WIXLIB

Spring 2007VAPA Insight NewsletterPresident’s ReportBy David Falkenstein, PA-C, VAPA PresidentHow many times have I heard the phrase that gettingPAs to work together, vote together, or do anything elsetogether is like “herding cats”? It is an apt visual imagemost of the time.Physician Assistants have varied tastes and run on theirown timetable. And in reality, considering the diversity ofour profession, from clinicians to academics, from ruralPAs, from employed PA, administrators, from generaliststo specialists, from private practice to large HMOs, it issurprising we ever agree on anything.Furthermore, who wants to be accused of “herd mentality”? Nonetheless, sometimes a little organization isbeneficial, as when organized medicine finds and protectscommon goals. If there was ever a time to circle the kittylitter, this is it. Without membership, we do not have anorganization. We are very important to VAPA. We are afamily, the Family of Medicine. In each and every thingthat we do, we represent this Family of Medicine. You arethe leaders in our PA community.In writing this message, I realized how much I needyour help. Sometimes we are asked to fill positions wedo not feel qualified to fill. Please keep in mind that otherpeople can see qualities in us that we cannot see in ourselves. Remember that during our life we are called toservice not only with our strengths but our weaknesses,fears, and mistakes. They will all be used for good. Do nothide them or be afraid of them. We learn best from those.Stretch yourself, you will grow and be blessed.We had some successes this legislative year thanksto the participation of the students from Virginia in fourphysician assistants programs and the twenty some stalwart graduate PAs who give of themselves time after timeand year after year. However, considering the number ofgraduate PAs in the state we can and must do better in ourinvolvement in our representative organization. Mother Teresa said, and I quote, “You can do what I cannot do. I cando what you cannot do. Together we can do great things.”Although politics has been a “dirty word” in our culture for some time, the truth of the matter is that legislation is enacted daily that affects all aspects of our lives.The practice of medicine is certainly no exception. Manyphysician assistants feel powerless when it comes todetermining the future of medicine, but working closelywith our supervising physicians, elected representatives,and educating them as to the issues and needs to provideour fellow citizens with improved access to health care hasproven to be critical, especially when changes to healthcare policy is being considered.President Dwight D. Eisenhower said: “Politics oughtto be the part-time profession of every citizen who would protect the rights and privileges of free people and who wouldpreserve what is good and fruitful in our national heritage.” On a local level. . . As Tip O’Neill famously said, “Allpolitics is local.” We are requesting nominations for theleadership of your academy. As members you should havealready received that mailed request. Please take the timeto consider recommending a VAPA member to the nominating committee for one of the open positions. Regardingopen positions we have need for a chairperson for our public relations committee and corporate support committee.If you have an interest in either position and would likemore information please let me know.Lastly, we arrive at the issue of communication. Oneof the chief complaints I hear from members and potential members is that they do not know what our societyis doing and what good it has done. I usually reply withsome statistics and recent legislative initiatives before theperson I am speaking to gets a glazed look in their eyesand I realize it is time to move along. This all-to-common experience has led me to a more committed effort toincrease and improve the various means of communicationthat are available to VAPA members. We will be keeping our Web page up-to-date with current information.We will be sending more frequent communications aboutcurrent regional and statewide activities and lastly wewill be giving our members several forums in which theycan expresses themselves about our organization and ourprofession. Watch for e-mail announcements about this andmore exciting changesAgain, I want to thank you for the honor and privilegeof being your academy’s president as we work to advanceour mission to strengthen the PA-Physician and patientrelationships both now and for the future of our profession.Regional InformationWe now have five regions within Virginia, to make iteasy for PAs to gather locally. Our newest is the Shenandoah Region with coordinator Susan Gongloff. They hadtheir first dinner meeting in February at the Village Squarerestaurant in Winchester with approximately 18 peopleattending. The lecture, sponsored by Forrest, was givenby Beth Omundsen M.D. a local family practice M.D.,and the topic was depression. They hope to have quarterlymeetings. The next one is scheduled for May 8, at OneBlock West. Pfizer is the sponsor, Philip O’Donnell M.D. alocal cardiologist is speaking, and the topic is cardiovascular effects of smoking cessation.The Western Region coordinator, Ken Anderson, hasbeen having monthly meetings with approximately ten PAsattending. They usually meet the second Tuesday or Thursday of the month. One of the PAs here will be speakingto our group on pain management in July. In other newsfrom the Western Region, Lauri Adkins is a psychiatric PAwho left her Roanoke practice in early March to hike thecontinued on page 5

