ORTHOPAEDICS

DEPARTMENT OF ORTHOPAEDIC SURGERY

CarilionClinic.org/ortho

Department of Orthopaedics

Not pictured: Michael S. Helvey, D.O.; Robert B. Stephenson, M.D.; Peter J. Apel, M.D., Ph.D.; Benjamin R. Coobs, M.D.; Jon R. Maher, M.D.; Robert B. Schopf, D.P.M.; Jesse B. Seamon, M.D.

Chairman’s Letter

It is with great pride and honor that I write to you as Chairman of the newly formed Department of Orthopaedic Surgery at Carilion Clinic. On June 1, 2014, Carilion Clinic added the Department of Orthopaedics to its organizational structure, which formally integrated the Carilion ortho-paedic practices in the Roanoke Valley, New River Valley, Giles, and Lexington into the first new department added since the incep-tion of Carilion Clinic. One month later on July 1, 2014, the Department of Orthopae-dic Surgery officially became a department of Virginia Tech Carilion School of Medicine (VTCSOM).

The journey began in 2006, shortly after the formal announcement that Carilion Health System would evolve into a clinic model. With the help and support of my colleagues from Carilion Bone and Joint and associ-ates of Roanoke Orthopaedic Center, we began to explore the concept of building a comprehensive orthopaedic group. Moving forward to 2010, Carilion Bone and Joint Center and Roanoke Orthopaedic Center

formally joined together, becoming Carilion Clinic Or-thopaedics. With the formalization of our depart-ment we now are a

unified entity pro-viding comprehensive

orthopaedic services to central and southwest

Virginia. Collectively, we have made significant progress

and were privileged to have more than 65,000 outpatient visits in our Roanoke locations last year. That averages out to 250 patient visits per business day. In addition, for the past two years, our surgical volume has been 20 percent greater than any other medical center in the state. We hope this is validation of our spectrum of services provided in a patient-centered, excel-lence-focused approach to orthopaedics.

As part of our new structure with VTCSOM, third- and fourth-year students at the school will now have three clinical rotation options in orthopaedics in addition to their eight core rotations. With the addition of the new department, students will be ex-posed to a healthy selection of orthopaedic subspecialties, such as adult reconstruction and total joint replacement, hand surgery,

spine and pediatric orthopaedics, sports medicine, foot and ankle, and trauma.

Finally, the Carilion Clinic Orthopaedics- Musculoskeletal Education and Research Center was established. This group of or-thopaedic clinicians/scientists engages the students in a mentor relationship to expose them to participation in and performance of musculoskeletal research and fosters their interest in research in coordination with the VTCSOM mission.

It is our goal to provide outstanding patient-centered care, teaching opportu-nities for medical students, residents and fellows, and participate in clinical and basic science research. We have attracted top candidates completing very prestigious fellowship programs, further strengthening our department’s expertise. I am humbled by the support and confidence I’ve received and eager to set in motion the next level of orthopaedic care for our region.

Sincerely,

Joseph T. Moskal, M.D., F.A.C.S.Chairman, Department of Orthopaedic Surgery

The section of adult reconstruction is comprised of five full-time surgeons who collectively perform approximately 1,500 joint replacements each year in addition to hip arthroscopy and joint preservation. We are proud to be awarded the gold standard for certification by Joint Commission for Disease Specific Care for Total Hip and Knee Replacements. The initial certification was received in July 2007. Gaining popularity worldwide is the anterior approach to hip replacement, a procedure we have

been performing since 2009. Carilion brought this new technique to the region and has completed

more than 2,000 of these surgeries. Our results show a shortened recovery period,

less pain, reduced length of stay, and quicker return to daily activities, including driving and working.

The section continues to focus efforts on quality outcomes, patient safety, and de-

veloping community education programs. We hold monthly meetings with represen-

tatives ranging from physicians and nurses, to pharmacy and dining services staff. Cooperative-

ly, we continually review outcomes and have been able to significantly decrease our blood utilization, increase patient satisfaction scores to a record high,

and shorten our length of stay, exceeding national averages. We continue to monitor 30-day bounce back in lowering any necessary hospital readmis-sions.

