Carilion Clinic Living - Spring 2014

Carilion Clinic

Inspiring better health.

Laughter Is Good Medicine

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Tod Whitehurst, founder of the Laughter Club of the New River Valley.

Spring 2014

in this issue NEW TREATMEnTS FOR ALLERGiES 5 SAVinG LiVES WiTH ECMO 10 LAUGHTER iS HEALinG 18 A WALK in THE WETLAnDS 22

How did we earn Magnet recognition for the third time in a row?

NURSES. Carilion Clinic’s Roanoke campus* has been designated a Magnet facility for a third time by the American Nurses Credentialing Center. First earned in 2003, our Magnet designation recognizes nursing excellence and professionalism and is widely accepted as nursing’s highest honor.

Recognition is a testament to the incredible passion for nursing shown by our staff at all levels of the organization. The commitment, compassion, and hard work of everyone at Carilion make achievements like this possible.

We don’t need awards and recognition to know our nurses are providing the highest quality patient care, but it’s an honor when national organizations agree.

CarilionClinic.org/magnet

*Includes Carilion Roanoke Memorial Hospital, Carilion Roanoke Community Hospital, and practices located in the Crystal Spring and Community Hospital medical office buildings, and at 127 McClanahan St., 1 and 3 Riverside Circle, and 902, 1030, and 2017 S. Jefferson St.

president’s message We all enjoy laughter, but did you know it can also help you stay healthy and fight disease? With its ability to relieve stress and lower blood pressure, laughing can help us cope with life’s setbacks. Laughter therapy is being used in more hospitals as a complement to medicine in treating severe illness. In our cover story, Randolph Walker explores this trend and gives you ideas for adding more laughter to your own life!

When someone you love is ill, you want to help in any way possible. Botetourt teacher Bruce Ingram found an unusual way to do that after his wife Elaine was diagnosed with breast cancer. Bruce helped Elaine change her diet to incorporate more fruits, vegetables, and other natural foods. He also encouraged her to exercise more. His account of their success is sure to inspire others.

We know that the elderly can suffer complications from the flu, but occasionally young adults do too. Amanda Lovern was only 29 when she suffered respiratory failure and was given a 3 percent chance of surviving a bout with the flu. To save her, Carilion cardiothoracic surgeon W. Scott Arnold, M.D., acted quickly to treat her with ECMO, a new procedure that kept her blood oxygenated and gave her heart and lungs a chance to rest. Alison Weaver tells you her draCarilion Clinic President and CEO Nancy Howell matic story.

Agee (right) receives the Ann Fralin Award for support of the arts and education from Della In this issue, we also introduce a new column, to be Watkins, executive director of the Taubman written by our very own doctors. Kimberly Dulaney, Museum of Art. The award showcases an original M.D., a family medicine physician in Rocky Mount, sculpture by noted Roanoke artist Betty Branch. launches the column with a not-so-sweet look at sugar.

What you may not know is that it’s now being added to many unlikely products, including spaghetti sauce, bread, and processed vegetables. Dr. Dulaney offers tips on how to spot added sugar, and how to eat a balanced diet while also indulging in a sweet treat now and then!

Warm regards,

Nancy Howell Agee President and CEO Carilion Clinic

Carilion Roanoke Memorial Hospital has been identified by Medicare as one of the best hospitals in the country for hip and knee replacement.

For more information, go to CarilionClinic.org/ better-than-national.

CarilionClinic.org | SPRING 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

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.

Jay Conley has been a reporter for newspapers including The Roanoke Times, a staff writer for Randolph College in Lynchburg, and a writer for national publications such as U.S. News & World Report.

Rachael Garrity is a Radford-based writer, editor, and book designer. She is also active in the community, contributing time to the WVTF Friends Council and other organizations.

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, Su Clauson-Wicker, Jay Conley, Rachael Garrity, Otesa Middleton Miles, Dan Smith, Erica Stacy, Randolph Walker, Alison Weaver PhotographerS Darryle Arnold, Jared Ladia

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 magazine.

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 SPRING 2014 | CarilionClinic.org

contents

8

18

features 5 allergies

New treatments are available for adults and children.

8 after breast cancer

A husband helps his wife make lifestyle changes.

10 medical advances

A new procedure saves the life of a young woman.

12 Wound care

departments 1 President’s message Humor can be healthy.

14

28 Better Living How does sugar really affect you?

17 COPD

A focused program and support group help patients.

22 Outdoors

6 In your community New physicians across our region.

Carilion Clinic makes it easier to eat well.

Laughter is good for you.

Tips from Carilion Clinic medical professionals.

26 New providers

14 Healthy eating

18 Stress Reduction

4 Healthy Lifestyles Making a difference in western Virginia.

Advanced treatments save limbs.

A new wetlands trail has something for everyone.

24

24 fitness

Have you tried a kettlebell workout?

25 Patient care

Awards recognize outstanding care.

CarilionClinic.org | SPRING 2014 3

HEALTHY LIFESTYLES

tips from our medical professionals When to Screen for Colon Cancer Did you know that the death rate from colon cancer is slowly but steadily decreasing? This is likely due to early detection through screening colonoscopy. Screening should begin at 50, but sooner if a parent was diagnosed before 60. Other risk factors include being male, race, obesity, cigarettes, alcohol, and possibly even long-term consumption of red or processed meat. Talk to your provider about your risk of colon cancer and when you should begin routine screening.

— Rachel C. Spencer, Certified Physician Assistant Carilion Clinic Family Medicine, Vinton Smoking Affects your Whole Body According to the American Heart Association, cigarette smoking is the most preventable cause of premature death in the United States. Many people know that smoking is harmful to the lungs, but its effects are more widespread. Smoking affects the vessel walls throughout the body and increases the buildup of cholesterol.

This can lead to many serious illnesses, including heart attacks, strokes, or loss of limbs. It is never too late to quit smoking and it can be one of the most important actions you can take for your health.

— R. Steve Andrews, Registered Respiratory Therapist and Certified Physician Assistant Carilion Clinic Cardiothoracic Surgery, Roanoke Be Alert to Seizures Do you know what a seizure looks like?

Not all people fall, lose consciousness, shake, stiffen, or bite their tongue during a seizure. That is one kind of seizure. Blank staring, fumbling, wandering, shaking, confused speech, and abnormal sensations can be symptoms as well. People may seem aware but are not acting normal. If someone is unconscious and you suspect a seizure: Don’t leave the person alone, or put anything in their mouth, or restrain them.

Do turn them on their side and remove sharp objects such as glasses. If they seem conscious and confused, stay with them, speak calmly, and keep them from hazards, yet don’t hold or grab them. The seizure will pass. Seek medical evaluation.

— Lisa Faist, Family Nurse Practitioner and Psychiatric Mental Health Nurse Practitioner Carilion Clinic Neurology, Roanoke 4 SPRING 2014 | CarilionClinic.org

Maintain a Healthy Weight Weight is a topic that many are uncomfortable talking about but is important for our health. Thousands of years ago, our bodies were programmed to store calories to survive. But our genes have not adjusted to the changes in our environment. Today, we can afford more calories and our lifestyles require less energy. We can no longer rely on “autopilot” to avoid gaining weight. In order to maintain a healthy weight, we have to consciously monitor the energy we put into our bodies and balance it with the energy our bodies expend.

— Charles D. Bissell, M.D., Chief New River Surgery Carilion Clinic General Surgery, NRV

Listen to your Body Gynecologic cancers start in a woman’s reproductive system and include endometrial, ovarian, cervical, vulvar, and vaginal tumors. Each type has different symptoms, and can include abdominal pain, bloating, changes in bathroom habits, vaginal bleeding, and vulvar lesions. Be sure to listen to your body and report any new symptoms that linger for more than two weeks to your physician.

