Carilion Clinic - Living Summer 2016

Living Inspiring better health.

SUMMER 2016

in this issue ‘INNOVATION DISTRICT’ PLANNED 5 SAME-DAY HIP REPLACEMENT 10 MEDIA AND KIDS 14 HELP FOR CHRONIC CARE PATIENTS 20

? h c u M o o T s I h uc M How

GOAL :

Schyler Sitton was afraid her scoliosis would keep her from playing soccer and competing with her friends.

Our doctors thought differently. To see how our team worked together to help Schyler reach her goal, visit CarilionClinic.org/Goals.

Common ground. Common goal.

Blacksburg Christiansburg Franklin Galax Giles Lexington Martinsville Roanoke Rocky Mount Wytheville

Institute for Orthopaedics and Neurosciences

800-422-8482 | CarilionClinic.org/ION

President’s Message When it comes to our kids, we want to give them the best of everything.

Today that often means the latest in technology. As many children log hours of screen time daily, though, we have to ask: How much is too much? Our cover story explores the health and developmental issues involved. There’s a lot at stake!

Research is the life blood of science and medicine, so we’re excited about our new plans to expand the Virginia Tech Carilion Research Institute. Our far-reaching agreement with Virginia Tech is to turn our Riverside campus into a Health Sciences and Technology Innovation District. You can read all about it on page 5.

Same-day hip replacement surgery? Yes, we have arrived at the point where it’s possible for certain patients, like Steven Pittman, 48. He recently checked in for his surgery early in the morning and was home by dinner time. We tell you how our doctors are helping Steven and others like him who want to walk again pain-free.

We all know it can be a challenge to serve delicious and nutritious meals to our families every day. But doing it on a budget? It’s actually easier than you may think, so take a look at the tips from one of our dietitians. We hope you’ll give them a try!

Nancy Howell Agee, Carilion Clinic president and CEO, greets visitors on Earth Day with Paul Davenport, vice president of emergency and care management services. Carilion shared information about its “green” programs and gave away pine seedlings and reusable shopping bags.

WARM REGARDS,

NANCY HOWELL AGEE PRESIDENT AND CEO CARILION CLINIC

CarilionClinic.org | SUMMER 2016 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

Andie Gibson is a freelance writer and editor based at Smith Mountain Lake. She has also been the editor of Smith Mountain Laker magazine and special sections editor for The Roanoke Times.

Kathie Dickenson is an award-winning writer and editor whose work has appeared in Roanoke Business and RU, Radford University’s magazine. She has also edited books, websites, and other publications.

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

CARILION CLINIC LIVING IS PRODUCED BY MARKETING AND COMMUNICATIONS: VICE PRESIDENT Mike Dame SENIOR DIRECTOR Amy Hoots-Hendrix CREATIVE SERVICES MANAGER John Griessmayer EDITOR Maureen Robb DESIGNERS Dave Porter, Nicholas Buehring CONTRIBUTING WRITERS Karen A. Chase, Su Clauson-Wicker, Jay Conley, Kathie Dickenson, Patrick Dunham, Andie Gibson, Sarah Beth Jones, Heidi Ketler, Donna Reynolds, Dan Smith, Randolph Walker, Alison Weaver PHOTOGRAPHERS Darryle Arnold, Jared Ladia PRINTING Chocklett Press

Heidi Ketler has been a writer and editor for Sentara Healthcare in Norfolk and is the editor of The Triangle Physician magazine in the Raleigh-Durham-Chapel Hill region of North Carolina. She lives in Roanoke.

Jon Maher, M.D., is a Carilion Clinic orthopaedic surgeon and sports medicine physician. He has been a physician for the Boston Celtics, Harvard University’s athletics department, and the U.S. Navy.

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.

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 2016 by Carilion Clinic. No part of this publication may be reproduced or transmitted in any form or by any means without written permission from Carilion Clinic. Articles in this publication are written by journalists or authors who strive to present reliable, up-to-date health information. However, personal decisions regarding health, finance, exercise and other matters should be made only after consultation with the reader’s physician or professional advisor. All editorial rights reserved. Opinions expressed herein may or may not reflect the views of Carilion Clinic.

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

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CONTENTS

10 12 features 5 RESEARCH VTC plans expansion.

7 COMMUNITY HEALTH Carilion Wellness has new services.

10 HIP REPLACEMENT For some, same-day surgery is possible.

12 APPALACHIAN TRAIL

14

departments 1 PRESIDENT’S MESSAGE Are kids using too much media?

28 RECIPE

Cool off with blackberries and almond cream.

18 DEHYDRATION Don’t let it sicken you this summer.

20 CHRONIC CARE

8 IN YOUR COMMUNITY New physicians and advanced clinical practitioners.

Are your kids overexposed?

A new treatment for our region.

Kefir gets attention.

26 GROWING TO SERVE YOU

14 MEDIA

19 HEARING LOSS

6 SUPERFOODS Making a difference in western Virginia.

A teen pursues his dream.

A new program for those 65+.

20

22 MOSQUITOES Tips to discourage bites.

24 NUTRITION You can eat well on a budget.

27 SCHOOL SPORTS A doctor’s advice for parents.

CarilionClinic.org | SUMMER 2016 3

RESOURCES

RESOURCES TO KEEP YOU HEALTHY CARILION DIRECT

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

“WELL SAID” SPEAKER’S BUREAU If you’d like a speaker on a health topic for your community group or workplace, call 540-983-4035 or visit CarilionClinic.org/speakers.

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

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

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

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

ONLINE HEALTH NEWS

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

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

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

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

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

For the latest health and wellness news, and expert advice from Carilion’s own providers, visit our online Carilion Clinic Living news site at CarilionClinicLiving.com.

WELLNESS

NEWS BLOG

GIVING TO CARILION CLINIC FOUNDATION

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

CarilionClinic.org/blogs/newsblog.

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Carilion Wellness offers programs to help people of all ages and fitness levels improve their health.

Visit CarilionWellness.com.

Be part of improving the health and vitality of communities in western Virginia. Make a gift at CarilionFoundation.org.

