Carilion Clinic Living - Spring 2015

Carilion Clinic

Inspiring better health.

SPRING 2015

in this issue COSMETIC CENTER TO OPEN 9 A NEW TREATMENT FOR HEART FAILURE 10 HOW HOSPICE CARE UNITED A FAMILY 12 STAND-UP PADDLE BOARDING TAKES OFF 19

Diabetes: Are You at Risk?

Through diet and regular walks through her neighborhood, Linda Waltz of Roanoke brought her blood sugar under control.

Dedicated to Caring for Women SPECIALIZED SERVICES TO MEET YOUR NEEDS At Carilion Clinic, we provide the comprehensive services you need for specialized gynecological care. We offer complete outpatient and inpatient care for a wide variety of gynecologic conditions at several locations in Roanoke.

WE CAN HELP WITH: » Incontinence

» Infertility

» Endometriosis

» Gynecologic cancer

» Genetic counseling

» Menopause

Give us a call today and let us help you.

800-422-8482 | CarilionClinic.org

PRESIDENT’S MESSAGE

Are you at risk for diabetes?

This disease is reaching epidemic proportions in our country, but many who have it aren’t aware of the damage being done to their bodies. Our cover story profiles one courageous woman who tackled her diabetes and through exercise and diet was able to get her blood sugar under control. Read the account of her success—and about all you and your family can do to keep this disease at bay.

We also have news about a treatment for heart failure that promises to be a game changer. Called CardioMEMs, it is a wireless sensor implanted in a patient’s pulmonary artery to remotely monitor the heart. Carilion is the first in Virginia and the Carolinas to offer the treatment, which clinical trials have shown significantly reduces hospital readmissions. Eight people in our region have received it so far.

Our patients at Carilion Roanoke Memorial Hospital also have a new tool to help them get better. Through our GetWellNetwork, recently introduced in hospital rooms, patients can watch videos on TV monitors that help them understand their conditions, medications, hospital services, and more. The network will eventually be available at other Carilion hospitals and outpatient facilities.

With spring comes the chance to get back outdoors. And one of the loveliest and most rejuvenating spots in our region has to be Woodpecker Ridge in Botetourt County.

The birds, wildlife, forest trails, and scenic vistas all combine to make it a perfect daytrip getaway. Reading our story will make you want to lace up your hiking shoes and pack a picnic lunch!

WARM REGARDS,

NANCY HOWELL AGEE PRESIDENT AND CEO CARILION CLINIC

AN INVITATION FROM THE PRESIDENT If you live in the Roanoke Valley, the Rockbridge area, or Giles County, Carilion Clinic and community partners invite you to take part in a survey. The survey will assess the community’s health care needs and help determine barriers and access to care. Please take the survey online at surveymonkey.com/s/2015CHNA or by phone at 888-964-6620 through April 30, 2015.

OUR CONTRIBUTORS CARILION CLINIC PRESIDENT AND CEO Nancy Howell Agee CARILION CLINIC 1906 BELLEVIEW AVE. P.O. BOX 13367 ROANOKE, VA 24033 540-981-7000

Karen A. Chase is an award-winning novelist who has also written for Virginia publications such as The Richmond Times-Dispatch. She is writing a historical novel about the Declaration of Independence. She lives in Richmond.

Bruce Ingram is an English teacher at Lord Botetourt High School in Daleville. He is the author of five books on fishing, and his articles on the outdoors have appeared in Outdoor Life, Virginia Wildlife, and many other magazines.

Sarah Beth Jones blogs about personal development, was an op-ed columnist for the Greensboro News & Record, and has written for publications including Valley Business FRONT, Mother Earth News online, and Today’s Woman magazine. She lives in Floyd.

CARILION CLINIC LIVING IS PRODUCED BY MARKETING, RESEARCH AND COMMUNICATIONS: VICE PRESIDENT Shirley Holland SENIOR DIRECTOR, COMMUNICATIONS Mike Dame EDITOR Maureen Robb LEAD DESIGNER David Porter DESIGNERS Taryn Anderson, Nicholas Buehring CONTRIBUTING WRITERS Karen Doss Bowman, Allison Buth, Karen A. Chase, Su Clauson-Wicker, Jay Conley, Sarah Cox, Bruce Ingram, Dan Radmacher, Dan Smith, Erica Stacy, Randolph Walker, Alison Weaver PHOTOGRAPHERS Darryle Arnold, Jared Ladia PRINTING Chocklett Press

Dan Smith is an award-winning journalist and photographer, an essayist on public radio, and a member of the Virginia Communications Hall of Fame. He is the author of a novel and several nonfiction books.

Randolph Walker is a writer and musician in Roanoke. Formerly a staff writer with The Roanoke Times, his work has appeared in many publications including Virginia Living, Valley Business Front, and The Roanoker.

Alison Weaver is a freelance writer based in Roanoke. Her work has appeared in Valley Business Front, The Roanoke Times, Good Housekeeping, Woman’s Day, Redbook, and Seventeen.

CARILIONCLINIC.ORG | 800-422-8482

Carilion Clinic is a not-for-profit health care organization based in Roanoke, Va. Through our comprehensive network of hospitals, primary and specialty physician practices, and other complementary services, we work together to provide quality care close to home for nearly 1 million Virginians. With an enduring commitment to the health of our region, we also seek to advance care through medical education and research to help our community stay healthy and inspire our region to grow stronger.

Copyright 2015 by Carilion Clinic. No part of this publication may be reproduced or transmitted in any form or by any means without written permission from Carilion Clinic. Articles in this publication are written by journalists or authors who strive to present reliable, up-to-date health information. However, personal decisions regarding health, finance, exercise and other matters should be made only after consultation with the reader’s physician or professional advisor. All editorial rights reserved. Opinions expressed herein may or may not reflect the views of Carilion Clinic.

If you would like to be added to or removed from the mailing list for Carilion Clinic Living, please call 800-422-8482, email us at direct@carilionclinic.org, or write to us at Marketing, Research and Communications, 213 McClanahan St., Roanoke, VA 24014.

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CONTENTS

10 16 features 5 GETTING WELL

A new program helps patients.

9 COSMETIC PROCEDURES

A cosmetic center will soon open.

10 HEART FAILURE A new implant saves lives.

12 HOSPICE

departments 1 PRESIDENT’S MESSAGE Diabetes is reaching epidemic levels.

20

A family expresses thanks for end-of-life care.

14 AUTOIMMUNE DISORDERS There are new treatment options.

16 DIABETES

You can take steps to prevent this condition.

4 SUPERFOODS

19 SPORTS

6 HEALTH NEWS

20 RECREATION

22 IN YOUR COMMUNITY

23 PATIENT CARE

Stand-up paddle boarding takes off.

Enjoy kale in all kinds of dishes.

Research findings that can improve your life.

Making a difference in western Virginia.

25 NEW PROVIDERS

New physicians and advanced care providers.

Enjoy nature at Woodpecker Ridge.

24

Awards recognize outstanding care.

24 HEALING

Pets help hospitalized patients heal.

28 RECIPE

What’s for breakfast? Blueberry-Oatmeal Cakes.

CarilionClinic.org | SPRING 2015 3

SUPERFOODS

Superfoods: Kale Are you looking for a versatile veggie that tastes great and is incredibly good for you?

Look no farther than kale.

You can munch it raw as a snack, toss it with fruit or other vegetables for salads, shred it in soups, or sauté it as a side dish for dinner. It also pairs well with a variety of herbs and spices.

Best of all, kale is loaded with nutrients. It is chock full of vitamins A, C, and K, has cancer-fighting flavonoids, and acts as an anti-inflammatory. It contains minerals such as potassium, iron, and copper.

Along with its dark-leafy-green goodness comes fiber that keeps you full and helps regulate your blood sugar. Add calcium and protein to the mix, and you have a vegetable that meets many nutritional needs.

In the Middle Ages, kale was a common vegetable in Europe and Asia. Lately it has become such a nutritional darling in the U.S. that it is popping up in restaurants and has spawned a number of cookbooks.

Two of the latest are Kale, Glorious Kale and Let Them Eat Kale!

Available in the grocery store and at farmers’ markets, kale is also easy to grow in your own back yard. And it comes in a number of varieties and colors, including pink and purple. With a small investment of time and money, you could reap a colorful bonanza every summer.

Still need more ideas for how to eat kale? Why not try: » Topping your pizza » Tossing with pasta » Mixing in smoothies » Grinding into pesto » Baking yummy kale chips.

Your friends and family will thank you!

