August 20, 2017

Preparing for ICD-10

By Newkirk Products, Inc. and submitted by McPhillips, Roberts & Deans, PLC

It’s coming. The transition to the International Classification of Diseases, 10th Edition (ICD-10), Clinical Modification/Procedure Coding System will occur on October 1, 2014, and will affect everyone working in the health care field. The most significant impact on you and your practice is likely to be the increase in outpatient diagnostic codes from close to 13,000 to more than 68,000.

A Big Transition
Transitioning to the new coding system will be a challenge for medical practices. It will place stresses and burdens on practice systems and staff. The costs for training and software upgrades could be significant. However, the cost of incorrectly implementing ICD-10 could be even greater. If you do not submit claims correctly, you will not be paid for your services. And remember, there is no phased implementation for ICD-10. It is a one-day transition.

Since ICD-10 will require a far greater specificity in coding than ICD-9, it’s important that your practice lay the groundwork now to ensure a successful transition.

Organize
If you haven’t already done so, select one person to manage the process, identify what work needs to be done, and prioritize. If yours is a larger practice, you may require several people to assume different roles in helping to implement ICD-10.

As soon as possible, map out the time and costs involved in system changes, resource materials, and training. Develop a timeline for training staff on the new coding, for claims testing, and for reviewing your coders’ test results.

Most practices perform a predictable set of patient examinations and tests. Your practice may be similar and use certain codes more frequently than others. Identify those codes and have your staff determine what they will be in ICD-10.

Reach Out
You will need to determine whether your systems support these changes. Most electronic health record (EHR) vendors are updating their software to accommodate ICD-10 in time for the transition. However, don’t assume all vendors will be on top of things. It’s better to contact them to determine their rollout plans, the dates of the roll-outs, and what upgrades may be necessary to your systems.

Contact payers to discuss their ICD-10 preparations. Ask them to commit to a date when you can start testing claims.

Arrange for Training
Allocate a lot of time for training clinical staff and providers, coders, and IT staffers to handle the upcoming changes. The Centers for Medicaid and Medicare Services projects that 24 to 40 hours of training will be required to get coders up to speed on ICD-10. Training for clinical staff should emphasize how the documentation they provide will affect the coding process.

Allow Time for Testing
Before going live, you’ll want to test transactions contain-ing ICD-10 codes to ensure they are being successfully transferred and received. Identify where the flaws and failures may be and work closely with all stakeholders to fix any problems. This process may require multiple tests to bring your operations up to a satisfactory level.

McPhillips, Roberts & Deans, trusted business advisors for over 40 years providing accounting, tax and consulting services. www.mrdcpa.com.

“Can You Hear Me Now?”

By Theresa H. Bartlett, AuD

earAbout 20 percent of adults in the United States, approximately 48 million, report some degree of hearing loss. Stated differently, at age 65, one out of three people has hearing loss. Of those with hearing loss, 60 percent are either in the work force or in educational settings. These statistics show that hearing loss is a major public health issue and that it is the third most common physical condition after arthritis and heart disease.

What is the one disability that people are most angry about? The person with the disability is not necessarily angry, but the person attempting to communicate with them is angry. This disability is hearing loss. When we see someone in a wheelchair, or using a walker or a cane, we will go out of our way to help them. When someone does not hear us, we generally feel they are not listening to us or do not care about what we are saying. Instead of repeating our statement in a manner that could be easily understood, we sigh heavily and yell the statement with a definite agitated tone.

Hearing loss affects us on so many levels. As Helen Keller states, “Blindness separates people from things; deafness separates people from people.” Without hearing, people will tend to socially isolate themselves from situations involving other people. Most will say they do not wish to be a part of a situation in which they cannot engage in a conversation. Those who suffer hearing loss are frustrated, and equally aware of the frustration of those they’re trying to converse with. Research has indicated recently that this social isolation can lead to the onset of dementia. Hearing loss can cause social isolation and therefore can indirectly lead to dementia.

Unfortunately most physicians are not aware of the impact hearing loss can have on someone’s life. It is the third most common physical condition and yet most physicians do not refer their patients out for hearing evaluations. It is most unfortunate, but hearing loss is often not even addressed in routine examinations. It is important for a hearing baseline to be obtained by age 65. From there, routine hearing examinations should be obtained when changes in auditory function occur. Medicare does not cover annual audiometric examinations, but they will cover hearing tests when there is concern about changes in auditory acuity.

