OurHealth Roanoke and New River Valleys Magazine October/November 2018 by OurHealth Media LLC

October •November 2018 ourhealthroanokeNRV.com

These are the

Decades of their

Lives

ONE LOCAL

MOTHER’S FIGHTAGAINST THE OPIOID CRISIS

FIVE TIPS TO EAT SMART

DURING THE HOLIDAYS

HOW CLOSE ARE WE TO CURING CANCER FOR GOOD?

69 30

FEATURES

OCTOBER • NOVEMBER 2018

LIKE SANDS THROUGH THE HOURGLASS, THESE ARE THE DECADES OF THEIR LIVES A survival guide to women’s health in each decade of life.

HOW CLOSE ARE WE TO CURING CANCER FOR GOOD?

FROM HEARTBREAK TO HOPE

If there’s one word that possesses a life of its own, it’s ‘cancer.’ Most of us know someone who has been impacted in some way by this dreaded diagnosis and it’s a word no one wants to say aloud because of its terrifying implications.

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How one mother is fighting the opioid crisis.

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DEPARTMENTS OCTOBER • NOVEMBER 2018

The Pulse | People. Places. News to Know.

Calendar | Things to Do in Roanoke & New River Valleys

Health Scene | Happenings. Who’s Who. Trending.

67 Five Ways to Maximize Family Time During Cancer Treatment: Five family coping tips inspired by Charlottesville-based journalist, Tim Wendel's book “Cancer Crossings: A Brother, His Doctors and the Quest to Cure Childhood Leukemia.”

During October and November for your Mind, Body and Soul.

69 From Heartbreak to Hope: How one mother is fighting the opioid crisis.

4th Annual Hike for Hospice

Volunteer Spotlight | Heroes. Champions. Community Minded. After a sister‘s life-saving liver transplant, a Roanoke College sorority takes action.

Q&A on Health | Questions. Answers. Knowledge.

Health A-Z | Insight. Awareness. Mindfulness for the Whole Family. 42 What Women Need to Know About Their Pelvic Floor: Ladies, do you know what your pelvic floor is — or why it’s an essential part of a healthy, functioning body? 56 Breaking the Silence: Hereditary Breast and Ovarian Cancers One local woman’s difficult decision to have a double mastectomy after testing positive for the the BRCA1 gene mutation — at age 34.

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Healthy Observations | Educate. Eradicate. Victory. 76 October 11, 2018 is National Depression Screening Day: The Hermitage Roanoke 79 November is National Homecare and Hospice Month: Warm Health at Home

82 Food and Fitness | Nutrition. Exercise. Prevention. 82 Smart, Healthy Holiday Recipes: To help you stay on track with your nutritional goals during the holidays, consider these tips and recipes from the American Heart Association

90 Funny Bone | Spot the Seven Differences

AWARDS 20

1 8 S I LV E R

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october • november 2018 PUBLISHER PRESIDENT/EDITOR-IN-CHIEF VICE PRESIDENT OF PRODUCTION VICE PRESIDENT OF BUSINESS DEVELOPMENT CHIEF DESIGNER GRAPHIC DESIGNER WEBMASTER ACCOUNTING MANAGER ORIGINAL PHOTOGRAPHY GUEST PHOTOGRAPHERS

McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Hungate Kim Wood Karrie Pridemore Tori Meador Heidi McClintic Laura Bower Sunny Wasiela / Sunnyography David Amos Bob Crawford Narik Page

CONTRIBUTING MEDICAL EXPERTS CONTRIBUTING PROFESSIONAL EXPERTS & WRITERS

Tyler Manee, CPO, MSPO Cheryl Rakes, PT Christopher Williams, MD Tara Wickline, FNP Linda Bailey Brandy Centolanza Susan Dubuque Tina Joyce Jennifer Lamont Stephen McClintic Jr. Michelle McLees Katherine Paljug Sue Ranson Tim Wendel

ADVERTISING AND MARKETING Kim Wood | P: 540.798.2504 kimwood@ourhealthvirginia.com SUBSCRIPTIONS Subscriptions are $19.95 per year. To receive OurHealth via U.S. Mail, please contact Jenny Hungate at jenny@ourhealthvirginia.com

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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 © 2018 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. OurHealth Roanoke and New River Valleys 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 words | STEPHEN McCLINTIC, JR.

News and Notes LewisGale Physicians Doctors and Staff Help Stamp Out Hunger for Local Children

LEFT: Savanna Bowling (l), special projects coordinator for LewisGale Physicians, and Diane Rose (r) principal of East Salem Elementary School, pack peanut butter for the school’s BackPack Program to benefit local students at risk of going hungry.; MIDDLE: Volunteers with Dublin United Methodist Church accept hundreds of jars of peanut butter from Brittney Bright with LewisGale Physicians. RIGHT: Volunteers with Micah’s Backpack program at St. Michael’s Lutheran Church in Blacksburg receive a large donation of peanut butter from Brittney Bright with LewisGale Physicians to benefit area school children.

Doctors and staff at LewisGale Physicians in Salem participated in stamping out hunger for local children throughout the Roanoke and New River Valleys through their collection and distribution of nearly 2,000 jars to area schools for students who are at risk of going hungry. This past August and September, “the LewisGale Physicians team spent time collecting jars of peanut butter from our physicians and staff,” explains Michelle Peery, director of operations at LewisGale Physicians. “All of our employees participated in donating for what turned out to be great team-building experience and way to benefit our community.”

In the New River Valley, peanut butter was collected and distributed to the Blue Ridge Church in Christiansburg for distribution to local schools there, to Dublin United Methodist Church for Dublin Elementary School, and to St. Michael’s Lutheran Church in Blacksburg for their Micah’s Backpack program. Through Micah’s Backpack program, every Friday afternoon 200 children at 10 Blacksburg schools receive a gift of healthy food to make meals. In the Roanoke Valley, Fallon Park Elementary School in Roanoke received peanut butter, as did East Salem Elementary. More information: www.lgphysicians.com.

