table of contents | november • december 2015
20 Examining the THYROID A functionally balanced thyroid gland is vital for the well-being of the entire body. To learn more about how the thyroid works and its most common ailments, OurHealth consulted the experts at University of Virginia Health System and Augusta Health.
MEDI•CABU•LARY.......................8 Local experts define health-related terms
JUST ASK!.......................................10 Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............12 A listing of new physicians, providers, locations and upcoming events in the Shenandoah Valley and Charlottesville communities
HEALTH POINTS.........................16 Interesting facts and tidbits about health
THE ANATOMY CHALLENGE..................................19 Are you up for the challenge? In this issue, test your knowledge when it comes to the THYROID.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
50 "I was THAT CLOSE to Diabetes"
When Joe Biggins heard his physician say “prediabetes� at his annual physical a few months ago, the 71-year-old Waynesboro resident admits he got frightened. According to the American Diabetes Association, approximately 86 million American adults have prediabetes.
hello, HEALTH!.............................. 56 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos.
FIT BITS!........................................ 59 Brave the Barre! This one-of-a-kind
workout is a continual, fat-burning series of exercises that tone the entire body in an effective yet safe way.
64 Healthy Children
Growing Emotionally
What more could a parent ask for than a happy, well-adjusted child? We explore tips and techniques to help parents, grandparents and educators nurture the development of emotionally healthy and resilient children.
NUTRITION..................................60 HEALTHY EATS: Whole Foods Market partners with Sentara Martha Jefferson Hospital to give you healthy recipes that will make your mouth water including arctic char, spaghetti squash and lentil chili.
CLOSER LOOK.............................. 74 Images reflecting the landscape of healthcare in the Shenandoah Valley and Charlottesville * PLUS * a chance to win prizes!
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OurHealth Shenandoah Valley & Charlottesville
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november • december 2015
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CONTRIBUTING SHENANDOAH VALLEY & CHARLOTTESVILLE MEDICAL EXPERTS
McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Deidre Wilkes Tori Meador Joseph Palotas Dalton Holody Laura Bower Jourdan Markey Gregory Degnan, MD Ami Keatts, MD, FACOG, CPPS Michael Henderson, OD Brian M. Showalter, MD Christopher Williams, MD Jeanne M. Young, MD
ONTRIBUTING PROFESSIONAL EXPERTS & WRITERS Susan Dubuque C Kelli Hughes, RD Suzanne Ramsey Edward Schwartz Deidre Wilkes ADVERTISING AND MARKETING Kim Wood • Vice President of Business Development 540.798.2504 • kimwood@ourhealthvirginia.com Cindy Trujillo • Senior Media Consultant 434.907.5255 • cindy@ourhealthvirginia.com
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Richard Berkowitz • Senior Vice President of Business Development 804.539.4320 • rick@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: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Ext. 1 Information in all print editions of OurHealth and on all OurHealth websites (websites listed below) and social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2015 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. OurHealth Lynchburg/Southside is published bi-monthly • Special editions are also published • McClintic Media, Inc. • 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. MAIN: ourhealthvirginia.com | ourhealthswva.com | ourhealthlbss.com | ourhealthrichmond.com | ourhealthcville.com | Advertising rates upon request.
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LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is Ankylosing Spondylitis? Ankylosing Spondylitis (AS) is an autoimmune disease which results in arthritis of the spine. It can also involve the tendons and ligaments. It is associated with overgrowth of the vertebrae which can lead to abnormal joining of the bones. Ankylosing spondylitis most commonly affects young men. Early symptoms include constant pain and stiffness in the low back, buttocks, and hips. Pain and stiffness in the area of the achilles tendon and the heel is common, as are fever, fatigue, and loss of appetite. The diagnosis of AS is usually made by orthopedists or rheumatologists and is based on a combination of x-ray findings, blood tests, and a thorough medical/family history and physical examination. There is no definitive cure for this disease, but there are treatments which can decrease pain and improve long-term function. Treatment usually includes physical therapy, exercise and prescription medications. Surgery is sometimes necessary to correct spinal deformities or to address joint arthritis.
Gregory Degnan, MD
Sentara Martha Jefferson Orthopedics Charlottesville | 434.654.7000 www.sentara.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
What is hyperhidrosis?
What is dry eye syndrome?
Hyperhidrosis is a condition of excessive sweating. It most commonly affects the palms, soles and underarms but can be more generalized. Primary hyperhidrosis describes this phenomenon when it occurs as a normal physiologic response to increased body temperature in otherwise healthy individuals. It will often worsen with exposure to warm temperatures, exercise and heightened emotional states but can be present all the time in some people. Rarely, more generalized hyperhidrosis can be associated with underlying systemic diseases or as a side effect of certain medications. This secondary hyperhidrosis can be seen in people with pregnancy, thyroid disease and other conditions that cause hormonal imbalances. Screening for many of these conditions can be done by a physician. A number of effective therapies exist for the treatment of primary hyperhidrosis. Secondary hyperhidrosis will often respond to the treatment of the underlying condition or the discontinuation of medications that contribute to sweating.
Approximately 10 million people in the U.S. suffer from dry eyes, and their symptoms are caused by a variety of factors including allergies, hormonal changes, poor tear quality, medications, contact lenses, eye surgery, and other eye diseases or disorders. Contrary to common belief, excessive tearing can also be a sign of dry eye syndrome as the eye tries to compensate for poor tear quality by flooding the eye with more moisture in an attempt to soothe the irritation. Other people don't produce enough tears to keep their eyes comfortably lubricated. Tears are made up of a complex mixture of water, fatty oils, electrolytes, proteins, and bacteria fighting substances. This mixture helps keep the surface of the eyes smooth and clear. Without good quality tears, good vision is impossible. Treatments are specific to the cause(s) of the dry eye and are aimed at decreasing symptoms. Treatment can include prescription or over-the-counter medications. If you are suffering from dry eye syndrome, consult with an eye doctor to determine the best course of treatment.
Jeanne M. Young, MD
Assistant Professor of Dermatology UVA Health System Charlottesville | 434.243.3675 www.uvahealth.com
Michael Henderson, OD
Primary Eyecare Charlottesville | 434.977.2020 www.cvilleeyecare.com
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H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
How can abdominoplasty help someone who has experienced a large weight loss? Massive weight loss, due to diligent diet and exercise or as a result of bariatric surgery (e.g. gastric bypass surgery), is often accompanied by significant skin laxity that is typically most prominent in the abdomen, arms, thighs, buttocks, and neck. This skin excess is a result of chronic stretching beyond the skin’s elastic ability to return to its natural preweight gain state. The hallmark of this phenomenon is stretch marks. Abdominoplasty is an operation also known as a "tummy tuck" that is designed to address the abundance of abdominal skin after significant weight loss or pregnancy. The main goals are to surgically improve the tone of the abdominal wall by tightening the abdominal muscles and recreate the waistline, remove skin that is deformed by stretch marks, and restore an attractive smooth contour to the abdominal skin. Abdominoplasty is an important part of the transformative process of massive weight loss that usually accompanies tissue removal from the buttock, thighs and arms as well.
Brian M. Showalter, MD
Monticello Plastic & Reconstructive Surgery, PC Charlottesville| 434.260.5130 www.monticelloplasticsurgery.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
At what age should I bring my daughter in for her first gynecologic exam?
How is PCOS (polycystic ovarian syndrome) diagnosed and treated?
Generally, this visit can occur between ages 13 and 15 and may not involve a pelvic examination. Becoming acquainted during this time helps the physician to create a trusting environment for the patient, before she is faced with a gynecologic problem. Typically, the things that are discussed during these early visits are normal development as a young girl grows into her adult body, ways to manage menstrual issues (like painful periods, irregular periods, use of tampons, etc.), preferred health behaviors and the HPV vaccination. If an adolescent is sexually active, or having difficulty with her menstrual periods, a pelvic examination may occasionally be needed. By around age 18 to 21, most young women should be seeing a gynecology provider on a regular basis. PAP screening is not generally done until age 21, but STD testing and reinforcing preferred health behaviors can be positively impactful. Many young women have questions during this time, and having access to an educated gynecology provider can help in alleviating some of the stress associated with understanding adolescent health.
Polycystic ovarian syndrome is an extremely common condition affecting 5 percent (about 1 in 20) of all reproductive age women. Common features of PCOS include irregular menstrual cycles, skin problems – such as acne and excessive hair growth (most commonly facial), and excess weight. It is also common for women affected by PCOS to have a close family member with diabetes. There is no single test for PCOS. All women being evaluated for PCOS should have a pelvic ultrasound and udergo a panel of blood tests to rule out other conditions that may be confused with PCOS, such as diabetes, thyroid disease, and other adrenal conditions. Treatment of PCOS depends on the goal of each woman, such as normalizing menstrual cycles or improving acne with oral contraceptives, or assisting in conception with fertility medication.
Ami Keatts, MD, FACOG, CPPS Augusta Health Care for Women Fishersville | 540.213.7750 www.ahcfw.com
Christopher Williams, MD
Reproductive Medicine and Surgery Center of Virginia, PLC Charlottesville | 434.654.8520 www.rmscva.com
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Shedding New Light on Depression Researchers identify genetic clues to causes of clinical depression.
Researchers from the Department of Psychiatry at Virginia Commonwealth University in Richmond, Va., working in collaboration with scientists from the University of Oxford and throughout China, have identified genetic clues to the underlying causes of clinical depression. VCU’s Virginia Institute for Psychiatric and Behavioral Genetics was a key participant in the research that successfully isolated specific changes in DNA that increase risk for major depression. This study was published online in the journal Nature in July of this year.
Kenneth S. Kendler, MD, professor of psychiatry and human and molecular genetics at VCU School of Medicine— part of a team that is uncovering the genetic links to clinical depression.
“This type of genetic study is the first step in uncovering specific biological pathways to the illness. The findings could potentially lead to new ways to predict hereditary risk for depression and more effective treatments for the disease,” says Kenneth S. Kendler, MD, joint-senior author and professor of psychiatry and human and molecular genetics at VCU School of Medicine. Depression is no small problem. It affects approximately 19 million Americans and 350 million people worldwide. Studies show that rates of depression for Americans have risen dramatically in the past 50 years. In fact, the World Health Organization has classified depression as a worldwide epidemic. To learn more, watch this video on the breakthrough research at www.VCUDepressionDiscovery.com or scan the QR code provided.
Check out this video about Dr. Kendler's genetic research on clinical depression.
Augusta Health Offers Drive-Thru Flu Shot Clinic Augusta Health, along with the Central Shenandoah Health District (Public Health) and Waynesboro Emergency Management, recently held their first annual ‘Drive-Thru Flu Shot Clinic’. In just two and a half hours, healthcare providers administered over 500 flu shots to the general public at Augusta Health’s Waynesboro Urgent Care. Participants, age three and up, were able to receive their flu shot without leaving their cars. It’s still not too late to get your flu shot! Call your local pharmacy or doctor’s office today to schedule your seasonal flu shot! For more information about other community health events at Augusta health, visit www.augustahealth.com.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Virginia Hearing Group
Announces Annual Holiday Hearing Aid Give-Away Each year before Thanksgiving, Virginia Hearing Group, in Verona, begins accepting letters from those in the community who have a hearing loss or those close to someone who has a hearing loss. Each letter should explain why the nominee being written about, would benefit from hearing aids. A group of judges will read each letter. A FREE set of top of the line digital hearing aids will be given to someone in the Augusta County community. The only qualifications are that you have a hearing loss, and live within the Augusta County boundaries. Each letter should include your contact information. If writing on behalf of someone else, please include his/her contact information as well; name, phone and address. “At Virginia Hearing Group we are passionate about helping each and every person in our community to hear well,” says Karen Klotz, owner of Virginia Hearing Group. “Anyone who wants a better quality of life through improved hearing can find it here at Virginia Hearing Group. We look forward to the opportunity to bless the life of an individual who really needs to hear better to more fully participate in life.” The deadline for submitting the nomination letters is Monday, November 30th. Letters can be submitted by mail to Virginia Hearing Group, 246-C Rolla Mill Rd, Verona, 24482 or by personal delivery. They may also be submitted by fax at 540.248.1670, by email at info@virginiahearinggroup.com, or through Virginia Hearing Group’s Facebook page.
Deadline for submitting nomination letters:
November 30th
Letters can be submitted by mail, email, fax, in person or by visting the Virginia Hearing Group Facebook page. ADDRESS:
Virginia Hearing Group 246-C Rolla Mill Road Verona, VA 24482 EMAIL:
info@virginiahearing group.com FAX:
540.248.1670
Scan the QR code to go straight to Virginia Hearing Group's Facbook page.
UVA Named One of 11 U.S. Palliative Care Leadership Centers The Center to Advance Palliative Care (CAPC) has named University of Virginia Health System as one of 11 Palliative Care Leadership Centers™ in the U.S. According to CAPC’s website, leadership centers are selected for “their clinical excellence, outstanding leadership, reputation and experience,” including the use of evidencebased best practices for palliative care. Palliative care helps patients cope with pain and other symptoms from a range of serious diseases or treatments for those diseases. Palliative care leadership centers such as UVA provide training and a yearlong mentoring program to help palliative care programs across the country provide high-quality care for their patients. “CAPC is a nationally recognized organization supporting excellence and growth in palliative care,” says Joshua Barclay, MD, a UVA palliative care specialist. “To be recognized as a leader in this field by CAPC is an incredible honor for us at UVA.”