Carilion and Virginia Tech to Create ‘Innovation District’ Carilion Clinic and Virginia Tech will expand their research institute and develop a Health Sciences and Technology Innovation District in Roanoke.

In May, the state approved $46.7 million in bond funding to help expand the Virginia Tech Carilion Research Institute by building a 105,000-square-foot medical research building.

Carilion and Virginia Tech also will spend $21 million on the expansion at Carilion’s Riverside campus in Roanoke.

Innovation districts are strategically created geographical areas that bring together experts from industry and academia and undergraduate, graduate, and medical students as well as postdoctoral fellows.

In Roanoke, Carilion physicians and clinicians will work with biomedical research scientists to solve complex health problems.

The expansion will add 25 research teams, bringing the total to about 55,

and will have an economic impact of $191 million annually. The new building also will house advanced diagnostic and imaging equipment and provide medical research training and education for Virginia Tech students.

“In five years, we will have an even more exciting research hub that will spin off new businesses.

It will be a catalyst for growth for our entire region.”

—C ARILION CLINIC PRESIDENT AND CEO NANCY HOWELL AGEE Eventually, about 500 undergraduate students will share the campus with researchers at the institute and students at the Virginia Tech Carilion School of Medicine.

Michael J. Friedlander, executive director of the research institute, has also been named Virginia Tech’s inaugural vice president for health sciences and technology.

“This amazing new vision builds on the success of our research institute, which already generates more than $110 million in research spending each year,” says Carilion President and CEO Nancy Howell Agee. “In five years, we will have an even more exciting research hub that will spin off new businesses. It will be a catalyst for growth for our entire region.”

“Working alongside Carilion Clinic, we also have the opportunity to influence global health outcomes and have a positive impact on southwest Virginia communities through engaged research and educational experiences,” says Virginia Tech President Tim Sands.

Agee remembers looking out her office window at Carilion Roanoke Memorial Hospital only eight years ago and seeing a deserted landscape. “Now there’s a medical school, a research institute, clinical facilities, and a beautiful park,” she says.

“This is a moment when we can take stock of all that has been accomplished and build on it to create an even more remarkable medical and educational resource for our region.”

CarilionClinic.org | SUMMER 2016 5

SUPERFOODS

Superfoods: Kefir

By Kathie Dickenson

It’s no wonder kefir has become so popular. This zingy fermented drink, which some call “the 21st-century yogurt,” is loaded with probiotics and other nutrients.

Tasting a bit like a vanilla yogurt smoothie, kefir (keh-FEAR) is being hailed for its many healthy effects. It can improve gastrointestinal health and boost the immune system. It also protects against gastroenteritis, vaginal yeast infections, and some foodborne pathogens. Plus it can reduce cholesterol.

Its healing and anti-inflammatory effects have been observed in mice, and animal and test-tube studies suggest that kefir may have cancer-preventive characteristics.

Like yogurt, it’s good with a little cinnamon or other spice sprinkled on top or mixed in. It could also be blended with fruit for a thicker, healthy drink.

Kefir originated in eastern Europe and is traditionally made from cow’s or goat’s milk. Kefir “grains,” which are live cultures that resemble tiny cauliflower buds or cottage cheese, are added to the milk to ferment it. Because kefir cultures convert lactose to lactic acid, milk kefir is better tolerated than plain milk in those with lactose intolerance.

A six-ounce serving of kefir contains: calcium (20 percent of the recommended dietary allowance, or RDA); phosphorus (20 percent RDA); vitamin B12 (14 percent RDA); riboflavin (19 6 SUMMER 2016 | CarilionClinic.org

percent RDA); magnesium (5 percent RDA); six grams of protein; and some Vitamin D. The amount of carbohydrates, fat, and calories depends on the type of milk used.

Studies reported in a 2013 Brazilian Journal of Microbiology article showed that the number and diversity of microbes in kefir vary according to the origin of kefir grains and the preparation method.

Live kefir grains or dried starters can be purchased at many natural food stores, such as the Roanoke Natural Foods Co-op, The Harvest Moon in Floyd, and Eats Natural Foods and Annie Kay’s Main Street Market in Blacksburg.

Kefir grains are also available through Amazon.com and from specialty websites like culturedfoodlife.com, site of Donna Schwenk, who wrote Cultured Food for Life and other books on probiotic foods. If stored properly and cultured regularly, live kefir grains can be used indefinitely. Grains from dried starters can be used several times.

Cheers!

WELLNESS NEWS

Carilion Wellness Opens in Blacksburg NEW CENTER ALSO PLANNED AT SMITH MOUNTAIN LAKE Carilion Clinic opened a new wellness center in Blacksburg in April and is planning another at Smith Mountain Lake for next year.

The new 4,800-square-foot Carilion Wellness center in Blacksburg is located at the Virginia Tech Corporate Research Center. It offers exercise equipment, Fitness On Demand group exercise classes, and Carilion’s popular Fit Rx program, which includes one-on-one personal training sessions and an individualized fitness plan for only $60 for 60 days.

The center also has amenities such as extended hours; monthto-month memberships; free annual flu shots for members; and discounts for Virginia Tech students, Corporate Research Center tenants, and Hokie Passport participants.

“Our neighbors and colleagues have long asked us to put a wellness center in Blacksburg,” says Bud Grey, Carilion’s vice president, wellness, who oversees the centers. “Working with the Corporate Research Center to expand wellness opportunities is a logical partnership for both organizations.”

Members of Carilion Wellness in Botetourt and Roanoke (Starkey Road) have unlimited use of all other Wellness centers.

Members of the Blacksburg center are allowed a number of visits to the Botetourt and Roanoke (Starkey Road) facilities.

The new 18,000-square-foot wellness center at the lake will be located at the Smith Mountain Lake Retirement Village, a subsidiary of Runk & Pratt Healthcare. It will offer many of the same features as other Carilion Wellness locations but will be

geared toward active, 50-and-older adults. Memberships will be open to the entire community.

Ground breaking will be this summer, with the center due to open in early 2017.

“For quite some time, Carilion has been researching a concept that would focus on programs specifically designed for the 50-plus market,” says Grey. “Runk & Pratt is the perfect collaborator on this project. They’ve always demonstrated their second-to-none care for their residents and residents' families.”