Staff Promotions, Additions and Changes Vistar Eye Center Appoints New Chief Operating Officer

Kathy Shelton

Vistar Eye Center announces the promotion of Kathy Shelton to Chief Operating Officer. Shelton joined Vistar in 2011 and most recently served as the manager of its Optical Department. "Kathy has shown great commitment to our organization," says Paul Levy, Chief Executive Officer of Vistar Eye Center. "Not only has she successfully improved the structure within our Optical Department, but she's proven time and again that

OurHealth | The Resource for Healthy Living in Roanoke and New River Valleys

every decision she makes is centered on our practice's ability to provide the highest quality of patient care." Shelton has nearly thirty years of optical experience including careers with National Optical and other regional optical providers. In her new role as Chief Operating Officer, she oversees all ongoing business operations within the practice. More information: www.vistareye.com.

The Pulse

News and Notes

Care Advantage Homecare Services Company Announces Acquisitions

Carilion Clinic Offering Weekend Injury Clinics for Local Student Athletes

Care Advantage, Inc., one of Virginia’s largest privately owned home health and personal care services companies, announces the acquisitions of Henrico-based Paradise Homecare and A Hopeful Home healthcare agencies. Care Advantage has also assumed 100 percent ownership stake in Care Advantage Plus, formerly a 50-50 joint venture with the Jefferson Area Board for Aging in Charlottesville. Paradise Homecare retains its name and brand while A Hopeful Home will fold into the Care Advantage brand. “As we continue to grow, these acquisitions further enhance our caregiver, patient and referral base in our markets, and we are thrilled to welcome the new family members from each of the organizations into our Care Advantage family,” says Tim Hanold, Care Advantage CEO.

Carilion Clinic sports medicine professionals are available on Saturdays for student athletes who sustain non-emergency injuries like sprains or strains during a weekend game or activity. The weekend injury clinics are held every Saturday this fall through November, starting at 8:30 am. Callahead appointments are preferred and walk-ins are encouraged to arrive by 9 am. Locations and contact information are: • Roanoke: 2331 Franklin Road, 540.512.1139 • Blacksburg: 215 Gilbert Street, 540.961.8061 • Lexington: 25 Crossing Lane, Suite 2 (walk-ins only – no appointment needed) More information: www.carilionclinic.org.

Care Advantage has two locations locally: 518 East Main Street in Salem and 610 Peppers Ferry Road, Suite H in Christiansburg. Deborah J. Johnston, a registered nurse, founded Care Advantage in 1988 in the Richmond area. She stepped down as CEO in January 2017 when Care Advantage was sold to BelHealth Investment Partners, a New York-based healthcare private equity firm. More information: www.careadvantageinc.com.

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• NEWS TO KNOW

Openings, Mergers and Acquisitions

The Pulse

• NEWS TO KNOW

Staff Promotions, Additions and Changes LewisGale Medical Center Announces Leadership Additions Three individuals have assumed leadership positions with LewisGale Medical Center in Salem: • Sam Williamson, Assistant Chief Financial Officer: A healthcare executive with a decade of experience, Williamson comes to LewisGale from Piedmont Healthcare in Atlanta where he served as Director of Finance. Among his primary accomplishments there was the financial planning in preparation for a large inpatient and emergency department expansion. Williamson has also held finance positions at Bon Secours Health System in Maryland and South Carolina. He is a Fellow of the American College of Healthcare Executives.

Sam Williamson

Tonya Kelly

Debbie Nicely

• Tonya Kelly, Associate Chief Nursing Officer: Kelly joins LewisGale after previously serving as the Director of Emergency Services and Pediatrics at StoneSprings/HCA in Northern Virginia. She is a graduate of the HCA Corporate Emergency Services Director Development Program and has been awarded the HCA Excellence in Nursing Award for Leadership and Mentorship. • Debbie Nicely, Patient Access Director: Nicely was previously employed with LewisGale Physicians (LGP), a division of HCA located on the LewisGale Medical Center campus, where she worked as a Practice Manager with Graduate Medical Education (GME) Psychiatry and Behavioral Health in both Salem and Alleghany. Prior to her position with LGP, Nicely was involved with insurance billing, management and various customer service jobs within Southwest Virginia. More information: www.lewisgale.com.

Awards and Recognitions LewisGale Imaging Center on Brambleton Avenue Receives Patient Excellence Quality Award LewisGale Imaging Center on Brambleton Avenue was recently awarded the prestigious Attributes for Patient Excellence (APEX) Quality Award for patient satisfaction, marking the fourth year in a row the facility and staff have won the award and recognizing the facility as the only imaging center in Virginia earning the distinction this year. This national award recognizes outstanding healthcare organizations that have demonstrated the highest levels of patient satisfaction and overall care over a 12-month period. Nationally, only two other imaging centers won the award this year. “This award is particularly impactful knowing that scoring comes solely from each facility’s patients,” explains Mike Stoots, Director of Diagnostic Imaging for LewisGale Regional Health System. “Our patients recognize LewisGale employees’ hard work, dedication and focus to provide the highest levels of quality patient care every day.” The APEX Quality Award is presented annually by SPH Analytics, a leader in healthcare analytics and population health management 14

OurHealth | The Resource for Healthy Living in Roanoke and New River Valleys

empowering clients to analyze and interpret their clinical, financial and consumer experience data to maximize performance. The award, based on key performance indicators, ties closely to clinical, operational, and interpersonal measures that are paramount drivers in the overall evaluation. More information: www.lewisgale.com.

