HealthLine 09 - Holston Medical Group

welcome
Message from the President
Welcome to our inaugural issue of the new HMG Health Line! I must
say I am most pleased with this fresh, engaging, magazine format
designed to guide you into enjoying improved health.
Often, when I step back and take a moment to examine the many
areas of health improvement, management, and advancement that
HMG is involved in—as I have in reviewing this issue of the Health
Line—I am most certainly amazed, and, humbled.
Since HMG’s inception more than 30 years ago, it has been our
every attempt to provide the residents of Southwest Virginia and
Northeast Tennessee with the level of medical excellence they
deserve. I’m pleased to say, we are well on our way.
Have we arrived? No. Will we ever? Most certainly not.
Regardless of the level of excellence we are able to provide, we
will never be satisfied because we know that healthcare
opportunities continually evolve, ever producing better outcomes.
And, it is our intent to do everything we can to provide you, our
most deserving patient, with the latest and greatest in health care
innovation, always mindful of the importance of attentive,
one-to-one patient interaction.
Top
Stories
This
Edition
Achieving best outcomes
and saving lives
HMG Integrated Health Management
. . . . . .3
HMG Welcomes New Providers . . . .7
Breaking Ground for Good
HMG Clinical Research . . . . . . . . . . . . . .10
HMG Opens Sleep Center . . . . . . .13
Within this edition of the new Health Line, you’re going to learn
more of several of our recent most valiant attempts to proceed with
the continuum of bringing you the very ‘best medicine’. You’ll learn
not only of our new Integrated Health Management offering that is
leading the nation, you’ll also learn of HMG’s robust activity as
one of the nation’s leading clinical research trial locations.
Specialty Spotlight:
In the process, you’ll also be introduced to our new providers,
including the debut of our new specialty of rheumatology.
Disaster Task Force . . . . . . . . . . .18
There’s so much to discover. Without
further introduction from me, I invite you
to open the pages of this new resource
and learn of all the wonderful ways
Holston Medical Group desires to
provide you and your family with the
excellence you deserve.
Wishing you a lifetime of
excellent health,
Jerry L. Miller, MD
HMG President & Founder
Rheumatology and Endocrinology
. . . . . . .14
Healthy U Center Now Open . . . . .16
Other top stories....
Samuel Breeding, MD,
recertified as an FAA examiner. . . . . . . .12
HMG outpatient diagnostic
centers achieve ACR accreditation . . . .13
Heart Healthy Lasagna . . . . . . . . . . . . .17
HMG in the Community . . . . . . . . . . . . .19
New Duffield Location . . . . . . . . . . . . . .19
HMG Integrated
Health Management
59-year old Mark Holland says he‘s
grateful to both his HMG primary care
provider, Dr. Warren Jones, and HMG
Integrated Health Management.
According to Holland, the combination
just may have saved his life.
“Getting in with HMG Integrated Health
probably means I’m going to live a lot
longer than I would have otherwise,”
explains Holland who has a family
history of heart disease. “I’m really
grateful to Dr. Jones for sending me to
HMG Integrated Health.
At Dr. Jones’ urging, Holland underwent
a CT cardiac calcium scoring that
revealed he was in the 98th percentile
for calcium in the artery as compared
with other men his age. With this
score, Holland was heading for a
probable heart attack. (The calcium
score is one of the greatest indicators
of an individual’s probability of a heart
attack.)
With a calcium score of 1,700, Holland
was quickly referred to HMG Integrated
Health Management where he received
aggressive care by William H.
Bestermann, MD, one of the nation’s
leading vascular medicine specialists.
(A calcium score greater than 100 or in
the 75th percentile calls for aggressive
care for blood pressure, LDL
cholesterol, triglycerides, and blood
sugar. A score greater than 400 or the
90th percentile calls for a stress test
and/or further interventional studies.
“The consultation with Dr. Bestermann
combined with medical therapy and
dietary changes was of enormous
benefit to me,” explains Holland who
says both his father and brother suffered
heart attacks early in life.
The outcome achieved through HMG
Integrated Health Management?
Holland’s LDL particle number went from
1,016 to 496—an outstanding
accomplishment considering leading
preventive cardiologists attest that a
number less than 700 is considered
“good.”
“Outcomes are what it’s all about. We’re
wanting to move patients into the best
venue to address their chronic medical
conditions so that they can experience
the best outcomes,” champions HMG
3
HMG Integrated Health Management
Medical Director Robert C. Lee, MD,
one of the principal architects of HMG
Integrated Health.
HMG Founder & President Jerry L.
Miller, MD, echoes Dr. Lee’s sentiments.
“I can give you dozens of examples, just
like Mr. Holland, where the multidisciplinary team approach of HMG
Integrated Health Management resulted
in outcomes that would not have been
achieved otherwise.”
Located on the fifth floor of the HMG
Medical Plaza, Kingsport, HMG
Integrated Health Management includes
a diverse team of physician consultants,
with specialized areas of focus ranging
from endocrinology and vascular
medicine to both pediatric and adult
wellness coaching. The team is also
comprised of pharmacists, certified
diabetes educators, dietitians, certified
personal trainers and behavioral health
clinicians.
“The best primary care provider
combined with the best nurse cannot
achieve the same outcomes as that of a
focused, multi-disciplinary team effort.
It’s impossible—not because the primary
care provider is incapable—but because
he or she doesn’t have the time nor the
resources. Adequately managing
chronic care while also trying to manage
acute care is nearly impossible in a 10,
15, or even a 20 minute office visit,”
explains Dr. Miller.
Dr. Jones readily agrees. “Utilizing
HMG Integrated Health Management
means that my patients get more
comprehensive care,” attests Dr. Jones.
