healthy living tips for the
Shenandoah Valley Charlottesville
&
Advice, insight and a lot more from local caregivers!
table of contents | january • february 2015
FIT BITS!........................................ 25 MEDI•CABU•LARY.......................8 Local experts define health-related terms
JUST ASK!.......................................10 Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............12 A listing of new physicians, providers, locations and upcoming events in the Shenandoah Valley and Charlottesville communities
HEALTH POINTS.........................16 Interesting facts and tidbits about health
THE ANATOMY CHALLENGE..................................19
Indoor, at-home circuit workout to fight the winter blues. With minimal space and equipment, you can do an at-home circuit workout that will work all major muscle groups. Circuit workouts are quick and challenging, and a great alternative to the gym.
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Good Health: To Keep It, Protect It
Good health. Everyone wants it and believes they’ll always have it, until they don’t. Health is often taken for granted, with its importance not truly being appreciated or realized until illness strikes and prevents an individual from doing the things they love and living the life they’re accustomed to living.
How much do you about our anatomy? In this issue, test your knowledge when it comes to the Vestibular System!
ANATOMY: A Matter of Balance...................... 20 You’re stepping off a curb and suddenly the world seems to tilt. Or, you’re going down the stairs and there’s no longer a step where you expect it to be. And down you go.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
32
hello, HEALTH!............................ . 42
Overcoming Barriers to Building a Family
Is infertility an epidemic? Today, according to the Society for Assisted Reproductive Technology, one of every 100 babies born has reproductive help of some type to bring it from conception to successful delivery.
Capturing the spirit of those working in our local healthcare and of people leading healthy lives through photos
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[series]
Breaking the Silence: Aneurysm
This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now.
p.37
Heart Health Resource Guide
NUTRITION.................................. 53 HEALTHY EATS: Heart healthy recipes that are sure to please your palate!
LOOKING BACK........................... 58 Images reflecting the landscape of healthcare in the Shenandoah Valley and Charlottesville * PLUS * a chance to win prizes!
www.OurHealthCville.com
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january • february 2015
read this edition of
OurHealth Shenandoah Valley & Charlottesville
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PUBLISHER PRESIDENT/EDITOR-AT-LARGE VICE PRESIDENT OF PRODUCTION PROJECT COORDINATOR AND FITNESS EXPERT CHIEF DESIGNER WEBSITE
CONTRIBUTING SHENANDOAH VALLEY & CHARLOTTESVILLE MEDICAL EXPERTS
McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Deidre Wilkes Karrie Pridemore Next Generation Designs Robert Battle, MD Mark Masonheimer, RN, BSN Brandy Patterson, MD Arun Prahash, MD Jeffrey Todd, MD, FACC, FASE John Zakaib, MD
ONTRIBUTING PROFESSIONAL EXPERTS & WRITERS Susan Dubuque C Rich Ellis Tricia Foley, RD, MS Rick Piester Deidre Wilkes Diane York ADVERTISING AND MARKETING Kim Wood • Vice President of Business Development 540.798.2504 • kimwood@ourhealthvirginia.com Cindy Trujillo • Senior Media Consultant 434.907.5255 • cindy@ourhealthvirginia.com SUBSCRIPTIONS To receive OurHealth Shenandoah Valley/Charlottesville via U.S. Mail, please contact Deidre Wilkes at deidre@ourhealthvirginia.com or at 540.387.6482
Visit us at
@ourhealthcville
ourhealthcville.com and click on the magazine cover to view the digital edition!
COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor-at-Large: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482, ext. 1 Information in all print editions of OurHealth and on all OurHealth’s websites (www.ourhealthcville.com, www.ourhealthrichmond.com and www.ourhealthvirginia.com), social media sites and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2015 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Shenandoah Valley and Charlottesville edition is published six times annually by McClintic Media, Inc. 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthcville.com | www.ourhealthrichmond.com | www.ourhealthvirginia.com | Advertising rates upon request.
LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is a heart catheterization? It is a procedure done to investigate if there are any blockages in the arteries of the heart muscle. It can also be a life saving test for someone having a heart attack. The hearts circulation is accessed from one of the limb arteries; traditionally from the artery supplying the leg (femoral artery) but more recently from an artery in the wrist (radial artery). More patients prefer the convenience and comfort of the wrist approach. The catheterization procedure involves local anesthesia and medications to induce a state of relaxed drowsiness but not complete unconsciousness. The test involves exposure to x-ray radiation and to x-ray dye. People who have major allergies will need premedication. Talk to your doctor about the reason for recommending a heart catheterization and the different approaches and potential outcomes. Being an invasive procedure, it does involve certain risks; your cardiologist will be able to explain how the potential benefits outweigh the risk of complications. Arun Prahash, MD
Cardiovascular Associates of Charlottesville Charlottesville | 434.293.4072 www.cvilleheart.com
What is arrhythmia? The heart is a muscular pump with four chambers and four valves responsible for circulating the blood within all the vessels of the body. The heart is controlled by electrical impulses that activate the chambers in synchrony. This synchrony is called the heart’s rhythm. The normal heart will contract 100,000 times per day. An arrhythmia is any disturbance of the heart’s normal electrical rhythm. There are a variety of types of arrhythmias. Some disturb the synchrony between heart chambers during a given heartbeat, and others can result in persistent disturbance of the heart’s normal beat and last for minutes, hours, days or even years. Some arrhythmias put patients at risk for more serious problems such as stroke or heart failure. Others can be benign and carry no symptoms or additional risk. Your doctor can identify heart rhythm problems using simple monitoring devices that record arrhythmias for analysis. Arrhythmias can be managed with medications or through invasive procedures. Cardiologists that specialize in arrhythmia care are called electrophysiologists (or EP doctors). John Zakaib, MD
Cardiovascular Associates of Charlottesville Charlottesville | 434.293.4072 www.cvilleheart.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
What is systolic and diastolic pressure? Blood pressure is usually given as two numbers, such as ‘120 over 80’. The systolic blood pressure, the top number and the higher of the two, is the peak or highest pressure generated by the heart when it is pumping the blood out to the rest of the body. The diastolic blood pressure, the bottom number and the lower of the two, is the pressure generated when the heart is at rest in between heart beats. Mark Masonheimer, RN, BSN Augusta Health Fishersville | 540.332.4127 www.augustahealth.com
H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
What is the difference between a cardiologist and a cardiovascular surgeon? Although both types of physicians work with cardiac patients, their training is quite different. Cardiologists spend 3 years training in internal medicine after medical school, and then at least 3 years specializing in the treatment of cardiac disease in a cardiology fellowship. Cardiologists are experts in the diagnosis and management of cardiovascular disease, using medicines, as well as catheter based techniques such as angioplasty. Electrophysiologists are cardiologists that specialize in electrical disorders of the heart, and implant pacemakers, and perform ablations to treatment rhythm disorders. Cardiac surgeons train first as general surgeons, and then enter a fellowship where they learn operative approaches to treating cardiac diseases. Typically patients are first evaluated and diagnosed by a cardiologist, and then referred to a cardiovascular surgeon if operative intervention is necessary, such as bypass surgery, or operative valve replacement. Close collaboration between these physicians occurs, ensuring optimal patient care. Jeffrey Todd, MD, FACC, FASE Carilion Stonewall Jackson Hospital Lexington | 540.463.2227 www.carilionclinic.org
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
What are some signs of cardiovascular disease in women that often get overlooked? Women may present with nonspecific symptoms that are easily confused with the flu, reflux and/ or aging. Symptoms include, but are not limited to: fatigue, dizziness/ lightheadedness, shortness of breath, an ache or burning in the chest, back pain, shoulder and/or arm pain, as well as numbness in a hand or both hands. Heart disease remains the number one killer of women age 40 and older. Cardiovascular disease develops later in women than in men and therefore the risk of heart disease in women is often underestimated. There is also a common mis-perception that females are protected against cardiovascular disease at all ages and therefore they may be less likely to seek medical attention including diagnostic tests and /or treatment. I believe that education, self-awareness and identification of cardiovascular risk factors is the key to making a positive impact on cardiovascular disease in women. Brandy Patterson, MD
UVA Heart and Vascular Center Charlottesville | 434.243.1000 heart.uvahealth.com
What causes a heart to be enlarged? An enlarged heart can have many causes, including abnormal thickening of the heart muscle from high blood pressure or dilation of the chambers due to weakened heart muscle. Cardiac enlargement is not always indicative of a disease process; it can occur in elite athletes as a normal adaptation to rigorous training. Individuals with an enlarged heart may experience shortness of breath, abnormal heart rhythm or swelling, or may have no symptoms at all. An enlarged heart is typically first seen in a chest X-ray, with additional tests used to diagnose the cause. To treat an enlarged heart, one must address the cause. Medication may help lower blood pressure; other therapies may be required to address heart valve problems, coronary artery disease or other causes of heart failure. To help prevent an enlarged heart, avoid developing diabetes, high blood pressure and high cholesterol. Also avoid all tobacco products. Robert Battle, MD
UVA Heart and Vascular Center Charlottesville | 434.243.1000 heart.uvahealth.com
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
John Otho ‘Rob’ Marsh, III, MD named
2014 Country Doctor of the Year This past December, John Otho ‘Rob’ Marsh, III, MD, an independent practitioner in Middlebrook and Raphine who is on the medical staff at Augusta Health, was named the 2014 Country Doctor of the Year. Presented by Staff Care, an AMN Healthcare company, since 1992, the Country Doctor of the Year Award recognizes the spirit, skill and dedication of exemplary physicians practicing in communities of 30,000 or less.
John Otho ‘Rob’ Marsh, III, MD
Before returning home to the Shenandoah Valley to practice in Middlebrook and Raphine, Dr. Marsh was a military physician. He is still remembered among Delta Force families for founding the first full-service, full-time family practice clinic for Delta Force families. He is also remembered for directing the medical care of Army Rangers and Delta Force soldiers in October of 1993—events that have been chronicled as Blackhawk Down. Two days later, Dr. Marsh was seriously injured when a mortar hit his base, and he continued to direct the medical care of the other wounded in spite of his own injury.
Since returning to the area, Dr. Marsh has continued to serve in many ways. His practice has offices in both Middlebrook and Raphine; he serves on the Board of Directors at Augusta Health; he is a preceptor for students from the University of Virginia School of Medicine; he is the sole provider for the residents of Blue Ridge Christian Home; he teaches Sunday School and serves as an elder at Old Providence Church; he is a volunteer firefighter, a farmer—and most importantly, a husband and father. “The physicians, the nurses, and the administrators who work with Dr. Marsh are literally in awe of him,” said Mary Mannix, CEO of Augusta Health. “His impact on the standard of care in our area has been immeasurable. We cannot imagine a physician more deserving of this honor.”
