table of contents | march • april 2015
20 MEDI•CABU•LARY.......................8 Local experts define health-related terms
JUST ASK!.......................................10 Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............12
Aggravating Allergies: There are Treatments that Can Help Allergens are everywhere. On the surface, they are often considered nothing more than a nuisance. But in some cases, allergens can be very debilitating and even deadly. To get a better understanding of how allergens affect us, OurHealth turned to a Charlottesville area expert.
A listing of new physicians, providers, locations and upcoming events in the Shenandoah Valley and Charlottesville communities
HEALTH POINTS.........................16 Interesting facts and tidbits about health
THE ANATOMY CHALLENGE..................................19 How much do you know you about Our Anatomy? In this issue, test your knowledge when it comes to the SINUS CAVITY!
SINUSITIS TREATMENT.............................. 26 Options for treating chronic sinusitis: Balloon Sinus Dilation
NUTRITION........................................................ 27 HEALTHY EATS: Gluten Free recipes that are sure to please your palate! Beef Tenderloin, Quinoa Salad and Pumpkin Rolls using great local ingredients!
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FIT BITS!........................................ 31 Spring Into Action This workout is based on a 7-day plan, including at least one rest day. Repeat for 4-6 weeks, and be ready to sport your shorts and tank tops just in time for the warmer weather!
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Decoding Blood Tests: Making (a little) sense of a mind-boggling topic)
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Women’s Gynecological Health:
Education and preventive care are the keys to better health at every age.
What in the world do all those acronyms, abbreviations and numbers mean?
Women’s Health: Incontinence..................................49 Symptoms. Causes. Treatment.
LOOKING BACK...........................50 hello, HEALTH!.............................. 40 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos
Images reflecting the landscape of healthcare in the Shenandoah Valley and Charlottesville * PLUS * a chance to win prizes!
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march • april 2015
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CONTRIBUTING SHENANDOAH VALLEY & CHARLOTTESVILLE MEDICAL EXPERTS
McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Deidre Wilkes Karrie Pridemore Next Generation Designs Jourdan Markey
Orlando Cedeno, Jr., DPM, FACFAS, FAPWH Peter Hallowell, MD James Sawyer, MSW, MBA, PCHA Marion Szwedo, MD
ONTRIBUTING PROFESSIONAL EXPERTS & WRITERS Rich Ellis C Tricia Foley, RD Karen Klotz Josh Lyons Suzanne Ramsey Edwin Schwartz 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 SUBSCRIPTIONS To receive OurHealth Shenandoah Valley/Charlottesville via U.S. Mail, please contact Deidre Wilkes at deidre@ourhealthvirginia.com or at 540.387.6482
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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-at-Large: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482, ext. 1 Information in all print editions of OurHealth and on all OurHealth’s websites (www.ourhealthcville.com, www.ourhealthrichmond.com and www.ourhealthvirginia.com), social media sites and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2014 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Shenandoah Valley and Charlottesville edition is published six times annually by McClintic Media, Inc. 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthcville.com | www.ourhealthrichmond.com | www.ourhealthvirginia.com | Advertising rates upon request.
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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 Tinnitus?
What is osteotomy?
50 million Americans report tinnitus – that’s the term that describes the noise that people hear in their ears that others cannot hear.
Osteotomy literally means ‘cutting of the bone.’ This can involve taking out part or all of a bone. The bone is possibly shortened, lengthened or angulated to change its alignment. Osteotomy procedures are most often performed to straighten a bone that has been fractured or align a crooked bone such as a bunion deformity in the foot. Osteotomy procedures are one of several surgical procedures, which aim to relieve arthritis pain especially in ankles, knees and hips. Recovery from these procedures typically mandates limited weight bearing to non-weight bearing for two months but potential benefits can be tremendous.
Tinnitus is most frequently caused by exposure to loud noises, and can also be caused by diabetes, medication, zinc deficiency, otosclerosis, impacted earwax, anemia, and rarely, auditory tumors. Of the 50 million individuals who report tinnitus about 15 million that it affects their lifestyle. Fortunately, tinnitus can be treated. Treatment is most effective when the treatment focuses on reducing both the patient’s perception of the tinnitus as well as their reaction to the tinnitus. Sound Therapy with hearing aids or with direct sound production is an effective tool for the management and treatment of tinnitus with 70 – 90 % success. The ability to accept or be compliant with a treatment regimen is a necessary condition for habituation or management. The investigation into tinnitus is as strong as ever, with ongoing research into new methods of treatment. “Nothing can be done” often isn’t the final answer. Karen Klotz
Owner/Provider Virginia Hearing Group Verona | 540.248.1670 www.virginiahearinggroup.com
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Orlando Cedeno, Jr., DPM, FACFAS, FAPWH
Harrisonburg Foot & Ankle Clinic, PC Harrisonburg | 540.434.2949 www.harrisonburgfootankle.com
What is acute supraglottitis? Acute supraglottitis, also known as epiglottitis, is an infectious inflammation of the epiglottis and surrounding structures in the throat above the vocal cords. Epiglottis can be life threatening as the associated swelling may block air entry into the lungs. The infection can be caused by bacteria, viruses, or fungi but is most often bacterial. The most common cause of epiglottitis in children is a bacteria called Haemophilus influenza type b (Hib). Due to the routine vaccination of infants in the United States against Hib since the 1980’s, epiglottitis is much less common than it once was. It does however still occur and can be caused by other types of H. influenza as well as streptococci and Staphylococcus Aureus. Children with epiglottitis typically become sick suddenly and have symptoms of difficulty breathing, difficulty swallowing, drooling and high fever. It is important to remember that epiglottitis is a medical emergency, and any child who is having difficulty breathing should be seen promptly by a doctor. Marion Szwedo, MD
Pediatric Associates of Charlottesville Charlottesville | 434.296.9161 www.charlottesvillepeds.com
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H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
How can I find out if I qualify to participate in PACE? PACE (Program of All-Inclusive Care for the Elderly) provides 24/7 access to personalized health care and a place to socialize and have fun during the day. Our mission is to keep individuals living safely at home and out of a nursing facility for as long as possible. Individuals who are 55 and older, live in the service area of a PACE organization, and are eligible for nursing facility care can join PACE. They must be assessed by the interdisciplinary team and be able to live safely in the community with the support of PACE services. James Sawyer, MSW, MBA, PCHA Site Director Blue Ridge PACE Charlottesville | 434.529.1300 www.riversideonline.com/blue_ridge_pace
Why is a multi-sensory environment important to individuals suffering from Alzheimer’s? People with Alzheimer’s or other cognitive conditions do not experience the world as we do. Daily environments challenge our brains to gain input from our senses to help us navigate our way. Individuals with cognitive impairments have an inability to translate the stimulation they are experiencing from their senses in a manner their brains can interpret. This can cause the person to become confused and anxious because the brain has misinterpreted input from the stimulation or lack thereof. The therapeutic use of a multi-sensory environment can help stimulate their senses beyond what they can get from normal living because it is designed to stimulate intellectual activity and promote relaxation. For example, a variety of lighting effects, soft sounds and tactile experiences, may offer individuals with cognitive impairments a therapeutic benefit that allows their senses to be enhanced or calmed depending on the stimulation they are experiencing. In many cases, cause and effect activities can be used to generate a sense of control for an individual, aiding in their relaxation. It may also open a window where a loved one can see their relative more clearly and share in those moments. Josh Lyons
Executive Director Sunnyside Retirement Community Charlottesville | 434.529.1300 www.sunnyside.cc
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
What are some health benefits of having bariatric surgery? Morbid obesity, the condition that bariatric surgery treats, is associated with a number of medical conditions. These conditions include diabetes, high blood pressure, sleep apnea, high cholesterol, asthma and other obesity–related breathing disorders, arthritis, gastroesophageal reflux disease, liver disease, urinary incontinence, cancer and early death. Bariatric surgery encompasses a number of different procedures (gastric bypass, gastric sleeve, and gastric banding) all designed to help lose significant weight and help address the conditions associated with morbid obesity. Bariatric surgery has led to the improvement or remission of type 2 diabetes, hypertension, sleep apnea, gastroesophageal reflux, liver disease and urinary incontinence. The surgery has been shown to decrease the risk of cancer and death from cancer. Multiple studies have shown a decreased risk of death in patients who have had bariatric surgery as compared to morbidly obese patients who have not had surgery. Peter Hallowell, MD
Director of Bariatric Surgery UVA Health System Charlottesville | 434.243.4811 www.uvahealth.com
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
UVA, Bon Secours Expand Joint Clinical Programs New Partnership Focused on Cardiac, Cancer, Population Health and Physician Recruitment University of Virginia Health System and Bon Secours Health System signed a nonexclusive agreement that will lead to new patient care partnerships in cardiovascular services, cancer, physician recruitment, population health, patient safety, and undergraduate and graduate medical education. Future additional collaborations between UVA and Bon Secours are expected to focus on heart care, cancer care and clinical trials, patient safety, enhancing the physician recruitment pipeline and population health. The population health model focuses on keeping patients healthy while providing them with high-quality care. The agreement also consolidates existing partnerships between the two health systems into a single agreement. The institutional agreement does not involve any exchange of money or ownership interest between UVA and Bon Secours. For more information, please visit www.uvahealth.com.