Believe it or not, hearing loss can be treated. Hearing technology in today’s world is so much different than it was even twenty years ago. The digitization of sound has significantly improved the way people hear and interact in varying environments. Nowadays it is not just about hearing aids, there are a wide selection of products to improve people’s means of communication.

The first step is realizing the importance of hearing and recognizing that patients are suffering as a result of hearing loss. Make the effort to start referring your patients to an Audiologist for a hearing evaluation.

TheresaBartlettTheresa H. Bartlett, AuD, is a Doctorate Level Audiologist who currently owns and operates a small, private, Audiology practice in Norfolk, Virginia. Dr. Bartlett specializes in Lyric hearing products and will soon be a Golden Circle Audiologist for Sensaphonics hearing conservation products. www.virginiahearing.com

 

Women and Carpal Tunnel Syndrome

By Boyd W. Haynes III, MD

carpalIf your patient is a woman with numbness in her hands, she is three times more likely to have Carpal Tunnel Syndrome (CTS) than her male counterpart. Some common symptoms of CTS are: Numbness, pain, burning or tingling in the thumb, index and middle fingers and palm; discomfort which awakens individuals from sleep, where shaking of the hand provides relief. It is believed that a combination of factors causes CTS, such as genetic predisposition, stress, overuse, rheumatic arthritis, previous injury to the wrist and other issues.

Some conditions that might increase a woman’s chances of developing CTS are:

Pregnancy ­— CTS is a frequent complication of pregnancy, with a prevalence reported as high as 62 percent. Hormonal changes during pregnancy and build-up of fluid can cause CTS. Most doctors treat the condition with wrist splints, rest, or cortisone injections, rather than surgery. CTS almost always dissipates following childbirth.

Menopause – Hormonal changes during menopause can put women at greater risk of getting CTS. In some postmenopausal women, the wrist structures become enlarged and can press on the medial nerve.

Breast Cancer – Some women who have a mastectomy get lymphedema, localized fluid retention and tissue swelling. Although rare, some of these women will get CTS due to pressure on the medial nerve from this swelling.

An Orthopaedic Specialist will ask your patient about her symptoms, do a physical examination of the fingers, palm and wrist, looking for swelling, discoloration or other obvious signs of trauma. Two tests are commonly ordered to confirm the diagnosis and to ascertain the severity of the condition; a nerve conduction study or electromyography. While highly reliable and informative, these tests are slightly uncomfortable for the patient.

All studies show that once a female patient gets CTS, her symptoms may be managed, but nothing will reverse the condition or cure it except for surgical intervention. CTS can permanently damage the medial nerve of the hand, causing irreparable damage, resulting in lifelong numbness. Even so, most people choose to try and manage the symptoms (at first) with anti-inflammatory medications, splints or bracing for the wrist and hand, or cortisone injections.

There are two that can be used to remedy CTS. The first surgical approach is the open approach, which has been used for many years with good outcomes. It is performed as outpatient surgery and requires a two-inch incision in the palm.

I prefer the endoscopic approach, that involves using a scope to see the ligament which needs to be released and performing the surgery through a surgical cannula. This approach has also been used for many years and the results are excellent, totally relieving symptoms. It too is performed as outpatient surgery, but the incision is much smaller (¼ inch) and the recovery time is quite minimal.

The long-term results of both the open and endoscopic surgeries are the same at three months, but the endoscopic technique will get the patient back to their activities and work two to three times faster than the open surgery.

BoydHaynesMDBoyd Haynes, MD is a Fellowship-trained, Board-certified Orthopaedic Specialist who currently practices at Orthopaedic and Spine Center in Newport News, VA. Dr. Haynes has a fellowship in Sports Medicine and specializes in total joint replacement and endoscopic carpal tunnel repair. For more information on Dr. Haynes or OSC, please go to www.osc-ortho.com.

 

The Power of Touch: Manual Physical Therapy

By Steve Howell

massageSomeone once said, “I don’t care how much you know until I know how much you care,” and it’s always stuck with me.

It’s applicable to so much of what we do as physical therapists, but perhaps most for manual physical therapy.

Putting your hands on a patient gently and confidently shows someone how much you care. Doing it the right way – in a way that will help them get better and gain trust in you – shows someone how much you know.

