Carilion Clinic
Inspiring better health.
Women and Heart Disease:
SYMPTOMS ARE OFTEN DIFFERENT THAN MEN’S Heart patient Angela Gillespie of Roanoke.
SUMMER 2014
in this issue E-CIGARETTES: HOW SAFE ARE THEY? 12 A NEW TREATMENT FOR BACK PAIN 16 HEART DISEASE IN WOMEN 18 ARCHERY SURGES IN POPULARITY 24
Valeta Pittman Roanoke, Va.
. e s u f o s r a e y y b n
. N O I L I R A C Y B T L I U B E R w o d n r o Hip w
We partner closely with patients to keep them healthy and out of the hospital. But when surgery becomes necessary, you can trust the region’s most experienced orthopaedics team. Our highly trained surgeons are pioneering new techniques and technologies, including the anterior approach to hip replacement, to help patients recover faster. Just ask Valeta Pittman, who can now tee off without pain. Let us help you rebuild from an unexpected injury or ongoing health condition. It’s what we do every day. Medicare ranked Carilion Roanoke Memorial Hospital as one of the best hospitals in the country for hip and knee replacements.
ING R E F F O W O N E-DEDAIYC SATM OR HOPMAENTS APPOINT
ORTHOPAEDICS 877-544-3770 | CarilionClinic.org/ortho
president’s message Did you know that in this country, more women than men die of heart disease? In fact, one in three women dies from it. But women often have different symptoms than men, and dismiss them too readily. In our cover story, Alison Weaver profiles two women in our region who discovered just in time that their hearts were failing, and whose cautionary tales might help you or someone you love. I hope you’ll read it. Another timely story concerns e-cigarettes. You know, those electronic devices that release nicotine as a vapor, and supposedly help you quit smoking? But do they really? E-cigarettes have never been more controversial, and in his article, Dan Radmacher explores why. You might also be interested in a new, minimally invasive treatment for back pain called oblique lateral interbody fusion, or OLIF. It can help reduce complications, discomfort, and pain, and can promote a faster recovery. Carilion orthopaedic spine surgeon Jonathan Carmouche, M.D., performed the first OLIF procedure Carilion Clinic President and CEO Nancy in Virginia last year. We bring you up-to-date on the Howell Agee (left) greets Shelly Williams, procedure here. a case management analyst, at a meeting And if you’re wondering about all the new constructo update employees on Carilion’s progress and direction. tion across from Riverside Center in Roanoke, take a look at Randolph Walker’s article. A new type of urban neighborhood is taking shape — with greenway and river access, a kayak launch, and a public promenade by the river. I think you’ll find the details exciting!
WARM REGARDS,
NANCY HOWELL AGEE PRESIDENT AND CEO CARILION CLINIC
CarilionClinic.org | SUMMER 2014 1
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 Doss Bowman is a writer who contributes to health care publications, including the University of Virginia’s Vim & Vigor. A native of Bassett, she lives in Bridgewater.
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.
Su Clauson-Wicker is the author of two travel books and the former editor of Virginia Tech magazine. Her articles have appeared in The Washington Post and other publications. She lives in Blacksburg.
CARILION CLINIC LIVING IS PRODUCED BY STRATEGIC DEVELOPMENT: VICE PRESIDENT Shirley Holland SENIOR DIRECTOR, MARKETING Mike Dame BRAND MANAGER Linda Staley EDITOR Maureen Robb LEAD DESIGNER David Porter DESIGNER Taryn Anderson CONTRIBUTING WRITERS Karen Doss Bowman, Allison Buth, Karen A. Chase, Su Clauson-Wicker, Jay Conley, Rachael Garrity, Bruce Ingram, Dan Radmacher, Dan Smith, Erica Stacy, Randolph Walker, Alison Weaver PHOTOGRAPHERS Darryle Arnold, Jared Ladia
Dan Radmacher, former editorial page editor of The Roanoke Times, is a freelance writer and editor. He lives in Roanoke.
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.
PRINTING Chocklett Press
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 2014 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 Strategic Development, 213 McClanahan St., Roanoke, VA 24014.
2 SUMMER 2014 | CarilionClinic.org
contents
8
12
features 5 SLEEP MEDICINE
Behavioral therapy is available to change sleep habits.
8 PEDIATRICS
Meet Ned, the robot who helps kids.
10 GYNECOLOGY
Botox is now used to treat women’s urinary incontinence.
12 E-CIGARETTES
departments 1 PRESIDENT’S MESSAGE Why women’s heart disease can be different.
18
28 BETTER LIVING
Why do we need children’s hospitals?
16 BACK PAIN
A new minimally invasive option is here.
22 RIVERSIDE
6 IN YOUR COMMUNITY New physicians and advanced care providers.
A neuroscience and orthopaedics center will open.
Women and men often don’t report the same symptoms.
Tips from Carilion Clinic medical professionals.
26 NEW PROVIDERS
15 SPECIALTY CARE
18 HEART DISEASE
4 HEALTHY LIFESTYLES Making a difference in western Virginia.
Are they a safe way to quit?
A new urban neighborhood rises.
24
24 ARCHERY
This sport is taking off across the region.
27 VTC GRADUATION The medical school’s first class graduates.
CarilionClinic.org | SUMMER 2014 3
HEALTHY LIFESTYLES
tips from our medical professionals PRESERVE BONE HEALTH Women of every age should be conscious of their bone health. For teenagers, calcium and vitamin D supplementation to build bone is important. Peak bone mass occurs around age 25 to 30, so after 30, supplementation is particularly important to maintain bone mass and help prevent osteoporosis. Other lifestyle changes to decrease your risk of osteoporosis include diet (high protein, low salt), weight-bearing exercise, decreased caffeine and alcohol intake, quitting smoking, and keeping your home environment low-risk for falls. — Kaylene J. Logan, M.D. Carilion Clinic Obstetrics and Gynecology, Roanoke
STEPS TO A LONGER LIFE Most people, if asked, want to live a long life. They also anticipate that it will be productive and functional. But what makes one live long and well? Make sure to eat moderately and choose healthy food; don’t smoke; don’t drink excessively; and don’t forget exercise. Most experts on longevity agree that exercise, including strength training, is one of the most important aspects of living long and well. And it’s never too late to begin your road to healthy living! — Gordon Weirich, M.D. Carilion Clinic Family Medicine, Weyers Cave
OTC MEDICATIONS AND AGING In older adults, over-the-counter medications such as sleeping aids, antihistamines for allergies, and non-steroidal anti-inflammatory drugs like ibuprofen can cause problems. These include confusion, difficulty urinating, increased blood pressure, or stomach inflammation. These medications, as well as supplements, may also interfere with your other medications. Tell your physician about all the overthe-counter medications and supplements you take, and ask if they are right for you. — Brian K. Unwin, M.D., Chief of Geriatrics and Palliative Medicine, Carilion Clinic Center for Healthy Aging
KNOW THE SIGNS OF A HEART ATTACK Heart disease is the leading killer of men AND women. One in 31 American women dies from breast cancer each year, while one in three dies from heart disease. Both the American Heart Association’s (AHA’s) “Go Red for Women” and Carilion’s “Know the Five” awareness campaigns emphasize that chest pain or discomfort is a common heart attack symptom. The AHA reminds us that women are more likely to experience some other common heart attack symptoms, especially shortness of breath, nausea and/or vomiting, and pain or discomfort in the back or jaw. Profound fatigue, profuse sweating, arm or stomach pain, and lightheadedness can also be symptoms of heart attack. For any of these symptoms, men and women should not wait to seek medical attention or drive themselves to the hospital. Call 911 right away. — Cathy D. Jennings, D.N.P, R.N., A.C.N.S.-B.C., Cardiac Surgery Clinical Nurse Specialist Carilion Roanoke Memorial Hospital
MAKE THE MOST OF ‘DOWNTIME’ Summer is often a time for family vacations. Whether you prefer a destination vacation or a “staycation,” it is important to have some quality downtime to unwind from work or school stress. “Unplugging” and spending time outdoors is a healthy way to de-stress. Playing outdoors is a good way to make physical activity fun for both kids and adults. It is also a great way for families to reconnect and have some old-fashioned fun. — Lori Dudley, Ph.D., Licensed Clinical Psychologist Carilion Clinic Children’s Hospital 4 SUMMER 2014 | CarilionClinic.org
For more health tips, visit Carilion Clinic’s expanded Health and Wellness section at CarilionClinic.org.