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MEDICAL NEWS

New Network Empowers Patients It takes only a trip or two on an airplane to become familiar with the pre-flight routine where flight attendants run through safety procedures. But for inexperienced fliers, it’s exactly the kind of information that empowers them.

“We want patients to have similar expectations,” says Andrew Kellam, Carilion Clinic’s interactive patient system manager. “We want patients to walk into the hospital expecting to learn and be involved in their care so they can have the best outcomes possible.”

Interactive in Kellam’s title is not just a description; it’s the guiding focus of Carilion Roanoke Memorial Hospital’s new patient care system, the GetWellNetwork (GWN).

Newly installed in patient rooms, the GWN might not look much different from a standard TV at first glance. Behind its simple exterior, though, are two care-changing functions.

First is an extensive entertainment package, including on-demand Hollywood movies, online arcade games, soothing relaxation audios and visuals, and full access to the Internet.

“It really helps to have a distraction

while receiving treatment,” says Mandy Allen, R.N., of the Pediatric Intensive Care Unit. “It helps take away some of the worry and discomfort of lying in bed.”

Second is a 700-video library designed to educate patients and their families about every aspect of their illness and care.

“It really stimulates your ability to remember both information about your diagnosis and how to better care for yourself...”

—A NDREW KELLAM; INTERACTIVE PATIENT SYSTEM MANAGER “There are videos about getting X-rays, MRIs, and other procedures that show pictures of the machines, which I think helps reduce the anxiety levels in ways that we couldn’t when it was up to nurses to just describe to patients what to expect,” says Allen.

“Imagine someone just telling you about your newly diagnosed heart condition,” says Kellam. “Now imagine also watching a video with an animated pic-

ture of the heart that shows you visually what’s happening. It really stimulates your ability to remember both information about your diagnosis and how to better care for yourself once you return home.”

The system includes an option for patients to offer real-time feedback to hospital staff, giving nurses and nurse managers a boost from the positive feedback, and an opportunity to resolve issues immediately if problems are reported.

Over the next two years, Kellam hopes to not only expand the system to other Carilion hospitals and every outpatient facility, but also to add more features.

These will include an electronic whiteboard in the hospital to display messages along with photos and bios of every member of a patient’s care team, and access to all prescribed videos from any computer through a patient’s MyChart account.

“Our goal is to influence health care change in our community,” says Kellam.

“We want patients and their families to engage with us so that together we can make the best care decisions possible, resulting in better outcomes.”

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HEALTH NEWS

Does Your Child’s School Stock a Life-Saving Drug?

Many states are passing laws allowing or requiring schools to stock epinephrine in case a child suffers a severe allergic reaction. The drug is the main treatment for anaphylaxis, which can cause trouble breathing, throat swelling, and a plunge in blood pressure — or even lead to death. The laws are intended to help children with severe food or drug allergies. For more information, go to bit.ly/allergic-reactions.

Contact Lens Misuse Causes Eye Infections Almost a million Americans suffer eye infections each year after wearing their contact lenses too long, or not cleaning them well, according to a new report by the U.S. Centers for Disease Control and Prevention.

Sleeping with lenses on, or letting them get wet while in the shower or swimming, significantly raised the risk of infection. See more study results at bit.ly/contacts-misuse.

A Single Blood Test for Cancer?

Scientists are moving closer to developing a single blood test for many cancers. They have identified more than 800 markers in the blood of cancer patients and are optimistic that a blood test can be created. Such a new approach to detect cancer early would save many lives, researchers said. For added information, go to bit.ly/cancer-test.

Too Many Adults over 45 Lack Muscle Strength Less than 25 percent of adults over 45 have enough muscle strength to sustain good health, according to a new study. They are advised to take up strength training, which can involve situps, push-ups, lifting weights, yoga, elastic bands, or weight machines. Learn more at bit.ly/muscle-guidelines.

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Are Babies from Green Neighborhoods Healthier?

Women from leafy, green neighborhoods have fewer premature or underweight babies, a new study suggests. After analyzing data from 64,000 births, researchers found that mothers who lived in areas with trees, grass, and plants were 20 percent less likely to have very preterm babies, or those born before 30 weeks. Find out more at bit.ly/green-neighborhoods.

Obesity Linked to ‘Silent’ Heart Damage Obesity may cause heart damage that produces no symptoms, researchers found. In a study of more than 9,500 people aged 53 to 75, heart damage was also seen in those who didn’t have such risk factors as high cholesterol, diabetes, or high blood pressure. For more information, go to bit.ly/silent-damage.

Hand Dryers in Restrooms May Spread Germs Warm-air dryers in restrooms may spread more germs than paper towels, according to a new study by British researchers. When they measured bacteria in the air around the dryers, they found more germs than around the paper dispensers. The bacteria also lasted 15 minutes after the dryers were used. See more study findings at bit.ly/hand-dryer-germs.

Do You Grind Your Teeth?

An estimated 40 million Americans grind their teeth — some so severely that they break dental fillings or otherwise damage their teeth. Morning headaches and facial pain have even been linked to teeth grinding. Stress, along with other psychological and physical causes, has been identified as a culprit. For suggestions on how to deal with the condition, go to bit.ly/grinding-teeth.

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RESOURCES

RESOURCES TO KEEP YOU HEALTHY CARILION DIRECT

MOBILE RESOURCES

“WELL SAID” SPEAKER’S BUREAU

Stay connected with our mobile apps, available for iPhone and Android: Carilion Clinic Mobile Health Resource – Use our interactive symptom checker to access the most relevant information in our digital health library, then connect with Carilion services by using the search feature to find Carilion health care providers, hospitals, and urgent care locations near you.

Our physician referral and health information service is here to help. Call us at 540-266-6000 or 800-4228482, or email us at direct@carilionclinic.org.

If you’d like a speaker on a health topic for your community group or workplace, call 540-266-6561 or visit CarilionClinic.org/speakers.

COMMUNITY HEALTH SCREENINGS Health screenings are available at little or no cost.

Call 540-266-6000 or 800-422-8482, or email us at direct@carilionclinic.org.

WEBSITE TAILORED FOR YOU Check out these features at CarilionClinic.org: »» Easy-to-use physician/provider finder »» Interactive maps to help you find your way to our locations »» Health and wellness content, including an A-Z library »» A community health education and events calendar

SOCIAL MEDIA Stay connected to Carilion Clinic through social media: facebook.com/carilionclinic twitter.com/carilionclinic youtube.com/carilionclinic google.com/+carilionclinic pinterest.com/carilionclinic

PUBLICATIONS Pick up a copy of Carilion Clinic Living at magazine racks throughout our facilities, or access the digital edition at CarilionClinic.org/living, where you can also read past issues. For health tips and news about upcoming health screenings events, subscribe to Living’s monthly e-newsletter at CarilionClinic.org/living.

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MyChart – Access your medical record, request an appointment or prescription refill, and stay in touch with your doctor, all while on the go. If you are interested in MyChart, speak with your doctor.

NEWS BLOG Keep up with the latest news, photos, videos, and more at Carilion Clinic’s newsroom.

CarilionClinic.org/blogs/newsblog.

SUPPORT GROUPS Support groups are available for a wide range of health needs, including gynecologic and breast cancer. Learn more at CarilionClinic.org/support.

CHILDREN’S HEALTH For the latest news and perspectives on children’s health care, read Close to Home, a blog by Alice Ackerman, M.D., chair of the Department of Pediatrics at Carilion Clinic. Visit CarilionClinic.org/ blogs/ackerman.

GIVING TO CARILION CLINIC FOUNDATION Be part of improving the health and vitality of communities in western Virginia. Make a gift at CarilionFoundation.org.

MEDICAL NEWS

Cosmetic Center to Open WHAT IS COSMETIC SURGERY? A cosmetic center will open in March in Roanoke.

The new Carilion Clinic Cosmetic Center, located on Rosalind Avenue, will be headed by Kurtis E. Moyer, M.D., Carilion’s chief of plastic and reconstructive surgery. Dr. Moyer will practice there along with Mark Schoemann, M.D., and Mark E. Feldmann, M.D. “We’ve all been trained within the last five to ten years, allowing us to be wellversed on the most up-to-date procedures,” says Dr. Moyer.

The three surgeons are trained in all types of surgical and non-surgical cosmetic procedures, including: »» Abdominoplasty (tummy tuck) »» Blepharoplasty (eyelid surgery) »» Body contouring (after gastric bypass surgery or significant weight loss) »» Breast augmentation »» Breast reduction »» Brow lift »» Breast reduction for men »» Breast lift »» Injections (Botox and fillers) »» Liposuction

There are two types of plastic surgery: cosmetic surgery and reconstructive surgery. Cosmetic surgery is an elective procedure designed to surgically enhance a physical feature. Reconstructive surgery is a procedure that restores or corrects both function and physical features of a part of the body.

