Dear Patients:

As many of you know, our offices at the Fort Norfolk Plaza building were damaged by a roof fire on Monday, April 9th. Unfortunately, until the necessary repairs are made, the building is not accessible. We are working closely with the building owners and the City of Norfolk to return to our location as quickly as possible. In the meantime, your continued care is our priority.

While the damage is assessed and reoccupancy plans established, we want you to know how to reach your healthcare team at the Dedicated Care Center.

• Main DCC Phone- (757) 252-9300 DCC On-Call Phone- (757) 252-9400
• Dr. Gregg Clifford- (757) 252-9250 Dr. Julie Damman- (757) 252-9310
• Dr. Glenn Jones- (757) 252-9280 Dr. Charles Lisner- (757) 252-9330
• Dr. Sherry Scheib- (757) 252-9350 Dr. Mark Weisman- (757) 252-9340

On Monday, April 23rd we began seeing patients at the Interstate Commerce Center (ICC) Building 16, formerly the Koger Executive Center, at 6333 Center Drive, Norfolk VA, 23502. Once you turn into the parking lot, you will see our entrance with the yellow awning. A map with directions is also included on the back of this letter.

We apologize for any inconvenience this event is causing and thank you for your patience and understanding as we work quickly to return to Fort Norfolk Plaza. If you have any questions or have a special need, please do not hesitate to contact us.

Sincerely,
The Physicians & Staff at Dedicated Care Center

When you call to schedule or reschedule your appointment, you will be directed to the Interstate Commerce Center (ICC), formerly the Koger Executive Center, at 6333 Center Drive, Norfolk VA, 23502. • The office is best accessed by turning right on Kempsville Road and then right on Center Drive after exiting I264 South at Newtown Road. The building will then be located on the right.

At Sentara, the safety of our patients, visitors, physicians and staff are of utmost concern to us. As situations arise that impact the safety of - or access to - our facilities, we are committed to keeping everyone informed and up-to-date.

The roof fire at 301 Riverview Avenue in Norfolk (last night/Apr. 9th) affected five of Sentaras practices, and as a result, all sites will be closed for patient appointments for at least the next few days. Impacted sites include:

• Executive Evaluation Center
• Dedicated Care Center
• Sentara Family Medicine Physicians
• Sentara Internal Medicine Physicians
• Fort Norfolk Diagnostic Center

We are still early in the process of working with inspectors and City officials to assess the damage and determine when we will be able to safely regain access to the building. While we await a final report on the length of time our building will be inaccessible, we are also in the process of identifying alternative sites of care with a goal to reestablish our ability to care for patients - wherever that may be - as soon as possible.

A team is meeting daily and will be coordinating regular updates for patients and the community at large here on Sentara.com. Patients with scheduled appointments will be contacted.

If care is needed immediately, there are also two Sentara Urgent Care locations nearby. A full listing is also available at Sentara.com/urgentcare.

1. Sentara Urgent Care
1326 E. Little Creek Road
Norfolk, VA 23518
Phone: (757) 583-6338

2. Sentara Urgent Care
850 Kempsville Road
Norfolk, VA 23502
Phone: (757) 261-5999

We apologize for any inconvenience this event may have caused and thank you for your patience as we work through the aftermath of the fire. We will continue to keep you updated as additional information is available and new locations for care are established.

Our offices will be closed Wednesday 4/11/12 and Thursday 4/12/12 due to a fire we experienced at the Fort Norfolk Building earlier this week. If you have an immediate emergency please call our on-call phone 757-252-9400.

2012 Schedule for Nutrition Seminars at the Dedicated Care Center

LOCATION: Fort Norfolk Building 301 Riverview Avenue, Suite 900

All Classes are from 1:30pm-2:30pm

February 1, 2012
Heart Healthy Eating

March 7, 2012
Navigating the Grocery Stores

April 4, 2012
Eating to Boost your Immunity

May 2, 2012
Carbohydrates-Friend or Foe?

June 6, 2012
Eating Away from Home

July 11, 2012
Nutrition Supplements

August 1, 2012
Cooking for One or Two

September 5, 2012
Nutrition as We Age

October 3, 2012
Label Reading

November 7, 2012
Holiday Eating Strategies

December 5, 2012
The Scoop on Fat in our Diet

The office will be closed on Monday, January 2, 2012 in observance of New Years Day. Please call the After Hours Number at 757-252-9400 for assistance.

