table of contents | september • october 2014
MEDI•CABU•LARY.......................8 Local experts define health related terms
JUST ASK!.......................................10 Healthcare questions answered by local professionals
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Women’s Health
Three Stories of Strength: Rosaline Blair, Carolyn ‘Lily’ Bramble and Linda Payne share their stories of breast cancer diagnosis and survival.
NEW & NOTEWORTHY.............12 A listing of new physicians, providers, locations and upcoming events in the Shenandoah Valley and Charlottesville
HEALTH POINTS.........................16 Interesting facts and tidbits about health
EDITOR’S LETTER......................18 Shenandoah Valley and Charlottesville... welcome to the OurHealth family.
ANATOMY: Death by Sunshine........................ 20 Summer’s pretty much over and days at the beach are becoming numbered, so the threat of skin cancer is behind us for another year, right?
THE ANATOMY CHECK-UP..................................... 24 Your Skin Self-Exam: Body Maps and Measurement Guide, provided courtesy of the Skin Cancer Foundation, to aid in your skin self-exam.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
WOMEN'S HEALTH CHART............................................ 37 Ladies? Are you staying on track with your health?
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Men’s Health
Prostate Cancer is the second most common cancer in men. Robert Cleminson and Edward J. Craney Jr. share their experiences with the disease.
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[series]
Breaking the Silence: Pancreatic Cancer
This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now. FIT BITS!........................................ 47 Health and Fitness On-the-Go: A Right to ‘Bare Arms’
hello, HEALTH!.............................. 48 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos
MEN'S HEALTH CHART........... 55 Are you staying on track with your health?
NUTRITION...................................57 HEALTHY EATS: Shop Local for Better Flavor and Extra Value—Brined Mesquite Turkey, Roasted Harvest Vegetables, Apple-Peach Oatmeal Crisp
SENIOR HEALTH........................ 60 Blue Ridge PACE: With the enormous growth of the aging population in our country, one of the biggest social problems we face is remaining in our own home and community once we become disabled due to age or health conditions.
LOOKING BACK........................... 66 Images reflecting the history of healthcare in the Shenandoah Valley and Charlottesville * PLUS * a chance to win prizes!
www.OurHealthCville.com
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PUBLISHER PRESIDENT/EDITOR-AT-LARGE VICE PRESIDENT OF PRODUCTION PROJECT COORDINATOR AND FITNESS EXPERT CHIEF DESIGNER ORIGINAL PHOTOGRAPHY WEBSITE
CONTRIBUTING RICHMOND MEDICAL EXPERTS
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october 2014 McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Deidre Wilkes Karrie Pridemore Shawn Sprouse/SDSimages.com Next Generation Designs
Frank Biscardi, MD Dana H. Breeding, RN, BSN, BS, CTTS Deborah Elder, MD Josh Lyons Mark Newbrough, MD Timothy N. Showalter, MD
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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor-at-Large: 305 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Information in all print editions of OurHealth and on all OurHealth’s websites (www.ourhealthcville.com, www.ourhealthrichmond.com and www.ourhealthvirginia.com), social media sites and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2014 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Shenandoah Valley and Charlottesville edition is published seven times annually by McClintic Media, Inc. 305 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthcville.com | www.ourhealthrichmond.com | www.ourhealthvirginia.com | Advertising rates upon request.
LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is PACE?
What is IORT?
What is Hypotension?
“PACE” stands for Program for AllInclusive Care for the Elderly. It is a comprehensive medical and social day care for adults age 55 and older who live in a defined service area, meet the criteria for long term nursing care, and who can live safely in the community with PACE support.
IORT stands for intra-operative radiation therapy. IORT is delivered in an operating room at the same time as surgery, and delivers a concentrated dose of radiation to the area where a breast tumor was removed. For women with earlystage breast cancer who choose breast-conserving therapy, IORT is one of several radiation therapy options available. It offers the convenience of finishing radiation at the same time as surgery, and is becoming increasingly popular after the results of a large, randomized trial were published that showed results similar to whole breast radiation for selected patients. At the University of Virginia Cancer Center, our breast cancer team has developed a new form of breast IORT that incorporates the latest techniques in imageguided brachytherapy to deliver a customized form of IORT. Our approach, using image-guided, high-dose brachytherapy with a CTbased treatment plan, is designed to sculpt the radiation dose to better target the area where the tumor was removed. We are evaluating this approach in an ongoing clinical trial.
Hypotension is the medical name for low blood pressure. The term is the opposite of hypertension, where blood pressure is too high. Tension, in both words, refers to the pressure on the artery wall.
By working closely with frail older adults and their families, the PACE team focuses on helping each “participant” to achieve their highest possible level of function and independence by offering: Adult day care that offers nursing; physical, occupational and recreational therapies; meals; nutritional counseling; social work and personal care • Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant • Home health care & personal care • All necessary prescription and nonprescription medications • Social services • Medical specialties, such as audiology, dentistry, optometry, podiatry and speech therapy • Respite care • Hospital and nursing home care when necessary Mark. Newbrough, MD
Medical Director, Blue Ridge PACE Charlottesville | 434.529.1300 www.riversideonline.com/blue_ridge_pace/
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Timothy N. Showalter
Radiation Oncologist UVA Cancer Center Charlottesville | 434.338.6982 www.uvahealth.com
According to the National Institutes of Health, normal blood pressure ranges from 90/60 mmHg to 130/80 mmHg. If blood pressure is lower than normal, then vital organs may not be receiving enough blood. Causes of low blood pressure can be loss of blood, infection, medications, dehydration and heart attack to name a few. Another common form of hypotension is orthostatic hypotension, which is caused by sudden changes in body posture. Shifting from lying down to standing is most common and can bring about dizziness, blurred vision, weakness and confusion. Falls can result from these symptoms, putting people at risk of a broken hip, spine fracture or head injury. Healthcare providers diagnose hypotension through repeated blood pressure readings, a full evaluation of medical history and reviewing medication usage. See your provider for questions or concerns. Dana H. Breeding, RN, BSN, BS, CTTS RN, Health Educator, Community Wellness, Augusta Health Fishersville | 540.332.4988 www.augustahealth.com
H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
Do exfoliants and skin peels do the same thing? Exfoliants work one of two ways. The first is to physically remove the top dead skin layers, with tiny beads or crystals. These types of products can cause redness and irritation of the skin, particularly skin that is prone to rosacea or acne, as the trauma to the skin irritates it and can worsen those conditions. The second way is to chemically dissolve the dead skin layers using alpha hydroxy, or glycolic acids. Creams, lotions, and toners containing these acids are available over the counter in various strengths, usually 5-20%. These are better for acne prone skin and for brightening skin, with less risk of irritation. Chemical peels also employ acids of various types and strengths to penetrate into the deeper layers of skin. Some chemical peels contain glycolic acids in strengths up to 70%, while others employ stronger acids such as trichloroacetic acid. The stronger the chemical, the deeper the peel. Some chemical peels can cause significant peeling and redness, and require strict care afterward. But they can effectively treat many skin conditions, including acne, age spots, and can even improve fine wrinkles and skin texture. A skin peel, particularly in a physician’s office, is a much more intensive procedure, but can give more dramatic results than exfoliants. Deborah Elder, MD
Charlottesville Dermatology Charlottesville | 434.984.2400 www.cvillederm.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
What are some meaningful activities that can be done with people suffering from dementia? Successfully caring for individuals with dementia means creating personal, meaningful experiences every day that nurture their mind, body and spirit – whole person wellness. Activities for these individuals should innovatively incorporate communication, imagination and creativity. Examples of such activities could include listening to music, aromatherapy, multisensory environments, reminiscence, art therapy, pet therapy and much more. Of course, one also needs to consider special limitations such as hearing and vision loss while planning ways to be physically active and engaged mentally, spiritually, and socially. Ideal activities will also stimulate multiple senses (taste, touch, smell, sight, sound). Gathering in-depth knowledge about the person is vital; interviewing the individual as well as friends and family members can be very helpful. Ask questions about their upbringing, occupation, hobbies and interests throughout their lifetime. Then offer planned as well as spontaneous activities that focus on the individual’s history of personal likes and interests, while in a safe nurturing environment. Josh Lyons
Executive Director Sunnyside Retirement Community Harrisonburg | 540.568.8411 www.sunnyside.cc
What is the difference between insomnia and sleep apnea? Insomnia is a sleep disorder that is characterized by the inability to initiate or maintain sleep. It is often associated with anxiety but can also be seen in shift workers, chronic pain patients and those with burdensome chronic illness. It can be also seen in healthy people for no apparent reason. It is perpetuated by poor sleep habits and worry about not sleeping. Sleep apnea is a disorder of interrupted breathing during sleep. It is usually due to obstruction of the airway when people breathe in at night. Sleep apnea results in sleep disruption and excessive sleepiness. It is a cause of premature vascular diseases, hypertension and car accidents. Frank Biscardi, MD
Carilion Clinic Sleep Center Lexington | 540.458.3213 www.carilionclinic.org
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Battle Building at UVA Children’s Hospital Now Open The Battle Building at University of Virginia Children’s Hospital, which consolidates and streamlines UVA’s outpatient pediatric care, opened this summer at 1204 W. Main St. in Charlottesville. The 200,000-square-foot facility brings together hundreds of doctors and healthcare staff devoted to caring for kids and families into a building designed to place children at ease and promote healing with cheerful colors and interactive play areas. Children will be able to receive primary care as well as care from pediatric providers in dozens of specialties, including allergy, cardiology, hematology/oncology and teen and young adult health. Care is organized in neighborhoods, with several services children may need grouped together. For example, one neighborhood will be home to orthopedics, physical and occupational therapy and developmental pediatrics. Also featured throughout the building is a storytelling theme, that inspires kids to explore, discover, and learn through interactive areas highlighting classic children’s books like Charlotte’s Web, Curious George, and The Jungle Book.
Kohl’s donates $45,828 for children’s health education
The Battle Building at UVA Children’s Hospital has been made possible through a grant from Ivy Foundation, long-time UVA Children’s Hospital benefactors Barry and Bill Battle, and many generous donors throughout Central Virginia. For more information about the Battle Building, visit childrens.uvahealth.com.
Cancer Center earns national honor for quality care
Kohl’s Department Store is donating $45,828 to support health education in Central Virginia through the Kohl’s Growing Up Healthy (KGUH) Program.
Becker’s Hospital Review has named the University of Virginia Cancer Center at UVA Medical Center to its 2014 list of 100 Hospitals and Health Systems With Great Oncology Programs.
The KGUH curriculum was designed by experts at the UVA Children’s Fitness Clinic and is delivered through a partnership between the clinic, the Social Issues in Medicine course at the UVA Medical School and the Albemarle County Extended Day Care Program. In the program, UVA medical students teach elementary school students about healthy nutrition and lifestyle habits to maintain a strong body and mind. The program has been implemented in 16 Albemarle County schools, five Charlottesville City schools, one Rockingham County school and four area community centers, educating more than 1,000 children.
This is the second consecutive year the healthcare publication has named UVA to the list, and UVA is the only hospital in Virginia to be recognized on the 2014 list.
“This program is a valuable resource to help kids become better informed and excited about getting exercise and good nutrition,” said Anna King, Outreach Coordinator for UVA Children’s Fitness Center. Since 2004, Kohl’s has donated more than $377,000 to UVA Children’s Hospital through Kohl’s Cares®.
According to Becker’s, hospitals named to the list are leading the way in terms of quality patient care, cancer outcomes and research. The publication also notes that other outside ranking agencies, such as the National Cancer Institute (NCI) and U.S. News & World Report, have recognized the hospitals on the list. In honoring UVA, Becker’s Hospital Review noted that UVA is a National Cancer Institute-designated cancer center – one of just 68 in the country – that are dedicated to research in the development of more effective approaches to prevention, diagnosis and treatment of cancer, according to the NCI website. Becker’s Hospital Review also cited the cancer center’s use of cancer-specific clinical teams, which include pathologists, radiologists, researchers, surgeons and additional healthcare professionals. For more information visit www. healthsystem.virginia.edu or www. beckershospitalreview.com
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Augusta Health Cancer Center Re-Accredited by National Accreditation Program for Breast Centers (NAPBC) Augusta Health Cancer Center’s Breast Program has been granted a full three-year accreditation by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. Accreditation by the NAPBC is only given to those centers that have voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous evaluation process and review of their performance. A breast center that achieves NAPBC accreditation has demonstrated a firm commitment to offer its patients every significant advantage in their battle against breast disease. In addition to being compliant in all 27 standards, the surveyor recognized clinical management, stating the “‘treating physicians work as a team to provide streamlined, comprehensive care to their patients”, with a “strong, hardworking” interdisciplinary team at the center. She also recognized the “very comprehensive (support) services offered, including an
awesome cancer-patient-focused exercise program run by a two-time breast cancer survivor and fitness guru.” Receiving care at a NAPBC-accredited center like the Augusta Health Cancer Center ensures that a patient will have access to: • Comprehensive care, including a full range of state-of-the-art services • A multidisciplinary team approach to coordinate the best treatment options • Information about ongoing clinical trials and new treatment options • Quality breast care close to home For more information about the National Accreditation Program for Breast Centers, visit their Web site at www.accreditedbreastcenters.org.