Offerings being considered include: • Exercise programs to help with chronic medical conditions • Fit Rx • Programs for pre-surgery preparation and post-surgery recovery • Nutritional counseling • Group exercise classes (tai chi, yoga, etc.)

• Functional training • Personal training • Aquatic therapy and water aerobics • Flu vaccinations • Health screenings for diabetes, high blood pressure, etc.

• Educational opportunities related to health and diet • A golf simulator When the Smith Mountain Lake center opens, Carilion will operate five wellness centers in the region.

CarilionClinic.org | SUMMER 2016 7

MEDICAL IN YOUR COMMUNITY NEWS

PATIENT SHUTTLE SERVICE LAUNCHED Shuttle buses are available to take patients to and from appointments on Carilion’s Roanoke campus.

Buses stop at Carilion Roanoke Memorial Hospital, the Cancer Center, 1 and 3 Riverside Circle, 2001 Crystal Spring Ave., and the Institute for Orthopaedics and Neurosciences. Patients can also ask to stop at Carilion Roanoke Community Hospital. Hours are from 8 a.m. to 6 p.m., Monday through Friday.

ENJOY A HEALTH WALK NEW VELOCITYCARE TO OPEN Join us for a Health Walk and Talk, held the second Saturday of each month through November. The 1 ½-mile

A new VelocityCare will open in Lexington

walks begin at 10 a.m. at the Booker T. Washington

across from Carilion Stonewall Jackson

National Monument in Hardy and are led by Carilion

Hospital. It will offer urgent care, along with

community health educators. Some of the talks this

occupational medicine services to the region’s

summer will be on portion control, how to read food

employers. Like Carilion’s other VelocityCare

labels, and enjoying fitness. For more information, go to

locations, it will be open seven days a week,

bit.ly/carilion-walk-talk or call 800-422-8482.

with no appointments needed.

VETERANS CHOICE PATIENTS ARE WELCOME After requests from veterans, Carilion is seeing patients with insurance through the Veterans Choice Program. It provides primary care, inpatient and outpatient specialty care, and mental health care for eligible veterans when the local Veterans Affairs center can’t. To schedule an appointment or for more information, call 866-606-8198 or visit va.gov/opa/choiceact.

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SPORTS INJURY CLINICS TO OPEN Carilion will again offer sports injury clinics this fall to help keep student-athletes safe. The clinics will be open every Saturday between August and November in Roanoke, Blacksburg, and Lexington. Whether it’s a sprain or strain, physicians will be available to treat a student’s post-game needs. For more information, go to CarilionClinic.org/sports-medicine/services or call 800-422-8482.

HELPING KIDS GET INSURED

YOU’RE INVITED

Carilion has helped to get health insurance for 471 children

Help us celebrate Life-Guard’s 35th

in the past year due to a $75,000 Project Connect grant. The

anniversary on Saturday, June 11 from

Virginia Health Care Foundation awarded us the grant to

11 a.m. to 3 p.m. at the Roanoke-

help families in Roanoke apply for Virginia’s low-cost health

Blacksburg Regional Airport. The

insurance for kids. Children without insurance miss more

free public event will feature aircraft

school and often go to the emergency room for necessary

and emergency vehicle tours and a

medical care. For information about whether you qualify for

medical emergency simulation.

help, call 800-422-8482.

FIRST CLASS OF CHAPLAINS GRADUATES Everyone knows Carilion trains doctors and nurses, but did you know we train clergy too? In 2014, we were accredited for a Clinical Pastoral Education program, and our first class of hospital chaplains graduated in April. Training in the healing arts is provided by Jefferson College of Health Sciences.

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MEDICAL NEWS

y a D e m a S t n e m e c a l Hip Rep ! s e Y ? y r Surge

10 SUMMER 2016 | CarilionClinic.org

Steven Pittman (left) says he has been pain-free since his hip replacement surgery. Right: Pittman enjoys time at the beach with his family.

By Stephanie Specht Years ago, if you had hip replacement surgery, you faced a hospital stay of 10 days or more. But now you can potentially go home the same day.

For Steven Pittman, the possibility of being able to recover at home sold him on being an outpatient for his recent surgery.

Pittman had endured pain in his left knee, shin, and hip for six years, and although he tried a few treatment options, they didn’t provide relief. Last fall, when he saw Carilion Clinic orthopaedic surgeon Jesse Seamon, M.D., Pittman learned that what he really needed was a total hip replacement.

“I was floored that I needed a hip replacement because I am only 48,” he says.

His surgery would be the first same-day hip replacement in southwest Virginia.

MAKING THE CHOICE

Pittman was referred to Benjamin R. Coobs, M.D., a Carilion orthopaedic surgeon and joint replacement specialist.

Dr. Coobs believed Pittman’s age and good health made him an excellent candidate for outpatient surgery.

“When Dr. Coobs asked me if I’d be interested in being an outpatient, my first thought was that I could go home and not have to spend the night in the hospital,” Pittman says. “I told him I wanted to consider it.

“I talked to my wife, who is an operating room nurse. I Googled every outpatient hip replacement reference I could find, and my wife asked her co-workers about it. After looking at all the pros and cons, I decided it would be a win-win for me.”

His surgery and recovery went well, and he was headed home by about dinner time that night.

“Recuperating at home was a big plus,” Pittman says. “We stopped at Starbucks

on the way home, and I got to sit in my chair that night. It was a great option for me.”

Pittman says he’s had zero pain since the surgery, and that his quality of life has improved greatly. “Before I was in pain 24/7, and I limped all the time.

I know it sounds a little silly, but now I can finally do simple things without pain, like walking across the yard or bending down to tie my Dr. Benjamin R. Coobs shoes.”

GETTING HOME SOONER

“There is a trend to getting people back home sooner after major surgeries,” says Dr. Coobs. “We’ve found that most people prefer to go home and actually recover better there.”

Many factors have contributed to this trend, including less-invasive surgeries and better surgical care, multi-modal pain management, anesthesia techniques, and physical therapy.

