can help you make informed decisions that help you achieve your goals.

Seek guidance from a local, knowledgeable financial professional who will never rush to fit you into a category or push products. One who believes that the best way to create a successful financial strategy is to build a strong relationship with his or her customers and will take the time to listen carefully to your needs, explain your options and customize solutions for you.

Choose a financially strong company to work with.
When it’s time to choose the products to help you implement your plans, look for a company with the financial strength to be there when you need them.

No matter what solutions are right for you, work with a financial professional who can help you make the good decisions that retirement success requires.

Insurance products issued by MassMutual, Springfield, MA 01111-0001 and its subsidiaries, C.M. Life Insurance Company and MML Bay State Life Insurance Company, Enfield, CT 06082.

©2013 Massachusetts Mutual Life Insurance Company, Springfield, MA 01111-0001. All rights reserved. www.massmutual.com CRN201401-155598

 

DANIJEL VELICKI, CFS CIS
Founder/Senior Partner
The Opus Group of Virginia

222 Central Park Ave., Ste. 1170, Virginia Beach, VA 23462
757-227-5000
Danijel@opusva.com
www.opusva.com

Bon Secours Surgical Specialists

Offering Hope For Individuals Suffering From the Health Effects of Morbid Obesity

It’s currently estimated that greater than 60 percent of Americans are significantly overweight, and that more than 16 million are 100 pounds or more over their ideal weight. It is well established in both the medical and the lay community that even mild obesity is associated with a host of medical conditions, including high blood pressure, heart disease, high cholesterol, diabetes, respiratory problems, sleep apnea and reflux. But unchecked obesity can also lead to urinary stress incontinence, degenerative arthritis, venous stasis disease/ulcers, several different cancers (including breast, uterine, ovarian, esophageal, colon, prostate and pancreatic), skin infections and infertility. And for the morbidly obese, the sequelae are greater still.

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Melodye Myers, Administrative Director, Bariatric and Metabolic Services

The surgical weight loss division of Bon Secours Surgical Specialists, led by four innovative and world-class surgeons, treats the whole person with a comprehensive plan tailored to the individual. This includes psychological, nutritional, and physical evaluations, as well as counseling, support groups and long-term coordination of care – in addition to weight loss surgery.

Commonly known as bariatric surgery, these procedures alter portions of the stomach, and in some cases, the small intestine. As a result, less food is consumed and fewer calories are absorbed. Bariatric surgery is generally considered an option for persons who have a BMI above 40. It’s also an option for people with a BMI of 35 to 40 who are experiencing potentially devastating health problems, such as Type 2 diabetes, high blood pressure or sleep apnea.

Today’s bariatric procedures are vastly different from the ineffectual and sometimes dangerous operations offered in the early days of weight loss surgery. Laparoscopic, less invasive techniques have rendered today’s procedures safer, faster and more successful.

Bariatric surgeons with Bon Secours Surgical Specialists offer three different procedures.

Gastric Bypass
In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top, using surgical staples or a plastic band.The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. The restrictive pouch along with the removal of the portion of the stomach that impacts the release of ghrelin (a hormone that stimulates hunger) makes patients feel less hungry. The rewiring of the small intestine helps with slight malabsorption. Loss of more than 100 pounds within the first three months is not uncommon.

Sleeve Gastrectomy
In this procedure, a thin vertical sleeve of stomach (about the size of a banana) is created using a stapling device. The rest of the stomach is removed. A sleeve gastrectomy limits the amount of food that can be eaten at one time, so patients feel full sooner and stay full longer.  As they eat less food, their bodies stop storing excess calories and start using their fat supply for energy, resulting in weight loss.

Gastric Band
This surgery reduces the amount of food the stomach can hold at one time by placing a silicone band around the upper portion of the stomach. The band is then connected by thin tubing to an access port just beneath the surface of the skin, which allows the surgeon to adjust the fit of the gastric band by inflating or deflating its inner lining. Most patients experience an average weight loss of one to two pounds per week until their goal weight is met.