Nancy Harding

Nancy Harding has been a Registered Dietitian for more than 35 years. She earned her BS from the University of Washington and did her Internship at Yale- New Haven Hospital in Connecticut. Nancy re-located to Virginia Beach more than 20 years ago with her family.

As a Registered Dietitian, Nancy can provide clinical expertise to clients who have nutritional needs from diabetic education and heart healthy meals to clients who are at high risk for nutrition support. Nancy has served the past 13 years at Sentara Home Care providing nutrition counseling and intervention to patients and their families in order to assure an understanding of nutrition therapy.

Nancy has earned a Sentara Promise Award for her outstanding commitment and service excellence. She currently enjoys traveling with her family.

Caroline R. Triepel, M.D.

Imagine how challenging activities of daily living might be if your fingers curled toward the palm of your hand causing your hand to be immobile or less functional. Activities requiring manual dexterity-like wrapping your hand around a car's steering wheel or even washing dishes-would be increasingly difficult for the person with the disease known as Dupuytren's (du-pra-tranz) contracture.

What is Dupuytren's Contracture?

Dupuytren's contracture is a condition where the connective tissue that lies beneath the skin in the palm of the hand tightens into a "cord". What begins as a small knot or painless lump at the base of the ring, little or middle fingers over time may impair the function of the hand as the contracture pulls the finger or fingers toward the palm. This results in losing the ability to fully open or flatten the hand. Interestingly, the index finger and thumb are seldom involved in this condition.

What are it's Causes?

No one really knows what causes Dupuytren's contracture, but it is well known that it runs in families. People of northern European descent-Scandinavia, England, Scotland and Wales-have the highest incidence. And it is about seven times higher among men than among women.

Most of the time, the disease doesn't show up until after age 40. However, a very aggressive form may rarely appear in teenagers and children Other factors have been suspected for causing Dupuytren's, such as trauma, diabetes, alcoholism, epilepsy, and liver disease, but there is no clear relationship. Once a patient develops it, there is no diet or exercise that will inhibit it.

What are the Treatment Options?

In mild cases, especially if hand function is not affected, only observation is needed. As Dupuyten's progresses, activities of daily living become affected. Common patient complaints include difficulty putting a hand in a pocket because the contracted finger gets caught. Many patients have difficulty gripping items such as a golf club. When hand function becomes affected, it's time to investigate possible treatment options.

One method is surgical removal (fasciectomy) of the "cord" of hardened connective tissue in the palm to restore some function to the hand. The disadvantage of this procedure is the lengthy recovery time and greater risk of injury to nerves or arteries in the hand.

A more recent, less invasive approach divides the "cords" but does not remove them. The procedure, called Needle Aponeurotomy, uses a needle to sweep and cut the cord (fasciotomy) and is an alternative that requires no incisions and can be performed under local anesthesia in the physician's office. Recovery is usually quicker as well.

Another newer treatment involves the injection of an enzyme called collagenase directly into the "cord". After the injection, the finger is straightened in the office under local anesthesia the next day.

While all three treatments should be considered, it's important to know therapy and splinting is an integral part of the rehabilitative process to maximize the straightening of the fingers and the function of the hand. Despite treatment, the disease process may recur in adjoining hand tissue or when the less invasive treatments are employed as opposed to the more invasive fasciectomy treatment.

If you think you may have Dupuytren's disease, the first step is to make an appointment with a hand surgeon specially trained to help you evaluate treatments that provide you with the best knowledge of all options to treat Duputryen's disease. Hand health is an important dimension of maximizing your physical health and maintaining optimum function for all activities of daily living.

Caroline R. Triepel, M.D. is a board certified and fellowship trained hand surgeon practicing with Sentara Hand Surgery Specialists in Hampton Roads VA. She received her medical degree at the University of Virginia followed by general surgery and orthopedic residencies at Wake Forest University Medical Center in North Carolina. Dr. Triepel completed a Hand and Upper Extremity Fellowship at Tufts University School of Medicine in Boston MA prior to practicing in the Hampton Roads area.

