verve - Fall/Winter 2010-11

Fall 2010 / Winter 2011

A community service of

Sally Field Battling a Silent Disease

Beyond the Limits of the Human Hand

da Vinci Surgical System: less invasive, more precise, faster recovery The human hand is truly amazing: Fingers that bend and grip; precise touch and feel; fluid movement.

Imagine all of that being enhanced in the operating room. That’s what the da Vinci Surgical System does. It takes the skill of a surgeon’s hand and elevates it to a higher level of performance.

That’s why the surgeries our doctors perform using da Vinci are more precise. And because they are less invasive, the surgeries provide a faster recovery time, giving patients the upper hand on getting back to their life.

Surgeries performed with da Vinci include: • Urologic • Gynecologic • Cardiac • General For more information about da Vinci surgery at Carilion Roanoke Memorial Hospital, call Carilion Clinic at 540-266-6000.

www.CarilionClinic.org/davinci

The da Vinci Surgical System offers Dennis Scribner, M.D., greater precision for complex procedures.

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Sports Injuries Sports medicine clinic expands

10 Education New medical school opens

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Local Authors These medical professionals also write

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Sally Field Her fight against osteoporosis

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Departments 3

Letter

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Sports Medicine

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Technology

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Cardiac Care Education

President and CEO ..........................

Chief Operating Officer, Carilion Clinic and President, Carilion Clinic Hospital Division ....

Vice President of Strategic Development ...............

Media Relations Director.................

Edward G. Murphy, M.D.

Nancy Howell Agee Shirley Holland Eric Earnhart

verve:

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Pregnancy

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Chronic Conditions

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Community

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Elderly Care

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Facilities

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Interdisciplinary Care

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Women’s Health

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New Physicians

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Excursions

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Food

Fall 2010 / Winter 2011

Editor................................................

Design ..............................................

Photography ....................................

Printing.............................................

Maureen Robb Gordon Garrett Darryle Arnold Chocklett Press

Contributing Writers Mary Brewer, Allison Buth, Shanna Flowers, Meredith Hite, Kate Jones, Gail Nordhaus, Matthew Sams

www.CarilionClinic.org 540-266-6000 or 800-422-8482 Carilion Clinic is a health care organization with more than 600 physicians in a multi-specialty group practice and eight not-for-profit hospitals.

verve is published quarterly by Carilion Clinic 1906 Belleview Ave. P.O. Box 13367 Roanoke, VA 24033 540-981-7000 Copyright 2010 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-todate 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.

verveletter

welcome

I

f you’ve been to Riverside Center in Roanoke lately, you may have seen some of our new medical students on their way to class. Our 42 students— 30 men and 12 women—have come from around the country to obtain their M.D. degrees at the new Virginia Tech Carilion School of Medicine.

Academically, they are among the best in the nation, with an average Medical College Admission Test Score of 33, vs. the national average of 30. We tell you more about the school and its innovative curriculum on page 10.

In this issue, we also take a look at Carilion Clinic’s expanded sports medicine program for student-athletes and adults; a new, invisible hearing aid that can be worn 24/7; and our cutting-edge maternal-fetal medicine practice. And we’re pleased to report that our Heart Alert program, which fast-tracks heart attack victims to life-saving care, has celebrated a milestone: saving its 1,000th patient.

For those of you who enjoy contemporary fiction, turn to page 16 to read about a Roanoke-based nurse and author, Gina Holmes, whose debut novel was published this year to wide acclaim. We also profile best-selling novelist Harry Kraus M.D., a Lexington surgeon, and John Ingram Walker, M.D. of the New River Valley, whose latest highly regarded book on mental health is now out.

You also may not know about some of the adventurous railway excursions now being offered across our region. Whether you’d like to take a day trip in mountainous West Virginia and watch Bald Eagles soar, or you’d enjoy a jaunt down to Danville and back, a variety of passenger trips are available.

Our cover story features none other than Sally Field, who has grown up in the national spotlight and is now a youthful-looking 64. Recently, Field has been sharing her story about her fight against osteoporosis—and has become a leading spokesperson on the subject. Read about her life, award-winning career, and mission to save others from her own debilitating disease.

Ed Murphy, M.D. President and CEO Carilion Clinic

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Resources to Keep You Healthy Nurse Line Carilion Clinic’s physician referral and health information service is here to help.

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

“Well Said” Speaker’s Bureau If you’d like a speaker on a health topic for your community group, call 540-224-4961. For a speaker at your workplace, call 540-224-4967.

Or visit www.CarilionClinic.org/speakers.

Community Health Screenings Health screenings throughout the community are available at little or no cost.

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

New, Improved Website Check out these features at www.CarilionClinic.org: • An easy-to-use physician database with multiple search criteria • Interactive maps to help patients find their way to our locations • Multimedia health and wellness content, including an A-Z library • A community health education and events calendar

News Blog Keep up with the latest news, photos, videos and more at Carilion Clinic’s news blog. Visit newsblog.CarilionClinic.org.

Social Media Stay connected with us through Facebook, Twitter, YouTube and LinkedIn: www.facebook.com/carilionclinic www.twitter.com/carilionclinic www.youtube.com/carilionclinic www.linkedin.com/companies/carilion-clinic

Publications Pick up a copy of verve, Carilion Clinic’s health and lifestyle magazine, at a magazine rack or grocery store near you. Or read past issues of verve and the Carilion Clinic Report at www.CarilionClinic.org/publications. For health tips and news about health events, check out our e-newsletter, Carilion Clinic Living, at www.CarilionClinic.org/living.

Support Groups Support groups are available for a wide range of health and emotional needs, including gynecologic cancer, breast cancer and perinatal loss. Learn more at www.CarilionClinic.org/support.

Health Information Centers Computer stations with health information are available at Carilion Clinic’s 3 Riverside building at the corner of South Jefferson Street and Reserve Avenue in Roanoke. Check out the audio library, video library, clinical wizards, health news and interactive tools.

Carilion Clinic Expands Sports Medicine Program

By Meredith Hite In any given week, millions of Americans compete in sports.

And whether they are playing tennis, baseball, or football, they often get hurt.

To treat athletic injuries, Carilion Clinic has expanded its sports clinic and its sports medicine program. The sports clinic, which is open on Saturday mornings during the fall season, aims to treat and prevent sports injuries in local athletes.

Student athletes who suffer practice or game-related injuries can either walk in or have their trainers call ahead for an appointment.

Sports clinic physicians are also working with local teams to provide better preventive care. The clinic’s doctors are now working with trainers for the Virginia Military Institute, Salem Red Sox, Ferrum College, and most of the region’s high school teams. Clinic physicians also provide sideline care and on-site initial evaluations of athletes.

“We like to work directly with the trainers at local schools and make ourselves available to them when they need us,” says orthopaedic surgeon Christopher John, M.D. The sports clinic also works with an athlete’s primary care physician to provide care tailored to a particular athlete.

“We see a wide range of sports injuries—from head to toe,” Dr. John says. “More than anything, though, we see shoulder, elbow, knee, and ankle Christopher John, M.D. problems.”

The sports clinic, created by Roanoke Orthopaedic Center (ROC) 10 years ago, has been expanded since ROC merged with Carilion Bone and Joint last April to form Carilion Clinic – Orthopaedics.

The merger has also allowed Carilion Clinic – Orthopaedics to expand its overall sports medicine program in many ways.

The practice now has expedited access to an advanced 3 Tesla MRI system and the availability of a dedicated musculoskeletal radiologist for consultation.

Other benefits of the merger include giving patients access

New research shows that concussions among football players is a greater problem than previously thought, leading to problems later in life.

to more orthopaedic subspecialties; coordination of care between the sports clinic’s two offices in Roanoke and Rocky Mount; and enhanced physical therapy programs. Athletes also now have access to multi-disciplinary assessment and care for concussions and related injuries.

Three of the orthopaedic surgeons in the practice are located in Roanoke: Christopher John, M.D.; Thomas K. Miller, M.D.; and Brent Johnson, M.D. Another, Robert Cassidy, M.D., practices in Rocky Mount. The sports medicine practice also has physician assistants with an interest in sports medicine, two of whom are certified athletic trainers.

The physicians also treat a variety of injuries in active adults who injure themselves while running, hiking, bicycling, or playing sports. “We perform reconstructive shoulder surgery and repair rotator cuff tears for people of all ages,” Dr. John says.

“Our goal is to offer preventive, diagnostic, non-surgical, and when needed, surgical services,” he says. “We’re here for all types of athletes—of any age.”

For more information, call Carilion Clinic – Orthopaedics at 540-776-0200 in Roanoke or 540-489-4541 in Rocky Mount.

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Partners in Care

Helping patients face life-limiting illness Partners in Care is a specially designed program that allows our sta to provide support and comfort to patients early in the course of a serious illness. Trained in the management of physical, emotional and spiritual needs of patients, our sta can also provide valuable information about hospice options and help patients stay involved in their treatment plans.

For a smooth transition from one program to another, choose Carilion Clinic Home Care and our Partners in Care program.

For more information or to make a referral, please call 800-964-9300 or visit www.carilionclinic.org/Carilion/HomeCare.

A patient must qualify for home health services to be eligible.