Carilion Expands Sleep Services By Karen Doss Bowman Carilion Clinic has a new sleep specialist, clinical psychologist Barbara Hutchinson, Psy. D., who practices behavioral sleep medicine.
Dr. Hutchinson provides cognitive behavioral therapy for patients suffering from insomnia or disruptive sleep patterns, or those struggling to use continuous positive airway pressure (CPAP) machines prescribed for sleep apnea. She conducts oneon-one sessions for adult patients who are referred by their doctor. Patients learn how to sleep better using proven techniques that help overcome underlying causes of sleep problems. While behavioral sleep medicine is practiced at major sleep centers around the country, it not widely available at this time. “Behavioral sleep medicine is a discipline that’s been around for a while, but it’s just started, in reDr. Barbara Hutchinson cent years, to gain momentum as an important component of treatment for sleep problems,” says Dr. Hutchinson, who completed her residency at Kaiser Permanente in the San Francisco Bay Area. “There’s a growing awareness that sleep disorders impact people’s day-to-day functioning. “A lot of research shows that just prescribing sleep medications isn’t necessarily the most effective treatment option, especially because of the long-term side effects of these drugs. We are learning that sleep treatments are most effective when patients actually take steps to overcome their sleep problems
by discovering and addressing what’s at the root of these issues.” When Dr. Hutchinson begins working with a new patient, she performs an evaluation to determine what type of sleep problem the patient has and the possible causes. She then develops an individualized treatment plan that includes educating the patient about proper sleep hygiene, how to develop a good sleep routine, and how to practice stress reduction and relaxation techniques. Patients are expected to maintain a sleep diary to track sleep habits and patterns, and to follow through with daily goals. Approximately 70 to 80 percent of people with insomnia may benefit from five weeks of cognitive behavioral therapy, which offers comparable short-term and better long-term symptom reduction than medication alone, Dr. Hutchinson says. These improvements have been shown to last up to two years. For patients having trouble using CPAP machines, new studies show that cognitive behavioral therapy has increased usage rates by up to 46 percent, she says. “Sleep therapy does take a commitment of time and the motivation to make changes to entrenched sleep habits — and for some people, that’s hard work,” Dr. Hutchinson notes. She hopes Carilion’s program eventually will expand to include teenagers and some group therapy options. “I’m excited that Carilion is offering this because it’s moving in the direction of the research. Studies show that the way to effectively treat sleep disorders is to incorporate behavioral sleep medicine techniques with any other treatment patients are using.” Cognitive behavioral therapy is available through Carilion’s pulmonary and sleep medicine practice at 2001 Crystal Spring Ave. in Roanoke. For more information, call 540-985-8505 or 800-422-8482.
CarilionClinic.org | SUMMER 2014 5
IN YOUR COMMUNITY
Bariatric Surgery Program Recognized
Carilion Roanoke Memorial Hospital was designated as a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery. The society renewed the hospital’s bariatric surgery accreditation for three years and said Carilion provides “multi-disciplinary, high-quality, patient-centered care.” The bariatric surgery team includes medical, surgical, psychological, and nutritional specialists who assist patients.
AGEE HEADS VIRGINIA HEALTH GROUP
F THE VI RG ET O N I T
AS NI
HE AR
Nancy Howell Agee, president and CEO of Carilion Clinic, was named chair of the Virginia Center for Health Innovation. The Richmond-based nonprofit group has 625 members including health care providers, health plans, pharmaceutical firms, and government agencies. It is dedicated to improving health care across Virginia through outreach, education, and technical assistance. One of the group’s current projects is the Virginia Health Innovation Plan. It aims to improve children’s health, chronic disease care, and the integration of physical and mental health and to make medical data more transparent and available, among other goals.
AN
NIVERSARY
6 SUMMER 2014 | CarilionClinic.org
HeartNet Celebrates 25th Anniversary
HeartNet of the Virginias, a network of Carilion and non-Carilion hospitals committed to improving cardiac care in Virginia and West Virginia, celebrates its 25th anniversary this year. By sharing educational and technological resources, HeartNet hospitals and physicians have improved the referral process, treatment, and follow-up care for cardiac patients. On Sept. 19, HeartNet will hold its annual symposium at the Hotel Roanoke & Conference Center.
ORGAN DONATION HONORED In Virginia, up to three people die every week waiting for an organ donor. To commemorate National Donate Life month, Carilion Clinic recently planted a butterfly bush in honor of organ donors. Butterflies were released to signify the transformative power of organ donation. The ceremony was held in the Dr. Robert L.A. Keeley Healing Garden on the Roanoke River Greenway near Carilion Roanoke Memorial Hospital.
Chef Wins National Contest
VELOCITYCARE OPENS IN BLACKSBURG Carilion Clinic opened its second New River Valley-based VelocityCare urgent care center, as well as a new location of Carilion Clinic Orthopaedics, in Blacksburg. The new facility is Carilion’s fifth VelocityCare location but is the first to share space with an adjoining orthopaedics office. The urgent care center is open Monday through Saturday from 8 a.m. to 8 p.m. and Sunday from 10 a.m. to 6 p.m. No appointments are needed. The Blacksburg location of Carilion Clinic Orthopaedics is open Monday through Friday from 8 a.m. to 5 p.m., and appointments are necessary.
Darla Mehrkens, a certified executive chef and catering supervisor for Carilion Clinic, won a national competition sponsored by FoodService Director magazine. The contest, similar to Chopped on television, requires chefs from health care, business and industry, and education to create dishes from specific ingredients. Given pork tenderloin, lemon pears, blueberries, baked beans, wasabi sauce, Sriracha sauce, and orange sauce, Mehrkens and her partner created Pan-Fried Pork Cutlets with Blueberry-Lemon-Plum BBQ Sauce and Sriracha Baked Beans. Mehrkens was also featured in the magazine and will be a judge next year.
Carilion Launches Enhanced Website
Have you seen Carilion Clinic’s redesigned website? Improved navigation makes it easier and quicker to find what you’re looking for. Redeveloped with the patient in mind, the site also has been designed to provide an optimal viewing experience on any device—desktop, laptop, tablet, or smartphone. Mobile apps help you find a doctor, access a health library, get first aid information, check symptoms, and connect to MyChart, Carilion’s online health care management tool. Visit CarilionClinic.org and give us your feedback.
ORTHOPAEDICS INTRODUCES SAME-DAY APPOINTMENTS To better serve patients, Carilion Clinic Orthopaedics is now offering same-day appointments in Roanoke and Franklin County. Appointments are made with an available provider at the Riverside or Postal Drive offices in Roanoke and the Westlake office in Franklin County. To make an appointment, call 540-725-1226 or 877-544-3770. CarilionClinic.org | SUMMER 2014 7
HEALTH NEWS
MEET NED, THE FRIENDLY ROBOT HE EXPLAINS TREATMENTS TO KIDS TO MAKE THEM LESS AFRAID
By Karen A. Chase Back in the 1970s, I had my tonsils removed. I was seven. I had never been in the hospital, and everything about it was larger than life. There were beeping machines that I was not allowed to touch. Strange doctors spoke quickly about things my mother later explained. Back then, the procedure required me to stay overnight. Alone. If it had not been for my teddy bear, it would have been scary.
The desire to alleviate that fear is exactly what led Carilion Clinic Children’s Hospital to bring in a sweet, high-tech employee. Ned. Ned is a talking, walking robot with a touch-screen belly. At just under five feet, he’s designed to interact with children in a fun way. Ned rolls from room to room, so if a child can’t go to him, he can roll up to the bed. When a child is facing a hospital procedure, Ned helps explain the steps the procedure might require. He can also tell kids what all the high-tech machines in the hospital do and how they work. Information can be called up on Ned’s belly-screen. If kids just want to play, Ned has a few games, like Angry Birds. Five-year-old Landyn Kidman is one patient who made friends with Ned recently. “When Landyn first came into Pre-Op, he said he was nervous about his surgery,” says child-life specialist Michelle Cumber. “He was afraid something was going to hurt. “We discussed why he was here and how the day would go, but Ned is what really got him to open up with me. When Ned came into his room, Landyn’s eyes lit up, and he appeared less anxious. He was excited to interact with Ned and seemed intrigued by the videos he could play and all of Ned’s other features. After Ned left, 8 SUMMER 2014 | CarilionClinic.org
Five-year-old Landyn Kidman interacts with Ned before his surgery at Carilion Clinic Children’s Hospital.