Spring 2007Legislative CornerThis year’s legislation proved both challenging and rewarding. Of the four bills filed to amend certain codes twohave passed, one was stricken by request, and one remainsin committee. See the following summaries and explanations of the legislation. You can view the legislation intheir entirety at: http://leg1.state.va.us/.HB1962 Summary as introduced:Prescription of certain controlled substances and devices by licensed physician assistants. Authorizes licensedphysician assistants to prescribe Schedule II through VIcontrolled substances and devices on and after July 1,2007.HB1962, whose patron is Delegate John O’Bannon,has passed, was signed by the Governor, and is now law,which goes into effect on July 1 2007. I want to thankZane Reasoner for attending the house committee hearingsAM and assisting with this legislation prior to its filing.SB993 Summary as passed:SB993 – Disabled parking. Allows licensed physicianassistants, licensed podiatrists, licensed chiropractors, orlicensed nurse practitioners the same certification powersgranted licensed physicians and certain other health careprofessionals in connection with obtaining various indiciaassociated with disabled parking privileges.continued from page 4Appalachian Trail with her husband. This will be her thirdtime hiking the 2,176 mile trail and her husband’s 5th or6th time. Best of luck to them!The Tidewater Area continues to have dinner meetings.They try to alternate venues on both sides of the tunnels,including interesting speakers on good topics. Coordination of the area has been upheld by Jen Wohl since Almatook off for Hawaii.The Richmond Region has been very successful withmonthly meetings under the direction of Brian Jalbert andTara Louka. Twenty or more PAs attend the monthly dinners on the last Wednesday of the month. They are bookedfor meetings a year in advance. The next Richmond Areameeting will be June 27 at 6:30 p.m. Watch your e-mails.The Northern Virginia Region of PAs is the Granddaddy of Regions with frequent dinner meetings, with70 PAs, and a large e-mail list. The coordinator, CarolinaDiaz-Perosa, is spending a few months in Japan, but isdepending on Donna Swanson and Deb Nelson to help outwith Regional meetings while she is gone. Be sure to addyour name if you are in the region and check the VAPAWeb site for details.Details of upcoming regional meetings are found onour Web site www.vapa.org. Any PA can attend a meetingin any region if you want.VAPA Insight NewsletterSB993, whose patron is Senator Harry Blevins, allowslicensed physician assistants, licensed podiatrists, licensedchiropractors, or licensed nurse practitioners the same certification powers granted licensed physicians and certainother health care professionals in connection with obtaining various indicia associated with disabled parking privileges. The bill has passed and was signed by the Speakerof the House and President of the Senate and awaits theGovernor’s signature to become law on July 1, 2007.HB2416 Summary as introduced:HB2416 – Exceptions to immunity of physicians,nurse practitioner, or physician assistant orders test. Addsto the exceptions to physician immunity for laboratorytests the physician did not order, tests that were ordered bya nurse practitioner or physician assistant with whom he oranother physician in his office had established a relationship in writing. Such physician must have been providedthe results of the test and failed to provide the same to thenurse practitioner or physician assistant for the exceptionto apply.HB2416, whose patron is Delegate Clifford Athey Jr.The immunity legislation was referred to the House Courtsof Justice Sub-Committee: Civil Law, where it will remainuntil the next session. The bill had opposition as it is currently enrolled by both the MSV and the Trial LawyersAssociation. This is a co-bill we have entered into with theNPs and the upper sections of amendment are where thetwo organizations are in disagreement. The lower portionsare not a problem, which is what the PAs need to have thesame immunity as their supervising physicians. The lobbyist for the NPs is working with the legislation.SB980 Summary as introduced:Supervision of physician assistants. Expands thetherapeutic activities that licensed physician assistants mayperform under the supervision of a licensed physician orpodiatrist to include treatment. The bill prohibits physicianassistants from prescribing or dispensing drugs, exceptprescriptive authority authorized for licensed physician assistants pursuant to ß 54.1-2952.1.The patron struck this bill at my request when a reasonable compromise with the Medical Society of Virginia’ssuggested substitute amendment (in order to gain their support and not opposition was unattainable? Sorry this makesno sense at all-editor). The good news regarding SB980is we live to fight another day and with some additionaleducation of the MSV we should be able to gain their fullsupport for the original legislation at the 2008 secession.An Important ReminderPA Lobby Day for the 2008 legislative session is January 21, 2008. Mark your calendars so you will be free toattend.