“My patients who have multiple medical
issues or chronic conditions receive the
focused aggressive treatment and
intensive education that I’m not able to
provide in a typical primary care office
visit.
“Without a doubt, HMG Integrated
Health enables me to help my patients
achieve better outcomes. And, that’s
my goal as their provider.”
Within HMG’s Integrated Health,
patients have the option of “combined
Brian Cross, Pharm.D., CDE
consults with a fourth-year
pharmacy student and pharmacy
resident using the electronic
medical record (EMR) system to
assess a patient's medication
regimen prior to seeing the patient
during a visit in Integrated Health
Management Services. HMG,
through a collaborative relationship
with the University of Tennessee
College of Pharmacy, serves as an
experiential training site for 40
doctor of pharmacy students on
clinical rotation and one postdoctoral, year-long pharmacy
specialty residency in primary care.
visits” with both a specialized
physician and a member of a
multi-disciplinary team who
can provide detailed education
and instruction.
Diabetes is the perfect
example of a chronic condition
that requires a multidisciplinary approach.
“Diabetes is probably one of
the most challenging of all
diseases that a family
physician handles and we see
it every day,” begins HMG
primary care provider John
Hollandsworth, MD, who also
refers many of his chronic
concerns patients to HMG
Integrated Health
Management. “Diabetes takes
an enormous amount of
resources to treat properly and
get the patient functioning at
his or her best. It’s truly a
multi-system disease that
requires a multi-disciplinary
team approach.”
“Our outcomes within HMG
Integrated Health
Management are outstanding,”
concludes Dr. Miller. “And,
that’s what counts. That’s
what our patients need and
deserve.”
Individuals with chronic
conditions such as diabetes,
heart disease, or high blood
pressure should talk with their
HMG primary care provider to
learn whether a consultative
visit within the multidisciplinary team of HMG
Integrated Health
Management would be
beneficial to their care. You
may also call HMG Integrated
Health Management directly at
423-857-2790 to request an
appointment.
It’s the “now” at HMG
and the future elsewhere
It’s not every day that you find
a primary care driven multispecialty group achieving
benchmark outcomes. Yet,
that’s exactly what you find at
Holston Medical Group.
“Integrated health is the ‘now’
at HMG,” explains Dr. Miller.
“It is the future, though, in
many groups across the
nation—and adoption is
essential.”
So essential, in fact, that HMG
has gone to great lengths to
assemble one of the nation’s
most diverse multi-disciplinary
teams designed to treat
patients with chronic
conditions.
“I work with more than 22
consulting groups around the
country. Continually, we
entertain groups from across
the nation who are interested
in our multi-disciplinary
approach to chronic care
management for one reason
and one reason alone—they
are interested in our results,”
explains Miller.
Utilizing leading-edge
analytics through a
sophisticated electronic
medicals records system,
HMG providers strive to
identify those patients who
could benefit from the
intensive focused care and
education of a multidisciplinary team of expert
clinicians.
“We have a proven track
record,” says Dr. Miller. “I put
us in the forefront of the nation
when it comes to actively
engaging the patient and
achieving the best outcomes.”
Tim Russert:
A possible scenario...
Most are familiar with the story of Tim Russert, longtime host of Meet the Press. Russert died following a
massive heart attack after having a completely normal
stress test two months prior to his death. So, what
possibly happened?
An autopsy revealed a fresh clot blocking an artery.
Sadly, Russert is a perfect example for a scenario
that happens to so many.
Here’s the situation. Most massive heart attacks
begin silently 5, 10 or even 20 years prior to the heart
attack or stroke occurring. What we now understand
is that many heart attacks and strokes occur as the
result of plaque rupturing, creating a clot that then
blocks the artery. The result is the destruction of the
heart muscle or brain tissue, respectively.
The most dangerous plaque begins as a tiny boil or
pimple. It forms as the result of LDL cholesterol
moving into the wall of the artery where it attracts
white blood cells or pus cells. The LDL movement is
made worse by diabetes, high blood pressure, high
triglycerides and smoking. The pus produces
inflammation and may cause a high c-reactive protein.
This tiny collection of pus and cholesterol ruptures
into the artery causing a blood clot.
(continued)
5
HMG Integrated Health Management
Often times this blood clot is not enough to block the
artery. But, it is like playing vascular Russian roulette.
If you keep pulling the trigger, sooner or later, you may
find a cylinder with a bullet in it.
Each one of these ruptures produces a small dot of
calcium on the wall of the artery.
Today, there is a test known to identify your calcium
score. This quick, non-invasive Cardiac CT scan can
quickly identify the number of plaque ruptures an
individual has had, and is an excellent predictor of
whether you may be a candidate for a heart attack.
Incidentally, 10 years prior to his death, Russert had a
calcium score of 200. Since each calcium rupture
identified on the CT scan is worth 5 points, we can
assess that Russert had approximately 40 plaques
that had ruptured—ten years prior to the fatal rupture.
The good news is that aggressive medical therapy
treatment of blood pressure, LDL cholesterol,
triglycerides and diabetes can dramatically stabilize
plaques so that they do not rupture, thus avoiding a
heart attack or stroke.
HMG vascular medicine specialist William
Bestermann, MD, who has recently been elected the
president for the nation’s leading Consortium of
Southeast Hypertension Control’s (CoSEHC)
Cardiovascular Center of Excellence program, has
received national recognition for his innovative
contributions in reducing cardiovascular mortality.
Talk with your HMG primary care provider to schedule
a Cardiac CT ($99.00) to determine your calcium
score. You may also call (423) 857-2790 to request
an appointment with Dr. Bestermann. HL
The Primary Care Provider “Quarterback”
Somebody’s got to call the play. At Holston Medical Group,
that’s the HMG primary care provider.