Landyn grabbed his anesthesia mask and began practicing with it!” Giving children a role in their own care can be important in reducing their fears. A Finnish study of four-to-six-year-olds between 2004 and 2006 concluded that children will learn coping strategies when given an active role in their care. “Preschool-aged children need information and guidance to orientate themselves in unknown situations and to participate in decisions concerning their everyday life,” says Marja Salmela, M.N.Sc., R.N., in the conclusion of the study by Helsinki Metropolia University of Applied Sciences.
Who’s Ned?
That thinking applies to older children as well, so in 2012, Alice Ackerman, M.D., chair of Carilion’s Department of Pediatrics and chief pediatrics officer, put together a group to come up with a mascot for the children. “We developed the concept of Ned, and
then we reached out to Virginia Tech via Dr. Andre Muelenaer, the head of Pediatric Pulmonary and Allergy at the Carilion Clinic Children’s Hospital. He’s an engineer by training who works collaboratively with the engineering program at Virginia Tech. We asked if he could find a way to bring Ned to life. “He brought the idea to professors at Virginia Tech and they turned it into an actual project. Students created Ned’s insides, and Dr. Muelenaer arranged for a plastics company to build his exterior.” A cartoon drawing was created to announce Ned’s arrival as a new Carilion Clinic Children’s Hospital mascot, and late last year, Ned rolled into the hospital. “It was really great to see the cartoon that was developed become a real thing,” says Sarah Cupp, another Carilion childlife specialist. “He became a real character that kids could interact with every day.” “We’ve had positive responses from children and parents,” says Dr. Ackerman. “Ned generates a lot of smiles, and a lot of joy and fun. He’s not what they are expecting in a ‘big bad hospital.’ And when children play with his touch-screen, they have some control over their environment, and they feel normal again.” When Ned is programmed with even more educational features, he’ll get out to health fairs and community events. For Dr. Ackerman, that means Ned will help contribute to the improved health of the Roanoke Valley. “We’ll be taking Ned out to the public to teach them about basic health concerns. Handwashing. The importance of immunizations. Using child safety seats. Regardless of how old you are, Ned speaks in a language you can understand. The information is more memorable if it comes from a friendly robot.” Ned’s charm and personality are endearing. With a smiling face, Ned is playful, educational, and reassuring all at once. He’s the 2014 version of that little teddy bear of mine, but he also walks and talks. He helps children learn about their own health, with less fear. Look for Ned to help more young patients to get well soon. To watch a video of Ned in action, go to bit.ly/child-life-specialists. CarilionClinic.org | SUMMER 2014 9
MEDICAL NEWS
A New Use for Botox:
Treating Women’s Urinary Incontinence By Erica Stacy
It’s uncomfortable and frustrating. It can happen at any time, in any place. When it does, it can be downright embarrassing.
Urge urinary incontinence affects more than 25 million adults in the United States, according to the National Association For Continence. It is a problem for nearly twice as many women as men, and most suffer in silence, assuming it’s a normal part of aging and that little can be done. But a new treatment involving Botox for women has been approved by the Food and Drug Administration and is now available. Carilion Clinic recently introduced the procedure on an outpatient basis and is the only provider in the region to offer it. The two Carilion urogynecologists skilled in performing the procedure have also been national leaders in introducing it. W. Jerod Greer, M.D., took part in a landmark clinical trial for the treatment, whose results were published in the New England Journal of Medicine. FDA approval followed the clinical trial, which showed Botox therapy to be more than twice as effective as the traditional oral treatments, with fewer side effects. Dr. Greer joined Carilion in 2013 after a three-year fellowship at the University of Alabama at Birmingham. He has five 10 SUMMER 2014 | CarilionClinic.org
years of experience using Botox for urge urinary incontinence. Jonathan L. Gleason, M.D., came to Carilion two years ago from the University of Alabama at Birmingham following a three-year fellowship. He has three years of experience with the Botox procedure.
Urogynecologist: A urogynecologist is a surgeon who specializes in the care of women with pelvic floor disorders and who is skilled in diagnosing and treating urinary incontinence.
A COMMON PROBLEM
“Urge urinary incontinence affects 20 percent of older women in the United States,” says Dr. Gleason. “It has historically been treated mainly with oral medications that have a very high discontinuation rate due to bothersome side effects and limited effectiveness. “It’s a hard topic for a lot of women to talk about,” he says. “They believe it’s just one of those problems they have to live with as they get older.” Both physicians stress that urinary incontinence is not just a part of normal aging. They recommend that if urinary
Jonathan L. Gleason, M.D. (left) – Dr. Gleason is an assistant professor of OB/ GYN and surgery at the Virginia Tech Carilion School of Medicine, where he was awarded the 2013 National Faculty Award from the Counsel of Residency Education in Obstetrics and Gynecology. He is an active member of the research community, is the resident research director for OB/GYN, and has published research on overactive bladder, caffeine intake, midurethral slings, urethral neurophysiology, prolapse surgery, and other areas related to pelvic floor disorders. W. Jerod Greer, M.D. – Dr. Greer served on the faculty at the University of Alabama at Birmingham and has expertise in the minimally invasive treatment of urinary incontinence and pelvic organ prolapse. He has participated in several National Institutes of Health-sponsored landmark surgical trials. Dr. Greer has published research on pelvic organ prolapse, urinary incontinence, and fecal incontinence, and in areas related to education.
frequency, urgency, or leakage affect quality of life, it is important to seek the help of a medical professional. “Botox is just one of many options that are currently available,” says Dr. Gleason. “Treatments vary depending on each woman’s situation,” says Dr. Greer. “Lifestyle changes such as limiting caffeine and managing fluid intake are effective for some women. Others benefit from pelvic floor physical therapy or oral medications.” How does a woman know if she has a problem? “Women with overactive bladder and urge urinary incontinence usually have urinary frequency, voiding every two hours or more, an urgent need to go to the bathroom that is hard to delay, and leakage of urine associated with the urge to go if they can’t get to the bathroom quickly enough,” says Dr. Greer. THE NEW PROCEDURE
Botox is a drug made from a toxin produced by the bacterium Clostridium botulinum. Botox is best known for its use in the reduction of facial wrinkles.
What is Urge Urinary Incontinence? If you have an overwhelming need to urinate and can’t quite make it to the bathroom in time, you may have urge urinary incontinence. Sometimes called overactive bladder or spastic bladder, it is caused when the bladder muscles contract at the wrong times. The result is an involuntary loss or leakage of urine. Many women with the condition complain of a sudden, uncontrollable need to urinate. They may need to do so as often as every two hours or even more frequently. Nighttime accidents are also common.
“Our clinical trial found that, when compared with oral medication for six months, Botox resulted in a similar quality of life and reduction in the number of daily leakage episodes,” says Dr. Greer. “Patients who had the Botox treatment were also twice as likely to have complete resolution of their incontinence.”
Currently, the Botox procedure is recommended for women who do not respond to traditional treatments or who suffer side effects from the medications. How is it administered? Botox, which works by relaxing the bladder muscle, is inserted directly into the bladder while using a local anesthetic. “We use a small camera so that we can see the inside of the bladder as we insert the medicine into the muscle wall using a very small needle,” says Dr. Gleason. To keep symptoms under control, the procedure may need to be repeated once or twice a year. The greatest risk is a 6-to11 percent chance of temporary difficulty with completely emptying the bladder. “Patients may be reluctant to discuss incontinence, and there may be a lack of awareness about how it is treated,” says Dr. Gleason. “Botox is just one of many options that are currently available. Talking with a doctor is the first step toward recovery.” All major insurers in Virginia cover this treatment for urge urinary incontinence. For more information, call 800-422-8482. CarilionClinic.org | SUMMER 2014 11
MEDICAL NEWS
: S E T T E R A E-CIG ARE THEY SAFE? By Dan Radmacher
E-cigarettes have never been more popular — or controversial.