Carilion Clinic’s team of experienced plastic surgeons performs both types of surgery and is committed to using the safest approach to achieve the best possible results for each patient. »» Ear surgery »» Rhinoplasty (nose reshaping) »» Face lift The center will also provide spa-level treatments by a medical esthetician, Gina Hunt. These will include laser therapies, micro-dermabrasion, and chemical peels.

Medical-grade, skin-care products such

as Obagi and SkinMedica will be available as well.

“It is unusual to find a practice that can offer this level of comprehensive cosmetic care under one roof in southwest Virginia,” says Dr. Moyer.

The 5,700-squarefoot center will have a soothing, spa-like atmosphere, and when it is completed, Dr. Kurtis E. Moyer the public will be invited to an open house.

“I’m a big believer in education,” says Dr. Moyer. “We strive to teach our patients about procedures, and all their options. We will do the same thing with our new facility. Carilion is recognized as a pillar of service to the community, and everything about our new cosmetic center has that idea behind it.”

To learn about additional cosmetic surgery procedures available, schedule a consultation, or make an appointment, call 540-8530510.

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MEDICAL NEWS

H G U O R H T K A A BRE TING A E R T IN E R U L I A F T R A E H Remote Monitoring a Reality

By Dan Smith Hazel Johnson made medical history last year.

Johnson, 74, of Stewartsville, was the first of eight people in Virginia to receive an implant that monitors the condition of heart failure patients. “My monitor lets the doctors know about any problems before they become serious, and that can keep me from having a heart attack or a stroke,” Johnson says.

Carilion Clinic is the first medical center in Virginia and the Carolinas to provide the treatment, which monitors patients from home.

The wireless implant, a sensor called the CardioMEMS HF System, is about the size of a paper clip. It can be implanted in the pulmonary artery Dr. Stephen G. Phillips 10 SPRING 2015 | CarilionClinic.org

during a minimally invasive, non-surgical procedure to monitor artery pressure.

The device that transmits the data is embedded in a small pillow, and patients lie against the pillow for about 20 seconds each day to send their readings to Carilion’s Heart Failure Clinic. Nurses there monitor the readings, alert for signs of worsening heart failure.

Traditionally, patients have had to make frequent office visits and have their conditions monitored by indirect measures, such as blood pressure or fluctuations in weight.

LIVING WITH HEART FAILURE

An estimated five million Americans live with heart failure, a condition in which the heart is still working but no longer pumping or filling as well as it once did. Patients are often hospitalized, have a reduced quality of life, and face a

higher risk of death.

“Heart failure is the No. 1 reason for readmission to hospitals,” says Stephen G. Phillips, M.D., director of the Heart Failure Clinic in Roanoke. “It accounts for $40 billion a year in medical costs, and two-thirds of that is for inpatient treatment.” Each heart failure patient is hospitalized on an average of once or twice a year, he says.

“Regular monitoring is where treatment is going,” says Dr. Phillips. “We don’t need to see the patients in person as frequently. The cost saving is winwin.”

In a clinical trial, the CardioMEMS sensor reduced the rate of heart failure hospitalizations at six months by 28 percent. There was a 37 percent reduction in hospitalizations during and after 15 months.

NEW PROGRAMS AID RECOVERY Two new programs at Carilion Roanoke Memorial Hospital are also helping heart failure patients.

The GetWellNetwork provides TV monitors and educational videos in hospital rooms so all patients can learn about their conditions, medications, and hospital services. The network is expected to eventually be available at other Carilion hospitals.

“The focus is on information people can understand—delivered in layman’s terms,” says Kathleen Baudreau, senior director of nursing quality and improvement. “We need to communicate in a form and a format that it is useful,” she says. “It is all about patient engagement.”

Hazel Johnson, a Carilion Clinic patient, is monitored daily from her home more than 20 miles away from her physician’s office in Roanoke.

NEW TECHNOLOGY

at the Heart Failure “It is the most amazing technology I’ve Clinic and one of the seen in years,” says Jason Foerst, M.D., nurses who monitors the interventional cardiologist who impatients. “Because planted the sensor in the eight Virginia we had the device, patients. “This just blows our minds.” we were able to nip a “Many of our patients live three to four potential problem in hours away from Roanoke, so the remote the bud.”

Dr. Jason Foerst monitoring is less expensive and much Since Carilion more convenient,” says Dr. Foerst. “The ranks in the top monitoring nurses are aware of the flucthree of Virginia hospitals in the number tuations in pressure well before the paof heart disease patients treated, the potient is aware of heart failure symptoms tential impact on patients is huge. like weight gain and shortness of breath.”

Johnson, who lives 20 miles from Ro“In one or two cases already, if we had anoke, says her monitor saves her from making office visits two or three times a week. “It saves time, gas, and doctors fees,” she says. “I’m delighted with it.”

So are Carilion physicians. “This technology represents an important step in — JASON FOERST, M.D., our comprehensive approach to heart INTERVENTIONAL CARDIOLOGIST failure management,” says David Sane, M.D., chief of cardiology.

“It’s the beginning of a new era in heart not had the device, we would have waited monitoring,” says Dr. Foerst. for a follow-up visit and the patient’s For more information, go to bit.ly/hfcondition would have worsened,” says monitor. To watch Hazel Johnson’s patient story, go to CarilionClinic.org/heart.

Meena Shah, R.N., clinical coordinator

“It is the most amazing technology I’ve seen in years.”

Before they go home, heart failure patients can learn specifically what is wrong with their hearts, what medications they need, how those medications act, and what follow-up care is needed at home, says Andrew Kellam, Carilion’s interactive patient care system manager.

A new pharmacy program, meanwhile, is helping patients to take their meds. Carilion’s pharmacy can now deliver prescriptions to patients’ rooms as they prepare to leave the hospital.

“Patients don’t always buy their needed prescriptions,” says Chad Alvarez, senior director of Carilion’s retail pharmacy systems. “It could mean an extra stop on the way home that they don’t want to make.”

In the past, 30 to 40 percent of prescriptions weren’t filled, he says.

“There is no charge for the in-room service, and medication prices are fully competitive,” Alvarez says. “Insurance co-pays are also the same as they would be elsewhere.”

For more information on the GetWellNetwork, see the story on page 5.

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MEDICAL NEWS

At End of Life

Making the Most of Every Day

For many, hospice is associated with the end of a person’s life. But for two sisters faced with their mother’s devastating illness, it also proved to be a life enhancer.

“I’m a firm believer that we had Mom three months longer because of hospice,” says Beth Croy Tanner.

It was May 2013 when Betty Croy, 81, was diagnosed with Stage IV lung cancer. She’d noticed that she was often tired, was losing weight, and had a nagging dry cough that never went away.

Beth and her sister, Barbara Croy Vesely, describe their mother as a humble “farm girl” who had lots of friends. She was a faithful member of her church in Pearisburg and sold Avon products for over 40 years.

“Mom loved sweets, so we knew something was wrong when she began losing weight,” says Barbara.

When Betty received her diagnosis, chemotherapy was presented as a treatment option. Barbara and Beth told their 12 SPRING 2015 | CarilionClinic.org

By Karen Dillon

mother that they would support her in whatever course of treatment she chose.

At first, Betty decided to forego chemotherapy and instead began taking a prescription drug to ease her pain. But she experienced serious adverse side effects. Low-dose chemotherapy became the next option, but before she could begin, she fell and broke her leg.

Betty then spent 20 days at Carilion Giles Community Hospital recovering from leg surgery in December 2013. “She had no complications and no pain,” says Beth.

On Dec. 30, Betty went to live with Beth and her family in their Pearisburg home (Barbara lives in Memphis, Tenn.). It was also the first day that Carilion Clinic Hospice came to care for Betty.

“At that point, we’d never had to experience anything like this,” says Beth. “Signing over care to hospice was an unknown to us.”

Left: Barbara Croy Vesely (at left) and her sister, Beth Croy Tanner, hold photos of their mother, Betty Croy.

L to R: Betty Croy; Betty with Barbara and Beth.

AN INDIVIDUAL CARE PLAN

The first two weeks were busy at Beth’s home. The hospice team made sure that the equipment needed to care for Betty was properly delivered and that she had her medications.

“Once it settled down, those people became my family,” says Beth.

Hospice caretakers created an individualized care plan for Betty that included stress relief techniques to keep her comfortable and relaxed. The care provided kept their mother alert, mobile, and as independent as she could be, the sisters say.

