SPOTLIGHTING SPECIALTY CARE SERIES: Counting on Colonoscopies to Cure Cancer + Are Allergies Affecting Us More Than Ever? March • April 2019 ourhealthcharlottesville.com
Bringing Beauty Back to Your BODY, SKIN AND SMILE Before Bathing Suit Season
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
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FEATURES
MARCH • APRIL 2019
20 2019 Charlottesville and Shenandoah Valley Leaders in Local Healthcare
Learn how 11 of the brightest members of the Charlottesville and Shenandoah Valley medical community are giving back not because it’s a part of their job description, but because it is the right thing to do.
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9 Cosmetic Procedures That Turn Back Time on Your Face, Body and Skin As plastic surgery becomes more affordable and technology advances, more people are electing to reshape themselves for added confidence, anti-aging benefits and enhanced physical health.
40 Spring Cleaning for Better Health: What You Shouldn’t Sweep Under the Rug
No matter how tidy you are, some spots in your home always attract bacteria, fungus, mold, pet dander and more. These microorganisms and allergens can impact your breathing, sleep and overall health.
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DEPARTMENTS MARCH • APRIL 2019
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The Pulse | People. Places. News to Know.
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Health Scene | Happenings. Who’s Who. Trending. On February 13th, Augusta Health in Fishersville celebrated Heart Month by hosting its annual Heart Health Fair for the community where they screened more than 100 people for heart disease and stroke.
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Q&A on Health | Questions. Answers. Knowledge.
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Colonoscopies: Not So Strange and Scary After All: Patients worried about risks of colonoscopies or unsure what the procedure involves are less likely to get it done. But when you strip away the myths surrounding colonoscopies, they’re a simple, life-saving procedure — not so weird or scary after all.
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Specialty Spotlight Series | Allergy, Asthma and Immunology Are Allergies Affecting Us More Now Than Ever? There’s a good chance that you have allergies or know someone who does. In the U.S., more than 40 percent of children and 30 percent of adults now suffer from the condition, and it appears this trend is on the rise.
46 Kids Care | Inform. Educate. Grow
Dental specialists who have further training in treating children with autism like those available at Children's Dentistry of Charlottesville can help make visits to the dentist much more successful and less stressful for young patients and their parents.
Specialty Spotlight Series | Gastroenterology
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Funny Bone | Spot the Seven Differences
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MORE THAN A MAGAZINE ONLINE
MARCH • APRIL 2019
SOCIAL MEDIA
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PUBLISHER PRESIDENT/EDITOR-AT-LARGE VICE PRESIDENT OF PRODUCTION GRAPHIC DESIGNER ACCOUNTING MANAGER ORIGINAL PHOTOGRAPHERS
CONTRIBUTING MEDICAL EXPERTS CONTRIBUTING PROFESSIONAL EXPERTS & WRITERS
McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Tori Meador Laura Bower Mark Miller Kenneth Barron, MD Jared Davis, MD Paul Diamond, MD Chelsea Johnson, OD Christopher Stewart, DPM Leonard Butler Jennifer Lamont Katharine Paljug Rick Piester Shareef Tahboub
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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 © 2019 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. OurHealth Charlottesville/Shenandoah Valley 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 | ourhealthroanokenrv.com | ourhealthlynchburg.com | ourhealthrichmond.com | ourhealthcharlottesville.com | Advertising rates upon request.
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The Pulse
INFORMATION • EVENTS • AWARENESS Awards, Recognitions and Nominations
Openings, Relocations and Expansions
Augusta Health Recognized As One of America’s 50 Best Hospitals
UVA Health Opens Advanced Diabetes Management Clinic to Improve Access to Devices and Supplies
Augusta Health has received the Healthgrades 2019 America’s 50 Best Hospitals Award™. This is the fifth consecutive year that the health system has been awarded this recognition for clinical quality, which places it among the top one percent of more than 4,500 hospitals assessed nationwide for its consistent, year-overyear superior clinical performance as measured by Healthgrades. “Because this award recognizes overall clinical quality, it is a great reflection of the excellent care that our medical staff and employees provide to the community. It demonstrates more than expertise; it represents the teamwork and professionalism required to deliver very high-quality care,” says Mary N. Mannix, FACHE, President and CEO of Augusta Health. “Over the past five years, Augusta Health has been developing the depth and breadth of our clinical expertise. Clinically, we can now provide almost all of the procedures and care that patients Mary N. Mannix, FACHE in our community may ever need. As we’ve increased the complexity of the procedures we can perform, we’ve maintained this superior clinical excellence. That’s incredibly important to our patients.” Augusta Health is one of two hospitals in Virginia to receive the America's 50 Best Hospitals Award™ this year, and the only hospital in the Shenandoah Valley to receive it. According to the Healthgrades analysis, from 2015 through 2017, patients treated in hospitals that achieved the America’s 50 Best Hospitals Award™ had, on average, a 27.1 percent lower risk of dying than if they were treated in hospitals that did not received the award, as measured across 19 rated conditions and procedures where mortality is the outcome. During the 2019 study period (2015-2017), these hospitals showed superior performance in clinical outcomes for patients in the Medicare population across at least 21 of 32 of the most common inpatient conditions and procedures – as measured by objective performance data (risk-adjusted mortality and in-hospital complications).* Along with the America’s 50 Best Hospitals Award™, Augusta Health was recognized with the 2019 Pulmonary Care Excellence Award and Five-Star Distinctions in treatment of Heart Failure, Pacemaker Procedures and treatment of Chronic Obstructive Pulmonary Disease in 2019.
University of Virginia Health System has opened an expanded outpatient clinic to help individuals diagnosed with Type 1 diabetes and insulin-dependent type 2 diabetes more easily obtain appropriate technology to effectively manage their condition. The Advanced Diabetes Management Clinic, located at 183 Spotnap Road, Suite 2 in Charlottesville, is among just a handful of similar clinics in the U.S., and builds off UVA’s groundbreaking research that seeks to better manage this chronic disease. Staffed by a team of five endocrinologists, a nurse practitioner, a certified diabetes educator Ananda Basu, MD and support staff, the Clinic is currently open Mondays from 8 am – noon (except first and third Mondays, when open 1 pm – 5 pm); Tuesdays and Wednesdays from 8 am – noon; and Thursdays from 1 pm – 5 pm, with additional times set aside for classes to educate patients on how to effectively use these diabetesmanagement devices. “We’ll fit you with the right technology and work with your insurer to get all necessary devices or supplies approved expeditiously,” says Ananda Basu, MD, a UVA endocrinologist and the clinic’s director. Nurse practitioner Mary Voelmle, FNP, CDE works closely with insurance providers to streamline the approval process for patients to receive diabetes management devices such as insulin pumps and continuous glucose monitors, with the goal of shortening the approval timeline from weeks or months to several days. “Our team works hard to educate patients and optimize the therapies available through these devices,” she says. UVA’s Center for Diabetes Technology has developed an artificial pancreas to automatically Mary Voelmle, FNP, CDE monitor and regulate blood-sugar levels in people with type 1 diabetes. The device is now undergoing its final round of clinical trials. If approved by the U.S. Food and Drug Administration, the artificial pancreas will also be available through UVA’s Advanced Diabetes Management Clinic. Dr. Basu says that the clinic now serves adult patients, and is considering expanding its services to adolescents in the near future. For more information: Call 434.293.7811 or visit www.uvahealth.com.
For more information: To learn more about how Healthgrades determines award recipients, visit www.healthgrades.com/quality. For more information about Augusta Health, visit www.augustahealth.com. *Statistics are based on Healthgrades analysis of MedPAR data for years 2015 through 2017 and represent three-year estimates for Medicare patients only.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
For More Events Visit:
www.ourhealthcharlottesville.com Do you have an event that our readers simply must know about? Tell us about it by emailing Stephen McClintic Jr. at steve@ourhealthvirginia.com. Please submit your information at least three months in advance to be considered for publication in the magazine.
Telehealth visits have been established between Augusta Health and patients of Bath Community Hospital located in Hot Springs, VA. The first telehealth visit was a pulmonology visit, and expansion into cardiology and neurology is planned. Telehealth is a daily in-home monitoring program that allows a medical care team to track a patient’s vital signs and symptoms on a regular basis from the comfort of the patient’s home. Patients participating in tele monitoring use supplied equipment to automatically submit to their doctor’s office a daily report of their vital sign measurements such as weight, blood pressure, pulse, blood glucose level and blood oxygen level, along with answers to questions about overall well being. The system helps alert the medical care team of any changes to a patient’s condition before a major problem occurs – potentially helping reduce hospital admissions. The program is available at no extra cost to patients.
Openings, Relocations and Expansions Piedmont Nephrology Joins UVA Primary and Specialty Care Pantops in New Location Piedmont Nephrology has moved to a new, fully renovated permanent location while becoming part of UVA Primary and Specialty Care Pantops, located at 650 Peter Jefferson Parkway, Suite 290 in Charlottesville. The new location offers ample free parking outside of the main entrance.
• NEWS TO KNOW
Augusta Health Introduces Telehealth for Patients at Bath Community Hospital
The Pulse
New Technology and Resources
Providers at the new location include: Brendan T. Bowman, MD, Uta Erdbruegger, MD and Amanda D. Renaghan, MD (pictured top to bottom on left). For patients who have appointments after March 5, 2019, the date, time and provider will stay the same, but the appointment will take place at this new location. For more information: Call 434.297.7140 or visit www.uvahealth.com.
Catherine Bonham, MD
UVA Health System Pulmonary Clinic Charlottesville | 434.924.5219 www.uvahealth.com
W. Darrin Clouse, MD, FACS, DFSVS, RPVI
Matthew Painter, NP
Augusta Health UVA Health System Vascular Primary Care Verona | 540.245.7425 and Endovascular Surgery Charlottesville | 434.243.1000 www.augustahealth.com www.uvahealth.com
Saraswati Srikantiah, MD
UVA Medical Center and UVA Transitional Care Hospital Charlottesville | 434.924.0000 www.uvahealth.com
For more information: Call 540.332.4900 or visit www.augustahealth.com/homehealth/telehealth.
Openings, Relocations and Expansions UVA Health Opens Expanded Eye Clinic University of Virginia Health System has opened an expanded, comprehensive eye clinic offering additional specialty care services. The expanded clinic includes nine additional exam rooms and new eye specialties available, including cornea and retinal care along with treatments for cataracts and uveitis (inflammation of the eye’s middle layer). The new clinic is located on the second and third floor of UVA Medical Park Northridge at 2955 Ivy Road in Charlottesville and offers free parking available outside the clinic building. For more information: Call 434.924.5485 or visit www.uvahealth.com. www.OurHealthCharlottesville.com
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Health Scene HAPPENINGS • WHO’S WHO • TRENDING photos | MARK MILLER
AUGUSTA HEALTH'S ANNUAL HEART HEALTH FAIR PROVIDES FREE SCREENINGS TO OVER 100 PARTICIPANTS For more than a decade, Augusta Health in Fishersville has celebrated Heart Month in February by hosting its annual Heart Health Fair. Open to the public, the event offers several free screenings, demonstrations and educational information about heart disease and its related chronic diseases. During this year’s Heart Health Fair held on Wednesday, February 13, 2019 in the Augusta Health Fitness Center on the Fishersville campus, more than 100 people who attended received screenings ranging from carotid artery ultrasound, pulmonary function testing and fasting blood glucose to stroke assessments, sleep assessments and blood pressure testing. Cholesterol lipid panels were available for a nominal $10 fee. Participants also had the opportunity to meet and speak with healthcare professionals about conditions like high blood pressure and diabetes that can contribute to stroke and heart disease, yet can be prevented through better awareness and understanding of the risks and associated symptoms. For additional information and to learn more about upcoming events offered through Augusta Health, visit www.augustahealth.com.