Additional information about the Country Doctor of the Year Award can be found at www.countrydoctoraward.com
UVA to determine best drug to stop potentially deadly seizures Researchers at the University of Virginia School of Medicine are launching a major clinical trial to determine the best medication to save people from potentially deadly prolonged seizures, known as status epilepticus, when other drugs have failed. “This is a very severe, sometimes life-threatening seizure,” explained lead investigator Jaideep Kapur, MD, PhD, of the UVA Department of Neurology. “Status epilepticus is a seizure that doesn’t stop.” Dr. Kapur has received a $21.4 million grant to conduct the five-year trial from the National Institutes of Neurological Disorders and Stroke. Forty trial sites will test the three medications most commonly administered when initial treatments for status epilepticus have failed. As of now, there is no clear understanding of which is best, so the trial has the potential to revolutionize the treatment of these patients. For more information, visit www.uvahealth.com.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Jaideep Kapur, MD, PhD
New President at
Martha Jefferson Hospital
Jonathan Davis brings a wealth of knowledge and experience to Martha Jefferson Hospital Davis, 44, moved with his family to Charlottesville after having served as president of Methodist Charlton Medical Center in Southwest Dallas, TX since October 2009. He follows Jim Haden, who announced his retirement in 2014. Davis says that he was drawn to Martha Jefferson by the hospital’s Caring Tradition, which “really spoke to my personal values and my passion to serve patients, families and the community. I know great outcomes at Martha Jefferson haven’t happened by chance,” he continues, “but through the commitment of many, including nurses, physicians, volunteers, leadership, support teams and passionate community members.” An avid outdoor sports enthusiast, Davis says he is looking forward to being in the Charlottesville area to sample the area’s opportunities to run, road bike and mountain bike, and “be outdoors with my family.” It was his interest in sports that led to Davis’ career in healthcare. “I grew up playing tennis,” he says, “and I really liked the sports medicine component of healthcare.” Davis began his healthcare career in 1993 as a physiologist intern providing direct patient care at St. Bernard’s Regional Medical Center in Jonesboro, AR. He has progressed in his career through various management and leadership roles in small, medium, and large hospitals in communities of all sizes. Davis grew up in Little Rock, AR, and earned a BS in physiology from Arkansas State University, a master’s in physiology from Northern Arizona University, and a master of public healthcare administration from Tulane University. He is a fellow of the American College of Healthcare Executives and was presented with the American College of Healthcare Executives Early Careerist Regent’s Award in 2003, was named Young Administrator of the Year in 2005 by the Arkansas Healthcare Executives Forum, and a 40 under 40 Honoree by the Joplin Tri-State Region’s Business Journal in 2007. During his tenure at Methodist Charlton, Davis guided the hospital as it improved access to cardiology services, launched an open-heart surgery program, started a program to decrease premature births, opened a quick-care clinic and improved existing facilities. Before joining Methodist Charlton, Davis served as president/chief executive officer of Mt. Carmel Regional Medical Center in Pittsburg, KS. As president of Martha Jefferson, Davis will be responsible for accomplishing the strategic priorities of the hospital, as well as continuing the hospital’s integration with Sentara, the Norfolk-based health system that Martha Jefferson joined in June 2011. “Jonathan greatly impressed us with his insight, maturity and his embrace of the unique culture and spirit of Martha Jefferson,” notes Peter Brooks, chair of the hospital’s board of directors. “Jonathan’s experience in managing healthcare facilities in a number of different settings has provided him with an in-depth understanding of the challenges and opportunities Martha Jefferson will face as we continue to improve on our already strong track record of delivering the highest quality care with affordable economics.” “My hopes and aspirations for Martha Jefferson are that we serve and improve health in more patients tomorrow than we did today”, says Davis. “My measure of success beyond that is that we, as a high performing team, provide ‘best in class’ care to every person coming through the doors.” Davis and his wife Janet have a son, Andrew, and a daughter, Sydney.
www.OurHealthCville.com
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NEW
NOTEWORTHY Alzheimer’s Association Arts Fusion
Director ONLY
Certified Timeslips™ Facilitator
in Virginia
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Sharon Celsor-Hughes, Creative Arts Director/Arts Fusion with the Alzheimer’s Association Central and Western Virginia, recently received certification as a facilitator for TimeSlips™. TimeSlips™ is a storytelling program that was developed to engage persons with Alzheimer’s disease and related dementias by “replacing the pressure to remember with the freedom to imagine”. “Research suggests that this program increases the quality and quantity of engagement between staff at adult care facilities and residents, so we are pleased that Sharon will be able to share TimeSlips with facilities in our chapter region,” says Sue Friedman, president and CEO. Celsor-Hughes was privileged to receive her initial training from TimeSlips™ founder Anne Basting while attending the 2014 Center for Creative Aging Leadership Conference. Currently, Celsor-Hughes is the only certified facilitator for this internationally recognized program in the commonwealth of Virginia. Celsor-Hughes uses this technique in area memory care facilities, early stage community programs, and with caregivers. For more information visit www.alz.org/cwva
Mohammed Abuannadi, MD
Farrell Adkins, MD
Meghan Cooper, MD
M. Truitt Cooper, MD
UVA Heart and Vascular Center Heart Failure and Transplant Charlottesville | 434.243.1000 heart.uvahealth.com
UVA Health System Pulmonary Charlottesville | 434.924.5219 www.uvahealth.com
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Carilion Clinic General Surgery Lexington | 800.422.8482 www.carilionclinic.org
UVA Health System Orthopaedic Surgery Charlottesville | 434.243.0245 www.uvaortho.com
Angela Algire, PA-C Carilion Clinic Hospitalist Lexington | 540.458.3300 www.carilionclinic.org
James Daniero, MD
UVA Health System Otolaryngology-Voice and Swallowing Charlottesville | 434.924.2040 www.uvahealth.com
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Lucia Flors Blasco, MD
Sean Burke, MD
Ralph Caldroney, MD
Violet Fernandes, MD
Daniel Freed, MD
Amanda Gerber, MD
UVA Health System Radiology Charlottesville | 434.982.6018 www.uvahealth.com
Carilion Clinic Pediatric Hematology and Oncology Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Neurology Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Hospitalist Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Internal Medicine Lexington | 800.422.8482 www.carilionclinic.org
Bluestone Pediatrics Harrisonburg | 540.437.4800 www.bluestonepediatrics.com
Chris Ghaemmaghami, MD
Thomas Hamilton, MD Carl Henderson, DO
Anthony Isedeh, MD
Mark Joseph, MD
Senaida Keating, MD
Nirmal Khandoobhai, MD
Veronica Kheyfets, MD David Luyimbazi, MD
Carilion Clinic General Surgery Surgical/Oncology Lexington | 800.422.8482 www.carilionclinic.org
Michelle Marks, NP
Ryan McKenzie, MD
Sentara RMH Hospitalists Harrisonburg | 540.689.1000 www.rmhonline.com
Hematology Oncology Associates Harrisonburg | 540.689.7000 www.rmhcancercenter.com
Katy Meinbresse, FNP
Kelley Morel, MD
Thomas Morel, MD
Scott Otallah, MD
Li Ouyang, MD
Biraj Patel, MD
Christopher Pile, MD
Natalie Powell, DMD
Georgios Psarros, MD
Sudhir Rao, MD
Hemendra Sarda, MD, MPH
Shawn Safford, MD
Kimberly St. Jean, MD
Chief Medical Officer University of Virginia Medical Center Charlottesville | 434.924.3627 www.uvahealth.com
Carilion Clinic OB/GYN Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Dentistry Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Family Medicine Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Center for Healthy Aging Lexington | 800.422.8482 www.carilionclinic.org
Sentara RMH Hospitalists Harrisonburg | 540.689.1000 www.rmhonline.com
Carilion Clinic Rheumatology Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Pediatric Neurology Lexington | 800.422.8482 www.carilionclinic.org
North American Spine and Pain Center Harrisonburg | 540.433.1905 www.naspacmd.com
Sentara RMH Hospitalists Harrisonburg | 540.689.1000 www.rmhonline.com
Carilion Clinic Hospitalist Lexington | 540.458.3300 www.carilionclinic.org
Sentara RMH Hospitalists Harrisonburg | 540.689.1000 www.rmhonline.com
Carilion Clinic Hospitalist Lexington | 540.458.3300 www.carilionclinic.org
Carilion Clinic Cardiothoracic Surgery Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Center for Healthy Aging Lexington | 800.422.8482 www.carilionclinic.org
Sentara RMH Hospitalists Harrisonburg | 540.689.1000 www.rmhonline.com
Carilion Clinic Family Medicine Waynesboro | 540.949.8241 www.carilionclinic.org
Carilion Clinic Interventional Neuroradiology Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Palliative Medicine Lexington | 800.422.8482 www.carilionclinic.org
Carilion Clinic Pediatric Surgery Lexington | 800.422.8482 www.carilionclinic.org
Sentara RMH Hospice and Palliative Care Harrisonburg | 540.564.5600 www.rmhonline.com
www.OurHealthCville.com
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T I P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U
February is...
AMERICAN
HEART MONTH
During the month of February, Americans see the human heart as the symbol of love. February is American Heart Month, a time to show yourself the love. learn about your risks for heart disease and stroke and stay “heart healthy” for yourself and your loved ones.
Are YOU at Risk for Heart Disease? Cardiovascular disease (CVD)—including heart disease, stroke, and high blood pressure—is the number one killer of women and men in the United States. It is a leading cause of disability, preventing Americans from working and enjoying family activities.
Take it One Step at a Time You can control a number of risk factors for CVD, including: • High blood pressure • Diet • Physical activity
• High blood cholesterol
• Obesity
• Diabetes
• Tobacco use
For more information, visit www.heart.org M
M
M
M
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You can burn 400 calories per hour* shoveling snow (*Assuming a body weight of 150 lbs)
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Physical Activity is Anything that Makes You Move Your Body... AND BURN CALORIES • Physical activities that burn more calories than you might think: climbing
stairs, doing housework & shoveling snow!
• Aerobic exercise benefits your heart, and includes playing sports, walking, jogging, swimming or biking. • The American Heart Association recommends 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week to lower the risk for heart attack and stroke. M
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M
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FASCINATING
FACT
During an average lifetime,
the heart pumps million gallons of blood
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– enough to fill New York’s Central Park 50 feet deep!