These procedures in the hands of experienced and skilled surgeons are remarkably safe. Patients quickly learn that surgery is just a tool, and their surgeon is only one member of an impeccably trained and dedicated team that can help them lead a long, healthy and satisfying life. The team consists of professional and compassionate experts in nutrition, psychology and exercise physiology.

The members of this team know well the challenges that face people with extraordinary amounts of weight to lose. They understand the obstacles their patients must overcome on a daily basis. And they are keenly aware of the need for ongoing support. Serious weight loss is a lifetime commitment and as the surgeons note, they never really discharge a patient.

Meet our board-certified bariatric surgeons. 

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Gregory Adams, MD, FACS

Gregory Adams, MD, FACS, began doing bariatric surgery more than a decade ago, in response to a community need. In the small Alabama town where he practiced, there were no surgeons performing weight loss procedures. “The nearest surgeon was a couple of towns over,” Dr. Adams remembers. “He was a one-man practice, and he was probably doing 600 surgeries a year. His procedures were good, but bariatric surgery needs the long term care of the surgeon involved, and he wasn’t offering that.” Without long term surgical care and the ongoing support of nutritionists and counselors, these patients were failing badly, and began showing up in Dr. Adams’ office seeking help. He and his partner obtained the training and expertise they needed, and established a program that met all of their weight loss patients’ needs.

Dr. Adams describes caring for weight loss patients as one of the more satisfying parts of his career. “Physicians who go into surgery usually do so because they like to fix problems,” he says. “I’m very much in that group. Patients come to me with a bad gallbladder or appendix, I take it out and they go on their way. And that’s very satisfying.”

But, like his partners, Dr. Adams enjoys his bariatric patients because of the long term relationships he establishes with them. “I get to really know people for a change, and that’s great because I get to see them actually getting healthier. I enjoy the interaction.”

The conversations can be challenging: Dr. Adams has to help patients face some hard truths. “It’s not politically correct to call obesity a disease of addiction, and it isn’t 100 percent addiction,” he says, “but the behavioral issues related to obesity do have addictive tendencies. Within a few days of starting any diet, most people can quantify the foods they really want that they had forbidden themselves. That behavior is strong, those psychological desires are real and the only way you decide to conquer those behaviors is when you can’t stand your life with them any longer. The patients who do the best are the ones who admit, ‘I cannot live like this. I need help.’”

But he cautions them. “Patients can have the misconception that weight loss surgery is a magic trick, that they can continue to live the way they’ve always lived,” he says. “I have to explain that in reality, that’s not true; it’s just a tool that makes it so they can live the way they need to. We’re asking people to literally change the way they eat, exercise, drink – those are very personal things and can be difficult.”

Changing those behaviors reaps tremendous health benefits for patients. Their diabetes is real, Dr. Adams assures them. Their sleep apnea is directly related to obesity, as is high blood pressure, high cholesterol and as many as nine different cancers. Their joint pain is real because the excess weight has compromised their joints.

Surgery changes patients’ set points so they can lose weight and keep it off, Dr. Adams notes. “At the physiological level, there are all kind of interactions, everything from hormones to actual absorption of nutrients,” he says. “In one way, it’s a metabolic tool, and in another, it helps reinforce the behaviors we’re asking patients to change. But it’s still just a tool. To succeed, they need that follow-up care and support that we offer.”

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Elizabeth Salzberg, MD, FACS

In her work with Bon Secours Surgical Specialists, Elizabeth Salzberg, MD, FACS, puts her undergraduate degree in psychology to good use. “I’ve always had a fascination with the human mind and behavior,” she says, “and I love all aspects of surgery, so treating weight loss patients allows me to marry together all of my interests.”