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Health Scene • HAPPENINGS www.OurHealthCharlottesville.com
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Questions. Answers. Knowledge.
I recently heard about a pain management option called COOLIEF* Cooled Radiofrequency. What is it and how is it different from other treatments? COOLIEF* Cooled Radiofrequency (RF) is a minimally invasive treatment option for back pain and osteoarthritis knee and hip pain. COOLIEF* Cooled RF targets nerves that transmit pain signals. It is the first and only radiofrequency treatment FDA-cleared for the relief of osteoarthritis knee pain.
COOLIEF* COOLED RF USUALLY PROVIDES
LONG-TERM PAIN RELIEF (up to 24 months), improves physical functionality, and reduces drug utilization. Patients are expected to have a quick recovery time with no incision and no need for opioid recovery medication.
Radiofrequency ablation (a procedure used to reduce pain in which an electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area) deactivates the nerves responsible for sending pain signals to the brain. COOLIEF* Cooled RF is a thermal radiofrequency pain management system using water-cooled technology to safely deactivate pain-transmitting sensory nerves, allowing a larger treatment area and greater chance at targeting pain-causing nerves. COOLIEF* Cooled RF usually provides long-term pain relief (up to 24 months), improves physical functionality, and reduces drug utilization. Patients are expected to have a quick recovery time with no incision and no need for opioid recovery medication. It is an excellent option for patients with chronic pain who are either not a candidate for surgery or want to delay surgery. Jared Davis, MD
Augusta Health Pain Management Clinic Fishersville | 540.332.5747 Augusta Health Multispecialty Clinic Lexington | 540.464.3465 www.augustahealth.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
How is endometriosis diagnosed and treated?
Why do I wake up with dry eyes?
Hormonal medications such as birth control can work well to reduce endometriosis symptoms for some women, but can have side effects. However, these medications do not cure endometriosis. Laparoscopy with biopsy is the only accurate way to make a diagnosis. Ultrasound and MRI can identify ovarian cysts and pelvic nodules, but the majority of endometriosis cases cannot be seen with ultrasound or MRI.
Eyelids are a lot like windshield wipers. Each time you blink, your eyelids distribute a healthy tear layer across the front surface of your eyes. Your tears then act like a barrier, protecting your eyes from the environment. For example, normal tears contain antibodies that fight against both viruses and bacteria. Ocular discomfort, such as foreign body sensation, grittiness, or dry eye symptoms are triggered by lack of adequate tear production or distribution causing an inadequate or disrupted barrier.
Laparoscopic treatment of endometriosis is done by either ablating (vaporizing or burning) or excising (cutting out the disease). Ablation is less invasive and less difficult but has a higher recurrence rate and cannot treat the disease in all locations (such as on the bowel). Excision requires more surgical expertise, but studies indicate it offers longer pain relief and less chance of needing future additional surgery. A surgeon with specialty training in endometriosis will be more skilled at identifying less obvious signs of endometriosis, ensuring that no disease is left behind at the time of surgery. Kenneth Barron, MD
The Center for Advanced Gynecology Charlottesville | 434.234.4903 www.virginiagyn.com
There are many things that can disrupt our blink rate and cause dry eye including hormone levels, aging, certain medical conditions like diabetes or rheumatoid arthritis and even sleeping patterns. Naturally your eyes dehydrate when you sleep because your blink rate decreases all the way down to zero percent. As soon as you wake up and open your eyes, your body’s defense system is back in action, immediately kick-starting your tear production. Chelsea Johnson, OD
Primary Eyecare Charlottesville | 434.977.2020 www.cvilleeyecare.com
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Questions. Answers. Knowledge. Can leaving toenail polish on too long cause nail damage or infection? The short answer is yes. There are two main reasons why leaving nail polish on too long can damage toenails. The first is that many nail polishes, particularly the cheaper polishes, often contain harsh chemicals which can damage the keratin nail plate. These harsh chemicals may include: Toluene, Formaldehyde and Dibutyl phthalate. A damaged nail plate is less capable of resisting both bacterial and fungal infections.
For the healthiest nails, consider using nail polish that is free of harsh chemicals. Also,
REMOVE
NAIL POLISH
EVERY TWO WEEKS to allow the keratin channels of the nail plate to “breathe.”
The second reason why leaving nail polish on too long is not in the best interest of the nail is that the small, microscopic keratin channels, or small tunnels to the nailbed, become blocked and therefore cannot provide a healthy exchange of gases such as oxygen. For the healthiest nails, consider using nail polish that is free of harsh chemicals. Also, remove nail polish every two weeks to allow the keratin channels of the nail plate to “breathe.” Christopher Stewart, DPM Central Virginia Foot and Ankle Charlottesville | 434.975.0456 www.cvillefootankle.com
Can you recover from paralysis after a stroke? A stroke can result in either partial or total loss of motor function of an arm, leg, or both. This is called hemiplegia or hemiparesis. When this occurs, it is important to call 9-1-1 and seek immediate medical attention as immediate attention and treatment can result in either partial or full recovery. If paralysis persists despite emergency care, intensive rehabilitation can still lead to significant recovery. In general, recovery of strength doesn’t plateau until two to three months following a stroke. The brain can actually be quite adept at recovery – a process called neuroplasticity. The way this works is when other regions of the brain take over the function of the brain cells that have been damaged by a stroke. Exercising the affected arm and leg is critical and sends signals to these areas so that recovery may begin. Recovery is more often proximal (closer to the torso) to distal (further away from the torso) with hand and foot function the last to see a return of strength. Physical and occupational therapists using specialized techniques and equipment provide the therapeutic exercise needed to optimize stroke recovery. Paul Diamond, MD
Director of Neurorehabilitation UVA Health Charlottesville | 434.243.5622 www.uvahealth.com
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Our mother and father have different senior living care needs. How can we keep them together? Even when care needs differ, it is often best for a couple to stay together. Home health agencies can help by bringing a variety of care options into the home. Additionally, assisted living communities are particularly well suited to provide support to couples with different care needs. Continuing care retirement communities conveniently offer a wide variety of senior living options on one campus. Be sure to explore these and others before making a final decision. Keeping parents together may seem like “the right thing to do,” but that isn’t always the case. Factors such as dementia and other medical needs may make living together challenging or even detrimental. Seek advice from family, physicians and organizations like the Alzheimer’s Association for support. While everyone’s journey is different, please know that you are not alone. Shareef Tahboub
Development Director Rosewood Village Charlottesville | 434.214.9729 www.rosewoodvillage.com
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LEADERS A
LOCAL HEALTHCARE
nthropologists tell us that the healer is one of the most important and revered roles of any culture. While the warriors, producers and merchants all have their uses and value, a functioning and thriving society always needs individuals with the proper training, wisdom and compassion to help their fellow men, women and children with any physical or mental condition, whether they practice in a tiny jungle hut or a cutting-edge medical clinic in a major modern city.
patient-focused, efficient and fiscally sound. Others focus on making sure access to quality healthcare is available to all segments of our population, striving to leave no one behind.
OurHealth Charlottesville and Shenandoah Valley Magazine recently invited community members to nominate online who they think best represents the Charlottesville and Shenandoah Valley area’s ideal healthcare leaders. We received many worthy suggestions, and we also learned that there’s a lot going on behind the scenes not everyone knows about. Colleagues shared “secret” details about Today’s healthcare providers and administrators after-hours activities some perform like shoulder the responsibility of continually helping kids at schools, coaching advancing the quality of care made sports teams, volunteering at available in our communities all while Giving back community clinics, or going on overcoming more than their share of to their community church medical mission trips to help obstacles and challenges. Yet, many of not because it’s a part others in need around the world. them extend themselves even further of their job description, to go above and beyond in an effort to but because it is the We were encouraged to learn that help us all become better humans. They right thing to do. all of these leaders are unified in research, they teach, they serve, and thinking that giving back, performing they look for other ways to give back to community service and building their professions and their communities to relationships all are the things they don’t inspire future generations and future healers. just do because it’s a part of a job description, but because they genuinely believe it’s the right thing to do. Some leaders in the healthcare community don’t even have to work directly with patients to have vital roles. In that spirit, we invite you to learn more about They could make sure an office, medical center or health 11 of the brightest members of our local exchange runs optimally; training and placing the right medical community who make up our list people in the best position for them to prosper; ensuring of 2019 Charlottesville and Shenandoah Valley that employees enjoy where they work even when under Leaders in Local Healthcare. stressful conditions; and establishing processes that are
www.OurHealthCharlottesville.com
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Saied Asfa, MD, FACS
Jonathan Bartels, RN, CHPN
Scott Crabtree, DPT, MHA, PT, OCS
HARRISONBURG
CHARLOTTESVILLE
FISHERSVILLE
Plastic and Reconstructive Surgeon/Owner Asfa Plastic Surgery and Medical Spa www.asfaplasticsurgery.com
Palliative Care Liaison University of Virginia Medical Center www.uvahealth.com
Administrative Director of Professional Services Augusta Health www.augustahealth.com
American Association of Critical Care Nurses’ Pioneering Spirit Award
American College of Healthcare Executives Member
Schwartz Center for Compassionate Healthcare’s National Compassionate Care Giver of the Year Finalist
American Physical Therapy Association Member
Virginia Society of Plastic Surgeons Board Member American College of Surgeons, Fellow Valley Outpatient Surgery Center Board Member
OurHealth Charlottesville and Shenandoah Valley Magazine readers may remember
Saied Asfa, MD for having recently won our Best Bedside Manner Award. He has established a reputation as not only a skilled medical and cosmetic plastic surgeon, but also someone who wants to ensure that all patients are comfortable and have a good experience whatever their reason for seeking his services. Since he began his private practice in Harrisonburg in 2006, Dr. Asfa has helped improve the appearance and the overall quality of life for a variety of patients, including those with severe burns and cancer scarring to other trauma related issues and significant weight loss. He also offers a “tandem” approach for breast cancer patients, where he can perform a mastectomy and breast reconstruction at the same time, rather than separate surgeries at different locations. Dr. Asfa received training at Long Island Plastic Surgery Group, the largest plastic surgery program in the U.S. He is active in local, state and national plastic surgery and patient advocacy organizations, and has even testified before Congress about the need for better patient access and liability reform.
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VCU School of Nursing Former Adjunct Faculty Member
While the topic of death can sometimes make people uncomfortable, even in the medical field, Jonathan Bartels, RN, CHPN has learned that even though it’s not necessarily something to be celebrated, death can be an occasion when the medical profession can and should show dignity, respect and compassion. As an original member of the University of Virginia School of Nursing’s Compassionate Care program, Bartels encourages future medical professionals to find ways to comfort people through this difficult time. Death may be routine to medical professionals, but is new and frightening for many patients. His approach to palliative care began when he was an orderly in 1986 and continued as he pursued his career in critical care nursing. In 2009, Bartels encouraged the UVA Medical Center Emergency Room to adopt “The Pause”, a moment when everyone stops working briefly when death occurs as a sign of respect, and he also has spent time beside many families as a loved one passes. Bartels has been commended internationally for his efforts, including the American Association of Critical Care Nurses’ Pioneering Spirit Award and a finalist for The Schwartz Center for Compassionate Healthcare’s National Compassionate Care Giver of the Year.