UVA’s palliative care providers include doctors, nurses, social workers, nutritionists, music therapists, chaplains, massage therapists and psychologists. The team helps patients better manage symptoms ranging from nausea and nerve damage to anxiety and depression while patients are in the hospital as well as at UVA’s outpatient palliative care clinic. “We have steadily expanded our services with support from leadership at the UVA Medical Center, School of Medicine and School of Nursing,” says Dr. Barclay. “This has resulted in family-centered care which is effectively integrated into the comprehensive care provided at UVA.” To learn more about CAPC, visit www.capc.org. For more information on UVA’s palliative care center, visit www.uvahealth.com.
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NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
New Test Predicts Teens’ Future Risk of Heart Disease Researchers Create Cardiac Crystal Ball in Battle Against Number 1 Killer of Men, Women Risk for cardiovascular disease, currently running rampant in the United States, can now be predicted for adolescents thanks to a new diagnostic test developed by a University of Virginia Children’s Hospital pediatrician and his collaborators. The test accounts for many risk factors for the deadly disease and has the potential to be adapted by physicians nationwide to assess teenagers’ future risk and encourage the healthy behaviors that could save their lives. Approximately 610,000 people die from heart disease every year in the United States — that’s one of every four deaths. Cardiovascular disease has predominantly modifiable risk factors, meaning that the disease is entirely preventable. These modifiable risk factors include high blood pressure, high cholesterol, obesity, physical inactivity, diabetes, unhealthy diets and smoking. The only risk factor unable to be changed is genetic predisposition. The new diagnostic test has been developed by a team that includes Mark DeBoer, MD, of the UVA Department of Pediatrics. The test relies on an evaluation of metabolic syndrome, a conglomeration of conditions including increased blood pressure, high levels of blood sugar, excessive body fat around the abdomen and waist, and abnormal cholesterol levels that together increase the risk of cardiovascular disease. It takes into account variables specific both to race and gender. The test is innovative in that it is able to assess changes in metabolic syndrome severity in a person over time and creates a specific number predicting risk. Previous diagnostic tests have been merely positive or negative, stating that a person either has or does not have metabolic syndrome, but the new test is able to create a scale, delineating the precise degree to which a youth is at risk. “We are hopeful that this score can be used to assess the baseline risk for adolescents regarding metabolic syndrome and their risk for future disease and use it as a motivator for individuals to try to change their risk so that they may have a healthier diet, engage in more physical activity or get medication to reduce their metabolic syndrome severity and their future risk for disease,” concludes Dr. DeBoer. The research has been described in articles in the Journal of the American College of Cardiology and the journal Diabetologia. For more information, visit www.uvahealth.com.
Jeffrey Alexander, MD Mosaab Bagegni, MD Sentara Blue Ridge Internal Medicine Charlottesville 434.654.4550 www.sentara.com
Sentara RMH Pulmonary Associates Harrisonburg 540.689.5600 www.sentara.com
Cindy Bailey, CNM Augusta Health Care for Women Fishersville 540.213.7750 www.ahcfw.com
Diane Barros, MD Northridge Internal Medicine Charlottesville 434.243.4500 www.uvahealth.com
Raymond A. Costabile, MD
UVA Specialty Care Pinnacle Drive Urology Charlottesville 844.472.8711 www.uvahealth.com/ augustapinnacle
Stephen H. Culp, MD UVA Specialty Care Pinnacle Drive Urology Charlottesville 844.472.8711 www.uvahealth.com/ augustapinnacle
Amrita De Zoysa, MD Augusta Health Primary Care Staunton |540.332.5687 www.augustahealth.com
Zsofia Hole, MD
Sentara RMH Neurology Harrisonburg 540.689.5400 www.sentara.com
Deborah Lusk, CRNP
Augusta Health Family Practice Churchville|540.245.7800 www.augusthealth.com
William P. Robinson, MD
UVA Heart and Vascular Center Charlottesville 434.243.1000 heart.uvahealth.com
Ben Farley, MD
Cara Goodell, MD
Zachary Gregg, MD
Leticia Hardy, MD
Surovi Hazarika, MD
Matthew Holland, MD
Arrossa Jamshid, MD
Amanda Jones, MD
Aric Jorgenson, MD
Sophia Leung, MD
Galina Lyles, MD
Jason Moore, MD
Janet Polansky, MD
Michael Potter, MD
David Ratliff, MD
Christopher Sutton, MD
Carol Maxwell Thompson, NP
Ruzbeh Toussi, DO
Kristin Turza, MD
Brannon Weeks, MD
Augusta Health Urgent Care Staunton|540.245.7470 www.augustahealth.com
National Spine & Pain Centers Harrisonburg 540.434.1759 www.treatingpain.com
Augusta Health Hospitalists Fishersville | 540.245.7010 www.augustahealth.com
Augusta Health Family Medicine Staunton |540.886.1300 www.augustahealth.com
Augusta Health Primary Care Stuarts Draft 540.245.7870 www.augustahealth.com
Augusta Health Hospitalists Fishersville | 540.245.7010 www.augustahealth.com
Sentara RMH Vascular Surgery Harrisonburg 540.689.5800 www.sentara.com
Augusta Health Urgent Care Staunton|540.245.7470 www.augustahealth.com
Sentara Martha Jefferson Medical and Surgical Associates Charlottesville 434.654.5260 www.sentara.com
Pediatric Associates of Charlottesville, PLC Charlottesville 434.296.9161 www.charlottesville peds.com
Augusta Health Urgent Care Staunton|540.245.7470 www.augustahealth.com
Augusta Health Pain Management Clinic Staunton |540.332.5747 www.augustahealth.com
Augusta Health Pediatric Hospitalists Fishersville 540.932.4298 www.augustahealth.com
Albemarle Anesthesia Charlottesville 434.654.7000 www.mjh anesthesiology.com
Sentara Martha Jefferson Orthopedics Charlottesville 434.654.4660 www.sentara.com
Augusta Health General Surgery Staunton |540.332.5909 www.augustahealth.com
UVA Heart and Vascular Center Charlottesville 434.243.1000 heart.uvahealth.com
Sentara RMH Orthopedics and Sports Medicine Harrisonburg 540.689.5500 www.sentara.com
Blue Ridge Radiologists, Inc. Staunton |540.886.0988 www.augustahealth.com
Sentara RMH Valley Behavioral Medicine Harrisonburg 540.564.7007 www.sentara.com
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TI P S , T I D B I T S A ND MO R E TO I NF O R M A ND ENT ERTA I N YO U
NOVEMBER
American Diabetes Month
Diabetes can strike anyone, from any walk of life. And it does, in increasing numbers every year. Raising awareness of this ever-growing disease is one of the main efforts behind the mission of the American Diabetes Association (ADA). November is American Diabetes Month. This month and every month, encourage people to make healthy changes. Eat healthy, don’t smoke, increase physical activity and have regular check-ups with your local physician. »» Of the nearly 30 million people in the US with diabetes, 90-95 percent are type 2 diabetics. »» Another 86 million Americans have prediabetes and are at risk for developing type 2 diabetes. »» The ADA estimates that the total national cost of all diagnosed diabetes in the U.S. is $245 billion.
»» There is hope. People who are at high risk for type 2 diabetes can lower their risk by more than half by making healthy changes. »» Are you at risk? Visit www.diabetes.org to take the ‘Ryan’s Challenge’ type 2 diabetes risk test or visit your local healthcare provider and ask about your risk for type 2 diabetes and heart disease.
29.1 MILLION people in the United States have diabetes.
9.3 % of the population. About
Source: www.diabetes.org
7th Annual
Earlysville Turkey Trot 5K & Kids Half Mile Run
DATE: TIME: LOCATION: 16
Thursday, November 26th 8:30 am Kid’s Half Mile Run 9:00 am 5K Turkey Trot 600 Earlysville Forest Drive Earlysville, VA (just 15 minutes northwest of Charlottesville)
The Earlysville 5k Turkey Trot welcomes and encourages runners and walkers of all ages and abilities! Enjoy a beautiful scenic run/ walk through the small town of Earlysville and one of its runner friendly neighborhoods on Thanksgiving morning. The Kid’s Half Mile Run is a great way to include the whole family in a healthy activity before the ‘big feast’! For more information, visit www.charlottesvillemultisports.com.
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
How Much Exercise is Needed to
Burn Off Thanksgiving Dinner? The average Thanksgiving meal packs a whopping 3,000 calories – yikes! That’s way more than most people need for an entire day! Here are some exercises for burning off those extra calories: Running (10min/mile)
4.5 hours
Cycling (12-14 mph)
5.5 hours
Circuit training
5.25 hours
Tennis
6.25 hours
Brisk Walking
6 hours
For customized calorie burning information, scan the code to access the OurHealth fitness and exercise calorie calculator.
*Calculated for a person weighing 150 pounds. Based on WebMD’s Fit-o-Meter Exercise Calorie Calculator.
Have you received your
F u Vaccine?
It’s not too late! December 6-12 is National Influenza Vaccination Week (NIVW). Sponsored by the Centers for Disease Control and Prevention (CDC), NIVW is a national observance that was established to highlight the importance of continuing influenza vaccination. While vaccination is recommended for everyone six months and older, it is especially important for protecting those at high risk for serious flu complications, including: •
Young children
•
Pregnant women
•
Adults 65 an older
•
Anyone with chronic health conditions such as asthma, diabetes, and heart disease
To schedule your yearly flu shot, call your doctor office or visit your local pharmacy.
5th Annual
Monticello Holiday Classic & Deck the Halls Kids Dash Join in the festivity and fun during the 5th Annual Monticello Holiday Classic 5K and Deck the Halls Kids Dash! This family-oriented 5K begins at the East Walk of Monticello and ends at the Thomas Jefferson Visitor Center and Smith Education Center. Kids 12 and under can enjoy the Deck the Halls Kids Dash, a loop around the West Lawn within the shadows of Monticello. Children under 18 must be accompanied by an adult. DATE: TIME: LOCATION:
Saturday, December 5th 8:00 am David M. Rubenstein Visitor Center 931 Thomas Jefferson Parkway Charlottesville, VA 22902
For more information and to register, visit www.monticello.org.
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the
Anatomy
CHALLENGE How much do you know about the
Thyroid? First, complete the
word search below. Next, match up the correct word with the part of the body in the illustration.
[ the Thyroid ]
WORD SEARCH clavicle
external carotid internal jugular vein isthmus of thyroid left lobe of thyroid
right common carotid artery thyroid
thyroid cartilage trachea
____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________
For answers, visit OurHealth Shenandoah Valley and Charlottesville’s Facebook page at www.OurHealthCville.com
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Examining the
THYROID
words | EDWIN SCHWARTZ
A functionally balanced thyroid gland is vital for the well-being of the entire body. To learn more about how the thyroid works and its most common ailments, OurHealth consulted the experts at University of Virginia Health System and Augusta Health.
What is the thyroid? The thyroid is a butterfly-shaped endocrine gland located on the front of the neck below the Adam’s apple. It is controlled by the pituitary gland, a small organ at the base of the brain just above the nasal passages. Typically, the thyroid remains invisible but can be felt as a soft mass. It varies in size, ranging from 18 to 60 grams in adults. “The thyroid is essential to life,” says Nelly Maybee, MD, an endocrinologist at the Augusta Health Diabetes & Endocrinology Clinic. “You can’t live without it. When it doesn’t work, the whole machine stops.”
What is the function of the thyroid?
The primary role of the thyroid is to produce two types of hormones. These are commonly referred to as T4 (thyroxine) and T3 (triiodothyronine).
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WHAT ARE ENDOCRINE GLANDS? Endocrine glands produce and secrete hormones that regulate the activity of cells and multiple organs. Hormones control growth, metabolism and sexual function. As hormones are released into the bloodstream, they act like chemical messengers that communicate information from one group of cells to another.
Thyroid hormones regulate overall body growth and metabolism and play an important role in brain growth during fetal development. Approximately 80 to 90 percent of the hormones secreted from the thyroid gland are T4 hormones; the remaining 10 to 20 percent are T3 hormones. However, up to 80 percent of the T4 hormones are converted to T3 hormones they are released into the blood stream.
How does the thyroid work?
The pituitary gland (near the brain) controls the thyroid’s production of T4 and T3 in a thyroid-pituitary negative feedback loop. As thyroid production of T4 and T3 decreases, the pituitary gland secretes a hormone called thyroid-stimulating hormone, which stimulates the thyroid to produce more thyroid hormones. When thyroid production of T4 and T3 increases, the pituitary gland reduces TSH production. These hormones are in constant communication, but although the TSH regulates the thyroid, it doesn’t tell the thyroid how much T4 and T3 to produce and secrete.
Conditions that affect the thyroid Thyroid conditions are common, and women are generally more susceptible than men. The two most common thyroid diseases are hyperthyroidism and hypothyroidism. Others are thyroiditis, thyroid nodules and thyroid cancer. Nelly Maybee, MD is an endocrinologist at the Augusta Health Diabetes and Endocrinology Clinic. Dr. Maybee is certified by the American Board of Internal Medicine with a subspecialty in Endocrinology, Diabetes and Metabolism.
Hyperthyroidism
Hyperthyroidism, or overactive thyroid, is the excessive production of thyroid hormones by the thyroid gland. Common symptoms include increased heart rate, anxiety, poor sleep, fatigue, muscle weakness, poor heat tolerance, increased metabolism, diarrhea and weight loss despite increased eating. Patients may have a goiter (enlarged thyroid), bulging eyes and hand tremor. Hyperthyroidism is typically diagnosed with a blood test that reveals high or normal T4 and T3 with a suppressed TSH level. The three treatment options include radioactive iodine, antithyroid medication to control thyroid function and, occasionally, surgery to remove the thyroid.