Although she still performs and enjoys the whole spectrum of general surgery, she estimates bariatric surgery constitutes about 70 percent of her practice. She calls bariatric surgery her passion and explains how and why she came to feel so strongly: “After I’d spent about five years in general surgery, I did a fellowship in advanced laparoscopy. I was able to really delve into bariatric surgery, and I felt an immediate connection. I’ve always had a keen interest in women’s health and nutrition, so it felt like a good fit. Today, 90 percent of my patients are women.

“Women in particular, every one of us, tend to have some struggle with weight,” she says. “We’re always seeking that work-life balance: finding time to exercise, eat properly, maintain a career and a home. I found a niche in caring for these women; not only is the surgery itself fascinating and technically challenging – and the biochemistry that goes into it – but I found I also really enjoyed the counseling.”

Part of her counseling is aimed at determining the best procedure for each individual patient. “It has a lot to do with their diet history as well as their medical history,” she explains. “There are certain operations that work better for some patients than others. It’s a complex decision. And I counsel them so they understand that surgery isn’t a magic wand. Their problems aren’t solved when they wake up from anesthesia; their work is just beginning. That’s when they need the invaluable support that our multidisciplinary program offers.”

Herself the mother of two young boys, Dr. Salzberg is keenly aware of the rising number of obese American children in the 21st century. Some of the problems these obese children face started when they were in utero, she says. “We know that when one child gestates in an obese woman’s body and another gestates in a body closer to normal weight, there’s a greater risk of gestational diabetes, pregnancy induced high blood pressure and macrosomia in the obese mother.”

But what was fascinating, Dr. Salzberg says, is the finding published in the journal Proceedings of the National Academy of Sciences (PNAS) that shows how different the children borne by obese women before and after bariatric surgery are. Compared with their peers born to obese women, children born to mothers following weight loss surgery are significantly less likely to be obese. They have healthier blood pressure, lipid profiles and metabolic function. The study makes clear that weight loss surgery does much more than change the example a mother sets for her child.

The PNAS findings suggest that, “a woman who goes into a pregnancy extremely obese is doing more than passing on genes that predispose her child to obesity and the health effects commonly associated with it; she may also be passing on the code that inclines those genes to behave in unhealthy ways. But maternal obesity does not set that code in stone; if reversed, as it was for these women by bariatric surgery, the chemicals that direct genetic expression may well become a force for good health.”

“If there is one way you can motivate a parent, it’s telling them something is better for their child,” Dr. Salzberg says. “I can tell you that data was very powerful to me.”

Revision Surgery
Bariatric surgeons are frequently consulted by patients whose previous weight loss surgery has failed. It might be the result of an ineffective procedure or perhaps a relapse into bad lifestyle habits. Two of the surgeons at the Bon Secours Surgical Weight Loss Center have the additional training and skill to perform revision procedures that set these patients back on the road to success.

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Anthony Terracina, MD, FACS

Anthony Terracina, MD, FACS, decided on a career in surgery when he was in the ninth grade.  A classmate’s father, a general surgeon, invited him into the operating room, and he “fell in love at that moment.  “I worked at the hospital as an orderly when I was in high school,” he says, “and by the time I went to college, I knew exactly what I was going to do for a living.”

Eager to work after completing his residency in general surgery in 1994, he joined a practice in Florida, where he performed a wide variety of procedures.  A few years later, when a friend told him about laparoscopic bariatric surgery, he was intrigued.  He returned to Parkland Hospital in Dallas to train in the procedure, and took it back to his practice in Florida.

Ultimately finding Florida too restrictive – many insurance companies were dropping coverage for weight loss surgery – Dr. Terracina looked for “a state where I could be guaranteed the profession that I loved.”  He chose Virginia, coming to Hampton Roads in 2004.  “When I left Florida, about half of my practice was bariatric surgery,” he says.  “When I got to Virginia, I went to 100 percent.”