All services are provided under the care of a physician.

Loving Your

Hearing Aid Introducing the First Invisible Hearing Device

By Matthew Sams Hearing aids often get mixed reviews from their users.

They can’t be worn in the shower or while sleeping, and their batteries need frequent replacement. Some are also large and clunky or can amplify background noises—interfering with the sounds a user wants to hear.

But now a new type of hearing aid, which is invisible and can be worn for months at a time, has been developed. The Lyric, created by InSound Medical, Inc. of Newark, California, is worn inside the ear canal, and doctors say it produces more natural hearing because of its proximity to the eardrum.

Recently, hearing specialists at Carilion Clinic began offering the Lyric to patients. It is not available elsewhere in the region; in fact, Carilion Clinic Otolaryngology was handpicked to provide the Lyric, along with about 200 other medical practices across the country.

“Carilion Clinic was chosen to distribute the device because of its perfect clinic setting,” says Lillian Beasley Beahm, Au.D., Carilion Clinic Otolaryngology. “We have readily available support, space, and equipment and we also operate on a patient-centered care model.”

Developed by physicians and audiologists, the Lyric is unique due to its incredibly small size. But only 50 percent of the patients who want it can actually wear it. If a patient’s ear canal is too narrow or shallow, the device will

not fit. However, InSound Medical is expected to release an even smaller version of the Lyric in 2011 that will fit a larger percentage of patients.

The Lyric is also unique because it can stay in the ear for long periods of time. Referred to as an “extended-wear device,” it can be worn continuously for up to four months. When its battery dies, patients receive a new device. Most patients subscribe to the Lyric on a yearly basis and are guaranteed eight devices per year.

“The Lyric eliminates many of the hassles of typical hearing aid devices,” says Dr. Beahm. “Users can talk on the phone comfortably, shower with it in, etc. It truly is a game-changer for us.”

Patients are also enthusiastic. Joseph Vipperman, 70, says he is enjoying better hearing in general, as well as on the phone. And he is pleased to not have to remember where he put his hearing aids, or to have to remove them for activities like gardening, when they could get wet from the sprinkler system.

“I am enjoying greatly improved hearing ability and rediscovering sounds such as bacon sizzling,” he says. “I can even hear my dog licking!”

Carilion Clinic Otolaryngology is located at 1 Riverside Circle in Roanoke. For more information, call 540-581-0232.

Half of all baby boomers in the U.S. are thought to be experiencing some degree of hearing loss.

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Heart Alert patient Norma Anderson was interviewed on the Blue Ridge PBS program HealthQuest. She was also shown riding in the same Life-Guard helicopter that flew her to care during her ordeal.

Saving a Life Coordinated Response Saves Franklin County Heart Attack Victim

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By Allison Buth

Carilion Clinic Life-Guard 10 helicopter.

On May 16, Norma Anderson was on an uneventful drive home from Greensboro with her family—until she reached Franklin County. On U.S. Route 220, Anderson, 58, suffered a heart attack.

Her daughter and the driver of the car, Tara Williams, saw Anderson pass out and immediately pulled over. “I got out and started jumping up and down trying to get help,” says Williams.

“Then a car stopped and a woman ran up. She gave my mom CPR until others arrived.”

That woman was Shannon Barber, a nuclear medicine technologist at Carilion Clinic. Although she’d been certified in CPR for 18 years, Barber had yet to put her skills to use.

“My husband and I were traveling out of town to pick up our children when we saw the vehicle pulled over with franticlooking passengers,” says Barber. “We decided to turn around and head back to their location.”

“I asked what was wrong and was told something had happened to their mother. Ms. Anderson at that point was in her seat, unresponsive with no palpable pulse. Her daughters quickly lowered her out of the van onto the ground, where I began CPR.” Williams, meanwhile, called 911. “I didn’t know where we were exactly,” Williams says. “I told them we were somewhere on 220 near a bridge.”

Fall 2010 / Winter 2011

With only this to go on, Franklin County police and EMS providers in Carilion Clinic’s Heart Alert program began searching for them.

Police Sergeant Dan Hale and Deputy Brian Garland were the first to arrive. “I saw an unresponsive woman on the ground,” Hale says, “so I quickly got out the portable defibrillator in my car and used it on her. As soon as I shocked her, she regained consciousness.”

(It was the first time Franklin County police had saved anyone with an automated external defibrillator.)

But Anderson wasn’t out of the woods yet. She again lost her pulse, and Sgt. Hale had to use the defibrillator a few more times.

When the EMS specialists arrived, they rushed Anderson to Carilion Franklin Memorial Hospital in Rocky Mount, where physicians were able to stabilize her.

Carilion Clinic’s Life-Guard 10 helicopter was then called, and it sped Anderson to Carilion Roanoke Memorial Hospital.

Carilion Clinic’s average response time for patients fast-tracked through its Heart Alert program is about 30 minutes faster than the national standard.

There cardiologist Alan McLuckie, M.D. of Heart of Virginia Cardiology cleared her blockage, and the hospital’s Catheterization Laboratory provided support and follow-up.

Anderson was placed on a ventilator for three days, and she remained in the hospital for nearly two weeks.

Commemorating Her Survival During the summer, everyone who helped save Anderson met to commemorate her recovery. The EMS crew, Sgt. Hale, the dispatcher on duty, the Life-Guard 10 crew—to name a few—gathered and acknowledged the quick responses that had led to her life being saved.

Anderson was overwhelmed—and couldn’t hold back her tears of joy. “I can't thank everyone enough,” she kept repeating as she hugged one person after another.

To this day, Anderson says she remembers nothing about her heart attack or its immediate aftermath.

“It was nice to meet her,” Sgt. Hale says. “We salute at a lot of funerals, but this was a good time, where we could smile and meet a person.”

Barber, who performed the CPR, was also touched. “Out of tragedy comes new life, new friendships, and new beginnings,” she says.

Every 34 seconds, someone in the U.S. has a heart attack, according to the American Heart Association. But tens of thousands do survive each year—and return to work and enjoy a normal life.

That has been the case for Anderson.

A Heart Alert Milestone Earlier this year, Carilion Clinic reached a milestone—its 1,000th Heart Alert patient was saved.

The Heart Alert program, which fasttracks heart attack victims to life-saving care, bypasses lengthy routines and coordinates care between EMS providers, physicians, and heart care professionals. It allows for a simultaneous and comprehensive response by both local ambulance crews and Carilion Clinic medical teams as a heart attack victim is en route to the hospital.

As a result, medical care is faster— and a patient suffers less heart damage.

Nationwide, the speed with which a hospital performs a heart-saving procedure is critical and is clocked from the moment a patient is rushed through a hospital’s doors. This interval is known as “door-to-balloon time,” and the national standard set by the American College of Cardiology is 90 minutes or less.

Carilion Clinic’s average response time for patients fast-tracked through its Heart Alert program is about 30 minutes faster than the national standard.

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Medical School Opens

By Maureen Robb

The new medical school is located at Riverside Center in downtown Roanoke.

The Virginia Tech Carilion School of Medicine, a world-class medical education center, has opened in Roanoke.

An innovative school with a leadership focus, it is the first new medical school in Virginia awarding an M.D. degree since 1973. It is also the fifth medical school in the state.

The VTC School of Medicine, which welcomed its inaugural class in August, will help alleviate a shortage of physicians nationwide. The United States is expected to face a shortfall of at least 125,000 doctors by 2025, according to the Association of American Medical Colleges.

A unique public/private partnership between Carilion Clinic and Virginia Tech, the school is located at Carilion Clinic’s Riverside Center, near Carilion Roanoke Memorial Hospital. It shares the Riverside campus with two Carilion Clinic outpatient facilities, with over 10 physician specialties represented.

The proximity of the school to these physicians is by design: medical students will work in small groups to learn from patient cases. Classes will also be small, with only 42 students.

Physicians and the researchers at the new Virginia Tech Carilion Research Institute will also take the process one step further by working together to potentially develop better care. In doing so, they will bridge a traditional divide between their two fields—and expand the frontiers of medical 10 Fall 2010 / Winter 2011

education and research.

In addition, VTC School of Medicine will train its medical students in research methods, and they will conduct their own original research. Only two other schools in the nation operate on this model: Harvard Medical School and the Cleveland Clinic’s Lerner College of Medicine.

The VTC School of Medicine will accordingly make an important contribution to the limited pool of doctors who do active medical research—less than 2 percent. More importantly, its graduates will be adept at using research in their daily practice of medicine, thereby improving the quality of care for their patients.

“Our students will be inspired by collaboration and discovery, and patients will reap the benefits,” says VTC School of Medicine President and Founding Dean Cynda Ann Johnson, M.D., M.B.A. The combined economic impact of the school and research institute is forecast to be $40 million annually. Every dollar spent by a medical school or teaching hospital creates an additional $1.30 in economic activity, according to the Association of American Medical Colleges.

For more information, go to www.vtc.vt.edu/ and www.me2md.vtc.vt.edu/.

Carilion Clinic Expands Residency and Fellowship Programs An estimated 80 percent of the doctors in southwest Virginia have received training through Carilion educational programs.