— Gretchen E. Glaser, M.D. Carilion Clinic Gynecological Oncology, Roanoke

Don’t Forget Calcium Daily calcium intake of 1,000 to 1,200 mg., with adequate vitamin D, is needed to maintain bone health after age 50. Recent research associating calcium pills with higher risk of heart disease indicates that calcium eaten as part of a balanced diet is superior to pills. You can boost your calcium intake by choosing cow’s or soy milk, yogurt, calcium-fortified orange juice, hard cheeses, tofu with calcium, dark-green leafy vegetables, and bony fish like sardines and salmon. If you are at increased risk for bone fracture and cannot eat enough dietary calcium, you might need a calcium supplement. Talk to your doctor for further guidance on your individual needs.

— Lisa Alleyne, M.D. Carilion Clinic Family Medicine – Fort Defiance, Verona

Suffer from Allergies?

New Treatments Are Available

By Su Clauson-Wicker Spring is coming— and with it allergies.

But a new allergy and immunology medical practice in Daleville, as well as new treatments, offer allergy sufferers in our region more options than ever.

Standard treatment for pollen and other irritating allergies has included antihistamines, nasal sprays, and allergy shots. The new treatments are immunoglobulin E-blocking injections and desensitization therapy for moderate to severe asthma.

The injections (of the drug Xolair) work by blocking the immunoglobulin E antibodies causing the body’s allergic reaction. Xolair is available to patients over the age of 11.

“It’s safer than the traditional allergy shot, and it’s not necessary that the specific problematic allergen be identified,” says Aneysa Sane, M.D., of Carilion Clinic’s Daleville practice. “It’s also effective faster — often after just three Xolair injections.”

Dr. Sane, who specializes in allergy and immunology, joined Carilion in 2013 after practicing for 20 years in North Carolina and serving on the faculty at Wake Forest Medical School. She completed fellowships in pulmonary and critical care at Duke University and in allergy and immunology at Bowman Gray School of Medicine.

Desensitization therapy, meanwhile, involves treating a patient with incremental dosages of an allergen to develop a tolerance. It is very effective in treating allergic rhinitis conjunctivitis and mild asthma when standard medications are not enough, says Dr. Sane.

It is also helpful in treating adult patients suffering from Samter’s triad, a combination of asthma, nasal polyps, and aspirin allergy, she adds.

Laura Dziadzio, M.D., another Carilion allergist, practices in Roanoke and specializes in pediatric allergy and immunology. She sees hope for oral immunotherapy for children. “It is most effective when treating children with one allergy rather than a cluster and is awaiting FDA approval,” she says.

Both doctors perform skin-prick testing and emphasize patient education. “It’s better to avoid the allergen, if possible,” says Dr. Dziadzio, “but spring is beautiful and children should be outdoors, so I advise them to control their spring allergies with medications and to start early.”

But watch out for ticks, Dr. Sane says. She’s seen 10 cases of a tick-induced allergy in the months she’s practiced in the Roanoke area.

“The ‘alpha-gal allergy’ to red meat is triggered by a lone star tick bite,” she says. “Alpha-gal is essentially a complex of sugars in mammal meat.

The reaction is delayed by four to six hours, so people often experience anaphylaxis in the middle of the night after eating meat. There’s no cure, so sufferers must avoid red meat and sometimes milk.”

Both Dr. Sane and Dr. Dziadzio are certified by the American Board of Allergy and Immunology. Dr. Dziadzio is also certified by the American Board of Pediatrics.

For more information or to schedule an appointment, call 540-591-9447 (Daleville) or 540-985-9835 (Roanoke).

CarilionClinic.org | SPRING 2014 5

In Your Community

Carilion Earns Magnet Recognition Again

Agee Receives Leadership and Community Awards

Carilion Clinic President and CEO Nancy Howell Agee received several awards: »» LifeNet Health’s 2013 Excellence in Leadership Award, which recognized her leadership of Carilion’s hospitals and her work to improve the organ donation process, thus saving lives. Under her direction, Carilion Roanoke Memorial Hospital achieved an organ donation conversion rate of 88 percent in 2012. »» The Ann Fralin Award for support of the arts and education at the ninth annual Taubman Museum of Art’s Women’s Luncheon, which featured former First Lady Laura Bush. »» Being named to “300 Hospital and Health System Leaders to Know,” a list compiled by Becker’s Hospital Review. Agee was recognized for her “admirable dedication to health care delivery at local, regional, and national levels.”

(Pictured: Former First Lady Laura Bush, at left, and Nancy Agee.)

Roanoke Memorial Ranked Most-Preferred

Carilion Roanoke Memorial Hospital has again received a Consumer Choice Award, placing it among the best hospitals in the country. The award, from National Research Corp., is based on a national survey of more than 270,000 households. It is given to a hospital ranked the highest in its market for overall quality, doctors, nurses, and image/reputation. Roanoke Memorial has received the award for 10 consecutive years.

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Carilion Clinic’s Roanoke campus has been designated a Magnet facility for the third time by the American Nurses Credentialing Center. The award recognizes nursing excellence and is widely accepted as nursing’s highest honor. The Roanoke campus includes Carilion Roanoke Memorial Hospital, Carilion Roanoke Community Hospital, practices in the Crystal Spring and Community Hospital medical office buildings, and practices at 127 McClanahan St., 1 and 3 Riverside Circle, and 902, 1030, and 2017 S. Jefferson St.

Flattery Is New Head of NRV, Giles, and Tazewell Hospitals

Bill Flattery was named vice president of Carilion Clinic’s western region and will lead the operations of Carilion New River Valley Medical Center, Carilion Giles Community Hospital, and Carilion Tazewell Community Hospital. Flattery previously was CEO of Bedford Memorial Hospital and Carilion’s vice president of operations and practice management for family and community medicine. He earlier held leadership positions in health care organizations in San Francisco and Mountain View, Calif., Buffalo, N.Y., and Galveston, Texas.

Carilion Provides over $131 Million in Community Benefit There are many ways an organization can give back to the community. Some pay taxes to support the cost of government services. As a tax-exempt organization, Carilion Clinic gives back in other ways.

In 2012, Carilion provided $131.5 million in community benefit. This meant that for every dollar of tax exemption, Carilion gave nearly $2.40 back to the community. This included an average of $360,274 in uncompensated care each day. Community benefit, as defined by the IRS, includes community outreach such as free health screenings and community programs, and investments in education to train new physicians and medical professionals.

Total Community Benefit: $131.5 Million

Uncompensated Care: $110.2 million (Charity Care: $71.8 million) Education:

$15.2 million

Community Outreach: $4.9 million Research:

$1.2 million

Trauma Center Marks 30-Year Anniversary Triumph over Trauma, an event for the community, was held to celebrate Carilion Clinic’s 30th anniversary as a Level I Trauma Center. The event reunited medical staff with former patients and their families as they shared their stories of recovery. Over the past 30 years, Carilion has treated 40,000 patients at the only Level I Trauma Center in southwest Virginia.

To watch patient videos, go to CarilionClinic.org/trauma-stories.

(Pictured: Former patient Betty Dooley.)

Home Care Receives Honors

Carilion Clinic Home Care in Franklin County and Roanoke were named to the 2013 HomeCare Elite™, placing them in the top tier of U.S. home health care agencies. The list, compiled

by National Research Corp. and DecisionHealth, names the nation’s top 25 percent of agencies in terms of quality of care, quality improvement and consistency, patient experience, process measure implementation, and financial performance.

