EveryDESERVES Woman the
Chance
TO BEAT BREAST CANCER
table of contents | september • october 2015
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Prostate Cancer A Survivable Disease
MEDI•CABU•LARY.......................8 Local experts define health-related terms
JUST ASK!.......................................10 Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............12 A listing of new physicians, providers, locations and upcoming events in the Shenandoah Valley and Charlottesville communities
HEALTH POINTS.........................16 Interesting facts and tidbits about health
THE ANATOMY CHALLENGE..................................19 Are you up for the challenge? In this issue, test your knowledge when it comes to the PROSTATE.
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Every Woman Deserves The Chance to Beat Breast Cancer
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
36
hello, HEALTH!
Augusta Health Lifetime Fitness Center
FIT BITS!........................................ 38 COUCH TO 5K! Have you ever dreamed
40
of running a 5k but didn’t know how to start? OurHealth resident fitness specialist Deidre Wilkes shows you how.
[series]
Breaking the Silence: Eating Disorders
This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now.
NUTRITION.................................. 53 HEALTHY EATS: Cancer fighting recipes including carrot ginger celery soup, herb flank steak and a green apple smoothie.
CLOSER LOOK.............................. 58 Images reflecting the landscape of healthcare in the Shenandoah Valley and Charlottesville * PLUS * a chance to win prizes!
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september • october 2015
PUBLISHER PRESIDENT/EDITOR-AT-LARGE VICE PRESIDENT OF PRODUCTION PROJECT COORDINATOR AND FITNESS EXPERT GRAPHIC DESIGNER ORIGINAL COVER ART WORK ORIGINAL PHOTOGRAPHY WEBSITE & DIGITAL MEDIA SPECIALIST ACCOUNTING MANAGER
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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Ext. 1 Information in all print editions of OurHealth and on all OurHealth websites (websites listed below) and social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2015 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. OurHealth Lynchburg/Southside is published bi-monthly • Special editions are also published • McClintic Media, Inc. • 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. MAIN: ourhealthvirginia.com | ourhealthswva.com | ourhealthlbss.com | ourhealthrichmond.com | ourhealthcville.com | Advertising rates upon request.
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LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is the Innovations program at RoseWood Village Assisted Living & Alzheimer’s Care? The Innovations Program at RoseWood Village is a secure memory care program that provides a nurturing, supportive and structured environment for residents with moderate to severe memory loss or cognitive impairment. Residents can reside in a secure environment if the physician agrees that he or she is unable to protect themselves from harm or recognize danger. One of the ways we assist with safety is by requiring a code to open exit doors, so that a resident does not wander off and become lost. Staff also check on each resident at least once an hour so that redirection and support can be provided. Days are structured to include periods of engagement, activity, and rest, which allows residents the opportunity to be involved in small or large group activities while providing rest in the afternoon. Everything residents require for a balanced quality of life is offered, from a special assisted dining program to a beauty shop and a beautiful, safe outdoor courtyard. The staff is trained and equipped with knowledge of dementia care techniques and the special needs of residents with cognitive impairment. Judi K. Cleary
Executive Director RoseWood Village Charlottesville | 434.975.5079 www.rosewoodvillage.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
What is hydrocephalus? Hydrocephalus means “water in the head.” Hydrocephalus is caused by over-production of cerebrospinal fluid (CSF) or under-processing syrupy fluid that circulates inside and outside the brain and around the spinal cord. We have seen images of babies with very large heads from the over-production of CSF. Today these children are treated early to reduce brain damage. Diagnosis of NPH is done in two steps. If an MRI or CT scan shows large ventricles (the caverns in the brain that CSF passes through) then a large amount CSF is drawn through a spinal tap. If symptoms improve, placement of a shunt can be considered. These patients should be evaluated by a neurologist. Bob Davis, FNP
Augusta Health Neurology Fishersville | 540.932.5878 www.augustahealth.com
What is conductive hearing loss? Conductive hearing loss occurs when something interferes with the transmission of sound waves through the outer and middle ear preventing the waves from reaching the inner ear sensory cells. Causes of conductive hearing loss may include: excessive cerumen (ear wax), presence of a foreign body in the external ear canal, damage to the tympanic membrane/eardrum, fluid in the middle ear space, ossification or damage to the middle ear bones, and/or congenital malformation of the outer or middle ear. Conductive hearing loss can range in severity from mild to moderate and can occur in children and adults. Fortunately, most conductive hearing loss is correctable either medically or surgically. Audiologists are equipped with a variety of diagnostic tests to identify the presence of any conductive component during hearing testing and can make the appropriate referral for management. In the event that conductive type hearing loss cannot be managed medically or surgically, traditional hearing aids and newer implantable bone conduction hearing devices can provide excellent improvement in hearing. Tammy Garber, AuD
Hearing Health Associates Crozet | 434.205.4207 www.hearinghealthassoc.com
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H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
What are the symptoms of a concussion?
Concussion symptoms may include: confusion, disorientation, memory disruption, dizziness, trouble with balance or coordination, headaches, nausea and vomiting. Some people may experience a loss of consciousness. Emotional changes, such as tearfulness, irritability, and anxiety can also occur. Concussion symptoms are typically temporary. Anyone suspected of having a concussion should be evaluated by a healthcare professional to make sure he or she does not have a more severe brain injury. Any indication of deteriorating symptoms in the minutes to hours after a concussion such as, declining mental status, worsening headache, difficulty speaking, weakness or numbness, or any change in neurologic status such as a seizure or unequal pupil sizes require an urgent medical evaluation. The good news is that the vast majority of concussions cause temporary symptoms that gradually improve. It may take a month or more for symptoms to reside in children and elderly adults. Donna Broshek, PhD
Co-Director, Brain Injury & Sports Concussion Institute UVA Health System Charlottesville | 434.924.2718 www.uvahealth.com
What are some things to consider when deciding to have joint replacement surgery? When a patient considers joint replacement surgery, it’s important to create a collaborative decision making process with his or her orthopedic surgeon, primary care physician, and their family. Proceeding with joint replacement surgery depends upon the level of the patient’s pain, the degree of the arthritis and deformity and the relative amount of disability and joint dysfunction. The patient and family members should develop a relationship with a highly qualified surgeon with extensive experience and excellent results in his or her specific type of surgery, e.g. hip or knee or shoulder replacement. The quality of the hospital and the rehabilitation process are important factors to consider as well. The best information is often a referral from a primary care physician or another patient who has experienced excellent results from a specific surgeon. Steve Gunther , MD
Sentara Martha Jefferson Orthopedics Charlottesville | 434.654.5575 www.sentara.com
What are some services that an elder law attorney can provide that address the unique needs of the senior and disabled population? Elder law attorneys focus on a variety of issues, from estate planning to long-term care planning. Elder law attorneys work with clients (or a loved one seeking assistance on behalf of an aging parent, grandparent, aunt, uncle, etc.) to ensure their final wishes are established and carried out. They work with clients to identify the best type of trust to address their estate planning goals and concerns. Examples of such trust include ones that protect assets from the cost of long term medical care costs, safeguarding assets for a spouse, ensuring assets are passed on to children and grandchildren and avoiding probate. Assistance with the Medicaid process is available, both preplanning and crisis planning. In addition, assistance can be provided to veterans to navigate the complex process of obtaining veterans aid and attendance benefits. Not all clients are elderly. In fact, many are planning for retirement well in advance Simon Stapleton
Principal Attorney Stapleton Elder Law Charlottesville | 866.284.4529 www.edlerlaw-va.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Hearing Health Associates Opens Office in Crozet Hearing Health Associates, a leading hearing care provider, is celebrating its 15th anniversary in 2015 with a new office location in Crozet.
Stem Cell Transplant Program Earns International Accreditation The Stem Cell Transplant Program at the University of Virginia Cancer Center has received FACT accreditation for its use of stem cells and bone marrow to treat patients with blood cancers. Bone marrow and stem cell transplants – whether a patient’s own cells or cells from a donor – are used to care for patients with immune disorders along with blood cancers such as leukemia, lymphoma and multiple myeloma. Programs earn this award from the Foundation for the Accreditation of Cellular Therapy (FACT) by meeting detailed standards in the collection, processing and use of stem cells and bone marrow in treating patients. Accreditation follows both a written application and an on-site inspection by a FACT survey team. UVA earned FACT accreditation for both autologous transplants (performed with cells from a patient’s own body) and allogeneic transplants (performed with cells from a donor). “Throughout UVA Cancer Center, we seek to provide the highest-quality care to all of our patients,” says Thomas P. Loughran Jr., MD, UVA Cancer Center’s director. “Earning FACT accreditation demonstrates our commitment to caring for patients with blood cancers and shows the dedication of our multidisciplinary clinical and laboratory teams.”
Tammy Garber, AuD spearheading bringing the new office location to Crozet, expanding from their flagship location in Roanoke. With her business partner, Douglas Cameron, AuD, the two bring more than 40 years experience in audiology care. Since 2000, Hearing Health Associates has provided the local community with elite hearing healthcare, including hearing diagnostics and evaluation, state-of-the-art hearing technology, and long-term treatment plans. The local Crozet office, located at 580 Radford Lane, Suite 106, is open Monday, Wednesday and Friday with free hearing technology demonstrations by appointment. Dr. Garber moved to the Charlottesville area and is proud to be a Crozet resident, “It has been rewarding to build a home with my family here in Crozet while also bringing the services of Hearing Health Associates to the local Charlottesville community.” For more information about Hearing Health Associates visit www.HearingHealthAssoc.com or to schedule an appointment call 434.422.3202.