Winter Fitness:
Safety Tips for
Exercising Outdoors Even though it might be cold, exercising outdoors during winter months is a great way ‘get out’, enjoy the winter views and get a breath of fresh air! Here are some tips to help stay safe and healthy when exercising outdoors during cold weather: • Dress in layers
• Pay attention to the forecast
• Be sure to protect your hands and feet
• Stay hydrated • Know the signs and symptoms of frostbite and hypothermia
• Wear a hat to help ‘keep the heat in’
Check out these ‘heart-healthy’ running events!
Adam & Eve Half Marathon & 8K M
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When: Saturday, February 14 at 8:00 am th
Location: McIntire Park, 250 Bypass and Veterans Memorial Hwy., Charlottesville
The Adam and Eve Half Marathon and 8K celebrates everyone who loves to run! It will be much more than just a Valentine’s Day run: it will be a celebration of existing relationships and a catalyst for new ones. What better way to meet someone who shares your interest than meeting them at a race! Visit www.adamandevehalfmarathon.com for more details and registration information.
When: Saturday, February 28th at 9:30 am Location: Coyner Springs Park, 2091 Lyndhurst Rd., Waynesboro This trail run style course brings excitement and vigor to those looking to participate. With an average
temperature of 45 degrees, this course will get your blood pumping and prove to be a challenge for competitors of all abilities. In addition to rolling terrain this historical stomp will include a few “battles” to test your resolve. Think of them as challenges for more than just your legs—you might even have to know a little history. Visit www.runthevalley.com for more details and registration information.
ON THE WEB
More at ourhealthcville.com (new website debuts March 2015)
www.OurHealthCville.com
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Local health. Anywhere you go. OurHealth magazine is Shenandoah Valley and Charlottesville’s only resource entirely dedicated to delivering information about local healthcare services and healthy living topics. Pick up our print edition at more than 400 locations throughout the area or get the digital edition by visiting
www.ourhealthcville.com
the
Anatomy
CHALLENGE
Here’s your chance to see how much you know about your Vestibular
System! First, fill in the word search puzzle below. Next, match up the correct word with the part of the body in the illustration.
[ the VESTIBULAR system ]
WORD SEARCH static equilibrium
otoliths
cupula
otolithic membrane
sensory nerve fibers
nerve fibers
hair cell
dynamic equilibrium
_______________________ _______________________
_______________________ _______________________
_______________________
For answers, visit OurHealth Shenandoah Valley
& Charlottesville’s Facebook page at
_______________________ _______________________
_______________________ _______________________
www.OurHealthCville.com
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abaofl r e t t a m words |RICK PIESTER
ance
It seems like a usual day. Everything’s normal. Then it comes out of nowhere.
You’re stepping off a curb and suddenly the world seems to tilt. Or, you’re going down the stairs and there’s no longer a step where you expect it to be. And down you go.
In a flash, before you can even think about it, you’re among the one in three adults over 65 who will suffer a fall each year, more than 2.4 million older Americans treated in hospital emergency departments in 2012. Maybe you’ll be lucky enough to escape serious injury, although there’s still a 50-percent chance that you will fall again soon, and next time you probably won’t be as lucky. But the chances are that you will suffer serious injury, serious enough to prevent your ability to walk a city block. And if you break a hip in the fall, as many do, there’s a pretty good chance (1 in 4) that you will die within a year.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Falls and the fear of falling are among the most serious health issues facing the growing population of older adults. Aging is no guarantee of a fall, but experts say that because of the aging process, the chances do increase dramatically. “As we age, our sense of balance does get worse,” notes Bradley Kesser, MD, an otolaryngologist (ear, nose and throat specialist) affiliated with the University of Virginia Medical Center. There’s a difference between dizziness and imbalance, Dr. Kesser notes. Dizziness, or vertigo, is when the world seems to be going ‘round and ‘round. It’s often associated with disorders of the inner ear (see the OurHealth Anatomy Challenge feature on page 19.) Imbalance is usually not announced by a feeling of dizziness. It’s a case of failures in the transmission of signals between your brain and your body. However, the gradual, age-related decline of the vestibular system (the complex structure of fluid-filled tubes in the inner ear) can also result in balance problems without a feeling of dizziness. Either way, it can be a serious problem. Falls and the fear of falling are among the most serious health issues facing the growing population of older adults. And people who restrict their activities can further reduce their independence. It’s a vicious cycle — the more inactive you become, the less you are eventually able to do, and that can well damage your overall health. Dr. Kesser explains that our sense of balance depends on what he calls a “threelegged stool” — a complicated combination of sensory factors that allow us to walk a straight line. There’s the inner ear, a sort of compass that keeps us on an even keel. There’s our vision, which provides continual clues as to where we are in space. And our muscles and joints, particularly our feet, which gives us a sense of strength, stability, and mobility. As we become older, particularly in people who are inactive, our muscle mass deteriorates and joints and ligaments lose strength, limiting our range of motion. Aging eyes can and often do develop such problems as cataracts and glaucoma, which can curb vision dramatically. Diseases like diabetes and kidney ailments can produce peripheral neuropathy, the loss of sensation in our feet. '
‘Falls’ —continued on page 22
Fall Statistics Among Older Adults • In 2012, 2.4 million nonfatal falls among older adults were treated in emergency departments and more than 722,000 of these patients were hospitalized. • Among older adults, falls are the leading cause of both fatal and nonfatal injuries.
• One out of three older adults (those aged 65 or older) falls each year but less than half talk to their healthcare providers about it. • In 2012, the direct medical costs of falls, adjusted for inflation, were $30 billion. *Source: CDC.gov
www.OurHealthCville.com
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‘Falls’—continued from page 21
Fall-Related Deaths • The death rates from falls among older men and women have risen sharply over the past decade. • In 2011, about 22,900 older adults died from unintentional fall injuries. • Men are more likely than women to die from a fall. After taking age into account, the fall death rate in 2011 was 41% higher for men than for women. Source: CDC.gov
A combination of medical causes — “co-morbidity” in medicalspeak — can further accelerate the body’s inability to respond to the brain’s commands. And medicines, particularly blood-pressure medications, can sometimes have a profound effect on our sense of balance. Sometimes, we don’t really have a sense of deteriorating balance. We create unconscious accommodations to make up for it, such as lightly touching a piece of furniture while walking through a room. We don’t recognize the signs, or simply ignore them, until that first fall.
So what are some of the signs? Physical therapists often ask new patients to stand on one foot for a moment or two, sometimes with their eyes closed. If you are unable to do that, you should speak with your physician about a possible problem with your balance. Try to walk a short distance backwards. If that doesn’t work, it may be a sign of diminished balance. Or try to walk a short distance using what’s called “tandem” walking. That’s walking with the toes of the back foot touching the heel of the front foot with each step. Or, simply talk with your physician about ordering a baseline physical evaluation, often done by physical therapists. If you have the evaluation done, even in your 40s or 50s, it can go a long way toward spotting little problems that may turn into big ones later on. And, it can set you on your way to helpful exercises that very likely will help avoid many problems as you grow older. “Imbalance is a problem that never gets better,” Dr. Kesser notes, but he says that there are a number of measures older people can take to manage difficulties with balance and prevent falls. One of the first things Dr. Kesser and many other experts recommend is to get into an exercise program tailored to improve or preserve balance. The American Geriatrics Society recommends tai chi — slow-motion Chinese exercises — as an effective way to prevent falls. Tai chi is based in part upon the correct alignment of the chest, pelvis and head to provide strength and maintain balance. The slow, controlled motions of tai chi are also a nonimpact form of exercise that builds strength without raising the fear of falling. Yoga is also great, because it also lowers the stress and anxiety felt by people with balance problems. Daily supplements of vitamin D is increasingly recommended for a constellation of health reasons, muscle strength and balance among them. In a review of nine ‘Falls’ —continued on page 23
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Yoga: it may make a difference In addition to doing wonders for your flexibility, stress levels and muscle tone, yoga has been shown in research to improve both balance and confidence. Stroke survivors who completed an eight-week course of twice-weekly yoga classes showed an impressive 15% increase on balance scores, according to study author Arlene Schmid, PhD, a rehabilitation research scientist at the Roudebush VA Medical Center and assistant professor at Indiana University. They were also more confident in their ability to perform everyday tasks, too. How does yoga do this? Yoga improves balance because it’s complex—it includes the mind and the body, and helps to coordinate movements. Whereas, simple strengthening exercises usually just work on one plane of movement. Source: Prevention.com ‘Falls’ —continued from page 22
research projects, the United States Preventive Services Task Force found that a daily dose of 800 international units (I.U.) of vitamin D reduces the risk of falling by 17 percent, compared to people who do not take the vitamin. (As with all things medical, check with your physician or pharmacist before taking any kind of medication, to avoid the risk of harmful drug interactions.) Dr. Kesser goes through a laundry list of things to do at home to reduce the risk of falls. Among them: • Drink plenty of fluids during the day. A dehydrated body can suffer dramatic drops in blood pressure, which in turn can play havoc with your sense of balance. • Slow down a bit. Take a beat or two between standing up and further movement to be sure that you have your bearings. This is especially important when getting up in the mornings, Dr. Kesser says. “All night, you’ve been lying flat, with blood pumping nicely to your brain. You wake up in the morning and sit up, and all of a sudden the heart has to pump against gravity. That’s one of the danger times for falls. So take a minute or two for the heart and blood vessels to become adjusted so that they’re moving blood to your brain efficiently. • Be careful on stairs. Not surprisingly, stairs are among the most likely places for a serious fall. Put up handrails, on ‘Falls’ —continued on page 24
Bradley Kesser, MD is an otolaryngologist (ear, nose and throat specialist) affiliated with the University of Virginia Medical Center. www.OurHealthCville.com
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‘Falls’ —continued from page 23
Fall Injuries • People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer. • Rates of fall-related fractures among older women are more than twice those for men. • Over 95% of hip fractures are caused by falls. In 2010, there were 258,000 hip fractures and the rate for women was almost twice the rate for men. Source: CDC.gov
both sides of the stairs. Dr. Kesser says it’s best for stairs to have no coverings, no carpet or runners. And keep them clear. • Use good lighting. Deploy plenty of night lights, and even motion-sensor lighting through the house, especially between bed and bathroom. • Be careful in the bathroom. Bathrooms are a big fall zone. Surfaces in the bathroom are hard and often slippery, an awful combination for bones of any age, but especially bad for the fragile bones of older adults. Install grab bars — the kind that are securely screwed in to wall studs, not the type with suction-cups — at easy-to-grab spots in the bathroom. Commodes that are built higher make sitting down and standing up easier and reduce the chance of losing balance. • Use a cane and, if you need it, a walker. There’s a lot of old-age stigma attached to them, but try to think of them as just another way to maintain contact with the floor or ground. • Keep floors clear. Newspaper and magazines, even pet toys and feeding dishes can be hazardous, as well as the pets themselves. Putting a bell on a pet’s collar or even a glow-atnight collar can reduce the chances of being tripped up by Fido or Fluffy. • Despite what some folks think, falling isn’t a natural part of aging. You can avoid falls by taking stock of your risk factors, getting the right kind of exercise, and removing the hazards that can cause trips and slips.