“The focus is still on safety,” Dr. Coobs says. For hip replacements using the common, less-invasive anterior hip approach, same-day patients must meet the same standards as other joint replacement patients in order to go home.

“The only difference is that we accelerate the post-operative recovery process,” says Dr. Coobs. “The surgery is typically the first case of the day, and we do different things on the anesthesia side, the physical therapy side, and the nursing side to help the patient progress along these benchmarks more quickly so he can be safely discharged.”

Even if patients meet the standards for discharge, they can stay in the hospital

overnight if they prefer.

“This surgery is a life-changing experience for the majority of patients,” Dr. Coobs says. “They go from a significant amount of pain and limitations to a high quality of life because of this surgery.

“The same-day option allows us to offer that next level of care to our patients and continue to be a Center of Excellence for hip surgery. It is really all about optimizing patient care.”

For more information, go to CarilionClinic.org/joint-replacement.

JOINT REPLACEMENT Carilion emphasizes minimally invasive techniques and innovative approaches, including the anterior approach to hip replacement that reduces recovery time by 50 percent in almost every case.

The inpatient orthopaedic unit at Carilion Roanoke Memorial Hospital has been certified since 2007 by the Joint Commission and has received its Gold Seal of Approval™ for quality care.

Carilion surgeons perform the vast majority of all joint replacements in western Virginia—over 1,500 hip and knee replacement surgeries each year with an exceptionally low rate of complications and high patient satisfaction scores.

CarilionClinic.org | SUMMER 2016 11

MEDICAL NEWS

By Heidi Ketler Tupper “Tup” Gillie Jr., 17, is on his way to becoming the youngest person with Type 1 diabetes to hike the 2,190-mile Appalachian Trail.

Traversing the eastern edge of the Appalachian Mountains from Maine to Georgia, the trail lays claim to being the “longest hiking-only footpath in the world.” In terms of elevation, hiking it is the equivalent of climbing Mount Everest 16 times.

Tup and his dad had talked about hiking the trail throughout his childhood.

But when Tup learned at 13 that he had diabetes, doing so “became more important and something to work toward,” says Tupper Gillie Sr., 53, a physical therapy supervisor at Carilion New River Valley Medical Center.

That summer the two kicked off at 12 SUMMER 2016 | CarilionClinic.org

Springer Mountain, the trail’s southern terminus in Georgia. Each summer since, Frodo T. Baggins and Sweet Feet—trail names for Tup and Tupper, respectively—have been pushing north, hiking some 15 miles a day for four weeks at a time.

In April, with over 1,000 miles hiked, they were halfway there and planned to finish the Virginia portion on weekends this spring. They’ve reserved nine weeks for their final advance this summer—896 miles from the Pennsylvania/New Jersey line to Maine’s Mount Katahdin, the state’s tallest peak (elevation 5,268 feet).

“I think it’s a great thing,” says Tup’s mom, Laura Gillie, a physical therapist.

She provides logistical support like mail drops to her husband and son while they’re en route. “The hike is beneficial

to Tup in many ways, not just for controlling his diabetes but for boosting his confidence and other things. I’m very proud of both of them.”

EXERCISE RX FOR CHRONIC DISEASE

Hiking the Appalachian Trail is no easy feat; it requires meticulous planning. “I wouldn’t say having diabetes makes it more important; it just makes logistics more difficult,” says Tup. Erica B. Reynolds, M.D., a pediatric endocrinologist with Carilion Children’s, is among Tup’s physicians and a proponent of exercise. “There are lots of competitive athletes with diabetes,” she says. “So diabetes doesn’t need to limit you.”

Type I diabetes is an autoimmune disease and represents only 5 percent of diabetes cases. It is more common in

SECTION 5

SECTION 3

FOLLOWING THEIR FOOTSTEPS

SECTION 4 SECTION 2 SECTION 1

Clockwise: Tup Gillie Jr. takes a break from hiking on the Appalachian Trail in Great Smoky Mountains National Park, which straddles the border of North Carolina and Tennessee. Tup climbs the trail in Pennsylvania. Tup and his dad Tupper Gillie Sr. relax in the Smoky Mountains.

Caucasians. It affects men and women equally, and it usually starts in people younger than 20, though it can be diagnosed in adulthood. There is currently no cure.

Type 1 occurs when the immune system destroys the beta cells in the pancreas. These specialized cells produce insulin, a hormone that helps the body store and use sugar, or glucose. It’s a metabolic process that turns food into fuel.

Type 2 diabetes occurs when the body becomes insulin resistant and doesn’t produce enough insulin to overcome it.

Obesity and lack of exercise are two common contributors.

Blood sugar control is central to all diabetes treatments, and a healthy diet and exercise are beneficial. Exercise helps the body use insulin more efficiently, so less is required.

While Type 1 diabetics will always need insulin support, no matter how fit they are, exercise for Type 2 diabetics may eliminate the need to take medication, says Dr. Reynolds. Prescribed insulin is administered as an injection or via an insulin pump.

For those with Type 1 diabetes, “there is a lot of trial and error with eating food both before and during exercise to avoid hypoglycemia, or low blood sugar,” says Dr. Reynolds. “It takes careful management, but it is very doable.

“I stress to all of my patients that they should do everything they can to stay healthy through exercise and a healthy diet. It’s even more important for those with a chronic disease, such as diabetes, which carries a long-term risk of complications, such as cardiovascular disease and kidney disease.”

Section 1: Springer Mountain, Ga., to Hot Springs, N.C. – 247 miles Summer 2013 Section 2: Hot Springs to McAfee Knob, Va. – 434 miles Summer 2014 Section 3: Elkton, Va., to Delaware River Gap, Pa./N.J. – 386 miles Summer 2015 Section 4: McAfee Knob to Elkton, Va. – 226 miles Spring 2016 Section 5: Delaware River Gap to Mount Katahdin, Maine – 896 miles Summer 2016

ACHIEVING THEIR GOAL

Almost 16,000 people have reported completing the trail, some hiking it multiple times, according to the Appalachian Trail Conservancy. Thru-hikers and section-hikers get equal credit; about 20 percent completed it in sections.

At least 28 who walked the entire trail reported being diabetic. The youngest was a 20-year-old female.

