The Health Journal Richmond Preview Edition by The Health Journal

the

Health Journal April 2010

Vol. 5 No. 11

Richmond Preview

FEATURES, PROFILES & LOCAL EVENTS HEALTHY LIVING STARTS HERE

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AprilContents

[ Sections ]

2010

7 Local Beat

Intervention of a divine kind; ER doc bakes up a business

15 Fitness

Get into tip-top shape with advice from our fitness pros

21 Features Author Tony Williams takes on the pox; preventing medical mix-ups; go green this spring

31 Healthwire

Todayâ&#x20AC;&#x2122;s top health headlines from Reuters Health

35 Expert Contributors

Help for aging skin; promising new treatment for allergy sufferers; dental health

42 Profiles

Famed Surgeon Dr. Mehmet Oz

[

In Every Issue

4 Editorâ&#x20AC;&#x2122;s Note

5 Inbox/Favorites

]

10 Calendar 15 Fitness

42 Profiles

Snapshots - Coming Soon!

Health Directory - Coming Soon!

Calendar of Events Check out these health happenings this spring

the

Health Journal

The Health Journal is a free, monthly consumer health magazine distributed in a variety of ways throughout Hampton Roads and Richmond. Four editions are currently available: Williamsburg, Peninsula, Southside and Richmond.

PUBLISHER Brian M. Freer

EXECUTIVE DIRECTOR Rita L. Kikoen EDITOR Page Bishop-Freer

ASSOCIATE EDITOR Beth Shamaiengar

MEDICAL EDITOR Ravi V. Shamaiengar, MD

ADMINISTRATIVE ASSISTANT Danielle Di Salvo SALES EXECUTIVES David C. Kikoen

GRAPHIC DESIGNERS Natalie Monteith Jean Pokorny PHOTOGRAPHY Brian M. Freer Page Bishop-Freer

CONTRIBUTING WRITERS Megan Brooks Gregory Epps Joseph Han, MD Anne Harding Alison Johnson Bridgit Kin-Charlton, CPT Gayle Pinn, CPT Keith Schumann, MD Sebastiana Springmann, DDS Brenda H. Welch

Subscriptions are available for $24/year. Please send a check or money order, payable to RIAN Enterprises, LLC, to the address below. Include current mailing address and other contact information. Notify us of any change in address. The editorial content of The Health Journal is produced with the highest standards of journalistic accuracy. However, readers should not substitute information in the magazine for professional health care. Editorial contributions are welcome. All submissions become the property of the publisher. We reserve the right to edit for style, clarity and space requirements.

For Advertising and editorial Information, call or write: The Health Journal 4808 Courthouse Street, Suite 204 Williamsburg, VA 23188

Editor’s

NOTE

Hello! Welcome to the introductory issue of The Health Journal’s new Richmond Edition! Whether you picked up your copy at the grocery store, or at a local hospital or medical center—or if you received it by mail—we’re glad we have your attention. Although The Health Journal may be brand-new to you, our Hampton Roads readers have been enjoying our publication since 2005, when we first launched the Williamsburg Health Journal with a circulation of just 15,000. Today The Health Journal reaches from our home base of Williamsburg to Virginia Beach, with three editions totaling nearly 80,000 monthly copies. Within a few weeks Richmonders will have their own edition to look forward to every month, which will be filled with stories of local interest and resources that can help you find health care services in your area. As you flip through the pages of this sample edition, you’ll see some editorial highlights from our five-year history of publishing (independently, I might add) in Hampton Roads. Our Richmond edition will deliver many of the same departments such as in-depth feature stories relevant to local readers, our “Local Beat” and “Profile” sections that spotlight people and programs of interest, columns written by leading local health and medical experts, national health headlines brought to you by Reuters Health, as well as a Health Directory (coming soon), a monthly Calendar of health events (see page 10 of this issue for April and May health happenings) and a Snapshots section where locals can send their health-related photos. In the era of “information overload,” it’s often hard to know what health advice to follow versus what should be taken with a grain of salt. That’s why I’d like to point out that every article that appears in The Health Journal is first reviewed by our medical editor, Dr. Ravi V. Shamaiengar, a diagnostic radiologist who’s been practicing in Hampton Roads for almost 10 years (he’s also a former Richmond resident and a graduate of the Medical College of Virginia, now Virginia Commonwealth University Medical Center). But Ravi is more than just our medical editor; he’s also family. When my husband, Brian Freer, a newspaper industry insider, had the idea years ago to start his own publication, he turned to Ravi, his uncle and closest friend, for guidance. They decided the focus should be on health and wellness, primarily because, at the time, there were no local health magazines in Hampton Roads. Brian’s aunt, Beth Shamaiengar, an experienced editor and writer and now our associate editor, would play a big role in helping to establish our editorial vision and standards, while Brian’s mom, Rita, handles our accounting. My mom Sandy has worked for us off and on as a freelance writer, and my stepdad has even stepped in on occasion to help with delivery. Needless to say— we run a true family business! So much has changed since those early days, when Brian and I set up shop on our dining room table, working from two laptops and sharing living space with a noisy fax machine. We eventually moved into a permanent office where today we work alongside a talented team of editors, designers, writers, administrative staff and photographers (not all of family relation, I promise). So, here we are—nearly five years and 58 monthly issues later—and our original mission hasn’t changed much at all: To educate consumers about relevant health topics (in a fun, attractive format) while providing a resource to the communities we serve, and to do it at no charge to our readers. (Did I mention The Health Journal is FREE?) I sincerely hope that you like what you see as you peruse this preview issue, and I’m looking forward to us getting better acquainted. I welcome your suggestions and feedback; tell us what you’d like to read about in upcoming issues of The Health Journal—Richmond Edition. You can e-mail me at page@thehealthjournals.com. From our family to yours, HJ Readers’ Poll: What’s

the best health advice your mother ever gave you, and

(757) 645-4475 • Fax (757) 645-4473 info@thehealthjournals.com www.thehealthjournals.com

did you follow it? Page Bishop-Freer, Editor E-mail your reply to page@thehealthjournals.com

4 THE HEALTH JOURNAL

April

inbox

page’s pics

KUDOS

Favorites

1. Vemma Liquid Vitamin Supplement ($60 for a 30-day supply; learn more at http://drinksome.vemma.com/) This great-tasting vitamin and mineral supplement is packed full of powerful antioxidants. Plus, it contains mangosteen— a fruit that’s high in antioxidants and believed to have been used by natural health providers for thousands of years.

“Thank you for sharing Claire and Ed Lampitt’s story [February 2010, p. 22] about the sad death of their daughter Josephine. Claire is a dear friend, and I am grateful you recognized the magnitude and tenderness of their life with and loss of Josephine.” —Kathy B., Boulder, Co.

INQUIRIES

2. Mrs. Meyer’s Clean Day Countertop Spray ($4.99 at Target stores) Get your spring cleaning on with this lemon-verbena scented spray made from essential oils and other natural ingredients. Just spray and wipe; safe for any non-porous surface. 3. Physician’s Formula Mineral Wear Correcting Powder ($13.95 at drugstores) This 3-in-1 corrector, primer and powder provides a polished finish by evening out skin tone and diminishing the look of imperfections. 4. Moisture Drops Rapid Replacement Formula ($115; available exclusively at Ageless Dermatology and Laser Center) Want baby soft skin? Apply a tiny dab on cleansed skin once or twice a day. Your skin will become smooth and hydrated with fine lines less apparent. Great as an every day moisturizer for normal, dry and sensitive skin types. Contains ceramides and sphingolipids, both natural components of the skin. 5. Groceries On-Demand ($4.95; www.harristeeter.com) Harris Teeter’s Express Lane online shopping is now available at four area stores (see website). This service is perfect for young professionals, working parents, caregivers—basically anyone short on time and energy. Plus, ordering online really helps you stick to your list. Oh, and don’t forget to pick up a copy of The Health Journal near the entrance—we’re now in every local Harris Teeter! 6. “The Natural” Eco-Friendly Umbrella ($32; www.greenhome.com) Each part of this umbrella is made from recycled materials, from its post-consumer plastic fabric to its handle made from 65 percent shredded wood. Available in green or black. The online store also features a golf-size umbrella for $52.

“The article on Child Development Resources [March 2010, Williamsburg Edition, p. 37] was beautiful. We truly appreciate everything you did to help increase awareness about CDR, our services and our annual auction.” —Sissy Allen, assistant director of development for CDR

“We have been receiving The Health Journal since you first started publishing. Thank you for a very enlightening and educational journal! In the October 2009 issue, you featured an article, “New Help for Hemorrhoids,” about infrared treatment. Are you aware of any other physicians on the Peninsula or Southside of Hampton Roads (or even the OBX!) who also use this treatment?” —Charles and Sally R., Newport News Ed.: According to Sentara Healthcare officials, Dr. Jared Brooks of Norfolk Surgical Group may be offering this method. “I have been told by all the nurses, my physician and the attending that my pregnancy mask is the worst they have ever seen. My son is now eight months old and my mask has been significantly diminished with creams. Any suggestions on removing the last of the pigment, which now is orange?” —Charity W., Alberta, Canada

Ed.: Here’s what our skin care expert had to say: “Melasma (known as the mask of pregnancy) often fades on its own but can also be treated with certain products and procedures as well as lifestyle changes. Pregnancy is not the only trigger: Birth control pills, hormone therapy, anti-seizure medications, and other medications can incite this condition. Our expert recommends consulting a board-certified dermatologist, who may prescribe Tri-luma cream (or other bleaching agent), kojic acid, azelaic acid or glycolic acids. Other treatments include gentle microdermabrasion, chemical peels, and laser surgery. No single treatment reliably works for every patient, and while melasma may disappear, it can return. It’s important that you avoid products that could irritate the skin as this could make the melasma worse.” Further information can be found at www.aad.org.

THE HEALTH JOURNAL

the

Health Journal

Richmond Edition

Frequently Asked Questions Q: A:

Who owns The Health Journal?

We are a family-owned, independent publishing company based in Hampton Roads. The Health Journal is our sole product and primary focus.

Why should my business advertise in The Health Journal?

Q: A:

Can readers trust the information inside?

Our publication’s reputation, strong readership and sophisticated delivery plan will ensure that your important message is seen by health consumers.

I want to advertise my services, but I don’t have an ad. What should I do?

No ad? No problem. Our team of award-winning graphic artists and copy writers will design a custom ad for your business—at no additional cost.

“

Yes! We’re the only local health publication with a Medical Editor on staff.

Effective marketing occurs when the right message is delivered to the right audience.

To advertise, call 757-645-4475.

6 THE HEALTH JOURNAL

local beat Stories of local interest

Intervention of a Divine Kind

Former ER Doctor Turns Up the Heat

Your Calendar of Health Events

THE HEALTH JOURNAL

Divine Intervention Faith-based wellness programs focus on disease prevention WRITTEN BY ALISON JOHNSON PHOTOGRAPHY BY BRIAN M. FREER

hen Pastor Walter Johnson delivered a recent Sunday sermon, he touched on a subject outside his traditional religious framework: the risk of vitamin D deficiency in African-Americans. The vitamin, found naturally in few foods, boosts bone strength and may lower the risk of certain cancers. The problem? Darker skin blocks more of the sunlight that helps the skin make vitamin D. After Johnson, pastor at Zion Prospect Baptist Church in Yorktown, learned at a doctor’s appointment that he had low levels of vitamin D, he was confident at least some of his church members did, too. Johnson’s sermon was just one example of how a growing number of local churches are diving into the field of health education. Zion Prospect Baptist also has taken part in an American Heart Association initiative called Power to End Stroke, a national campaign that includes an educational film on stroke risk factors and symptoms. In addition, the church has held workshops on heart disease, obesity, AIDS and senior health as well as prostate and breast cancer. Church officials schedule blood pressure checks once a month and organize a walking group during good weather. “The church is such a good place to disseminate this kind of information,” Johnson says. “You’re getting right at the people who live in the community. These are people who might not otherwise hear the things we’re saying. There’s not a doubt in my mind that it’s making a difference. People are much more aware of what they can do to be healthy.” Churches now touch on a wide variety of health topics, from prenatal care and childhood obesity to alcohol addiction and caring for Alzheimer’s patients. Some have replaced fatty, salty or sweet fare at celebrations with fruit, vegetables and nuts, and in addition have passed along healthy recipes. Church-run programs to help keep kids active include sports leagues and martial arts classes. Many also have hosted visits from public health representatives and mobile vans offering immunizations, blood pressure and cholesterol screenings and educational programs. “Churches are important centers of family and community life,” says Dr. David Trump, director of the Peninsula Health District. “They have the opportunity—and many churches definitely have taken on 8 THE HEALTH JOURNAL

the role—to share messages on healthy eating, physical activity and disease prevention and screening with the members of their congregations and within the community they serve.” In Newport News, for example, churches have been an important partner in the city health department’s “Heal-thy Generations: A Southeast Community Health Movement,” a program that works to reduce chronic diseases such as diabetes and asthma in high-risk communities. (Read The Health Journal’s July 2008 coverage of this program online at www.thehealthjournals.com.) African-American churches in particular have boosted their health care ministries to fight common risks within the population. For example, African-Americans are 1.5 times more likely to die from heart disease compared to Caucasians and 1.8 times more likely to have a fatal stroke, according to the American Heart Pastor Walter Johnson

Bon Secours Richmond Nationally Recognized for Advancing Women

David H. Trump, MD, MPH

“Promoting healing and good health is part of addressing the spiritual needs of our congregation.” — Priscilla Channel, health care ministry president, Bethel African Methodist Episcopal Church, Hampton

Association. In response to these statistics, Bethel African Methodist Episcopal Church, an approximately 600-member congregation in Hampton, has organized presentations and public health fairs to provide information on diabetes, nutrition, weight control and high blood pressure. “We really think promoting healing and good health is part of addressing the spiritual needs of our congregation,” says Priscilla Channel, health care ministry president at the church. “We emphasize holistic care—a mind, body and spirit approach that we hope can empower our families.”