He was performing the gastric bypass on a daily basis for years and was responsible for introducing the sleeve gastrectomy and gastric band procedure to the area. He is eager to also extend the lap band procedure to patients with a lower BMI of 30 with diabetes, whose disease can be cured by a weight loss of 40 or 50 pounds.

Matching the procedure to the patient is a painstaking process and done only after significant counseling. “We present the options to patients in a seminar format,” Dr. Terracina says.  “We listen to their health problems, their concerns, what’s important to them, what they want to accomplish with the surgery.  Then I tell them to go home, think about it and we’ll talk again.”  He lets the patient decide ultimately, but he’ll guide them if he thinks there’s a better choice.  “Once you’ve performed over 3,200 weight loss operations on patients, you know what surgery a person needs and what they’ll respond to.”

Several years ago, Dr. Terracina added another type of surgery to his arsenal: the technically challenging and complex revision procedure.  These are for patients who have had other bariatric procedures in the past, who need to move on from the type of surgery they had to a more suitable one.

“These aren’t situations that are cut and dried,” he explains.  “Often you’re looking at old, failed procedures that are no longer performed.  The surgeon has to figure out how to revise the older procedure and implement the newer one, without significant issues or putting the patient in jeopardy.”

Unfortunately, revision isn’t always possible.  In fact, for every 10 people who seek revision surgery, there may be no more than two or three who are viable candidates.  This is especially true in the case of the older procedures, the more unusual open procedures done before the advent of laparoscopy.  “In the modern era of weight loss surgery, I always have an option,” Dr. Terracina says, “but that’s not true of the more archaic operations surgeons did years ago.”

For example, if a gastric bypass patient regains weight, he can put a lap band over the pouch – or take a sleeve gastrectomy patient who isn’t doing well and either put a lap band in place or convert to a gastric bypass, giving these patients a fresh start.

But even when revision isn’t an option, Dr. Terracina emphasizes, they don’t turn patients away.  “Even if we can’t help them surgically, we can help them from a medical standpoint.  We enroll them in our program, we follow them and get them to lose weight naturally with our dietician.”

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Eric DeMaria, MD, FACS, FASMBS and Erin Burton, LPN

The newest member of Bon Secours Surgical Specialists weight loss team, Eric DeMaria, MD, FACS, FASMBS, joined Bon Secours Weight Loss Center in September of 2013. A pioneer in bariatric surgery, Dr. DeMaria has 23 years of experience and is considered an expert in advanced laparoscopic surgery procedures.  His surgical skills are often sought for high risk patients and those with complications, as well as patients in need of revisional procedures to correct complications or reverse weight regain.

Throughout his career, Dr. DeMaria has seen many of the milestones in the understanding of obesity and the treatment of obese patients. In 1991, he notes, the National Institutes of Health consensus conference set the stage for what has turned out to be a very slow adoption of the concept that obesity should be categorized, and treated, as a disease.

He acknowledges the strong evidence of a genetic predisposition to obesity – studies with identical twins raised apart who each become obese are compelling – but “You don’t see extreme morbid obesity unless you have the prosperity to purchase food and a lifestyle that allows you to be sedentary. You need these factors to see the full expression of genetic type. I prefer to say it’s a genetic predisposition that’s aggravated by numerous social, behavioral and cultural factors,” says Dr. DeMaria.

Unfortunately, he notes, there is still a great deal of ignorance about obesity. He has spent his career battling that ignorance, as well as caring for patients.

A year before the 1991 NIH conference, Dr. DeMaria had joined the faculty at the Medical College of Virginia and worked alongside the renowned bariatric surgeon Dr. Harvey Sugerman. “The work was fascinating and really helped people,” he says. “It had a lot of positives. And later, when we started doing advanced laparoscopic procedures, it became my primary career focus.”

In 1996, he and his colleagues worked on the FDA trials for the gastric band procedure, which gained initial approval in 2001 for severely obese adults and expanded approval in 2011 for adults with lower BMI and obesity-related comorbidities.

