verve - Spring/Summer 2011

Spring / Summer 2011

A community service of

Sheryl Crow A New Outlook after Breast Cancer

Beth Polk, M.D., Carilion Clinic

I’d do just about anything to keep patients healthy and out of the hospital.

At Carilion Clinic, our doctors partner with you at every step of the healthcare journey.

They don’t just ask patients to exercise more, they get out and exercise with them. Help them make good choices. And an electronic medical record makes it easy to track your history and treatment—or stay in touch by e-mail.

These are just some of the ways Carilion Clinic is improving healthcare to work the way you want.

Find a doctor at CarilionClinic.org, or call 800-422-8482.

Inspiring better health.

5 Energy Drinks Are they safe?

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Excessive Sweating There is a cure

16 Genetic

Counseling

When family history matters

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Sheryl Crow Striking a new chord

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Departments 3

Letter

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Public Health

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Cardiac Care

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New Procedures

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Women’s Health

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Chronic Conditions

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Genetic Counseling

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News & Notes

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Physicians

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: Editor................................................

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

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

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

Maureen Robb Gordon Garrett Darryle Arnold Chocklett Press

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

CarilionClinic.org twitter.com/CarilionClinic facebook.com/CarilionClinic 540-266-6000 or 800-422-8482

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Excursions

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Food

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Talk

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 2011 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.

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If your children are fans of energy drinks, you may have wondered just how safe these popular beverages are. After all, some contain large quantities of caffeine and have been linked to heart palpitations, seizures, and even strokes. Medical researchers and physicians are concerned too, and they’ve been studying the question. We tell you about their findings on page 5.

In this issue we also discuss a surgical procedure for a troubling genetic condition: excessive sweating. For those who’ve ever been embarrassed by this problem—or know someone who is limited socially or professionally by it—we are pleased to report that there is a cure. Our story begins on page 10.

Other stories address the many genetic counseling services now available in southwest Virginia; an innovative diagnostic procedure for heart disease; and an unusual type of surgery that allows women who’ve had cervical cancer to still have children. We also bring you news of a social media site that lets you connect with friends and family during an extended illness.

Finally, our cover story brings you up-to-date on singer/songwriter Sheryl Crow, who overcame breast cancer several years ago. She is now busier than ever, with a new album, a cookbook, and an upcoming nationwide tour. Find out how she juggles a newfound dedication to health and fitness with her demanding career.

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

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Some Sounds Are Too Important to Miss.

Hears the news about an invisible and comfortable hearing device Hearing aids can help those with hearing problems, but their bulky size and uncomfortable fit can sometimes get in the way of everyday living. At Carilion Clinic, there is a much easier and better way to improve hearing.

The Lyric hearing device, available in western Virginia only from Carilion Clinic, works with your ear’s anatomy to deliver clear, natural sound. It is the world’s first 100-percent-invisible hearing aid that can be worn 24/7, for up to four months at a time*.

With no batteries to change and no daily insertion or removal, the Lyric is hassle-free, giving you complete freedom to exercise, sleep, shower or talk on the phone.

To find out what you may be missing out on or to schedule an appointment, please call 540-581-0232.

The Lyric fits deep in the ear canal next to the ear drum and works with your ear’s anatomy to produce natural sound quality in both quiet and noisy environments.

CarilionClinic.org * Individual replacement needs may vary. Lyric is not appropriate for all patients. Only a hearing professional can determine if Lyric is right for you.

Energy Drinks: Are They Safe?

By Matthew Sams

Energy drinks may give your child an extra boost, but at what cost?

According to a recent study, the popular drinks pose serious health risks for some children, especially ones with diabetes, cardiac abnormalities, seizures, or mood and behavior disorders. The study, published in the journal Pediatrics, involved a review of case reports and other current literature by pediatric researchers at the University of Miami’s Miller School of Medicine.

High levels of caffeine and other stimulants in the drinks can be potentially dangerous, and excessive consumption of them can lead to seizures, stroke, or even sudden death, according to the study.

“Until further research establishes their safety, routine energy drinks usage by children and teen-agers should be discouraged,” says Steven E. Lipshultz, M.D., chairman of the department of pediatrics and senior author of the study.

“Our systematic review suggests that these drinks have no benefit and should not be a part of the diet of children and teens,” Dr. Lipshultz says. “We need long-term research to define maximum safe doses of these beverages and the effects of chronic use, especially in at-risk populations.”

Yet energy beverages are often marketed to teenage athletes and young adults—and 30 to 50 percent of adolescents

report drinking them for an energy boost. Many athletes who drink the beverages after practice, believing they are healthful, may actually be consuming large amounts of stimulants that can rev their hearts up, physicians say.

Doctors also warn that the caffeine in some energy drinks might cause sleep deprivation, depending on when they are consumed. Many people don’t realize it, but caffeine can act as a stimulant in the bloodstream for about 12 hours.

What about the new, alcoholic energy drinks? Many doctors think these are even more dangerous. “The stimulant component actually masks the alcohol consumed, so users don’t feel the effects as strongly,” says David Sane, M.D., Carilion Clinic section chief of cardiology. “That typically leads to consuming more alcohol,” he says.

Although the FDA did determine in November that caffeine is an unsafe food additive to alcoholic beverages, drinks combining the two are currently still being sold.

Others warn that young adults often mix energy drinks with alcohol on their own. As a result, many young drinkers— and drivers—consistently underestimate their real level of impairment.

What is the one thing that everyone in the medical community does seem to agree on? That energy drinks should be consumed with caution.

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Thank You for Making Us #1 in Healthcare Carilion Roanoke Memorial Hospital is the Consumer’s Choice For seven years in a row, you’ve named us first in the region in the National Research Corporation’s annual ranking of local hospitals’ quality and image. We’re proud to be your choice in healthcare.

For more information, visit CarilionClinic.org or call 800-422-8482 or 540-266-6000.

Carilion Clinic Names New President “Our organization is fortunate to have someone of Nancy Agee’s caliber to take the lead.”

— James Hartley, chairman of the Carilion Clinic Board of Directors

As of July 1, Carilion Clinic will have a new president and chief executive officer—Nancy Howell Agee.

Agee will succeed Ed Murphy, M.D., who will step down to work with TowerBrook Capital Partners L.P., a New York- and London-based investment firm, as well as become chairman of the board of Sound Physicians. Agee is now chief operating officer and executive vice president of Carilion Clinic.

“We are greatly appreciative of Dr. Murphy’s work and the milestones we have achieved during his tenure,” says James Hartley, chairman of the Carilion Clinic Board of Directors. “Our organization is also fortunate to have someone of Nancy Agee’s caliber to take the lead. As one of the architects of our vision with more than 30 years of service to our employees, patients, and communities, she will continue our growth and focus on improving health and patient-centered care.”

Agee holds degrees with honors from the University of Virginia and Emory University. She began her career in nursing at Carilion, serving in various management roles over the past 20 years. In 1996, she was appointed vice president of medical education. In 2000, she became senior vice president of the organization, advancing to executive vice president and chief operating officer in 2001.

Nancy Howell Agee will become president of Carilion Clinic.

“This is a unique organization, with truly remarkable people, and I am honored to have this opportunity,” Agee says. “I still remember the faces of my patients back in 1973 and as I see our patients today, I know that even with new technology, new facilities, and a new medical school, our core mission remains the same—providing high-quality, coordinated, compassionate care tailored to meet the individual needs of our patients every day.”

Agee has been at the forefront of the successful 2006 initiative to reorganize Carilion into a patient-centered clinic, working to develop a leadership infrastructure of physicians. She says both employed and private physicians will continue to play a key role in the organization’s success.

Incidentally, Agee was also born at Carilion Roanoke Memorial Hospital and completed her nursing training there.