Studies have shown church programs can be powerful weapons. At an American Heart Association conference in March 2009, researchers reported that nearly half of overweight and obese African-Americans who completed a 12-week program called Fit Body & Soul at a church in Georgia lost five percent or more of their body weight. Nearly 70 percent had kept the weight off after six months. At Community United Methodist Church in Virginia Beach, registered nurses are available after two services every Sunday to take members’ blood pressure. “We get a chance to speak with our regulars and assess their wellbeing,” says Jim Hoffower, one of the nurses involved. “If they have had medication changes, we provide counsel on the effects and potential side effects they may encounter. It’s a great service to be providing as well as representing a ‘fellowship’ moment.” The church also will train members in CPR as requested, Hoffower adds. Betsy Davis, a member of Community United Methodist, says the church support can become like a second family. “This city is so transient, and people may not have family here who can accompany them to the doctor or hospital,” Davis says. “People need an advocate.” Church leaders also say they have the power—and the responsibility—to reach out beyond their congregations. Many host health support groups for people struggling with alcoholism, abusive relationships and a variety of health problems (find support groups near you on page 41 of this issue). Warwick United Church of Christ in Newport News, for example, provides a room for “Moms Helping Moms”, a group for family members of children fighting cancer. Linda Manning, a member of the church who lost a son to cancer, is one of its leaders. “The church just believes really strongly about having a strong presence in the community and reaching out when there’s a need,” Manning says. “This is a need. The church is a perfect, safe, peaceful place for people to come together. We can discuss our issues and concerns, educate each other and lean on each other.” That spirit of community is why leaders at Zion Prospect Baptist have screened the educational film on stroke for other congregations, not just their own. The presentation includes a pre- and post-film quiz on basic stroke facts, including how to live a healthier lifestyle and recognize early signs of heart disease and stroke. “You can really empower people,” Pastor Walter Johnson says, “and that is a way to make a great difference in their lives.”

The Bon Secours Virginia Health System in Richmond has been named to the National Association of Female Executives’ (NAFE) Top 50 Companies and 10 Nonprofits for Executive Women. This is the fifth year NAFE has recognized Bon Secours for their policies and practices that encourage women’s professional advancement and place women among the highest levels of corporate leadership. About 85 percent of Bon Secours’ employees are women, as are 14 of nearly 35 corporate executives.

VCU Medical Center First in Virginia to Offer New Robotic-Assisted Thyroid Surgery Amelia Grover, M.D., a Virginia Commonwealth University Medical Center physician, is the first in the state to perform a new minimally invasive da Vinci robotic-assisted surgical procedure to treat thyroid nodules without leaving a scar on the patient’s neck. Grover says the da Vinci procedure magnifies what a surgeon can see while operating and helps with the visualization of the surrounding structures. The robot itself is controlled completely by the surgeon, whose actions are translated by the robot into very accurate movements. The patient can typically return home after a one-night hospital stay and return to normal activities within one or two weeks.

Breast Center Receives National Accreditation The Breast Health Center at the VCU Massey Cancer Center was awarded accreditation by the National Accreditation Program for Breast Centers. This distinction is given only to centers that are committed to improving the quality of care for women through various breast health-related programs. The VCU Breast Health Center’s team of national leaders in mammography and breast health provides comprehensive diagnosis and treatment through a multidisciplinary approach to patient care.

SEND US YOUR HEALTHRELATED NEWS! The Health Journal encourages businesses from Richmond’s health care and wellness industries to send us their announcements for inclusion in upcoming issues. Don’t know what to send? Start with staff promotions, open houses and other special events, awards earned and fundraising initiatives for non-profits. E-mail your press releases to info@thehealthjournals.com. THE HEALTH JOURNAL

AprilCalendar 7

Vegan 101

2010

Have you ever considered switching to a vegan lifestyle? From 7 to 8 p.m., at Ellwood Thompson’s Community Table, join Lexa—a steward from Ellwood’s and vegan for the last six years—for this free class to learn the ups and downs of removing animal products from your diet and lifestyle. Space is limited. Call (804) 359-7525 to register.

9 , 16 , 23 , 30 th

Farm to Family

Arming to connect area farms with communities in the hopes of re-establishing a personal relationship with locally grown food and encouraging a local diet of freshly grown products in Central Virginia, Mark Lilly rigged up an old-fashioned country store in an old school bus and launched a oneman venture—bringing fresh produce to communities throughout Richmond. You can find Mark Lilly from 11 to 3 p.m. on Forest Hill Avenue and Westover Hills Boulevard, and from 5 to 8 p.m. on Cary Street (in front of the Mezzanine Restaurant) and at the First Friday’s Art Walk in front of Gallery 5. Call Mark Lilly at (540) 872-6528 for more information.

10 th 14 th 19 22

Walking History Hounds Tour

24 th 24to25th

Herbs Galore and More

10 THE HEALTH JOURNAL

Join the Valentine Richmond History Center, in partnership with the Richmond SPCA for a walking tour of Oregon Hill. Dogs must have current shots and mix well with others. Owners are responsible for food and refreshments. Space is limited, and registration is required. Tickets are $5 for History Center members and $10 for the general public. For more information, call (804) 649-0711.

Mommy & Me (and Daddies Too)

Join the Shops at Willow Lawn from 10 to 11:30 a.m. on the second Wednesday of each month through October for a morning filled with crafts, games, storytelling, dancing and educational programs designed to enhance parent-child interaction. Contact Julia Preusser at (434) 977-9234 or e-mail jpreusser@federalrealty.com for more information.

Food & Fitness Weight-Loss Seminar

With warmer weather approaching, VCU Women’s Health Care at Stony Point wants to help you drop those extra pounds before swimsuit season. Cost for class is $35. For more information or to register, contact Mary-Jo Sawyer at (804) 327-8830 or e-mail msawyer@mcvh-vcu.edu.

17th Street Farmers’ Market

Beginning April 22 at 100 North 17th Street, area growers and bakers will showcase their fruits and vegetables, fresh flowers, potted plants and freshly baked bread and muffins. The four weekly market days include Wednesday and Thursday Growers’ Markets, and Friday evenings will feature the Red, White and Brew Celebration at the Market. The Bohemian Market will take place on Saturdays, featuring vendors of handmade crafts, art, antiques and collectibles. For more information, contact George Bolos at (804) 646-0477 or visit www.17thstreetfarmersmarket.com.

More than 50 plant and craft vendors from the mid-Atlantic will be at Maymont from 9 a.m. to 5 p.m. to sell herbs, annuals, perennials, heirloom plants, vegetables, trees, herbal products and more. Enjoy demonstrations and classes that will get you motivated to grow and use herbs. Fees vary for classes, and advance registration is required. Cost of admission is $3. For more information, call (804) 358-7166.

National Duathlon Festival

The Duathlon Festival offers the traditional on-road national championship foot and bike race as well as off-road events, all in one weekend. With no qualifying requirements, it’s a chance for anyone to try a duathlon for the first time and a great opportunity for the experienced athlete to compete for a national championship title. The duathlon will run from 8 a.m. to noon. For more information and admission rates call (804) 285-9495 or visit http://www.duathlonnationals.com/.

May Calendar 1

2010

Farmers Market at St. Stephen’s

From 8 a.m. to noon, attend the St. Stephen’s Farmers Market (rain or shine) Saturdays through October at 6000 Grove Ave. The Farmer’s Market offers local produce such as seasonal vegetables, fruits, herbs, eggs, meats, cheeses and pasta. In addition the market features work of local artisans, locally roasted coffee and more. For more information, call (804) 288-2867.

Infant and Child CPR

New and expectant parents are invited to learn CPR, a critical skill for anyone caring for a newborn, from 7 to 9 p.m. at St. Francis Hospital (13710 St. Francis Blvd.) in the Assisi Room. The class is offered for first-time learners as well as those wanting to refresh their CPR skills. To register, visit www.bonsecoursloveandlearn.com/bonsecours/.

A joint program of the Richmond SPCA and Sprite’s HERO gives kids the opportunity to read to certified therapy dogs at the Robins–Starr Humane Center from 11 a.m. to noon at 2519 Hermitage Rd. All ages of readers are welcome. Bring a favorite title, or choose from the wide selection of books in the Richmond SPCA children’s room. To register, call (804) 521-1327 or e-mail pharris@ richmondspca.org.

11 th 13 th 14to th 15 th 19& 26th th

Some parenting advice has changed over the years. From 6:30 to 9 p.m. at St. Mary’s Hospital (5801 Bremo Rd.), grandparents can get a quick update on topics such as pregnancy, support, safety and care of newborns and infants as well as SIDS awareness. To register, visit www. bonsecoursloveandlearn.com/bonsecours/.

Paws to R.E.A.D.

What’s New for Grandparents?

Komen Richmond Race for the Cure

The Komen Race for the Cure is an opportunity for thousands of locals to run or walk for breast cancer awareness. A 5K and 1-mile walk begin at 8 a.m. Visit www.komenrichmond.org to learn more and register.

Thrive with Baby

So, having a baby has changed your life more than you had ever imagined. Healthy management of stress can enhance the joy a new baby brings to a family. Join other new and expectant parents from 6:30 to 8 p.m. at the Commonwealth Parenting Center (4121 Cox Rd., Ste. 110) to discuss personal and work-related changes, partner communication, establishing a support system and ways to relax. To register, visit www.bonsecoursloveandlearn.com/bonsecours/.

Toddler Time

At the East End Library (2414 R. St.) from 10:30 to 11:30 a.m., engage your toddler (18-36 months) in fun stories, music, rhymes and more to develop early literary skills. Call (804) 646-4474 for more information.

Dominion River Rock

Join the celebration uniting the community through a mix of sports, music and fun, set against Richmond’s downtown riverfront. The event begins Friday from 5 to 11:30 p.m. with live music, a mud run and a freestyle bike competition. From 3 to 11:30 p.m. on Saturday, watch as regional athletes compete in the James River Scramble trail run, mountain biking, kayaking and more. For more information, call (804) 285-9495.