The Pulse â&#x20AC;˘ NEWS TO KNOW

Corrections In the Massage Therapy category of the 2018 Senior Living Awards section of the August/September 2018 edition of OurHealth Roanoke and New River Valleys Magazine, the location where first place winner Erin Headrick, LMT practices was incorrectly listed as The Center for Ultra Health. Erin now practices in her new location at 3536 Brambleton Avenue, Suite 10, Roanoke, VA 24018. For appointments or more information, call 540.728.0082 or visit www.erinheadrick.fullstate.com

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The Pulse

â&#x20AC;˘ NEWS TO KNOW

Ali Hama Amin, M.D.

Jashoman Banerjee, MD Jessica Beaudoin, OD Reproductive Medicine and Surgery Center of Virginia, PLC Winchester | 866.540.5190 www.rmscva.com

Blacksburg Eye Blacksburg | 540.953.2020 www.blacksburgeye.com

Sarah Bekri, NP

Frances Benko, DO

Phyllis Carpenter, NP

Lawrence Carpio, DO

Cory Cummings, MD

Alan Davis, DO

Dominique Dempah, MD Thomas DiCarlo, MD LewisGale Physicians General Surgery Salem 540.772.3620 www.lgphysicians.com

Valley Sports and Spine Blacksburg | 540.443.3832 www.valleysportsandspine. com

Andrew Hilldrup, DO

Alice Inouye, MD

David Jones, ALF

Tonya Kelly

Amber Neal, FNP

Debbie Nicely

Jane Nwaonu, MD

Adeolu Olasunkanmi, MD

Carilion Clinic Cardiology Roanoke| 540.982.8204 www.carilionclinic.org

Carilion Clinic Obstetrics & Gynecology Christiansburg 540.731.4578 www.carilionclinic.org

John Entwistle, DO

Carilion Clinic Endovascular Neurosurgery Roanoke | 540.224.5170 www.carilionclinic.org

Patrick Kenney, FNP LewisGale Physicians Spine Surgery Salem | 540.725.9771 www.lgphysicians.com

Carilion Clinic Family Medicine Roanoke | 540.265.5500 www.carilionclinic.org

Adrienne Gentry, DO

Carilion Clinic Reproductive Medicine Roanoke | 540.985.8078 www.carilionclinic.org

Angela Link, FNP

Carilion Clinic Family Medicine Blacksburg | 540.951.0352 www.carilionclinic.org

Carilion Clinic Family Medicine Roanoke | 540.265.5500 www.carilionclinic.org

Foot and Ankle Associates of Radford Internal Medicine Southwest Virginia Radford | 540.731.1600 Salem and Roanoke www.lgphysicians.com 540.344.3668 www.drzelen.com

OurHealth | The Resource for Healthy Living in Roanoke and New River Valleys

Carilion Clinic Neurology Roanoke | 540.224.5170 www.carilionclinic.org

Christiansburg Internal Medicine Christiansburg 540.381.1882 www.lgphysicians.com

LewisGale Physicians Family Medicine Roanoke | 540.265.4210 www.lgphysicians.com

Patient Access Director LewisGale Medical Center Salem | 540.776.4000 www.lewisgale.com

Carilion Clinic Family Medicine Rocky Mount | 540.483.5168 www.carilionclinic.org

Showalter Center Administrator Warm Hearth Village Blacksburg | 540.552.9176 www.retire.org

Carilion Clinic Rheumatology Roanoke | 540.224.5170 www.carilionclinic.org

Susan Blick, NP

Carilion Clinic Pulmonary Medicine Roanoke | 540.985.8505 www.carilionclinic.org

Associate Chief Nursing Officer LewisGale Medical Center Salem | 540.776.4000 www.lewisgale.com

Carilion Clinic Complex Spinal Neurosurgery Roanoke | 540.224.5170 www.carilionclinic.org

The Pulse

Will Pauley, FNP

Cemil Purut, MD

Amanda Reese, DO

Matthew Roby, DO

John Rudderow, DO

James Taylor, MD

Charlene Viers, NP

Carilion Clinic Orthopaedic Surgery Roanoke | 540.510.6200 www.carilionclinic.org

Carilion Clinic Cardiology Roanoke | 540.982.8204 www.carilionclinic.org

LewisGale Physicians Family Medicine Roanoke | 540.265.1607 www.lgphysicians.com

Carilion Clinic General Surgery Roanoke | 540.224.5170 www.carilionclinic.org

LewisGale Physicians Cardiothoracic Surgery Salem | 540.776.2020 www.lgphysicians.com

â&#x20AC;˘ NEWS TO KNOW

Blayne Patton, DPM

Montgomery Surgery Associates Blacksburg | 540.552.0005 www.lgphysicians.com

Carilion Clinic Family Medicine Blacksburg | 540.951.0352 www.carilionclinic.org

For More of The Pulse Visit:

OurHealthRoanokeNRV.com Sam Williamson

Assistant Chief Financial Officer LewisGale Medical Center Salem | 540.776.4000 www.lewisgale.com

Candace Wise, DO

Blacksburg Continuity Clinic Blacksburg | 540.443.7400 www.lgphysicians.com

Do you have health-related news to share for The Pulse? Send to Stephen McClintic Jr. via email at steve@ourhealthvirginia.com.

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OCTOBER & NOVEMBER

CALENDAR

10.6

INFORMATION • EVENTS • AWARENESS

LLAMA FEST

Creative Therapy Care invites you to a fun filled day with the animals at Llama Fest! Come support local participants as they show off their handling skills by leading their llamas through obstacle courses. A fiber contest and special petting time with all of the animals will follow. Food and baked goods will be available for purchase. Creative Therapy Care is a non-profit organization that aims to treat children and adults with special needs through the use of occupational and speech therapies incorporating animals.