Education is vital to our future and we are pleased to offer an ACGME-accredited fellowship in adult reconstruction. In addition, our outpatient joint coordinator has been recognized for “building a bridge” between her role and the various team mem-bers involved in the surgical process. The patient becomes part of the process, simplifying the complex process of total joint arthroplasty. Challenges con-tinue; however, this strategic approach has improved problem-solving, cultivated an open culture, and fostered educational opportunities. We are commit-ted to furthering our clinical care into unsurpassed patient care.

OUR ADULT RECONSTRUCTION FACULTYRoanoke and New River ValleyJoseph Moskal, M.D., ChairmanJeffrey Chain, M.D.Ryan Harris, D.O.John Mann, M.D.Michael Wolfe, M.D.Benjamin R. Coobs, M.D. (August 2015)

Section of Adult Reconstruction

The foot and ankle section treats the entire spectrum of foot and ankle issues, ranging from injury and sports problems to the effects of aging. Fractures are managed both with surgical and nonsurgical treatments. Arthritis of the foot and ankle has many treatment options, including ther-apy, medication, fusion, and replacement. Ankle instability or tendon injuries after sports mishaps can be effectively treated to get patients back in their game. Defor-mity of the foot or ankle can interfere with everyday activities and can also be correct-ed, much improving quality of life. Diabetic foot problems can be limb threatening; limb salvage techniques are readily available.

Deformities of the foot and ankle related to stroke, brain injury, or nerve injury can be corrected, much improving a patient’s ambulatory ability. Many patients are able to become brace-free.

We are dedicated to improving care

for our patients and actively par-

ticipate in research. Currently, we have three

ongoing FDA trials inves-tigating topical medications

used in venous leg ulcerations and diabetic foot infections. Our third podiatry resident class began July 1, 2014. We are excited to finally reach full maturity and look forward to continue to develop a curriculum that supports evidence-based practice and learning.

OUR FOOT AND ANKLE FACULTYRoanoke, New River Valley, Lexington, Franklin, and Westlake James Chandler, M.D., Co-ChiefJ. Randolph Clements, D.P.M., Co-ChiefJohn L. Clements, D.P.M.Jason Naldo, D.P.M.Marc Platt, D.P.M.Robert B. Schopf, D.P.M. (August 2015)

Section of Foot and Ankle

We are pleased to offer several new services to better serve our patients and referring physicians. We have expanded our Westlake clinic to five days a week, providing care closer to home for the residents of Franklin and Bedford counties. For patients who need to be seen in a timely manner for routine orthopaedic needs, we offer same-day appointments in Roanoke and Westlake. We continue to offer an after-hours clinic four days a week at our Riverside location in Roanoke as well. Our seasoned group of general ortho-paedists offers expert care in diagnosing and treating orthopaedic conditions.

OUR GENERAL ORTHOPAEDIC FACULTYAll Carilion Orthopaedic LocationsJoseph Moskal, M.D., ChairmanDallas Crickenberger, M.D.Michael Helvey, D.O.Douglas Kells, M.D.Robert Stephenson, M.D.

Section of General Orthopaedics

We offer comprehensive care for conditions of the hand and upper extremity for patients of all ages.

Non-operative, surgical, and supervised reha-bilitation services are provided for congenital, acquired, traumatic, and arthritic problems that lead to pain, deformity, and loss of func-tion of the upper extremity.

Problems commonly cared for and services provided include:

» Birth deformities of the hand » Benign and malignant tumors of the hand » Arthroscopy of the wrist, elbow, and shoulder

» Treatment of fractures, sprains, tendon injuries, and lacerations of the hand, wrist, elbow, and shoulder (rotator cuff and labral tears) using modern techniques of internal fixation and rehabilitation

» Shoulder replacement » Collagenase injections for Dupuytren Contracture Disease

» Treatment of acute and chronic nerve problems in the upper extremity, includ-ing carpal tunnel syndrome, using both

endoscopic and open decompression tech-niques for pinched nerves in the hand, wrist, and elbow

» Repair of injured nerves and blood vessels in the hand and arm using modern micro-surgical techniques

» Tendon and nerve transfers of the hand and upper extremity

» Treatment of arthritic conditions of the hand, wrist, elbow, and shoulder using modern techniques such as fusion and joint replacement (standard and reverse total shoulder) when needed

OUR HAND SURGERY FACULTYRoanoke and LexingtonHugh J. Hagan III, M.D., ChiefCesar J. Bravo, M.D.Horatiu Dancea, M.D.Cassandra Mierisch, M.D.Cay Mierisch, M.D.Peter Apel, M.D., Ph.D. (September 2015)

Our certified hand therapists include: Amy Conforti, O.T., C.H.T.; Patti Jones, O.T., C.H.T.; and Janis Lewis, O.T., C.H.T., at our 3 Riverside location and Kathryn Larson, O.T., C.H.T., at our Postal Drive location.