Manual therapy is a specialized area of physical therapy. It’s literally putting hands on a patient with multiple goals in mind. It could be soft tissue work to relax muscles and tendons to increase blood flow. It can be to help increase the mobility of a joint, to soften scar tissue to make it more pliable to improve mobility or as a resistance approach to strengthen joints.

Because of the broad application of manual therapy, a lot of people will say they do manual therapy, but not everyone is a manual therapist. The reality is, physical therapists invest in hundreds of continuing education hours to receive credentials in this area.

For example, there are Certified Integrated Manual Therapists (CIMTs) and Orthopedic Clinical Specialists, both of which are manual therapy certifications. As a company, we’re really proud of that because we’ve invested in our clinicians to get that additional training.

As clinicians, we think it’s vitally important because manual therapy is such a key part of the treatment of every patient.

There may not be a scientific term to explain the power of the human touch, but we believe in it so much that every patient we encounter has a hands-on component to every treatment session – stretching, mobilizing a joint, massaging for swelling.

Physicians who recommend physical therapy for their patients should ask their patients during follow up visits if their therapist is putting their hands on them every time. Are they seeing the same physical therapist at every appointment? Are they progressing exercises and receiving treatments that they could not ordinarily do at home?

These things are important to helping patients get back to moving, back to their active lives.

And so is the relationship the patients report having with a physical therapist.

It’s not human nature to move a joint and stretch it beyond what hurts. Human nature is to protect that joint, stop it from moving, rest it and hope it will get better.

Physical therapy counteracts this instinct by demonstrating that you can progress to move safely and efficiently, even beyond what may be comfortable at first.

As physical therapists, we have to get our patients to believe in us, to trust that we will not hurt them. Manual therapy with its power of the human touch and specific treatment techniques is a strong way to develop that trust.

And when you have trust, patients are more likely to comply with the exercises we ask them to complete at home.

Why? Because no one cares how much you know until they know how much you care.

touchauthorSteve Howell, PT, MEd, ATC, is a Vice President and Peninsula Regional Director for Tidewater Physical Therapy, an independent, physical therapist-owned outpatient practice headquartered in Newport News, Virginia. Tidewater Physical Therapy features more than 30 clinics and three Performance Centers from Virginia Beach to Richmond. Learn more about Tidewater Physical Therapy at www.tpti.com.

 

Lynne Stockman, DO

Stockman_LynneHonoring the Volunteer Service of
Lynne Stockman, DO

Growing up as the daughter of an Army officer, Lynne Stockman became accustomed early on to pulling up roots and moving. “I attended 10 different schools,” she remembers, “four of them high schools.” In fact, she began her senior year at Portsmouth’s Churchland High, but finished at Nürnberg American High School.

Having lived so many different places, Dr. Stockman calls herself only a “sort of” native Virginian, although her bona fides are strong: a mother originally from Portsmouth, and great uncle and aunt among the original settlers of Bennett’s Creek.

If home base was subject to frequent change, there were two aspects of her life that remained constant no matter where she was: her dedication to service through church mission work and her commitment to becoming a physician.

“I knew from the time I was 14 that I wanted to be a doctor,” she says. “After high school, I came back to Virginia and earned my undergraduate degree from Mary Washington College in Fredericksburg.” While there, she met an osteopathic physician through her church, whose holistic approach to medical care impressed her. She applied to the same school he had attended – the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine – where she earned her doctorate in osteopathy. She returned to Virginia to complete both her internship and residency in family medicine at Riverside Regional Medical Center.

Her stay was short lived, as after finishing her residency, she and her husband were called to Kentucky. “He’s a Chaplain,” she explains. “He finished his seminary training, and received his masters in divinity at the Southern Baptist Theological Seminary in Louisville.” But once again, the Old Dominion beckoned when she was recruited by Obici Hospital to come to Suffolk to open a family medicine practice. The year was 1995, and she and her family have lived here ever since.

Dr. Stockman is excited that Virginia is now home to a school of osteopathy at Virginia Tech, which she serves as community faculty. In addition, she is a community family medicine physician for EVMS, as preceptor for the medical students who rotate through her office several times a year. And for the past six years, she has devoted a day each month to the Western Tidewater Free Clinic in Suffolk, doing volunteer medical care.

She’s committed to working with teenage girls at her church, teaching them to find their own heart for missions, through programs like Acteens. “The girls raise monies for different projects, collecting things for CARE packages for college students, or toys and gifts for kids through Operation Christmas Child,” she says, “and they collect and deliver food and donations for the community food pantry in Hampton.”