Hypothyroidism
With hypothyroidism, or underactive thyroid, the thyroid gland does not produce enough thyroid hormones. 22
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Common symptoms include lowered metabolism, decreased heart rate, weight gain, lack of energy, poor tolerance of cold, dry skin and depression. Patients may have a goiter (enlarged thyroid), bulging eyes and hand tremor. Hypothyroidism affects women to men by a ratio of 2:1. It causes menstrual irregularity, impaired fertility and increased risk of miscarriage. Diagnosis is relatively simple and consists of a blood test that shows an elevated TSH with low thyroid hormones. The TSH is high because it functions like a thermostat that keeps trying to stimulate without effect. Treatment includes oral synthetic T4 hormones (for example, levothyroxine) or a combination of T3 and T4.
Conditions that affect the
1
Hyperthyroidism
2
Hypothyroidism
3
Thyroiditis
4
Thyroid Nodules
5
Thyroid Cancer
“Patients should have blood work done every month or month and a half while adjusting their dose,” says Dr. Maybee. “Once it’s set, they stay on that amount.”
Thyroiditis
Thyroiditis, or inflammation of the thyroid, can be chronic or acute, depending on the cause. The common form is Hashimoto’s thyroiditis, which is a frequent cause of hypothyroidism. Patients with Hashimoto’s thyroiditis usually show no symptoms until they develop hypothyroidism. In cases of acute thyroiditis, patients may have neck pain with symptoms similar to either hyperthyroidism or hypothyroidism. Although there is no cure for Hashimoto’s, hormone replacement with medication can regulate hormone levels and restore normal metabolism.
Thyroid nodules
Thyroid nodules are growths within the thyroid. They are very common in the elderly and may cause anxiety when discovered. Most are benign, cause no symptoms and are found when medical professionals are looking for something else. For benign nodules without symptoms, treatment is not required; regular ultrasound monitoring is usually adequate. Surgical removal of tissue may be in order for nodules with symptoms or if malignancy is a concern.
Thyroid cancer
Thyroid cancer is three times more common in women than men. Most thyroid cancers demonstrate slow growth with no symptoms. The most effective management for thyroid cancers is surgical removal of the thyroid followed by radioactive iodine ablation — where radioactive iodine is administered to destroy residual healthy thyroid tissue remaining after the thyroidectomy — and TSH suppression therapy.
THYROID Also known as overactive thyroid, hyperthyroidism is the excessive production of thyroid hormones by the thyroid gland.
Also known as underactive thyroid, hypothyroidism is when the thyroid gland does not produce enough thyroid hormones.
Thyroiditis or inflammation of the thyroid, can be chronic or acute, depending on the cause.
Thyroid nodules are growths wintin the thyroid that are very common in the elderly and may cuase anxiety when discovered.
Thyroid cancer demonstrates slow growth with no symptoms.
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23
COMMON MISPERCEPTION
“Many people believe if they are tired all the time or if they are unable to lose weight, their thyroid function must be low and a thyroid hormone supplement would help,” says Dr. Liu. “In reality, these symptoms are experienced by many people with normal thyroid functions. If thyroid function is normal, one should work with their doctors to find other causes of these symptoms and refrain from taking thyroid supplements or remedy products.”
Common misperceptions about the thyroid According to Zhenqi Liu, MD, professor of medicine in the Division of Endocrinology and Metabolism at University of Virginia Health System, the most common misnomer about the thyroid is it increases energy and helps people lose weight. “Many people believe if they are tired all the time or if they are unable to lose weight, their thyroid function must be low and a thyroid hormone supplement would help,” says Dr. Liu. “In reality, these symptoms are experienced by many people with normal thyroid functions. If thyroid function is normal, one should work with their doctors to find other causes of these symptoms and refrain from taking thyroid supplements or remedy products.” “People try to focus on symptoms associated with underactive thyroid,” agrees Dr. Maybee. “But the symptoms are nonspecific. That is, many people are tired. But the symptoms don’t mean you have an underactive thyroid. You really need the blood work to be sure.”
Thyroid health The thyroid requires iodine to make thyroid hormones. In the past, iodine deficiency was common in noncoastal areas where seafood was in short supply. Today however, iodine deficiency is less common because it is in most foods via salt. Zhenqi Liu, MD is a physician at the UVA Diabetes and Endocrinology Clinic. Dr. Liu is certified by the American Board of Internal Medicine with a subspecialty in Endocrinology, Diabetes and Metabolism.
There is not much we can do to improve the health of our thyroid. The recommended dietary allowance for iodine in adults is 150 micrograms per day. One teaspoon of iodized salt contains approximately 400 micrograms of iodine. “There are numerous thyroid supplement or remedy products available in the market, and they should be taken with caution,” says Dr. Liu. “Patients are advised to consult their physicians before taking them.” MEDICAL EXPERTS Zhenqi Liu, MD with UVA Diabetes and Endocrinology Clinic in Charlottesville. Nelly Maybee, MD with Augusta Health Diabetes and Endocrinology Clinic in Charlottesville.
ON THE WEB
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FIT BITS BRAVE THE BARRE
Staunton Parks & Recreation
Staunton | 540.332.3945 www.staunton.va.us
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BO D & D M IN
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2200 Old Ivy Road Charlottesville | 434.245.1119 www.purebarre.com/ va-charlottesville
317 East Main Street | Suite 201 Charlottesville | 434.293.8776 www.pilatesvirginia.net
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Pure Barre Charlottesville
Pilates Virginia, LLC
ST
216 West Water Street | Suite C101 Charlottesville| 434.973.2030 www.barredstudio.com
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Barre [d]
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Utilizing the barre while contracting the abdominals provides the low back and spine with the stability needed to complete safe movements. It also allows smaller muscle groups to be isolated and sculpted while major muscle groups are simultaneously worked. This technique provides an intense, yet low-impact workout that garners quick, dramatic, and lasting results.
TRY A BARRE CLASS
IB ILT
Most barre-based classes use a combination of postures inspired by ballet and other disciplines like yoga and pilates, which also provide a mind-body connection. The barre is used as a prop to balance while doing exercises that focus on isometric strength training (holding the body still while contracting a specific set of muscles) combined with high reps of small range-of-motion movements.
Deidre is our resident fitness specialist for OurHealth Charlottesville and the Shenandoah Valley.
EX
Barre training is designed to use the body's own mass and very light weights as resistance. This one-of-a-kind workout is a continual, fat-burning series of exercises that tone the entire body in an effective yet safe way.
AFAA, ACSM
Certified Personal Trainer
FL
Have your friends been talking about going to 'barre', and you're wondering what new hotspot you're missing out on? When you finally realize they're not drinking cocktails, but rather working their tails, you're even more intrigued. So, what's the barre craze all about?
Deidre Wilkes,
MODERATE INTENSITY
The Inaugural Best Bedside Manner awards The 1st Annual Best Bedside Manner Awards Medical expertise and compassionate care should always go hand-in-hand when it comes to treating patients. Going to the doctor or health provider can be an unnerving experience for many people. Professionals who incorporate The Golden Rule into their practice philosophy are ones that stand out in people’s minds for the better.
Reprints To order reprints of the original artwork featured on this issue’s cover, contact Deidre Wilkes at 540.387.6482 or via email at deidre@ourhealthvirginia.com. To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com
The 2015 Best Bedside Manner Awards, presented by OurHealth Shenandoah Valley & Charlottesville magazine, honor medical providers who were voted by the local community for their kindness, empathy and attentiveness—attributes that go a long way in gaining a patient’s confidence.
The Voting Process From May 1st – June 15th 2015, the Best Bedside Manner Awards voting form was available on OurHealth’s website, www.ourhealthcville.com. The form consisted of over 40 medical specialties (with definitions of each specialty) in which the public could submit the first and last names of local medical providers by the applicable specialty. Please join us in congratulating this year’s 1st Annual Best Bedside Manner Award winners. If you have any questions, please contact Stephen McClintic Jr., publisher of OurHealth, at steve@ourhealthvirginia.com or 540.387.6482.
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ALLERGY & IMMUNOLOGY Allergy and immunology encompasses a broad array of diagnoses, ranging from nasal and sinus problems and severe food or bee sting allergy to recurrent infections due to sinus disease, immune deficiency and asthma conditions.
First Place
Gary Rakes, MD Allergy Partners of Charlottesville “Good bedside manner means that I'm being the best doctor I can be. I try very hard to listen and make sure that patients and parents feel comfortable enough to ask questions and really understand my explanations and advice.”
Second Place Arvind Madaan, MD
Charlottesville Allergy & Respiratory Enterprises Charlottesville | 434.295.2727 www.cvilleallergy.com
Third Place Gretchen Beck, MD
Blue Ridge Allergy and Asthma Inc. Charlottesville | 434.977.6673 www.blueridgeallergy.com
Waynesboro | 540.949.5154 | www.allergypartners.com/charlottesville
ANESTHESIOLOGY Anesthesiology is the practice of medicine dedicated to relief of pain and total care of the surgical patient before, during and after surgery.
First Place
Burkhard Spiekermann, MD Albemarle Anesthesia, PLC “Bedside manner is important just like ‘manner’ in general is important: Treat people like you want to be treated yourself, it’s pretty simple!”
Second Place Barbara Castro, MD
UVA Health System Charlottesville | 434.924.2283 www.uvahealth.com
Third Place John Ulmer, MD
Anesthesia Services of Augusta Fishersville | 800.249.5835 www.augustahealth.com
Charlottesville | 434.982.7000 | www.mjhanesthesiology.com
AUDIOLOGY Audiology is the branch of science that studies hearing, balance, and related disorders. Its practitioners treat those with hearing loss and proactively prevent related damage.
First Place
Kristin Koch, AuD Evolution Hearing “I am honored to receive this award, but I also have to give credit to my entire staff. We are all very passionate about helping people hear better and creating a comfortable atmosphere. We give patients the attention and time that they need, knowing each person has a unique story.”
Charlottesville | 434.227.4100 | www.evolutionhearing.com 28
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Second Place Karen Klotz
Virginia Hearing Group Verona | 248.1670 www.virginiahearinggroup.com
Third Place Amber Kiser, PhD
UVA Health System Charlottesville | 434.982.0129 www.uvahealth.com
CARDIOLOGY Cardiology is the branch of medicine focusing on the structures, functions and disorders of the heart.
First Place
Robert Battle, MD UVA Adult Congenital Heart Disease Clinic “Much of this is a credit to my team at UVA and in Fishersville. The nurses and technical staff that assist me are motivated and caring providers that understand this is the core for success. I care deeply about all my patients, with their aspirations and goals in life as important as their cardiovascular care. They have full access to me directly in clinic, which is exactly what they want: an attending physician who knows them, cares about them and wants them to succeed in health and life.�
Second Place Roy Flood, Jr., MD
Augusta Health Cardiology Staunton | 540.332.4278 www.augustahealth.com
Third Place Joshua Fischer, MD
Cardiovascular Associates of Charlottesville Charlottesville | 434.293.4072 www.cvilleheart.com
Charlottesville | 434.243.1000 | www.uvahealth.com
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CHIROPRACTIC Chiropractic is a health profession concerned with the diagnosis, treatment (without drugs or medication) and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health.
First Place
Douglas Cox, DC Cox Chiropractic Clinic Charlottesville | 434.293.6165 www.coxclinic.com
Second Place Brian Prax, DC
Prax Family Chiropractic & Massage Charlottesville | 434.977.5433 www.chiroprax.com
Third Place William Knizner, DC
Waynesboro Chiropractic Waynesboro | 540.943.1434 www.augustawaynesboro chiropractic.com
DENTISTRY – COSMETIC
Second Place
Cosmetic dentistry improves the appearance and function of a person's teeth. Dentistry is the art and science of improving the appearance (aesthetics), function and health of the teeth and associated structures.
William Potter, DDS
First Place
James Rice, DDS Crozet Dentist “Patients may never fully understand the quality of the dentistry you are doing, but they will always understand the quality of the relationship you are building.”
Aesthetic Dentistry of Charlottesville Charlottesville | 434.984.3455 www.cvillesmiles.com
Third Place Lawrence Brannon, DMD Charlottesville | 434.974.4555 www.drbrannon.com
Honorable Mention Duane J. Bickers, DDS
Crozet | 434.823.2290 | www.crozetdentist.com
DENTISTRY – GENERAL General dentistry is the evaluation, diagnosis, prevention and/or treatment (non-surgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity.
First Place
Daniel LaGrua, DMD Dental Health Associates “Good bedside manner means being yourself, being honest and having fun.”
DJ Bickers, DDS, PLC Charlottesville | 434.984.6400 www.djbickers.com
Second Place Richard Mansfield, DDS Waynesboro | 540.943.2859
Third Place Andrew Martoff, DDS
UVA Department of Dentistry Charlottesville | 434.924.1774 www.uvahealth.com
Honorable Mention Douglas Wright, DDS Staunton | 540.248.2500 | www.mydentalhealthassociates.com 30
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Harrisonburg | 540.432.6616 www.harrisonburgsmiles.com
DENTISTRY – PEDIATRIC Pediatric dentistry specializes in treating children from birth through adolescence.
First Place
Kevin Clifford, DDS Crozet Pediatric Dentistry, PC “I believe caring and compassionate bedside manner is what cements the patient/doctor relationship. It helps calm fears or anxiety and opens the pathway for great communication in order to treat dental concerns.” * Photo courtesy of Crozet Gazette
Crozet | 434.205.4587 | www.crozetpediatricdentistry.com
Second Place Brian Brumbaugh, DDS Brian Brumbaugh Pediatric Dentistry Staunton | 540.213.2244 www.cavityfreekid.com
Third Place Kathryn Cook, DDS
Children’s Dentistry with a Mother’s Touch Charlottesville | 434.817.5437 www.childrensdentistry charlottesville.com
Honorable Mention Sarah McKnight, DMD
Harrisonburg Pediatric Dentist Harrisonburg | 540.433.0075 www.hburgpedo.com
DERMATOLOGY
Second Place
Dermatology is a specialty focusing on diagnosis and treatment of diseases of the skin.