Cancer Center Doctor Honored by American Cancer Society Find us on social media. Follow us on Facebook, Twitter, LinkedIn and YouTube.
The American Cancer Society has honored Leslie Blackhall, MD, MTS, the founder of the Palliative Care Clinic at UVA Cancer Center, with a national award for improving cancer patients’ quality of life. Dr. Blackhall is one of seven winners of the 2015 American Cancer Society Lane W. Adams Quality of Life Award. The American Cancer Society said it recognizes individuals like Dr. Blackhall who provide what Adams – a longtime American Cancer Society executive vice president – described as the “warm hand of service.” “They are driven to provide excellent care not for awards or recognition, but for the satisfaction of knowing they made a difference in someone’s life,” said Susan Henry, chair of the American Cancer Society Lane W. Adams Award Workgroup. Dr. Blackhall was honored for her work in palliative care, which helps patients through pain relief and managing their symptoms. At UVA Cancer Center, Dr. Blackhall began one of the first outpatient palliative care clinics in 2001, seeing patients a half day each week. As the clinic has expanded over the past 14 years – it now cares for patients five days a week – so too has the use of palliative care beyond end-of-life care to help patients at all stages of fighting cancer. For more information, please visit www.uvahealth.com.
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Elizabeth Casner, MD Piedmont Emergency Consultants Charlottesville 434.982.7150 www.pec-cville.com
Allegra Deucher, MD
OB/GYN Associates Charlottesville 434.979.2121 www.obgynassociatescville.com
Kenneth Donohue, PA
Augusta Health Urgent Care & Convenient Care 800.932.0262 www.augustahealth.com
Sentara RMH Achieves Magnet® Recognition for Nursing Excellence Rare recognition signifies top-notch experience for patients and families Sentara RMH Medical Center has achieved the Magnet Recognition Program® designation from the American Nurses Credentialing Center (ANCC). Magnet® designation is granted to approximately 7 percent of U.S. hospitals and recognizes sustained excellence in nursing care.
Amanda Gummo, PA Augusta Health Urgent Care & Convenient Care 800.932.0262 www.augustahealth.com
Shahid Ilyas, MD
Hospitalist Augusta Health Hospitalists Fishersville | 800.932.0262 www.augustahealth.com
Jose Gurrola II, MD
Rhinology and Endoscopic Sinus Surgery Charlottesville 434.924.5934 www.uvahealth.com
Chad Moorman, DPM, CPed Hess Orthopaedics & Sports Medicine Harrisonburg 540.434.1664 www.hessortho.com
Monica Heck, MSN, FNP-C
Augusta Health Urgent Care & Convenient Care 800.932.0262 www.augustahealth.com
Jean Parrish, NP
Augusta Health Urgent Care & Convenient Care 800.932.0262 www.augustahealth.com
A Magnet hospital is one that has met the specific standards set forth by ANCC. These standards define the highest quality of nursing practice and patient care. Research shows there are clear benefits to patients and their families who receive care at Magnet facilities, including confidence in caregivers and positive outcomes. The designation is awarded for four years, during which time the ANCC monitors facilities to ensure high standards of care remain intact.
UVA DISCOVERS KEY TO CANCER’S SPREAD In a breakthrough in the understanding of how cancer spreads, researchers at the University of Virginia School of Medicine have identified a substance secreted by lung cancer cells that enables them to metastasize, beginning their deadly march to other sites in the body. By blocking that process in lab studies, the researchers were able to confine cancer cells to a single tumor site, offering hope that drugs could one day block the spread of cancers in people. This discovery also may lead to a simple blood test that doctors could use to track metastatic progression and determine the best course of treatment. For more information, please visit www.uvahealth.com.
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NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
UVA Finds Trigger for Protective Immune Response to Spinal Cord Injuries Discovery Points Way to Better Treatments, Sheds Light on Alzheimer’s.
Hot on the heels of discovering a protective form of immune response to spinal cord injury, researchers at the University of Virginia School of Medicine have pinpointed the biological trigger for that response—a vital step toward being able to harness the body’s defenses to improve treatment for spine injuries, brain trauma, Alzheimer’s disease and other neurodegenerative conditions. The trigger for the immune response, the molecule interleukin-33, is concentrated in what is known as “white matter” in the healthy brain and spinal cord. Interleukin-33, the researchers have discovered, is released upon injury and activates cells called glia, beginning the body’s protective response and promoting recovery. The discovery also sheds light on previous findings connecting interleukin-33 to Alzheimer’s disease. Researchers have identified a strong connection between interleukin-33 and Alzheimer’s disease, and this work will pave the way for future studies on this topic. Eventually, the findings could lead to both improved treatments and new diagnostic tests for brain and spinal cord injury, Alzheimer’s and other conditions. For more information, please visit www.uvahealth.com.
egionTen and Martha Jefferson Hospital
Partner to Open Peterson Health Center Region Ten and Martha Jefferson Hospital are pleased to announce the opening of the Peterson Health Center. Located in Downtown Charlottesville, the center will bring primary care services to consumers already benefiting from Region Ten’s behavioral health services, as well as provide primary care services to anyone in the area who needs it.
Find us on social media. Follow us on Facebook, Twitter, LinkedIn and YouTube.
The center will be open Monday through Friday from 8 am to 5 pm and be staffed with a physician as well as two nurse practitioners. The Peterson Health Center provides preventative care, including vaccines and physicals, treatment of acute illnesses, diabetes and high blood pressure management, women’s health services and geriatric medicine. For more information, please visit www.marthajefferson.org.
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T I P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U
March is...
NATIONAL
COLORECTAL
CANCER AWARENESS MONTH Among cancers that affect both men and women, colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer deaths in the United States. But this disease is highly preventable, by getting screened beginning at age 50.