In 2013, sales doubled to $1.7 billion. Across the country, teen use recently doubled as well, with 10 percent of teenagers saying they’ve used e-cigarettes, according to the U.S. Centers for Disease Control and Prevention. The slim electronic devices, which mimic the look and feel of real cigarettes, use a rechargeable battery to heat a cartridge filled with a liquid containing nicotine. The heat turns the liquid into a vapor that users inhale. But a debate has erupted among public health officials over the safety of e-cigarettes, and whether they will help people limit or quit smoking. Teenagers are also flocking to a sub-genre of e-cigarettes that come in an assortment of flavors like Belgian waffle and peppermint blast. Many of them don’t even realize they are using e-cigarettes. Instead, they call the products “vape pipes” or “hookah pens.” Experts worry that teenagers will unwittingly become addicted.
12 SUMMER 2014 | CarilionClinic.org
A smoker inhales vapors containing nicotine from an e-cigarette.
A HEATED DEBATE
How safe are e-cigarettes? Proponents argue that they are far safer than real cigarettes because they don’t contain toxic tar, the component that most damages health. Opponents point to the dangers of liquid nicotine used to refill some e-cigarettes, calling it a strong neurotoxin that has caused accidental deaths in children. They also fear that e-cigarettes may have unknown health effects and give smokers an ongoing crutch without weaning them off nicotine. Unfortunately, few scientific studies have been done, and the results have been inconclusive. “We don’t have enough data right now to reach a straightforward conclusion,” says Maciej L. Goniewicz, Ph.D., Pharm.D., a pharmacologist, toxicologist, and assistant professor of oncology at the Department of Health Behavior, Roswell Park Cancer Institute in Buffalo, N.Y. “We know little about the actual effects of the product. We don’t know what will happen after 10, 20, or 30 years of daily use,” he says.
Evidence so far indicates that e-cigarettes are about as effective as other nicotine-replacement therapies. There is enough evidence to conclude that they are safer than tobacco cigarettes, says Goniewicz, but not enough data to show they are entirely safe. “If you are not a smoker, there is no reason to experiment with this product,” Goniewicz says. Doctors also emphasize the need for caution. Jose M. Goyos, D.O., a Carilion Clinic specialist in pulmonary, sleep, and critical care medicine, advises those who’ve never smoked to avoid e-cigarettes. “Data show that young people who experiment with electronic cigarettes are more likely to pick up the real thing,” he says. Donna Bond, R.N., D.N.P., a Carilion pulmonary clinical nurse specialist, agrees, noting that the flavors and some of the advertising for e-cigarettes appear to be aimed at the youth market. “Nicotine is a much more powerful addiction if you start when you’re young,” says Bond. E-cigarettes may be marginally better
than smoking, says Bond, but she recommends smokers quit by using gum, lozenges, or a nicotine inhaler available by prescription, especially until more studies are done. Dr. Goyos and Bond both stress that, unlike the inhaler available by prescription, e-cigarette vapor delivers carcinogens, including diethylene glycol and nitrosamines. “The biggest problem is you don’t know
Prevent Chronic Lung Disease Smoking is the leading cause of chronic obstructive pulmonary disease, or COPD. A progressive disease that makes it hard to breathe, COPD is the third leading cause of death in the United States, according to the American Lung Association. For more information, go to CarilionClinic.org/copd.
CarilionClinic.org | SUMMER 2014 13
Quit Smoking
what you’re getting,” Bond says. Nicotine levels and other additives in the “juice” that is vaporized vary by brand, and even brands that advertise they contain no nicotine have been found to have small amounts, she says. Dr. Goyos says he has seen a few longterm smokers successfully use e-cigarettes to quit altogether. This may be because, unlike nicotine patches, gum, or the prescription inhaler, e-cigarettes fulfill some of the psychological aspects of smoking. That’s important to Jeff Allen, a Roanoke Valley resident who is using e-cigarettes in his latest effort to stop smoking. “You want to have something in your hands while you’re talking to someone,” Allen says. “E-cigarettes check off all the boxes that cigarettes do.”
Still, Allen knows there hasn’t been much research into the health impacts of e-cigarettes. “It does concern me very much. I don’t consider it a healthy substitute. It’s the much lesser of two evils.” REGULATIONS PENDING
Successful quitters have tried to quit an average of seven times. If you’d like to quit within the coming year, consider attending an informative program sponsored by Carilion Clinic in Roanoke on Aug. 11. It will help you understand the stages of readiness, the addiction process, and what to expect ahead of time to help you quit for good. The event is free. For more information or to register, call 800422-8482. Quit Now Virginia, a program sponsored by the Virginia Department of Health, can also help. It offers a toll-free phone counseling service 24 hours a day, seven days a week. Callers can receive free information and coaching by telephone or online. Call 1-800-784-8669 or go to quitnow.net/virginia.
The U.S. Food and Drug Administration in April proposed new regulations Would the same thing occur with e-cigafor e-cigarettes, which include treating rettes? them as “tobacco products” and banning For his part, Dr. Goyos would like to sales to anyone under 18. But industry see the enticing flavors that appeal to observers are divided over whether the youth banned, along with an effective rules will curb the growth in sales. Some ban on sales to minors. “The most imsay much will depend on exactly how the portant thing for people to know is this: FDA implements them. e-cigarettes are not benign,” he says. Another concern is that although it is “They do, in fact, contain chemical subillegal in most states for those under 18 stances that are toxic to the lung.” to buy regular cigarettes, many teenagers To watch a video on how to stop smoking, do manage to obtain and smoke them. go to CarilionClinic.org/quit-smoking.
Lung Disease Support Group If you have chronic lung disease, the Better Breathers Club can help. A support group for patients and their families, the club offers ways to better cope and live with the disease. Sponsored by Carilion Clinic, the club meets the third Thursday of each month in Roanoke. Topics covered include breathing retraining, preventing infections, airway clearance, emotional and social well-being, sleep disorders, exercise, energy conservation, medications, oxygen therapy, nutrition, and travel. For more information or to register, call 800-4228482 or go to CarilionClinic.org/better-breathers.
14 SUMMER 2014 | CarilionClinic.org
Carilion to Open Neuroscience and Orthopaedics Center
Carilion Clinic is developing an outpatient center in Roanoke that will specialize in neuroscience and orthopaedics.
Areas of focus will be neurology, stroke, neurosurgery, orthopaedics, spine surgery, physical medicine, rehabilitation therapies, diagnostics, and pain management. Other clinical services will also be considered during the planning phase, which is expected to run through mid-summer. The center will be located at 2331 Franklin Road—the former site of Ukrop’s grocery store—and is tentatively scheduled to open in late 2015. As the region’s population ages, the need for orthopaedic, neurology, and neurosurgical care is expanding, and more space is required to meet patient needs. “This is the next logical step for our patients,” says Carilion Clinic President and CEO Nancy Howell Agee. “I’m genuinely excited by the whole concept and that Carilion is moving forward with such an ambitious project—it will be a tremendous service for patients,” says Gary Simonds, M.D., Carilion’s chief of neurosurgery. “One key benefit is the location. It has easy access—right off the highway—and there’s plenty of parking. “Having so many different specialists in the same space at the same time will
mean less travel for patients, many of whom come from three or four hours away. They’ll be able to undergo testing and see a variety of specialists, instead of having to schedule multiple appointments over a period of weeks or even months.” Dr. Simonds is particularly excited about the co-mingling of many different types of practitioners. “It will allow us to exchange ideas and information easily, and enable us to detect emerging patterns that might become topics for research,” he says. “The quality of care will be extraordinary.” He also notes that the new center will be able to utilize expertise from the nearby Virginia Tech Carilion School of Medicine and Research Institute. “We’re working on plans for brain tumor research that would involve physical medicine and rehabilitation specialists, neurologists, neurosurgeons, and pain management physicians, as well as speech, physical, and occupational therapists,” he says. Joseph Moskal, M.D., Carilion’s chair of orthopaedics, is also enthusiastic. “While physicians prefer to specialize in certain areas such as bones, joints, spine, brain, etc., the human body performs better when treated as a single, comprehensive unit,” he says.
Lifetime Achievement Award Joseph Moskal, M.D., Carilion Clinic’s chair of the Department of Orthopaedics and professor of surgery at the Virginia Tech Carilion School of Medicine, is the latest recipient of the Virginia Career Award. The prestigious lifetime award, given annually by the Virginia Orthopaedic Society, recognizes an individual who has had a major impact on orthopaedic surgery in Virginia.