Carilion Clinic to offer Urgent Care Services in the Lexington-Rockbridge Area A new VelocityCare will open at Carilion Stonewall Jackson Hospital in Lexington in early 2016. This new opening is part of Carilion’s effort to offer urgent care as a complement to their primary care and emergency department. “Carilion has responded to the number one identified need from our Community Health Needs Assessment Survey earlier this year,” says Chuck Carr, CEO of Carilion Stonewall Jackson Hospital. “The number of urgent needs that have come into our emergency department in the past several years indicates a real need for VelocityCare in our community,” says Carr. For patients, VelocityCare provides a lower cost alternative path for people who are seeking treatment for minor injuries or illnesses.” If the patient warrants a higher level of care, then the transition to the emergency department is close by. Carilion Stonewall Jackson Hospital will be the first to offer emergency department and urgent care services in one facility and provide a destination point for health services in the Lexington, Buena Vista and Rockbridge County areas. “We ensure that patients get connected back to their primary care services in the region for follow-up, and we help patients get connected to specialists if further care is needed,” says Kim Roe, Vice President for Family and Community Medicine. In addition, the Carilion will offer occupational medicine services to the region’s employers. VelocityCare will be open 8 a.m. until 8 p.m. Monday through Saturday and 10 a.m. until 6 p.m. on Sunday, and will be located on the ground floor of the hospital. For more information, visit www.carilionclinic.org.
For more information on UVA Cancer Center, visit cancer.uvahealth.com.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Sentara Rockingham Memorial Hospital Dedicates Site for New Timberville Health Center Sentara RMH Medical Center recently held a site dedication and ground breaking ceremony for the new Sentara Timber Way Health Center in Timberville. The free-standing 13,577-square-foot facility will be home to the physicians and staff members of Springbrook Family Medicine in Broadway, and Timberville Health Care. The center will offer X-ray, laboratory and rehabilitation services. “After Sentara RMH Medical Group acquired the Timberville Clinic in 2012, it became clear a larger clinic was needed in the northwest section of Rockingham County,” says John McGowan, MD, president, Sentara RMH Medical Group. “Neither of the clinics in Timberville or Broadway could adequately meet the needs of the patients served in that area, so a new clinic was requested and approved by Sentara Healthcare and the Sentara RMH Board of Directors. We’re pleased to have this project get underway.” The new health center is expected to be completed in February 2016. For more information, visit www.sentara.com.
Participating in the ground breaking ceremony for the new Sentara Timber Way Health Center are, from left, Austin Garber, Timberville town manager; Jordan Hill, DO of Springbrook Family Medicine; Pablo Cuevas, supervisor of Rockingham County; Ann Homan, chair of the Sentara RMH board of directors; John McGowan, MD, president of Sentara RMH Medical Group; and Jim Krauss, president of Sentara RMH Medical Center.
U.S. News & World Report ‘Best Hospitals’ Guide Honors Five UVA Specialties U.S. News & World Report has honored five specialties at University of Virginia Health System in the publication’s 2015-2016 “Best Hospitals” guide. UVA’s diabetes and endocrinology program is ranked in a tie for 39th, placing UVA among approximately three percent of U.S. hospitals with a nationally ranked program. Four additional specialties were honored as “high-performing,” meaning they rank among the top 25 percent nationally in their specialties. Those specialties include: cancer, nephrology, neurology, neurosurgery, and orthopedics. These five adult specialties join four pediatric specialties – neonatology, orthopedics, pulmonology, and urology that are nationally ranked in U.S. News & World Report 2015-2016 “Best Children’s Hospitals” guide. “While rankings like these are just one of many ways to evaluate hospitals, I’m pleased to see the hard work of our team members from across the Health System receive national recognition,” says Richard P. Shannon, MD, UVA’s executive vice president for health affairs. “This reflects our ongoing efforts to become the safest hospital in America to provide care.” For more information on UVA Health System, visit www.uvahealth.com or U.S. News & World Report at health.usnews.com.
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NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
New Technology Ushers in Era of Precision Medicine at UVA Clinical Genomics Lab Lets Doctors Use DNA Sequencing to Personalize Treatments The University of Virginia Health System has opened a high-tech clinical genomics lab that will personalize care for patients, help doctors determine the best treatments for cancers and other diseases and allow UVA to offer the most cutting-edge clinical trials.
School of Clinical Laboratory Science Celebrates Anniversary Augusta Health’s School of Clinical Laboratory Science is celebrating its 60th anniversary this year. Founded in 1955 and originally named King’s Daughters’ School of Medical Technology, the school of Clinical Laboratory Science offers a one-year post-baccalaureate certificate program in Clinical Laboratory Science. This certificate prepares graduates for a career in performing diagnostic laboratory testing in areas such as hematology, clinical chemistry, microbiology and blood banking. For more information, visit www.augustahealth.com.
Jason Asistores, MD Sentara RMH Mount Jackson Health Center Mount Jackson 540.477.3185 www.sentara.com
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The new lab, under the direction of Mani S. Mahadevan, MD, professor in the Department of Pathology, gives doctors the power to examine patients’ DNA quickly and effectively. By doing so, they can diagnose genetic disorders, identify cancer-causing gene mutations and tailor treatments for maximum effectiveness. In short, it puts UVA at the forefront of precision medicine – medicine that is personalized for each patient’s particular condition and needs. “We’re using the latest technology for DNA sequencing,” says Dr. Mahadevan. “Called massively parallel sequencing or ‘next gen sequencing’, it enables us to sequence millions of bases of someone’s DNA – or many, many, many genes at once,” explains Mahadevan. “In the case of one of the tests we’re using now, it allows us to sequence many genes within a cancer patient’s tumor to determine what mutations or changes they have in their tumor’s DNA, with the goal of helping the clinicians decide if the patient will respond or not respond to a particular therapy. So that’s where the precision medicine comes in – it’s very individualized to that patient and the particular cancer that patient has.” The facility will also have tremendous effects on the treatment of genetic disorders, such as the heart condition known as cardiomyopathy, and in diagnosing genetic disorders, such as in children with neurological or developmental conditions. “This technology allows us to sequence over 4,500 genes at once in a child and a child’s parents to help us find out if there’s a genetic basis for their clinical condition,” continues Dr. Mahadevan. “That panel covers pretty much most of the known genetic disorders.” The new lab represents an important collaboration between the UVA Medical Center and the School of Medicine, and Dr. Mahadevan and his colleagues are tremendously excited by its arrival. “To have this now at UVA,” he says, “is a big step forward for the institution and the patients who come here.” For more information, visit www.uvahealth.com.
Ralph Caldroney, MD Carilion Clinic Family Medicine Internal Medicine Lexington 540.463.2181 www.carilionclinic.org
Adam Carlson, MD UVA Health System Clinical Rheumatology Fishersville 844.472.8711 www.uvahealth.com
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Tushar Chopra, MD UVA Health System Nephrology Fishersville 844.472.8711 www.uvahealth.com
Meg Crook, MD
UVA Blue Ridge Endocrinology Charlottesville 434.293.7811 www.uvahealth.com
CONTINUED
Lindsey Dupre, MD
Marc Flickinger, MD
Adam Goldberg, MD
Allan Scott Hamby, MD
Sinclair Harcus, Jr., MD
Cardiovascular Associates of Charlottesville Charlottesville 434.293.4072 www.cvilleheart.com
Carilion Family Medicine Lexington 540.463.7628 www.carilionclinic.org
Charlton Jordan, MD
Judy Ko, MD
Adrienne Koch, DO
Kelly Mahaney, MD, MS
Henry Monsour, Jr., DO
Sean O’Reilly, MD
William Sayre, MD
Carol Shirey, MD
Nicholas Spinelli, MD
Katarina Topchyan, MD
Yaqing Wen, MD
Matthew Wolf, MD, PhD
Sentara Martha Jefferson Inpatient Services Charlottesville 434.654.7580 www.sentara.com
Harrisonburg Physicians for Anesthesiology Harrisonburg 540.879.2583 www.sentara.com
Sentara Martha Jefferson Medical and Surgical Associates Charlottesville 434.654.5260 www.sentara.com
Sentara Martha Jefferson Inpatient Services Charlottesville 434.654.7580 www.sentara.com
Sentara Martha Jefferson Inpatient Services Charlottesville 434.654.7580 www.sentara.com
Sentara RMH Rheumatology Harrisonburg 540.564.5700 www.sentara.com
Carilion Clinic Internal Medicine Lexington 540.463.2181 www.carilionclinic.org
UVA Health System Cardiology and Cardiovascular Genetics Charlottesville 434.243.1000 www.heart.uvahealth.com
Cardiovascular Associates of Charlottesville Charlottesville 434.293.4072 www.cvilleheart.com
Sentara RMH Internal Medicine Harrisonburg 540.564.7100 www.sentara.com
Sentara Martha Jefferson Inpatient Services Charlottesville 434.654.7580 www.sentara.com
Cynthia Yoshida, MD UVA Health System Digestive Health Charlottesville 434.244.5008 www.uvahealth.com
UVA Health System Pediatric Neurosurgery Charlottesville 434.243.5749 neuro.uvahealth.com
Sentara Martha Jefferson Medical and Surgical Associates Charlottesville 434.654.5260 www.sentara.com
Harrisonburg Physicians for Anesthesiology Harrisonburg 540.879.2583 www.sentara.com
UVA Blue Ridge Endocrinology Charlottesville 434.293.7811 www.uvahealth.com
Sarah Zeller, MD
Dermatology, PLC Charlottesville 434.296.0113 www.dermatologyplc.com
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TI P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U
SEPTEMBER
Prostate Cancer Awareness Month Survival rates are often used by doctors as a standard way of discussing a person’s prognosis (outlook). Some men with prostate cancer may want to know the survival statistics for others in similar situations.
