OurHealth Charlottesville & Shenandoah Valley Jul/Aug 2015 Edition

table of contents | july • august 2015

18

Exploring Total Reverse Shoulder Replacement

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.........................14 Interesting facts and tidbits about health

THE ANATOMY CHALLENGE..................................17

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School Times

Schools provide parents with a list of supplies needed for the new school year, but left off that list are steps to ensure a child's good health. In this issue, OurHealth provides parents with a step-by-step resource full of valuable physical, emotional, and social information to consider, as well as tips from local healthcare and heathcare-realted providers from Charlottesville and the Shenandoah Valley to help your children make healthy choices all year long.

Are you up for the challenge? In this issue, test your knowledge when it comes to the SHOULDER.

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The results are in!

Senior Living Awards Sen

Sen

Sen

Living Aw ior

ds ar

ior

Living Aw

ds ar

46

ds ar

Living Aw ior

hello, HEALTH!.............................. 44 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos

[series]

Breaking the Silence: Huntington's Disease

This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now.

FIT BITS!........................................54 STRETCH IT OUT! Many people neglect this aspect of their fitness regime, because they don’t understand that stretching has major benefits. Hopefully these reasons will inspire you to make it part of your schedule!

NUTRITION.................................. 55 HEALTHY EATS: Eat Local! Local Grown Sweet Grilled Corn, Bison Burger and Watermelon Sorbet!

CLOSER LOOK.............................. 58 Images reflecting the landscape of healthcare in the Shenandoah Valley and Charlottesville * PLUS * a chance to win prizes!

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OurHealth Shenandoah Valley & Charlottesville

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july • august 2015

PUBLISHER PRESIDENT/EDITOR-AT-LARGE VICE PRESIDENT OF PRODUCTION PROJECT COORDINATOR AND FITNESS EXPERT GRAPHIC DESIGNER ORIGINAL COVER ART WORK ORIGINAL PHOTOGRAPHY WEBSITE DIGITAL MEDIA SPECIALIST ACCOUNTING MANAGER

CONTRIBUTING SHENANDOAH VALLEY &

CHARLOTTESVILLE MEDICAL EXPERTS

McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Deidre Wilkes Tori Long Joseph Palotas Tyler Darden Next Generation Designs Dalton Holody Laura Bower Christian Chisholm, MD Stacy Seibert, PT Alex Schult, MD Evan Wenger, MD

ONTRIBUTING PROFESSIONAL EXPERTS & WRITERS Matthew Barresi C Susan Dubuque Tricia Foley, RD Joe Grooten, MS Edwin Schwartz Michelle Stephenson Deidre Wilkes

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

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ourhealthcville.com and click on the magazine cover to view the digital edition!

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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: 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 websites (websites listed below) and social media updates 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. OurHealth Lynchburg/Southside is published bi-monthly • Special editions are also published • McClintic Media, Inc. • 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483.

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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 congenital cytomegalovirus?

Congenital cytomegalovirus (CMV) is the most common infection the fetus acquires in the uterus and the most common infectious cause of neurologic injury in the fetus and newborn. Most adults have protective immunity from exposure or infection during childhood, but up to 30 percent lack immunity and are at risk for infection. Congenital CMV affects 40,000 pregnancies per year in the U.S., resulting in 400 fetal or newborn deaths and 8,000 children with permanent disability. Potential complications include abnormalities in the brain, hearing loss, inflammation of the retinas leading to vision loss, enlargement of the liver and spleen, and intellectual disability. Women most at risk for infection during pregnancy are childcare workers and mothers of children under age three.

There is no vaccine available for congenital CMV; the most effective prevention strategy is careful hand washing after contact with a young child’s body fluids, especially saliva and urine.

Christian Chisholm, MD

Maternal-Fetal Medicine UVA Department of Obstetrics and Gynecology Charlottesville | 434.924.2500 www.uvahealth.com

What is the Activities in Motion program at LifeWorks Health and Rehab centers?

What is obstructive sleep apnea and what are some of the health risks for men who suffer from it?

The Activities In Motion program at LifeWorks Health and Rehab centers is a company exclusive activities program designed to motivate both the mind and the body through dynamic groups.

Integrated with LifeWorks Rehab, Activities In Motion maximizes the patient’s potential to attain the best possible quality of life outcomes.

Each series of therapeutic activities in the program complements the patient’s clinical rehabilitation goals, cultivates good physical health and mental well-being, and continues life-long interests and routines.

The Exercise Series promotes physical health and focuses on energy and movement for strength, endurance, balance, coordination, and flexibility. The Recreation Series focuses on fostering independence, social-interaction, and community living and emphasizes lifelong enrichment, increased activity levels, and personal satisfaction.

The Imagination Series focuses on mental exercise and inspires creativity, individuality, and resourcefulness. This distinctive combination of exercise, recreation, and imagination is part of a complete provision for patient wellness.

Obstructive sleep apnea is characterized by repeated collapse of the upper airway while sleeping.

This results in significant sleep disruption and low oxygen levels.

Men are twice as likely as women to develop sleep apnea with common risk factors including obesity and a large neck size.

Joe Grooten, MS

Medical Director Augusta Health Sleep Center Fishersville | 540.332.4169 www.augustahealth.com

MFA Education Specialist Charlottesville Health & Rehab Center Charlottesville | 434.978.7015 www.charlottesvillerehab.com

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Sleep apnea disrupts normal heart and brain function just when the brain and body should be resting and rejuvenating. High blood pressure, heart attacks, and strokes are more likely if sleep apnea is left untreated.

Excessive daytime sleepiness occurs, along with increased tendencies for memory problems, irritability, and depression symptoms. Closer to home, there can be strain placed on the relationship with a spouse.

Due to the disruptive snoring and gasping for breath, a spouse may move to another bedroom.

Sleep apnea may result in sexual dysfunction and impotence.

Sleep apnea further disturbs sleep due to increased heartburn, need to urinate, dry mouth, and headaches.

Fortunately, treatment improves health and quality of life.

Evan Wenger, MD

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H E A LT H C A R E QUESTIONS ANSWERED

BY LOCAL PROFESSIONALS

What are some fall prevention exercises and activities, and what are some benefits of engaging in this type of physical activity?

Several factors can contribute to falls, and one of the most surprising factors is using a walker. The walker should usually be considered a temporary aide. Improving your balance so that walking without an assistive device, if possible, is desired. Lack of exercise leads to weakness and increases your chances of falling. Ways to improve your balance include a routine exercise or stretching program, a simple walking program, Tai Chi, or yoga to stay active. Swimming is a low impact type of exercise to also consider if you love the water. Group exercise classes are fun and help you stay motivated.

Many of these activities are often available in the community at low or no cost. Routine exercise not only makes you stronger, but makes you feel better too. A quick consult with your health care professional or doctor before starting any exercise program is highly recommended.

Stacy Seibert, PT Charlottesville Health and Rehab Center Charlottesville | 434.978.7015 www.charlottesvillerehab.com

What are some benefits of aquatic exercise for people with arthritis?

Aquatic exercise has proven to be one of the best ways for older adults and people with arthritis to meet the goal of participating in 150 minutes of moderate intensity exercise each week.

Water exercise covers the full fitness spectrum- from aerobic workouts to strength training and flexibility. The aquatic environment provides natural buoyancy for the body, which lessens the impact on joints by up to 75 percent. This can relieve joint stress and pain. The pool water also serves as natural resistance, which promotes gains in muscle strength, bone density, and flexibility. Studies have also shown that getting into a pool can improve circulation, lower blood pressure, and help control the heart rate- all factors in decreasing inflammation, therefore easing the stiffness and discomfort caused by arthritis.

Many participants also enjoy the social interaction of participating in a water class, and report an overall sense of wellbeing.

Matthew Barresi

Fitness Coordinator Westminster Canterbury of the Blue Ridge Charlottesville | 434.972.2619 www.westminstercanterbury.org

In addition to smoking, what are the other causes of COPD and the symptoms to look out for?

Other causes of chronic obstructive pulmonary disease (COPD) include chronic obstructive asthma, bronchiectasis, workrelated obstructive lung disease and passive smoking exposure.

In a small portion of chronic asthmatic patients, the long-term inflammation results in permanent damage to the bronchial tubes, resulting in chronic constriction and limitation of normal flow of air into and out of the lungs. Bronchiectasis is typically related to persistently troublesome infections that result in injury to the walls of the airways preventing them from clearing mucus. Work-related chronic obstructive pulmonary disease can occur with fiber or fabric dust exposure in coal miners, hard-rock miners, tunnel workers, concretemanufacturing workers, non-mining industrial workers and others. It is now shown that passive smoking predisposes towards COPD. It should be noted, that while there are other causes of COPD, it is reported that 20 percent of chronic smokers develop COPD, and of all patients with COPD, 85 percent are related to smoking.

The symptoms to look out for are primarily related to shortness of breath with activity, persistent cough, recurrent sputum production and intermittent wheezing.

Alex Schult, MD

Martha Jefferson Medical & Surgical Associates Charlottesville | 434. 654.5260 www.sentara.com

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NEW

NOTEWORTHY Augusta Health

Receives Chest Pain Center Accreditation with PCI Augusta Health received full Chest Pain Center Accreditation with PCI (coronary angioplasty) from the Society of Cardiovascular Patient Care.

To become an Accredited Chest Pain Center, Augusta Health was rigorously evaluated for its ability to assess, diagnose and treat patients who may be experiencing a heart attack.

Augusta Health met or exceeded a wide set of criteria and an onsite review by a team of accreditation specialists.

“This accreditation is a reflection of the professional excellence and teamwork of the physicians and staff here at Augusta Health,” says Donna Hurst, BSN, RN, CEN, NREMTP, clinical coordinator in the emergency department and chest pain accreditation chair. “It also has great impact on the people in our community. This accreditation verifies that we have processes in place to reduce the time from the start of symptoms to diagnosis and treatment, to treat patients more quickly during the window of time when heart muscle can be preserved, and to monitor patients when it’s not certain they are having a heart attack—to be sure they aren’t sent home too quickly.”