“We’ve learned a lot,” says Tupper of their five-year quest. “As much as the diabetes is a life-changing event, so is hiking the Appalachian Trail. Tup has learned to camp and hike and just keep going.”

The best part of their adventure? “All the really cool people you meet,” says Tup. What’s next after Tup sets his record?

College—and hiking the 2,650-mile Pacific Crest Trail.

CarilionClinic.org | SUMMER 2016 13

COVER STORY

Kids and Media Use: How Much Is Too Much?

By Randolph Walker

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L to R: Drew Benne, 15, of Salem uses his iPhone to search for soccer cleats online.

Max Benne, 9, plays a game on his iPad as Alex Benne, 12, checks out Instagram on his computer.

Are we raising easily distracted kids with short attention spans?

Some health professionals fear that kids’ use of media is interfering with their brain development, and excessive media use is being blamed for more obesity, bad grades, stunted social development, aggression, and loss of sleep.

In 2013, children ages 2 to 4 spent two hours a day with screen media and those ages 5 to 8 spent two hours and 21 minutes, according to a Common Sense Media study.

The average 8- to 12-year-old gets four and a half hours of screen time daily—not counting screen time spent on homework—and teens get six and a half hours, according to a 2015 study by Common Sense.

Kids spend this time on activities like games, texting, watching television or streaming movies, and posting on social media.

But the more time pre-school children spend watching screens, the less time they spend in creative play and constructive problem-solving, which their brains need to develop, child development experts say. And children of any age can be harmed by violent or sexualized content, they add.

NEW REALTIES

Across western Virginia, educators, health professionals, and parents are dealing with these new realities. Kelly Henchel, M.D., chief of Carilion Children’s Pediatric Medicine – Jefferson and Franklin Clinics, one day saw a child under 5 watching a mature video on YouTube. “The mom said, ‘It’s okay, he’s just watching videos,’ ” Dr. Henchel recalls. “And I said, ‘Just a minute, look what he’s watching. It has prostitution, drugs, and violence.’ ” Even apps created for babies and

toddlers aren’t the best thing for their development, Dr. Henchel says. “What young children need is hands-on learning, exploring their environment, and getting out a book and looking at it and talking about it,” she says.

For older children and adolescents, excessive screen time is linked to increased psychological difficulties that include hyperactivity, emotional and conduct problems, difficulties with peers, and poor school performance, according to a study published in the Archives of Pediatric and Adolescent Medicine. Studies have shown that excessive media use can also lead to sleep and eating disorders, according to the American Academy of Pediatrics.

The data aren’t conclusive, but one study by the Pew Research Center found that 87 percent of Advanced Placement and National Writing Project teachers say that technology is creating an “easily CarilionClinic.org | SUMMER 2016 15

COVER STORY

KEEPING YOUR TEEN SAFE There’s a potential dark side of media use. One in seven children receives a sexual solicitation online, according to the National Center for Missing & Exploited Children.

Yet many parents don't know the passwords to their teen’s email or social media accounts.

“Parents need to know what their kids are doing online,” says Brooks Michael, a Carilion Children’s adolescent health educator. “Parents have to know about the apps, learn about the apps, get the apps. My son just got Instagram, so I just got Instagram.”

Laura Griffith attended a seminar to learn about social media safety.

Griffith and her husband, Chris, live in Botetourt County with their 12-year-old daughter, Lorien, who is home-schooled.

Lorien does have a phone but it only works over Wi-Fi. She has a texting app which enables her to contact her parents if they have gone out, or her home-school friends. “We have talked to her about not accepting friends that she does not know,” Laura says. “Occasionally her dad and I will check her phone.”

“There need to be rules and guidelines,” says Michael. “I definitely think parents should know their kids’ passwords. Parents have to have consistent conversations with their kids about all the risky behaviors of adolescence. They need to keep having this talk, even if it's uncomfortable.”

16 SUMMER 2016 | CarilionClinic.org

Laura Griffith has warned her daughter Lorien about accepting online friends she does not know. Right: Phil and Stephanie Benne (center) look on as their sons get absorbed in online activities.

distracted generation with short attention spans,” although the Internet and digital search tools have had a “mostly positive” impact on students’ research habits.

What does excessive screen time actually do to the brain? The following doesn't apply to every screen user, but a study presented at the American Psychiatric Association’s annual meeting in 2014 showed that heavy Internet use results in increased blood flow to areas of the brain involving reward and pleasure centers, and decreased blood flow to hearing and visual areas.

SETTING LIMITS

Brooks Michael is an adolescent health educator for Carilion Children’s.

One of her duties is speaking to teens in classrooms. “I ask them who’s getting eight to nine hours of sleep and they almost all laugh,” she says. “Sometimes it’s because of homework or because of a job but a lot of times it’s because of their phone.”

It’s all right for parents to set limits, says Michael—even taking phones away, if necessary.

As a second-grade teacher at Mountain View Elementary School in Roanoke County, Stephanie Benne uses media to support the education of her students. And while she says computers are helpful in many ways, she also believes adults need to control access.

“Some of the games that the younger children are playing at home are inappropriate for them,” she says. “Some have a hard time distinguishing between reality and a game.” On the playground she sometimes sees them trying to mimic video games.

Stephanie is a parent as well as a teacher. She and her husband, Phil, who coaches women’s soccer at Roanoke College, live in Salem and have three boys: Drew, 15; Alex, 12; and Max, 9.

The family enjoys going to sports games together, and all three boys play soccer and basketball.

Three to four nights a week, the Bennes

sit down and have a family dinner.

“Everything is turned off. That is one rule we do have,” says Stephanie. “There are no phones, nothing.”

At other times, “We don’t have any exact limits, but I’ll tell Drew if it’s time to get off,” says Phil. “It’s on a case-bycase, day-by-day basis.”

With a coach for a dad and a teacher for a mom, the boys know that work comes first. Even so, says 9-year old Max, “It’s hard to get off your device if you’re very into it.”

TEACHING STANDARDS

Mobile devices are everywhere at Salem High School. In 2013 the decision was made to allow cell phones at school.

Students can be seen in the hallways before class calling, texting, and emailing.