Sentara RMH Employees Give More than $98,000 to 2014 Employee Gifts Campaign Employees of the Sentara RMH Medical Center believe that “Giving Makes You Happy!” and proved it as they gave more than $98,000 to the 2014 Employee Gifts Campaign. “The campaign raised $98,386, which is 116 percent of this year’s goal of $85,000,” says Janet Wendelken, development officer for the RMH Foundation. Wendelken directs the Foundation’s annual fund, which includes the Employee Gifts Campaign. A total of 741 Sentara RMH employees made gifts to the campaign, which ran from May 21 through June 30. “This generosity shows that our Sentara RMH employees care about their patients, their coworkers, their work, and this hospital,” says Sentara RMH President Jim Krauss. The campaign was led by five employees who served as volunteer cochairs: Deanna Lam, Funkhouser Women’s Center; Janet Macarthur, Oncology Services and Hahn Cancer Center; Neil Mowbray, Corporate Communications; Meg Robinson, Sentara RMH Wellness Center; and Rusty Tusing, Facilities Management. The annual Employee Gifts Campaign was launched in 1975. This year employees could focus their donations to support the hospital equipment and program fund or the Employee Relief Fund, or to support their own or another department. The Employee Relief Fund is a fund set up by the hospital to assist employees who are facing a financial crisis due to a serious illness or unfortunate personal situation.
Janet Wendelken, RMH Foundation, far left, announces the official end of the Employee Gifts Campaign as campaign cochairs—from left, Meg Robinson, Neil Mowbray, Cory Davies, Deanna Lam and Janet Macarthur—unveil the final donated amount at a July celebration at the hospital. www.OurHealthCville.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
President and CEO of Carilion Clinic appointed to Board of Trustees of the American Hospital Association President and CEO of Clinic, Nancy Howell Agee, appointed to serve on the Trustees of the American Association.
Carilion has been Board of Hospital
She is one of eight new members from around the country selected by the AHA for three-year-terms beginning January 1, 2015.
Amy Alson, MD
Nicholas Brandt, MD
Nick Brenton, MD
Victor Buckwalter, MD
Greg Cohron, NP
Jared Davis, MD
UVA Health System Internal Medicine, Psychiatry University Medical Associates Charlottesville | 434.924.1931 www.uvahealth.com
Martha Jefferson Inpatient Services Charlottesville | 434.654.7000 www.marthajefferson.org
“Nancy’s election to this prestigious board is reflective of the growing national reputation of Carilion and its leaders,” said James Hartley, Chairman of the Carilion Clinic Board of Directors. The AHA is a not-for-profit association of health care provider organizations and serves as the national advocate for nearly 5,000 hospitals, health care systems, networks and other providers of care. “I am honored to join the Board of this exceptional organization and support its vital mission to improve the health of our communities” Agee said, “A mission Carilion has pursued in Virginia for many years.”
UVA Health System Pediatric Neurology Charlottesville | 434.924.2706 www.uvahealth.com
Carilion Clinic Family Medicine Wyers Cave | 540.234.9241 www.CarilionClinic.org
The AHA was founded in 1898, one year before the opening of Carilion Roanoke Memorial Hospital in 1899.
Augusta Health Primary Care Fishersville | 540.332.5687 www.AugustaHealth.com
Augusta Health Pain Management Clinic Fishersville | 540.332.5747 www.AugustaHealth.com
ON THE WEB
More at ourhealthcville.com 14
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Mary Flynn, MD
Martha Jefferson Inpatient Services Charlottesville | 434.654.7000 www.marthajefferson.org
Steve Hoover, MD
Martha Jefferson Orthopaedics Charlottesville | 434.654.5575 www.marthajefferson.org
Ionut (Alex) Mosteau, MD
UVA Health System Internal Medicine University Physicians at Orange Orange | 540.661.3004 www.uvahealth.com
Deborah Frank, MD, PhD
Randy Gallagher, MD
John Geary, FNP
Shakun Gupta, MD
Edward Hemphill, MD
Sarah Jones, MD
Ayesha Kelly, MD
Jason Lawrence, MD
Sorin Laza, MD
Sula Mazimba, MD, MPH
UVA Children’s Hospital Critical Care Charlottesville | 434.924.5879 childrens.uvahealth.com
UVA Health System Neurology Charlottesville | 434.924.2706 www.uvahealth.com
Catherine Muller, NP Augusta Health Primary Care Fishersville | 540.332.5687 www.AugustaHealth.com
Anna Smith, MD
Martha Jefferson Inpatient Services Charlottesville | 434.654.7000 www.marthajefferson.org
Carilion Stonewall Jackson Emergency Medicine Lexington | 540.458.3348 www.CarilionClinic.org
Carilion Stonewall Jackson General Surgery Lexington | 540.463.7108 www.CarilionClinic.org
Evan Ross, DPM
Virginia Foot & Ankle Surgical Associates Charlottesville | 434.977.8040 www.vfasa.com
Elliot Smith, MD
Martha Jefferson Inpatient Services Charlottesville | 434.654.7000 www.marthajefferson.org
Crossroads Behavioral Health Services Fishersville | 540.332.4060 www.AugustaHealth.com
Augusta Health Pulmonology Fishersville | 540.245.7190 www.AugustaHealth.com
Sumera Salim, MD
Augusta Health Hospitalist Fishersville | 800.932.0262 www.AugustaHealth.com
Jayme Stokes, MD
Martha Jefferson Medical and Surgical Associates Charlottesville | 434.654.5260 www.marthajefferson.org
UVA Children’s Hospital General Pediatrics Charlottesville | 434.924.9130 childrens.uvahealth.com
Martha Jefferson Inpatient Services Charlottesville | 434.654.7000 www.marthajefferson.org
Richard Schartz, MD
Albemarle Anesthesia Charlottesville | 434.296.7733 www.mjhanesthesiology.com
Jason Strampe, MD
Martha Jefferson Inpatient Services Charlottesville | 434.654.7000 www.marthajefferson.org
Carilion Stonewall Jackson Orthopaedics Lexington | 540.463.2103 www.CarilionClinic.org
UVA Heart and Vascular Center Heart Failure Charlottesville | 434.243.1000 www.uvahealth.com
Brian Showalter, MD
Monticello Plastic Surgery Charlottesville | 434.322.1255
Jennifer Tromberg, MD
Dermatologic Surgery of Central Virginia Charlottesville | 434.979.7700 www.dermsurgcv.com
www.OurHealthCville.com
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T I P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U
OBESITY
A TINY fact:
The tiniest bone in your body is only 3mm long and is found in your ear!
SEPTEMBER IS
National Childhood Obesity MONTH
Childhood Obesity Facts and Figures*
Obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.
Children and adolescents who are obese are
The percentage of obese children in
28% of adults in the GREATER CHARLOTTESVILLE area were obese.
eleven increased from 7% in 1980 to nearly
Healthy lifestyle habits, such as
the U.S. between the ages of six and 18% in 2012.
More than 1/3 of children and adolescents are currently overweight or obese.
likely to be obese as adults. Between 2008 and 2010, approximately
maintaining a proper diet and engaging in regular physical activity, can lower
the risk of becoming obese and developing related conditions such as
diabetes, high blood pressure and heart disease.
and exercising tips at www.move2healthcentralva.org
The Community Action on Obesity (CAO) was organized in
Move2Health is a community-
1999 to raise community awareness
residents of the Thomas Jefferson
of the problem of obesity, particularly
Health District (TJHD) – comprised
in children based on height and weight
of the City of Charlottesville and
received from Charlottesville City
Albemarle,
wide campaign created to encourage
Fluvanna,
Greene,
schools. It's composed of representatives from community agencies and
Louisa, and Nelson counties – to improve their health by adding more
private partners with a shared vision to create a supportive community that
physical activity into their daily routines. Participants are asked to
fosters healthy weight and overall fitness for citizens of the community.
log the number of minutes they move so a district-wide count can be
The CAO strives to provide innovative solutions to the obesity problem and recognizes the importance of organizational partnerships working collaboratively to find solutions and develop strategies that address the needs of everyone in the community – resulting in a collective impact on obesity.
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Check out great healthy eating
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
established. With the community counter on our website, we can all watch our community’s progress and challenge each other to increase our activity levels. Each minute logged every day is another step closer to a healthy community! *Source: www.cdc.com and www.move2healthcentralva.org
October is
Breast Cancer Awareness Early Detection is Crucial Did you know there is an alternative to oral and topical antibiotics in treating moderate acne? BLU-U® light treatments are gentle and typically well tolerated by patients. Ask your dermatologist for more info.
Charlottesville Dermatology www.cvillederm.com
September is
Prostate Cancer Awareness Month
Ways to Reduce the Risk Although there is no proven prostate cancer prevention strategy, there are steps men can take to reduce their risk of developing the disease. Consider these healthy choices: • Maintain a low-fat diet • Increase the amount of fruits and vegetables consumed daily • Replace red meat with fish, chicken and other lean meats • Reduce intake of dairy products • Replace sodas with water & green tea • Incorporate soy into your diet • Limit consumption of alcohol
Month
When breast cancer is detected early, in the localized stage, the 5-year survival rate is 98%* *National Cancer Institute
care provider. Breast self-exam (BSE) is an option for women starting in their 20s.
Ways to Reduce the Risk
• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health
Although you cannot prevent cancer, some habits that can help reduce your risk are:
• Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over
• Maintain a healthy weight
• Women should know how their breasts normally look and feel and report any breast change promptly to their health
• Stay physically active • Eat fruits and vegetables • Do not smoke • Limit alcohol consumption
Get Involved in the Fight! Interested in participating in a local event in support of Breast Cancer Awareness Month? Here are some ways you can get involved:
Brides Against Breast Cancer • WHAT: Charity Wedding Gown Sale and Bridal Show • WHERE: Morais Vineyards and Winery | Bealeton, Virgina (Located just outside north Charlottesville, this venue makes a wonderful day trip!) • WHEN: September 28th, 2014 For more information, visit the event website www.bridesagainstbreastcancer.org The revenue generated by Brides Against Breast Cancer makes it possible to deliver FREE information and services to thousands of children and adults impacted by cancer. Brides Against Brides Cancer will contribute $2 million dollars to help people impacted by cancer this year.
• Maintain a healthy weight • Exercise most days of the week Age, gender and family history all play a role when it comes to prostate cancer. Maintaining regular appointments with a primary care physician and having necessary testing performed are important steps to take to ensure early diagnosis.
12th Annual Race to Beat Breast Cancer 5K Run/Walk • WHAT: Come out this year for the 12th Annual Race to Beat Breast Cancer 5K Run/Walk. • WHERE: Westover Park | Harrisonburg, VA • WHEN: October 25, 2014 • Last year about $15,000 was raised for Rockingham Memorial Hospital Breast Cancer Treatment and brought in about 530 participants. Help to match that or do better in 2014! • Registration is available online, visit www.active.com
ON THE WEB
More at ourhealthcville.com www.OurHealthCville.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
INTRODUCING
OURHEALTH SHENANDOAH VALLEY AND CHARLOTTESVILLE The cover of this inaugural edition of OurHealth Shenandoah Valley and Charlottesville magazine is a one-of-a-kind painting of Skyline Drive, the historic, 105-mile scenic highway that traverses throughout the Shenandoah Valley and towards Charlottesville. We considered several options for our cover Image. But in the end, we felt honoring a stretch of rural road that is widely recognized as a beacon of consistency, a celebration of local heritage and an eventual path to cities and counties offering bountiful opportunities best symbolized our own direction.
How We Started Fifteen years ago, I began my career in healthcare in the Roanoke Valley. During the first seven years, I worked at two major healthcare systems in the communications, marketing, advertising, and public relations fields. In short, I was responsible for getting the word out to the community about local healthcare services, procedures and advancements. I loved my jobs at the healthcare systems. I loved learning about new and existing medical advancements that were helping people in our community. I loved talking with doctors, nurses and other healthcare professionals about what they do and why they devoted their lives to it. I loved interviewing local patients and hearing stories about beating the odds and fighting against the odds. I especially loved that we had access to such high quality care options in our own backyard. And I believed the depth of healthcare and health-related services offered in our communities, both at the health systems and independent level, needed a consistent medium to share all the good being done - good that can help educate and save lives.