“We’re a primary care-driven multi-specialty group because
we know the patient receives the best care when the primary
care provider is the one who ultimately directs the care,”
explains Dr. Lee, who says that even when a patient is
referred to HMG Integrated Health Management, the primary
care provider still calls the plays.
“He’s still the quarterback to the team,” explains Dr. Lee.
“When he refers a patient to HMG Integrated Health, he’s
simply utilizing all the players he has on his team to the best
advantage for the patient.”
According to Dr. Miller, patients can rest in the fact that their
primary care provider is carefully overseeing every detail of
care they receive within HMG Integrated Health—a
communication effort greatly aided by HMG’s electronic
medical records system.
“One of the advantages we have at HMG is that we have a
very elaborate and sophisticated EMR and we can readily
communicate with the primary care physicians,” explains
HMG endocrinologist Sherif Yacoub, MD, who serves as a
physician consultant within HMG Integrated Medicine.
Here’s how the primary care provider relationship with HMG
Integrated Medicine works: When a primary care provider
refers one of his or her patients to HMG Integrated Health, the
patient is referred for treatment of a specified chronic
condition. As the HMG Integrated Health team identifies
protocols that should be followed and changes that should
occur within the patient’s care, members of the HMG
Integrated Health team consult with the patient’s primary care
provider so that open communication allows for optimal
treatment.
“A patient is only referred to Integrated Health Management
for a specific health management need. When that patient
has been brought to goal, the patient’s care is then continued
by the HMG primary care provider,” explains Dr. Miller. “The
longevity and breadth of the relationship with HMG Integrated
Health is controlled by the primary care provider and the
patient.”
“I believe the primary care physician should have full
ownership of the patient,” explains Dr. Yacoub. “We’re merely
here to augment the care the patient receives. We provide
the focused expertise, tools and resources the primary care
provider needs to get his or her patient to goal.” HL
new providers
HMG welcomes several new
providers into our
Family of Care
David Hensley, MD
Family Medicine, Church Hill
Family physician David Hensley, MD,
comes to HMG with more than 25 years
of clinical experience, most recently
providing care at Outpatient Family
Medicine, Cairo, Ga. He is board
certified by the American Board of
Family Medicine.
Michelle Estes, MD
Song Zang, MD
Pediatrics, HMG Medical Plaza
Rheumatology, HMG Medical Plaza
Pediatrician Michelle Estes, MD, comes
to HMG Pediatrics from First Choice
Pediatrics, Johnson City.
Rheumatologist Song Zang, MD, comes
to HMG following fellowship training at
the University of Alabama at
Birmingham.
Board certified by the American Board of
Pediatrics, Dr. Estes received her
doctorate of medicine degree from
ETSU’s Quillen College of Medicine,
Johnson City, where she also completed
her pediatric residency training.
Additionally, Dr. Estes holds a bachelor
of arts from Carson Newman College,
Jefferson City, Tenn., where she
graduated cum laude.
A native of Northeast Tennessee, Dr.
Estes is the recipient of numerous
awards and honors, including the
“Pediatric Resident of the Year Award.”
In addition to being a fellow in the
American Academy of Pediatrics, she is
a member of the Alpha Omega Alpha
medical honor society and the Christian
Medical and Dental Association.
After receiving his doctorate of medical
degree from the Peking Union Medical
College, Beijing, China, Dr. Zang
completed an internal medicine
residency at the University of Kentucky,
Lexington, KY. Following, he completed
a fellowship in rheumatology at the
University of Alabama, Birmingham. Dr.
Zang is board certified by the American
Board of Internal Medicine.
The author of numerous peer-reviewed
publications, Dr. Zang recently received
the honor of first place finalist in the
recent “National Young Rheumatology
Investigator Forum.” He is a member of
the American College of Rheumatology.
A native of Kingsport, Dr. Hensley
received both his undergraduate degree
and doctorate of medicine from East
Tennessee State University. Following,
he completed his residency training in
Gadsden, Ala, through the Family
Practice Residency Program.
During his extensive career, Dr. Hensley
has held many administrative positions
and has accepted numerous academic
appointments.
Dr. Hensley is a member of the Georgia
Association of Family Practice, the
Southern Medical Association, the
Southern Medical Association Family
Division and the American Association
of Family Physicians.
When not practicing medicine, Dr.
Hensley enjoys reading, sports (tennis,
racquetball, weight lifting), target
shooting, philosophy, fishing,
photography and art (pencil, pen
and ink).
(continued)
7
new providers
HMG welcomes Kelly Egbert, PA-C,
who is now serving within The
Orthopaedic Center of the Southeast.
Edward J. “Ward” Fore,
MD, FACS
General Surgery, HMG Medical Plaza
General surgeon Edward J. “Ward”
Fore, MD, FACS, comes to HMG from
The Surgical Group of Northeast TN,
PC, Erwin, Tenn. He currently serves
as an associate professor in general
surgery at ETSU’s Quillen College of
Medicine.
Board certified by the American Board
of Surgery, Dr. Fore received his
undergraduate degree from Wake
Forest University, Winston Salem, NC,
prior to receiving his doctorate of
medicine from the Medical University of
South Carolina, Charleston. He
completed both an internship and
residency in General Surgery at the
Quillen College of Medicine.
Daniela Wright, DO
Board certified by the National
Commission on Certification of
Physician Assistants, Egbert received
her undergraduate degree from Spring
Hill College, Mobile, Ala., where she
graduated cum laude. She completed
her graduate training at Mountain State
University, Beckley, WVa., prior to
completing a physician assistant
fellowship in orthopaedics with Watauga
Orthopaedics, Johnson City.