Sentara is committed to becoming a stronger partner in your healthcare. Now, Sentara patients can use their iPhones to access their electronic medical information on the go - anytime, anywhere. Read More

2011 Schedule for Nutrition Seminars at the Dedicated Care Center
The 1st and 3rd Monday of the Month

LOCATION: Fort Norfolk Building 301 Riverview Avenue, Suite 900
________________________________

February 7, 2011
The Food Mood- Connection – 1:30-2:30pm
Sorting out Sodium – 3:00-4:00pm

March 7, 2011
The Power of Protein – 1:30-2:30pm
Nutrition Supplements – 3:00-4:00pm

April 4, 2011
Fueling your Fitness – 1:30-2:30pm
The “Skinny” on Fats – 3:00-4:00pm

May 2, 2011
Understanding the Nutrition Label – 1:30-2:30pm
Eating Out – 3:00-4:00pm

June 6, 2011
Smart Shopping – 1:30-2:30pm
The Beauty of Breakfast – 3:00-4:00pm

Please call your PSC to schedule 252-9300

11.8.10 The New York Times, Nov 4 2010 CT Scans Cut Lung Cancer Deaths, Study Finds

Since December 2003, The Executive Evaluation Center has been a leading force in the early detection of Lung Cancer by incorporating a Lung CT in their comprehensive physical evaluation. For more information, or to schedule your Executive Evaluation please call 757-252-9200. What you don't know can hurt you.

Read More

11.5.10 Dedicated Care Center is "going live" on e-Care in December!

Dedicated Care Center is "going live" on e-Care in December! Stay connected for further details on our official "go live" date.

For more information on e-Care Click Here

For more information on Sentara MyChart Click Here

7.26.10 Dedicated Care Center Moving to Fort Norfolk Plaza

Our New Address:
301 Riverview Avenue, Suite 900
Norlfolk, VA 23510
Phone: 757-252-9300

From Colley Avenue
Pass through the intersection of Colley and Brambleton Avenue. Take a right
off Colley Avenue onto Southampton Avenue, and then take a right onto
Riverview Avenue. The Dedicated Care Center will be located on the 9th floor,
suite 900.

From Brambleton Avenue – West
When traveling west on Brambleton Avenue, take a left on Colley Avenue.
Then, take a right off Colley Avenue onto Southampton Avenue and then a
right onto Riverview Avenue. The Dedicated Care Center will be located on
the 9th floor, suite 900.

From Brambleton Avenue – East
While traveling east on Brambleton Avenue take a right on Colley Avenue.
Then, take a right off Colley Avenue onto Southampton Avenue and then a
right onto Riverview Avenue. The Dedicated Care Center will be located on
the 9th floor, suite 900.

2010 Schedule for Nutrition Seminars at the Dedicated Care Center
The 1st and 3rd Monday of the Month

LOCATION: Wainwright Building, 9th Floor Conference Room
________________________________

January 18, 2010
The Food Mood- Connection – 1:30-2:30pm
Nutrition as We Age – 3:00-4:00pm

February 1, 2010
The Skinny on Fats – 1:30-2:30pm
Fueling your Fitness – 3:00-4:00pm

February 15, 2010
Understanding the Nutrition Label – 1:30-2:30pm
Carbohydrate Confusion – 3:00-4:00pm

March 1, 2010
Sorting out Sodium – 1:30-2:30pm
The Power of Protein – 3:00-4:00pm

March 15, 2010
The Beauty of Breakfast – 1:30-2:30pm
Smart Shopping – 3:00-4:00pm

April 5, 2010
Cooking “Lite” but Luscious – 1:30-2:30pm
Nutrition Myths and Mysteries – 3:00-4:00pm

May 3, 2010
Nutrition Myths and Mysteries – 1:30-2:30pm
Eating Out Hype or Helpful? – 3:00-4:00pm

May 17, 2010
The Food-Mood Connection – 1:30-2:30pm
Understanding the Nutrition Label – 3:00-4:00pm

June 7, 2010
The Skinny on Fats – 1:30-2:30pm
Fueling your Fitness – 3:00-4:00pm

June 21, 2010
The Power of Protein – 1:30-2:30pm
Smart Shopping – 3:00-4:00pm

July 19, 2010
Sorting out Sodium – 1:30-2:30pm
Nutrition as We Age – 3:00-4:00pm

August 2, 2010
Eating Out Hype or Helpful?– 1:30-2:30pm
Carbohydrate Confusion – 3:00-4:00pm