Out of this passion became OurHealth OurHealth is a local magazine and online resource exclusively focusing on healthcare and healthcare-related services available in the communities in which it is published. It started in 2006 with the OurHealth Southwest Virginia edition, which covers the Roanoke and New River Valleys. And it has grown since. In 2008, we introduced OurHealth Lynchburg and Southside. In 2012, we introduced OurHealth Greater Richmond. Now, we are proud to bring this community-dedicated healthcare resource to the Shenandoah Valley and Charlottesville communities with this inaugural edition. I can say with 100% certainty that our growth is because we have stayed true to our original guiding principles: • keep each publication’s content specific to the community in which it is published; and
Reprints To order reprints of the original artwork featured on this issue’s cover, contact Jenny Hungate at 540.387.6482 or via email at jenny@ourhealthvirginia.com.
• ensure our content is not only informative and credible, but also making a difference in the health of individuals and families. This commitment will undoubtedly continue with OurHealth Shenandoah Valley and Charlottesville. We are committed to being your resource for local healthcare and healthcare-related information. If you have any questions or ideas, please contact me. Stephen C. McClintic, Jr.
To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com
Publisher steve@ourhealthvirginia.com www.OurHealthCville.com
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deathBY
sunshine words | RICK PIESTER
Summer’s pretty much over and days at the beach are becoming numbered, so the threat of skin cancer is behind us for another year, right?
WRONG. While it may hold center stage during the summer, that “lucky ol’ sun” is also very much with us during the rest of the year—while we’re skiing, golfing or hiking, sitting in the stands at a football game, or doing just about anything during daylight hours. Most skin cancers are linked to ultraviolet (UV) light rays emitted by the sun. According to Fiona Fang, MD, of Charlottesville Dermatology, about 80 percent of all skin cancers are associated with exposure to the sun’s UV rays. “It’s the single biggest risk factor for skin cancer,” she notes. And according to the Skin Cancer Foundation, 65 percent of melanomas—the most deadly of skin cancers—are caused by exposure to the sun’s rays. Although the American Cancer Society says that skin cancers are the most preventable of cancers, they are alarmingly common—more than 3 ½ million skin cancers are diagnosed every year, more new cases of the disease than cancers of the breast, prostate, lung, and colon combined.
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The good news from the Cancer Society, however, is that skin cancers are also the most curable of cancers, if caught early. “Skin cancer” is actually an umbrella term for a variety of cancers that develop most readily on areas of the skin that are exposed to the sun—the face, lips, scalp, ears, neck, chest, hands and arms, and (in women especially) on the legs. But they can also appear on areas of the body that are rarely exposed to the sun. Skin cancers occur in people of all skin tones, from light to dark.
The more common forms of skin cancer include: Basal Cell Carcinoma
This most common form of skin cancer occurs in the deeper layers of the epidermis, which is the outer layer of your skin. It is usually found in the sun-exposed areas of the body, such as the face or neck. Early basal cell carcinoma might look like an open sore on the skin, or it might look like a red patch of skin, or a pearly, waxy bump. Basal cell carcinomas rarely spread beyond the original site, but they are not to be taken lightly; they can be terribly disfiguring.
Squamous Cell Carcinoma
Pronounced SKWAY-mus, this is another type of skin cancer that usually occurs in the upper layers of the epidermis. Like basal cell carcinoma, a squamous cell carcinoma can look like scaly red patches of skin, an elevated growth on the skin with a depressed area at the center, an open sore, or a wart. If allowed to grow, this skin cancer can become fatal.
Melanoma
Dr. Fang says that this type of cancer is “thankfully rare,” because this is the most dangerous form of skin cancer. Damage to your body’s DNA caused by the sun results in skin cells multiplying rapidly and forming tumors that are malignant. Melanomas can look like moles, and often develop from moles. Most melanomas are black or brown in color, but they can also be flesh-colored, as well as pink, red, or other colors. When it’s identified and treated early, it is usually curable. But if undetected or ignored, a melanoma can spread to other parts of the body, become very difficult to treat, and it can be fatal. Heredity as
More than 3.5 million skin cancers are diagnosed every year. well as the sun plays a role in the development of melanoma. If you have a parent, a child, or a brother or sister who has been diagnosed with melanoma, you have a 50 percent greater chance of developing melanoma yourself. Dr. Fang notes also that people who have had an earlier melanoma are much more likely to develop others.
Treatment Options are Varied Fortunately, the more common basal cell and squamous cell carcinomas can be treated with comparatively minor surgery or various types of non-surgical treatments. Treatment of melanomas usually involves surgery, often in combination with chemotherapy or radiation therapy to kill or slow the growth of cancerous cells. Specific treatment for skin cancers is determined by the type and size of the cancer, where it’s located, and how far the particular cancer has progressed. The vast majority of people with a skin cancer that is detected early need only a simple skin biopsy. That’s a procedure (done in the physician’s office) to remove a small sample of skin in the affected area. The skin sample is then examined under a microscope. Very often, taking the skin sample also removes the entire growth.
If further treatment is required, some of the options include:
Fiona Fang, MD, is a board certified dermatologist at Charlottesville Dermatology. Her interests in dermatology include general medical dermatology, pediatric dermatology, and international health.
Cryosurgery
Some small, early skin cancers can be removed by freezing them with liquid nitrogen.
Excisional Surgery
A physician cuts out the cancerous tissue and a surrounding margin of healthy skin, which is then examined by microscope to be sure that all of the cancerous tissue has been removed. www.OurHealthCville.com
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How to Perform a Skin Self-Exam
It’s important to know the pattern of moles, blemishes, freckles, and other marks on your skin so that you’ll notice any new moles or changes in existing moles. Your first line of defense is monthly skin self-examination. It’s best to do a self-exam in a well-lit room in front of a full-length mirror. Use a hand-held mirror to help look at areas that are hard to see, such as the backs of your thighs. Examine all
areas, including your palms and soles, scalp, ears, nails, and your back. Friends and family members can also help you with these exams, especially for those hard-to-see areas, such as your scalp and back.
Use the Body Maps and Measurement Guide, provided courtesy of the Skin Cancer Foundation, on Pages 24 and 25 to aid in your skin self-exam.
Mohs Surgery
This procedure commonly used in areas of the body where it’s important to conserve as much skin as possible, such as cancers on the nose. In this surgery, skin is removed by micro-thin layers and each layer is examined until no more cancer cells remain.
Curettage and Electrodesiccation or Cryotherapy
After removing most of a cancerous growth, a physician removes remaining layers of cancer cells using a device with a circular blade (curet). An electric needle then destroys any remaining cancer cells. Liquid nitrogen can also freeze the treated area, as it does with cryosurgery.
Radiation Therapy
High-powered beams of energy kill cancer cells, an option when cancer can’t be completely removed during surgery.
Chemotherapy
Drugs, often in the forms of creams or lotions, are used to kill cancer cells on the top layers of the skin.
Photodynamic Therapy
Drugs that make cancer cells sensitive to light are used in combination with laser light to destroy cancer cells.
Biological Therapy
Biological treatments stimulate your body’s immune system to kill cancer cells.
Prevention is the Key Dr. Fang reminds us that most skin cancers are preventable, and for the most part, prevention involves just a few simple changes in your regular routine. Here are some of them:
Wear Sunscreen Year-Round
“A lot of our patients simply don’t know how to use sunscreen,” Dr. Fang says. Use a broad-spectrum sunscreen with an SPF of at least 30. Apply it generously, and reapply every two hours—or more often if you’re swimming or perspiring. Use sunscreen on all exposed skin, including your lips, the tips of your ears, and the backs of your hands and neck. 22
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And remember that cloudy days offer very little protection from the damaging rays of the sun.
Avoid the Sun During the Middle of the Day
The sun’s rays are stronger between noon and about 4 PM in North America, so it’s always a good idea to schedule outdoor activities during other times of the day. For many parts of North America, the sun’s rays are strongest between about 10 a.m. and 4 p.m. Schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy.
Protective Clothing Helps
Sunscreens help a lot, but they don’t provide complete protection from damaging rays. So wear clothing that covers your arms and legs, and a broad-brimmed hat, which provides more protection than a baseball cap or visor does. And wear sunglasses.
Avoid Tanning Beds
There’s a reason that sun tanning parlors in Virginia are required to post conspicuous warnings on the dangers of tanning beds. Lights used in tanning beds emit UV rays and can greatly increase your risk of skin cancer.
Know About Sun-Sensitizing Medications
Some common prescription and over-the-counter drugs, including antibiotics, can make your skin more sensitive to sunlight. Ask your physician or pharmacist whether medications you are taking make you ultra-sensitive to sunlight, and take extra precautions if they do.
Check Your Skin, and See Your Dermatologist Regularly
Examine your skin often for new skin growths or changes in existing moles, freckles, bumps and birthmarks. And a regular exam by a dermatologist—with a schedule based on your lifestyle and your medical history—is the best way to seek the sun safely. Note: For much more detailed information on prevention, identification, and treatment of skin cancers, visit The Skin Cancer Foundation page at www.skincancer.org.
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body maps
Anatomy
reprinted with permission from The Skin Cancer Foundation
the
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reprinted with permission from The Skin Cancer Foundation
THREE WOMEN’S STORIES OF
words | MICHELLE STEPHENSON photography | KG THIENEMANN
Breast cancer hurts. It hurts the people it has inflicted. It hurts the families and friends who see their loved one endure it. It even hurts those who don’t even know they may have it.
But it doesn’t have to. Breast cancer is a disease. And it can be cured if caught early. The following stories provide insight from local people who have battled breast cancer and what they would have done differently to beat it earlier. Rosaline Blair was a 47-year-old, uninsured, McDonald’s employee when she went to a free clinic for her yearly mammogram in October 2012. Shortly thereafter, the clinic called and asked her to come back for a second mammogram and then a biopsy. A month later, they called her at work with the news. Rosaline had breast cancer. “I had to leave work because I was so upset. I called my husband, and then my husband called my aunt who lives next door because he wouldn’t get home until late, and he wanted someone to be with me,” Rosaline says. When she was diagnosed with cancer, the free clinic said they could no longer see her, and they filled out the paperwork for her to apply for Medicaid. Along with her husband, daughter, son, and daughter-in-law, Rosaline went to her first doctor’s appointment to learn about the treatment options.
Rosaline Blair
STUARTS DRAFT, VA www.OurHealthCville.com
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What is Chemo Brain or Cancer Brain Fog? Most doctors define it as a decrease in mental “sharpness” – being unable to remember certain things and having trouble finishing tasks or learning new skills.
Here are just a few examples of what patients call chemo brain: • Forgetting things that they usually have no trouble recalling (memory lapses) • Trouble concentrating (they can’t focus on what they’re doing, have a short attention span, may “space out”) • Trouble remembering details like names, dates, and sometimes larger events • Trouble multi-tasking, like answering the phone while cooking, without losing track of one task
• Taking longer to finish things (disorganized, slower thinking and processing) • Trouble remembering common words (unable to find the right words to finish a sentence) For most people, brain effects happen quickly and only last a short time. Others have long-term mental changes. Usually the changes that patients notice are very subtle, and others around them might not even notice any changes at all. Still, the people who are having problems are well aware of the differences in their thinking. Many people don’t tell their cancer care team about this problem until it affects their everyday life. (source www.cancer.org)
The news wasn’t good. Rosaline learned she had two different types of cancer in two different places in the same breast. A lumpectomy surgery was needed immediately. “I got scared, and on the day of surgery, I called and canceled it. I just needed more time to think about it,” Rosaline says. An hour after she cancelled, Rosaline’s doctor’s office called and convinced her to reschedule the surgery. Two weeks, she underwent two lumpectomies. “Once I went through the surgery, I never looked back. I knew that I was going to be okay. I had a good team,” she adds.
Shanique Palmer, MD specializes in Medical Oncology/Hematology at the Augusta Health Cancer Center
What is a lumpectomy?
A lumpectomy is a is surgery to remove cancer or other abnormal tissue from the breast. A lumpectomy is also called breast-conserving or breast-sparing surgery because—unlike a mastectomy—only a portion of the breast is removed.
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“In Rosaline’s case, she required surgery followed by chemotherapy for 18 weeks. She also took Herceptin®, a medication that inhibits the protein that can cause tumor growth. Rosaline continued this treatment for a year, in addition to radiation. She is now on hormonal therapy,” explains Shanique Palmer, MD, an oncologist with Augusta Health Cancer Center. Rosaline didn’t fight this battle alone. She says that a family member accompanied her to every doctor appointment, chemotherapy and radiation session. Having family by her side made a huge difference in her ability to get through. But she doesn’t sugar coat the challenges, because, as she puts it, “It’s not an easy path and you need to know about the bumps in the road.” “I couldn’t eat for seven days after the big treatments. I could only eat watermelon and Jell-O. And chemotherapy made me forget stuff. They call this ‘chemo brain’. I had to go to the doctor every day, so I couldn’t work,” she says. “But the alternative was worse. I endured it, and I am here.” Rosaline finished chemotherapy in June of 2013 and is currently cancer-free. “My doctor said he got it all out. I will now take a pill for five years to keep the cancer from recurring,” she explains. With three children and two grandchildren, Rosaline says she “just put it in the Lord’s hands, and I never looked back.” “Rosaline and I have become pretty good friends,” explains Dr. Palmer. “During the year that I have known her, she has come around a great deal. She was very emotional in the beginning, as expected. There were times when I was trying to communicate with her, and she would just break down in tears. Our breast health navigator was a big support to her during those initial days.