“As an Accredited Chest Pain Center, we’ve demonstrated that we are committed to high standards and enhanced quality of care for the cardiac patients in our community,” adds Mary N. Mannix, FACHE, President and CEO of Augusta Health. “Augusta Health’s cardiac care encompasses the entire continuum for heart patients—from the EMS and emergency department, through the cath lab and cardiac rehab programs—and including our quality and community outreach screening and prevention programs. This special accreditation demonstrates that Augusta Health has all elements of a high quality cardiac program in place to assure the community receives the care it needs when time is critical.”

For more information, visit www.augustahealth.com.

NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS

Missing Link Found Between Brain, Immune System Implications Profound for Neurological Diseases from Autism to Alzheimer’s to Multiple Sclerosis In a stunning discovery that overturns decades of textbook teaching, researchers at the University of Virginia School of Medicine have determined that the brain is directly connected to the immune system by vessels previously thought not to exist. That such vessels could have escaped detection when the lymphatic system has been so thoroughly mapped throughout the body is surprising on its own, but the true significance of the discovery lies in the effects it could have on the study and treatment of neurological diseases ranging from autism to Alzheimer’s disease to multiple sclerosis.

“We believe that for every neurological disease that has an immune component to it, these vessels may play a major role,” says Jonathan Kipnis, PhD, professor in the UVA Department of Neuroscience and director of UVA’s Center for Brain Immunology and Glia (BIG). “It is hard to imagine that these vessels would not be involved in a [neurological] disease with an immune component.”

The unexpected presence of the lymphatic vessels raises a tremendous number of questions that now need answers, both about the workings of the brain and the diseases that plague it. For example, take Alzheimer’s disease. “In Alzheimer’s, there are accumulations of big protein chunks in the brain,” Dr. Kipnis says. “We think they may be accumulating in the brain because they’re not being efficiently removed by these vessels.” He notes that the vessels look different with age, so the role they play in aging is another avenue to explore. And there’s an enormous array of other neurological diseases, from autism to multiple sclerosis that must be reconsidered in light of the presence of something science insisted did not exist.

The findings have been published online by the prestigious journal Nature and will appear in a forthcoming print edition.

Four UVA Children’s Hospital Specialties Ranked in U.S. News ‘Best Children’s Hospitals’ Guide Four University of Virginia Children’s Hospital specialties have earned national rankings in the 2015-2016 U.S. News & World Report “Best Children’s Hospitals” guide.

The four ranked specialties are pulmonology, urology, orthopedics, and neonatology.

The U.S. News children’s hospital rankings are based on a range of criteria that include patient safety and patient outcomes, use of best practices including measures to prevent infections, whether hospitals provide specialized clinics and programs, availability of advanced technology and a national survey of pediatric specialists.

“This national honor showcases the teamwork of our providers and their efforts to give our young patients coordinated, safe and high-quality care,” says Pamela M. Sutton-Wallace, chief executive officer of UVA Medical Center.

For more information visit UVA Children’s Hospital at childrens.uvahealth.com or US News & World Report at health.usnews.com.

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UVA Earns Top National Honor for Nursing Care Among 7 Percent of U.S. Hospitals to Receive Magnet® Recognition

Beth Cullen, FNP

Carilion Clinic Family Medicine Fairfield | 540.377.2156 www.carilionclinic.org

Benjamin Farley, MD

Augusta Health Urgent Care Staunton | 540.245.7470 www.augustahealth.com

Cawood Fitzhugh, NP

UVA Primary and Specialty Care Pantops and Integrative Medicine Family Medicine Charlottesville| 434.297.7140 www.uvahealth.com/pantops

University of Virginia Medical Center has received Magnet® recognition from the American Nurses Credentialing Center (ANCC) for its quality patient care, excellence in nursing care and innovative nursing practices.

Approximately 7 percent of U.S. hospitals have earned Magnet recognition. The recognition is achieved following a detailed review that includes a written application highlighting quality patient care outcomes as well as an on-site review by a team of ANCC surveyors.

“This is a remarkable achievement that demonstrates the extraordinary things we can accomplish as we strive to be the safest hospital to provide and receive care,” says Pamela M. Sutton-Wallace, chief executive officer of UVA Medical Center.

According to the ANCC, studies of hospitals with Magnet recognition have shown they have a lower risk of 30-day patient mortality and higher patient satisfaction with nurse communication, availability of help and receipt of discharge information.

Allan Hardy, MD

Laura Lanier, MD

Parag Patel, MD

Thomas Peck, MD

Robert Pickral, MD

C. David Sutton, MD

Rajanshu Verma, MD

Denise A. Way, MD

Augusta Health Gastroenterology Staunton | 434.245.7350 Waynesboro | 540.245.7590 www.augustahealth.com

Carilion Clinic Family Medicine Fairfield | 540.377.2156 www.carilionclinic.org

Martha Jefferson Inpatient Services – Internal Medicine and Infectious Disease Charlottesville 434.654.7000 www.sentara.com

Carilion Clinic Family Medicine Lexington | 540.463.9158 www.carilionclinic.org

Carilion Clinic Family Medicine Lexington | 540.463.9158 www.carilionclinic.org

Martha Jefferson Inpatient Services – Internal Medicine and Infectious Disease Charlottesville |434.654.7000 www.sentara.com

For more information, visit the University of Virginia Medical Center website at www.healthsystem.virginia.edu.

Augusta Health Family Medicine Staunton | 540.886.1300 www.augustahealth.com

UVA Primary and Specialty Care Pantops and Integrative Medicine Family Medicine Charlottesville | 434.297.7140 www.uvahealth.com/pantops www.OurHealthCville.com

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TI 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

August marks Back-to-School &

NATIONAL IMMUNIZATION AWARENESS MONTH

Did you know that in 2006, the Virginia General Assembly passed a law which requires ALL 6th grade students to have a Tdap booster prior to entry into school, unless there is documentation of receipt of a dose of Tdap booster after age 7?

Splash for a

CURE

ACAC is hosting their seventh annual Splash for a Cure to raise money and awareness for the devastating childhood cancer neuroblastoma. In addition to the traditional pool party and games, this year an inaugural 5K race has been added to the event.

th Date: Saturday, August 29

Fairview 5k Run The Fairview 5K Run, sponsored by Ragged Mountain Running Shop and the Charlottesville Track Club is a benefit run for the American Cancer Society (all proceeds donated locally).

Date: Saturday, July 18th Time: 7:30 am Location: Fairview Swim and

Tennis Club 707 Belvedere Blvd Charlottesville

Time: 8:00 -10:30 am Location: ACAC Adventure Central

For more information, visit Charlottesville Track Club at www.charlottesvilletrackclub.org.

200 Four Seasons Dr Charlottesville

For more information, and to register, visit www.splashforacure.com.

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DON'T FORGET TO

DRINK UP!

The human body can only survive for two days without fluids.

Not sure how much water you should drink each day? To determine your water requirement, divide your weight (in pounds) by two. This gives a customized daily ounce recommendation. your weight (in pounds)

2

water needed daily

SNACK TIME Snacks are an important part of child’s diet as children may not get sufficient nutrients from breakfast, lunch and dinner.

It’s important to ensure that kids have nutritious healthy snacks available in their lunchbox to get them through the school day and provide the extra energy and nutrients they need.

Avoid the trap of filling your child’s lunchbox with items such as chips, cookies, chocolate bars and soft drinks that are high in saturated fat, salt and sugar and offer little nutritional value. These foods are known as ‘extra’ or ‘occasional’ foods and while they can be included in a healthy diet they should not be eaten on a daily basis.

A FEW TIPS FOR HEALTHY LUNCHBOX SNACKS: Keep it small – there should be just enough to get kids through until their next meal, not a meal themselves.

Make it nutrient rich – use this opportunity to get extra nutrients into your child’s diet, such as calcium, vitamins, minerals and fiber.

Think like a kid – choose snacks that kids can eat easily without too much fuss, that way they are more likely to eat them!

DID YOU KNOW? On average, 240 people go to the emergency room everyday with firework-related injuries in the month around the July 4th Holiday.

NEED SOME IDEAS?

HERE ARE JUST A FEW HEALTHY, SIMPLE AND FUN-TO-EAT-SNACKS: • Fruit and cheese ‘kabobs’ (on a skewer, alternate cheese cubes or shapes with various varieties of fruit) • Pretzel rods and cream cheese • Carrots and ranch dressing • Avocado spread on whole wheat toast • Watermelon cubes mixed with feta cheese (or any cheese) • Plain yogurt with frozen berries • Ants on a log (celery, peanut butter*, and raisins) * for school lunch boxes, substitute cream cheese or cottage cheese for peanut butter

Fascinating

FACT: The circulatory system of arteries, veins, and capillaries is about

60,000 MILES LONG. www.OurHealthCville.com

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the

Anatomy

CHALLENGE

How much do you know about your Shoulder? First, fill in the word search puzzle below. Next, match up the correct word with the part of the body in the illustration.

[ the Shoulder ]

WORD SEARCH acromion

glenoid socket

biceps muscle

humerus

bursa

rotator cuff

clavicle

scapula

deltoid muscle

For answers, visit

OurHealth Shenandoah Valley and Charlottesville’s Facebook page at www.OurHealthCville.com

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Exploring

Total Reverse

Shoulder Replacement words | EDWIN SCHWARTZ

Each year, thousands of total shoulder replacements are successfully performed in the United States. But many patients are better-suited for a relatively new procedure called reverse total shoulder replacement.

To learn more about this operation, OurHealth went to the experts at Orthopedic Associates Ltd. and the Department of Orthopaedic Surgery at the University of Virginia School of Medicine.

Anatomy of the shoulder The shoulder consists of three bones: the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). Shoulders are considered ball and socket joints because the ball (head) of the humerus fits into a shallow socket (glenoid) in the scapula.

Inside the shoulder, articular cartilage covers the surface of bones where they touch to provide protection and ease of movement.

A thin tissue called synovial membrane covers all other surfaces inside the joint. In healthy shoulders, this membrane produces a fluid that lubricates the cartilage for smooth movement.

The arm is held in the shoulder socket by the rotator cuff — a system of four muscles that come together as tendons to cover the head of the humerus. The rotator cuff attaches the humerus to the scapula and helps lift and rotate the arm.