Breastfeeding Tips

Join other expectant mothers from 7 to 9 p.m. at the VCU Medical Center at Stony Point (9000 Stony Point Pkwy.) to learn about the benefits of breastfeeding for mother and baby while gaining helpful hints and suggestions from lactation consultants. The class will provide information on breastfeeding techniques and common problems mothers encounter while breastfeeding. To register, call (804) 828-4409. THE HEALTH JOURNAL 11

Former ER Doctor Turns Up the Heat and Gets

Baking

Feeding a child with food allergies can be a challenge— learn how a mother’s search for safe but tasty treats turned out sweeter than she ever imagined. WRITTEN BY BRENDA H. WELCH PHOTOGRAPHY BY BRIAN M. FREER

hile children tend to be wary of doctors, the kids attending preschool at Ghent United Methodist Church in Norfolk fidget with excitement at the prospect of seeing Dr. Lucy Gibney. The secret to “Dr. Lucy’s” popularity isn’t a warm stethoscope or painless shots—it’s her cookies. Gibney, whose four-year-old son, Colin, attends the school, frequently provides cookies and other snacks for Colin and his classmates. But Gibney doesn’t mix and bake the treats at home in her kitchen—she brings them straight from her nearby cookie factory. Four years ago while working as an emergency room (ER) physician at Sentara CarePlex Hospital in Hampton, Gibney never imagined she would one day trade in her doctor’s coat and prescription pad for a chef’s apron and six ovens. “I knew that when Colin was born, life as we knew it would change,” Gibney says. “But I didn’t anticipate it would involve owning and operating a cookie factory.” The 2,500-square-foot factory located off Tidewater Drive in Norfolk is unique in that it is free of ingredients such as wheat, gluten, dairy, milk, casein (a milk protein), butter, eggs, peanuts and tree nuts—a decision Gibney made not as a matter of principle but one born of love and necessity. A FRIGHTENING DIAGNOSIS The impetus for Gibney’s career change came when Colin was just four months old. Still breastfeeding him at that time, Gibney decided to introduce a dairy-based formula into Colin’s diet. When Colin’s face became red and swollen and his breathing labored, Lucy and her husband, Paul, also an ER physician, recognized that Colin was experiencing a life-threatening anaphylactic reaction to the formula. They gave him infant Benadryl before rushing him to the emergency room. Colin survived, but the Gibneys remained paralyzed with fear. “Even with our medical backgrounds, we were confused and scared,” says Paul. “Colin came very close to dying, and we needed answers.” After a battery of tests, the Gibneys learned that Colin had developed severe food allergies, which occur when the body’s immune system determines that a certain food ingested is harmful and in turn creates antibodies to attack it. The next time the food is eaten, the immune system releases a wave of chemicals meant to protect the body, but instead they cause allergic reactions that can affect the respiratory and cardiovascular systems, the skin and the gastrointestinal tract. Symptoms can appear within minutes or as long as two hours after the person has eaten the allergenic food. Dr. Angela Hogan, a pediatrician specializing in allergies at Children’s Hospital of the King’s Daughters (CHKD) in Norfolk, has treated Colin for the past four years; she says one of the most important items all new parents

12 THE HEALTH JOURNAL

Drs. Lucy and Paul Gibney, founders of Dr. Lucy’s, LLC

should have readily available is a liquid antihistamine (such as Benadryl for infants), as food allergies can emerge at any time. “Benadryl helps decrease symptoms during an allergic reaction, which can buy parents precious time if they need to get their child to the emergency room,” Hogan advises. Like Colin, some children may experience anaphylaxis—a serious allergic reaction that happens instantly and can be fatal. Certain foods and medications as well as bee stings and exposure to latex can trigger this response in a person with such allergies, and administering epinephrine (adrenaline) immediately is crucial. Says Hogan: “If a parent suspects that their child is having a reaction, they should immediately call their pediatrician; if it is severe and the child’s breathing is impaired, they should call 911.” In Colin’s case, dairy, eggs, wheat, peanuts, tree nuts and crab proved to be the dangerous triggers that, if ingested or even touched, could cause him to have an anaphylaxic reaction. Because of this, Lucy and Paul stripped their cupboards and refrigerator bare, disinfected every surface, and then faced the task of restocking their home with food.

Ninety p ercent o f all food alle rgies inv olve eight foo ds: milk , eggs, wh eat, soy, peanuts , tree nu ts, shellfish and fish .

was y r o t s s Thi red u t a e f y l original 08 0 2 y a M in our Lucy’s . n o i t i d e now e r a s e i Cook 000 , 7 r e v o sold at ations. c o l . S . U

“I spent hours in the grocery store almost in tears trying to decipher the wording on the food labels to figure out what was safe to bring in our house,” Gibney remembers. “I realized that if I made a mistake or misread something, our son could die. The weight of that was enormous.” Hogan says the Gibneys are not alone in feeling overwhelmed by the task of feeding a child who has food allergies: “Society has been slow to realize the prevalence and seriousness of this epidemic, which means restaurants and the food industry haven’t been paying attention either.” Michelle Hoang of Suffolk has two children under the age of five who have food allergies and are also under Hogan’s care. Hoang says she is all too familiar with feeling confused and crippled with fear when deciding what to feed her children at home as well as in public. “In restaurants, parents of children with food allergies are not being ‘picky’ when they ask questions,” she says. “It literally can be a matter of life or death.”

ALL TOO COMMON In 2007, Hoang—with encouragement from Dr. Hogan as well as guidance from the Food Allergy and Anaphylaxis Network (FAAN)—started a food allergy support group for Hampton Roads families called the Food Allergy Support Group of Tidewater, or FASGOT. Fifteen parents attended the group’s first meeting last October, and the circle has since grown to include 47 families. “Parents experience a lot of stress, anxiety and isolation when their child has food allergies,” Hoang says. “Some of the more important goals of the group are to support parents, raise awareness and provide a safer environment for our kids.” According to the FAAN Web site, food allergies are a growing public health concern in the United States. More than 12 million Americans have food allergies, with the incidence highest among young children—approximately 2.2 million children are afflicted, and one in 17 among those is under age three. And for reasons not fully understood, the number of children with food allergies has doubled over the last 10 years. Ninety percent of all food allergies involve eight foods: milk and other dairy products, eggs, wheat, soy, peanuts, tree nuts (e.g., almonds, cashews, pecans, pistachios, walnuts), shellfish (e.g., shrimp, crab, lobster) and fish (e.g., tuna, salmon, catfish). Most children outgrow their food allergies, although allergies to peanuts, nuts, fish, and shellfish often linger for life. The Gibneys learned about FASGOT through Dr. Hogan and immediately joined the group. In talking with other parents in similar situations, Lucy and Paul realized that Colin’s severe food allergies could alienate him from his peers during snack time at school and at birthday parties. Lucy Gibney recalls how she scoured grocery store aisles in search of any treat he could eat on such occasions, but she was unable to find even a simple cookie that tasted close to the “real” thing. “All I could find were rock-hard cookies that had no taste whatsoever,” she remembers. FINALLY, A COOKIE THAT PASSED THE TEST So she began baking cookies herself, consulting countless vegan and glutenfree cookbooks and downloading recipes off the Internet, only to be disappointed time after time with the result. Gibney’s frustrations led her back to tried-and-true family recipes that had been used for generations. From these recipes she pieced together the makings of a cookie that not only pleased Colin, but prompted Paul to offhandedly remark, “These are so good, you should start a business!” And that is exactly what she did. After a year of research and education, Dr. Lucy made her cookies available to the masses through her Web site, www.

drlucys.com, and at stores throughout Hampton Roads and Richmond, including all Farm Fresh locations. Her production team includes Larisa Jachman, a registered nurse who happened to be an avid baker with a culinary degree from Johnson and Wales; Jachman’s husband, Troy Swiger, who conducts the company’s lab testing and oversees technology; Susan Franklin, who manages the production area; and seven part-time employees who assist in cookie production and packaging. With help from Paul Gibney, the team developed a quality control program involving three main practices: buying ingredients from carefully selected producers, testing those ingredients for allergen proteins upon arrival, and banning wheat, gluten, milk, eggs, peanuts and tree nuts from the bakery, thereby removing the chance of cross-contamination. The packaging clearly lists ingredients that are and are not in the cookies to avoid parental confusion, and each cookie sold is vegan-certified and “kosher pareve,” meaning the product neither contains nor has come into contact with meat or dairy products. Says Gibney: “I want children with food allergies to have delicious treats to eat and share with their friends, but more than that, I want to impact the food industry as a whole. “Food allergies are very real, very serious, and very common,” she adds. “The food industry has to respond to this, and it needs to be done under rigorous quality standards to ensure the safety of our children.” Today Colin is thriving at his preschool and is a healthy, well-adjusted fouryear-old with friends who view him as just one of the crowd. “Parents of children with food allergies need to know that although it is scary, they are not alone,” Gibney says. “They need to get as educated on the issue as possible, reach out to medical professionals and the community for help, and create a lifestyle that is safe wherein their children can thrive.” As the Gibneys have shown, with a little innovation and a lot of hard work, life for a family dealing with food allergies can end up sweeter and more delicious than they ever thought possible.

Gibney shares the kitchen with head baker Larisa Jachman, a registered nurse who still works full-time hours at Sentara CarePlex Hospital. THE HEALTH JOURNAL

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Workout tips from the experts Balance Training Basics

Tone Up Anywhere with the TRX System

16 18

BALANCE BASICS WRITTEN BY GAYLE PINN PHOTOGRAPHY BY BRIAN M. FREER

BASIC MOVES Research shows that muscle strengthening and balance retraining exercises can reduce the risk of fallrelated injuries by as much as 45 percent. Nevertheless, balance exercises are often overlooked as part of a total body workout. I recommend incorporating specific balance exercises, like the ones below, into your current workout or daily routine. (If you have severe balance problems or an orthopedic condition, consult your doctor before performing these exercises.)

One-leg stands 1) First, clear your environment of any obstacles that

may interfere with your balance training. (Note: Any person whose balance is severely diminished should not perform these exercises alone.) Begin by standing on one foot. Time yourself for 10 to 30 seconds, then switch standing legs. If you are a novice, hold onto something sturdy, like a wall or table, with both hands. As you progress, and your balance improves, you can decrease the amount of support by using one hand for stability, then one finger, then no hands. Even as you progress and become more comfortable with this routine, always do these exercises near a wall or a sturdy object that can provide support if needed.

2) Once you’ve mastered standing on one leg without support for more than 30 seconds, try the first training exercise again but with your eyes closed.

Tandem walk

Try these moves to improve coordination, prevent injuries, boost confidence

W Gayle Pinn is the owner of Results Personal Training Studio. She has 10 years experience as a certified personal trainer. 16 THE HEALTH JOURNAL

ould you place a full glass of water on a table with wobbly legs? Of course not—because the glass might fall, spill or break. The same principle applies to your body. Your body needs a strong foundation to maintain balance well into your later years. Good balance is important at any stage of life, but especially among the elderly. Balance worsens as we age, and falling becomes a major concern. According to the U.S. Centers for Disease Control and Prevention (CDC), one out of every three Americans over the age of 65 will fall each year, and among individuals 65 to 84, falls account for 87 percent of all bone fractures and are the second leading cause of spinal cord and brain injury. The most common types of injuries sustained during a fall include fractures of the hip, spine and wrist as well as head trauma.

Place one foot directly in front of the other and walk a straight line (as if you were taking a sobriety test). Once you can do this, strive to comfortably do the same in reverse. Those at a more advanced level can perform the tandem walk with their eyes closed.

ADVANCED TRAINING Once you’ve mastered the basic balance exercises above, consider using some balance tools such as a BOSU, balance board, foam roller or stability discs. A certified personal trainer can show you how to use these tools for maximum benefit.

Try this move: Stand on a BOSU or two balance discs. Have someone gently push you while you try to keep your balance. Then, play catch with a lightweight medicine ball (if you don’t have a medicine ball, a basketball will work). You can also slowly lower into and out of a squatting position while catching the ball and returning it to your partner. Don’t be surprised if you initially have trouble just standing on a BOSU or the balance discs. It’s unlikely that your balance will improve after a few short sessions. Aim for 15 minutes of balance training daily, but know that it will take time and commitment to achieve better balance.

BALANCE EXERCISES FOR EVERY DAY: • Balance on one foot while waiting in line at the grocery store, talking on the telephone or brushing your teeth. • Stand up and sit down without using your hands. • Sit on a stability ball while working at your desk or watching TV.

