table of contents | november • december 2014
MEDI•CABU•LARY.......................8 Local experts define health related terms
JUST ASK!.......................................10 Healthcare questions answered by local professionals
20 The Aging Ear Approximately one in three people between the ages of 65 and 74 has hearing loss and nearly half of those older than 75 have difficulty hearing
NEW & NOTEWORTHY.............12 A listing of new physicians, providers, locations and upcoming events in the Shenandoah Valley and Charlottesville communities
HEALTH POINTS.........................16 Interesting facts and tidbits about health
ANATOMY CHALLENGE: The Amazing Ear............................19 Test your knowledge about The Amazing Ear through our Anatomy Challenge Word Search and learn more along the way!
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
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Unhappy Holidays
27
When 'the most wonderful time of the year' isn't Dealing with grief near the holidays, a few share their experiences with losing loved ones.
New Technologies:
Today’s doctors, providers and hospitals and others continue to redefine and refine quality of care. In our cover story feature, we highlight a few local advancements in healthcare that further improve the quality of life in our communities. FIT BITS!........................................ 47 Health and Fitness On-the-Go: Work the Back to Wear the 'Black'
LOOKING BACK........................... 58 Images reflecting the landscape of healthcare in the Shenandoah Valley and Charlottesville * PLUS * a chance to win prizes!
hello, HEALTH!.............................. 48 Capturing the spirit of those working in our local healthcare and of people leading healthy lives through photos
NUTRITION.................................. 50 HEALTHY EATS: Diabetic friendly fall recipes that are sure to please your palate!
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PUBLISHER PRESIDENT/EDITOR-AT-LARGE VICE PRESIDENT OF PRODUCTION PROJECT COORDINATOR AND FITNESS EXPERT CHIEF DESIGNER WEBSITE
december 2014 McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Deidre Wilkes Karrie Pridemore Next Generation Designs
CONTRIBUTING SHENANDOAH VALLEY & Cherie Allen CHARLOTTESVILLE MEDICAL EXPERTS Tricia Foley, RD, MS Kara Hawkins, MD Miki Hori, DPM Bruce Libby, PhD Raj Pillai, MD Jeffrey Todd, MD CONTRIBUTING PROFESSIONAL EXPERTS & WRITERS Deniz Ataman Susan Dubuque Laura Neff-Henderson, APR Steve McClintic, Jr. Suzanne Ramsey Christine Stoddard Deidre Wilkes Diane York ADVERTISING AND MARKETING Kim Wood • Vice President of Business Development 540.798.2504 • kimwood@ourhealthvirginia.com Cindy Trujillo • Senior Media Consultant 434.907.5255 • cindy@ourhealthvirginia.com SUBSCRIPTIONS To receive OurHealth Shenandoah Valley/Charlottesville via U.S. Mail, please contact Deidre Wilkes at deidre@ourhealthvirginia.com or at 540.387.6482
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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.
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 plantar fasciitis? Plantar fasciitis is a common cause of heel pain that affects people of all ages. However, aging results in changes that may increase the risk for developing heel pain: the fascia becomes less elastic, and the fat padding on the bottom of the heel may become atrophied and thinned. This results in inflammation and pain even with routine daily activities. The best way to avoid heel pain is to wear comfortable, supportive shoes such as lace-up athletic shoes with a good arch support. Insoles may help. Heel chord and plantar fascia stretches are essential. Although recovery may take months, most people are able to resume normal activity, and surgical intervention is rarely necessary Miki Hori, DPM
Harrisonburg Foot & Ankle Clinic Harrisonburg | 540.434.2949 www.harrisonburgfootankle.com
What is echocardiography and the benefits of using it to diagnose coronary artery disease? Echocardiography is a noninvasive ultrasound imaging of the heart to measure its pumping function, assess valves, and pressures. It gives a lot of very important information that guides decision-making during a heart catheterization. Finding certain abnormalities on an echocardiogram prior to going for catheterization can also change the plan and may lead to additional testing. For example, if a scar is found in a certain area of the heart and a blockage on catheterization corresponding to that, a stent is not likely to be placed. If high pressures in the lung circulation are seen, then additional testing may take place on the catheterization table. If heart function is not normal, heart bypass for multiple blockages might be done instead of stenting. While it is easy to do an echocardiogram, repeating a catheterization for something found on an echocardiogram is adding unnecessary risk through an invasive procedure. Raj Pillai, MD
Cardiologist Augusta Health Cardiology Fishersville | 540.332.4278 www.augustahealth.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
What is a dosimetrist? A medical dosimetrist is a part of the radiation therapy team, along with radiation oncologists, radiation therapists, and medical physicists. While the work that a dosimetrist performs is behind the scenes and patients seldom meet the dosimetrist, their job is one of the most important in the radiation treatment of cancer. A dosimetrist is a trained person who, along with the radiation oncologist, plans the course of treatment that a patient will receive. This planning includes determining the orientation of the treatment beams, calculating the dose that the tumor receives and working to limit the dose that normal structures – such as the spinal cord, rectum, or bladder – receive. Both the medical physicist and radiation oncologist then review this plan prior to the patient being treated. . Since a dosimetrist plans all treatments, it is often said that the dosimetrists are the most important personnel in the department. They are the first step in ensuring that a patient receives the proper radiation treatment for their cancer. Bruce Libby, PhD
Associate Professor of Radiological Physics and Director of Clinical Physics Residency UVA Cancer Center Charlottesville | 434.924.5191 www.medicine.virginia.edu
H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
What are some ‘uncommon’ symptoms of a heart attack that people should be aware of ? Although most people think a heart attack feels like an elephant sitting on the chest, in reality, there are many symptoms that may, or may not be present. Most people feel a discomfort in the chest, but 1/3 of patients don't have any chest pain. Shortness of breath is common, but there are numerous other symptoms that can occur as the only sign of the heart attack. Some patients develop weakness, nausea and vomiting, palpitations, anxiety, arm pain (typically left arm), jaw pain, unusual sweating, or altered mental status, in any combination. Women and elderly patients, as well as diabetics, are more likely to have an atypical presentation. Because timely care is critical with heart attacks, I always advise patients to call 911 if having suggestive symptoms. When in doubt, check it out! Jeffrey Todd, MD
Carilion Clinic Cardiology Carilion Stonewall Jackson Hospital Lexington | 540.224.1041 www.carilionclinic.org
What are the differences between Type 1 Diabetes and Type 2 Diabetes?
What are some meaningful activities for people with dementia?
Type 1 diabetes occurs when the body’s immune system attacks the cells in the pancreas that make insulin, causing little to no insulin production. Insulin helps move glucose from blood into the cells of the body to make energy, and when there is not enough, glucose levels rise. Type 1 diabetes typically occurs in childhood, but it can occur at any age. Treatment includes insulin, either with injections into the skin or continuous infusion through a pump, as well as managing diet and exercise.
For individuals with dementia, it is important that activities are enjoyable, can be adapted to changing needs, and create a sense of purpose. We all want to feel needed, and this desire is a valuable opportunity to engage those with memory loss. Meaningful activities can be domestic in nature – from baking and setting tables, to folding laundry – or creative, like painting or arranging flowers.
Type 2 diabetes begins with insulin resistance, meaning that muscle, liver and fat need more insulin than usual to move glucose into their cells to make energy. The pancreas initially makes more insulin to keep up with the higher demand, but eventually it cannot compensate and blood glucose levels rise. Most often it occurs in middle-aged to older adults. Treatment can include dietary changes, exercise, checking blood glucose, and oral medication and/or insulin. Kara B. Hawkins, MD
Martha Jefferson Medical and Surgical Associates Charlottesville | 434.654.5260
Our Lady of Peace residents enjoy walking, raking leaves, and gardening, which are not only fun, but great exercise as well. Other popular activities include singing, games, facials, manicures, looking at photos, pet visits, sorting objects, writing letters, and more. When doing activities with our residents, we try not to focus on the outcome, but on the positive feelings that arise during and after an activity. Life for individuals with memory loss is made up of moments, and while we may not be able to create a perfect day for our residents, we can create a perfect moment and bring smiles to their faces. Cherie Allen
Activities Coordinator Our Lady of Peace Retirement Community Charlottesville | 434.973.1155 www.our-lady-of-peace.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Augusta Health's Big Squeeze Program Provides Community-Based Blood Pressure Screenings and Education The Big Squeeze, a hypertension screening and education program designed to lower blood pressure readings throughout the community, will began this November and continues throughout 2015. The Big Squeeze events will be held every other month at four community locations—at the Valley Mission in Staunton and Casa de Amistad in Waynesboro on odd months and at Booker T. Washington Community Center in Staunton and Rosenwald Community Center in Waynesboro on even months. The first four events scheduled are: • Valley Mission, Staunton—Wednesday, November 5, 5-6 pm • Casa de Amistad, Waynesboro—Wednesday, November 19, 5-6 pm • Booker T. Washington Center, Staunton—Tuesday, December 2, 6-7 pm • Rosenwald Center, Waynesboro—Tuesday, December 16, 6-7 pm In addition to blood pressure screening, information on health topics—such as eating healthy on a budget, maintaining a healthy weight and easy ways to exercise—will be provided. During the November and December events, free flu shots and colon cancer test kits will be available. “Over the past few months, we’ve worked together with the Parks and Recreation staff in Staunton and Waynesboro, and the staffs at Valley Mission and Casa de Amistad, to create a program that will become a part of their communities, and help people live healthier lives. We all want to prevent
A. Bobby Chhabra, MD, Appointed Chair of UVA Department of Orthopaedics University of Virginia School of Medicine has named A. Bobby Chhabra, MD, as Chair of the Department of Orthopaedics. Dr. Chhabra is a hand, wrist and elbow specialist who helped create the UVA Hand Center and was appointed chair after serving as vice chair for five years. Dr. Chhabra is a fellow of the American Academy of Orthopaedic Surgeons, a member of the American Society for Surgery of the Hand and a fellow of the American Orthopaedic Association. For eight consecutive years, he has been named to the Best Doctors in America List by Best Doctors, Inc.
To make an appointment with Dr. Chhabra, please call 434.982.4263. To learn more about the UVA Department of Orthopaedics, visit uvaortho.com.
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illnesses like heart disease and stroke, and we all believe this program can do that through awareness and education,” says Krystal Diehl, M.Ed, CHES, Health Educator at Augusta Health. “Managing chronic disease, and specifically heart disease, was a health priority identified in the Community Health Needs Assessment. It’s been a great experience to work with community partners on this project to help meet this need.” The Big Squeeze program is funded by the Community Benefit Committee of the Board of Directors at Augusta Health. Augusta Health is an independent, nonprofit community hospital whose mission is to promote the health and well-being of our community through access to excellent care. Named one of the 100 Top Hospitals in America by Thomson Reuters in both 2011 and 2012, Augusta Health also has been nationally recognized by HealthGrades as one of America’s 100 Best Hospitals for clinical excellence and patient safety for the last three consecutive years. For more information about Augusta Health, its programs or its services, please contact Public Relations at 540.245.7329 or visit our website, www.augustahealth.com.