“I am grateful for the leadership of our physicians, whose energy and insight are driving meaningful advances in treatment and improvement in quality,” Agee says. “I look forward to working with them as we continue our commitment to establishing new standards for patient-centered care.”

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Technique to Examine the Heart Wins Praise Many Doctors Are Choosing to Perform Radial Catheterizations

By Allison Buth

When Geneva Walters, 79, suffered a heart attack, her doctors soon found that her case posed special problems.

Normally, to examine blockages in her arteries, cardiologists would have inserted a catheter tube into the large femoral artery in her leg, near the groin, and threaded it up to her heart. But due to the complexity of Walters’ coronary disease—and her previous lower-extremity surgery—performing this traditional cardiac catheterization procedure was not an option.

Instead, cardiologist Timothy Ball, M.D., who examined Walters at Carilion Roanoke Memorial Hospital, proposed a different path to her heart: through the smaller radial artery in her wrist.

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Dr. Timothy Ball

Radial option also speeds recovery Walters, who had traveled to Roanoke from her home town of Princeton, West Virginia, was ecstatic to learn she had an alternative.

Radial catheterization, as this procedure is called, is increasingly being favored by cardiologists such as Dr. Ball, who cite its increased comfort and safety.

Some studies have also found it to result in fewer complications than the femoral approach.

Dr. Ball, who recently came to Carilion Clinic from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, is a firm believer in the procedure.

“The radial artery is a more patient-friendly access point,” he says. “I prefer to use the radial artery if possible because it is associated with lower bleeding risk, more patient comfort, shorter recovery time, less risk of nerve trauma, and lower rates of complication.”

“Some patients are not good candidates for the traditional femoral catheterization,” he says. This may be due to their weight; back or spine problems; peripheral artery disease; or restless legs syndrome. “The radial approach can be very beneficial for those patients,” Dr. Ball says.

Unlike the femoral approach, which requires patients to lie on their backs for several hours after the procedure to prevent bleeding, the radial approach allows patients to get up and move around right away.

“Patient response to this procedure has been great,” Dr. Ball says. “Personally, my favorite aspect is having my patients be able to get up and walk with me immediately afterwards to the recovery room.”

Also, when bleeding complications occur using the femoral approach, bleeding into the leg can be slow, subtle, and hidden until a large amount of blood is lost. If a similar complication occurs using the radial artery, bleeding can be seen immediately near the skin and can be easily controlled by firm external pressure. Bleeding complications are seen in five to eight percent of femoral cases, compared to one to two per-

cent of radial cases.

“There is an increasing body of data over the last five years showing that bleeding complications are a predictor of mortality and morbidity,” says Dr. Ball.

“Anything you can do to minimize bleeding Radial Artery is encouraged, and bleeding complications are markedly reduced through the use of the radial artery.”

Roanoke Memorial, which performs thousands of catheterizations annually, has six catheterization labs, making it one of the largest such facilities in the state.

Dr. Ball is one of the cardiologists there who can perform catheterization either through the femoral or radial approach.

Throughout the United States, less than five percent of hospitals now perform radial catheterizations. They are technically more difficult because the radial artery is significantly smaller than the femoral artery, and cardiologists are required to go through extensive training to master the procedure.

In treating Walters, Dr. Ball was able to use the radial approach to reach her heart, and he injected a dye through a catheter tube to identify cholesterol deposits in her diseased arteries. A stent was then inserted to stabilize the arteries, restoring blood flow.

“I was so happy afterwards that I felt like hugging Dr. Ball,” Walters says. “It was amazing. I got up right afterwards and felt fine. Everyone there was wonderful.”

Radial catheterization is not for every heart patient, however, cautions Dr. Ball. In patients where the radial artery may be used as a conduit for bypass surgery, or in those with arteries too small or too tortuous to pass the catheters, the radial approach cannot be used.

But for many patients—such as Geneva Walters—the radial approach has proved to be a life saver.

For more information, call 540-266-6000 or 800-422-8482.

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If You Sweat Sweat Gland Removal Called a Lifestyle Changer Many people experience sweaty palms during important presentations, job interviews, or other stressful moments. For some, however, sweaty palms are more than just a simple part of everyday life.

According to Peter Mikhail, M.D., a Carilion Clinic cardiothoracic surgeon, one to three percent of the population has hyperhidrosis, a genetic disorder that causes excessive sweating. Such people are born with the disease, and they can experience not only excessive sweating of their palms, but also of their underarms and lower back.

Often, people who suffer from hyperhidrosis have to carry hand towels and extra clothing in case of emergencies. Such measures can pose difficulties, both socially and professionally.

Fortunately, a procedure called a sympathectomy can remedy excessive sweating and the issues that accompany the disorder.

A Simple Surgery At Carilion Clinic, skilled cardiothoracic surgeons such as Dr. Mikhail and W. Scott Arnold, M.D., perform the minimally invasive surgery, which involves removing the affected portion of sympathetic nerves. A sympathectomy is mainly intended to cure palmer (palm) sweating and axillary (underarm) sweating, but it can sometimes help those with facial sweating or facial blushing.

Dr. Mikhail performed many such surgeries in Orlando, Florida prior to coming to Carilion Clinic recently. Dr. Arnold has also surgically helped many hyperhidrosis patients in his long tenure at Carilion.

Sweat gland removal is a simple procedure that involves only a pair of half-inch incisions below the armpit.

The surgeon gently places a microscopic camera inside one incision to view the affected sympathetic nerves.

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Too Much

By Matthew Sams

Via the other incision, he or she then removes the troublesome portion of the nerves. The surgeon basically re-wires how a person sweats.

“It’s a very direct treatment plan and recovery process,” says Dr. Mikhail. In fact, most patients are back at home just six hours after the procedure. “Patients may have a little bit of pain at the incision sites for a week or so, but that’s it,” Dr. Mikhail says. Incision scars are typically not visible after a few weeks.

Although the procedure has been available for years, many people who suffer from hyperhidrosis have not been aware of it. Many patients instead consult a dermatologist and receive a Botox injection, which inhibits sweating. “The problem with Botox is that it only lasts six to eight months, so it’s very short-lived,” says Dr. Mikhail. “The surgical procedure we perform, however, is a permanent fix.”

A Life-Changing Procedure Those who suffer from hyperhidrosis show symptoms at different times—it all depends on the body’s maturation process. Many people start experiencing symptoms in their teen years, but due to the varying levels and timing of symptoms, no exact age is recommended for sweat gland removal surgery.

According to Dr. Mikhail, patients who undergo the procedure vary widely in age. Most are between 15 and 50, with the older patients having dealt with the disorder since their teen years. The vast majority, however, are in college or of college age, when overly sweaty hands can be quite troublesome. That’s why Dr. Mikhail refers to sweat gland removal as a “lifestyle changer.”

“It is a procedure that can significantly improve your quality of life,” he says. “I’ve seen it help many people be more confident, both personally and professionally.”

Chelsea Brewbaker, 17, is a recent patient of Dr. Mikhail’s who plans to study forensic anthropology in both college and medical school. “I’m so pleased with the results that it’s hard to pinpoint one way that the procedure improved my life,” she says. “I can definitely say that I’ve gotten a big selfesteem boost because it’s much easier to interact with people.”

Who Is a Candidate for Sweat Gland Removal?

Anyone who suffers from overly sweaty palms, underarms, back, or face and is embarrassed in a social or professional setting.

For more information, call 540-266-6000 or 800-422-8482.

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New Cervical Cancer Surgery Can Preserve Fertility

By Allison Buth

Karen Hall

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A Pulaski Woman Is the First to Undergo the Procedure in Southwest Virginia Karen Hall and her husband were happily expecting their first child when Hall, at 29, suffered a miscarriage.