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Now, she is very cheerful and very jovial. And she is just a good person. She always has been. You could see the difference in her emotional state as time went on.” “Despite all my challenges, I feel so blessed to still be here. To be with my family and all my loved ones. I am truly, truly blessed,” she says. Although Rosaline did not have insurance when she was diagnosed, she received exceptional care through Medicaid. Medicaid paid for a large part of her treatment and her medications. “I pay a nominal fee for prescriptions, and medical bills. In April of this year, a local church hosted a cancer benefit and honored my and me. They gave us a lot of gifts and a monetary donation,” she says.
What is a breast health navigator? Breast Health Navigators (BHN) are nursing professionals who are specially trained to coordinate the clinical, educational and supportive needs of patients who are either facing a possible breast cancer diagnosis or are newly diagnosed with breast cancer. The BHN is available to help patients and their families through the healthcare system connecting them with the appropriate resources and support. The Breast Health Navigator's role includes: • Obtaining a focused patient history
• Providing clinical breast exams • Assisting patients in the interpretation and understanding of test results • Working with providers to facilitate the scheduling of diagnostic tests • Assessing and referring patients who are at high risk for developing breast cancer for genetic counseling • Serving as a resource to patients diagnosed with breast cancer or benign breast changes
Medicaid coverage varies depending on an individual’s circumstances. However, if a person does not have insurance and is suffering from a health condition, it is an option that may be available to help ensure treatment is provided. Dr. Palmer explains that Rosaline’s prognosis is good. “With breast cancer, there is a saying that you are not considered cured until you die of something else. It is one of those cancers that can recur 20 or 30 years down the road. However, the first five years are perhaps the years when the risk is highest. We say cancer-free after then, but we are still very vigilant. We want to beat this disease completely. Until then, we will be here for Rosaline, as well as all other patients fighting cancer. We never give up,” concludes Dr. Palmer.
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Double Trouble In June 2013, Carolyn Bramble (also fondly known as Lily) began experiencing some gynecological issues.
Shortly before her appointment with her gynecologist, Lilly did her regular breast-self exam (visit www.breastcancer.org/ symptoms/testing/types/self_exam/bse_steps to learn more about a breast-self exam) and discovered a lump in her left breast. Lily shared her concern about the lump with her gynecologist. So, in addition to scheduling Lily for a uterine biopsy for her gynecological concern, she also scheduled her for further testing on her breast, which ultimately resulted in a breast biopsy.
A biopsy is an examination of tissue removed from a living body to discover the presence, cause, or extent of a disease. “A week or so later, my gynecologist called me with the results that both were positive for cancer. I really didn’t know who to turn to or what to do because I never had any real health issues,” explains Lily. Lily's gynecologist referred her to Shayna Showalter, MD, a surgical oncologist at the University of Virginia Medical Center’s (UVAMC) Breast Care Center in Charlottesville and Susan Modesitt, MD, a gynecological oncologist, also with UVAMC.
photos courtesy of Lily Bramble
Carolyn L ‘ ily’ Bramble
LOUISA, VA
What is Ductal Carcinoma?
After further testing and additional biopsies, the news was not good. Dr. Showalter confirmed the diagnosis of ductal carcinoma (see box below), and Dr. Modesitt confirmed the diagnosis of uterine cancer. Lily was faced with some very difficult decisions. Decisions that would change her life, but also saved it. “Lily had stage II breast cancer, and she had the choice to be treated with either breast-conserving surgery, which is a lumpectomy followed by radiation, or mastectomy, which requires reconstruction of the breast with a plastic surgeon,” explains Dr. Showalter. “We talked a lot about the pros and cons of those two options, and she was adamant that she wanted to attempt breast conservation.”
Ductal carcinoma in situ (DCIS) – is the most common type of non-invasive breast cancer. DCIS means that the cancer is only in the ducts and has not spread through the walls of the ducts into the tissue of the breast. Nearly all women with cancer at this stage can be cured. Often the best way to find DCIS early is with a mammogram. 30
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What is a robotic da Vinci hysterectomy? Puppies Shay (left) and Sweet Sue, named after Drs. Showalter and Modesitt.
To treat her uterine cancer, a hysterectomy was an option to be performed. Lily decided to undergo a lumpectomy and a hysterectomy, and, although it hadn’t been done by Dr. Showalter and Dr. Modesitt before, she asked to have both surgeries done on the same day. Lily also decided to forgo chemotherapy. “With a lot of hard work, I was able to coordinate the surgery with Dr. Modesitt, so we could do both surgeries on the same day,” Dr. Showalter says. On September 30, 2013, Lily went to UVAMC and underwent breast surgery first. “They did a lumpectomy and also took three lymph nodes and checked those. Then, when that surgery was complete, I had a robotic da Vinci® hysterectomy” Lily explains. Dr. Modesitt examined 35 of my lymph nodes, and they came back negative for cancer cells. I was in the hospital overnight, and the next day, I was ready to go home.” This journey was not as easy as it sounds, however. The treatment was fraught with health insurance issues. “My doctors have fought for me. Insurance companies are not the most willing participants,” she says.
Using da Vinci System technology, surgeons are able operate through a few small incisions instead of a large open incision - similar to traditional laparoscopy. The da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables surgeons to operate with enhanced vision, precision, dexterity and control. The surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body.
Dr. Showalter said that UVAMC is not in the network of Lily’s health insurance. “We had to put in pretty significant petitions to her insurance company to get her treated at UVAMC. It was so important to us at UVAMC, and most especially important to Lily, for us to get the issue resolved so we could treat her. We actually had a surgery date scheduled, and finding an operating room at a time when both doctors were available was more complicated than you can even imagine. We almost had to delay it because she hadn’t received the approval from her insurance. We figured it out at the very last second. We never gave up,” she explains. The first two requests were denied by the insurance company. Dr. Showalter and her staff also petitioned to get the breast radiation done at UVAMC. “Her breast cancer was on her left side, and we tell people with left-sided breast cancer about the effects of radiation on the heart. There are techniques that our radiation oncologists can do that other places can’t do in order to protect the heart and lungs. Petitioning the insurance company is time-consuming. I have a great nurse who was able and willing to help, and Lily was savvy enough to realize that she would benefit from specialized care,” Dr. Showalter says. Throughout her diagnosis and treatment, Lily has remained amazingly upbeat. “I haven’t worried that much about the cancers. It is what it is.
Susan Modesitt, MD as a gynecological oncologist, also with UVA Medical Center
Shayna Showalter, MD, a surgical oncologist at University of Virginia Medical Center’s Breast Care Center in Charlottesville
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worried that much about “ Ithehaven’t cancers. It is what it is. Even during my recovery period, I just kept moving forward. I’m a very energetic and active individual. I’m very healthy. This knocked me off my feet for a week or two, but I needed that down-time.
”
Lily Bramble
Even during my recovery period, I just kept moving forward. I’m a very energetic and active individual. I’m very healthy. This knocked me off my feet for a week or two, but I needed that down-time,” she says with a smile. Lily is very active in the community. She is the president of her local rescue squad, and she volunteers at the Louisa Animal Shelter and for Meals on Wheels. Just before her cancer diagnosis, she rescued a dog from the shelter, and a month later (a week before her diagnosis), the dog had 11 puppies. Lily was so grateful to everyone at UVAMC for her care that she named all 11 dogs after her team of doctors. “I sent them all a picture of their dog,” she adds. She kept three of the 11 puppies, and two of those are named after Drs. Modesitt and Showalter (Sweet Sue and Shay). “Dr. Showalter and Dr. Modesitt saved my life, and I know that. I am forever in their debt. I know that my dogs were sent to me to distract me. They are my earth angels,” she adds. Lily is continuing her recovery. “I can’t walk dogs at the shelter. I’m still getting the strength back in my left arm. I can’t volunteer at Meals on Wheels because I can’t lift the heavy coolers. But I am getting there,” she concludes.
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Linda Payne
CHARLOTTESVILLE
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Providing Care for Those Without Insurance words | MICHELLE STEPHENSON photography | KG THIENEMANN
In 2002, Linda Payne went with her mother and sister to a free breast screening at Martha Jefferson Hospital to have a mammogram. When one of the nurses called with the results, Linda refused to answer the phone. “I was unemployed, and I didn’t want to know if something was wrong. After the nurse called me several times, she left a message saying that she just really needed to talk to me. Finally, I called her back and asked her not to tell me anything because I didn’t want to know. I was uninsured, and I just didn’t have time to deal with it because I was looking for a job. If I had thousands of dollars in medical bills, I would lose my car, my house, everything,” says Linda. The nurse then told her about a program called Every Woman’s Life that would pay for her care. Linda returned to Martha Jefferson for several more mammograms and an ultrasound. “I started to worry at this point because they had done so many mammograms, they must be seeing something. Next, they said they were going to send me for a biopsy. I did the biopsy without anesthesia, and it really hurt. Then, I got a phone call asking me to come in to talk about my results. When I went in, they told me that I had Stage I breast cancer. I just went into a fog. I could hear what the doctor was saying but, ‘you have Stage I breast cancer’ kept repeating itself in my head,” she says. The doctor explained her treatment options. “If there was cancer in the lymph nodes, they would take both breasts. I never really thought about my breasts before that. You start thinking in ways you never imagined,” says Linda. Linda’s husband of 41 years was very supportive. “He said, ‘Linda, if it’s going to save your life, just take them. It doesn’t matter,” recalls Linda. “It turned out that they just did a lumpectomy,” explains Linda. The lumpectomy was followed by brachytherapy, which is a form of radiation. “They insert a balloon-type object in your chest in the spot where the lump was removed. They blow the balloon up, and then the radiation goes into your chest. The first two nights I had to sleep sitting up. It literally felt like I had a 20-pound weight on my chest. It wasn’t heavy. It was just the feeling from where the balloon was expanded,” she explains. She underwent an x-ray before every brachytherapy treatment to make sure that the balloon had not moved. After completing brachytherapy, she met with an oncologist to discuss hormone replacement therapy and the chances of the cancer recurring. “Because I didn’t have cancer in my lymph nodes, I had a less than 10 percent chance it returning. I had read about all these side effects you can get from hormone replacement therapy, so I really didn’t want to take it,” she says.
Every Woman's Life (EWL) is a public health program that helps medically under-served, uninsured, low income women gain access to free breast and cervical cancer screening services. EWL has served over 24,000 women since 1998. They provide breast and cervical cancer screening services for women ages 40-64. Additional state funds are used to screen symptomatic women ages 18-39. Screening and early detection reduces death rates, improves treatment options, and greatly increases survival. Please visit www.vahealth.org/EWL or call 866.EWL.4YOU to find out if you are eligible for services and to find the provider site nearest you.
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For the first few years after her diagnosis, she saw the doctor twice a year, and now she continues to see a doctor once every year.
October 25: Free Breast Screening at Martha Jefferson The Women’s Committee at Martha Jefferson hosts two free breast screenings a year, and the next one is scheduled for October 25. These screenings are for women in Central Virginia who don’t have health insurance and who would otherwise not be able to see a doctor for breast exams and mammograms. “Originally, we were doing 20 women at each clinic. We now have spots for 60 women twice a year. Just in the last 4 years, we have diagnosed 4 women with breast cancer in whom we got it at an early stage. Otherwise, these women may not have been able to have mammograms,” says Mary Beth Revak, RN, BSN, OCN, Breast Health Liaison at Martha Jefferson. Physicians and nurse practitioners are available to conduct the breast exams, and the women have mammograms on the same day. If a patient requires followup care, the Women’s Committee will arrange for payment for that as well. In addition to the twice-yearly free screenings, no woman is ever turned away from Martha Jefferson’s mammogram department if she cannot pay. If a patient doesn’t have insurance and is having a breast problem, she should contact Ms. Revak. “I know that the women’s committee will always go out of their way to make sure that these women are helped,” she says.