What YOU Can Do If you’re aged 50 to 75, get screened for colorectal cancer regularly. Screening tests help prevent colorectal cancer by finding precancerous polyps (abnormal growths) so they can be removed. Screening also finds this cancer early, when treatment can be most effective. • Be physically active
• Don’t drink too much alcohol
• Maintain a healthy weight
• Don’t smoke
Fast Facts Risk increases with age. More than 90% of colorectal cancers occur in people aged 50 and older. Precancerous polyps and colorectal cancer don’t always cause symptoms, especially at first. You could have polyps or colorectal cancer and not know it. That is why having a screening test is so important. If there are symptoms, they may include— • Blood in or on the stool (bowel movement) • Stomach pain, aches or cramps that do not go away • Losing weight and you don’t know why These symptoms may be caused by something other than cancer. If you have any of them, see your doctor. Some people are at a higher risk than others for developing colorectal cancer. If you think you may be at high risk, talk to your doctor about when and how often to get tested.
For more information about colorectal cancer, visit www.cdc.gov. 16
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Celebrate
NATIONAL STRESS AWARENESS DAY
April 16, 2015
Taking a breath every once in a while is the best thing you can do for your overall health, and April 16, is a special day set aside for Americans to be aware of just how stressed they may have become! Here are some tips:
• Exercise. Chemicals called endorphins are released during exercise that lend a feeling of relaxation and well-being.
• Meditate • Get enough rest • Pet your dog—or any other pet. Unconditional love pets exhibit help to naturally lower blood pressure
Be aware of the people or events that habitually cause stress in your daily life. Just knowing the usual triggers may go a long way in helping to avoid them.
***** FASCINATING
FACT
When you exercise hard, your body BURNS UP ENERGY
TIMES AS FAST as normal!
Autism
World
World Autism Awareness Day (WAAD), celebrated each year on April 2, was adopted by the United Nations in 2007 to shine a bright light on autism as a growing global health crisis. Additionally, WAAD celebrates the unique talents and skills of persons with autism around the world. On World Autism Awareness Day, Autism
Speaks celebrates its international Light It Up Blue Campaign. Thousands of iconic landmarks, communities, businesses and homes across the globe unite by shining bright blue lights in honor of the millions of individuals and families around the world affected by autism. Visit www.autismspeaks.org for more information on Light it Up Blue and World Autism Awareness Day.
DID YOU KNOW? Walk in March for Babies and give hope to nearly half a million babies born too soon each year. The money raised supports programs in the community that help moms have healthy, full-term pregnancies. And it funds research to find answers to the problems that threaten babies. Two local area events to choose from:
March for Babies Augusta County 2015 Date: Saturday, April 18, 2015 Time: 9:00 am Location: Augusta Health Lifetime Fitness Center Augusta Health Campus Fishersville, VA 22939
March for Babies Charlottesville 2015 Date: Sunday, April 26, 2015 Time: 2:00 pm Location: nTelos Wireless Pavilion 700 East Main Street Charlottesville, VA 22902
For more information, and to register for either event, visit the Virginia Chapter of March of Dimes at www.marchofdimes.org/virginia
A baby’s brain is one of the fastest growing parts of its body!
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Ourhealthcville.com
the
Anatomy
CHALLENGE
Here’s your chance to see how much you know about your Sinuses! First, fill in the word search puzzle below. Next, match up the correct word with the part of the body in the illustration.
[ the Sinus Cavity ]
WORD SEARCH frontal sinus
adenoid
superior turbinate
nasal vestibule
middle turbinate
nasal cavity
inferior turbinate
eustachian tube orifice
sphenoid sinus
fossa of rosenmuller
nosopharynx
_______________________ _______________________
_______________________
_______________________
_______________________ _______________________
_______________________ _______________________
_______________________
_______________________
_______________________
For answers, visit OurHealth Shenandoah Valley
& Charlottesville’s Facebook page at
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there are treatments that can help words | EDWIN SCHWARTZ original artwork |JOE PALATOS
Allergens are everywhere. On the surface, they are often considered nothing more than a nuisance. But in some cases, they can be very debilitating and even deadly. To get a better understanding of how allergens affect us, OurHealth turned to an expert at Charlottesville Allergy and Respiratory Enterprises. ••••• Most people know some allergens can be dangerous, especially for those allergic to bee stings or specific foods such as peanuts. But fortunately, everyday allergens such as pollen and dust – despite their daily annoyance – are rarely life threatening. “In certain instances, such as in the presence of uncontrolled asthma, exposure to inhaled allergens in high quantities can potentially result in life-threatening asthma exacerbation,” says Arvind Madaan, MD, Mayo Clinic-trained Allergist and President at CARE. “Similarly, allergic reactions with certain food allergens may have much worse clinical outcomes in the presence of underlying risk factors such as uncontrolled asthma, cardiovascular disease, etc.”
Generally speaking, allergies are divided into three categories: inhaled allergies, ingested allergies and contact allergies.
Dr. Madaan attributes a higher risk of systemic reaction (reactions that involve the entire body) to three causes: if one of the “shock organs”, e.g., lungs and heart, is already compromised, if a person is exquisitely sensitive to the offending allergen or if the exposure is too intense. According to Dr. Madaan, the most common foods for allergic reactions include dairy, egg, soy, wheat, peanuts, tree nuts and seafood.
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
“Out of these foods, most life-threatening reactions are attributed to peanuts, tree nuts and seafood,” he explains. “The common respiratory allergens include perennial aeroallergens such as dust mites, molds, animal dander and cockroaches,” says Dr. Madaan, “as well as seasonal aeroallergens like tree pollen (spring time), grass pollen (late spring into fall) and ragweed (late summer into fall).” “Bee-sting allergic reactions are still not being optimally addressed by patients and physicians alike,” continues Dr. Madaan. “Carrying epinephrine auto-injectors (at least two) is essential. But it is important to note that www.OurHealthCville.com
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successful desensitization for bee-sting allergies (honey bee, wasp, yellow jacket and white and yellow-faced hornets) can be achieved in more than 97 percent of sufferers.”
How untreated allergies can be harmful “Systemic reactions, no matter what the triggering allergen, can cause irreversible tissue damage and even death, if not recognized and managed promptly,” says Dr. Madaan. “Other instances where chronic tissue damage can occur include conditions such as asthma and chronic rhinosinusitis.” Dr. Madaan also says that uncontrolled upper respiratory allergic inflammation can compromise an individual’s ability to fight off infections. “Children with uncontrolled allergic inflammation may end up repeatedly visiting their pediatrician's office and eventually ENT providers for surgical intervention. This may be required if they experience chronic inflammation of tonsils or adenoids along with upper airway obstruction.”
How allergies are mistaken for something else Many people may not be aware of pollen during months when their symptoms get worse. As a result, they don’t associate their symptoms, such as congestion, headaches or facial pain, with pollen. They mistakenly believe it is linked to a cold or stress.
Undesirable effects of antibiotics A growing concern among allergists is the use of antibiotics to treat allergylike symptoms. In these cases it is important for patients to be tested for allergies for two important reasons: to get proper treatment and to avoid developing resistance to antibiotics. Airborne allergy sensitivity can increase susceptibility to recurrent, chronic sinus infections. Treating these underlying allergies appropriately as such can lead to decreased frequency and severity of infections. As a result, the need for antibiotics is reduced. 22
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Individuals with poorly controlled allergies are more likely to get sick, and the resulting allergic inflammation makes it more difficult for the body to clear the infection. “Repeated antibiotic use should never be taken lightly,” says Dr. Madaan. “In addition to the potential risk of developing resistance or allergic reactions to antibiotics, one can also experience substantial alterations in the composition of gut microflora which can potentially have longterm consequences.”
Common myths about allergies A common myth pertains to use of “local honey” to treat allergies by building up immunity through ingestion of an allergen. “While honey is nutritious, it does not have much scientific merit in curing allergic symptoms,” explains Dr. Madaan. “Bees typically pollinate flowers and not trees, grasses or weeds,” adds Dr. Madaan. “They have no role to play in transporting other allergens such as mites, molds or animal dander. Beehives may catch some pollen flying by but the quantity of these allergens in honey is just not enough to elicit a scientifically sound immune response to these allergens.”