Family Medicine, Sapling Grove
Med/Peds
Family medicine physician Daniela
Wright, DO, comes to HMG from
Concentra Clinic North Charleston, SC,
where she served as a locum tenens
provider.
Board certified by the American Board
of Family Medicine, Wright received her
undergraduate degree from Marshall
University, Huntington. She received
her doctorate of medicine from the West
Virginia School of Osteopathic Medicine,
Lewisburg, where she graduated cum
laude. The recipient of numerous
awards and honors, including
membership within the Sigma Sigma Phi
Honor Society, Wright enjoys volunteer
work with children’s organizations,
including the Special Olympics.
Dr. Fore is a member of the American
College of Surgeons, the American
Medical Association, the Washington,
Carter and Unicoi County Medical
Society, the Tennessee Medical
Association, and the Society of
American Gastrointestinal and
Endoscopic Surgeons (SAGES).
Renette Davis, FNP
Family Medicine, Colonial Heights
Family nurse practitioner Renette Davis
joins HMG’s family medicine practice in
Colonial Heights, coming from Wellmont
Holston Valley Medical Center. Davis’
experience includes both acute and
inpatient care.
Board certified by the American Nurses
Credentialing Center, Davis received her
bachelor of science in nursing from the
University of South Alabama, Mobile.
She received her masters of science in
nursing from the University of Alabama,
Tuscaloosa.
Davis is a member of the Signma Theta
Tau Honor Society of Nursing.
Kelly Egbert, PA-C
Orthopaedics, The Orthopaedic
Center of the Southeast
8
Certified by the American Nurses
Credentialing Center as an adult health
clinical nurse specialist, Fraysier
received both her bachelor of science in
nursing and her master of science in
nursing from King College, Bristol, Tenn.
Karie E. Bennett, FNP
Fraysier’s decade of clinical experience
includes numerous diabetes-related
presentations and classes. She is a
member of the American Nurses
Association, the Tennessee Nurses
Association and the National
Association of Clinical Nurse
Specialists.
will provide care within HMG Pediatric
Gastroenterology.
Ragsdale received both her bachelor of
science in nursing and her master of
science in nursing from ETSU, where
she graduated magma cum laude and
with honors, respectively.
Healthy U, HMG Medical Plaza
HMG welcomes Karie E. Bennett, FNP,
to its family of Healthy U wellness
initiatives. Bennett comes to HMG from
Weight Loss Success, Inc., Johnson
City, where she was responsible for
assessing and monitoring patients with
weight concerns.
Jamie E. Givens, FNP
HMG Urgent Care
Bennett holds a bachelor of science in
dietetics/food systems management and
a bachelor of science in nursing, both
from East Tennessee State University.
She went on to receive her master of
science in nursing, also from ETSU.
HMG welcomes family nurse practitioner
Jamie E. Givens who is now providing
care at HMG’s Urgent Care locations.
Rhonda Ragsdale, FNP
Pediatric Gastroenterology,
HMG Medical Plaza
Rhonda Ragsdale, FNP, comes to HMG
from Wellmont Holston Valley Medical
Center where she provided care in both
the ICU and the GI lab. At HMG, she
Board certified by the American Nurses
Credentialing Center, Givens received
her undergraduate degree from The
University of Virginia College at Wise.
She received her master of science in
nursing from East Tennessee State
University, Johnson City. HL
Donna C. Fraysier, APN
Endocrinology, HMG Medical Plaza
Clinical nurse specialist Donna C.
Fraysier, APN, joins HMG, working
alongside endocrinologist Sherif
Yacoub, MD. Fraysier comes to HMG
from the Wellmont Diabetes Treatment
Center.
9
HMG Clinical Research participants
see value beyond themselves
There are many reasons 58 year-old
LeVern Nunley decided to participate in
an HMG Clinical Research study. As an
insulin-dependent diabetic, the most
obvious reason is that he hoped the trial
medication might perhaps be a pathway
to bring his blood sugar levels under
better control.
Yet, according to Nunley, beyond the
benefits he could possibly have hoped
to gain, one overarching result has been
that of a feeling of personal satisfaction
in simply doing something for the “good”
of others.
“I guess the best part of my experience
has been the feeling that by taking part
in this study, whether it benefits me or
not, I’ve made a contribution to people
down the line who acquire diabetes and
may be able to use this medication,”
explains Nunley. “Maybe I’ve broken
some ground.”
10
According to HMG Clinical Research
Director Joyce Caldwell, RN, CCRC,
Nunley is doing just that.
“It’s patients, just like Mr. Nunley, who
are doing incredible good for those
around them, and, for countless
individuals they will never know,”
explains Caldwell who has directed
HMG’s Clinical Research since its
inception in 1996. With more than 100
active clinical studies, HMG’s clinical
research efforts are the most
comprehensive in the Tri-Cities Region.
29 year-old Brandon VanHuss agrees.
Both he and his wife, Penny,
participated in a 22 month study
within HMG.
“Clinical trials are a good thing,” begins
VanHuss. “Being a part of this study
has allowed me to think that eventually,
down the line, if this medication does
HMG Clinical Research Director Joyce
Caldwell, RN, CCRC reviews upcoming
clinical trials with members of her team,
consisting of more than two dozen
professionals, including RNs, LPNs,
Medical Assistants and Medical Laboratory
technicians.
come out, it could be something that
can help people. It’s really been a good
feeling knowing that I was helping.”
According to HMG Founder & President
Jerry L. Miller, MD, it’s because clinical
trials benefit so many that HMG is
willing to participate.
“It’s good for so many reasons,” begins
Dr. Miller. “Often, it gives you a new
approach to many chronic conditions.