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Symptoms of a torn rotator cuff The most common symptoms of a rotator cuff tear include pain while resting at night (especially if lying on the affected shoulder), pain or weakness when lifting and lowering the arm and a cracking or popping sensation (known as crepitus) when moving the shoulder in certain positions.

If one or more of the rotator cuff tendons are torn, the tendon will no longer fully attach to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff could be involved. Tears can be either partial or complete and most often are caused by injury and degeneration.

The tendons and muscles around the shoulder provide support and stability. These structures give the shoulder a greater range of rotational movement than any other joint in the body.

When arthroscopic isn’t enough Orthopaedic surgeons use arthroscopic surgery, or arthroscopy, to visualize, diagnose and treat problems within joints.

“Arthroscopy” originates from the Greek words, “arthro” (joint) and “skopein” (to look at or examine) — to examine the joint.

Arthroscopy is not effective in treating arthritic shoulders. If arthritis is the predominant cause of pain, arthroscopic surgery is not recommended. But if pain in an arthritic shoulder has progressed to the point that other treatments, such as nonsteroidal anti-inflammatory drugs or cortisone injections, do not alleviate it, shoulder replacement is an option.

There are two types of total shoulder replacement surgeries — conventional replacement and reverse replacement. Both procedures remove damaged shoulder parts and replace them with artificial ones.

Conventional shoulder replacement Conventional or standard shoulder replacement is designed to imitate the anatomy of the shoulder. In this surgery, a plastic lining is attached to the socket to provide smooth movement. The surgeon removes the top of the humerus and inserts a metal stem with a ball or half-sphere on the end.

In a normal shoulder, the rotator cuff muscles position and power the arm through the range of motion. Likewise, a conventional replacement also uses the rotator cuff muscles for proper shoulder function.

“Standard, most commonly called either ‘anatomic’ or ‘conventional’ shoulder replacement has been available for 40 years,” says Stephen Brockmeier, MD, an orthopaedic surgeon and an associate professor in the Department of Orthopaedic Surgery at the University of Virginia School of Medicine. “It is used for the treatment of advanced arthritis of the shoulder joint.”

Candidates for conventional shoulder replacement A candidate for conventional shoulder replacement could be a patient with a painful, arthritic shoulder and a functioning rotator cuff who is no longer benefiting from non-operative treatments.

Conventional shoulder replacement is also used in cases that involve severe shoulder fractures from a fall or other trauma where the bones can’t be repaired.

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Advantages of conventional shoulder replacement Conventional shoulder replacement allows intact rotator cuffs to continue to function while eliminating arthritic pain caused by worn out shoulder joints. In theory, this allows greater and often near normal range of motion.

Reverse shoulder replacement A severely damaged rotator cuff may not allow the joint to be stabilized or to function properly. Large rotator cuff tears can cause a complex type of shoulder arthritis called “cuff tear arthropathy.” In such cases, conventional shoulder replacement may provide an inferior outcome and will be at great risk for early failure; in this setting, a reverse total shoulder replacement may be advised.

This operation is also called reverse total shoulder arthroplasty (reverse TSA). The term combines “arthro” (joint) with “plasty” (to mold surgically).

Rotator cuff tear arthropathy Patients with a significant rotator cuff tear may develop cuff tear arthropathy — shoulder arthritis caused by an irreparable rotator cuff tear. It can cause changes to the shoulder joint and destroy joint cartilage. Reverse TSA was designed for patients with this condition.

The concept behind reverse shoulder replacement With reverse TSA, the normal ball and socket structure is switched. This means a metal ball is attached to the scapula, and a plastic socket is attached to the top of the humerus. The large deltoid muscle that covers the shoulder will then be used to lift the arm, in place of the torn rotator cuff.

Candidates for reverse shoulder replacement Reverse TSA may be recommended for patients who have a completely torn, irreparable rotator cuff or severe arthritis with rotator cuff tearing.

Candidates for reverse TSA may also have had a previously unsuccessful conventional shoulder replacement surgery or tried other treatments such as medications, cortisone injections and physical therapy that were unsuccessful. They may also experience severe shoulder pain and difficulty lifting the arm away from their side or over their head.

For these patients, a conventional total shoulder replacement can leave them with pain and poor function. They may not be able to raise their arm beyond a 90-degree angle.

Stephen Brockmeier, MD is an orthopaedic surgeon with the UVA Sports Medicine Clinic. He is certified by the American Board of orthopaedic surgery with a subspecialty in orthopaedic sports medicine.

In recent years, reverse TSA has also been used to manage substantial fractures of the proximal humerus (top of the upper arm bone) in elderly patients.

“Patients have usually had pain for years that has slowly worsened to the point that there is a constant, severe ache and often very restricted range of motion with the shoulder,” says D. Brian Dean, MD, of Orthopedic Associates Ltd. in Fishersville.

“Some patients actually lose the ability to move the shoulder at all, a condition called ‘pseudo-paralysis,’” Dr. Dean says.

The reverse shoulder replacement procedure Reverse TSA is performed under general anesthesia. The surgeon makes an incision in the front of the arm and shoulder and then separates muscles and cuts tissues to expose the joint.

The surgeon removes the humerus from the socket and cuts off the top of the bone, preparing it to receive the artificial part. The socket is also prepared, with a plate screwed to the socket and a half-sphere attached.

D. Brian Dean, MD is a physician at Orthopedic Associates, Ltd. in Fishersville.

The surgeon then inserts a metal stem into the arm bone and attaches a plastic socket to the top. The new socket is fitted against the new ball (half-sphere) to allow for movement that is smooth. www.OurHealthCville.com

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Advantages of reverse shoulder replacement Reverse TSA is designed to relieve pain and restore function. It may provide increased motion to a patient whose shoulder has been almost nonfunctional due to a chronic, irreparable rotator cuff repair.

Rehabilitation after reverse shoulder replacement Following a reverse replacement, patients are often kept in the hospital for one to three nights for medical observation and pain relief.

After being discharged, the patient wears a protective sling for four to six weeks.

Physical therapy begins about one week after surgery and lasts two to three months.

PT is designed in supervised phases in order for the patient to regain shoulder mobility, function and strength.

“Generally, full recovery can take anywhere from four to six months,” says Dr. Brockmeier, “with some patients gaining strength and function up to one year or more from surgery.”

The life-changing impact of reverse shoulder replacement According to Dr. Brockmeier, reverse TSA has come a long way since its approval in the United States. The procedure has fairly predictable results regarding pain relief and functional improvement and has a low risk of complications.

“For certain patients with particularly complex and debilitating shoulder problems, it can provide a dramatic impact and drastically improve their quality of life and activity level,” says Dr. Brockmeier.

Dr. Dean agrees that reverse TSA has revolutionized the treatment of rotator cuff arthropathy. Before, there was no procedure that consistently eliminated pain and restored function in patients with severe arthritis and a nonfunctioning rotator cuff.

“For patients with severe pain or pseudo-paralysis, this procedure can be a truly life-changing event,” says Dr. Dean.

Expert Contributers: Stephen Brockmeier, MD, of the University of Virginia Department of Orthopaedic Surgery D. Brian Dean, MD, of Orthopedic Associates, Ltd.

ON THE WEB

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Pick up our print edition at more than 900 locations throughout the area or get the digital edition by visiting

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SCHOOL

TIMES

words |MICHELLE STEPHENSON

Thankfully, schools provide parents with a list of supplies needed for the new school year, but left off that list are steps to ensure a child’s good health. That’s where OurHealth comes in. This step-by-step resource provides parents with valuable physical, emotional and social information to consider, as well as tips from local healthcare and healthcare-related providers from Richmond to help your children make healthy choices all year long.

The First Alarm If you haven’t already done so, this is the perfect time to schedule your child’s check-up or sports physical. These appointments are a great way to ensure that your child is up-to-date on immunizations and ready to start school.

Also, if your child suffers from allergies, asthma, diabetes, or other chronic conditions, make sure to refill all medications so you can check them in with the school nurse before the first day. You may also want to schedule an eye exam so that new glasses and contacts can be ordered and delivered before the first day of school.

A week or two before the start of school is also a good time to encourage your children to move from their summer schedule, or lack thereof, to a more structured schedule.

Reprints To order reprints of the original artwork featured on this issue’s cover, contact Deidre Wilkes at 540.387.6482 or via email at deidre@ourhealthvirginia.com.

To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com

One of the most difficult transitions can be moving to an earlier bedtime. A commonly used way is to move children’s bedtime back 15 minutes each night or every other night until they are back on their school-year schedule.

For younger children, it can be helpful to write down their morning routine and how long each task should take. They can even start practicing the morning routine before the first day. This helps children become more independent and can free up parents who are trying to get ready for work or get other children ready for school or daycare.

Wake Up! The key to a successful and stress-free morning is to plan ahead. Check the weather on school nights and lay out appropriate clothes for the weather and temperature. Make sure children pack up their backpacks at night, and start thinking about breakfast.

Possibly the single most important thing your child can do in the morning is to eat breakfast. Eating breakfast has been associated with better memory, test scores, and attention span, as well as decreased irritability, healthier body weights, and improved overall nutrition.

Many families choose to skip breakfast because they don’t have time in the morning. Quick fixes include cereal or a bagel with low-fat cream cheese. Another solution is to make breakfast the night before. For example, hard boil eggs and cut up fruit are ideal options.

If there is simply no time to eat breakfast at home, be sure to ask what breakfast options are available at your child’s school or daycare provider, or pack a breakfast for the bus or car ride to school. Good options include fresh fruit, high-fiber unsweetened cereal, nuts, reduced-fat cheese, peanut butter, bagels, pretzels, low-fat granola bars, dried fruit, rice cakes, whole-grain crackers, and cut veggies.

"If your child takes medications that are taken at school, such as ADHD medication or asthma medication, you should bring your child for a back-to-school physical. Your child will need forms for medication administration at school filled out yearly, so it is helpful to obtain these prior to the first day of school."