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FITBITS
H EA LT H A ND F I T NES S O N
Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer
THE GO
INDOOR, AT-HOME WORKOUT
Deidre is a certified personal trainer with more than 15 years experience in the health and fitness industry. She is the resident fitness specialist for OurHealth Shenandoah Valley & Charlottesville.
to Fight the Winter Blues
One day there’s snow and the next there’s rain. There may be days when getting out of the house to go to the gym is impossible. With minimal space and equipment, you can do an at-home circuit workout that will work all major muscle groups. Circuit workouts are quick and challenging, and a great alternative to the gym.
At-Home Circuit Workout
1.
Rest 20 seconds in between each exercise and do up to 3 sets total, resting a full minute in between set.
15 squats 20 second rest
2.
5.
Beginner:
Go through once.
Intermediate: Go through twice.
Advanced:
Go through three times.
15 medicine ball back extensions 20 second rest
6.
15 push-ups 20 second rest
20 side leg lifts on medicine ball right, then left 20 second rest
3.
1 minute plank 20 second rest
4.
7.
15 bicep curls with weights 20 second rest
8.
1 minute abdominal crunch 1 minute rest
20 alternating lunges 20 second rest
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(
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GOOD HEALTH to keep it, protect it words | RICH ELLIS
s it and t n a w e n . Everyo have it, until h t l a e h ys Good ’ll alwa y e h t s e believ not truly ’t. portance events im s it they don h it ted, w and pr
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Exercise Bodies are designed to move. Regular exercise is an important, proactive step toward protecting one’s health. Exercise strengthens the mind, body, and immune system and can help prevent diseases, such as diabetes or heart disease. Too often, people mistakenly think they don’t have time for exercise and understandably so in our highly scheduled society. At first glance, the Centers for Disease Control’s (CDC) recommendations for adults to perform moderateintensity aerobic exercise for two-and-a-half hours per week might seem like a lot to try and fit into an already jam-packed schedule. Spread those 150 minutes of exercise over four days, however, and suddenly it doesn’t seem so daunting. When it comes to managing schedules, making time for wellness should be at the top of the list. The CDC defines moderate exercise as anything that gets the body working hard enough to increase the heart rate and break a sweat, including brisk walking, biking or even pushing a lawn mower. In addition to the recommended 150 minutes of moderate exercise, the CDC also recommends two days per week of muscle-strengthening activity, such as lifting weights, doing push-ups and sit-ups, or heavy gardening involving raking and shoveling. For those looking to cut their exercise time commitment in half but still realize the health benefits, the CDC recommends performing vigorous aerobic exercise, defined as “breathing hard and fast, with the heart rate having gone up quite a bit,” for just 75 minutes per week, in addition to the previously mentioned strength training. Some forms of vigorous exercise include running, fast biking, and playing singles tennis or basketball. 28
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For children ages 6 to 17, the CDC recommends even more aerobic exercise with a minimum of 60 minutes of physical activity per day. Establishing physical activity as a habit early in life can help prevent the growing trend of childhood obesity and lay the foundation for healthy living later in life.
Diet While exercise can have a significant impact in preventing obesity in both adults and children, it’s not the only factor. Diet is the other half of that equation. When it’s a balanced diet, the positive health effects are powerful, and when it’s a poor diet, the results can be deadly. The United States Department of Agriculture (USDA) issues dietary guidelines periodically and recently replaced its well-known but often confusing “food pyramid” with a plate (www.choosemyplate.gov). The main, health-protecting, nutritional messages the USDA wants consumers to take from the new plate-based guidelines include the following: • Balance calories by eating less and avoiding oversized portions • Dedicate half the plate at mealtime to fruits and vegetables • Ensure that 50 percent of the grain consumed is whole grain • Switch to skim or one percent milk • Check sodium levels and reduce foods that have high levels • Drink water instead of sugary drinks It’s also important to focus on consuming foods that are lower in fat and added sugar and to balance the amount of calories being consumed with the calories being burned through activity and exercise. Too many calories taken in with not enough calories going out leads to weight gain, which can be the beginning of a slippery slope to becoming overweight or obese, the difference being that the CDC defines “overweight” as having a body mass index (BMI) of 25 or higher and “obese” as a BMI of 30 or more. Regardless, the effects of being either are incredibly detrimental to good health. According to the Centers for Disease Control at www.cdc.gov, both conditions can significantly increase risks for “coronary heart disease, type 2 diabetes, cancers, high blood pressure, stroke, www.OurHealthCville.com
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Healthy Tips from UVA Heart and Vascular Center
liver and gallbladder disease, sleep apnea, and a variety of other health-related problems.
• Make small changes to your diet, like switching to a smaller dinner plate.
Get to Sleep
• Find fun ways to get more exercise. • Get 7-9 hours of sleep per night to reduce your risk for heart disease. • Reduce stress by talking with friends, stretching or yoga-type breathing. • Figure out what changes will work for you and set reasonable goals. • Know how your weight, blood pressure and cholesterol measure up against national recommendations. Brandy Patterson, MD UVA Heart and Vascular Center and Club Red
In addition to lack of exercise and a poor diet, lack of sleep or poor quality sleep can also cause weight gain because sleep affects hormones that control appetite.
A good diet and exercise alone aren’t enough to strengthen and protect good health if sleep, and good quality sleep, are missing from the equation. Too little sleep, as well as too much sleep, affects cognitive thinking, weight gain, mental attitude, the body’s ability to resist disease, and a host of other functions. The National Sleep Foundation recommends that adults get seven to nine hours of sleep, children ages five to 17 should get 10 to 11 hours, and newborns 12 to 18 hours. Based on a recent CDC study, American workers aren’t getting anywhere near enough sleep, with more than 40 million reporting six or less hours of sleep per night. Lack of sleep has been shown to lead to an increased risk for heart disease and cancer, in addition to the risks that come with driving or operating machinery while drowsy. Whether it’s because of the sleep environment, behaviors, or medical problems, such as sleep apnea, factors that prevent someone from getting the sleep they need can often be resolved. The National Sleep Foundation provides some of the following tips to help fall asleep and stay asleep: “establish consistent sleep and wake schedules, even on weekends; create a regular, relaxing bedtime routine such as soaking in a hot bath or listening to soothing music an hour or more before the time you expect to fall asleep; create a sleep-conducive environment that is dark, quiet, comfortable and cool; sleep on a comfortable
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mattress and pillows; avoid caffeine and alcohol close to bedtime; and exercise regularly.” If sleep quality, as opposed to the amount of hours spent sleeping, is the problem, a sleep study performed at a recognized sleep center might be a recommended course of action to discuss with a physician as it can help determine if there are underlying medical conditions interfering with sleep. Even if there isn’t any reason to suspect that underlying medical conditions are impacting sleep, it’s important to establish and maintain a relationship with one’s healthcare provider in order to stay healthy.
Know Your Physician and Family Health History Much like a vehicle needs periodic maintenance, so too does the body in order to run well and long. That maintenance schedule begins early in life with childhood immunizations that protect against deadly and crippling diseases and continues throughout life with immunization boosters and regular testing to both prevent disease and detect it early, thereby improving the chances for a cure. There are a number of preventive medical tests that should be part of any proactive health plan, many of which depend on age, sex, and family health history. Because of these variables, a personal physician is often the best guide and most trusted source for information when it comes to determining when and how often routine testing should occur, including cholesterol and blood pressure screenings, mammograms, colonoscopies, or pap smears. A variety of symptomless conditions, such as high cholesterol, can be corrected if caught early – before they lead to more serious, life-threatening health issues. And, just as knowing what conditions are happening within the body, it’s also critically important to know your ancestors’ health histories and the conditions and diseases they may have suffered from. Genetics and lifestyle choices play equally large roles in determining health, but while genetics can’t be changed, lifestyle choices can.
Don’t Be a Risk Taker Taking risks that could ultimately lead to negative health consequences is a losing proposition. Tobacco usage, excessive alcohol consumption, not wearing a seat belt, not using sunscreen, and having unprotected sex are just a few behaviors that put good health and longevity at risk. Coupled with other lifestyle choices that can have significant health implications, such as exercise and diet, these risky behaviors can result in the loss of health – probably not today or even tomorrow, but down the road, when good health is needed more than ever. For many people, good health is an option and a choice, but it’s one that can only be realized through a dedicated commitment to making the right choices, starting early in life and continuing through the years.
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BARR overcoming
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RIERS FAMILY to building a words | DIANE YORK
Is infertility an epidemic? Today, according to the Society for Assisted Reproductive Technology, one of every 100 babies born has reproductive help of some type to bring it from conception to successful delivery.
Fertility problems can be numerous, including: male sperm counts, ovulation dysfunction, uterine fibroids, abnormal hormone levels, endometriosis, pelvic inflammatory disease and irregular menstrual cycles, among many others. And, in over forty percent of cases, no specific problem is identified. An important cultural change that has led to increased need for fertility treatments is that women are waiting longer to start their families. Christopher Williams, MD, of the Reproductive Medicine and Surgery Center of Virginia, author of the book, The Fastest Way to Get Pregnant Naturally, says that the age of the mother is one of the most important factors in conception. “Conception can be more difficult as women wait to start trying in their mid- thirties. Ovarian function declines with age.” When should a couple seek professional help? Dr. Williams suggests that women with no obvious problems, (like irregular cycles) can try for one year before seeking help but after age thirty-five, they should not wait longer than six months. When choosing fertility clinic he says to look for the following criteria: the clinic should be open seven days a week and the physicians should be subspecialty trained and certified in reproductive endocrinology and infertility. They should offer all levels of care. He says, “Fertility treatments are almost always ovulation-based, so the clinic and doctor need to be available every day or it can compromise your care and prolong the time it takes for you to conceive.” But, while there are many barriers to pregnancy- the good news is that never before have there been so many advanced ways to overcome them.