Deborah Elder, MD
First Place
Charlotttesville Dermatology Charlottesville | 434.984.2400 www.cvillederm.com
Hannah Pearce, MD
Third Place
Albemarle Dermatology Associates
Kristen Savola, MD
"To me, bedside manner means putting patients at ease, letting them know they are welcome and that we plan to address all of their concerns. If we care deeply for each individual and let them know that they are important to us, we can earn the trust they place in us.”
Savola Aesthetic Dermatology Center Fishersville | 540.451.2833 www.savoladermatology.com
Honorable Mention Fletcher Askew, MD
Charlottesville | 434.923.4651 | www.albemarledermatology.com
EMERGENCY MEDICINE Emergency medicine is the specialty of providing care for patients requiring prompt medical attention and urgent medical evaluation and treatment.
Dermatology, P.L.C. Charlottesville | 434.296.0113 www.dermatologyplc.com
Second Place Lisa Hardy, MD
First Place
Christopher Holstege, MD UVA Health System “I treat my patients as I would want my family to be treated. I try to assure that each individual is cared for appropriately in a caring manner during their stay, spending the necessary time at the bedside to allow their questions and concerns to be addressed.”
Emergency Department Martha Jefferson Hospital Charlottesville | 434.654.7150 www.sentara.com
Third Place William Talbott, Jr. MD
First Med Charlottesville | 434.984.4200 www.firstmed charlottesville.com
Charlottesville | 434.924.5185 | www.uvahealth.com www.OurHealthCville.com
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ENDOCRINOLOGY Endocrinology is the study of the glands and hormones of the body and their related disorders.
First Place
Second Place Angela Sutton, MD
UVA Diabetes and Endocrine Clinic
Augusta Health Diabetes & Endocrinology Clinic Staunton | 540.245.7180 www.augustahealth.com
“I believe the relationship between the doctor and patient, whether it’s for 10 minutes or 10 years, is vital. Listening to the patient and earning their trust is key to providing the right care.”
Third Place
Charlottesville | 434.924.1825 | www.uvahealth.com
Charlottesville | 434.295.5155
Jennifer Kirby, MD
FAMILY PRACTICE Family practice is the medical specialty that includes diagnosis and treatment of disease, injury, and illness for patients of any age.
First Place
John Marsh, MD Middlebrook Family Medicine “Bedside manner is a communication style that facilitates the doctor/patient interaction. There are two important aspects, the first is listening and the second is explaining. Listening means understanding the patient’s concerns and complaints, as well as appreciating their expectations and desires. Explaining requires the physician to put into understandable phrases the reason and the meaning of medical tests, medical procedures, and most importantly, the treatment plan. In summary, bedside manner exemplifies the art of medicine physicians need to master in order to effectively treat their patients.”
Michael Santulli, MD
Second Place Hakan Dagli, MD
Pantops Family Medicine Charlottesville | 434.979.4440 www.pantopsfamily medicine.com
Third Place Sam Caughron, MD
Charlottesville Wellness Center Charlottesville | 434.977.3140 www.cwcfp.com
Honorable Mention Thomas Shapcott, MD
Augusta Health Medical House Call Program Staunton | 540.245.7510 www.augustahealth.com
Middlebrook | 540.887.2627 | www.augustahealth.com
FERTILITY CARE Fertility care or reproductive endocrinology and infertility (REI) is a subspecialty of obstetrics/ gynecology that trains physicians in reproductive medicine addressing hormonal functioning as it pertains to reproduction as well as the issue of infertility.
First Place
Bruce Bateman, MD Reproductive Medicine & Surgery Center of Virginia, PLC “Everyone in our practice is mindful of the special emotional support necessary for fertility patient's.”
Charlottesville | 434.654.8520 | www.rmscva.com 32
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Second Place Christopher Williams, MD Reproductive Medicine & Surgery Center of Virginia, PLC Charlottesville | 434.654.8520 www.rmscva.com
Third Place Laura Smith, MD
Reproductive Medicine & Surgery Center of Virginia, PLC Charlottesville | 434.654.8520 www.rmscva.com
GASTROENTEROLOGY Gastroenterology is the specialty dealing with the treatment of disorders of the digestive gastroenterology or GI system.
First Place
David Balaban, MD Charlottesville Gastroenterology Associates “The demands of modern medicine should never outweigh the importance of listening, examining, and engaging with a patient so that every visit is meaningful.�
Charlottesville | 434.817.8490 | www.cvillegi.com
Second Place Javier Pou, MD
Shenandoah Valley Gastroenterology Waynesboro | 540.946.1662 www.svgastro.com
Third Place Barrett Barnes, MD
UVA Division of Pediatric Gastroenterology & Nutrition Charlottesville | 434.924.2457 www.uvahealth.com
GERIATRICS Geriatrics is a medical specialty that addresses the complex needs of older patients and emphasizes maintaining functional independence even in the presence of chronic diseases.
First Place
Marisa Christensen, MD Charlottesville Family Medicine Charlottesville | 434.973.1831 www.charlottesvillemedicine.com
Second Place
Laurie Archbald-Pannone, MD
Jefferson Area Board for Aging Charlottesville | 434.817.5237 www.jabacares.org
Third Place Jonathan Evans, MD
Blue Ridge Long Term Care Associates Charlottesville | 434.242.7077
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HEMATOLOGY/ONCOLOGY Hematology/oncology is the diagnosis, treatment and prevention of blood diseases (hematology) and cancer (oncology) and research into them.
First Place
Patrick Dillon, MD Emily Couric Clinical Cancer Center “Listening to and understanding the needs of patients is what builds trust between doctors, patients and families. I try to remember that every time I interact with a patient.”
Charlottesville | 434.982.1495 | www.uvahealth.com
Second Place Gail Macik, MD
Emily Couric Clinical Cancer Center Charlottesville | 434.982.1495 www.uvahealth.com
Third Place Brian Belyea, MD
UVA Health System Pediatric Hematology Charlottesville | 434.924.8499 www.uvahealth.com
INFECTIOUS DISEASE Infectious disease is the medical specialty focusing on the diagnosis, cause and treatment of contagious disease.
First Place Costi Sifri, MD
UVA Transplant Clinic “I feel that having a good bedside manner and developing positive personal relationships with patients is fundamentally important to what I do as a doctor. As an infectious disease physician, I don’t perform surgeries or procedures but rather rely on my ability to understand a person’s story in order to diagnose illness and improve health. I find that these stories are best revealed when relationships are built on a foundation of honesty, appreciation, and respect.”
Second Place Brian Wispelwey, MD
Ryan White HIV Clinic Charlottesville | 434.982.1700 www.uvahealth.com
Third Place Daniel Sawyer, MD
Infectious Disease Medicine Charlottesville | 434.977.1933 www.danielsawyermd.com
Charlottesville | 434.982.1700 | www.uvahealth.com
INTERNAL MEDICINE Internal medicine is the branch of medicine that deals with diagnosis and nonsurgical treatment of diseases affecting adults.
First Place
Barbara Post, MD Northridge Internal Medicine “I very much enjoy the practice of medicine, and I consider it a privilege to care for patients. Patients share their personal concerns, problems and lives with me and I truly enjoy helping them when I can. It is really a pretty simple formula (as our mothers always told us), treat people the way you would want to be treated.”
Charlottesville | 434.243.4500 | www.uvahealth.com 34
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Second Place Richard Brantley, MD
Fox Brantley Internal Medicine Charlottesville | 434.244.5684 www.foxandbrantley.com
Third Place Kimberley Bauman, MD Northridge Internal Medicine Charlottesville | 434.243.4500 www.uvahealth.com
NEONATOLOGY Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn infant. It is a hospital-based specialty, and is usually practiced in neonatal intensive care units (NICUs).
First Place
Jonathan Swanson, MD UVA Health System “I view my bedside approach as part of the “art of medicine.” Part of the healing process for patients, and in my clinical practice – parents, is being heard and feeling like they are part of the healthcare team. This ultimately leads to the building of a trusting relationship between myself and the parents in our unit.”
Charlottesville | 434.924.5428 | www.uvahealth.com
Second Place Robert Sinkin, MD
UVA Health System Charlottesville | 434.924.5428 www.uvahealth.com
Third Place Robert Boyle, MD
UVA Health System Charlottesville | 434.924.5428 www.uvahealth.com
NEPHROLOGY Nephrology is the study of the function and diseases of the kidney and related organs.
First Place
Brendan Bowman, MD UVA Dialysis – Orange “In nephrology, developing a trusting, mutually respectful relationship with patients is still the best diagnostic and therapeutic tool we have. I don't think that will change any time soon.”
Orange | 434.924.2185 | www.uvahealth.com
Second Place Douglas Keith, MD
UVA Transplant Clinic Charlottesville | 800.543.8814 www.uvahealth.com
Third Place Warren Bolton, MD
UVA Medical Park – Augusta Fishersville | 540.885.7979
NEUROLOGY Neurology is the specialty of medicine which focuses on the diagnosis and treatment of disorders of the nervous system.
First Place
Renzo Figari, MD Augusta Health Neurology “It is perhaps one of the most important components of the physician-patient relationship. As doctors, we must deal with the disease but ultimately, treat the person first and foremost. When I see a patient I think of him or her as an individual – a mother or father, brother or sister who needs my help at a vulnerable time. I want to treat them with the same respect and diligence I would expect for my own family members. I believe by engaging into this personal relationship, I can better understand their problems and get to a better treatment outcome.”
Fishersville | 540.932.5878 | www.augustahealth.com 36
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Second Place Kenneth Leone, MD
UVA Neurology Clinic Charlottesville | 434.924.0211 www.uvahealth.com
Third Place Kristen Heinan, MD
UVA Health System Charlottesville | 434.924.5129 www.uvahealth.com
NURSE PRACTITIONER Nurse practitioner is a registered nurse with advanced academic and clinical experience, which enables him or her to diagnose and manage most common and many chronic illnesses, either independently or as part of a healthcare team.
First Place
Kari Somers, CNM, WHNP Augusta Health Care for Women “My role as a Certified Nurse Midwife is to help educate and empower women and their families. By listening to them and building a relationship, I can help them to meet their healthcare goals.�
Fishersville | 540.213.7750 | www.ahcfw.com
Second Place Peggy Willis, NP
Obstetrics & Gynecology Associates Charlottesville | 434.979.2121 www.obgynassociatescville.com
Third Place Wendy Wimer, FNP-C
Valley Pediatric Group Staunton | 540.885.8143 www.valleypediatricgroup.com
Honorable Mention
Honorable Mention Continued... Fannie Utz, FNP, MSN, RN
UVA ENT (Ear, Nose and Throat ) Clinic Charlottesville | 434.924.5700 www.uvahealth.com
Jennifer Mentore, FNP, MSN, RN Stuarts Draft Family Practice Stuarts Draft | 540.337.3710 www.medicalcenter. virginia.edu
Deborah Meslar-Little, CNM, NAMS
Augusta Health Care for Women Fishersville | 540.213.7750 www.ahcfw.com
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OBSTETRICS & GYNECOLOGY Obstetrics & gynecology is the specialty of medicine that includes care for women before, during, and after pregnancy and child birth and the diagnosis and treatment of disorders affecting the female reproductive system.
First Place
Daniel McMillan, MD, FACOG Augusta Health Care for Women
Second Place Edward Wolanski, MD
Charlottesville | 434.293.9800 www.wolanskiobgyn.com
Third Place Siva Thiagarajah, MD
“To provide good care you must speak to your patients in terms to which they can relate and to make them comfortable enough to ask or tell you anything. If I don't do that, I'm not doing my job as a physician.�
Obstetrics & Gynecology Associates Charlottesville | 434.979.2121 www.obgynassociates cville.com
Fishersville | 540.213.7750 | www.ahcfw.com
Honorable Mention Matthew Montgomery, MD
Jefferson Ob/Gyn Charlottesville | 434.977.4488 www.jeffersonobgyn.net
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OPHTHALMOLOGY Ophthalmology is the medical specialty that treats eye disorders, including injuries, infections, tumors and cataracts.
First Place
James Tiedeman, MD, PhD EyeOne
Second Place Mohit Nanda, MD
Virginia Retina Consultants Charlottesville | 434.978.2040 Waynesboro | 540.949.9080 www.varetina.com
Third Place (tie)
“Bedside manner is all about caring. If you really care about someone it comes naturally.”
Ashley Schauer, MD
Fishersville | 540.213.7720 | www.eyeoneva.com
Third Place (tie)
Blue Ridge Ophthalmology Charlottesville | 434.295.3227 www.blueridgeeyemd.com
Bruce Carter, MD
Albemarle Pediatric Ophthalmology & Strabismus, PC Charlottesville | 434.295.5193 www.aposva.com
OPTOMETRY Optometry is the specialty where the practitioner is trained and skilled in examining and testing the eyes for defects in order to prescribe corrective lenses or treatments.
First Place
Joseph DiGirolamo, OD Primary EyeCare “At Primary Eyecare, we are pleased to have served the Charlottesville/Albemarle community for nearly 30 years. Our mission is to provide the highest quality eye care and eyewear in a manner that our patients find is a joy to do business with us.”
Charlottesville | 434.977.2020 | www.cvilleeyecare.com
ORAL SURGERY Oral surgery is the dental specialty that is limited to the diagnosis, surgery and treatment of diseases, injuries, deformities and defects of the mouth.