Rebecca Isbell, MD Augusta Pediatrics

Before leaving the house, make sure your child has a jacket and athletic shoes for physical education. But always make sure that his or her backpack is not overstuffed. Many children suffer from back pain because they are lugging around too many books and supplies. Physicians and physical therapists recommend that backpacks should not be heavier than 10 percent of a child’s body weight. Also, make sure that your child wears the backpack with both straps in place, rather than over just one shoulder.

Children who wear a backpack incorrectly typically lean to one side to offset the extra weight. This can cause back pain as well as shoulder and neck strain.

Overstuffed backpacks are not the only cause of back pain in children. Poor posture is also a contributor, so encourage your children to sit or stand up straight. Establishing good posture during childhood may prevent back issues later in life.

At the Bus Stop Even if your children have been riding the school bus for years, it’s a good idea to revisit bus safety every year before the start of school: • Wait for the bus to come to a complete stop before approaching it.

• If there are seatbelts, buckle up.

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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville

• Stay seated at all times to avoid injury if the driver has to stop or swerve suddenly. • If your child has to cross the street to enter or exit the bus, he or she should cross at least 10 feet in front of the bus and look both ways before crossing. Don’t just assume that all drivers will stop.

If you have teenagers who are driving to school, remind them to wear their seatbelts, and when it comes to passengers, the fewer, the better. Virginia law says that teenagers who are under 18 and turned 17 after July 1, 2013 may only carry one passenger under age 21, unless accompanied by a licensed parent or other adult acting in place of a parent in the front passenger seat. However, if a teen has had his or her license for a year, he or she may carry up to three passengers under the age of 21 to and from a school-sponsored event.

Encourage teens to minimize distractions. Phones and other electronic devices, as well as eating and drinking, should not be allowed while driving.

Do You Know the Rules for Motorists & School Bus Safety? tt TWO LANE: When approaching a school bus with flashing signals and/ or extended stop sign on a public or private road, vehicles traveling in both directions must stop.

tt MULTI-LANE Paved Across: When approaching a school bus with flashing signals and/ or extended stop sign on a public or private road, vehicles traveling in both directions must stop.

tt DIVIDED HIGHWAY unpaved space (min 5ft.) OR any raised median/physical barrier: When approaching a school bus with flashing signals and/or extended stop sign on a public or private road, vehicles behind bus MUST stop.

Vehicles traveling in the opposite direction proceed with caution.

The First Bell In addition to academics, children experience significant social-emotional learning opportunities at school, particularly in their classroom community. Through work and play, they will be building friendships for the school year and beyond. Talk with your children about the importance of being nice to others and developing strong bonds with classmates. Extra steps may be necessary to help quieter children foster connections. Encouraging them to join youth organizations or sports teams creates an opportunity for building friendships. These friendships can be great buffers when bad things do happen at school.

Responding appropriately to classroom challenges with friends and other peers is important. Talk to your children about the importance of reporting bullying to you and a trusted adult at school if it does occur. Learn the differences between bullying and other forms of aggression so you can help your children learn the differences and respond best to each.

"Did you know that the prevalence of hearing loss in teenagers is on the rise? If your child uses headphones or ear buds to listen to music, teach them early to keep the volume at 50%. If someone else can hear the music, it is too loud."

Karen Klotz, Owner/Provider Virginia Hearing Group

Some boys and girls both engage in bullying behaviors towards others and become the target of bullying behaviors. www.OurHealthCville.com

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These children are at a much higher risk for disengaging in school and for other negative academic, social, mental, and physical health outcomes. Help your children learn appropriate ways to meet their needs and engage with other students effectively.

There are three types of bullying: • Physical: hitting, kicking, pushing, etc.

• Verbal: threatening, taunting, name-calling •

Social: excluding peers from activities or starting rumors about them.

(Cyber bullying is often classified as verbal, social, or both verbal and social.)

If you find out that your child is engaging in bullying behavior, take it seriously. Get his or her perspective on the event, suggest alternative ways to have needs or desires met, and be clear that bullying behavior is never an acceptable strategy. Use logical consequences, linking the consequence to the aggression when possible. Use nonphysical discipline and remain consistent in your expectations. Model the behaviors you want your child to exhibit at home and at school.

The Mid-Morning Stretch "Send your child with a reusable water bottle to school every day to keep them hydrated in a healthy, earth-friendly way."

Kathy Smyth, MD Palmyra Medical Associates

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Physical education class is a very important part of a student’s schedule. With childhood obesity issues at an all-time high, physical activity, along with a balanced and nutritious diet, are essential to maintaining a healthy weight during the early stages of life. On days that your child has gym, make sure that he or she is wearing comfortable clothes and shoes that fit well and have good support.

Physical activity is a key component of a healthy lifestyle and should begin in early childhood. In addition to the health benefits, it promotes psychological well-being, increases self-esteem and capacity for learning, and helps children and adolescents cope with stress. Higher-intensity physical activity generally provides more benefits than moderate-intensity physical activity, but any activity is better than none. The U.S. Department of Health and Human Services and the U.S. Department of Agriculture’s Dietary Guidelines for Americans recommends that children and adolescents engage in at least 60 minutes of moderate to vigorous physical activity on most days of the week, preferably daily.

OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville

The Lunch Whistle If your child buys lunch at one of our local schools, there is typically a good variety of food offerings in appropriate portions. However, if your child usually brings a lunch from home, there are a few keys to making sure that he or she has a healthy lunch.

First, avoid caffeinated soda and energy drinks. Research has shown that caffeine increases blood pressure and decreases heart rate in people of all ages. The American Academy of Pediatrics maintains the position that stimulant-containing energy drinks have no place in the diets of children and adolescents.

Additionally, make sure to pack a variety of healthy foods.

Children between the ages of four and eight should eat/drink the following daily: • 1.5 cups of fruit • 3 to 4 ounces of meat and beans • 1.5 cups of vegetables

• 2 cups of milk

• 4 to 5 ounces of grains

• 4 teaspoon of oils

Girls between the ages of nine and 13 should consume: • 5 ounces of meat and beans • 1.5 cups of fruit • 2 cups of vegetables

• 3 cups of milk

• 5 ounces of grains

• 5 teaspoon of oils

Boys between the ages of nine and 13 should consume: • 5 ounces of meat and beans • 1.5 cups of fruit • 3 cups of milk • 2.5 cups of vegetables • 6 ounces of grains

• 5 teaspoon of oils

Girls between the ages of 14 and 18 should consume: • 5 ounces of meat and beans • 1.5 cups of fruit • 2.5 cups of vegetables

• 3 cups of milk

• 6 ounces of grains

• 5 teaspoon of oils

Boys between the ages of 14 and 18 should consume: • 6 ounces of meat and beans • 2 cups of fruit • 3 cups of vegetables

• 3 cups of milk

• 7 ounces of grains

• 6 teaspoon of oils

This equates to 1,000 calories per day for children aged 2 to 3 years, 1,400 calories a day for children aged 4 to 8, 1,600 calories for girls aged 9 to 13, 1,800 calories for boys aged 9 to 13 and for girls aged 14 to 18, and 2,200 calories for boys aged 14 to 18. It is important to note that active children may require more calories.

To keep caloric intake in check, encourage your child to eat slowly. People who eat quickly typically take longer to feel full, and they often have no idea how much they have actually eaten. Children need to eat slowly enough to give their brain the chance to recognize that they have eaten enough to no longer feel hungry. Slowing down and chewing food more thoroughly also makes food more enjoyable.

“Make sure asthma and allergy symptoms are well controlled with appropriate use of controller medications. If your child has food allergies, make sure they wear allergy bracelets, don’t share food, and make other people are aware of their allergies so they don’t accidentally expose them to their allergic triggers.

Teach them and help others identify symptoms of a systemic reaction and proper use of epinephrine.

Always be sure they carry two epinephrine auto-injectors and call 9-1-1 promptly after using the first unit. Realize the serious risk of your children getting bullied in school because of their food allergies. “ Arvind Madaan, MD, FAAAAI, FACAAI President, CARE - Charlottesville Allergy and Respiratory Enterprises www.OurHealthCville.com

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"Call to schedule your back-to-school physicals as early as possible with your pediatrician."

Rebecca Isbell, MD Augusta Pediatrics

"Properly-fitted shoes are important to provide support and prevent injury.

Running in a worn-out shoe can predispose children to injuries like stress fractures and heel pain.

Ill-fitting shoes can cause pain including ingrown toenails. A podiatrist can treat these problems should they occur."

Miki Hori, DPM Harrisonburg Foot and Ankle Clinic

Children should be encouraged to drink plenty of water. Half of kids’ body weight is made up of water, so water is required to keep bodily systems functioning properly. It’s a good idea to offer water throughout the day and not just when they are thirsty. Children should be encouraged to drink more than usual when it’s hot or when they are taking part in physical activity. Fruits and vegetables are also excellent sources of water.

School’s out!

Many Shenandoah Valley and Charlottesville families have two working parents, so after-school care can be a challenge. There is no hard and fast rule on when children are old enough to be left home alone after school, and children mature at very different rates, so parents need to make this call. One consideration may be how long the child will be home alone before a parent or older sibling arrives home. As a rule of thumb, most children are not able to handle stressful or emergency situations until they are about 11 or 12 years old.

If you are considering leaving your child alone for a few hours after school, make sure that he or she is prepared for knocks on the door, emergency situations, and injuries. Shenandoah Valley and Charlottesville-area YMCAs offer babysitting courses that can help prepare children to stay home alone.

How do you know if your child is ready? Consider the following: • A child who is home alone needs to know his or her full name, address, and phone number as well as how to reach you. You might consider having him or her call you once inside the house each day so that you will know that he or she has arrived home safely. Children also appreciate the security of knowing that they will be able to talk to you when they get home from school.

• Establish a routine so that he or she knows what to do during the time he or she is alone. Do you expect that homework and/or chores will be done before you arrive home?

• Make sure your child knows how to lock the door when he or she arrives home and that it should be kept locked.

• Is there a neighbor nearby that he or she could check in with if needed?

• Does your child know never to enter your home if a door or window is open or broken?

• Explain what to do if someone knocks on the door (tell the person knocking that you are busy and are unable to come to the door, not that you are not home).