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Virginia Physical Therapy Association Member American Board of Physical Therapy Specialties Member Murphy Deming College of Health Sciences at Mary Baldwin University DPT Program Advisory Committee Member
While it’s easy to think of a facility like Augusta Health in terms of providing exceptional patient care, there’s plenty going on behind the scenes to ensure providers and support staff always have the right tools and resources available to help them best perform their roles. This is part of the day-to-day challenges that Scott Crabtree, DPT, MHA, PT, OCS focuses on in his role as Administrative Director of Professional Services with Augusta Health. As a member of the organization’s leadership team, Crabtree is responsible for the clinical, fiscal and regulatory health of nine disciplines, including pharmacy and clinical laboratory. His responsibilities involve collaborating with various department heads in an effort to help maintain stability to facilitating large growth and improvement efforts, including a recent restructuring of the Pharmacy program, in which he introduced and implemented new equipment, safety procedures and processes. Crabtree also helped develop an Anthem Member Assistance Center, which provides personalized assistance to members at August Health, and he assisted in creating a multidisciplinary workgroup focusing on reducing falls by patients, which have included making fall prevention classes available at local senior centers. He also directed the creation of a medical fitness program, and has organized a collaborative relationship between Augusta Health and Murphy Deming College of Health Sciences at Mary Baldwin University.
Drew Ellen Gogian, EdD, MSN, RN FISHERSVILLE Director of the School of Nursing and Associate Professor Murphy Deming College of Health Sciences at Mary Baldwin University www.marybaldwin.edu International Nurses Association Member American Association of Colleges of Nursing Member Virginia Association of Colleges of Nursing Member DuPont Community Credit Union Board of Directors Associate Director DuPont Community Credit Union Governance Committee Board Member
The nurses of tomorrow are in school today, and people like Drew Ellen Gogian, EdD, MSN, RN are responsible for making sure they acquire the right skills so they can best serve their future patients and the community. Dr. Gogian has been active in nursing education since 2005 with her roles including supporting faculty, developing partnerships in the health and nursing communities, and encouraging students to learn and excel in their chosen career paths within the profession. She has taught and continues to teach at all levels of nursing education, from associate to doctorate while further developing her own skills through actively practicing and serving patients. Dr. Gogian previously taught at Blue Ridge Community College from 2005 to 2014 as well as at a variety of healthcare organizations. At Mary Baldwin University’s Murphy Deming College of Health Sciences, she oversees the degree programs that include career and education paths such as RN-to-BSN and RN-to-BSN-to-MSN. This latter path requires students to spend longer in school, but gain more advanced knowledge needed to help them professionally. Students and staff alike appreciate the role that Dr. Gogian brings to the table as a nurse educator, professional nurse and director of nursing.
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Ethan S. Long, PhD, BCBA-D
Greg Madsen, FACHE
Derrick Mathis Sr., CDAL
CHARLOTTESVILLE
LEXINGTON
CHARLOTTESVILLE
President Virginia Institute of Autism www.viaschool.org
Vice President Carillon Stonewall Jackson Hospital and Northern Region Operations www.carilionclinic.org
Executive Director Commonwealth Senior Living www.commonwealthsl.com
American College of Healthcare Executives
Commonwealth Senior Living has about 100 residents, divided into assisted living suites, independent living apartments and a memory care neighborhood. It takes about 65 associates to keep everyone calm, secure and supported, which is part of the role of Executive Director Derrick Mathis, Sr., who has been working with senior populations for nearly 20 years. Mathis encourages the staff to focus on customer service and hospitality and has successfully developed a variety of appropriate programs and activities dedicated to this purpose. At the same time, he also ensures everyone’s healthcare needs are taken care of and that each resident receives appropriate medical care and services, including helping adapt the services Commonwealth Senior Living offers should their physical or mental needs change. Mathis, who has also been pastor at St. Steven’s Baptist Church since 2011, provides calm and respectful leadership. He brings skills in mentoring, business development, coaching, sales development and public speaking to his role at Commonwealth Senior Living, and is known by residents and staff for being able to put people at ease while ensuring exceptional care is always delivered.
Council of Autism Service Providers Member Behavioral Analysis in Practice Editorial board U.S. Department of Education/Centers for Disease Control and Prevention Grant Reviewer
Although more and more people are being diagnosed with autism, there is still much that we don’t know about the health condition, including how it begins, how to minimize its effects and how to understand some of its behaviors. But there are many dedicated people eager to continue research and work with people with autism, including Ethan S. Long, PhD, BCBA-D at the Virginia Institute of Autism. Dr. Long provides resources to more than a dozen schools in our area to help instructors connect better and allow students to learn better. With one in every 59 children diagnosed with autism, family members and school officials do not always know how to properly interact and understand the behaviors associated with the condition. Dr. Long, a clinical psychologist and Licensed Behavioral Analyst, has been working with autistic patients for years, and the Virginia Institute of Autism now serves 200 clients, includes a day school and offers in-home services, parent training and vocational training. The Institute also partners with clinical experts at the University of Virginia and other local educational leaders. Along with being an administrator and grant reviewer for the U.S. Department of Education and the Centers for Disease Control and Prevention, Dr. Long continues to work on his own studies focusing on various research projects related to behavioral health, including treatment methods to reduce distracting behaviors in children.
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Alleghany Highlands Economic Development Corporation Community Foundation of Rockbridge, Bath and Alleghany Virginia Rural Health Association
Greg Madsen is considered the ultimate ‘people person,’ and makes sure that everyone served by Carillion Clinic in a five-county region has access to healthcare, whether they live in rural, urban or suburban areas. His base of operations is Carillion Stonewall Jackson Hospital, but he works with other facilities and providers to provide care to a diverse population throughout the area. This collaboration includes partnerships with community hospitals, two urgent care centers and a network of physicians. Prior to his current role, he served as CEO at Spotsylvania Regional Medical Center and LewisGale Hospital Alleghany, and held earlier leadership roles at medical centers in Kansas and the West Coast. Madsen has been commended for his abilities to build relationships, whether it’s with other healthcare entities, area businesses, or simply interacting positively with patients, providers and staff. In addition to his administrative duties, he’s active in a variety of volunteer activities, from regional economic development councils and chambers of commerce to service clubs and religious organizations. Colleagues describe him as someone who is passionate and gets excited about what can be done and how to help others in new ways.
OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Pastor at St. Stevens Baptist Church
Tiffany Ryder CHARLOTTESVILLE Director of Diabetes Programming and Exercise Physiologist acac Fitness and Wellness Centers www.acac.com/charlottesville Cardiovascular Health and Metabolic Profile Study Research Investigator International Health and Racquet Sport Association Keynote speaker
There’s no argument that our culture has an obesity problem, but thanks to people like Tiffany Ryder, there are professionals continually identifying ways to help us lose weight, improve nutrition habits and be well. In her role at acac Fitness and Wellness Centers, Ryder is involved with developing and implementing the Diabetes Prevention Program, a Centers for Disease Control and Prevention-backed effort that provides people with tools to live better and healthier. In the Diabetes Prevention Program’s first year, more than 50 people enrolled with many already realizing positive results, including weight loss and improved physical activity. Ryder is also involved in a cardiovascular health and metabolic profile research study between Johns Hopkins University and acac. She’s been involved in medical programming in the fitness industry for 16 years, and she serves as the keynote speaker at the International Health and Racquet Sport Association Conference. Ryder studied exercise science at Towson University and is pursuing a professional certificate as a Physician Assistant and a Master’s degree in Health Science from the University of Maryland. She enjoys working with clients and helping them become more aware of their own health, including risks of developing pre-diabetes, diabetes and other weight-related diseases, noting that as many as one in six Americans have pre-diabetes symptoms, but nine out of every 10 people aren’t aware of they are affected, making her dedication to education and research so vitally important.
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Christopher B. Stewart, DPM
Peter Thompson
Rhonda Zingraff, PhD
CHARLOTTESVILLE
CHARLOTTESVILLE
HARRISONBURG
Owner/Podiatrist Central Virginia Foot and Ankle Laser Center www.cvillefootankle.com
Executive Director The Center www.thecentercville.org
Chief Executive Officer Novonail, LLC
Livable for a Lifetime Steering Committee
Associate Dean, College of Health and Behavioral Studies and Director of the Institute for Innovation in Health and Human Services James Madison University www.jmu.edu
American Board of Podiatric Surgeons Member American College of Foot and Ankle Surgeons Diplomate Virginia Podiatric Medical Association Member American Podiatric Medical Association Member
Toenail fungus is something not many people like to talk about, let alone get excited about. Thankfully, for the thousands of people affected by this condition, there is local medical expert and practicing podiatrist Chris Stewart, DPM, who specializes in its treatment. In 2011, Dr. Stewart developed NovoNail, an innovative method of treating patients with fungal infections while restoring health to the overall nail, including in cases that have previously been considered untreatable. In addition to founding NovoNail, Dr. Stewart is the head of Central Virginia Foot and Ankle Laser Center, where he assists patients with feet and ankle needs, including outpatient and inpatient surgical care. Dr. Stewart also is part of podiatry and podiatric surgery organizations in Virginia and at the national level, and he is continually seeking new advances in podiatry resources, procedures and laser treatments to help his patients realize better care, service and outcomes from the field of podiatric medicine.
Charlottesville Area Alliance Chair Habitat for Humanity Southwood Community Committee
Peter Thompson is a longtime advocate for seniors – and senior centers – locally and nationally. He has lived in the Charlottesville area for more than 30 years, receiving his undergraduate degree from University of Virginia and his master’s degree in public administration with a concentration in nonprofit management from Virginia Commonwealth University. Thompson joined the staff at The Center in 1999, a special place that goes beyond being a gathering spot for area residents; The Center is where healthy aging is celebrated, organized events take place and volunteer opportunities are available. Thompson served six years on the National Institute of Seniors Centers Delegate Council and chaired a national task force on new models of senior centers. Today, he serves as an accreditation reviewer for other senior centers, and was a founder of the Virginia Association of Senior Centers within the Virginia Recreation and Parks Society. He also was a founding director for the Virginia Network of Nonprofit Organizations and the Center for Nonprofit Excellence, based in Charlottesville. Thompson has received many honors for his service and expertise, including the annual Excellence in Nonprofit Leadership Award from the United Way – Thomas Jefferson Area in 2010.
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OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville
Lindsay Institute for Innovations in Caregiving Advisory Board Harrisonburg/Rockingham Community Safety Net Coalition Member
Although the Institute for Innovation in Health and Human Services at James Madison University has received more than $7.2 million in grants to provide care to residents of the Shenandoah Valley, it takes strong vision to make sure the right people get the right help. That’s where Rhonda Zingraff, PhD comes in. As institute director, she makes sure that more than 25 programs continue to meet the health and wellness needs of the community for individuals and families of all ages, demographic groups and health conditions. Dr. Zingraff especially focuses on vulnerable populations, from children to teens to seniors, and leads programs including counseling, occupational therapy, behavioral health, literacy, child development, homeless support and respite care. She also creates collaboration between James Madison University students and faculty and community members who need services. Dr. Zingraff was a founding member of Harrisonburg Community Health Center and is part of the Harrisonburg/ Rockingham Community Safety Net Coalition, which assesses needs and community capacity to determine if any resources can be added. Dr. Zingraff has been commended by James Madison University for using all funds received to directly benefit human services in communities. Her colleagues credit her personally with making sure the most vulnerable people in our area receive the attention and assistance they need and deserve.