Carilion Clinic To Offer Family Medicine Services in Buena Vista City of Buena Vista purchases building which will house new practice Carilion Clinic is proud to offer family medicine services to the city of Buena Vista. Family medicine physician Thomas F. Hamilton, MD, has joined Carilion Clinic and will begin seeing patients in November. “Buena Vista is a large part of our community and we’re thrilled to be able to offer family medicine in this area,” says Chuck Carr, vice president and hospital administrator at Carilion Stonewall Jackson Hospital. “We have future plans that include adding additional physicians and specialists to this practice which will have a significant impact on the care we can provide to this region.” The new practice will be located in a space recently purchased by the city of
Buena Vista. Carilion has agreed to lease the space from the city. Those involved in the purchase and lease agreement include the Buena Vista Economic Development Office, Buena Vista City Attorney, Carilion Stonewall Jackson Hospital, and the Bank of Botetourt. “We are pleased to partner with Carilion to offer additional medical care to the citizens of Buena Vista. This agreement provides our citizens with access to world class care through the nationally recognized health program of the Carilion Clinic,” says Mayor Frankie Hogan. “We are thankful to all of those involved in the development of this important partnership.”
Carilion Stonewall Jackson Hospital Receives 2014 PRC Award for Excellent Communication With Doctors Awards recognize organizations that have achieved excellence Carilion Stonewall Jackson Hospital (CSJH) was named a 2014 PRC award winner from Professional Research Consultants, Inc. (PRC), a national healthcare marketing research company for providing patients with excellent communication with doctors. “We are very pleased that our patients feel that their physicians are available to them and communicating effectively,” says Chuck Carr, vice president and hospital administrator at CSJH. “Receiving an award that highlights this sentiment is truly gratifying.” PRC conducts a confidential survey of patients’ perceptions of their care annually. CSJH was awarded a 5-Star Award, scoring in the top 10 percent or above the 90th percentile of PRC’s national client database for 2013 in the “communication with doctors” category. Other hospital award recipients included Carilion Giles Community Hospital 5-Star Awards for communication about medications, communication with nurses, communication with doctors, and discharge information, Carilion Giles Community Hospital 4-Star Award for overall quality of care in the Emergency Department, Carilion Roanoke Community Hospital 5-Star Award for overall quality of care in endoscopy, and Carilion Roanoke Memorial Hospital NICU 5-Star Award for overall quality of care.
been recognized in our system and I’m proud of those who have contributed to this achievement.”
“PRC Awards are truly an honor to receive because they are the direct result of positive patient interactions,” said Nancy Howell Agee, president and chief executive officer of Carilion Clinic. “It’s exciting to see how many areas have
Professional Research Consultants provides marketing research for hospitals across the United States. Company information can be found on their corporate website, www.PRConline.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
Tampons Show Promise in Ovarian Cancer Screening A pilot study led by a University of Virginia School of Medicine researcher suggests that tampons could help detect ovarian cancer. “Gynecologic malignancies such as cervical cancer can be detected at early stages through regular pap smears, but similar screening is not available for ovarian cancer, which often presents in an advanced stage when the cancer has spread,” says the study’s principal investigator, Charles Landen Jr., MD, a gynecologic oncologist at UVA Cancer Center. For the study, women who were expected to undergo surgery for potential ovarian cancer inserted a tampon the night before their surgery. Of the women who had ovarian cancer and had intact fallopian tubes, 60 percent had DNA derived from the tumor in the tampon.
that in some cases tumor DNA was found in the vaginal canal is promising,” Dr. Landen says.
Next Steps The next step is to improve the specificity of the test so that no women with cancer would be missed and to test women with early or even precancerous disease to see if these cells are also shed into the vaginal tract. DNA testing is still too expensive for screening the general population, but that may change in coming years.
“While more research is needed to improve the sensitivity of the test, the fact
“This is exciting proof that cancer cells can make it through the gynecologic tract and be detected in a noninvasive way with something as simple as a tampon,” says Dr. Landen.
William Bess, MD
Jonathan Black, MD
Laurie Brenner, PhD
Michael Brookings, MD
William Davidson, MD
Natalie Davies, MD
Urgent Care/Convenient Care Augusta Health Urgent Care & Convenient Care Fishersville | www.augustahealth.com
UVA Children's Hospital Plastic Surgery Charlottesville | 434.924.2413 childrens.uvahealth.com
UVA Health System Pediatric Neuropsychology Charlottesville | 434.982.1012 www.uvahealth.com
Urgent Care/Convenient Care Augusta Health Urgent Care & Convenient Care Fishersville | www.augustahealth.com
Otolaryngology Augusta Health Otolaryngology Fishersville | 540.221.7010 www.augustahealth.com
Family Dermatology of Albemarle Charlottesville 434.964.9500 www.drkrasner.com
Peter Dean, MD
Deonna Dearing, FNP
Fiona Fang, MD
Andrea Garrod, MD
Urgent Care/Convenient Care Augusta Health Urgent Care & Convenient Care Fishersville | www.augustahealth.com
Radhika Dhamija, MBBS, MD
Adrienne Duffield, MD
UVA Children's Hospital Cardiology Charlottesville | 434.924.2350 childrens.uvahealth.com
Albemarle Anesthesia, PLC Charlottesville 434.296.7733 www.mjhanesthesiology.com
Charlottesville Dermatology Charlottesville 434.984.2400 www.cvillederm.com
UVA Children's Hospital Respiratory Medicine Charlottesville | 434.243.2269 childrens.uvahealth.com
Ovarian cancer is often fatal when not caught early. According to the National Cancer Institute, 61 percent of patients are diagnosed when the disease has metastasized, when the five-year survival rates are only 27.4 percent. In 2014, an expected 21,000 women will be diagnosed as having ovarian cancer.
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UVA Health System Neurogenetics Charlottesville | 434.924.8371 www.uvahealth.com
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
ON THE WEB
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Ryan Gentzler, MD
Oleg Glushkov, MD
Stephanie Grice, MD
Rick Hall, MD
UVA Cancer Center Medical Oncology—Lung and Chest Cancers Charlottesville | 434.924.9333 cancer.uvahealth.com
Hospitalist Augusta Health Hospitalists Fishersville | www.augustahealth.com
Piedmont Pediatrics Charlottesville 434.975.7777 www.piedmontpediatrics.net
UVA Cancer Center Medical Oncology—Lung and Chest Cancers Charlottesville | 434.924.9333 cancer.uvahealth.com
Rachel Hallmark, MD, PhD
Hamid Hassanzadeh, MD
Physiatry Augusta Health Spine Clinic Fishersville | 540.245.7400 www.augustahealth.com
UVA Health System Spine Surgery Charlottesville | 434.243.5647 www.uvahealth.com
Ellis Johns, MD
Michael Keng, MD
Rachel Keng, MD
Chip Landen, MD
Family Medicine of Albemarle Charlottesville 434.973.9744 www.fmoa-online.org
UVA Cancer Center Medical Oncology—Blood Cancers Charlottesville | 434.924.9333 cancer.uvahealth.com
OBGYN Associates UVA Cancer Center Charlottesville 434.979.2121 Gynecological Oncology www.obgynassociatescville.com Charlottesville | 434.924.9333 cancer.uvahealth.com
Jason Lawrence, MD
Tonia Martin, FNP
Pulmonology Augusta Health Pulmonology Fishersville | 540.245.7190 www.augustahealth.com
Urgent Care/Convenient Care Augusta Health Urgent Care & Convenient Care Fishersville | www.augustahealth.com
Jacob Meyer, MD
Julie Monroe, DO
David Repaske, MD
Anuj Singla, MD
Virginia Retina Consultants, PLC Charlottesville 434.978.2040 www.virginiaretinaconsultants. com
Family Medicine Augusta Health Primary Care, Lexington Lexington | 540.463.3381 www.augustahealth.com
UVA Children's Hospital Pediatric Endocrinology Charlottesville | 434.924.9144 childrens.uvahealth.com
UVA Health System Spine Surgery Charlottesville | 434.243.0291 www.uvahealth.com
Victor Soukoulis, MD, PhD
Salim Sumera, MD
Marion Szwedo, MD
Ashley Taylor, FNP
Mareen Thomas, MD
Danielle Wales, MD
Maryellen A. Waltz, DPM Elizabeth (Liz) White, MD
Pediatric Associates of Charlottesville Charlottesville 434.296.9161 www.charlottesvillepeds.com
Urgent Care/Convenient Care Augusta Health Urgent Care & Convenient Care Fishersville | www.augustahealth.com
UVA Children's Hospital Pediatric Endocrinology Charlottesville | 434.924.9144 childrens.uvahealth.com
Pediatric Hospitalist Augusta Health Hospitalists Fishersville | www.augustahealth.com
Christopher Steward, DPM Charlottesville 434.979.0456 www.cvillefootankle.com
UVA Heart & Vascular Center General Cardiology Charlottesville | 434.243.1000 www.uvahealth.com
Hospitalist Augusta Health Hospitalists Fishersville | www.augustahealth.com
UVA Children's Hospital General Pediatrics Northridge Pediatrics Charlottesville | 434.980.6555 childrens.uvahealth.com
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T IP S, T ID B I T S A ND MO R E TO IN FO RM A ND ENT ERTA I N YO U
GREAT AMERICAN SMOKEOUT DAY
November 20th, 2014 The American Cancer Society
marks the Great American Smokeout on the third Thursday of November each year by encouraging smokers to use the date to make a plan to quit, or to plan in advance and quit smoking that day. By quitting — even for one day — smokers will be taking an important step towards a healthier life – one that can lead to reducing cancer risk. Tobacco use remains the single largest preventable cause of disease and premature death in the US, yet about 42 million Americans still smoke cigarettes — a bit under 1 in every 5 adults. As of 2012, there were also 13.4 million cigar smokers in the US, and 2.3 million who smoke tobacco in pipes — other dangerous and addictive forms of tobacco. Source: American Cancer Society
Surviving Holiday Eating The holidays can pose a great risk to even the healthiest eating plans. On average, Americans gain about a pound at holiday time, which may not seem like a lot, but we usually don't lose this pound. Long term, after 10 years, you've put on a lot of extra weight. Short term, all the sugar, calories, sodium and fat that you've consumed during the holidays may make for an extra wrinkle and dull skin for the New Year. You can survive holiday parties and avoid overeating with a few simple tactics.
• Go for the passed hors d'Oeuvres, and
skip the buffet • Choose low-calorie and healthy festive foods
• Bring the healthy fare to parties and potlucks • Use a napkin to control portion size • Drink plenty of
water
• Watch ‘liquid calories’
• Bring gum or mints to parties
A TINY fact: Did you know?
The tiniest bone in your body is only 3mm long and is found in your ear!
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The ear’s malleus, incus and stapes (otherwise known as the hammer, anvil and stirrup) are the smallest bones in the human body. All three together could fit together on a penny.
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
• Hit the
veggie tray
The Earlysville 5K TURKEY TROT AND FREE 1/2 MILE KIDS RUN
RACE DAY:
Thursday, November 27, 2014
START TIME:
FOOD FACTS ABOUT
THANKS-
GIVING
The average person consumes 4,500 calories at Thanksgiving dinner. That is equal to:
• 9 large boxes of fries at McDonald’s • 7 Whoppers from Burger King • 4 carnitas burritos from Chipotle
• 4 medium cookie dough Blizzards™ from Dairy Queen Choose wisely – put more vegetables on your plate, cut down on gravy, mashed potatoes, stuffing and desserts! You can also counter-balance calories by participating in a pre-dinner 5K!