By Matthew Sams

Carilion Clinic resident physicians (L to R) Christopher Wood, D.O., Christopher Morley, M.D., and Suchet Kaur, M.D. check on patient Kenneth Senter. After graduating from medical school, doctors spend three to seven more years training in their specialty. During this time, they are known as resident physicians, or residents.

Carilion Clinic has welcomed 70 new medical doctors to its residency and fellowship programs this year—a record number.

The arrival of these new graduates reflects Carilion Clinic’s strong role in training physicians. Carilion has provided medical education for over 60 years, and an estimated 80 percent of the doctors in southwest Virginia have received training through its educational programs.

(After graduating from medical school, doctors spend three to seven more years training in their specialty.)

The 70 new doctors come from seven countries and 24 U.S. states, and more than 40 medical schools. They will study under the auspices of Carilion Clinic’s Graduate Medical Education Program within the Office of Academic Affairs. This office in turn will help facilitate the clinical rotations for the new Virginia Tech Carilion School of Medicine.

Seven residency programs are offered: family medicine, internal medicine, obstetrics and gynecology, neurosurgery, psychiatry, general surgery, and transitional year. Two other residency programs in emergency medicine and pediatrics

are being considered.

Fellowships are offered in six specialties: geriatric medicine, geriatric psychiatry, pulmonary medicine, infectious disease, addiction psychiatry, and child and adolescent psychiatry. The number of annual fellowships awarded has grown from two to six in recent years, and expansion of the fellowship program will continue. Applications are now being considered for fellowships in cardiovascular medicine, critical care, and surgical critical care.

Carilion Clinic’s transition to the clinic model has heightened its already strong emphasis on education, says Daniel P. Harrington, M.D., vice president of academic affairs. “Without the conversion to the clinic model and development of the new medical school, we would not have had the opportunity to expand our education programs so substantially,” he says.

“The new medical school truly defines Carilion Clinic as an academic medical center with a superb faculty and services and facilities that other hospitals in the region simply cannot offer.”

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Melissa Wright and her daughter Bailey.

Overcoming High Risk in Pregnancies When Mother and Child Need Cutting-Edge Care

By Maureen Robb When Melissa Wright was nine weeks pregnant, she was told she had a rare blood disorder that could kill her baby.

Wright, 28, learned she was “Kell-positive,” which meant she had a marker on her red blood cells that caused her to produce atypical antibodies. “As my baby was developing her own red blood cells, mine were killing them,” she says. “The doctors told me, ‘You could have a dead baby before your pregnancy reaches 20 weeks.’ ” Her goal became to keep the baby alive until the 20week mark, when doctors might be able to do blood transfusions. (Babies younger than that can’t tolerate them.) Wright says she was “scared beyond belief.”

Luckily she had access to the maternal-fetal medicine specialists at Carilion Clinic, who spelled out her risks— and the state-of-the-art resources they had to combat them.

Wright made it to 20 weeks, and began going in for weekly ultrasound monitoring to determine if the baby 12 Fall 2010 / Winter 2011

was anemic. If so, the doctors were prepared to perform a blood transfusion in utero—possibly every two to three weeks until birth. Wright was also told that severely anemic babies can develop congestive heart failure.

Sure enough, she needed two transfusions: one at 26 weeks and another at 28 weeks. And because such transfusions are high-risk—doctors enter a needle into the uterus and aim to hit a 6-mm blood vessel without the baby moving—Wright had to be prepped each time for a possible emergency delivery.

“I was numbed from the chest down and my abdomen was shaved in case I needed a Cesarean section,” she says.

“The surgical team stood by in the same room, ready to act at a moment’s notice.”

It was upon admission for the third transfusion that her doctors decided to deliver—the baby was too anemic to undergo the procedure—and Bailey Wright came into the world two months premature. She was rushed into Carilion Clinic’s Neonatal Intensive Care Unit, or NICU.

Then Wright—who happens to be a Roanoke Memorial labor and delivery nurse—faced another ordeal. Bailey, at 3 pounds and 14 ounces, stayed in the NICU for almost a month. She had two IVs in her at all times and received round-the-clock, highly specialized care designed to build her immune system so she could begin to produce her own healthy blood cells. Otherwise doctors would have to drain all her blood and transfuse her.

Thankfully, Bailey never needed that final transfusion, and she is now a thriving 9-month-old. “The NICU and the doctors did everything possible for her,” says Wright. “My husband and I told them: ‘You’re heroes. You saved her life. Twenty years ago, she would have died.’ ” Wright’s story is one of the many successful outcomes at Carilion Clinic’s NICU in association with the Clinic’s maternal-fetal medicine practice. And while many high-risk expectant mothers in southwest Virginia used to be referred to the University of Virginia Hospital in Charlottesville, they now have access to the most advanced technology and medical care close to home.

The Carilion Clinic NICU, the largest in the region, is located within Carilion Clinic Children’s Hospital in Roanoke and cares for about 600 babies each year. Infants born as early as 16 weeks premature are cared for in this Level III facility (the highest designation given by the Virginia Department of Health).

Eighteen hospitals in southwest Virginia send mothers with complicated pregnancies to Roanoke Memorial, the regional perinatal referral center. They also send critically ill babies to the NICU for life-saving technology. Often they ask Carilion Clinic’s highly trained neonatal transport team to perform the delicate transport process.

As for Wright and her daughter Bailey, both are doing well. Says Wright proudly: “My daughter is as healthy as any other baby now.”

For more information, talk to your obstetrician or call 540-985-9985.

Specialized Care for High-Risk Pregnancies When a pregnancy is deemed highrisk, a physician may refer expectant mothers to a maternal-fetal medicine specialist. Reasons for referral may include a woman’s age, family history, or personal history of miscarriages or stillbirth.

For women in southwest Virginia who need such specialized care, Carilion Clinic provides the largest maternal-fetal medicine program in the region. With three physician specialists and certified genetic counselors, Carilion Clinic’s team works closely with a patient’s obstetrician, the staff of the Neonatal Intensive Care Unit, and other medical specialists to provide full-spectrum care.

The field of maternal-fetal medicine, which has grown significantly in recent years, includes obstetricians who specialize in the diagnosis, treatment, and ongoing care of highrisk expectant mothers and their unborn babies.

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When It’s Hard to

By Mary Brewer

COPD Is the Fourth Leading Cause of Death in the U.S. Are you often breathless? Do you have a chronic cough? Do you wheeze or feel a tightness in your chest when you’re performing activities that never used to give you trouble?

“These are not normal signs of aging,” says Jose M. Goyos, D.O. of Carilion Clinic Pulmonary Medicine. “If you are an adult in your 60s, 70s, or 80s and experiencing these symptoms, you want to get tested for COPD. This is especially true if you are a current or former smoker, or spent a lot of time around people who smoke.”

COPD stands for Chronic Obstructive Pulmonary Disease, a term used to describe a number of lung diseases that make it hard to breathe and that can get worse over time. They include chronic bronchitis, emphysema, and refractory asthma.

What many do not realize is that COPD is the fourth leading cause of death in the United States. By 2020, it is expected to be the third leading cause. The National Heart, Lung and Blood Institute estimates that 12 million Americans have been diagnosed with COPD, and that another 12 million are undiagnosed or developing the disease.

“Younger people are getting diagnosed all the time,” says Dr. Goyos. “Yes, it’s people smoking, but it’s also more awareness of the disease.”

While smoking is the main cause of COPD, exposure to second-hand smoke is also a significant cause.

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“We are seeing people with COPD in our pulmonary clinic who never smoked,” Dr. Goyos says. “Many are women who were around fathers, brothers, and husbands who smoked.”

Other important causes are occupational dust and chemicals, while air pollution and genetic factors can also cause or contribute to some cases of COPD. There is no cure, but treatments are available to help manage symptoms. At Carilion Clinic, for instance, the pulmonary clinic has nine board-certified pulmonologists who provide a full spectrum of treatments. These can include bronchodilators, drugs that relax muscles in the airways and improve breathing.

Other COPD patients require supplemental oxygen— either all day, while sleeping, or at both times.

“We also offer pulmonary rehabilitation that includes exercises that increase exercise tolerance and decrease shortness of breath and other symptoms,” says Dr. Goyos. Training in optimal breathing strategies is provided as well.

“We offer hope,” Dr. Goyos says. “The people who see us really feel a very significant difference after pulmonary rehab. We hear it all the time.”

In conjunction with the Carilion Clinic Sleep Center, the pulmonologists may also do sleep testing. “In more severe cases of COPD, we may elect to do a sleep study in order to evaluate for the presence of sleep apnea (disrupted breathing during sleep),” Dr.

Breathe

Possible Causes of COPD Smoking Exposure to second-hand smoke Occupational dust and chemicals Air pollution Genetic factors

Goyos says. “There is a higher incidence of this disease in patients with more severe COPD. This can be effectively treated.”

If you have symptoms, start by seeing your primary care physician to talk about taking a spirometry test to determine the health of your lungs. This is an easy, painless test that requires you to blow into a machine that can detect changes in and measure your breathing ability.

Even those without symptoms but who are at risk can benefit. Spirometry tests are recommended for all smokers older than 45, all former smokers, people exposed to significant second-hand smoke or workplace irritants, or anyone with a family history of COPD. For smokers, the most important step is to quit smoking. Smokers are also advised to guard against flu and pneumonia, which can be prevented with vaccines.