Free | 10 am – 4 pm Creative Therapy Care – Mona’s Ark | 8249 Williamson Road, Roanoke More Information: w www.ourhealthvirginia.com/events/llama-fest

10.16: HEALTHY HAPPY HOURS IN BOTETOURT

10.13: WARM HEARTH FOUNDATION

PARROT STRUT 5K AND 1 MILE TRAIL RUN/WALK The Warm Hearth Foundation and LewisGale Hospital Montgomery present the 2018 Parrot Strut 5K Trail Run/Walk. Come strut your tail feathers to raise funds for seniors in need of housing and healthcare at Warm Hearth Village. The run/walk route follows along the scenic woodland trails of the Warm Hearth Village campus. Refreshments will be available following the race courtesy of LewisGale Hospital Montgomery.

$35 | 9 am – 11 am Warm Hearth Village Center 2387 Warm Hearth Drive, Blacksburg More Information: w www.ourhealthvirginia.com/events/ parrot-strut 18

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Are you in need of your seasonal flu shot? Curious about your body composition or blood pressure? Want to relax with a chair massage? Take care of your health needs and more during the Carilion Wellness Healthy Happy Hours event! Free services/ screenings that will be offered include flu shots (must be 18 or older), InBody (body composition) screenings, blood pressure checks, lipid panel and A1c and glucose testing. You can also schedule your mammogram at the event! Carilion Wellness certified personal trainers and registered dietitians will be on hand to answer your questions, and healthy snacks, mocktails, prizes and more will be available for you to enjoy!

7:30 am – 10:30 am and 4:30 pm – 7:30 pm Carilion Wellness – Botetourt 105 Summerfield Court, Roanoke More Information: w www.ourhealthvirginia.com/ events/2018-healthy-happy-hour

Calendar • OCTOBER & NOVEMBER

10.18: HOW TO SIMPLIFY AND CUSTOMIZE YOUR AGING OPTIONS

Are you curious about the different options available locally for aging in place? If so, this seminar is for you! Presented by Western and Central Virginia Aging in Place Council, this seminar will feature keynote speaker Dr. Nancy Brossoie, Senior Research Scientist at the Center for Gerontology at Virginia Tech in addition to more information about local aging services and options, from housing, legal, health and wellness to finance, transportation, and community and social interaction.

FREE | 5 pm – 7:30 pm Jefferson Center | 541 Luck Avenue, Roanoke More Information: w www.ourhealthvirginia.com/events/ simplify-and-customize

10.21:

FOREST BATHING WORKSHOP Join Trees Roanoke and Roanoke Urban Forestry for this exciting introduction to the practice of Forest Bathing, also known as Shinrin-Yoku. Sponsored by Carilion Community Health and Outreach and Downshift, participants will learn how to tune their senses to connect with the forest and how it may help improve mental and physical health. Enjoy guided yoga, meditation, as well as blood-pressure readings before and after the workshop. Proceeds benefit the non-profit, Trees Roanoke, whose purpose is to plant new trees in the City of Roanoke.

$15 | 1 pm – 3:30 pm | Mill Mountain Park Discovery Center 2000 JP Fishburn Parkway, Roanoke More Information: w www.ourhealthvirginia.com/events/ forest-bathing-workshop

10.27: 2018 VIRGINIA TECH SCIENCE FESTIVAL

The Virginia Tech Science Festival is a celebration of science as a way of thinking. Visitors will experience all kinds of hands-on exhibits that highlight the unique ways science plays a role in our lives while centering on dozens of topics, including history, economics, geology, astronomy, medicine, chemistry, big data and more. From DNA exploration, musical robots and a human powered submarine, to surgical robotics and rad rockets, there is certain to be something for everyone to learn from and enjoy!

FREE | 10 am – 4 pm | Virginia Tech campus |620 Drillfield Drive, Blacksburg More Information: w www.ourhealthvirginia.com/events/2018-vt-science-fest www.OurHealthRoanokeNRV.com

Calendar

• OCTOBER & NOVEMBER

11.1: PINTS N’ POSES

Grab your mat and a few friends and plan to wind down after work by enjoying an evening of yoga at Soaring Ridge Craft Brewers, hosted by Roanoke City Parks and Recreation. Open to all ability levels. Pre-registration is encouraged, but drop-ins are welcome. Ages 21+.

$15 (includes one beverage) | 5:45 pm – 7 pm (class is from 6 pm – 7 pm) Soaring Ridge Craft Brewers | 523 Shenandoah Avenue, Roanoke More Information: w www.ourhealthvirginia.com/events/flow-and-glow

11.5: LAUGHTER YOGA WITH KYLE EDGELL Looking for a different and refreshing way to relax? Try Laughter Yoga with Certified Laughter Yoga Leader Kyle Edgell! Growing in popularity locally and throughout the country, Laughter Yoga combines meditation and mindful breathing with humor and laughter, confirming what many have long believed in that laughter really is the best medicine. Come see what the buzz is about!

FREE | 6:30 pm – 7:30 pm South County Library | 6303 Merriman Road, Roanoke More Information: w www.ourhealthvirginia.com/events/laughter-yoga-nov

11.6:

OPEN T.O.P. CLUB (TEEN OUTREACH PROGRAM) Attention parents of 6th – 12th graders! Do your teens need guidance with his or her leadership, life and service skills? This club is just for them! Meet with like-minded youth and get to know people from across the area while learning skills from positive adults having fun! Hosted by Roanoke Valley's Teen Outreach Program® offered through Family Service of Roanoke Valley.