Facts and Myths about Food Allergies Lactose intolerance is often thought of as a food allergy. It isn’t. “Lactose intolerance is a condition caused by a deficiency of lactase in the digestive system, an enzyme that metabolizes milk sugar or lactose,” says Dr. Turner. “If this sugar is not metabolized, it stays in the digestive system, resulting in diarrhea and cramping.”
What’s the difference between lactose and lactase? Lactose is a sugar that is commonly found in milk. Lactase is an enzyme that many people have in their digestive system that breaks down lactose into simpler sugars that can be absorbed by the intestine. Lactose intolerant people do not have lactase and therefore cannot digest lactose, leading to digestive problems. According to the National Institute of Allergy and Infectious Diseases, eight foods or food groups are responsible for 90 percent of all food allergies. They
are cow’s milk, egg, fish, shellfish, tree nuts (almonds, walnuts, pecans), wheat, peanuts and soy. The Federal Allergen Labeling and Consumer Protection Act of 2004 requires that U.S. food manufacturers clearly declare the presence of these major food allergens or proteins derived from them—such as hydrolyzed casein, a milk product—on their prepared food labels. Unlike peanuts, peanut oil does not have to be labeled as an allergen. However, that doesn’t necessarily mean it’s safe for people with peanut allergies. The Federal Drug Administration has concluded that highly refined peanut oil will not cause allergic reactions for the majority of peanut-allergic individuals because the peanut proteins have been removed during processing. Yet, unrefined or partially processed peanut oil—also referred to as crude, extruded, cold-pressed or expeller-pressed—contains concentrations of peanut protein that can trigger allergies. Those with peanut allergies should consult an allergist before consuming peanut oil.
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Why allergies should not be taken lightly Most people think of itching, sneezing and runny nose as the most common symptoms of unmanaged allergies. But Dr. Madaan sees a larger number of patients with “background problems”, such as lack of restorative sleep, being tired in the afternoon and poor performance at work or school in the presence of pre-existing conditions. These conditions include asthma, sleep apnea and attention deficit disorder. “Allergic inflammation can have widespread ramifications on coexisting disorders such as asthma and recurring upper airway infections in children and adults alike,” says Dr. Madaan. Arvind Madaan, MD, FAAAAI, FACAAI, FAAP is a Fellow of the American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology, as well as American Academy of Pediatrics. He completed his Allergy/Immunology Fellowship at Mayo Clinic and is certified by the American Board of Allergy and Immunology. He can be reached at info@cvilleallergy.com.
Allergic inflammation and medications such as antihistamines can potentially impact the quality of restorative sleep which can in turn, result in fatigue and lack of optimal school or work performance. Antihistamines block symptoms but do not effectively help with airway inflammation. “If you need antihistamines or other allergy/asthma medications repeatedly, a visit to an American Board of Allergy and Immunology -certified allergist may be helpful and even illuminating,” adds Dr. Madaan. “Medications mask symptoms, but do not cure or alter the natural history of the allergic disease process.”
Seeing dramatic differences in everyday lives “A vast majority of patients report improvement in sleep quality, reduction in repeated allergic symptoms, fewer secondary infections and better control of comorbid, i.e., simultaneously existing conditions, such as asthma. And in cases of certain food allergies, we see a reduction in recurring gastrointestinal symptoms, itching, hives, etc.,” says Dr. Madaan.
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options
for treating
CHRONIC SINUSITIS
balloon sinus dilation procedure
words | EDWIN SCHWARTZ
Stephen Keefe, MD with Augusta ENT and Facial Cosmetic Surgery works closely with allergists to manage the symptoms of chronic sinusitis in their patients. He offers a procedure called In-Office Balloon Sinuplasty to help treat the condition. The balloon dilation provides significant relief for patients whose extremely narrow sinus openings worsen their chronic sinusitis symptoms. “By permanently widening their passages, we help sinusitis sufferers decrease the amount of medications needed and significantly reduce and eliminate the debilitating headaches that often accompany a patient’s sinusitis symptoms,” says Dr. Keefe. During the past two years, balloon sinuplasty technology has emerged as a new complement to existing approaches. The information below summarizes the primary approaches for treating chronic sinusitis.
Medical Therapy Stephen Keefe, MD is an American Board of Otolaryngology-certified physician. He is trained in reconstructive head and neck cancer surgery and in sinus and facial cosmetic surgery.
Sinusitis is typically treated first with medication. Treatment with antibiotics or topical nasal steroid sprays is often successful in reducing mucosal swelling, fighting infection, and relieving obstructions of the sinus opening (ostium). Inhaling steam or use of saline nasal sprays or drops can also help relieve sinus discomfort. However, at least 20% of patients do not respond adequately to medications.
Endoscopic Sinus Surgery (ESS) The goals of sinus surgery are to clear blocked sinuses restoring normal sinus drainage and to preserve normal anatomy and mucosal tissue. Specialized instruments are placed into the nose along with a small endoscope to help the surgeon see inside the nose and nasal cavities.
Traditional Instrumentation Sinus surgery with traditional instrumentation removes bone and tissue to enlarge the sinus opening. The removal of bone and tissue may lead to post-operative pain, scarring and bleeding. Uncomfortable nasal packing may be required to control the bleeding.
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Healthy Eats
gluten free recipes
Gluten Free Entrée: Beef Tenderloin
Directions: 1. Pre-heat oven to 425 degrees.
Makes 12 servings
2. Place roast in a shallow roasting pan with rack.
Ingredients: 1 beef tenderloin (5 lbs)
3. In small bowl, mix oil, garlic, salt and pepper and rub over roast.
2 tbsp olive oil
4. Roast for 50-70 minutes.
4 garlic cloves, minced
5. Remove from oven and tent with foil, allow to rest for 15 minutes before serving.
2 tsp sea salt 1.5 tsp ground pepper
Local Beef from: Wolf Creek Farms www.wolfcreekfarm.com | 540.948.5574 info@wolfcreekfarm.com Wolf Creek’s mission is to create a sustainable farm that enhances the health of their livestock, community, and customers. Nestled in the Blue Ridge Mountains, they pride themselves on reconnecting people to a more natural, wholesome, and healthy environment. All their beef is 100% grass fed without antibiotics or hormones.
Tricia Foley’s
BEEF TENDERLOIN Tricia Foley is OurHealth Magazine’s resident nutritionist.
Healthy Eats
gluten free recipes
Gluten Free Side: Quinoa Salad Makes 8 servings
Salad Ingredients: 2 cups quinoa
2 medium shallots, peeled and diced 2 firm apples, cored and diced 1/4 cup pomegranate seeds 1/2 cup diced celery 1 cup sliced cherry tomatoes
Directions:
1. Rinse the quinoa under water for several minutes, rubbing the grains together to remove film. 2. Place the quinoa in a medium saucepan and add 4 cups of water. Cook over medium heat until tender (about 20 minutes). 3. Drain any excess water and lightly drizzle with extra virgin olive oil. Sauté the shallots and apples until lightly browned.
1/4 cup chopped fresh parsley
4. Toss together the quinoa along with the remaining ingredients and add the vinaigrette.
2 tablespoons chopped basil
5. Add salt and pepper to taste.
11/4 cup sliced red grapes
Local apples from: Hartland Orchard 3064 Hartland Lane | Markham, VA 22643 www.hartlandorchard.com | 540.364.2316 About Hartland Orchard: Just over an hour’s drive from Harrisonburg, Hartland is an old family working farm and orchard. They produce top quality fresh fruit at affordable prices for you and your family. They take pride in offering you the freshest, juiciest fruit possible. During the fruit season, you can stop by to purchase fruit that has already been picked; or spend a few hours picking your own fruit. Containers and bags are provided so no need to bring your own.