School-issued Chromebooks are used for school work.

“I couldn’t really name anybody that doesn’t have any social media or some way to find somebody on the Internet,” says Drew, who attends Salem High.

But there are limits. Teachers tell the students when to put the devices away.

“Rather than ban cell phones, we’d rather teach kids to use them appropriately,” says Scott Habeeb, Salem High’s principal. “They’re learning to be adults.

“We focus on educating young people on digital citizenship. How to use social media for positive purposes, how to recognize when people are being inappropriate, how to be wise in the way that they interact online so they build themselves a good reputation.”

One thing parents should not do is ignore the issue, says Brooks Michael. “It’s a challenge and it’s time-consuming, but as parents it’s a new age and we have to do our best to keep up.”

“The most important thing is supervision,” says Dr. Henchel. “Make sure you keep screen time limited for your kids, and make sure the media is in a family area where you can see what’s going on.”

RECOMMENDED STEPS • No TV or other entertainment media for kids under 2 • No televisions, computers, or video games in children’s bedrooms • Turn off the TV during dinner • No more than one or two hours of entertainment media daily for children and teens • Content should be high-quality • Pay attention to ratings for shows, movies, and games to avoid inappropriate content such as violence, explicit sexual content, or glorified tobacco and alcohol use • Kids should spend time on outdoor play, reading, hobbies, and using imagination in free play Source: The American Academy of Pediatrics

CarilionClinic.org | SUMMER 2016 17

MEDICAL NEWS

D E H Y D R AT E D ?

W H Y I T M AT T E R S

SYMPTOMS

HUMAN BODY

Moderate dehydration can cause fatigue, constipation, and dizziness or confusion.

Severe dehydration can cause rapid heartbeat or breathing, fever, and low blood pressure.

70%

Your body is about two-thirds water, so you need it to function properly and feel your best.

FLUIDS

Serious complications can include heat stroke, seizures, or swelling of the brain.

To prevent dehydration, drink enough fluids to urinate every 2-4 hours.

Look for lightcolored or clear urine; dark yellow usually means you’re dehydrated.

EAT RIGHT Foods like fruits and vegetables help meet the body’s need for water.

DIURETICS Coffee, soda, and alcoholic drinks have a diuretic effect, so drink water to replace what you lose.

RISK FACTORS Risk factors include exercising or working outdoors when it’s hot and humid, and living at high-altitude.

Infants and children, people with chronic illnesses, and older adults are more at risk.

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BEING THIRSTY Being thirsty isn’t always the best sign that you need more water. Drink fluids before you feel thirsty.

Seek medical care immediately if you have extreme thirst or shriveled skin, can’t urinate, or feel dizzy and confused.

Dr. Wayne Robbins specializes in disorders that disrupt the connection between the ear and the brain.

Hearing Loss Specialist Brings Advanced Treatment to Region

By Loren M. Blinde Wayne Robbins, D.O., an ear, nose, and throat specialist, has joined Carilion Clinic. One of his specialties is cochlear implants, for which patients used to have to travel outside the region.

A cochlear implant is an electronic device that can improve hearing in those who’ve had limited success with hearing aids. Unlike hearing aids, which make conversations and other sounds seem louder, cochlear implants help the damaged inner ear (cochlea) send sound signals to the brain.

Although results vary, most patients find the implants help their hearing and improve their quality of life.

Hearing loss can stem from a variety of problems and affect people of all ages.

Noise exposure over a lifetime and aging are common causes in adults; hearing loss in children is more likely due to a genetic condition. Other causes include

infections, injury, and certain medications. Treatments are available for those at any stage—from slight hearing impairment to deafness.

As hearing loss progresses, individuals often become increasingly isolated and are at higher risk for depression and anxiety.

Dr. Robbins, an otolaryngologist (also known as an ear, nose, and throat doctor), specializes in disorders that disrupt the communication between the ear and the brain, including tumors of the ear and nerves leading to the brain, chronic ear disease, and hearing loss. He treats both adults and children.

He comes to Carilion from Grand Blanc, Mich., where he was affiliated with several hospitals.

During cochlear implant surgery, which takes two to three hours, Dr. Robbins makes a small incision behind

the ear to access the middle ear. He then threads the tiny implant electrode into the cochlea, just as you might thread a blade of grass into an empty snail shell.

The patient goes home the next morning and typically has minimal postsurgical pain. After the incision heals in about a month, Dr. Robbins activates the implant during an office visit.

“It is exciting for people who haven’t heard for so long to be able to turn the hearing world back on again,” Dr. Robbins says. “Also, until now patients had to travel a few hours not just for the surgery but for follow-up care.

“I am thrilled to be doing this work at Carilion Clinic.”

For more information, call 800-422-8482. To make an appointment with Dr. Robbins, call 540-224-5170.

CarilionClinic.org | SUMMER 2016 19

MEDICAL NEWS

65 ? +

A New Program Can Help Manage Your Chronic Conditions

By Tana M. Schiewer

Any medical condition can be difficult to manage. But what about three at once? Or four? Or even more?

Four out of five older Americans struggle with managing multiple chronic conditions. Donnie Martin of Franklin County is one of them. He suffers from COPD, Stage III CKD (chronic kidney disease), diabetes, high blood pressure, and asthma, and he has been trying—with the help of his wife Kathy—to manage these conditions for years.

“You can’t just focus on one thing,” Donnie says. “What might be beneficial for one disease might cause problems with another.”

The Martins must balance visits to their primary care doctor and several specialists, and they are continually learning how to manage diet, exercise, medications, and other factors.

To help patients like them with their ongoing struggle, Carilion Clinic has developed BetterLiving 65, a new chronic care management program for Medicare patients.

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L to R: April Vaughan, a Carilion senior care coordinator, is enthusiastic about the chronic care program. Dr. Anthony Stavola says the program lets patients participate more in their own care.

A TEAM APPROACH

BetterLiving 65 uses a team approach to help patients understand and manage their conditions. For instance, after enrolling in the program, Donnie received a personalized care plan developed by a team of his physicians, a pharmacist, a dietitian, a diabetes educator, and a registered nurse who acts as his care coordinator.