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Important Safety Considerations for Restylane Restylane restores volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth (nasolabial folds). After your treatment, you might have some swelling, redness, pain, bruising, and tenderness. This will normally last less than seven days. Although rare, red or swollen small bumps may occur. If you have had facial cold sores before, an injection can cause another outbreak. In rare circumstances, the doctor may inject into a blood vessel, which can damage the skin. To avoid bruising and bleeding, you should not use Restylane if you have recently used drugs that thin your blood or prevent clotting. If you are pregnant, breastfeeding, or under 18 years, you should not use Restylane. Restylane should not be used by people with previous bad allergies, particularly to certain microorganisms known as gram-positive bacteria; by people with previous bad allergies to drugs that have required in-hospital treatment; or by people with bleeding disorders. Restylane should not be injected anywhere except the skin or just under the skin. Patients should be limited to 6.0 mL per treatment. The safety or effectiveness of Restylane for the treatment of anatomic regions other than nasolabial folds has not been established in controlled clinical studies. The use of Restylane at the site of skin sores, pimples, rashes, hives, cysts, or infection should be postponed until healing is complete. Use of Restylane in these instances could delay healing or make your skin problems worse. Restylane is available only through a licensed practitioner. Complete product and safety information is available at www.RestylaneUSA.com. Restylane is a registered trademark of HA North American Sales AB. All other trademarks are the property of their respective owners. © 2009 Medicis Aesthetics Inc. APB 08-132C 3/31/10

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WHY USE THE TRX SYSTEM? It’s portable > While TRX Suspension classes are offered at gyms around the country, various attachments enable you to fasten the system to doors or walls at home, in hotel rooms or just about anywhere. It’s adaptable to every fitness level > Because the TRX uses your own body weight, you can change the difficulty of any exercise by changing the length of the straps and your body position. Transitions are easy > The system allows you to change exercises in less than 15 seconds. This means that you can make the most of your training with fast-paced, circuit-style workouts. Strengthens core muscles > Works the body across different planes and directions, mimicking real-life movement. Perfects your posture by strengthening the stabilizer muscles in your back. Improves flexibility > Your body is forced to stretch and flex in new ways and directions.

TONE UP

Anywhere

SUSPENSION BODY WEIGHT TRAINING WITH THE TRX WRITTEN BY BRIDGIT KIN-CHARLTON | PHOTOGRAPHY BY BRIAN M. FREER

he TRX (Total Resistance eXercise) suspension training system is new, but it looks and feels old. A simple, lowtech exercise modality—all substance and no flash—it uses straps, a central pivot point and your own body weight to transform the way you work out. Celebrities, professional athletes, U.S. Marines, Navy Seals, Ultimate Fighting Champs and NFL teams use this system. It’ll work you harder than any other gym session, and you’ll feel the benefits immediately. Best of all, it’s portable. You can use it at home, in a hotel room or even in your office. 18 THE HEALTH JOURNAL

To understand the strengths of this system, you need to know its origins. While serving in the U.S. Military, Navy Seal Randy Hetrick (now retired) often did body weight exercises like push-ups and pull-ups, but he found that he couldn’t work the muscles of his back and legs effectively. So, in 1996, he created his own suspension system from extra parachute harnesses. Once it became popular, he started manufacturing the TRX system on a commercial scale. Since then, it has become widely used throughout the U.S. and the world.

Bridgit KinCharlton is the founder of B-defined Innovative Personal Training and Wellness, located in Williamsburg.

ALL THE RIGHT MOVES

Here is a circuit of six exercises designed to rebuild your body from head to toe. Perform each exercise for 60 seconds, moving quickly between each one. Work your way up to completing three sets of the entire circuit, for a total of 20 minutes.

1. CHEST PRESS works: chest, shoulders and triceps With back to the TRX, stand with feet hip-width apart, holding handles with arms extended forward and parallel to floor, palms down. Lean forward onto balls of feet. Bend elbows and lean body further forward, lifting one leg behind you (as shown). Return to start position and repeat with opposite leg.

2. SINGLE-LEG SQUAT works: glutes, legs and core Convert straps to the single-handle position. With back to TRX, place right toes into handle and hop left foot forward, hands on hips. Bend left knee, lowering to a lunge, keeping knee over ankle (as shown). Rise to standing position and repeat for 30 seconds. Switch legs. 3. SQUAT TO ROW works: glutes, shoulders, back and legs Facing the TRX, hold one handle in each hand. Squat (as shown). As you return to standing position, pull elbows back until the wrists are at your hips. Repeat. 4. MOUNTAIN CLIMBERS works: chest, shoulders and core Kneel, facing away from the TRX, and hook toes into handles. Walk hands forward until legs and back are straight (plank position). Bring one knee to chest (as shown) and continue to alternate. 5. HAMSTRING CURL足 works: hamstrings, glutes and low back Lie on your back and place heels in the TRX handles, legs extended, arms at sides. Lift hips until torso aligns with the legs and body forms a straight line. Bend knees, bringing heels toward glutes (as shown). Return to starting position and repeat. 6. SINGLE-LEG PUSH-UP TO PIKE works: entire body Kneel, facing away from the TRX, and hook right toes into handles. Walk hands forward until legs and back are straight (body is in a push-up position) and cross left foot over right. Lower into a push-up, keeping body in a straight line. Push your body up and lift glutes to ceiling, keeping legs straight and shoulders over hands (as shown). Extend body back to start position and repeat.

5 6

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features

In-depth articles on health topics

Author Tony Williams Takes on the Pox Medical Mix-Ups and How to Avoid Them PHOTO BY PAUL HARRISON

22 28

THE HEALTH JOURNAL

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two Lynne; e f i W : Family d6 ges 8 an Paul, a N.J. nsack, e k c a H wn: g, Va. Hometo amsbur i l l i W : story es llege hi o tly resid c n t e h r g r u C hor; tau ime aut t l l u F tion: years Occupa ather, e for 10 r u t a r nant: M e t e i v l o d C n e a erica’s nd th ged Am he Pox a n T a : h s C k o t ed bo ic tha ne of Publish Epidem Hurrica e ; ) h t 0 1 d 0 n torm 2 in a eadly S s, April D k e Frankl o o h t b e f c o tory ution (Sour n Revol ntold S a U Destiny c i e r h e T m : dence f the A ted for Indepen oment o oks sla o M b o g w n t i atic ecid 2008); e Dram t s h u T at the D : g s u g nial ginnin books, A er (Colo t ica’s Be (Source c r e a r m a h A C he tion— 010); T ation’s 2 N l l a a publica d F e ap the field, that Sh tory of n Little S a e l m b Events w a o k that emar sburg/R Results t: The R d n e e t William c m e i p r x e e he Un wn Exp y and t Jamesto n 1) o l o C ing ks, 201 s o i o r b p e r c e r t En a (Sou use Americ , Syrac d y e r p o a t s h i hio S rts in h story, O i A h f o n r a o c l che meri ion: Ba rts in A A f o Educat r e t s ity; Ma Univers y t niversi State U

INTERVIEW BY PAGE BISHOP-FREER PHOTOGRAPHY BY BRIAN FREER

ast month major health agencies investigated reports of a suspected smallpox outbreak in eastern Uganda. Though it turned out to be a false alarm, the world sat up and took notice. One of the most virulent diseases the world has ever seen, smallpox has seldom made headlines since 1979, when the World Health Organization, which had launched an attack on the disease decades earlier, declared it eradicated. According to the U.S. Centers for Disease Control and Prevention, “a single, confirmed case of smallpox would be considered an emergency.” What many people don’t know, though, is that Colonial America, particularly Boston, served as a testing ground for smallpox inoculation well before it gained approval from London’s Royal Society, a premier institute for scientific research and discovery. In The Pox and the Covenant: Mather, Franklin and the Epidemic that Changed America’s Destiny (Sourcebooks, April 2010), local author Tony Williams reveals how the smallpox epidemic of 1721 and the ensuing debate over inoculation changed America forever, depleting the authority of the Protestant ministry and shifting societal attitudes towards a more secular view of liberty and self-governance. Williams says the most startling finding in his research lay not in the 1721 smallpox epidemic itself, which began with the arrival of the HMS Seahorse in Boston’s harbor early that April. Rather, Williams became fascinated with the fierce debate over smallpox inoculation that arose between the minis-

22 THE HEALTH JOURNAL

Tony

ters (including Reverend Cotton Mather) and the physicians of Boston. Who sided with science and who attacked inoculation using spiritual evidence may surprise you, Williams says. What’s more, Benjamin Franklin, a key figure in the American Enlightenment, in his younger days publicly attacks inoculation to disparage the ministry and, as Williams puts it, “really knock them down a notch in society,” a little known fact that inevitably places Franklin “on the wrong side of history.” In the following interview, Williams—whose East Coast book tour began April 1—shares details from his new book, and he has allowed us to share with you an excerpt (starting at right).

What sparked the idea for his book: I was working on a piece on Benjamin Franklin, and I’d read a number of biographies and kept coming upon the mention of this 1721 smallpox epidemic in which Franklin plays a role as a very young man. But it was frustrating, because there’d be only a few pages on it and then they’d move on to his later career. I was just fascinated with it. My editor and I were going around on book ideas, and I just kind of threw the idea out there. They said: “That’s it! That’s the one we want to publish.”

Why smallpox was so horrific: First, it was so deadly. Death rates for seasoned populations [those who had some exposure to the virus from previous epidemics] ran as high as 15 to 30 percent. Second, it was highly communicable. In 1721, most of the people who did not have immunity caught the disease. Eventually 6,000 people got smallpox in Boston—a city of 11,000. So it spread very quickly. The other 5,000 probably had immunity from a previous epidemic. Why things get hot in Boston: As more and more people seek inoculation, it sets off a huge firestorm of protest. Not only from the people in town, but more surprisingly—almost shockingly—from the doctors. They argue that it’s untested, but they also make religious arguments. They argue that if people are predestined or fated to get sick, then that is the will of God and you cannot intervene. Because if you do, God, who is already punishing us with this epidemic, will unleash further plagues against us in different forms than this disease and ruin the town.

Williams takes on

What surprised him most in his research: While the doctors make scriptural arguments against inoculations, for the most part the ministers do not. In fact it was Cotton Mather who acts very scientifically to test inoculation. It’s the opposite of what you would expect.

Where Benjamin Franklin comes in: Brothers James and Benjamin Franklin are 21 and 17 respectively during the debate over inoculation. James opens a newspaper [the New England Courant] that summer to, well, sell newspapers. He really focuses exclusively on inoculation and serves as a mouthpiece for the opposition. He uses the paper to attack the power of the ministry and gives the doctors a platform to say whatever they want. James was so impetuous he was jailed, and Benjamin takes over the paper, continuing the attack against the authorities. He later comes to support inoculation when his own four-year-old son dies of smallpox. He even writes his regret in the pages of his autobiography, in which he urges parents to get their children inoculated, even though there was still opposition to it up through the time of the Revolution. People still felt like they were introducing smallpox to people through the practice of inoculation. How the debate changed Puritan society: Neither the covenant to form a city upon a hill nor the authority of the ministers could survive such withering attacks that were, for the most part, unprecedented. This epidemic shatters the covenant. Authority declines. There remains a general respect for ministers as men and women of God, much like today, but not reverence. The covenant becomes more secularized, focused on natural rights, self-government and liberty. The idea of the covenant survived, but it changed as a result of this epidemic and debate over inoculation.

Challenges of writing and researching this book: The research process was actually quite easy because I had access to every document right here in Colonial Williamsburg. I wanted to go to Boston, but I had no excuse to. I found every pamphlet, diary, autobiography, newspaper and letter right here. I read every book on medical history, disease, Puritan society and Colonial history that I could find to learn both the medical side of things as well as the historical side. It was compelling as an author to read the sources and Interview continued on page 24

From Chapter 15: “Cotton Mather, You Dog, Damn You!” [As the year 1721 comes to a close, the smallpox epidemic is waning but has left nearly 1,000 Bostonians dead and the covenant in tatters. Reverend Cotton Mather and Dr. Zabdiel Boylston had continued to inoculate patients well into the fall despite repeated warnings from the Selectmen—a group of local representatives who’d sided with the physicians—and ongoing attacks published in the Franklin brothers’ New England Courant.]

Cotton Mather felt chronically hassled throughout the late autumn as hundreds perished in Boston and thousands lay sick. The freeholders had decided against him and Boylston by voting against inoculated persons coming to town. Meanwhile, the interminable animosity against the procedure was expressed in sustained attacks upon him and Boylston. The divisions in the town persisted. The dispute, however, was not one that could be confined to the pages of a newspaper or pamphlet any longer. Mather passionately confronted James Franklin in the street. More ominously, there was a plot afoot to assassinate the Puritan minister. Mather found the opposition to the inoculation experiment unintelligible. It had worked successfully scores of times while those who caught the disease in the common way had an atrocious death rate. Still, he would attempt to reason with the ignorant and persuade them to accept the plain truth: “The sottish Excerpt continued on page 25 THE HEALTH JOURNAL

SMALLPOX: A SHORT HISTORY 1350 BC

First recorded smallpox epidemic

1157 BC Mummified head of Egyptian pharaoh Ramses V bears first physical evidence of smallpox. From there the disease is carried by traders to India and China.

1012-1063 AD

Written accounts of inoculation are found in ancient Buddhist texts.

Middle Ages Smallpox epidemics happen frequently throughout Europe.

