FirstHealth of the Carolinas has taken steps to create centers of excellence that will offer the highest quality health care to the community. The Specialty Clinics Division, located at FirstHealth Moore Regional Hospital in Pinehurst, has expanded to include a new Esophageal Center that opened Sept. 8. The Esophageal Center joins two other programs that are a part of the Specialty Clinics Division: the Chest Center of the Carolinas, which opened Jan. 20, 2004, and the Bariatric Center, which became a part of the division this year.

A team approach sets these centers apart from more traditional methods of patient care. Patients can now see all of the specialists who will be involved with their diagnosis and treatment in one location.

This multidisciplinary approach saves the patient time and allows treatment plans to be developed and implemented more quickly. The approach also improves communication among specialists regarding a patient’s progress.

The division’s structure is typical of universitybased programs.

“This gives physicians the opportunity to practice medicine in the way they were trained,” says Cindy Mooney, R.N., director of the Specialty Clinics Division. “It offers the benefit of multiple disciplines working together for the diagnosis and treatment of a patient.”

The Chest Center
The Chest Center of the Carolinas, under the guidance of its medical director, Andy Kiser, M.D., treats diseases of the chest and lung. These include sarcoids, benign lung tumors and lung cancer. The Chest Center coordinates patient treatment with medical oncologists, radiation oncologists, pulmonologists, radiologists and pathologists. (See sidebar).

Lung cancer is the number one disease treated by the Chest Center team. “We are one of the hotbeds of lung cancer, because we are in the tobacco belt,” Dr. Kiser says.

North Carolina has one of the highest rates of lung cancer in the nation. “For years, it was socially acceptable to smoke,” Dr. Kiser says, “so we have an increase in the cancer rate because of the number of people who are smoking. We have seen lung cancer in men for years. Now lung cancer has become the number one cancer cause of death in women.”

Lung cancer is difficult to find early, because the soft tissue of the lung is protected by the chest wall. In a few months, the Chest Center will begin using esophageal ultrasound, a new tool to help diagnose and treat lung cancer. Dr. Kiser estimates that the esophageal ultrasound will benefit between 10 and 20 percent of patients with lung cancer and may, in some cases, eliminate the need for surgery.

“One finds curable lung cancer by accident,” he says. “Often, someone has a chest X-ray for a separate reason and a treatable lung cancer is found.”

Dr. Kiser expects physicians to stage some lung cancers with the esophageal ultrasound to prove that they are still curable. “We can use the ultrasound to see how bad the tumors are and determine the stage of the lung cancer,” he says.

The Esophageal Center
Dr. Kiser also serves as medical director of the new Esophageal Center. Tracy Overton, R.N., is the program’s supervisor.

The Esophageal Center coordinates with gastrointestinal specialists and ENT (ear, nose and throat) physicians, and general and thoracic surgeons.

“I don’t know of another esophageal center in the country,” says Dr. Kiser. “We are the only one in private practice that I am aware of.”

The Esophageal Center gives patients access to physicians with expertise in the problems of the esophagus. “This allows us to evaluate the patient in one setting,” says Dr. Kiser. “Patients are cared for by practicing, board certified physicians, who have joined forces to provide top-ofthe- line, academic-quality care.”

Physicians expect their highest caseload to involve patients with gastroesophageal reflux disease (GERD). The condition occurs when acid from the stomach “refluxes” into the esophagus, irritating the lining and causing a burning sensation usually called heartburn.

An estimated 41 million Americans suffer from GERD. Ten percent of participants in one study reported having symptoms of GERD daily.

According to Dr. Kiser, GERD is on the increase because of our changing lifestyle. “We have become a society of people who do not get a lot of exercise,” he says. “We take in a lot of caffeine, we don’t eat until late, we drink alcohol, and we smoke. The way society has developed, we have set up these problems.”

Control of GERD is important, because it is the major contributing factor in the development of esophageal cancer, the cancer with the most rapid rate of increase of any cancer in the United States, according to Dr. Kiser. Use of the esophageal ultrasound will help diagnose the severity of esophageal cancer.

“The ultrasound gives us a picture inside the body,” Dr. Kiser says. “It lets us look at the lining of the esophagus to see tumors on the wall of the esophagus that we cannot see visually. We can look at the lymph nodes outside the esophagus with the ultrasound. It also helps us look at suspicious masses outside the esophagus that we otherwise wouldn’t know were there.”

In addition to treating GERD, the Esophageal Center will also treat reflux of the larynx and pharynx (LPR). Symptoms include chronic hoarseness and excess mucous in the throat, or post-nasal drip. A person may have LPR without the burning sensation typically associated with GERD. Individuals with either LPR or GERD may also suffer from asthma or have trouble swallowing.

Other patients served by the Esophageal Center are those diagnosed with noncancerous lesions and noncardiac chest pain, as well as children with pediatric gastrointestinal diseases.
Continued on page 2 >>