“For this reason, bringing the disciplines of orthopaedics, neurosciences, and the other musculoskeletal subspecialties together in a comprehensive center will improve our ability to care for the whole patient in a multidisciplinary approach. “It will also allow us to grow as a premier destination center for musculoskeletal and neurological disorders,” says Dr. Moskal. In addition, the center is expected to become a regional hub for education, cutting-edge research, and future innovations, “all with the potential to further improve quality of life for our patients,” he says. For more information on Carilion’s neurosurgery and orthopaedics services, go to CarilionClinic.org/neurosurgery and CarilionClinic.org/orthopaedics. CarilionClinic.org | SUMMER 2014 15
A NEW T N E M T A TRE N I A P K C A FOR B GINIA R I V N I T S R I F IS E R U CARILION T D E C O R P E TO OFFER H
By Allison Buth
Edgar Dietrich has always enjoyed hiking, canoeing, and camping. And at 74, he is still an active member of the Boy Scouts of America. But with age has come back pain, and me that he was surprised I was still up Dietrich has had to limit his activities. and walking around after seeing my imPhysical therapy hasn’t helped. ages,” Dietrich says. “A few years ago, I started feeling by “Throughout my mid-afternoon like I needed to sit down whole experience, and rest,” he says. “I had been doing floor he has always been exercises for a long time to help with so willing to sit and my core and back, but physical therapy talk with me and my wasn’t helping with the pain. In time, wife about what’s coughing and sneezing even caused segoing on.” Dr. Jonathan Carmouche vere pain.” In most cases, He went to his primary care physician, people with back William Daniel Prince, III, M.D., with pain can benefit from treatments such Carilion Clinic Family and Internal Medas anti-inflammatory medication, heat, icine in Martinsville, for an MRI. Images ice, or physical therapy. But others, like showed spinal stenosis, a narrowing of Dietrich, are advised to consider surgery, the space for the nerve in the spine; and usually after failing to improve with spondylolisthesis, the forward slippage of non-surgical treatment. one of the vertebra in his lower back. Dr. Prince referred Dietrich to JonEVALUATING OPTIONS athan Carmouche, M.D., a Carilion or“Mr. Dietrich expressed concern about thopaedic spine surgeon in Roanoke. Dr. the weakness and pain he was experiencCarmouche is fellowship-trained in scolio- ing and wanted to return to physical acsis and minimally invasive spinal surgery. tivities like hiking,” says Dr. Carmouche. “When I met Dr. Carmouche, he told “He really had two options — to continue 16 SUMMER 2014 | CarilionClinic.org
physical therapy or have a multiple-level fusion operation. “Having surgery made sense for him. The better your physical shape, the better your outcome should be.”
Oblique lateral interbody fusion (OLIF) is the latest advance in spine surgery.
On Nov. 18, 2013, Dr. Carmouche performed the first oblique lateral interbody fusion (OLIF) procedure in Virginia on Dietrich. The procedure lets surgeons access the lumbar region of the spine from the patient’s side through small incisions, minimizing surrounding tissue trauma. This approach can help reduce post-operative complications, discomfort, and pain, and promotes a faster recovery. It also allows a surgeon to work in front of the spine without involving the back muscles and abdominal structure
Edgar Dietrich of Martinsville, the first patient in Virginia to have the OLIF procedure for back pain, enjoys hiking (left) and canoeing with the Boy Scouts of America.
while still accessing all levels of the lower lumbar region as the patient remains in one position. With less muscle disruption, patients can then walk with assistance immediately and function more normally than with traditional surgery. Patients with degenerative disc disease, spinal stenosis, or spondylolisthesis in the lower back are typical candidates for the OLIF procedure. “Traditional surgical methods access the spine through a long incision in the back, which is associated with longer hospital stays, scarring issues, greater blood loss, more post-surgical pain, and higher narcotic consumption,” says Dr. Carmouche. “Now we can do big surgery in small ways.” After a successful operation, Dietrich spent two days in a dedicated in-patient unit at Carilion Roanoke Memorial Hospital staffed with specialists trained in providing care to patients having spine procedures. “They had me up and moving around
immediately,” Dietrich says. “I used a walker at first, and then switched to a cane. After two weeks, I was walking on my own and felt almost back to normal.” ADVANCES IN SURGERY
The OLIF proceEdgar Dietrich dure—the latest advance in spine surgery—evolved from the direct lateral interbody fusion (DLIF) procedure, which, while minimally invasive, requires surgeons to split the hip flexor muscles to gain access to the spine. “This newest approach utilizes the advantages of historically successful options while implementing new minimally invasive techniques, so that we may avoid cutting any muscle,” says Dr. Carmouche. OLIF and other minimally invasive, cutting-edge procedures are available at
the Carilion Clinic Spine Center, which specializes in treating injuries to the neck, back, or spine. The center also treats patients with painful chronic degenerative conditions, pinched nerves, and spine deformities, so that patients may live with fewer limitations and less discomfort. Spine center orthopaedic surgeons and neurosurgeons work collaboratively in a multi-disciplinary team with specialists in pain management, rehabilitative medicine, radiology, neuropsychology, and psychiatry to deliver the highest level of care. Today, Dietrich says he made the right choice to have surgery. “The things that hurt the most before surgery I can now do without any pain,” he says. “I’m really pleased with where I am now, and very happy with the care I received.” For more information, call 800-422-8482 or e-mail direct@carilionclinic.org.
CarilionClinic.org | SUMMER 2014 17
COVER STORY
Women Often Don’t Recognize Heart Disease MORE WOMEN DIE OF IT THAN MEN
By Alison Weaver Nausea. Extreme fatigue. Profuse sweating. Shortness of breath.
Cardiovascular disease is the No. 1 the throat, but they don’t typically expekiller of women in the United States. rience the ‘elephant sitting on my chest’ “More women die from heart disease feeling that men more often have.” These were among the symptoms than from all types of cancer comthat brought Angela Gillespie and Sandi bined,” Dr. Austin ‘I HAD NO RISK FACTORS’ Clemmer to Carilion Roanoke Memorial emphasizes. “This Angela Gillespie, of Roanoke, began Hospital’s emergency room on separate isn’t a new phenoma routine August day in 2011. She had occasions. enon. For almost 30 been feeling nauseated and tired but “I knew something was very wrong, but years, more women went out to mow her lawn. “I began I had no idea what,” Gillespie, then 49, have been dying of sweating profusely, even though it recalls. Clemmer, a retired elementary heart disease than wasn’t a hot day. I thought I was going to school principal, says her symptoms men. Yet for some pass out.” escalated so rapidly, “I didn’t even have reason, it is often She stopped mowing and went inside. time to think about what it might be.” DeEtta Compton still thought of as a “I felt tired the rest of the evening. The Both women were stunned when man’s disease.” next morning, as I was getting ready to they learned what was happening: Their DeEtta Ray Compton, D.N.P., F.N.P., walk my dog, I collapsed.” hearts were failing. B.C., is co-director of the Heart Failure Gillespie was able to call 911 and was Cardiologist Joseph Austin, M.D., Clinic at Carilion Clinic’s cardiology taken to the emergency room, where medical director of cardiac rehabilitapractice in Christiansburg. “Women initial tests showed that she was anemic tion at Carilion Clinic, often hears simoften write off their symptoms as somedue to a bleeding stomach ulcer. Anemia ilar accounts from his female patients. thing else,” she says. “If they experience can cause shortness of breath, fatigue, “Women don’t always present like men severe fatigue, they tend to rationalize and dizziness, which fit her symptoms. do. People think of crushing chest pain it—‘I’m a mother, I work a full-time job, However, the attending physician, as a primary symptom of a heart attack I’m taking care of my elderly parents, of Carilion Chief of Cardiology David Sane, or heart disease, but women are more course I’m tired.’ M.D., also ordered an echocardiogram to likely to experience nausea, profuse “They may report pain in the arm or look at her heart. sweating, and fatigue, perhaps accompashoulder blade, or a burning sensation in The echocardiogram showed a connied by pain in the upper back.” 18 SUMMER 2014 | CarilionClinic.org
Sandi Clemmer, shown with her husband Dick, suffered a heart attack last year.