When she saw her doctor, however, Hall received more bad news. “After the miscarriage, I had a dilation and evacuation procedure,” she says. “Tissue examined from that procedure showed highly abnormal cells.”

Upon further examination, Hall learned that she had cervical cancer.

“I was devastated,” she says. Not only did she have to cope with the cancer diagnosis, but she feared becoming infertile.

At that point, Hall’s physician referred her to Dennis Scribner, M.D., a gynecologic oncologist at Carilion Clinic.

He told Hall about a new type of surgery—a radical trachelectomy—that could preserve her uterus and give her a chance of becoming pregnant.

“Dr. Scribner explained that due to the size of the cancer, either a radical hysterectomy or a radical trachelectomy would be the appropriate treatment,” Hall says. She fervently hoped that a radical trachelectomy would be possible. “He told me I wouldn’t know until I woke up from surgery if he had been able to do it.”

According to the National Cancer Institute, about 12,000 women are diagnosed with cervical cancer each year in the United States. About a third of them die of the disease, even though, when detected early, cervical cancer is highly treatable. The number of cases in this country, and the mortality rate, are about half of those in the rest of the world, due in part to the widespread use of the Pap smear. Pap test screening has greatly helped to identify the cancer, and a new vaccine has helped prevent it.

“In the past, there was no hope for survivors of cervical cancer to conceive a child or to bear it to term,” says Dr. Scribner. “A radical hysterectomy has been the traditional standard of care. But in recent years, there’s been an increased emphasis on the preservation of fertility. In Karen’s case, she was young and wanted to have children, so we wanted to be sensitive to that while also facing the cancer head on.”

Dr. Scribner was able to perform a radical trachelectomy on Hall at Carilion Roanoke Memorial Hospital last year. Hall, of Pulaski, was the first patient to undergo the procedure in southwest Virginia.

A Complex Surgery During a radical trachelectomy, surgeons remove a woman’s cervix, surrounding tissue including the lymph

nodes, and part of the vagina. The uterus is then attached to the remaining portion of the vagina, and the lower portion of the uterus is sewn shut. This allows a woman to still carry a child and have it delivered by cesarean section.

The difficult procedure was pioneered in France about 15 years ago, and Dr. Scribner is among a small group of experienced gynecologic oncologists worldwide Dr. Dennis Scribner who are trained to perform it. He is also the only physician in southwest Virginia to do so.

Women who have had a radical trachelectomy have a 75 percent chance of conceiving a baby, a 50 percent chance of carrying it to a viable state, and a 25 percent chance of carrying it to full term. Their pregnancies are considered high-risk, and they are often put on bed rest for a good portion of the pregnancy.

During Hall’s surgery, Dr. Scribner also performed a lymphadenectomy to make sure Hall’s cancer had not spread. As she lay under anesthesia, Dr. Scribner’s team took a thin slice of her remaining uterus and examined it microscopically. It showed that the margins and lymph nodes were clear of cancer.

Hall spent four days in the hospital and a few weeks at home recuperating.

Looking to the Future “Based on the depth of the cancer, Karen was a good candidate for a radical trachelectomy,” Dr. Scribner says.

“In the past, women treated for cervical cancer could preserve their eggs and use a surrogate, but were unable to personally carry their child. My hope is that Karen will have that opportunity.”

Hall, meanwhile, is happy with her experience. “Dr. Scribner treated me like his own family,” she says. “There really aren’t enough nice things I can say about him and all the staff at his office and the hospital.

“He gave me the answers I needed, explained all the possible outcomes, and helped me physically and emotionally to deal with this overwhelming situation. Most of all, he gave me peace of mind.”

For more information, go to carilionclinic.org/Carilion/ gynonc or call 540-266-6000 or 800-422-8482.

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High Blood Pressure: The Silent Killer

By Mary Brewer High blood pressure, also known as hypertension, is a misunderstood disease.

Many people think that only tense, high-strung individuals suffer from it. Or that you’ll “feel it” if your blood pressure spikes because you’ll get a headache, or feel flushed. Those are myths that all too many of us accept.

The truth is: calm, relaxed people can and often do have high blood pressure. And unless you are in hypertensive crisis—with extremely high blood pressure that requires immediate medical attention—you likely will have no symptoms at all. Not a headache, not a nosebleed. No flushing. No sweating.

“That’s why it’s been called the silent killer,” says David Sane, M.D., Carilion Clinic section chief of cardiology. “People may feel completely fine until they have a heart attack or a stroke, or develop kidney disease.

That is why high blood pressure is so serious.”

How do you know if you have hypertension? Have your doctor check your blood pressure. “If it’s 140/90 or more, you have high blood pressure and an increased risk of cardiovascular events,” says Dr. Sane.

A Chronic Toll When you have this chronic condition, it takes a steady toll on your body. “With every beat, your heart has to work harder to pump the blood throughout your body,” says Dr. Sane. This leads to thickening of the walls of the heart, which can in turn cause a variety of problems such as heart rhythm disturbances including atrial fibrillation, a major cause of stroke.

This process can also lead to plaque 14 Spring / Summer 2011

buildup in your vessels, and over time, heart failure can result. Or damage can occur to the vessels that supply blood to your kidneys, leading to kidney disease and, eventually, the need for dialysis. Other possible problems are vision loss, erectile dysfunction, and angina.

Who has high blood pressure? About a third of the U.S. population, or nearly 70 million Americans, have been diagnosed.

Risk Factors - Family history of high blood pressure - African American heritage - Obesity - Being over 35 - Having diabetes or kidney disease - Taking birth control pills - Inactivity - Eating too much salt - Drinking too much alcohol - Smoking - Having high cholesterol

Many others don’t know they have it. Risk factors include age, heredity (African Americans are more prone to develop it), obesity, smoking, diabetes, and high cholesterol levels.

Normal blood pressure is below 120/80, according to the American Heart Association. Dr. Sane goes further to say that “epidemiological studies indicate that the best blood

pressure is 115/75.” And if you are in the range of 120 to 139 over 80 to 89, you have what is called pre-hypertension.

Dr. Sane prescribes lifestyle changes for this group of people. “The goal is to recognize that this reading is not ideal. You need to lose weight, stop smoking, exercise, and avoid NSAIDS (non-steroidal anti-inflammatory drugs, such as ibuprofen), whenever possible. These have been shown to raise blood pressure.”

If your blood pressure is high enough that you have been prescribed medication, “you must take it,” says Dr. Sane. “The consequences down the line are serious but can be avoided with proper treatment. Particularly for patients with diabetes, chronic kidney disease, or highrisk coronary disease, shoot for 130/80 as a target blood pressure. Medication and lifestyle changes can help.”

For more information, call 540-266-6000 or 800-422-8482.

What Do the Numbers Mean?

Blood pressure is written as two numbers, for example: 128/72. The top, or systolic number, measures the pressure when the heart beats. The bottom, or diastolic number, measures the pressure when the heart rests between beats.

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Carilion Expands Genetic Counseling Services

By Allison Buth

If cancer or other diseases run in your family, you may have wondered if genetic counseling is right for you.

Genetic counseling can in fact assess a person’s risk of inheriting any number of diseases or conditions. Genetic counselors gather a patient’s family medical history and develop personalized risk assessments. They can also recommend options for managing a disease and inform patients about research studies that might help them.

Reasons to seek genetic counseling include having a family history of a genetic disorder, chromosome abnormalities such as Down syndrome, recurrent cancers, mental retardation, miscarriages or stillbirths, or birth defects.

As the field of genetics expands, so do the genetic counseling services offered at Carilion Clinic. Comprehensive genetic counseling services are available for children, adults, and prospective parents.