9:00 AM - 5k Turkey Trot
600 Earlysville Forest Drive, Earlysville, VA 22936 (just 15 minutes northwest of Charlottesville)
LOCATION:
This event benefits the Blue Ridge Area Food Bank, an emergency food assistance agency that serves more than 114,000 people each month. Last year, they distributed 18 million meals to hungry families across the Blue Ridge. They expect to serve even more this year. Please help this worthy cause. Visit www.charlottesvillemultisports.com to register.
Lexington GOBBLE WOBBLE 5K & FUN RUN
Thursday, November 27, 2014
START TIME:
8:30 AM – 1 Mile Kids Fun Run
RACE DAY:
• 2 medium pepperoni pizzas from Pizza Hut • 37 chicken drumsticks from KFC
8:30 AM - Free Kid's Half Mile Fun Run
LOCATION:
9:00 AM - 5k Run/Walk
Brubaker Field, Lexington, VA
Continue the Thanksgiving tradition at the 3rd Annual Lexington Gobble Wobble 5k & Fun Run! With both a 5k (walk or run) and Children's 1 Mile Fun Run, the whole family can participate in a exciting, healthy activity to start their Thanksgiving Day. Enjoy a well-organized community event and still get home in time to put the turkey in the oven. Open to runners/walkers of all abilities. Strollers welcome. Pets welcome. Register at www.lexingtongobblewobble.com
WINTER
ALLERGIES
To help dry, red eyes: • Run a humidifier at night • Eat more omega 3s (fish and flax) • And use preservative-free artificial tears
ON THE WEB
More at ourhealthcville.com (new website debuts January 2015)
www.OurHealthCville.com
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Local health. Anywhere you go. OurHealth magazine is Shenandoah Valley and Charlottesville’s only resource entirely dedicated to delivering information about local healthcare services and healthy living topics. Pick up our print edition at more than 900 locations throughout the area or get the digital edition by visiting www.ourhealthcville.com.
the
Anatomy CHALLENGE
Here’s your chance to see how much you know about the
amazing EAR! First, find all the hidden words in the word search below. Next, match up the correct word with the part of the body in the illustration.
[ the amazing EAR ]
WORD SEARCH antihelix
incus
cartilage
malleus
cochlea
scapha
cochlear nerve
semicircular canals
concha
stapes
ear canal
temporal bone
eardrum
temporal muscle
earlobe
triangular fossa
eustachian tube
tympanic cavity
helix
vestibular nerve
______________ ______________ ______________
______________ ______________
______________ ______________
______________
______________
______________ ______________
______________ ______________
______________ ______________ ______________ ______________
______________
______________
______________ www.OurHealthCville.com
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aging the
EAR words | LAURA NEFF-HENDERSON, APR
Although grey thinning hair and deep wrinkles are two of the most commonly talked about signs of getting older, age-related hearing loss is a significant concern for many Americans. Age-related hearing loss, presbycusis, is one of the most common conditions affecting older and elderly adults. Approximately one in three people between the ages of 65 and 74 has hearing loss and nearly half of those older than 75 have difficulty hearing, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). There is no known single cause of age-related hearing loss, according to the National Institutes of Health, and the damage is permanent. Having trouble hearing can make it hard to understand and follow a doctor's advice, to respond to warnings, and to hear doorbells and alarms. It also makes the most basic interaction with friends and family difficult. Individuals with hearing loss tend to shy away from social activities, including going out to dinner with loved ones. They often report being embarrassed to ask others to repeat themselves and, as a result, remove themselves from the world around them because of it. There is also a much higher incidence of depression, anxiety, cognitive decline and psychosocial disorders in hearing impaired persons, as well as an increased risk of dementia. Hearing loss is much more than an inconvenience, according to Michael J. Combs, hearing instrument specialist with Hearing Healthcare of Virginia in Harrisonburg. An
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
increased risk of dementia and falling are both major issues associated with hearing loss, he says. Depression is also more likely in patients with untreated hearing loss, says Kristin Koch, AuD, F-AAA, a clinical audiologist and the owner of evolution HEARing in Charlottesville.
Symptoms Early signs of hearing loss include difficulty understanding certain speech sounds when in the presence of background noise, consistently turning the television to a higher level than other people in the same listening environment, ringing or buzzing in the ear (tinnitus), and the tendency for an individual to ask people to repeat themselves often. In most cases, the onset of hearing loss is so gradual that people don’t even realize it’s happening until a loved one points it out to them, says Koch.
Causes The onset of age-related hearing loss begins to affect most people in people in their early 60’s, though it can be seen earlier, particularly if there is a genetic predisposition in the family. Noise and age-related hearing loss usually is most pronounced in the higher frequencies, which make it difficult for the hearing impaired individual to understand women and children's voices. Men's voices are an octave lower and are usually better heard and understood. Patients often complain that the speaker is mumbling, because the high frequency consonant sounds are often poorly heard, while the low frequency vowels may be normally heard. Individuals who listen to extremely loud music and/or work in professions where they are exposed to loud noise for prolonged periods of time (factory workers, musicians, construction workers, farmers, chefs, musicians, airport workers, yard and tree care workers, and people in the armed forces)
are especially susceptible for sensorineural hearing loss. Noise induced hearing loss is 100 percent preventable agree Combs and Koch, who both advise people to wear hearing protection anytime they are exposed to loud noises which destroy nerve endings (hair cells), and can result in permanent hearing loss. “If you have to shout over surrounding noise, it's loud enough to damage your hearing,” says Combs. Koch recalls treating a young patient who spent weekends hunting with his dad from the time he turned 9. By the time the boy was 12, he needed hearing aids as a result of the exposure to the gun shots. While that may seem extreme, it’s important for people to realize that even one time exposure to a loud noise can cause permanent damage, Koch explains. Hearing loss can also be caused by viral or bacterial infections, cardiovascular problems, head injuries, tumors, and certain medications. Smoking has also been linked to hearing loss. Other medical issues including diabetes, heart disease, and multiple sclerosis can have a significant impact on hearing as well. More obvious cases of hearing loss include earwax buildup, an object in the ear, injury to the ear or head, ear infection, a ruptured eardrum, and other conditions that affect the middle or inner ear.
Kristin Koch, AuD, F-AAA is a clinical audiologist and the owner of evolution HEARing in Charlottesville
Getting help As with most health conditions, early intervention is the key to a positive prognosis. In fact, it’s critical to slowing down the rate at which the patient is losing hearing. Protection against hearing loss begins in childhood. Babies are screened for hearing loss at birth, before leaving the hospital. Children who are identified with hearing loss should be fitted with hearing aids within the first six months of life and considered for cochlear implantation during the second
Michael Combs of Hearing Healthcare of Virginia, is a Hearing Instrument Specialist and helps patients suffering from hearing loss in the Harrisonburg office
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The Experts Several different types of professionals are available to help with hearing loss. Each has a different type of training and expertise. A hearing instrument specialist is a state-licensed professional salesperson who is trained to perform hearing tests, take measurements of the ear canal, fit hearing aids, program hearing aids, and make routine repairs. The hearing instrument specialist is not licensed to diagnose or treat any medical illness, and is required by state law to recommend a medical examination by a physician prior to selling a hearing aid. An audiologist is a hearing professional who is trained not only to manage hearing aids but also to perform more detailed examinations of the hearing using sophisticated electronic equipment. The audiologist is also trained to evaluate and test the balance system. All audiologists have a college degree and at least a master’s degree plus one year of clinical training. Recent graduates now complete a four year doctoral program after college. An otolaryngologist, also known as an ear, nose, and throat specialist, is a medical doctor and surgeon trained to provide comprehensive care of the ears nose and throat, including the hearing. The otolaryngologist is the most highly trained physician for diagnosing and treating hearing loss and is the only physician trained to perform surgery in the ear. Many patients with ear complaints, hearing loss or ringing in the ears will be referred to an otolaryngologist for initial evaluation and treatment planning. Most otolaryngologists employ or collaborate with hearing instrument specialists or audiologists to provide the diagnostic testing and programming of hearing aids.
In addition to wearing ear protection in noisy environments, one of the most effective ways to mitigate the effects of hearing loss is the use of hearing aids, which can significantly impact a person’s quality of life. Medical professionals can tell pretty quickly via a simple hearing test, also known as an audiogram, whether that’s the case.
Treatment Options Because there is no cure for age-related hearing loss caused by nerve damage, treatment is focused on improving everyday function, and reducing some of the risks associated with hearing loss. The first line of treatment for hearing loss should be a medical evaluation to determine whether or not the hearing impairment can easily be resolved through medical intervention. One of the most common options for patients with hearing loss caused by nerve damage to the inner ear is hearing aids.
Parents should also monitor their children’s use of headphones when listening to music or video gaming.
In addition to making it hard to hear, sensorineural hearing loss frequently causes distortion of the sounds that the person does hear. Hearing aids can improve speech understanding by selectively amplifying the frequencies that have been damaged resulting in significantly improved speech quality.
Combs and Koch both advocate for adults to get a hearing assessment as part of their annual checkup.
Nearly all hearing aids used today are digital and are programmed specifically for the individual user, according to Koch.
“A patient with a gradual hearing loss will not recognize that they may have a damaged auditory system because there brain has simply learned to accept their loss as normal,” says Combs. “Because of this we suggest that patients begin to have hearing screenings done at the age of 55.”
“No longer should a patient have to wear big bulky devices that screech and make all kinds of noises,” says Combs. “The hearing devices today are small, sleek and can even help patients hear in noisy environments. It really is quite amazing what we can do now.”
year of life if necessary.
Adults should use caution working around noisy machinery, including backyard tools. Occupational noise exposure is regulated by the Occupational Safety & Health Administration 22
(OSHA), which requires employers to provide hearing exams and hearing protection to employees who work in environments with sustained high levels of noise.
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Hearing aids today use noise reduction algorithms, directional microphones and advanced signal processing strategies to provide the best possible listening experience for users. Some of the newest technology uses
wireless compatibility to stream Bluetooth enabled devices directly into the hearing aid. Additionally, advancements in telephone technology utilizing Bluetooth landline and cellphone adaptability to hearing aids have offered an improved approach to improving telephone communication for the hearing impaired. Many local specialists allow patients to evaluate the effectiveness of hearing aids through a trial period, before they actually purchase them. Patients have to be seen regularly for fittings and cleanings. In recent years, hearing aid technology has improved significantly and patients are now able to control a variety of settings that maximize hearing potential.