FREE | 5:30 pm – 6:30 pm Family Service of Roanoke Valley | 360 Campbell Avenue, Roanoke More Information: w www.ourhealthvirginia.com/events/11-6-top 20

OurHealth | The Resource for Healthy Living in Roanoke and New River Valleys

11.14: THE NATURE

OF FORGETTING:

Come experience The Nature of Forgetting, an original play conceived and directed by actor, director, mime and magician Guillaume Pige that bursts with creativity, joy, and even heartache in telling the story of Tom, a middle-aged father struggling with the early stages dementia. Virginia Tech’s Theatre Re collaborates with London neuroscientist Kate Jeffery to create a moving articulation of the countless dimensions of memory and amnesia, linking science with real life experiences through physical theatre and compelling live music. The original play premiered in January 2017 at the London International Mime Festival. Arrive early at 6 pm for a panel discussion presented in partnership with the Lifelong Learning Institute at Virginia Tech to explore the question, What Do We Know About Memory? Featured panelists will include: Rachel Diana, Assistant Professor, Department of Psychology at Virginia Tech, Tina King, Executive Director, New River Valley Agency on Aging, Rachel Weaver, Assistant Professor, School of Visual Arts at Virginia Tech and moderator Harald W. Sontheimer, Executive Director of the School of Neuroscience at Virginia Tech.

$10 - $45 | 7:30 pm – 9:30 pm Moss Arts Center 190 Alumni Mall, Blacksburg More Information: w www.ourhealthvirginia.com/events/ what-is-memory

Calendar • OCTOBER & NOVEMBER

: ACY 11.15 E & LEG ESTAT PLANNING

ites munity inv ment Com re ti e g R in y n e n ll pla f the Va and legacy itive Our Lady o ative estate ow to create a defin rm fo in n a h rn w a o le you to h n d a ing an here you c h while liv al seminar w your wealt g atured loc in g Fe a . n a th fter dea er a ld plan for m e te , a sq st e e , r n te you . Gree M n n A PC, , re to distribu n a e r the event on, Desimone & Gre ing iv speakers fo rs G e d d n e ey with A r of Plann rn to o c e of tt ir a D w e , la EdD e Dioc se ie Keenan, dation of th n u Fo y and Magg it n lic Commu with Catho . the Valley Richmond ur Lady of

|O pm – 8 pm FREE | 6:30 oanoke t, . n Stree R o rs e ff lthvirginia Je . 650 N ww.ourhea w : w n o rmati lanning More Info dy-legacy-p la ru /o ts com/even

11.15: ENHANCING QUALITY OF LIFE IN DEMENTIA CARE CONFERENCE

Sponsored by the Alzheimer’s Association, this full-day conference brings together health professionals and families to understand a person-directed approach to caring for those living with this dreaded disease. Breakout sessions during the conference include Professional Practice Recommendations, NonPharmacological Behavior Approaches for All and Family Caregiver Legal Education. For information about scholarships for family caregivers or persons with a diagnosis, contact Ellen Phipps at 434.270.0539. CEUs can be purchased on the day of the event. PLUS: A professional pre-conference seminar on Practice Recommendations for Long Term Care will be held on Wednesday, 11/14 from 1 pm – 4 pm at the Holiday Inn Roanoke– Valley View in Roanoke.

$85 - $95 ($35 for those actively providing care for a family member with dementia) | 8:30 am – 4 pm Holiday Inn Roanoke – Valley View 3315 Ordway Drive, Roanoke More Information: w www.ourhealthvirginia.com/events/ alz-annual-conference www.OurHealthRoanokeNRV.com

Health Scene HAPPENINGS • WHO’S WHO • TRENDING photos | EXPOSURE ROANOKE

4th Annual Hike for Hospice On Sunday, September 9th, more than 428 participants of all ages gathered at Explore Park on the Blue Ridge Parkway for a walk in the woods during the 4th Annual Hike for Hospice, raising a total of $20,700. All proceeds from the event go to support Good Samaritan Hospice’s Bereavement Program, which serves Roanoke Valley residents who are coping with loss and grief. Lunch off the grill was provided by Hethwood Market Catering, Homestead Creamery served delicious ice cream and live bluegrass music was performed by the band Eastern Divide. Games, face painting, yoga, massage and music therapy demonstrations, raffle prizes and much more all concluded with the heartwarming Moment of Reflection memorial ceremony, complete with a dove release. Good Sam’s Bereavement Program annually serves approximately 700 individuals, hosts 100+ grief counseling classes and groups in the community that are free and open to the public and follows each patient’s family for 13 months after they pass to offer support and reassurance. The Program is considered uncompensated care and is totally sustained by funds raised from our community. Good Sam is committed to not only providing the very best care for its patients, but also supporting the families and loved ones who must process the grief and reconcile with the loss. To learn more about Good Sam and its programs, visit www.goodsamhospice.org.

OurHealth | The Resource for Healthy Living in Roanoke and New River Valleys

Health Scene â&#x20AC;¢ HIKE FOR HOSPICE

VOLUNTEER

Spotlight HEROES • CHAMPIONS • COMMUNITY-MINDED

After a

SISTER'S

LIFE-SAVING LIVER TRANSPLANT, A Roanoke College Sorority

TAKES ACTION

words | KATHARINE PALJUG

Many sororities and fraternities on Virginia’s college campuses raise money for charity. But most of them will never be personally affected by the work that charity does. That’s not the case for the sisters of Sigma Alpha Omega at Roanoke College. When the sorority opened a chapter on campus in 2016, one of the founding sisters had a rare disease that required a liver transplant. At the time, she had already received one donated organ; before she graduated, she would need a second.

Inspired to Get Involved After seeing firsthand the struggle that their sister went through, the Roanoke College chapter decided to make Donate Life America (DLA) their official philanthropy, and they set to work raising money for their cause. Fundraising work has affected the sisters in my chapter in such a positive way,” says Megan Long, a senior at Roanoke College and the sorority’s Vice President. “We know we are helping save somebody’s life just like they helped save our sister’s. “For us as a sisterhood it helps to unite us for something that hits close to home,” agrees Allison Tice, the chapter’s Secretary. “It reminds us that life is a precious gift that we are grateful to have, and therefore want to not only show our support to our sister but DLA as a whole.”