First Place
Corey Burgoyne, DMD Blue Ridge Oral & Maxillofacial Surgery “All of us, regardless of age, deserve trust, safety, and security in our relationships. I seek that for myself, and try to provide that peace and comfort for my patients.”
Fishersville | 540.886.2956 | www.blueridgeoralsurgery.com
Second Place Trudy Rohm, OD
Drs. Bare, Basic & Rohm Optometrists Charlottesville | 434.971.2020 www.rohm-eyecare.com
Third Place Michael Henderson, OD
Primary EyeCare Charlottesville | 434.977.2020 www.cvilleeyecare.com
Second Place Carlos Ibanez, DDS
Charlottesville Oral Surgery & Dental Implant Center, PLLC Charlottesville | 434.295.0911 www.cvilleoralsurgery.com
Third Place William Bigelow, DDS
Oral and Maxillofacial Surgery Fishersville | 540.213.8750 www.bigelowstauntonoral surgery.com
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ORTHODONTICS Orthodontics is the specialty of dentistry that is concerned with the study and treatment of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw relationships, or both.
First Place
David Hamer, DDS Hamer & Hamer DDS Orthodontics “I was born and raised in Charlottesville, and am honored to help bring healthy, beautiful smiles to my community. After joining my father’s practice 27 years ago, I feel that we have built a professional team with a tremendous sense of reliability. The Hamer Orthodontic team is dedicated to maintaining the legacy of integrity, quality, care and patient satisfaction.”
Second Place Bart Weis, DDS
Charlottesville Orthodontics Charlottesville | 434.971.9601 www.charlottesville orthodontics.com
Third Place Brent Lenz, DDS, MDS
Bluestone Orthodontics Harrisonburg | 540.433.1060 www.bluestone orthodontics.com
Charlottesville | 434.465.6521 | www.cvillebraces.com
ORTHOPAEDICS Orthopaedics is focused on diseases, injuries, and conditions of the musculoskeletal system relating to the body's muscles and skeleton, as well as the joints, ligaments, tendons and nerves.
First Place
Quanjun Cui, MD
Orthopedic Associates, Ltd.
Third Place
Ramon Esteban, MD “For me, an important part of taking care of people is caring about them. I try to express that at their bedside and in my office.”
Fishersville | 434.932.5850 | www.orthopedicassoc.com
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Second Place
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
UVA Musculoskeletal Center Charlottesville | 434.243.1673 www.uvahealth.com
Stephen Gunther, MD
Martha Jefferson Orthopaedics Charlottesville | 434.654.5575 www.sentara.com
OTOLARYNGOLOGY (ENT) Otolaryngology is a surgical specialty focusing on the diagnosis, management, and treatment of diseases and disorders of the ear, nose, throat (ENT) and related structures of the head and neck.
First Place
Steven Keefe, MD Ear, Nose, Throat & Facial Plastic Surgery “The number one teaching point I strive to impart to the medical students I have the privilege to help train, is to listen to your patients; not only what they say, but how they say it. It is often that tiny piece of information offered to the physician during the exam, almost as an afterthought, that leads to an appropriate diagnosis."
Second Place Paige Powers, MD
Piedmont Otolaryngology Charlottesville | 434.220.0045 www.entdoc.com
Third Place George Hashisaki, MD
UVA ENT (Ears, Nose and Throat) Clinic Charlottesville | 434.924.2020 www.uvahealth.com
Fishersville | 540.245.7028 | www.drkeefeent.com
PAIN MANAGEMENT Pain management encompasses pharmacological, non-pharmacological, and other approaches to prevent, reduce, or stop pain sensations.
First Place
Rasheed Siddiqui, MD Charlottesville Pain Management Center Charlottesville | 434.295.3600 www.charlottesvillepainmanagementcenter.com
Second Place John Rowlingson, MD
UVA Health System Charlottesville | 434.924.2283 www.uvahealth.com
PALLIATIVE MEDICINE Palliative medicine is a multidisciplinary approach to specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, physical stress and mental stress of a serious illness – whatever the diagnosis.
First Place
Joshua Barclay, MD UVA Palliative Care Clinic “Trust is the cornerstone of a good doctor-patient relationship, and this is established with excellent bedside care.”
Second Place Leslie Blackhall, MD
UVA Palliative Care Clinic Charlottesville | 434.243.3922 www.uvahealth.com
Charlottesville | 434.243.3922 | www.uvahealth.com
www.OurHealthCville.com
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PEDIATRICS
Second Place
Pediatrics focuses on the detection, diagnosis, treatment and prevention of diseases in children, ages infant to 18-years of age.
Robert Michel, MD
First Place
David Hawkes, MD, FAAP Pediatric Associates of Charlottesville “Becoming a physician was a fulfillment of a childhood dream, and a good bedside manner is fundamental to serving in that role. It is the basic foundation of relating to patients and their families, and it starts with remembering what a privilege we have in caring for patients. Pediatrics in particular is unique, because it provides such a wonderful opportunity to interact with kids on their individual level. A good bedside manner helps to earn their trust, facilitate the examination, and maybe make it a little bit fun when possible. It means trying to be 100 percent in that moment with the patient and family.�
Charlottesville | 434.296.9161 | www.charlottesvillepeds.com
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Piedmont Pediatrics Charlottesville | 434.975.7777 www.piedmontpediatrics.net
Third Place Kurtis Sauder, MD
Valley Pediatric Group Verona | 885.8143 www.valleypedgroup.com
Honorable Mention Carlos Armengol, Jr., MD Pediatric Associates of Charlottesville Charlottesville | 434.296.9161 www.charlottesvillepeds.com
Robert Trundle, MD
Pediatric Associates of Charlottesville Charlottesville | 434.296.9161 www.charlottesvillepeds.com
PERIODONTICS Periodontics is the specialty of dentistry that studies supporting structures of teeth, diseases and conditions that affect them.
First Place
David Krese, DDS Charlottesville | 434.971.8159 www.davidlkresedds.com
Second Place John Knight, DDS
Charlottesville | 434.293.9793 www.cvilleteeth.com
PHYSICAL THERAPY Physical therapy or physiotherapy often abbreviated PT, is the art and science of physical care and rehabilitation.
First Place
James Collins, PT, CSCS Pantops Physical Therapy & Occupational Therapy “While technology has provided huge medical advances over the past decade, it is important to never lose the human connection. I believe that communication and the ability to establish a relationship are the most important tools that a physical therapist can possess.”
Second Place Becky Keller, DPT, ATC
Physical Therapy @ ACAC Charlottesville | 434.817.4276 www.acacpt.com
Third Place Dustin Dimitt, PT, DPT, OCS, CSCS Barren Ridge Physical Therapy Fishersville | 540.949.5383 www.barrenridgept.com
Charlottesville | 434.245.6472 | www.pantopsphysicaltherapy.com
PHYSICIAN ASSISTANT Physician assistant is licensed to practice medicine under the supervision of a licensed physician, and who thereby extends the physician's capacity to provide medical care.
First Place
Johanna Claasen, PA Charlottesville Neurology and Sleep Medicine “To me, the foundation of a good bedside manner is empathy, and if clinicians cannot convey empathy, patient trust is harder to establish. If they trust you, they are likely to tell you more about their true condition and related facts, and not withhold potentially important information.”
Second Place Caroline Metsch, PA-C
UVA Health System Charlottesville | 434.243.2874 www.uvahealth.com
Third Place Denise Jackson, PA
UVA Pediatric Otolaryngology Charlottesville | 434.924.0123 www.uvahealth.com
Charlottesville | 434.293.9149 | www.cvilleneuroandsleep.com
www.OurHealthCville.com
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PLASTIC SURGERY COSMETIC Cosmetic plastic surgery is the field of surgery that is performed to reshape structures of the body in order to improve appearance and self-esteem.
First Place
Brian Showalter, MD Monticello Plastic & Reconstructive Surgery “Good bedside manner is essential to building a strong doctor-patient relationship and is both the first and last impression I make on my patients.�
Charlottesville | 434.260.5130 www.monticelloplasticsurgery.com
Second Place Victoria Vastine, MD
Martha Jefferson Aesthetic and Reconstructive Surgery Charlottesville | 434.654.8920 www.mjhplasticsurgery.org
Third Place Saied Asfa, MD
ASFA Plastic Surgery Harrisonburg | 540.432.0303 www.asfaplasticsurgery.com
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PLASTIC SURGERY – RECONSTRUCTIVE Reconstructive plastic surgery is the field of surgery concerned with reducing scarring or disfigurement that may occur as a result of accidents, birth defects, or treatment for diseases, such as melanoma.
Second Place
First Place
Kant Lin, MD
UVA Breast Care Center
Third Place
UVA Plastic Surgery Clinic Charlottesville | 434.924.5078 www.uvahealth.com
David Drake, MD “I believe that empathy is the key to a good bedside manner. Imagining yourself in the patient’s situation and dealing with them on an equal level while understanding and addressing their concerns is key.”
Charlottesville | 434.924.1555 | www.uvahealth.com
Christopher Campbell, MD UVA Breast Care Center Charlottesville | 434.924.1555 www.uvahealth.com
Second Place (tie)
PODIATRY Podiatry is the branch of medicine that deals with the diagnosis, treatment and prevention of diseases of the human foot.
First Place
Jimmy Downing, DPM
Charlottesville | 434.979.0763 www.drjimmywdowning.com
Second Place (tie) Miki Hori, DPM
Christopher Stewart, DPM Central Virginia Foot & Ankle Laser Center Charlottesville | 434.979.0456 www.cvillefootankle.com
Harrisonburg Foot & Ankle Clinic Harrisonburg | 540.434.2949 www.harrisonburg footankle.com
Third Place Robert Baglio, DPM, FACFAS
Albemarle-Charlottesville Podiatry Associates, Ltd. Charlottesville | 434.295.4443 www.virginiafootandankle.com
PSYCHIATRY Psychiatry is the branch of medicine that deals with the diagnosis, treatment and prevention of mental and emotional disorders.
First Place
David Byrnes, MD Dr. Lewis Weber & Associates “I feel that the cornerstone of having good bedside manner is treating each person with the respect, dignity and integrity that I would want for myself and my own family members. What I have found is that if I am able to find the good in someone, and speak to those best aspects of their person, they will have more ability to show those qualities to me and others.”
Second Place Randolph Canterbury, MD
UVA HealthSystem Charlottesville | 434.924.2241 www.uvahealth.com
Third Place Richard Merkel, MD
UVA Health System Charlottesville | 434.980.6555 www.uvahealth.com
Charlottesville | 434.971.9809 | www.weberpsychotherapy.com
www.OurHealthCville.com
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PSYCHOLOGY & COUNSELING Psychology & counseling is the branch of medicine that deals with the diagnosis, treatment and prevention of mental and emotional disorders.
First Place
Valeri Pineo, LPC Augusta Psychological Associates “Bedside manner is the cornerstone of client centered psychotherapy. A clinician who meets clients where they are, and expresses genuine curiosity about their clients’ lives, puts clients at ease and enables them to view therapy as the collaborative endeavor it truly is. While many clinicians write down the importance of these practices in their therapeutic disclosures or post them around the office, the most effective of us show our clients, session to session, that the therapeutic process is about them, and their wellbeing.”
Second Place Karen Durland-Jones, LCSW
Blue Ridge Therapy Associates Charlottesville | 434.962.5251 www.blueridgetherapy associates.com
Third Place Lester Pearlstein, PhD
Charlottesville Psychological Associates Charlottesville | 434.971.4747 www.cpatherapy.com
Fisherville | 540.949.4202 | www.augustapsychological.com
PULMONARY MEDICINE Pulmonary medicine, also known as pulmonology, is the specialty that deals with disease of the respiratory tract and respiratory disease.
Second Place William Hammond, MD
First Place
Alexander Schult, MD Sentara Martha Jefferson Medical & Surgical Associates “A good relationship with a caregiver engenders trust and is likely to help the patient understand or have a desire to follow directions and options of a care plan. If nothing else, I can aim to make patients feel taken care of, listened to and respected. None of this is possible without adequate time and I am grateful to have sufficient time to be allowed to do this.”
Charlottesville | 434.654.5260 | www.sentara.com
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Sentara Martha Jefferson Medical & Surgical Associates Charlottesville | 434.654.5260 www.sentara.com
Third Place Y. Michael Shim, MD
UVA Pulmonary & Critical Care Medicine Charlottesville | 434.243.4845 www.uvahealth.com
RADIATION ONCOLOGY Radiation oncology is the specialty for the treatment of cancer patients, using radiation therapy as the main modality of treatment.
First Place
Robert Kyler, MD Augusta Health “Caring for cancer patients can often involve complex and highly technical issues, and I see the ability to communicate effectively and compassionately with my patients and their families as one of my most important responsibilities. Making a personal connection with my patients is vital in establishing a therapeutic relationship; it teaches me what I need to know about my patient as an individual and how best to work with them. It also hopefully gives my patients some level of comfort, trust and confidence in me and my team.”
Second Place James Larner, MD
Emily Couric Clinical Cancer Center Charlottesville | 434.924.9333 www.uvahealth.com
Third Place Paul Read, MD
Emily Couric Clinical Cancer Center Charlottesville | 434.924.9333 www.uvahealth.com
Fishersville | 540.245.7100 | www.augustahealth.com
Second Place
RADIOLOGY Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body.
First Place
C. Scott Pease, MD Charlottesville Radiology, LTD & CRL Surgical Associates “For me, patient care in radiology extends beyond reading an image and making a diagnosis. When I have the opportunity to see patients, I seek to provide perspective and empathy in moments of anxiety and uncertainty.”