The program was introduced in a few Carilion practices in 2015 and has since been expanded to 40. It is available to Medicare patients with two or more chronic conditions; 1,200 patients are enrolled.

“This program gives patients the resources to participate more actively in their own care,” says Anthony Stavola, M.D., vice chair of Family and Community Medicine at Carilion. “Our team approach helps to address the multiple needs of patients. In a one-on-one relationship, you just can’t do it all.”

“It’s a coordinated, comprehensive approach to patient care,” adds April Vaughan, a Carilion senior care coordinator. “We’re trying to help promote patient wellness, provide care coordination, and engage patients in the hopes of helping them better manage their conditions as well as avoid hospitalizations and ER visits.”

The BetterLiving 65 care teams have

been able to help patients develop meal plans, adjust medications, and stay out of the hospital. In one case, a care coordinator recognized a patient’s problem over the phone and quickly communicated with his doctor to change his medication—avoiding a likely hospital visit.

“We absolutely want to prevent problems rather than react to them after the fact,” Vaughan says.

A PHONE CALL AWAY

As her husband’s primary caretaker, Kathy Martin appreciates getting check-up calls from Lori Eastman, L.P.N., and clinical coordinator Lisa Myers, R.N., of Dr. Stavola’s office. And she likes being able to call their care coordinator, Mary Brewer, R.N. Kathy has been able to ask Brewer about such things as foods to avoid, and easy meals to prepare.

“Calling and talking to someone is so much better than waiting for a doctor visit,” Kathy says. “To be able to pick up the phone and talk to someone is key. It gives us both peace of mind.”

“I like to say that our role is similar to that of a health coach,” Brewer says.

“We take a lifestyle improvement journey with the patient, supporting them so they can take a more powerful role in their own health. We help them locate all the resources they need. The result is a

AT A GLANCE BetterLiving 65 provides: • A personalized care plan • After-hours access to a provider for urgent chronic care issues • Health coaching to achieve your health improvement goals • Education and tools to help you and your caregiver better manage your conditions at home • Access to a pharmacist, diabetes educator, and dietitian • Help with managing medications • Preventive care reminders • Follow-up contacts after emergency room, in-patient, and skilled nursing facility discharges • Coordination with home health and community resources

better quality of life.”

Kathy Martin agrees. “Since starting the program, Donnie has definitely gotten better,” she says. “I’d encourage others our age who have chronic conditions to take advantage of this program.

It’s really fantastic.”

For more information, call 800-422-8482 or go to CarilionClinic.org/primary-care/BL65.

CarilionClinic.org | SUMMER 2016 21

MEDICAL NEWS

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22 SUMMER 2016 | CarilionClinic.org

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standing s that collect em it g in v o m by re tires, potted buckets, old as ch su er at w d toys plant trays, an rnamental of water in o g n si o p is D » hs on a ch as bird bat containers su weekly basis d pants at ng sleeves an » Wearing lo oes are hen mosquit (w sk u d d an dawn . most active) area that g a trip to an in n n la p e ’r If you of the Zika d an outbreak ce n ie er p ex ilion’s has us disease, Car io ct fe in er th virus or o ffers a se Division o ea is D s u io Infect sess risk and to help you as ic in cl el av tr ysicians cautions. Ph re p ry sa es take nec rds and r medical reco u yo w ie v re l wil ations recommend ed iz al u id iv make ind ations to ions or medic at n ci ac v as such take with u leave, or to yo re o ef b e k ta traveling. et sick while g u yo ld u o you sh 715 or call 540-981-7 , n o ti a rm fo For more in diseases/ rg/infectious.o ic lin C n lio ri visit Ca services.

CarilionClinic.org | SUMMER 2016 23

‘Eat Healthy’ MEDICAL NEWS

ON A BUDGET

By Stephanie Specht

How important is a healthy diet?

It can help you feel better, look better, function better, and live longer, says Don Mankie, R.D., a Carilion Clinic dietitian.

“Consuming a diet rich in vegetables, fruits, nuts, whole grains, and lean protein foods, as well as drinking plenty of water and exercising, are key to maintaining a healthy weight and keeping disease at bay,” he says.

Many people think a healthy diet costs more, but Mankie says that’s not necessarily true. Here are his top 10 tips for healthy eating on a budget.

2.

24 SUMMER 2016 | CarilionClinic.org

Make a list: After planning, make a grocery list according to a set budget and stick to it. Avoid any aisles in the grocery store that don’t include items on your list.

1.

Plan: Before you head to the grocery store, plan your meals for the week. This is a good time to search for quick and easy recipes online.

Stews and stir-frys are great options to bulk up on vegetables and protein, and you can double a recipe and freeze some for later.

3.

Hit the sales: Check your local grocery store for sales and don’t forget your coupons.

4.

Buy in-season: Fresh fruits and vegetables in-season are usually cheaper and fresher.

6.

Avoid convenience items: Pre-cut fruits and vegetables are convenient but they cost more. Buy them whole and prep them for the week on Sunday to save money.

9.

Don’t waste food: Instead of letting fresh fruits and vegetables spoil and throwing them out, add any left-over vegetables to soups or casseroles. Over-ripe fruit is great for smoothies and baking.

5.

7.

Look for canned and frozen: Fruits and vegetables that are canned or frozen are also healthy options. They are sometimes cheaper than fresh foods, and you can buy them in bulk to stretch your budget.

When buying canned items, always opt for low-sodium or no-salt-added versions and fruits canned in 100 percent fruit juice.

8.

Buy store brands: These are often cheaper than name-brands.

Stock up on staples: Buy items such as canned produce, dried beans, and pastas in bulk. Having these in your pantry can make assembling a weeknight meal a snap.

10.

Start a garden: Plant a small garden in your back yard or try container gardening. It’s a great way to save money. Get the entire family involved, and you won’t be able to beat that garden-fresh taste!

For more information, go to CarilionClinic.org/calendar to find nutrition classes and events.

CarilionClinic.org | SUMMER 2016 25

GROWING TO SERVE YOU PHYSICIANS Brian Beacham, M.D.