Since 1993, The Women’s Committee of Martha Jefferson Hospital has supported many women’s healthcare programs with the emphasis on Breast Health. Through the tremendous success of their
“Without the Every Woman’s Life program, I probably wouldn’t have gone back for the second mammogram, and I probably wouldn’t be talking to you today. I 100% wouldn’t have had the first mammogram had it not been for the free screening. Since this has happened, I wear a breast cancer ribbon every day because if people see it, they can ask me about it, and I can tell them that they have a chance of surviving it. Make sure you get your mammograms, and make sure you do self-checks,” advises Linda, who is currently employed as a family counselor. Mary Beth Revak, RN, BSN, OCN, a breast health navigator at Martha Jefferson Hospital, says that MJH is very grateful that it can provide this service to women without insurance. “Certainly, most of them have their minds put at ease because we don’t find anything wrong. For those few who do have something wrong, it can save their life. The Women’s Committee has set aside money to pay for everything up to and including biopsy,” she says. After a biopsy and diagnosis, women meet with social services and financial counselors at MJH to determine if they are eligible for aid. “Some people are eligible for Medicaid, for those that are not, there are many different types of assistance programs that our counselors put people in touch with,” she adds.
fundraising events, including Martha’s Market, In-The-Pink Tennis Tournament, and Squash Cancer Tournament, the Women’s Committee has raised over $4 million in support of areas such as breast health, technology, women’s midlife health, heart disease and outreach to underserved populations.
Upcoming Dates • In The Pink Tennis Tournament ~ Saturday, September 27 • Martha’s Market ~ October 10-12 • Squash Cancer Tournament ~ Sunday, November 16 For additional information visit www.mjhfoundation.org
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Women’s
CHART for HEALTHY AGING
OBSTETRICS & GYNECOLOGY
While aging for women can be felt in “our bones” and in our stamina and cause us distress, it should instead be looked upon as a privilege to experience a different chapter in our lives. We have much for which to be grateful, and the key to understanding that is taking care of our mind and our body.
The most important gift you can give yourself is a healthy diet, weight bearing exercise, and lots of water. Well balanced and nutritious eating habits help us to maintain a better body weight and keep us more mobile and energetic. Weight bearing and cardiovascular exercise maintains our mobility, strengthens our bones, and increases our endorphins, endogenous chemicals that make us happy. Hydration is key to maintaining mental health, younger looking skin, and good renal function. Equally important is tending to your medical needs. A regular examination, including a pelvic exam that assesses for cervical, uterine, and ovarian cancer, is a must. Knowing your family history will allow your provider to best manage your care. Scheduled laboratory studies permit an evaluation of renal health, liver health, thyroid health, chemistries, and blood counts. This permits adjustments as needed. Vitamin D is especially important, as it keeps our joints strong and pain free, strengthens our bone structure, aids restfulness, and strengthens mental health. An annual mammogram is essential – today we can find breast cancers very early so they are curable and no longer a death sentence. Colonoscopy on a schedule prevents colon cancer and the havoc it can bring to us and our families.
PEDIATRICS Early infancy can be one of the most vulnerable periods in a child’s life. Newborn screening helps pediatricians to identify certain life-threatening conditions that could otherwise go undetected until serious complications develop. A few drops of blood collected from the heels of all new babies has become one of the most vital screening tests in a child’s life. With it in the state of Virginia, 28 different disorders including problems with metabolism, congenital hypothyroidism, cystic fibrosis, and sickle cell disease can be identified shortly after birth. Although none of these conditions are curable, early diagnosis and treatment saves lives. Sarah E. Knight, MD Pediatric Associates of Charlottesville, PLC 1011 East Jefferson St | Charlottesville, VA 434.296.9161 | www.charlottesvillepeds.com
Finally, but equally important, is our sexual health. It is important to feel good about who we are and our sexuality. Sexually active older women are known to receive general health benefits from their relationship. Regular activity helps to maintain the interest, as inactivity can permit a decrease in libido to predominate. Relationships benefit from a mutually beneficial intimacy. Additionally, being proactive regarding incontinence will keep us confident and socially involved, as well as supporting that general sense of well being. Catherine M. Slusher, MD Harrisonburg OB/Gyn Associates 2291 Evelyn Byrd Avenue | Harrisonburg, VA 540.434.3831 | www.harrisonburgobgyn.com www.OurHealthCville.com
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Breaking the Silence
Pancreatic Cancer
words | SUSAN DUBUQUE photography | COURTESY OF THE UNIVERSITY OF VIRGINIA
This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them. That is, until now. We will bring these “orphan” diseases into the light—and dedicate these stories to the courageous patients and families living with them and the providers and researchers who commit their lives to treating and seeking cures for these silent killers.
Game On: Debbie Ryan’s Story She’s a formidable coach of national and international acclaim, with a career spanning 34 years and 736 victories. Architect of the University of Virginia’s women’s basketball program. Inductee into the Women’s Basketball Hall of Fame. Yet not one of these accomplishments can come close to the most significant victory of her life—beating pancreatic cancer. In late 1999, Debbie Ryan was already a coaching legend—by now taking her team to the NCAA tournament was SOP. But a nagging stomachache prompted her to seek medical attention. “The problem kept coming and going,” recalls Debbie, “and initial imaging tests didn’t show anything abnormal.” In August 2000, as Debbie was coming home from a recruiting trip, a particularly severe episode sent her reeling. She saw a gastrointestinal specialist at UVA Health System, who performed an endoscopy. The results were devastating—a tumor in the pancreatic duct.
“I knew the odds. I had done my research,” says Debbie. “Everyone dies.” But Debbie did defy the odds. And 14 years later she is considered “cured.”
This was no easy battle. “Imagine something as personal as struggling with cancer being waged on the front page of USA Today,” recalls Debbie. “And other coaches tried to use my health issues against me. I was battling for my career and my life.” But she wasn’t fighting alone. Virginia State Senator Emily Couric was diagnosed with pancreatic cancer just three weeks before Debbie. “We went through our treatment together—but sadly Emily’s cancer was inoperable.” Joined by this common experience, Debbie and Emily Couric spent their time together in chemotherapy plotting and planning. “We distracted ourselves from the fear and pain of cancer treatment by designing a new cancer center. We thought about every little detail of the experience—from the mediation garden and exercise facilities, right down to the robes,” says Debbie. The new UVA Cancer Center became a reality and the facility bears the name of Emily Couric Clinical Cancer Center.
Retired UVA Women’s Basketball Coach, Debbie Ryan, is now an advocate for pancreatic cancer research and funding.
Although Debbie Ryan retired from coaching in 2011, her role as an inspirational leader is far from over. Debbie is on a new mission—to create awareness of pancreatic cancer and help raise money for research. “Only four percent of pancreatic cancer patients survive more than five years,” remarks Debbie, “so there is no one to carry the flag.” It’s clear that this cause now has a bold new champion. “We need to better understand the ‘genetic triggers’ for this cancer so we can figure out how to prevent the disease,” says Debbie. “And we need to assume personal responsibility. Pancreatic cancer has a ‘sweet tooth’—by eating whole, healthy foods and exercising we can reduce the likelihood of flipping the trigger.” If there were a Hall of Fame for cancer survivors, there is little doubt that Debbie Ryan would be its first inductee.
It’s time to get this conversation started. Let’s talk frankly and openly about pancreatic cancer—the nature of the disease, risk factors, current treatments and what the future holds. The pancreas—it’s one of those organs that we all know we have, but its purpose is a little muddled. So let’s begin with the most fundamental questions—what is the pancreas and what does it do? 40
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The pancreas is an organ in the abdomen that sits in front of the spine above the level of the bottom of the breastbone. It performs two main functions. First, it makes insulin, a hormone that regulates blood sugar levels. Second, it makes enzymes that help break down proteins so they can be more easily absorbed by the body and used for energy. Enzymes leave the pancreas through a system of tubes called “ducts” that connect the pancreas to the intestines. The pancreas is close to many important structures like the small intestine (called the duodenum), the bile ducts, blood vessels and nerves.
Understanding Pancreatic Cancer Pancreatic cancer makes up only three percent of all cancers, yet it is the fourth leading cause of cancer-related deaths among both men and women in the United States. Cancers of the pancreas fall into two major categories—endocrine and exocrine. Cancers of the endocrine pancreas—the part that makes insulin and other hormones—are called “islet cell” or “pancreatic neuroendocrine” cancers. Islet cell cancers are rare and typically grow slowly. These tumors often release hormones into the bloodstream, including insulin, glucagon and gastrin. Cancers of the exocrine pancreas—the part that makes enzymes—develop from the cells that line the ducts that deliver enzymes to the small intestine. These cancers—called pancreatic adenocarcinomas—compose 95 percent of all pancreatic cancers and will be the focus of this article.
Causes and Risk Factors There are more than 46,000 new cases of pancreatic cancer diagnosed each year in this country alone. But, most people who develop the disease have no known risk factors. There are cases that run in families, but these are rare. Perhaps the biggest risk factor is increasing age, as the majority of cases occur in individuals over the age of 60. African Americans may be at slightly greater risk, as well as individuals with close family members who have been diagnosed with the disease. These factors are all beyond our control. “But there are some behaviors that increase the risk of developing pancreatic cancer,” notes Dr. Struble, “including smoking, obesity, a sedentary lifestyle and a fatty diet.” Other factors associated with the disease are diabetes, chronic inflammation of the pancreas (called pancreatitis), stomach surgery and chronic infections such as hepatitis B. Despite these identified risks, there is no specific cause found in most people who develop pancreatic cancer.
Symptoms of Pancreatic Cancer
Erika Struble, MD, Medical Oncology/Hematology, Martha Jefferson Hospital
“The pancreas lies deep in the belly—and a cancer can grow silently for years before it is discovered,” says Dr. Struble. Symptoms may only appear once the tumor grows large enough to press on other nearby structures such as nerves (which causes pain), the intestines (which affects appetite and causes nausea and weight loss) or the bile ducts (which results in jaundice or a yellowing of the skin, loss of appetite and itching).
Todd W. Bauer, MD, talks about how UVA is working to more quickly identify patients at high risk for pancreatic cancer. Listen here: www.OurHealthCville.com
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Bauer Lab: Todd William Bauer, MD leads a laboratory research program in pancreatic cancer.
Different symptoms may occur if the pancreatic cancer metastasizes or spreads through the blood and lymph systems. Pancreatic cancer most commonly spreads to the liver, lymph nodes and the lining of the abdomen. At this time, there is no simple screening test for pancreatic cancer, and since the symptoms are often vague, most pancreatic cancers are found when the disease is in an advanced stage and has spread to other organs. Fortunately, University of Virginia (UVA) Cancer Center is breaking new ground in this field with its High-Risk Pancreatic Cancer Clinic. Established a year ago with funding from the Buchanan Endowment, this clinic is thought to be one of few of its type in the country. Todd Bauer, MD, surgical oncologist at UVA Cancer Center and director of the clinic, says, “We’re working with individuals who are at greatest risk to develop pancreatic cancer—aggressively screening them so we can detect the disease early—even at a pre-malignant stage. We also work with each patient to help them modify their behaviors—such as smoking cessation, diet modification and exercise—in an effort to prevent the disease.” “Looking down the road, our country is going to experience a huge increase in pancreatic cancer,” says Dr. Bauer. “With the aging population and dramatic increases in obesity and diabetes, pancreatic cancer is predicted to become the second leading cause of cancer deaths in the U.S. by the year 2020.”
How is Pancreatic Cancer Diagnosed? Todd William Bauer, MD, Associate Professor of Surgery in the Division of Surgical Oncology, director of the High-Risk Pancreatic Cancer Clinic, leader of the pancreatic cancer research program at UVA
Some people with pancreatic cancer first see their primary care physician complaining about digestive problems, weight loss or back pain. These complaints may be further evaluated with a physical examination, blood tests and, sometimes, X-rays and an ultrasound. When pancreatic cancer is present, an ultrasound will reveal an abnormality in the pancreas about 75 percent of the time. The next step in the process is likely to be a computed tomography (CT) scan. If a pancreatic mass is identified and cancer is suspected, a biopsy is performed to make a definitive diagnosis.
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“An endoscopic ultrasound may also be performed to help determine whether the mass can be removed surgically,” reports Dr. Struble. A blood test called CA 19-9 can be abnormally high in people with pancreatic cancer. Unfortunately, this test is not specific for pancreatic cancer—and it’s not perfect. Other cancers as well as some benign conditions can cause the CA 19-9 to be elevated, and about 10 percent of the time the CA 19-9 will be at normal levels in the blood despite a confirmed diagnosis of pancreatic cancer. However, tracking the rise and fall of CA 19-9 during the course of illness, may be useful in guiding treatment. “Progress against pancreatic cancer has been slower than we would like,” remarks Michael E. Williams, MD, chief of hematology/oncology for UVA Cancer Center. “But there is promise in next generation screening techniques—blood tests that look for markers for the disease. And until we discover a cure for pancreatic cancer, early detection offers the best hope.”
Michael E. Williams, MD, ScM, Byrd S. Leavell Professor of Medicine and Chief, Hematology/Oncology Division, UVA Health System
Treatments for Pancreatic Cancer Treatment options for pancreatic cancer vary depending upon the stage of the disease when it is diagnosed. Pancreatic cancer is broken into four stages—stage I being the earliest stage and stage IV being the most advanced. The four stages are categorized into three groups.