Whether a parent is home or not, make sure to have healthy snacks on hand in the afternoon, and make sure your child has a designated homework space. This space should be quiet and distraction-free with comfortable seating and good lighting.

Family Time Family time on school nights typically revolves around preparing and eating dinner, although many families are unable to have meals as a family due to children’s extracurricular activities or parents’ job schedules.

Even though it can be challenging, try to have as many meals together as a family as possible. During family meals, turn the TV off, and don’t allow electronics at the table. In addition to the relationship benefits of family meals, research has shown children eat more fruits and vegetables and fewer fried foods and sugary drinks when they eat with the entire family.

Wind Down While some children focus best on homework right after school, other children are better able to focus after dinner. Some parents choose a specific time for children to start homework (by 4 pm), while others give guidelines (no video games or TV watching until homework is complete).

After dinner is also a great time for families to read together. This can further nurture your child’s love of reading and help him or her wind down for bedtime.

The importance of sleep cannot be overstated. Well-rested children are more focused, and poor sleep habits can also increase the risk of obesity. According to the Centers for Disease Control and Prevention, school-aged children require at least 10 hours of sleep each night, and teens require 9 to 10 hours a night.

24/7 Be Aware In addition to bullying, children can also be introduced to drugs, alcohol, violence, and sex at school. Unfortunately, although safer than most, Shenandoah Valley and Charlottesville schools are no exception.

Most parents of teenagers are concerned about the use of tobacco, alcohol, and drugs in this student population, because there is tremendous peer pressure to experiment with these substances during high school, and even middle school. Parents should take steps to ensure that teens are aware of the dangers involved with their use. For example, smoking often becomes more than a high

"Don't forget to gradually move to earlier bedtimes so that getting up for the school bus won't be as difficult."

Paige Nolte, MD Palmyra Medical Associates

www.OurHealthCville.com

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school habit. In fact, it can turn into a lifelong addiction that can be extremely difficult to break. When talking to your teen about smoking, emphasize the more undesirable effects, including bad breath, stained teeth, wrinkles, a long-term cough, and decreased athletic performance. Other forms of tobacco, such as chew or snuff, can also lead to nicotine addiction and cause the same health problems as smoking cigarettes, with the addition of mouth sores.

Alcohol is the most socially accepted drug in our society, and even small amounts can impair judgment and provoke risky and violent behavior. Drinking can also slow reaction time, and many teenagers are unaware that alcohol use can have deadly consequences. Inform your teen that alcohol-related car crashes are the leading cause of death for those aged 15 to 24 years.

Another concern of parents is teenage sex. Even more concerning is unprotected teenage sex. Encourage abstinence, and encourage your teen to avoid situations that can lead to sexual activity. Choosing not to use alcohol or drugs can help your teen make clearer choices about sex. If you know that your teen is having sex, it is important for him or her to know the facts about birth control and sexually transmitted diseases. Encourage the use of condoms; however, remind them that only abstinence is 100% effective in preventing disease and pregnancy.

Although Shenandoah Valley and Charlottesville elementary, middle- and high-schools have not seen a major act of violence, such as a deadly school shooting, students have occasionally been known to fight and to bring weapons to school. While it is difficult to pinpoint exactly which children will engage in violence at school, there are some risk factors: • A prior history of violence • Drug and/or alcohol abuse • Association with delinquent peers • Poor family functioning • Poor grades in school • Poverty in the community.

The keys to a successful school year are encouraging your children to make healthy choices and maintaining open communication with them. A little planning can ease the transition back and can provide a stress-free first day for kids and parents alike.

Sources: www.aap.org www.cdc.gov www.dmv.virginia.gov www.healthychildren.org www.kidshealth.org www.pediatriccareonline.org

ON THE WEB

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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville

"Immunization records are important well after infancy! Be sure to keep them well documented and up-to-date; especially for those later vaccinations like HPV, tetanus, meningitis, and flu. Keep handy; these records are mandatory for students planning to attend college."

Ami Keatts, MD Augusta Health Care for Women

Check out this Vaccine Record for Teens & Adults

Check out this Immunization Tracker

Senior Living AWARDS Sen

Sen

Sen

Living Aw r o i

ds ar

Living Aw r io

ds ar

ds ar

Living Aw r io

After Life FIRST

Hill & Wood Funeral Service Charlottesville | 434.296.6148 | www.hillandwood.com

SECOND Teague Funeral Home Charlottesville | 434.977.0005 www.dignitymemorial.com/teague-funeral-home

Assisted Living FIRST

Rosewood Village

RoseWood Village has been providing exceptional assisted living and memory care to the Charlottesville community since 1983. Family owned and operated, RoseWood Village is committed to creating a warm and caring environment for you or your loved ones.

Come in for a tour at one of our two Charlottesville communities!

Charlottesville | 434.963.7673 www.rosewoodvillage.com

THIRD Henry Funeral Home Staunton | 540.885.7211 www.henryfuneralhome.net

HONORABLE MENTION Kyger Funeral Homes & Crematory Harrisonburg | 540.434.1359 www.kygers.com

Preddy Funeral Home Gordonsville | 540.832.2111

SECOND The Heritage Inn of Charlottesville Charlottesville | 434.977.0002 www.heritageinncharlottesville.com

THIRD Westminster Canterbury of the Blue Ridge Charlottesville | 434.972.2622 www.westminstercanterbury.org

HONORABLE MENTION Brightview Baldwin Park Find us on social media.

Follow us on Facebook, Twitter, LinkedIn and YouTube.

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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville

Staunton | 540.885.1122 www.stauntonva.brightviewseniorliving.com

Our Lady of Peace Charlottesville | 434.973.1155 www.our-lady-of-peace.com

UVA – Healthsouth Rehabilitation Hospital

FIRST

"At UVA-HealthSouth the key to our patient’s success is a team approach. Our physicians and treatment teams include the patients and their families in goal planning so that together, they develop the best treatment plan for the patient’s recovery."

Tom Cook, MBA Chief Executive Officer Charlottesville | 434.244.2000 | www.uvahealthsouth.com

Rehab - Inpatient

SECOND

HONORABLE MENTION

The Laurels of Charlottesville

Charlottesville Health & Rehabilitation Center

Charlottesville | 434.951.4200 www.thelaurelsofcharlottesville.com

THIRD The Heritage Inn of Charlottesville Charlottesville | 434.977.0002 www.heritageinncharlottesville.com

FIRST

Charlottesville | 434.978.7015 www.charlottesvillerehab.com

Envoy at Staunton Staunton | 540.886.2335 www.consulatehealthcare.com

Martha Jefferson Outpatient Care Center at Pantops

"As caregivers, it's our job to not only care for people when they are in the hospital, but to help them continue the journey in the outpatient setting. Rehab plays an important role in a patient's recovery, whether from a cardiac event, stroke or serious injury, and we are happy that patients believe in us for their continued care."

Nancy Maloy, Chief Nurse Executive Martha Jefferson Hospital Charlottesville | 434.654.7000 | www.sentara.com

Rehab - Outpatient

SECOND

HONORABLE MENTION

UVA – Healthsouth Rehabilitation Hospital

Synergy Rehab and Wellness

Charlottesville | 434.244.2000 www.uvahealthsouth.com

THIRD Kings Daughters Community Health and Rehab

Verona | 540.416.0530 www.synergyrehabandwellness.com

ACAC Fitness & Wellness Centers Charlottesville | 434.978.3800 www.acac.com

Staunton | 540.886.6233

www.OurHealthCville.com

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FIRST

Home Instead Senior Care

Home Health

"Home Instead Senior Care has been helping seniors and their families in Charlottesville since 2003. We employ professional and reliable CAREGivers who provide care and assistance at home to ensure safety and independence."

Jeanne McCusker, Owner Charlottesville Home Instead Senior Care Charlottesville | 434.227.4726 | www.homeinstead.com/532

SECOND

HONORABLE MENTION

Augusta Health Home Health

Visiting Angels Living Assistance Services

Staunton | 540.332.4900 www.augustahealth.com/home-health

Charlottesville | 434.227.5917 www.visitingangels.com/Charlottesville/home

THIRD

Encompass Home Health

UVA-Continuum Home Health Charlottesville | 434.984.2273 www.healthsystem.virginia.edu/pub/continuum

Charlottesville | 434.202.7138 www.ehhi.com

FIRST

Hospice of Piedmont

Hospice

Charlottesville | 434.817.6900 | www.hopva.org

SECOND

HONORABLE MENTION

Legacy Hospice

Interim Health Care

Charlottesville | 434.970.7776 www.legacy-hospice.com

Charlottesville | 434.295.5501 www.interimhealthcare.com

THIRD

Hospice of the Blue Ridge

Hospice of the ShenandoahAugusta Health

Winchester | 540.313.9200 www.brhospice.org

Fishersville | 540.332.4909 www.augustahealth.com/hospice 36

"Since 1980, Hospice of the Piedmont—the region’s oldest, largest, and most respected nonprofit hospice organization—has proudly provided patients, families, and communities across Virginia with compassionate, comprehensive end-of-life and grief support care."

James Avery, MD, Chief Executive Officer Hospice of the Piedmont

OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville

www.OurHealthCville.com

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FIRST

Westminster Canterbury of the Blue Ridge

"Westminster-Canterbury of the Blue Ridge, celebrating 25 years of extraordinary care, is proud to be Charlottesville's only accredited, not-for-profit Lifecare community. "

Independent Living

Gary Selmeczi, President and CEO Westminster-Canterbury of the Blue Ridge Charlottesville | 434.972.2622 | www.westminstercanterbury.org

SECOND

HONORABLE MENTION

Brightview Baldwin Park

Branchlands

Staunton | 540.885.1122 www.stauntonva.brightviewseniorliving.com

Charlottesville | 434.973.9044 www.branchlands.com

THIRD

Martha Jefferson House

The Colannades Charlottesville | 434.963.4198 www.sunriseseniorliving.com/communities/the-colonnades

Charlottesville | 434.293.6136 www.marthajeffersonhouse.org

The Legacy of North Augusta Staunton | 540.885.5454 www.thelegacyatnorthaugusta.org

FIRST

Roberts Home Medical

Medical Equipment

Karen Jones, RRT, RCP Roberts Home Medical Charlottesville | 434.973.7847 | www.robertshomemedical.com

SECOND

THIRD

HONORABLE MENTION

Simple Comforts

Medi Home Health& Hospice

Lincare

Charlottesville | 434.244.0890 www.msa-corp.com

Charlottesville | 434.974.6688 www.lincare.com

Charlottesville | 434.245.0001 www.simplecomforts.com

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"Our commitment is to service, to embrace and hurdle the ever looming challenges that the DME (durable medical equipment) industry faces regarding reimbursement while always assuring that the patients’ needs are met."

OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville

FIRST

Our Lady of Peace Christopher Center

"The mission of the Christopher Center is to provide compassionate memory care by fully embracing the uniqueness of each resident in a thoughtfully designed environment that enhances security, comfort, and support."

Sara Warden, Executive Director Our Lady of Peace Charlottesville | 434.973.1155 www.our-lady-of-peace.com/memorycare

Memory Care

SECOND

HONORABLE MENTION

The Heritage Inn of Charlottesville

Brightview Baldwin Park’s Wellspring Village

Charlottesville | 434.977.0002 www.heritageinncharlottesville.com

THIRD Westminster Canterbury of the Blue Ridge Charlottesville | 434.972.2622 www.westminstercanterbury.org

Staunton | 540.885.1122 www.stauntonva.brightviewseniorliving.com

Rosewood Village Charlottesville | 434.963.7673 www.rosewoodvillage.com

FIRST

The Laurels of Charlottesville

Nursing Home

"We are honored to be the recipient of this wonderful recognition. Laurel Healthcare strives to be the best provider it can be in the long term care and skilled nursing arena. This award is a confirmation that the local facility has been able to achieve the standards set forth by the corporation and live up to our mission statement."

Scott Overstreet, Administrator The Laurels of Charlottesville Charlottesville | 434.951.4200 www.thelaurelsofcharlottesville.com

SECOND

HONORABLE MENTION

Summit Square Retirement Community

Brookdale Staunton

Waynesboro | 540.941.3100 www.sunnyside.cc

Staunton | 540.765.1549 www.brookdale.com

Trinity Mission Health & Rehab of Charlottesville

THIRD Westminster Canterbury of the Blue Ridge Charlottesville | 434.972.2622 www.westminstercanterbury.org

Charlottesville | 434.973.7933 www.covenantdove.com

Our Lady of Peace Charlottesville | 434.973.1155 www.our-lady-of-peace.com

FIRST

Hospice of the Piedmont

Palliative Care

"Since 1980, Hospice of the Piedmont—the region’s oldest, largest, and most respected nonprofit hospice organization—has proudly provided patients, families, and communities across Virginia with compassionate, comprehensive end-of-life and grief support care."

James Avery, MD, Chief Executive Officer Hospice of the Piedmont Charlottesville | 434.817.6900 | www.hopva.org

SECOND

THIRD

UVA Palliative Care

Martha Jefferson Hospital

Charlottesville | 434.243.3675 www.uvahealth.com/services/palliative-care 40

OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville

Charlottesville | 434.654.7000 www.sentara.com

Post-Acute Rehab FIRST

UVA - Healthsouth Rehabilitation Hospital

"UVA-HealthSouth is proud to be Charlottesville’s only acute rehabilitation hospital."

Tom Cook, MBA Chief Executive Officer Charlottesville | 434.244.2000 www.uvahealthsouth.com

Skilled Nursing FIRST

Charlottesville Health & Rehabilitation Center

"We believe that providing the best care begins with getting to know our patients first – that’s the cornerstone of our personalized approach to rehabilitation services and skilled nursing care."

Cheryl Martin, Administrator Charlottesville | 434.978.7815 www.charlottesvillerehab.com

SECOND Charlottesville Health & Rehabilitation Center Charlottesville | 434.978.7815 www.charlottesvillerehab.com

THIRD

SECOND Westminster Canterbury of the Blue Ridge Charlottesville | 434.972.2622 www.westminstercanterbury.org

UVA-Continuum Home Health

THIRD

Charlottesville | 434.984.2273 www.healthsystem.virginia.edu/pub/continuum Gordonsville | 540.832.2111

Augusta Nursing and Rehab Center Fishersville | 540.885.8424 www.consulatehealthcare.com

For a digital copy of the winners, check out our website at

ourhealthcville.com www.OurHealthCville.com

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UVA - Healthsouth Rehabilitation Hospital

FIRST

Speech Therapy

"UVA-HealthSouth speech therapy helps patients improve their ability to receive information and express themselves verbally, create techniques to support memory, and improve swallowing to support nutritional needs."

Tom Cook, MBA Chief Executive Officer

Charlottesville | 434.244.2000 | www.uvahealthsouth.com

SECOND

THIRD

Charlottesville Health & Rehabilitation Center

Golden Living Center - Charlottesville Charlottesville | 434.218.7905 www.goldenlivingcenters.com

Charlottesville | 434.978.7015 www.charlottesvillerehab.com

UVA - Healthsouth Rehabilitation Hospital

FIRST

Stroke Care

"UVA-HealthSouth has the only acute stroke rehabilitation program in Charlottesville combining the latest stroke rehabilitation technologies with the expertise of the specialized multi-disciplinary team to give each patient the individual attention they need to recover their maximum independence."

Tom Cook, MBA Chief Executive Officer Charlottesville | 434.244.2000 | www.uvahealthsouth.com

SECOND

HONORABLE MENTION

Augusta Health Stroke Center

Shenandoah Nursing and Rehab

Fishersville | 540.332.4000 www.augustahealth.com/stroke-care

Fishersville | 540.949.8665 www.autumncorp.com

THIRD

The Heritage Inn of Charlottesville

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Charlottesville | 434.977.0002 www.heritageinncharlottesville.com

OurHealth staff photographer, KG Thienemann, spent a recent Saturday morning at Charlottesville City Market

Charlottesville Farmers Market With summer now in full swing, the Charlottesville City Market bustles with activity every Saturday morning. With hours from 7am – 12pm every Saturday through December, there is plenty to see, smell, eat and experience for the whole family! Come on out to enjoy musical entertainment, seasonal fruits, vegetables and flowers, aromatic baked goods, made-to-order meals, and local farmers, bakers and artisans showcasing and selling their goods. A great way to support the local community and enjoy the lazy, hazy days of summer!

To keep up with Market happenings, visit and like their facebook page: www.facebook.com/CharlottesvilleCityMarket

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Breaking the Silence

Huntington's Disease words | SUSAN DUBUQUE photography | TYLER DARDEN

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 medical issues 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 enigmatic conditions.

Joe’s Story Twenty-seven years. That’s how long Joseph Galano and Beverly Peterson dated before finally tying the knot. They were compatible, happy and very much in love.

But both had successful and fulfilling careers that just happened to be 300 miles apart. Bev was an English professor at Penn State Fayette in Lemont Furnace, PA, and Joe was a psychology professor at the College of William and Mary in Williamsburg, VA. But in January 2008, when Joe was diagnosed with Huntington’s disease, this lovely couple’s lives were changed forever. However, it might surprise you to learn that to Bev and Joe, the changes were not all bad.

Joe inherited many things from his mother, including a kind heart and giving spirit. Unfortunately, he also inherited the gene mutation that causes Huntington’s disease.

“My mother was never diagnosed with the disorder. All the time that we were working with her and her doctors, nobody mentioned the word ‘Huntington’s,’ ” recounts Joe. “My mother had heart rhythm problems that were misdiagnosed, and she was given heart medicine to suppress her heartbeat. The medicine masked one of her real issues, hyperthyroidism. Her Huntington’s disease www.OurHealthCville.com

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further complicated matters.” Eventually Joe’s mother ended up in a nursing home in Colorado near Joe’s brother and his wife.

Then another piece of the hereditary puzzle was uncovered. While attending a family reunion, Joe learned that his cousin was suspected of having Huntington’s. Being an avid researcher, Bev discovered a documentary by Chris Furbee called “Huntington’s Dance.” The video shows clips of Furbee’s mother, who exhibited the same jerky, involuntary movements as Joe’s mother. Bev now strongly suspected that Joe’s mother had Huntington’s disease.

The first hint that Joe may also have developed this disorder occurred at the 30year reunion of his psychology doctoral intern class. Two of Joe’s friends asked him about his gait—wondering if he was experiencing any problems. Joe dismissed their queries, attributing his odd gait to his uneven leg lengths. But the friends were not to be put off that easily. They pulled Bev aside and expressed their concern that Joe might have Parkinson’s disease.

“The doctor said on the basis of my genetic test, a diagnosis of Huntington’s was irrefutable,” Joe recalls. The doctor didn’t hold anything back.

“He told us there is no treatment or cure for the disease, but he advised us to ‘plan for the worst and expect the best.’ ”

When a physical therapist recommended a neurological evaluation, Joe could no longer ignore the warning signs. The therapist observed that Joe’s balance was poor despite his having excellent strength and overall physical abilities.

The neurologist completed an in-depth family history and suggested testing for Huntington’s disease. That was in November 2007. “Waiting for the results was the longest two months I’ve ever experienced,” shares Bev. “I truly believed Joe had Huntington’s.” Joe, on the other hand, completely put the test out of his mind, declaring that “denial is a very effective coping mechanism.”

Finally the results were in. “The doctor said on the basis of my genetic test, a diagnosis of Huntington’s was irrefutable,” Joe recalls. The doctor didn’t hold anything back.

“He told us there is no treatment or cure for the disease, but he advised us to ‘plan for the worst and expect the best.’ ” That counsel has served Joe and Bev well through the last seven years, and today Joe considers his doctor to be a friend and advocate.