Charlottesville | 434.244.4580 | www.crlsurgical.com
Heather Peppard, MD
UVA Breast Care Center Charlottesville | 434.924.1555 www.uvahealth.com
Third Place (tie) Thomas Zumsteg, MD Augusta Health Blue Ridge Radiologists Staunton | 540.886.0988 www.augustahealth.com
Third Place (tie) Christopher Gaskin, MD
UVA Radiology and Medical Imaging Charlottesville | 434.924.9400 www.uvahealth.com
RHEUMATOLOGY Rheumatology is the specialty in the non-surgical treatment of rheumatic illnesses, especially arthritis.
First Place
Donald Kimpel, MD UVA Health System “When I was a medical student, our ‘doctor-patient relations’ class emphasized that knowing the patient's personal story is an important part of treating their disease. Even as we move into the age of technology-based ‘personalized medicine,’ that experience has helped me keep my sights on what is best for each patient, as an individual.”
Second Place Gregory Pudhorodsky, MD
UVA Rheumatology Pantops Charlottesville | 434.243.0439 www.uvahealth.com
Charlottesville | 434.924.5214 | www.uvahealth.com www.OurHealthCville.com
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SLEEP MEDICINE Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders.
First Place
Christopher Winter, MD Charlottesville Neurology and Sleep Medicine “If a physician does not have the ability to make his patient feel both comfortable and listened to, then that physician should consider a different profession. A doctor's bedside manner is at the core of everything we do.”
Second Place Pearl Yu, MD
UVA Physicians Group Charlottesville | 434.980.6110 www.upg.virginia.edu
Charlottesville | 434.293.9149 | www.cvilleneuroandsleep.com
SURGERY – CARDIAC Cardiac surgery is surgery on the heart to correct congenital heart disease or the complications of heart disease or valve problems created by various causes.
First Place
Leora Yarboro, MD UVA Heart and Vascular Center “Undergoing open-heart surgery can be stressful for a patient and their family. My approach is to be as open and reassuring as possible. It’s important that my patients understand that their wellbeing is my first priority.”
Second Place James Gangemi, MD
UVA Health System Charlottesville | 434.243.6828 www.uvahealth.com
Third Place Jerome McDonald, MD
Sentara RMH Cardiothoracic Surgery Harrisonburg | 540.689.5555 www.sentara.com
Charlottesville | 434.243.1000 | www.uvahealth.com
SURGERY – GENERAL General surgery is the treatment of injury, deformity and disease using operative procedures.
First Place
Shayna Showalter, MD UVA Breast Care Center “I am often seeing patients as they are struggling with a new cancer diagnosis. Patients are upset and scared, but they are simultaneously faced with very big decisions regarding their healthcare. It is my job to comfort them, educate them and help them through this very emotional process. I take pride in connecting with my patients and their families while I guide them through their treatments.”
Charlottesville | 434.924.1555 | www.uvahealth.com 48
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Second Place William Thompson, MD, FACS
Shenandoah Valley Surgical Associates Fishersville | 540.332.5999 www.svsainc.com
Third Place William McKibbin, MD Augusta Surgery Staunton | 540.332.5909 www.augustahealth.com
SURGERY – NEUROSURGEON Neurosurgery is a surgical specialty for the treatment of diseases and disorders of the brain, spinal cord and peripheral and sympathetic nervous system.
First Place
John Jane Jr., MD UVA Health System “If I am deserving of this award it is simply because I am emulating the great physicians under whom I trained. They emphasized to me that caring for patients is an honor and that we as physicians should honor the trust that patients put in us by providing the best care that we can. We have a sacred duty to not only treat disease and alleviate suffering but to communicate the rationale for our treatments. There is nothing so complicated in medicine that it can’t be explained.”
Second Place Kenneth Liu, MD
UVA Neuro-Oncology Center Charlottesville | 434.982.4415 www.uvahealth.com
Charlottesville | 434.338.6960 | www.uvahealth.com
SURGERY – VASCULAR Vascular surgery is the treatment of surgery on diagnosed patients with diseases of the arterial, venous and lymphatic system.
First Place
Kenneth Cherry, MD UVA Heart and Vascular Center “I used to go on rounds with my father, who was a general surgeon in Richmond, when I was a little boy and as an adult. He was a wonderful surgeon and man – I watched him in his dealings with patients and nurses and tried to model myself on him. Dr. Martin Adson at the Mayo Clinic in Rochester, Minnesota, also a wonderful man and surgeon – really a Renaissance man – said, ‘Every patient deserves an examination.’“
Second Place Jacek Paszkowiak, MD, FACS Shenandoah Valley Surgical Associates Fishersville | 540.332.5999 www.svsainc.com
Third Place John Ligush, Jr., MD
Charlottesville Radiology, LTD & CRL Surgical Associates Charlottesville | 434.244.4580 www.crlsurgical.com
Charlottesville | 434.243.1000 | www.uvahealth.com
UROLOGY Urology is a medical specialty that deals with disturbances of the urinary (male and female) and reproductive (male) organs.
First Place
C. Buckley Gillock, MD Blue Ridge Urological, PC Fishersville | 932.5926 www.augustahealth.com
Second Place Geoffrey Habermacher, MD Urological Associates, Ltd. Charlottesville | 434.295.0184 www.cvilleurology.com
Third Place Alan Jenkins, MD
UVA Zion Crossroads Primary and Specialty Care Charlottesville | 434.243.9466 www.uvahealth.com
www.OurHealthCville.com
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Joe & Frani Biggins of Waynesboro 50
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
"I was
THAT CLOSE to
Diabetes
"
words | SUZANNE RAMSEY
original photography | KG THIENEMANN
When Joe Biggins heard his physician say “prediabetes” at his annual physical a few months ago, the 71-year-old Waynesboro resident admits he got frightened. “A friend of mine, my fishing buddy, has diabetes,” Biggins says. “In the last year, he lost part of his foot to diabetes, and he may lose more of his foot, actually. I was that close to diabetes. I know how serious it is, so it did scare me.”
Nearly 30 million people in the United States have diabetes. According to the American Diabetes Association, approximately 86 million American adults have prediabetes. The ADA defines the condition as one where a person’s blood sugar levels are “higher than normal but are not high enough for a diagnosis of diabetes,” and says having prediabetes puts a person at greater risk for Type 2 diabetes, stroke and heart disease. Type 2 diabetes, once called “adult-onset diabetes,” can have devastating consequences, including blindness, heart disease, kidney failure and amputations. The ADA reports that diabetes causes more deaths each year than AIDS and breast cancer combined, while the Centers for Disease Control and Prevention lists it as the seventh leading cause of death in the United States. Unlike Type 2 diabetes, which exhibits symptoms such as excessive thirst, blurry vision, fatigue and others, prediabetes is largely asymptomatic. “It can only be picked up with blood work,” says Rita Smith, a registered dietitian and certified diabetes educator with Sentara Martha Jefferson Hospital in www.OurHealthCville.com
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Charlottesville. “There are rarely symptoms. Typically, the symptoms of way out-of-control blood sugar don’t happen. It’s sort of silent, if you will. You really need to get lab work done.” It’s also important that people know their family medical history. “Often, folks have it in their family tree,” Smith says. “If someone knows diabetes is in their family, then they really want to be good about being checked regularly so it can be picked up during the prediabetes stage. The earlier you pick it up, the better.” In Biggins' case, his grandmother died of complications related to diabetes. “She died when she was 65, and she had diabetes and took insulin,” Biggins says. “That was a long, long time ago, but she died young.” The CDC reports that 1 in 3 adults in the U.S. have prediabetes, and about 90 percent of them don’t know it. Without lifestyle changes to improve their health, the CDC states, 15 to 30 percent of those with prediabetes will have Type 2 diabetes within five years.
Making a Change While medications are sometimes prescribed for people with prediabetes — the drug metformin, in particular — dietary changes, exercise and weight loss are usually the first lines of defense. “I tell my patients that what they do with their diet and activity level is more powerful than any medication I can give them,” says Margaret Crook, MD, of UVA Blue Ridge Endocrinology in Charlottesville. “I feel that sugar and starchy foods are addictive. When you have a little, you tend to want more and more. This makes it very difficult to moderate sweets. “Unfortunately, our society is so geared toward food, and high sugar or starchy food at that. It’s best to keep this type of food limited and not easily available. Don’t bring it in the house and expect to be able to moderate it, as that is very difficult to do.”
For about 30 years, Smith has been taking people with prediabetes and diabetes on a field trip to a local supermarket to learn about reading labels and making better food choices. “We go through the aisles, certain sections, reading labels together,” Smith says. “Labels are hard to understand because there’s so much information on them. We narrow it down to the most important things to check on the label. We look at products they are accustomed to purchasing and look at better options.” When reading labels, Smith says the most important things to look for are total carbohydrates and fiber. High-carbohydrate foods include things you might expect — potatoes, bread, pasta, rice — and some you might not expect, such as fruit, milk and yogurt. “The carbohydrate foods are the ones that turn into blood sugar, and all carbohydrate foods will turn into glucose,” Smith says. “All your sweet things turn into glucose in fairly short order.” That’s why fiber is important, and Smith recommends the more the better. “Look for total carbohydrates and check to make sure there is fiber,” advises Smith. “Dietary sugar has already been added into the total carbohydrate number. Fiber slows the rise of the glucose. That’s the most important part for blood sugar control.”
What is diabetes? Diabetes is a disease in which blood glucose levels are above normal. Most food is turned into glucose, or sugar, for the body to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of the body. When one has diabetes, the body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in the blood.
Dr. Crook explains the importance of fiber this way: “It’s difficult for our body to break down fiber and convert it to glucose. Therefore, high-fiber food is much better for patients with prediabetes. It doesn’t rapidly increase the blood glucose level and tends to keep people full. Having protein and fat at the same time as carbohydrates tends to help keep the glucose level from increasing as much, as well.” Dr. Crook, who watches her diet and runs five times a week to combat a family history of diabetes, said she can tell when she doesn’t get enough fiber and protein. “I feel awful if I eat a lot of low-fiber carbs with no protein,” she says. “This can happen to people with prediabetes. You will never catch me eating pancakes for breakfast, as I’m simply starving two hours later.” Biggins confesses he wasn’t living the healthiest lifestyle when he was diagnosed with prediabetes. “I was kind of exercising, if I felt like it,” he says. “Maybe a couple of times a week my wife and I would take a walk. Not much else. We’d go shopping and walk around the mall, but nothing regimented or planned or anything like that. We weren’t watching what we were eating, and we weren’t reading labels on products. That’s what most people do, the kind of life that we lived.”
Where to Start Biggins' physician recommended he visit the Augusta Health Diabetes SelfManagement Education Program so he could learn how to make the necessary changes and hopefully avoid getting Type 2 diabetes. The program, which serves people throughout the Shenandoah Valley, is located in the Augusta Health Heart and Vascular Center in Fishersville. Jane Blosser, the program's director, says a national survey showed that “patients who got diabetic education statistically showed a significant improvement when they were working with a diabetes educator,” and that this was particularly true for those with prediabetes.
Am I at risk for Type 2 diabetes? You may be at risk for Type 2 diabetes if you •
Are 45 years of age or older.
•
Are overweight.
•
Have a family history of Type 2 diabetes.
•
Have high blood pressure.
•
Are physically active fewer than three times per week.
•
Ever had diabetes while pregnant (gestational diabetes) or gave birth to a baby that weighed more than 9 pounds. www.OurHealthCville.com
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Joe & Frani Biggins walk together daily. Blosser also wants to educate healthcare professionals. “We’re hoping to educate the physicians so they are picking up prediabetes, and all allied healthcare workers are picking it up,” she says. “It really impacts the health and healthcare dollar that an individual is spending if we can pick it up early and prevent Type 2 diabetes.” Among other things, Blosser’s program offers “Preventing Diabetes,” an educational session aimed at those with prediabetes. The course will be offered six times during 2016, including some evenings and Saturdays. It’s free and lasts about two hours. “It’s an excellent course,” Blosser says. “From that point, they can decide where they want to go. Do they want to go into the weight-loss class or if they have diabetes, do they want to get a referral from their doctor to go with some heavy-duty diabetic education? Basically, what we like to think we’re doing is promoting a behavior change, and that’s our focus, particularly with prediabetes.” Blosser, who’s been educating people about diabetes and diabetes prevention for what she describes as “eons,” says the area she serves in western Virginia is known to be high in diabetes and high in obesity. Geographically, it sits next to West Virginia, which has the highest incidence of diabetes and the second highest incidence of obesity in the country. This proximity to the Mountain State has resulted in what Blosser calls “cultural bleed over.” She thinks the only hope for Virginia’s diabetes epidemic is a culture-wide, behavioral change, done one family at a time. “No law is going to change it,” Blosser says. “No mandate will change it. No fear will change it. What will change it is by educating the community; the community wants to be healthy. That’s really what we’re trying to achieve and it’s not easy.”
Armed with a Plan At Augusta Health, Biggins met with diabetes educator Jean Magee. She talked with him about the importance of reading food labels, counting carbohydrates, eating a 54
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healthy diet and starting a regular exercise routine. Then she sent him home with some homework. “She had me write down all the foods that I ate during the day, and my wife did the same thing,” Biggins says. “And then, when I went back for the second visit, she actually critiqued what I did and made further suggestions.” Biggins got serious and started making changes. At Magee’s direction, he started eating six small meals a day, rather than three big ones, and high-protein snacks between meals — things like nuts and cheese. He and his wife, Frani, started walking every day. It wasn’t easy at first. “When we first started taking our walks, we might have walked for 30 minutes,” Biggins says. “Where we live, it’s uphill and downhill. We were out of breath, and it hurt a little bit. Now, we can walk an hour or more and feel good. You don’t even have to go sit down when you’re done, so it works.” In the first month or so, Biggins lost about 10 pounds. He suspects his wife has also lost some weight. “She hasn’t told me that, but I know she feels better because of the exercise we’re doing together, and it gives us time to talk and stuff too,” Biggins says.