If you know physicians who are performing good deeds – great or small – who you would like to see highlighted in this publication, please submit information on our website – www.hrphysician.com or call our editor, Bobbie Fisher, at 757-773-7550.

Elise French, NP

Elise_French

Recognizing Outstanding Nurse Practitioners and Physician Assistants in Hampton Roads

Elise French, NP
Riverside Medical Group, Partners for Women’s Health Care

In a scrapbook at the home of Elise French’s parents is a photograph of her as an 8-year old, ready for trick-or-treat, dressed in the traditional red cape and white cap of a nurse. It was much more than just a Halloween costume, she explains. “I always wanted to be in medicine,” she says. “I knew it as long ago as I can remember.”

After graduating from high school, she enlisted in the Army reserves, and became a respiratory therapist. It was rewarding, but lacked the hands-on experience of caring for patients that she yearned for. She ultimately graduated from the University of Florida in 2002 with a Bachelor’s in Nursing.

Her marriage brought her to Hampton Roads, and an opportunity to care for open-heart surgical patients at Riverside Regional Medical Center. “I worked open heart for five years,” she says, “where I was very fortunate to have wonderfully supportive role models and mentors, who were willing to help me navigate my path through medicine.”

Like respiratory therapy, cardiac patient care was rewarding, but still didn’t allow her to see what she calls “the complete picture. We’d have patients for 24 to 72 hours, and then they were gone. I always felt a bit empty at the end of their care.”

Wanting to have more of an impact, French entered a Nurse Practitioner program at Virginia Commonwealth University, initially assuming she’d return to acute care. But when she took classes in women’s health, she realized that was where she wanted to be.

She’s been a Nurse Practitioner for nearly five years now, working with Riverside Medical Group’s Partners in Women’s Health Care. “It wouldn’t have been my first choice, had you asked me five years ago,” she admits, “but there is something wonderful about seeing a woman through her pregnancy. I first see them as new patients, do lab work, and see them throughout their pregnancies, from the simplest complaints to recognizing and working with physicians to manage high-risk conditions like hypertension, diabetes and pre-term labor.” A mother of two herself, French can also offer advice about some of the other logistics of pregnancy and delivery.

There’s something else she’s uniquely qualified to offer a particular sub-set of her patients – something that’s not taught in school, but of critical importance to these women. In Hampton Roads, many of French’s patients are wives of soldiers or sailors who may be deployed during the pregnancy and/or delivery. In an unfamiliar city, away from home and family, they’re often overwhelmed. “I tell them that my husband is also in the military,” she explains, “so I know how they feel. He was gone for most of my two pregnancies and much of my daughters’ first years at home. My patients really appreciate that I understand what it’s like to be doing this huge milestone in your life, alone.”

As to ‘the complete picture,’ she says, “Managing a patient through pregnancy gets me full circle with them, and also opens the door for a continued relationship over the years. In women’s health, I see patients from their early teens ‘til well into menopause. It doesn’t get more complete than that.”

The best thing about medicine, says Elise French, is that “you can never get bored.” It’s a lesson she tries to impart to the students she precepts each year. “I love working with them,” she says. “I expect them to work hard and know their stuff.”

And because there’s always more to know, and more ways to apply it, she’ll begin working on her PhD this August.

If you work with or know a physician’s assistant or nurse practitioner you’d like to nominate for a profile in Hampton Roads Physician, please visit our website – www.hrphysician.com – or call our editor, Bobbie Fisher, at 757-773-7550.

“Sometimes it’s hard to be a woman…”

pregnentSo begins a certain country music song that unwittingly turned out to be an anthem of both the pro– and anti–feminism movements alike. Although the song itself dealt with broken hearts rather than unhealthy ones, the sentiment expressed in those seven words has a significant basis in medical fact.

There’s the obvious; that is, conditions and their sequelae that apply only to women:

•Gynecological health and disorders – menstruation and menstrual irregularities: menopause; urinary tract health, including urinary incontinence and pelvic floor disorders; and such disorders as bacterial vaginosis, vaginitis, uterine fibroids, and vulvodynia.

•Pregnancy issues – preconception care and prenatal care, pregnancy loss (miscarriage and stillbirth), preterm labor and premature birth, sudden infant death syndrome (SIDS), breastfeeding, and birth defects.

•Disorders related to infertility – uterine fibroids, polycystic ovary syndrome, endometriosis, and primary ovarian insufficiency.