2 tablespoons lemon juice
Extra virgin olive oil
Vinaigrette Ingredients: 1/4 3 1/2 1 1/2
cup local honey tablespoons lemon juice cup extra virgin olive oil teaspoon kosher salt teaspoon freshly cracked pepper
Tricia Foley’s
HEALTHY QUINOA SALAD Tricia Foley is OurHealth Magazine’s resident nutritionist.
Local health. Anywhere you go. OurHealth magazine is Shenandoah Valley and Charlottesville’s only resource entirely dedicated to delivering information about local healthcare services and healthy living topics. Pick up our print edition at more than 900 locations throughout the area or get the digital edition by visiting www.ourhealthcville.com.
Healthy Eats
gluten free recipes
Gluten Free Dessert: Pumpkin Rolls: Makes 8 servings
Ingredients: 3 eggs ¼ C local honey 2/3 cup unsweetened pumpkin puree 1 teaspoon lemon juice 1/3 cup coconut flour 1 teaspoon baking powder 1 tbsp cinnamon 1 teaspoon ground ginger 2 teaspoon ground nutmeg 1/2 teaspoon salt *add water as needed
Filling Ingredients: 2 tbsp honey 8 ounces reduced fat cream cheese, softened 4 tablespoons butter 3/4 teaspoon vanilla
Directions: 1. In a mixing bowl beat eggs on high speed of electric mixer; gradually beat in honey, beating until light and lemon colored.
6. Bake in a preheated 375° oven for 15 minutes, or until cake bounces back when touched lightly with finger. 7. Turn cake out onto a clean dish towel. Starting at narrow end, roll towel and cake up together; cool. Unroll. 8. Combine the honey, cream cheese, butter, and vanilla; beat until smooth. 9. Spread over the cooled cake and roll up. Chill. 10. Makes 15-20 servings, depending on thickness of slices. This pumpkin cake roll freezes well.
2. Stir in the pumpkin and lemon juice. 3. In a separate bowl, sift together the coconut flour, baking powder, spices, and salt. 4. Fold flour mixture into the pumpkin batter. 5. Spread in a generously greased and floured 10x15-inch jelly roll pan.
Tricia Foley’s
HEY PUMPKIN! ROLLS Tricia Foley is OurHealth Magazine’s resident nutritionist.
FITBITS
H EA LT H A ND F I T NES S O N
Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer
THE GO
Spring into Action!
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 Richmond.
This workout* is based on a 7-day plan, including at least one rest day. Repeat for 4-6 weeks and be ready to sport your warm weather wear just in time for summer! *Consult with your physician/provider before beginning any new fitness program.
Make sure you are properly warmed up before you begin this workout! Your warm-up should consist of 5-7 minutes of low-impact movement, such as marching in place or walking.
2.
Day 1:
Strength Training Program Perform each exercise per diagram at right for one minute with a 15-second transition between each step (Completing steps 1-10 is one set). Rest two minutes between each set. Complete 2-3 sets.
Day 2:
Take a cycle class or spend 45minutes on an elliptical machine.
Day 3:
REST DAY!
Upright Row with Tubing 15-second rest
1.
3.
Hamstring Curl on Ball 15-second rest
4.
Squats
15-second rest
Overhead Press with Weights
Day 4:
Strength Training Program (repeat day 1)
Day 5:
Take a mind/body class, such as yoga, pilates or barre.
Day 6:
Engage in 45-minutes of outdoor cardio, such as walking/jogging/ biking (weather-permitting). Take advantage of nice weather days! (In case of inclement weather, take it ‘indoors’ using the treadmill, bike or elliptical machine.)
Day 7:
Take a group fitness class or do an ‘at-home’ workout such as the one featured in the January/ February 2015 issue of OurHealth CVILLE/SV (scan this QR code to view the January/February digital version of Fit Bits located on page 24) or, if
needed, Day 7 can be used as another ‘rest’ day!
10.
15-second rest
5.
DAY 1 Strength Training
Plank
15-second rest
15-second rest
9.
Reverse Fly with Weights 15-second rest
8.
Triceps Kickbacks with Weights
Alternating Lunges
7.
6.
Bicep Curls with Weights 15-second rest
Push-Ups 15-second rest
15-second rest
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decoding words |Suzanne Ramsey
lab tests Making (a little) sense of a mind-boggling topic A few years ago, I had some lab work done at my physician’s office. At this point, I don’t even recall what led me to make the appointment in the first place, but when I got my results back, the only readily recognizable thing on the two-page report was a handwritten note from my physician: “Your lab is all essentially normal.” That was good news, of course — who wouldn’t want to be essentially normal? — But what in the world did all those acronyms, abbreviations and numbers mean? One can deduce that “L” means low and “H” means high, but what’s a CBC or an HCT, and what the heck is osmolality? Wouldn’t it be nice if there was some user-friendly, online source that could explain it all, without having to pester your physician unnecessarily? Well, there is.
Julie Plumbley, MD is certified by the American Board of Pathology in Anatomic Pathology & Clinical Pathology and in Hematology. Dr. Plumbley practices at Blue Ridge Pathologists in Fishersville.
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“An excellent website for learning about lab results is LabTestsOnline.org,” Julie Plumbley, MD, chairman of the pathology department for Augusta Health, says. “It’s sponsored by numerous professional organizations within the clinical laboratory field.” So I took a peek at Lab Tests Online and found Dr. Plumbley to be absolutely correct. There, on the easy-to-navigate website, one can find an explanation for what appears to be every lab test known to mankind, from A/G Ratio to Zinc Protoporphyrin.
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I quickly discovered that osmolality is a test “to help evaluate the body’s water and electrolyte balance,” among other things, and that CBC means “complete blood count” and HCT stands for “hematocrit.” I also found that many of the dozen or so tests listed on my “comprehensive metabolic panel” are used to identify kidney and liver problems. Anemia, caused by iron deficiency in the blood, and infections are also biggies. Having lab tests run often begins with a complaint to the physician. “‘I’m fatigued.’ That’s probably a big one,” Scott Seaton, MD, of the University of Virginia Health System’s Waynesboro Primary Care, says. “Or, ‘I’m having a fever.’ ‘I’m having abdominal pain.’ ‘I’m short of breath.’ ‘My periods are heavy.’ “That’s probably among your most frequent things. We’re concerned about an infection and anemia, looking at white blood cells and red blood cells. If you have a rash, we sometimes also order serologies. Certain bacteria that you can get from ticks, can cause autoimmune diseases that would develop a rash.” I began to wonder, with all those liver-related tests, if my physician suspected I drank too much or had other bad habits. Dr. Plumbley, who has been practicing for 15 years, eased my paranoia, explaining that my physician was simply “casting a wide net, based on medical experience” and that “a comprehensive metabolic panel has a bunch of individual tests in it. It’s been constructed over the years to be a good starting point to screen the function of various organ systems. “This can help in several possible ways: narrowing down the search for the source of the patient’s symptoms, confirming the physician’s hypothesis of what’s going on, or pointing in another direction. Some of the commonly used panels, such as CBC, lipids and comprehensive metabolic panels are done as part of a routine physical examination to help the physician see beyond history and physical examination findings. “Lab tests can help make the invisible visible.” While deemed “essentially normal,” a couple of my results were a smidgen high and a couple a teensy bit low. For example, my TCO2 — also known as “bicarbonate” — was 30 instead of within the “reference range” of 20 to 28. My RBC — red blood cell count — was 3.96 instead of 4.20 to 5.50. Should I have been concerned? According to Dr. Seaton, probably not. “When you look at lab tests ... 95 percent of people fall into those normal ranges, but that doesn’t mean that five percent of people are abnormal,” he says. “So, you can be outside the range and you’re still a normal person.