The survival rate for patients who live at least 5, 10, and 15 years after their prostate cancer diagnosis (no matter the stage) is:
5 year
10 year
15 year
The relative 5-year survival rate is almost 100 percent
The relative 10-year survival rate is 99 percent
The 15-year relative survival rate is 94 percent
Source: www.cancer.org
OCTOBER
Breast Cancer Awareness Month
Breast cancer is the 2nd most common cancer diagnosed in women in the U.S., next to skin cancer. It is the second leading cause of cancer death in U.S. women, after lung cancer.
The chance of a woman having invasive breast cancer some time during her life is about 1 in 8. The chance of dying from breast cancer is about 1 in 37.
Be self-aware in your breast health. Know your risk. Get screened. Know what is normal for you. Make healthy lifestyle choices. For more information visit www.cancer.org. For answers to all your breast health questions, schedule an appointment with your local physician. Source: www.cancer.org
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Did you know? Binge eating disorder often leads to many of the same health conditions associated with clinical obesity, including:
•
High blood pressure.
•
High cholesterol levels.
•
Heart disease as a result of elevated triglyceride levels.
•
Type II diabetes mellitus.
•
Gallbladder disease.
Source: www.nationaleatingdisorders.org
Backpack Tips
Backpacks are an ideal and convenient way for all students – from kindergarten through college – to carry their books and other materials. However, when loaded too heavy or worn improperly, they can put a child at risk for injury. Below are some helpful tips to consider:
Tip
1
Tip
2
A loaded backpack should weigh no more than 10 percent of a student’s total body weight.
Get your
The height of a backpack should extend from approximately two inches below the shoulder blades to waist level or slightly above the waist.
Tip
RUN on!
3
Both straps should be used to ensure weight is distributed evenly. A waist belt can also help distribute weight more evenly across the body.
Tip
4
Backpacks with padded backing not only provide increased comfort, but also offer protection from sharp edges on objects such as pencils, rulers and notebooks.
Tip
5
Fall is a great time for runners! Our local communities boast clubs and resources for runners of all levels, including several 5K, 10K, half and full marathon training programs. Additionally, if you are interested in hitting the pavement or running the trails, you are sure to find a variety of group runs, races and running gear in the Shenandoah Valley and Charlottesville area. For more information, visit these local websites below:
Bad to the Bone Endurance Sports
Backpacks with multiple compartments can help distribute weight more evenly.
www.badtothebone.biz
Source: www.aap.org
Charlottesville Area Trail Runners
National
www.charlottesvilletrailrunners.org
is October 24
th
National Food Day is observed to remind us to make changes in our own diets and to take action to solve food-related problems at the local, state, and national level. The theme is Toward a Greener Diet. For more information about National Food Day and ways you can participate, visit www.foodday.org.
Charlottesville Track Club www.charlottesvilletrackclub.org
Ragged Mountain Running www.raggedmountainrunning.com www.OurHealthCville.com
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[ the Prostate ]
WORD SEARCH adrenal gland
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____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________
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PROSTATE CANCER A Survivable Disease words | RICH ELLIS
Screening and treatment options require close consultation with a trusted healthcare provider. Prostate cancer is the second most common type of cancer in men, eclipsed only by skin cancer. Fortunately, it’s also a very survivable cancer, with more than two million prostate cancer survivors alive today. Unlike other cancers, prostate cancer is unique in that its treatment and even its screening guidelines are subject to interpretation and debate, requiring patients and their health care providers to thoroughly discuss and carefully weigh the monitoring and treatment options as well as the potential risks versus outcomes before making any decisions. Ryan Smith, MD, a specialist in male infertility and an assistant professor in the University of Virginia’s Department of Urology in Charlottesville, explains that the prostate gland is part of the male reproductive system that helps produce semen, which protects and nourishes sperm. The size and shape of a walnut, the prostate sits below the bladder and in front of the rectum, with the urethra — responsible for transporting urine — passing through the prostate. As men age, the prostate gland can increase in size, making urination difficult. While prostate enlargement is somewhat common, it’s important to determine if the enlargement is noncancerous — known as benign prostatic enlargement — or cancerous.
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According to Brian Stisser, MD, a urologist with Blue Ridge Urological in Fishersville, the prevalence of prostate cancer is such that 1 in every 6 to 7 men will be diagnosed with it during their lifetimes. “There is ongoing research about possible causes, including dietary, environmental, ethnic and genetic influences,” Dr. Stisser says. “Both prostate cancer detection and prostate cancer related death rates have declined slightly over the last two decades.” Ryan P. Smith, MD is a urologist with UVA Specialty Care in Culpeper. Dr. Smith is certified by the American Board of Urology.
Brian C. Stisser, MD is a urologist with Blue Ridge Urological, PC in Fishersville. Dr. Stisser is certified by the American Board of Urology.
Risk factors for prostate cancer also include age and family history. “The older a man’s age, the higher the risk of prostate cancer, and man with a father or brother with prostate cancer has a two to three times higher risk of prostate cancer,” says Dr. Stisser. Based on data provided by Dr. Smith, the Centers for Disease Control reports a significant decrease of 3.4 percent annually in the incidence of prostate cancer among men from 2002 to 2011 in the United States. Mortality decreased 3.3 percent over the same period. Even with those declines, however, the American Cancer Society estimates there will be 220,800 new cases of prostate cancer and 27,450 deaths from the disease in the U.S. in 2015.
Screening
“PSA is not a perfect screening test for prostate cancer and carries its own limitations and potential risks,” Dr. Smith says. “Screening’s advantage, however, lies in identifying cancer early, when treatments may be most effective and prevent it from becoming lifethreatening or causing serious symptoms.’
Screening for prostate cancer is the only way to detect its presence, and early detection can lead to improved outcomes. Screening, however, brings with it differing opinions throughout the medical community. “Screening for prostate cancer has come under increased scrutiny recently, making the decision of whether to pursue testing all the more confusing for patients and physicians,” Dr. Smith says. “Prostate cancer screening is generally conducted with a digital rectal exam and a PSA test, with PSA being an acronym for prostate specific antigen — a protein produced by cells within the prostate. PSA levels in the blood are often elevated in men with prostate cancer, however they can also be high in men with an enlarged, infected or inflamed prostate.” Determining the cause of a high PSA level can be complex and must also consider factors such as a patient’s prior PSA values, age, prostate size, and the medications the patient is taking. “PSA is not a perfect screening test for prostate cancer and carries its own limitations and potential risks,” Dr. Smith says. “Screening’s advantage, however, lies in identifying cancer early, when treatments may be most effective and may prevent it from becoming life-threatening or causing serious symptoms. Additionally, many detected cancers are slow-growing and may never spread beyond the prostate gland. It’s estimated that PSA testing may prevent prostate cancer mortality in 1 man
Augusta Health Cancer Committee for every 1,000 men screened over a decade. Overall, however, there is a low risk of death due to prostate cancer, estimated to be a 3 to 4 percent lifetime risk.” Dr. Stisser recommends that prostate cancer screening be considered in all healthy men. Screening typically begins at age 40 or 50, depending on a patient’s health, ethnic background and family history. “Most screening begins with a physical examination and a PSA blood test, but there are also new screening tests based on blood and urine samples that can further help to stratify the risk of a clinically significant cancer,” says Dr. Stisser. Differing opinions within the medical community about prostate screening can be traced in part to the fact that different professional organizations have issued different recommendations related to PSA screenings. The American Urological Association recommends that men, beginning at age 55, discuss and decide with their doctor whether to undergo a PSA test. Earlier testing should be considered in men at higher risk for contracting prostate cancer. The AUA recommends against routine screening in men over age 70 or those with less than a 10- to 15-year life expectancy. Similarly, routine PSA screenings are not recommended for men younger than 40 or those between the ages of 40 and 54 who are deemed to be at average risk for contracting prostate cancer. After the initial screening, AUA recommends additional screenings every two years.
sponsors free prostate cancer screenings! Prostate cancer is the second most common type of cancer death for men Augusta Health Cancer Center will hold a free prostate cancer screening September 23rd at 5:30 p.m. The screenings at the Cancer Center, located at 78 Medical Center Drive in Fishersville, Virginia, are available for men who: • Are not currently patients of a urologist • Are 40 and older, or African American and 35 or older • Have a family history of prostate cancer and are older than 35 Appointments are required by calling 540.245.7910. Preference being given to patients who didn’t receive a screening last year.
Offering a contrasting opinion is the U.S. Preventive Services Task Force. The group, which describes itself as “an independent, volunteer panel of national experts in prevention and evidencebased medicine,” recommends against PSA-based screening regardless of age, and gives PSA testing a D grade. “One thing most groups agree on, however, is that the PSA test should not be used without a discussion between the patient and his physician about the screening’s risks and benefits,” Dr. Smith says. “In the right patient, a PSA test may save a life by identifying a prostate cancer that needs early and prompt treatment.” If an elevated PSA is indicated, a prostate biopsy may be one of the recommended courses of action to determine the presence of cancer, says Dr. Smith. “The majority of men who undergo a prostate biopsy will not have prostate cancer, but the biopsy itself carries some associated risks, including bleeding, infection, and procedural discomfort.” One of the challenges with the PSA screening is that it may provide “false negative” or “false positive” results. A false positive test where an elevated PSA level is due to benign causes can lead to unnecessary worry and additional medical procedures and expenses.
