August 22, 2019

The Expanding Role of PD-1 Inhibitors in Cancer Treatment

By John C. Paschold, MD

 

Since 2006, when the first clinical trial began testing the effectiveness of PD-1 inhibitors, the use of these immunotherapy drugs has increased dramatically. Over the last two to three years, these drugs have moved from research trials into mainstream cancer treatment, particularly for late stage melanoma, lung cancers, kidney cancers, and head and neck cancers.

PD-1 inhibitors, delivered through one or two quick infusion treatments, uncloak cancer cells and allow the body’s T-cells to fight cancer the way they fight other diseases. But though these drugs are promising and lifesaving in some cases, they are not the magic bullet for many cancers. Thanks to extensive media coverage, many patients have sky-high expectations for all types of immunotherapy treatments and are now asking about their treatment options. Unfortunately, the truth is that PD-1 inhibitors are not 100 percent effective in all patients or in all cancer types. 

With hundreds of clinical trials underway across the country, our goal is to determine exactly when PD-1 inhibitors are most effective. In trials, these drugs are being used on almost all cancer types, and at many different stages of cancer growth. So far, research suggests that they may be effective at treating any cancer type if those cancer cells have a high mutational burden. However, researchers and physicians still have a lot of work ahead of them in identifying exactly which biomarkers indicate effectiveness.

Other research is examining what role PD-1 inhibitors can play in combination with current treatments. Chemotherapy and immunotherapy together seem to have a synergistic benefit for some patients, improving the effectiveness of both treatments. These combination treatments may be the next wave of cancer care. 

Still other trials are examining when these drugs should be delivered, searching for any benefits to pre- or post-operative use. Currently, PD-1 inhibitors are typically used after chemotherapy treatment, and mostly only in patients with late-stage disease. In the future, it’s likely that these drugs will be used much earlier in the disease process and perhaps even earlier in the care plan.

Though we don’t know yet exactly how they’ll be used, PD-1 inhibitors are only going to become more common in cancer treatment. Almost quarterly, our practice receives new research and new indications for the use of PD-1 inhibitors. 

As more and more patients receive this treatment, it’s vital that oncologists and other providers work together to spot any unhealthy side effects of immunotherapy, such as autoimmune colitis, skin rashes, or issues with the thyroid, kidney, or adrenal glands. When caught early, these side effects are often reversible. If you have a patient who has received immunotherapy and exhibits these side effects, please contact his or her oncologist.

John C. Paschold, MD is a Board certified and Fellowship trained medical oncologist and hematologist with Virginia Oncology Associates, based out of their Williamsburg office. Please visit virginiacancer.com.

Medical Marijuana – Can I Prescribe It?

(A Practical Guide to Getting Started)
By Erica Pero

 

CBD oil seems to be the miracle drug du jour. From epilepsy to anxiety, CBD oil is making its way across the nation as states legalize its use. Virginia recently enacted laws that allow medical professionals to assist patients to purchase CBD oil and THC-A oil, but it isn’t like writing a prescription for antibiotics. So – when patients start asking about medical marijuana, what should you do?

First, we’re talking about oil derived from medical marijuana, not from hemp products. Hemp is an industrial crop with almost 0% THC. The CBD oils you see for sale in your local gas station or supplement store are made with CBD oil from hemp, not medical marijuana – and NOT regulated. New laws in Virginia now allow medical professionals to certify patients to purchase oils that contain THC – the drug that gets you “high” – and which ARE regulated.

Second, marijuana possession is still illegal in Virginia. Recent legal developments give Virginians an “affirmative defense” to possession of products containing THC for those who have been given a “written certification” by a “registered professional” and have registered with the Virginia Board of Pharmacy. Theoretically speaking, if you jump through all the hoops, when the drug-sniffing dogs stop your car the law allows you to hold up your registration card and continue on your merry way. (Which is probably what usually happens, but I’m a lawyer and law school was full of scary drug-sniffing dog scenarios where no one went on their merry way.)

Medical Professionals: 
Physicians, nurse practitioners, and physician assistants must first register with the Virginia Board of Pharmacy to obtain “written certification”. This registration is separate from obtaining a DEA number, as CDB and THC-A oil are not drugs approved by the FDA. The initial physician registration fee is $50, and the annual renewal fee is also $50. It takes 7-10 days to receive a written certification from the Board of Pharmacy. Once you receive your written certification, you can certify patients. It’s also important to note that registered physicians are limited to certifying 600 patients.