Pediatric and Adult Genetics Clinical geneticist Emily Doherty, M.D. specializes in providing both medical care and counseling for people with, or at risk of, hereditary conditions. Dr. Doherty sees patients with all genetic disorders other than cancer or prenatal risks, and her goal is to help them understand and appropriately medically manage their condition.

In children and teenagers, Dr. Doherty sees cases involving birth defects; suspected genetic syndromes; 16 Spring / Summer 2011

developmental delay or mental retardation; autism; cystic fibrosis; sickle cell; neurofibromatosis; and connective tissue disorders.

Because many childhood disorders have a genetic cause, Dr. Doherty helps families understand and manage all the aspects of these disorders. “We know so much more now and have so much to offer children with special needs than we did even a few years ago,” she says.

For patients over 18, Dr. Doherty provides care for those diagnosed with a genetic condition in childhood and those who have a family history of genetic conditions such as Huntington’s disease and polycystic kidney disease. She also provides genetic testing and counseling for adult-onset diseases such as hemochromatosis, a disorder that causes too much iron to be absorbed from food.

“Genetic problems impact people of all ages and at different stages in life,” says Dr. Doherty. “Some patients need only a one-time consultation, while others require regular monitoring.” Nearly all the patients that Dr. Doherty sees are able to receive the care they need locally.

“It’s also important to remember that as people change over time, their counseling needs change as well,” Dr. Doherty says. “And due to the fact that the field of genetics is constantly evolving, it often makes sense to re-consult with patients as new information becomes available.”

Top: Clinical geneticist Dr. Emily Doherty sees Keylie St. Clair and her grandmother Karen Sutphin. Right: Thuy Vu is Carilion Clinic's new cancer genetic counselor.

Cancer Genetics Thuy Vu, M.S., C.G.C., a cancer genetic counselor, recently came to Carilion Clinic from the Clinical Cancer Genetics Program at the University of Texas M.D. Anderson Cancer Center in Houston. She provides comprehensive risk assessments and genetic counseling to patients for inherited cancer conditions.

Vu also educates patients about their cancer risks and about guidelines for cancer screening and prevention; links them to resources and support groups; coordinates genetic testing and related insurance issues; and identifies and enrolls eligible patients in cancer research studies.

Typically, Vu sees individuals and families who have an unusual pattern of cancer in the family. These include the onset of cancer at an unusually young age; family members with the same kind or related types of cancer; family members with more than one kind of cancer; and rare forms of cancer.

“I talk to people about their family cancer history and then determine if their pattern is of concern,” says Vu. “The good news is that most cancer is sporadic and is caused by personal, environmental, lifestyle, and occupational risk factors. Usually, when a family member is diagnosed with cancer, it does not increase other relatives’ chances for it.

Red Flags for Hereditary Cancer If you and your family fit any of the descriptions below, you may be at risk for hereditary cancer.

– Three or more relatives on the same side of the family with the same type of cancer or related cancers (e.g. breast and ovarian cancer) – More than one new cancer in the same person – Cancer at a young age (e.g. breast or colon cancer diagnosed under the age of 50) – Rare cancer (e.g. male breast cancer, ovarian cancer) – Ashkenazi Jewish descent and cancer in the family – More than five to 10 polyps in the colon/GI tract

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L to R: Prenatal genetic counselors Catherine Griswold and Ann F. Jewell.

“However, about five to 10 percent of cancer is hereditary. In these families, a gene mutation is being passed down through the family tree. These families have a higher chance of developing certain types of cancer in their lifetime. We can’t predict if they will get cancer, but they can learn if their risk is higher.”

“A significant part of obtaining a personalized risk assessment is learning about opportunities to make changes in one’s life to lower cancer risks,” says Vu. “Individuals can be more proactive about their medical management.”

Those found to be at high risk can benefit greatly from increased cancer screening and cancer prevention options.

Screening can begin at younger ages and occur more frequently. Some patients can also take medications or elect to have surgeries to stop cancer from ever starting.

Prenatal Genetic Counseling Each year, three out of 100 babies are born with birth defects, many of which are inherited. Through risk assessment and screening tests, it’s possible to determine if a couple is at risk for having a child with a specific disorder.

If a woman is already pregnant, diagnostic tests can sometimes show if a specific disorder is present.

At Carilion Clinic’s Prenatal Diagnostic Center, Ann F. Jewell, M.S., C.G.C., and Catherine Griswold, M.G.C., C.G.C., serve as the region’s only prenatal genetic counselors. Together, they provide prospective parents with information to help them make informed decisions.

“When patients arrive, we evaluate their medical, family, and pregnancy histories, and then assess what risks the baby may have,” says Jewell. “After that, we can offer appropriate prenatal testing if available.”

Jewell and Griswold recommend that patients talk to their doctors about genetic counseling if they have any of 18 Spring / Summer 2011

these risk factors: • They are over 35 and pregnant or are considering pregnancy • An alpha-fetoprotein (AFP) test result is abnormal • Screening indicates an increased risk for a chromosomal abnormality in the baby • A sonogram suggests an abnormality in the fetus • They have had three or more unexplained miscarriages • Maternal diabetes, epilepsy, or any other chronic medical conditions that may affect the pregnancy run in the family • They had exposure in the pregnancy to medications, drugs, alcohol, or radiation which might pose risks to the baby.

Counseling is also recommended if patients have a family history of birth defects, mental retardation, or genetic disorders such as Down syndrome, muscular dystrophy, Tay-Sachs disease, cystic fibrosis, sickle cell anemia, hemophilia, or thalassemia.

“If an abnormality is found, we can provide supportive information to explain the implications of the diagnosis and pregnancy management issues,” says Jewell. “Genetics is incredibly complex, and it’s important to stay up-todate with the newest testing and latest developments.”

Jewell and Griswold also offer their patients emotional support during a critical time. “We can connect families to community resources and support groups,” says Griswold.

“It can be helpful to meet others going through a similar situation.”

For more information, call Pediatric and Adult Genetics: 540-985-8454. Cancer Genetics: 540-525-2195. Prenatal Genetics: 540-985-9985. Most health insurance plans cover genetic consultations if a patient is referred by his or her doctor.

Treating Congestive Heart Failure Heart Program Offers Specialized Care to Prolong Active Life

Congestive heart failure is on the rise as America’s population ages.

This chronic condition—also simply called heart failure—occurs when the heart can’t pump enough blood to other parts of the body. About five million people in the United States now live with the condition, which can be caused by high blood pressure, viral infections, coronary artery disease, damage from a heart attack, a genetic condition, or other factors.

And while it cannot be cured, it can be managed.

To help patients increase their lifespan and stay active for as long as possible, Carilion Clinic developed the Heart Failure Program in 2009. Both inpatient and outpatient care are provided.

Within the inpatient unit, patients are cared for by nurses with specialized training in heart failure cases. Patient care coordinators also educate patients about their heart failure diagnoses, medications, recommended activity levels and exercise, nutrition, and discharge programs, including follow-up appointments. All of this helps patients decrease the chance of re-admission.

The outpatient unit also offers diagnosis and management of heart failure. Outpatient care includes: • Ongoing visits to monitor symptoms • Management of medications • Education and support to help manage the disease • Telephone consultations • Follow-up after a hospital discharge • Coordination with a patient’s primary physician • Referrals to other providers and services as needed, including Cardiac Rehabilitation for further education, management, and exercise as appropriate.

“We do a lot of patient education through the Heart Failure Program,” says Carilion Clinic cardiologist Stephen Phillips, M.D. “Patients know when to call us so we can implement changes in their medical care, such as medication or diet, to keep them as healthy as possible. Our rehab program is also provided at no cost to patients.”

For more information, call Carilion Clinic at 540-981-8749.