The Vital Role of Organ Donations DLA works to increase rates of organ, tissue and cornea donation through education, community outreach and a national donor registry. The issue is an urgent one in the medical community: according to DLA, a new person is added to the transplant waiting list every 10 seconds, and single healthy organ donor can save up to eight lives. Both adults and children can stay on the transplant list 24

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for years, undergoing painful and invasive medical treatment while they wait for good news. For some, that good news never comes: 22 people die each day because they don’t receive a donation in time. Yet, though 98 percent of Americans are in favor of being a donor, only 58 percent of them are actually registered.

Raising Funds and Awareness The sisters at Roanoke College wanted their work not only to raise money, but also to educate their community about becoming a donor. Tice worked with several other members to design a “Donate Life” themed t-shirt, which the sisters sold on campus and nationally to other chapters to raise funds. As part of the sale, they set up tables on campus where sisters talked to community members about the life-saving impact of registering as a donor. “This specific fundraiser was the most successful fundraiser we have had,” says Long. “Not only did we raise money for DLA, but we also brought awareness.” The process was so gratifying, Tice says, that she’s excited to continue fundraising in the coming years. “For me, it is a reminder that one small step or monetary donation can significantly make a difference.” She’s also enthusiastic now about encouraging others to get involved in charity or volunteer work. “Do it with your whole heart.” Even though she’ll graduate after this year, Long is grateful to know that her sorority plans to continue raising money and promoting community awareness around organ and tissue donation. “My father is going through the process of needing an organ transplant, and when I went to appointments with him, I myself saw first-hand the work that DLA does,” she says. “Charities and organizations are always there to lend a helping hand, and we also as a community need to lend a hand.”

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Questions. Answers. Knowledge.

After surgery like knee replacement,

patients are typically less mobile, putting them at risk for developing

BLOOD CLOTS in the legs. This condition is also known as deep vein thrombosis (DVT).

When is a child considered too sick to go to school?

What is Photobiomodulation Therapy?

Each year as the cold and flu season approaches, I am frequently asked by parents how long should they keep their child home from school when ill. This varies with each illness, but there are a few general rules we can follow:

Photobiomoodulation therapy (or PBM), is the application of red LED and near infra-red light to tissue where there is degeneration or injury in order to improve, repair and reduce inflammation and pain. PBM does one thing very well: reduce oxidative stress at the cellular level. This is important because oxidative stress is accepted as the underlying trigger for most diseases and degenerative conditions.

Fever: For children with a fever greater than 100.4 degrees, it is better that they stay home until it is no longer present for 24 hours. The presence of a fever doesn’t necessarily mean a child is contagious; a fever can cause fatigue making it difficult to participate in class. Stomach Bug: Children who have experienced the stomach bug should stay home two days after symptoms resolve. Sore Throat: Children who wake up with a sore throat don’t necessarily have strep. This can be the start of a viral cold or another upper respiratory infection. They may go to school as long as they don’t have a fever. Children diagnosed with strep throat should remain home for 72 hours after starting an antibiotic. Flu: Children who test positive for influenza should stay home 24 hours after their fever and respiratory symptoms improve. To help reduce the spread of these illnesses to others, children should wash their hands frequently and cover their mouths when they cough. Tara Wickline, FNP

LewisGale Physicians – Westlake Moneta | 540.719.0424 www.lgphysicians.com

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Unlike drugs or surgery, PBM therapy promotes regeneration, reduces inflammation and pain, is non-toxic and non-invasive, and has no side effects. Scientific research has clearly demonstrated that red LED and near infra-red light interact directly with our body’s cells and mitochondria in a way that leads to increased cellular energy. This results in a much more rapid resolution of inflammation and has even been shown to increase local growth factors and stem cells. Linda Bailey, Owner

Total You Health, LLC Roanoke | 540.404.8858 www.totalyouhealth.org

I just had knee replacement surgery and my doctor ordered me to wear compression stockings to improve my circulation. How long do I need to wear them? After surgery like knee replacement, patients are typically less mobile. This puts them at risk for developing blood clots in the legs – a condition known as deep vein thrombosis (DVT) – because the muscles are not pumping blood and fluid through the legs as efficiently. Compression stockings are like long socks worn on legs with the primary role being to reduce the risk of developing blood clots. Physical therapists follow the protocols of individual surgeons, but generally compression stockings are worn for approximately two weeks following knee replacement. By this time, the surgical swelling in the leg is decreasing and the patient is significantly more mobile as a result of physical therapy through leg exercises and increased walking. Increased use of the muscles decreases the risk of blood clots developing and thus the need for compression stockings, however, always check with your physician or provider before discontinuing use of compression stockings. Cheryl Rakes, PT

Interim Healthcare Roanoke | 540.774.8686 www.interimhealthcare.com

Questions. Answers. Knowledge. How do I know when it’s time to see a fertility specialist? In general, if you are younger than age 35, the definition of infertility is the inability to conceive after attempting for more than 12 months, while if you are over 35, it is a shorter duration – attempting to conceive for at least six months. Most of our patients have tried to conceive for a reasonable period of time before seeking help.

Infertility is the inability to conceive after attempting for more than

MONTHS.

If you are younger than 35, it is a shorter duration of attempting to conceive for at least six months.