Warning Signs of Hearing Loss in Adults
• Inattentiveness • Buzzing or ringing in their ears • Failure to respond to spoken words • Persistent ear discomfort after exposure to loud noise (regular and constant listening to electronics at high volumes) • Muffled hearing • Constant frustration hearing speech and other sounds • Avoiding conversation • Social isolation • Depression
The most basic models begin at about $1,000 for a pair, with the more advanced options topping out at $7,000. They do generally have to be replaced every three to five years; however, some patients are able to wear them for much longer before buying a new pair. While hearing aids are believed to be one of the most effective ways of treating age related hearing loss, there are other options available to people. For individuals with profound hearing loss, for whom hearing aids offer no significant benefit, cochlear implants are an option. Cochlear implants are small electronic devices surgically implanted in the inner ear. Implementation surgery is the very beginning, and often the easiest part, of learning to live with and maximize cochlear implants. Patients often undergo years of programming sessions and therapy following the surgery. Assistive listening devices can also help those with hearing loss. Some of these devices include telephone and cell phone amplifiers, smart phones or tablet apps, and closed circuit systems in large venues, including places of worship, theaters, and auditoriums. Friends and family can also help by making minor accommodations to make the situation most ideal for the hearing impaired person. To help those with hearing loss, friends and family can speak louder, without shouting and should talk directly to the person with the hearing impairment. One of the most common ways that people cope with hearing loss is by learning to read lips and body movement to piece together pieces of the conversation they are unable to hear. It’s nearly impossible for a person with a hearing impairment www.OurHealthCville.com
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The Cardiovascular Connection Recent research reveals a strong connection between hearing loss and cardiovascular health. Studies have shown that a healthy cardiovascular system—a person’s heart, arteries, and veins—has a positive effect on hearing. Experts believe that because the inner ear is extremely sensitive to blood flow, it is sometimes the first area of the body to respond to abnormalities in the cardiovascular system. In one study published in “The Laryngoscope,” researchers found that patients with low-frequency hearing loss should be regarded as at risk for cardiovascular events, and appropriate referrals should be considered.
of any level to understand what’s been said when the speaker talks as they are walking away. People should also be willing to repeat themselves instead of saying “never mind” when the person doesn’t hear them or understand. It’s also a good idea to turn off the television and/or radio and move away from any other background noise when possible. Avoid sitting near the kitchen at a restaurant or near a band playing music at an event. Even without a hearing loss, background noise makes it hard to hear people talk.
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Advancements
in Healthcare
Introduction by Steve McClintic, Jr. Oh, how far we have come in the diagnosis and treatment of medical conditions. Consider this: 100 years ago, some doctors used cocaine to treat patients suffering from alcoholism. Others used arsenic and tobacco smoke as treatments for asthma. Care for the common cold? Sulfuric acid nasal spray. When we reflect back on how diseases were treated a century ago, it’s natural to shake our heads and wonder what medical providers were thinking. But that is exactly what they were doing: thinking. Trying to identify ways to cure using whatever knowledge they had at the time. They stood on the shoulders of their predecessors and made medical care better through practice and perseverance.
Reprints To order reprints of the original artwork featured on this issue’s cover, contact Jenny Hungate at 540.387.6482 or via email at jenny@ourhealthvirginia.com. To view additional work by our
Today’s doctors, providers, hospitals, scientists and others also continue to redefine and refine quality of care based on what they learned from their predecessors. As a result, medical science is more advanced now than during any other time in history. In this section, we have highlighted a few advancements in healthcare that further improve the quality of life for our communities. In subsequent editions of OurHealth, we will offer insight about other advancements, as well.
artist, Joe Palotas, visit www.salemartcenter.com www.OurHealthCville.com
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matters OF THE
heart words | CHRISTINE STODDARD
New Hope for Virginians with End-stage Heart Failure Once upon a time, the facts about heart failure in America were quite dreary. The European Heart Journal article, “The forgotten past: The practice of cardiology in the 1950s and now” (2000) states, “The 1950s must seem like the Dark Ages to the 21st century cardiologist. No echocardiography or nuclear imaging, no coronary care, no coronary angiography, no angioplasty, no pacemakers, no coronary surgery.” The article, “A view from the millennium: the practice of cardiology circa 1950 and thereafter” in the Journal of the American College of Cardiology claims that 60 years ago, heart failure patients may have survived up to two years. Half a century later, cardiology looks like another world. “Heart failure can present in several different ways,” says John Kern, MD, a thoracic and cardiovascular Surgeon at University of Virginia Medical Center (UVA). “It's possible even in a healthy individual who doesn't smoke and has no family history of heart disease.” Today, heart failure may still mean gloom but it doesn't have to mean doom. An estimated 150,000 Americans suffer from chronic and severe heart failure, but they have more options than the past presented and the chance at a longer life. Traditionally, doctors have had to rely on heart transplants to save these patients. Yet the 2,100 donor hearts available each year make that an unfeasible solution for many.
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Is there such thing as an assist device for the right-side of the heart? Yes, and it's called a right ventricular assist device (RVAD), but the LVAD is more common. RVADs tend to be used as a short-term solution.
Cue the left ventricular-assist device (LVAD). LVADs have existed in some form since the 1960s. Historically, they have been used as temporary treatment for patients awaiting a heart transplant. Today's LVADs are smaller and made to last longer than the LVADs of yesteryear. In case high school biology is a blur, here's a quick refresher about the anatomy of the heart: The heart has four chambers. The upper chambers are called atria (singular atrium); the lower chambers are called ventricles. Oxygen-rich blood from the lungs first pumps to the left atrium. It moves into the left ventricle, from where it is pumped to the rest of the body. The right side is in charge of pumping oxygen-depleted blood back to the lungs. In order for this whole process to function smoothly, the four chambers must pump in sync with each other. An LVAD helps the chambers stay in sync with each other by supporting the left ventricle. To paraphrase the American Heart Association, heart failure doesn't mean the heart has stopped working altogether. It means that the heart isn't pumping as well as necessary. When this happens, the body isn't getting all the blood it needs— including the oxygen and nutrients that come with it. When cells don't get enough blood, fatigue, shortness of breath and difficulty walking are all part of the package. According to WebMD, heart failure is the leading cause of hospitalization in people age 65 and older. The LVAD does not replace the heart, and it has what the uninformed may deem an otherworldly appearance. The device has a tube that feeds through the skin. Above the skin, the tube resembles a cord. The LVAD also comes with a computer controller, a power pack, and a reserve power pack, all of which are also above the skin. Depending on the model, a patient may wear these units on a belt or harness. “For those with reasonable right heart function and lung pressure, the LVAD makes sense,” says James D. Bergin, MD, Medical Director of Cardiac
Transplant/Heart Failure and the Director of the Coronary Care Unit at UVA. Traditionally, the LVAD has served as a bridge to cardiac transplant and recovery in the case of possibly reversible myocardial pathology. Now the LVAD is becoming a destination therapy. That is, a long-term solution for patients ineligible for transplant. Dr. Bergin has worked as a teacher, researcher and clinical practitioner in the field of heart failure and transplantation for more than two decades. During that time, he has observed and even pioneered advances in heart failure technology. “In the next year or two, the LVAD will become even more desirable because it will likely be totally implantable, which is not possible with the artificial heart,” says Dr. Bergin. “There's already an LVAD in trial that lacks a cord.”
John Kern, MD, is the Surgical Director of both the Heart and Vascular Center and UVA’s Heart Transplant Program. Dr. Kern is also the medical director of the Non-Invasive Vascular Lab and the Physician Assistant Program in the Division of Thoracic Cardiovascular Surgery.
Right now there are several LVAD models on the market. HeartWare and HeartMate are perhaps the best known. “The life expectancy for someone who experiences heart failure in their fifties is much different than for someone with the same condition in their seventies, and that has to be taken into consideration,” says Dr. Kern.
Carry Me Back
Most LVAD’s vary in size, but the HeartMate II®, measures approximately three inches in length and weights approximately 10 ounces. Reprinted with the permission of Thoratec Corporation
The Appalachian Regional Commission cites heart disease as the leading cause of death in Appalachia and the U.S. While Appalachia as a whole may experience poor heart health, West Virginia and Kentucky suffer more than the Commonwealth. www.OurHealthCville.com
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American Heart Failure Statistics According to the Centers for Disease Control and Prevention: • 5.1 million Americans have heart failure. • About half of those with heart failure die within five years of their diagnosis. • Each year heart failure costs the United States about $32 billion due to the cost of healthcare services, medications and missed days of work. Learn more about heart disease at www.cdc.gov.
What are common causes of heart failure? • Coronary artery disease • High blood pressure • Atrial fibrillation • Valvular heart disease • Cardiomyopathy
Dr. Kern explains that while a large segment of Shenandoah Virginia's population once lived as tobacco farmers and therefore lagged behind the rest of the country in terms of heart health, today Virginia is much like the rest of the country. “At UVA, we try to focus on preventative health,” says Dr. Kern. “We want the community to be educated. At the same time, we're not in the middle of New York City. Not everyone has running water and electricity and sometimes we have to overcome those kinds of barriers.” Dr. Kern explains that a “huge support staff” is crucial to ensuring success with an LVAD. “There is a psychosocial component to having an LVAD,” Dr. Kern says. “A patient has to have the neurocognitive capacity to appreciate ahead of time what it means to have an LVAD. They have to be competent and they can't be completely independent. They need to have someone to check in on them.”
To live in hearts we leave behind While there is currently no cure for heart failure, the National Heart, Lung, and Blood Institute states that researchers are still on the prowl for a promising solution. Treatments like the LVAD bring patients the shining light of longer, more active lives, but they are no guarantee. Dr. Bergin recalls one story with a less than ideal outcome. A patient came to UVA very sick. With an LVAD, he perked up and lived comfortably for the next year or two until he started experiencing bleeding problems. While bleeding is one of the risks associated with having an LVAD, this patient had inoperable cancer in no way related to the device. The cancer had spread throughout his body and, despite UVA's efforts, he died. James D. Bergin, MD, is the Medical Director of Cardiac Transplant/ Heart Failure and the Director of the Coronary Care Unit at UVA.
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“The story, though sad, makes an important point,” says Dr. Bergin. “An LVAD does not make someone immortal. We don't intend for someone to live forever.” The intent is to ensure a high quality of life. And even with the tragedies, the reality is that, to quote Dr. Kern, “there is almost a 95 percent chance of survival.”
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A heart-healthy recipe from UVA's Club Red:
Cumin-Cinnamon Sweet Potato Wedges INGREDIENTS Three (3) sweet potatoes, peeled/cut into wedges Extra virgin olive oil ½ tsp. ground cumin
DIRECTIONS
½ tsp. ground cinnamon
• Preheat oven to 375 degrees convection or 400 degrees conventional
1-2 Tbsp. sugar
• Toss sweet potato wedges with olive oil to coat
1 tsp. salt
• Toss with spices, sugar and salt • Spread onto a rimmed baking sheet, do not crowd
NUTRITION FACTS
• Bake about 30 minutes, until tender and beginning to brown (stir once)
Calories: 346 | Protein: 3.5 grams | Carbohydrates: 41 grams | Fiber: 6 grams | Fat: 19 grams Saturated Fat: 2.5 grams | Monounsaturated Fatty Acid: 12 grams Cholesterol: 0 mg | Sodium: 200 mg | Calcium: 69 mg Developed by the UVA Heart and Vascular Center, Club Red is an online heart-health initiative focused on women. Learn more at www.clubreduva.com.