“One thing most groups agree on, however, is that the PSA test should not be used without a discussion between the patient and their physician about screening’s risks and benefits,” Dr. Smith says. “In the right patient, a PSA test may save a life, identifying a prostate cancer that needs early and prompt treatment.”
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23
The Stages of Prostate Cancer Stage
1
In stage 1, the cancer is confined to the prostate. Stage 1 can’t be detected during a digital rectal exam (DRE). It is usually expected to be slow growing.
Stage
2
With stage 2, cancer can be detected during a DRE. It’s still confined to the prostate, but the cells may be more abnormal and may grow faster.
Stage
3
With stage 3 prostate cancer, the cancer is in tissues near the prostate. It also may have reached the seminal vesicles.
Stage
4
Stage 4 prostate cancer means that cancer has invaded other parts of the body, such as the rectum, nearby lymph nodes or bone. Source: www.cancercenter.com
Staging Staging indicates the cancer’s extent, based on the amount of cancer in and around the prostate and whether it has spread to other parts of the body. “Stage T1c is the most common initial stage at diagnosis because it is based on detecting cancer following an abnormal PSA test in the absence of abnormal physical examination findings,” Dr. Stisser explains. “The other stages — T2 through T4 — are determined based on findings revealed during the treatment of choice, such as surgery and imaging.”
According to Dr. Stisser, the five-year relative survival rate for all stages of prostate cancer in which the cancer has not spread to distant parts of the body is close to 100 percent, with 10- and 20-year survival rates for early stage prostate cancer typically greater than 90 percent, depending on the chosen treatment. In addition to staging, the cancer is also graded to help indicate its level of aggressiveness. For example, a higher grade indicates a more aggressive cancer that is more likely to spread. “For prostate cancer, the Gleason score is the scale used to evaluate the cancer cells’ grade,” Dr. Smith says. “Scoring combines two numbers and can range from 2, a nonaggressive cancer, to 10, a very aggressive cancer.”
Treating prostate cancer “The primary treatments with the intent of curing the cancer involve surgery or radiation,” says Dr. Stisser. “Surgery typically involves removing the prostate or freezing it in place, whereas radiation leaves the prostate in place, but the cancer cells are destroyed with radiation beams or radioactive seeds that are implanted. Side effects associated with all prostate cancer treatments can include urinary and erectile complications, bleeding and infections. Fortunately, those side effects are typically at low rates and can usually be treated.” Surgery to remove the prostate — radical prostatectomy — may be accomplished via several approaches, depending on the surgeon’s preference, including robotic assistance, laparoscopy, or an open approach through an incision in the lower abdomen or the perineum — the area between the anus and scrotum. Not all prostate cancers need treatment, however. “For men with early stage prostate cancer, physicians may recommend ‘active surveillance.’ “This involves regular and scheduled follow-up with PSA testing, digital rectal exam and
intermittent prostate biopsies to monitor the cancer’s progression. Active surveillance may be a reasonable approach for patients with low-grade, low-volume disease and for men who have significant health conditions or are at an advanced age. Active surveillance is not without risks, however, as the cancer may grow or spread between evaluations.” When treatment is determined to be the best course of action, hormone therapy may also be used to halt the growth of prostate cancer cells and impair testosterone production. “Most commonly, hormone therapy is used in men with advanced prostate cancer to shrink the tumor and slow the growth of cancer cells,” Dr. Smith explains. “Side effects may include erectile dysfunction, reduced sex drive, weight gain and osteoporosis.” New treatment options on the horizon may include high-intensity focused ultrasound to ablate cancer cells and focal — as opposed to whole-gland — therapies for prostate cancer. Like most decisions related to one’s health, decisions regarding screening and treatment for prostate cancer are very personal and shouldn’t be made lightly or without in-depth discussions with a trusted health care provider. Maintaining an awareness of prostate enlargement’s symptoms as well as knowing whether there is a family history of prostate cancer can help patients and their physicians determine the best course of action for a disease whose screening and treatment options are anything but straightforward.
Sources www.cancercenter.com
Expert Contributers Brian C. Stisser, MD is a urologist with Blue Ridge Urological, PC in Fishersville. Ryan P. Smith, MD is a urologist with UVA Specialty Care in Culpeper.
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DESERVES
TO BEAT BREAST CANCER
words |SUZANNE RAMSEY photography |KG THIENEMANN artwork |JOE PALOTAS
The American Cancer Society estimates that nearly 300,000 women will be diagnosed with some type of breast cancer in 2015, and more than 40,000 women will die of the disease. Breast cancer does not discriminate. It affects women of all ages, ethnicities and backgrounds. It also has no regard for income level. That said, having breast cancer is costly. Before it’s all said and done — chemotherapy, surgery, radiation, breast reconstruction, etc. — the cost of treatment for breast cancer can exceed $100,000 according to some estimates, and that doesn’t include expenses like transportation to and from appointments, overnight hotel stays and lost work hours. “Even if patients can afford their treatment, it’s an unfortunate situation,” says Pranav Patel, MD, who specializes in hematology and oncology at the University of Virginia Health System’s Hope Community Cancer Care in Culpeper. Fortunately, there are resources available for women with low incomes. “The majority of our population in that region is either low-income or indigent patients. We try our hardest to get them access to UVA’s — continued on page 28
Reprints To order reprints of the original artwork featured on this issue’s cover, contact Deidre Wilkes at 540.387.6482 or via email at deidre@ourhealthvirginia.com. To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com
assistance programs, financial assistance through drug manufacturers and community resources that are available,” Dr. Patel says. “We have a robust patient advocacy program — each office has one — that looks into resource needs, as well as a social worker who tries to meet with the patients to make sure financial pieces are addressed. Dealing with cancer is not only a big emotional burden, but the stress of finances, the cost of care, is an additional piece.” Before she was diagnosed with breast cancer in April 2014, Devona Wilson wasn’t the kind of person to ask for help. Pranav D. Patel, MD is a physician at UVA Health System’s Hope Community Cancer Care Culpeper. He is certified by the American Board of Internal Medicine with subspecialties in Hematology and in Medical Oncology.
Upcoming Events Pamper Me Pink event raises money for mammography fund Pamper Me Pink, a fundraiser for the Pamper Me Pink Mammography Fund, will be held at 5 p.m. Tuesday, October 27, at the State Theatre in Culpeper. No tickets are required, and admission is free. The event includes free food, music, spa treatments, door prizes, a raffle and educational information. Pamper Me Pink and its free mammography program are open to both men and women. To apply for the free mammography program, call UVA Culpeper Hospital Financial Counseling at 540.829.4320.
When: Where:
Tuesday, October 27 at 5 p.m. The State Theatre in Culpeper
In the Pink Tennis Tournament When: September 26, 2015 Where: Charlottesville, VA For more information or to resister visit www.mjhfoudation.org/in-the-pink.
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“I was one of those who would do the best I could,” says Wilson, a 48-yearold single mother from Locust Grove. “I wouldn’t say there was necessarily pride, but it was something I just didn’t do. I’ve always been pretty independent and self-sufficient. This experience humbled me a great deal.” It was around Christmas in 2013 when Wilson thought something was wrong with her right breast. “I just happened to be at the mirror one day after getting dressed,” she says. “As I was combing my hair, my arm slipped and brushed against my chest, and I thought, ‘That doesn’t feel right. What is that?’ I just kind of looked at it and felt it and thought about it and then said, ‘Maybe it’s nothing.’ I let it go for a couple of days and just kept feeling it and said, ‘This isn’t right; it’s not going anywhere.’ So I said, ‘I need to do something.’” The big question for Wilson wasn’t what to do — she knew she needed a mammogram as soon as possible — but how to do it. At the time, she had no health insurance and no job. She and her young son, Truth, were struggling to get by and being what she calls “thrifty.”
Uninsured patients and those from ethnic minorities are substantially more likely to be diagnosed with cancer that is at a more advanced stage, when treatment can be more extensive, more costly and less successful.
Hoping to find a clinic that provided mammograms for free or at reduced rates, Wilson opened the Yellow Pages. She’d heard about mobile mammography and hoped she could use that option. In the end, her search came up empty. “Unfortunately, I wasn’t able to get anybody that was able to do anything, and every resource I looked into didn’t pan out,” she says. Then her son’s godmother told her about Every Woman’s Life, a public health program of the Virginia Department of Health that, according to its website, “helps uninsured, low-income women gain access to free breast and cervical cancer screening services.”
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
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ecruoS
The Stages of Breast Cancer Stages
0
&
1
These lowest numbered stages represent the earliest detection of breast cancer development. At Stage 0 and 1, the cancer cells are confined to a very limited area.
Stage
2
Stage 2 breast cancer is still in the earlier stages, but there is evidence that the cancer has begun to grow or spread. It is still contained to the breast area and is generally very effectively treated.
Stage
3
Stage 3 breast cancer is considered advanced cancer with evidence of cancer invading surrounding tissues near the breast.
Stage
4
Stage 4 breast cancer indicates that cancer has spread beyond the breast to other areas of the body.