“In 1997, we started do the laparoscopic gastric bypass, which was really a technical challenge to do,” he remembers. “We were one of the early adopter groups. It was energizing to be involved. It fit with my teaching and research interests.” The procedure has stood the test of time, with good reason. The surgeons often see patients three weeks after a gastric bypass, who’ve already lost 20 to 30 pounds. And the effect on diabetes is phenomenal: it’s not uncommon to send a diabetic patient home from the hospital off of insulin, before they’ve lost even one pound.

But it is revision surgery that has been his focus in recent years. “In all of bariatric surgery, that’s what I do more than anything else,” he says. “It’s a hodge podge of things: it includes taking care of complications of previous surgeries. It includes fixing or converting surgeries that have failed for one reason or another. The risks of the operation are always increased when there’s been a previous bariatric operation. It’s challenging work that I love.”

And it was the opportunity to do challenging work in a world-class facility, surrounded by exceptional surgeons and staff, that brought Dr. DeMaria to the Bon Secours Surgical Weight Loss Center. “I wanted to spend the next 10 to 15 years with a higher performing program around me, with people who understand how good bariatric surgery is for their patient population. Bon Secours Maryview has one of the top programs in Virginia, with a track record of excellent outcomes. I now have the opportunity to take this program to an even higher level, and they have the pieces in place to help me do that. It’s very, very exciting.”

Ongoing Events and Seminars Offer Education and Support
The surgical team understands that education and support are vitally important to current and potential patients. Each month, a dozen or more weight loss seminars are offered to interested members of the public free of charge, on days and at times that fit within every schedule. These seminars cover the basic surgeries as well as options for revision procedures.

In addition, weight loss support groups meet each month, offering patients the opportunity for advanced education and guidance, as well as a place to share experiences.

The physicians and staff of Bon Secours Surgical Specialists have the knowledge, experience and compassion to help patients make significant weight loss a permanent reality, no matter how much they may have struggled in the past.

For more information or to sign up for an free educational seminar – and to read what some of our patients have to say about our program – visit us online at bonsecourssurgicalweightloss.com.
To schedule an appointment,

call us 757.673.5990.

Dominique R. Williams, MD, MPH, FAAP

williamsDr. Dominique Williams is a Board-certified pediatrician who serves as Medical Director of the Healthy You for Life program at Children’s Hospital of The King’s Daughters. She earned a Bachelor of Science in Nutrition from Case Western Reserve University and her doctor of medicine degree from Wright State University School of Medicine in Dayton. She completed her internship and residency in pediatrics at Columbus Children’s Hospital in 2004, and earned a Master of Public Health in Nutrition in 2013 from the University of Massachusetts Amherst. She is an assistant professor in the Department of Pediatrics at EVMS.

Dr. Williams is a Fellow of the American Academy of Pediatrics and its Virginia Chapter.

 

When Dominique Williams was 11 years old, she told her mother she was going to be a neurosurgeon. Her mother, an RN and director at a school of nursing, knew better than to question her daughter. “Education was always emphasized in my family,” she says, “so it was assumed we’d finish college and go beyond. My mother didn’t bat an eye: she found residents who would talk to me.”

She took her bachelor’s degree in nutrition, because, she says, “Even as an undergrad I had no interest in biology to study it for four years, no interest in chemistry. But I had a very big interest in nutrition, and I felt that would be relevant on my road to being a brain surgeon.”

At no time did she ever consider a career as a pediatrician. “I didn’t like kids,” she says candidly. “I didn’t like being around them; I didn’t understand why they cried so much. I internalized it – I thought I wasn’t supposed to take care of children.” But that was before she had any clinical experience. It was in her third year that she took a pediatrics rotation. “I had enjoyed all the others,” she remembers, “and I received positive feedback – but I always had a headache at the end of the day. But after my first day in pediatrics, no headache. Second day, no headache. I remember thinking, ‘this is compelling.’”