But without a doubt, Joe’s most ardent advocate is Bev. Her response to Joe’s diagnosis was utterly selfless. Taking early retirement from a job she loved, she moved to Williamsburg to care for Joe. Bev admits, “When I came to Virginia I had every expectation that I would be assuming a caregiver role. I was overwhelmed and felt abandoned.” Bev’s investigations led her to the Huntington’s Disease Clinic at UVA Medical Center. “I called them on a Friday afternoon and left a message. At 4:15 that same day, the genetic counselor, Pat Allinson, called me back. She told me there was a whole team at UVA, including a neurologist, Madaline Harrison, MD, and several other professionals from physical therapy, occupational therapy, speech therapy and social work to support us. It was the most reassuring phone call I could ever have.” Joe visits the clinic twice a year, and Dr. Harrison has given Joe and Bev the opportunity to speak with medical students to help the students gain a better understanding of the patient’s and family’s perspectives. Bev takes comfort in knowing that if she and Joe need more help in the future, the clinic team will be there.

Bev’s positive attitude has contributed greatly to the couple’s adjustment in the face of this monumental challenge. “When I came home from work one day shortly after being diagnosed, I found the living room floor strewn with 20-some recommendations and resources on Huntington’s,” says Joe. “There were fun things like dark chocolate, red wine and a kite, as well as informational items, including the latest research findings.” Joe then took Bev to the travel agency where they booked a cruise to the Caribbean that he dubbed the “Spit in the Face of Adversity Cruise.”

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Joe and Bev in their Williamsburg, Virginia home.

Joe refuses to let Huntington’s dominate his life. In fact, he gives no credence to his medical condition, by not calling it a “disease” at all. “I simply say ‘Huntington’s’ or ‘H,’ ” declares Joe. “There is no point in reinforcing the idea that I have a disease. I just don’t want to give it that much power.”

Although retired from classroom teaching after 33 years, Joe continues to pursue his passion working in the field of child abuse prevention. In fact, in recognition of his work, he received the 2014 Commissioner’s Award from the U.S. Department of Health and Human Services. When presenting the award, Mark H. Greenberg, acting commissioner for the Administration on Children, Youth, and Families, captured Joe’s essence in saying, “With his infectious enthusiasm about prevention, the always optimistic, articulate and good-humored Dr. Galano has inspired colleagues, collaborators and students to join the mission of promoting child well-being.”

“I simply say ‘Huntington’s’ or H,” declares Joe. “There is no point in reinforcing the idea that I have a disease.

I just don’t want to give it that much power.”

Another way that Joe contributes to the betterment of others is by participating in a clinical trial at Johns Hopkins School of Medicine. Joe’s only brother, who also tested positive for Huntington’s, is participating in one of the same clinical trials.

At a conference of researchers and patients, when Joe was asked to describe his experience being in a clinical trial, Joe stated, “Imagine a world without clinical trials. That would be a world without hope. A world with clinical trials is a world that gives us reason to be hopeful.”

Joe’s zeal for prevention also applies to his own state of well-being. Always an athlete, Joe remains active—staving off the physical effects of Huntington’s. “We bike about four days a week and play some golf,” says Joe. Recently, he took up yoga. “It’s OK with me if I am the worst in my yoga class, as long as I am working on my breathing, balance and flexibility.” And he challenges Bev on the Wii Fit ski slopes. Joe and Bev have cycled their way through Italy, the Baltics and Costa Rica. “I won’t be going down any more mountains like the ones in Costa Rica,” reflects Joe. “I respect my limitations, but I’m not letting them keep me from doing what I love.”

But what Joe loves the most is Bev. Last year, Joe and Bev were married in the Wren Chapel at William and Mary, and at the reception they danced to Etta James’s “At Last,” to the absolute delight of family and friends. www.OurHealthCville.com

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Seven years after being diagnosed, Joe occasionally notices chorea—the involuntary movements associated with Huntington’s—as well as a little more difficulty with balance and speaking some words. “Bev probably notices more than I do,” Joe notes, “but if something doesn’t bother me, it doesn’t seem to bother her.”

Author's Note: I’m not a medical professional, but I love learning about all kinds of esoteric medical conditions—the more obscure, the better. I delve into the details and explore the causes and cures. I strive to fully understand the effects on the body and the psyche.

But when I was asked to write this piece on Huntington’s disease I had the sensation of wading into a cold, dark murky lake. It was with some trepidation that I contacted Joe and Bev for an interview. I conjured up all sorts of depressing images of Joe’s impending debilitation. A life put on perpetual hold—waiting for the first twitch, the first moment of irritability, the first forgotten item at the grocery store.

“I know my genes are not my destiny. They are a part of a larger story that includes all the things I can control—like exercise, maintaining friendships, being a good husband, remaining passionate about my work and being grateful every day.”

- Joe Galano

But I needn’t have worried. What I found was a wonderful couple. Joe and Bev are smart, funny, sweet and immensely happy. Despite Joe’s having a major medical “condition” (out of respect for Joe, I will refrain from calling it a disease), their lives are filled with joy and contentment. But Joe says it best: “I know my genes are not my destiny. They are a part of a larger story that includes all the things I can control—like exercise, maintaining friendships, being a good husband, remaining passionate about my work and being grateful every day.”

We should all live with such grace and courage.

Let’s now explore Huntington’s disease—what it is, its causes, the signs and symptoms, how it is diagnosed and treated, and what the future holds.

What is Huntington’s disease?

Huntington’s disease is a genetic disorder that has a marked impact on mood, cognition and motor function. First described by Dr. George Huntington in 1872, Huntington’s affects 30,000 Americans and an additional 150,000 are estimated to be at risk.

According to, “Huntington’s disease is a ‘neurodegenerative’ disorder. Most simply stated, this means a condition that affects the nervous system and gradually gets worse over time. Huntington’s disease has some features in common with Alzheimer’s and Parkinson’s disease. In each of these disorders, the brain cells in a specific region of the brain die prematurely.” In Huntington’s disease, the initial damage occurs in the basal ganglia and later affects the cortex as well.

What causes Huntington’s disease?

Huntington’s disease is hereditary and the defective gene that is responsible for the disorder may be acquired from either the mother or father. A child born to an individual with the gene mutation for Huntington’s has a 50 percent chance of inheriting the mutation and getting the disease.

All humans have the gene that may cause Huntington’s disease. So why do some people develop the disorder, while others do not? It has to do with expansion of a particular stretch of DNA in a specific gene, now known as the Huntington’s gene. Without getting too technical, there is a section in this gene in which part of the DNA code 50

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known as a trinucleotide repeats itself over and over again. In Huntington’s disease, the trinucleotide involved is known by the initials CAG. People with Huntington’s disease have more repeats than usual, which means that this region of the gene has expanded more than it should. It is this expansion that can lead to Huntington’s disease, which is often referred to as a “CAG repeat disorder.”

The symptoms of Huntington’s disease typically appear in adult life, with most individuals affected between the ages of 35 and 50. There is also a juvenile form of the disease, which develops before the age of 20 and makes up six to ten percent of all cases, sometimes called the Westphal variant of Huntington’s disease. Developing Huntington’s over the age of 50 defines late onset disease.

Signs and Symptoms Huntington’s disease produces devastating physical, emotional and cognitive effects.

Early symptoms may include clumsiness and poor coordination. As the disease advances, involuntary movements of the face, arms and legs—called chorea—may develop. Chorea is a Greek word that means “dance,” and refers to the irregular movements that are common in Huntington’s disease. Often causing people with Huntington’s disease to look restless or appear fidgety, these movements are the hallmark of Huntington’s disease; in fact, it used to be called Huntington’s Chorea. In addition to involuntary movements, people with Huntington’s disease also develop problems with coordination of voluntary movements. This can cause difficulty walking, leading to falls, as well as problems with slurred speech and impaired coordination, to the point that people with Huntington’s may be mistakenly thought to be intoxicated.

Huntington’s disease also takes a toll on emotional and behavioral health. Depression is common and there is a higher risk of suicide. Other mood changes may develop, including anxiety and irritability, and may lead to outbursts or aggressive behaviors.

The cognitive effects of Huntington’s disease may include problems with concentration and short-term memory. “This usually involves difficulties organizing, processing and retrieving information,” says Dr. Harrison. “Despite these changes in cognitive function, people with Huntington’s disease usually remain able to understand and recognize others.”

Madaline Harrison, MD, is a neurologist and the director of the Huntington's Disease Program at UVA Health System. Dr. Harrison is certified by the American Board of Psychiatry and Neurology.

In later stages of the disease, speaking and swallowing become difficult and most people with Huntington’s lose the ability to walk safely. Eventually the individual will require total nursing care. The disease advances at varying rates, but the average lifespan after diagnosis is 20 years.

Diagnosing Huntington’s disease In 1993, scientists isolated the gene for Huntington’s disease. A blood test can now accurately tell if an individual has the gene mutation, however the test cannot predict when symptoms will begin. Since there is no cure for Huntington’s, most people who know they are at risk choose not to have the test.

“Any individual who is working through the decision whether or not to be tested should seek genetic counseling,” advises Dr. Harrison. “And once that decision is made to be tested, counseling can help prepare for the outcome. Testing positive for Huntington’s disease is a difficult experience, even for those who think they are ready. This result is truly life-changing and I encourage my patients to seek support from family, friends and healthcare providers.” www.OurHealthCville.com

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Although you might think testing negative for Huntington’s would be a cause for celebration, many patients who receive a negative finding experience feelings of guilt.

This can be particularly acute if there are siblings or other family members involved who may be at risk or who are known to be positive. Again, counseling may be helpful in working through this “survivor’s guilt.”

Testing can be particularly important to individuals with Huntington’s who are deciding whether or not to have children. There are many Huntington’s patients who wish to have a baby—but there is a 50-50 chance of passing the gene mutation along to their offspring, making this a difficult decision for many families.

“While there is no cure for Huntington’s disease,” states Dr. Harrison, “we are making strides in managing many of the symptoms—which can have a tremendous impact on the quality of life for the patient and the family.”

“There is an option available—called pre-implantation genetic diagnosis,” explains Dr. Harrison. Through in vitro fertilization, the mother’s eggs are combined with sperm outside the body in a laboratory. Then, the fertilized eggs—called embryos—are genetically tested to determine if they contain the gene mutation for Huntington’s disease. Embryos that do not have the gene mutation are implanted into the mother’s uterus and, if a baby is born, that child will not have Huntington’s disease.

Unfortunately, in vitro fertilization is an expensive process that is not covered by insurance, and it is successful only about 30 percent of the time.