Source: www.nationalbreastcancer.org
EWL is grant-funded through the Centers for Disease Control and Prevention. Wilson called EWL and was approved for the program within about a month. It took another five or six weeks, however, to get her mammogram scheduled. “There was a wait for my age category, but they said they would get me seen as soon as possible,” Wilson says. “At the time, I was like, ‘What else can I do?’ There was no one I could afford, no health insurance at all. There was just nothing. I couldn’t go to the emergency room and say, ‘Give me a mammogram.’ It was kind of unlikely and even then, how would I pay for that emergency room bill?” According to Christina Benton, EWL’s cancer control supervisor, 80 percent of the women EWL serves are 50 or older — an age the CDC considers a clinical indicator for breast cancer because of that population’s higher rates of breast cancer. Research has shown that women in their 50’s and 60’s benefit most from mammograms. “That’s why there’s a limited number of spots for women ages 40 to 49, and at times they may end up being put on a waiting list. Our goal is to serve every woman who comes to the program in need of a mammogram,” explains Benton. Wilson had her mammogram through UVA Health System on March 18, 2014. It showed that what she’d felt that day in front of the mirror was a harmless calcium buildup. Deep beneath that, however, there was a suspicious mass. After a follow-up ultrasound and biopsy, the mass was diagnosed as stage 3 breast cancer. When Wilson got the call with her diagnosis, she says she was in disbelief, and her first thoughts were, “Am I going to die? How did this happen?” As the caller talked to her about medical appointments and other routine things, Wilson says it was like listening to Charlie Brown’s teacher: “Wah, wah, wah, wah.” For the next few days, Wilson worried. “The week or so I had to wait to see the doctor was a bit of a mess because as soon as I woke up, I was thinking, ‘What’s going to happen to me? Am I going to see my son grow up? Am I going to live? Am I going to die?’” she recalls. “It was consuming me through the whole day. I don’t even know how I functioned. It was on my mind 24/7.” Finally, Wilson says she decided to “give it over to the Lord.” She said, ‘I’m giving this to you, God. I can’t handle it.” Wilson also called on her younger sister, Ruthanna, who had gone through breast cancer a few years earlier. She says her “baby sister” puts a positive spin on everything and seems to have a direct connection to God. When she
told Ruthanna about the cancer and the team of doctors who had been assembled to treat it, Wilson says her sister was perplexingly ecstatic. “She was like, ‘Aren’t you excited?’” Wilson responded, “Excited? What are you talking about?” Ruthanna countered enthusiastically: “It sounds like you have a great team that’s positive they can get this under control. You’re going to be fine. You’ll have new breasts, and you’re going to probably be better than you were before!” Wilson had chemotherapy, followed by a bilateral — sometimes called “double” — mastectomy. Radiation treatments followed and then breast reconstruction this past summer. She qualified for Medicaid, which meant her medical bills would be less of a worry. While it was not the case for Wilson, breast reconstruction can be a financial burden for patients without insurance or access to public facilities like UVA. “Each hospital has its own assistance programs, but I think it just depends on what the patient’s financial situation is and what resources that hospital has to offer,” says Dr. Patel.
What is Medicaid? Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Even with her medical bills taken care of, things weren’t easy for Wilson. During the winter of 2014, while she was undergoing radiation treatments five days a week for six weeks, she couldn’t afford propane. The house was cold, there was no hot water and she couldn’t cook.
“The week or so I had to wait to see the doctor was a bit of a mess because as soon as I woke up, I was thinking, ‘What’s going to happen to me? Am I going to see my son grow up? Am I going to live? Am I going to die?’” she recalls. “It was consuming me through the whole day. I don’t even know how I functioned. It was on my mind 24/7.” — Devona Wilson
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Fortunately, her pastor and friends pitched in and paid the bills. When she didn’t have gas for the 27-mile commute to and from Culpeper and had to miss a couple of radiation treatments, the clinic gave her a gas card to get her over the hump. Tamara Fisher, a nurse navigator who works with breast cancer patients in the UVA Health System, says transportation is a huge barrier for many patients, some of whom travel from as far away as West Virginia for treatment. Unfortunately, there aren’t many resources available in the Culpeper area. Tamara Fisher, RN is a Nurse Navigator in UVA Health System’s Breast Care Center.
Fisher says she tells patients to ask friends and family for help, and to “reach out to churches to see if there’s anyone who would be willing to bring them to appointments.” Medicare and Medicaid might cover transportation services, she says, but sometimes these rides need to be scheduled days in advance. “It’s difficult,” Fisher says. “The resources are difficult. A lot of times we know that a patient has difficulty with transportation, and we try really hard to adjust the appointments and different things to be able to work so they can get here.” Some patients have to deal with lodging expenses as well. In Charlottesville, patients and their families can stay at the UVA Health System’s Hospitality House at a cost of $10 per person, per night. Fisher says some local hotels also give discounted rates to patients.
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Asked her advice for patients who need financial help, Fisher suggests that they “use the resources that are available and don’t be afraid to use them. Reach out and ask for help if it’s needed. If they reach out, it has no bearing on who they are. That’s what we’re here for, to help them and point them in the right direction to the people to get them the resources they need.” Wilson knows things will never be the same after breast cancer. Lately she’s been rediscovering herself and “the — continued on page 34
What is ‘chemo brain’? Chemo brain is a term to describe the thinking and memory problems that can occur after cancer treatment. Chemo brain can also be called chemo fog, chemotherapy-related cognitive impairment or cognitive dysfunction. A few examples of what patients call ‘chemo brain’ are as followed: •
•
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 (they are less able to do more than one thing at a time)
•
Taking longer to finish things (disorganized, slower thinking and processing)
•
Trouble remembering common words (unable to find the right words to finish a sentence)
FOUNDATIONS and ORGANIZATIONS Cancer Center Bridge Fund at Augusta Health 78 Medical Center Drive Fishersville | 540.332.5174 www.augustahealth.com
Every Woman’s Life Program Augusta Regional Clinic 342 Mule Academy Road Fishersville | 540.332.5606 www.augustafreeclinic.org
Every Woman’s Life Program UVA Cancer Center 1300 Jefferson Park Avenue Charlottesville | 434.243.9782 cancer.uvahealth.com
Martha Jefferson Hospital Foundation 400 Martha Jefferson Drive Charlottesville | 434.654.8258 www.mjhfoundation.org/ cancer-care
MEDICAL FACILITIES and IMAGING CENTERS Augusta Health Cancer Center 78 Medical Center Drive Fishersville | 540.332.5960 www.augustahealth.com/ cancer-center
Carilion Clinic Imaging – Carilion Stonewall Jackson Hospital 1 Health Circle Lexington | 540.458.3322 www.carilionclinic.org
Martha Jefferson Cancer Care Center 500 Martha Jefferson Drive Charlottesville | 434.654.7009 www.sentara.com/ charlottesville-virginia
Northridge Breast Imaging Center 2965 Ivy Road (250 West) Charlottesville | 434.924.1555 www.uvahealth.com
Orange Diagnostic and Mammography Center 661 University Lane, suite D Orange | 540.661.3082 www.uvahealth.com
UVA Breast Cancer Center 1240 Lee Street Charlottesville | 434.924.9333 cancer.uvahealth.com
UVA Imaging Zion Crossroads 1015 Spring Creek Parkway Zion Crossroads | 434.243.9198
UVA Mobile Mammography Coach For the mobile coach’s monthly schedule, visit: Cancer.uvahealth.com/mobile or call 434.243.4704 Appointments are required.
Virginia Breast Care 595 Martha Jefferson Drive, Suite 320 Charlottesville | 434.984.6120 www.vabreastcare.com
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Above: Devona with her son Truth (age 12), her biggest supporter.
“I don’t sweat the small stuff,” Wilson says. “If I’m able to take a walk, take a drive with the top down and the sun on my face, it’s a good day.”
new normal.” More than a year after chemotherapy, she still struggles with “chemo brain” — a cost of breast cancer she didn’t expect — and has trouble with memory, directions and other day-to-day things. It’s frustrating, Wilson says, of not being able to find your way home from the 7-Eleven on a road you’ve driven a thousand times or being unable to remember which floor the doctor’s office is on. “That’s not something I was prepared for. It changes the way you do everything. The way you cook, everything you do. It’s really scary. You feel totally out of control, like you’re losing your mind.” There are good things, though. Wilson says she feels closer to normal than she has in two years and that breast cancer has given her “a new appreciation for life and having life.” “I don’t sweat the small stuff,” Wilson says. “If I’m able to take a walk, take a drive with the top down and the sun on my face, it’s a good day.”
Sources www.cancer.org www.mayoclinic.org www.nationalbreastcancer.org
Expert Contributers Pranav D. Patel, MD is a physician at UVA Health System’s Hope Community Cancer Care Culpeper. Tamara Fisher, RN is a Nurse Navigator in UVA Health System’s Breast Care Center.
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BEST THE FIRST ANNUAL
BED S I D E M A N N E R
AWARDS IN
S H E N A N D O A H VA L L E Y & CHARLOTTESVILLE
COMING SOON!