How do I lower my diabetes risk?
Rita Smith, RD is a registered dietitian and certified diabetes educator at Sentara Martha Jefferson Hospital in Charlottesville.
Research shows that you can lower your risk for Type 2 diabetes by 58 percent by: •
Losing 7 percent of your body weight (or 15 pounds if you weigh 200 pounds).
•
Exercising moderately (such as brisk walking) 30 minutes a day, five days a week.
•
Don't worry if you can't get to your ideal body weight. Losing even 10 to 15 pounds can make a huge difference.
Asked about his advice for others with prediabetes, Biggins says making changes was not really difficult, but “just like anything else,” it takes a commitment. “When you exercise, you have to make time in your life to do it,” he says. “Get out of the chair, put your book down, turn off the TV and do some things that are healthy. You just have to make time for yourself to exercise, and you’ll feel better once you do it.” MEDICAL EXPERTS Jane Blosser, MS is a registered dietitian and certified diabetes educator with Augusta Health in Charolettesville. Margaret Crook, MD is an endocrinologist with UVA Blue Ridge Endocrinology in Charlottesville.
Margaret Crook, MD is an endocrinologist at UVA Blue Ridge Endocrinology in Charlottesville. She is certified by the American Board of Internal Medicine with a subspecialty in Endocrinology, Diabetes and Metabolism.
Rita Smith is a registered dietitian and certified diabetes educator with Sentara Martha Jefferson Hospital in Charlottesville.
SOURCES American Diabetes Association CDC.gov
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Photos Courtesy of Bad to the Bone and Competition Imaging
Charlottesville Fall Classic Half Marathon and 10K The conditions were perfect – sunny and brisk, with fall foliage in full glory – as runners of different ages, shapes and sizes took to the streets for the Charlottesville Fall Classic Half Marathon and 10K. The race, an out-and-back course starting near Charlottesville’s Historic Downtown Mall at Lee Park, features a number of stretches through some of Charlottesville’s most historic neighborhoods. This year, the 10K race had 114 finishers, while the half marathon boasted an impressive 223 runners who crossed the finish line!
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HALF MARATHON & 10K
www.badtothebone.biz
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CLICK HERE to learn more about
the Albemarle Health & Rehabilitation Center.
HealthyEats
proudly sponsored by Sentara Martha Jefferson Hospital & Whole Foods Market
Whole Foods Market
ARCTIC CHAR
“Wild arctic char is one of the most nutritious, high quality fish options available. It is high in Omega 3 fatty acids and has a mild flavor. The velvet like texture is a result of the high fat content, which makes it ideal for dry heat cooking.” Kelli Hughes, RD, CDE Sentara Martha Jefferson Hospital
Ingredients: (serves 4) 1
cup French green lentils
1
(12-ounce) skin-on arctic char fillet 7 tablespoons cider vinegar, divided
½ cup diced shallots (about 2), divided 1
large ripe but firm pear or Granny Smith apple, finely chopped
1
tablespoon Dijon mustard
1/4
teaspoon ground black pepper
1/8 teaspoon coarse sea salt 4
green onions, very thinly sliced
1/4
cup chopped fresh flat-leaf parsley
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Directions:
In a medium saucepan, bring 3 cups water to a boil over high heat. Stir in lentils, lower heat and simmer until lentils are just tender, 18 to 20 minutes. Drain and set aside. Place arctic char, 4 tablespoons vinegar and ¼ cup shallots in the pan used for cooking lentils (fold tail under fillet if necessary so it fits in the pan). Add enough water to just cover fish. Bring to a simmer, lower heat, cover and cook until fish is opaque in the center, 5 to 6 minutes. Remove fish with a slotted spoon and transfer to a plate, leaving on any shallots that cling to the fish. Place pear in the same pan, set over medium heat and warm, about 1 minute. Add remaining ¼ cup shallots and cooked lentils, cover and cook, stirring occasionally, 4 to 5 minutes. In a small bowl, whisk together mustard, pepper, salt and remaining 3 tablespoons vinegar. Pour over lentils, add green onions and parsley and toss to combine. Flake fish away from skin and serve over lentils.
Nutrition:
Per serving: 380 calories (110 from fat), 13g total fat, 2.5g saturated fat, 55mg cholesterol, 230mg sodium, 41g toatl carbohydrates (9g dietary fiber, 9g sugar), 27g protein.
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HealthyEats
proudly sponsored by Sentara Martha Jefferson Hospital & Whole Foods Market
Whole Foods Market
SPAGHETTI SQUASH “Spaghetti squash is a high fiber winter squash that is loaded with carotene and is a very good source of Vitamin C, while being low in calories and extremely filling. It makes a wonderful substitute for noodles and is a great filler food!” Kelli Hughes, RD, CDE Sentara Martha Jefferson Hospital
Ingredients: (serves 4) 1
small (2½-pound) spaghetti squash
1 (14-ounce) can no-salt-added diced tomatoes ½ cup unsweetened almond butter 2
teaspoons curry powder
1/2
cup of chopped celery
3/8
teaspoon fine sea salt, divided
3
cups thinly sliced greens, such as baby kale or spinach
Nutrition:
Per serving: 290 calories (160 from fat), 18g total fat, 1.5g saturated fat, 0mg cholesterol, 370mg sodium, 29 total carbohydrate (9g dietary fiber, 11g sugar), 9g protein.
Directions:
Preheat oven to 375°F. Halve squash lengthwise and use a spoon to scoop out seeds and discard. Place squash cut-side down in a 9x13-inch baking dish. Pour 1 cup water into the dish and roast until squash shells are tender when pressed with your finger, about 30 minutes. Let sit until cool enough to handle. Leave oven on. Meanwhile, pour tomatoes into a strainer set over a bowl. Set tomatoes aside and pour juice into a blender. Add almond butter, curry powder and ¼ teaspoon of the salt and blend until smooth. Rake a fork back and forth across squash to remove flesh in strands, keeping shells intact. Transfer squash to a bowl and toss with remaining ⅛ teaspoon salt. Return shells cut-side up to the baking dish. Spoon one-third of the squash into shells, dividing evenly. Top with half of the tomatoes and half of the greens, then drizzle with about one-third of the almond sauce. Repeat the layering. Top with remaining squash and sauce. Roast until filling is heated through and greens have wilted, about 15 minutes.
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HealthyEats
Whole Foods Market
LENTIL CHILI
Ingredients: (serves 8) 1
large yellow onion, chopped
1
large red bell pepper, chopped
8
cups low-sodium vegetable broth, divided
5
cloves garlic, finely chopped
4
teaspoons salt-free chili powder
1
(16-ounce) package brown lentils (about 21Ž4 cups lentils)cups thinly sliced greens, such as baby kale or spinach
2
(15-ounce) cans no-salt-added diced tomatoes
1/4
cup chopped fresh cilantro
Directions:
Heat a large pot over medium-high heat. When hot, add onion and bell pepper; cook, stirring frequently, until vegetables brown and begin to stick to the bottom of the pot, about 6 minutes. Stir in 3 tablespoons of broth and continue to cook, stirring, until onion is soft and lightly browned. Stir in garlic and chili powder and cook 1 minute, stirring constantly. Add lentils, tomatoes and remaining broth. Bring to a boil, reduce heat to medium-low and simmer, partially covered, 30 minutes or until lentils are almost tender. Uncover and cook 10 minutes longer. Stir in cilantro and serve.
Nutrition:
Per Serving: Serving size: , 130 calories (5 from fat), 0g total fat, 0g saturated fat, 0mg cholesterol, 180mg sodium, 23g carbohydrates, (7 g dietary fiber, .7g sugar), 6g protein.
proudly sponsored by Sentara Martha Jefferson Hospital & Whole Foods Market
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Growing Emotionally Healthy Children words | SUSAN DUBUQUE
What more could a parent ask for than a happy, well-adjusted child? Today, health and family magazines abound with valuable information on children’s mental health issues — from attention deficit hyperactivity disorder and autism spectrum disorder to bipolar disorder and youth suicide. But let’s approach the subject from a different perspective. We will explore tips and techniques to help parents, grandparents and educators nurture the development of emotionally healthy and resilient children. At the foundation of emotional health you will find the combined effects of our genes and environment — nature and nurture. We can’t control our genetic makeup, but there are many ways we can influence a child’s state of emotional well-being through our behaviors, interactions, communications and the environment we create at home, at school and in our communities.
Look in the mirror Children tend to reflect the emotional status of their parents, and it goes beyond the hereditary implications. Make an honest assessment of your own emotional status. Are you generally happy, stable and able to cope with the trials and tribulations of everyday life? Or are you depressed, anxious, angry or struggling with some other form of mental distress? In any case, you serve as an emotional role model for your child. When you gaze into the emotional looking glass, if you don’t like what you see, get help. If you had diabetes, cancer or the flu, you wouldn’t hesitate to seek medical attention so you could be there for your family. Only if you are mentally healthy can you truly be available to your child. And your child will learn an important lesson too — that it is OK to ask for help when life becomes emotionally overwhelming.
Focus on the whole child “A child’s physical and emotional health are intertwined. In fact, they are really one in the same,” says Aradhana “Bela” Sood, MD, a pediatric psychiatrist with the Virginia Treatment Center for Children, in Richmond. So let’s start with the basics — the things your grandmother would have endorsed. www.OurHealthCville.com
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Nutrition
The relationship between a balanced diet and emotional well-being has been recognized for a number of years. The literature is filled with articles on the consequences of inadequate nutrition, including social withdrawal, decreased concentration, sleep disturbances, irritability, apathy and depression. According to national nutritional expert and registered dietitian Eileen Meyers, “Perhaps the best rules to follow regarding your child’s nutrition are driven by common sense.” •
Provide three well-balanced meals a day. That may sound too fundamental to even bother mentioning, but it's essential to make this point in light of the busy schedules that many families maintain.
•
Allow some sugar and fats, but not in excess or in place of a wholesome diet.
•
Watch out for caffeine, sodium and chemical additives, which are abundant in kids' favorite snack foods. But don’t be a fanatic — an occasional Twinkie is really all right.
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Serve as a role model for good eating habits.
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Stock your refrigerator and cupboards with healthy, fun treats like fresh fruit, yogurt, carrot sticks and fruit juice.
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Don’t use food as a means of nurturing your child. Rather than rewarding your child with a cookie, give him a hug. Instead of a piece of cake, take a walk together.
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Most importantly, don’t allow food to become a source of stress in your child’s life. Mealtime should be relaxed and enjoyable. This is a time for sharing the day’s events, not fighting over uneaten Brussels sprouts.
Forty winks
Inadequate and poor sleep can lead to mood swings and behavioral problems, as well as difficulty concentrating and poor performance at school. But how much sleep is enough? (see the box below)
While every child is different, the National Sleep Foundation offers the following guidelines:
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•
Newborns (0 to 3 months) – Up to 18 hours around the clock on an irregular schedule
•
Infants (4 to 11 months) – 9-12 hours at night and 30 minute to two-hour naps, one to four times a day, fewer as the child reaches age 1
•
Toddlers (ages 1-2) – 11-14 hours of sleep in a 24-hour period; when the child reaches about 18 months of age, naps will decrease to once a day, lasting about one hour
•
Preschoolers (ages 3-5) – 11-13 hours per night; most children do not nap after 5 years of age
•
School-age children (ages 6-13) – 9-11 hours per night
•
Teens (ages 14-17) – 8-10 hours per night
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Tips for avoiding the bedtime drama include: •
Encourage your baby to fall asleep independently and to become a “self-soother.”
•
Allow toddlers and young children to use a security object such as a blanket or stuffed toy.
•
Develop regular daytime and bedtime schedules.
•
Create a consistent and enjoyable bedtime routine, such as reading a book or sharing a story.
•
Establish a sleep-friendly environment — cool, quiet and dark.
•
Keep TVs and computers out of the bedroom.
•
Avoid caffeine.
Just do it
Provide your child with plenty of opportunities for exercise. Physical exertion releases natural endorphins that have an emotionally uplifting effect. And there are lots of other benefits from specific activities, so find one that meets your child’s needs. •
Martial arts can help children gain confidence as well as self-control and discipline.
•
Soccer, softball and baseball are great sports that children of any age, size and physique can play. There are plenty of youth leagues that emphasize skill development, fitness, teamwork and sportsmanship.
•
Weightlifting can help teens who aren’t particularly competitive build self-esteem while they build muscles.
•
Running and walking are activities that can be done pretty much anywhere, anytime.
•
When your child is feeling stressed or anxious, suggest a five-minute “power break.” Jumping rope, running around the block or bouncing a ball 100 times can provide a needed bit of relief, especially during a demanding homework session.
Eileen Myers, MPH, RDN is Vice President, Affiliations and Patient Centered Strategies with The Little Clinic. The Little Clinic is a retail health clinic company operating inside select Kroger stores in central Virginia.
“Without mental health, there is no health,” says Dr. Sood. Perhaps this should be our new mantra.
Express yourself Help your child develop a “feeling vocabulary” so she can express what’s really going on inside. Otherwise she is may resort to throwing a temper tantrum, acting out, sulking or just holding it all inside and feeling miserable. “Our feelings are not necessarily “good” or “bad”, though we often describe them one way or the other,” says Valeri Pineo, LPC, licensed professional counselor with Augusta Psychological Associates in Fishersville. Acknowledge and accept your child’s feelings even when she is sad, angry, hurt, jealous, insecure, lonely, afraid — whatever. “Helping children understand and learn from their feelings starts with helping them understand that feelings are often the result of perception, which we have the power to change,” say Pineo.