As for their crying, the more she was exposed to sick kids, the more she understood what the crying was about. For some of them, that was the best they could do. “And that,” she says, “was the beginning of my using my powers for good.”

Dr. Williams describes herself as “fun-sized,” referring to her not-quite-five-foot frame. “I’m kind of a dorky, goofy person, and for the first time, that worked to my advantage. For kids, suddenly a doctor in a white coat was accessible. I used my size and my personality to reach them. And I fell in love.” She knew she had found her specialty.

Her first position was in primary care with Chesapeake Pediatrics. “They took a chance on an Ohio girl with a nutrition background,” she says. Six months into practice, she was offered the opportunity to talk to parents about the complications of obesity for their children. It was then that she knew she had found her niche.

It took a leap of faith to leave private practice to focus entirely on the problems of overweight and obese kids, but, as Dr. Williams describes it, “It became increasingly evident that this is where I was supposed to be. I have a heart to serve these kids.”

She has strong feelings about the epidemic of childhood obesity. “It’s like a jigsaw puzzle with the tiniest pieces. Every piece needs to be connected to another piece in order to solve the puzzle. I can’t say it’s any one thing I’d attribute the epidemic to; it’s been more of a shift over time. We’ve changed how foods are packaged and supplied, and we’ve created a salty, fat palate that has a preference for something with little nutritive value.”

But that’s only one of the pieces of the puzzle. Dr. Williams’ Master’s thesis was on the role of victimization in aspects of obesity. She researched the theory that witnessing domestic violence, being a victim of domestic violence, being a victim of bullying, operating in a constant state of fear and trepidation, wreaks havoc on a child’s metabolism. It wreaks havoc on coping skills, and on willingness to go outside and play, whether for fear of getting beaten up or fear of being isolated. “These kids seek refuge in food that always makes them feel good, doesn’t give them negative feedback,” she says. “My thesis was that victimization was just as important to address as the food supply and environment and physical activity. Domestic violence, intimate partner violence, moms and children not feeling safe – these are the undercurrents that create obesity.”

In the Healthy You for Life program, Dr. Williams says, “We have two social workers, a dietician, a physical therapist, an exercise specialist – there’s a team of us to address the different aspects. But if that kid’s heart is broken, it will undermine the attempts to address how they’re going to eat or move their body. It will even undermine their willingness to consider that they’re capable of change, if all they do is operate in this circle of negativity.”

There is accountability but no judgment in the program, which is evidence-based and proven. Instead, the emphasis is on helping families gain the confidence that they had the potential to change all along. “We never ask for perfection, we ask for your best,” Dr. Williams says. “We add personality to the science. I can still be nerdy and intellectual and use that drive to help these families.”

 

Anthony D. Terracina, MD

DrTDr. Anthony Terracina is a Board-certified surgeon specializing in laparoscopic bariatric surgery with the Bon Secours Surgical Weight Loss Center. He earned his medical doctorate degree at the University of Mississippi Medical Center in Jackson and completed his residency in general surgery at Parkland Hospital in Dallas, Texas. 

He is a member of the American College of Surgeons and the American Society of Bariatric Surgeons. He is currently Chief of Surgery and the Director of Bariatric Surgery at Mary Immaculate Hospital.

 

Dr. Terracina remembers the first gastric bypass he performed in 1999. “The patient told me his name was Capt. Hornblower. He played the trumpet in local jazz clubs. He was a severely obese 65-year-old man who was suffering from both diabetes and hypertension.” Dr. Terracina was honest: “I told him, ‘look, this is the first time I’ve performed this surgery.’ To which Hornblower replied, ‘Doc, look what I’ve done with my body my whole life. I need help.’”

Months after the surgery, Capt. Hornblower’s diabetes, hypertension and sleep apnea were resolved. “He said he wished he’d had the surgery 30 years ago,” Dr. Terracina says.