Treatment Options “While there is no cure for Huntington’s disease,” states Dr. Harrison, “we are making strides in managing many of the symptoms—which can have a tremendous impact on the quality of life for the patient and the family.”

“Tetrabenazine is a drug that has been used for treatment of various movement disorders. In 2008, the FDA approved this medication for treatment of chorea in Huntington’s disease,” says Dr. Harrison. “This is the first pharmaceutical approved in the U.S. to treat the movement symptoms of Huntington’s disease.”

In addition to creating involuntary movement, Huntington’s disease interferes with voluntary movements. “Activities that require a precise, coordinated sequence of movements—like writing, eating and walking—are particularly affected,” notes Dr. Harrison. “Physical, occupational and speech therapy can help with mobility, skills of daily living and communication. There are many adaptive strategies available to make life easier for Huntington’s disease patients and their families.”

Standard treatments—including medications and therapy—may be used to treat patients with Huntington’s for depression, other mood disorders such as anxiety and irritability, and rarely psychotic symptoms. Dr. Harrison comments, “These emotional and behavioral issues are very treatable. Effective treatment can reduce distress and improve quality of life for patients with Huntington’s disease.” Having set routines and a calming environment can help avoid behavioral problems. Patient and family support groups can also be invaluable in easing the stress and feelings of isolation associated with Huntington’s.

“While there are no medications to treat the cognitive problems arising from Huntington’s,” says Dr. Harrison, “there are compensatory strategies and environmental adjustments that can make it easier for individuals to function on a day-to-day basis.”

What does the future hold?

It has been 22 years since the gene that is responsible for Huntington’s disease was isolated, and since that time scientists around the world have been striving to 52

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convert this insight into effective ways to treat, cure and hopefully one day prevent this dreaded disorder. A variety of research efforts are underway, including: Genetic research. Investigators are continuing to study the effects of the gene mutation on the body with the goal of translating that knowledge into diseasemodifying therapies.

Animal models. Laboratory animals, such as mice, that carry the Huntington’s gene mutation have been developed and have led to new understanding of the effects of the gene for Huntington’s disease. This has enabled scientists to learn more about the symptoms and progression of the disease and to develop treatments that can be studied in patients with Huntington’s disease.

Imaging. Studies using PET scans, MRI and other imaging technologies are enabling scientists to see what the defective gene does to various structures in the brain and how it affects the brain’s chemistry and metabolism.

Additional References: Websites Huntington’s Disease Society of America Numerous informational publications and links to many resources for patients and families with Huntington’s disease. www.hdsa.org HD Youth Organization An international nonprofit organization providing support for young people around the world impacted by Huntington’s disease www.en.hdyo.org/

Clinical research. Studies by neurologists, psychologists, psychiatrists and other investigators are improving our understanding of the symptoms and progression of the disease in patients while attempting to develop new, more effective treatments.

These studies are being carried out worldwide through organizations such as the Huntington’s Study Group and the European Huntington’s Disease Network as well as by individual researchers and other groups. Numerous approaches have been and are being studied, including nutritional therapies, medications both to treat symptoms and potentially to slow the disease (disease-modifying therapies), fetal tissue transplants, stem cell therapies and gene-silencing therapies. While some approaches have not been successful, several potentially promising treatments are in the early stages of investigation and new strategies continue to be developed.

National Institutes of Health Genetics Home Reference Information in genetic testing and guidance in decision making. www.ghr.nlm.nih.gov/condition/ huntington-disease

Sources and References:

“Gene Veritas” blog.

An advocate for patients and families at risk for Huntington’s. curehd.blogspot.com Huntington’s Buzz Translates the latest research for a lay audience. www.hdbuzz.net

Medical Expert Madaline Harrison, MD, neurologist and director of the Huntington's Disease Program, UVA Health System Clinical UVA Huntington’s Disease Program, a Huntington’s Disease Society of America (HDSA) Center of Excellence. UVA is one of only 29 HDSA Centers of Excellence across the country. Here, patients, families and caregivers are supported by a multidisciplinary team including neurologists; neuropsychologists; genetic specialists; social workers; and physical, occupational and speech therapists.

Medline Plus – NIH U.S. National Library of Medicine General information on Huntington's from a trusted governmental source. www.nlm.nih.gov/medlineplus/ huntingtonsdisease.html

Books Inside the O’Briens: A Novel by Lisa Genova The Woman Who Walked into the Sea by Alice Wexler Videos The Lion’s Mouth Opens. A documentary that captures the precarious journey into genetic self-knowledge by Marianna Palka, a 33-year-old filmmaker-actress when she decided to test for Huntington’s disease.

Huntington’s Dance. Chris Furbee chronicles his experiences in learning to cope with the potential hereditary nature of Huntington’s Disease.

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Check out Joe and Bev's helpful tips for individuals and families living with Huntington's disease. www.OurHealthCville.com

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FITBITS

H EA LT H A ND F I T NES S O N THE GO

S tretch i t Ou t !

Did you know that regular stretching is just as important as regular exercise?

Many people neglect this aspect of their fitness regime, because they don’t understand that stretching has major benefits. Hopefully these reasons will inspire you to make it part of your schedule!

Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer 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 Charlottesville and the Shenandoah Valley.

*Consult with your physician/provider before beginning any new fitness program.

Benefits of stretching: • Improves flexibility (increases range of motion).

• Assists in correct posture by lengthening tight muscles that pull areas of the body away from their intended position.

Here are a few simple stretches for the core and lower body that can be done after each workout:

Cat/Cow stretch

• back and abdominals

• Reduces risk for injury by keeping muscles loose.

Cobra stretch

• Increases blood and nutrient supply to muscles, thereby possibly reducing muscle soreness.

• abdominals

Tips for effective stretching: Skip the Pre-Workout Stretch

• Muscles should be warm before you begin your stretching. Do a warmup before a workout that simulates the movements you’ll be doing in order to prepare your body. Movements such as walking or marching in place are great examples. Stretch after the workout when your muscles are already warm.

Focus on the Muscles That Need the Most Help

• Instead of trying to stretch your whole body after every workout, focus on a key area of the body each time. Spend longer on each stretch and include more stretches for that specific area.

If you are aware of muscles that are tight, then focus on those.

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Seated side stretch

• obliques (side of abdominals)

Hamstring stretch • back of legs

Child’s pose

• shoulders, chest and abdominals

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Healthy Eats Healthy on the Grill Entrée: Burger with Fresh Lettuce & Tomato Makes 8 Servings

Directions:

1. Sauté the onions in the coconut oil over medium-high heat until translucent.

2. Turn off the heat and let it cool.

Once cool, add the onions to the raw bison burger meat.

Ingredients: 2 pounds ground bison (buffalo) 2 tablespoon finely chopped fresh sage 1 1/2 teaspoons sea salt 2 teaspoons black pepper 1/2 onion, finely chopped 2 tablespoon coconut oil

3. Add all remaining ingredients, and mix gently with clean hands.

4. Form patties with the meat, using about 1/4 pound of meat per patty.

5. Grill the burgers on medium heat, about six to seven minutes per side, or until the internal temperature is 140°F for medium rare or 160°F for well done.

6. Allow the burgers to rest about five minutes before serving.

Serve the burger with lettuce and tomato.

Tricia Foley's

BISON BURGER Tricia Foley is OurHealth Magazine’s resident nutritionist.

HealthyEats Side: Sweet Grilled Corn (Makes 8 servings)

Ingredients: 8 ears corn, husk and silk removed 1/4 cup organic butter (ghee) 2

tablespoon minced garlic

1

teaspoon crushed rosemary

1 teaspoon dried basil 1 teaspoon dried thyme

salt and pepper to taste

½ cup grated parmesan cheese

Directions: 1. Allow the corn to soak in cool water for 1 to 3 hours.

2. Melt butter in a bowl. Season with garlic, rosemary, basil, thyme, salt, and pepper; stir in Parmesan cheese.

3. Remove the corn from water and pat dry.

4. Brush the butter mixture evenly over each ear of corn, and place each piece on a square of aluminum foil.

5. Wrap each ear of corn in foil, and punch holes to allow excess steam to escape while grilling.

6. Preheat an outdoor grill for medium heat.

7. Grill the corn cobs about twenty to thirty minutes, turning frequently.

8. Remove from the grill and place on a dish.

Tricia Foley uses

LOCAL GROWN VEGGIES Tricia Foley is OurHealth Magazine’s resident nutritionist.

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HealthyEats Dessert: Watermelon Sorbet Ingredients: 21/4 pounds chopped watermelon

(about 6 cups) 5 cups Stevia

Juice from about 1 lemon

kosher salt to taste

¼ cup roasted cocoa nibs (optional)

Directions: 1. In batches, combine watermelon and Stevia in a food processor and process until smooth (about one minute).

5. Pour the watermelon mixture into a shallow metal pan and freeze until ice crystals form around the edges, about thirty minutes.

Local Tomato, Sweet Corn, Herbs & Watermelon from:

6. Stir the ice crystals into the center of the pan and return to the freezer; repeat every twenty minutes until all the liquid is frozen.

100 Water Street | Charlottesville Phone: 434.970.3371 www.charlottesvillecitymarket.com

7. Serve immediately, or transfer to a storage container and let harden in the freezer for an hour to an hour and a half.

Charlottesville City Market

The Charlottesville City Market was established in 1973 with the help of the Cason brothers.

This wonderful market has everything from fruits, veggies, foods, plants, cut flowers, unique gifts, pottery and much more.

8. Serve in chilled dishes.

2. Pour contents into a strainer.

3. Once strained, stir in lemon juice and salt to taste.

4. Finally, add the cocoa nibs.

Tricia Foley’s

WATERMELON SORBET Tricia Foley is OurHealth Magazine’s resident nutritionist.

www.OurHealthCville.com

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closer LOOK

Can you identify which local practice the image belongs to?

5 2 $ NA

WI

O T D CAR

T h F I s e G r F he t!

T

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e k Mar

Post the correct answer on our Facebook page by AUGUST 7TH for a chance to WIN a gift card to The Fresh Market!

The winner will be announced on our Facebook page by AUGUST 20TH so make sure you check it out!

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