What is a comprehensive metabolic panel? A comprehensive metabolic panel is a blood test that measures your sugar (glucose) level, electrolyte and fluid balance, kidney function, and liver function. Glucose is a type of sugar your body uses for energy. Electrolytes keep your body’s fluids in balance. Source: WebMD
“So, you can look at it this way: If you order a CBC, which has 10 different things on it, what’s the chance that you’re going to fall outside of one of those ranges out of www.OurHealthCville.com
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What is a complete blood count? A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. A CBC helps your doctor check any symptoms, such as weakness, fatigue, or bruising, you may have. A CBC also helps him or her diagnose conditions, such as anemia, infection, and many other disorders. Source: CDC.gov
10 times? If it’s 95 percent, you might have one or two of these things that, 50/50 chance, you’ll be slightly abnormal, but that doesn’t mean you’re abnormal.” Dr. Plumbley says this is an excellent point. “Hurray for Dr. Seaton for pointing that out,” she says. “As a laboratorian, I worry that people will lose sight of that. Yes, just based on the statistical methods used to arrive at normal ranges, if 20 tests are ordered on a healthy individual, odds are very good that one result will be out of range. Also, not all lab results use this method of designating normal. It depends on what you’re testing for.” And what’s “normal” can vary based on things like ethnicity. “If you have a white [blood cell] count that’s 3.8 and you’re African American heritage, that’s normal,” Dr. Seaton says, adding that African American’s “tend to have lower white counts than northern Europeans would have.” So, how do you know when to worry? “If something is really bad... [the lab is] going to be calling me at two in the morning,” Dr. Seaton says. “Then, I’m going to be calling you at 2 am to say, ‘Pack your bags and get over to the hospital right away.’ ” Scott Seaton, MD is certified by the American Board of Internal Medicine. Dr. Seaton accepts patients at UVA Health System’s Waynesboro Primary Care.
That said, no news isn’t necessarily good news. Give it a couple of weeks, Dr. Seaton says, and if you haven’t heard anything about your lab results call the medical office. He says patients should always ask for a copy of their lab work and, on occasion, things have been known to get hung up somewhere in the process. “You shouldn’t assume that if I haven’t heard anything from the doctor things are perfectly normal,” he says. “I’ve had lab tests that came back to me a month or two later that I’ve never seen before. Thankfully, they’ve always been normal. That always disturbs me.” Even with resources such as Lab Tests Online literally at your fingertips, this whole thing might still be about as easy to understand as Charlie Brown’s teacher. Luckily, your physician has it covered. “Lab testing is a very complex science,” Dr. Plumbley says. “You can’t expect to understand it just because you see the numbers. You need the guidance that comes from your physician. But I do like the idea of people becoming more familiar with the science and gaining some appreciation of the complexity of medical decision making. “Doctors often make it look straightforward, but it’s complex. Just like an Olympic gymnast makes a back flip look easy. But they’ve trained. A lot. There’s a lot of data integration going on in looking after a patient and lab results are just part of the data set. They don’t stand alone. Abnormal results have to be interpreted in context.”
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words
What do all those and MEAN anyway?
acronyms
Using information from Lab Tests Online, here are some of the lab tests routinely ordered by physicians:
Sodium:
To determine whether your sodium concentration is within normal limits and to help evaluate electrolyte balance and kidney function; to monitor chronic or acute hypernatremia or hyponatremia (higher or lower than normal levels of sodium in the blood).
Potassium:
To determine whether your potassium level is within normal limits and to help evaluate an electrolyte imbalance; to monitor chronic or acute hyperkalemia or hypokalemia (higher or lower than normal levels of potassium in the blood).
Chloride:
To determine if there is a problem with your body’s electrolyte balance and/or to monitor treatment.
Acid-base balance:
The body’s maintenance of a healthy pH range for blood and tissues that is slightly basic (pH between 7.35 - 7.45). This balance is achieved through the use of systems in the blood (which help to minimize pH changes) and by the lungs and kidneys, which eliminate excess amounts of acids or bases from the body.)
TCO2 (Bicarbonate):
As part of an electrolyte panel to identify or monitor an electrolyte imbalance or acid-base (pH) imbalance
Glucose:
To determine if your blood glucose level is within a healthy range; to screen for and diagnose diabetes and prediabetes and to monitor for high blood glucose (hyperglycemia) or low blood glucose (hypoglycemia); to check for glucose in your urine.
Urea Nitrogen (Blood Urea Nitrogen, BUN):
To evaluate kidney function; to monitor the effectiveness of dialysis and other treatments related to kidney disease or damage.
Creatinine:
To determine if your kidneys are functioning normally and to monitor treatment for kidney disease.
Calcium:
To screen for, diagnose, and monitor a range of conditions.
Blood Testing Basics • Blood testing is basic to confirming good health and diagnosing disease. • Blood testing shouldn’t hurt. If a phlebotomist needs more than two tries to find a vein, ask for someone else. • When your doctor orders fasting blood tests, it is very important to be actually fasting when you arrive at the lab. This means no food for 12 hours, and no black coffee or diet sodas either. • Fasting isn’t always required for blood testing. In fact, it’s a good idea to have non-fasting (postprandial) testing of blood sugar levels for early detection of diabetes. • Laboratory values differ from lab to lab. Each report comes with a reference range. Source: SteadyHealth.com
Total Protein:
As part of a general health checkup, to determine your nutritional status or to screen for and help diagnose certain liver and kidney disorders as well as other diseases. Acronyms—continued on page 36
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Acronyms—continued from page 35
Albumin, Serum:
To screen for and help diagnose a liver disorder or kidney disease, sometimes to evaluate nutritional status, especially in hospitalized patients.
AST (GOT):
To detect liver damage and/or to help diagnose liver disease.
Alk. Phosphatase (ALP, Alkaline Phosphatase)
To screen for or monitor treatment for a liver or bone disorder.
What is a reference range? The usual range of test values for a healthy population. Source: Medical Dictionary for the Health Professions and Nursing
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Total Bilirubin:
To screen for or monitor liver disorders or hemolytic anemia.
ALT (GPT) (ALT, Alanine Aminotransferase):
To screen for liver damage and/or to help diagnose liver disease
GFR (Calculated Glomerular Filtration Rate, cGFR, Estimated Glomerular Filtration Rate):
To assess kidney function and diagnose, stage, and monitor chronic kidney disease (CKD).
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Acronyms—continued on page 37
Acronyms—continued from page 36
Osmolality (CALC):
To help evaluate the body’s water and electrolyte balance; to investigate low sodium levels in the blood (hyponatremia) and increased or decreased urine production; to detect alcohol poisoning due to ingestion of toxins such as methanol or ethylene glycol; to monitor the effectiveness of treatment for conditions affecting osmolality; to help determine the cause of chronic diarrhea.
TSH Reflex (Thyroid Function Panel):
To help evaluate thyroid gland function and to help diagnose thyroid disorders.
RBC (Red Blood Cells):
To evaluate the number of red blood cells (RBCs); used to screen for, help diagnose, or monitor conditions affecting red blood cells.
HGB (Hemoglobin):
To evaluate the hemoglobin content of your blood as part of a general health checkup; to screen for and help diagnose conditions that affect red blood cells (RBCs); if you have anemia or polycythemia, to assess the severity of these conditions and to monitor response to treatment.
HCT (Hematocrit):
To determine the proportion of your blood that is made up of red blood cells (RBCs), thus to screen for, help diagnose, or monitor conditions that affect RBCs; as part of a routine health examination or if your doctor suspects that you have anemia or polycythemia.