•Violence against women – the statistics are stunning. According to the National Coalition Against Domestic Violence, one in every four women will experience domestic violence in her lifetime. An estimated 1.3 American women are victims of physical violence by an intimate partner each year.

And there’s the not-so-obvious, disorders that affect women in substantially higher numbers than men:

•Multiple sclerosis – two to three times more common in women.

•Lupus – women account for 90 percent of sufferers.

•Chronic fatigue syndrome – women are four times more likely to suffer.

•Depression – affects twice as many women as men.

•Celiac disease – 60 to 70 percent of sufferers are women.

•Rheumatoid arthritis – two-thirds of these patients are women.

There are even some that are esoteric:
•Turner syndrome – a chromosomal condition that describes girls and women with common features that are caused by complete or partial absence of the second sex chromosome.  TS occurs in approximately 1 of every 2,000 live female births and approximately 10 percent of all miscarriages.

•Rett syndrome — a neurodevelopmental disorder that affects girls almost exclusively. It is characterized by normal early growth and development followed by a slowing of development, loss of purposeful use of the hands, distinctive hand movements, slowed brain and head growth, problems with walking, seizures, and intellectual disability.

There are conditions that occur in men and women in similar numbers, but which affect women very differently:
•Alcohol abuse – more and more women are abusing alcohol, which can lead to an increased risk of breast cancer, heart disease, liver inflammation, brain damage or fetal alcohol syndrome.

•STDs/STIs – The Centers for Disease Control and Prevention website states that sexually transmitted diseases remain a major public health challenge in the U.S., “especially among women, who disproportionately bear the long-term consequences of STDs. For example, each year untreated STDs cause infertility in at least 24,000 women in the U.S., and untreated syphilis in pregnant women results in infant death in up to 40 percent of cases.”

•Stress – a 2013 report by The Huffington Post states that stress in women can reduce their sex drive, cause irregular periods and reduce fertility. It can cause outbreaks of acne, digestive problems, insomnia, weight gain and depression. It can also lead to an increased risk of heart attack and stroke.

•Stroke – according to the National Stroke Foundation, women suffer more strokes each year than men, mainly because women live longer than men and stroke occurs more often at older ages.  Additionally, women are two times more likely to die of a stroke than breast cancer annually.

And of course,

•Heart disease.

The National Institutes of Health reports that while more men suffer from heart disease, its toll on women is harsher: women are more likely to die of a heart attack than men. In the United States, one in four women dies from heart disease.

The most common cause of heart disease in both men and women is coronary artery disease, narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. It’s the major reason people have heart attacks.

Heart diseases that affect women more than men include coronary microvascular disease, a condition that affects the tiny arteries of the heart. Many researchers think the disease is caused by a drop in estrogen levels during menopause combined with traditional heart disease risk factors.

And, in keeping with the song, there actually is a medical condition known as “broken heart syndrome.” According to the American Heart Association, broken heart syndrome, also called stress-induced cardiomyopathy or takotsubo cardiomyopathy, can strike even a healthy individual.

Women are more likely than men to experience the sudden, intense chest pain — the reaction to a surge of stress hormones — that can be caused by an emotionally stressful event. It could be the death of a loved one or even a divorce, breakup or physical separation, betrayal or romantic rejection. It could even happen after a good shock (like winning the lottery.)

Broken heart syndrome can be misdiagnosed, because the symptoms and test results are similar to a heart attack. Tests show dramatic changes in rhythm and blood substances that are typical of a heart attack. But unlike a heart attack, there’s no evidence of blocked heart arteries in broken heart syndrome. In broken heart syndrome, a part of the heart temporarily enlarges and doesn’t pump well, while the rest of functions normally or with even more forceful contractions.

The threats to women’s health may be complex and varied; but with caring and dedicated physicians like the ones featured throughout the pages of this magazine, they can feel confident that they are in skilled, capable hands.

Alfred Z. Abuhamad, MD

Alfred Z. Abuhamad, MD
Eastern Virginia Medical School
Mason C. Andrews Professor and Chair, Department of Obstetrics and Gynecology;
Director of the Maternal-Fetal Medicine Fellowship Program; Vice Dean for Clinical Affairs

Alfred-Z.-Abuhamad,-MDAs a high school student in Lebanon, Alfred Abuhamad had to make a decision: “We had to choose between three different tracks: science, math or philosophy. That was standard,” he explains. “The basic classes were the same, but we had more focused studies at a higher level in one of those tracks.” Luckily, the choice wasn’t difficult: he’d had a tremendous interest in science and biology from childhood, and was particularly intrigued with life science.