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A New PERSPECTIVE

By Maureen Robb The past five years have been life-altering for singersongwriter Sheryl Crow. At 44, she was diagnosed with breast cancer—and went on to overcome it. She and fiancé Lance Armstrong, of Tour de France fame, ended their engagement. Then, on her own, Crow adopted two young sons, making a home for them on a 154-acre farm outside Nashville.

Now at 49, Crow is as creative—and in demand—as ever. She has a new, introspective album, 100 Miles from Memphis, and she is making her debut as a cookbook author, eager to share the health-giving recipes she enjoyed during her recovery. In May and June, she will hit the road on a nationwide tour.

Crow has also gone back to her roots in her new album, marking a return to themes that first attracted her to writing and performing music. “I grew up in a small town 100 miles from Memphis, and that informed not only my musical taste, but how I look at life,” she says. “The drive to Memphis is all farmland, and everyone is community-oriented, God-fearing people, connected to the earth.

The music that came out of that part of the world is a part of who I am, and it’s the biggest inspiration for what I do and why I do it.”

A Musical Family Sheryl Crow was born in Kennett, Missouri, to a lawyer father who played the trumpet and a mother who taught piano. The family included Crow’s two older sisters and a younger brother. During high school, Crow was an All-State track star, a majorette, and a National Honor Society member. At the University of Missouri, she sang in a local band and earned her B.A. in music composition, performance, and education.

After graduation, Crow followed in her mother’s footsteps and became a music teacher. She taught at an elementary school in Fenton, Missouri and sang in local bands on the weekends. Her career got a boost when she was hired to sing 20 Spring / Summer 2011

in television commercials, including spots for McDonald’s and Toyota.

She soon went on to be a backup vocalist for Michael Jackson, touring with him in the late 1980s, and she performed one of his hits, “I Just Can’t Stop Loving You,” in duets with him. She also recorded background vocals for other music artists, including Stevie Wonder, Don Henley, and Belinda Carlisle.

Her debut album, the Tuesday Night Music Club, was released in 1993, and Crow skyrocketed to national prominence. The album won three Grammy Awards—for Best New Artist, Record of the Year, and Best Female Vocal Performance—and earned her a spot in Rolling Stone’s New Faces section.

International Success Crow, who now has seven albums to her credit, has won a total of nine Grammy Awards and has performed with Luciano Pavarotti, The Rolling Stones, Eric Clapton, Sting, and others. She has sold over 35 million albums worldwide. Her music is best described as eclectic— incorporating elements of pop, country, folk, hip hop, and rock.

She made her acting debut in 1999, in the film The Minus Man, and she has appeared on television shows such as 30 Rock, Cougar Town, and Hannah Montana Forever. Crow has produced records as well, and she plays a variety of instruments, including the guitar, piano, organ, harmonica, autoharp, accordion, and mandolin.

After years of acclaim, she is also happy to have returned to her roots with 100 Miles from Memphis (a reference to the distance between her hometown and the music capital). The album has been described as a statement of purpose—both emotional and musical. “My last record was pretty political, extremely personal, and more lyric-driven,” Crow says of Detours, which was released in 2008. “So it seemed like a great time to do something soulful and sexy and more driven by the music.” (continued on page 22)

BREAST CANCER RISK FACTORS With early detection, breast cancer has a high survival rate. The keys are understanding your risk factors, recognizing symptoms, and seeking treatment in a timely manner.

Risk factors include: • Being female and over age 50 • Family history of breast cancer • Changes in breast tissue • Overuse of alcohol • Early onset of menstruation or late onset of menopause • No childbearing or late childbearing • Absence of breastfeeding • Taking hormone replacement therapy for more than four years

(continued on page

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(continued from page 20) It was something she had thought about for a long time—as had her manager, Scooter Weintraub. “When [he] first started working with me 20 years ago, what he heard in me was that I had heavy influences from the south—Delaney and Bonnie, all the Stax records,” Crow says. “So for years he’s been asking me, ‘When are you going to make that record?’”

The result was a set of songs considered unusually open and direct for Crow.

“This music called for emotion . . . and that’s a little challenging for me,” she says. “Sometimes it’s easier for me to hide behind more intellectual lyrics. So it was a great stretching experience to show more vulnerability in my writing.”

Confronting Cancer When Crow was diagnosed with breast cancer in 2006, after a routine mammogram, it was a pivotal moment in her life.

She had no family history of the disease— or any reason to suspect that she had it.

She has since credited her practice of getting annual mammograms with the early detection of her tumor, and she encourages other women to get regular screenings.

Among other things, cancer proved to be a wake-up call for Crow to eat better. During her illness, she met Chuck White, a chef who taught her to cook with seasonal, locally grown foods rich in nutrients. She has now incorporated such foods into her everyday meals, whether she is on the road touring, throwing a dinner party for friends, or cooking for her sons. She and White have also collaborated on a new cookbook, If It Makes You Healthy.

Crow especially cares about how food is produced. “Since I started eating free-range, organic chicken, I can’t imagine going back to ‘supermarket birds,’ she says. “And it really mat22 Spring / Summer 2011

ters to me that my two boys will grow up knowing the difference intrinsically, but also that they will not be ingesting the kinds of chemicals that these birds are shot up with to make them grow bigger faster. That is the philosophy I embrace across the board when it comes to meat, in general.”

She adopted her boys, four-year-old Wyatt and one-year-old Levi, in 2007 and 2010, respectively, after she and Armstrong broke off their engagement.

Breast cancer awareness continues to be a major cause for Crow, and last year she lent her name and support to the new Sheryl Crow Imaging Center for breast care in Los Angeles. The center, which offers state-ofthe-art digital screening and diagnostic imaging technologies, is housed within the Pink Lotus Breast Center, where Crow was treated.

Crow also performs in concerts to benefit breast cancer awareness and other causes. To date these have included performances to benefit The Nature Conservancy; the Charlottesville, Virginia Free Clinic, which provides medical care for low-income adults without health insurance; and residents of Tennessee affected by the massive flooding there last year.

New Challenges As she prepares for her new tour this year, Crow is optimistic about the future. “I feel artistically revitalized and the music feels fresh . . . . ,” she says.

And she thanks her fans “. . . for coming with me on this long and wonderful journey of the past 17 years.”

In harkening back to her roots, Crow has succeeded in tapping into her own considerable creative reservoir. “I’m looking forward to many more years to come,” she says.

When You’re Sick:

Creating a Caring Network

Being in the hospital or having an extended illness can take a toll on patients and their families. That’s why Carilion Clinic has partnered with CaringBridge, a nonprofit organization that provides free websites to connect families and friends to share information, love, and support during serious health events.

Similar to social media sites like Facebook, CaringBridge gives patients and caregivers a place to provide health updates, post photos, and receive messages of hope and encouragement in a guestbook.

CaringBridge can connect a patient’s entire community—creating a network of support for everyone involved. This in turn reduces isolation and relieves stress to promote healing.

A CaringBridge computer station is available in the lobby of Carilion Roanoke Memorial Hospital so that patients and families can create their own CaringBridge websites. Setting up a site is a simple, three-step process that just takes a few minutes. Sites can later be updated from this computer, or from home or work.

Privacy is also built in. CaringBridge sites can’t be found by Internet search engines such as Google or Yahoo! To view a CaringBridge site, you must know the unique site name. Site authors can also add additional layers of privacy and security.

CaringBridge services are available for free to families because of the donations of individuals and partners such as Carilion Clinic.

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

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News& Notes

Carilion Hospital Wins Consumer Choice Award Carilion Roanoke Memorial Hospital has once again been awarded the Consumer Choice Award as the “most-preferred” hospital in the Roanoke Valley. The award, given by the National Research Corp., identifies hospitals that health care consumers chose as having the highest quality and image in over 300 markets throughout the country. Roanoke Memorial has won the award for seven years in a row. The National Research Corp. is the leading provider of survey-based performance-measurement, analysis, and tracking services to the health care industry.