August 16, 2010
Cooking Lite but Luscious – 1:30-2:30pm
Nutrition Supplements:Hype or Helpful? – 3:00-4:00pm

September 20, 2010
Nutrition Myths and Mysteries – 1:30-2:30pm
The Beauty of Breakfast – 3:00-4:00pm

October 4, 2010
Fueling your Fitness – 1:30-2:30pm
Smart Shopping – 3:00-4:00pm

October 18, 2010
The Skinny on Fats – 1:30-2:30pm
The Power of Protein – 3:00-4:00pm

November 1, 2010
The Food-Mood Connection – 1:30-2:30pm
Festive but Fit Holidays – 3:00-4:00pm

December 6, 2010
Festive but Fit Holidays – 1:30-2:30pm
Nutrition as We Age – 3:00-4:00pm

December 20, 2010
The Beauty of Breakfast – 1:30-2:30pm
Cooking Lite but Luscious – 3:00-4:00pm

Sessions are held on the first and third Monday of each month except for the following: January 4, April 19, July 5, September 6 and November 15

To you and yours! As an added convenience we have prepared instructions for the upcoming holiday closings. As always, we here at the Dedicated Care Center hope you have a safe, healthy, and happy holiday season!

11/26/2009 -The office will be closed in observance of the holiday. Please call the after hours number at 388-1080 if you have an urgent need and would like to speak with the on-call physician.

11/27/2009 - During the hours of 8:00a.m.- 5:00p.m. there will be staff members available to answer your phone call, however the office is closed in observance of the holiday. If you are a patient of Dr. Clifford, Dr. Jones, or Dr. Damman and need assistance between the hours of 8:00a.m.- 5:00p.m., please call 388-1889. If you are a patient of Dr. Lisner or Dr. Weisman and need assistance between the hours of 8:00a.m.-5:00p.m., please call 388-1871. If you are calling after hours, and need to speak with a physician, please call 388-1080.

Schedule for Nutrition Seminars at the Dedicated Care Center
October 5, 2009 – December 21, 2009
The 1st and 3rd Monday of the Month

________________________________

Day Classes
LOCATION: Wainwright Building, 9th Floor Conference Room

October 5, 2009
The Power of Protein – 1:30-2:30pm
Carbohydrate Confusion – 3:00-4:00pm

October 19, 2009
Eating Out – 1:30-2:30pm
Nutrition As We Age– 3:00-4:00pm

November 2, 2009
Nutrition Myths/Mysteries – 1:30-2:30pm
Nutrition Label Logic – 3:00-4:00pm

November 16, 2009
Fueling Your Fitness – 1:30-2:30pm
Festive and Fit Holidays – 3:00-4:00pm

December 7, 2009
Festive and Fit Holidays – 1:30-2:30pm
Smart Shopping – 3:00-4:00pm

December 21, 2009
Cooking “Lite” but Luscious– 1:30-2:30pm
The Beauty of Breakfast – 3:00-4:00pm

_____________________________________

Night Classes
LOCATION: Heart Hospital, Conference Room 1

October 8, 2009
Nutrition as We Age– 5:30-6:30pm

November 5, 2009
Understanding the Nutrition Label– 5:30-6:30pm

December 3, 2009
Festive and Fit Holidays– 5:30-6:30pm

Nutrition Seminars are presented by a registered dietician. Space is limited and everyone in attendance must be pre-registered. To sign up, please call your Patient Service Coordinator. The seminars are held at the Wainwright Building in the 9th Floor Conference Room.