The Resource for Healthy Living in the Shenandoah Valley & Charlottesville
Winners announced in the November/December edition of OurHealth
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Augusta Health Lifetime Fitness Center offers a variety of wellness, exercise and medical fitness programs to the community. Specializing in medical fitness, Augusta Health Lifetime Fitness Center features programs that integrate physician referrals for physical and occupational therapies, cardiac rehabilitation, and oncology services with your fitness needs. These programs are designed to educate while teaching self-monitoring skills and moving towards independent exercise. Augusta Health Lifetime Fitness Center is certified by the Medical Fitness Association (MFA), and is proud to be the first and only medical fitness facility worldwide receiving a score of 100 percent on both its initial certification and recertification. The MFA certification program is the only accreditation offered specifically to facilities in the medical fitness industry. In addition to offering medical fitness programs, Augusta Health Lifetime Fitness welcomes all members of the community looking to benefit from preventative wellness and a healthy lifestyle. Whether its group classes, personal training, water fitness and swimming, or tennis, there is something for everyone looking to achieve optimal results through fitness!
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Photos Courtesy of Mark Miller and Augusta Health Lifetime Fitness.
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FIT BITS Couch to 5K
CHALLENGE Have you ever thought the idea of participating in your first 5K sounded enticing, but just didn’t know how to get started? Then the Couch to 5K Challenge may be right for you! The 10-week Couch to 5K Challenge program* gradually integrates different intervals of walking and jogging with adequate rest and recovery time to help you reach a goal of jogging an entire 5K! Follow the chart at the right to guide you on your journey.
Start your Couch to 5K Challenge by September 17, 2015 and be ready to participate in the 7th Annual Earlysville Turkey Trot 5K on Thursday, November 26, 2015.
6th Annual Earlysville
TURKEY TROT 5K
Deidre Wilkes, AFAA, ACSM
Certified Personal Trainer Deidre is the resident fitness specialist for OurHealth Shenandoah Valley & Charlottesville.
WEEK WEEK
DAY 1 DAY 2
DAY 3 DAY 4 DAY 5 DAY 6 DAY 7
1
5 min walk 2 min jog 5 min walk
REST
5 min walk 2 min jog 5 min walk
REST
5 min walk 3 min jog 5 min walk
REST
REST
2
5 min walk 3 min jog 5 min walk
REST
5 min walk 4 min jog 5 min walk
REST
5 min walk 5 min jog 5 min walk
REST
REST
3
5 min walk 6 min jog 5 min walk
REST
4 min jog 5 min walk 4 min jog 5 min wakj
REST
5 min walk 7 min jog 5 min walk
REST
REST
4
5 min walk 7 min jog 5 min walk
REST
5 min walk 8 min jog 5 min walk
REST
5 min walk 9 min jog 5 min walk
REST
REST
5
5 min walk 9 min jog 5 min walk
REST
6 min jog 5 min walk 6 min jog 5 min walk
REST
5 min walk 10 min jog 5 min walk
REST
5 min walk 11 min jog 5 min walk
6
5 min walk 11 min jog 5 min walk
REST
13 min jog 5 min walk
REST
15 min jog 5 min walk
REST
REST
7
15 min jog 5 min walk
REST
8 min jog 5 min walk 8 min jog 5 min walk
REST
16 min jog 5 min walk
REST
17 min jog 5 min walk
Race Date:
November 26, 2015
Race Time:
9 a.m.
8
17 min jog 5 min walk
18 min jog 5 min walk
REST
20 min jog 5 min walk
REST
REST
Location:
600 Earlysville Forest Drive, Earlysville, VA 22936
REST
9
20 min jog
REST
12 min jog 5 min walk 12 min jog
REST
24 min jog2
REST
5 min jog
10
27 min jog
REST
30 min jog
REST
RACE DAY!
CELEBRATE! You did it!
(Located just 15 Minutes Northwest of Charlottesville at the 3-way intersection of Earlysville Road, Reas Ford Road and Earlysville Forest Drive) To register and for more information: www.charlottesvillemultisports.com/CMS/ Earlysville_Turkey_Trot.html
RUNNING TIPS »» »»
*Before starting any new diet and exercise program please check with your doctor and clear any exercise and/or diet changes with them before beginning.
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»»
STRETCH IT OUT: Stretch after every workout to avoid injuries.
KNOW YOUR LIMITS: If you start
developing an injury, STOP running before it gets worse and take a few days off.
TRY IT OUT: This is only a rough outline of the perfect plan for you. You can change it as you need to.
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
»»
TAKE IT EASY: Don’t push yourself too hard when you jog. Go at a comfortable pace.
»»
HYDRATE: Hydrate properly and energize yourself at least an hour before you run.
»»
GEAR UP: Make sure you have the proper running shoes. Most local running stores can assist with fitting and recommending the right shoe.
of Bridgewater VA, with fiancĂŠ Justin.
Breaking the Silence Eating Disorders words | SUSAN DUBUQUE photography |KAYLA KOSLOW PHOTOGRAPHY
This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them. That is, until now. In each issue of OurHealth, we will uncover and discuss these medical issues and dedicate these stories to the courageous patients and families living with them and to the providers and researchers who commit their lives to treating and seeking cures for these enigmatic conditions.
Thin as a whisper. Frail bones. Stabbing heart pain. Insomnia. Hair loss. Extreme fatigue. These were just a few of the signs that Krystal Diehl, then 19, was literally dying of starvation. As a student at Virginia Tech, Krystal had a tough time adjusting to college life. She never felt like she fit in, and living off campus exacerbated her feelings of isolation. “At the end of my first year, my best friend—who also went to Tech—decided to transfer home to attend community college, and my boyfriend and I broke up. I was unhappy at school, unhappy with my relationships, and I felt like my life was spiraling out of control. I began to look for something I could control to relieve my stress and sadness,” recalls Krystal. “I did that through food and exercise. I had never been happy with the way I looked. I had always had low self-esteem and poor body image.” Looking back, Krystal realizes she was depressed—not just suffering from a passing sadness—and with a Type A personality, nothing was ever good enough when it came to her grades or performance. This became the recipe for a perfect storm. Krystal started restricting her eating and regimenting her exercise habits. “At the beginning I truly believed that what I was doing was healthy, that I was cleansing my body and making
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“At the beginning I truly believed that what I was doing was healthy; that I was cleansing my body and making it healthier,” says Krystal.
it healthier,” says Krystal. But things snowballed very quickly. “I was eating very little and working out several times a day. And I was miserable. I had no energy and constantly felt like I was going to pass out, but I couldn’t stop. My brain played on a continuous loop of thoughts about how much weight I needed to lose because I was so fat and disgusting, how many calories I would burn during the next workout and how little I would eat at the next meal.” Krystal’s behavior had morphed into something obsessive, unstoppable and socially isolating. Working out came above all else, including her classes, family and friends. Krystal would go several weeks without seeing her parents, so when she visited, her weight loss was extreme and apparent to them. “On Oct. 17, 2004, when I was home for the weekend, my mom told me that she really wanted me to think about the amount of weight I had lost, and she thought I may have a problem. I collapsed into her arms and told her that I needed help. I was scared to admit it out loud, but I was also so relieved,” says Krystal. The next day Krystal was diagnosed with anorexia nervosa and exercise bulimia, and she began treatment for her eating disorders. Her primary care physician performed blood work, checked her vital signs and referred her to other health care providers—a dietitian, counselor and psychiatrist—in an effort to form a makeshift treatment team.
“I now had a treatment team. But, it was up to me to commit to recovery,” says Krystal. “I had to face my greatest fear, gaining weight, or die.”
Krystal was too sick to stay at Virginia Tech and live on her own, so she moved back into her parents’ home and finished the fall semester from there. She started seeing treatment professionals on a weekly basis and transferred to James Madison University for the spring semester. “There are no words to describe how fortunate I was to have the love and support of my mother, father and younger brother,” says Krystal. “I know I would not be alive without their support. Every day they would help me prepare my meals and then sit with me while I ate. Starving was not an option in my parents’ home. Neither was voicing out loud that I was fat, ugly or disgusting. That was the eating disorder talking. My family fought the eating disorder with the one thing it couldn’t argue with: unconditional love.” It took several more years and a number of treatment professionals until Krystal hit rock bottom. “Even though I had been ‘walking the walk,’ I hadn’t really committed to recovery,” she admits. “For more than two years, I continued to lose weight. I hadn’t been able to find the right treatment professionals who really understood the eating disorder and my struggle.”
“Eating and gaining weight was scary and painful, but the physical recovery was the easy part. Working through the emotional issues—the root cause of her eating disorder—was the tough part.”
By this point, Krystal’s body was starting to shut down. She could only function for a few hours at a time because her energy level was so low. Her long dark hair had a bald spot. Her menstrual cycle had long since stopped and she developed osteopenia—thinning of bone density. Layers of downy hair covered her skin in her body’s effort to insulate itself since she no longer had any fat mass. She suffered from muscle wasting and sharp heart pains caused by a lack of nutrients. Even thinking was difficult—her brain didn’t have adequate fuel to process thoughts. Krystal could feel herself dying. Krystal’s mother heard of a dietitian in the area who specialized in eating disorders, and the family agreed to see her as a last-ditch effort before resorting to inpatient treatment. “On the way to the first appointment, I was not optimistic,” Krystal remembers. “One more time telling my story and filling out forms. Here we go again. But from the start, this dietitian was different. We didn’t waste time. And she didn’t let the eating disorder manipulate her. She could see right through its smokescreen. She got it! Finally!” Within a few weeks the dietitian had referred Krystal to a primary care physician
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and a counselor who also understood eating disorders. “I now had my treatment team. But, it was up to me to commit to recovery,” says Krystal. “I had to face my greatest fear—gaining weight—or I would die.” “The unknowns of recovery were overwhelming, but I wasn’t ready to give up, nor did I think that God’s purpose for my life was to die from an eating disorder at 22 years old,” says Krystal. “I was lying in bed having this inner contemplation when it all came together. I got up, went out to my parent’s kitchen, got out a box of Oreos and ate the whole damn thing. I have to give my family credit. They proceeded like nothing was happening, but I’m sure they wanted to shout from the rooftops with joy.”