Section of Hand and Upper Extremity

Our focus continues to emphasize compas-sionate, quality, outcomes-oriented spine and pediatric orthopaedic care. The section of spinal surgery, scoliosis, and pediatric or-thopaedic surgery remains exceedingly busy.

We have four fellowship trained spine sur-geons whose practice emphasizes complex spine deformity reconstructions in the adult and pediatric population as well as mini-mally invasive spine surgery. Jonathan J. Carmouche, M.D., concentrates on complex spine deformity reconstructions in the adult and pediatric population as well as minimally invasive treatments for cervical, thoracic, and lumbar reconstructions. In the summer of 2014, we welcomed a new

colleague to our section. Caleb Behrend, M.D., completed a fellowship in

spinal surgery at the prestigious Rothman Institute at Thomas Jefferson University in Phila-delphia. Each year, our team has grown tremendously in terms of productivity. We currently perform over 500 spine surgical procedures each

year. The majority of these are minimally invasive treatments

for degenerative and deformity conditions of the spine.

We are proud to have the region’s only surgeon having completed a fellowship in pediatric orthopaedic surgery, Julia Bulkeley, M.D., offering highly specialized service to our community, region, and state. Her practice consists of general pediatric orthopaedics and scoliosis. Dr. Bulkeley collaborates well with her colleagues and readily guides team-based interdisciplinary care for our patients. Common conditions that she treats include: pediatric fractures and dislocations, complicated limb and spinal deformities, club foot, hip dysplasia, and pediatric neuromuscular conditions.

Our team continues to experience exciting growth and our services have expanded such that all aspects of spine and pediatric care are expertly covered. We are committed to leading and providing state-of-the-art spine and pediatric orthopaedic care and educa-tion in our region.

OUR SPINE AND PEDIATRIC SECTION FACULTYRoanoke, New River Valley, and LexingtonJonathan Carmouche, M.D., ChiefCaleb Behrend, M.D.Julia Bulkeley, M.D. Michael Mauro, D.O.

Section of Spine and Pediatrics

The goal of the members of the section of sports medicine is to provide comprehen-sive care to athletes across the spectrum of competition and ages. From the adolescent athlete, to the elite, and finally the mature competitor, we offer assessment, diagnos-tics, non-operative care and, when required, operative care. We provide athlete educa-tion, on-site care at athletic events (high school and intercollegiate), urgent work-in clinics during high-demand seasons, and medical staff support at national and inter-national events.

Our fellowship-trained physicians and their staff offer arthroscopy of the shoulder, knee, ankle, and elbow, and beginning in 2015, hip arthroscopy as a coordinated service with our adult reconstruction and joint preservation service. Among the operative procedures routinely performed are liga-ment reconstruction of the knee (ACL, PCL, multi-ligament), treatment of meniscus injuries, cartilage restoration (microfracture, osteochondral autograft transplantation), treatment of patellofemoral instability, shoulder reconstruction and instability surgery, rotator cuff repair, labral repair, biceps tendon surgery (proximal and distal), and elbow reconstruction (Tommy John) among others.

OUR SPORTS MEDICINE FACULTYRoanoke, New River Valley, and LexingtonThomas K. Miller, M.D., ChiefChristofer Catterson, M.D.Edward Hemphill, M.D.Christopher John, M.D.Brent Johnson, M.D.Jon R. Maher, M.D. (2015)

Section of Sports Medicine

Our three fellowship-trained orthopaedic trauma surgeons offer treatments of the multiple-injured patient with complex fractures seen at our Level I Trauma Center at Carilion Roanoke Memorial Hospital. We also offer access for general fracture care; in particular, we have seen an increase in the need for providing hip fracture care and are pleased to care for that patient population as well.

Carilion Clinic has dedicated an operating room to this team five days a week, allowing us to efficiently offer care to our patients.

This allows us to treat upper and lower ex-tremity long bone and periarticular fractures as well as pelvic and acetabular fractures.