Breast Care Center Gets Funding

To raise awareness of breast cancer, Member One Federal Credit Union sold special pink sweatshirts reminding women to get screened. More than 300 sweatshirts were sold, and Member One gave Carilion Clinic’s Breast Care Center a share of the proceeds — $7,037.82 — to provide life-saving screening and breast care services to women in our region.

CarilionClinic.org | SPRING 2014 7

Health news

After Breast Cancer A Husband Helps His Wife Change Her Lifestyle

By Bruce Ingram

When my wife Elaine was diagnosed with a virulent form of breast cancer in the fall of 2008, we were both devastated.

Throughout her six rounds of chemotherapy, bilateral mastectomy, and oral chemo, we talked often about dietary and lifestyle changes she could make that would reduce the chance of the cancer returning.

After her chemo was completed, Elaine hired former oncology nurse Laura Pole, R.N., who operates Eating for a Lifetime in Hardy. Pole is a “health-supportive gourmet chef” with a chef certification from the Natural Gourmet Institute for Food & Health in New York City. She is also a leader in the growing field of health-supportive cooking for people with serious illnesses.

Pole emphasizes a whole-foods, plantbased diet with the addition of healthier types of animal foods such as grass-fed beef; organically fed, preferably pastured chickens; wild game; and eggs from pastured chickens.

Elaine adopted this diet, which includes whole grains such as quinoa and oatmeal; healthy sources of fat such as avocadoes, flax, and chia seeds; nuts like walnuts and almonds; and nut butters such as ones made from almonds. As recommended, Elaine also minimizes the processed foods she previously ate such as those high in sugar, and refined carbohydrates like pasta and bread made from white flour.

But Elaine does enjoy plenty of “fun” foods like dark chocolate with its healthy 8 SPRING 2014 | CarilionClinic.org

Clockwise: Elaine Ingram picks wineberries behind the Ingrams’ Botetourt County home; Elaine shows one of her heritage Rhode Island Red chicks to her grandson Sam and daughter Sarah; Bruce Ingram prepares Venison Sloppy Joes in the couple’s kitchen.

flavonoids and anti-oxidants, red grapes with their resveratrol, and tasty berries (think blueberries and cranberries, for example) with their Vitamin C, flavonoids, and anti-oxidants.

Another part of Elaine’s recovery was our starting to raise backyard chickens.

Now our Rhode Island Red hens Sweetie Pie, Baby, and Tootsie (watched over by our rooster Boss) provide us with eggs high in Omega 3s and Vitamins A and E. “I knew there were things I could do to improve my odds of keeping the cancer

at bay,” Elaine says. “What has surprised me is how much better I feel in general from these changes.”

Add in Exercise

Elaine also started exercising and practicing stress-reducing activities such as yoga and tai-chi. The diet, exercise, and stress-reduction combine to become “the three-legged stool” of good health, a term coined by oncologist Matt Mumber, M.D., in his book Sustainable Wellness.

Why Whole Foods?

The term “whole foods” refers to eating all the edible parts of a food, as nature provides. When we eat a whole grain such as brown rice, for instance, we consume the energy-rich part of the grain as well as fiber, essential fatty acids, vitamins, minerals, and phytochemicals. The refined foods that most Americans eat have had many nutrient-rich parts removed.

Eating grass-fed beef and other meats is also often recommended because when cows and other pastured animals eat the foods they have evolved to eat (i.e. grasses, seeds, and insects), their meat or eggs contain healthier fats and other nutrients for humans. Grassfed beef, for instance, has a higher Omega-3 fatty acid content and a lower Omega-6 fatty acid content than mass-produced, corn-fed beef.

Studies indicate that cancer patients who are the most physically active fare much better than the least active patients. The more active patients are less likely to see their cancer progress, or to die from their cancer. Routine exercise also helps with weight control, as obesity is a cancer risk.

Elaine now follows a regular regimen of swimming, yoga, and tai-chi, and happily reports a higher quality of life.

Emphasizing Natural Foods

Ironically, Elaine has adopted my own eating regimen, as I gave up commercially produced pork in the mid-’70s, beef in the early ’90s, and chicken and turkey

more than a decade ago. Since we had our home built in 1989 in rural Botetourt County, I have come to rely more on meat from the deer and turkeys I hunt.

But since Elaine adopted her new eating plan, venison is the only red meat that we eat, and she has become so adept at cooking it that we now write a cooking column, “Celebrating Venison,” in an outdoor magazine, Whitetail Times.

I turkey hunt in three states and annually try to bring home the meat from five or six birds. Throw in fish that I catch and the fresh, wild salmon (think Omega 3s and 6s) that Elaine buys, and we’re good to go in the meat part of the menu.

We also enjoy pies, cobblers, and jams

made from the summertime blackberries, wineberries, and raspberries we pick behind our house or from our own crabapple and cherry trees. And together we grow onions, tomatoes, peppers, and strawberries in our garden, and buy other fresh produce locally as needed.

In June Elaine and I will have been married for 36 years. My wonderful wife is healthy, and life is good.

Bruce Ingram teaches creative writing at Lord Botetourt High School and is the author of five books on fishing and numerous magazine articles. He and Elaine Ingram also write a weekly blog on the outdoors and their experiences at bruceingramoutdoors.com.

CarilionClinic.org | SPRING 2014 9

Medical news

LIFESAVER

When a young woman is near death from the re to save her flu, doctors use a new procedu

By Alison Weaver Amanda Lovern was struggling to get over a case of the flu. The aches, fever, and coughing had utterly drained her energy, and the medicines her doctor had given her didn’t seem to be helping. The working mother of two asked her mom to take her older daughter to a soccer event and then curled up to go to sleep.

That was October of 2009. The next thing she remembers is waking up in the hospital the next year.

Amanda, a completely healthy 29-year-old, had become a victim of the H1N1 influenza virus, a pandemic that swept the world from April 2009 until the summer of 2010.

Debbie Hamilton, Amanda’s mother, found her daughter in bed in her Parrott, Va., home on Oct. 25 — barely breathing, with her lips white. She took Amanda to Carilion New River Valley Medical Center, where physicians quickly assessed her grave condition.

Amanda was transported by helicopter to Carilion Roanoke Memorial Hospital. Cardiothoracic surgeon W. Scott Arnold, M.D., was among the first to examine her.

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Left: Amanda Lovern, who was near death due to complications from the flu, has made a remarkable recovery.

“Amanda was in complete respiratory failure when she arrived,” Dr. Arnold recalls. “We couldn’t even see her lungs on the X-ray because of the excess fluid and infection.”

Amanda was given a 3 percent chance of surviving. “Something had to be done immediately and at the bedside,” Dr. Arnold says. “We decided to treat her with veno-arterial ECMO to keep her blood oxygenated and give her heart and lungs a chance to rest.”

Veno-arterial ECMO, or extracorporeal membrane oxygenation, is a relatively new procedure similar to that of using a heart-lung machine during open-heart surgery.

The patient’s blood is drawn out, mixed with oxygen, and sent back into the Dr. W. Scott Arnold venous system.

But ECMO hadn’t been used in an H1N1 case before, and doctors were unsure if it would provide much benefit. “I was looking at a formerly healthy 29-year-old with two little children who was hours away from death.

I was determined to try every option to save her,” Dr. Arnold says.

With the machine doing the work for Amanda’s failing heart and lungs, her condition stabilized fairly quickly. “She was only on ECMO for four or five days, but then we had to treat a host of other problems,” Dr. Arnold says.

Amanda’s heart failed three times; she was on dialysis; and she had a tracheotomy and numerous chest tubes.

“My mother says there were so many machines and monitors around me that the nurses had to move things just so she could come to my bedside,” Amanda relates.