Aetna and Carilion Clinic Announce Plans to Collaborate Aetna and Carilion Clinic have announced a partnership aimed at creating new health insurance plans that will lower costs for patients. One of their key goals is to develop a new system of payment that rewards Carilion Clinic physicians for improving patients’ health and the quality and safety of medical care. Carilion’s goal is to be more accountable to patients, actively involving them in their care and doing everything possible to keep them healthy. At the same time, Carilion will continue to participate in existing health plan provider networks and accept members of other Aetna and private insurance plans.

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Curtis Mills Receives National Award for Volunteer Service Curtis E. Mills, Jr., Carilion Clinic senior vice president for facility services, was awarded the National Medallion Award from the Boys & Girls Clubs of America. Mills has served on the board of trustees for the Boys & Girls Clubs of Southwest Virginia for the past nine years, and he has served as the organization’s president for the past year and a half. The award is given to people “whose unusually devoted service has contributed greatly in helping youth to achieve a fuller and richer life through the positive guidance and influence of the Boys & Girls Clubs.” In southwest Virginia, the organization provides after-school programs and summer camps for children.

Carilion Home Care Services Named among Nation’s Elite Two Carilion Clinic home health care services have been named to the 2010 HomeCare Elite, a listing of the top tier home health care agencies in the United States. They are Carilion Home Care Franklin, which serves Franklin County, and Carilion Tazewell Community Hospital Home Healthcare. The list names the top 25 percent of agencies nationally in terms of quality of care, quality improvement, and financial performance.

Leading Brain Researcher to Head New Research Center Warren Bickel, a leading researcher on brain processes that affect human decision-making, has been named director of the new Center for Substance Abuse at the Virginia Tech Carilion Research Institute. “It is a major coup for us to be able to attract Dr. Bickel to the Virginia Tech Carilion Research Institute and Roanoke,” says Michael Friedlander, executive director. “He is a renowned research leader in understanding the strategies used by the human brain during addiction, and his latest work is providing valuable new insights into potential therapeutic strategies for rehabilitating the addicted human brain.” Bickel had been the Wilbur D. Mills Chair of Alcoholism and Drug Abuse Prevention and director of the Center for Addiction Research and the Center for the Study of Tobacco Addiction at the University of Arkansas for Medical Sciences.

Hospital Staff Goes Beyond the Call of Duty When Voleta Meyer was hospitalized recently at Carilion Roanoke Memorial Hospital, she unfortunately had to miss her son’s wedding in Florida. The staff on the hospital floor, however, came up with an idea to let her virtually participate in the festivities. They arranged for her, her husband, and two friends to view the wedding through Skype. “They gave me a little corsage and party, including apple cider and wedding cake,” says Mrs. Meyer. “My husband and I felt like we were there—the staff really went the extra mile.”

L to R: Jeff Krasnow, Dr. Michael Meyer, Voleta Meyer, and Rita Krasnow.

Carilion Clinic Debuts Facebook Pages for Teens and Moms Carilion Clinic has launched two new Facebook pages—one for teens, and another for mothers.

The page for teenagers offers information and educational resources geared toward those aged 10 to 19 and stresses the importance of making healthy lifestyle decisions. Topics covered include eating disorders, texting while driving, teen pregnancy, and cyber bullying. The new page for mothers offers pregnancy and parenting tips and the opportunity for moms to upload videos and discuss their own experiences.

For more information, go to the Carilion Adolescent Health or Real Moms Know pages on Facebook.

Women’s Health University to Address Breast Health “What’s Best for the Breast” will be the topic of Carilion Clinic’s next Women’s Health University on Thursday, May 5. Speakers will be breast surgeon Roxanne Davenport, M.D. (shown at right), radiologist James G. Mullet, M.D. (left), and genetic counselor Thuy Vu, M.S., C.G.C (center).

All are with Carilion Clinic. The luncheon event, at Fitzpatrick Hall at the Jefferson Center in Roanoke, will begin at 11:30 a.m.; the cost is $15. For more information, call 540-266-6000.

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Carilion Clinic

New Physicians Leading Cancer Specialist Joins Carilion Gynecology Oncology

Dr. Janet Osborne

Janet L. Osborne, M.D., a nationally recognized gynecologic oncologist, has joined Carilion Clinic.

Dr. Osborne specializes in the treatment of gynecological cancers, including ovarian, cervical, and endometrial. She is trained to perform minimally invasive surgeries and to administer intraperitoneal chemotherapy—an innovative treatment that delivers chemotherapy directly into the abdomen to treat cancer cells and minimize exposure to healthy tissue.

She is named in the listings “Best Doctors in America” and “America’s Top Oncologists,” and she has conducted research in ovarian, cervical, and endometrial cancer.

Dr. Osborne was formerly with the Medical College of Wisconsin where she served as the director of gynecologic oncology for the past ten years, as well as where she received her M.D. degree. She completed her residency in OB/GYN at the University of Minnesota Hospital and Clinics and a fellowship in gynecology oncology at the University of Michigan Hospital.

Board-certified by the American Board of Obstetrics & Gynecology, Dr. Osborne practices at Carilion Clinic Gynecology Oncology at 1 Riverside Circle in Roanoke. She can be reached at 540-581-0160.

Prominent Gastroenterologist Joins Carilion Clinic

Dr. Paul Yeaton

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Paul Yeaton, M.D., a leading gastroenterologist recognized for performing and teaching advanced endoscopic techniques, has joined Carilion Clinic.

Dr. Yeaton, whose special focus is the evaluation and treatment of pancreatic and hepatobiliary diseases, both benign and malignant, was formerly with the University of Virginia.

He brings a new service to southwest Virginia—endoscopic ultrasound—a technique to examine structures and perform interventions using ultrasound inside the intestinal lumen. (An endoscope is an instrument, often a flexible tube with a tiny camera, used to examine organs within the body.)

Services being expanded due to Dr. Yeaton’s arrival include removal of large and/or difficult lesions from within the colon, stomach, and small intestine.

Dr. Yeaton received his M.D. degree from West Virginia University and served his residency in internal medicine there. He completed a fellowship in gastroenterology at the University of Virginia and another in therapeutic endoscopy at the Free University of Brussels. He is board-certified in gastroenterology.

He practices at Carilion Clinic Gastroenterology at 3 Riverside Circle in Roanoke and can be reached at 540-224-5170.

Department of Medicine Moises R. Cossio, D.O. Pulmonary and Critical Care Education: Loma Linda University Medical Degree: A.T. Still University Residency: Internal medicine, Yale University-Norwalk Hospital Fellowship: Pulmonary and critical care, Louisiana State University 2001 Crystal Spring Ave., Suite 205 Roanoke, VA 24014 540-985-8505

Michael A. Riel, D.O., F.A.C.P., F.A.C.G. Gastroenterology Education: University of Arkansas at Little Rock Medical Degree: Kansas City University of Medicine and the Biosciences, College of Osteopathic Medicine Residency: Internal medicine, Eisenhower Army Medical Center Fellowship: Gastroenterology, Brooke Army Medical Center 110 Akers Farm Rd., Christiansburg, VA 24073 540-382-9405

Kelly Henchel, M.D. Pediatric Medicine Education: Michigan State University Medical Degree: Wayne State University School of Medicine Residency: Pediatric medicine, St. John’s Medical Center 1030 S. Jefferson St., Suite 106, Roanoke, VA 24016 540-985-8230

Daniel J. Mackey, M.D. Pediatric Critical Care Education: University of North Carolina at Chapel Hill Medical Degree: University of North Carolina School of Medicine Residency: Internal medicine/pediatrics, Baystate Medical Center Fellowship: Pediatric critical care, University of Virginia 1906 Belleview Ave., Roanoke, VA 24014 540-981-7000

Department of Primary Care and Regional Medicine Alicia G. Hollis, D.O.