And, it’s good for patients in that it gives
them constant engagement. The
attentive care they receive is incredibly
thorough.”
Caldwell says that, due to the level of
care a patient receives, often the HMG
clinical research team identifies health
issues and concerns that the patient
never knew they had.
“I’ve had patients tell me that they owe
their life to a clinical trial,” explains
Caldwell, who says her team has
identified everything from heart murmurs
to cancer.
(averaging 15 minutes to an hour),
patients receive attentive care by
experienced clinical research
coordinators (directed by an HMG
physician principal investigator). All
clinical research team members adhere
to the rigorous guidelines established by
the Institutional Review Board.
Clinical study participants are
compensated for their time by the trial
sponsor (compensation ranges from $10
to $100 per visit, depending upon the
time commitment and type of visit) and
receive all trial-related medication and
monitoring as a complimentary safety
measure.
“
HMG primary care provider Ed McBride,
MD, who serves as an HMG clinical
research principal investigator says he
has seen the benefits first-hand.
“Clinical research allows for excellent
healthcare,” begins McBride. “Patients
are provided wonderful follow up,
receiving not only their medications but
also reimbursement for their time in
office visits, lab work, and diagnostics.”
Dr. Miller adds that it’s the close
monitoring of trial participants that
produces the greatest “good” for their
health.
“They are seen very regularly. Their
blood is monitored as well as other
physical findings and parameters. They
receive excellent education and
training,” explains Dr. Miller. “The
attentive care they receive is good for
attention to chronic illnesses in general.”
“We have a very close relationship with
our patients. We do a lot of education,
a lot of encouragement and a lot of
hand-holding,” adds Caldwell. “They
become our friends.”
Typically, the average study involves a
patient commitment of approximately
one year, with study visits ranging from
weekly to bi-weekly. During these visits
“I guess the best part
of my experience has been
the feeling that by taking part
in this study, whether it
benefits me or not, I’ve made
a contribution to people
down the line who acquire
diabetes and may be able to
use this medication,”
explains Nunley. “Maybe I’ve
broken some ground.”
Patient Safety Always First
Ever wonder what it would be like to
consider participating in clinical
research? LeVern Nunley will tell you.
“Sure, I was a little skeptical at first,”
says Nunley, before he continues with a
warm smile and a twinkle in his eye.
“But I never felt like a guinea pig.”
Nunley says his initial concerns quickly
dissipated.
“After I fully realized that they were
primarily concerned with my overall
health and that they were not going to
purposefully do anything that would
jeopardize my health, my apprehension
went away,” attests Nunley.
“It’s certainly not just about the
medication,” affirms Caldwell. “We’re
patient advocates and the patient
always comes first. If the patient needs
extra care when they come in for their
appointment, we make sure we give
them the time they need.”
Today, the HMG Clinical Research team
consists of more than two dozen
professionals, including RNs, LPNs,
Medical Assistants and Medical
Laboratory technicians. HMG actively
participates in Phase II, Phase III and
Phase IV clinical research studies.
“I will put our team up against any in
their performance, in their objectivity,
and in their ability to follow protocol,”
attests Dr. Miller. “In the 12-plus years
we’ve been doing clinical trials—and
we’ve done more than 500 of them—we
have never had a violation that would
warrant any type of sanction.”
Dr. McBride says he’s “very comfortable
with the entire process,” most notably
the informed consent where a patient is
explained the key facts involved in a
clinical trial before deciding whether or
not to participate.
“Patients are screened very carefully
before entering a trial and have a
thorough understanding of the informed
consent. Then, if, during a study, any
red flags are ever raised, the patient is
promptly removed from the study. No
matter what, patient safety comes
before the study, always.”
Since HMG Clinical Research’s
inception, more than 1,800 HMG
patients have participated in clinical
research studies.
(continued)
11
A Reputation of Excellence
With leading pharmaceutical partners
such as Merck, Hoffman LaRoche,
Pfizer and Glaxo-Smith-Kline, HMG
Clinical Research has developed a
reputation of excellence, with
pharmaceutical partners eager to
engage in additional studies.
“We are a robust group for clinical
trials,” boasts Dr. Miller, adding that
Holston Medical Group is very
particular as to the studies they will
accept.
“Holston Medical Group is well known
across the nation for excellence in
clinical studies,” explains Dr. Miller.
“Why? Because of the quality of our
team and our adherence to best
practices. Clinical research is an exact
science.
“There’s no room for variation. You
have to dot the i’s and cross the t’s
and that’s exactly the way our team
achieves excellence.”
“Trials must meet our objectives. We
evaluate each trial in advance. Is this
study good for our patients? Is it good
for science? It’s questions like these
that we must consider before agreeing
to participate in a trial.”
Interested in Participating in a Trial?
HMG is currently actively enrolling
participants for a variety of trials,
including:
Type II Diabetes (multiple trials)
Osteoarthritis (multiple trials)
Gastroenterology
Cardiac outcome
Pediatric vaccine
Dr. Miller, who says he is quick to turn
down trials that fail to meet HMG’s
established criteria, believes clinical
trials have “somewhat characterized”
Holston Medical Group.
To learn whether you meet the
protocols for participation, please talk
with your HMG primary care provider
or call HMG Clinical Research at
(423) 578-1506. HL
A Drug’s Long
Road to Market
A great deal of advance research is
conducted before a drug is ready for
the lengthy clinical trial phases of
development. First, potential drugs
have to be discovered, purified,
characterized, and tested in labs (in
cell and animal studies) prior to ever
beginning the clinical trial process.