For nearly three months, Amanda

was oblivious to her surroundings. “I remember, or think I remember, a nurse washing my hair. But I had so many hallucinations that I’m not sure if that’s a real memory,” she says. “The first thing I definitely remember is waking up in the hospital and seeing my family smiling

“I was looking at a formerly healthy 29-year-old with two little children who was hours away from death. I was determined to try every option to save her.”

— W. Scott Arnold, M.D.

and talking to me. I couldn’t talk because of the trach tube, and I couldn’t move my arms or legs.”

Amanda was transferred for inpatient rehabilitation at Carilion Roanoke Community Hospital for a month and finally returned home in the spring of 2010. She was in a wheelchair, on oxygen 24 hours a day.

“It was a long recovery process. I lost 54 pounds in the hospital and I had to learn to walk again. I didn’t drive for the first time until April of 2011,” Amanda says.

To pass the time, she began taking online classes at New River Valley Community College. As her strength and mobility improved, she attended classes on campus to complete two associate degrees at the same time. She was inducted into the Phi Theta Kappa honors society and graduated magna cum laude in May. Amanda marvels at her recovery, and is now a mother for the third time. “I’m off the oxygen machine. I take no medications, except for asthma,” a condition she developed after her illness. “I can run; I can walk normally, although I wear a brace on one foot. I’m enjoying my children and my new baby boy. God has been very good to me.”

Dr. Arnold describes Amanda’s case as an example of successful collaboration by a variety of medical professionals to deliver high-quality care. “That’s what regional health care systems like ours are about. It’s just a humongous effort by so many people.

“If you wanted to take a photo of Amanda with her ‘caregivers,’ you’d need an auditorium to hold everyone. There were hundreds of people involved in her care — nurses, physician assistants, pulmonologists, housekeeping, perfusionists, nephrologists, lab techs, blood donors… it took a village. Big problems require big solutions.”

For more information, go to CarilionClinic.org/cardiac-thoracic.

What is ECMO?

CarilionClinic.org | SPRING 2014 11

MEDICAL NEWS

Saving Limbs:

New Approach prevents amputations

By Karen Doss Bowman

When a boating accident at Smith Mountain Lake shattered Glenn Miller’s left ankle two years ago, it led to other complications. Miller, of Covington, was told his leg might have to be amputated.

Carilion Clinic podiatrist J. Randolph Clements, D.P.M., however, was determined to explore every alternative. To preserve Miller’s ankle, Dr. Clements performed several surgeries, including inserting metal rods to stabilize the joint.

But Miller’s diabetes complicated matters. An infection developed in his ankle and wouldn’t heal. Still, Dr. Clements refused to give up. He fused Miller’s ankle to his leg bone — and saved his leg.

“Dr. Clements was so attentive in giving care to me,” says Miller, 56, who now walks with the aid of a leather medical boot. “He tried everything to save my leg, and there aren’t a lot of doctors who would do that.

“I can never thank him enough for what he did for me. Saving my leg is going to extend my life.”

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“Dr. Clements was so attentive in giving care to me.”

— Glenn Miller

L to R: Glenn Miller developed a severe infection in his ankle after a boating accident; Roger Jefferson, who broke many bones in his feet in an accident, relaxes with his grandchildren.

Lives at Risk

Specialists Work Together

Dr. Clements’ commitment to help Miller — and all of his patients — reflects a broader effort by Carilion to save limbs that in the past would have been amputated.

Since 2006, amputations have decreased by 80 percent at Carilion due to an informal collaborative effort by podiatrists, interventional cardiologists, general surgeons, orthopaedic surgeons, vascular surgeons, plastic surgeons, endocrinologists, hospitalists, and others.

Now Carilion has formally recognized this effort and launched its Inpatient Comprehensive Limb Salvage Service, operated by Carilion’s outpatient Wound Healing Center in conjunction with the vascular surgeons at Jefferson Surgical Clinic. The service is believed to be the first of its kind in Virginia.

Setting Consistent Guidelines

“Every patient is evaluated according to consistent guidelines and many specialists are available to consult on each case, as necessary,” says James E. Foster II, M.D., medical director of Carilion’s Wound Healing Center.

“This is a proven model that has resulted in excellent outcomes here and at other centers across the U.S.,” says Dr. Foster.

Through the Wound Healing Center, patients have access to the latest treatments, including endovascular options to restore blood flow, and skin substitutes to cover wounds. The center also offers hyperbaric oxygen therapy, delivered within an enclosed, see-through chamber, where the patient breathes pure oxygen to stimulate blood circulation and new skin growth.

Types of Patients

Many of the patients seen are diabetic.

“These patients often develop wounds in their legs or feet due to arterial occlusive disease or severe venous disease,” says James Drougas, M.D., a vascular surgeon at Jefferson Surgical Clinic.

Most patients whose limbs are at risk can be helped, he says. “After an evaluation that can involve both invasive and noninvasive techniques, some patients will need an open operation to salvage their limbs, while others can be helped with a minimally invasive approach.

“Our collaboration between podiatry, vascular surgery, and interventional radiology gives us the best opportunity to give most patients a functional limb.”

Patients who suffer traumatic injuries are also treated. Roger Jefferson of Salem is one of them. Last April, Jefferson feared he would lose both his feet

Diabetes is the leading cause of non-injury-related amputation of feet and legs among adults, according to the Centers for Disease Control.

Half of those who have a leg amputated are also likely to die within five years.

“This alone shows why it’s so important for us to try to save limbs whenever possible,” says Carilion Clinic podiatrist J. Randolph Clements, D.P.M. “By saving limbs, we are saving lives.”

after a stack of steel beams weighing nearly 2,000 pounds crushed them in an accident at work.

With multiple fractures in one foot — and the other completely shattered — Jefferson’s condition seemed hopeless.

But he was in excellent health otherwise, so Dr. Clements ordered treatments in the Wound Healing Center’s hyperbaric oxygen chamber.

Within three months, Jefferson was able to get around with the aid of medical cast boots and a knee walker.

“A lot of doctors would have just amputated my legs, but Dr. Clements wanted to give me a chance,” says Jefferson, 62.

“My life is never going to be the same, but it will be as close to normal as possible because of everyone at Carilion who took good care of me.

“They were excellent — they get five stars.”

For more information, call 540-266-6000 or 800-422-8482 or go to bit.ly/wound-care.

CarilionClinic.org | SPRING 2014 13

specialty care Nutrition

s n g i S n o i l i Car e g d e l P d o o F y h t l a e H

By Maureen Robb

Carilion Clinic has signed a pledge to provide local, nutritious food to patients and employees, and to encourage healthy eating in the community.

Last fall Carilion signed the Healthy Food in Health Care Pledge, developed by the international coalition Health Care Without Harm. The pledge outlines steps that health care providers agree to take to improve the health of their communities and protect the environment.

Carilion is the first health care system in the region to sign the pledge.

At its hospitals and employee cafés, Carilion will serve more fruits and vege14 SPRING 2014 | CarilionClinic.org

tables, along with minimally processed, unrefined foods. And it will cut down on trans and saturated fats and sweetened foods.

Carilion will also work with local farmers to obtain fresh, local, and sustainably produced food; encourage its other suppliers to provide healthy foods; and educate the community about the importance of food as preventive medicine.

At the signing, Carilion’s Chief Medical Officer Dr. Wayne Gandee said, “When we heard about the Healthy Food in Health Care Pledge, it was great to realize we were already doing many of the

things it advocated. This pledge fits our mission. The food we eat or avoid greatly affects our well-being.”

The pledge also recognizes that the way food is produced has an impact on the environment.