Beth and Barbara also felt empowered to care for their mother due to the support they Betty Croy got from hospice staff. Having never gone through a prolonged illness, they admitted they didn’t know what to expect and had many questions.

“Hospice equipped us and trained us enough that when faced with a difficult situation, we knew what to do,” says Barbara. “And if we really tripped up, they were always a phone call away,” says Beth.

As Betty’s health slowly deteriorated, Beth kept a journal so she could remember her mother’s final days. In the last two weeks of Betty Croy’s life, Beth and

Barbara prepared for the service that would be a celebration of her life.

Betty Croy passed away on May 28, 2014. While still grieving, the sisters find comfort in the care she received and are thankful for the time they had with her.

ENHANCING HER FINAL DAYS

Beth and Barbara say they will forever cherish the quality time hospice allowed them to have with their mother. “Because of the care hospice provided and because they monitored Mom’s pain, she was able to stay relatively coherent until the very end,” says Barbara. “Mom was dying with dignity.”

After Betty’s death, the sisters wrote a letter to the editor of the Virginian Leader, Giles County’s local newspaper, recognizing Carilion Clinic Hospice for the care it provided.

“They taught us to be what Mom needed us to be on the difficult days,” the sisters wrote. “They told us the importance of holding her hand because it showed Mom that she would not face death alone. Hospice eased our fears of death and showed us the way to be physically and emotionally present with our mother during her final days with us.”

Beth has since been inspired to share her family’s experience with others.

“What I learned from hospice was just amazing,” she says. “I can’t even begin to wrap my head around what would have happened without hospice.”

Barbara adds: “Hospice does not mean

WHAT IS HOSPICE? Hospice professionals provide expert pain and symptom management, caregiver education, and emotional and spiritual support for the patient and family. Typically patients who enter hospice early live longer and better.

The hospice team consists of physicians, nurses, social workers, health aides, volunteers, chaplains, and bereavement counselors who take the time to get to know patients and their loved ones.

Whether patients live in a private residence, a nursing home, or an assisted living facility, hospice care allows them to spend their last days in comfort surrounded by family and friends.

That is the mission of Carilion Clinic Hospice, says Aubrey Knight, M.D., a Carilion specialist in geriatrics and palliative medicine. “The goal is to provide specialized care for that individual in order to allow them to spend their last days with family where they want to be—at home,” he says.

a death warrant. Instead it prepares you for the journey — for what’s going to happen.”

Carilion Clinic Hospice has offices in Roanoke, the New River Valley, and Franklin County. For more information, visit CarilionClinic.org/Hospice or call 800-964-9300.

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MEDICAL NEWS

Is It an Autoimmune Disease?

ADVANCES IMPROVE TREATMENTS

By Alison Weaver “Being a rheumatologist is like being a detective at times,” says Shanthi Dhaduvai, M.D. “Each patient presents a challenging puzzle of symptoms and it’s our job as physicians to figure out what the problem is.”

wide range of symptoms that at first might appear to be unrelated. “No two people have the same symptoms, depending on which organs are affected,” he says. “Lupus, for example, means very different things to different people. Cold Rheumatology is a subspecialty of toes, mouth sores, painful breathing, internal medicine dedicated to diagnosrashes, eye problems, and unexplained ing and treating disorders of the bones, fevers can all be symptoms of lupus.” joints, and muscles, often caused by auDetecting the cause of such diverse toimmune diseases. symptoms can require a variety of blood “Many people don’t really know what tests, X-rays, MRIs, biopsies, and electrorheumatology is,” notes Adegbenga physiological testing, but “the most imBankole, M.D., Carilion Clinic’s chief of portant tools doctors have are our eyes rheumatology. “Sometimes they know and ears,” Dr. Dhaduvai says. “We take that we treat arthritis, but they might very careful patient histories, listening not realize that we treat all types of auto- to every detail, and do comprehensive immune or auto-inflammatory ailments, exams.” such as gout, lupus, and scleroderma.”

Dr. Bankole says that many patients The body’s immune system detects and come in convinced that they have a cerdestroys harmful viruses and bacteria by tain disease based on a blood test alone. creating antibodies. However, sometimes “Fifteen to 20 percent of the population the system goes haywire and begins would have positive blood tests if you attacking healthy cells. “We don’t know randomly tested them,” he says. “That’s for sure what causes that switch to be why we have to look at all of the clues to tripped, but research indicates that it’s make a diagnosis.” partly genetic and partly due to environCarilion’s rheumatology department mental causes,” Dr. Bankole explains. provides laboratory, imaging, and infuAutoimmune disorders can cause a sion services on-site. “It’s like one-stop

14 SPRING 2015 | CarilionClinic.org

L to R: Dr. Shanthi Dhaduvai and Dr. Adegbenga Bankole say autoimmune disorders can cause a wide range of symptoms that at first might appear to be unrelated.

shopping for our patients,” says Dr. Bankole. “We’re one of only a few facilities in the region that incorporate research, medical education, and clinical services in a single location.

“Because autoimmune diseases can affect so many different parts of the body, we work with a team of specialists that might include orthopaedists, neurologists, occupational and physical therapists, dermatologists, and dietitians.”

In addition to Dr. Bankole and Dr. Dhaduvai, Carilion’s rheumatology department includes Robert Johnson, M.D., and John Pendleton, M.D., both of whom have more than 20 years’ experience. “They don’t just have two decades of clinical experience,” Dr. Bankole says.

“They have 20+ years of being at the forefront of research and new treatments.”

Jeff Croteau, M.D., Carl Henderson, D.O., and nurse practitioner Sandy Sandridge-Moser are more recent arrivals in the department. “We are committed to recruiting the best candidates who share our enthusiasm for teaching medical residents and conducting research,” Dr. Bankole says.

MAJOR ADVANCEMENTS

“Over the past 15 to 20 years, there’s

been a dramatic change in our ability to treat autoimmune disorders,” Dr. Dhaduvai says, ”primarily due to new medications called biologics.”

These biological drugs, which have been available only since 1998, are genetically engineered medicines that mimic naturally occurring proteins in the body. “Biologics are given to lessen inflammation and can target very specific areas,” Dr. Bankole says. “They are usually used in conjunction with traditional medicines such as prednisone, and they’re most often delivered by injection or IV. Because they can have significant side effects, they’re not for mild symptoms that can be managed other ways.”

Both doctors emphasize that biologics do not cure autoimmune diseases. “We can’t reverse the damage that’s already been done, but we can control the symptoms and stop the progression,” Dr. Bankole says.

“The new medications are one reason I wanted to go into the field of rheumatology; they allow us to really help people,” Dr. Dhaduvai says. “When I hear someone use the term ‘crippling arthritis,’ it surprises me. Arthritis is no longer a crippling, disfiguring disease if it’s treated early on.”

PREVENTION

Dr. Bankole has two pieces of advice for helping prevent autoimmune diseases: take care of your teeth and quit smoking.

“People are really surprised to hear that keeping your teeth and gums healthy can go a long way toward preventing disease,” he notes. “The mouth contains many types of bacteria, some helpful and some harmful. Mouth ulcers or bleeding gums can allow bacteria to enter the bloodstream and spread rapidly throughout the body. You wouldn’t ignore a bleeding eye; don’t ignore bleeding gums.”

Evidence continues to mount that smoking cigarettes increases the risk of developing autoimmune disorders, including rheumatoid arthritis, lupus, and Grave’s hyperthyroidism. In fact, according to the U.S. Department of Health and Human Services, smoking doubles the risk of developing rheumatoid arthritis.

“We’ve known for a long time that smoking increases inflammation in the body and weakens the immunity system,” Dr. Bankole says. “More and more research is showing the link between cigarettes and the onset of autoimmune diseases.”

For more information, go to CarilionClinic. org/rheumatology.

CarilionClinic.org | SPRING 2015 15

COVER STORY

DIABETEreS:

Which Futu ? e s o o h C u o Y l il W Diabetes can sneak up on you. Ask Linda Waltz.

Waltz, now 65, was admitted to Carilion Roanoke Memorial Hospital in 2013 for an unrelated health issue. Routine blood tests were done. Waltz was stunned when her providers told her she was diabetic.

Her blood sugar level was 455 milligrams per deciliter. (Normal on a fasting blood glucose test is between 70 and 100 mg.)

16 SPRING 2015 | CarilionClinic.org

L to R: Linda Waltz eats more fruits and vegetables as part of a diet designed to help control her diabetes. Kate Jones, a Carilion Clinic registered dietitian and diabetes educator, compares the nutritional values of popular breakfast foods.