Patients: 
Before purchasing CBD or THC-A oils from a dispensary, patients must first: (1) obtain “written certification” from a certified physician AND (2) register with the Board of Pharmacy. If the patient is a minor or otherwise incapacitated, a parent or legal guardian can complete the process on the patient’s behalf, but the parent/guardian must also complete an application for themselves and any other parent/guardian who may possess the oils on behalf of the minor. The registration fee for patients, parents, and guardians is $50/person. Patients may purchase products from any of the five dispensaries in Virginia but must appear in person at the dispensary before purchasing for the first time. Patients can purchase up to a 90-day supply.

This is a very dynamic area of law that is changing rapidly. Please consult a healthcare attorney.

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

A Mission to Expand Specialized Genitourinary Procedures

By Jessica DeLong, MD

 

The complex disorders that require genitourinary and pelvic floor reconstructive surgery are often highly disruptive, painful and embarrassing, yet access to specialists is limited or non-existent in many parts of the country and world. 

These are significant quality-of-life issues that most men and women don’t like to discuss: urethral stricture disease, fistulas, incontinence, erectile dysfunction, hypospadias, Peyronie’s disease and vaginal prolapse, to name just a few. 

Hampton Roads patients are fortunate to have access to five reconstructive urologists at the Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, the largest such group in the United States. The advanced plastic surgery techniques pioneered by the center’s founding physicians have transformed the lives of patients affected by birth defects, traumas, and a variety of medical and surgical treatments. 

As subspecialists, I believe we also have a responsibility to spread our expertise to reach suffering children and adults around the globe, as well as to help train the physicians, nurses, anesthesiologists and technicians who can treat many others.  

For six years, my colleague Ramón Virasoro, MD, and I have traveled to the Dominican Republic to provide sustainable urology care, initially on trips with the nonprofit Physicians for Peace. In 2016, we co-founded the first fellowship in the Caribbean for genitourinary reconstructive surgery and have graduated one fellow, with another currently in training. 

We have now taken another step forward: incorporating a non-governmental organization (NGO) called Surgery and Anesthesia for Everyone, Inc. The goal is to provide access to quality surgical and anesthetic care in low- and middle-income countries. 

Working in partnership with an anesthesiologist in Argentina, we aim to train enough specialists in the Dominican Republic over the next three years to cover its population’s needs, with future plans to extend into possibly Bolivia and Argentina with additional programs.  

We also have formed an exciting new partnership with Eastern Virginia Medical School Global Health, a co-sponsor of our most recent trip to the Dominican Republic. This cooperative effort should provide unique educational exchange and service opportunities for medical students, residents and fellows at EVMS. 

Since 2013, we have treated more than 200 Dominican patients through mission trips, which are scheduled at least twice a year. Some of their stories are truly heartbreaking. One patient I remember in particular was a 52-year-old manual laborer who had suffered from urethral stricture disease for 35 years, relying on a catheter following a crush injury at work. I corrected his problem in 90 minutes, allowing him to go back to his job and support his family. 

On each trip, we train at least 10 residents and attending physicians, along with five or more anesthesia residents. We also give didactic talks to audiences of 80-plus health care professions and have used telemedicine and online education programs to further expand that impact. 

Patients with complicated genitourinary conditions should not hesitate to reach out for care; we can help so many who may have given up hope. As for all specialists – whether in urology or another field – we should do our best to bring advanced services to as many people as possible. The work is difficult, but it will surely bring you great joy.

Dr. DeLong is a specialist in pelvic floor and genitourinary reconstruction at Urology of Virginia’s Devine-Jordan Center in Virginia Beach, and an Assistant Professor of Urology at Eastern Virginia Medical School. She is Board certified in Urology. Urologyofva.net

Cardiac Clearance for Surgery

Expectations and Risks for the Cardiologist
By Douglas E. Penner and C. Thea Pitzen

 

Often cardiac patients, or their surgeons or primary care physicians, may present before a non-cardiac operative procedure requesting “cardiac clearance” for surgery. It is a familiar concept, but perhaps a misnomer. In fact, many cardiologists prefer to avoid the term “cleared” for surgery altogether. Instead, this preoperative evaluation may be best framed as a discussion and consideration of the risks and benefits to the patient.