Since that first surgery, he has performed more than 3,400 bariatric procedures, including the three standard operations in use today: gastric bypass, sleeve gastrectomy and gastric banding. He’s still amazed at the number and variety of conditions that can be corrected by weight loss, including hypertension, reflux disease, polycystic ovarian syndrome, pseudotumor cerebrii, sleep apnea and several others. He also remembers one of his first patients reporting that six months after weight loss surgery, her glaucoma was gone. “I looked through the literature for any link between obesity and glaucoma, and found absolutely nothing,” he recalls, “but 13 years later, sure enough an article was published reporting glaucoma being cured by weight loss surgery. Obesity affects virtually every organ system in the body.”

In short, he says, “We know many conditions that are cured with weight loss, and there may be many more as well. There are things we don’t yet completely understand – like curing diabetes. There are many theories about why diabetes is cured almost instantaneously in eight out of ten patients. No one understands that perfectly – yet.”

The gastric bypass, Dr. Terracina explains, is one of the most studied operations in the world. “We really don’t know everything about how and why it works,” he says, “but there are four main mechanisms to help patients: portion control, hunger control, delayed digestion and aversion to sweets.”

“We think the gastric bypass is a near-perfect operation,” Dr. Terracina says. It’s often the procedure he uses when doing one of the complicated revisions that make up a large percentage of his practice. These revision surgeries include improving an outdated prior surgical procedure, or converting a previous procedure to a different one. Recently, he operated on a patient who had a vertical banded gastroplasty twenty-eight years ago. “She had a staple line failure, a typical result with one of these archaic surgeries. Her stomach looked as normal as the day she had her first surgery. I did a gastric bypass on her,” he says, “and she’ll do well as long as she continues with the follow-up that’s so important.”

What he particularly likes about his practice with the Bon Secours Surgical Weight Loss Center, Dr. Terracina says, is the fact that everyone who walks through the front door is a weight loss patient. “Our waiting room becomes a sort of impromptu support group: everyone’s either had or is having the surgery. There’s a built in camaraderie. They develop alliances and friendships. Our patients know that when they come to our office, everybody’s the same. There’s no judgment, just support and understanding.”

For patients in the super-obese category, finding a place where there is no judgment but plenty of understanding can be critical. “We see a tremendous population of the super obese,” Dr. Terracina says, “people who are well over 500 pounds. These patients aren’t always candidates for surgery due to the higher risk of their body size. But we can make them candidates in most situations.” He cites the example of a patient who presented last year at 540 pounds: “He was 5’10”. We first put him in our pre-op program, and he lost 80 pounds. We took him to the operating room and did a sleeve gastrectomy. He proceeded to lose more than 200 more pounds.”

Dr. Terracina knows that even the most successful weight loss patients can relapse. “About 15 to 20 percent of people will need to get back on track at some time in their lives,” he says. “And while we operate on people every day, the rest of the time, we’re listening to them. Due to stress and busy lives, they can resort to bad eating behaviors. I assure them they can get through those situations. Sometimes, I counsel as much as I operate.”

Dr. Terracina has a high percentage of patients who relocate from Hampton Roads after surgery, but they return every year to see him. They want that follow-up, he knows: “They want to come back in. If they did really well, they want that pat on the back. If it’s the opposite scenario, they want that ‘get back on track’ help.”

He insists, when his patients do well, that the credit ultimately belongs to them: “We perform the surgery and offer guidance. It’s the individual patient who makes the lifestyle changes and commitment to a healthier existence.”

 

Glen L. Moore, MD

Moore_GlennDr. Glen L. Moore is a Board-certified surgeon specializing in general and bariatric surgery with Chesapeake Surgical Specialists, and Director of the Bariatric Program at Chesapeake Regional Medical Center. He received his medical degree from the Eastern Virginia Medical School, and completed his general surgery internship and residency at Naval Medical Center Portsmouth, where he also served as staff surgeon. He has held academic posts as an instructor at Uniformed Services University of the Health Sciences in Bethesda.