If the choice was easy, life was anything but. “I grew up during the civil war,” Dr. Abuhamad says. “In Beirut, we were right in the middle of it.” Despite the challenges living in a warzone presented, he earned his medical degree from the American University of Beirut.

Striving to advance his knowledge as far as possible, Dr. Abuhamad decided to pursue his studies in the United States. He completed his residency in obstetrics and gynecology and a fellowship in high risk obstetrics, both at the University of Miami. During this time, he developed a profound interest in ultrasound, and moved to New Haven to pursue a second fellowship in prenatal diagnosis and ultrasound at Yale.

“I felt in the field of maternal fetal medicine, ultrasound allows us to elevate the fetus to the status of patient, because we can look at the baby and determine if there are problems,” Dr. Abuhamad says. “We can also anticipate problems and address them in utero to improve the outcome.”

By the time he left Yale, his parents had come to America to flee the war, joining his brother in Boston. Dr. Abuhamad had hoped to find a position nearby, where he could be close to his family. He interviewed at several facilities, nearly signing a contract with Tufts, when he received a call that changed his plans. “It was Arthur Evans,” Dr. Abuhamad says. “He was at UC Davis, and was being recruited to come to EVMS to start the division of maternal fetal medicine. Dr. Evans had gotten my name from Dr. Peter Heyl, who had recommended me highly.”

Dr. Abuhamad didn’t know where Norfolk was, but when he talked with Dr. Evans, he was intrigued to find out more about the medical school’s budding plans for a division in maternal fetal medicine. “It was January of 1992,” Dr. Abuhamad remembers. “I flew down on a Friday, and I felt immediately attracted to the place. Dr. Evans was really supportive of the program in ultrasound that I wanted to build. I called him back on Monday and told him I wanted the job.” He still remembers that he never even asked about the salary.

It was the opportunity to pursue the potential of ultrasound in an academic setting that made the choice as easy as the one he’d made in high school. “We use ultrasound in obstetrics to date a pregnancy or diagnose complications – not only malformations in the fetus, but the baby’s overall well-being,” he says. “In gynecology, we can detect ovarian cancer, uterine malformations and other conditions. That’s what I started here, and the program has grown clinically. On the research side, we’ve received both national and international attention.”

Additionally, Dr. Abuhamad has received acclaim for his patents, and for the books he’s written and co-authored, two of which deal with fetal echocardiography. Both are in wide use and available from a number of commercial and medical booksellers. His third book, however, will not be for sale; he intends to offer it as open access download to anyone throughout the world. Near completion, the book, entitled Basic Obstetric and Gynecologic Ultrasound, is not about making money. Rather, it’s an extension of the many missions Dr. Abuhamad has led throughout the developing world – in remote areas of Haiti, Somaliland, Ghana and Mongolia.

He explains: “I started an outreach committee of ISUOG, the International Society of Ultrasound Obstetrics and Gynecology. We have partners in industry who donate ultrasound machines. We then send trainers to developing countries to train physicians and midwives in the use of ultrasound, with the goal of reducing complications in pregnancy and labor, and reducing maternal mortality and morbidity. These caregivers can rarely afford books, but they often have Internet. I knew it would be beneficial to have a book that anybody could download.” When completed, the book will be offered through the EVMS website.

Between seeing patients, writing, research and inventing, there’s little time left for other activities – but Dr. Abuhamad uses what he has effectively. He’s the faculty director of the women’s health clinic within HOPES, an initiative begun several years ago by EVMS students to offer medical care to Norfolk’s indigent, uninsured population. He currently chairs the Safety in Women’s Health Care council, which works on initiatives to reduce maternal mortality within the US. “The major causes of maternal mortality are postpartum hemorrhage, severe hypertension, clots that go to the lungs and heart problems,” Dr. Abuhamad says. “We’re working at a national level to have an impact.”

The division is also in putting together a comprehensive program to study fetal origins of adult disease. “If we can identify high-risk newborns, we may be able to intervene sooner to ameliorate problems that happen later in life,” he says. And of course, ultrasound is part of it.

And best of all, he says, he still gets to deliver babies.