Contrary to popular belief, you can schedule an appointment with a fertility specialist whenever you would like. You do not need a referral from your primary doctor to schedule an appointment with a fertility specialist, which is also known as a reproductive endocrinologist, and you do not have to attempted to conceive for a certain period of time. We are happy to meet with couples for preconceptional counseling, particularly when there are any concerns or medical issues for either partner that may be important to alleviate first before trying to conceive. A good example is when a female has an obvious medical issue that is expected to cause problems conceiving, such as irregular menstrual periods or polycystic ovary syndrome. Christopher Williams, MD

Reproductive Medicine and Surgery Center of Virginia, PLC Charlottesville | 434.654.8520 www.rmscva.com

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What role do hospice volunteers serve? Hospice volunteers embody the true heart of hospice. For no money or reward other than the benefit of making a difference in someone’s life, they offer their time and talents to meet the needs of hospice patients, their families, our organization and our community. There are generally three types of hospice volunteers: Family Support Volunteers: These volunteers complete a special training program to learn how to be present with hospice patients and families in their homes or wherever they reside. They may read to the patient, listen to stories, sing, or just sit quietly at the bedside, offering a loving, caring presence. Office Volunteers: These volunteers make phone calls, file, assist with data entry or mailings, or put hospice care packets together. Special Projects Volunteers: These volunteers may assist with fundraising, community education, and special events, such as Hike for Hospice. They also may bake for special patient events, such as birthdays and anniversaries, or knit or crochet shawls and lap blankets. At Good Sam, we can help find a volunteer niche for all interested persons! Sue Ranson, President/CEO Good Samaritan Hospice Roanoke | 888.466.7809 www.goodsamhospice.com

How has 3D printing affected the prosthetics profession and what is the potential for the future? 3D printing has been in the prosthetic field since the 1970s, but has only become part of the average prosthetist’s toolbox in the last three-five years. Companies like E-nable, Additive O&P, Standard Cyborg, and Create 3D are making 3D-printed prostheses available to patients and clinicians. While established for upper limb prostheses for children, use of 3D printing in lower limb prostheses for socket production is still new. Clinics employing this technology, however, are finding it to be less expensive, more repeatable, and more time efficient than traditional methods, speeding up and increasing the quality of care they can provide to their patients. As material and printer technology advances further, the future may allow for same-day fabrication of definitive sockets, a significant decrease from the current standard five-to-ten day turnaround. The compact nature of 3D printers also lends itself to mobile prosthesis production, which will benefit patients in remote areas and developing countries. Tyler Manee, CPO, MSPO

Virginia Prosthetics & Orthotics 888.366.8287 www.virginiaprosthetics.com

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words | JENNIFER LAMONT

Each new stage of a woman’s life brings new

a survival guide to women’s health in each decade

adventures, unique challenges and health concerns— made even more interesting by hormonal shifts, mood swings and the magical quest to find permanent youth and beauty. You don’t need your grandmother to tell you that your health changes as you grow older. But change it does. This guide to women’s health gives insight into some of the top health issues women are concerned with during each decade of life.

Forever 21! Ah, sorry. No. your

20s

You’re in your 20s. Life is good. Your collagen hasn’t started to betray you yet and your skin glows no matter how many hours you spend partying. You can eat and eat, and then eat some more, with few consequences. It may not feel like it at times, but you have more energy than you will ever have. If only you could bottle it for later...

The choices you make in your 20s shape your health and body during your later years. The younger you are, the less you tend to care about this fact. But if 55-Year-Old Future You could travel back to chat with 21-Year-Old You now, you don’t want her whining about her aching joints, age spots and expanding waistline the whole time, do you? Ugh, so not your problem.

Health A-Z

• WOMEN'S HEALTH

Taking care of your health seems like an idea best left for the ‘olds’ to worry about. You usually don’t have chronic health issues to face in your 20s, but there are two health issues that are especially concerning for women in your age group.

Love the Skin You’re In…Now After all, you live in it. Taking care of your skin at this age means more than washing your makeup off at night. (Which is a must, by the way.) While getting natural sunlight is important for your health, protecting yourself against sun damage helps prevent both aging and skin cancer. According to a 2015 report in the Journal of the American Academy of Dermatology, melanoma is the leading cause of cancer deaths among women in their 20s. The good news is that skin cancer is treatable when caught early. You should get a yearly skin screening by a physician, and perform self-checks, especially if you like to tan. Taking care of your skin keeps you safer—and younger-looking for longer. Girls in ancient Britain believed that carrying an acorn in their pocket kept them young because of the oak tree’s long lifespan. You don’t have to do that, unless you want to. There are other ways to effectively preserve your stores of collagen and elastin.

To get dermatologist-recommended skincare tips that will keep your skin beautiful, healthy and youngerlooking, visit ourhealthvirginia.com/va/women/ skincare-tips.

It Only Takes One Time

While getting

Your early 20’s is the time when your libido is raging and your brain’s risk-taking amygdala is still trying to run the show after your angsty teen years. That’s why taking care of your sexual health now lays the foundation for your long-term health.

natural sunlight is important for your health, PROTECTING

YOURSELF AGAINST SUN DAMAGE helps prevent both

AGING AND SKIN CANCER.

Of the 19 million new STD infections occurring each year, nearly half of them are in those ages 24 and younger, according to the Centers for Disease Control and Prevention (CDC). Doctors are saying that herpes, HPV (human papillomavirus) and chlamydia are rampant. HPV and chlamydia also have the added bonus of being asymptomatic, which means you or your partner can have it and not know it.

of the 19 MILLION

NEW STD INFECTIONS occurring each year,

NEARLY HALF ARE AGES

Left untreated, sexually transmitted diseases can lead to pelvic inflammatory disease, infertility, cervical cancer, HIV and unwanted pregnancies—all of which affect your long-term health.

Visit ourhealthvirginia.com/va/women/sex-smart to get SEX-SMART TIPS and to find out which must-have tests you need in every decade, BUT ESPECIALLY IN YOUR 20S.