Schedule for Nutrition Seminars at the Dedicated Care Center
October 5, 2009 – December 21, 2009
The 1st and 3rd Monday of the Month

October 5, 2009
The Power of Protein – 1:30-2:30pm
Carbohydrate Confusion – 3:00-4:00pm

October 19, 2009
Eating Out – 1:30-2:30pm
Nutrition As We Age– 3:00-4:00pm

November 2, 2009
Nutrition Myths/Mysteries – 1:30-2:30pm
Nutrition Label Logic – 3:00-4:00pm

November 16, 2009
Fueling Your Fitness – 1:30-2:30pm
Festive and Fit Holidays – 3:00-4:00pm

December 7, 2009
Festive and Fit Holidays – 1:30-2:30pm
Smart Shopping – 3:00-4:00pm

December 21, 2009
Cooking “Lite” but Luscious– 1:30-2:30pm
Cooking Lite but Luscious – 3:00-4:00pm

Nutrition Seminars are presented by a registered dietician. Space is limited and everyone in attendance must be pre-registered. To sign up, please call your Patient Service Coordinator. The seminars are held at the Wainwright Building in the 9th Floor Conference Room.

Holiday Hours

The Dedicated Care Center office will be closed in observance of Independence Day on Friday, July 3, 2009. Although the office will be closed, a Patient Service Coordinator will be standing by to help you with your immediate needs. As always, we here at the DCC are committed to providing the highest level of customer service.

If you are a patient of Dr. Lisner, Dr. Weisman, or Dr. Bethea and need assistance between the hours of 8:00 a.m. and 5:00 p.m., please call 388-1846 or 388-1082.

If you are a patient of Dr. Clifford, Dr. Jones, or Dr. Damman and need assistance between the hours of 8:00 a.m. and 5:00 p.m., please call 388-1852, 388-1069, or 388-1093.

For after hours assistance, please call our dedicated after hours line at 388-1080.

The Physicians and Staff at the Dedicated Care Center would like to wish you a safe, healthy, and happy holiday!

Schedule for Nutrition Seminars at the Dedicated Care Center
October 5, 2009 – December 21, 2009
The 1st and 3rd Monday of the Month

________________________________

Day Classes
LOCATION: Wainwright Building, 9th Floor Conference Room

October 5, 2009
The Power of Protein – 1:30-2:30pm
Carbohydrate Confusion – 3:00-4:00pm

October 19, 2009
Eating Out – 1:30-2:30pm
Nutrition As We Age– 3:00-4:00pm

November 2, 2009
Nutrition Myths/Mysteries – 1:30-2:30pm
Nutrition Label Logic – 3:00-4:00pm

November 16, 2009
Fueling Your Fitness – 1:30-2:30pm
Festive and Fit Holidays – 3:00-4:00pm

December 7, 2009
Festive and Fit Holidays – 1:30-2:30pm
Smart Shopping – 3:00-4:00pm

December 21, 2009
Cooking “Lite” but Luscious– 1:30-2:30pm
The Beauty of Breakfast – 3:00-4:00pm

_____________________________________

Night Classes
LOCATION: Heart Hospital, Conference Room 1

October 8, 2009
Nutrition as We Age– 5:30-6:30pm

November 5, 2009
Understanding the Nutrition Label– 5:30-6:30pm

December 3, 2009
Festive and Fit Holidays– 5:30-6:30pm

Nutrition Seminars are presented by a registered dietician. Space is limited and everyone in attendance must be pre-registered. To sign up, please call your Patient Service Coordinator. The seminars are held at the Wainwright Building in the 9th Floor Conference Room.

Schedule for Nutrition Seminars at the Dedicated Care Center
October 5, 2009 – December 21, 2009
The 1st and 3rd Monday of the Month

October 5, 2009
The Power of Protein – 1:30-2:30pm
Carbohydrate Confusion – 3:00-4:00pm

October 19, 2009
Eating Out – 1:30-2:30pm
Nutrition As We Age– 3:00-4:00pm

November 2, 2009
Nutrition Myths/Mysteries – 1:30-2:30pm
Nutrition Label Logic – 3:00-4:00pm

November 16, 2009
Fueling Your Fitness – 1:30-2:30pm
Festive and Fit Holidays – 3:00-4:00pm

December 7, 2009
Festive and Fit Holidays – 1:30-2:30pm
Smart Shopping – 3:00-4:00pm

December 21, 2009
Cooking “Lite” but Luscious– 1:30-2:30pm
Cooking Lite but Luscious – 3:00-4:00pm

Nutrition Seminars are presented by a registered dietician. Space is limited and everyone in attendance must be pre-registered. To sign up, please call your Patient Service Coordinator. The seminars are held at the Wainwright Building in the 9th Floor Conference Room.