On average, a new cancer drug has
at least six years of research behind
it before it even makes it to the
clinical trial phase. Then, once there,
on average about eight years pass
from the time the drug enters the
clinical trial process until it receives
approval from regulatory agencies for
sale to the public. HL
Occupational medicine specialist Samuel Breeding, MD,
has been recertified as a Federal Aviation Administration
(FAA) examiner. As a senior examiner with the FAA, he is certified to
perform class one physicals as well as second and third class physicals.
Relocating to Kingsport in 1984, Dr. Breeding has enjoyed an
occupational medicine career within the Tri-Cities for more than 25 years.
Currently, he is the only board-certified occupational medicine physician
in private practice in Kingsport, Tenn. Dr. Breeding’s experience in
aerospace medicine dates back to the early 1980s when he was trained
in aerospace medicine while serving as the chief of aeromedical services
at Altus Air Force Base, Oklahoma. HL
12
Celebrating a “Rare” Achievement:
All modalities at
both HMG outpatient
diagnostic centers achieve
ACR accreditation
... the HMG
Sleep Center
is now open!
The HMG Medical Plaza is
home to Kingsport’s new
HMG Sleep Center. And,
according to Samantha
Sizemore, the Center’s
director, the facility is unlike
any other.
“We recently gave a group
of out-of-the-area visiting
physicians a tour of our new HMG Sleep Center,” begins Sizemore. “They
were very impressed. They even commented that they thought they had
one incredible facility until they saw ours!”
In addition to a state-of-the-art monitoring room, the Center includes four
bedrooms with private baths. Decorated in warm, soothing colors, the
atmosphere is comparable to what you might expect to find at any of the
nation’s leading hotel chains. Each room boasts of a queen-size pillow-top
bed with six pillows per bed.
“One defining characteristic of our sleep center facilities is our ability to
accommodate those who work third shift,” explains Sizemore. “In an effort
to achieve the most accurate sleep study results, we try to mimic the
patient’s normal routine as much as possible. If they normally sleep during
the daytime hours, then we want to perform the study during the daytime.”
The addition of the new Kingsport location brings HMG’s sleep center
offerings to two. A sister HMG sleep facility, is located in Bristol.
The HMG Sleep Center is located on the 2nd floor of the new HMG
Medical Plaza, Kingsport. HL
A two-year pursuit resulted in a rare
achievement—all modalities at both HMG
outpatient diagnostic centers (ODC at Sapling
Grove, Bristol, and the ODC at MeadowView
Lane, Kingsport) have achieved accreditation
through the American College of Radiology.
“This is indeed a very rare achievement,” boasts
Samantha Sizemore, HMG director of radiology.
“The accreditation process is incredibly rigorous.
It took a great deal of effort and a demonstration
of excellence to achieve accreditation in every
modality we offer.”
According to Sizemore, HMG is the only such
healthcare entity within the Tri-Cities region to
achieve ACR accreditation on all modalities.
The mission of the American College of
Radiology is to serve patients and society by
maximizing the value of radiology, radiation
oncology, interventional radiology, nuclear
medicine and medical physics by advancing the
science of radiology, improving the quality of
patient care, positively influencing the socioeconomics of the practice of radiology, providing
continuing education for radiology and allied
health professions and conducting research for
the future of radiology. HL
Specialty Spotlight/Rheumatology
HMG Rheumatologist
Song Zang, MD, discusses
the current profile of
rheumatoid arthritis.
The world of
rheumatology—a
subspecialty that
treats diseases of
the joints and
connective
tissues—has
radically changed
from that of 20 or 30 years ago.
Consider rheumatoid arthritis alone.
The whole profile of the disease is
completely different.
• Joint pain and swelling
• Stiffness, especially in the morning
or after sitting for long periods
• Fatigue
Rheumatoid arthritis affects everyone
differently. In most people, joint
symptoms develop gradually over
several years. But in some, rheumatoid
arthritis may progress rapidly and yet
other people may have rheumatoid
arthritis for a limited period of time and
then enter a period of remission.
Rheumatoid arthritis is a type of chronic
arthritis that typically occurs in joints on
both sides of the body (such as hands,
wrists or knees). This symmetry helps
distinguish rheumatoid arthritis from
other types of arthritis.
“Research is an important part of
rheumatology,” explains HMG
rheumatologist Song Zang, MD, who
says that an enjoyment of research is
one of the factors that influenced his
decision to pursue a medical career in
rheumatology. “Within the last ten
years, with the development of different
biologics, the entire prognosis of
rheumatoid arthritis has changed.”
In addition to affecting the joints,
rheumatoid arthritis may occasionally
affect the skin, eyes, lungs, heart, blood,
or nerves.
Symptoms of rheumatoid arthritis
include:
14
Today, rheumatoid arthritis afflicts
approximately one percent of the
population in the United States.
According to Dr. Zang, aggressive
treatment at the beginning of the
disease, rather than waiting, is yielding
the best outcomes.
“A good rheumatologist can do so much
to impact a patient’s life,” begins Dr.
Zang. “For those who have their
disease managed aggressively, there is
really a lot of opportunity.”
Dr. Zang says promising outcomes are
being achieved with lupus, another
disease state treated within the
subspecialty of rheumatology. Following
medical school, Dr. Zang did extensive
research regarding lupus at the
University of Southern California, Los
Angeles.
Another of Dr. Zang’s areas of interest is
that of juvenile idiopathic arthritis (JIA),
formerly referred to as juvenile
rheumatoid arthritis or juvenile chronic
arthritis (JRA and JCA, respectively).
“The name has changed constantly
within the last ten years because the
Specialty Spotlight/Endocrinology
concept of the
condition has been
evolving continuously,”
explains Dr. Zang who
has received significant
shoulder-to-shoulder
training during his time
at the University of
Alabama, working
alongside respected
pediatric
rheumatologists.