Signing the pledge is one of many steps Carilion has taken over the past year to encourage healthy eating. These include providing: »» Snack machines with healthy choices »» rBGH-free milk (milk that does not contain a genetically engineered hormone used to boost cows’ milk production)

L to R: Diners enjoy lunch at the Mountain View Café in Carilion Roanoke Memorial Hospital; Amber Duncan, Carilion Clinic food services supervisor, creates healthy recipes that are posted on Carilion’s website and on social media for the public each week. (Registered dietitians Gwinn Firing and Don Mankie determine the calories and nutritional content of the recipes.)

CarilionClinic.org | SPRING 2014 15

To receive a healthy recipe each month, go to CarilionClinic.org/living to sign up for the Carilion Clinic Living e-newsletter. Or scan the QR code below.

»» Healthy recipes created by Carilion and posted on Carilion’s website and Pinterest. »» Nutrition information for many café items »» Tiered beverage pricing to discourage drinking sugared soft drinks »» Hydration stations with free infused water in the cafés »» A Choose Wisely Food-of-the-Month program »» No-Fry Fridays in the cafés »» The Farmers’ Table (a farmers market)

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at Carilion Roanoke Memorial Hospital from May through October »» Sponsorship of Happy Healthy Cooks, a local program that teaches children to enjoy and cook healthy food »» Participation in Food for Thought, a local program that gives healthy cooking demonstrations to middle-school students »» Matching SNAP (food stamp) dollars at local farmers’ markets »» Employee payroll deduction for a “Farm

Share” program. (Employees buy shares in order to receive produce in season.)

“We are proud of our commitment to make healthy food available to our patients, employees, and members of the community,” says Carilion President and CEO Nancy Howell Agee. “Eating nutritious food is essential to good health.”

To see Carilion’s healthy recipes, go to CarilionClinic.org/recipes.

Living with chronic obstructive pulmonary disease, or COPD, can be a daily challenge.

The progressive disease, which makes it hard to breathe, is the third leading cause of death in the United States, according to the American Lung Association. The two main types are emphysema and chronic bronchitis, with most cases linked to cigarette smoking.

Doctors in western Virginia see many cases, since residents of rural communities are more likely to smoke and be exposed to secondhand smoke.

“The best way to prevent COPD is to not smoke,” says Edmundo Rubio, M.D., chief of pulmonary and critical care medicine at Carilion Clinic. “And if you do smoke, to start a smoking cessation program immediately.

“COPD symptoms don’t typically appear until there has been considerable lung damage, so by the time we see patients, we are looking to control symptoms and minimize further damage.”

But COPD is treatable. Carilion, for instance, has a COPD program that begins with primary care to identify patients who may have the disease and to offer treatment before their symptoms get worse.

Common symptoms include shortness of breath, wheezing, chest tightness, excess mucus in the lungs, and a chronic cough.

Treatments can reduce or control symptoms, reduce the risk for infections and complications, and improve a patient’s quality of life.

“Keeping patients as healthy and independent as possible is our goal,” says Dr. Rubio. “One therapy that we highly encourage is pulmonary rehabilitation, which helps patients increase their lung capacity and makes daily activities easier.”

Treatment may also include oxygen therapy, medications, inhaler options, and lifestyle changes. For some, surgery may be necessary to improve lung function. In very serious cases, patients may consider lung transplants.

“We need to look at our patients’ entire medical pictures and ensure that other health issues are under control,” Dr. Rubio says. “And we really encourage our patients to get all the recommended vaccinations to prevent future infections.”

Carilion recently participated in a national clinical research trial to demonstrate the safety and efficacy of the AeriSeal System — therapy that involves releasing foam to block off airways to damaged lung tissue.

“We are committed to seeking advanced alternative therapies that may benefit patients in the region,” says Dr. Rubio.

Carilion also sponsors the Better Breathers Club, a support group that helps patients cope with the disease.

For more information, call 540-266-6000 or 800-422-8482. To watch a video on how to quit smoking, go to bit.ly/smoking-cessation.

g n i at Tre COPD

By Allison Buth

CarilionClinic.org | SPRING 2014 17

cover story

Laughter Is Good Medicine

By Randolph Walker Did you know that laughter can lower your blood pressure and boost your immune system?

Or that it can relieve stress and decrease pain?

Laughter also strengthens relationships by bringing people together and creating positive bonds. It’s an antidote to conflict, whether with family, co-workers, or friends.

A growing body of evidence shows that laughter is good for the mind and body.

And it’s increasingly being used to sustain health and help patients cope with illness.

A Time-Honored Treatment

Belief in the therapeutic power of laughter dates back many centuries. “A joyful heart is good medicine,” says the Bible’s Book of Proverbs. Physicians have also long harnessed its power. In the 13th century, for instance, surgeons used humor to distract patients.

18 SPRING 2014 | CarilionClinic.org

The modern father of therapeutic laughter is Norman Cousins, author of Anatomy of an Illness, published in 1979.

Cousins, editor of Saturday Review magazine, wrote his best-selling book after being diagnosed with a serious disease of the connective tissue.

In consultation with a supportive doctor, Cousins incorporated laughter into his treatment. He started by watching Marx Brothers movies and Candid Camera TV shows.

“The most wasted of all days is one without laughter.”

— e. e. cummings

“I made the very interesting discovery that 10 minutes of good belly laughter would give me two hours of pain-free sleep,” he said in a television interview

at the time. He also found that “laughter produced a natural body anesthesia.”

Cousins recovered from his illness and went on to write numerous books and articles on health and well-being before his death at 75 in 1990. Today others such as Allen Klein, author of The Healing Power of Humor, and Annette Goodheart, Ph.D., author of Laughter Therapy, are following in his footsteps. Corporations and other organizations also bring in speakers such as Goodheart to talk about the healing power of laughter.

Laughter Therapy

Stress relief from laughter is no joke, according to the Mayo Clinic. It helps to oxygenate the blood, stimulating the heart and lungs. It also boosts the release of endorphins (natural painkillers).

The benefits aren’t just physical; laughter can even ease depression and anxiety, the clinic says.

At the University of Texas at Austin, a

Left: A clown visits Kayela Boyd at Carilion Clinic Children’s Hospital as child-life specialist Sarah Cupp looks on. Clockwise: Ventriloquist Kelly Harris holds her puppet Dee-oh-Gee, dressed as a doctor-in-training; Greg Trafidlo performs at the Third Street Coffeehouse in Roanoke; Angela Steahly of Carilion Clinic’s Home Care and Hospice uses humor to relax patients.

recent study found that chuckling while viewing a comedy increased the dilation of blood vessels by one-fifth for up to 24 hours. Watching a serious documentary, however, constricted blood vessels by 18 percent. (Constriction can lead to high blood pressure.)

Whether it is called laughter therapy or humor therapy, the use of humor can relieve physical or emotional pain and stress, according to the American Cancer Society. It describes laughter therapy as “a complementary method to promote health and cope with illness.”

At the Cancer Treatment Centers of America, laughter therapy is offered as a supplement to conventional cancer treatments.

Closer to home, Carilion Roanoke Memorial Hospital has four child-life specialists who employ humor. “Part of my role is helping children find ways to cope with being in the hospital, using play and laughter,” says Sarah Cupp, one

“We had a teenager who was here for chemotherapy and he knew that one of Seek Out Ways to Laugh his nurses was terrified of snakes,” Cupp » Read the comics says. “I gave him a plastic snake and he » Watch a funny show dangled it from his IV pole before calling the nurse to say that his pump was beep» Play games with friends ing. » Spend time with funny people “When the nurse came in, she screamed » Be silly with children and jumped back and the patient and » Play with pets family laughed and laughed. Even though » Schedule fun activities this was a difficult time and he did not » Share amusing stories feel well, during this moment he was simply a teenage boy teasing a friend and all else was forgotten.” of the specialists who works in the pediAnother Carilion employee who uses atric intensive care unit and in hematololaughter with patients is Angela Steahly, gy-oncology. care coordinator for Home Care and Younger patients enjoy clown visits, Hospice.