We also offer reconstructive services for nonunions, malunions, and infections. Trevor Owen, M.D., has special interest in use of the Taylor Spatial Frame for these challenging cases.

Jesse Seamon, M.D., a graduate of the Uni-versity of Virginia orthopaedic program, will be joining us in August 2015 after complet-ing his orthopaedic trauma fellowship.

OUR TRAUMA AND FRACTURE CARE FACULTYThomas Shuler, M.D., ChiefFranco Coniglione, D.O.Trevor Owen, M.D.Jesse B. Seamon, M.D. (August 2015)

Section of Trauma and Fracture Care

The Carilion Clinic Orthopaedics – Muscu-loskeletal Education Research Center (CCO – MERC) has been established to facilitate musculoskeletal research in our department and to foster musculoskeletal research edu-cation for the Virginia Tech Carilion School of Medicine. We seek to connect clinician scientists with basic scientists and engineers to perform meaningful translational re-search projects with real world applications.

This council meets regularly to review prog-ress on musculoskeletal research projects. CCO – MERC is closely integrated with the Virginia Tech Carilion School of Medicine, specifically with students interested in performing orthopaedic research and those interested in careers in orthopaedic surgery and musculoskeletal care. In addition, inte-grated projects are already in progress with multiple institutions, including, but not lim-ited to, the Virginia Tech Carilion Research Institute, the school of bioengineering at Virginia Tech, Thomas Jefferson University in Philadelphia, University of Virginia, Wake Forest University, and the University of Rochester.

Musculoskeletal research is performed by many members of the Department of Ortho-paedics and research is not limited to the five council members. The aim of the council is to facilitate progress, give guidance, and create infrastructure wherein busy clinicians may be even more academically productive. Our goal is to serve as an academic model for the greater Carilion organization to improve the health of the communities we serve.

If you have questions about orthopaedic and musculoskeletal research, please contact our Director, Dr. Carmouche, at jjcarmouche@carilionclinic.org.

OUR RESEARCH FACULTYJonathan J. Carmouche, M.D., DirectorCaleb J. Behrend, M.D.J. Randolph Clements, D.P.M.Cay Mierisch, M.D.Trevor Owen, M.D.

Orthopaedic Research

Resident Education

Our department is dedicated to education-al efforts in our local community and the region. This began more than 40 years ago with a relationship with the University of Virginia’s Department of Orthopaedic Surgery. Currently, four orthopaedic residents rotate with us at all times for 10-week blocks: two during their second year and two during their third year of orthopaedic residency. Each resident will complete four rotations for a total of 40 weeks in Roanoke. Residents who complete the program consistently highlight their training in Roanoke as an indispensible part of their education, with a high number of residents from the University of Virginia choosing to practice in this area. The late Robert Pruner, M.D., was a previous program director and graduate of the University of Virginia orthopaedic residency program. The current resident teaching award is appropriately named in his honor.

The podiatry residency program is now in its second full year, under the direction of

J. Randolph Clements, D.P.M. This is a combined program and inte-

grated into the Department of Orthopaedics to ensure

that our graduates have a breadth and depth of experience in foot and ankle. There are two residents accepted each

year into this three-year program.

Our department has a fully developed conference schedule

covering all of the major orthopae-dic subspecialties. Attending surgeons as well as resident staff present during these conferences and offer many educational opportunities. Our offices will be glad to provide the schedule upon request.

If you have questions about our resident education program, please contact our Program Director, Thomas Shuler, M.D., at teshuler@carilionclinic.org.

We are fortunate to have a thriving adult reconstruction surgery fellowship program. This year we have had an excellent fellow, Ryan Harris, D.O. Dr. Harris has been busy honing his surgical skills on all aspects of total joint surgery, including anterior ap-proach hip replacement, computer navigated total knee and hip replacement, and complex revision knee and hip surgery.

In addition to his clinical cases, Dr. Harris has been active in clinical research. He presented Cost Saving Analysis of Tranexamic Acid on Total Hip Arthroplasty from 2009-2013 to the Virginia Orthopaedic Society at the annual meeting in Roanoke in May. He also presented his data at the Carilion Research Day as a poster presentation. This work as well as the Cost Analysis of Tranexamic Acid Use in Total Knee Arthro-plasty Patients have both been accepted for publication.