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Procedure Cosmetic Procedures
That Turn Back Time on Your Face, Body Skin
words | JENNIFER LAMONT
If you wish you could change something, or a few things, about your face or body, you’re not alone. As plastic surgery becomes more affordable and technology advances, a greater number of people are electing to reshape themselves for added confidence, anti-aging benefits and enhanced physical health.
Let’s be honest: most of us just want to look more like our filtered selfie pics. The good news is that cosmetic enhancements are not such a big deal anymore. Thanks to social media, everyone it seems – including celebrities and your neighbor two doors down – is not only talking about what they’ve had “done,” they’re posting their videos and before-and-after pics online. Americans have over 17 million surgical and minimally invasive cosmetic procedures each year, according to the American Society of Plastic Surgeons—including a 28 percent jump since 2000 for men. Those numbers are increasing rapidly as lasers do more of the work, making cosmetic procedures not only safer, but faster and less invasive.
Of the millions of plastic surgeries performed each year, these are five of the 10 most popular:
A
BREAST AUGMENTATION (enlargement and reduction)
B
LIPOSUCTION (most popular procedure for men)
C
RHINOPLASTY (nose reshaping)
D
EYELID SURGERY (blepharoplasty of upper or lower lids, or both)
E
“MOMMY MAKEOVER” (tummy tuck plus other procedures based on individual patient)
Continued on page 30...
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Community Care Connection For any type of medical procedure, you want a provider with the knowledge and skill to give you safe treatment and natural results. From plastic surgery to minimally invasive cosmetic treatments, residents in the Shenandoah Valley and Charlottesville area have access to some of the region’s best providers.
Who to Check Out for Cosmetic Surgery Innovations: On the cutting edge of innovation, Stephen D. Keefe, MD is a board-certified otolaryngologist and facial plastic surgeon who has been a pioneer in the field of laser technology and aesthetics.
Stephen D. Keefe, MD Keefe Centre for Aesthetics & ENT www.drkeefeent.com
...continued from page 28
“Tweakments” Offer Popular Body and Skin Changes with Little or No Downtime “Tweakments” such as injectables, lasers and skin resurfacing are on the rise as more people are opting for less drastic options. These micro-adjustments can be done on your lunch hour with limited or no downtime.
The five most popular beauty tweaks are:
A BOTOX® COSMETIC (frown lines and crow's feet treatment) B FILLERS/INJECTABLES (Juvederm, Elevess, Perlane and Restylane
are some of the brands. Injectables are not created equal and they focus on different areas of need)
C D
CHEMICAL PEEL (light, medium or deep) LASER HAIR REMOVAL (sometimes requiring repeat treatments, this isn’t totally painless)
E MICRODERMABRASION (“sanding” or abrasion of the skin’s surface) Wondering if you’re a good candidate for liposuction? Or, whether you should consider a breast lift instead of the enlargement you’ve been wanting forever? Here are the ins and outs for nine of the most popular procedures in the Charlottesville and Shenandoah Valley areas to help you refresh your face, skin and body.
FISHERSVILLE | 540.416.0927 70 Medical Center Circle | Suite 210
The
Who to Check Out When You Want Gorgeous Eyes:
1. Liposuction
to Improve Your Body Shape
Sara A. Kaltreider, MD performs every procedure herself, whether it’s a BOTOX® Cosmetic injection or advanced laser surgery – all in a private boutique setting.
WHY IT’S POPULAR:
•
Local or general anesthesia, or IV sedation
Sara A. Kaltreider, MD
•
Areas of fat are removed from directly beneath the skin by using a vacuumsuction canula, a tube-shaped instrument. Ultrasound or laser (SmartLipo) may also be used to break up fat deposits prior to removal.
Slims down chin, thighs, stomach, waist, hips, calves, buttocks, back, arms, face and breasts
HOW IT’S DONE:
Eyelid and Facial Aesthetics 630 Peter Jefferson Parkway | Suite 140 Charlottesville | 434.244.8610 www.eyelidandfacialaesthetics.com
BEST CANDIDATES:
Who to Check Out for Cosmetic Dermatology: Kristin Savola, MD, MEd, FAAD, a boardcertified dermatologist, specializes in cosmetic dermatology and is the only board-certified skin care specialist in Fishersville, VA to perform cosmetic procedures. Kristin L. Savola, MD, M.Ed, FAAD Savola Aesthetic Dermatology Center Dermatology/Aesthetics 66 Parkway Lane | Suite 101 A Fishersville | 540.451.2833 www.savoladermatology.com
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Most Popular Surgeries
CHARLOTTESVILLE | 434.284.3472 908 E. Jefferson Street | Suite 101
•
Those who are within 30 percent of their ideal weight with pockets of fat that don’t respond to diet or exercise
•
People with firm, elastic skin and more muscle tone
WORST CANDIDATES: •
People who want to use it for weight loss or treatment for obesity
•
Those who are trying to treat cellulite
TYPE OF PROVIDER TO LOOK FOR: Board-certified cosmetic, plastic or dermatologic surgeon
AVERAGE COST:
$3,374*
2. Breast Augmentation Enlargement and/or Lift HOW IT’S DONE: •
General or local anesthesia
•
Implants – silicone or saline
•
Fat transfer enlargement – using liposuction to take fat from other parts of your body and inject into your breasts has the benefit of being safer but without as much volume as silicone implants.
BEST CANDIDATES: • ENLARGEMENT: those who have fully developed breasts, but are bothered by the feeling they’re too small. • LIFT: women who are dissatisfied with breast shape after pregnancy, weight loss or aging, and have a good amount of breast tissue left.
WORST CANDIDATES: •
Those with severely sagging breasts. A breast lift may have to be done at the same time as an enlargement to correct severe situations.
TYPE OF PROVIDER TO LOOK FOR: Board-certified cosmetic or plastic surgeon
AVERAGE COST: Implants –
$3,718*
| Lift – $4,672*
3. Tummy Tuck WHY IT’S POPULAR: •
Gives you a flatter, contoured abdomen that’s more proportionate with your body type and weight
•
Sometimes part of a “mommy makeover” to restore a woman’s body after childbearing. Mommy makeovers involve multiple sites depending on the patient’s circumstances. Possible procedures alongside a tummy tuck are breast augmentation, breast lift, buttock augmentation, vaginal rejuvenation and liposuction.
HOW IT’S DONE: •
General anesthesia (most often) or IV sedation
•
The skin over the lower abdominal area is removed and the remaining skin is tightened.
BEST CANDIDATES: •
Those who aren’t carrying too much excess fat in the abdomen, but have loose skin after pregnancy or after losing a large amount of weight
•
Finished with childbearing
•
Close to ideal body weight
WORST CANDIDATES: •
Those who may get pregnant again in the future
TYPE OF PROVIDER TO LOOK FOR: Board-certified cosmetic or plastic surgeon
AVERAGE COST:
$3,000*
The Most Effective Ways to Take Years Off Your Face
Spotlight On: Stephen D. Keefe, MD Keefe Center Stephen D. Keefe, MD with the Keefe Center in Fishersville and Charlottesville is an award-winning surgeon who achieves natural-looking results in his patients by balancing minimally invasive techniques, such as SculpSure, fillers, injectables and laser treatments, with more traditional procedures, such as facelifts and LA Lifts (face/neck/eyelids/brow). His most popular procedures are face and neck lifts, injectables and Profound, a nonsurgical radio frequency treatment that tightens the skin and creates more elastic tissue. Dr. Keefe’s office is the only location offering this technology in the Greater Shenandoah Valley and Charlottesville areas. A good candidate for plastic surgery, says Dr. Keefe, “is a patient who is healthy, realistic about what kind of improvement they are looking for, understands, and is committed to the process and journey of image improvement and enhancement. A good candidate is someone who also understands that healing takes time and full results can take up to six months to a year to appreciate.” With the goal of turning all his patients into “great” candidates, Dr. Keefe maintains his philosophy of “if it doesn’t look natural, it doesn’t look good.” Good consultations result in patients having more than one option to meet their aesthetic goals. “However, there is not one magic bullet. Patients are usually counseled to prioritize their concerns with the 3 C’s: Cost, Convalescence and Correction,” adds Dr. Keefe.
Stephen D. Keefe, MD Keefe Center in Fishersville and Charlottesville
1. Facelift (Rhytidectomy) WHY IT’S POPULAR: Smooths wrinkles and sagging skin all over the face – on the forehead, eyes, cheeks, jowls and chin. Often performed with a forehead lift and eyelid reshaping (blepharoplasty) for better, more youthful results.
HOW IT’S DONE: •
General anesthesia or IV sedation
•
Tissue is lifted and repositioned through small incisions just behind the hairline. Excess skin is removed, while deep folds are smoothed out and skin is tightened.
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Spotlight On: Kristen L. Savola, MD, M.Ed, FAAD
BEST CANDIDATES:
Savola Aesthetic Dermatology Center
•
People who want to rejuvenate their face and feel they look older than they are
•
Those who still have supple, elastic skin and a well-defined bone structure
Dr. Savola’s practice, Savola Aesthetic Dermatology Center, provides general dermatology services, as well as laser and cosmetic dermatology and med spa services to complete the package. Some of her most popular cosmetic procedures performed are fillers and injectables, laser treatments and Platelet-Rich Plasma Therapy (PRP). PRP is the “latest innovation in hair replacement treatments. Using the essential growth proteins in a patient’s own plasma to stimulate hair growth, this therapy is a nonsurgical, natural approach to hair restoration with minimal discomfort and risk, no downtime, and a high rate of success for most patients,” says Dr. Savola.
•
Popular non-invasive procedures include laser treatments that stimulate permanent collagen development, or tighten and firm skin. Her ideal candidates are adults over 18 who are physically healthy, no history or neuromuscular disease, and are neither pregnant nor nursing.
Kristen L. Savola, MD, M.Ed, FAAD Savola Aesthetic Dermatology Center
WORST CANDIDATES:
Those who are overweight
TYPE OF PROVIDER TO LOOK FOR: Board-certified plastic or cosmetic surgeon AVERAGE COST:
$7,448*
2. Non-Surgical “Tweakments”
Laser Skin Resurfacing, Fillers and Microdermabrasion WHY THEY’RE POPULAR: Without highly invasive surgery, they minimize problem areas: •
Fine lines and wrinkles around or under eyes, forehead and mouth
•
Sun-damaged skin and dark spots
•
Acne or chickenpox scars
•
Birthmarks and freckles
•
Thin lips and hollow cheeks
•
Large pores
•
Skin irregularities and pre-cancerous growths
HOW IT’S DONE:
A
LASER SKIN RESURFACING – short, concentrated beams of light pulsate against the area of damaged skin to remove one layer at a time. Collagen growth is stimulated to improve the skin’s elasticity.
B
DERMAL FILLERS – often made from Hyaluronic Acid (HA) which is naturally occurring in the body and moisture-rich, fillers plump lips, cheeks and add definition to the jawline. Brands include Juvederm, Restylane, Radiesse and Voluma.
C
MICRODERMABRASION – a special tool “sands down” the top layer of skin, essentially refinishing it to give a smooth appearance.
BEST CANDIDATES: •
People who want to rejuvenate their face, look younger and aren’t ready yet to “go under the knife.”