STUDY SEEKS PARTICIPANTS When you come to a fork in the road, know your choices.

If you’re prediabetic, one fork leads to diabetes. The other leads to healthy blood sugar. Sarah Wall wants to help you avoid the road with the “Diabetes” signpost.

By Randolph Walker

“You could have knocked me over with a feather,” she says.

Once she got over the shock, the Roanoke resident got down to business. She started attending diabetes education classes. She learned about the A1C, a test

IT’S AN EPIDEMIC Diabetes affects 29 million Americans, or 9.3 percent of the population, according to the U.S. Centers for Disease Control and Prevention.

Another 86 million, or more than one in three adults, have prediabetes.

Type 2 diabetes is the most common form of the disease. Symptoms include frequent urination, unusual thirst, fatigue, blurred vision, wounds that are hard to heal, and numbness in the hands or feet.

Some people don’t experience symptoms until their blood glucose levels have been high for some time.

The good news is: diabetes is preventable.

that measures average blood sugar level.

Normal is less than 5.7 percent.

“My A1C was 8.2,” Waltz says. “I

started a diet and I’m down to 5.4, and I’ve lost about 47 pounds through walking and diet. I eat a lot of fruits and vegetables. I’ve cut out salt as much as I can.

I’ve cut out white sugar completely and white bread.” Under the management of her primary care physician, Waltz has been able to cut her medication in half, and she only tests her sugar once a week.

Waltz is living (and walking) proof that diabetes can be successfully controlled. And for people whose blood sugar is still in the healthy range, or even slightly elevated, diabetes can actually be prevented.

That’s saying something, because diabetes can be a Dr. Erica Reynolds formidable or even devastating foe. Uncontrolled, it can damage the eyes, feet, nerves, and kidneys and lead to heart attack and stroke.

In people with diabetes, the body cannot regulate the amount of sugar in the blood. Normally, blood sugar is controlled by insulin, a hormone produced by the pancreas. In type 1 diabetes, most often seen in children and teens, the

Wall is project manager for diaBEAT-it, a research study by Carilion Clinic and Virginia Tech. She is recruiting participants through fall of 2015.

“We are working with Carilion Clinic’s family practice clinics to identify participants who might be at risk for type 2 diabetes or be classified as prediabetic in the hopes that we can help them avoid developing type 2 diabetes,” she says.

“We ask our participants to wear an accelerometer that tracks their physical activity for seven days,” says Wall.

“And then we ask some questions about lifestyle, eating habits, social connections and support, things that can contribute to someone’s success in being able to lose weight and stick with the plan.”

DiaBEAT-it does not involve medication. It’s a behavioral and educational intervention based on the Diabetes Prevention Program, a national study that identified lifestyle choices as being more effective at preventing diabetes than medication.

If you’re interested, check with your doctor first. “We don’t take anybody who has diabetes,” Wall says. Then contact the study team at 540-8576668 or 540-857-6066. They will screen you over the phone to determine eligibility.

CarilionClinic.org | SPRING 2015 17

COVER STORY

BARIATRIC SURGERY: MORE THAN WEIGHT LOSS body makes little or no insulin. In type 2 diabetes, which is much more common, the body makes insulin but does not respond correctly to it.

“In the past we mostly saw type 2 diabetes in adults,” says pediatric endocrinologist Erica Reynolds, M.D. “But with increasing rates of obesity, we’re now seeing a lot of type 2 diabetes in teenagers. We also see a lot of kids that don’t have full-blown type 2 diabetes yet, but they might have borderline or prediabetes with risk of developing type 2 diabetes down the road.”

“Frequent urination, blurred vision, fatigue, and excessive thirst are red flags,” says endocrinologist Demetrios Herodotou, M.D. “Even if you don’t have symptoms, you Dr. Demetrios Herodotou should ask yourself: Are you predisposed because of your family history? Are you overweight? Do you have a relatively sedentary lifestyle, unhealthy nutrition? If the answer is yes, you have to be on the alert. You should not go for a year without having a fasting glucose level or an A1C.”

“With increasing rates of obesity, we’re now seeing a lot of type 2 diabetes in teenagers.”

—E RICA REYNOLDS, M.D., PEDIATRIC ENDOCRINOLOGIST

Diabetes can be diagnosed and treated at the patient’s medical home. All Carilion primary care practices have adopted the medical home model, says Wanda Bowman, Carilion’s senior care coordinator in the New River Valley. “The medical home concept is a more comprehensive approach to patient care that has the patient as the focus,” she says.

“A key part of the medical home is the 18 SPRING 2015 | CarilionClinic.org

care coordinator,” Bowman says. “Repeatedly, we hear success stories from care coordinators about patients whose diabetic testing results have improved drastically, and who are losing weight and improving their overall health through healthy food choices and exercise.”

Diabetes education classes have also helped many. “We’re helping folks to understand their diabetes better and giving them the tools to help them manage it so they don’t have to deal with long-term complications down the road,” says Kate Jones, a Carilion registered dietitian and diabetes educator.

Jones would like people to adopt healthy habits early, before diabetes has started. “If they make lifestyle changes, become more active, change eating habits, lose a modest amount of weight, it is very much possible Dr. Kinga Powers to delay or even prevent the development of type 2 diabetes,” she says. Jones recommends exercising at least 150 minutes per week, which breaks down to between 20 and 30 minutes each day.

It may be a cliché, but Waltz is finding that eating an apple a day (and other fruits and veggies, plus exercise) really does keep the doctor away—or at least reduces her medical visits.

“You have to have the mindset that it’s not a death sentence,” she says, “but you do have to control it.”

RESOURCES Carilionclinic.org/diabetes-endocrinology bit.ly/cc-diabetes-support bit.ly/cc-healthy-living

How important is treatment of obesity? Important enough for Carilion Clinic to establish an accredited bariatric center based at 3 Riverside Circle in Roanoke.

To receive the distinction of being named a comprehensive bariatric center, Carilion Roanoke Memorial Hospital and all program providers underwent a rigorous evaluation by outside experts in weight-loss surgery.

Carilion’s surgeons must perform a certain number of procedures each year, show high-quality outcomes, and participate in quality improvement projects. Its team includes a bariatric nurse practitioner, a bariatric coordinator, three surgeons, a medical bariatrician, bariatric nurses, a dietitian, and a psychologist.

In addition to weight loss, bariatric surgery can either cure or improve related diseases including diabetes, cardiovascular disease, obstructive sleep apnea, gastroesophageal reflux disease, and osteoarthritis.

Procedures performed at Roanoke Memorial include gastric bypass, sleeve gastrectomy, and gastric banding. “All of the procedures are done laparoscopically through small incisions, which has eliminated a lot of the long recovery period,” says Kinga Powers, M.D., director of the Carilion Bariatric Program. Gastric banding is also offered at Carilion New River Valley Medical Center.

Carilion’s bariatric center is accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program of the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery.

To learn more about surgical weight loss, call Carilion Direct at 540-266-6000 to register for a bariatric information session. Many insurers cover bariatric surgery.

STAND-UP

REGIONAL INTEREST

Paddle Boarding

By Sarah Beth Jones

IT’S TAKING OFF Imagine standing on a large surfboard.

Now add one long oar capped with a curved paddle. Welcome to stand-up paddle boarding (SUP).

Though some trace SUP back to the 1930s, its modern incarnation picked up steam around 2005 when Hawaiian surfers began using an oar to take them farther out into the ocean. An aid to surfing soon became a sport unto itself when those same surfers noticed that SUP worked a different array of muscles and gave them a fresh perspective on the ocean with which they already felt such a soulful kinship.

Unlike surfing, SUP has a minimal learning curve and can be practiced as anything from a slow, meditative movement to a high-speed thrill ride.

“It’s a great way to be on the water and see the scenery,” says Janet Crawford, a Roanoke-based professional coach. “You can go as fast as you want, as slow as you want. You can take a break, sit down and paddle on your knees, or just sit down and rest. No matter what age you are, you can paddle board.”

Pete Eshelman, director of outdoor branding for the Roanoke Regional Partnership, agrees, saying, “Most of the people I know [who SUP] are in their

mid-30s to mid-40s, but the core demographic are people in their mid-20s to mid-30s.”

Eshelman was a white-water paddler until he and his wife started their family. The intensity of the sport led him to look for an alternative that still offered outdoor adventure. “A river that would be less thrilling in a kayak, like Class 2 water, is more exciting on an SUP,” he says, referring to river rapids that even newbies to white-water paddling could maneuver.