“I try to introduce humor and pet therapy, riding a car in the hallways, and playing games. “Kids find it hilarious laughter to break the ice,” she says.

“Sometimes they need something to when adults are terrible at Wii,” Cupp help them relax a little bit, and a release says. from the stress of the health conditions Older pediatric patients enjoy playing practical jokes on nurses and doctors. they’re going through.”

CarilionClinic.org | SPRING 2014 19

L to R: At the Laughter Club of the New River Valley, attendees practice “laughter meditation,” which is quickly gaining popularity across the country. Participants laugh for at least several minutes to quiet and clear the mind; Serena Lok laughs at a recent meeting.

Humor’s Benefits

Across western Virginia, many have discovered the health benefits of laughter, including Tod Whitehurst, who was at Virginia Tech one terrible day in 2007.

“I was in the building next to the shootings,” he says. “I suffered from post-traumatic stress for about a year, and tried different techniques to get over it.”

While attending sessions at Yogaville in Buckingham County, Whitehurst tried laughter yoga. “I went and I started laughing, then I started crying, then I started laughing again. And after that my post-traumatic stress pretty much disappeared.”

Laughter yoga, he explains, has nothing to do with stretches. “It is a practice involving prolonged voluntary laughter which is a form of breathing,” Whitehurst says. “When you laugh from your belly, you expel more carbon dioxide, which means your next breath has more oxygen in it. It’s a way for everyone to enjoy deep-breathing exercises.”

Eager to share his discovery, Whitehurst, a massage therapist, started the 20 SPRING 2014 | CarilionClinic.org

Enjoy the Benefits Laughter has been shown to: » Reduce stress » Boost immunity » Lessen pain » Relax your body » Reduce anxiety » Help your mood » Ease conflicts » Promote bonding

Laughter Club of the New River Valley.

The group meets twice a month, but uses games and activities to promote laugher.

It attracts up to 20 participants each session, and attendance is free.

It is also one of more than 400 laughter clubs across the United States.

“Once you laugh with people in a group, you feel bonded with them,” says Blacksburg resident Sue Santamaria, a Laughter Club participant. Santamaria finds that whatever problems she’s dealing with

don’t matter as much after attending the club. “They still matter — you just have a different perspective on them.”

Santamaria also doesn’t necessarily wait for club meetings to laugh. At home, she uses the “mad scientist” technique.

“You pretend you’re a mad scientist coming up with a plan to rule the world and start laughing an evil, scary laugh,” she says. “You can’t not laugh.”

She even laughs in public without attracting attention. “You can put up your cell phone and just laugh. Nobody’s going to know.”

Ways to Laugh

Others in our region are finding different ways to laugh: at standup comedians, theatrical shows, situation comedies, jokes, songs, or the funny thing the dog did.

In some situations, public laughter is just the ticket. That’s where Lexington resident Kelly Harris comes in. As K.C. the Clown, she has entertained at nursing homes, churches, and special events.

As a ventriloquist, Harris has dressed her

L to R: Sue Santamaria is a laughter club participant who says laughter helps you gain perspective on life’s problems; Ned, a new child-friendly robot at Carilion Clinic Children’s Hospital, explains treatments to kids to make them less afraid. He also often gets them laughing.

Photo by Christina O’Connor

puppet, Dee-oh-Gee, as a doctor-in-training and performed for the American Cancer Society in Georgia.

Harris also dresses Dee-oh-Gee in other outfits to entertain audiences such as children and the elderly. She says she gets joy from reaching people through humor.

Greg Trafidlo, a musician who lives outside Salem, has found another way to share the joy of laughter: through music.

Trafidlo, who writes funny songs, has won awards for two (both co-written with Neal Phillips).

The awards “are real validations, but not as much as hearing an audience’s laughter,” he says. “There’s a bond that’s created, and a release that puts an audience in a comfortable place.”

Trafidlo, a professional singer-songwriter who has performed at venues including the Ryman Auditorium in Nashville, has had his comic song “I Got Stuck behind Buford,” played on National Public Radio’s Car Talk.

Audiences do like to laugh, as Marlow

Ferguson, co-founder of the Star City for public entertainment, some residents Playhouse, can tell you. One way to get look for chuckles in everyday situations. people laughing is to mix up the momen- “Around here laughter is generated with tous and the trivial, he says. friends, day-to-day interacting,” says Ferguson, who has been training comic Andy Necessary, a teacher in Tazewell. actors for 40 years, personally enjoys Laughter isn’t a substitute for medical watching The Big Bang Theory on TV for care. But it can make you feel better in all laughs. kinds of ways. So go ahead and laugh—at Mike DiGiorgi of Smith Mountain Lake, a comedian, a funny cat video, the absuron the other hand, is a management/ dities in life, or for no reason at all. If you training consultant who uses personality enjoy laughing, that’s reason enough. assessments as clues to understanding humor preferences. “I discovered there are some strong links between personResources ality preferences and the kind of things people find funny, and what they don’t Mayo Clinic: find funny,” he says. mayoclinic.com/health/stress-relief/SR00034 Traditionalists prefer jokes with setups American Cancer Society: and punch lines, DiGiorgi says, while othbit.ly/humor-therapy ers like himself have a “Far Side” sense Helpguide.org: of humor. “I’m always laughing at situahelpguide.org/life/humor_laughter_health.htm tions where there’s an absurd connection Cancer Treatment Centers of between things,” he says. His favorite America: comics include Dennis Miller and Steven cancercenter.com/treatments/laughter-therapy/ Wright.

In rural areas with fewer opportunities CarilionClinic.org | SPRING 2014 21

Recreation

Clockwise: Kent Davis, president of the Roanoke Valley Bird Club, enjoys bird watching on a new Roanoke County trail; the trail’s pine boardwalk was specifically treated for wetlands use; Ron and Bonnie MacEwan often walk on the trail as part of their fitness program.

s nd la Wsuaet eers Unu th alknokin AW l Opportunities Trail in Roa e County Off A New

By Dan Smith

A couple strides across a honeycolored boardwalk.

A young woman crouches and lifts her arms skyward in a yoga position.

Birdwatchers spot a blue grosbeak, seldom seen in the Roanoke Valley.

These are just a few of the area’s residents who are enjoying the new wetlands trail in the Penn Forest section of Roanoke County.

The scenic trail, in the shadow of the Blue Ridge Mountains, includes a curving boardwalk built over a marsh. It offers walkers and bicyclists a view of a wetlands habitat and connects the new South County Library to Penn Forest Elementary School.

It is the first link in a planned extension of the greenway system that will run through Starkey Park to Back Creek.

22 SPRING 2014 | CarilionClinic.org

Recreation and Education

At 1,700 feet, the trail is short in length but long on opportunity.

Kent Davis, president of the Roanoke Valley Bird Club, is a frequent visitor to the trail, where he recently spotted a rusty blackbird and a blue grosbeak. “The potential for other uncommon birds showing up in these marshes is very good,” he says.

Retirees Ron and Bonnie MacEwan, who live near the library, walk three miles several times a week as part of their wellness program. They often like to incorporate the trail in their walks. “It’s much more pleasant than the road,” says Ron. Alan Hale of the library staff uses the trail for a lunchtime walk nearly every day. “It’s like being in the country, and

I’m only 100 yards from the library,” he says. “The other day I saw three deer, and there seem to be different flowers blooming nearly all the time.”