Left untreated, COPD may quickly worsen. But with proper diagnosis and treatment, COPD symptoms can be controlled. “The progression of the disease may also be delayed,” says Dr. Goyos.

Carilion Clinic Pulmonary Medicine is located at 2001 Crystal Spring Ave. in Roanoke and 2900 Lamb Circle in Christiansburg. For more information, talk to your doctor or call 540-985-8505 in Roanoke or 540-693-4860 in Christiansburg.

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They’re Medical Professionals— Roanoke Nurse Writes Contemporary Fiction Gina Holmes became a Eventually she began reading outside the suspense nurse in order to help genre. “I read some amazing novels, and it was like anothers and to make a dif- other world opened up,” Holmes says. “I decided I no ference in the world. The longer wanted to write thrillers, but stories that would same impulse has guided change lives the way these books had changed mine.” her writing career.

Her agent told her that while her thrillers were good, Her debut novel, Cross- Crossing Oceans seemed to be written more in her true ing Oceans, was pub- voice. Holmes, now 39, agreed. “That was a turning point lished earlier this year to for me, and the right advice,” she says. “I’m now writing wide acclaim. Holmes what comes naturally, and I love it.” describes it as the story Along the way, she founded a literary blog, Novel Jour“of a dying ney, which has featured interviews with such y o u n g popular authors as Dean Koontz and mother who Nicholas Sparks. She has also written about Gina Holmes must return her favorite books, which include Jane home to face the ghosts of her past, and Eyre, The Catcher in the Rye, Jonathan Livtransition her daughter into the arms of a faingston Seagull, Lord of the Flies, Memoirs of ther who didn’t even know she existed.” a Geisha, and The Secret Life of Bees.

Best-selling author Tess Gerritson has She is often asked if Crossing Oceans is called the book “an uplifting and inspiring autobiographical. “Every character—good tale that reminds us to live every day as if and bad—is drawn from parts of me,” she it’s our last.” Another reviewer has praised says. But as Holmes wrote the story, she also it as a story of “choices and consequences” discovered that her characters took on a life that explores every human emotion. of their own.

Holmes, a nurse at Carilion Roanoke Holmes, who lives with her husband and Memorial Hospital, never set out to write two sons in the Roanoke Valley, is now at what is often called women’s fiction. The cover work on her next book. “I have a burning deGrowing up in New Jersey, she had al- of Holmes’ first novel, sire to tell good stories,” she says. ways read suspense novels and thought Crossing Oceans. that was what she should write.

For more information, go to www.ginaholmes.com/.

In her 20s and early 30s, she spent 10 years writing four thrillers—and looking for a publisher. “I had fleeting moments of despair along the way, especially when I came close to getting a contract and then saw it fall through,” she says.

16 Fall 2010 / Winter 2011

and Authors

By Maureen Robb

New River Valley Doctor Is a Mental Health Expert “Life is about keeping your eyes on your dream,” says author and physician John Ingram Walker, M. D. Dr. Walker, who is director of Psychiatric Education at Carilion Clinic Saint Albans Hospital, ought to know. He is the author of 13 books and many articles about psychiatry and the behavioral medicine field.

John Ingram Walker, M.D. His most recent book is Complete Mental Health: The Go-to Guide for Clinicians and Patients, published in April by W.W. Norton & Co. It has been praised for its warm, inviting style that appeals to both the medical professional and lay person, and it balances research with personal insights, clinical anecdotes, and practical tips.

“Research shows that 50 to 70 percent of people visiting a primary care physician have a mental health issue that is contributing to their presenting problem,” Dr. Walker says. “Yet most doctors receive only a few weeks of psychiatric training.”

“I wrote Complete Mental Health to fill that educational gap by empowering physicians and other health professionals to quickly recognize, diagnose, and treat a broad spectrum of psychiatric disorders,” he says. “And I wanted patients to have a better understanding of their illnesses, so I wrote the book with them in mind too.”

Locally, Dr. Walker has also acquired a following as the inspirational author of the newsletter LifeWorks, published

by Saint Albans Hospital. In its pages, he takes on problems that prevent us from living our lives to the fullest.

He counsels readers to not waste time on unimportant tasks but to make time for priorities.

“We spend all our time on insignificant things and have no time left for the activities that will achieve our dreams,” he wrote in a recent issue. “A well-used time management rule says, ‘Success depends on what you neglect,’ ” he points out.

He advises making a daily list of the things you want to accomplish, and tackling them in order of importance.

“If you can’t finish them all, so be it,” he says.

For his own part, Dr. Walker enjoys the act of writing.

“Writing helps me organize my thoughts,” he notes.

“Sometimes I don’t know what I am thinking until I read what I write.”

Dr. Walker came to Carilion Clinic two years ago from College Station, Texas, where he was the behavioral health unit medical director for St. Joseph Regional Health System. He had formerly been a professor of psychiatry at Duke University and the University of Texas Health and Science Center–San Antonio.

He and his wife had been looking for a place to live that would allow them to be closer to their children and grandchildren. “We enjoy the small town charm and the academic amenities that the New River Valley offers,” he says. “I am especially pleased to be with Carilion Clinic, an innovative health care organization that will be a model for the next generation’s medical care.”

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They’re Medical Professionals— and Authors (continued from page 17)

Lexington Surgeon Draws on Missionary Experience Harry Kraus, M.D. began writing his first novel during his surgical training at the Veterans Administration Hospital in Lexington, Kentucky. Although he was practicing medicine up to 80 hours a week—and raising two young sons with his wife— Dr. Kraus couldn’t ignore the urge to write.

He has since succeeded in both careers—surgeon Harry Kraus, M.D. and author—and has published 12 contemporary inspirational novels and three nonfiction books on faith. And he is now practicing in Lexington, Virginia, at Carilion Stonewall Jackson Hospital, while on sabbatical from his post as a missionary surgeon at Kijabe Hospital in Kenya.

Dr. Kraus’ experience as a writer has certainly been atypical. He studied biology and chemistry in college, then received his M.D. degree from the Medical College of Virginia. The longest thing he’d ever written before becoming a novelist was a college term paper. “My only preparation for a writing career was a love of reading,” he says.

He also didn’t attempt to learn the craft of fiction until after he’d published four novels. “I would not recommend this to others,” he says. “I may have had a natural talent for plotting, but my initial success probably stunted my growth as a writer. I could have progressed faster if I’d studied the craft.”

Dr. Kraus does believe that writing and performing surgery complement one another. He likes the variety of his surgical cases, and particularly enjoys performing advanced laparoscopic surgery. Many of his plots are drawn from his medical cases.

His latest best-selling novel is The Six-Liter Club, published by Simon & Schuster. It tells the story of Dr. Camille Weller, the first black female doctor at the Medical College of Virginia, who manages to save a patient who has lost six liters of blood.

She is, however, plagued by flashbacks from her childhood in the Congo that hamper her ability to work. Her 18 Fall 2010 / Winter 2011

faith is also threatened.

This African dimension reflects Dr. Kraus’ long tenure as a missionary surgeon in East Africa, and he says he is fascinated by the opportunity to combine medicine with Christian ministry.

He is currently working on the second book in a threebook contract for David C. Cook publishers. “It is another contemporary novel with a realistic medical stripe,” he says.

African zebras and flamingos photographed by Dr. Kraus.

Dr. Kraus and his wife Kris—whom he describes as the model for the inspiring female characters in his books— live in Harrisonburg; they now have three sons. Dr. Kraus will be working in Lexington until next May, when he will be moving back to East Africa to continue his surgical work among the Somali people.

For the time being, he is enjoying living and working in Virginia. “I love Lexington because it is a friendly, college town with salt-of-the-earth people,” he says.

For more information, visit www.harrykraus.com.

Preventing Anorexia in the Elderly

By Darrell Kirtland Shomaker In our society, where almost two out of three Americans are overweight, shedding pounds is a goal for many. But being thin doesn’t always mean optimal health—especially when you’re older.

Sadly, many older adults and caregivers are unfamiliar with anorexia in aging, and the health problems associated with it. These can include protein-energy malnutrition, functional and cognitive decline, acute illness, and even death. Older adults with anorexia are also at significantly higher risk for fall-related injuries.

As we age, our chances of experiencing unintended weight loss actually increase. But anorexia in the elderly is different from anorexic disorders found among younger people.

Elder anorexia is defined by involuntary weight-loss caused by physiologic changes in aging body systems. It is caused in part by changes in the brain that alter older adults’ ability to perceive hunger and adequately regulate food intake.

Deterioration of the hypothalamus and other regions of the brain prevents hormones and neurotransmitters associated with hunger from properly signaling the need to eat, so older persons do not feel hungry as often and eat less. Over time, the process causes continual weight loss.

Several other physiologic conditions can also contribute to anorexia in aging. These include poor-fitting dentures, loose or missing teeth, and other dental problems that make eating difficult or embarrassing. Sores, infections, and other painful conditions in the mouth can have the same effect.

Similarly, chemical and structural changes in the gastrointestinal tract can create problems such as pain, bloating, and diarrhea that negatively affect appetite, nutrient absorption, and weight management. Older adults’ ability to taste their favorite foods often declines as well as they lose some of their sense of smell (which accounts for approximately 70% of taste).