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Intrauterine insemination (IUI) Washed Sperm Sperm washing is the process in which individual motile or live, moving sperm are separated from the fluids and proteins in the semen. Washed sperm is used in artificial insemination using the intrauterine insemination (IUI) technique and in in vitro fertilization (IVF).
Procedure in which the man’s washed sperm is injected into the woman’s uterus with a catheter. This is generally attempted before in vitro fertilization.
Erin Rollins had tried to get pregnant for a year and a half before she came to the Reproductive Medicine and Surgery Center in Charlottesville. She had worked with her own gynecologist, trying different medications; then a fertility clinic in Northern Virginia. She had tried everything recommended except for in vitro fertilization (IVF.) She and her husband moved to Charlottesville and she forwarded her medical file to Dr. Williams at the center. “When I first met with him I could tell he had actually read my entire file and made notes on it.” While Dr. Williams could not find a definite cause, he found she was symptomatic of several problems. He performed minimally invasive laparoscopic surgery for removal of endometriosis and a cyst. “What I like best about Dr. Williams,” says Erin, “was they let me proceed at my own pace, never pushing me.” Part of her treatment was surgical and the other part was finding the right combination of medications. The doctors tried multiple intrauterine inseminations (where her husband’s washed sperm was injected into her uterus.) When these treatments did not produce a pregnancy, they underwent two cycles of IVF and then five separate transfers of resulting embryos into her uterus. In the end, they were successful. During this time, Erin asked the doctor’s office to leave the results of each attempt on her phone so she and her husband could listen to the message together. She says, “After so many sad messages, finally the one saying I was pregnant came! I called the office back to verify and the sheer joy those nurses and staff shared with me was wonderful.” After her two year struggle, Erin gave birth to a son, Christian, now age four. Some problems are easier to solve. Dr. Williams feels if a woman is having irregular cycles or has polycystic ovarian syndrome, she should see a fertility specialist right away as it is often possible to resolve those issues quickly. One of the most common problems, ovulation dysfunction, can often be solved with the pharmaceuticals, Clomiphene or Letrozole. Other problems, like blocked fallopian tubes, can be treated with surgery. He adds, “There are many simpler things to try before in vitro fertilization.”
Christopher Williams, MD of the Reproductive Medicine and Surgery Center of Virginia. Dr. Williams is the author of the book The Fastest Way to Get Pregnant Naturally
In vitro Fertilization In vitro fertilization is one of the most amazing medical techniques developed in the last thirtyfive years. While expensive, Dr. Williams says that, depending on the age of the female partner, over fifty percent of attempts are successful on the first try. In vitro fertilization, (IVF), in which embryos are created in a specialized lab and then transferred into the uterus, led to a record 61,740 births in 2012. That is 2,000 more than the previous year and 1.5 percent of all births in the nation. To begin the process, the woman is given injections of a medication that ripens the developing eggs and starts ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. After the eggs are retrieved, they are mixed with the sperm. If men have very low sperm counts, sperm can be injected directly into the egg to allow normal fertilization rates. The fertilized egg
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can be transferred into the woman’s uterus or frozen for future use. When an embryo is transferred, the hope is that it will develop and grow to full term. Erin was so thrilled with her first child that they decided to try again. This time she required the drug Clomid, which was a much simpler treatment. The in vitro fertilization was not necessary and she gave birth to another boy, Reese, who is now one and a half years of age.
The Future The future of fertility science includes such wonders as the ability of a woman to “bank” her eggs for future use if she needs to delay pregnancy for personal or medical reasons, (as in chemotherapy) Also, pre-implantation genetic diagnosis (PGD) is also commonly used now to detect a severe disease present in an embryo. If parents carry a deadly disease in their genes, they can screen the embryos for that disease. To avoid having an affected child, PGD is also commonly used to screen embryos of older women and women with recurrent miscarriage. Over fifty percent of the embryos in a woman over thirty-nine are chromosomally abnormal. There are thousands of diseases that can be screened for including ones most likely to cause miscarriage.
EGG (Oocyte) retrieval (ER) Under sedation, with ultrasound guidance, a needle is inserted into the ovary to gently remove eggs. These eggs are then fertilized with the partner’s sperm in the laboratory. Many of the eggs will fertilize resulting in embryos. One or two of the embryos are then placed in the woman’s uterus through the cervix. Additional embryos can be cryopreserved for future use.
Causes of Infertility—FEMALE Definition
Possible Solutions
Endometriosis
A condition, in which endometrial tissue (the uterine lining that grows outside the uterus,) is a major cause of infertility in women. Common symptoms: painful menstrual periods, difficulty conceiving and uncomfortable intercourse.
Surgery to remove abnormal tissue or unblock tubes and/ or fertility treatments
Ovulation Problems
Any condition (usually hormonal) that prevents the release of mature egg from an ovary. Possible symptoms: absent or infrequent periods and excessively heavy or light bleeding.
Ovulation-stimulating drugs such as Clomiphene, Letrozole (in more complicated cases), follicle-stimulating hormones, human chorionic gonadoptrophin (HCG) and in vitro fertilization (IVF) using these drugs.
Poor Egg Quality
The genetic quality of the eggs declines to such a level that pregnancy is a challenge. This problem is usually age- related. Egg quality declines significantly in the late 30s and early 40s. Possible symptoms: Usually none.
Follicle stimulating hormone. In more complicated cases egg donation or embryo donation.
Polycystic Ovarian Syndrome
Possible symptoms: irregular menstrual Ovulation-stimulating drugs such as Clomiphene, (Letrozole periods, excessive hair growth, acne and weight in a small minority of cases), follicle stimulating hormones gain. and IVF.
Female Tubal Blockages
Blocked or damaged fallopian tubes prevent eggs and sperm from getting together. Leading causes include endometriosis, previous pelvic surgery, pelvic inflammatory disease. Symptoms: None
Laparoscopic surgery to open tubes, if possible blockage. IVF may be an option.
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In Vitro Fertilization (IVF) In vitro fertilization (IVF) is the least common type of assisted reproductive treatment but the most effective. The mother-to-be injects herself (subcutaneous) with medicine designed to stimulate egg production. If multiple eggs result, they are harvested through egg retrieval. The eggs are then fertilized in the lab with sperm. One or two of the resulting embryos are then transferred to the woman’s uterus.
COST Most Virginia insurers pay for diagnostic testing of infertile couples. Sometimes treatment costs are covered depending on the employer. But it is very worthwhile to have the diagnostic testing done because as Dr. Williams says, “Most couples having trouble conceiving do not require IVF; simpler and less costly treatments are most often successful.” While the cost of IVF is high, Dr. Williams adds that many who require it conceive on the first attempt. He says, “I get great personal satisfaction helping people achieve their dreams of starting or expanding their family. It’s incredibly rewarding to meet the children of our patients. I am truly blessed to be able to do this work.” Erin suggests that it’s very helpful to find a support group. “Find or start a support group, it’s important to talk about your feelings through this process.
I was thirty-seven years old when I had my first child and forty when I had my second, so don’t give up!
Causes of Infertility—MALE Definition
Possible Solutions
Male Tubal Blockages
Any obstructions in the vas dererens or epididymis (the tubes that transport fertile sperm) Symptoms: None.
Surgery to repair the blockage or other obstruction. Testicular extraction of sperm followed by IVF.
Poor Sperm Quality
Low sperm counts, poor sperm motility (the ability to move), and abnormally-shaped sperm can all cause infertility. Varicoceles (varicose veins) in the testicles. Symptoms: None.
Fertility Drugs may boost sperm production. Other options include intrauterine insemination (IUI) and IVF by injecting sperm directly into the egg (intracytoplasmic sperm injection) Also, surgery to correct varicocele.
Sperm Allergy
Less than one percent of infertile women and men have clinically significant immune reactions to sperm, which cause them to produce antibodies that kill sperm cells. In men, this is most common after a vasectomy. Diagnosis of a sperm allergy is controversial. Symptoms: None.
Sperm washing and intrauterine inseminations often combined with IVF in more severe cases
Unexplained Infertility
This catch-all term is used when doctors can't find a cause for infertility after a full services of tests and assessments. It can be due to problems not able to be discovered in a routine evaluation, such as fertilization failure, endometriosis or DNA damage in eggs or sperm. Symptoms: None.
It is common for fertility doctors to recommend laparoscopy to diagnose and treat endometriosis when found. Alternatively, trying fertility drugs combined with IUI is often successful. For those who don't conceive, IVF is the next step.
Source: www.babycenter.ca/a6020/major-causes-of-infertility
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2015 Heart Health Resource Guide
Where to Go for heart Healthcare
The Heart and Vascular Center at Augusta Health 78 Medical Center Dr. Fishersville, VA 22939 www.augustahealth.com •••••
Carilion Clinic Cardiology Lexington 108 Houston St., Suite E Lexington,VA 24450 540.463.2227 www.carilionclinic.org •••••
Martha Jefferson Hospital Cardiology Martha Jefferson Hospital 500 Martha Jefferson Dr. Charlottesville, VA 22911 434.654.7009 www.mjhcardiology.org •••••
University of Virginia (UVA) Heart and Vascular Center heart.uvahealth.com
UVA Locations for Care: • Adult Congenital Heart Disease Clinic
Battle Building | 1204 W. Main St. Charlottesville, VA 22908 434.924.9119
• Advanced Cardiac Valve Center University Hospital, 2nd Floor 1215 Lee St. | Charlottesville, VA 22908 434.243.1146
• Advanced Heart Failure and Transplant Center
• Atrial Fibrillation Center Primary Care Center, 2nd floor 1221 Lee St. | Charlottesville, VA 22908 434.924.0393
• Cardiac Catheterization Lab University Hospital, 2nd Floor 1215 Lee St. | Charlottesville, VA 22908 434.243.1000
• Cardiac Device Clinic Primary Care Center, 2nd Floor 1221 Lee St. | Charlottesville, VA 22908 434.924.9527
• Cardiac Surgery Clinic University Hospital, 2nd floor 1215 Lee St. | Charlottesville, VA 22908 434.243.1000
• Cardiovascular and Pulmonary Rehabilitation and Wellness Northridge Medical Park 2955 Ivy Rd. (250 West), Suite 105 Charlottesville, VA 22903 434.243.4600
• Cardiovascular Genetics Clinic Primary Care Center 1221 Lee St. | Charlottesville, VA 22908 434.243.1000 (adult) 434.924.9119 (pediatric)
• Echocardiography Lab
Primary Care Center, 2nd Floor 1221 Lee St. | Charlottesville, VA 22908 434.243.1000
• Electro-physiology Clinic Primary Care Center, 2nd floor 1221 Lee St. | Charlottesville, VA 22908 434.243.1000
• Heart and Vascular Center University Hospital, 2nd Floor 1215 Lee St. Charlottesville, VA 22908 434.243.1000 ‘UVA locations’ —continued on page 38
Primary Care Center, 2nd Floor 1221 Lee St. | Charlottesville, VA 22908 434.243.1000
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‘UVA locations’ —continued from page 37
• Heart and Vascular Center at Northridge Northridge Medical Office, Suite 201 2955 Ivy Rd. (250 West) Charlottesville, VA 22903 434.243.4520
• Nuclear Cardiology and Stress Lab University Hospital, 2nd Floor 1215 Lee St. | Charlottesville, VA 22908 434.924.5265
• Transplant Clinic (Heart) Primary Care Center 1215 Lee St., 2nd Floor Charlottesville, VA 22908 800.257.0757
• UVA Specialty Care Augusta Cardiology and Vascular 57 Beam Ln., Suite 205 Fishersville, VA 22939 540.213.9550
• UVA Specialty Care—Culpeper 541 Sunset Ln., Suite 103 Culpeper, VA 22701 540.829.1919
Independent Cardiology/ Cardiovascular Medical Practices Blue Ridge Heart and Vascular
434.296.9596 | www.blueridgeheart.com
Locations for Care:
• Blue Ridge Heart and Vascular– Main Office 300 Hickman Rd., Suite 202 Charlottesville, VA 22911
• Blue Ridge Heart & Vascular– Forest Lakes Office 3263 Proffit Rd. Charlottesville, VA 22911
Local Screenings
& Heart Health Events Augusta Health • Shenandoah Valley Stroke Club When: February 6, 2015 12:00 pm - 2:00 pm Where: For additional information about the location and to make reservations, call Shelley at 540.332.4047 or 540.932.4047. For those who have suffered a stroke and their family members, partners and friends.