Robert C. Squatrito, MD

Robert C. Squatrito, MD
Gynecologic Oncologist, Virginia Oncology Associates
Division Director, Gynecologic Oncology, Eastern Virginia Medical School

squatritoHad it not been for a kind word from one patient during his medical school rotation in OB/GYN, Dr. Robert Squatrito might have chosen another surgical discipline. “This is a very distinct memory,” he says. “As a med student, you’re the lowest person on the team, so you’re the one seeing patients before dawn, knocking on their doors and waking them up.” He says he’d gotten used to patients grumbling and even “kicking me out of their rooms.” But one morning, he remembers, “I was on gynecological oncology. I knocked on a post-surgery patient’s door at about 4:30, and the patient, who was in her 70s, invited me in and listened to me attentively. And when I left, she thanked me for coming. That was the first time in my career as a med student that I woke someone up who was not only nice to me, but actually thanked me.”

Of course, it takes more than a kind word to build a career. For Dr. Squatrito, surgery itself was always a given: interested in medicine early on, he’d had the opportunity in high school to work with a general surgeon who became not just a role model but a valued family friend as well. “My mother was his office manager,” he remembers, “and he invited me to come to the office, go on rounds with him, and even watch him do surgery.” After college, Dr. Squatrito earned his medical degree at Medical College of Virginia, where he set up an elective rotation that allowed him to return to New Jersey to follow his mentor for a full month.

Like many medical students at that time, he hadn’t been aware of gynecologic oncology as a specific discipline. But in the diseases of the mature patients he encountered, he found both a surgical niche and a patient population that interested him. “I didn’t analyze it at the time,” he says, “but these are people who have headed families. They’ve gone through childbirth. They’ve undergone tremendous stresses. And I knew I could bond with them.”

He was also unaware that the specialty would require seven years of training after medical school: a four-year residency in obstetrics and gynecology and a three-year fellowship in gynecologic oncology. But, as he says, “I’ve always had the attitude that you live your life along the way. I’ve always had a lot of things going on in my life besides medicine.” Case in point: during his fellowship at the University of Iowa Hospital and Clinics, he found time to open a kung fu school.

He always wanted to return to Virginia after graduating from MCV, but there were no openings in his field when he completed his training. Instead, his first job took him to Burlington, as assistant professor at the University of Vermont. He stayed from 1995 to 1998, but because gynecologic oncology fell within OB/GYN, he was covering obstetrics as much as performing surgeries. There was starting to be a movement away from hospitals into private practice, enabling surgeons to avoid routine obstetrical care, and concentrate on their specialized training. He began scanning positions on the East Coast, and found Virginia Oncology Associates, which was then in the process of forming.

“Cancer groups were just beginning to incorporate gynecologic oncology into their practices,” Dr. Squatrito says. “Virginia Oncology was visionary in that regard – they wanted to offer gynecologic oncology.” He came down to Virginia for an interview, liked what he found, and moved here to establish the division of gynecologic oncology at VOA.

Today, the division boasts four fellowship-trained physicians. In the field of gynecologic oncology, Dr. Squatrito says, one of the most exciting recent developments is the switch to robotic surgery. In 2012, he became certified on the daVinci surgical robotic system, and is now considered a thought leader and innovator by Intuitive, the vendor of the system. “It’s a tremendous advantage for women,” he says. “Nearly 95 percent of our minimally invasive surgeries can be done robotically. Some women can go home after only a few hours, or overnight. And many are back to work within one or two weeks. Recovery is quicker, and scarring is minimal.”

That’s important to women, Dr. Squatrito knows. He was recently explaining his procedure for making clean, precise incisions to a medical student. When the student commented that the incision mattered less than the surgery itself, Dr. Squatrito explained that the scar left by the incision would remain with the patient the rest of her life. She would see it every day, and remember the surgeon who gave it to her. “That,” he explained, “is why the incision needs to be as perfect and precise as the surgery itself.”

Such passion for detail is important to this physician, who not only practices the art of surgery, but also teaches the discipline of Chinese martial arts. The school he started in his fellowship days in Iowa is still operating; and when he joined VOA, he opened a school in Virginia Beach, where he and his wife Jennifer teach students the ving tsun style of kung fu.

At the school, he is referred to as “Sifu” or “Master,” rather than “Doctor.”

By either name and in either setting, he is a skilled, dedicated and well-respected practitioner with a passion for excellence.