For others, the health benefits of SUP draw them in. The instability of the board activates core muscles while the paddling works the upper body, and all in a low-impact package. Add the aerobic workout and the often peaceful scenery and SUP can also provide notable stress-reduction benefits.

Some have even taken the fitness component further, fusing SUP with other sports including yoga.

“Our SUP yoga classes have been filling faster than we can add boards,” says Patrick Boas, outdoor education coordinator for Roanoke City Parks and Recreation.

“Some things are easier on a paddle board than on the ground, like a handstand. I guess it has to do with the way the board

stabilizes your body. Of course, people do fall but most of the time they pop out of the water with a big smile on their face.”

Though an SUP can cost anywhere from $600 to $1,200 and up, many shops in Roanoke and at Smith Mountain Lake and Claytor Lake offer rentals at a fraction of the price. Classes are also available, including summer classes at Claytor and Smith Mountain Lakes by Blacksburg-based SUP manufacturer Stride, and winter classes in Roanoke at the Gator Aquatic Center.

Whether it’s to take a slow, peaceful paddle; try some yoga; or shoot the rapids, Boas encourages everyone to give it a try. “Go in with an open mind and positive attitude and you’ll go far.”

The 3rd Annual Smith Mountain Lake SUP Race was also held last year.

RESOURCES bit.ly/roanoke-paddle claytorlakewatersports.com smwake.com hfhboats.com roanokeoutside.com CarilionClinic.org | SPRING 2015 19

REGIONAL INTEREST

WOODPECKER RIDGE A LOCAL OASIS

The afternoon was extremely hot, but as my wife Elaine and I drove up the Botetourt County mountainside to the Woodpecker Ridge Nature Center, we could feel the air growing cooler.

Pausing at the entrance, where trees envelop a narrow lane, we heard a pileated woodpecker drumming on a hardwood—announcing to other males of his species that he was on duty and in charge of this particular woodlot.

Woodpecker Ridge, a 108-acre nature preserve just outside of Troutville, is one of the best places in our region to enjoy nature. Verdant trails meander through hardwood forests, pond habitats, and butterfly gardens, offering glimpses of birds and wildlife.

Wood ducks call one pond on the property home, while a cattail pond is frequented by green herons and red-winged blackbirds. The woodlands and brush are habitats for the pileated woodpecker, great horned owl, red-tailed hawk, scarlet tanager, and other birds.

Feeding stations attract many species of songbirds and ruby-throated hummingbirds.

At an elevation of 1,644 feet, Woodpecker Ridge also commands fine views, and many visitors enjoy the 20 SPRING 2015 | CarilionClinic.org

By Bruce Ingram

hawk-watching platform, where broadwinged hawks can be seen sweeping through the valley.

“I’ve been there many times the past 25 years, and it’s a wonderful place,” says Kent Davis, president of the Roanoke Valley Bird Club. “Visitors don’t have to be bird watchers to enjoy coming. The wildflower gardens, ponds, fields, forested knoll, and hawk-watching platform with a great view of the Roanoke Valley add to the experience. Woodpecker Ridge is a wonderful place to get outside and bring a picnic lunch.”

WANDERING THE PRESERVE

After driving down the shady driveway, Elaine and I met owners Barry and Teresa Kinzie at the visitor’s center, where detailed maps of the property are available. Nearly four miles of trails dot the landscape, and Barry shepherded us down a pathway leading to a mature hardwood forest consisting of white and red oaks, ashes, poplars, and red maples.

“This is where I go to hear wood thrushes in the morning,” said Barry.

“There’s no better sound in nature.” He also said that in early summer, he can hear or see 30 species of songbirds between 7 and 8 a.m.

Barry explained why he has thinned

his mature oak/hickory forest and left a number of dead trees standing. “Many people get upset when landowners cut trees, but by cutting certain trees and leaving others, I create a better wildlife habitat so that a greater variety of songbirds can live here,” he said.

“You see that standing dead tree?

Woodpeckers, titmice, and chickadees are all cavity nesters and they need old snags like that one to raise their young.

Cutting down some trees also gives the remaining ones more room to grow and to produce more food for wildlife. I’ve cut down the ashes and poplars around this oak so that it can get more sunlight and produce more acorns.”

We walked to a knoll at the highest point on the Kinzie property. Earlier Barry had predicted that butterflies would be there to greet us, and sure enough, some Red Admiral butterflies flitted about.

“For mating purposes, butterflies often congregate at the highest point in an area, especially if it is in sunlight,” Barry said. “This is also a divide for the James and Roanoke river watersheds.”

We then headed for a man-made bog that Kinzie’s friend Bill Opengari of Montgomery County created a number of years ago. A green frog, also known

Clockwise: The entrance to Woodpecker Ridge; a box turtle basks in the sun; the hawk-watching platform has a view of the Roanoke Valley; one of many toads that live in the ponds; a pipevine swallowtail caterpillar feeds on a leaf; pileated woodpeckers are among the many birds you might see at Woodpecker Ridge.

as a banjo frog because of the “notes” in his mating song, sounded off. Barry said he has tallied as many as seven different species of frogs in the small pool at one time.

Another stop was at a spruce grove that Barry planted several decades ago.

“This is a unique, very cool habitat,” he said. “Magnolia warblers will stop here on their way northward to breed, and purple finches and crossbills will visit come winter.”

PROTECTING THE LAND

The Kinzies placed the Woodpecker Ridge property under a conservation easement in 2010, thus forever protecting the land from development. They also created an easement to open the land to the public.

“I wanted to share my feelings about nature; that’s why all this exists,” Barry

said. “To give people a chance to come here and relax either in the morning or after work and commune with nature is very meaningful to me.

“Our land sort of evolved from a place that we and members of the Roanoke Valley Bird Club could go to enjoy bird watching to a place where we wanted other folks to gain that same enjoyment,” he added. Kinzie credits members of the club for helping him build and maintain trails and determine bird-feeding stations.

“We feel it is very important to protect rural land for the future,” he said. “And we also feel that people should have places where they can walk for exercise and be a part of nature. Coming to Woodpecker Ridge is very good for a person’s mental and physical health.”

Kinzie also gives credit to Genevieve Goss, a former volunteer at Wood-

pecker Ridge and now the Upper James Program Manager for the Valley Conservation Council, a land trust, for encouraging the couple to go the easement route.

Goss, in turn, says: “Woodpecker Ridge Nature Center wouldn’t exist without Barry and Teresa’s love of nature and their generosity in sharing it with others. They’ve protected an oasis of habitat for wildlife and an oasis of peace for walkers.”

RESOURCES Woodpecker Ridge: bit.ly/birding-wildlife roanokevalleybirdclub.com valleyconservation.org virginiaoutdoorsfoundation.org CarilionClinic.org | SPRING 2015 21

IN YOUR COMMUNITY

ATHLETIC CLUBS SHIFT FOCUS TO WELLNESS The Roanoke Athletic Club (RAC), Botetourt Athletic Club, and RAC Xpress have a new focus—wellness.

The clubs will emphasize functional training, which strengthens the core muscles to improve balance, coordination, and endurance. It is designed to condition the body for everyday activities without stress.

“We will be offering programs with a clinical emphasis, like those for pre- and post-surgery patients, to members and non-members alike,” says Bud Grey, who as Carilion Clinic’s vice president of wellness directs the centers. “Some of it has to do with the aging of the population.

We are not just a gym.”

The RAC had a complete physical makeover late last year, which included creating a 2,400-square-foot room for functional training and “assist changing rooms” with private showers and grab bars in the showers. The assist changing rooms will serve the elderly as well as parents with young children.

In keeping with the new focus, the clubs also have new names: Carilion Wellness-Roanoke; Carilion Wellness-Botetourt; and Carilion WellnessDowntown. The Botetourt and downtown facilities will get new logos but are not undergoing renovations at this point.

CARILION HOSPITALS ARE ‘TOP PERFORMERS’ Carilion Roanoke Memorial Hospital and Carilion Tazewell Community Hospital were named “Top Performers on Key Quality Measures” by The Joint Commission, which accredits U.S. hospitals. Roanoke Memorial was recognized for heart attack, heart failure, pneumonia, and surgical care and Tazewell Community was recognized for pneumonia care. Only about a third of the country’s hospitals earned this distinction.