Spring 2007VAPA Insight NewsletterCyberKnife Comes to Southwestern VirginiaBy Portia Tomlinson, PA-CCarilion Cancer Centerof Western Virginia is oneof only 50 centers in theUnited States and the first inVirginia to offer CyberKniferadiosurgery to patients withpreviously inoperable tumorsof the brain, spinal cord, andother organs. About 14,000people worldwide have undergone treatments.What is CyberKnife? CyberKnife radio surgeryis a painless, precise, noninvasive radiation treatmentthat can be an alternative to open surgery in somecases. It is so precise that beams can be sculpted tosmall, complex-shaped tumors near critical structures.This allows it to accurately irradiate only the tumorand protect healthy tissues. Multiple beams of highenergy radiation are delivered from multiple pointsoutside the body and converge precisely at the tumoror lesion inside the body. It combines a lightweightradiation delivery system mounted on a multi-jointedrobotic arm with an image guidance system allowingthe system to locate the tumor throughout treatmentand correct for small patient movements, which allows radiation to be delivered without a stereotacticframe with sub millimeter accuracy. Being 100% frameless, the system corrects for patient movement during treatment and spares the patient from the pain andinconvenience of the conventional head frame thatmust be affixed to the skull with screws. There is noincision, no blood, no pain, no anesthesia, no frame,and no recovery time. Another advantage to the CyberKnife system is that treatments can be staged orhypo-fractionated – where the total radiation dose isdivided into 3-5 smaller doses, that is beneficial fortreating lesions near sensitive structures. This is incontrast to traditional daily radiation treatment averaging 6-8 weeks duration. It is painless and done asan outpatient, allowing patients to undergo treatmentswhile continuing their usual activities. The treatmentteam consists of a trained neurosurgeon, radiationoncologist, physicist, and radiation therapists. Before treatment, the patient will undergo CT scan, PET, MRor 3D Angio images to obtain coordinates by whichthe computer will locate the target area. For some procedures (non-head), tiny gold markers called fiducialswill be imbedded near the area to be treated. Thesehelp the computer plot coordinates for treatment. Thehigh resolution image detectors capture x-ray imagesand generate digital images of the anatomy. Theseimages, which are taken throughout treatment, arecompared to the digitally reconstructed radiographs(DRRs) generated from the CT scans used for treatment planning. The imaging system then determinesthe patient’s position and sends a command to therobotic manipulator to correct for movement. Duringtreatment, the robotic arm delivers beams of radiation from many different directions to the lesion whilethe patient lies on a table. The patient can even take abreak if they become uncomfortable without disrupting the process. Treatments last from 45 minutes to2 hours in 1-5 sessions. It is the only system in theworld that tracks tumor position in real time accounting even for respirations. The CyberKnife team reliesheavily on the neurosurgeon’s knowledge of anatomyto map or contour the lesion to be treated. A fusionand dose review can actually be done from the neurosurgeons office with a CyRIS InView station. Usergroups all over the globe are available to discusscases with the neurosurgeons. The CyberKnife systemhas broad clinical applications and has proven clinicalefficacy in over 14,000 patients treated since August2001. What are the indications? Lesions adjacent toradiosensitive structures, complex shaped lesions,previously irradiated lesions, recurrent surgical lesions, lesions requiring difficult surgical approaches,medically inoperable lesions or for patients to frail toundergo surgery or who refuse surgery. Cyberknife ishighly utilized for intracranial, neck and spine tumors,AVMs, and functional disorders such as trigeminalneuralgia and has expanded to lung, liver, pancreas,skeletal, and prostate tumors. This treatment is nolonger an afterthought, and should be part of the treatment options considered for patients.