“There are a wide variety of uses for this kind of trail, including field trips for

“Everybody needs beauty as well as bread, places to play in and pray in, where nature may heal and give strength to body and soul.”

— John Muir students and naturalists,” says Lon Williams, Roanoke County parks planning and development manager. “One group of naturalists recently identified 100 species of butterflies in a day.”

“A lot of families also use the trail,” he

adds. “I’ve been out there with my own.”

Preserving the Environment

The boardwalk trail was conceived during the construction of the new county library two years ago. “When we built the library, we were committed to being a good neighbor to the wetlands next door,” says Diana Rosapepe, director of the Roanoke County Public Library.

As a result, the trail is the first in the Roanoke Valley to be built with both environmental protection and education in mind.

The total project cost $335,000 and the boardwalk portion ($268,000) was built

by Bridge Builders USA, Inc., a Franklin, N.C. firm specializing in wetlands construction. “Getting the supports for the boardwalk in without disturbing the wet-

lands was crucial,” says Williams.

Roanoke County staff then helped create the 800-foot upland trail, a simple gravel surface that leads to and from the boardwalk.

“In the next year or so, we’ll establish some way points to identify plants and animals,” says Rosapepe. “One of our intentions is to present the opportunity to do things like teach about wetlands.”

Jean Brammer, principal of Penn Forest Elementary School, welcomes the opportunity. “Perhaps in the future teachers may incorporate this into a unit of study such as habitats, life cycles, or human impact on the environment,” she says.

The Boardwalk in Brief Location: 6303 Merriman Rd., Roanoke, next to South County Library Opened: April 2013 Boardwalk length: 900 feet Upland trail: 800 feet Boardwalk cost: $268,000 Total project cost: $335,000 Funding: Roanoke County Contractor: Bridge Builders USA, Inc., Franklin, N.C. Construction: Pine boardwalk specifically treated for wetlands use

CarilionClinic.org | SPRING 2014 23

s l l e b e l t Ket

By Rachael Garrity

A Trend Takes Off

If you want to rev up your workout, kettlebells may be for you.

These weights made of cast iron burn more than 600 calories in 30 minutes, giving you a total body workout in a short time.

And they are catching on all over the country, attracting fans like actress Jennifer Aniston as well as seasoned athletes.

Kettlebells are by no means new. They were used in ancient Greece and were popular with body-builders in 18th-century Russia. Today they come in shades from the original black cast iron to bright pink and weigh as little as five pounds or as much as 140 pounds.

According to a study by the American Council of Exercise, lifting kettlebells can significantly improve your aerobic capacity, core strength, and balance.

The study’s subjects were young men and women with some weight training, but the council said older people might also benefit by improving their balance and avoiding dangerous falls.

“Kettlebells are especially easy to incorporate into almost any routine,” says Liz Kane, fitness manager of the Roanoke Athletic Club. “In cardio training, for instance, you want to involve as many muscles as possible, and this is an excellent way to do that.”

You can begin with traditional moves like bentover rows or overhead presses and then move on to more demanding exercises like swinging the bells between your legs or around your torso.

But proper form is important, so professional instruction is recommended at first to avoid injury.

“In this, as in almost all training, the best way to start is working with someone who can coach you,” says Kane. “Do you need to rotate your wrists more or less? Are your knees in the right position? Regardless of your fitness or ability, the primary goal is a safe workout.”

Are all kettlebells created equal? “Pretty much,” Kane says. “Choose whichever one motivates you.

Put glitter on it, if that helps!”

Liz Kane, fitness manager of the Roanoke Athletic Club, lifts a kettlebell.

24 SPRING 2014 | CarilionClinic.org

Quality Awards Recognize Exceptional Patient Care At Carilion Clinic, many doctors and medical professionals consistently go above the call of duty.

To recognize their contributions, Carilion recently announced its 2013 Quality and Values Awards.

Paladin Award

Douglas Martin, Carilion Roanoke Memorial Hospital, for his passion and dedication to continuous improvement.

Provider Excellence Awards Advanced Clinical Practitioner

Elizabeth Hall, P.A., Inpatient Cardiology, Carilion Roanoke Memorial Hospital Resident

Kevin Loughry, D.O., chief resident, Internal Medicine, Virginia Tech Carilion School of Medicine Physician

Michael McMahon, M.D., hospitalist, Carilion Giles Community Hospital

Nancy Howell Agee, Carilion Clinic president and CEO, and Douglas Martin, Paladin Award recipient.

Quality Awards

The “Time-Out” to Save 9 Lives project team at Carilion New River Valley Medical Center increased compliance for contacting LifeNet Health about patients who met criteria for possible organ donation.

The Workplace Possibilities Team helps employees with medical conditions by developing interventions or accommodations so they can return to or stay at work.

The Pulling the Line on CLABSIs project team has continued to achieve success in preventing central line-associated bloodstream infections.

The Collaborative Heparin Project improved the reliability of safely administering a high-risk drug.

Values Awards

Commitment: Kelly Howard, Property Maintenance Kelly creatively coordinated repairs so patients could be seen safely when two floods in less than a week threatened a practice’s operation.

CommUNITY: Carilion Tazewell CommUNITY Team This team volunteered hundreds of hours supporting the community.

Compassion: 8 Mountain ICU Team, Carilion Roanoke Memorial Hospital The 8 Mountain ICU team provided empathetic care and service to a patient and his family during his last moments of life.

Courage: Martha Devinney, Practice Support Martha accepted a challenge and provided leadership through a time of change.

The Pulling the Line on CLABSIs project team. From left are: Heather Bramblett, R.N., Ellen Harvey, R.N., Terry Tilley, R.N., Kelli Loftus, R.N., Jason Hoffman, R.Ph., and Kathryn Booth, R.N., with Nancy Howell Agee.

Curiosity: Brandon Jones, R.N., Emergency Department, Carilion Roanoke Memorial Hospital Brandon’s quest to provide the best possible experience for our patients became a journey of changing the culture.

To read more about the awards and other winners, go to CarilionClinic.org/shine2013.

CarilionClinic.org | SPRING 2014 25

New Providers PHYSiciAnS M. Jonathan Bern, M.D. Gastroenterology

Horatiu C. Dancea, M.D. Orthopaedic Surgery

Medical Degree: University of Miami Residency: Baylor University Medical Center Fellowship: Gastroenterology, University of North Carolina at Chapel Hill 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Medical Degree: Carol Davila University of Medicine and Pharmacy Residency: Geisinger Medical Center Fellowship: Hand Surgery, Christine M. Kleinert Institute for Hand and Microsurgery 4064 Postal Dr., Roanoke, VA 24018 540-725-1226

Anne Elizabeth Bush, M.D. Gastroenterology

Amrita de Zoysa, M.D. Family Medicine

Medical Degree: University of Mississippi Residency: Methodist Hospital Fellowship: Gastroenterology, Medical College of Ohio 110 Akers Farm Rd., Christiansburg, VA 24073 540-382-9405

Medical Degree: Ross University Residency: Aultman Hospital Family Medicine Residency Program 200 High St., Bridgewater, VA 22812 540-828-2634

John M. Bush, M.D. Internal Medicine

Monica Paz Garin-Laflam, M.D. Pediatric Gastroenterology

Medical Degree: University of Tennessee Residency: Medical College of Ohio 2900 Lamb Circle, Suite 250, Christiansburg, VA 24073 540-639-9071