Valeri Pineo, LPC is a licensed professional counselor with Augusta Psychological Associates in Fishersville.
“This is especially important as children age, and their social lives become their central focus. Establish an internal system of reinforcement, so feelings and self-worth are not determined by external factors over which they have little or no control,” she says. www.OurHealthCville.com
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As a parent, you are entitled to your feelings too. If you are sad, it is fine to share that with your child. In fact, it gives you the perfect opportunity to demonstrate the best way to deal with negative feelings. For example you could share, “I am very disappointed that we didn’t get to go to the beach today because it rained. But let’s see what else we can do that’s fun. Why don’t we bake some cookies or make a dress for your doll.” Show your child how to look for plan B — a great tool to build resiliency. While it is important for your child to understand and express his own feelings, it is equally important that he learn to interpret other people’s feelings. In the aftermath of a dispute between your child and a sibling or friend, take a moment for a little lesson in empathy. Ask your child, “How do you think that made Billy feel when you called him a fatty pants? How does it make you feel when someone calls you a name?” There are excellent books, posters, games and even flashcards devoted to decoding other’s feelings. Children will adopt the family’s attitudes toward other people. Be aware of disparaging comments — even when made in jest — regarding others. Show respect for people who may be different than your family, and your child will acquire a sense of acceptance and openness. Bela Sood, MD, FAACAP is a psychiatrist with Virginia Treatment Center for Children in Richmond. She is certified by the American Board of Psychiatry with a subspeciality in Child and Adolescent Psychiatry.
Amanda Jones, MD is a pediatrician with Pediatric Associates in Charlottesville. She is certified by the American Board of Pediatrics.
Be an active listener “Busy parents are often half-hearted listeners. Take a few minutes to really connect with your child,” says Dr. Sood. Here are the components of active listening: •
Eye contact. Look at your child, not the TV, your phone or the morning newspaper.
•
Attentive body language. Lean toward your child. Sit close. Nod your head to let him know you're listening.
•
Be quiet. Resist the temptation to offer an immediate solution. Ask your child if she would like a suggestion or if she just wants you to be a sounding board.
•
Verbal following. Make little “I’m listening” sounds, like “oh,” “really?” or “hmm.” Or restate what you heard your child say, like, “It made you feel really sad when Becca didn’t invite you to her party.” Simply paraphrase, rather than getting into deep interpretations. This lets your child know you are really hearing her and allows her to clear up any miscommunications.
•
Make sharing time a priority. Set aside time to talk with your child on a regular basis — not just when something’s wrong. It may only be 15 minutes every Saturday morning over a cup of hot chocolate, but make sure that time is sacred. Even if you child isn’t in the mood to talk, let her know that time is reserved just for her.
Look for the positives How will your child know what good behavior looks like if you only tell him when he is being bad? Make it a point to catch your child in the act of being good. Reinforce the behaviors you would like to see with praise. Thank your child for not interrupting you while you were on the phone or remark how nice it was to see him share with a friend. When your child does slip, as all kids will, provide opportunities to turn things around. Give him a chance to succeed.
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Help your child find activities or talents where she can succeed and shine. If your daughter has two left feet, don’t insist that she continue with the ballet classes that she dreads. Instead, find something that will help her build her sense of accomplishment and self-confidence. Instead of praising your child for his accomplishments and achievement, you can also emphasize •
Intrinsic goodness. Your child’s goodness comes from within and is not attached to any external measure of success. Reinforce positive attributes like kindness, patience, gentleness and humor. Give love unconditionally. Like Mr. Rogers used to say, “I like you just the way you are.”
•
Effort. Praise your child for trying something new or sticking with a tough assignment, regardless of the outcome.
•
Intentions. Your daughter drops and breaks a dozen eggs along with your favorite serving dish. OK, so you want to scream. Before sending her to her room, take a deep breath and ask what she was doing. Her answer: She wanted to make breakfast for Mrs. Smith next door who is sick in bed. There isn’t a plate in the world worth more than that act of kindness. Give her a hug and work together to clean up the mess and make Mrs. Smith’s breakfast.
A routine matter “Children benefit from daily routine. A steady and relatively predictable schedule helps children feel grounded and secure in their environment,” says Amanda Jones, MD, pediatrician with Pediatric Associates in Charlottesville. “When traveling or dealing with other scheduling conflicts, strive for regular nap and bed times, as well as typical morning routines,” she says. Though routine is important, Dr. Jones continues, “It is also important to remember it can be too structured and limited. Create a basic structure so that expectations are defined but that also allow older children some choices and flexibility.”
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Author’s note: When I was a teenager, my parents did not give me a set curfew. Instead they told me to “be home at a reasonable hour.” When I asked what that hour was, they would reply, “We trust you to use good judgement.” I came home an hour before any of my friends. Of course, I had to earn their trust, but that lesson stuck with me all these years.
Establish family traditions “Traditions are important in the development of a child. They help with establishing identity for a child within the family, and within the community,” says Vishal Madaan, MD, MBBS, Assistant Professor in the Department of Psychiatry and Neurobehavioral Sciences, Division of Child and Family Psychiatry at the UVA School of Medicine in Charlottesville. “Family traditions are useful in securing comfort for the child, and assist with strengthening bonds between family members, as well as serve as a connection between generations,” says Dr. Madaan. “They encourage family members to spend quality time together, and thus result in healthier families.”
All together now Children are not born with a work ethic; it must be taught. “Chores help teach children life skills as well as generate independence and foster selfreliance. They help promote self-esteem and children like to be helpers,” says Dr. Madaan. “Of course, parents need to be aware of limitations that a child of a specific age may be able to handle,” adds Dr. Madaan. Children can contribute to the household in an age-appropriate way, from picking up their toys when they are toddlers to mowing the grass as teens. Even very young children can learn to complete their work before playtime. As children get a little older, they can also be encouraged to contribute to their community. A child can recycle, donate money to a charity or volunteer to work for a worthy cause. These are wonderful ways to foster giving, build empathy and help children to be less self-centered.
Natural consequences Your child is late for dinner for the fifth night in a row, and you’re tired of being treated like a short-order cook. First, you lecture him for 15 minutes about being inconsiderate. Next, you take away a privilege or ground him after school. Then you cook dinner — all while continuing the verbal assault. Finally, you swear this will be the last time you will ever prepare a second meal if he is late. Sound familiar? Next time this happens, allow natural consequences to prevail. If your child misses dinner, either he doesn’t eat or he prepares his own meal and cleans up afterward. He made the choice; let him live with the consequences. It is a far less combative approach. It puts your child in control of the outcome and removes you from being “the enforcer.”
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Maybe yes, maybe no “Good parenting is a full time job and more,” says Dr. Madaan. “There is no manual for it,” he continues. “The word ‘no’ or anything similar in a negative context, is often the recipe for arguments in the household, and potentially refuels defiant behaviors. Research and clinical evidence suggest that providing positive attention to good or acceptable behavior brings better results,” he adds. In her book, “Stop Struggling With Your Child,” Evonne Weinhaus offers a simple suggestion for parents who are tired of arguing with their children over every little thing — just say “yes.” Instead of saying, “No, you can’t have a cookie because we will be eating dinner in 15 minutes,” say, “Yes, you can have a cookie — right after dinner.”
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At the mere mention of the word “no,” your child is suddenly prepared for battle. But there isn’t a lot to argue with when you say “yes.”
Limit screen time Let’s face it. We’re living in a digital age, surrounded by gadgets. We even refer to our children as “digital natives.” But what are the effects of spending hours each day in front of a computer or television? And how much screen time is too much? Dr. Jones offers guidance from the American Academy of Pediatrics on this important subject. “The AAP recommends no screen time for children under the age of two. Screen time includes exposure to TV, computers, tablets and phones. After age two, the recommendation is to limit screen time to one to two hours per day”. In a recent study conducted at UCLA, results indicate a relationship between screen time and social skill development in children. When screen time was limited, the children’s ability to read other peoples’ emotions improved. Other studies suggest that screen time can have a variety of negative effects on kids, including childhood obesity, irregular sleep patterns and behavioral problems. As an alternative to screen time, provide opportunities for children to spend more time interacting with the family. “While it can be difficult to limit exposure in this electronic-driven world, it is important to remember that a child's development depends on being exposed to a variety of stimuli including books, puzzles, toys, going outside to play, and face to face time with others,” concludes Dr. Jones.
Cut your losses Even a happy, well-adjusted child can face a very real and devastating loss such as the death of a beloved grandparent or family pet. Or it may be less obvious, such as the loss of self-esteem when your daughter does not make the cheering squad. You can help your child through the grieving process by •
Letting her know that losing someone or something special hurts. Give her permission to grieve.
•
Encouraging your child to talk about her full range of feelings, such as anger, sadness, denial, guilt, jealously and fear.
•
Holding on to the good feelings. Help your child create a memory box or memory book. Give him photos of his grandfather and memorabilia like a class ring or medals from military service. Help him capture and preserve the warm loving feelings he had for his loved one.
Vishal Madaan, MD, MBBS is an assistant professor in the Department of Psychiatry and Neurobehavioral Sciences, Division of Child and Family Psychiatry at the University of Virginia School of Medicine in Charlottesville. He is certified by the American Board of Psychiatry and Neurology with a subspecialty in Child and Adolescent Psychiatry.
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•
Taking on the positive characteristics of a loved one. Let’s say a close friend or relative dies or moves away. Or perhaps your child is feeling the loss of a favorite teacher when it's time to move to the next grade. Ask your child what he liked or admired most about that person. Then encourage him to adopt that trait. Your child can keep the memory alive by being as nice as grandma, as funny as Jason or as courageous as Mr. Smith.
•
Letting go. If your daughter is deeply saddened that she didn’t make the basketball team, help her let go of those feelings and move on. Rather than dwelling on the loss, encourage her to focus her energies on a new activity. While it is important to recognize the pain your child is feeling, it is equally important to help her learn coping mechanisms and regain her sense of control.
Pull together, even when you’re apart When parents separate or divorce, children suffer. If you and your spouse have made the decision to end your marriage, do not drag your child into the battleground. Allow him to maintain a close and loving relationship with both parents. A child’s self-image is in large part a reflection of both parents. If you tell a child that Mommy is bad, he will think he is bad. If tell him that Dad is a creep, he will assume he is one too. It is important to remember to set aside your differences and put the needs of your child first. Here are some ways to be good co-parents: •
Refrain from making disparaging comments about each other.
•
Avoid blaming and finger-pointing.
•
Give your child free access to the other parent.
•
Try to maintain consistency in parenting styles and household rules.
•
Make major decisions about your child as a team.
The concept of positive co-parenting is not limited to parents who live apart; they also apply to intact families. Even moms and dads who live together can unknowingly pull and tug at their child’s emotions.
Bullying “Bullying can take many forms, including verbal (name calling), social (exclusion, spreading rumors) or physical,” explains Dr. Jones. “Children who experience bullying are more likely to have depression or anxiety. They may exhibit changes in appetite or sleep or start to lose interest in activities they once enjoyed,” she says. Encourage a child who is being bullied to:
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•
Understand bullying. Explain that bullies are really unhappy, frustrated and insecure people. They try to make themselves feel better by controlling other people and making them feel lousy.
•
Walk away. Bullies want to know they have control over your emotions, so don’t react with anger or retaliate with physical force. If you walk away, ignore them or calmly and assertively tell them you’re not interested in what they have to say, you’re demonstrating that they don’t have control.
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•
Find the humor. If you relax and comment on the bullying situation with humor, you’ll likely no longer be an interesting target for a bully.
•
Control what you can. Many things in life are beyond our control, including the behavior of other people, so focus on the things you can control such as the way you choose to react to bullies.
•
Report the bullying to a trusted adult. Unless bullies are reported and stopped, they may become even more aggressive.
“Stress from bullying can manifest itself in physical symptoms too – headaches or even abdominal pain. It is not uncommon for these complaints to lead to school absences and poor academic performances,” notes Dr. Jones. If your child is not able to resolve the bullying on her own, get involved. Tell the teacher, contact the bully’s parents, and if you have to, call the police. Your child must feel confident that you will step in to protect her.
“There is no simple recipe for raising an emotionally healthy child,” says Dr. Sood. “The best advice I can offer is to love and accept your child unconditionally. Focus on your child’s strengths and positive attributes. Keep your sense of humor. And, finally, remember: Before you blink, your child will be grown. So enjoy every moment of the toughest job you will ever love.” MEDICAL EXPERTS Amanda Jones, MD with Pediatric Associates in Charlottesville. Vishal Madaan, MD, MBBS with the University of Virginia School of Medicine. Eileen Myers, MPH, RD, LDN, FADA, national expert on nutrition and eating disorders. Valeri Pineo, LPC with Augusta Psychological Associates in Fishersville. Aradhana “Bela” Sood MD, MSHA with Virginia Treatment Center for Children at VCU Health
RESOURCES Stop Struggling with Your Child by Evonne Weinhaus Stop Struggling with Your Teen by Evonne Weinhaus and Karen Friedman The Optimistic Child: A Proven Program to Safeguard Children Against Depression and Build Lifelong Resilience by Martin Seligman Transforming Teen Behavior: Parent – Teen Protocols for Psychosocial Skills Training by Mary Nord Cook SOS: Help for Parents by Lynn Clark 1-2-3 Magic: Effective Discipline for Children 2–12 by Thomas Phelan Magic Years: Understanding and Handling the Problems of Early Childhood by Selma Fraiberg
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