CARILION PROVIDES OVER $138 MILLION IN COMMUNITY BENEFIT

$111 MILLION

UNCOMPENSATED CARE

$22.3 MILLION EDUCATION

$4.2 MILLION

COMMUNITY OUTREACH

$138.8 MILLION COMMUNITY BENEFIT

$1.3 MILLION RESEARCH

SNOW AND ICE IN THE FORECAST? CHECK BEFORE YOUR DOCTOR’S APPOINTMENT

22 SPRING 2015 | CarilionClinic.org

When winter weather strikes, visit CarilionClinic.org before heading to your doctor’s appointment. A red banner will appear at the top of the home page when snow and ice make it too dangerous for travel.

Click on the banner for a detailed list of closings and delays. If there’s no banner, your doctor’s office is on its normal schedule.

In 2013, Carilion Clinic provided $138.8 million in community benefit. This included $111 million in uncompensated care; $4.2 million in community outreach such as free health screenings and community programs; $1.3 million in research; and $22.3 million in investments in education to train new physicians and medical professionals.

Awards Recognize Outstanding Patient Care Patient care is paramount at Carilion Clinic.

To recognize the contributions of our exceptional doctors and medical professionals, we recently announced Carilion’s 2014 Quality Awards.

PALADIN AWARD Brenda Gilliam, R.N., unit director for Presurgical Testing in Roanoke, for 35 years of compassion serving as an advocate for our patients and for quality care.

PROVIDER EXCELLENCE AWARDS RESIDENT Matthew Roby, D.O., resident, Internal Medicine, Virginia Tech Carilion School of Medicine ADVANCED CLINICAL PRACTITIONER Portia Tomlinson, P.A.-C., physician assistant, Neurosurgery PHYSICIANS Mary Beth Sweet, M.D., physician, Carilion Family Practice Roanoke Salem

Nancy Howell Agee, Carilion Clinic president and CEO, and Brenda Gilliam, R.N., Paladin Award recipient.

L to R: Melina Perdue, executive vice president, Carilion Clinic, and the members of the Vascular Progressive Care Unit Community Outreach team: Alicia Broughman; Carla Hazelwood; Cecile Dietrich; Cynthia Gillespie; Tony Derossi; Evelyn Rubongoya; and Andrea Steuart.

QUALITY AWARDS The Creating a Culture of Quiet team from Carilion Stonewall Jackson Hospital worked to provide a quieter environment at night to help patients rest and heal.

The team that worked on the project, Is Safe Care Possible?

Mitigating the Risk of Inpatient Suicides in Medical Hospitals, found ways to reduce the risk of harm for suicidal patients.

The Collaborative Heparin Project team found ways to reduce medication errors related to anticoagulant medications.

The Reducing First-Birth Cesarean Sections team worked to lower the Cesarean section rate for babies born at Carilion Roanoke Memorial Hospital.

VALUES AWARDS Commitment: Vascular ICU Leadership team, Carilion Roanoke Memorial Hospital. Team members were recognized for their work to eradicate central-line infections and ventilator-associated pneumonia on their unit.

Curiosity: Timothy Salyer, R.N., Emergency Department, Carilion Roanoke Memorial Hospital. Tim developed, teaches, and tracks the ultrasound-guided IV program within the department.

CommUNITY: Vascular Progressive Care Unit Community Outreach team, Carilion Roanoke Memorial Hospital. This team was recognized for service to patients, the community, and to fellow employees.

Compassion: Amanda Kitchner, Carilion Clinic Cardiology – Christiansburg. Amanda, a medical office associate, was recognized for the way she connects with patients and for ensuring they get the care they need.

Courage: Joe Castiglioni, Communications. Joe, a videographer, filmed a video series documenting his weight-loss journey through one of Carilion’s FIT Rx programs.

Learn more about these award recipients and their achievements by visiting CarilionClinic.org/Shine2014.

CarilionClinic.org | SPRING 2015 23

MEDICAL NEWS

Clockwise: Alex Lakes lights up when he gets a hospital visit from Ellie, a Pet Pals dog; Cristin Parsons pets Ellie; Gabriel Scott holds Ellie close.

Healing with Pets

Long-Standing Program More Popular than Ever Five-year-old Alex Lakes lay in pediatric intensive care looking tired, his eyes half closed, his mother close by.

When Ellie, a white Golden Doodle, gently placed her paws on Alex’s bed and rested her head on them, looking at Alex, he opened his eyes wide and smiled. He wasn’t yet ready to pet her, but he leaned toward the dog.

Ellie is one of 10 gentle and friendly certified dogs participating in Carilion Clinic’s Pet Pals program. For 14 years, volunteers from the community have taken their dogs to visit patients at Carilion Roanoke Memorial or Community Hospitals.

“The first thing you notice is the smiles,” says Linda Perdue, a Pet Pal volunteer who coordinates the visits. “Everybody smiles: the patients, the staff, the doctors. Everybody.”

Pet Pals dogs include a golden retriever, a St. Bernard mix, a Yorkshire terrier, and a black Labrador. All are certified by Pet Partners, the nation’s largest non-profit registering organization of therapy animals. Pet Partners 24 SPRING 2015 | CarilionClinic.org

runs them through a battery of tests that re-create some of the situations they will encounter in the hospital: people in wheelchairs and walkers, toys on the floor, people being loud or arguing. “It is a high standard that Carilion demands,” says Perdue.

Four more dogs are awaiting certification to join the program.

Perdue accompanies the owners and their pets, who take turns visiting Roanoke Memorial most days of the week for a couple of hours.

HEALING PROPERTIES

Pets are said to have been used in patient therapy for more than 150 years, and one study has found that heart attack patients with pets live longer than those without. Another study found that petting your dog can lower your blood pressure.

Carilion physicians often put in special requests for Pet Pals visits. “They are enthusiastic about it,” Perdue says.

When Ellie eventually stepped into

A Staff Report

17-year-old Cristin Parsons’ room, Cristin immediately sat up on the edge of her bed, smiled, and reached out to touch her. Cristin was only minutes from being released from the hospital following surgery and was in some pain, but the dog seemed to ease that.

“This is so awesome,” Cristin said.

“She’s pretty.” Cristin has two small poodles at home.

“Ellie gets all this attention, which she loves, then goes home and sleeps the rest of the day,” says her owner, Neely Conner, who works at Carilion as manager of the Employee Assistance Program. She is one of two Carilion employees who volunteer their dogs for Pet Pals.

Perdue is delighted that people are starting to recognize and understand the program. “The owners are so proud to be involved in this, and they have to take on some expense to become evaluated and certified,” she says. “There are a lot of warm fuzzy moments.”

For more information about the Pet Pals program, call 540-981-7819.

NEW PROVIDERS Farrell C. Adkins, M.D. General Surgery and Colorectal Surgery Medical Degree: West Virginia University School of Medicine Residency: West Virginia University Fellowship: Colorectal Surgery, Cleveland Clinic Florida 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Jill Devlin, D.O. Obstetrics and Gynecology Medical Degree: Edward Via Virginia College of Osteopathic Medicine Residency: Maine Medical Center 2900 Lamb Circle, Suite 202, Christiansburg, Va 24073 540-731-4578

Sean Burke, M.D. Neurology

Violet Fernandes, M.D. Pediatric Hematology and Oncology

Medical Degree: University of Maryland Residency: Penn State College of Medicine Fellowships: Neuromuscular, Penn State University; Multiple Sclerosis, University of Maryland; Neurophysiology, Allegheny General Hospital 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Medical Degree: Drexel University College of Medicine Residency: Jefferson Medical College/Alfred I. DuPont Hospital for Children Fellowship: Pediatric Hematology Oncology, Children’s National Medical Center 1906 Belleview Ave., 4 North, Roanoke, VA 24014 540-981-7376

Ralph Caldroney, M.D. Internal Medicine

Kevin Griffin, M.D. Urology

Medical Degree: Medical College of Virginia Residency: Medical University of South Carolina Fellowship: Critical Care Medicine, University of Florida 108 Houston St., Suite A, Lexington, VA 24450 540-463-2181

Medical Degree: University of Texas Health Science Center at San Antonio Residency: University of Texas Health Science Center at San Antonio 120 Akers Farm Road, Christiansburg, VA 24074 540-382-3440

Judy Chun, M.D. Urology

Thomas Hamilton, M.D. Family Medicine

Medical Degree: University of Iowa Carver College of Medicine Residency: University of North Carolina at Chapel Hill 120 Akers Farm Road, Christiansburg, VA 24073 540-382-3440

Medical Degree: University of Minnesota Medical School Residency: Richland Memorial Hospital 2252 Magnolia Ave., Buena Vista, VA 24416 540-261-7421

Kevin Combs, D.O. Emergency Medicine; Internal Medicine

Ryan Harris, D.O. Orthopaedic Surgery

Medical Degree: Pikeville College School of Osteopathic Medicine Residency: Norton Community Hospital 141 Ben Bolt Ave., Tazewell, VA 24651 276-988-8850