MCV, MCH, MCHC, RDW:
These are measurements or calculations related to red blood cells (RBCs) and are components of the complete blood count (CBC), a commonly requested test used for a variety of purposes.
MCV (Mean Corpuscular Volume):
Indicates RBCs are larger than normal (macrocytic), for example in anemia caused by vitamin B12 or folate deficiency.
MCH (Mean Corpuscular Hemoglobin):
Mirrors MCV results; macrocytic RBCs are large so tend to have higher MCH.
MCHC (Mean Corpuscular Hemoglobin Concentration):
Increased MCHC values (hyperchromia) are seen in conditions where the hemoglobin is more Acronyms—continued on page 38
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37
Acronyms—continued from page 37
concentrated inside the red cells, such as autoimmune hemolytic anemia, in burn patients, and hereditary spherocytosis, a rare congenital disorder.
RDW (RBC Distribution Width):
Your Health in One Drop • 70% of data needed for accurate diagnosis and health management is in your blood. This data is critical for wellness and prevention. • Your blood cells regenerate every 120 days, so you can quickly measure significant improvement from lifestyle and nutritional changes. • Blood diagnostic testing can provide greater knowledge about risks for heart disease and other chronic illnesses.
70%
Source: NIH.gov
Indicates mixed population of small and large RBCs; immature RBCs tend to be larger. For example, in iron deficiency anemia or pernicious anemia, there is high variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis), causing an increase in the RDW.
Platelet Count:
To determine the number of platelets in a sample of your blood as part of a health exam; to screen for, diagnose, or monitor conditions that affect the number of platelets, such as a bleeding disorder, a bone marrow disease, or other underlying condition.
WBC (White Blood Cells):
To screen for or diagnose a variety of conditions that can affect white blood cells (WBC) such as an infection, inflammation or a disease that affects the production or survival of WBCs; to monitor treatment of a blood disorder or to monitor therapy that is known to affect WBCs.
White Blood Cell Differential (LYMPH, MONO, NEU, EOS, BASO):
White blood cell differential may or may not be included as part of the panel of tests. It identifies and counts the number of the various types of white blood cells present. There are five types:
LYMPH (Lymphocytes):
Leukocyte (white blood cell) that normally makes up about 25% of the total white blood cell count but can vary widely. Lymphocytes occur in two forms: B cells, which produce antibodies, and T cells, which recognize foreign substances and process them for removal.
MONO (Monocytes):
Leukocyte (white blood cell) that functions in the ingestion of bacteria and other foreign particles. Monocytes make up 5-10% of the total white blood cell count.
NEU (Neutrophils, also Granulocyte):
Normally the most abundant type of white blood cell in healthy adults.
EOS (Eosinophils):
Leukocyte (white blood cell) with granules that are stained by the dye, eosin. Eosinophils, normally about 1-3% of the total white blood cell count, are believed to function in allergic responses and in resisting some infections.
BASO (Basophils):
Type of white blood cell (leukocyte), with coarse granules that stain blue when exposed to a basic dye. Basophils normally constitute 1% or less of the total white blood cell count but may increase or decrease in certain diseases.
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OurHealth
staff photographer, Keith Thienemann, captures a variety of healthy activities at
acac
acac is the club for everybody, and we can prove it! With locations at Albermarle Square, Downtown Charlottesville and Crozet, each comprehensive fitness center offers a variety of cardio and strength training equipment, group exercise and mind-body classes, programs and aquatics. Also featured are racquetball and squash (Downtown), basketball and pickleball (Albermarle Square), and a rooftop deck and pool for adults (Downtown). acac is also proud to offer its Physician Referred Exercise Program,
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Fitness & Wellness
or p.r.e.p.®, which encourages physicians to prescribe exercise to their patients as a way of answering many health concerns. p.r.e.p.® participants are engaged with acac nurses and exercise physiologists for 60 days for $60 to begin an exercise regime in conjunction with their doctor’s wishes. Each acac facility is open seven days a week, with the Crozet location offering 24-hour access to its members. For more information on everything acac has to offer, visit www.acac.com.
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Convenient Locations:
Albemarle Square
500 Albemarle Square | Charlottesville, VA 22901 | 434.978.3800
Downtown
111 Monticello Avenue | Charlottesville, VA 22902 | 434.984.0660
Crozet
1015 Heathercroft Circle | Suite 100 | Crozet, VA 22932 | 434.817.2055
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Women’s
words | RICH ELLIS
GYNECOLOGICAL
HEALTH
Education and preventive care are the keys to better health at every age. Many women are so focused on and busy caring for others—an aging parent, children, siblings, spouse, neighbor, co-worker or good friend—that their own health often takes a back seat to helping someone in need. Whether spending time with a father suffering from dementia or comforting a toddler with a stuffy nose, many women face a seemingly never-ending demand for their care, time, and attention—so much so that it often takes a personal healthcare crisis for some women to realize the importance of caring for themselves first. To increase the likelihood of enjoying good health throughout life and well into her later years, a woman must not only realize that her personal wellbeing is important, but also act on that awareness by pursuing preventive care at every age.
Pediatrician to gynecologist—when to make the switch, and why it’s important. The American College of Obstetricians and Gynecologists recommends that adolescent females have their first visit with an obstetrician-gynecologist (OB/GYN) between the ages of 13 and 15. Making that switch from a pediatrician or family practitioner to an OB/GYN, however, should not be a decision made by a young woman or her parents based strictly on age alone. JoAnn V. Pinkerton, MD, is a professor of obstetrics and gynecology and director of midlife health at the University of Virginia’s Health Center in Charlottesville. Dr. Pinkerton explains that there are a number of specific concerns that would indicate a young woman should see a gynecologist—regardless of age—including: • Considering or having had any type of sexual relations or intimate sexual contact • If it has been 3 or more months since her last period
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• Abdominal pain, fever, and vaginal discharge – which may indicate a pelvic infection • Periods that are very long, heavy or painful • If the first period is late starting – i.e. hasn’t started by age 15 or within three years of breast development • Continually missing periods • If pregnancy is a possibility
JoAnn Pinkerton, MD is certified by the American Board of Obstetrics and Gynecology and is a North American Menopause Society Menopause Specialist. She is the division director midlife health at the University of Virginia’s Health Center in Charlottesville.
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Making that transition to see an OB/GYN can be difficult for some young women, in part because they may be nervous about the idea of a pelvic exam and a new physician, but it’s a change that needs to occur. Young women should realize that their first visit with an OB/GYN will probably be more of a “get-acquainted” visit and in all likelihood won’t even include a pelvic exam, which should help alleviate some reluctance on the young patient’s part. Barbara Paszkowiak, MD, specializes in internal medicine at Augusta Health Internal Medicine in Fishersville. Dr. Paszkowiak explains that guidelines call for a woman who isn’t experiencing any problems to have her first pelvic exam and Pap smear beginning at age 21. That doesn’t mean, however, that a woman should wait until
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Young women who are considering becoming sexually active or already are should be seen by a gynecologist to discuss contraception and sexually-transmitted diseases (STD), among other issues. This is particularly important, Dr. Royal says, because studies have shown that 16 percent of women report being sexually active by age 15, 48 percent by age 17, 61 percent by age 18, and 71 percent by age 19. age 21 to see an obstetrician-gynecologist. One of the reasons she encourages young women first consult with an OB/GYN is if they are contemplating becoming sexually active or pregnant. Dr. Paszkowiak also points out that it’s important to remember that young girls, as well as boys, should be vaccinated against the Human Papillomavirus (HPV) before they become sexually active and are exposed to the virus. HPV is one of the most common sexually transmitted diseases, affecting women as well as men, and can cause future health problems, including genital warts and cancer. It’s recommended that both girls and boys receive the HPV vaccine beginning at age 11 or 12, Dr. Paszkowiak says, and up to age 26 for women and 21 for men. Another reason young women should be seen by an OB/GYN is so they can have a discussion about contraception and sexually-transmitted diseases (STDs). While those discussions often occur in the home first, between a child and their parent or when accompanied by a parent to the physician’s office, minors in Virginia can make the decision on their own with the help of an OB/GYN. Under current Virginia law, minors may be considered as adults for the purposes of consenting to medical and health services related to testing for STDs, birth control, pregnancy or family planning, without obtaining parental consent. Ami Keatts, FACOG, MD, an OB/GYN with Augusta Health Care for Women with offices in Fishersville and Lexington, says that in addition to the important topics usually discussed by patients, parents and physicians during a young woman’s first visit to a gynecologist, she has a few additional topics that she likes to discuss. “I try to talk with them about date rape, because unfortunately that does occur,” Dr. Keatts says, “and seat belt use, because at that age, a lot of them are just starting to drive and car accidents are a big risk to them.”