What kind of medical
problems do you deal
with in endocrinology?
Endocrinology treats thyroid,
adrenal, pituitary gland
problems, osteoporosis, and
diabetes. Treatment of
diabetes is a big part of what
we do in clinic. This is a
problem I am personally
passionate about.
Why is that?
“Receiving the
appropriate
rheumatology referral
and beginning
aggressive treatment at
an early stage is very
important,” says Dr.
Zang, emphasizing that
many of the concepts
used in treating adult
rheumatology are not
appropriate in
managing children.
Q
&
A
For more information or
to schedule an
appointment with Dr.
Zang, please call HMG
Rheumatology at (423)
857-2790. HL
Welcome to the TriCities! Please tell us a
little bit about yourself.
with Endocrinologist Sherif
Yacoub, MD
Thank you. It’s good to be
here. I was born, raised and
went to medical school in
Egypt. I came to America nine
years ago; I did my residency
in New York and my specialty
training in endocrinology at the
Medical University of South
Carolina in Charleston. I
joined HMG in 2008. I now
live in Kingsport with my wife
and two children.
I have seen firsthand how
diabetes can damage the
body. It can cause blindness,
kidney failure, pain and
amputations; it also increases
one’s risk of getting a heart
attack or a stroke. The best
approach is to prevent these
dangerous complications from
happening by controlling the
blood sugar and by taking the
needed medications.
What is the reason
diabetes, as a health
problem, is not as wellcontrolled as we would
like it to be?
There are many reasons.
First, diabetes is a subtle
disease. Many people have
had it for years and yet don’t
know they have it. Obviously,
one cannot address a problem
until he knows he has it.
Second, there is a stigma
about diabetes that makes
people give up and not want to
fight because they think,
‘What’s the use, anyway?’
Needless to say, that way of
thinking is incorrect. The way
you treat diabetes makes a big
difference in your health in
general. We have patients
who have had diabetes for 60
years and are in good health
today because they took care
of themselves. Third, there
are some myths and
unrealistic expectations that
cause people to feel burdened
and hassled when they are
diagnosed with diabetes. For
example, many think they
have to starve or never eat
anything tasty again, which is
not true. Actually, they just
need to make wiser food
choices and cut back on their
portion sizes, and we teach
them how to do that while still
enjoying food.
Outside of work, what
are your interests and
hobbies?
I enjoy sports, reading and
spending time with my family.
The most important thing for
me is my Christian faith. It is
my relationship with Jesus
Christ that gives meaning to
everything else in my life.
To learn more about Dr. Yacoub
or to schedule an
appointment regarding an
endocrinology-related issue,
please talk with your HMG
primary care provider. Or, you
may contact Dr. Yacoub’s office
directly at (423) 857-2790. HL
15
healthy U
Healthy U Center opens
inside HMG Medical Plaza.
Need a first aid therapy hot & cold teddy
bear for injuries? What about HMGapproved self-care wellness materials?
Or, maybe you simply want to sport the
latest Healthy U fashion merchandise?
If so, you’ll find it all at the new HMG
Healthy U Center.
It’s a great place to find everything from
wellness items to nutraceuticals (multivitamins, antioxidant, and Omega 3 fish
oil products) and smoking cessation aids.
And, according to HMG Healthy U
Manager Eric Rouse, M.Ed., what’s
best, is that you can select from a
“menu” of services ranging from meal
planning and fitness assessments to
metabolic profiles, exercise
prescriptions, and weight management
initiatives (Lose it 4Good).
16
“An individual can
simply walk in off
the street and
purchase something
as simple as theraband fitness
product or service
(such as a
personalized
exercise
prescription) or
something as
comprehensive as our Lose it 4Good
initiatives,” explains Rouse, who says
that HMG Healthy U’s offerings are
second to none in the Tri-Cities region.
“Every service and product of Healthy U
can be provided here, in a single
location,” explains Rouse.
According to Rouse, while there are
other models similar to HMG Healthy U,
none “are as integrated and seamless.”
Registered dietitian, David Talley, a
member of the HMG Healthy U team,
assists a customer with merchandise in
the new Healthy U Center.
The Healthy U Center is located on the
2nd floor of the HMG Medical Plaza with
daytime hours that extend into the early
evening. For daily hours of operation or
additional details, visit
www.holstonmedicalgroup.com. HL
Lasagna
Backyard Garden
Ingredients:
1 medium zucchini, halved lengthwise and sliced
1 medium yellow squash, halved lengthwise and sliced
1/3 cup chopped red onion
1 cup shredded mozzarella cheese
1/2 cup crumbled feta cheese
2 Portobello mushrooms, sliced
4 cups fresh baby spinach
1/4 cup chopped fresh basil
1 Tbsp. chopped fresh oregano
9 Roma tomatoes, thinly sliced
3 cloves of garlic, minced
3 Tbsp. olive oil
1/4 cup balsamic vinegar
1 tsp. sugar
1/2 teaspoon salt
1/4 teaspoon black pepper
1 (8 oz.) package of whole
wheat lasagna noodles
Directions:
1. Cook noodles according to directions on package.
2. Preheat oven to 350° F. Lightly coat a 9x9 inch baking dish with cooking spray.
3. In a large bowl, toss together the zucchini, squash, mushrooms, spinach, garlic, red
onion, 1/2 cup mozzarella cheese, and feta cheese. Drizzle the olive oil and balsamic
vinegar, and stir in basil, oregano, sugar, salt and pepper. Stir the mixture until
evenly blended.
