Ok, so I'm trying to get my custom paging going on the Telerik RadGrid (similar to the asp:Gridview), but I'm still hitting a wall.  (the first part of my question was answered here)
So I have implemented the suggestion. I use the following Stored Proc
ALTER PROCEDURE [dbo].[bt_HealthMonitor_GetAll]
(
    @StartRowIndex      int,
    @MaximumRows        int
)
AS
SET NOCOUNT ON
Select
RowNum,
[ID],
[errEx],
[errURL],
[errSource],
[errUser],
[errMessage],
[errIP],
[errBrowser],
[errOS],
[errStack],
[errDate],
[errNotes]
From
(
Select
    [ID],
    [errEx],
    [errURL],
    [errSource],
    [errUser],
    [errMessage],
    [errIP],
    [errBrowser],
    [errOS],
    [errStack],
    [errDate],
    [errNotes],
    Row_Number() Over(Order By [ID]) As RowNum
    From dbo.[bt_HealthMonitor] t
) 
As DerivedTableName
Where RowNum Between @StartRowIndex And (@StartRowIndex + @MaximumRows)
Order By [ID] Desc
Then another stored procedure to get the record count
ALTER PROCEDURE [dbo].[bt_HealthMonitor_GetRecordCount]
AS
SET NOCOUNT ON
return (Select Count(ID) As TotalRecords From bt_HealthMonitor)
And I'm using LINQ to SQL to bind to my RadGrid
Protected Sub RadGrid1_NeedDataSource(ByVal source As Object, ByVal e As Telerik.Web.UI.GridNeedDataSourceEventArgs)
    Dim startRowIndex As Integer = (RadGrid1.CurrentPageIndex * RadGrid1.PageSize)
    Dim maximumRows As Integer = RadGrid1.PageSize
    Dim HealthMonitorDC As New DAL.HealthMonitorDataContext
    Dim r = HealthMonitorDC.bt_HealthMonitor_GetAll(startRowIndex, maximumRows)
    RadGrid1.DataSource = r
End Sub
Protected Sub Page_PreInit(ByVal sender As Object, ByVal e As System.EventArgs) Handles Me.PreInit
    Dim HealthMonitorDC As New DAL.HealthMonitorDataContext
    Dim count = HealthMonitorDC.bt_HealthMonitor_GetRecordCount()
    RadGrid1.MasterTableView.VirtualItemCount = count.ReturnValue
    RadGrid1.VirtualItemCount = count.ReturnValue
End Sub
But the problem I'm experiencing is that the grid only grabs the first 10 rows (as expected) but I need to get it so that it will recognize that there are 200 rows in the table so that the paging icons show up.
If I use the dropdownlist to display 50 records, then 50 show up, but still no paging icons to get me to the next 50.
What am I doing wrong?