VAPA Membership ApplicationPlease check your desired class of membershipo Fellow 60o Affiliate 35o Sustaining 60o Student 10 for length of programo New Membero Honorary Membero RenewalPlease print or type:Name: Title: o PA-C o PA o Student o M.D. o OtherAddressCity: State: Zip:Phone Number:Company:Company Address:City: State: Zip:Phone Number:Fax Number:: E-Mail:AAPA Member: o Yes o NoAAPA Member Number:Licensed: o Yes o NoVA License Number:Certified: o Yes o NoNCCPA Number:Supervising Physician:PA Program: Grad Date:Preferred address for mailings and billing: o Worko HomeRemember that VAPA sends all publications and membership materials to the mail and e-mail address you have selected.It only takes a minute to adjust your preferred address or update your information with VAPA. Just call 703/836-4207 ore-mail vapa@vapa.orgo I am not interested in being listed in the membership directory.The directory is only distributed to VAPA members.o Checko Money Ordero MasterCardo Visao AMEXCredit Card Number: Expires: /Signature:Printed name on card:Membership dues are not tax deductible as charitable contributions for income tax purposes. However, they may be deductible as ordinaryand necessary business expense or an itemized miscellaneous deduction subject to restrictions imposed as a result of association lobbyingactivities. It is estimated that the nondeductible portion of your 2007 dues subject to lobby law is 27% ( 16.00).Send payment to:Virginia Academy of Physician Assistants (VAPA) Dues Renewals950 North Washington Street Alexandria, VA 22314-1552Phone 703/836-4207 Fax 703/684-1924vapa@vapa.org www.vapa.orgDues are paid annually for the period from January 1 - December 31Application information is intended for VAPA use only and will not be re-distributed.

Tragedy at Virginia TechBy Marie Waller PA-C, VAPA Newsletter ChairmanBeing PAs in Virginia, we all have a connection and familiarity with Virginia Tech. We, more than most, know that a HOKIE is nota castrated turkey and have heard all of the UVA vs. Tech jokes so many times we can repeat them in our sleep. I grew up in Virginia,so I have very close ties to many of the state’s universities. However, Monday, the 16th of April will live in my mind as the day my soulwas tested to the very limits, an experience that no PA, physician, policeman, or EMT should ever have to face. The cruelty of it all ismind-boggling.From personal experience being a PA at the level one trauma center closest to Va. Tech, I can tell you, that is not something I everwant to repeat. I, of course, cannot disclose sordid details or our hospitals experiences, but I can tell you that the response from EMSand the five local hospitals was almost flawless. They turned a very difficult situation into a stellar performance. I can tell you how veryproud I am with the support and camaraderie that surrounded our area since the news broke shortly before 10 a.m. on that fateful day.For example: 3 The Chest Pain center staff that donated supplies for “Hokie Angels.” 3 The number of people I see wearing themin the halls, knowing they made a donation to the victims fund to get their angel. 3 An administrative vice president, graduate fromanother Virginia school, wearing a Hokie pin promised parents that she would not remove it until their child awakened and told her shecould. 3 A local pediatrician, who would not have bought a single maroon item in his life for fear

VAPA will be hosting the 25th Annual Sum-mer CME conference in Virginia Beach, July 23-27th, 2007. There are many informative and exciting lectures planned. We have included the following new workshops: ACLS renewal, Trig-ger Point Injections, and Medical Spanish. These are in addition to: Diabetes Patient Management, EKG, and Suture Workshops.