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Liz Shupe
OF LEXINGTON
BACK
IN THE
What is a Critical Access Hospital? (from www.hrsa.gov, U.S. Department of Health and Human Services) A Critical Access Hospital (CAH) is a hospital certified under a set of Medicare Conditions of Participation (CoP), which are
OF THINGS words | SUZANNE RAMSEY • photos | KG Thienemann
structured differently than the acute care hospital CoP. Some of the requirements for CAH certification include having no more than 25 inpatient beds; maintaining an annual average length of stay of no more
Swing bed program helps patients get better closer to home If you ask Liz Shupe, she’ll tell you she never does anything in the “normal way.” For instance, while her friends were headed down the marriage-and-family track after graduating from Mary Baldwin College in 1970, Shupe joined the Red Cross and spent a year in Vietnam, working with paraplegics, quadriplegics and drug addicts, an experience she describes as “life changing ... in mostly good ways.” And when it came to getting seriously injured this past spring in a tree-falling accident, Liz took an equally unorthodox approach. While taking down a dead tree on the 11-acre minifarm she and her husband, who she affectionately calls “Super Shuper,” own in Lexington, something freaky happened. Liz, 66, says she was driving the tractor, something she loves to do, and had a chain looped around the tree’s trunk. The plan, she says, was “to slide [the tree] on down,” like she’d done many times before. Well, that didn’t happen. Instead, as she puts it, the 35-foot-tall tree “cartwheeled off where it was standing and landed on me.” Liz was rushed by helicopter to Carilion Roanoke Memorial Hospital, where she was diagnosed with serious injuries, among them, fractures in her neck, lower back and ribs. According to physicians, Liz says, “I was lucky to be alive.” Fortunately, Liz wasn’t paralyzed and there were no serious internal injuries. She was, however, about an hour away from home, which made it difficult for friends and family, including her husband, who was recovering from a stroke at the time, to visit during her two-week hospital stay.
than 96 hours for acute inpatient care; offering 24-hour, 7-day-a-week emergency care; and being located in a rural area, at least a 35 mile drive away from any other hospital or CAH (fewer in some circumstances). The limited size and short stay length allowed to CAHs encourage a focus on providing care for common conditions and outpatient care, while referring other conditions to larger hospitals. Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates. This reimbursement has been shown to enhance the financial performance of small rural hospitals that were losing money prior to CAH conversion and thus reduce hospital closures.
“Everyone was traveling to Roanoke to try to see me,” she says, adding that when it came time for her to start rehabilitation, she wondered if there were any options closer to home. Enter Carilion Stonewall Jackson Hospital’s Swing Bed Program. At first glance, the “swing bed program” might sound like a complicated physical therapy device. It’s not. Swing bed is a program that allows a small, rural hospital like CSJH — called a Critical Access Hospital — to use some of its beds for patients like Liz, who need a couple www.OurHealthCville.com
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Liz is able to enjoy her Zumba classes again at the Rockbridge YMCA.
The swing bed program allows CSJH, located in Lexington, “to use its beds for acute inpatient care or skilled care, the kind of care that is given in the rehabilitation center or nursing facility,” says Bob Capito, CSJH’s utilization review coordinator. “In cases where someone has a skilled need, such as daily physical therapy to improve functioning with a goal of discharge to home, or 20 to 30 days of intravenous antibiotics that can’t be done in the home; or wound care that needs to be monitored. [They’re] not acutely sick but not safe for discharge.
weeks of physical therapy or other treatment that’s not practical or possible to do at home “Most of these patients would go to a nursing facility for a short-term stay, but in rural places, no skilled beds are available, or they’re in their 90s and it’s 40 miles away and the husband can’t drive. They allow CAHs to utilize beds as skilled or acute beds.” As for why it’s called “swing bed,” Capito admits it’s an odd name but says it comes from how the patient is “swinging from one status to the other, from inpatient to skilled care to going home.” While it began as a program associated with Medicare, more and more insurance companies are covering swing bed services. Liz, for example, is privately insured. “Over the last number of years, many insurance companies have realized this is a good way to get skilled care for their patients as well,” Capito says. “Not all payers, but many will approve skilled care in an acute hospital setting.” Asked about the benefits of the swing bed program, Capito says they are numerous. “[They’re] spectacular,” he says. “The physicians are walking up and down the hallway, radiology is easily available, and the wound clinic is easily available.” As for disadvantages, the swing bed program lacks the social activities of a traditional skilled nursing facility. “In other words, we don’t do Bingo,” Capito says. In some situations, a skilled nursing facility — sometimes called a “nursing home” — is a more appropriate option. “Mrs. Shupe was one of those people. She really needed a doctor to see her every day. She was somewhat between stable and unstable. She wanted to be closer to home.” Liz was in swing bed for about two weeks, working with physical therapists and preparing to go home. She gave a shout out to several staff members at CSJH, among them physical therapist Pat McCarthy-Hall and her “magic hands.”
“When someone needs skilled care and the team — the doctor, patient, family, physical therapist — says she’s going to need four to eight weeks before she’s strong enough to go home, we don’t recommend swing bed,” Capito says. “Two weeks to practice stairs, that’s the perfect swing bed patient."
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Liz explains that when she arrived at CSJH, her right arm was swollen about three times its normal size. It had been that way for a couple weeks and she wasn’t sure — still isn’t sure — why. One day, she says, McCarthy-Hall came into her room and asked to “borrow” her arm for a minute. “I said, ‘Just keep it attached please,’” Liz says, adding that McCarthy-Hall “got underneath my arm and my armpit and worked on me for half an hour. Then she smiled and said, ‘There are those wrinkles, they’re back.’ In one half hour she got my very swollen arm back to normal and it has stayed that way forever. She is magic.” Several months later, Liz is doing physical therapy on an outpatient basis and says she’s “making progress.” She’s even taking Zumba, a dance aerobics class. And if you ask her, she’ll tell you that she’s happy to “stand up and holler” for CSJH and its swing bed program anytime. “For me, the swing bed program offered the best medical care but allowed me to have the family and friend support that is critical at a difficult time in one’s life,” she says, adding, “It was a great opportunity for me.”
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A Helping Hand at Home Because it’s special and comfortable, home often provides the best medicine. That’s why Carilion Clinic Home Care and Hospice deliver compassion, technology, and experience right to your door.
Carilion Clinic Home Care was the first certified home care provider in the area. We are proud to offer: » 24-hour, on-call service » Specialty-trained nurses in wound care and pediatrics » Resources, providers, and an electronic medical record in connection with Carilion Clinic » Special programs such as Telehealth, Lifeline, Partners in Care, and the Longevity Program (chronic disease management) » Health care protocols involving head and neck and hyperemesis
Carilion Clinic Hospice has been providing care in the area since 1980. We are proud to offer: » Specialty therapies such as massage, music, and pet therapy » Programs designed for families, such as Partners in Care, Family Treasures, We Honor Veterans, and Camp Treehouse » Bereavement counseling » Pediatric services » Spiritual resources » Symptom and pain management » Volunteer opportunities
» IV infusions
HOME CARE CarilionClinic.org/homecare | 800-964-9300
CarilionClinic.org/hospice | 800-964-9300 www.OurHealthCville.com
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Augusta words | DIANE YORK
Above: Augusta Health’s Heart & Vascular Center is a state-of-the-art facility, providing clinical and diagnostic services with Augusta Health’s cardiovascular and pulmonary service line, in one convenient location.
Heart and Vascular Center State of the art, all-inclusive center brings top-notch care to Augusta County
Caring for cardiac conditions is complicated by the wide variety of professionals and services needed for each patient’s total care. Distance, time and effort of travel make coordination of services exhausting for the patient and difficult for the treating physician. Augusta Health has created a state of the art, all-inclusive center to vastly improve the quality and efficiency of patient care. In the past, heart patients had to visit their physician’s office in one location and they might then take a stress test in another location. If they needed treatment such as catheterization (cath), they went to the hospital lab and for dietary advice to a dietician’s office at yet a different location. All that travel cost patients time and money and took its toll on an already ill patients. The many individuals and departments working with each cardio patient had difficulty organizing care in an efficient and effective way. Mark Masonheimer, RN, is the Director of Cardiovascular Services at Augusta Health’s new Heart and Vascular Center.
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The dream of administrators and physicians at Augusta Health was to change all of that. They did, with the creation of the new Augusta Heart and Vascular Center. Today, a patient can in one day, in one building, see his physician, have blood work done, get his prescriptions, take a stress test, have a session with a dietitian or other necessary procedures. All individuals
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involved with the patient’s care can coordinate with his physician that day and inperson should they need to. This new method of care provides a life-changing and possibly life-saving experience for cardiac patients. Mark Masonheimer, RN, director of the cardiovascular center says this 80,000 square foot center with its own dedicated parking lot, is designed to meet the needs of the community by providing all these services under one roof. “In the past, when patients came in for services, they might have to go from one end of the hospital to see their physician and then to the other end to have tests done. Now a patient comes in to see his physician and, if tests are suggested, he can have those done right here, then go to rehab or the cath lab all in one area. The doctors, technicians and therapist are all in close proximity so they can share information quicker. It’s also convenient for the physicians and saves them time too. In an emergency, a doctor can get his patient right to the cath lab for treatment immediately. “We had a dedicated elevator installed to take cardio patients up to the lab if they need it,” adds Masonheimer. Cardiac rehabilitation space has more than doubled in size, allowing more patients to make speedier recoveries. The dedicated parking area and entrance adds to patient convenience. This building also has a new diabetic care center and dietitian's offices. The new institute includes the widest range of cardiovascular and pulmonary services including: cardiac rehabilitation, pulmonology, cardiology, pulmonary rehabilitation, stress tests, echocardiography, vascular lab, Pacemaker clinic, Holter monitoring, tilt table, nocturnal pulse oximetry, heart cath and stents, balloon angioplasty, electrophysiology, as well as nutrition counseling. And the technology for these services is the most advanced available. The cardiovascular institute has also assembled a top-notch team of medical professionals to work in this new
environment. Augusta Health has hired three highly experienced cardiologists. Rajeev Pillai, MD, is an interventional cardiologist who has performed more than 5,000 heart catheterizations; Rodney Garber, MD, who trained at the University of Virginia and had a private practice in Columbus, Ohio and John Yang, MD. Dr. Yang, most recently was assistant professor of cardiology at Washington University School of Medicine. Augusta Health plans to have six or seven cardiologists on staff and, because of its state of the art technology and facilities, will have the ability to recruit the most skilled and talented medical staff. Masonheimer adds, “we now also have on board an electrophysiologist who specializes in heart rhythms. Glenn Brammer, MD, a board-certified cardiologist and electrophysiologist, has joined the Augusta Health Cardiology office. He can perform surgeries such as the insertion of pacemakers and defibrillators. Dr. Pillai, an interventional cardiologist, says that this new facility compares to the best cardiac centers he has seen. “The quality of staff here is incredibly high compared to other similar facilities and the administration is very supportive of the work we are doing. They are willing to get the best equipment available for our patients. We are a community-based hospital and adapt to their needs.” As an example, he points out that most hospitals will not do catheterizations on the weekends. But people often need that service, and doing it within twenty-four hours of the cardiac event makes for better outcomes. He adds, “so here we do those through the weekend as needed, providing better patient care.” One innovation Dr. Pillai has introduced at Augusta health is cardiac catheterization from the wrist, a more advanced technique that isn’t widely available. These types of cardiac catheterizations are more comfortable for patients and have fewer bleeding risks than the traditional method, in which the catheter is inserted in a blood vessel at the groin.
Electrophysiologist An electrophysiologist is a physician who specializes in monitoring and correcting heart rhythms. Your heart can beat too fast or too slow. A heartbeat that's too fast is called tachycardia. A heartbeat that's too slow is called bradycardia. During an arrhythmia, the heart may not be able to pump enough blood to the body. This may cause symptoms such as fatigue, shortness of breath, or fainting. Severe arrhythmias can damage the body's vital organs and may even cause loss of consciousness or death. Pacemakers or defibrillators can be inserted into the patient’s body to correct these problems.