Holiday Hours

The Dedicated Care Center office will be closed in observance of Independence Day on Friday, July 3, 2009. Although the office will be closed, a Patient Service Coordinator will be standing by to help you with your immediate needs. As always, we here at the DCC are committed to providing the highest level of customer service.

If you are a patient of Dr. Lisner, Dr. Weisman, or Dr. Bethea and need assistance between the hours of 8:00 a.m. and 5:00 p.m., please call 388-1846 or 388-1082.

If you are a patient of Dr. Clifford, Dr. Jones, or Dr. Damman and need assistance between the hours of 8:00 a.m. and 5:00 p.m., please call 388-1852, 388-1069, or 388-1093.

For after hours assistance, please call our dedicated after hours line at 388-1080.

The Physicians and Staff at the Dedicated Care Center would like to wish you a safe, healthy, and happy holiday!

Schedule for Nutrition Seminars at the Dedicated Care Center
July 6, 2009 - September 21, 2009
The 1st and 3rd Monday of the Month

July 6, 2009
The Beauty of Breakfast – 1:30-2:30pm
Nutrition Myths & Mysteries – 3:00-4:00pm

July 20, 2009
Nutrition Labels – 1:30-2:30pm
Fueling Your Fitness – 3:00-4:00pm

August 3, 2009
The Beauty of Breakfast – 1:30-2:30pm
Nutrition As We Age – 3:00-4:00pm

August 17, 2009
Smart Shopping – 1:30-2:30pm
Carbohydrate Confusion – 3:00-4:00pm

September 7, 2009
NO CLASSES: LABOR DAY

September 21, 2009
The “Skinny on Fats” – 1:30-2:30pm
Cooking “Lite” but Luscious – 3:00-4:00pm

Nutrition Seminars are presented by a registered dietician. Space is limited and everyone in attendance must be pre-registered. To sign up, please call your Patient Service Coordinator. The seminars are held at the Wainwright Building in the 9th Floor Conference Room.

http://www.cdc.gov/h1n1flu/sick.htm

Construction is underway on our new home, Fort Norfolk Plaza. Developers and officials from the city of Norfolk held a groundbreaking ceremony Thursday, February 12th, 2009. The new facility is located less than a mile from where we currently reside in the Wainwright Building. The Fort Norfolk building is located on the water across from Sentara Norfolk General and is expected to be completed in the Spring of 2010. We will be keeping you up to date on each phase of construction via the website's Photo Gallery. We look forward to extending our commitment of exceptional service by moving our ever growing practice to this larger, state of the art facility.

View the Photo Gallery

Schedule for Nutrition Seminars at the Dedicated Care Center

May 4, 2009- July 20, 2009

The 1st and 3rd Monday of the Month
1:30–2:30 p.m

5/04/2009 - Nutrition As We Age

5/18/2009 - The Power of Protein

6/01/2009 - Carbohydrate Confusion

6/15/2009 - Eating Out

7/06/2009 - The Beauty of Breakfast

7/20/2009 - Understanding a Nutrition Label

Nutrition Seminars are presented by a registered dietician. Space is limited and everyone in attendance must be pre-registered.  To sign up, please call your Patient Service Coordinator.  The seminars are held at the Wainwright Building in the 9th Floor Conference Room.

To you and yours! As an added convenience we have prepared a list and instructions for the upcoming holiday closings. As always, we here at the Dedicated Care Center hope you have a safe, healthy, and happy holiday season!

12/24/2008 - The office will be open from 8:00a.m. until 12:00 noon. Please call the after hours number at 388-1080 if you have an urgent need and would like to speak with the on-call physician.

12/25/2008 -The office will be closed in observance of the holiday. Please call the after hours number at 388-1080 if you have an urgent need and would like to speak with the on-call physician.

12/26/2008 - During the hours of 8:00a.m. to 5:00p.m. there will be staff members available to answer your phone call, however the office is closed in observance of the holiday. If you are calling after hours, and need to speak with a physician, please call 388-1080.

12/31/2008 - The office will be open from 8:00a.m. until 12:00 noon. Please call the after hours number at 388-1080 if you have an urgent need and would like to speak with the on-call physician.

12/01/2009 - The office will be closed in observance of the holiday. Please call the after hours number at 388-1080 if you have an urgent need and would like to speak with the on-call physician.