Local, Resectable Cancer (Stage I and II) Patients with stage I and II cancers are classified as having “local” or “resectable” cancers. These are cancers that are contained in the pancreas and can be completely removed with surgery—the only treatment today that can cure pancreatic cancer. The type of surgery typically performed to remove a pancreatic cancer is called a pancreaticoduodenectomy—but more commonly referred to as a “Whipple”—named after Dr. Allen O. Whipple, who first performed this procedure in 1935. “A Whipple involves removing a portion of the stomach, duodenum (the first part of the small intestine), pancreas, bile ducts, lymph nodes and gallbladder,” says Dr. Bauer. UVA Cancer Center takes great pride in having a high survival rate and outcomes for this incredibly complex surgery. “Ensuring a better outcome for patients with ‘curable’ pancreatic cancer,” says Dr. Bauer, “is a three-step process: surgery to remove the cancer, chemotherapy to kill any free-floating cells and radiation therapy to get at the ‘root’ of the cancer.” Unfortunately, only about 15 to 20 percent of the patients diagnosed with pancreatic cancer have tumors that can be treated surgically. The rest have tumors that are too advanced to be completely removed or have metastasized at the time of diagnosis.
Locally Advanced, Unresectable/Marginally Resectable Cancer (Stage III)
Pancreatic cancer is a harsh disease. Even for tumors that are discovered at an early stage and can be treated surgically, the risk of cancer recurrence is high.
If pancreatic cancer is diagnosed when the tumor has expanded to nearby major blood vessels but not spread to distant sites, this is described as “locally advanced” pancreatic cancer (stage III). At this point, the tumor cannot safely be removed with surgery and is therefore considered “unresectable.” Pancreatic cancer is an aggressive disease, and fortunately the specialists in this field are embracing treatment protocols that are just as aggressive. “We can offer a glimmer of hope to some stage III pancreatic cancer patients by classifying them as ‘marginally resectable,’ ” says Dr. Bauer. “Chemotherapy and radiation treatments are used to treat the tumor. Then, the patient is re-staged to determine if the tumor is now “resectable”—and can be removed surgically.” www.OurHealthCville.com
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“from the meditation garden and exercise facilities, right down to the robes” —The Emily Couric Clinical Cancer Center became the brainchild of both Debbie Ryan and Virginia State Senator Emily Couric. The Cancer Center is also home to one of the only High Risk Pancreatic Cancer Clinics in the country.
Metastatic Cancers (Stage IV) Once a pancreatic cancer has metastasized or spread beyond the pancreas to other organs it is classified as stage IV. At this point chemotherapy is used to fight the disease “systemically.” Chemotherapy travels through the bloodstream and can therefore attack a cancer that has spread wherever it is found in the body. In metastatic pancreatic cancer, chemotherapy is used to extend and improve the quality of life. Unfortunately the overall benefit is modest and chemotherapy prolongs life for the average patient by only a few months. Side effects of treatment for pancreatic cancer vary depending on the type of treatment. Radiation therapy tends to cause fatigue, nausea and diarrhea. Chemotherapy side effects may include fatigue, loss of appetite, changes in taste, hair loss and lowering of the immune system that can increase the risk of infections. Today, much better supportive medications are available to help patients manage side effects. But the discomfort of treatment is usually considered minor when compared to the risks of uncontrolled pancreatic cancer.
Prognosis of Pancreatic Cancer
“I’ve walked the Pancreatic cancer is a harsh disease. Even for tumors that are discovered at an early stage and be treated surgically, the risk of cancer recurrence is high. “About 20 percent of patients who walk,” reflects can have curable pancreatic cancer—stage I and II— live five years,” says Dr. Struble. For patients locally advanced or metastatic pancreatic cancer—which represents about 80 percent of Carol. “I really with the cases—survival is even shorter and is typically measured in months. think I could What Does the Future Hold? offer tremendous Doctors and researchers across the nation and around the world are collaborating on the of better treatments for pancreatic cancer. Progress over the past quarter century support to newly development has been slow, but there are promising developments on the horizon thanks in part to the diagnosed cancer efforts of UVA Cancer Center. UVA has 13 scientists from eight disciplines who are dedicated to uncovering new and better ways of detecting and treating pancreatic cancer. They work in patients.” collaboration with colleagues from nationally recognized institutions such as the University of Texas M.D. Anderson Cancer Center. Here are a few examples of the innovations that are underway right here in Charlottesville:
• Investigation of “targeted cancer therapies” designed to get at the core of what drives pancreatic cancer. Many of these treatments focus on proteins in the cells that are involved in “signaling pathways.” By blocking signals that tell cancer cells to grow and divide uncontrollably, targeted cancer therapies can help stop the progression of cancer. 44
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• Patients who have surgery, chemotherapy and radiation therapy for pancreatic cancer have only a 20 percent survival rate in five years. Death is often due to a recurrence of the cancer in the liver. UVA is now studying a class of drugs called MEK inhibitors to determine if they can wipe out the microscopic cancer cells that spread and invade the liver. • UVA is also investigating immunotherapy as a potential option for patients with advanced and metastatic cancers. Osama Rahma, MD, medical oncologist at UVA Cancer Center, is engaged in a two multi-center studies to evaluate to effectiveness of different therapeutic pancreatic cancer vaccines. “The vaccines are designed to stimulate the immune system to recognize and attack the patient’s pancreatic cancer cells,” says Dr. Rahma. ”The longer-term goal is to reduce recurrence of the disease—and ultimately to create a vaccine that will prevent this silent killer and relegate pancreatic cancer to medical history.”
Osama Rahma, MD, Assistant Professor of Medicine in the Division of Hematology/Oncology, UVA Health System
Pancreatic Cancer:
Arm Yourself with Knowledge Pancreatic Cancer Snapshot
Local Resources
»» Pancreatic cancer is the fourth leading cause of cancerrelated death among both men and women in the United States, yet it makes up only 3 percent of all cancers
The Charlottesville area has advanced medical services for patients coping with pancreatic cancer. Here is a summary of what each of the major health systems has to offer.
»» In 2014, an estimated 46,400 people will be diagnosed with pancreatic cancer in this country and more than 38,000 will die of this disease
The Martha Jefferson Hospital Cancer Center is conveniently located adjacent to Martha Jefferson Hospital and has a dedicated parking facility for patients in order to make their experience as easy as possible from the very beginning. With the latest cutting-edge technology and physician specialists educated at some of the most prestigious schools in the country, Martha Jefferson's Cancer Care Center offers the sophisticated treatments our patients need. Additionally, our community hospital setting provides a tradition of caring that ensures we never forget what is at the heart of any treatment—a person. From our experienced team of physicians, to our oncology-certified nurses, to the customer service representatives who park your car, we combine the resources of a major medical center with the compassionate, individualized care found in a community hospital. That is the difference between delivering treatment and care.
»» Because pancreatic cancer usually is diagnosed at an advanced stage, the survival rate is extremely low compared with those of many other cancer types »» The incidence rate of pancreatic cancer has increased since 1999 and the mortality rate also has increased slightly since 2000 »» More than $2 billion is spent annually in the United States for pancreatic cancer treatment
Seeking Support for Pancreatic Cancer Many hospitals provide special services for patients and families battling pancreatic cancer. The American Cancer Society and Pancreatic Cancer Action Network (PANCAN) both provide information and support for people living with this disease. The American Society of Clinical Oncology website contains a wealth of information for patients, families and professionals interested in learning more about pancreatic cancer. »» American Cancer Society - cancer.org »» PANCAN - pancan.org »» American Society of Clinical Oncology - cancer.net or asco.org
The Martha Jefferson Cancer Center includes a broad range of specialties—breast surgery, general surgery, hematologyoncology, radiation oncology, radiology, neuroradiology, pathology, urology, gastroenterology, otolaryngology and neurosurgery. And, most important, Martha Jefferson achieves survival outcomes better than the state and national averages, meaning you can be confident that the treatment you receive at Martha Jefferson Hospital is the best available. To learn more, visit marthajefferson. org or to make an appointment, call 434.654.7009. www.OurHealthCville.com
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UVA Cancer Center is accredited by the Commission on Cancer and is one of 68 National Cancer Institute (NCI) designated cancer centers in the U.S. for its work in cancer research, prevention, detection and treatment. UVA Cancer Center provides comprehensive, world-class cancer treatment in an environment of caring for patients across Virginia, led by doctors who have been honored by publications such as Best Doctors in America® and America’s Top Doctors®. At UVA we’re for a team approach to caring for pancreatic cancer. We offer multidisciplinary care by doctors and staff who specialize in pancreatic disease from prevention to diagnosis to treatment. For more information on pancreatic cancer resources at UVA visit, uvahealth.com/pancreatic-cancer or to make an appointment, call 434.924.2839. To learn more about clinical trials offered at UVA Health System, call 434.243.6303.
article—and especially for their tireless dedication to pursue more effective ways to treat—and ultimately cure—pancreatic cancer.
For information on supporting pancreatic cancer research, contact Debbie Ryan at 434.982.3803 or UVA Health System Office of Development, PO Box 800773, Charlottesville, VA 22908
Additional References
Expert Contributors Thanks to the following medical experts who shared their time and knowledge to provide the technical information for this
»» Todd William Bauer, MD, Associate Professor of Surgery in the Division of Surgical Oncology, director of the High-Risk Pancreatic Cancer Clinic, leader of the pancreatic cancer research program at UVA »» Osama Rahma, MD, Assistant Professor of Medicine in the Division of Hematology/Oncology, UVA Health System »» Erika Struble, MD, Medical Oncology/Hematology, Martha Jefferson Hospital »» Michael E. Williams, MD, ScM, Byrd S. Leavell Professor of Medicine and Chief, Hematology/Oncology Division, UVA Health System
»» American Cancer Society »» National Cancer Institute
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FITBITS
H EA LT H A ND F I T NES S O N T H E G O
A Right to 'Bare Arms'
Get ready to show off your shapely and toned arms! Here are three exercises that will target the muscles of the upper arms and shoulders to give you that well-defined look! For optimum results, perform three sets of 8-12 repetitions of the following exercises three - five times per week.
#1. Bicep Curl 1. Stand in an upright position with your knees slightly bent. Contract your abdominal muscles to support your back and relax your shoulders. 2. Grasp the dumbbells with an underhand grip, palms facing up. Fully extend your arms, keeping them tight against your sides. Your elbows must be loose and not locked. 3. Lift the weights slowly until your hands reach your shoulders. Your arms should be the only muscles working during the exercise. At the top of the motion, contract your bicep muscles. Keep your abdominals tight and shoulders relaxed during the exercise. 4. Lower the dumbbells back to your starting position, arms extended and elbows loose. Repeat the exercise for a desired number of repetitions and sets.
#3. Upright Shoulder Row with Fitness Tubing 1. Step on the tube with both feet, holding one handle in each hand. 2. Cross the tubing to form an X shape. Palms should face your legs. 3. Raise your elbows toward the ceiling, pulling on the tube.
#2. Triceps Kickback 1. Grab a dumbbell in one hand and put the other hand on your knee. 2. Point your elbow as high as you can towards the ceiling while leaving the dumbbell hanging by your side.
4. Keeping your wrists in a neutral position and raise to shoulder height. 5. Slowly lower to starting position and repeat for desired number of repetitions.
3. Slowly extend your arm until it is as straight as it will go. (DO NOT change the position of your elbow!) 4. Pause for a second, then lower back to starting position. 5. Repeat steps 3 and 4 for desired reps 6. Your upper arm and elbow should not move at all during the entire set. This is very important in order to target the triceps muscle.
Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer Deidre is a certified personal trainer with more than 15 years experience in the health and fitness industry. She is the resident fitness specialist for OurHealth Shenandoah Valley and Charlottesville
OurHealth’s photographer, KG Thienemann, spent a recent Saturday morning at
Charlottesville City Market
Late this summer OurHealth’s staff photographer, KG Thienemann, spent some time at the Charlottesville City Market. Even though warm days are nearing their end and crisp fall mornings are on our doorstep, we will still be able to enjoy fresh local bounty at Charlottesville’s finest open-air market. Charlottesville’s City Market will be open on Saturdays from 7am-12pm now through December. Come on out to enjoy some great mountain music, yummy fall vegetables and flowers (and oysters), delicious smelling baked goods, made-to-order meals, and of course to enjoy local friends, farmers, bakers and artisans selling their wares. We hope to catch you there!
Like their facebook page to keep up with Market happenings – www.facebook.com/CharlottesvilleCityMarket
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Again Again Again On the Road words | MICHELLE STEPHENSON photography | KG THIENEMANN
According to the American Cancer Society, prostate cancer is the most common cancer among men (after skin cancer), but it can often be treated successfully. In the United States, more than two million men count themselves as survivors of this disease. Robert Cleminson of Nellysford, said his prostate cancer diagnosis was not a surprise. His physicians had been monitoring his PSA since the early 1990s, and it hovered around the '2' to '4' mark for many years. Two years ago, his PSA suddenly rose to '7', and then during the last 9 months, it rose to '9.3'. “This was an aggressive, potentially life-threatening cancer,” says Sylvia Hendrix, MD, a radiation oncologist with Central Virginia Radiation Oncologists group on the Martha Jefferson Hospital campus. At that point, his urologist recommended a biopsy of the prostate. According to Cleminson, he was considered intermediate risk, leaning toward high risk. His urologist recommended 42 treatments of radiation. “The next decision was which hospital or cancer center was going to provide 42 treatments,” Cleminson says.