ADVANCED CLINICAL PRACTITIONERS Amy Chico, F.N.P.-C.

Michael S. LaRue, P.A.-C.

Family Medicine 15 Killdeer Lane, Dayton, VA 540-879-4300

Family Medicine 108 Houston St., Suite A, Lexington, VA 540-463-2181

Wayne K. Robbins, D.O.

Emily Fischer, N.P.

Kaitlin E. Seelig, P.A.-C.

James T. Thompson II, M.D.

Christopher Hewitt, N.P.

General Surgery 180 Floyd Ave., Rocky Mount, VA 540-224-5170

Otolaryngology 3 Riverside Circle, Roanoke, VA 540-224-5170

Plastic and Reconstructive Surgery 2107 Rosalind Ave., Roanoke, VA 540-853-0510

Orthopaedic Surgery 2331 Franklin Road, Roanoke, VA 540-725-1226

Family Medicine 428 S. Magnolia Ave., Waynesboro, VA 540-949-8241

Pediatric Practice Opens in Rocky Mount A new Carilion Children’s Pediatric Medicine practice has opened in Rocky Mount. It will fill a community need since Rocky Mount’s only pediatric clinic closed more than a year ago when its pediatrician retired.

Located at 490 S. Main St., the practice will see patients from birth to age 17 and provide comprehensive outpatient treatment, routine checkups, and regular immunizations.

Pediatrician Kathryn C. Self, M.D., a U.S. Navy veteran, is seeing patients at the practice. “The health of our children is a fundamental building block of our community,” she says. “I’m also grateful to be living and working in such a wonderful place.”

26 SUMMER 2016 | CarilionClinic.org

Neurosurgery 2331 Franklin Road, Roanoke, VA 540-224-5170

Dr. Kathryn C. Self and the pediatric medicine office in Rocky Mount.

A N O T E T O PA R E N T S O F S T U D E N T- AT H L E T E S

By Jon Maher, M.D. Carilion Clinic Orthopaedic Surgery and Sports Medicine

As a physician and a father, I can attest to the benefits of athletics for students of all ages. But I also encounter the other end of the spectrum where sports, due to stress or injury, can harm an athlete.

Here are three strategies that can help your child succeed on and off the court this coming fall.

KEEP IT FUN! Sports can be a great diversion from the pressures of student life, providing physical and mental stress relief. Unfortunately, if the fun is lost and there’s too much pressure, sports can also harm a child.

AVOID HELICOPTER PARENTING One source of pressure can come from parents—or what is commonly known as helicopter parenting.

I was at a sports dinner with Coach David Crist (40-year football coach of Blacksburg High School and a living

legend) when he was asked if he saw any changes in student-athletes over his career. He replied: “The athletes have always remained the same. It’s the parents who have changed.”

Parents don’t wake up in the morning thinking they are going to harm their children, but many inadvertently do by pressuring them to succeed. Some kids are encouraged to play through injury, train for excessive periods, or continue a sport that no longer interests them.

Often parents try to live vicariously through a child or hope for a college scholarship. Or they just want the best for their child. Parents should periodically take a step back and reexamine the child’s activities to make sure they’re in it for the right reasons.

PLAN REST AND RECOVERY TIME Doctors who treat student-athletes often find they are being over-trained.

Some start with repetitive focused training in one sport at an early age. Some even play on multiple teams in the same

season. This trend is risky and often harmful, especially to younger athletes.

A developing athlete’s body needs time to rest and recover from the stresses of a particular sport. Playing a single sport year-round at a young age and not allowing enough time for recovery between workouts can result in career-ending injuries.

Studies show that a student-athlete is more likely to make it to the elite level as a professional or scholarship college athlete if he or she plays many sports at a young age rather than specializing in only one.

PUT IT ALL TOGETHER Get involved for the right reasons, and do help your child maximize health and success. Most of all—have fun!

Dr. Maher has been a team physician for the Boston Celtics and Harvard University’s athletics department. He also spent 14 years as a U. S. Navy physician, where he treated Marine and Navy SEAL teams.

CarilionClinic.org | SUMMER 2016 27

RECIPE

Summer ries r e b k c a Bl e p u o l a t n & Ca If you like the sweetness of cantaloupe and the tang of blackberries, why not try them together? Add a mellow sauce of almond cream, and you have the perfect afternoon snack or dessert after dinner.

BLACKBERRIES AND CANTALOUPE WITH ALMOND CREAM

SERVES: 4 INGREDIENTS

• • • •

1/2 cup fat-free cream cheese, softened 1 tablespoon 1% low-fat milk 1/4 teaspoon almond extract 1/2 (2.5-pound) cantaloupe, peeled, seeded, and diced into one-inch cubes • 1 cup blackberries • 4 teaspoons sliced almonds, toasted • Mint sprigs (optional) PREPARATION 1. Combine first four ingredients in a small bowl and beat at high speed in mixer until

smooth.

2. Arrange cantaloupe, 1/4 cup blackberries, and 2 tablespoons cream cheese mixture on each

of four dessert plates.

3. Sprinkle each with a teaspoon of toasted almonds and garnish with mint, if desired.

NUTRITION

Per serving: 84 Calories; 1.1 g Fat; 5.4 g Protein; 3.7 g Fiber

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The Region’s Only

When it comes to trauma, you want a team that’s trained and prepared for anything.

Your trauma team at Carilion Roanoke Memorial Hospital has served patients throughout our region with the highest level of trauma and critical care for more than 30 years. As the only Level 1 Trauma Center in western Virginia, Carilion offers the region’s only always-ready, always-prepared, always-on-your-side trauma team.

CarilionClinic.org/trauma | 800-422-8482

CARILION CLINIC P.O. BOX 13727 ROANOKE, VA 24036-3727

NON-PROFIT ORG. U.S. POSTAGE

PAID

ROANOKE, VA PERMIT NO. 247

Are behavioral changes a sign of bullying?

Get the answer to this and many other health questions from Carilion Clinic Living’s Fact Check, hosted by Karen McNew. A new video is posted every Friday, so you’ll never have to wait long to find out what’s myth and what’s good medicine.

CARILIONLIVING.COM/FACTCHECK