Martha Jefferson Hospital • Heart Healthy Supermarket Smarts When: February 9, 2015 6:30 pm - 7:30 pm Where: Giant Food on Pantops | Rivanna Ridge Shopping Center 1900 Abbey Rd.| Charlottesville, VA 22911 Learn how to shop heart healthy by selecting foods lower in saturated fat, trans fats and sodium, as well as higher in fiber, potassium and antioxidant vitamins. Taught by a Martha Jefferson Hospital registered dietitian. This class is free, but registration is required. For more information and to register, call Health Connection at 434.654.7000
• Pump and Circumstances When: February 10, 2015 1:00 pm - 2:00 pm Where: Martha Jefferson Health and Wellness 590 Peter Jefferson Pkwy, 2nd Floor | Charlottesville, Virginia 22911 This is a free, two-part class that goes over the causes and symptoms of chronic heart failure. We discuss ways to reduce impact and optimize health through proper nutrition, exercise, medication and other disease management strategies. For more information and to register, call Health Connection at 434.654.7000
• Get Cholesterol Down Now! When: February 19, 2015 from 9:00 am - 10:00 am Where: Martha Jefferson Education Center | 400 Martha Jefferson Dr. Charlottesville, VA 22911 This one-hour seminar will help you learn how to reduce total cholesterol, LDLcholesterol and triglycerides through your food choices and exercise. Topics covered include label reading, meal planning ideas, food preparation tips, and choices for healthy fats and high-fiber foods that can work to lower your numbers. Taught by Martha Jefferson Hospital registered dietitians. There is a fee for this class. Martha Jefferson Hospital will bill your insurance company, since many will cover the cost. For more information or to register, call Health Connection at 434.654.7000.
• Blue Ridge Heart & Vascular– Crozet Office
Beginning March 2015
1646 Park Ridge Dr. | Crozet, VA 22932
Cardiovascular Associates of Charlottesville 650 Peter Jefferson Pkwy, Suite 100 Charlottesville, VA 22911 434.293.4072 www.cvilleheart.com
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For a complete listing of local screenings and health events, be sure
OurHealth Shenandoah Valley & Charlottesville Calendar of Events on our website to check the
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
at www.ourhealthcville.com
Common
Heart & Vascular Conditions* Aneurysm: The bulging of an artery caused by uncontrolled blood pressure, injury or weakness. As the aneurysm continues to grow, it may rupture or leak and cause massive internal bleeding. Aortic Dissection: A tear in the lining of the aorta (the largest blood vessel in the body) which can cause it to rupture, causing serious internal bleeding. Atrial Fibrillation: A disorder in which the heart beats in an irregular, chaotic rhythm. Atrial or Ventrical Septal Defect: When a hole in the wall that separates the right and left lungs causes excess blood flow to the lungs. Blood Clot (thrombosis): A hardened glob of blood within an artery or vein which breaks away and blocks the flow of blood to a particular area of the body. Chest Pain (angina): Pain in the chest, arms, shoulders, neck or jaw caused by narrowing of the coronary arteries, thus resulting in an insufficient supply of blood and oxygen to the heart. Coarctation of the Aorta: Constriction of the large blood vessel (aorta) as it curves down to supply the lower body, thus causing an elevation in blood pressure before the narrowed area. Coronary Artery Disease: When the arteries that carry blood to the heart become blocked or narrowed by a gradual buildup of fat (cholesterol). Diabetes: A disease in which the amount of sugar (glucose) in the blood is too high, because the pancreas either cannot produce or use insulin. When blood sugar is not turned into energy, it
Where to Find
Knowledge & Support Heart Health Resources • American College of Cardiology – Virginia Chapter 3445 Seminole Trail, Suite 253 | Charlottesville, VA 22911 877.793.8171 | www.vcacc.org
• American Heart Association – National Chapter 272 Greenville Ave. | Dallas, TX 75231 | 800.242.8721 | www.heart.org
• American Heart Association – Nearest State Chapter 4217 Park Place Ct. | Glen Allen, VA 23060 | 804.747.8334
• Club Red – A UVA Heart and Vascular Center Initiative For more information on upcoming events and healthy living tips throughout the year from the University of Virginia Heart and Vascular Center, visit Club Red – a women’s heart-health initiative at www.clubreduva.com
• Heart Rhythm Society 1325 G St., NW, Suite 400 | Washington, DC 20005 | 202.464.3400 www.hrsonline.org
Local Heart Health Support Groups • Heart to Heart Support Group When: February 26, 2015 | 6:00 pm –7:30 pm Where: Martha Jefferson Hospital Outpatient Care Center | 595 Peter Jefferson Pwky. Kessler Conference Room | Charlottesville, VA 22911 Recovery after a serious heart event involves more than physical healing — coping with related emotional changes takes time, too. The Heart to Heart program offers education, discussion and reassurance with structured meetings that include a presentation by a physician and time for discussion and questions. This is a free support group.
Heart attack and stroke are life-anddeath emergencies — every second counts. If you see or have symptoms (see list on page 41), immediately call 9-1-1 to get help right away!
‘Common Conditions’ —continued on page 40 www.OurHealthCville.com
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‘Common Conditions’—continued from page 39
Heart & Cardiovascular
Disease
Questions to Ask Symptoms vary depending on what kind of heart or cardiovascular disease you have, but informing your doctor of any chest pain, shortness of breath, or pain or numbness in your limbs could save you from having a heart attack, stroke, or worse. If you haven’t yet been formally diagnosed with heart or cardiovascular disease, and you suspect your may, talk to your doctor about arranging a cardiac evaluation. Once you have a formal diagnosis and know which type of heart or cardiovascular disease you have, your doctor will give you information about the condition and recommend a course of treatment. You'll probably have questions and concerns about your diagnosis and how heart or cardiovascular disease will affect your overall health and your life. Consider asking your doctor the following: • I have a family history of heart disease; how might that affect my health? • Are there any pretest restrictions I need to know about? For example, do I need to fast if I’m going to have a cholesterol test? • What form of heart or cardiovascular disease do I have? What is the severity? What is my prognosis? • What does high blood pressure (hypertension) have to do with heart and cardiovascular disease? Should I be concerned about high blood pressure? Do I need to lower my blood pressure? If so, how? • What role does cholesterol play in heart and cardiovascular disease? Do I have high cholesterol? Do I need to lower my cholesterol? If so, how? • What role does diabetes play in heart disease? Do I have diabetes? Do I need to lower my blood sugar? If so, how? • What caused my heart condition? Did I do something to cause it? Is heart disease a hereditary condition? • Am I at risk for a heart attack? What symptoms would indicate a heart attack? • What is the best method of treatment for my heart or cardiovascular disease? • What are the risks of not treating my heart or cardiovascular disease? • How will my heart or cardiovascular disease affect me over the long term? • Do I need surgery for my cardiovascular disease? Will I need surgery in the future? • What should I do if my symptoms worsen? Source: www.everydayhealth.com
can accumulate in the bloodstream and damage the heart. Heart Attack (acute myocardial infarction): A complete blockage of blood flow in an artery leading to the heart. Heart Failure: When the heart loses its ability to pump enough blood, because the heart muscle has been weakened or injured by high blood pressure or a heart attack. Heart Rhythm Disorder (arrhythmia): An unusual rhythm of the heartbeat, either too fast or too slow. High Blood Pressure (hypertension): When the pressure of the blood is so great against the walls of the artery, it causes the heart to work harder to pump blood throughout the body. Mitral Valve Prolapse: A leak in the mitral valve, which controls blood flow through the left side of the heart. Patent Ductus Arteriosus (PDA): When the PDA artery present in the fetus fails to close properly, causing an excess blood flow to the lungs. Peripheral Vascular Disease: When the same fat buildup that causes coronary artery disease occurs in arteries and veins supplying blood to other areas of the body. Stroke: The condition that occurs when an artery or vessel that supplies blood to the brain either bursts or is blocked by a clot. Within minutes, the nerve cells in that area of the brain are damaged, and they may die within a few hours. Sudden Cardiac Death: Death caused by dangerously fast electrical signals that limit the heart’s ability to pump blood to the body and brain. Tetralogy of Fallot: Four cardiac malformations that appear together. Due to a hole in the wall between the ventricles and a narrowing in the outlet, blood lacking in oxygen is directed away from the lungs until the baby becomes increasingly blue. *Source: healthwise.net
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Helpful Tips for
Heart Health
Some risk factors for heart disease are beyond our control. But the good news is that there are many lifestyle choices you can make to help you take charge of heart health and reduce your risk of heart disease. • Maintain Regular Doctor Visits Even if you feel healthy and have few risk factors for heart disease, you should still make regular appointments with your doctor. It’s important to take control of your health. An important part of doing this includes being proactive about preventive care.