•
Those who know non-surgical options are temporary, requiring repeat treatments
WORST CANDIDATES: •
LASER THERAPY – those with acne, deep wrinkles, excessive skin or very dark skin
•
DERMAL FILLERS – those who may be allergic to any of the components in the fillers, or if pregnant or breastfeeding
• MICRODERMABRASION – people who develop rashes or suffer from cold sores, or have acne or very dark skin
TYPE OF PROVIDER TO LOOK FOR: Board-certified plastic, cosmetic or dermatologic surgeon, or nurse practitioners/physician assistants
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AVERAGE COST:
Ablative Laser Therapy – $2,124*
Dermal Fillers – $450 – $750* per syringe. (Some procedures only need one syringe but most patients need several.) Microdermabrasion – $1,170*
3. Gingival Contouring – The “Gummy” Smile Fix WHY IT’S POPULAR: Enhances the smile, shows more teeth and makes the mouth more proportionate and comfortable
HOW IT’S DONE: •
Local anesthetic
•
Using a laser (most often) or cutting tool, excess gum tissue is removed and sculpted to lengthen the crown of the tooth and expose more of the enamel. Bone is sometimes removed if necessary.
Myth vs. Reality? Cosmetic Surgery and Plastic Surgery are the Same.
Although we tend to use the terms interchangeably, cosmetic surgery is not the same as plastic surgery. Cosmetic surgery can be performed by several different types of doctors who may not have training in plastic surgery. Plastic surgeons are trained in reconstruction and in cosmetic surgery.
BEST CANDIDATES: •
Those with thick, puffy gums or smiles that show more gum than teeth
•
People with asymmetric, uneven gums
WORST CANDIDATES: •
Those with poor oral hygiene and periodontal disease
TYPE OF PROVIDER TO LOOK FOR: Cosmetic dentist, periodontist or oral surgeon AVERAGE COST: $300 –
$3,000
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(depending on how much gum tissue needs to be contoured)
ASK THE EXPERT
BEN B. ROSS, DMD, FACP Board Certified Prosthodontist
PANTOPS PROSTHODONTICS 404 People Place, Suite 301 | Charlottesville | w www.pantops.org | f f f g f
c 434.977.9836
What can patients do to keep their own teeth, natural or prosthetic, healthy as long as possible? Re-call, Re-care, Re-check! Regular and frequent visits to the prosthodontist is the best advice we can give to our patients who have prosthetic teeth. These patients need to see the prosthodontist more often than average patients to be ahead of any changes that are constantly occurring in our mouths and bodies. For natural teeth, I see the biggest threat today coming from the acidity levels in our diet and the number of medications that cause xerostomia, or dry mouth. It’s the high acidity levels that cause cavities, still the number one cause of tooth loss. BEN B. ROSS, DMD, FACP
What can patients expect when they visit a prosthodontist? Most people haven’t heard of a prosthodontist and what they can do for them. A prosthodontist is a specialist who has three years of training beyond dental school that deals with reconstructive, aesthetic, and functional dentistry. This includes implants, cosmetic makeovers, full mouth rehabilitations, single and multiple crowns and bridges, as well as removable teeth, tooth grinding/clenching problems, and sleep apnea appliances. Prosthodontists are the experts when it comes to looking at the whole mouth, the jaw and facial muscles, the temporomandibular joints, and the teeth. Once these are all in balance, then and only then can a harmonious relationship exist that functions great and looks even better! It’s even been said that we are known as the dentist’s dentist. With all this in mind, patients can expect the most thorough exam and detailed diagnosis.
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Spotlight On: Sara A. Kaltreider, MD Eyelid and Facial Aesthetics An oculoplastic and reconstructive surgeon, Sara A. Kaltreider, MD with Eyelid and Facial Aesthetics in Charlottesville performs eyelid and facial surgery in a boutique office setting. She says the most popular procedure is eyelid surgery, or blepharoplasty.
The
“Wherever an incision is made, there will be a scar. The pertinent question is, ‘will that scar be visible?’ Surgeons do their best to optimally position the scar and help it to heal with minimal visibility,” Dr. Kaltreider says. Dr. Kaltreider enhances surgical procedures with non-invasive treatments to improve healing and give patients more “mileage” from their procedures. These include fillers, BOTOX® and laser and radiofrequency treatments. As technology has improved over the years, she says, there are filler options for every area of the face to contour and smooth wrinkles. Sara A. Kaltreider, MD Eyelid and Facial Aesthetics
Skin & Hair Glow
1. Cellulite Treatment – Cellfina WHY IT’S POPULAR: Smooths out dimpling on thighs and buttocks up to an amazing three years
HOW IT’S DONE: •
Local anesthesia and minimally invasive
•
A small, needle-size incision under the skin releases the tight bands of connective tissue that are trapping the bulging fat cells. Once released from this tension, the skin appears smooth.
“Restoring a youthful appearance of the upper and lower eyelids is by far the most popular procedure that I perform in the office. Removal of folds and puffiness of the lower eyelid fat pads is very gratifying to patients. The longevity of the procedure is fantastic because it is based on removal of tissue that does not regenerate,” says Dr. Kaltreider. Ideal candidates for eyelid or facial surgery, she adds, are in good general health and have realistic expectations for results. They know there will be scars and they’re getting the procedure for themselves, not to please anyone else.
Treatments that Help Your
BEST CANDIDATES: •
People who are a healthy weight but want to reduce cellulite
•
Those who know treatments won’t completely eliminate cellulite
WORST CANDIDATES: •
Those who are significantly overweight
•
Those who are trying to eliminate fat, not cellulite
•
Those who have excessive varicose veins or other vein-related illnesses
TYPE OF PROVIDER TO LOOK FOR: Board-certified plastic, cosmetic or dermatologic surgeon, or a licensed physician working under the supervision of a board-certified plastic surgeon
AVERAGE COST: $3,500 –
$6,500*
depending on the size and number of dimples
2. Scar Revision WHY IT’S POPULAR: Although no revision technique can completely erase scars, revision minimizes scars anywhere on the body where they are conspicuous, bothersome or disfiguring
HOW IT’S DONE: •
Local anesthesia for minimally invasive procedures
•
General anesthesia for surgical revision requiring advanced wound closure techniques. No revision technique can completely erase the scar.
BEST CANDIDATES: •
People of any age
•
Those with scars that are painful, itchy or preventing a joint from moving properly
WORST CANDIDATES: •
Those who have acne or other infections in the area to be treated
TYPE OF PROVIDER TO LOOK FOR: Board-certified plastic, cosmetic or dermatologic surgeon
AVERAGE COST:
$500 – $3,000*
depending on the size and complexity of the procedure
3. Hair Restoration WHY IT’S POPULAR:
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Restores a balding or thinning scalp with transplanted hair from an area of thick growth and becomes permanent. This procedure helps the two-thirds of all men and one-fifth of all women suffering from hair loss to bypass the hereditary and/ or hormonal factors that cause it. Continued on page 36...
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35
Community Care Connection
...continued from page 34
HOW IT’S DONE: •
Local anesthesia with sedation
•
Small pieces of hair-bearing scalp are removed from a donor site and grafted to a bald or thinning area of the scalp.
How to Find a Surgeon :
BEST CANDIDATES:
Choosing a surgeon and a facility is one of the most important decisions to make if you’re considering cosmetic surgery. Go beyond Google reviews and even HealthGrades to really vet your doctors. Look for board certifications and accredited hospitals. The American Board of Plastic Surgery (ABPS) is part of the American Board of Medical Specialties (ABMS).
•
Candidates with a healthy growth of hair at the back and sides of the head to serve as ‘donor areas.’
•
People who know that sometimes two or more techniques are used together, or treatments repeated, to achieve the best result
WORST CANDIDATES: •
Those who are completely bald
•
People who take medicines or have medical illnesses that cause hair loss
TYPE OF PROVIDER TO LOOK FOR: Board-certified plastic, cosmetic or dermatologic surgeon
$6,000 – $15,000* (depending on how many grafts are placed)
www.abplasticsurgery.org
AVERAGE COST:
The American Society of Plastic Surgeons (ASPS) members are certified by the American Board of Plastic Surgery and is a terrific resource for consumer information.
With these and any other cosmetic procedure, it’s important to be as healthy as possible when undergoing treatment. People who have the best outcomes share the following factors:
www.plasticsurgery.org The American Board of Cosmetic Surgery (ABCS) offers a helpful checklist to consumers to vet cosmetic surgeons. www.americanboardcosmeticsurgery.org
A B C D
As close to ideal weight as possible Non-smoker (Smoking causes spasms of the small blood vessels needed for normal blood circulation and healing afterward.) Free of illnesses that can impair healing Positive outlook with stable mental health and realistic expectations
Where Should You Start? Cosmetic surgeries and minimally invasive treatments are medical procedures that carry risks, and they’re also an art form. Know who’s a DaVinci and who’s a Picasso during his Surrealism phase:
Did you know? The real reason you have cellulite: Cellulite is not “normal” fat. As most women are keenly aware, it’s a formidable opponent that doesn’t respond to diet or exercise. Appearing on nearly 90 percent of women and 10 percent of men, cellulite forms on both thin and overweight people alike. The issue is in the connective tissue of fibrous strands (collagen septae) under the skin. If the septae isn’t strong or tightly woven, fat cells bulge between the strands and get trapped in the dermal layer, creating the dreaded orange peel effect. The septae in men is thicker, stronger and more closely knit than in women. Genetics, thinner skin, diminishing estrogen levels and hormonal imbalances also play a role.
•
The physician you choose should have plenty of ‘before-and-after’ photos. Start there and don’t be afraid to ask for more. Because results are everything, you’ll want a skilled physician who consistently produces many quality results.
•
Do extensive research on any treatment and physician you are considering. Confirm whether your surgeon is board-certified by searching on the American Society of Plastic Surgeons (ASPS) website.
•
Use a physician with extensive knowledge of facial anatomy and structure when having even non-invasive procedures done. For instance, you may know you want a filler, but do you know the best kind to get? They’re all different and not created equal. Know your stuff before they put it in your face.
Arming yourself with knowledge will give you the safest, most optimal (a.k.a. natural) results. With laser advancements, new techniques and the boom in effective anti-aging procedures, cosmetic procedures are safer, quicker and more effective than ever before. * 2017 costs published by the American Association of Plastic Surgery EXPERT CONTRIBUTORS Sara Kaltreider, MD, Eyelid & Facial Aesthetics, Charlottesville, VA Stephen D. Keefe, MD, Keefe Centre for Aesthetics & ENT, Fishersville, VA Kristin Savola, MD, Savola Aesthetic Dermatology Center, Fishersville, VA
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ASK THE EXPERT
SAIED ASFA, MD, FACS
ASFA PLASTIC SURGERY AND MEDICAL SPA 1502 Brookhaven Drive | Harrisonburg, VA 22801
c 540.432.0303 | w www.asfaplasticsurgery.com I struggle with cellulite and nothing I do is getting rid of it. What are the latest options available? There are various treatments available for cellulite, but the first step is to address the cause of it. What we call “cellulite dimples” are actually caused by bands of connective tissue attached to the underlying skin that sometimes pulls skin in, which makes surrounding fat bulge. This causes the lumpy, dimpled appearance known as cellulite, which is actually very common. About 90 percent of people — of all ages — have some cellulite. For those who want to be rid of cellulite, the only procedure cleared by the United States Food and Drug Administration (FDA) is called Cellfina®. It’s a minimally invasive procedure, performed by a physician in his or her office, using local anesthetic. It’s currently cleared by the FDA for cellulite on the back of the thighs and on the buttocks. D u r i n g t h e procedure, we use a tiny needle that’s about one mm wide (about the size of three grains of table salt laid side by side) to cut those bands of tissue under your skin and release and smooth the dimples. We numb the a r e a being
treated while the patient lies on his or her back, usually reading or checking email or playing games on their cell phones while the procedure is being done, which takes approximately one hour to perform. There will likely be some soreness after the procedure for a few days, and because we are working with tissue under the skin, some bruising may occur that goes away in two to three weeks. For this reason, we recommend having the Cellfina® procedure done a month or so before any trips to the beach or events for which you may be wearing clothing that reveals the treated area(s). The best news is Cellfina® Cellulite Treatment that you see the results in only a few days – it’s successful 94 to 96 percent of the time – and the results AFTER BEFORE are guaranteed for three years. The company that developed the procedure is so confident that if there is still cellulite present at the end of the first year, it will underwrite all or part of a second treatment. The size of the treated area and the number of cellulite dimples determines the cost of the Cellfina® treatment. Prices usually range from $4000 to $6000. Usually, only one treatment is needed. One caution is that patients must avoid aspirin, aspirin products, or any prescription blood thinners for eight days before the procedure. People with controlled diabetes are eligible, and we do not recommend having the procedure if you expect to be losing 25 pounds or so after Cellfina®. In that case, lose the weight first, and then consider Cellfina®.