Certainly, all patients scheduled to undergo non-cardiac surgery should be evaluated for risk of an intraoperative cardiovascular complication. Often, the initial evaluation may be performed by the primary care physician. However, if the patient is under the regular care of a cardiologist – or if the initial evaluation reveals an elevated cardiovascular risk – evaluation by the cardiologist will be required. 

Cardiologists are well suited to perform these evaluations, and there are many resources available regarding the medical evaluation itself. But from a legal/risk perspective, there are also a few key points to keep in mind. 

First, clear communication is key. Have an honest conversation with your patient about the risks and benefits of the procedure being considered. Also, be sure to communicate clearly and in writing with the physician requesting “clearance.” Pay close attention to the information requested, and to anything you sign. If you receive a form to return to the physician requesting cardiac clearance, review it carefully before signing – even if a staff member assists in filling it out. If there is pertinent information about your patient that is not included, bring that information to the requesting physician’s attention by adding it to the form, calling the physician, or both. If you communicate by phone, note that in the patient’s chart. Examples of pertinent information might include when you last evaluated the patient, any additional testing or labs needed, and any particular considerations regarding the timing or operative setting for the procedure being planned.

Second, review the chart and document your preoperative assessment. In addition to examining the patient, review the chart for previous notes or records received from other providers in the course of your treatment that might affect your evaluation of the risks associated with surgery. Document your analysis, as well as your communications with the patient and other physicians. Thorough documentation is a good habit and guards against any future question as to whether your evaluation was appropriate.

Finally, timing is critical. If you evaluate a patient for surgery but then learn surgery will be delayed for some reason, consider whether there have been any changes in the patient’s health that would affect your evaluation, and communicate that to the patient and the requesting physician. If you provide an initial evaluation but receive a subsequent request or form for that patient (for example, asking to hold a particular medication or to assess a particular condition or medical device), consider the reason for the follow-up request. If necessary, request additional information about the planned procedure, or consider whether another evaluation is necessary so that you can be confident in your preoperative assessment.

Douglas Penner and C. Thea Pitzen are attorneys with the law firm of Goodman Allen Donnelly.  Mr. Penner specializes in hospital risk management, medical malpractice defense, health care law, and State Board licensing and credentialing matters.  Ms. Pitzen focuses her practice on advising and defending hospitals, physicians, and other healthcare providers in litigation and in professional regulatory board investigations.  www.goodmanallen.com

 

George L. Murrell, Jr., MD, FACS

Otolaryngology-Head and Neck Surgery, Facial Plastic and Reconstructive Surgery; Bayview Ear, Nose & Throat, Chesapeake

 

When the introduction of endoscopic techniques revolutionized sinus surgery in the late 1980s, Dr. George L. Murrell immediately embraced the advance. 

Since then, Dr. Murrell has become one of the country’s most experienced physicians in both sinus and rhinoplasty surgeries. He has completed more than 4,000 nasal operations in his 30-plus-year career and also published his findings on combining sinus surgery and nasal reshaping for best functional results. 

“Options for patients with chronic sinusitis have improved so much since the beginning of my career,” Dr. Murrell says. “We used to only operate on people with very severe cases. Today, so many more people can benefit. Many of my patients don’t even remember what normal breathing feels like, after suffering from congestion, pain and recurring infections for so long. It’s very gratifying to help them.”

Yet even as his specialty has grown increasingly high-tech, Dr. Murrell has held fast to a “boutique-style” medical philosophy of handling each patient’s case himself from start to finish. 

“If someone has a problem at 2 a.m. and calls my office, they’re going to be connected to me,” he says. “I’m the only one who operates on my patients. I want them to have a real relationship and connection with me. They’re happier that way, and I believe we get better results.” 

Dr. Murrell, a retired Navy Captain, has published more than two dozen scientific papers and delivered over 50 national and international scientific presentations. His research on the use of ear cartilage grafts in nasal surgery, which gained him membership to the prestigious Triological Society, is the largest such study in medical literature. Prominent leadership roles include Past President of the Rhinoplasty Society, a worldwide organization of experienced nasal surgeons. 