genital abnormality of her aortic valve, which regulates blood flow in the body’s largest artery. More alarmingly, the image detected an aneurysm near her aorta that could rupture and quickly cause death. “I’ve been active all of my life. I had no symptoms, no risk factors, and no family history of heart problems. Never in a million years would I have thought that this is the way I was going to die,” Gillespie says. Before she could have surgery, Gillespie had to wait for the bleeding ulcer to heal. “Those were the darkest two months of my life. I was afraid if I lifted anything or sneezed, the aneurysm would rupture,” she says. Gillespie underwent open-heart surgery and was outfitted with an artificial, metal valve. “This valve will outlast me, but I do have to take blood thinners for the rest of my life,” she says. A STRESSFUL YEAR
In March 2013, Sandi Clemmer’s rou-
tine annual mammogram detected breast cancer, and she immediately underwent a lumpectomy and six weeks of radiation. In early October, Clemmer, of Roanoke, had difficulty breathing and was treated for multiple blood clots in both lungs. About three weeks later, she developed a pain in her left side, which she describes as “like a bubble under my rib cage. It was severe enough that I went to my doctor.” All of her vital signs were normal and tests showed nothing un-
“More women die from heart disease than from all types of cancer combined.” —Cardiologist Joseph Austin, M.D.
called 911.” Paramedics checked her vital statistics and saw no indications of problems. They thought she might have a severe case of the flu and transported her to the emergency room. Soon after, when she was hooked up to an EKG machine, she received the prognosis: “You’re having a heart attack.” Clemmer was immediately taken for a scan which showed one artery in her heart was 99 percent blocked and a second was 90 percent blocked. Within an hour, she was undergoing cardiac catheterization to treat the largest blockage. The second blockage was treated the next day. HIGHER MORTALITY RATE
usual. She headed home, thinking she might have pulled a muscle. That night she awoke with arms “that felt like cinder blocks. I couldn’t move them. I began sweating profusely and then I got violently ill. My husband
Women are more likely than men not to survive their first heart attack. Dr. Austin attributes this to multiple factors. “Women tend to develop heart disease later in life, so they’re likely to have other medical issues and not be as healthy,” he says. “Also, women often CarilionClinic.org | SUMMER 2014 19
THE FACTS ABOUT WOMEN AND HEART DISEASE
#1
Heart disease is the No.1 killer of women, and is more deadly than all forms of cancer combined.
While 1 in 31 American women dies from breast cancer each year, 1 in 3 dies of heart disease.
An estimated
43in themillion women U.S. are affected by heart disease. Since 1984, MORE WOMEN THAN MEN have died each year from heart disease.
Ninety percent of women have one or more risk factors for developing heart disease.
90% Source: American Heart Association
wait longer to seek medical attention.” Other reasons are based sheerly on biology. Women’s arteries tend to be smaller than men’s and can become blocked with plaque more easily. Also, “women’s risk of coronary artery disease increases dramatically after menopause,” Dr. Austin explains. “Female hormones have a protective effect that disappears as women age.” Furthermore, Compton points out that some of the symptoms of menopause mimic those of a heart attack. “Fatigue, hot flashes, and night sweats are all common complaints of women going through menopause, but they can also be signs
Signs of Heart Attack in Women Women may experience one or more of the following:
pressure, squeezing, fullness, 1 Uncomfortable or pain in the center of the chest or discomfort in one or both arms, 2 Pain back, neck, jaw, or stomach of breath, with or without chest 3 Shortness discomfort
4 Extreme fatigue out in a cold sweat or nausea and 5 Breaking lightheadedness
ALWAYS CALL 911 WHEN YOU FEEL ANY OF THESE SYMPTOMS. DO NOT WAIT OR TRY TO DRIVE YOURSELF TO THE HOSPITAL. 20 SUMMER 2014 | CarilionClinic.org
of heart problems,” she notes. “Women often dismiss heart symptoms as menopause-related, stress, or even panic attacks.” RISK FACTORS
The first step women can take in reducing their risk of having a heart attack is to educate themselves. Dr. Austin’s succinct advice is, “Know the risk factors and know if you have those risk factors. Know your family medical history. Seek medical attention if you have symptoms, and take steps to lessen any of the risk factors that can be modified.” Primary risk factors include high blood pressure; high cholesterol (especially when paired with low levels of HDL); smoking; lack of exercise; obesity; diabetes; age 50+ and/or post-menopausal; and history of heart problems in parents or siblings. Prior medical conditions can also be risk factors. For example, women who’ve undergone treatment for breast cancer are at a higher risk of developing heart disease. Radiation can cause hardening of the arteries and blood clots, and common chemotherapy drugs such as Herceptin (trastuzumab) and anthracycline can increase the risk of heart problems. HPV (human papilloma virus), better known for causing genital warts and most types of cervical cancer, is also linked to a higher rate of future heart disease. “People are enamored of technology, but one of the best diagnostic techniques is direct communication,” Dr. Austin says. “I pay close attention to family history and the patient’s medical history, and listen carefully to how my patients describe their symptoms.” He also advises people to “be alert to changes in exercise capacity. That means that if suddenly you find yourself getting out of breath or fatigued going up a flight of stairs or carrying groceries—activities that hadn’t affected you before—you should see your doctor. Another warning sign is upper-back
At 49, Angela Gillespie went to the hospital suffering from a congenital heart abnormality. Today, after treatment, she is back to living an active lifestyle.
pain or arm pain triggered by exertion that goes away with rest.” LIVING WITH HEART DISEASE
After their release from the hospital, both Gillespie and Clemmer went to cardiac rehabilitation. “Participants wear a heart monitor while exercising, which made me feel very safe,” Clemmer says. “I was with a small group of patients who’d gone through the same thing so they became a support group.” Gillespie is candid in saying, “Recovery was not easy. There are lots of emotional issues and depression. I couldn’t sleep, had anxiety, couldn’t take care of my pets, and couldn’t drive for eight weeks. I can’t speak enough about the whole heart care team and the tremendous support they Dr. Joseph Austin provided.” Clemmer continues a medically prescribed exercise regimen three times a week at Roanoke Athletic Club, a Carilion affiliate. “The FIT Rx program is wonderful. Cardiac nurses are there to check your blood pressure and heart rate, answer questions, and address concerns. “It’s really made a big difference. My lifestyle is now healthier due to better food choices and a daily exercise routine.” At the Heart Failure Clinic, Compton devotes much of her time to patient education. “Little changes will bring about big changes,” she says. “I’m a realist. I know people aren’t going to completely change their lifestyles, but I work with them on taking tiny steps: substitute grilled chicken or fish for a hamburger; smoke one less cigarette each day; take the stairs instead of the elevator; take your blood pressure medication; check your blood sugar. As patients reach these small goals, they feel a sense of accomplishment.
“Some risk factors aren’t modifiable—such as age, family history, and ethnic origin—but others are within your control— blood pressure, cholesterol, alcohol and tobacco use, and exercise.” Gillespie is fully back to her former, active lifestyle and is able to laugh about “the ticks and clicks” her artificial valve makes. “It’s no big deal, and this is what’s keeping me alive. Your heart is an incredible machine. But you’ve got to take care of it.” For more information, go to CarilionClinic.org/heart.