4. Place a layer of lasagna noodles into the bottom of the prepared pan. Make a layer
of tomato slices over the noodles. Spread generous amount of spinach mixture over
the tomatoes. Don’t worry; it shrinks a lot while cooking. Lay slices of tomatoes over
the spinach mixture, then another layer of noodles. Start with another layer of
tomatoes on top of the noodles, and repeat layering until the dish is heaped with
lasagna, ending with the vegetable mixture. Sprinkle remaining cheese on the top.
5. Bake for 35 to 45 minutes in the preheated oven, until noodles, and vegetables are
tender. Let stand for a few minutes to set, then slice and serve.
Nutrition facts per serving (334g):
Calories:
Total fat:
Saturated fat:
Cholesterol:
336
14.5g
5.3g
21mg
Sodium:
472mg
Total carbohydrates:36.4
Dietary fiber:
7.9g
Protein:
15.9g
Disaster Preparedness
The Disaster Task
Force increases disaster
preparedness
It’s one thing to ponder potential
disasters; it’s another thing to develop
solid plans in preparation for a
potential disaster.
This summer, The Disaster Task
Force (www.disastertaskforce.com),
is sponsoring a rather creative
“Disaster Preparedness
Challenge” where regional
businesses will have the
opportunity to submit their
disaster plans for review.
F3
Comprised of a team of regional
technology-related companies
that specialize in different aspects of
disaster planning, the Task Force will
provide a free assessment, carefully
detailing the strengths and weaknesses
of individual plans.
Twitter—to stage a mock, real-time
disaster.
“We’re using over-the-top creativity to
push the envelope of preparedness,”
explains OnePartner Director Tom
Deaderick. “In the end, everyone who
the ATAC (Advanced Technology &
Applications Center) data center in
Duffield, Virginia. OnePartner is one of
the five regional organizations
participating in the Disaster
Preparedness Challenge.
The OnePartner ATAC is the only
commercial data center in
America certified as a Tier III (or
higher) level by The Uptime
Institute.
Organizations judged to have the best
plan will win substantial prizes (as listed
on the website).
The certification provides
verification that the ATAC design
provides a high-availability
computing environment. High
availability is critically important
for a data center that provides
tornado, March 1, 2007, Americus, GA.
disaster recovery services
because a company that invests
participates will win; they’ll have a solid
in a mirrored disaster recovery site has
disaster preparedness plan.”
to be certain that second site will be up
and running if a tornado, a fire or a
A report by A.M. Best Underwriters
simple equipment failure disrupts
indicates that 94% of all businesses that service at the primary site. HL
experience a catastrophic data loss go
out of business. Yet, surprisingly, very
few businesses are prepared for a
potential disaster.
The Disaster Task Force will also utilize
the social networking organization—
On October 2, 2008, OnePartner
officially began uninterrupted service in
18
HMG in the
Community
March of Dimes
HMG is pleased to have raised money for the March of
Dimes by participating in America’s favorite walking event!
The money raised supports programs in communities
across America that help moms have healthy, full-term
Chip Childress and his wife Beth with their two daughters, Lauren
and Abby, join Dawn Fletcher and other HMG participants at the
2009 Neil’s Walk.
Neil’s Walk 2009
HMG employees again formed a team to walk in the July
11th Neil’s Walk. Participants were encouraged to walk in
“memory” or in “honor” of a loved one who has been
affected by heart disease. There were over 800 walkers in
the event sponsored by HMG, Cardiovascular Associates,
and the Eastman Credit Union.
HMG Denim Days Provide
Dollars for Community Charities
If you happen to see an HMG employee wearing denim
either the first Thursday or Friday of the month, know that
Several members of HMG’s March of Dimes Team
they are quietly—and comfortably—
pregnancies. The HMG team,
doing a good thing! As of June 30,
participating in the event Saturday,
Denim Days had generated more
than $7,200.00 for community
May 9 at the Appalachian
charities. The money is raised by
Fairgrounds, Gray, raised more
employees
willing to donate $5 in
than $3,500 for the March of
exchange
for
the privilege of wearing
Dimes.
denim to work. Area charities
benefiting from Denim Days include:
25th Anniversary
St. Judes Children’s Hospital, the
of Relay For Life
Neil Danehy Heart Foundation, Small
Celebrating the 25-year anniversary Funds raised through Denim Days enabled the
Miracles, The Language Center at
of Relay For Life, HMG participated Neil Danehy Heart Foundation to purchase a
Nave (a local program for children
portable defibrillator to be placed in the Dobynsin the American Cancer Society’s
with autism), March of Dimes,
Bennett Dome. At the presentation were Terry
signature activity. The Relay, held
American Cancer Society, and Susan
Arnold, Kingsport Fire Department; Myra Danehy,
HMG; Vicki Johnston and Lenore Kilgore,
May 29 & 30, was hosted by The
G. Komen for the Cure. HL
Kingsport City Schools.
Bristol Motor Speedway.
J. Bryston Winegar
Medical Center opens in Duffield
August 2009 is the slated opening for the new
35,000-plus sq. ft. medical office building in
Duffield, Va. Located on the same campus as
the OnePartner ATAC, the new medical facility
is named in honor of J. Bryston Winegar, MD,
who has served the Duffield area for nearly
three decades. The first phase of occupation
will include primary care and rehabilitation.
19
HMG Health Line
Jerry L. Miller, M.D.
President and
Founder
Robert C. Lee, M.D.
Medical Director
Craig M. Kilgore
Executive Director
Kellie Crowe
Communciao
tin
Consultants, Editor
MyraWi ndle Danehy
Layout and Design
A publication for the
employees and friends of:
Holston Medical Group
2323 N. John B. Dennis Hwy.
Kingsport, Tennessee 37660
(423) 857-2000
www.holstonmedicalgroup.com