A graduate of Georgetown University School of Medicine, Dr. Murrell has completed residencies in General Surgery and Otolaryngology-Head and Neck Surgery at Duke University Medical Center, as well as a fellowship in Facial Plastic and Reconstructive Surgery at the University of Illinois at Chicago.

About 75 percent of Dr. Murrell’s practice involves nasal work, including septoplasty, turbinate reduction and removal of polyps and scar tissue. In 2011, he tracked 100 of his nasal patients for 18 months and found an average nasal airflow improvement of more than 300 percent, a study published in the Aesthetic Surgery Journal.   

The rest of Dr. Murrell’s cases cover a wide spectrum: tonsillectomies, ear tube placements and eardrum repairs, treatment of thyroid and parathyroid disorders, Mohs reconstruction, and sleep apnea surgery, to name a few.  

That diversity was what drew him into the ENT specialty. Born in Savannah, Georgia, Dr. Murrell grew up with a talent for science and general interest in a medical career. He majored in biology at Davidson College in North Carolina and went to medical school planning to be a cardiologist or internist. 

However, Dr. Murrell soon discovered his task-oriented personality favored a more surgical specialty. A breast surgeon at Georgetown recommended an ENT rotation. “I immediately liked the variety of ages and procedures involved,” he recalls. “I also saw that you’re able to make a major impact on people’s quality of life.” 

After completing his training, Dr. Murrell spent 20 years in the Navy, with posts in Portsmouth and two bases in California. He also had temporary duty assignments in Guantanamo Bay, Cuba, and Guam Naval Hospital and earned numerous service medals. 

“You get a lot of experience right away as a military physician, because you have a built-in patient roll,” he notes. “You don’t have to create a practice, so you hit the ground running right out of training and learn to work well in many different environments.” 

Dr. Murrell settled permanently in Hampton Roads in 2012 and has worked with Bayview Physicians since 2014, with privileges at Chesapeake Regional Medical Center. The father of two girls, he is married to a nurse anesthetist and enjoys playing guitar, surfing, boating and backpacking. 

Being an active participant in his specialty’s rapid evolution has been a privilege, Dr. Murrell says. For example, pre-1980s surgery for sinusitis could be quite invasive, in some cases requiring physicians to lift up the cheek or peel back the scalp to reach and puncture the sinuses. 

Today, with the exception of a few tumor removal cases, all work is done endoscopically. Real-time computer navigation systems and high-definition cameras and monitors also have continuously improved outcomes and recovery time. 

“There’s still a rehabilitation process that can last several months,” Dr. Murrell cautions. “That’s why I feel it’s important to form a rapport with my patients. However, they are generally very compliant because they begin to feel so much better.” 

Dr. Murrell’s simultaneous expertise in nasal reshaping sets him apart in his field. He is Board certified by both the American Board of Otolaryngology and the American Board of Facial Plastic and Reconstructive Surgery. 

“A lot of patients benefit from having both procedures,” he explains. “Rhinoplasty often allows for further improvements in breathing. If a patient also sees an improvement in appearance, that’s only an additional advantage.” 

Dr. Murrell expects surgical equipment will continue to evolve, along with physicians’ understanding of why sinus disease occurs and the best preventive strategies. Non-surgical treatments such as steroid nasal sprays, topical medications and allergy therapies – always the first line of attack – also are regularly emerging on the market. 

“There’s a lot of innovation,” Dr. Murrell says. “I’m always ready to incorporate any advances that can change my patients’ lives for the better.”

Catherine Rees Lintzenich, MD, FACS

Otolaryngology, Riverside Ear Nose & Throat Physicians & Surgeons

 

Throughout her life, Dr. Catherine Rees Lintzenich has focused on the voice. She grew up with a passion for singing in choirs and musicals, and today her advanced training and comprehensive treatment approaches are helping patients preserve their own vocal function. 

With fellowship training in Laryngology and Bronchoesophagology, Dr. Lintzenich is able to offer specialty care for complex voice and swallowing issues that sets her apart from most general ENT providers. 

Dr. Lintzenich also partners with a Riverside speech pathologist to offer a multi-disciplinary clinic for voice problems linked to a variety of causes, including inflammation from allergies or reflux, lesions such as polyps and nodules, vocal cord paralysis and cancer. In addition, she performs laser treatments for small vocal cord tumors, which can take the place of radiation. 