We are very pleased that Dr. Harris accepted a position in adult reconstructive surgery at the Carilion New River Valley Medical Center and began his practice in August.

We are excited to have him as a partner in the Department of Orthopaedic Surgery at Carilion Clinic.

Matt Stover, D.O., started a fellowship with us in August 2014. He has a strong research background from clinical rotations at the Cleveland Clinic. We look for-ward to having him work with us in the upcoming year.

If you have questions about our fellowship program, please contact our Associate Director, John Mann, M.D., at jwmann@carilionclinic.org.

Fellowship Program

The physicians and staff of Carilion Clinic Orthopaedics are honored to participate in the educational process across a spectrum from high school students to graduates of the Virginia Tech Carilion School of Medi-cine (VTCSOM) and resident education for Carilion Clinic.

The education division is divided into four subsections, allowing individualized educa-tional opportunities appropriate to student needs and interests.

The VTCSOM section provides all ortho-paedic based MS1 and MS2 lectures and workshops, MS3 and MS4 clinical rotations, student mentorship, and special interest presentations as requested by VTCSOM and student groups.

The graduate medical education (GME)section is responsible for coordination of resident electives and observation opportunities in orthopaedics for resident physicians from family medicine, internal medicine and pediatrics. The GME section also offers specialty based rotations for visiting resident education through the Office of Visiting Students.

Our Jefferson College education section provides both the core clinic-based edu-cation and specialty elective rotations in orthopaedics for students from the phy-sician assistants program of the Jefferson College of Health Sciences.

In coordination with the Office of Visiting Students, we have a variety of student shad-owing, mentorship, and education programs for high school and university students.

As an extension of the education division we offer an annual orthopaedics in primary care symposium, which provides updates on subspecialty orthopaedic issues as they relate to care provided by family medicine, internal medicine, and pediatric providers.

If you have any questions about our medical education program, please contact our Director, Thomas K. Miller, M.D., at tkmiller@carilionclinic.org.

Graduate and Undergraduate Medical Education

SAVE THE DATEThe Annual Orthopaedics in Primary Care CME conference at The Hotel Roanoke & Conference Center offers presentations designed to enhance or develop clinicians’ knowledge of current trends in the diagno-sis and treatment of orthopaedic conditions.

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ORTHOPAEDICS IN PRIMARY CARE

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The advanced clinical practitioners com-mittee is comprised of the Department of Orthopaedic Surgery’s advanced clinical practitioners, representatives from the physician pool, and representatives from administration. This committee exists to allow dialogue regarding day-to-day clini-cal, administrative, academic, and research activities to occur on a consistent basis throughout the year. It provides a forum to discuss ideas, as well as any concerns, in a format that allows for necessary reflection and decision making to occur. This commit-tee also allows for future events involving the advanced practitioners to be planned and reviewed well ahead of the occurrence.

This committee assists in the “team” approach, allowing the Department of Orthopaedic Surgery to provide the most efficient and best available care of a patient with musculoskeletal concerns.

If you have any questions, please contact our Director, Brent Johnson, M.D., at bmjohnson@carilionclinic.org.

The scheduling committee is comprised of administrative personnel and physician representatives from the various call cate-gories, such as unassigned, trauma, hand, and foot/ankle. Unassigned call involves the general musculoskeletal emergency depart-ment coverage, in-hospital consultations, and decision-making regarding transfers of patients with general musculoskeletal in-juries or issues from outlying facilities that are unable to provide this service. Trauma call involves management of patients with multiple and more complex injuries that present directly to the Carilion Roanoke Memorial Hospital Emergency Department (CRMH ED) or are transferred from an-other facility due to these types of injuries. Hand call provides subspecialty services for patients with upper extremity injuries or issues in the CRMH ED, in the hospital, and transfers from outlying facilities that do not have this capability. Foot/ankle call provides the same services as noted for hand call but for foot and ankle injuries or disorders.

The committee is responsible for uninter-rupted coverage of these responsibilities by the appropriate physicians in a fair and balanced distribution.

The committee also oversees the clinical schedules (office appointments and surgery

availability), continuing medical education requests, and vacation requests for the physicians and advanced clinical providers of the Department of Orthopaedic Surgery to assure appropriate availability of muscu-loskeletal services for our geographic area, as well as outlying areas, at all times.