Above: Krystal with her parents, Kim and Dennis, and brother, Derek.
“My family fought the eating disorder with the one thing it couldn’t argue with: unconditional love,” says Krystal.
For Krystal, the Oreos were a symbol—marking the beginning of a lot of hard work, both emotionally and physically. Eating and gaining weight were scary and painful. The physical recovery was the easy part. Working through the emotional issues— the root causes of her eating disorder—was the tough part. And then there was working on healthy relationships, stress management and self-esteem. “You need a solid foundation of recovery to support you through the tough times that will inevitably come later in life so you don’t revert back to old, unhealthy behaviors,” advises Krystal. “Achieving true recovery is possible, but it is a long and tedious process to achieve a life of balance.” One of the most helpful things Krystal did in the recovery process was to “come out” about her eating disorder. “Letting others know about my struggle was freeing and empowering,” she says. “My journey in recovery has been far from perfect. And I would not wish an eating disorder on anyone. But because of my battle with anorexia and obsessive exercising, today I am stronger, more empathic and more intuitive,” says Krystal. “I learned to listen to my body and give it what it needs. I love the curves I inherited www.OurHealthCville.com
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Above: Krystal and Justin will marry this fall!
from my grandmother instead of loathing them. And, I found my passion. I know my purpose is to help others who are struggling to find health and happiness.”
“In our home, just like in my parents’ home, fat talk will always be unacceptable, a meal will never be allowed to be skipped and the value of a person will never be based on a number of pounds or dress size,” says Krystal.
Krystal put her passion to work by completing her master’s degree in health education and establishing Transformations, a business devoted to helping others navigate the rough waters of eating disorder recovery by providing them with local resources and coordinating treatment teams. “The word ‘transformations’ has a lot of significance to me,” says Krystal. “Recovery is about transforming your identity from that of anorexic or bulimic to your true self—who you are authentically at your core.” Krystal’s experience led her to Augusta Health, where she works as a health educator. “I am so blessed with a family who provided unending support and unconditional love, with a team of treatment professionals who understood the complexity of the eating disorder, and by God, who showed me how to help others because of what I have experienced,” says Krystal. “And now I am blessed with a fiancé who understands that the eating disorder molded me into who I am today, and he believes I am a better person for it. In our home, just like in my parents’ home, fat talk will always be unacceptable, a meal will never be allowed to be skipped and the value of a person will never be based on a number of pounds or dress size.
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Let’s bring eating disorders into the light and learn what they are, their signs and symptoms, how they are diagnosed and treated and what the future holds for those who suffer from them.
What are eating disorders? “Eating disorders are illnesses that significantly impact nutritional status, such as eating extremely small amounts of food or severely overeating,” says Eileen Myers, a registered dietitian and national expert on eating disorders. “They involve distorted thoughts, emotions, attitudes and behaviors surrounding weight and food issues.” Approximately 30 million people in the United States suffer from an eating disorder, but only 1 in 10 will receive treatment. Eating disorders can occur across a broad age range, including childhood, the teenage years and older adulthood. However, according to Julia Taylor, MD, pediatrician, with the University of Virginia Health System, “We tend to see a spike in early adolescence around the time of puberty and again during the early college years.” Teenage girls and young women are more likely than teenage boys and young men to have an eating disorder, but recent studies show that the gender gap is closing. Heredity may play a part in why certain people develop eating disorders, but these disorders also affect many people who have no family history. A variety of psychological issues, such as depression, anxiety, panic disorder, obsessive-compulsive disorder and substance abuse frequently occur in people with eating disorders. There is no doubt that societal factors also play a role in eating disorders. There is tremendous pressure in our culture to be thin and svelte—to the point that even the photographs of supermodels are retouched. Young girls, in particular, are affected by these images of the so-called perfect body. “While dieting does not cause eating disorders, severe dieting could spiral out of control and be the first step toward an eating problem,” says Dr. Taylor. Without treatment, eating disorders can be life-threatening. In fact, people with anorexia nervosa—one type of eating disorder—are 18 times more likely to die early compared with people of similar age in the general population. But with proper treatment of both physical and emotional symptoms, those suffering from eating disorders can resume appropriate eating habits and return to better physical, emotional and psychological health.
Eileen Myers, MPH, RD is Vice President, Affiliations and Patient Centered Strategies with The Little Clinic. The Little Clinic is a retail health clinic company operating inside select Kroger stores in Central Virginia.
Approximately 30 million people in the United States suffer from an eating disorder, but only one in 10 will receive treatment.
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Types of eating disorders The signs and symptoms of anorexia nervosa include: •
Extremely restricted eating.
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Severe thinness, emaciation.
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A relentless pursuit of thinness and an unwillingness to maintain a normal or healthy weight.
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Intense fear of gaining weight.
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Distorted body image; denial of the seriousness of low body weight.
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Self-esteem that is bound to perceptions of body weight and shape.
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Lack of menstruation among girls and women.
There are many types of eating disorders—among the most common are anorexia nervosa, bulimia nervosa and binge-eating disorder.
Anorexia nervosa Anorexia nervosa is characterized by self-starvation and excessive weight loss. People with this eating disorder are often obsessed with food, eating and weight control. They typically eat very small quantities of only certain foods and weigh themselves repeatedly. This is a complex medical condition—people with this diagnosis may also engage in binge eating followed by extreme dieting, excessive exercise, self-induced vomiting and misuse of laxatives, diuretics or enemas. “Anorexics tend to be perfectionists,” says Myers. “They may suffer from low self-esteem and are extremely critical of themselves and their bodies. They usually feel fat and see themselves as overweight, sometimes even despite life-threatening semi-starvation or emaciation.” An intense fear of gaining weight and of being fat may become all-pervasive. In the early stages of these disorders, patients usually deny that they have a problem. Over time, anorexia nervosa may result in a variety of health issues, such as brittle hair and nails, dry yellowish skin, severe constipation, anemia, muscle wasting, weakness, lethargy and infertility. If the behavior persists, the individual may suffer from thinning bones (osteopenia or osteoporosis), low blood pressure, heart damage, brain damage and, ultimately, multiple organ failure.
Bulimia nervosa Individuals with bulimia nervosa have repeated and frequent episodes of eating large amounts of food. Sufferers feel out of control as they eat astounding amounts of food in a short time, often consuming thousands of calories that are high in sugar, carbohydrates and fat. They may eat very rapidly, sometimes gulping down food without even tasting it.
The signs and symptoms of bulimia nervosa include:
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Chronic sore throat.
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Swollen salivary glands in the neck and jaw area.
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Acid reflux disorder and other gastrointestinal problems.
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Worn tooth enamel and decaying teeth due to exposure to stomach acid.
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Intestinal distress and irritation from laxative abuse.
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Severe dehydration from purging of fluids.
After a binge, those with bulimia nervosa purge by inducing vomiting, using laxatives or diuretics, exercising excessively or a combination of these behaviors. This cycle is usually repeated at least several times a week or, in serious cases, several times a day. “Although they may frequently diet and vigorously exercise, these individuals can be slightly underweight, normal weight, overweight or even obese,” says Dr. Taylor. At the same time, they fear gaining weight, want desperately to lose weight and are intensely unhappy with their body size and shape. Bulimic behavior is done secretly, as it is accompanied by feelings of shame or disgust. Many people don’t know when a family member or friend has bulimia nervosa. Because sufferers almost always hide their binging and since they don’t become drastically thin, their behaviors may go unnoticed. Bulimia nervosa can be life-threatening. Electrolyte imbalance—too low or too high levels of sodium, calcium, potassium and other minerals—can lead to heart attack.
Binge-eating disorder A person with binge-eating disorder loses control over his or her eating. Unlike bulimia nervosa, periods of binge eating are not followed by purging, fasting, excessive exercise or laxative abuse. As a result, people with binge-eating disorder often are overweight or obese. Bingeing can lead to feelings of guilt, shame and distress, which in turn can lead to more bingeing. The binge-eating behavior is
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Pay attention.
Be tuned in to what your loved one says, how they behave and what they eat. Be alert to an apparent preoccupation with weight, food, calories, and body image.
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Take ownership of the solution. “Here is the action I need to take for my peace of mind. I need to make an appointment for you to see the doctor.”
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Sit down.
This is not a conversation to have in passing. Show your genuine concern and caring by sitting down and talking face-to-face.
Avoid blame.
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Remember: your loved one isn’t under- or overeating by choice or to annoy you.
Stick to the facts.
While showing your love, do it in a factual, nonaccusatory way. Express your concern with “I statements.” For example, "Here is what I have observed. I am worried about how much weight you have lost in the past three months."
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from a medical condition. You wouldn’t scold your child or lecture your spouse if they had cancer or diabetes.
Brace yourself.
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Your loved one may respond with anger, defensiveness or denial. Just stick to the facts and restate what you need to do for your peace of mind.
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Take a Long-term view.
Even after your loved one has achieved a healthy weight, continued support and counseling will likely be needed to prevent relapse.
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Seek help.
The importance of a team of professionals to address both the physical and emotional aspects of eating disorders cannot be stressed enough.