Laura Gonzalez, MD is a pulmomologist at Augusta Health. Her medical interests include interventional pulmonology/ thoracic oncology, acute lung injury, asthma and allergy, management of end stage COPD/ lung cancer patients, and pulmonary rehabilitation
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Implantable cardioverter defibrillator Most people are familiar with the term “defibrillator,” a paddle-like machine used by physicians or emergency personnel that uses electrical shock to start a person’s heartbeat again. An implantable cardioverter defibrillator (ICD) is a small device that's placed inside the chest or abdomen. Doctors use the device to help treat irregular heartbeats called arrhythmias. An ICD uses electrical pulses or shocks to help control life-threatening arrhythmias, especially those that can cause sudden cardiac arrest (SCA).
Thoracic Surgery Thoracic refers to the chest area. A thoracic surgeon is a medical doctor who performs operations on the heart, lungs, esophagus, and other organs in the chest. This also includes surgeons who can be called cardiothoracic surgeons, cardiovascular surgeons, general thoracic surgeons, and congenital heart surgeons. Thoracic surgery can include removal of tumors of the lung, esophageal cancer, gastroesophageal reflux (GERD) and many other disorders.
Pulmonary Care Pulmonary, (relating to the lungs) care is an important component of cardiovascular care, and the Augusta Health Cardiovascular Institute has included a pulmonary department in its new center. Laura Gonzalez, MD, a specialist in pulmonology, is another new addition to the center. George Verghese, MD and Jason Lawrence, MD complete the pulmonology team. Dr. Gonzalez says, “In the past we used basic x-rays to scan for lung cancer. That is not a very sensitive tool, and it missed problems. But at our center we now offer low-dose computerized tomography (CT) scans for lung cancer screening. It takes a picture of just the chest and uses no more radiation than a mammogram. The biggest impact of this technology is on early stage lung cancer detection.” Of all types of cancer, lung cancer is the number one killer. Dr. Gonzalez explains that in late-stage lung cancer the recovery rate is very poor, so this screening program is an important advance. Using the new Super Dimension navigation system, which works much like a global positioning system (GPS), they can navigate to very specific targets on the lung. The Super Dimension system is a GPS sensor combined with a CT scan and a computer that can reconstruct the area of the lung they are trying to treat. Medical staff can confirm what they see by placing a small mini-scope, (the Cell Vizio Microscope) the smallest microscope in the world according to its manufacturers, through the windpipe and into the lung. Using the GPS probe they can leave the sleeve in place and pass through a small microscope to view the tissue. Following this, a tool (like a forceps, for example) can be inserted into that sleeve and tissue samples can be removed. With this technology they can make sure they are sampling the right area. If the tissue is abnormal, the patient is referred for surgery which can be done on site. Dr. Gonzalez adds, “the GPS will get you close but this Cell Vizio Microscope will help you get exactly the right tissue. This is a great improvement.” Dr. Gonzalez explains that with the new technology she and other medical staff have identified numerous cases of lung cancer that probably would not have been found in the past. Catching it early and getting all of it may mean no radiation or chemotherapy for those patients. “This center is such a positive for the community. When you are sick going even 20 miles may be a long, long way. We want to keep care close to home,” she adds. She points out that if they cannot remove all the cancer, they have oncologists on hand to work with patients. They use a team approach, and because of the new institute, they can all meet together easily to discuss cases. The Augusta Health Institute now has a thoracic surgeon on board so thoracic surgery can be performed there. Christine Lau, MD, Director of Thoracic Surgery at University of Virginia Hospital will be available at Augusta Health to perform surgeries of this kind. Dr. Gonzalez stresses, “we can now offer patients very sophisticated care right here in their own community, there are very few things we can’t do here.”
The new facility, the new technology and the highly credentialed and experienced staff, all position Augusta Health as a medical facility of the highest standards that offers comprehensive, quality care in a convenient, patient-friendly center. Augusta Health was named to Thomson Reuters' 100 Top Hospitals in 2012.
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in Pediatric Epilepsy words | DENIZ ATAMAN
How Virginia research is leading the way with research and treatment in pediatric epilepsy According to the Center for Disease Control (CDC) epilepsy is estimated to affect over 460,000 children up to 17 years of age. The difference between seizures and epileptic seizures is based on repetition and an occurrence without a specific cause, such as low blood sugar, lack of sleep, or high fever. The most common causes of epilepsy are ones that cannot be identified, aka “cryptogenic,” in which case neurons are uncontrollably fired in the brain. “Overall, about 10% of people will have a seizure at some time in their life. Only 3% will have recurrent seizures and thus epilepsy. Finally, it remits in about 2/3 of people, so that only about 1% of the US population has epilepsy at any one moment in time”, says Nathan B. Fountain, MD, Director of the F.E. Dreifuss Comprehensive Epilepsy Program at the University of Virginia School of Medicine Some seizures are more noticeable than others. A grand mal seizure, where a child falls to the ground and convulses, is easier to diagnose than an absence seizure, where a child appears as if in a daze. The causes of epileptic seizures are due to imbalances in the central nervous system, controlled by the brain and spinal cord. Some neural 40
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disruptions in the brain are related to conditions such as oxygen deprivation, brain infections, traumatic brain injury, stroke, brain tumors, and genetic disorders (Center for Disease Control, 2013). Research in the past 50 years has made remarkable discoveries and advancements in treating epileptic patients, with a recent focus on children. The most common option is anti-epileptic medication, such as Keppra or Lamictal. With an array of medication available, doctors are able to prescribe one or more based on the child’s physiological factors, such as the severity and type of epilepsy, frequency of seizures, age, and overall health conditions.
A single gentle rain makes the grass many shades greener. So our prospects brighten on the influx of
Side effects are mild ranging from “inattention, drowsiness, memory difficulties, or difficulty concentrating,” states Dr. Fountain.
better thoughts.
It is essential that epileptologists prescribe the exact dosage to prevent severe side effects. Sources from the Epilepsy Foundation and Epilepsy Therapy Project estimate that 65 percent of epileptic children respond positively to treatment with symptoms disappearing by mid-adolescence.
Henry David Thoreau
When medication is not enough to treat symptoms, patients may opt for Vagus Nerve Stimulation (VNS), a procedure where a pacemaker is implanted in the neck to send weak electrical signals to the brain. This device serves as a buffer to prevent the neural bursts that cause seizures. When neither medication nor VNS are effective treatments for patients affected by severe epilepsy, resective surgery is a common option. In this treatment, a surgeon removes the tissue in the brain causing neural disruptions. With surgery, however, patients are not guaranteed a reduction in seizures and also run the risk of cognitive or behavioral changes. Another option is the Gamma Knife, or radiosurgery, that focuses almost 200 laser beams into the targeted area of the brain. Though less invasive than surgery, side effects include headaches, brain swelling, numbness, and nausea. Despite patients who are ideal candidates for surgery, the health risk has caught the attention of researchers to find alternative methods in treating epilepsy effectively. “Unfortunately, epilepsy can be difficult to diagnose as it can manifest itself in a variety of ways, and seizure types can vary greatly”, according to Russell C. Bailey, MD, Pediatric Epileptologist at UVA Children’s Hospital Fritz E. Dreifuss MD’s pioneering efforts as head of the Commonwealth of Virginia’s Child Neurology Program in the 1960’s, brought neurological treatment and awareness to the forefront of Virginia’s pediatric healthcare system. With his team of neurologists, Dr. Dreifuss formed a neurological sub-group targeting epileptic research and treatment. Enter the internationally recognized, Comprehensive Epileptic Program (CEP) at the University of Virginia. With the help of technology that takes photos and videos of brain “maps,” such as MRI, EEG, and CT scans, anti-epileptic drug
Nathan B. Fountain, MD, is the Director of the F.E. Dreifuss Comprehensive Epilepsy Program at the University of Virginia School of Medicine.
Russell C. Bailey, MD, is a Pediatric Epileptologist at UVA Children’s Hospital.
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For families interested in complementary and alternative therapies (CAM), either alone or with medication, there are several nonpharmacologic options in treating epilepsy in children: • Acupuncture: a Chinese practice where placement of needles can alter brain activity. • Chiropractic Therapy: seizure control can be improved and maintained through spinal manipulation • Ketogenic diet: a diet consisting of high fat and proteins and low carbohydrates help manage episodes These options have been growing in popularity, though they are subject to careful examination due to a lack of controlled clinical studies. Please be sure to inform your epileptologist of any changes in lifestyle and treatment before undertaking a new option.
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research is moving closer to slowing down neurons that create the traffic jam in the brain. Along with pediatric epileptologists, CEP’s multidisciplinary team of nurses, technicians, social workers, nutritionists, and counselors are available for patients and their families throughout both the outpatient and inpatient clinics that are provided for them. With outpatient clinics located in Charlottesville and Southwest Virginia, about 3,500 patients are provided with comprehensive diagnostic and therapeutic services each year. The current Inpatient Epilepsy Unit provides services for up to seven patients whose seizures are difficult to control or diagnose. These services include digital/ video EEG monitoring allowing specialists to pinpoint neural disruption in real time. In the past, inpatient clinics were provided at the old Blue Ridge Hospital (BRH). Recently retired neurological nurse, Carol Clerico, who worked alongside Dr. Dreifuss, recounts cottages in the mountainous setting for patients to stay in as a means to calm their nerves alongside their treatment. “I was there at the perfect time during both neurological and psychological research”, Carol says. As one of the first programs at BRH, Carol and Dr. Dreifuss, worked closely and intuitively with patients both in and out of clinics. “Back then, we were able to take patients to the Downtown Mall and involve them with the community,” Carol explains. “It was important for us to see how the normal environment affected each patient’s behavior and if they were able to make decisions on their own.” Jaideep Kapur MD, PhD, the Eugene Meyer III Professor of Neuroscience, Professor of Neurology & Director of Neuroscience Center of Excellence at the University of Virginia School of Medicine, alongside several doctors along the east coast and Midwest, are leading a study with a $21 million grant from the National Institute of Neurological Disorders and Strokes (NINDS). Dr. Kapur’s study conducted at the University of Virginia is researching patients who are unresponsive to the anti-epileptic drug, benzodiazepine, (designed to calm neurons sending signals to the brain) and thus considered to have established status epilepticus or prolonged epilepsy. Patients in this study are older than two years of age and will be treated with three different drugs in order to determine effectiveness over a period of five years. Dr. Kapur’s research team is well on the way of discovering breakthroughs in effective treatments potentially leading to a cure in epilepsy. The age range of the participants will serve as another insight to seizures and neural development – how will seizures and treatment effects change at each age during the study? Will long-term use of medication lead to a decrease in seizures? Questions like these will hopefully be answered throughout the next five years.
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Alongside research, what can you do to help your child during epileptic episodes? • It is vital that your child take his/her prescribed medication at the proper time
• Avoid potentially dangerous areas, i.e., stairs, hot appliances, moving machinery
• Remain calm during an episode for both your safety and your child’s
• Be mindful of certain times and locations that are triggers to prepare for an episode
• Avoid injury by keeping hands away from your child’s mouth and avoid restraining his/her body
• For quick control of a seizure, rectal medication is the best option to avoid injury
• Ensure your child is on his/her side to prevent any swallowing of oral secretions
• Overexcitement in the brain may trigger a seizure, be sure to practice mindfulness and meditation with your child in order to remain calm and reduce stress.
• Ensure nothing is in his/her mouth to prevent choking
With comprehensive and accessible advancements provided by Virginia’s pediatric neurologists, the brain becomes less of a mystery in the quest for a cure for epilepsy. To meet with an epileptologist, please call the Epilepsy Division of University of Virginia’s Neurology department at 434.924.2706.