Fortunately, early intervention and support from care providers can help offset many of these problems. Visits by friends and family can ward off the social causes of anorexia in elders—such as isolation and loneliness. Other causes like depression and cognitive impairment should be assessed by a physician.

Registered nutritionists and dieticians can also provide tips on how to compensate for losses in appetite, taste, and interest in cooking and eating.

So the next time you encounter ads for weight loss programs directed at older adults, realize that weight management in later life can be a complex issue.

Darrell Kirtland Shomaker is an assistant professor and director of the humanities and social sciences program at Jefferson College of Health Sciences. He is in the doctoral program in adult development and aging at Virginia Tech. He can be reached at dkshomaker@jchs.edu.

For more information, contact the Carilion Clinic Center for Healthy Aging and its Geriatric Assessment Clinic in Roanoke at 540-981-7653.

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Battling a Silent Disease

By Maureen Robb

Sally Field

“I was raised to sense what someone wanted me to be and to be that kind of person. It took me a long time not to judge myself through someone else’s eyes.”

This may seem like a surprising assertion by two-time Academy Award winner Sally Field—an icon to audiences of all ages. But she has never flinched from the truth.

After winning fame as the bubbly Gidget—the quintessential California surfer girl—Field went on to tackle diverse and evermore challenging roles over the course of her career: Norma Rae, a feisty union organizer; Sybil, a young woman afflicted by multiple personality disorder; and matriarch Nora Walker on the drama Brothers & Sisters, to name a few. Field has always been determined to make the most of her talent.

“I must go to what desperately frightens me—the chance of failure,” she said after being typecast as The Flying Nun. Proving Herself Sally Field, 64, was born in Pasadena, California, to an actress mother and a military officer father. Her first television role, as the 1960s-era Gidget, delighted viewers and soon led to The Flying Nun. Yet even as she became a household name, Field yearned to break free of her typecasting and to grow as an actress. She eventually began studying with celebrated acting teacher Lee Strasberg, who had helped Marilyn Monroe extend her own acting range.

The roles that followed included the lead in the 1976 TV movie Sybil and the co-starring role in Smokey and the Bandit, with Burt Reynolds. After she portrayed Norma Rae—for which she won her first Oscar in 1979—Field cemented her reputation as a dramatic actress and went on to other challenging roles. She earned her second Academy Award in 1984 for Places in the Heart, in which she played a widow beset by obstacles as she strove to support her children on a Depression-era cotton farm.

It was in accepting this Oscar that Field uttered what has become an often parodied—and misquoted—statement. Her actual words in her acceptance speech were not, “You like me, you really like me!” but: “I haven’t had an orthodox career, and I’ve wanted more than anything to have your respect. The first time I didn’t feel it, but this time I feel it, and I can’t deny the fact you like me, right now, you like me!” With good humor, Field has even on occasion parodied her own purported comment.

20 Fall 2010 / Winter 2011

Field’s ensuing film roles included those in Murphy’s Romance, Steel Magnolias, Mrs. Doubtfire, Forrest Gump, Not without My Daughter, and Where the Heart Is. She has also triumphed in numerous television roles, winning three Emmy Awards. One was for her recurring role on ER; another was for her portrayal of Nora Walker on Brothers & Sisters.

In the 1990s, Field expanded her repertoire by directing the television movie The Christmas Tree. She later went on to direct the film Beautiful and an episode of From the Earth to the Moon, the critically acclaimed TV mini-series.

Family Ties Field’s marriage to construction contractor Steven Craig, from 1968 to 1975, produced two sons: Eli Craig, a producer and actor, and Peter Craig, a novelist. Field later became romantically involved with Burt Reynolds and co-starred in several movies with him. From 1984 to 1993, she was married to film producer Alan Greisman and had another son, Sam. In 1988, she and her family suffered a crash in their charter plane on takeoff. Thankfully, they all incurred only minor injuries.

Combating Osteoporosis When Field was diagnosed with osteoporosis several years ago, at the age of 58, she was initially surprised. She had no symptoms. She had also been vigilant about her health.

“I always watched my diet,” she says. “I always ate lots of leafy greens. I took my vitamin D…I never smoked.”

She even exercised regularly. “I’ve always worked out because I’m an actor, and I have to stay fit,” she says. “It’s always been a big part of my life.” Field thought she had done everything right.

But “there does come a time when your genetic predisposition is going to kick in,” she says, noting that she fit the profile for women at risk: she was over 50, smallframed and thin, and Caucasian. She had also watched her grandmother grow hunched over due to weakened bones.

What Is Osteoporosis?

Osteoporosis is an often silent disease that causes bones to become weak and brittle. It often goes undetected, and about 80 percent of those affected are women. It is estimated to cause about 1.5 million fractures annually.

Ten million Americans are believed to have the disease, and almost 34 million more are thought to have low bone mass, increasing their risk for osteoporosis, according to the National Osteoporosis Foundation.

For more information, go to the National Osteoporosis Foundation’s website at www.nof.org/.

(continued on page 22)

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Battling a Silent Disease (continued from page 21)

Risk Factors for Osteoporosis Include: • Age • Gender (female) • Ethnicity (Caucasians and Asians) • Family history • Poor nutrition (low calcium intake)

Sally Field in a scene from the television drama Brothers & Sisters.

When Field was diagnosed, she assumed a new role in life: that of an osteoporosis activist. And she is tackling this new role with her typical determination.

She has spoken with the media in countless interviews about what she terms a huge health threat to warn other women that they, too, might be vulnerable. “Women need to go in armed with information that this disease—bone health issue—actually exists,” she says. “They could very well be at risk.”

“They should go in and ask for a bone density test, and if they are at risk, they can discuss with their health care practitioner the options,” she says. “There are very effective treatments for osteoporosis.”

Field has also teamed up with pharmaceutical firm Roche Therapeutics Inc. to spread the word. In their joint campaign and website, Rally with Sally for Bone Health, Field speaks out on how to prevent and deal with osteoporosis. She also offers bone-healthy workouts, questions to ask your doctor, tips on eating right, and a bone health quiz.

She has even taken her quest to Washington, where she attended a briefing on the disease with members of Congress.

The good news, Field says, is that osteoporosis can be prevented or delayed through diet and exercise. The keys are a balanced diet and weight-bearing exercise such as walking, jogging, or dancing.

Although Field herself looks younger than her years— and retains her youthful enthusiasm and energy—she has a message for other women. Aging well isn’t only about looking good, she says: it’s about feeling good, and staying healthy.

Photos courtesy of ABC. 22 Fall 2010 / Winter 2011

• Physical inactivity • Tobacco and alcohol use • Certain medications (diuretics, corticosteroids, blood thinners, anti-seizure medications)

News&Notes Stroke Program Awarded National Certification

The Stroke Program of Carilion Roanoke Memorial Hospital has received the Gold Seal of Approval from the Joint Commission as a Primary Stroke Center.

This certification recognizes stroke centers that make exceptional efforts to foster better outcomes for stroke care. It also signifies that Roanoke Memorial is in compliance with the highest standards for treating strokes, and that it has the critical elements to achieve long-term success in improving outcomes.

To become a Primary Stroke Center, a hospital must meet stringent response criteria. “Studies have consistently shown that stroke victims treated at Primary Stroke Center hospitals have shorter hospital stays and better outcomes from their strokes,” says Sidney Mallenbaum, M.D., medical director of Carilion Clinic’s Stroke Unit.

This Gold Seal of Approval is the second awarded to Carilion Clinic. The Joint Commission earlier granted the Inpatient Orthopaedic Unit at Roanoke Memorial a Gold Seal for total hip and knee replacement.

Carilion Clinic Ranks as a National Leader in Electronic Medical Records Systems

With the conversion of Bedford Memorial Hospital to the Epic electronic medical records (EMR) system, Carilion Clinic continues to rank as a national leader in implementing EMR systems. Carilion Clinic is now the only multi-hospital health system in Virginia, North Carolina, West Virginia, Maryland, and the District of Columbia to have all of its hospitals live on a single integrated EMR system for clinical care, orders, and finances.

Over 100 physician practices are live as well, with about 30 more practices to be added. Three Carilion Clinic hospitals have also been ranked in the top 2.5 percent of all U.S. hospitals for their use of EMR systems: Carilion Roanoke Memorial Hospital, Carilion New River Valley Medical Center, and Carilion Franklin Memorial Hospital. These three hospitals are certified at Stage 6 by the Healthcare Information and Management Systems Society, which grades hospitals on the scope of their adoption of EMR systems on a scale of Stage 1 to Stage 7. All seven Carilion Clinic hospitals are expected to achieve Stage 6 proficiency in the near future.

Carilion Clinic Partners with Radford University in Doctorate Program

Carilion Clinic and its affiliate Jefferson College of Health Sciences have formed a partnership with Radford University to base Radford’s new doctorate of physical therapy program in Roanoke. The program will be taught at Carilion Roanoke Community Hospital and will share space, services, and resources with Jefferson College of Health Sciences.