J. Craig Merrell, MD, FACS

J. Craig Merrell, MD, FACS
Plastic and Reconstructive Surgeon 
Plastic Surgery Associates of Tidewater

MerrelIn 1966, on a baseball diamond in Arlington, Virginia, 15-year old Craig Merrell took a hard swing at a curveball and missed. He didn’t know it, but that strike was about to change his life. “I broke my back,” he says, “and I had to have a spinal fusion. I was in the hospital for two weeks, flat on my back. When I recovered, I knew I wanted to become a physician to help people the way my doctors had helped me.”

When he shared that ambition with a school guidance counselor, she laughed. “It was a real wake up call,” he remembers. “She bluntly said that my grades were all over the place — not the sort of transcript top colleges and medical schools were looking for.” He left her office determined to always do his best – and to achieve his goal.

From that day on, he was an A student (only two B’s blemished his record), and he graduated summa cum laude from Wake Forest University in 1975. He accepted the invitation to study medicine at the University of Virginia, where he soon discovered his temperament was best suited to surgery. Next, as general surgery resident at the Hershey Medical Center in Pennsylvania, he heard about the pioneering work in the new field of microsurgery being done by Dr. Bernard O’Brien and Dr. Harry Buncke. “They were among the first to figure out the potential of using a microscope and sutures half the diameter of a human hair to do complex reconstruction,” he says. “The possibilities seemed limitless.”

Dr. Merrell became the first microsurgery fellow at Southern Illinois University (SIU), where he was trained by Dr. Robert C. Russell, a protégé of Dr. O’Brien. The farming community around Springfield gave Dr. Merrell frequent opportunities to restore patients with devastating injuries that required microsurgical intervention.

Following his fellowship, Dr. Merrell completed two years of plastic and reconstructive surgery residency at SIU before joining Plastic Surgery Specialists, Inc. in Norfolk in 1983. “I was here less than a week when a young shipyard worker lost four fingers below the knuckles to a sheet metal cutter,” he remembers. “It took me 24 straight hours to put them all back on.”

As the first Board-certified plastic surgeon with fellowship training in microsurgery, Dr. Merrell says the evolution to the delicate and incredibly demanding work of performing breast reconstruction was natural. “At the time, one in every nine or ten women would get breast cancer,” he says, “and many of them required mastectomies. A tremendous milestone was achieved in 1998 with the passage of the federal Women’s Health and Cancer Rights Act that guaranteed a women’s right to insurance coverage for breast reconstruction.”

His practice naturally gravitated more and more to caring for amazing and courageous women who came seeking surgery in hopes that it might help them feel whole after the ordeal of a cancer diagnosis, surgery, chemotherapy and at times radiation therapy. The more he saw these women suffer the more he began to envision a “breast care center,” where women, regardless of their age or need, could receive the care they deserved. “I saw it as a continuum of care, an initiative that could save women’s lives,” he says, “and give their daughters hope as well. You don’t treat women for just a year or two; you must be committed to following them for life. I saw a whole team of doctors in many specialties working together to offer women the best.”

Unable to convince one local hospital to consider his vision, he decided to move his practice to Obici Hospital, which embraced the concept. After a lengthy and demanding process, in 2013, Obici became one of only a limited number of accredited breast care centers in the United States.

Just having a team and the latest equipment is not enough. Dr. Merrell’s compassion for the plight of breast cancer patients, coupled with an artist’s sensitivity and a microsurgeon’s skill, has led him to devote much of his practice to making women feel whole again. His patients come to him from near and far, and speak as highly of his genuine compassion as his skill. In the words of the patient pictured here, “The key to truly putting cancer behind me was reestablishing my confidence and the self-esteem that cancer robbed from me. Dr. Merrell understood that. He goes to extraordinary lengths to get things right.”

The foundation of Dr. Merrell’s life is his great faith in Jesus Christ. It gives him the unwavering desire to care not only for these women, but to serve others throughout the world as well. “I believe firmly in the Savior’s doctrine that when you focus on yourself you lose yourself, but when you lose yourself in serving others, you find yourself.”

Dr. Merrell knows this is a true principle through church missionary service, medical missions, and his work in Hampton Roads. He has been on more than two dozen mission trips with Operation Smile, often accompanied by his wife and one or more of their eight children. Focusing on performing and especially teaching microsurgery to physicians in countries across the globe allows them to also care for children, women and men who are suffering. “These are all children of a loving God,” he says. “It is my privilege to serve them.”