1500s

European explorers bring smallpox to the Americas, decimating native populations.

1670

Inoculation is practiced in the Turkish Empire. It’s already common practice in China and India.

1714-1716

Europeans visit Istanbul and write letters to London’s Royal Society describing the technique; British physicians show little interest.

1721-1722

1754

1796

While Reverend Cotton Mather and Dr. Zabdiel Boylston inoculate people in Boston, Lady Mary Wortley Montague of England (after suffering an episode of smallpox in 1715) inoculates her four-year-old daughter in front of physicians in the Royal Court. Inoculation is being tested “simultaneously yet independently” in Britain and the Colonies, notes Williams. The French-Indian War marks the first use of smallpox as biological warfare, as it is used to wipe out the Native American population. English Physician Edward Jenner coins term “vaccine” after discovering that the milder cowpox virus can help prevent smallpox; by turn of the century, 100,000 people worldwide are vaccinated using Jenner’s method.

1949

Last smallpox outbreak in U.S. reported in Texas; one person dies.

1959-1967

Global health agencies launch attack on smallpox, hoping to eradicate it.

1972

Routine smallpox vaccination ends in U.S.

1979

World Health Organization declares smallpox cured; inoculation ceases worldwide.

24 THE HEALTH JOURNAL

Continued from page 23 put all the facts together in a dramatic way, as dramatic as possible for a nonfiction work. I like to say that it’s nonfiction that reads like a novel. I hope readers will agree with that. The role of women in the epidemic: The women of Boston obviously played an extremely important role in this story. They took care of their families, used their herbal medicine books that had been passed down from earlier generations. You can just imagine them by the fireside, caring for their child who might be dying of smallpox. You imagine the agony they would have felt when burying that child. There were no sources for those stories, though, so I relied on facts of how women of the time lived. What about Native Americans? In 1620, the first Puritans, the Pilgrims, were expecting to find a lot of Native Americans, and they were just gone. There’d been an epidemic a year before [the Pilgrims’ arrival] and the death rate among Native Americans was 80 to 90 percent because they had never been exposed to the virus.

What he hopes readers will take away: This story is not really about the smallpox virus; it’s about human beings. I wanted to show how the people of Boston would generally react during an epidemic. Would you flee? Would you stay? Would you go into church and pray? How would you react to your neighbors if someone next door were getting inoculated? Would you be willing to do it yourself? Mather has to face his own son wanting to get inoculated. Would you have the courage to let your son do that, and if not, would he defy his father and do it anyway to survive? These are all very human stories, and that is ultimately what the book is about.

His favorite books: 1776, David McCullough; The Devil in the White City, Erik Larson; In the Heart of the Sea, Nathaniel Philbrick; Krakatoa, Simon Winchester; Will in the World: A Biography of Shakespeare, Stephen Greenblatt; Lord of the Rings, J.R.R. Tolkien; Iliad and The Odyssey, Homer; Aeneid, Virgil; and Beowulf. If not an author, what he’d be: If I were not a teacher or author (and if I weren’t married!), I might be a Roman Catholic priest.

His heroes include: Firefighters, police officers, health-care professionals, soldiers, priests and ministers—those who live their lives to serve others day in and day out. Some of my favorite heroes from history are Winston Churchill, Abraham Lincoln, the 300 Spartan soldiers who stood at Thermoplyae [during the Greco-Persia War, 480 BC], and George Washington and the Revolutionary patriots who sacrificed so much that we might have liberty. How he handles the stress of a looming deadline: By sitting in my library and writing to meet the deadline. There is no substitute for hard work and perseverance in any job. Favorite quote? Read the classics and great biographies and you’ll find my favorite quotes in there.

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Excerpt continued from page 23 errors and cursed clamors that fill the town and country, raging against the astonishing success of the smallpox inoculated,” he wrote, “makes it seasonable for me to state the case and exhibit that which may silence the unreasonable people….”434 The Selectmen knew that there were people from Roxbury in Cotton Mather’s home to receive inoculations. The officials had had enough of Zabdiel Boylston’s risky procedure and Mather’s collaboration in it. They certainly did not want to encourage people to come from all over the countryside as if under Indian attack, rushing to Boston to receive inoculations and possibly rekindle a diminishing epidemic. The Selectmen stated that they were “credibly informed that many persons belonging to other towns are already come into this town, and have taken the infection of the smallpox, in the way of inoculation, but that as yet the infection has not operated upon them yet expect that in a few days it will.” Moreover, the officials were concerned that “many others belonging to other towns intend to come to this town for the purpose aforesaid, and that they know how to come in and where, and what houses to use in spite of the town.” The Selectmen empowered the justices of the peace and constables with warrants to search the town diligently, apprehend the outsiders, and “carry them to the respective towns to which they belong or to the province hospital” at Spectacle Island. The measures were an attempt to “keep them from infecting others.”437 Boylston apparently did not heed the word of the Selectmen. He performed more than a hundred inoculations during the month, including several prominent individuals, including ministers, a Harvard professor, and Samuel Sewall’s grandson, Samuel Hirst.438 Even on November 29 Mather related to his diary that “several persons at this time under the smallpox inoculated. I must look on as my patients, and so, my relatives.”439 The Selectmen called several ministers to appear at a meeting and answer accusations that they were encouraging country people to come to Boston to be inoculated in violation of the law. “After some hot discourse on both sides,” the ministers denied it with barefaced lies, knowing full well that they were continuing.440 One thing the public authorities failed to do was to arrest the inoculator who continually defied the law. Boylston and Mather broke the law, perhaps believing they had a higher law to obey. If they did, they helped undermine the covenantal basis of Puritan

society that respected the voluntary submission to law and authority. They were breaking the law in tandem: Boylston performing inoculations in Mather’s home and certainly with his support elsewhere. Others were similarly preparing to violate the civil law as well as God’s commandment against murder. There was a complete breakdown of law and order in Boston.

One person in Boston had had enough of the high and mighty Cotton Mather. He lorded his position over everyone, thinking he was better than everyone else. He was filled with rage that the fool minister was in league with the quack Boylston giving people smallpox. What they were doing just did not make sense. The resentment boiled for weeks, if not months, and was now about to explode....

If you’re over 50 or have osteoporosis, it’s important that you don’t ignore your back pain. It may signal a spinal fracture. See your doctor right away if you think you may have one.

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For more information on balloon kyphoplasty or call 800-652-2221 visit www.kyphon.com Medtronic maintains a list of physicians who have been trained to use, and are believed to be both active and proficient users of, Medtronic’s products and who are willing to accept patient referrals. Physician participation on this list is voluntary and free. All referrals are identified based upon geographic criteria only. Medtronic does not guarantee the accuracy of the listings or the capabilities of the physicians listed. The physicians referenced may be paid consultants of, and research cited may have been funded partially or in whole by, Medtronic. Although the complication rate with KYPHON® Balloon Kyphoplasty has been demonstrated to be low, as with most surgical procedures, there are risks associated with the procedure, including serious complications. This procedure is not for everyone. A prescription is required. Please consult your physician for a full discussion of risks and whether this procedure is right for you. © 2008 Medtronic Spine LLC. All Rights Reserved.

MEDTRONIC Spinal and Biologics Business 1221 Crossman Avenue Sunnyvale, CA 94089 USA Tel: (408) 548-6500 16003152_021 [01]

THE HEALTH JOURNAL

money matters

Health Savings Accounts Provide Tax Savings Learn How HSAs Can Reduce Your Healthcare Expenses WRITTEN BY KATHLEEN M. CRAMER

pril 15 is a day etched into the minds of Americans as the day that our state and federal taxes are due. Are you ready? Have you done everything you can to reduce the taxes you owe? As the economic downturn has influenced much of our spending, we’re now looking for other ways to save money. One way to reduce health care costs is by opening a health savings account (HSA) in conjunction with your health plan. An HSA is a savings and spending account that offers health plan members a way to pay for qualified medical expenses with tax-free dollars, as well as a tax-advantaged way to save for future medical and retirement expenses. HSAs were originally created by an expanded Medicare bill and approved by Congress in 2003 to help individuals save for the future on a tax-free basis. Individuals must first be covered through a government-approved highdeductible health plan (HDHP) structure when making HSA contributions. With more and more companies moving to higher deductible plans, HSAs are becoming a popular alternative for controlling health care spending. enrolled in high-deductible health plans that also offer HSAs and Health HDHPs can be thought of as “low-cost” plans with lower premiums and highReimbursement Arrangements, up from four percent in 2006. Additionaler deductibles. With an HDHP, a member is responsible for satisfying a dely, 12 percent of firms offered such plans to their workers last year, comductible and paying for initial health pared to only seven percent in 2006. care expenses. The HSA may be used A survey of health insurers performed to cover those expenses. Also, with by America’s Health Insurance Plans most HDHP plans, preventive care is (AHIP) found that 6.1 million Amerioffered pre-deductible with little or cans were covered by HSA-qualified HSAs Can TRIPLE Your Tax Savings no member cost to encourage health health plans as of January 2008. maintenance. An HSA is like your own private bank 1. tax deductions when you contribute to your account HSAs can be funded by you, your account: it’s used to pay for current employer or a third party and still 2. tax-free interest or investment earnings health care expenses or to save money 3. tax-free withdrawals for qualified medical expenses be tax-free to you. In 2010, the for future expenses. HSAs are accounts maximum individual contribution that are owned by the health plan amount is $3,050 and the family member, regardless of who contributes maximum is $6,150. Additional catch-up contributions can be made by funds and the money earns interest and other potential returns over time. individuals after age 55. These contribution limits may be subject to change Individuals on Medicare cannot continue to contribute to HSAs; however, you every year by the IRS. can keep the existing money in your account and use it for medical expenses So, what types of expenses are considered “qualified medical expenses” tax-free. The beauty of HSAs is that it’s your money—even if you leave an emfor which you can use your HSA funds? Some examples are: doctor’s visits, ployer, the funds stay with you. Individuals may choose to invest their HSA hospital expenses, lab work, diagnostic services, prescription drugs, dental dollars in stocks, bonds, mutual funds or other eligible savings vehicles. care and vision care. For a complete list, visit the IRS website and reference Publication 502, “Medical and Dental Expenses” (http://www.irs.gov/ The Bottom Line pub/irs-pdf/p502.pdf). Funds used for other purposes are regarded by the HSAs are a great option for paying for medical expenses now as well government as taxable income, with an additional 10-percent penalty for as saving for retirement. So, consider choosing a qualified plan and open non-qualified expenditures. an HSA today.

3 WAYS

So, Who’s Using HSAs?

A survey of employers published by the Kaiser Family Foundation in September 2009 found that eight percent of covered workers were 26 THE HEALTH JOURNAL

Kathleen M. Cramer is the manager of product development for Optima Health, a Virginia-based health plan with more than 440,000 members, nationallyrecognized for its quality, service and innovative programs.

Sources: U.S. Department of the Treasury, www.ustreas.gov; Kaiser Family Foundation, www.kff.org.

THE HEALTH JOURNAL

ere’s a scary statistic: Preventable medical errors occur roughly 15 million times a year, according to the Institute for Healthcare Improvement. That includes mistakes with prescription medications and in doctors’ offices and hospitals, which can range from minor to deadly. Luckily, doctors say patients have more control over their safety than they might think. People who educate themselves on the medicines, tests and procedures they need—and ask lots of questions—do better than passive types. “Most doctors appreciate patients who take some responsibility for keeping up with their own health care,” says Dr. Jim Schmidt, a pediatric emergency specialist in Norfolk. Here are five major mix-ups that occur, and some steps patients can take to protect themselves:

Medical Mix-Ups

and how to avoid them

WRITTEN BY ALISON JOHNSON PHOTOGRAPH BY BRIAN M. FREER

28 THE HEALTH JOURNAL

1. MISSING TEST RESULTS The results of screening and laboratory tests don’t always make it to patients. A Weill Cornell Medical College study published earlier this year found that about seven percent of abnormal results never get to patients in primary care practices. Paperwork may get lost in busy labs and offices or mistakenly filed before a doctor sees it. Medical practices also may not have systems to record which patients have gotten their results. Patients should never assume “no news is good news” but should always call to check, Schmidt urges. “Until medicine progresses to a more integrated medical record [system], a system of many stand-alone symptoms makes following results a real challenge,” he says. “I recommend that each patient clearly ask their doctor how or if they should expect to get their results. Patients should not make assumptions but instead ask their doctor after each test if they are uncertain about how results will be shared. In some medical systems, no news is good news; in others, no news means a potential oversight. Some systems ask patients to call for results; others will send them automatically.” 2. PRESCRIPTION DRUG ERRORS More than 3,000 medications have similar names to other drugs on the market, according to a 2008 report by U.S. Pharmacopeia, a nonprofit that promotes patient safety. There’s Klonopin for seizures and Clonidine for high blood pressure, for example, and Zyrtec for allergies and Zantac for acid reflux. Errors can stem from a doctor’s bad handwriting, a busy pharmacist grabbing the wrong pills or a patient mispronouncing a needed medication.