• Quit Smoking It’s a well-known fact that smoking is bad for your health. In fact, smokers can be at two to three times greater risk of developing heart disease than nonsmokers. So if you smoke, be sure to make time to talk to your doctor about how to quit.
• Eat Smart By eating a diet low in saturated fat and cholesterol, you can reduce your risk for heart disease. This includes foods such as fish, poultry, lean meats, low-fat or nonfat dairy products, and plenty of fruits and vegetables. In addition, to help lower blood pressure, strive to limit your daily sodium intake to less than 1500 mg per day.
• Be Active* Just as eating well is important to your health, it’s just as important to make exercise part of your daily routine. Regular physical activity not only can help people lose weight, it’s also good for your heart! Studies show that physically active people have a lower risk of heart disease than sedentary ones. The American
.
Heart Association recommends 40 minutes of aerobic exercise, at a moderate to vigorous intensity, three to four times per week.
• Watch Your Alcohol Intake Although many studies have debated the connection between drinking alcohol and heart health, drinking too much can have a negative impact on your health. Overindulging in alcohol can put you at risk for high blood pressure, obesity, stroke, and breast cancer. If you plan to drink alcohol, do so in moderation.
• Take Charge It’s important to set realistic and achievable goals that can become part of your life and routine.
• Make yourself a priority By maintaining your health, you’ll be better prepared to be your best at work, at home with family, or anywhere else.
• Tackle your health as a team It’s essential to have open communication and regular dialogue with your doctors to identify the best approach to supporting your health.
• Seek out support Partner with friends and family to help you accomplish your goals. Support a healthy lifestyle by connecting with other people who enjoy similar activities, such as biking or sharing health recipes.
• Celebrate your success. Feeling good about yourself and reinforcing the positive steps you’re taking will help you stay on track for success. Source: www.truheart.com *Be sure to check with your doctor before starting any kind of exercise routine.
Warning Signs of
Heart Attack, Cardiac Arrest & Stroke Signs of Heart Attack
Signs of Cardiac Arrest
• Chest Discomfort
• Sudden loss of responsiveness • No response to tapping on shoulders • No normal breathing
Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in Other Areas of the Upper Body • Shortness of Breath
Stroke Warning Signs • Face Drooping Does one side of the face droop or is it numb? Ask the person to smile.
• Arm Weakness Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• Speech Difficulty Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like “the sky is blue.” Is the sentence repeated correctly?
TIME TO CALL 9-1-1 If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.
Rockbridge Area YMCA The goal at the Rockbridge YMCA is to improve lifestyle health—striving to develop a culture of wellness. They help people reduce the common risk factors associated with chronic disease—emphasizing prevention for all people—whether they are healthy, at-risk, or reclaiming their health. The Rockbridge YMCA offers over 60 group exercise classes each week, for all abilities and age groups. Trained staff are onsite to help members achieve their wellness goals. In addition to wellness, the Y also offers classes in healthy cooking for older adults, after-school programs, a variety of summer camps and a monthly ‘coffee house’ social for adults with disabilities. For more information on the many programs and services offered at the Rockbridge area YMCA, visit them online at: www.ymcarockbridge.com.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Waynesboro Family YMCA The Waynesboro Family YMCA is a cause-driven organization, with a mission for youth development, for healthy living and for social responsibility. There is something for everyone at the Y! Group fitness, water and active older adult classes, as well as a wide variety of youth sports and fitness programs. To learn more about the Waynesboro Family YMCA, visit www.waynesboroymca.com or call 540.943.9622.
ON THE WEB
More at ourhealthcville.com (new website debuts March 2015)
www.OurHealthCville.com
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Breaking the Silence
Aneurysm words | SUSAN DUBUQUE
This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them. That is, until now. In each edition of OurHealth, we bring these diseases into the light—and dedicate these stories to the courageous patients and families living with them and the providers and researchers who commit their lives to treating and seeking cures for these silent killers.
Vivian’s Story She’s a lifelong fitness fanatic—a coach, personal trainer and fitness instructor. And she’s a fierce competitor—completing countless triathlons and halfmarathons and racing with a professional cycling team. But nothing could prepare Vivian for the challenge of her life—a brain aneurysm. “It started in February 2011. I’ve been health conscious all my life and I am really in tune with my body—so I knew something was seriously wrong,” says Vivian Arenas. “I had these incredible dizzy spells and it got so bad that I almost passed out several times.” Those were the initial symptoms that sent Vivian to her family physician, Tom Reynolds, MD, and then on for a complete cardiac workup. Her heart was perfectly fine, but the symptoms kept coming back. The culminating event happened while Vivian’s husband, Bruce, was out of town on a skiing trip. The bouts of dizziness and palpitations got so severe that she had to call her husband in Colorado and ask him to come home.
‘Aneurysm’—continued on page 46
Vivian, of Culpeper, with her granddaughter, Aurelia
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‘Aneurysm’—continued from page 44
Vivian’s doctor ordered an MRI of her head and, when those results were inconclusive, an MRI with contrast. “I was terrified,” recalls Vivian. “I really thought I had a brain tumor—and I desperately wanted to be here for my family. I wanted to live to see my youngest daughter graduate from college that spring and someday play with my grandchildren.” above and at right: Vivian, a lifelong fitness fanatic, at a few of her many triathlons and half marathons.
Vivian’s brain scans were sent for evaluation to Kenneth Liu, MD, a neurosurgeon at UVA Neurosciences Center. “I’ll never forget Dr. Liu’s exact words when he called us with his findings,” says Vivian. “‘You have an aneurysm that is ready to misbehave.’” Two days later, Vivian met with the specialist to discuss treatment options. “He had a confident, reassuring manner that made me feel that I was in good hands,” says Vivian. Based on the location and nature of Vivian’s aneurysm, Dr. Liu recommended a treatment plan that involved taking a blood thinner for two weeks followed by surgery. “That was the longest two weeks of my life,” says Vivian. “The hardest part was not being able to exercise or be active. “I didn’t tell anyone that I was having brain surgery,” says Vivian. “I didn’t want a pity party.” Finally, the day arrived—and on April 4, 2011, Vivian underwent endovascular surgery—a minimally invasive procedure to repair her aneurysm. “I was scared to death,” says Vivian. “I was afraid of dying or being seriously debilitated by the surgery. It may be called ‘minimally invasive,’ but after all, it is still brain surgery.” Vivian was comforted by having her husband and two daughters, Natalie and Monica, with her every step of the way. And she was fortified by her strong faith and the support she received from her minister, Dr. R. Wayne Bernardo.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Vivian made a remarkable recovery. She was able to go home the day following her surgery and returned to her job as a dental hygienist only one week later. “I was pretty exhausted for a few weeks after getting out of the hospital,” says Vivian, “and in hindsight, I should have taken it a little easier. For anyone going through this, I would recommend counseling to help with the fear and uncertainty, as well as being kind to yourself and taking time to heal.” Her follow-up care consisted of a brain MRI six months after surgery and then once a year thereafter. “My last MRI showed no indication that I had ever had an aneurysm.” Vivian’s appreciation for her physicians and the care she received at UVA runs deep. She will unabashedly tell anyone who asks that Dr. Liu saved her life. In gratitude, Vivian sponsored a 5k race as a fund-raiser for brain aneurysm and donated the proceeds to medical research. She also dedicated a show on a television program that she hosts, called Out and About with Coach Vivian, to stroke awareness.
from left: Vivian and her daughter, Natalie, at a local triathlon.
But perhaps the greatest outcome of Vivian’s recovery is the joy she receives and the value she places on every day of her life. “My mantra is simple,” says Vivian. “Today is all I have. Let’s go get this! I’ve always loved life, but somehow coming out the other side of an experience like this just makes every moment a little sweeter.” And the sweetest moments of all are when she gets to hold Aurelia, her 5-month-old granddaughter.
It’s time to learn more about brain aneurysms—the nature of the condition, various causes, risk factors, treatment options and what the future holds.
Understanding Aneurysms A brain aneurysm—also called a cerebral aneurysm or intracranial aneurysm (IA)— is a weak, bulging spot on the wall of an artery that supplies blood to the brain. “Envision, if you will, a balloon with a thin spot,” describes R. Webster Crowley, MD, a neurosurgeon at UVA Neurosciences Center. “Over time, blood flowing through the artery can cause the weakened wall to bulge and swell outward. Occasionally, pressure may cause the aneurysm to rupture and release blood into the skull around the brain.” This is referred to as a subarachnoid hemorrhage or, more commonly, a hemorrhagic stroke. Most brain aneurysms are small—from 1/8 inch to less than one inch. Aneurysms larger than one inch are called “giant” aneurysms and can pose a particularly high risk. “Brain aneurysms are most prevalent in adults ages 35 to 65,” says Dr. Liu, “although I have treated patients from less than one year to 93 years old.” Aneurysms may be caused by high blood pressure, congenital (present at birth) abnormalities in the artery, infection, trauma or injury to the brain, a tumor or plaque ‘Aneurysm’—continued on page 49 www.OurHealthCville.com
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[ www.ourhealthcville.com ]
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
‘Aneurysm’—continued from page 47
buildup on the artery walls. A number of factors increase your chance of developing a brain aneurysm, including: • Age over 40 • Gender (women are more likely to have an aneurysm than men) • Family history of brain aneurysm • Smoking • High blood pressure • Drug use, particularly cocaine and amphetamines • Certain medical conditions such as Marfan syndrome, polycystic kidney disease and fibromuscular dysplasia Brain aneurysms are not as rare as you may think. In fact, six million people in the United States have unruptured brain aneurysms—that’s one in 50 people. “Most aneurysms are harmless and have no symptoms,” says Dr. Crowley. “They are often discovered when a patient has a test to evaluate an unrelated condition such as a head injury.” There are instances, however, when an unruptured aneurysm is pressing on an area of the brain that does cause problems, such as headaches, pain above and behind the eye, blurred vision, numbness and changes in speech. Every year about 30,000 people in this country suffer a brain aneurysm rupture. The symptoms of a ruptured aneurysm may come on suddenly and include: • Severe headache, often described as the worst headache of your life • Stiff neck • Nausea and vomiting • Sensitivity to light, fainting or loss of consciousness
“I’ve been health conscious all my life and I am really in tune with my body—so I knew something was seriously wrong,”
• Blurred or double vision • Pain above or behind the eye • Seizures
says Vivian.