SAIED ASFA, MD, FACS
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Varicose Veins: Unattractive Sign of Deeper Trouble?
They’re almost too simple to identify:
the knotty, swollen areas, usually on the legs, that look a little like badly formed bunches of grapes. But the circulatory problem underlying the appearance of varicose veins is hardly a cosmetic issue alone. It can be dangerous, and it can be a killer.
For years, varicose veins and the underlying causes were left untreated, because the only treatment available at the time was “stripping the veins,” where multiple incisions were made along the bad veins and they were actually stripped out, segment by segment. Dr. Sternberg rightly calls this approach “barbaric.” Recovery was long and painful.
words | RICK PIESTER
Medical professionals call the condition venous insufficiency. It happens when the walls and valves of blood vessels, mainly in the legs, become ineffective, causing blood to pool in them. That in turn creates pressure, swelling and quite often what we know as varicose veins.
Symptoms of Varicose Veins Symptoms can indicate venous insufficiency as well as a host of other conditions. There are not always visible signs and can include a feeling of heaviness or fatigue in the legs, swelling, aching, cramping, burning or itching sensations, leatheryappearing skin around the ankles and what‘s called “restless legs,” or the feeling that your legs are so uncomfortable that you can’t resist moving them. According to interventional cardiologist Kenneth Sternberg, MD, of Augusta Health Heart and Vascular Center in Fishersville, as many as 30 million people in America develop venous insufficiency each year, not all of them developing visible varicose veins. Women are more prone to the condition, Dr. Sternberg says, although he and his colleagues treat a good number of males. It’s not uncommon in young people, although age tends to makes us more prone to the condition, and the symptoms worsen with age. And, Dr. Sternberg says, it’s quite common in people who must spend long hours standing on hard surfaces — nurses, barbers and beauticians, construction workers, police officers and the like. The condition can also be passed from one generation to the next. In advanced cases, Dr. Sternberg says, the circulatory problems can lead to difficult-to-heal ulcers on the surface of the legs, even amputations. Pooled blood can clot, traveling to the heart or to the brain. That’s when it turns deadly.
Then, roughly 15 years ago, medicine adopted minimally invasive techniques to close off diseased veins using lasers or radiofrequency waves guided through catheters. These outpatient techniques were much more merciful, with a much shorter recovery.
VenaSeal Process the Latest, Less Invasive Treatment Option for Varicose Veins And more recently, just this past January in the case of Dr. Sternberg and his colleagues at Augusta Health Heart and Vascular Center, patients have been treated with a new process called VenaSeal. The process employs a medical grade glue applied by catheter to close the walls of the diseased veins, which is eventually absorbed by the body and disappears. To target the locations to be glued, health professionals use the same ultrasound imaging that is used to identify and map the problem areas in the veins during diagnosis. Dr. Sternberg reports that the process is highly effective, with long-term research showing a 95 percent success rate five years after the procedure is done. And more good news: VenaSeal is covered [by insurance] as a medical necessity in patients whose symptoms are affecting their lives and cannot be controlled with conservative measures. To learn more about the VenaSeal procedure offered by Augusta Health Heart and Vascular Center or other techniques for treating varicose veins, visit www.augustahealth.com/ amg/cardiology or call 540.332.4000.
Kenneth Sternberg, MD
Augusta Health Heart and Vascular Center in Fishersville
www.OurHealthCharlottesville.com
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Spring Cleaning Better Health WHAT YOU SHOULDN’T
SWEEP UNDER THE RUG words | KATHARINE PALJUG
No matter how tidy you are, some spots in your home
always attract bacteria, fungus, mold, pet dander and more. These microorganisms and allergens can impact your breathing, sleep and overall health. The start of spring is the ideal time for a thorough cleaning of areas in and around your home and other places that you may not always have on your “To-Do” list. “Certain things result in that allergic response in the lungs and nasal passages,” says Anna Smith, MD, an allergist at the University of Virginia Health System. “But there are things in the environment that can still make us feel poorly without an allergy.” Luckily, most of these irritants can be cleaned away once you know where they’re hiding. And even if it takes a little extra time, it’s definitely worth it, says Dr. Smith. “It’s important to get a handle on everyday activities you can do to optimize your health and environment, to feel better, sleep better, breath better.”
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BATHROOM TOWELS:
Towels are often home for Staphylococcus bacteria, which causes staph infections. Bathroom humidity keeps towels damp, breeding mold and fungus that can exacerbate allergies, asthma and COPD. Shared towels, such as hand towels, get especially dirty.
How to Clean: Wash every three to seven days; add bleach or white vinegar to kill even more bacteria. Anna Smith, MD An allergist with the University of Virginia Health System.
“Use a dehumidifier to bring down mold or dust mites,” suggests Dr. Smith, both of which thrive in humid environments. Running your bathroom fan after baths and showers will also help.
TOOTHBRUSH HOLDER:
SPONGES:
Toothbrushes transfer saliva and bacteria from your mouth, hands and bathroom surfaces. (On more than a quarter of toothbrush holders, this includes Salmonella and E. coli bacteria.) Damp holders are also a breeding ground for mold and fungus, which end up on your toothbrush, hands and mouth.
How to Clean: Put toothbrush holders in the dishwasher every week, or scrub by hand and rinse with hot water.
Bacteria and mold grow on sponges, especially if they get reused frequently.
How to Clean: Instead of a sponge, use cleaning cloths that you wash after every use. If you use a sponge, replace with a new one every week. (This applies to kitchen sponges too!)
»
BONUS TIP: Every time you flush the toilet, contaminants such as fecal matter and bacteria fly out. Close the lid before flushing to keep those germs contained.
KITCHEN COFFEE MAKER:
Nearly half of coffee makers have yeast and mold in them. “Those with allergic sensitization to these allergens are most at risk for nasal allergies symptoms and asthma,” says Madeline Dillon, MD, an allergist at Allergy Partners of Charlottesville. But even without allergies, you can still be impacted by these irritants or become sick if you ingest them.
How to Clean: Once a week, put all the removable parts of your coffee maker in the dishwasher. Anything that can’t go in the dishwasher should be wiped down with soap and hot water.
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REFRIGERATOR DRAWERS:
Mold, yeast, Salmonella and E. coli often live in refrigerator drawers. Food packaging, raw meats and vegetables from grocery store bins transfer these allergens and germs to your home, where they multiply in the humid interior of a refrigerator.
How to Clean: Clean refrigerator drawers once a month, either in the dishwasher or by hand with soap and hot water. Wipe with white vinegar to kill bacteria, mold and yeast.
BONUS TIP: Instead of throwing away baking soda away when it’s finished its 30-day stint in your fridge, dump it down the garbage disposal with running water. It will keep your disposal fresh too! 42
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BEDROOM MATTRESSES:
Dust mites often live in mattresses, which can be especially irritating if you have allergies, asthma or breathing difficulties like COPD.
How to Clean: Vacuum both sides of
your mattress at least twice a year. Pay special attention to edges and crevices, where dust and dead skin get trapped. “Purchase mite-proof covers for your mattresses and pillows,” suggests Dr. Dillon. These covers zip shut around the whole mattress, box spring or pillows. They should be washed with your sheets.
PILLOWS:
You shed skin, saliva and bacteria every night, and these get trapped in your pillows, along with dust, pollen, pet dander, fungi and mites.
How to Clean: Launder pillows at least
twice a year in water that is at least 140° F to kill bacteria and mites. As with your mattress, use machine-washable pillow protectors. Dr. Dillon also recommends getting a HEPA air cleaner [and] changing the filters in your HVAC unit every three months to improve your home’s air quality.
STUFFED ANIMALS:
Well-loved stuffed animals attract dust, mites and bacteria, especially when kids are sick.
How to Clean: Stuffed animals should
be laundered at least once a month and after every illness. To kill more bacteria and viruses, add white vinegar to the rinse cycle.
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BONUS TIP: Pets carry dust, bacteria, dander and dirt. Keep them out of the bedroom, especially if you have allergies or trouble sleeping. www.OurHealthCharlottesville.com
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LIVING ROOM REMOTES:
Everyone touches the TV remotes, covering them in food, bacteria and other particles. Many remotes have yeast, mold and Staphylococcus bacteria on them.
How to Clean: Use a light cleaner and cloth to wipe them down weekly, or daily if anyone is sick.
RUGS AND CARPETS:
COMPUTERS:
Rugs and carpets can trap mold, mites, dust, mud, fungus, pet dander and food. These exacerbate allergies and breathing problems, cause poor air quality and expose you to germs.
The average desktop computer has 400 times more bacteria than a toilet seat. These are transferred from your hands, usually after you touch your nose or mouth, or from eating while using the computer. Computers also collect dust, pollen and animal dander.
How to Clean: Rugs and carpets should be cleaned yearly with a professional-grade steam cleaner.
How to Clean: Dust computer weekly using antibacterial wipes or a damp cleaning cloth with white vinegar to kill bacteria. Vacuum keyboards regularly.
Madeline Dillon, MD An allergist at Allergy Partners of Charlottesville.
“Dusting and vacuuming can reduce allergens. Having a HEPA filter can reduce indoor dander, and keeping the humidity below 50 percent reduces dust mites in the environment.”
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BONUS TIP: Take shoes off at the door to avoid tracking in mud, pollen, animal feces and other particles.
“It’s a lot of maintenance,” Dr. Smith admits. “But just like exercise or a healthy diet, they’re all good things that we should always be working on. We should make sure that we keep in mind our home environment and how it impacts us.” Expert Contributors Madeline Dillon, MD is an allergist at Allergy Partners of Charlottesville. Anna Smith, MD is an allergist with the University of Virginia Health System.
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Kids Care INFORM • EDUCATE • GROW
for CHILDREN with Autism words | CHRISTY RIPPEL
Dental specialists who have additional experience or have received further training in treating children with autism like those available at Children’s Dentistry of Charlottesville can help make visits to the dentist much more successful and less stressful for young patients and their parents.
Finding A Dentist who Treats Children with Autism and Other Resources on Dental Care
wwww.scdaonline.net Click on “Need a dentist?” for a database you can search by city or zip code
The dentist’s office can make even the most easy going child anxious. The loud whirl of the drill, diagnostic tools like X-rays and all those shiny, sharp tools can send a kid running for the exit. Parents of children with autism face even more challenges in getting them into the dentist’s chair, because kids with autism can be sensitive to light, touch and sound and may have difficulty communicating. “The spectrum is really broad, and there are different challenges Jessica Moore, DDS Dentist with for each patient,” says Jessica Moore, DDS, a dentist who Children’s Dentistry of Charlottesville treats children with autism in her office at Children’s Dentistry of Charlottesville. “Attachment to routine is also a common issue, and visiting the dentist’s office is outside the normal routine, so that alone can be threatening to them,” she explains.