Patients should know how to say and spell the name of a drug they’ve been prescribed, as well as the dosage and the reason they’re taking it. They also can talk to a pharmacist when picking up a medication, says Dave Merryfield, director of clinical pharmacy programs for Sentara Healthcare. “Sometimes consumers feel like they’re in too big a hurry,” Merryfield says. “But there’s real value in those conversations, and a lot of mistakes can be caught during them.” It’s also wise for the doctor to write what a medication is for on a prescription—“for arthritis,” next to Celebrex, say—and for the consumer to ask questions if a refilled medication looks different. “It may simply be a new generic product,” Merryfield notes, “but it’s always smart to check.” 3. NEGATIVE DRUG INTERACTIONS Every medication has the potential to do harm in combination with another drug, whether by reducing effectiveness or doing dangerous damage. The blood thinner Coumadin, taken with certain over-the-counter painkillers such as Aleve and Motrin, for example, can

making a big difference, but patients still need to be assertive, says Dr. Gene Burke, vice president and executive medical director for clinical effectiveness at Sentara Healthcare. That includes asking doctors, nurses and visitors if they’ve washed their hands and questioning medications and tests not discussed previously with a doctor. “Don’t feel in the least bit timid,” Burke advises. “A responsible caregiver won’t take it as insulting. They will welcome having a partner in the process.” Patients and family members also should repeat back instructions from doctors and medical staff to ensure they’re clearly understood. In addition, patients should know the basics of how medical monitors work and, if they have a catheter, intravenous line or ventilator, have a daily conversation with a doctor about the need for that device. Catheters, IVs and ventilators raise the risk of, respectively, urinary tract infections, bloodstream infections and pneumonia. Patients with an IV in their hand or arm should expect to have it changed every two or three days, Burke adds, and catheter bags should never be raised above a patient’s bladder (otherwise, urine can run back into the body). “For a

“For a long time, hospital-acquired infections were taken as a cost of doing business. Now we see that if we create an atmosphere of awareness and accountability, most of them are preventable.”

lead to serious gastrointestinal bleeding. Patients need to make sure their pharmacist and all of their doctors have a written list of every medication they take, Merryfield says—not just prescriptions but also over-thecounter pills, vitamins, supplements and herbals. Filling prescriptions at a single pharmacy helps, Merryfield adds. Pharmacies keep detailed records on each customer and can double-check for potential interactions. “If you go to too many places, sometimes the right hand may not know what the left hand is doing,” he warns. Patients also should read labels carefully to learn about proper dosing, common side effects and instructions on when and how to take a medicine, including the time of day and whether to take it with or without food. 4. IN-HOSPITAL ERRORS Preventable infections and medication mistakes are two of the biggest concerns for hospitalized patients. Electronic medical records and bar-coded bracelets— which caregivers must match with medications—are

WHERE MEDICAL ERRORS CAN HAPPEN • • • • • • •

Hospitals and clinics Outpatient surgery centers Your doctor’s office Nursing homes Pharmacies Laboratories At home

— Dr. Gene Burke long time, these infections were taken as a cost of doing business,” he says. “Now we see that if we create an atmosphere of awareness and accountability, most of them are preventable.”

5. SURGICAL ERRORS Patients who know their medical history—medications, allergies and previous surgeries—are great allies for surgeons, says Dr. Marshall Cross, a general surgeon with Riverside Medical Group. He recommends that everyone keep a card with a detailed, up-to-date history in their wallet. “Somebody might say to me, ‘I don’t know, they worked on my stomach,’ ” Cross says. “That could mean so many things. If I’m going back into that abdominal area, [the patient’s accurate knowledge of previous surgeries] could make a difference as to how I approach it.” Similarly, a patient who doesn’t report a history of heart problems is more likely to get into trouble during surgery. Following preoperative instructions is crucial to avoiding surgical problems. And if an operation is on a body part of which there’s more than one, such as an arm or leg, patients should be awake and aware to ensure the surgeon marks the correct body part with a permanent marker. Patients also can ask if there’s a “time-out” procedure once they’re on the operating table—a moment when the operating team pauses to confirm they have the right patient and are about to do the right procedure. “If patients aren’t sure about what’s going to happen,” Cross says, “absolutely they should ask questions.”

TO HELP PREVENT MEDICAL ERRORS, TAKE AN ACTIVE ROLE IN YOUR HEALTH CARE Keep a list of current medications (including over-the-counter meds) and any dietary or herbal supplements (including the dosage of each) and share it with your physician.

Never take a medication without first discussing with your provider the possible side effects (including allergic reactions) or interactions with other medications, food or alcohol. Know the name of each medication prescribed and its intended effect.

Pay attention to warning signs on the labels of prescription and over-thecounter medications.

To reduce pharmacy error, make sure your doctor’s handwriting is legible on any written prescription.

Research the hospital or clinic where you’ll be having a procedure performed and compare its quality of service to other facilities in your area. Visit the facility ahead of time. If having surgery, request to have the surgical site marked on your body with permanent marker.

Appoint a family member or friend to serve as your advocate if you are hospitalized. He or she can take notes, ask questions and alert the staff quickly if you have a reaction to a medication.

Follow up on test results; don’t assume that no news is good news.

Have a solid understanding of any medical conditions you may have as well as of any procedure you may be having. THE HEALTH JOURNAL

10 Simple Ways To

GO GREEN 1. Carry a Canteen Swap plastic bottles for a stainless steel canteen. Plastic bottles—especially the hard, reusable kind—may contain biphosphenol-A (BPA), while disposables usually end up in our landfills. (Try the Green Bottle, shown here in “Apple Blossoms” design, for $15.99 at www.greenbottle.com.)

2. Go Organic

VIRGIN

1 2

Look for the USDA Organic seal on agricultural products including food and personal care items. Items labeled “100-percent Organic” contain only organically produced ingredients, and those labeled “Organic” are made with at least 95 percent organically produced ingredients.

3. Buy Local! Support your local community by shopping at farmers’ markets and small farms. The farther food must travel from farm to table, the more carbon emissions get released into the atmosphere. Visit www.localharvest.org to find the best organic foods grown closest to you.

4. Maintain a Compost Bin Food and yard waste can be put into a composter, creating soil rich in nutrients and removing the need for chemical fertilizers. Visit www.simplemom.net/how-to-make-a-compost-bin to learn the how-to’s of making a compost bin for just $15.

5. Create a Water Basin for Rainwater

GO PA

Collecting rainwater in outdoor bins is an earth-friendly way to water your lawn and garden. You can also collect water in the shower by setting pitchers or buckets on the shower floor.

S PERLES

6. Shop with Reusable Bags Americans use over a billion single-use plastic bags each day. Visit www.makelovenottrash.com to purchase fashionable and fun reusable bags that help create a bright ecological future.

WASH TEMPERATURE

7. Pay Bills Online

8 9

Cut back on paper waste by requesting e-bills and/or setting up online bill payments from your bank account. Some companies now charge a processing fee for paper bills, so you could save some bucks while helping to save the planet.

8. Unplug Chargers and Appliances COLD

HOT

According to the U.S. Department of Energy, plugged-in appliances continue to draw electricity even while not in use. In fact, up to 75 percent of your electricity bill could be attributed to this so-called “vampire energy.”

9. Wash Laundry in Cold Water Ninety percent of the energy used in washing clothing is from heating the water, and you could save $60-100 a year on your energy bill simply by switching the knob to cold.

10 30 THE HEALTH JOURNAL

10. Plant an Herb Garden Add spice to home-cooked meals (and save money) by planting your own indoor or outdoor herb garden. You’ll cut the risk of consuming commercial pesticides and always have the right herbs on hand. Find a grow-it-yourself guide at www. herbgardens.about.com.

healthwire Today’s headlines from Reuters Health Why Women Should Drink Up Medication’s ‘Nocebo’ Effect

32 34

THE HEALTH JOURNAL

Wine May Help Women Keep Weight in Check

New research suggests moderate alcohol consumption, particularly wine, could stave off obesity. WRITTEN BY MEGAN BROOKS NEW YORK (REUTERS HEALTH)

ight to moderate alcohol consumption, especially red wine, is not only good for a woman’s heart, it’s also good for her waistline, according to a study reported in March. The study started out with nearly 20,000 trim, middleaged and older women. Over time, women who drank alcohol in moderation put on less weight and were less apt to become overweight compared to non-drinkers. This was true even after taking into account various lifestyle and dietary factors that might influence a woman’s weight. Red wine seemed best at keeping weight in check, but white wine, beer and spirits also had some benefit. “Our study results showed that middle-aged and older women who have normal body weight initially and consume light-to-moderate amount of alcohol could maintain their drinking habits without gaining more weight compared with similar women who did not drink any alcohol,” Dr. Lu Wang from the division of preventive medicine, Brigham and Women’s Hospital, Boston, noted in an e-mail to Reuters Health.

32 THE HEALTH JOURNAL

Red wine seemed best at keeping weight in check, but white wine, beer and spirits also had some benefit.

Many prior studies have suggested that moderate drinking—usually defined as a drink or two a day—can be a healthy habit, particularly with regard to heart health, while heavy drinking can harm health. The new study, published in the March 8 issue of Archives of Internal Medicine, is the first to examine ties between alcohol consumption by a normal-weight individual and the risk of becoming overweight or obese. The women were all at least 39 years old when the study began. About 38 percent said they did not drink alcohol; 33 percent said they drank less than five grams daily (a standard drink has about 10 grams of alcohol); 20 percent drank from five to under 15 grams daily; six percent drank 15 to less than 30 grams daily; and three percent downed 30 grams of alcohol or more daily (about two to three drinks per day or more). Over an average of about 13 years, the women generally gained weight. However, the teetotalers gained the most weight, with weight gain decreasing with increasing amount of alcohol consumed.

Put another way, Wang said an initially trim woman who did not drink alcohol had about a 43 percent chance of becoming overweight or obese over 13 years. Her risk fell to 33 percent if she drank 15 to 30 grams of alcohol a day. Women who did not drink gained an average of 3.63 kilograms (eight pounds) compared with 1.55 kilograms (3.4 pounds) for those who consumed 30 grams of alcohol or more each day. During the 13 years the initially normal-weight women were followed, 41 percent became overweight or obese. Women who drank 15 to less than 30 grams per day had the lowest risk of becoming overweight or obese, which was 30 percent less than that of non-drinkers. Put another way, Wang said an initially trim woman who did not drink alcohol had about a 43 percent chance of becoming overweight or obese over 13 years. Her risk fell to 33 percent if she drank 15 to 30 grams of alcohol a day. Women who drank higher amounts of alcohol were generally more physically active, weighed slightly less at the outset and were more apt to be smokers, than other women. However, the association between drinking and a reduced risk of becoming overweight or obese remained strong after accounting for these factors. This suggests that alcohol may independently affect body weight beyond its relationship with diet and lifestyle factors. There are several reasons why alcohol might help women stay trim, Wang told Reuters Health. In the current study, women consuming more alcohol ate less, particularly carbohydrates— a finding seen in other studies. Moreover, it’s been shown that women tend to expend more energy after drinking alcohol— more so than that contained in the alcohol. “Taken together, regular alcohol consumption in light-to-moderate amount may lead to a net energy loss among women,” Wang said.

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 The Health  Journal - 1/4 vertical which is 4.75" x 6”

WHAT’S ONE SERVING? When it comes to alcohol, serving sizes may be smaller than they appear.