I hope that you will allow me to reminisce a bit since today is my birthday, and I am about to begin my sixty-fourth year on earth; thirty-seven of which have been as a physician. During those years, I have witnessed changes in the treatment and prevention of heart disease that rival some of mankind’s most impressive advances. Read the full article

Successful bypass surgery has this Norfolk man back on the walking path and looking to a longer, healthier life.

Watch the Video

In an effort to help all members of the DCC in their pursuit of optimal health, we have partnered with registered dietitian Judy Metnick, M.J., R.D. and certified personal trainer Reese Edgington with Fitness Together.

Judy will be providing bimonthly seminars on a variety of nutritional and wellness topics. A list and brief description of upcoming seminars are attached for your convenience. Space for each session is limited so contact your PSC for dates and times of each session and reserve your spot today. Seminars will be repeated over the upcoming months to allow ample opportunity for all to benefit.

Fitness Together will be offering one-on-one personal fitness assessments. Your session will begin with a baseline evaluation of your current aerobic fitness level with our microfit bicycle under the supervision of a qualified expert.  A one-on-one discussion with our trainer will follow. Recommendations on beginning an exercise program or improving on your current program will be provided. All questions are fair game, so bring your comfortable clothes and get fit! Call your PSC to schedule your individual session today.

Authored by Glenn C. Jones, M.D.,M.B.A.,F.A.C.P. April 2008

There has been quite a bit of concern and confusion since the release of information about the ENHANCE trial on Zetia.  We feel it is important to put this study in perspective – particularly since it raises the immediate question of whom, if anyone should use Zetia.

Zocor is a statin like Lipitor and Crestor.  Zetia mixed with Zocor is called Vytorin.  This combination is hoped to mix two approaches to cholesterol therapy.  In simple terms, Zetia works by blocking absorption of bad cholesterol in the intestines and Zocor works by inhibiting a liver enzyme that makes bad cholesterol (LDL).  The TV commercial calls this combining “the fettuccini Alfredo” (Zetia) with “the Uncle Alfredo” (Zocor).

ENHANCE is a surrogate endpoint trial conducted in only 720 patients with Heterozygous Familial Hypercholesterolemia (HeFH), a rare condition that affects approximately 0.2% of the population (2 people in one thousand).  A “surrogate endpoint” does not directly measure hard outcomes like reduction of chance to die, to have a heart attach, or to have a stroke.  For example, a “surrogate endpoint” is one that might be associated with reduction in risk of death or heart attacks.  Bad cholesterol (LDL) in heart patients and hemoglobin A1C in diabetic patients are examples of surrogate markers.

The primary endpoint in the ENHANCE study was the mean change in the intima-media thickness (IMT) measured at three sites in the carotid arteries between patients treated with Zetia and Zocor versus patients treated with Zocor alone for a two year period.  Thus, the study was designed to measure the inner lining of the carotid arteries.

There was no difference between treatment groups on the primary endpoint – thickening of the carotid arteries.  The change from baseline in the mean carotid IMT was 0.011mm for the Zetia/Zocor group versus 0.006mm for the Zocor only group, which was not statistically significant.  Realizing that a millimeter (mm) is less than 1/25 of an inch, this represents an incredibly small difference, whichever way the results may have come out. 

The overall rates of treatment-related serious side effects or side effects leading to stopping the medicines were very low and similar between both treatment groups.  Both medicines were well tolerated.  Overall, the safety profiles of Zetia/Zocor and Zocor alone were very good.  Specifically, no serious liver or muscle problems developed with either group.

There was a significant difference in “bad” cholesterol “LDL” lowering seen between treatment groups – 58% LDL cholesterol lowering on Zetia/Zocor as compared to 41% on Zocor alone.  Lowering LDL cholesterol has been shown to lower the risk of death, heart attack, and stroke in previous outcome trials.

Three large outcomes trials with Zetia/Zocor (Vytorin), which involve more than 20,000 high-risk patients, are currently in progress.  The completion of these studies will be late 2009 and early 2010.  The results will establish whether adding Zetia to a statin drug like Zocor or Lipitor will benefit patients more than just lowering their bad cholesterol about 20% more than statin therapy alone.