The three-year program will admit 25 students per year for a total of 75 students at full enrollment. It will also build on a historical relationship between Carilion Clinic and Radford in nursing education and will set the stage for future opportunities to collaborate.

Carilion Clinic Medicare Health Plan Expands Carilion Clinic Medicare Health Plan has announced the expansion of the plan’s service area to include Buena Vista. The plan’s service area for 2011 now includes: Bedford, Lexington, Radford, Roanoke, Salem, and the counties of Bedford, Botetourt, Craig, Floyd, Franklin, Giles, Montgomery, and Roanoke.

For 2011, the plan offers one Health Maintenance Organization (HMO) and three different HMO-Point-of-Service (POS) coverage options with a range of benefits, including options with low and no monthly premiums.

HMO members must use Carilion Clinic Medicare Health Plan providers, while HMOPOS members can choose to use out-of-network providers with increased out-of-pocket expenses. All plan options include prescription drug coverage.

The Carilion Clinic Medicare Health Plan has also announced that its four Medicare Advantage plans will be offered though local insurance brokers and agents for the first time.

The health plan’s own sales staff will also sell these, and a series of sales seminars is scheduled for the fall.

The Medicare Annual Enrollment Period— when eligible individuals can join a Medicare Advantage plan, switch to another plan, or go back to Original Medicare—begins on Nov. 15 and continues through Dec. 31, 2010 for coverage beginning on Jan. 1, 2011. Those who are turning 65 or who have other special circumstances may be able to join before the annual enrollment period opens.

To find out if you are eligible, or for more information, call 1-800-332-1625 from 8 a.m. to 8 p.m., seven days a week. The Carilion Clinic Medicare Health Plan is a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor.

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The Carilion Clinic inpatient rehabilitation center provides intensive physical, occupational, and speech therapy services.

Individual therapy sessions are designed to maximize each patient’s recovery.

By Meredith Hite

Carilion Clinic’s rehab center is the most comprehensive in southwest Virginia.

24 Fall 2010 / Winter 2011

When an Injury Injuries, strokes, and other medical problems can cause permanent damage—and force you to change how you live. That is why rehabilitation is so important. Rehab therapists can help you relearn how to do simple daily tasks.

To give patients every chance for a full recovery, Carilion Clinic has expanded its inpatient rehabilitation center to provide the most advanced rehab technology and medical expertise. The new rehab center has also been relocated to the 7th floor of Carilion Roanoke Community Hospital and is almost triple the size of the previous center.

“We went from a 12-bed unit where patients shared rooms to one with 34 private rooms and one of the most therapeutic views around,” says Stimis Smith, unit director of Carilion Clinic’s Physical Medicine and Rehabilitation. The center’s panoramic view overlooks downtown Roanoke, Mill Mountain, and the Roanoke Valley.

“One patient joked that he wanted to come back for his next vacation,” says Smith.

The rehab center, the most comprehensive in southwest Virginia, is designed for those who need a short stay with intensive physical, occupational, or speech therapy services. All staff members are dedicated professionals who have a passion for rehabilitation and expertise in helping patients recover from all types of injuries, illnesses, and surgeries.

Requires Rehab Everyone on the staff is focused on helping patients regain independence by teaching them new ways to perform daily tasks such as getting dressed, bathing, eating, cooking, and cleaning. “Our emphasis is on health, wellness, and teaching patients how to help themselves,” says Dan Gaskell, rehabilitation manager.

The rehab staff includes doctors and nurses and physical, occupational, and speech therapists. Individual therapy sessions are developed to maximize each patient’s recovery, and therapy sessions are tailored to a patient’s lifestyle and hobbies.

Therapists are skilled in a variety of therapeutic approaches, including neuropsychology, therapeutic recreation, and pet therapy. They also utilize every means at their disposal to help patients recover. Kitchen cabinets, for instance, are outfitted with every type of knob imaginable, allowing patients to practice opening doors and drawers like they have at home.

Carilion Clinic’s rehab center is fully accredited by the national Joint Commission, which accredits health care providers and programs in the United States. This year also marks the 25th anniversary of Carilion Clinic’s rehab program.

For more information, or for a guided tour, please call 540-985-8550.

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Fighting Lung Cancer A Team Improves Care

By Allison Buth

Brice Towle, a retired physician’s assistant from Texas, thought he had contracted bronchitis last March. But he went to see his primary care physician, just to be sure.

After a chest X-ray, Towle learned that he had a mass on his lung, and before he knew it, he was meeting with David Wyatt, M.D., a cardiothoracic surgeon at Carilion Clinic.

“I was surprised that I was able to see Dr. Wyatt only a couple of days after I saw my primary care physician,” Towle says. “At that point, we didn’t know if the mass was cancerous or not.”

Dr. Wyatt told Towle that his case would be evaluated by a thoracic oncology team whose members—all specialists in different areas of medicine—focus on lung cancer. The team at Carilion Clinic meets weekly to evaluate individual patient cases from an interdisciplinary point of view, with each physician applying his or her specialized expertise to the case at hand.

The thoracic oncology team works to improve access, timeliness of care, and outcomes and is an example of how physicians are working together to benefit patients.

The team includes Carilion and non-Carilion physicians, and its size varies, depending on the cases being reviewed.

After the team reviewed Towle’s case, Dr. Wyatt told Towle he needed to see a pulmonologist for a bronchoscopy and a biopsy. Within days, Towle saw Christian Butcher, M.D., a Carilion Clinic pulmonologist. The biopsy revealed that Towle’s lung mass was indeed a cancerous tumor.

The thoracic oncology team’s next step was to ensure that a thyroid mass also discovered by Towle’s primary care physician was of less concern than his lung tumor. A series of biopsies and other imaging studies were obtained 26 Fall 2010 / Winter 2011

to correctly identify the stage of the lung and thyroid mass in order to recommend treatment.

Only days later, Towle returned to Dr. Wyatt for an update on the results. “I referred Mr. Towle to one of our ear, nose, and throat physicians to get a biopsy of the thyroid,” says Dr. Wyatt. “The results of that biopsy demonstrated a lower-grade cancer, giving the lung cancer priority for treatment.”

Towle then underwent surgery to remove his lung tumor.

Treating Lung Cancer Receiving a cancer diagnosis is never easy. Receiving a lung cancer diagnosis is all the more daunting, as lung cancer is the leading cause of cancer death in the United States among both men and women. In fact, lung cancer claims more lives each year than colon, prostate, ovarian, lymph, and breast cancers combined.

There is also a high incidence of lung cancer in southwest Virginia. And with people living longer and baby boomers aging, lung cancer diagnoses are expected to increase.

“Treating lung cancer requires many sub-specialties and a lot of coordination,” says David A. Buck, M.D., a radiation oncologist with Blue Ridge Cancer Care. As a result, the thoracic oncology team was created to provide such interdisciplinary care.

“Many sub-specialists like me noticed that we were seeing new patients with lung cancer, and we felt uncomfortable with them having to wait longer than necessary to receive treatment,” says Dr. Buck.

The thoracic oncology team at Carilion Clinic consists of sub-specialists in pulmonology, medical oncology, cardiothoracic surgery, radiation oncology, pathology, radi-

Members of the thoracic oncology team review a patient case.

ology, and interventional radiology. They meet weekly to discuss and review patients with suspected or diagnosed lung cancer.

“The team discusses how to best treat patients, maximize outcomes, and weigh risks versus benefits,” says Michael Boyd, M.D., an interventional pulmonologist with Carilion Clinic. “We provide a pathway for patients so less time passes before their diagnosis and treatment.”

“All the sub-specialists need to work together collaboratively for a program like this to be successful,” says Dr. Buck. “The relationship we have with Carilion Clinic is unique.”

A Successful Outcome Less than one month after Towle’s initial visit to his primary care physician, Dr. Wyatt had good news for him: pathology reports confirmed that his surgery was successful and that his lung cancer was in an earlier stage that carries a good prognosis. The thoracic oncology team then recommended four rounds of chemotherapy at Blue Ridge Cancer Care as a precaution, due to the size of the tumor removed. Plans have been made for treatment of the thyroid cancer as well.

“Everyone I saw was excellent and very professional,” says Towle of his course of treatment. “The staff was super the whole way through. I really don’t have enough nice things to say about everyone that’s helped me.”

“I’d like the people I worked with in Texas to come here and see the type of care Carilion provides.”

According to the American Lung Association, the following symptoms can be indicators of lung cancer: • A cough that doesn't go away and gets worse over time • Constant chest pain • Coughing up blood • Shortness of breath, or wheezing • Loss of weight and loss of appetite • Frequent lung infections, such as bronchitis or pneumonia

For more information, talk to your doctor, or call 540-985-8505.

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Breast Care:

World-class Expertise When Quality of Care Counts

By Allison Buth Breast screening could save your life—or that of someone you love.

Yet the Carilion Clinic Breast Care Center estimates that only 34 percent of the region’s eligible women get screened for breast cancer each year. This statistic has been stable for many years, despite the fact that a cuttingedge breast care program exists right here.

The quality of the program is among the best in the country—offering advanced technology and breast care experts in surgery, radiology, pathology, and medical and radiation oncology. These specialists also collaborate on a regular basis to provide a multi-disciplinary approach and comprehensive, high-quality care.