Prostate-specific antigen (PSA) is a protein produced exclusively by prostate cells.
He was concerned about the side effects of treatment. “He had some concerns specifically about receiving radiation. He was very anxious about his diagnosis and how he was going to tolerate treatment. He wondered what this meant for how he was going to feel and be able to function on a day-to-day basis. When I first met him, because of his anxiety, he was considering relocating out of state and moving in with a family member to help take care of him during this treatment. He really believed that it was going to be necessary for him to disrupt his entire life and live with a family member because he thought he would need extra care. He also did not think he could get the best care possible locally. There was a knowledge deficit because he thought he couldn’t stay in this little community in rural Virginia and really get stateof-the-art care,” Dr. Hendrix says.
Through a simple blood
After meeting with Dr. Hendrix, he chose to be treated at Martha Jefferson Hospital, which is the only hospital in the area that has the Calypso System.
history of prostate cancer.
test, PSA levels are monitored, helping to detect early prostate cancer. A normal PSA may range between 1 and 4, depending on age, ethnicity, and family An increase of more than .75 between screenings may suggest a need for additional testing.
t
Robert Cleminson | NELLYSFORD, VA
what is the calypso system? The prostate can move during radiation treatment as a result of breathing and normal movement in the intestines. Typically, radiation oncologists expand the treatment area to ensure the moving target is irradiated. In the process, healthy tissue near the prostate may also be affected, leading to a high rate of urinary, bowel and sexual side effects. The Calypso® System provides the capability to see and track target motion in real time during treatment delivery, enabling the table the patient is lying on to be repositioned if necessary. Calypso System helps clinicians deliver maximum radiation directly to the tumor while avoiding healthy surrounding tissues and organs improving the quality of life for your patients.
“By spending a lot of time with him during his initial consultation, I was able to convince him that he was going to get the best care possible here and that he was going to be able to drive himself here every day and function normally. The biggest problem for us is that we had to schedule his appointments around his tee times. He came in by himself, had lunch here in the cafeteria, went to play golf, and we’d see him the next day. I wish that was true for all of my cancer patients,” Dr. Hendrix says. Every weekday from April to July, the 78-year-old made the 48-mile trip from his home to Martha Jefferson in his Honda Fit. He actually underwent two different types of treatment. He had an injectable medication that helps the radiation to be more effective in treating his prostate cancer, and he received those shots throughout his radiation, according to Dr. Hendrix. The radiation he received is called intensity-modulated radiation therapy (IMRT). According to Dr. Hendrix, it is a computer-driven planning system that delivers much focused treatment to the prostate. “This decreases the dose of radiation to the normal structures (the bladder and the rectum) that are right beside the prostate. When you lower the side effects by limiting the dose to the prostate, you can give a higher dose. If you can give a higher dose, you can improve the cure rate. That is something we do for all of our prostate cancer patients,” she explains. The problem is that, even though IMRT is focused treatment, the prostate moves throughout the day. “We use Calypso beacons, which are like a GPS system. There are three little beacons that are implanted into the prostate before the patient starts radiation. Wherever the prostate moves, those beacons move along with it. When the patient is on the treatment table, the beacons ping off a signal, like a radio signal. Ten times a second, it sends a signal to a panel for each one of these three little beacons. It tells our treatment system exactly where the prostate is. When we have that information, we can move the table without even touching the patient, so that every day we are essentially repositioning the prostate. If the patient should move during his treatment, we would know immediately,” Dr. Hendrix says. She explains that the treatment is painless and that some patients actually fall asleep during it. Patients lie on their backs with their hands on their stomachs, and the machine rotates around and delivers the treatment. “Nothing touches them. We come into the room and tell the patient that he is done for the day. There are no immediate side effects to receiving this radiation treatment. Patients are not radioactive, so they can be around anyone. A lot of our patients with prostate cancer continue to work during their treatment,” she says. Cleminson did not experience any side effects. He said that he didn’t lose any strength, was still walking 2 miles a day, and was doing yard work. He and his wife Barbara have been married for 54 years. They have three children, four grandchildren, and six great-grandchildren. Fortunately, his prognosis is good. Dr. Hendrix explained that he will continue to be followed by her and a urologist, and he will continue to receive injections for a few months.
Sylvia Hendrix, MD, a radiation oncologist with Central Virginia Radiation Oncologists group on the Martha Jefferson Hospital campus
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High-Risk
Patients Require
words | MICHELLE STEPHENSON photography | KG THIENEMANN
special care
Edward J. Craney, Jr. of Fishersville, is a 59-year-old African-American man, and two of his family members died of prostate cancer, which made him at high-risk for contracting the disease himself. Because of this, he was being screened yearly by his primary care physician. Craney says that his doctor found out about his family history of prostate cancer, and he had been receiving annual screenings for 5 years when his elevated PSA level was detected. “He was referred from his primary care doctor’s office after it was discovered that he had an elevated PSA. His PSA was almost 5.5. For a man his age with his racial background and his family history, his PSA was considered significantly elevated. We discussed medically all of the things that can cause elevated PSA, including prostate cancer. His physical examination was very benign, including his prostate exam. I recommended that we do a prostate biopsy, which was done as a simple procedure in the office under local anesthesia,” says Brian Stisser, MD of Blue Ridge Urological Associates, located on the Augusta Health campus. His biopsy came back positive for prostate cancer. “He had low-grade prostate cancer, but he did have a fairly high volume of prostate cancer. We presented a variety of different treatment options including surgery, radiation, and active surveillance. He was not a very good candidate for the last option given his age and the amount of cancer he had. He decided to move forward with brachytherapy, which is a form of radiation,” Dr. Stisser adds. He underwent that procedure in the operating room on April 15, and when Dr. Stisser examined him on June 28, his PSA had reduced down to 1.36. “He was feeling well, and he is not going to see me again for almost a year because he is doing so well. This is an indicator that the cancer is well-treated. He has minimal symptoms, he has maintained full potency, and he has minimal urinary symptoms,” he explains. “Two months after I had the procedure, they tested my blood, and the levels had dropped. I was still working until I had my procedure done. I was out of work for maybe 2 months, and then I went right back to work,” Craney says.
Brian Stisser, MD of Blue Ridge Urological Associates at Augusta Health
Dr. Stisser notes that recurrence is always a possibility. Craney will continue to require regular follow-up with a urology team for basic tests and exams. “Hopefully, he will not require any other active treatments for the rest of his life,” Dr. Stisser says. C. Buckley Gillock, MD, also of Blue Ridge Urological Associates, notes that high-risk patients have different screening and treatment needs than an average patient. “Most of the time, we recommend screening in African-Americans at an earlier age because
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• Except for skin cancer, prostate cancer is the most common cancer in American men. It is the second most common cause of death from cancer among white, African American, American Indian/ Alaska Native, and Hispanic men, and the fourth most common cause of death from cancer among Asian/Pacific Islander men. • About 1 man in 7 will be diagnosed with prostate cancer during his lifetime. • Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.5 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.
the disease can be more aggressive. Certainly, in African-Americans who have a family history, especially a first-degree relative with prostate cancer, we recommend screening them earlier,” he says. He explains that there has been some disparity in the press about whether measuring PSA levels is worthwhile or not. All men should be screened starting at age 50, until the patient no longer has a life expectancy of 10 years. “There is no upper limit these days depending on the patient’s medical condition. They might be screened longer than previously because cardiovascular conditions and cancers may be less lethal. The discussion about undergoing screening should start earlier if a man is high risk, such as those who are African-American or with a first-degree relative who has had prostate cancer,” Dr. Gillock explains.
If a man has more than one first-degree relative with prostate cancer, he should be screened at age 40 with a simple blood test. “PSA is a protein that is only made in prostate cells, and it is a reproductive enzyme. It is the best indicator of prostate activity that we have right now,” he explains. It is important for patients to know that every elevated PSA level does not indicate the presence of cancer. Other conditions, such as urinary tract infections or instrumentation (having a urinary tract catheter inserted), might cause an elevated PSA. Additionally, if there is prostate growth or sexual activity near the time of the screening, PSA levels can be elevated. “It is advised that men abstain from sexual activity 24 to 48 hours before having a PSA test, or it may give a false elevation. One of the difficult things about PSA testing is that we screen during the same years in which men undergo physiologic growth of the prostate. While we don’t understand why the prostate grows so much between the ages of 50 and 70, we have to recognize that some large prostates simply make a lot of PSA,” Dr. Gillock says. The other important element in screening for prostate cancer is a digital rectal exam. Up to 20% of cancers are detected with a rectal exam rather than with a PSA elevation. “Men should not only have the blood test, but also an annual rectal exam. If a patient has a nodule and a normal PSA, he should still have a biopsy,” he says. Dr. Gillock recommends that men seek out free evaluations with a primary care physician, or take advantage of community-centered prostate cancer screenings, if they have inadequate access to care otherwise.
C. Buckley Gillock, MD of Blue Ridge Urological Associates at Augusta Health
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AUDIOLOGY CARDIOLOGY DENTISTRY
CHART FOR HEALTHY AGING DENTISTRY Periodontal Screening and Charting: This simple screening checks for pocketing, infection and bone loss around your teeth. Oral Cancer Screening: Your dentist and Hygienist should perform this exam at every regular cleaning and exam appointment. Oral cancer is on the rise and it doesn’t just affect smokers or smokeless tobacco users. Periodic Digital X-rays: These screenings check for decay between the teeth where we can’t see, infections, cysts/tumors, bone loss and impacted teeth. Digital x-rays have about half the exposure of traditional x-rays. Jack T. Kayton III, DDS JTK Cosmetic & Family Dentistry 315 Old Ivy Way, Suite 101 Charlottesville, VA | 434.977.3939 www.dentistrycharlottesvilleva.com
CARDIOLOGY Blood Pressure: Starting at age 20. If less than 120/80, check every two years. If higher, more often, especially with other risk factors for heart disease. Cholesterol Profile: Start checking in childhood, but at age 20, at least every four to six years. More often if elevated, or other cardiac risk factors. Blood Sugar: Check at least every three years starting at age 45. Weight/Body Mass Index: During regular doctor visits. Lifestyle Assessment (smoking, diet, physical activity) at each doctor visit starting at age 20. Children also need early education on maintaining a healthy lifestyle. Abdominal Aortic Aneurysm Screening: one-time screening for men age 65-75, with history of smoking. Jeffrey S. Todd, MD, FACC, FASE Carilion Stonewall Jackson Hospital 1 Health Circle | Lexington, VA 540. 458.3300 | www.carilionclinic.org
AUDIOLOGY You go to the eye doctor when you're vision is blurry. You go to the dentist when you have a tooth ache. You see your family doctor when you're "under the weather." What about your hearing? Did you know that yearly hearing screenings are very important for many healthrelated issues? Yes, that's right! Recent studies have shown that when a person reports a "mild" hearing loss, their risk of developing the dreaded disease of dementia is twice as likely to happen; a "moderate" hearing loss increases the risk to three times, and a "severe" hearing loss jumps a person's risk up to four times! It has been reported by the John's Hopkins Medical research team of such findings. As a professional hearing healthcare provider, I have seen first-hand the other increased negative emotions that untreated hearing loss can cause, such as depression, anxiety, paranoia, and a withdrawal from social situations. The reports also show that those individuals with hearing loss, but who have decided to get the necessary help with hearing instruments, fare much better in daily activities, and can actually help stave off the negative impact that hearing loss could bring. If you or a loved one suspects hearing loss, we encourage you to have your hearing checked by a professional hearing healthcare provider, or if you are age 50 or older, it is a good idea to have a screening every year. Roger D. Merchant Augusta Hearing Solutions 101 Mactanly Place Staunton, VA | 540.885.1120 www.augustahearingsolutions.com
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Healthy Eats
harvest recipes
Entrée: Brined Mesquite Turkey
4. Remove the brine and pat the turkey dry with a paper towel.
Serves: several
Turkey Ingredients:
5. Pre-heat the oven to 350ºF.
1 6-8 pound boneless turkey breast Coconut oil Salt and pepper to taste
6. Rub the skin of the turkey with coconut oil and season with salt and pepper to taste.
Brine Ingredients: 1 3 3 5 ½
tbsp black peppercorns sprigs fresh thyme bay leaves garlic cloves, sliced cup sea salt
7. Place the turkey on a roasting rack in a baking pan and roast, uncovered until the internal temperature reaches 165ºF. (Approximately 40 minutes per pound).