In summary, the results of the ENHANCE trial show no benefit from the combination of Zetia and Zocor (sold together as Vytorin) over Zocor alone in terms of affecting the rate of thickening in the carotid arteries.  The study involved only 720 patients with heterozygous familial hypercholesterolemia – a group of patients with extremely high cholesterol at levels of 600 and above.   Thus, it is not reasonable to assume these results apply to most of the population.

The American College of Cardiology (ACC) recommends that major clinical decisions not be made on the basis of the ENHANCE study alone.  This study does deserve careful thought and follow-up.  The overall incidence rates of heart attacks and strokes were very low and nearly identical between both treatment groups.  Both medicines were well tolerated.  The difference in carotid artery lining changes between the Zocor group and the Zetia/Zocor group was 0.006mm versus 0.011mm.  This represents 5/1000 of a millimeter (mm).  Remembering that a millimeter (mm) is less than 1/25 of an inch, this difference is meaningless.

Further, the ACC notes that this trial is an imaging study and not a clinical-outcome study.  Final conclusions cannot be made until the three large clinical-outcome trials on Zetia are presented within the next two or three years.  The ACC recommends that Zetia remain a reasonable option for patients who are currently on a high dose statin but have not reached their goal for reducing bad cholesterol (LDL).  Zetia is also a reasonable option for patients who cannot tolerate statins or can only tolerate a low dose of stating therapy.

If you have any questions concerning Zetia given the above, please feel free to contact your Dedicated Care Center physician.  We want you to continue your current medication regimen, including Zetia/Vytorin, until we can talk about it on your next visit.

Dr. Glenn Jones was named the 2008 Virginia Young Internist of the Year by the American College of Physicians, the academic and professional association for Internal Medicine physicians. The award was decided by the Virginia chapter’s Awards Committee, which includes a past president of the American College of Physicians, the current Governor of the Virginia chapter and the Director of Medical Services at the National Naval Medical Center. Five letters of support were required and were submitted by physicians from around the state, including one from his DCC colleague Dr. Charles Lisner. The award is designed to recognize excellence in leadership within the profession, academics, medical research, teaching and mentoring, and volunteerism. Dr. Jones is Chair of the 2008 Virginia ACP Annual Scientific Meeting being held in Williamsburg, and chairs several committees on the Governor’s Council. He served as Chairman of Medicine at Danville Regional Medical Center and volunteered as an attending physician at the Danville Free Clinic before he joined the Dedicated Care Center in July 2007. He has been a principal investigator or sub-investigator on over 40 pharmaceutical clinical trials involving diabetes, heart disease, inflammatory bowel diseases and emphysema. He has taught medical students since 2003 in his role as Visiting Assistant Professor of Medicine at the University of Virginia. He will receive his award at the Virginia ACP’s annual meeting in March.

The Dedicated Care Center is excited to announce our latest efforts to reinforce our commitment to service and efficiency by opening an on-site dispensary of prescription medications. We are currently stocked with over 100 medications and are credentialed with most major insurance carriers. If you need a prescription filled and don’t want the hassle of waiting at your local drug store chain, please stop in and see us! Holly, our licensed Pharmacy Technician will ask you for your insurance and prescription card(s) and fill your prescription in a matter of minutes! For more details, please consult your Patient Service Coordinator. As always, we are committed to exceeding your expectations and thank you for your on-going trust and confidence.

Dr. Jones graduated from high school in England where he won an academic scholarship to Eton, and then earned a Bachelor of Arts and Science degree from Stanford University in 1991. He went on to study at the Ecole Nationale des Ponts et Chaussées in Paris, and received his MBA in International Business in 1993. His medical degree is from the University of Chicago and he completed his internship and residency at Duke University Medical Center in 2001. He was certified by the American Board of Internal Medicine in 2002.

To schedule an appointment with Dr. Jones, please call (757) 388-1852.

Please join us in congratulating Dr. Bethea on setting sail toward some much needed rest and relaxation! Dr. Bethea has decided to take a leave of absence and we are looking forward to seeing him back to work at the Dedicated Care Center. If you are a patient of Dr. Bethea’s, please continue to call 757-388-1851 and a Patient Services Coordinator will be happy to direct your care to one of our other Dedicated Care Physicians.