• Weakness or numbness • Trouble walking or dizziness • Change in mental status or awareness A ruptured aneurysm is a life-threatening condition. If you experience some or all of these symptoms, or you observe them in someone else, don’t wait. Call 911 immediately. When an aneurysm leaks or ruptures, it can result in a number of serious complications. Blood can enter the space around the brain called the subarachnoid space. As the blood clots, it can irritate damage or destroy nearby brain cells. A ruptured aneurysm can also cause a buildup of pressure on the brain, called hydrocephalus. A “shunt” may be placed in the ventricles to drain off the blood and reduce the pressure. A third complication of a ruptured aneurysm is called vasospasm. Here, the blood vessels constrict and narrow, reducing the blood flow to the brain. Certain medications and the use of balloons to open the vessels may be used to treat vasospasm. Ruptured aneurysms are fatal in about 40 percent of cases, and patients who survive are likely to have serious neurological disabilities. ‘Aneurysm’—continued on page 51
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‘Aneurysm’—continued from page 49
How Is an Aneurysm Diagnosed and Treated? Aneurysms are diagnosed using a variety of imaging techniques—CT scan (computed tomography), MRI (magnetic resonance imaging) or angiogram. In some cases, a contrast dye is injected into a vein to enhance the image. Millions of people are walking around with brain aneurysms and don’t even know it. “We suspect that the number of brain aneurysms has not increased,” says Dr. Crowley, “but they are being diagnosed with greater frequency due to the increased use of these imaging studies.” If an unruptured aneurysm is detected, a number of things will determine whether it should be treated or if watchful waiting is the best course of action. “We consider the size and location of the aneurysm and the patient’s age, general health and family history,” says Dr. Liu. “Then we will weigh the risk of the aneurysm rupturing against the risk of treatment. Of course, the patient and family are actively involved in the decision-making process.” Dr. Crowley describes the two general types of treatment that are used to treat aneurysms—clipping and coiling. These same procedures are used to treat both ruptured and unruptured aneurysms. Clipping is an effective and well-researched surgical treatment for aneurysm that has been used since the 1930s. The patient is put under general anesthesia, and the neurosurgeon makes an incision in the scalp and a small opening in the skull. Working under a microscope, the surgeon approaches the aneurysm in the space between the brain and the skull, not through brain tissue. The neck of the aneurysm is then sealed off with a tiny titanium clip that prevents blood from entering the aneurysm. As a result, the aneurysm cannot grow and future bleeding or rupture is avoided. The skull bone is replaced and held in place with a tiny metal plate and screws and the incision is closed.
“I was pretty exhausted for a few weeks after getting out of the hospital,” says Vivian, “and in hindsight, I should have taken it a little easier. For anyone going through this, I would recommend counseling to help with the fear and uncertainty, as well as being kind to yourself and taking time to heal.”
Coiling—or endovascular embolization—is a newer procedure that became available in the 1990s. Endovascular means “within the blood vessel,” and that is just how the brain is accessed—through an artery. A neurosurgeon or interventional radiologist performs this procedure by making an incision in the artery—most commonly the femoral artery located in the upper thigh. A catheter (hollow plastic tube) is placed in the artery and carefully guided through the blood system to the brain. The physician uses continual X-ray visualization throughout the process. Once the aneurysm is located and evaluated, tiny platinum coils are placed in the neck of the aneurysm to reduce or block the flow of blood. The blood then clots around the coils, essentially sealing off the aneurysm and preventing it from progressing or bleeding. In some instances, the opening of the aneurysm may be wide. Here, a balloon or stent (small mesh tube) may be used to assist in the coiling procedure. If the balloon is used, it is deflated and removed once the coils are in place. If a stent is used, it is permanently placed inside the artery, where it serves as scaffolding to hold the coils in place in the neck of the aneurysm. ‘Aneurysm’—continued on page 52 www.OurHealthCville.com
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‘Aneurysm’—continued from page 51
“My mantra is simple,” says Vivian. “Today is all I have. Let’s go get this! I’ve always loved life, but somehow coming out the other side of an experience like this just makes every moment a little sweeter.”
“There are advantages and disadvantages of both coiling and clipping,” says Dr. Crowley. “While coiling is a less invasive procedure, clipping may be more durable. That’s why it is important to consider the whole medical picture when helping a patient to make an informed decision about the best option to treat his or her aneurysm.” “For some patients with unruptured aneurysms—particularly those who are elderly, medically fragile or whose aneurysms are small (less than 3 mm or about 1/8 inch)—a very conservative ‘wait and watch’ approach may be recommended,” says Dr. Liu. In these cases, the patent is advised to keep his or her blood pressure under excellent control and avoid smoking and heavy alcohol intake to reduce the risk of the aneurysm progressing and rupturing. Repeated brain imaging will be used to monitor the situation and determine if more aggressive treatment is warranted.
What Does the Future Hold? The newest innovation for treating aneurysms is called flow diversion. “The FDA (Food and Drug Administration) has approved one such device—called Pipeline®— with two more presently in clinical trials,” reports Dr. Crowley. A flow-diverting stent is placed inside the artery across the opening of the aneurysm. It “diverts” the blood flow away from the aneurysm and in a short period of time the aneurysm clots off. “Whenever you enter an aneurysm to insert a coil, there is a risk of causing bleeding or rupture. Since the flow-diverting stent doesn’t require the surgeon to actually manipulate the aneurysm, this may offer a safer alternative, especially for large or ‘giant’ aneurysms.” Aneurysms are a major health issue in the United States—and pose a serious threat to millions of people. While we can’t control our genetic make-up and any possible predisposition to aneurysms, there are steps we can take to protect ourselves. “The most important things you can do to reduce your risk,” says Dr. Crowley, “are don’t smoke, work with your physician to monitor and manage your blood pressure and know the warning signs and symptoms of aneurysm.” Fortunately, Vivian didn’t hesitate to seek medical help. And with expert intervention, she now can look forward to many years of vibrant health, completing more triathlons and, most of all, enjoying watching her grandchild grow.
Medical Experts • R. Webster Crowley, MD, Co-director, Division of Cerebrovascular and Endovascular Neurosurgery; Assistant Professor of Neurosurgery and Radiology, Department of Neurosurgery, University of Virginia • Kenneth Liu, MD, Co-Director, University of Virginia Stroke Center; Co-Director, Division of Cerebrovascular and Skull Base Surgery; Assistant Professor of Neurosurgery and Radiology, Department of Neurosurgery, University of Virginia
Sources ON THE WEB
More at ourhealthcville.com (new website debuts March 2015)
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• Brain Aneurysm Foundation (www.bafound.org)
Learn more • neuro.uvahealth.com • www.facebook.com/kenneth.c.liu.md
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Healthy Eats
h e a r t h e a lt h y r e c i p e s EntrĂŠe: Lemon Honey Salmon Yield: 6 servings
Ingredients: 6
6 oz salmon fillets
1 lemon 1 teaspoon rosemary 1 teaspoon basil 1 teaspoon black pepper 1
clove garlic, sliced
1/2 red onion, sliced 2 tbsp olive oil 2 tbsp honey
Directions: 1. Zest and squeeze the juice from the lemon. 2. Mix all other ingredients together with the exception of the salmon in a sealable freezer bag. 3. Add the fish and toss to coat. Place in refrigerator for 6 to 8 hours. 4. Bring grill pan to a mediumhigh heat. 5. Allow salmon to come to room temperature as the pan heats. 6. Place the fish on the grill for about six minutes per side or until it begins to flake.
Local salmon from: Seafood @ West Main
7. Remove from grill and serve.
416 West Main Street | 434.296.8484 www.sfdatwestmain.com sfdatwestmain2@embarqmail.com Seafood @ West Main is a local, family-owned business located in downtown Charlottesville, VA. They offer fresh fish, certified shellfish and a wide variety of seafood available for wholesale and or retail. They also offer sashimi-quality fresh fish, Japanese groceries, and expertly prepared Sashimi trays.
Tricia Foley says
LEMON HONEY SALMON Tricia Foley is OurHealth Magazine’s resident nutritionist
Healthy Eats
h e a r t h e a lt h y r e c i p e s
Roasted Vegetables from:
Bellair Farm
5375 Bellair Farm | Charlottesville VA 22902 434.262.9021 | www.bellairfarm.com Bellair Farm is located on historic Bellair Farm just outside of Charlottesville. They offer a CSA and are committed to providing its member families with the freshest vegetables available. They produce fifty different types of vegetables with hundreds of varieties to choose from. They pride themselves on using organic standards. Families are encouraged to come straight to the farm where they can “PickYour-Own” produce while experiencing the harvest first hand.
Side: Herb Roasted Vegetables
1/4 teaspoon sea salt 1/4 teaspoon pepper
Directions:
Ingredients: 2 medium sweet potatoes cut into 1 inch cubes 2 carrots, cut into 1-inch chunks 1 C cauliflower, chopped 1 medium red onion, quartered 1 tbsp olive oil 3 cloves garlic, minced 2 teaspoons dried herbs (including thyme, rosemary, and oregano)
1. Place sweet potatoes, carrots, cauliflower and red onion in a 13x9x2-inch baking pan. 2. Combine oil, garlic, mixed herbs, salt, and pepper. 3. Drizzle over vegetables and toss to coat. 4. Cover with foil. Bake in a 425ºF oven for 30 minutes. 5. Remove foil; mix vegetables. 6. Bake, uncovered for five to ten more minutes or until tender.
Tricia Foley uses
HERB ROASTED VEGGIES Tricia Foley is OurHealth Magazine’s resident nutritionist
www.OurHealthCville.com
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Healthy Eats
h e a r t h e a lt h y r e c i p e s
Local Walnuts and Blackberries From: Ayrshire Farms 21846 Trappe Rd. | Upperville, VA 20184 540.592.7018 | www.ayrshirefarm.com Ayrshire Farms is a certified organic farm offering an array of produce, nuts and meat. It is a working manor farm, priding itself on efficiency, sufficiency and serenity. Visit the farm or shop online at: www.shop.ayrshirefarm.com
Dessert: Kiwi Blackberry Creamy Oats
Directions:
Yield: 2 servings
1. Combine oats, Greek yogurt, walnuts and unsweetened almond milk.
Ingredients
2. Divide into 2 half pint mason jars. Cover and refrigerate overnight.
½ cup old fashioned oats ½ cup plain Greek yogurt 1 tbsp walnuts
3. Divide the fruit in half and add to each mason jar. Enjoy!
⅔ cup unsweetened almond milk
4. You may refrigerate up to 3 days.
1 kiwi, peeled and diced ¼ cup fresh (or frozen) blackberries
Tricia Foley’s
KIWI BLACKBERRY OATS Tricia Foley is OurHealth Magazine’s resident nutritionist
Photo Courtesy of: Virginia Military Institute Archives
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