“Many people don’t realize the effectiveness of pairing good voice therapy with the correct surgical or medical interventions,” Dr. Lintzenich says. “Some patients even can see dramatic improvement without surgery. We’ve been very happy with the outcomes we’re seeing.” 

Based in Williamsburg, Dr. Lintzenich handles the gamut of common ENT concerns in both children and adults, such as ear and tonsil problems, hearing loss, tinnitus, and thyroid disorders and cancers. 

Other focus areas of care include laryngopharyngeal and gastroesophageal reflux disease, dysphagia, chronic cough and globus pharyngeus, or the sensation that a foreign body is stuck in the throat, which can be related to allergies, muscle spasms, anxiety or abnormal nerve sensations. 

“While we can’t always cure these disruptive conditions, we often can improve symptoms and have a significant impact on quality of life,” Dr. Lintzenich notes. 

No matter what the health issue, Dr. Lintzenich aims to partner with her patients on care decisions as much as possible. Patients, in turn, have rated her an average of 4.84 out of 5 stars on satisfaction reviews.  

“I just try to talk to each of them in a very straightforward manner,” she says. “I am open and honest – not only about what I know, but about what I don’t know. That way, we can have a good conversation on how to move forward.” 

A nationally-recognized speaker, Dr. Lintzenich also is committed to incorporating promising new treatments and knowledge into her practice. For example, emerging research suggests that the human papillomavirus may play a larger role in vocal cord cancers than once thought. 

If true, that could open the door to less aggressive treatments – allowing some patients to avoid chemotherapy or immediate surgery – and to potential use of the HPV vaccine for prevention. “In general, with any kind of head and neck cancer associated with HPV, patients have a better prognosis and we can stage the disease lower,” Dr. Lintzenich explains. 

Another developing advance is newer injectable materials for the treatment of vocal cord paralysis. To date, physicians mainly have relied on collagen and other substances frequently used in cosmetic procedures in order to plump up a paralyzed cord, which allow better closure of the vocal folds for sound production.   

“These different materials may last longer, and they also may not cause as much irritation,” Dr. Lintzenich reports. “It’s exciting that some better options might come out for my patients.” 

Born and raised in Newport News, Dr. Lintzenich earned a bachelor’s degree in public health at the University of North Carolina at Chapel Hill. At the Wake Forest School of Medicine, she gravitated toward a surgical specialty because she enjoyed working with her hands. She also liked ENT’s balance of medical and surgical treatments. 

“Then I was introduced to a laryngologist there, and he was doing the most amazing procedures to help people with voice problems,” she recalls. “That really sealed the deal for me.” 

After graduation, Dr. Lintzenich completed a year-long internship in General Surgery and a four-year residency in Otolaryngology, Head and Neck Surgery, both at Wake Forest University Health Sciences. She followed that with her fellowship in Laryngology/Bronchoesophagology at the University of California, Davis.   

Before arriving at Riverside four years ago, Dr. Lintzenich provided subspecialty care and trained residents and medical students at Wake Forest School of Medicine for seven years, first as an Assistant Professor and then an Associate Professor. She held numerous faculty leadership posts and also served a term as President of the North Carolina Society of Otolaryngology and Head and Neck Surgery. 

Dr. Lintzenich is a frequent presenter at the American Academy of Otolaryngology’s annual meetings, and she has worked on multiple AAO committees: as a member of the Voice Committee, Airway and Swallowing Committee, and Education Steering Committee; as Co-Chair of the Laryngology Home Study Course Committee; and as Chair of the Laryngology/Bronchoesophagology Education Committee. 

Today, Dr. Lintzenich sits on the Board of Riverside Medical Group and heads the Surgical Clinical Practice Committee at Riverside Doctors’ Hospital in Williamsburg, where she moved to be closer to family after having her son, now 5. Her husband, Mike, is a charter boat fishing captain; outside of work, she likes to cook and explore historic sites with her family.

As for her own voice, Dr. Lintzenich still loves to sing, even if she doesn’t have enough time to perform in a choir at the moment. Through her work, however, she can help others regain their voices – or get back to doing whatever it is they love. 

“Having a healthy voice has always been so important to me,” she says. “So, having the chance to work with people who are struggling with theirs – or with any other ENT concerns – is just very gratifying.”