Women’s health through adulthood As a woman matures, one of the most important steps she can take to protect her health, beginning in her 20s throughout adulthood, is an annual visit with that OB/ GYN. Dr. Paszkowiak says it’s recommended that women receive their first Pap test or smear – a procedure during which cells are collected from the cervix and tested for cancer or pre-cancerous conditions – beginning at age 21. But that test isn’t the only reason for seeing an OB/GYN on a regular basis. There are a number of other gynecological problems as well as preventive health screenings that women should be aware of and discuss with their providers.
Barbara Paszkowiak, MD is certified by the American Board of Internal Medicine and accepts patients at Augusta Health Internal Medicine in Fishersville.
“Testing on Pap smears has improved so much over the years in terms of what we’re able to test for that we feel in many cases it’s not necessary to actually send a test to the lab every year to ensure that someone doesn’t have cervical cancer,” Dr. Moore explains. “Unfortunately many people read that as meaning they don’t need to come in period. I think every OB/GYN will tell you they would love to see you every year.“ www.OurHealthCville.com
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Hot flashes, decreased libido, disrupted sleep, weight gain, night sweats, depression, moodiness – there are a lot of myths about what every woman can expect as she approaches and enters menopause, and they’re not all true. Dr. Pinkerton shares her thoughts on some of the more common concerns or problems women in this age range may experience, including: A Urinary tract infection, also known as “honeymoon cystitis,” is a bladder infection often associated with intercourse. The condition presents with an increased frequency in urination, burning during urination, and sometimes the presence of blood in the urine. Sexually transmitted diseases (STDs) can occur at any age, but women in their 20s are more likely to be exposed to them because they are the most likely to have multiple sexual partners. Prevention, and testing, should be discussed with a gynecologist. Vaginal yeast infections present with vaginal itching, a white, clumpy discharge, and sometimes painful urination. They’re caused by an overgrowth of the yeast that occur naturally in the vagina, and the likelihood they will occur increases with stress, diabetes, pregnancy, or the use of oral contraceptives or antibiotics. Bacterial vaginosis (BV) is treatable and is an overgrowth of “bad” bacteria found normally in the vagina. It’s more likely to happen to women who are in their 20s and 30s and who are very sexually active, or who have a new sexual partner, or multiple partners. Polycystic ovarian syndrome (PCOS) is the most common cause of female infertility and is associated with high levels of androgens. Often diagnosed in women in their 20s and 30s, indications may include multiple, small ovarian cysts, being overweight (although this is not always the case) and facial-hair growth. Less common but serious medical issues including endometriosis, or the growth of smooth muscle tumors called fibroids. Dr. Pinkerton adds that irregular, heavy, light, or painful periods, as well as changes in menstrual flow, should also all be evaluated by a gynecologist. Dr. Keatts says that in addition to those menstrual problems, which become more common in women in their 40s, she recommends women receive an HPV test as well as a Pap smear, a mammogram beginning at age 40 as part of a breast cancer screening, screening blood work for cholesterol, a review of risk factors for diabetes, and a discussion about lifestyle issues, such as alcohol and drug use. Patients with a family history of breast or ovarian cancer should also consider having genetic testing done – performed by means of a blood test – to see if they have inherited mutations in the 46
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BRCA1 or 2 genes, Dr. Keatts explains. Having the mutations increases the risk of developing breast or ovarian cancer.
Women, hormones, and the 40’s and 50’s Hot flashes, decreased libido, disrupted sleep, weight gain, night sweats, depression, moodiness – there are a lot of myths about what every woman can expect as she approaches and enters menopause, and they’re not all true. The average age of menopause – defined as 12 months without a period – is 52, explains Dr. Pinkerton, but the ovaries usually begin acting irregularly before menopause and usually within a range of ages 45 to 55, or earlier or later. Perimenopause – the time around or leading up to menopause – marks the body’s natural progression toward menopause and can last for a number of years.
Additional preventive health considerations for a woman in her 50s include a colonoscopy at age 50 to establish a baseline, and if the results are normal, another one approximately 10 years later, Dr. Moore recommends. He also stresses the importance of bone-density
The fluctuations and decrease in ovarian hormone production that occur leading up to and during menopause can cause many physical and emotional changes, Dr. Pinkerton says. Common symptoms include hot flashes, night sweats, becoming emotional, crying easily, difficulty sleeping, irritability, vaginal dryness or painful intercourse, increased urination frequency, headaches, or irregular or heavy bleeding.
testing to look for signs of
Contrary to popular belief, however, not every woman will experience symptoms related to menopause. For example, hot flashes will occur in about 75 percent of
someone.
osteoporosis because you can’t, as he explains, discern thinning bones simply by looking at
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women, with symptoms being severe enough to consider therapy in 25 percent of those women, Dr. Pinkerton says. Other myths include that all menopausal women gain weight and abdominal fat, and experience a reduced libido. Not true, says Dr. Pinkerton. “Hormonal changes do increase the chance of developing abdominal fat but this can be avoided through increased movement and exercise and by eating fewer calories throughout the day,” she explains. “Lowered hormone levels can affect vaginal dryness and sexual response, however many women are able to use vaginal moisturizers, lubricants, or vaginal estrogen to protect their vaginas. Sexual drive may decrease but can be increased through more attention to increasing couple pleasure, taking time, and decreasing stress.” Women experiencing menopausal symptoms that are unbearable – such as hot flashes – may want to consider hormone replacement therapy to help alleviate the symptoms, Dr. Paszkowiak says. Hormone replacement therapy isn’t recommended for every woman across the board, and there are nonhormonal treatment options available, including low-dose antidepressants or other medications. Additional occurrences around menopause can include changes in a woman’s lipid profile – including cholesterol or triglycerides – that may increase the risk of cardiovascular disease, the loss of muscle mass and a gain of fat mass, Dr. Paszkowiak explains. Bone density loss is also a problem some menopausal women will experience, Dr. Keatts explains, and it can be countered by performing weight-bearing exercises, adding calcium and vitamin d to the diet, and through bone density screenings. She also recommends that women over age 50 receive a colonoscopy to screen for colon cancer, and reminds them that the risk factors for developing heart disease increase after menopause – one of the many reasons to avoid a high-fat diet, get plenty of exercise, and not smoke.
Ami Keatts, MD is certified by the American Board of Obstetrics and Gynecology and accepts patients at Augusta Health Care for Women in Fishersville.
As they age, women have a lot to think about when it comes to their health and wellbeing, in addition to everything else occurring in their lives. And while caring for another is a noble cause, it’s a practice that should begin with one’s own health. The first step can be establishing and maintaining a relationship with an obstetriciangynecologist, seeing them annually, and practicing and maintaining a lifelong commitment to preventive healthcare measures. Only when women care for themselves first and consistently can they effectively help care for those who care most about them.
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