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chronic and can lead to serious health complications, particularly severe obesity, diabetes, hypertension and cardiovascular diseases. “Eating disorders are underrecognized and underreported,” explains Dr. Taylor. “Toddlers, children and adolescents may have transient eating abnormalities—and most parents assume that the child will soon outgrow it. Unfortunately, this isn’t the case with eating disorders. And it can be difficult to tell the difference between the healthy appetite of a growing teen and true bingeing.”
Treatment Eating disorders clearly demonstrate the close links between emotional and physical health. “For that reason, a multidisciplinary treatment team is essential,” says Myers.
Here are the possible members of a treatment team and their respective roles: Julia Taylor, MD is a pediatrician with UVA Health System. She is certified by the American Board of Pediatrics.
Restoring a person to normal weight or temporarily ending the being-purge cycle does not address the underlying emotional problems that cause or intensify the abnormal eating behavior.
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Primary Care Physician. Monitors the overall health and wellbeing of the patient. Conducts routine blood pressure checks, heart rate and blood work to ensure that the disease is not affecting internal organs.
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Psychologist/licensed counselor. Works through the emotional issues and helps the individual get to the root cause of the eating disorder. This process may continue long after the weight has been restored.
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Dietitian. Provides nutrition counseling, management and education to help the patient achieve and sustain a healthy weight. Meal planning to incrementally increase or decrease food intake.
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Psychiatrist. Prescribes medication, if needed to treat depression, anxiety and compulsive behavior that often accompanies an eating disorder.
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Patient and Family. Actively participates in designing and implementing the treatment plan.
The first step in treating anorexia nervosa is to help patients regain weight to a healthy level. For those with bulimia nervosa, interrupting the binge-purge cycle is vital. And for people with binge-eating disorder, it is important to help them interrupt and stop binges. However, restoring a person to normal weight or temporarily ending the binge-purge cycle does not address the underlying emotional problems that cause or intensify the abnormal eating behavior. Psychotherapy—individual, group and family-based—can help individuals with eating disorders understand the thoughts, emotions and behaviors that trigger these disorders. In one form of therapy—called the Maudsley approach—parents of adolescents with anorexia nervosa assume responsibility for feeding their child. This approach appears to be effective in helping patients gain weight and improve their eating habits and moods. To reduce or eliminate binge-eating and purging behaviors, patients may benefit from cognitive behavioral therapy. In CBT, the therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, alter inaccurate beliefs and change behaviors. Medication can play a role in treatment. Antidepressants, antipsychotics and mood stabilizers can help resolve mood and anxiety symptoms that often occur along
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with the eating disorder. Fluoxetine (Prozac) is the only medication approved by the U.S. Food and Drug Administration for treating bulimia nervosa. This medication appears to help reduce binge-eating and purging behaviors, reduce the chance of relapse and improve attitudes related to eating. “Introducing food to a patient who may be terrified of gaining weight requires a delicate hand,” says Rita Smith, a registered dietitian with Sentara Martha Jefferson Hospital. “It is important to work with the patient and come to an agreement on eating and nutritional goals.” Some patients may need to be hospitalized to treat medical problems caused by malnutrition and to provide intensive psychiatric support to relieve the issue leading to the eating behaviors. “A patient may feel a sense of relief when they are hospitalized,” observes Smith. “Their food choices are made for them, freeing them to deal with other issues that contribute to their eating disorders.” In addition to the array of traditional medical services that are deployed to treat eating disorders, patients may benefit from complementary or alternative treatments that can be integrated into their treatment plans, such as massage, animal-assisted therapy (equine and canine), expressive therapy (dance/ movement, art and drama) and mindfulness relaxation therapy (progression muscle, deep breathing, yoga and meditation).
What does the future hold?
Rita P. Smith, is a Registered Dietitian and Certified Diabetes Educator at Sentara Martha Jefferson Hospital.
There are a number of exciting developments in this field that offer new hope to people suffering from eating disorders. Here are just a few: •
Researchers continue to investigate questions about behavior, genetics and brain function to better understand risk factors, identify biological markers
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and develop specific psychotherapies and medications that can target areas in the brain that control eating behavior. •
Various combinations of genes to determine if any DNA variations are linked to the risk of developing eating disorders.
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Studies using functional magnetic resonance imaging show different patterns of brain activity between women with bulimia nervosa and healthy women. Researchers were able to see the differences in brain activity while the women performed a task that involved self-regulation—that is, a task that requires controlling an impulsive behavior such as binge eating.
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Psychotherapy interventions are being evaluated. One study of adolescents found that more youth with bulimia nervosa recovered after receiving Maudsley model family-based treatment than those receiving psychotherapy that did not specifically address the eating disorder.
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Another study suggests that an online intervention program may prevent some at-risk women from developing an eating disorder.
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Researchers and clinicians continue to evaluate the effectiveness of various medications in addressing the symptoms and the contributing psychiatric issues related to eating disorders.
“An eating disorder is an illness, not a choice,” says Krystal. “It isn’t a fad that will pass. You won’t just ‘get over it’ or outgrow it. Anorexics can’t make themselves eat; bulimics can’t just make themselves stop throwing up. But, recovery is a choice. You can choose to fight against the eating-disordered thoughts and behaviors and find and accept the help you need to do so.” Thankfully, Krystal made the right choice—to regain control of her eating, her emotions and her life. And now she is paying it forward—helping others who suffer from the same disease find the resources they need to love, respect and accept their bodies and achieve lasting health.
Sources and References: Additional References:
Medical Experts
Anorexia Nervosa: A Guide to Recovery by Lindsay Hall and Monika Ostroff
Eileen Myers, MPH, RD, LDN, FADA, author of the counseling manual “Winning the War Within: Nutrition Therapy for Clients with Eating Disorders” Julia F. Taylor, MD, NA, assistant professor, Department of Pediatrics and Adolescent Medicine, UVA Health System
Brave Girl Eating: A Family’s Struggle with Anorexia by Harriet Brown
Krystal Diehl, MEd, CHES, Health Educator and Community Outreach, Augusta Health, and principal, Transformations
Bulimia: A Guide to Recovery by Lindsay Hall and Leigh Cohn
Rita P. Smith, MS, RD, CDE, Registered Dietitian and Certified Diabetes Educator, Sentara Martha Jefferson Hospital
Books
Goodbye ED, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life by Jenni Schaefer Life Without Ed by Jenni Shaefer The Beginner’s Guide to Eating Disorders Recovery by Nancy J. Kolodny The Secret Language of Eating Disorders by Peggy Claude-Pierre
Websites Academy for Eating Disorders – www.aedweb.org Eating Disorders Coalition – www.eatingdisorderscoalition.org Eating Disorders Resource Catalogue – www.Edcatalogue.com Maudsley Parents – www.maudsleyparents.org National Association of Anorexia Nervosa and Associated Disorders – www.ANAD.org National Eating Disorders Association – www.nationaleatingdisorders.org National Institute of Mental Health – www.nimh.nih.gov
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HealthyEats Carrot Ginger Celery Soup (Makes 4-6 servings)
Ingredients: 1/2 medium onion, diced 2
cloves of garlic
1 tablespoon olive oil 1
pound of carrots, cut into 1-inch slices
1/2 cup of chopped celery 1
tablespoon peeled and chopped ginger root
2 cups of low sodium chicken broth
Directions: 1. Sauté the onion and garlic in the olive oil until tender. 2. Add remaining ingredients and allow to simmer about 10 minutes. 3. Add sea salt and pepper to taste.
Local fruit, veggies, and herbs from: Charlottesville City Market 100 Water Street Charlottesville | 434.970.3371 www.charlottesvillecitymarket.com The Charlottesville City Market was established in 1973 with the help of the Cason brothers. This wonderful market has everything from fruits, veggies, foods, plants, cut flowers, unique gifts, pottery and much more.
Tricia Foley’s Cancer Fighting
CARROT GINGER SOUP Tricia Foley is OurHealth Magazine’s resident nutritionist.
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HealthyEats Grass fed beef from:
Polyface Farms 43 Pure Meadows Lane Swoope | 540.885.3590 www.polyfacefarms.com Polyface Farms is a family owned, multi-generational, pasture-based, beyond organic, local-market farm and informational outreach in Virginia’s Shenandoah Valley. They produce grass fed beef, pigaerator pork, pastured poultry, forage-based rabbits, and forestry products.
Herb Flank Steak (Makes 4 servings)
Ingredients: 1
pound steak
2
tablespoons of lemon juice
1/2 teaspoon of dried oregano 1/2 teaspoon of sea salt 1/2 teaspoon of onion powder 1
clove of garlic
3/4 teaspoon of pepper
Directions: 1. Pound out the meat to tenderize. 2. Mix the remaining ingredients and rub into the meat. 3. You can choose to refrigerate over night. 4. Place the oven on broil. 5. Line the pan with foil and place the beef on a rack in a broiler pan. 6. Broil for 5 minutes, turn, and repeat for an additional 5 minutes.
Tricia Foley’s Cancer Fighting
HERB FLANK STEAK Tricia Foley is OurHealth Magazine’s resident nutritionist.
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HealthyEats Green Apple Smoothie (Makes 3 servings)
Ingredients: 1
green apple
3/4 cup of unsweetened coconut milk 1/2 cup of grapes, frozen 1/2 cup of blueberries, frozen 1
cup of strawberries, frozen
20 walnuts
Directions: 1. Blend all ingredients until smooth.
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GREEN APPLE SMOOTHIE Tricia Foley is OurHealth Magazine’s resident nutritionist. www.OurHealthCville.com
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