WINE

5 oz. (12% alcohol)

BEER

12 oz. (5% alcohol)

SPIRITS

1.5 oz. (80 proof)

 



        

Medication Fears Lead to Worse Side Effects

In one study, patients with rheumatoid arthritis who expected medication side effects were more likely to experience them. WRITTEN BY ANNE HARDING NEW YORK (REUTERS HEALTH)

N O C E B O

Pronunciation: “nO-’sE-(“)bO The nocebo effect occurs when patients taking medications experience adverse side effects unrelated to the specific pharmacological action of the drug. The nocebo effect is associated with the person’s prior expectations of adverse effects from treatment as well as the conditioning in which the person learns from prior experiences to associate a medication with certain somatic symptoms. Source: medterms.com

34 THE HEALTH JOURNAL

t may not be surprising, but a new study offers some proof that patients who are worried about their medications are more likely to have side effects from them. The study involved patients with a particular kind of arthritis. While more research has to be done in patients with other illnesses to know for sure, “my guess would be that this is happening across a wide range of drugs,” Dr. Yvonne Nestoriuc of Philipps-University Marburg in Germany, the study’s lead author, told Reuters Health. “This is really something that happens in a lot of patient populations.” While most medication side effects are not life threatening or seriously harmful, she and her colleagues note in the journal Arthritis Care & Research, they can still be “frightening and distressing” to patients, and can also lead to patients not taking drugs as recommended. People with a variety of illnesses who don’t feel their medications are necessary and are concerned about their side effects are known to be less likely to take these drugs as directed, the researchers add. To investigate whether these beliefs might be related to experiencing side effects as well, Nestoriuc and her team had 100 rheumatoid arthritis patients complete the “Beliefs about Medicines Questionnaire,” which explores general and specific beliefs about the necessity and risks of medication. Patients also reported any side effects related to their rheumatoid arthritis medication and how much they were bothered by these symptoms. Rheumatoid arthritis is an autoimmune disease characterized by inflammation that leads to stiff, swollen and painful joints. It affects some 20 million people, according to

the National Rheumatoid Arthritis Society. At the study’s outset, 77 of the patients reported having been bothered by side effects. Eighty-seven of the original 100 study participants were followed up with at six months; 45 of these patients, or 52 percent, reported being bothered by side effects at this point. The patients who had concerns about their medications—for example agreeing with the statement that “having to take arthritis medications worries me”—were more likely to have reported having side effects, both at the study’s outset and if they started a new drug during the six-month study period. Side effects typically included rashes, gastrointestinal discomfort and headaches. These patients were also more likely to report these side effects to their doctors, take non-prescription medications to deal with them, and change their medication dosages on their own. The only other factor that influenced the likelihood of reporting side effects was age. Patients with rheumatoid arthritis “who are especially concerned about their arthritis medications, or who expect side effects, are at greater risk of experiencing them,” the researchers say. “Starting a new drug is a specifically risky time because people tend to misattribute pre-existing bothersome but [benign] symptoms as side effects of the new drug,” Nestoriuc said. Doctors may be able to help their patients avoid side effects by talking with them about their concerns before prescribing a new medication, she added, and helping them to get a more “realistic view about the drugs.”

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Premature Skin Aging:

More Than a Wrinkle in Time WRITTEN BY DR. KEITH W. SCHUMANN

Premature skin aging is not normal, and it doesn’t have to happen to you. Preventing the signs of aging is possible, and treatments are available to help erase the damage that’s been done. There are two types of aging: intrinsic and extrinsic. The genes we inherit cause intrinsic (internal) aging, also known as the natural aging process. I’ll focus on extrinsic (external) aging, because it is here that we can make a big difference by avoiding one of the main risk factors—sun exposure.

Drooping

Wrinkles

Keith W. Schumann, M.D., is a board-certified dermatologist with advanced training in lasers. The founder of Ageless Dermatology & Laser Center, he has practiced in Williamsburg for the last 10 years. He can be reached at info@agelessderm.com.

Sunspots Dull tone

Roughened texture

Elongated upper lip

Thinning

Loss of volume

Skin laxity and sagging

Treating the Damage

Treatments for signs of premature skin aging range from topical products to laser procedures, with many options in between. The right intervention is based on the extent and type of skin damage. Three ingredients stand out in topical products: vitamin A (tretinoin, retinol), alpha hydroxy acids, and vitamin C. These products are not appropriate for all

skin types, and the form and strength of each are important to know before using products that contain them. Beyond topical care, effective and popular treatments include wrinkle fillers, botulinum toxin A, microdermabrasion, chemical peels, and laser procedures. A consultation with a qualified physician is the best way to get started.

YOUR THREE-STEP SUN-SAFETY PROGRAM

1 2 3

Avoid the sun. If your shadow is shorter than you are, seek shade. Wear sun-protective clothing such as long-sleeved shirts, pants, widebrimmed hats and sunglasses whenever possible. Many sporting goods stores and specialty retailers sell clothing with a built-in high SPF (sun protective factor).

Detailed sun safety guidance is available at the following Web sites: www.skincancer.org/ www.skincarephysicians.com www.sunprecautions.com/ www.coolibar.com/

Use sunscreens daily. THE HEALTH JOURNAL

The primary advantage of sublingual immunotherapy is its convenience.

You Want Me to Put What Under My Tongue? Sublingual immunotherapy: An alternative to allergy shots WRITTEN BY JOSEPH K. HAN, M.D.

Dr. Joseph K. Han is the director of the new Eastern Virginia Medical School Allergy Division as well as the director of Allergy, Rhinology and Endoscopic Sinus and Skull-Based Surgery within the Department of Otolaryngology/ Head & Neck Surgery. He is one of only a handful of physicians in the United States to have completed a fellowship in Rhinology, Sinus Surgery and Allergy. He is board-certified in otolaryngology/head and neck surgery and a fellow of the American Academy of Otolaryngic Allergy. He is also a member of EVMS Health Services, a not-forprofit medical practice through Eastern Virginia Medical School.

38 THE HEALTH JOURNAL

here is growing evidence to support a startling new treatment for allergies. Several U.S. studies are finding that putting particles of grass and other allergens under the tongue is a safe and effective treatment for certain allergies—not to mention a lot less painful than shots. An allergy is an abnormal reaction to an ordinarily harmless substance called an allergen. Allergens are simply small proteins that trigger an allergic response when absorbed into the bodies of certain allergic people. Following an exposure, these individuals may experience symptoms such as a runny nose, watery eyes, itching and sneezing. The most common allergens are grass or tree pollens, molds, dust mites, animal dander, foods, cockroach droppings and insect stings. Allergies are quite common in the United States, affecting about one in six people. The easiest way to control an allergic reaction is to avoid exposure entirely. Since that isn’t always possible or realistic, many people use medications that can block the allergic response (such as antihistamines) or treat its symptoms (decongestants). For a more targeted treatment for a specific allergen, we must first determine specifically what the patient is allergic to via allergy testing. Allergy testing can be conducted using either a blood test or skin test. Allergy experts can either study a blood sample to determine which allergens affect the patient or place a small amount of an allergen onto the skin and examine how the patient’s body responds. If histamine blockers or other allergy medications fail, subcutaneous immunotherapy (more commonly known as allergy shots) is the next line of defense and the most common method of allergy treatment. But some U.S. doctors are now adding a new therapy to the allergy treatment mix—sublingual immunotherapy, or SLIT. Presently, SLIT is not commonly practiced within the U.S. but it has been popular throughout Europe and Asia for years. SLIT involves placing very small amounts of an allergen, such as grass particles in oral drops, under a patient’s tongue for a few minutes. Studies have shown that SLIT works in a fashion similar to traditional allergy shots and has proven to be just as effective. The same extracts used in subcutaneous allergy injections are found in these oral allergy drops; and, as with allergy shots, patients must take the drops for three to five years for the treatment to work.

What is the difference between an allergy shot and sublingual therapy? Allergy shots involve placing, over time, increasing amounts of an allergen under the skin via injection. After repeated exposure to the allergen, the patient eventually becomes less allergic to the substance because the gradual introduction of the allergen allows the patient to build a natural immunity or tolerance. However, this type of therapy requires quite a bit of time and effort because patients must schedule weekly doctor visits for the shots. In addition to the pain associated with the injections, some side effects include localized swelling at the injection site or systemic reactions such as wheezing, sneezing and nasal congestion. Anaphylactic reaction, a rare but potentially life-threatening allergic response, is also a risk. For this reason, doctors require patients to stay at the practice 30 minutes after a shot is given to evaluate any possible side effects. In contrast, the primary advantage of sublingual immunotherapy is its convenience. SLIT can be administered at home on a daily basis instead of requiring weekly office visits. Some studies have also shown that sublingual therapy may result in fewer systemic adverse reactions than allergy shots, making it a potentially safer option. The most common reported side effects of the drops are tingling of the tongue following ingestion. There are a few disadvantages to sublingual therapy. First, since it is a relatively new type of treatment, there are only a few published studies to support its efficacy. Despite this, there is sufficient data to demonstrate that it works. Second, there is no general consensus on the optimal amount of allergen that is required for sublingual administration. Doctors can, however, follow a set of guidelines developed by the American Academy of Otolaryngic Allergy for administering sublingual therapy to patients.

The bottom line? All of the above therapies will help control and prevent allergic reactions. Some questions about SLIT still need to be answered with further scientific research, but luckily, patients and their doctors have several good treatment options from which to choose. The best way to determine which allergy treatment is best for you is to talk with your doctor.

Your attorney should be as qualified and specialized as your physician.

Stephen M. Smith Founder, Brain Injury Law Center

Stephen M. Smith Founder, Brain Injury Law Center The Best Lawyers in America ~ 2010 Super Lawyers ~ 2010 President of the Brain Injury Association of Virginia Internationally recognized expert in traumatic brain injury litigation Super Lawyers ~ 2010 Only attorney in Virginia to ever be awarded Diplomate status by the American Board of Trial Advocates. Chairman of the Traumatic Brain Injury Litigation Group of the American Association of Justice Licensed to practice in Virginia, New York and the District of Columbia and all other states by permission Won the largest mild traumatic brain injury verdict ever awarded in the world Won the largest personal injury verdict ever awarded in Virginia Public Justice national board member Belli Society national board member Multi-Million Dollar Advocates Forum member Listed in “Who’s Who in American Law” Law Dragon ~ 500 Leading Lawyers in America Washington Post “DC’s Best Lawyers” 2010 Graduate of Marquette University, College of Health Sciences, in Neuro Anatomical Dissection of the Human Brain and Spinal Cord

Your attorney should be as qualified and specialized as your physician.

The Best Lawyers in America ~ 2009 Super Lawyers ~ 2009 President of the Brain Injury Association of Virginia Internationally recognized expert in traumatic brain injury litigation Only attorney from Virginia to ever be awarded Diplomate status by the American Board of Trial Advocates.

Brain Injury Law Center theonly onlylaw law fifirm Chairmandedicated of the Traumatic Brain Injury “The“The Brain Injury Law Center is isthe rm in the United States Litigation Group of the American in the United in States dedicated exclusively in survivors and their families. exclusively representing brain injury victims, Association of Justice representing brain injury victims, survivors and their I have dedicated both my personal and professional life to helping brain Licensed to practice in Virginia, New York families. I have dedicated both my personal and injury survivors, their families, and other victims of catastrophic events.” and the District of Columbia and all other professional life to helping brain injury survivors and their families and other victims of catastrophic events.”

states by permission.

Won the largest mild traumatic brain injury verdict awarded in the world only forever the victim, but for

Your attorney should be as qualified and specialized as Stephen M. Smith 840-3431 BRAIN INJURY your physician. 650-9818

Brain injuries are devastating and life-changing not Brain injuries are devastating and life changing not only for the the largest personal injury verdict their ones asones well. Stephen Smith, Esq., is anWon internationally recognized victim,loved but for their loved as well. Stephen M. M. Smith, Esq., ever awarded in Virginia is an internationally recognized expert in traumatic brain injury expert in traumatic brain injury litigation who handles and assists with lawsuits litigation and settlements who handles and assists with lawsuits Public Justice national board member worldwide. IfStates you and or the a loved suffered across the United world. Ifone you orhas a loved one has a head injury and are experiencing Belliyour Societyrights. national board member suffered a head injury and arecontact experiencing difficulties, M. contact cognitive difficulties, Stephen Smith to learn him to learn about your rights.

Multi-Million Dollar Advocates Forum member

BRAIN INJURY LAW Injury CENTER - law Advocates for Brain Injury Survivors Brain Center - Advocates for Brain Injury Survivors and their Families Throughout the United States and the World.