Umar F. Sofi, M.D. Pulmonary and Critical Care Education: Kashmir University, Hazratbal, India Medical Degree: Government Medical College Srinagar, Kashmir, India Residency: Internal medicine, Episcopal Hospital Fellowship: Pulmonary and critical care, UMDNJ University Hospital 2001 Crystal Spring Ave., Roanoke, VA 24014 540-985-8505

Department of Emergency Medicine Timothy J. Fortuna, D.O. Emergency Medicine Education: Rochester Institute of Technology Medical Degree: New York College of Osteopathic Medicine Residency: Emergency medicine, SUNY Upstate Medical Center 1906 Belleview Ave., Roanoke, VA 24014 540-981-7000

Department of Pediatrics Michael Burbridge, D.O. Pediatric Hospitalist Education: University of Florida Medical Degree: Nova Southeastern University College of Osteopathic Medicine Residency: Wake Forest University Baptist Medical Center 1906 Belleview Ave., Roanoke, VA 24014 540-981-7000

Internal Medicine Education: University of Virginia Medical Degree: Touro University College of Osteopathic Medicine Residency: Carilion Clinic Internal Medicine Residency Program 3 Riverside Circle, Roanoke, VA 24016 540-224-5170

Mary D. Leatherland, M.D. Family Medicine Education: Virginia Polytechnic Institute and State University Medical Degree: University of Maryland School of Medicine Residency: Cabarrus Family Medicine Residency Program 6920 Roanoke Rd., Shawsville, VA 24162 540-268-1400

Department of Surgery Peter S. Mikhail, M.D. Cardiothoracic Surgery Education: John Abbott College Medical Degree: McGill University Residency: Cardiothoracic surgery, University of Florida General surgery, University of Toronto 2001 Crystal Spring Ave., Roanoke, VA 24014 540-853-0100

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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Rising Above It All Hot Air Ballooning in Virginia

By Su Clauson-Wicker

The view from the gondola sweeps over almost 60 miles of verdant ridges and valleys. There is no bouncing, no wind resistance—essentially no motion—because your balloon is traveling with the wind. Your altitude hovers between 1,000 and 3,000 feet, and you may fly low enough to see horses galloping away from your shadow. Or so high that the landscape flattens like a topographical map.

The experience is strangely grounding, because all earthly problems seem so small and far below.

If you’ve ever wanted to fly in a hot air balloon, there may never be a better time. About 7,500 balloons now operate in the United States, and several companies make rides available within a 90-minute drive of Roanoke. Balloon festivals in Virginia are also a good way to try out a flight, or a tethered ascent.

Going with the Flow Taking a ride can be an adventure in serendipity. Balloonists can’t steer, so they don’t know exactly where they will land. As they ascend, they find winds. If they don’t like the direction of the wind at one altitude, they can rise or descend to find another current.

To take off, pilots start by firing up the aircraft’s propane burner to heat the air filling the balloon. Hot air rises, so up the balloon goes. To descend, pilots open a valve at the top of the balloon, letting warm air escape.

Because air in the balloon cools naturally, pilots must fire the burner at intervals throughout the flight to stay aloft.

“We make plans, but nature rules,” says Lisa Baity, 28 Spring / Summer 2011

who, with her pilot husband Ken, runs Forest Winds ballooning company in Forest, Virginia. “We have 30 launch sites around Lynchburg and Bedford County. We choose one depending upon how the wind is blowing.”

And while balloonists can fly at any hour, any time of the year, they usually prefer to launch just at dawn, or before dusk, when upper winds are calmest. So trips should be planned accordingly.

Celebratory Occasions The colorful balloons attract many who are celebrating a special occasion. The Baitys, for instance, have taken up their share of bridal couples, families celebrating birthdays, and people working on their “bucket list” of things they want to do in their lifetimes.

For some reason, men like to propose during balloon rides. Ken Baity even works out a set of signals with the prospective groom so he’ll be ready to capture the proposal on film; he also radios his wife to put champagne on ice for the landing.

L to R: Hot air balloons fly over Thomas Jefferson's Monticello; Smith Mountain Lake; and the Shenandoah Valley countryside.

Photos at left and right courtesy of Blue Ridge Balloon, LLC; photo at top courtesy of Ed McDaniel.

“We usually do have champagne for landings, that or sparkling fruit juice,” Lisa Baity says. “We also take pictures and post them on our website with a story of the flight. We want to make the ballooning experience special.”

Baity and one of her sons usually comprise the chase crew, which picks up the balloon and its passengers upon landing—often in a pasture. More than once, Baity has stared down bulls while helping satin-gowned brides step into her truck.

“We help them make memories,” she says. “There’s no doubt about it.”

Flying On Your Own Other aficionados, like Ed McDaniel of Salem, enjoy piloting their own balloons. McDaniel, who is an imaging technician with Carilion Clinic, got hooked on ballooning in college and has been flying for almost 25 years. Since operating a balloon requires an FAA pilot’s license, McDaniel earned his private and commercial certifications and purchased his own balloon. He also gives commercial balloon rides.

“A pilot must be really good at reading the winds and using them to get where he wants to go,” McDaniel says.

“The balloon also drifts with the winds, so weather is everything.”

If You Go If you’d like to experience a flight: a typical hour-long trip covers five to 10 miles and costs $160 to $225 per person (for a trip shared with other passengers). Private

flights with food and photographs run $225 to $400 each.

For the incurable romantic, Blue Ridge Balloon in Charlottesville offers wedding ceremonies in the air (bride, groom, and minister) for $1,000.

Purchasing a balloon is like buying a car—a new one can cost about $45,000, while used balloons run around $18,000. Those who make the commitment to buy say there’s nothing like floating silently, high in the sky, taking a bird’s-eye view on the human high jinks below. It can become a passion.

Companies Boar’s Head Ballooning, Charlottesville (434) 971-1757 Charlottesville; www.boarsheadballooning.com Blue Ridge Balloon, LLC, Charlottesville (434) 589-6213; www.blueridgeballoon.com Forest Winds Inc., Forest (434) 385-8118; www.forestwindsinc.com Ed McDaniel, Salem (540) 384-7400 Festivals Western Virginia Balloon Festivals Wytheville Chautauqua Festival Balloon Rally June 24- 25 Lexington Sunrise Rotary Balloon Rally July 2-5

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vervefood

Eat Well for a Healthy Heart

By Kate Jones Do you know your numbers? Your cholesterol, blood pressure, and blood sugar numbers, that is.

You may know that they affect the health of your heart. But did you know that what you eat can help keep them all in a healthy range?

According to the CDC, heart disease is the leading cause of death in the United States for both men and women. And while some of us inherit bad heart health genes, for most people, the risk of heart attack and stroke can be significantly reduced with a healthy lifestyle.

One of the key things to watch out for is oversized servings. Portion sizes have grown by 30 percent in recent years. Think it’s only happening in restaurants?

Think again. The plates in our homes have become super-sized as well. Try using a smaller plate and you’ll be amazed at how satisfied you still feel even when eating less food.

Another important step is to lower your saturated and trans fat intakes. Saturated fat is most often found in animal products like high-fat meat and dairy products. It raises our LDL (lousy) cholesterol levels. Opt for lowerfat choices like skinless chicken breast and low-fat (1 percent) or fat-free dairy products.

Trans fat is found in processed foods like stick margarine, baked goods, and fried foods. It not only raises our LDL cholesterol levels, it also lowers our HDL (healthy) cholesterol levels. Look for it on the nutrition facts product labels and try to make your food choices “Trans Fat Free.”