Eat Right for Your Heart
CarilionClinic.org | SUMMER 2014 21
RECREATION
? E D I S R E S V S I E C R C A T Y A A W N E W E R E N AND G
S ’ R E T V I A R H H T WURBAN LIVING, WI er
lph Walk
o By Rand
A new type of urban neighborhood is coming to Roanoke. Set on the riverfront near downtown, it will include a 157-unit apartment building, restaurant/coffee house, public promenade along the river, music stage, kayak launch, and office and retail space. The apartment building is scheduled to open in August and the restaurant in late fall, with the other features to be completed over the next two years. The $150 million, 22-acre project is located across from the Virginia Tech Carilion School of Medicine and Research Institute and Carilion Clinic’s Riverside Center on Jefferson Street. It is named The Bridges because a proposed pedestrian bridge would connect the promenade on the Jefferson Street side of the river to the Roanoke River Greenway on the Mill Mountain side. The Jefferson Street and Walnut Avenue 22 SUMMER 2014 | CarilionClinic.org
bridges will also form part of the projand properties. ect’s skyline. “The development will provide housing AERIAL The boat launch—for kayaks and cafor The WVS Companies, LLCuse by our students and staff, and noes—will be built near the HoneyTree restaurants for everyone including our Early Learning Center, and the music patients,” Mills says. “It will make the stage will go up in an area bounded by area more inviting and vibrant to doctors, the Walnut Avenue bridge, the river, and staff, and students we will recruit in the the existing trolley barn on the property. future. There is also the added benefit of Richmond-based WVS Companies, tying the area around the river to downLLC, the developer, previously created town.” Rocketts Landing, a similar urban-hisPete Eshelman, director of outdoor toric-riverfront neighborhood in Richbranding for the Roanoke Regional Partmond. nership, expects the outdoor amenities to be welcomed by tenants of the new apartments as well as others in the RoaCONNECTING TO THE OUTDOORS noke Valley. “People who choose to live in “When we purchased the land where an urban environment like The Bridges The Bridges is taking shape, we thought place high value on the ability to easily it would be great for mixed-use develconnect with the outdoors, whether it’s opment to support the Riverside Center hiking on Mill Mountain, riding on the and areas around Carilion Roanoke MeRoanoke River Greenway, or paddling morial Hospital,” says Curtis Mills, Cardown the Roanoke River,” he says. ilion’s senior vice president for facilities
Left: An architect’s rendering shows apartments under construction between the Norfolk Southern tracks and the Virginia Tech Carilion School of Medicine and Research Institute. Top: The Walnut Avenue Bridge forms one of the boundaries for the new, mixed-use project. Right: The Roanoke River Greenway will be accessible from The Bridges.
“The greenway has helped our community see the value in the river, and now people are asking for better access to it. The access point proposed by The Bridges fills a gap. There are access points further up and down stream, but nothing in between. I have no doubt we’ll see more and more people arriving at The Bridges via bike and kayak.” “What we had in that location 15 years ago was a hole in the doughnut,” says Roanoke Mayor David Bowers. (The site of the project is a former mill and scrap yard.) “We had a downtown area that was thriving and a medical complex in Roanoke Memorial, but in between was a milling company, a junkyard, storage, and unused space. The Bridges is part of this visionary development in that area.” The project has received $10 million in financing from the City of Roanoke for public infrastructure such as a riverside
park, sidewalks, landscaping, and roadways. HISTORIC BUILDINGS
Amenities for the Public Look for a: » River walk » Riverside park » Pedestrian bridge to the greenway » Kayak and canoe launch » Music stage » Restaurant/coffee house with patios facing the river » Repurposing of historic buildings
Along with new construction, the project will also incorporate historic buildings on the site, including a former streetcar garage known as the trolley barn. With its high ceilings and skylights, the trolley barn will be repurposed as office space with an industrial feel. Another historic structure, an early Aaron Ewert, project manager for WVS, 20th-century lumber warehouse, will sees The Bridges and its riverfront amehouse the restaurant and coffee house, nities as a key part of the region’s efforts with patios facing the river. And while many cities have turned riv- to rebrand itself as a sports and outdoor destination. A soccer player, he’d love to ers into urban centerpieces, they can be dangerous if not controlled. The Roanoke see people attend athletic tournaments River Flood Reduction Project, an under- at the nearby River’s Edge Sports Complex, then stop by the restaurant for a taking of Roanoke and the Army Corps meal, followed by a river walk or concert. of Engineers, is helping make the river “We want to be a part of that,” he says. an asset rather than a liability. CarilionClinic.org | SUMMER 2014 23
A Staff Report
Allison Bora, 12, straightens her shoulders, draws back her bow, pauses, then lets her arrow fly. Bull’s-eye.
understand that through hard times, she still has archery and hunting in the woods with her bow to calm her down. That’s what gets girls inspired to shoot.” Allison took up archery on her own Allison, who attends Central Acadlast year. She then went to the state Naemy Middle School in Fincastle, is one tional Archery in the Schools Program of many girls in the region who has (NASP) tournament in March 2013, taken up archery in the wake of The stirring interest among her peers. Last Hunger Games books and movies and fall her school formed an archery club, other films showcasing the sport. which has since grown to 50 members. Archery’s popularity locally also reAlexis Bierce, a classmate of Allison’s, flects a national trend. It’s one of the has followed her lead. “Allison actually fastest growing sports in the country— started by showing me The Hunger particularly among girls, who admire Games, and I read it a couple days bethe fictional teenage heroine, Katniss fore the movie came out,” Alexis says. Everdeen. “After seventh grade started, she wanted “I got interested in archery by readme to join the club with her.” Alexis ing The Hunger Games,” says Allison. “I says archery has strengthened her arms, read all three books before the movies in addition to being fun. came out. I was inspired by Katniss. She Like other girls in the club, Madison ranks very high as a role model for girls. Wrenn was also inspired by the series. “If you were to read the books, you’d “I really like the character Katniss,” she 24 SUMMER 2014 | CarilionClinic.org
says. “Her weapon is a bow. She goes to the Hunger Games and they have to fight to the death. She is really good at it and I liked how she is really brave and strong. When I found out about the club I joined right away.” Five members of the Fincastle club attended the 2014 Virginia NASP tournament in Doswell on March 8, says Kevin Painchaud, the club’s sponsor and a school physical education teacher. The excitement even infected his daughter Kathryn, who attends school in Bedford. “It’s all she talked about for a while,” Painchaud says. “It’s pretty powerful for a girl.” “It’s a confidence builder, for one,” says Rick Bora, Allison’s father and a volunteer with the club. “A lot of the kids that aren’t on the big sports teams can really excel in the archery program. It puts everyone on an even plane. It makes them feel good about themselves
Left: Allison Bora of Fincastle’s Central Academy Middle School has competed in a state archery tournament. Top: Allison is shown with fellow archery club members Alexis Bierce (center) and Madison Wrenn (far right). With them is their coach, Kevin Painchaud.
when they hit around the bull’s-eye. We have a lot of kids excited about coming back.” Archery clubs and athletic supply stores elsewhere in the region also report a surge of interest in the sport among young people. “Our three-year-old archery instruction program has seen a 100 percent growth rate each year,” says Allen Hayes, director of Roanoke County’s athletic division, which runs children’s camps and classes for all ages. “We’re expecting 250 students in 2014.” Hayes credits archery’s popularity to the recent movies and video games as well as Virginia’s NASP program, which brought the sport to area schools in the past few years. About a third of the budding archers Hayes sees are female. Darrell Musselman, owner of Whitetail Outfitters in Christiansburg, says he’s seeing more interest among the young, especially those seeking traditional bows. “I’m seeing more pink stuff aimed at girls, and more women hunters.”