On-site are four dedicated breast imagers (physicians) who specialize in mammography, ultrasound, and MRI. All mammograms are read on-site by board-certified radiologists. The center also has a dedicated breast surgeon and a nurse navigator, who acts as a patient educator and advocate, empowering patients to make informed decisions.

This interdisciplinary team meets weekly to review every breast cancer diagnosis to determine the best course of treatment. Team members also review all benign findings.

New Federal Guidelines In 2009, the U.S. Preventative Services Task Force revised its guidelines for breast screenings. It reversed its 28 Fall 2010 / Winter 2011

recommendation that women in their 40s get routine annual mammograms and said that women ages 50-74 should cut back their exams to one every other year.

“When new guidelines come out, physicians should look critically and scientifically at those recommendations,” says Roxanne Davenport, M.D., surgeon at the Carilion Clinic Breast Care Center. The center in turn decided to do further research to evaluate the new federal guidelines.

After intensive research and analysis, the breast center found that replacing yearly exams with screening every two years Roxanne Davenport, M.D. over age 50 would result in increased death rates from breast cancer. Before mammograms became widespread in the mid-80s, women typically came in with advanced forms of breast cancer, says Dr. Davenport.

The high death rate from breast cancer had also been unchanged for 50 years, she says. But by the early 90s, death rates had declined by 30 percent with the help of screening mammography.

“We feel that the new recommendations are a step backwards,” Dr. Davenport says. “We diagnose about one new breast cancer in a 40-to-49-year-old woman each

in Western Virginia

surgery patients. At the Carilion week at the breast center, and there Clinic Breast Care Center, however, is a greater than 90 percent chance the re-excision rate is only 6.7 perthat if a breast cancer should decent, well below national statistics. velop in a woman, annual screening The breast care center attributes would detect it before the patient this lower rate to its comprehensive would find it. We recommend anapproach to care before, during, and nual screening mammography for after surgery. Its pre-operative planwomen age 40 and over.” ning includes imaging (mammoThe new federal guidelines state gram, ultrasound, and MRI) and a that temporary harm may result from case review by the interdisciplinary having annual mammograms, such Mammograms are an important part of team. During surgery, the use of as emotional anxiety, possible biop- a breast care program. specimen radiography allows the sies, and higher costs. But the breast center contends that every woman has a certain risk for radiologist and surgeon to see precisely what tissue needs developing breast cancer and that the benefit of screening to be removed. And post-operatively, the team uses advanced technology to look for residual cancer. far outweighs these potential factors.

As a result, fewer deaths occur, and women suffer less emotional harm. Better cosmetic results are also reported, A Focus on Quality Screening is the first important step to ensure good and added costs are prevented.

This focus on quality is reflected in every procedure at breast health, but for those with a cancer diagnosis, consistency in the way a breast center delivers care is also the breast care center—where everyone is dedicated to paramount. At the Carilion Clinic Breast Care Center, con- making a difference in the fight against breast cancer. sistency has been a core focus and has led to improved The Carilion Clinic Breast Care Center is located at 1211 outcomes.

Take the re-excision rate—the percentage of women South Jefferson Street in Roanoke. For more information, diagnosed with cancer who’ve had surgery but who have call 540-985-9885 or visit www.carilionclinic.org/Carilto go back for a second surgery. Recent literature reports ion/Breast+Care+Center. national re-excision rates of 20 to 60 percent for breast Fall 2010 / Winter 2011

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Carilion Clinic

New Physicians Department of Medicine

Department of Surgery

Timothy C. Ball, M.D., Ph.D.

Stepheny D. Berry, M.D.

Cardiology Education: Medical University of South Carolina Residency: Wake Forest University Baptist Medical Center Fellowships: Critical Care Medicine, Wake Forest University Baptist Medical Center Cardiology, Dartmouth-Hitchcock Medical Center Interventional Cardiology, Dartmouth-Hitchcock Medical Center 127 McClanahan St., Roanoke, VA 24014 540-982-8204

Trauma and Critical Care Surgery Education: University of Kansas School of Medicine Residency: Henry Ford Health System Fellowship: Trauma and Surgical Critical Care, University of Tennessee at Memphis 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Joann G. Journigan, M.D. Cardiology Education: Vanderbilt University School of Medicine Residency: Vanderbilt University Fellowship: Cardiology, Emory University 127 McClanahan St., Roanoke, VA 24014 540-982-8204

M. Ayoub Mirza, M.D. Cardiology Education: Kashmir University Residency: Geisinger Medical Center Fellowships: Cardiology, University of Virginia Interventional Cardiology, University of Virginia 127 McClanahan St., Roanoke, VA 24014 540-982-8204

Carl W. Musser, Jr., M.D. Cardiology Education: Wake Forest University Baptist Medical Center Residency: Mayo Clinic College of Medicine Fellowships: Cardiology, Dartmouth-Hitchcock Medical Center Cardiac Electrophysiology, Dartmouth-Hitchcock Medical Center 127 McClanahan St., Roanoke, VA 24014 540-982-8204

Department of Emergency Medicine Keel E. Coleman, D.O. Emergency Medicine Education: University of New England College of Osteopathic Medicine Residency: Virginia Commonwealth University Health Systems 1906 Belleview Ave., Roanoke, VA 24014 540-981-7000 30 Fall 2010 / Winter 2011

Department of Radiology Thomas H. Bishop, M.D. Radiology Education: University of North Carolina School of MedicineChapel Hill Residency: University of North Carolina Hospitals Program Fellowship: Vascular/Interventional Radiology, University of North Carolina 1906 Belleview Ave., Roanoke, VA 24014 540-981-7083

Daniel R. Karolyi, M.D., Ph.D. Radiology Education: Medical College of Georgia Residency: Emory University Fellowship: Body MRI, Emory University 1906 Belleview Ave., Roanoke, VA 24014 540-981-7122

John W. Steffe, Jr., M.D. Radiology Education: Medical College of Virginia Residency: Medical College of Virginia Fellowship: Musculoskeletal Radiology, Medical College of Virginia 1906 Belleview Ave., Roanoke, VA 24014 540-981-7122

Department of Pediatrics James T. Wilson, III M.D. Pediatric Neurology Education: Medical College of Virginia Residency: Medical College of Virginia Fellowships: Child Neurology, University of Minnesota Electroencephalography, Medical College of Virginia 102 Highland Ave., Suite 104, Roanoke, VA 24013 540-985-8147

Department of Obstetrics and Gynecology Jamie L. Jennell, M.D. Obstetrics and Gynecology Specialty: Obstetrics and Gynecology Education: Virginia Commonwealth University Residency: Wake Forest University Baptist Medical Center 1997 S. Main St., Suite 704, Blacksburg, VA 24060 540-961-1058

Department of Primary Care and Regional Medicine Richard D. Kauffman, D.O. Family Medicine Education: Midwestern University, Chicago College of Osteopathic Medicine Residency: MacNeal Hospital, University of Chicago Family Medicine Program 3707 Brambleton Ave., Roanoke, VA 24018 540-725-7800

Jo-Anne A. Llavore , M.D. Family Medicine Education: University of Santo Tomas Residency: Carilion Clinic Family Medicine Residency Program 3369 Colonial Ave., Roanoke, VA 24018 540-772-0555

Arlene S. McCain, M.D. Family Medicine Education: Eastern Virginia Medical School Residency: Eastern Virginia Medical School, Portsmouth Family Residency Program 200 High St., Bridgewater, VA 22812 540-828-2634

Nationally Praised Physicians Join Carilion Clinic Two nationally prominent physicians, surgeon Christopher Baker, M.D. and emergency physician John H. Burton, M.D., have joined Carilion Clinic. Each will play a pivotal role in improving patient care at the physician-led Clinic.

Dr. Baker, a trauma surgeon, will be the new chair of the Department of Surgery for Carilion Clinic and the VTC School of Medicine. Most recently he has been the Isidore Cohn, Jr. Professor and chair of the Dr. Baker Louisiana State University Department of Surgery in New Orleans. He received his M.D. from Harvard Medical School and completed his surgical training at the University of California at San Francisco, where he had a National Institutes of Health-funded research fellowship.

He has also taught at Yale University, the University of North Carolina School of Medicine and Harvard Medical School. He will join the Clinic on November 1.

Dr. Burton is the new chair of the Department of Emergency Medicine.

He comes to Carilion Clinic from Albany Medical College, Albany, New Dr. Burton York, where he was interim chair of the Department of Emergency Medicine and vice chair for the medical college’s academic affairs. He received his M.D. from the University of North Carolina School of Medicine-Chapel Hill and completed his residency at the University of Pittsburgh.

For more information or to find a physician go to: www.CarilionClinic.org or call: 540-266-6000 or 800-442-8482.

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My heart is warm with the friends I make, And better friends I'll not be knowing; Yet there isn't a train I wouldn't take, No matter where it's going.

— Edna St. Vincent Millay, from her poem “Travel”

Taking the Train

By Gail Nordhaus Pulitzer Prize-winning poet Edna St. Vincent Millay wrote her ode to trains almost 100 years ago, but her words still speak to many aspiring travelers today.

If you, too, enjoy rail travel—or have always yearned to try it—a regional rail excursion may be just the ticket.