Medical Degree: University of Miami School of Medicine Residency: Jackson Memorial Hospital Fellowship: Pediatric Gastroenterology, Cincinnati Children’s Hospital Medical Center 102 Highland Ave., Suite 305, Roanoke, VA 24013 540-985-9832 2900 Lamb Circle, Christiansburg, VA 24073 540-224-4545

Vikas Chitnavis, M.D. Gastroenterology

Heather O. Greer, M.D. Gynecology

Medical Degree: Government Medical College Residency: St. Mary’s Hospital Fellowship: Gastroenterology, Brown University 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Medical Degree: University of Alabama Residency: University of Alabama 150 Market Ridge Lane, Daleville, VA 24083 540-966-0460

Jeff S. Croteau, M.D. Rheumatology

W. Jerod Greer, M.D. Urogynecology

Medical Degree: University of Kentucky Residency: Dartmouth Hitchcock Medical Center Fellowship: Rheumatology, Dartmouth Hitchcock Medical Center 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

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Medical Degree: University of Alabama Residency: University of Alabama Fellowship: Women’s Pelvic Medicine and Reconstructive Surgery, University of Alabama 101 Elm Ave., Suite 400, Roanoke, VA 24013 540-985-4099

Michael S. Helvey, D.O. Orthopaedic Surgery

Kevin Mercure, M.D. Gastroenterology

Medical Degree: West Virginia School of Osteopathic Medicine Residency: Mercy St. Vincent Medical Center 159 Hartley Way, Pearisburg, VA 24134 540-922-4350

Medical Degree: Albany Medical College Residency: Wake Forest University School of Medicine Fellowship: Gastroenterology, Albany Medical Center 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Edward S. Hemphill, M.D. Orthopaedic Surgery

Arthur Pemberton, M.D. Internal Medicine

Medical Degree: University of Cincinnati Residency: Eisenhower Army Medical Center Fellowship: Sports Medicine, The Hughston Clinic 25 Crossing Lane, Suite 2, Lexington, VA 24450 540-463-2103

Medical Degree: University of Tennessee Residency: Naval Medical Center, Portsmouth, VA 199 Hospital Dr., Suite 5, Galax, VA 24333 276-236-6136

Michael D. Mauro, D.O. Orthopaedic Surgery

Brian K. Unwin, M.D. Geriatrics

Medical Degree: Kirksville College of Osteopathic Medicine Residency: Grandview Hospital and Medical Center Fellowship: Orthopaedic Spine Surgery, Johns Hopkins Hospital 2900 Lamb Circle, Christiansburg, VA 24073 540-633-0523; 540-731-243

Medical Degree: Uniformed Services University of the Health Sciences Residency: Martin Army Community Hospital Fellowship: Geriatrics, Madigan Army Medical Center 2001 Crystal Spring Ave., Suite 302, Roanoke, VA 24014 540-981-7653

Tara C. Mauro, D.O. Psychiatry and Behavioral Medicine Medical Degree: Pikeville College School of Osteopathic Medicine Residency: Wright State University 2900 Lamb Circle, Christiansburg, VA 24073 540-731-7311

Russell W. Melton, M.D. Family Medicine Medical Degree: University of Virginia School of Medicine Residency: Lancaster General Hospital 430 Boxwood Lane, Pearisburg, VA 24134 540-921-3636

CarilionClinic.org | SPRING 2014 27

BETTER LIVING

r a g Su The Not-So-Sweet Truth

By Kimberly Dulaney, M.D.

Who doesn’t love a delicious treat: a homemade birthday cake, a flaky pastry, or a cup of ice cream?

Desserts can add sweet pleasure to life and accentuate life’s special occasions. In today’s world, however, sweets and added sugar are no longer a “special treat.”

Sugar is added to all sorts of unlikely things like spaghetti sauce, crackers, vegetables, and bread. It is the daily consumption of large quantities of sugar that has contributed to our poor health as a nation: the rise of obesity, diabetes, and heart disease. Our taste buds have been brainwashed by all the sugar in our food, and we no longer enjoy the taste of natural sweetness because it pales in comparison to the extreme sweetness of added sugar.

Here are some tips for retraining your taste buds!

1) Avoid sweet drinks. Soda/pop/cola is the worst thing you could possibly drink. It makes your blood sugar spike and then drop Dr. Dulaney very quickly, which makes you feel tired, foggy-brained, and achy.

2) Stay away from artificial sweeteners. Contrary to popular belief, artificial sweeteners are no better than regular sugar, and may even be worse. There is ample evidence that aspartame and saccharin increase your risk of stroke and digestive problems.

Sucralose is a newer sweetener that is a molecular mirror image of sucrose (table sugar). At best, it can still make you gain weight despite having no calories. At worst, it could have other negative health consequences—we just don’t know much about it yet because it is so new. Artificial sweeteners also keep your taste buds and brain addicted to that “sweet” taste.

28 SPRING 2014 | CarilionClinic.org

3) Eat sweets sparingly. When you do choose to eat sweets, it is best to make the goodies yourself out of all-natural ingredients.

Avoid buying cookies and candy to have around the house. If you feel the need to have a small treat each day, a small square of dark chocolate would be the best choice.

4) Look for hidden sugar. Read the labels of the processed food you buy. Flavored yogurts, breakfast cereals, baked goods, spaghetti sauce, and bread often have a lot of added sweetener.

Some foods that are marketed as “healthy” actually have more added sugar than cookies (such as kids’ yogurt)! If you start reading labels, you will be quite surprised at how much sugar is in the food we eat. Disguised sugars such as fructose, glucose, dextrose, sucrose, high-fructose corn syrup, and cane syrup should be avoided.

5) Choose sweeteners that are minimally processed. Chemical and industrial processes that are used to make white sugar and high-fructose corn syrup are quite destructive to the earth and to your body. Honey and maple syrup are excellent and tasty sweeteners that are all natural, as well as Rapadura and coconut (palm) sugar. Even though these sweeteners are all natural, it is still best that they be used sparingly.

So enjoy your sweets for those special occasions, but if you want to improve your health, work on reducing your daily intake of added sweeteners. It will make your life even sweeter!

Dr. Dulaney practices at Carilion Clinic Family Medicine in Rocky Mount. Visit her health blog at: thisgoodmedicine.com.

Dreamed of working with airplanes and military jets.

Sidetracked by an irregular heartbeat.

Treatment available, close to home.

Surgery performed by an expert heart care team.

Normal heart rhythm restored.

Now serves as an officer in the United States Air Force.

So grateful Carilion is here.

Daniel Wickham, 23, Roanoke, Va.

FOR

hearts

MADE HEALTHIER, AND LIVES MADE

happier.

When it comes to matters of the heart, we’re here to care for you and your condition. As the region’s leading heart care team, with cardiologists who specialize in electrophysiology and heart arrhythmias, we’re helping improve and extend the lives of our patients.

To watch Daniel’s story, visit CarilionClinic.org/heart.

CarilionClinic.org/heart • 800-422-8482

Carilion Clinic P.O. Box 13727 Roanoke, VA 24036-3727

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Your Doctor is a Click Away ACCESS YOUR MEDICAL RECORDS WITH MYCHART Carilion Clinic offers MyChart, western Virginia’s first online healthcare management tool.

MyChart not only offers secure, 24/7 access to your health records, but also allows you to: Review your medications, immunizations, allergies, and medical history Receive test results online (no waiting for a phone call or letter) Communicate with your physician securely online Request refills of your medications online Request your next appointment online View inpatient hospital visits Request access to a loved one’s medical record NEW: You can now access your medical information while on the go!

The MyChart mobile app is now available for iPhone, iPad, and Android devices.

To find out if MyChart is right for you, speak with your physician.

CarilionClinic.org/mychart | 800-422-8482