At Sherwood Archers, a Roanoke archery club, Auvray Shumate says more youngsters have been coming out for tournaments and joining the club since 2012. “The girls starting out tend to do better than boys,” says Shumate, club secretary. “They seem a little more patient and disciplined, more focused. The boys want to shoot again and again.” “Girls now comprise 45 percent of Virginia’s archery in the schools program,” says Karen Holson, state NASP coordinator and supervisor of outdoor education for Virginia’s Department of Game and Inland Fisheries. NASP is designed for students in grades 4-12, and Holson says that more than 225,000 youth participated in archery instruction last year. The program has a positive influence on school attendance, behavior, confidence, and concentration, she says. Connie Waddell, co-coach for a team based at Roanoke County’s Hidden Valley High School, says archery is a good
sport for students who don’t consider themselves athletic, as well as those with disabilities. “We’ve had a student shooting from a wheelchair. This year two club members are hearing-impaired,” she says. Many colleges also now have archery clubs, and a few offer archery scholarships. Then there are girls like Cory Mullins of Ferrum, who began shooting before actress Jennifer Lawrence, who plays Katniss, ever touched a bow. Mullins, 17, learned the sport from her family. “She was 10 when I bought her a bow; she won a tournament four weeks later,” says her dad, Carl Mullins, a respiratory therapist at Carilion Franklin Memorial Hospital. “I like archery because it’s something I do on my own, but I meet lots of people,” Cory Mullins says. “It’s stress relief. I’m usually by myself when I’m doing it, but it releases pent-up energy. It feels great when I’ve made a good shot.” CarilionClinic.org | SUMMER 2014 25
NEW PROVIDERS PHYSICIANS Michael Rowland, M.D. Family Medicine
Kennie I. Koelsch, A.C.N.P.-B.C. Nurse Practitioner, Cardiology
Medical Degree: Louisiana State University Medical Center Residency: University of Tennessee - St. Francis Family Practice Residency Program 1613 Oakwood St., Suite 201, Bedford, VA 24523 540-586-4723
Undergraduate Degree: University of Delaware Graduate Degree: Rutgers University 1906 Belleview Ave., Roanoke, VA 24014 540-981-7268
Christopher Sullivan, M.D. Obstetrics and Gynecology
Emily Sherburne, P.A.-C. Physician Assistant, Family Medicine
Medical Degree: Rush Medical College Residency: University of Vermont/Fletcher Allen Health Care 102 Highland Ave., Suite 455, Roanoke, VA 24013 540-985-9910
Undergraduate Degree: South University 6920 Roanoke Rd., Shawsville, VA 24162 540-268-1400
ADVANCED CARE PROVIDERS Samuel Arnold, F.N.P. Family Nurse Practitioner, Family Medicine Undergraduate Degree: James Madison University Graduate Degree: University of Virginia 1371 Lee Highway, Verona, VA 24482 540-248-3413
Paula P. Janey, N.P. Nurse Practitioner, Obstetrics and Gynecology Undergraduate Degree: Radford University Graduate Degree: Old Dominion University 902 S. Jefferson St., Roanoke, VA 24016 540-985-9862
Jenna Kellstrom, P.A.-C. Physician Assistant, Family Medicine Undergraduate Degree: Virginia Tech Graduate Degree: Jefferson College of Health Sciences 415 South Pollard St., Vinton, VA 24179 540-983-6700
26 SUMMER 2014 | CarilionClinic.org
JEFFERSON GRADUATION MOVES TO ELMWOOD PARK In May, Jefferson College of Health Sciences celebrated its first outdoor commencement in Elmwood Park’s new amphitheater in downtown Roanoke. The college is located just across Elm Street at Carilion Roanoke Community Hospital. Enrollment has grown rapidly in recent years, from 200 students in 1988 to an all-time high of nearly 1,100 in 2014. The college now has students from 29 states and 77 localities across Virginia enrolled in 12 academic programs. Between 150 and 200 students graduate every May and December, earning master’s, bachelor’s, or associate degrees. Historically, about 95 percent of graduates are employed in their degree fields within three months of graduation. Eighty to 90 percent go on to work at Carilion Clinic, thus fulfilling the college’s mission of training clinicians to work in local communities.
VIRGINIA TECH CARILION SCHOOL OF MEDICINE:
The First Class Graduates By Karen Dillon
Four years ago, 42 students made history as the first class of the new Virginia Tech Carilion School of Medicine (VTC). “Our graduates will not only possess exceptional knowledge in basic and clinical sciences, but will have the research and interprofessional skills required to excel in the 21st century,” Cynda Johnson, M.D., M.B.A., the school’s president and dean, said at the time. Fast forward to May of 2014, when those students are graduating and preparing for the next step in their training. One of those graduates, class president Matt Joy, will perform his residency in general surgery at Carilion Roanoke Memorial Hospital. “One of the big factors for me wanting to stay in Roanoke was my experience working with the surgery teams and the learning environment of the residency program,” Matt says. Matt’s time at VTC has been just as eventful on a personal
Matt Joy
level. Since arriving in Roanoke, he and his wife, Jessica, welcomed their two children—Miles (age 2 ½) and Ari (5 months)—doubling the size of their family. “We’ve been here for four years, and we’ve built some roots in the city as well,” Matt says. “All those things were a big draw.” When Matt began searching for a medical school, the California native knew there was a good chance it would be somewhere in the mid-Atlantic close to his wife’s family in Winston-Salem, N.C. “We were looking for a slower pace, a better cost of living, and a place we felt would be conducive to starting a family,”
Members of the Class of 2014 take a “selfie.”
recalls Matt. Through his research and talking with family, Matt found VTC. “I was really excited about the innovative curriculum and smaller size of the school,” Matt says. “I felt it would be an asset to have the level of attention that comes with a small class size.” At the core of VTC’s curriculum are four value domains— basic sciences, clinical sciences and skills, research, and interprofessionalism, which help prepare students for a career in any medical discipline after graduation. Of VTC’s graduates, 11 will begin their residency training at Carilion Clinic. “We are thrilled about how many will stay to do the next phase of their training in Roanoke,” says Aubrey Knight, M.D., VTC’s associate dean for student affairs. “I think that speaks to the level of respect for our residency programs and the degree of trust that our students have in getting their training here.” Twenty-nine graduates are moving on to begin residencies at medical centers including Duke, Vanderbilt, the University of Maryland, and Georgetown University. As for being part of VTC’s charter class, Matt admits there were challenges, but also benefits. “It’s afforded us awesome opportunities to do things a different way and come up with traditions on our own,” Matt says. “We also had a lot of input into the curriculum, and the day-today life of the medical students.”
CarilionClinic.org | SUMMER 2014 27
BETTER LIVING
A Doctor’s View:
Nurse Daisy Bulla plays with patient Amar Singh at Carilion Clinic Children’s Hospital.
Children’s Hospitals Are Special Places By Alice Ackerman, M.D.
Why are children’s hospitals so special? They are full of sick children who smile while they get tested and treated for diseases. They have clowns and singing, video games and Bingo, crafts, and Legos. Oh yes, and they have doctors and nurses and aides and techs, and X-rays and needles and medicines and IVs and beds and wheelchairs and stretchers. But some of the beds look like race cars, and some of the wheelchairs resemble go carts. Every member of the staff is there because of his or her love and concern for children. They are trained to provide the very best care to kids and their parents. People who work in children’s hospitals have a special mission. And they have to perform miracles daily. They have to help children be children while they help parents be parents despite the child’s illness. Kids go to hospitals for mundane things like diarrhea, to life-changing and potentially devastating things like meningitis or cancer. Regardless of the illness, all children must be treated according to their age and their weight as well as their developmental stage and individual personality. At Carilion Clinic Children’s Hospital, child-life specialists are available to make the stay a bit less intimidating and frightening. These staff members can help children need less pain medication by teaching them guided imagery techniques, and can help siblings understand what is happening to their brother or sister, and WHY Mom and Dad spend so much time in the hospital. Child-life specialists are integral to the successful work of a children’s hospital, but there is not a single insurance 28 SUMMER 2014 | CarilionClinic.org
company who pays for the work that they do. Children’s hospitals are special places because they provide more services and care than is absolutely required to cure an illness or treat a physical injury. Their staffs understand the wide variety of needs that families face when confronted with a child with a chronic disease, or one that might limit their lifespan. They face sad situations every day, but do so with a smile on their faces, for the children. People sometimes ask me how I can manage the sadness that happens to us all when the illness or injury overcomes our abilities to “make it better.” But that is what is most special about a children’s hospital. Those of us who work there know we are doing the best we can to support the child and the family throughout the illness and recovery. And when recovery is not possible, we know we have played a very important part in the life of a child who is special to a family. We have done whatever we could to make an unthinkable outcome into what will become a positive memory for a loving family—one of health care providers who felt something, who held their hand, who cried a little too. And who laughed, and loved their patients with all their hearts. And that’s what makes a children’s hospital special. Alice Ackerman, M.D., M.B.A., F.A.A.P., F.C.C.M., is the chair of the Department of Pediatrics at Carilion Clinic and professor and founding chair of pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care. Visit her blog at: CarilionClinic.org/blogs/ackerman.
Acclaimed sculptor Betty Branch was going about her life, doing what she loved, when the grenade went off in her head. That’s precisely what her brain hemorrhage felt like. The interventional radiologists and neurosurgeons at Carilion Roanoke Memorial Hospital took action. Working through a remote incision, they skillfully plugged Betty’s hemorrhage. Her team of nurses, doctors, and therapists got to work right away, helping Betty regain control of her left side, and her whole life. Now Betty is well along the way to recovery and back in her studio, where everything is possible. Especially Betty.
i’m possible the
happens here.
CarilionClinic.org/neurosurgery • 800-422-8482
CARILION CLINIC P.O. BOX 13727 ROANOKE, VA 24036-3727
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