Railways offer scenic day trips in both Virginia and West Virginia.

The Roanoke chapter of the National Railway Historical Society (NRHS), for instance, has partnered with Amtrak for the past two years to provide all-day excursions in the fall. One of these leaves Roanoke and travels along the former Virginian Railway route through Moneta and Stone Mountain, then turns south on the former Southern Railway route to Danville. It returns via Lynchburg, Forest, and Bedford.

Another excursion takes passengers from Roanoke to Bluefield, West Virginia and traverses spectacular mountains and valleys. This popular trip includes a climb up Christiansburg Mountain and a ride through the New River Valley and the narrows of the New River. The train also goes through tunnels and over bridges.

Both of these excursions offer layovers and an opportunity for dining and other activities.

The New River Train, meanwhile, offers trips through the New River Gorge in southern West Virginia each fall.

These run along the former Chesapeake & Ohio main line from Huntington, West Virginia to Hinton, West Virginia and feature gorgeous scenery in an area often called the Grand Canyon of the East. Passengers can also view Charleston, Kanawha Falls, the New River Gorge Bridge, the Hawks Nest Dam, and historical coal mining towns.

These trips are sponsored by the Collis P. Huntington 32 Fall 2010 / Winter 2011

Railroad Historical Society of Huntington, West Virginia.

For those with a more urban bent, another excursion this fall will take passengers to Washington, D.C. Sponsored by the Botetourt County Department of Parks, Recreation and Tourism, it will bus local passengers to Lynchburg, where they can board Amtrak. The train will then go through Charlottesville, Culpeper, Manassas and other towns en route to Washington, where travelers will have a 2 1⁄2-hour layover.

In addition, the Potomac Eagle Scenic Railroad in

A train crosses a bridge over Smith Mountain Lake in southwest Virginia. Photo courtesy of Norfolk Southern Corp.

Romney, West Virginia offers its own trips through the mountains above the south branch of the Potomac River.

What makes these trips particularly memorable are the Bald Eagles that routinely soar along the route.

Potomac Eagle Scenic Railroad offers a number of trips throughout the fall, and they can be boarded at three locations: Romney, West Virginia (west of Winchester, Virginia); Moorefield, West Virginia; and Petersburg, West Virginia.

So when wanderlust overcomes you—or you just want

a fun weekend trip with the family—think about heading for the nearest railway station.

Roanoke’s chapter of the NRHS, with 167 members, is dedicated to preserving the railroad history of western Virginia. For more information on it and its trips, go to http://roanokenrhs.org/excursions.html. For information on the West Virginia trips, go to www.newrivertrain.com and www.potomaceagle.info/trips.php. For Botetourt County trip information, call 540-473-8326.

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vervefood

Soup’s On!

By Kate Jones

As the weather turns cooler, there’s nothing quite like a bowl of hot soup. We associate certain foods with sensations or memories, and for many, soup is linked with feelings of comfort. Like a warm blanket, soup warms us up, physically and emotionally.

Soup conjures up feelings of security and being taken care of—chicken soup, anyone? And yes, there is an almost magical quality about soup that envelops us when we’re feeling sick or down. It’s no surprise: nutritious ingredients in a good soup sustain us. Fragrant steam helps to decongest our noses and throats. A soup’s fluids help to hydrate us and fight infection. Researchers now even think that certain substances in soup might help fight the inflammation associated with the common cold.

The versatility of soup also allows it to be enjoyed at any time—not just when one is ill. Soup can be a precursor to a meal or the meal itself. Thanks to the freeze-ability of broth-based soups, they can be made in large batches and frozen in single-serving containers, then reheated whenever one needs a quick and easy meal.

Soup is also a great way to inject more veggies into your diet. Most soups call for some sort of veggies or beans, and you can even freeze leftover vegetables and save them for that next batch of soup. Although some soups are made from fruits and served cold, we’ll focus on the warm ones here.

While soup is generally a great addition to any diet, be aware of a few things if you’re trying to manage your weight. First, there is potentially a big difference in calories and fat when it comes to broth-based vs. cream-based soups. A cup of Manhattan Clam Chowder has 134 calories and 3.4 grams of fat (2.1 grams saturated fat), whereas a cup of New England Clam Chowder can have 190 calories and 10 grams of fat (2.5 grams saturated fat).

There is also potentially a big calorie difference be34 Fall 2010 / Winter 2011

tween a cup and a bowl in a restaurant. I once ordered a bowl of soup as my main course, and it was actually more like a trough.

Speaking of portion sizes, research is constantly under way to try to discover the keys to weight management.

Research does show that when given the choice, people tend to want to eat more rather than less. (You might know what I’m talking about.)

When trying to “diet,” people tend to severely restrict their food choices. All too often, people on diets lose weight in the short-term, then tire of the effort to maintain their weight loss. They give up altogether and put the weight back on.

Dr. Barbara Rolls, professor and researcher at Pennsylvania State University, has done a lot of research in the area of food energy density (calories per volume) and its impact on weight management. She has found that eating higher-volume, lower-calorie foods (e.g., non-starchy vegetables) leads to fewer calories consumed overall. Thus, if you add sliced tomatoes, lettuce, and onion to your sandwich, thereby giving it more volume, it will look more satisfying and help you to skip the cookie and eat fewer calories overall at that meal.

Similarly, foods with a proportionally high water content (e.g., grapes vs. raisins) will seem more filling psychologically because we can eat a larger portion for the same number of calories. This principle can be extended to soups as well. Dr. Rolls found that people who included broth-based soup in a meal generally ate fewer calories at that meal.

The same effect was not found when drinking a glass of water. It turns out that water is good for quenching thirst, but not for filling us up. You can read more about it in Dr. Rolls’ book The Volumetrics Eating Plan.

Something else to consider is the sodium content. Most soups contain large amounts of sodium. The daily recommendation for sodium in the diet is no more than 2,300 milligrams (mg), but some soups easily contain half of that or more per serving. If you’re buying canned soup, check the label and look for no more than 600 to 800 mg per serving if the soup will be the main part of your meal, especially if you have hypertension or high blood pressure.

If you want to make your own soup, even better. There are hundreds of enticing recipes to try. And who knows?

You may enjoy it so much that it becomes a weekly ritual!

Here is an easy and nutritious recipe: Gingered Butternut Squash Soup 1 small yellow onion 1 tablespoon butter 1 butternut squash 5 cups chicken stock Fresh or powdered ginger 1 ⁄2 cup cream (optional) Split the squash lengthwise and bake in a covered baking dish at 350 degrees for about 50 minutes, or until soft.

Scoop out the flesh and reserve it. Dice the onion and sauté it in a tablespoon of butter in a stock pot until soft.

Stir in the squash and then the chicken stock and simmer.

Add ginger, salt, and pepper to taste and puree. For a richer soup, stir in cream after pureeing.

For more delicious soup recipes, go to www.allrecipes.com, www.cooks.com, and www.foodnetwork.com.

Kate Jones is a Carilion Clinic registered dietitian and certified diabetes educator.

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ervetal 36 Fall 2010 / Winter 2011

vervetalk Tell us what gives you life + energy.

Whether it’s a home remedy, a family recipe, or just something that makes life worth living, share it with the readers of verve. We would also love to hear your opinions in letters to the editor. After all, sharing things that matter is what makes us a community.

Food Share your grandmother’s recipe or a new discovery that keeps your family healthy and happy.

Fitness If you’ve got a routine that’s anything but routine, tell us about it and start the next fitness craze.

Parting shots Send us your photos or artwork that you think reflects our lives.

verve E-mail: verve@carilionclinic.org Mail: 711 S. Jefferson St. Roanoke, VA 24016 Phone: 800-422-8482

Physicians on Foot Get in stride by walking with a doc

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The doctors of Carilion Clinic are putting on their walking shoes and hitting the Greenway. Because the health of the Valley is so important to us, we encourage you to lace up your shoes and join our weekly walking program. We’ll be with you every step of the way on the path toward a healthier you.

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Location: Roanoke Valley Greenway Corner of Hamilton Terrace and Belleview Avenue (In front of Carilion Roanoke Memorial Hospital)

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For more information, call 800-422-8482 or visit www.CarilionClinic.org/walking.

Our Cardiac Team Shares a Single Goal Getting you back to your life and the ones you love

The physicians of Carilion Clinic – Cardiology on the steps of the Virginia Tech Carilion School of Medicine and Research Institute, where they will participate in research projects designed to improve patient care. Not pictured: Tim Ball, M.D., Ph.D., John Bushkar, M.D., Rod Savage, M.D., and Dhun H. Sethna, M.D.

Carilion Clinic – Cardiology continues to be a leader in providing comprehensive cardiovascular services in southwest Virginia. Our team of more than 20 cardiologists has the experience to handle virtually any cardiovascular problem. We are one team sharing a single goal: getting you back to your life and the ones you love.

To schedule an appointment at our offices conveniently located in Roanoke, Lexington, Westlake and Bedford, please call 540-982-8204.

To schedule an appointment at our offices conveniently located in the New River Valley, please call 540-731-7420.

For more information, please call Carilion Direct at 800-422-8482 or visit www.CarilionClinic.org/Carilion/Cardiology.

Cardiology