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Beautiful Technology
The Art of Radiation Treatment Gets a Breakthrough Tool
words | DIANE YORK
The Art of Radiation Therapy has just gotten a new tool that makes radiation treatments more precise, safer and provides additional comfort for patients. And Martha Jefferson Hospital in Charlottesville is one of the only health facilities in the area to have it. It’s a beautiful thing! That’s what Sylvia Hendrix, MD, Medical Director of Radiation Oncology at Martha Jefferson Hospital, has to say about the new piece of equipment in her radiation oncology department. It’s not often you hear a physician say that about a medical device. With a comprehensive background in radiation oncology and special interests including treatment of breast cancer, skin cancer and prostate cancer, Dr. Hendrix has extensive experience making radiation therapy safer and more effective. Its long name belies the simplicity of its purpose; the Varian PerfectPitch six-degrees-of-freedom robotic couch is actually a table (or couch as it is called) for patients undergoing radiation therapy for cancer.
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left: Perfect Pitch couch performing “Roll” functionality by tilting left side of table up.
Radiation has always been an art, involving locating the exact site of the tumor and targeting it for treatment. The radiation works by destroying the DNA of the cancer cells causing cell death. To spare normal tissues (such as skin or organs which radiation must pass through to treat the tumor), shaped radiation beams are aimed from several angles of exposure to intersect at the tumor, providing a much larger absorbed dose there than in the surrounding, healthy tissue. That is why precision is critical. Plus, the development in the past few years of even higher intensity machines has made the day to day positioning of patients increasingly critical. In the past, patients undergoing treatment were asked to lie still on a table while images of the tumor were used to determine where the beam of radiation should be directed. The average appointment time for this treatment was about fifteen to twenty minutes, most of which Dr. Hendrix says, was spent trying to adjust the patient’s body and the table the patient lay on (which could only move in three directions, up, down and in-out.) Dr. Hendrix says, “The challenge was and is to get the patient in the right position on the table. The actual treatment might only take as little as several minutes. These treatments were sometimes uncomfortable because of positioning on the table and because the machines took much longer to apply the radiation. Side effects were worse, with some patients experiencing painful burns.
above: Perfect Pitch couch performing “Pitch” functionality; head of table/ patient is tilted upward.
People are different, some are not able to move in certain ways or directions and hold a posture. This can be due to illness, injury, weight, age or other factors. Dr. Hendrix says, “for example, we might have a patient with lung cancer. He may be coughing. The tumor most likely is moving as he breathes.” Dr. Hendrix adds, “some patients undergo radiation every day for several weeks in small doses. Some need a very high dose in just three sessions. There is no room for error. Each time they come in we need to treat them in the exact same spot. Most of the time we spend with each patient is getting that placement exactly right.” These differences in patients, along with the table limitations, made radiation therapy difficult for medical staff and patients alike. Now, with the new Varian PerfectPitch six-degrees-of-freedom robotic couch, the technicians can tell the computer to adjust by millimeters and it can move in six different directions. Terms that are usually nautical or aeronautical, are used to describe the three additional directions. In addition to up, down or in-out, there is pitch, which is up and down (like a box lid); yaw is left and right (like a door on hinges); and roll is rotation. The table is digitally operated so the operator can enter in very precise requests on the keyboard and the computer automatically adjusts the table accordingly. In addition, the use of a computed tomography scanner (CT scan) produces a color, three-dimensional image far sharper than the simple x-rays used in the past. For the average patient, this means additional comfort and less time spent on the table, as well as more perfect targeting for the technician. Today, the patient lies on the table (or couch as it is called) under a large circular machine.
Sylvia Hendrix, MD is the Medical Director of Radiation Oncology at Martha Jefferson Hospital. Dr. Hendrix joined the Martha Jefferson medical staff in 1994, and her special clinical interests include treatment of breast cancer, skin cancer and prostate cancer, including brachytherapy.
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Radiation therapy or radiation oncology Radiation therapy or radiation oncology, often abbreviated RT, RTx, or XRT, is therapy using ionizing radiation, generally as part of cancer treatment to control or kill malignant cells. Radiation therapy, by itself, can cure a number of types of cancer when localized to one area of the body. It may also be used as part of multiple therapies, to prevent tumor recurrence after surgery or to remove a primary malignant tumor (for example, an early stage breast cancer). Radiation therapy can be used with chemotherapy or before or after chemotherapy and/or surgery. In advanced cancer, it is often used to relieve symptoms such as pain or bleeding.
Once he or she is positioned correctly, the machine puts out a radiation beam (not visible) and the treatment is over very quickly. There is room around the head and body so most say there are no claustrophobic feelings as with magnetic resonance imaging (MRI) scans. Some report the sensation of warmth in the area being treated. Some have a “sunburn’ type effect in that area later. Many people who receive radiation therapy experience skin problems, such as dryness, itching, blistering, or peeling. These issues usually resolve a few weeks after treatment has finished. Fatigue is the most common side effect, and may increase as the course of treatment continues over days. Some of the benefits, as well as the side effects, of the radiation may continue days or weeks after treatment as the radiation continues to kill cancer cells. With the advent of newer technology, less radiation can be used and more frequent, smaller treatments given. According to staff, Martha Jefferson Hospital is the only facility in the area with this technology. The nearest might be Duke University Health System in North Carolina. The radiation oncology department at Martha Jefferson is so pleased with the results of the Varian PerfectPitch six degrees of separation robotic couch; they have already ordered a second one. Advances like this help Dr. Hendrix to have a positive outlook on the field of medicine and cancer treatment in particular. She says, “It’s all getting better, early diagnosis, surgery, radiation, medical treatments all are progressing. There are lots of reasons for hope!”
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FITBITS
H EA LT H A ND F I T NES S O N T H E G O
Work the ‘Back’ to Wear the ‘Black’ (Holiday Dress) The holidays are right around the corner, and that may mean wearing that ‘little black dress’ or taking that holiday ‘getaway’ or cruise. Start working your back now, and see results in time to show it off before that first holiday event! For optimum results, perform three sets of 8-12 repetitions of the following exercises 3-5 times per week:
#1. Back Extension on Exercise Ball This exercise works the lower back muscles (erector spinae), even though these muscles actually run the entire length of the back along the spine. The erector spinae extend the spine backwards and provide torso stabilization. 1. Lie down with the ball under the belly and hips, legs straight out behind you (or knees bent for a modification).
2. Place the hands behind the head or under the chin - you can also keep the hands resting on the ball if you need a modification. 3. Round down over the ball and then squeeze the lower back to lift the chest off the ball. 4. Raise up until the body is straight (don’t hyperextend), lower down and repeat.
#3. Reverse Fly with Dumbbells This exercise trains the back side of the shoulder muscles (rear deltoids). 1. Stand with feet shoulder width apart, bend knees slightly and lean forward. Upper body should almost be parallel to the floor. Look forward and don’t round back. Hold a dumbbell in each hand with palms facing each other. Elbows should be slightly bent. 2. Raise dumbbells sideways and backwards, until arms are parallel to the floor. Move weights slowly and concentrated. Exhale as you lift dumbbells and don’t create momentum. At the end of the movement, palms should face the floor. Notes: Make sure to keep back straight and exhale as you raise arms. The reverse dumbbell fly is not designed for heavy weights.
#2. Reverse Hyperextension on Exercise Ball: The reverse hyperextension targets a number of posterior muscle groups, including the glutes, hamstrings, and lower back.
3. Complete the movement by lowering the leg back to the starting position, and repeat for desired number of repetitions
1. Place the stability ball on the floor, and lie on top of the ball
4. Repeat the movement using the other leg
2. Place hands on the floor for stability. Slowly raise one leg off the floor until it is at least parallel. Try to keep your legs straight.
Notes: An advanced variation is to raise both legs at the same time. This exercise should not be done by anyone with existing lower back injuries or conditions.
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 Shenandoah Valley and Charlottesville and is a trainer and instructor at the YMCA
The Alzheimer's Association Walk to End Alzheimer’s® is the world’s largest event to raise awareness and funds for Alzheimer’s care, support and research. Held annually in more than 600 communities nationwide, this inspiring event calls on participants of all ages and abilities to reclaim the future for millions. Together, we can end Alzheimer’s disease, the nation’s sixth-leading cause of death. Earlier this fall, more than 300 residents from Augusta County gathered at Ridgeview Park in Waynesboro for their local chapters Alzheimer’s Association Walk to End Alzheimer’s. Participants raised more than $54,500, exceeding their $38,000 goal to fund the Alzheimer's Association care, support and research programs.
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Healthy Eats
d i a b e t i c f r i e n d ly fa l l r e c i p e s
Entrée:
POT ROAST Makes 8 servings
Ingredients: • 1 tsp dried thyme • Salt and pepper to taste • 4 lbs sirloin tip roast (boneless and trimmed) • 2 tbsp olive oil • 2 medium onions, chopped • 2 cloves garlic, crushed with press • 14 ounces beef broth • 2 cups water • 2 tsp Worcestershire sauce • 1 bay leaf
Directions: Preheat oven to 350 degrees F. In a small bowl, combine thyme, salt and coarsely ground black pepper; use to rub all over roast. In 6-quart pot, heat oil on medium-high until hot. Add roast and cook about ten minutes or until browned on all sides. Transfer roast to plate. Reduce heat to medium. Add onions and garlic to the pot, and cook eight minutes or until lightly browned, stirring periodically. Add broth, water, Worcestershire, and bay leaf then heat to a boil on high heat. Transfer contents in pot to a baking dish with the pot roast; cover with foil and place in oven. Cook 2 hours. Place roast on a large platter, discard bay leaf. Spoon broth over roast and enjoy.
Local Beef & Eggs from: J & L Green Farm
4010 Swover Creek Rd | Edinburg, VA 22824 Contact: Chris Smith | 540.333.4014 www.jlgreenfarm.com Count on J & L Green Farms for local pasture raised meats and eggs. They are located in Edinburg and sell Grass finished beef, lamb, pork, chicken and turkey at the Harrisonburg Farmers Market from 8 am to 1 pm.
Tricia Foley says
SOURCE LOCAL FOOD Tricia Foley is OurHealth Magazine’s resident nutritionist
Healthy Eats
d i a b e t i c f r i e n d ly fa l l r e c i p e s
Side Dish: Green beans with mushrooms and onions Ingredients: 3 tbsp coconut oil 6 cups onion, thinly sliced 15 button mushrooms, halved and sliced 1 tsp salt 1/2 tsp pepper ¼ cup vegetable broth 8 cups green beans, blanched
Directions: 1. Heat the oil in a heavy large pan, over medium-high heat. 2. Toss in the onion and sauté for seven to ten minutes, until the onions start to caramelize. 3. Add the mushrooms and reduce heat to medium; cook for five minutes. 4. Season with the salt, pepper and add the vegetable broth. 5. Stir in the blanched green beans and cook for 5 minutes. 6. Serve with pot roast.
Green beans from: After its Kind Produce
4741 Scenic Highway | Bridgewater, VA 22812 540.578.6133 After its Kind Produce offers no-spray vegetables and fruits, grown on their farm, with sustainable farming practices. They are open Monday through Saturday, and closed on Sunday.