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and their families throughout the United States and the world. Law Dragon ~ 500 Leading Lawyers in Acquired Brain Injury

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BRAIN INJURY M. Smith Stephen LAW CENTER™ “The Brain Injury Law Center is the only law firm Cerebral Palsy

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(877) 840-3431 (757) 650-9818 in the United States dedicated exclusively(direct) in representing brain injury victims, survivors and their Acquired Brain Injury • Auto and Motorcycle Accidents • Brain Injury Litigation • Railroad Accidents • Maritime Injuries Plane Crashes • Tractor Trailer / Truck Crashes • Cerebral Palsyboth • Wrongful Death • Medical Negligence families. I have dedicated my personal and professional life to helping brain injury survivors and E-mail: ssmith@braininjurylawcenter.com | Website: of www.braininjurylawcenter.com their families and other victims catastrophic events.”

A Healthy Mouth Helps Ensure A Lifetime of Health

WRITTEN BY DR. SEBASTIANA GAGLIANO SPRINGMANN

ccording to the American Dental Association, most Americans enjoy excellent oral health and keep their natural teeth throughout their lives. But beyond the benefits of an attractive smile, does oral health really matter? You’ve probably heard the phrase “the oral–systemic link.” There is an important correlation between L A oral health and overall health. In other words, T DEN H healthy mouth = healthy body. The same culprits LT HEA AGE, behind gum disease, tooth decay and oral cancer VERY GE are linked to heart disease, diabetes, obesity and AT E A Y ST other diseases. EVER Regular dental examinations and good oral hygiene at home can prevent most dental disease. What should good oral hygiene include? Here’s a look at what you can do at various life stages to maintain a healthy mouth and, ultimately, a healthy body.

Sebastiana Gagliano Springmann, DDS, has practiced dentistry in Williamsburg since 1992. She attended New York University, the College of William and Mary and VCU Medical Center, formerly known as the Medical College of Virginia (MCV). Her volunteer work includes Smiles for Life, Donated Dental Services and Smiles for Success. She is an active supporter of William and Mary Athletics and the Heritage Humane Society.

40 THE HEALTH JOURNAL

AGE 0 TO 12 MONTHS A baby’s first tooth erupts between zero to 12 months of age, and he should have his first visit to the dentist by the first birthday. (Easy to remember: all firsts!) Parents should clean Baby’s gums with a wet washcloth after feedings (nursing or bottle) and begin brushing once any teeth have grown in. Avoid bedtime bottles (other than water), which can lead to baby-bottle tooth decay or “nursing cavities.” Tooth decay is always about the bacteria, and bacteria feed on sugars.

1 TO 3

AGE YEARS From age one to three years, more primary (baby) teeth come in. Parents should brush their child’s teeth at least twice daily, limit juice and provide a frozen teething ring to help ease teething pain. Children can start learning to brush on their own around age two, but parents still need to supervise and/ or do a second sweep of brushing themselves. Every six-month checkup with the child’s dentist is important. If any cavities are detected, removing the decay and placing fillings is important to keep the toddler’s mouth developing properly. You’ve all heard people say, “Oh, they’re only baby teeth.” Not so—they perform an important function, so keeping them is key.

3 TO 7

AGE YEARS Somewhere between three to seven years of age, a child begins to lose baby teeth and the first permanent molars begin to erupt. Thumb-sucking and other related habits can cause bite problems that will require correction with surgery or braces. Your child’s dentist will take radiographs to determine any areas of decay and evaluate whether the teeth and bones are forming properly. Sealants should also be placed on any teeth with deep grooves to help prevent chewing-surface cavities.

A HEALTHY MOUTH Depends on What You Put in It To help prevent tooth decay and gum disease, eat a well-balanced diet based on the USDA food pyramid (www.mypyramid.gov), take dietary supplements as directed by your physician, and drink lots of water. These practices will also reduce your risk for heart disease, diabetes and obesity.

Treat yourself

7 TO 13

AGE YEARS A child will lose all his baby teeth between seven and 13 years of age. Regular brushing, dental checkups, fluoride treatments (as recommended by a dentist) plus daily flossing are part of a healthy routine. It may be time for a visit to the orthodontist for braces. If the child is active in any contact sports, a sports mouth guard should be used to prevent tooth breakage or loosening as well as trauma to the jaw or concussions.

you deserve it!

13 TO 25

Here’s a look at some of the

ORAL HEALTH ISSUES that affect men and women disproportionately: WOMEN Eating disorders—bulimia can destroy tooth enamel, while anorexia can deplete the body of vital nutrients and affect the health of teeth and gums.

Oral contraceptives—progesterone-containing birth control pills can inflame gum tissue by elevating the body’s reaction to the toxins that dental plaque creates. Pregnancy—increases risk for gingivitis and pregnancy tumors in the mouth.

Menopause—hormone changes and certain medications can cause dry mouth.

MEN Tooth loss—Men are more likely than women to experience tooth loss. The average male will lose 5.4 teeth by age 72. Smoking—Men who smoke will lose an average of 12 teeth by age 72!

Gum disease—Men are more likely than women to develop gum (periodontal) disease and oral cancer.

AGE YEARS Adolescents and young adults need to brush and floss twice daily and also use a daily fluoride rinse. It’s a good idea to keep travel toothbrushes in backpacks, purses or briefcases for use at or after school and work. Limit sugary or starchy foods and soft drinks. Don’t smoke, and beware of oral piercing. Bacteria tend to cluster around metal piercings, not to mention that biting on metal can crack the back teeth. During this time, an oral surgeon should be consulted for the removal of wisdom teeth.

ADULTS

SPECIAL CONCERNS OF Along with all the other health concerns adults face, oral health needs, too, may become more complex. Cavities can form around existing fillings, and root decay is common. Tooth and gum sensitivity may develop, crowns may be needed to strengthen damaged teeth, and gum disease—a major cause of tooth loss—may require treatment. Ninety-five percent of oral cancers occur in people over age 40, so be sure to have a thorough oral cancer screening at each six-month dental checkup.

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70s, 80s, 90s AND BEYOND

People in this age group may need replacement fillings and crowns as teeth break or wear. Implants can replace missing teeth, and much like a new knee or hip, implants can let you function normally again without relying on dentures. Many seniors suffer from dry mouth, whether caused by age or medications like decongestants, antidepressants and blood pressure medicines. Saliva rinses away food particles and neutralizes harmful acids, therefore playing a major role in cavity prevention. Your dentist can help you select special products to help alleviate dry mouth symptoms. Drink lots of water and avoid sweets, tobacco, alcohol and caffeine to fight gum disease, dry mouth and decay. (Sugar-free chewing gum and some other products that your dentist can recommend may help.) Those in this age category should use a topical fluoride as directed by their dentist, and dental tools such as rotary brushes (as they have large handles) and irrigators (such as Water-Piks™) if arthritis makes handling a toothbrush or floss difficult. More frequent visits to the dentist may be needed to combat gum disease and root decay.

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www.knowyourteeth.com — View the visual timeline “The Life of a Tooth,” courtesy of the Academy of General Dentistry. Also worth checking out is the Dental Diary widget.

www.ada.org — The American Dental Association’s website has an easy-to-use database, Oral Health Topics A-Z.

www.crowncouncil.com — Quick, easy-to-read information about the links between oral health and overall health.

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Surgery

Johnstuart M. Guarnieri, M.D. Board Certified Plastic Surgeon

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profiles Dr. Lisa Harris [Nov. 2009] 42 THE HEALTH JOURNAL

rgery rdiac su a c f o r o ar profess ovascul i d d n r a a r C i e f the ce cha Medicin irector o tion: Vi d y a r ; p a y u t t c i n c s e O plem niver enter/ mbia U the Com f o r e edical C d at Colu M n u n o a f i tor, er te and al direc c Presbyt i a n i i b l Institu c m ital; co at Colu a.; About his new beauty book with Michael n Hosp a i r Program outh, V e t m y s t b r s o e r P P , e Roizen: What Mike and I realized very early on is t k r u t o i NewY TV host art Inst e d H n s a that [humans] are hardwired to look for beauty, r t u s co olumni c Bon Se , r o h t and both men and women need to figure out ed au acclaim who we are going to mate with. As we began to Ohio veland, e l C look at what humans across the planet see as : n w rk, N.J. Hometo a P e beauty, we learned it is not the color of your d i s s: Cliff a, Zoe e l l d e i b s e a r r eyes—it is the symmetry of your body, the A tly aphne, D Curren — n e r texture of your skin and the body in your hair, child e, Lisa; f i because they reflect your health. There are W : ; y l y t Fami niversi U d r also subconscious odors called pheromones r a e v iv ar and Ol ss gree, H e e d n i e s t that stimulate the olfactory glands, and they u a B a ergradu er’s in i t d s n n a a v U l M : y can actually make you attractive or not ation e and Penns Educat Medicin sity of f l r e o o tractive to somebody, depending on if you o v r i h o c t n c S U siness joint Do egrees, u d B n o are compatible or not. n i o t t istra d Whar n a Admin e n i c of Medi binet: lly, School How he balances stress: For most icine ca , K-Y Je d n e e f m o r s i p bu nh e i i , n i d s people, what is really stressful is lack a n d i fi M l A f dou’l Tom’s o n, Ban , i r What y i m l p of control. What I try to do is autoa s a B ismol, (replace a, Tiger h c s i u n r r b mate certain portions of my day to Pepto-B A h t , lm, too re pads a a b c a p i l m r s simplify it. My morning routine is The ’s Bee floss te, Burt l s a a t very set. I get up at 5:30, do seven p n h e t o d to onths), m o minutes of yoga, shower, shave and w t every

Mehmet C. Oz, M.D.

INTERVIEW BY SHARON MILLER CINDRICH PHOTOGRAPHY BY BRIAN M. FREER

o countless fans of the Oprah Winfrey show, Dr. Mehmet Oz is “America’s Doctor”—a term coined by the talk show queen herself. But Hampton Roads residents may be surprised to learn that in addition to being the vice chair of surgery and professor of cardiac surgery at Columbia University—as well as director of the Cardiovascular Institute at Columbia Presbyterian Medical Center—Dr. Oz is the co-clinical director of Bon Secours Heart Institute, located at Maryview Hospital in Portsmouth. As if his medical commitments weren’t enough to keep him busy, Oz is the co-author of five books in his “YOU” series: YOU: The Owner’s Manual; YOU: The Smart Patient; YOU: On a Diet; YOU: Staying Young; and the most recent, YOU: Being Beautiful, released in November 2008. He’s also the host of “The Dr. Oz Show” on XM Satellite Radio’s Oprah & Friends channel. He is chief medical consultant to Discovery Communications for which he has hosted several popular series, including “Transplant!” which won both a Freddie (the International Health and Medical Media Award) and a Silver Telly award (recognizing the best in local, regional and cable TV). In addition to numerous appearances on “Good Morning America,” he has guest hosted “The Charlie Rose Show” and appeared on all the national evening news broadcasts. He served as medical director of Denzel Washington’s film “John Q” and has participated in several other feature films. He also has a regular column in Esquire magazine. Dr. Oz is known for eschewing the pretenses that typically surround a person of his celebrity, and his Nov. 25 interview with the Health Journal held no exceptions. He was gracious, charming, easygoing and eager to share the knowledge he has gleaned from his 20-plus years working as a physician, including the impetus behind his latest book, YOU: Being Beautiful; plans for his daily television talk show; and how Americans can take 10,000 steps a day toward better health. Below are excerpts from our interview:

get on the road. I’m in my office by 6:15, and by 8:30, I’ve got the bulk of my day organized and on its way. After 8:30, it is a much less predictable time. But because I got my day organized right and I was proactively involved in planning it, I believe that it helped create what was going to happen in my day. I always emphasize to people that if they aren’t a few minutes early, they’re late. You want to set the agenda by being there on time. On his new talk show scheduled to air in fall 2009: Oprah is being very supportive, so we are going to air right around her show—either just before or just after it. We are out there looking for ideas and thoughts and trying to get ways to get America to change. The big idea behind the show, for me anyway, is that it isn’t just a TV show—it’s a movement. If we get great ratings, but nobody does what I’m telling them about, then I’ve failed. I really want people to change their lives based on what we show them. We’d like the show to be practical and current. We are going to be using the classic “Oprah style”—going into people’s homes and lives, trying to figure out what makes them tick and helping them make it tick better. I also want to take audience questions.

The best health-related advice he can give: Walk. You won’t get hurt, you can do it every day and you are designed to do it endlessly. If you can’t walk, you can’t run. If you can’t walk, you can’t lift. If you can’t walk, you can’t stretch. Buy a pedometer, put it on your waist and walk 10,000 steps a day.

What he is most proud of: Family. In your worst periods of life, when things aren’t going well, it is always your family who will bolster you. There is nothing more effective for stress mitigation than family.

file was o r P s i h T d in our publishe edition. 9 0 0 2 January

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