1 in 59
www.autismspeaks.org A dental tool kit with videos and checklists on how to help brush a child’s teeth, find a dentist and prepare for the visit.
DOWNLOAD THIS: Visit
www.ourhealthvirginia.com/ va/autism-dental-guide to view and download a PDF of the Dental Guide Tool Kit from Autism Speaks and Colgate.
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BIRTHS ARE ESTIMATED TO BE DIAGNOSED WITH AUTISM SPECTRUM DISORDER
Autism spectrum disorder is a complex developmental disability that affects a person’s ability to communicate and interact with others, according to The Autism Society. It is the fastestgrowing developmental disability in the world, with prevalence estimated at 1 in 59 births. The demands of caring for a child with autism are great, and families can experience high levels of stress in coordinating and paying for care, such as speech and physical therapy.
Helping Children with Autism Ease into Dental Care With a lot on their minds and to-do lists, parents of children with autism sometimes let dental care fall off the priority list. Who can blame them? Finding a dentist who is experienced with special needs can be time consuming, and squeezing in another appointment feels like a chore. But there are things that can be done to ease the stress of dental visits and ensure this vital aspect of health care isn’t neglected.
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Establish a Dental Routine at Home First, a parent should establish a consistent, twice-daily brushing routine at home by allowing the child to choose a flavor of fluoride toothpaste that they like, and a toothbrush they are excited to use.
Contact a Dentist with Experience Treating Special Needs Patients Dentists who specialize in treating special needs patients can be found through organizations like Autism Speaks and the Special Care Dentistry Association. Their websites (see sidebar) have listings of dentists by state and zip code. When you speak with a dentist, be candid about your needs, such as requesting the first appointment of the day and a private room with a door to minimize noise to see if the office will be a good fit. If possible, visit the office with your child before the appointment so it’s more familiar.
Access Books and Other Resources Written for Children with Autism Books from the library or available for purchase at bookstores can also be helpful; there are many that focus on visiting the dentist for the first time. The book “Sensitive Sam Visits the Dentist” was written especially for kids with sensory issues. There are other things that can be done beforehand, such as practicing what will happen during the dental visit. A parent can review directions and teach the steps to children with autism so they aren’t flustered when asked during the appointment. “Put your hands on your stomach and open your mouth wide,” would be an example. A small dental mirror from the drugstore and a flashlight can mimic the experience of being in the dentist’s chair, and practicing in a more relaxed environment at home is more comfortable for most kids.
“The dental care that children receive is going to set them up for lifetime of good dental health,” says John Will, DDS, a dentist at Children’s Dentistry of Charlottesville who has advanced training in working with special needs patients and is a member of the Special Care Dentistry Association. “Addressing oral health issues at a young age prevents damage to permanent teeth, and allows good habits to be formed early.” Both Dr. Moore and Dr. Will say dental John Will, DDS care should begin at age one or when a baby’s Dentist with Children’s Dentistry first teeth appear, and starting early can make of Charlottesville a twice yearly check-up less intimidating. “I would say to a parent of a special needs child to not give up,” says Dr. Will. “There are dentists willing to work with you for a good outcome.” EXPERT CONTRIBUTORS Jessica Moore, DDS, Children’s Dentistry of Charlottesville John Will, DDS, Children’s Dentistry of Charlottesville
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Specialty Spotlight Series GASTROENTEROLOGY
COLONOSCOPIES: Not So Strange and Scary After All words | KATHARINE PALJUG
If you’re over 50, your doctor likely has mentioned a colonoscopy. But have you followed through and scheduled one? A colonoscopy screens the rectum and large intestine, or colon, for abnormal growths. It’s a standard procedure that doctors recommend, but many adults still hesitate to get one. “One in three eligible people don’t get screened,” says Savita Srivastava, MD, a gastroenterologist with Augusta Health in Fishersville. “Some people are embarrassed by the procedure. They can be uncomfortable talking about it.” “People are worried about the invasiveness of the procedure,” agrees Cynthia Yoshida, MD, a professor at the University of Virginia School of Medicine and practicing gastroenterologist in Charlottesville. “Another concern is pain.”
Patients worried about risks of colonoscopies or unsure what the procedure involves are less likely to get a it done. But when you strip away the myths surrounding colonoscopies, they’re a simple, life-saving procedure — not so strange or scary after all.
Myth #1
ASK THE EXPERT: Why Did the American Cancer Society Update its Colorectal Screening Guidelines? Ellliot Smith, MD, a gastroenterologist with Charlottesville Gastroenterology Associates discusses why the American Cancer Society updated its guidelines and how this can affect you in his Ask the Expert column found on page 51.
You’ll Have Diarrhea the Day Before
The prep for a colonoscopy is easier than you might imagine. To clear the bowels, doctors give you two doses of a laxative. “Most people have a pretty normal day, the day before,” says Dr. Srivastava. You drink one part of the fluid, then you get a break, then you “Most people drink the second round of fluid a few hours later. have a pretty The prep causes you to have bowel movements, but that doesn’t mean you spend hours in the bathroom. “I have patients tell me all the time that it wasn’t as bad as they thought it would be,” says Dr. Srivastava.
normal day, the day before.” – Savita Srivastava, MD
Patients having a morning procedure prep the night before, then drink only liquids until the colonoscopy is done. For an afternoon procedure, many people have a normal morning, then start preparing before lunch.
Myth #2 It’s Going to be Awkward and Uncomfortable Getting a colonoscopy is no more awkward than a visit to the dentist — and for many people, less uncomfortable than having their teeth cleaned.
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The whole process is personalized to each patient. “When we get a referral from a family doctor, it goes through an extensive process where your whole medical chart is seen by an endoscopy nurse,” explains Dr. Yoshida. “They triage you to the right location, the right sedation and the right prep that they “It can feel like a think you should have. It’s not an assembly line. It’s very routine doctor’s visit. meticulously reviewed.” Everyone tries to be On the day of your colonoscopy, you’ll meet your medical very supportive.” team, including the anesthesiologist and nurses. You’ll have – Savita Srivastava, MD a private space to change into a gown, and only necessary medical staff will be in the room during the procedure. “It can feel like a routine doctor’s visit,” Dr. Srivastava explains. “Everyone tries to be very supportive.”
You’ll be sedated for the colonoscopy, which should eliminate discomfort or awkwardness. During the actual exam, the scope is carefully slid all the way through your colon to check for anything abnormal. If doctors do find anything, they will typically remove it right away so you don’t have to come in for a second procedure.
“You’ll wake up in the post-op room, and most people are amazed that it’s already over,” says Dr. Srivastava. The team will make sure you’re not feeling any side effects of the anesthesia, then your doctor will discuss your results and any follow-up steps. “We want everybody to feel really comfortable,” says Dr. Srivastava. “We want to make sure there are no barriers to coming back again.”
Myth #3
You Don’t Have Time to Get One
A colonoscopy takes about 20 minutes, and most patients need another 15 to 20 minutes to wake up from sedation. Even with time to talk with the doctor afterwards, you’ll probably be out of the office in about two hours. Due to the sedation, someone else should drive you home, and you should take it easy for the rest of the day. “If you take a taxi or an Uber, almost every place is going to recommend you have another adult with you,” Dr. Yoshida advises. “You can pretty much eat what you want after the procedure, just no driving and no alcohol.” For most people, a colonoscopy doesn’t require more than 24 hours out of your normal routine. “We suggest not going back to work the day of your procedure,” Dr. Srivastava says. “Honestly, most people feel pretty refreshed afterwards.”
Myth #4
It’s Too Risky
Every medical procedure comes with risks, but the risks during a colonoscopy are low. A few people react to the sedation, either during the procedure or with some sickness afterwards. But that’s uncommon. If the doctor removes a precancerous growth, called a polyp, there’s a risk of bleeding afterwards. This tends to be minimal and ends quickly. The most serious risk is a perforation in the colon from the procedure itself, which can cause pain and further complications. But that’s also very rare.
In fact, you’re more likely to develop colon cancer as a result of not having a colonoscopy than to experience complications from having one.
“Your risk of perforation is about one in 1000, whereas your risk of getting colon cancer is about one in 20.”
Cynthia Yoshida, MD Professor at the University of Virginia School of Medicine and practicing gastroenterologist in Charlottesville.
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GASTROENTEROLOGY
Myth #5 “We want everybody to feel really comfortable. We want to make sure there are no barriers to coming back again.”
You Don’t Need a Colonoscopy if You Feel Fine
During many screening tests, doctors are looking for tumors. But colonoscopies find and remove polyps before they develop into cancer. This means that the best time to get a colonoscopy is when you feel perfectly fine — and hopefully, getting one will mean that you continue to stay healthy and free from colon cancer.
Discuss with Your Doctor to Determine When It’s Best for You to Get a Colonoscopy Current healthcare guidelines recommend that most patients get colonoscopies by age 50, though some groups with higher risk levels should have them earlier. African Americans, those with a family history of colon cancer or polyps and anyone with inflammatory bowel disease should talk to their doctor by age 40 about when to get a colonoscopy. While a colonoscopy is considered the gold standard, there are tests that can use stool samples to screen for signs of colon cancer. If you are hesitant about getting a colonoscopy, talk to your doctor about the possibility of one of these tests instead. “One way or another, just get screened,” advises Dr. Yoshida. “The best test is a test that gets done.” EXPERT CONTRIBUTORS
Savita Srivastava, MD A gastroenterologist with Augusta Health in Fishersville.
Savita Srivastava, MD is a gastroenterologist with Augusta Health in Fishersville. Cynthia Yoshida, MD is a professor at the University of Virginia School of Medicine and practicing gastroenterologist in Charlottesville.
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ASK THE EXPERT
ELLIOT SMITH, MD
CHARLOTTESVILLE GASTROENTEROLOGY ASSOCIATES 1139 E. High Street | Suite 203
| Charlottesville, VA 22902
c 434.817.8484 | w www.cvillegi.com In May 2018, the American Cancer Society updated its colorectal cancer screening guidelines for average-risk adults to begin at age 45 rather than 50. Why was this change made and what determines if I am an averagerisk adult or not? Colorectal cancer is the second most common cancer among men and women and the second leading cause of cancer-related death. It is also a preventable cancer and, when caught early, highly treatable. One of the challenges we see is that patients do not experience symptoms of colon cancer until the disease has reached an advanced stage, which makes preventative testing like colonoscopies so vital. In the last decade, we’ve seen a slight reduction in colorectal cancer rates for patients over age 50. Regrettably, there has been an observable increase in this cancer among younger adults. We still don’t know why this is occurring, but we do know many of the risk factors for colon cancer. These include age, family history of colorectal cancer, and a history of colon polyps found during prior screening exams. Obesity is a significant risk factor as well as poor nutrition habits, such as eating higher amounts of red meat and fewer fruits and vegetables. The obesity epidemic is thought to be one factor leading to increased colon cancer rates among y o u n g e r patients. ELLIOT SMITH, MD
The American Cancer Society (ACS) issued its updated colorectal cancer screening guidelines in 2018 to address this observation. The current guidelines recommend screening begin at age 45 among average risk individuals rather than age 50. This improves the chances of catching polyps and cancers at an early stage. Current guidelines recommend testing every 10 years. Testing should be done more frequently for higher-risk individuals, such as those with a first-degree relative who has been diagnosed with colorectal cancer. Typical screening options include three types of stool tests that are able to detect cancer, including standard hemoccult for blood, FIT, and Cologuard DNA testing. The ACS recommends these tests every one to three years, depending on the test. One drawback to these tests is that they are not designed to detect smaller polyps growing inside the colon. The other type of screening is colonoscopy, which is the method recommended by gastroenterologists as the gold standard. Colonoscopy not only detects cancer but also permits detection and removal of any potentially dangerous polyps before they turn into cancer. Currently, the American Cancer Society is on its own in lowering the recommended screening age – the national gastroenterology associations haven’t changed their guidelines as of yet. These new guidelines might create some challenges with insurance coverage, so we advise patients to check their benefits carefully. We are always happy to talk to patients and answer questions about the various options available for colorectal cancer screening and detection. Nobody should ever die of embarrassment; for patients of appropriate screening age, we recommend having a discussion with your doctor about the best test for you.