Joseph K. Han, MD, FARS, FAAAAI, FAAOA

Otolaryngology, Rhinology and Skull Base Surgery, EVMS Ear, Nose and Throat Surgeons; Chief of the Division of Rhinology & Endoscopic Sinus and Skull Base Surgery and the Division of Allergy, Eastern Virginia Medical School

 

For more than 30 years, no new medical treatment has emerged to treat chronic sinusitis.

Thanks to groundbreaking clinical research led by Dr. Joseph Han and his colleagues at Eastern Virginia Medical School (EVMS), that’s about to change.

Dr. Han’s studies in the emerging field of biologics have helped spur the development of monoclonal antibody therapies to target specific cell messengers, in this case those linked to abnormal immune system signals to inflammatory polyp growth. He expects that there likely will be multiple biologics used to treat patients with chronic sinusitis and nasal polyps.

“We will be able to treat patients far more effectively than we have in the past” he says. “It’s remarkable. We’ve been very fortunate to have the opportunity to do a lot of important clinical research here.”

An internationally-known researcher and educator, Dr. Han has received millions of dollars in basic science and clinical research funding during his career and served as lead principal investigator for several major multicenter trials.

In recent years, he has focused on phenotype and endotype of chronic sinusitis. Information gained from understanding the condition on a broad and cellular level can contribute to the federal approval of several promising new treatments.

With polyps, Dr. Han zeroed in on Interleukin-4 (IL-4), a cytokine, as one of the targets for therapy of nasal polyps. Given that finding, he expects the injectable medication dupilumab (Dupixent) – already used to treat poorly-controlled asthma and atopic dermatitis – will soon gain FDA approval for patients with nasal polyps.

“Until recently, there have been very few options to stop these polyps from reappearing after surgery,” he notes. “In fact, the chance of polyp regrowth after surgery is 100% without postoperative therapy. Patients with nasal polyposis have had to deal with this condition for the rest of their lives.” EVMS is the only site involved in all five and possibly six biologic studies evaluating nasal polyposis in the world.

Dr. Han also was a lead investigator on clinical trials for sinusitis treatment approved just last year: Sinuva, an implant that delivers an anti-inflammatory steroid directly to the site of polyp growth. Additionally, he was one of the lead authors for Xhance, an exhalation delivery system of fluticasone that increases intranasal corticosteroid deposition into the nose and sinuses.

In another clinical trial, Dr. Han, along with Dr. Kent Lam and his research team, are evaluating the effectiveness of cryoablation of the posterior lateral nasal nerve in cases of rhinitis. This office-based procedure could help patients’ symptoms without further use of medication or need for nasal surgery. 

Fittingly, Dr. Han believes he likely gravitated to his specialty in part due to his own struggles with severe allergies, asthma and sinus problems as a child. His two children suffer from allergies as well.

“I have a lot of empathy for what my patients go through,” he says. “My conditions are under control now, but I remember exactly how miserable I felt.” The ENT field also combines his love for both medicine and surgery, he adds.

Originally, however, Dr. Han chose medicine as a way to do mission work around the world. His parents, who immigrated to the United States from South Korea, became pastors and instilled a deep faith in their children, as well as a desire to help others.

A molecular cell biology major at the University of Washington, Dr. Han earned a medical degree at the Medical College of Pennsylvania and completed a residency in Otolaryngology at the Medical College of Wisconsin. He followed that with a Rhinology and Sinus Surgery Fellowship at Oregon Health and Science University.

Dr. Han arrived at EVMS in 2007 after serving as Director of Rhinology and Endoscopic Sinus Surgery at the University of Virginia School of Medicine. By then, he had secured National Institutes of Health funding for his research on how sinusitis, asthma, and allergy may be related.

“There are so many signs you can’t detect visually, even in an in-depth office exam,” he notes. “My goal has been to look much deeper for answers.”

A prolific author, Dr. Han has lectured to physicians worldwide and assumed numerous leadership roles. He will become President of the American Rhinologic Society (ARS) in fall 2020 and is an Associate Editor and on the Editorial Board for the International Forum of Allergy and Rhinology, the official journal for the ARS and the American Academy of Otolaryngic Allergy (AAOA). 

In addition, Dr. Han is the only physician who is a fellow of all three major national organizations that specializes in the treatment of allergy and sinusitis: the ARS, AAOA, and the American Academy of Allergy, Asthma and Immunology (AAAAI).