Also, increase your fiber intake. Soluble fiber—found in oats, beans, and some fruits and veggies—binds with the cholesterol in our bodies and removes it from our circulation. Some sources report that by eating just 6 grams of soluble fiber per day, LDL cholesterol levels can be reduced by 5 to 10 percent.

Fiber is not found in meat, but saturated fat and 30 Spring / Summer 2011

cholesterol are, so try meatless meals on occasion. Eating pinto beans and cornbread for dinner? No need for meat, the protein is in the beans. Just add some greens to round out the meal. Top green salads with garbanzo and/or kidney beans. Try oatmeal for breakfast. These are all inexpensive ways to bump up your soluble fiber intake and can even help you save money at the grocery store, since beans are cheaper than meat.

Reaching a healthy weight will also help your heart and the rest of your body. Losing just 5 to 10 percent of your body weight if you’re overweight can improve your numbers and lower your risk of chronic health problems. No restrictive, impossible-to-follow-for-a-longtime regimes are necessary. Just follow some basic, healthy eating guidelines: Eat regularly. Not only does skipping meals slow down your metabolism, it causes you to overeat the next time you’re at the table.

Eat a variety of foods. In case you’ve forgotten your food groups, check out www.mypyramid.gov for ideas about how to fit fruits, veggies, etc. into your diet. All the groups provide important vitamins and minerals.

Yes, you can take a vitamin supplement, but not all the benefits of whole foods can be packaged in a pill.

Portion control. We’ve said it before, but each time you sit down to eat, ask yourself: How much food does my body really need?

For more information, visit www.americanheart.org and click on “Nutrition Center.” You can find lots of additional resources, cooking tips, and recipes there.

You might also want to check out your body mass index, or BMI, to see if your weight is in a healthy range for your height. You can find out more at www.nhlbisupport.com/bmi/.

Finally, at right is a heart-healthy recipe I’ve grown to love over the years. It’s my mother’s—and it’s as delicious as it is good for you!

Heart Healthy Chili Servings per Recipe: 12 24 ounces (2 bags) soy crumbles 1 large onion, chopped 1 large green pepper, chopped 1 cup celery, chopped 2 15-ounce cans dark or light red kidney beans, drained and rinsed 2 15-ounce cans black beans, drained and rinsed 2 15-ounce cans diced tomatoes, no sodium added 1 29-ounce can tomato sauce, no sodium added 1 10-ounce can Healthy Request tomato soup 1 to 2 teaspoons garlic powder 1 to 2 tablespoons chili powder Tabasco sauce, to taste Nutrition Facts per Serving: Calories: 261 Fat: 3 grams Sodium: 573 milligrams Total carbohydrates: 41 grams Fiber: 12 grams Protein: 19 grams

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Letters from Patients’ Families

My sister, Wanda Carter, pa ssed away while in Roanok e Memorial Hospital Decem She received the BEST car ber 22, 2010. e while there from all the do cto rs, nurses, and your securi they helped to get her int ty staff as o Palliative Care. I saw my sister receiving the kinde care she could have ever st and gentlest received from any hospita l in the country and from heart I want to thank each the bottom of my and every one for all their help.

When driving to the cem etery to visit my sister’s gra ve I noticed the big heart pital and I thought how be on top of the hosautiful and how appropri ate . I think this heart should ALL the time since Roanok be displayed e Memorial Hospital is on e of the biggest and best the southwest. Also, I wo he art hospitals in uld like to say that the he art is to Roanoke Memoria Star is to Mill Mountain. Ple l Ho sp ita l as the ase consider keeping the heart displayed all the tim e.

Kindest regards, Karen Bushnell Roanoke, Virginia lland family. l Holland, on behalf of the Ho hae Mic by er lett a m fro ts 9 and was treated at Following are excerp d a stroke in November 200 fere suf d, llan Ho len He r, es. Mrs. Holland Mr. Holland's mothe d later for various medical issu an n the al spit Ho l ria mo Me Carilion Roanoke died in January 2011.

d for by so many wonFrom the first day to the last, [Mom] was care ily. fam our to e hom nd seco a me beca excellent health “Over 20 months, RMH at the right hospital. . . . “In addition to the e wer we bt dou a r neve was e Ther ors. derful nurses and amazing doct compassion in every interaction with personally cared about Mom and showed that ors doct and es nurs with sed bles e care, we wer our family. her life. . . . He not y include] Dr. Paul A. Haskins [who] saved [The ors. doct ul derf won the of e som e ins in charge. . . . We would like to recogniz life were on the line, I would want Dr. Hask my If . . . on. pers ul derf won a is he or, only has amazing talent as an ER doct ’s treatment. She consistently exchanged close to 15 emails concerning Mom I and z Lant Dr. Day, as stm Chri On . . . z . . . Dr. Jeri L. Lant t a physician should be. ily. She walks the talk and is epitome of wha went the extra mile for Mom and our fam give us advice. phone and e-mail to answer questions and via me with act cont tant cons in ed stay . . . Dr. Joseph L. Austin . . . [who] an excellent doctor. much time as needed for our family. He is as take ld wou he ds, roun his e mad in When Dr. Aust ed such compassion so I could reach him at any time. Dr. Patel show ber num ne pho cell his me gave o] [wh . . . wrote a letter to . . . Dr. Vishal D. Patel with Dr. Patel’s ability and compassion, Dad ed ress imp so was er fath My . tion ersa in dealing with us in every conv ul doctor she has for a son.”

Dr. Patel’s mother telling her what a wonderf

32 Spring / Summer 2011

Time Lost is Brain Lost

Call 911 if you experience a sign or symptom of stroke The message is simple: Stopping stroke early—especially in the first three hours of the first symptom—saves brain cells and limits the lasting effects. That’s why it is so important to call 911 immediately if you experience any of the signs of stroke.

After treating numerous stroke victims through the Stroke Alert program at Carilion Roanoke Memorial Hospital (certified as a Primary Stroke Center by The Joint Commission), we

believe healthcare should be about one thing: Signs of Stroke getting you back to living your life.

1. WALK - Loss of balance For more information about stroke symptoms, droopy face 2. TALK -Slurred speech or call 540-266-6000 or 800-422-8482, or visit akness of the face, 3. REACH - Numbness or we dy CarilionClinic.org. e side of the bo arm or leg, especially on on difficulty seeing in 4. SEE - Impaired vision or one or both eyes with no known cause 5. FEEL - Severe headache

Inspiring better health.

YES, M MM Mammograms Save Lives It’s not just a nice thing to say, a mammogram can save your life.

As women, we often say “yes” to more than we have time for. This year, when your doctor or girlfriend asks if you plan to get your annual mammogram, say “yes” to something that really makes a difference.

A mammogram is the best way to detect breast cancer early, when it’s most treatable. Carilion Clinic’s Breast Care Center recommends annual mammograms beginning at age 40. Most insurance companies will pay for it — often without a co-pay. And it takes only 20 minutes. With convenient locations and walk-in appointments, it’s easy to fit into your day, too.

So, say YES, MAMM to your annual mammogram.

Talk to your doctor or schedule yours today.

Hospitals: Bedford Memorial Hospital, 540-587-7806 Carilion Franklin Memorial Hospital, 540-484-8594 Carilion Giles Community Hospital, 540-921-6051 Carilion New River Valley Medical Center, 540-731-2720 Carilion Stonewall Jackson Hospital, 540-458-3321 Carilion Tazewell Community Hospital, 276-988-8730

CarilionClinic.org/YESMAMM

Breast Care Centers: 1211 S. Jefferson St., Roanoke, 540-985-9885 3707 Brambleton Ave., Roanoke, 540-772-7401 6415 Peters Creek Road, Roanoke, 540-265-5545 Physician Offices: 415 S. Pollard St., Vinton, 540-983-6700 901 Plantation Road, Blacksburg, 540-951-0352

Breast Care Center