Medical Degree: West Virginia School of Osteopathic Medicine Residency: Pinnacle Health Hospital Fellowship: Adult Reconstruction and Total Joint, Carilion Clinic – Virginia Tech Carilion School of Medicine 2900 Lamb Circle, Suite L-760, Christiansburg, VA 24073 540-731-2436

CarilionClinic.org | SPRING 2015 25

NEW PROVIDERS Carl S. Henderson, D.O. Rheumatology

Sanjiva M. Lutchmedial, M.D. Pulmonology Medicine

Medical Degree: Rowan University School of Osteopathic Medicine Residency: University of Vermont at Fletcher Allen Healthcare Fellowship: Rheumatology, Duke University Health System 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Medical Degree: University of West Indies Residency: Carilion Clinic - Virginia Tech Carilion School of Medicine Fellowship: Pulmonary and Critical Care Medicine, University of Vermont 2900 Lamb Circle, Suite 7-700B, Christiansburg, VA 24073 540-731-7450

Gregory Howes, D.O. Neurosurgery

David Luyimbazi, M.D. General Surgery Surgical/Oncology

Medical Degree: West Virginia School of Osteopathic Medicine Residency: Midwestern University Fellowship: Stanford University 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Medical Degree: New York Medical College Residency: University of Connecticut School of Medicine Fellowship: Surgical Oncology, City of Hope National Medical Center 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Mark Joseph, M.D. Cardiothoracic Surgery

James Allen Maxey, D.O. Family Medicine

Medical Degree: University of Oklahoma College of Medicine Residency: University of North Carolina Fellowships: Cardiothoracic Surgery and Critical Care/Trauma, University of North Carolina at Chapel Hill 2001 Crystal Spring Ave., Suite 201, Roanoke, VA 24014 540-853-0100

Medical Degree: Edward Via Virginia College of Osteopathic Medicine Residency: Riverside Regional Medical Center 195 Maple Ave., Rocky Mount, VA 24151 540-483-5168

Senaida Keating, M.D. Geriatric and Palliative Care

Kelley Morel, M.D. OB/GYN

Medical Degree: Spartan Health Sciences University Residency: Carilion Clinic – Virginia Tech Carilion School of Medicine Fellowships: Geriatrics Medicine and Hospice and Palliative Medicine, both at Carilion Clinic – Virginia Tech Carilion School of Medicine 2001 Crystal Spring Ave., Roanoke, VA 24014 540-981-7653

Medical Degree: Louisiana State University Health Science Center School of Medicine Residency: Virginia Commonwealth University Health System 102 Highland Ave., Suite 303, Roanoke, VA 24013 540-985-9715

William King, M.D. Urology

Thomas Morel, M.D. Palliative Medicine

Medical Degree: University of Virginia School of Medicine Residency: Bowman Gray School of Medicine Fellowship: Urology Research, Bowman Gray School of Medicine 120 Akers Farm Road, Christiansburg, VA 24073 540-382-3440

26 SPRING 2015 | CarilionClinic.org

Medical Degree: Louisiana State University Health Science Center School of Medicine Residency: Virginia Commonwealth University Health System Fellowship: Hospice & Palliative Medicine, Virginia Commonwealth University Health System 1906 Belleview Ave., Roanoke, VA 24014 540-981-7515

Scott Otallah, M.D. Pediatric Neurology

Isaac Spence, D.O. Family Medicine

Medical Degree: University of Virginia School of Medicine Residency: University of Virginia Fellowship: Pediatric Neurology, University of Virginia 102 Highland Ave., Suite 104, Roanoke, VA 24013 540-985-8454

Medical Degree: Edward Via Virginia College of Osteopathic Medicine Residency: Wake Forest University Baptist Medical Center 901 Plantation Road, Blacksburg, VA 24060 540-951-0352

Biraj Patel, M.D. Interventional Neuroradiology

Shen-Li Tan, M.D. Interventional Cardiology

Medical Degree: Virginia Commonwealth University School of Medicine Residency: University of Cincinnati Medical Center Fellowships: NeuroInterventional Surgery and Diagnostic Neuroradiology, Northwestern University; Neuroendovascular Surgery, University of Wisconsin Hospital and Clinics 127 McClanahan St., Suite 201, Roanoke, VA 24014 540-981-8353

Medical Degree: National University of Singapore Residency: Mayo Clinic Fellowships: Cardiology, Mayo Clinic; Interventional Cardiology, Mayo Clinic 2900 Lamb Circle, Suite 301, Christiansburg, VA 24073 540-731-7600

Christopher Pile, M.D. Palliative Medicine

Priscilla Tu, D.O. Family Medicine

Medical Degree: Eastern Virginia Medical School Residency: Riverside Hospital 2001 Crystal Spring Ave., Suite 302, Roanoke, VA 24014 540-981-7653

Medical Degree: Kirksville College of Osteopathic Medicine Residency: Carilion Clinic - Virginia Tech Carilion School of Medicine Fellowship: Primary Care Sports Medicine, Duke University Medical Center 1314 Peters Creek Rd., Roanoke, VA 24017 540-562-5700

Natalie Powell, D.M.D. Dentistry

Christine Ullman, D.O. Family Medicine

Medical Degree: University of Pennsylvania School of Dental Medicine Residency: VA Medical Center, Washington, D.C. 2017 S. Jefferson St., Roanoke, VA 24014 540-981-7128

Medical Degree: Edward Via Virginia College of Osteopathic Medicine Residency: Lewis Gale - Montgomery 118 Broad St., Dublin, VA 24084 540-674-8805

Shawn Safford, M.D. Pediatric Surgery

Wei Wei, M.D. General Surgery

Medical Degree: University of Pennsylvania School of Medicine Residency: Duke University Medical Center Fellowship: Pediatric Surgery, Children’s Hospital of Philadelphia 102 Highland Ave., Suite 404, Roanoke, VA 540-985-9812

Medical Degree: Tongji Medical University Residency: Carilion Clinic - Virginia Tech Carilion School of Medicine 2900 Lamb Circle, Suite 302, Christiansburg, VA 24073 540-731-7600

CarilionClinic.org | SPRING 2015 27

RECIPE

Add Blueberries to Your Breakfast!

BREAKFAST BLUEBERRY-OATMEAL CAKES

6 SERVINGS

INGREDIENTS

Did you know that blueberries are one of the best foods you can eat?

Loaded with antioxidants thought to protect against heart disease and cancer, they also have other nutrients that may lower blood pressure and keep blood vessels elastic.

These blue gems will help keep you healthy—and happy— throughout your day.

• • • • • • • • • •

2 1/2 cups old-fashioned rolled oats 1 1/2 cups low-fat milk 1 large egg, lightly beaten 1 /3 cup pure maple syrup 2 tablespoons canola oil 1 teaspoon vanilla extract 1 teaspoon ground cinnamon 1 teaspoon baking powder 1 /4 teaspoon salt 3 /4 cup blueberries, fresh or frozen

PREPARATION 1. Combine oats and milk in a large bowl. Cover and let soak in the refrigerator

until much of the liquid is absorbed—at least eight hours and up to 12 hours.

2. Preheat oven to 375°F. Coat a 12-cup nonstick muffin tin with cooking spray.

3. Stir egg, maple syrup, oil, vanilla, cinnamon, baking powder, and salt into the

soaked oats until well combined. Divide the mixture among the muffin cups (about 1/4 cup each). Top each with 1 tablespoon blueberries.

4. Bake the oatmeal cakes until they spring back when touched, 25 to 30 minutes.

Let cool in the pan for 10 minutes. Loosen and remove with a paring knife.

Serve warm.

Per serving: 264 Calories; 9 g Fat: 1 g Sat., 4 g Mono.; 34 mg Cholesterol; 41 g Carbohydrates; 7 g Protein; 4 g Fiber; 219 mg Sodium; 277 mg Potassium 28 SPRING 2015 | CarilionClinic.org

What makes

your children’s hospital special?

We know how to treat patients who can’t tell us where it hurts

Our staff of 350 pediatric professionals is specially trained to care for the unique needs of children

We make going to the doctor less scar y for you and your kids

Because tests, treatments, and facilit ies are tailored to fit your child

Carilion Clinic Children’s Hospital is the only dedicated hospital for children and adolescents in western Virginia.

From allergy shots to stitches to cancer care, we know how to care for kids because it’s all we do!

VISIT OUR WEBSITE TO MEET OUR MASCOT, NED!

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