Tricia Foley uses
A VARIETY OF VEGGIES Tricia Foley is OurHealth Magazine’s resident nutritionist
Healthy Eats
d i a b e t i c f r i e n d ly fa l l r e c i p e s
Local Honey from: Mud-E Acres
Dessert: Honey Muffins Directions:
Ingredients:
Broadway, VA | 540.896.8938 cgmepley@hotmail.com www.mud-eacres.webs.com Local honey available from Mud-E Acres on-line store by the glass, jar or jug! Check them out at www.mud-eacres.webs.com
3 2 2 3 ½ 1 ¼ ¼ ¼
eggs tbsp organic butter tbsp coconut milk tbsp local honey tsp ground nutmeg tsp cinnamon tsp baking powder tsp salt cup sifted coconut flour
1. Mix together eggs, butter, coconut milk, honey, salt, cinnamon, nutmeg and vanilla. 2. Combine coconut flour and baking powder together and stir into batter until smooth. 3. Pour batter into greased muffin cups. 4. Bake at 400 degrees F for 15 minutes.
Tricia Foley’s
AFTER MEAL TREAT Tricia Foley is OurHealth Magazine’s resident nutritionist
Unhappy
The Ra mseys
Holidays
When ‘the most wonderful time of the year’
isn’t
words | SUZANNE RAMSEY
There’s a photo of my family, taken during the 2008 holidays. We’re standing on a beach, the Atlantic behind us, all smiles. You wouldn’t know it to look at me, but I’m two months pregnant and already thinking about future holidays with my child. Someday, we’d make ornaments, sing carols and bake Christmas cookies with sprinkles. We’d buy presents for Daddy and write letters to Santa. It would, indeed, be “the most wonderful time of the year.” Six months later, my daughter, Hattie, was born. Nine days later, she was gone, due to a genetic brain defect, and with her went dreams for lots of things, among them the memories we’d make at Christmastime. Since then, I’ve learned to “deal” at the holidays. I hang a sparkly wreath on the door and bake for the neighbors. I assemble a Christmas shoebox, marked for a girl and jam-packed with crayons, drawing paper, costume jewelry and toys. But still, there’s always a little something (someone) missing.
For many people, including those dealing with grief, the holidays "unleash an
emotional flood,” says Larry French, LPC,
founder and executive director of the Virginia Center for Family Relations in Charlottesville. He compares what happens to a flash flood:
“The ground was saturated and when it rained so heavily, it just overflowed.”
Kara Gloeckner, who lost her 13-year-old son Kody in 2004, understands this all too well.
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Kody,age 7
“Holidays are so fraught with triggers, memories and whatever,” Peggi says, adding, “To me, survival mode requires a certain amount of avoidance at that time of year.”
The Charlottesville resident describes the holidays as “especially dangerous emotionally, because what you see is everybody else’s joy and your lack,” and it’s especially true early on, she says, “when you don’t even know what the little things are that are going to trigger you to a really dark place.
was purely my husband’s plan and he was pretty desperate about what to do with me.
Since her 19-year-old son Jordan died six years ago, Peggi Johnson hasn’t put up a Christmas tree or sent out cards. She doesn’t go to the mall during the holidays or listen to the radio with its 24/7 carols.
Kara initially used a similar coping strategy, holing up in a rented cabin.
The first three Christmases after Jordan died, Peggi and her family left the country, the first year for the Atacama Desert in Chile, said to be the driest place in the world. “It was trying to escape, trying to run away,” she says. “Trying to not be in a place where the holidays are celebrated in a hyper-kinetic way, like we do. To have a much more subdued environment, but yet one with tremendous beauty. That
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Kody,age 5
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“Going away is not an option for everyone but I do know that a lot of people do find that helpful, at least in the early years. It’s a very typical thing.”
“I tucked myself away from all things red and green and all Christmas music,” she says. “I didn’t shop. I didn’t buy gifts. I didn’t decorate. I didn’t give or receive gifts. I was not going to have a holiday.” Albemarle County resident Margie Howell lost her 32-year-old son Edward in September 1996. When Christmas came around, she and her husband fled, visiting family in Northern Virginia and Tidewater, and spending a few days in Colonial Williamsburg. “We remember this place with great
“It kind of breaks the cycle,” French says, referring to what would otherwise be the familiar holiday meal with an empty seat at the table. “Spend Christmas at Wintergreen or go to the Caribbean. There’s no expectation of the other person being a part of that because they haven’t been a part of that. It breaks out of that mindset of ‘so-and-so isn’t a part of the holiday.’” fondness, since we had taken our young sons there for Christmas many years ago,” Margie says. “We needed to be in a different place from our usual custom that year. This worked for us, although we took our deep sadness with us, of course.” French agrees that it’s a good idea to do something different for the holidays the first year or two after the death of a loved one. Kara started celebrating Christmas again three years after Kody died. She said it’s “still a lot of work” but instead of focusing on grief she concentrates on family, friends and the children she works with at STARS, the therapeutic foster home she founded 17 years ago. “It’s a lot of cooking and decorating and a lot of energy, but I don’t spend energy sitting alone by the tree with a broken heart,” she says. “That’s not for me anymore.” Kara also finds volunteering and charitable giving beneficial. Since Edward’s death, Margie hasn’t put up a live Christmas tree, her family’s usual practice. Instead, she decorates a potted Norfolk pine with “small lights and a few trinkets with special memories.” As advice for others grieving during the holidays, she says, “Know that holidays and anniversaries will never be the same. Make a plan, engaging all family members, if possible. Change your usual customs, or pick essential ones you want to continue. Stay at home or leave. It’s all up to you. There are no rules. Find what works best for you and your family.” For the past two years, Peggi and her family have spent Christmas stateside with her sister’s family.
‘Toxic’ families can make holidays difficult words | SUZANNE RAMSAY
Many families have had that holiday, the one that goes down in the annals of family history as “The Dysfunctional Family Christmas.” Inevitably, when everyone gets together, unresolved family issues float to the surface. Add a little “holiday spirit” and watch out. “If you have hard feelings for someone and don’t see them all year, then you get together and mix a little alcohol in there, it reduces people’s inhibitions and they say mean things,” French says. “You’re tired from wrapping presents all night, someone knocks the tree over and all hell breaks loose.” So, what’s the answer when “home for the holidays” is the last thing you’d ever put on your Christmas list? French says to ask yourself, “How much am I OK being part of?” He suggests setting a time limit. Perhaps dropping by the relative’s house for 30 minutes, or just for the meal, or staying in a hotel; so you can escape the chaos. “Going home is not always uplifting and edifying,” he says, adding that when people say, “I just feel obligated, but I hate it,” he asks, “Why are you doing it?” French compares it to someone with asthma in a house full of smokers. “You can see the smoke and physically [are] not able to breathe,” he says. “You know it’s toxic. Figure out what your tolerance level is. Do the best you can to be sweet, loving, polite and kind, and then ‘We’ve got other things to do.’ They might be upset, but as you get healthier, you have to say, ‘No.’ Some family members are not healthy to be around.” Not everyone will understand, French says, but they might eventually get the drift and start behaving better. “Part of it is being able to say, ‘I know being around the family is toxic and not good for me’ or ‘I need a break and need to go do something else,’” he says.
“It’s very subdued,” she says, “but there’s a small tree, some exchange of gifts, a Christmas dinner. So, there’s something.”
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“Any time you can do anything to help others, it helps you,” she says. “If you would have purchased such-and-such for your own child, pull an angel off the tree and make those purchases in memory of your child.”
Peggi says someday she might want do more.
s through The two became friend Chapter Friends" - Piedmont "The Compassionate
Kara and Colleen
“It is possible that down the road I might put out a tree,” she says. “I haven’t thrown away my Christmas decorations. They’re in a storage facility. I just don’t know yet. I will say that most of the other bereaved parents that I know said that if they got back to the place where they did something it usually took five to seven years.” Asked if she’d like to get there, Peggi tears up.
Peggi has some words of advice for those dealing with a bereaved person at the holidays: Don’t remove them from your Christmas card list, but also don’t send them the "newsy" letter you’re sending everyone else — the one about your Ivy League son and what every member of the family is doing. A “Thinking of you at the holidays” card might be better. Stop by the loved one’s gravesite and leave an ornament or token. While it might seem paradoxical, invite the bereaved person to holiday parties, even if they might not attend.
“Let me know you’re aware that I’m on the planet,” Peggi says.
“I think there’s a part of me that would like to get to a place where I could use my Spode Christmas Tree china and have a few things out,” she says. “I would like to get to that place.” French says dealing with issues such as grief during the holidays brings to mind a passage from C.S. Lewis’ “The Lion, the Witch and the Wardrobe,” describing Narnia, the land beyond the back of the wardrobe: “Always winter, but never Christmas.” He says he would add to that, “Always bleak, but never joy.” He recommends that “at some point you need to get closure,” and this applies not only to grief but to all of life’s disappointments. “You might have been hoping for good health, hoping to travel, hoping to be in a better place,” he says. “It’s a part of life, but if you make it a barrier to moving forward in life you miss out on all the joys that are possibilities there.” Don’t remove them from your Christmas card list, but also don’t send them the newsy letter you’re sending everyone else — the one about your Ivy League son and what every member of the family is doing. A “Thinking of you at the holidays” card might be better. Stop by the loved one’s gravesite and leave an ornament or token. While it might seem paradoxical, invite the bereaved person to holiday parties, even if they might not attend. “Let me know you’re aware that I’m on the planet,” Peggi says.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Avoiding overspending can make Christmas merrier words | SUZANNE RAMSEY
Colleen Baber
The Piedmont Chapter of The Compassionate Friends, a support group for those grieving the death of a child, holds an annual memorial candle lighting service, at Church of our Savior on Rio Road in Charlottesville. The service is held in November each year, before the start of the holiday season. The nondenominational, non-religious service includes speakers, singing and a candle lighting ceremony. During the ceremony, the names of children who have passed are read aloud. “It’s really special and an opportunity to say our child’s name, to hear your child’s name said,” Kara says. “It’s a special way to honor them and the holidays. That, to me, is sort of the most important event for the holiday season.” For more information, visit www.thecompassionatefriends.org or contact Colleen Baber at 434.977.8930 or via email at cobaber@aol.com.
If you’re not careful, holiday spending can lead to credit card debt and other financial problems. Financial services companies, like Ameriprise Financial Services in Charlottesville, say these problems can be avoided with self control and planning. The biggest thing people need to do, and it’s an act of discipline, is make a list. If you start buying emotionally, you’re going to overspend. If you make a list and stick to it, knowing what you’re going to buy and what you’re going to spend per person, that can be very helpful. Here are more tips for averting financial peril during the holidays: • Pay cash and if you don’t have it, don’t spend it. • If you must use plastic, charge only what you can reasonably pay off by the time the bill arrives. • Avoid “six or 18 months, no interest, no payment” plans. • Make gifts or throw a party instead of purchasing gifts. • It’s not the size or the dollar amount of the gift. It’s about spending time with people and not necessarily spending money to get someone something so they can get you something. • Avoid last-minute shopping. You will end up spending more out of guilt. • Turn one gift into several. Choosing gifts one by one is more time consuming and expensive than buying sets that can divided.
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• Look for deals, but also buy quality products, even if you have to save up for them. The ‘cheapest way’ isn’t always the cheapest way. Buy good, quality items, something that’s worth it and lasts 10, 15, 20 years. • Start saving in January. If you set aside $50 a month, you’ll have nearly $600 to spend in December.
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