Directions:
8. Allow the turkey to rest 15 minutes before slicing and serving.
1. Combine all ingredients for the brine until the salt is dissolved. 2. Place the turkey in a sealable plastic bag and pour the brine over the turkey. 3. Seal the bag and allow brining for 12 hours.
Local Turkey from: Polyface Farms, Inc.
43 Pure Meadows Lane | Swope, VA 540-885-3590 | polyfacefarms@gmail.com www.polyfacefarms.com Polyface, Inc. is a family owned, multi-generational, pasture-based, beyond organic, local-market farm and informational outreach in Virginia’s Shenandoah Valley. They produce salad bar beef, pigaerator pork, pastured poultry (eggs, broilers, turkeys), foragebased rabbits and forestry products.
Sunrise Farms, Inc.
2177 Tinkling Spring Road | Stuarts Draft, VA 540.337.3773 | info@sunrisefarm.net www.sunrisefarm.net Located in the heart of the Shenandoah Valley, Sunrise Farm raises free-range chickens and turkeys, pastured cattle, and hogs on its beautiful acreage. Their goal is to provide naturally grown meat and eggs that are free of added medications or hormones. Additionally, Sunrise Farm manufactures its own feed, which is free from genetic modification.
Tricia Foley says
SOURCE LOCAL TURKEY Tricia Foley is OurHealth Magazine’s resident nutritionist.
Healthy Eats
harvest recipes
Local Vegetables can be found at the following: The C’ville Market 221 Carlton Road | Charlottesville, VA | 434.984.0545 info@cvillemarket.com | www.cvillemarket.com
C’Ville Market has been locally owned and operated for over a decade by Steve and Denise Yetzer. As the retail arm of Cavalier Produce, wholesaler of high-quality produce to restaurants, institutions and local markets in Charlottesville, they are able to offer the very best in local fruits and vegetables.
Farm to You
637C Waddell Street | Lexington, VA | 540.460.2990 www.farmtoyoulex.com Farm To You is the region's only all local food grocer. At Farm To You, it’s all local, all the time. Fresh produce; eggs & dairy products; meats; pantry goods, including syrup, jams, peanuts & Virginia wine vinegars; fresh pasta; raw fermented krauts and kraut juice; and a whole host of other products. They also offer the convenience of on-line shopping for customers who subscribe to that service.
Side Dish: Roasted Harvest Veggies Ingredients: ½ butternut squash, peeled, cubed and seeds removed (1.5 cups) ½ acorn squash, sliced in ½ inch thick rounds and seeds removed 1 small sweet potato, cubed 1.5 cup raw Brussels sprouts, stems removed and sliced in half 2 tbsp olive oil 1 tsp chili powder ¼ tsp cayenne 2 tbsp maple syrup Salt and pepper to taste ½ cup pecans ¼ cup dried figs, chopped
Directions: 1. Preheat the oven to 425º F. 2. In a small bowl combine the olive oil, chili powder, cayenne, maple syrup and a pinch of salt and pepper. 3. Spread the veggies out on one or two baking sheets so they are not overlapping. 4. Drizzle the olive oil mixture over the veggies and toss to coat. 5. Roast in oven until vegetables are tender and starting to brown, about forty minutes. 6. Stir the veggies halfway through. 7. When there are fifteen minutes remaining, add the pecans and figs, toss to coat.
Tricia Foley uses
A VARIETY OF VEGGIES
Tricia Foley is OurHealth Magazine’s resident nutritionist.
Healthy Eats
harvest recipes
Local Apples from: Carter Mountain Orchard
575 Thomas Jefferson Parkway Charlottesville, VA | 434.977.1833 Info@CarterMountainOrchard.com www.cartermountainorchard.com
Carter Mountain Orchard is open mid-April through November (and weekends in December). They have apples, peaches and pumpkins for picking in season, as well as a market with readypicked fruit and vegetables.
Dessert: Apple-Peach Oatmeal Crisp Filling Ingredients: 2 apples, sliced 3 firm peaches, sliced 1 tbsp Stevia 1.5 tsp ground cinnamon 1 tsp ground nutmeg 1 tbsp lemon juice ½ cup water
Topping Ingredients: 1 1/3 3/4 1 1/4 6
cup oats cup whole wheat flour cup Stevia tsp cinnamon tsp salt tbsp Ghee butter, melted
Directions: 1. Preheat oven to 375°F. 2. To create the filling, place the fruit slices in the bottom of a greased 9-inch dish. 3. Drizzle with lemon juice. 4. Sprinkle Stevia, ground cinnamon, ground nutmeg, and water on the fruit. 5. In a separate bowl, combine the dry ingredients for the topping. 6. Add melted Ghee and mix until crumbly. 7. Spread the crumb mixture evenly on top of the fruit. 8. Bake for fifty to sixty minutes, so the top is lightly brown and the fruit is bubbly. 9. Serve warm and enjoy!
Tricia Foley’s
APPLE-PEACH TREAT Tricia Foley is OurHealth Magazine’s resident nutritionist.
“As I age, I will control my destiny in a place of my choosing….” — Blue Ridge PACE Vision Statement
The Blue Ridge PACE Program words | DIANE YORK photography | KG THIENEMANN
With the enormous growth of the aging population in our country, one of the biggest social problems we face is remaining in our own home and community once we become disabled due to age or health conditions. Most of us prefer to stay where we have lived, in familiar surroundings, retaining our neighbors, friends, pets and the belongings of a lifetime. For some, it is simply impossible, but now, thanks to a program new to the Charlottesville area, older residents in the area can stay in their homes and still get the medical and social care they need. PACE stands for Programs of All-Inclusive Care for the Elderly. PACE is a national program, begun in the 1970’s, which now has 104 programs in 31 states. Blue Ridge PACE, based in Charlottesville, is a joint venture between the University of Virginia, Jefferson Area Board for Aging (JABA), and Riverside Health System. It opened in March of this year and has 26 participants to date. Anne Barker, age 77, lived in Richmond with her husband. After his death, she found herself alone, unable to drive and isolated from the community. She moved to Charlottesville to live with her daughter. While that was helpful, she still needed medical assistance, in addition to physical and social activity. She joined the Blue Ridge PACE program and she says it has changed her life. “It’s made a big difference to have physical therapy on my arm on a regular basis and to have help taking medications and monitoring my high blood pressure, and I’ve made some nice friends too.”
At left: Ann Barker, of Charlottesville, receives physical therapy at Blue Ridge PACE.
The program’s objective is to help elderly individuals who want to stay in their home do so, by keeping their physical and mental health up to par. While all participants must be certified to need nursing home level of care to enroll in PACE, only about 7 percent of PACE participants nationally are actually residing in a nursing home, the others continue to live at home.
UCP (Universal Care Partner), Claudine Currie, and participant Ellen Gay Mickles
The Blue Ridge PACE Center in Charlottesville is, at first glance, an adult day care facility, but its services go far beyond that. It has its own full time, on-premises medical director, a registered nurse dedicated to the facility, as well as a home care coordinator, dietician, social worker, chaplain, physical, speech, occupational and recreational therapists as well as a site director who acts as team leader. These individuals conduct an assessment of need for each new PACE participant and a plan of care is tailored for that person’s specific needs. Mark Newbrough, MD, medical director of Blue Ridge PACE, who is board certified in both internal medicine and geriatric medicine, says: “I came to Charlottesville to join this program because I have spent my career helping the elderly and PACE helps them in so many ways. We can often solve the specific problems and barriers that make it difficult for them to remain in their own homes. I am thrilled to be working with the very experienced team of professionals at Blue Ridge PACE.” The PACE Center is a vital part of the delivery model. The building itself is a unique structure incorporating a fully equipped primary care clinic, a therapy and wellness gym, bathing area with accommodations, a kitchen, a day center, library, meeting and quiet spaces, and space for team planning and interaction enabling full coordination of its many functions and services under one roof. A typical day for Anne, and other participants, begins with pickup at her home by transport services from Blue Ridge. When she arrives at the center she has breakfast. If she is having any medical issues, they are addressed. She may also have some physical therapy. With the assistance of the recreational therapist she may do some knitting or play games with other participants, (bingo and cards.) The lunch provided at PACE is substantial (such as chicken-fried steak and mashed potatoes with gravy) to ensure that each participant gets at least one large meal a day. A league bowler previously, Anne particularly enjoys bowling at PACE (both ten pins and Wii) which, until PACE, she had given up. She walks with the
Walkers and Rollers group at the center and occasionally reads to other participants. Field trips are available, the most recent; a visit to a local peach orchard. In the afternoon she is dropped off at her home. The driver ensures that she gets safely inside before leaving. When someone joins PACE, the program takes the place of traditional Medicare and Medicaid benefits. PACE becomes the payer of all services normally covered by Medicare and Medicaid. Additionally, because of the way PACE is financed, PACE programs have the ability to provide additional services not usually covered by Medicare or Medicaid. Eligible persons who are receiving Medicaid may receive all services at no cost depending on their income. There is also a private pay option for those who do not have Medicaid. In addition to keeping individuals in their preferred home setting through a full schedule of preventative and primary care, the program also reduces pressure on family members, caregivers as well as local community services such as rescue squads. Some PACE participants live alone while others may live with family members who are working and/or may simply be unable to provide the attention, transportation and other services a person with health care issues requires. The program is able to assist those family members in keeping the participants fit and mobile enough to remain outside of institutional care, whether a hospital emergency room or a nursing home facility. Louise, (not her real name) eighty-one years old, lived with her daughter in a rural area. Her daughter cannot drive. Louise had back surgery previously, suffered from painful spinal stenosis, arthritis and anxiety and needed a walker for mobility. In one year, she called the 911 emergency services number and asked for assistance approximately thirty times. This put
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an incredible strain on the 911 system. After entering the PACE program and visiting the PACE Center three times a week, her health, pain and anxiety problems were so controlled that in the following year she did not call 911 even once.
Services Above: Joyce Jackson, Blue Ridge PACE cook; above right: Heidi White, Enrollment Coordinator, and Charlie Eubank, participant
The uniqueness of the PACE program is its versatility, range and deliverance of services. As mentioned above, PACE provides a full complement of medical and therapeutic care at its center. Often however, it is one issue that prevents a person from remaining in their home. What makes PACE different is its ability to remedy those issues. In addition to what is available in the PACE Center, services provided in the home can include: 24hour on-call physician services, home health care services, personal care services, homemaker/ chore services, adaptation of the home for disability and a lifeline emergency response system. PACE may also provide: prescription medications, over-the-counter medications, audiology and hearing aids, dentistry, optometry and eyeglasses, foot care, mental health, medical specialist care (with a referral), preventive health services, non-emergency transportation, lab tests and procedures, medical equipment and supplies, radiology services, outpatient surgery, emergency room care, ambulance transportation. If someone becomes an inpatient while participating with the PACE Program, they may also be eligible for hospital stays, mental health/substance abuse, physician services, nursing home stays and rehabilitation. This kind of flexibility in problemsolving is what makes PACE invaluable to the community. As an example, a frequent problem for us, as we age, is the use of stairs. Marie , (not her real name) who is eighty-eight years old, lived in a home built by her husband. She loved her home but it had stairs that she could no longer climb. The PACE program helped her transition to an apartment where her mobility would not be an issue. Support from the PACE program has enabled her to make the one change she needed to remain in the community. That kind of transitional service is not available through traditional programs for the aging, yet it made all the difference for Marie.
Who Can Participate? To qualify for the program, individuals must be over fifty-five years of age. They must meet the requirements for nursing home admittance yet be able to remain safely in the community. Susan VonHemert, Social Worker at Blue Ridge PACE says, “medical or mental conditions that require skilled nursing or those which prevent the patient from being able to perform basic activities of daily living qualify. These conditions could include inability to cook for themselves, bathing or feeding issues, wound care, cognition problems such as memory loss or difficulty keeping medications straight, wandering or issues of pain or mobility.” Since there is such a wide range of conditions that might qualify- it’s best to speak with admissions coordinators at the program to make that determination. Participants are required to fully participate in the PACE program, attending the day care program at least several times a week. Transportation can be provided. Blue Ridge PACE will enable many elderly to remain in the place they love best, their home. Anne Barker’s advice to others is, “don’t be afraid to try it….it’s a wonderful program!”
Mark Newbrough, MD, medical director of Blue Ridge PACE, who is board certified in both internal medicine and geriatric medicine,
The Blue Ridge PACE Program, located at 1335 Carlton Avenue, Charlottesville, VA 22902, covers the city of Charlottesville as well as the counties of: Albemarle, Greene, Louisa, Nelson & Fluvanna. For more information or to apply contact Betty Sharp, Outreach Manager at (434) 529-1300. There are also PACE Programs located in Roanoke, Big Stone Gap, Richmond, Norfolk, Hampton and Northern Virginia.
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photo Courtesy of Historical Collections & Services, Claude Moore Health Sciences Library, University of Virginia
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