 

Dr. Moore is a member of the American Society for Metabolic and Bariatric Surgery and a fellow of the American College of Surgeons.

Dr. Glen Moore developed an interest in bariatric surgery in the mid- to late ‘80s, while he was in the Navy, completing his internship and residency. At that time, he remembers, “Surgery for obesity was almost considered to be one of those fringe activities. It wasn’t widely available, and certainly not widely accepted by the surgical community or by medical internists.” Nor was it well understood by patients, carrying with it the stigma of being a last option that signaled failure on their part. Unfortunately, it also carried the stigma of a fairly high complication rate – a rate Dr. Moore found unacceptably high at the time.

But all that changed in the late ‘90s, Dr. Moore says, when surgeons learned how to perform the procedures laparoscopically, with markedly decreased complication rates and much better outcomes – leading to greater acceptance in the medical and lay communities.

During that same timeframe, Dr. Moore was reunited with a former Navy colleague, Dr. David D. Spencer, with whom he had trained during their residency in Portsmouth. “Dr. Spencer finished his residency in San Diego,” Dr. Moore explains. “We stayed in touch until he returned to Portsmouth in the late ’90s, when we rekindled our friendship and our interest in weight loss surgery.”

The two surgeons established the weight loss surgery program at Portsmouth Naval, leading it until they each retired from the Navy in 2003. Today, with fellow bariatric surgeon Dr. Robert J. Chastenet, they work with the Bariatric Program at Chesapeake Regional Medical Center.

“We’re also seeing a high prevalence of obesity in cohorts of populations as they age,” he notes. “The percentage of obese teenagers keeps increasing, and it’s predicted that some of these current cohorts are going to have diabetes and severe obesity in the 40 percent range in their 50s.”

Dr. Moore knows that many of these individuals will eventually seek the services of a bariatric surgeon to help them lose weight, but he contends that the surgical procedure by itself isn’t the most important element of successful weight loss for the severe and morbidly obese. “I think we have to start with the premise that weight loss surgery by itself is not the solution to the epidemic of obesity in the United States,” he says. “We are very selective with our patients, and apply the surgical option to those people who very much need it, who will benefit from it and who will be successful with it.”

To accomplish that, Dr. Moore’s emphasis is more on pre-operative education and preparation, and post-operative care and follow-up. Surgery can serve as a psychological line of demarcation, but it’s patient selection, preparation, education, follow-up that make the surgery successful.

After surgery, he tells his patients clearly that they’ll be followed for life. “At a minimum, they’re seen by the surgeon once or twice the first month after surgery, again every three months for a year – that’s the absolute minimum,” he says. “They’re seen by our nutritionist at one month, at six and again at twelve. And we encourage them to attend our monthly support groups.”

He performs all three of the standard procedures – gastric bypass, sleeve gastroplasty and lap band – but for patients with complex problems like reflux, or those who need to lose a large amount of weight quickly, Dr. Moore prefers the gastric bypass. “Gastric bypass has proven to be the most successful, most durable, long term successful operation for most patients,” he explains. “It has a very low and very favorable risk benefit ratio. Especially for obese patients with diabetes, there’s a strong bias toward gastric bypass because of its dramatic results. It’s not just the weight loss itself, but we’re changing something on the inside, affecting some of the hormones that modulate diabetes. We see pronounced improvement, and in most cases, resolution of their diabetes.”

“When patients are that obese, we have to do really good surgery. We have to get good results. We have to have low risk, low morbidity. It’s a difficult operation, and it has to be done very well,” he states. “While many surgeons don’t want to operate on people who are very sick and have complex medical conditions, those of us in weight loss surgery feel just the opposite – this is our chance, and the patient’s chance, to gain control of those conditions and get back their health and activity and quality of life. That’s so rewarding. And I love seeing the success and the change in people’s lives that comes about.”