If you have questions about our scheduling committee, please contact our Director, Brent Johnson, M.D., at bmjohnson@carilionclinic.org.

Advanced Clinical Practitioners Committee

Scheduling Committee

Honors and Awards

Cesar Bravo, M.D., received the 2014 Robert Pruner Teaching Award for exceptional resident education.

J. Randolph Clements, D.P.M., was reappointed by Virginia Gov. Terry McAuliffe to the Virginia Board of Medicine.

Joseph Moskal, M.D., received the Lifetime Achievement Award from the Virginia Orthopaedic Society (VOS).

Becker’s ASC Review recognized Thomas K. Miller, M.D., in its recent “100 Physician Leaders to Know in the ASC Industry.”

Thomas K. Miller, M.D., was appointed Chair for the VTCSOM Appointment, Promotion and Tenure Committee.

Michael Wolfe, M.D., and Trevor Owen, M.D., served as the Program

Directors for the VOS annual conference.

John Mann, M.D., served as Presi-dent of the VOS, holding the annual conference in Roanoke at The Hotel Roanoke & Conference Center with record attendance.

Thomas K. Miller, M.D., served as the Secretary and Treasurer for the VOS annual conference and will now serve as Vice President of VOS.

40 peer-reviewed publications since 2010

500 international or national presentations

Thomas K. Miller, M.D., was appointed Chief Physician for the race day medical services at the Iron-man Triathlon World Championship in Hawaii.

Cesar Bravo, M.D. Randolph Clements, D.P.M. John Mann, M.D. Trevor Owen, M.D. Thomas K. Miller, M.D. Michael M. Wolfe, M.D.

Our dedicated inpatient orthopaedic unit, at Carilion Roanoke Memorial Hospital, was awarded the Gold Seal of Approval® by The Joint Commission for Disease Specific Care for Total Hip and Knee Replacements. This symbol of quality signifies the highest level of achievement for safe and effective care. The initial certification was received in July 2007 for outstanding quality care.

The award is granted to an individual who has made a major impact on the practice of orthopaedic surgery in Virginia. The award also recognizes Dr. Moskal’s career of ser-vice to his patients and support of orthopaedic surgeons throughout the Commonwealth.

Joseph Moskal, M.D., received the Lifetime Achievement Award from the Virginia Orthopaedic Society.

PLANNING AND CONSTRUCTIONPlanning is underway for a new 66,000 square-foot complex for a musculoskeletal and neurosciences center in Roanoke. The tentative date of completion is early 2016.

Department of Orthopaedic Surgery

ADULT RECONSTRUCTIONJoseph T. Moskal, M.D., ChairmanJeffrey R. Chain, M.D.Ryan N. Harris, D.O.John W. Mann, M.D.Michael M. Wolfe, M.D.Benjamin R. Coobs, M.D. (August 2015)

FOOT AND ANKLEJames T. Chandler, M.D., Co-ChiefJ. Randolph Clements, D.P.M., Co-ChiefJohn L. Clements, D.P.M.Jason V. Naldo, D.P.M.Marc A. Platt, D.P.M.Robert B. Schopf, D.P.M. (August 2015)

GENERALJoseph T. Moskal, M.D., ChairmanDallas P. Crickenberger, M.D.Michael S. Helvey, D.O.Douglas U. Kells, M.D.Robert B. Stephenson, M.D.Bertram Spetzler, M.D.

HAND AND UPPER EXTREMITYHugh J. Hagan, M.D., ChiefCesar J. Bravo, M.D.Horatiu C. Dancea, M.D.Cassandra R. Mierisch, M.D.

Cay M. Mierisch, M.D.Peter J. Apel, M.D., Ph.D. (September 2015)

SPINE AND PEDIATRICSJonathan J. Carmouche, M.D., ChiefCaleb J. Behrend, M.D.Julia A. Bulkeley, M.D.Michael D. Mauro, M.D.

SPORTS MEDICINEThomas K. Miller, M.D., ChiefChristofer C. Catterson, M.D.Edward S. Hemphill, M.D.Christopher K. John, M.D.Brent M. Johnson, M.D.Jon R. Maher, M.D. (August 2015)

TRAUMA AND FRACTURE SERVICEThomas E. Shuler, M.D., ChiefFranco M. Coniglione, D.O.Trevor M. Owen, M.D.Jesse B. Seamon, M.D. (August 2015)

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