More locally, Dr. Han is the Chairman of the Virginia Society of Otolaryngology, as well as the Past President of the Tidewater Otolaryngology Society.

Outside EVMS, Dr. Han and his wife, Dr. Caroline Han, a family practice physician, have done medical mission work in Bolivia, and he also has traveled to Moldova and China. Dr. Han hopes to take their children, Joshua and Alicia, on mission trips once they are a bit older. In his off hours, his hobbies include golfing and fishing.

As biologic therapies continue to gain prominence, Dr. Han remains deeply committed to research, as well as to patients who turn to him for relief. “With the increased knowledge we have now, there are so many more studies we’ll be able to do,” he says. “I love my job.”

Western Tidewater Free Clinic

Anthony J. DiStasio, II, MD, Board-certified Orthopaedic Surgeon, Sports Medicine & Orthopaedic Center – Suffolk

 

The patients who Dr. Anthony DiStasio treats during his volunteer hours at the Western Tidewater Free Clinic often work multiple jobs yet struggle to support their families. They cannot afford commercial health insurance and many do not qualify for employers’ health plans as part-time employees.

Many have suffered from painful and debilitating orthopaedic conditions for months, if not years, from carpal tunnel syndrome to arthritis in their hips or knees. 

“These are people who have truly slipped through the cracks,” Dr. DiStasio says. “They’re not looking for a handout. They’re simply looking for a little help to get back to their regular jobs and home life.” 

Dr. DiStasio volunteers several hours a month at the Suffolk-based clinic, which is open five days a week to serve uninsured and underinsured patients in Suffolk, Franklin, and Isle of Wight and Southampton counties. If patients need surgery, he also performs those for free on a second day.   

Western Tidewater offers non-emergency healthcare to patients ages 19 to 64 who live at or below 200 percent of the federal poverty level ($50,200 for a family of four, for example). As the only free clinic in a 1,400-square-mile service area, the bustling operation is one of the fastest-growing clinics in the region. 

Clinic staff and volunteers provide medical, dental, vision, women’s health and mental health care; pharmacy consultation and assistance programs; and laboratory and diagnostic testing services. Patients also gain access to surgeries and specialists through clinical partnerships. 

Since opening in 2007, the clinic has cared for a diverse group of more than 5,300 patients during 150,000-plus visits. Staff focuses on primary care and continuous education on chronic conditions such as diabetes and high blood pressure, both in individual appointments and group counseling. 

Not surprisingly, volunteers are critical. In fact, medical professionals from a wide variety of specialties have donated more than 125,000 hours to date, a nearly $4 million market value. 

Dr. DiStasio handles injuries and overuse or degenerative conditions in the shoulders, hips, knees, ankles and hands. He typically does five to six follow-up surgeries a month at Sentara Obici Hospital, such as carpal tunnel releases, knee and shoulder arthroscopies and fracture repairs. “It’s gratifying to be able to help so many people with fairly simple procedures,” he says. 

Most total joint replacement patients get a referral to a larger surgical program at Virginia Commonwealth University, he adds: “I see some very advanced pathology on our X-rays. You know a joint replacement is going to be absolutely life-changing.” 

Both medicine and community service have appealed to Dr. DiStasio since early childhood. As a football, rugby and track athlete, he suffered multiple injuries and was grateful when his orthopaedists recognized his eagerness to return to action. 

“They taught me how to take care of a whole person, not just a body part or problem,” he says. “I was also raised in a family that always emphasized giving back.” 

Dr. DiStasio, a graduate of Georgetown University School of Medicine, served for 13 years in the Navy before transitioning to private practice in 1995. Prior to joining SMOC, he completed a fellowship at the R Adams Cowley Shock Trauma Center in Baltimore and worked as Director of the Orthopaedic Traumatology Division at Naval Medical Center Portsmouth. He has lived in Hampton Roads for 30 years.  

The Western Tidewater Free Clinic is a real team effort, Dr. DiStasio stresses, based on core mission values of excellence, unity of purpose, respect, diversity, integrity and stewardship of all resources. 

“Access to health care is a huge problem in our country, and the staff is all in for these patients,” he says. “I’m happy to be a small part of its impact.”

To learn more about volunteering, visit wtfreeclinic.org, call (757) 923-1060 or send email to info@wtfreeclinic.org.