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Specialty Spotlight Series ALLERGY, ASTHMA AND IMMUNOLOGY
Are Allergies Affecting Us More Now Than Ever? words | KATHARINE PALJUG
There’s a good chance that you have allergies or know someone who does. In the U.S., more than 40 percent of children and 30 percent of adults now suffer from the condition, and it appears this trend is on the rise. “Allergies are expanding,” says Anna Smith, MD with the Allergy and Clinical Immunology division at University of Virginia Health System. Medical experts aren’t sure why, and potential causes range from early antibiotic use to not getting enough vitamin D. While research continues, there’s good news: most environmental allergies can be managed with environmental control, medication and desensitization with allergy shots.
FOOD ALLERGIES Any food can trigger an allergic reaction; common ones are peanuts, tree nuts, shellfish, eggs, dairy, wheat and some fruits. “Food allergies have significantly increased in the last 20 to 30 years,” says Madeline Dillon, MD with Allergy Partners of Charlottesville. Doctors have also seen new food allergies develop. “For example: there is a new food allergy that is related to a tick bite in the southeastern U.S. called alpha-gal allergy, which causes a delayed allergic reaction after eating mammal meat, such as beef, pork, and lamb.”
Food Allergy Symptoms
Nausea, vomiting, diarrhea, constipation, and hives or swelling in areas of the skin that touch the food. “Food triggers for eczema are a little more common in kids,” adds Dr. Smith. “But we’re still figuring out how they interact in adults.” Severe food allergies can cause trouble breathing, swelling in the mouth or face known as angioedema, or a sensation of your throat closing.
Madeline Dillon, MD An allergist with Allergy Partners of Charlottesville.
“Angioedema in an allergic reaction occurs when histamine is released in the deeper layers of the skin tissue,” explains Dr. Dillon. “Tissues can swell in the airway or oral cavity and block air supply.” This is a medical emergency known as anaphylaxis.
Diagnosing Food Allergies Many food allergies are assessed with a blood test to check for antibodies to foods. Sometimes, an allergist may recommend a food challenge in the office where a food is given to the patient in very small amounts and increasing the amount every 15 minutes under careful supervision, making www.OurHealthCharlottesville.com
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ALLERGY, ASTHMA AND IMMUNOLOGY
sure epinephrine and antihistamines are readily available. This can sometimes allow the patient to safely re-introduce that food into their diet.
Managing Food Allergies The best way to manage a food allergy is by cutting the food that triggers it out of your diet. If you have a severe food allergy, especially if there is any angioedema, you should also carry an epinephrine device, such as an EpiPen or an Auvi-Q, in case of an anaphylactic reaction. If you have an anaphylactic reaction, go to the nearest emergency room immediately, then follow up with your doctor. “Severe allergic reactions, like anaphylaxis, need to be treated with epinephrine quickly,” Dr. Dillon cautions.
The sequence of treatment for an acute allergic reaction should be done in this order:
A Administer epinephrine B Call 9-1-1 C Take Benadryl Don’t take Benadryl first as it takes an hour to work. You need epinephrine that works in 10 minutes if you can’t breathe.
ENVIRONMENTAL ALLERGIES “I see a lot of hay fever and environmental allergies,” Dr. Smith says. These include pollen, dust mites, mold and animal dander. Synthetic air fresheners and cleaning sprays can also sometimes cause reactions as some contain harsh chemicals that irritate the eyes, throat and nasal passages, though usually not on an allergic basis.
Environmental Allergy Symptoms
Runny nose, itchy eyes, throat or ears, sneezing, coughing, wheezing or asthma can all be symptoms of environmental allergies. Less common are hives, rashes or other skin irritation.
Diagnosing Environmental Allergies Allergists use a skin test to determine if the patient has specific environmental allergies. Your doctor will prick areas of the skin with different substances and watch for a reaction, which appears in 15 – 54
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20 minutes and looks like a mosquito bite but without the central mark. These are sometimes followed by intradermal tests to double-check prick test negatives.
Cleaning for Dust Mites and Mold Allergies:
What is an Intradermal Test? VACUUM FREQUENTLY
ALLERGY, ASTHMA AND IMMUNOLOGY
Intradermal allergy testing is another method of skin testing to help determine whether an individual is allergic to a specific allergen, often used in follow-up after a negative prick test. The test involves injection of a small amount of the suspected allergen in the very top layer of the skin called the dermis.
Managing Environmental Allergies Environmental allergies are managed by limiting exposure and taking over the counter (OTC) medications such as nasal sprays or antihistamines. “Allergy shots are also used,” adds Dr. Smith. “We do these for three to five years with the goal of teaching your immune system to stop responding to those allergens.”
CLEAN OR REPLACE AIR FILTERS MONTHLY
People who have dust mite or mold allergies need to go the extra mile when it comes to cleaning. Vacuum frequently, clean or replace air filters monthly and wash sheets and towels at least once a week in very hot 130-degree water. You’ll also need to protect your bed from dust mites with a pillow protector, full mattress encasement and box spring encasement – ones that are made with fabric of a very tight weave, as three dust mites are small enough to fit end-to-end across the eye of a fly. It is also helpful to keep humidity levels between 37 percent and 50 percent as molds and dust mites thrive in humid conditions. Doctors also recommend living somewhere with hardwood floors, rather than carpets or rugs, which can trap allergens. It is also best to avoid blinds and heavy curtains.
WASH SHEETS AND TOWELS AT LEAST ONCE A WEEK in very hot 130-degree water.
You should seek treatment when OTC medications are no longer effective for your condition. Your doctor may prescribe stronger antihistamines or an inhaler. You should also see a medical specialist immediately if your allergies cause wheezing, trouble breathing, constant hives or severe swelling in the face and throat.
PROTECT YOUR BED FROM DUST MITES with a pillow protector, full mattress encasement and box spring encasement.
MEDICATION ALLERGIES “Penicillin is the most common medication allergy we see,” Dr. Smith adds, which also includes related antibiotics, such as amoxicillin. It frequently affects children, but many adults outgrow childhood antibiotic allergies. In general, though, medication allergies are more common in older adults, who often don’t discover these allergies until they have to take multiple medications for the first time.
KEEP HUMIDITY LEVELS BETWEEN 37 PERCENT AND 50 PERCENT as molds and dust mites thrive in humid conditions.
Medication Allergy Symptoms Rashes, swelling or gastrointestinal symptoms. Less common are angioedema, trouble breathing or anaphylaxis. Reactions to medication usually happen quickly, so doctors can pinpoint the cause based on what you are taking. If you are using multiple medications, your doctor may recommend a blood test or elimination test to be sure.
Managing Medication Allergies In general, doctors won’t prescribe medication you are allergic to unless it’s absolutely necessary. “Some people may have an isolated rash, and we may decide to treat through that,” explains Dr. Smith. “If there’s no alternative and the patient really needs it, we can do a slow introduction and escalate it to the treatment dose for the time that you need it.”
What’s the Hygiene Hypothesis? The Hygiene Hypothesis is when the immune system is not exposed to many infectious agents, and thus doesn’t have the chance to build up an immunity. It looks for something else to do, and allergies may result.
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ALLERGY, ASTHMA AND IMMUNOLOGY
If you are seeing a medical provider for the first time, always make sure you disclose your known medication allergies. It is helpful to bring a list of your current medications as well as your medication allergies every time you see a doctor. People who are severely allergic to medications often wear an alert bracelet or carry a card at all times that lists their medication allergies.
“Eczema and asthma are considered their own diagnosis, but they can also happen as symptoms of other allergies.”
Always consult a doctor if you believe you are reacting to a medication. If you experience trouble breathing, throat tightness, wheezing, hives or angioedema, go to an emergency room immediately.
ASTHMA AND ECZEMA Some reactions are caused by an overactive immune system, but not necessarily in response to a specific allergen. Two common ones are asthma and eczema. “Eczema and asthma are considered their own diagnosis, but they can also happen as symptoms of other allergies,” explains Dr. Smith. Asthma makes the airways in your lungs tighten, causing wheezing, coughing and trouble breathing. Eczema affects your skin, causing itching, dryness, dark patches, peeling, bleeding and swelling.
Diagnosing Asthma and Eczema Doctors can usually determine whether you have eczema by examining your skin. Asthma is assessed with a lung function test to see how much air you move in and out.
Managing Asthma and Eczema Anna Smith, MD An allergist with the Allergy and Clinical Immunology division at University of Virginia Health System.
Asthma is treated with an inhaler or nebulizer, which delivers medication to open your airways. Most patients with asthma need inhaled corticosteroids or inhalers that combine corticosteroids with bronchodilators. These should be administered every day as a preventative measure for all asthma patients that have asthma episodes more than two times per week during the day or more than two times per month during the night. Those who have only mild intermittent asthma can be treated with an as needed albuterol inhaler. There are asthma controllers, which are usually inhaled corticosteroids or Singulair, and asthma relievers – usually albuterol, a bronchodilator. The relievers or rescue inhalers are for acute asthma which is not being controlled by the preventative medication. Eczema is treated topically with creams, OTC hydrocortisone or prescribed corticosteroids. As well, eczema is treated with daily soaking baths in lukewarm water to let the moisture soak into the skin and applying prescription corticosteroid creams and moisturization, which is a process called the Soak and Seal Method that was developed at Duke. Anti-itch medication, such as antihistamines are also essential to keep the patient from scratching. You should always see a doctor if you have trouble breathing or a rash that won’t clear up. Once you do, your doctor may refer you to an allergist for additional testing, as many people who have one of these conditions also have allergies.
The American Academy of Pediatrics (AAP) advises introducing new foods to babies one at a time and watching for allergic reactions. Though the AAP used to recommend delayed introduction of highly allergenic foods, such as peanuts, new guidelines recommend early exposure to reduce food allergies. 56
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Even mothers who exclusively breast feed their infant child should be advised they can possibly cause their child’s eczema to worsen if the infant is allergic to certain foods that the mother has consumed, as food proteins can transfer into the breast milk. Food allergies are more common in children with eczema.
YOU DON’T HAVE TO ‘LIVE WITH ALLERGIES’ No matter the cause of your symptoms, seeing a doctor is the first step towards managing them and finding relief. With the treatment options available today, no one should feel they must live in discomfort. Break free from the burden allergies, asthma or eczema may be causing you, and start feeling better than you ever imagined you could.
Expert Contributors Madeline Dillon, MD is an allergist with Allergy Partners of Charlottesville. Anna Smith, MD is an allergist with the Allergy and Clinical Immunology division at University of Virginia Health System.
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