AND YOUNGER

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As you roll in your 30s, your libido and other things may slow down a bit. The one you’ll care about the most is your metabolism. You could eat anything in your 20s. Now, not so much.

Health A-Z

• WOMEN'S HEALTH

19TH CENTURY

women resorted to

your

COMPLETELY ABSURD

30s

measures to lose weight. Some of them

Nothing Tastes as Good as Being Thin Feels… in Your 30s

to speed up their metabolism.

It becomes slightly harder to maintain a healthy weight in this decade as you juggle life and work responsibilities. It can feel impossible to shed the extra pounds that begin to creep up on you.

SWALLOWED ARSENIC

That’s probably why women in the 19th century resorted to completely absurd measures to lose weight. Some of them swallowed arsenic to speed up their metabolism. Even in tiny amounts, it wasn’t a safe practice. Others swallowed tapeworms in a capsule. Yes, tapeworms. The ‘theory’ was that the tapeworm cysts would reach maturity inside the intestines and absorb extra food. Blech. There are healthier and more effective ways to go about losing weight in your 30s which don’t involve ingesting poisons or parasites.

Visit ourhealthvirginia.com/va/women/weightloss-tips get research-backed tips for losing weight and THE SURPRISING LINK BETWEEN YOUR FRIENDS AND YOUR WEIGHT.

DID YOU KNOW? 1 in 8 women will develop a thyroid condition in her lifetime

After your roaring 20s and during the slowdown of your 30s when things are hopefully a bit more stable, your 40s are when things get a bit, well, crazy. That’s really the only way to describe the hormonal roller coaster that is perimenopause and menopause.

You’re on Fire! And Not in a Good Way! The Fiery 40s. You’re burning up, sweating and then freezing. And then the cycle repeats. This can happen a few times a week or multiple times a day. As cycles become irregular, women in their 40s suffer from hot flashes that can be mild or severe, lasting up to 10 infuriating minutes at a time. They can wake you up from a deep sleep and be triggered by stress, eating, caffeine, heat, spicy foods and… anything really.

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Health A-Z • Women: These are the Decades of Their Lives

your

40s Extreme fluctuations in estrogen and progesterone create such an imbalance that estrogen levels in a perimenopausal woman can be higher than a younger woman’s levels. For many women, this is a rough time for trying to stay in balance. As estrogen also gradually declines, you lose bladder tone, natural lubrication and have increased urinary tract infections, night sweats and emotional symptoms. It’s a delicate balancing act to try and stabilize symptoms. Getting your hormones tested can help, but, because they fluctuate on an hourly basis, it can be hard to stabilize your hormones even with hormone replacement therapy (HRT). On the other hand, natural remedies may help, but the closer you get to actual menopause, the more severe your symptoms may become.

Visit ourhealthvirginia.com/ va/women/menopause to get expert lifestyle tips that will HELP YOU TRANSITION THROUGH THIS EXCEPTIONALLY HAIRY TIME. Getting your hormones tested can provide a snapshot of whether you may be approaching menopause. Your provider should test your thyroid hormones as well. Because hypothyroidism increases in frequency as women age into their 40s, researchers believe it may be connected to high levels of estrogen during this time. Research shows that too much estrogen can prevent the thyroid hormone from getting to where it needs to go and from converting to its active form. The American Thyroid Association estimates that one in eight women will develop a thyroid condition in her lifetime. Getting a comprehensive look at both thyroid and sex hormones will help you discover what is actually happening. Unfortunately, it could be both a thyroid problem and menopausal symptoms. www.OurHealthRoanokeNRV.com

Health A-Z

• WOMEN'S HEALTH

DIABETES and other symptoms of

METABOLIC SYNDROME INCLUDE:

LARGE WAIST, ELEVATED BLOOD PRESSURE AND TRIGLYCERIDES, HIGH BLOOD GLUCOSE LEVELS AND GLUCOSE INTOLERANCE these are the most important risk factors for heart attacks in women at an earlier age.

If you reach the other side of menopause with your sanity intact, your 50s can be downright freeing. They’re certainly calmer. No more menstrual cycle or fear of pregnancy. No more mood swings. And remember when 55-Year-Old You visited 21-Year-Old You? She’ll thank you for all the times you put down the donuts, went for a walk and ate avocado. Because her heart and blood sugar will be better for it.

your

50s

Your 50s is Not for the Faint of Heart As you age, you lose some of your natural defenses against both heart disease and Type 2 diabetes. But you can prevent these conditions, even in your 50s. Both heart disease and diabetes are easily the most dangerous conditions facing women in this decade, but also the most preventable.

They’re also intricately related. According to Harvard Medical School, diabetes and other symptoms of metabolic syndrome—large waist, elevated blood pressure and triglycerides, high blood glucose levels and glucose intolerance—are the most important risk factor for heart attacks in women at an earlier age. And your 50s is early. Heart disease may not abruptly present itself until later but it’s already starting now. During this decade, it’s extremely important to know your numbers. In a study conducted by the American Heart Association, half of the women knew that heart disease is the leading cause of death in women, but only 13 percent of them were worried about it. For younger women in their 50s, it’s dangerous to think it can’t happen to you.

DO YOU KNOW

YOUR

Because women in this age group tend to dismiss symptoms that aren’t easily recognized as heart attack symptoms, they die more than men of the same age who have typical pain and shortness of breath. Research shows women also die of diabetes more than men because it hits them harder during menopause. Women—continued on page 39

NUMBERS?

Visit ourhealthvirginia.com/va/women/heart-healthy-numbers to FIND OUT WHAT YOUR HEART-HEALTHY NUMBERS SHOULD LOOK LIKE. 36

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Health A-Z

• WOMEN'S HEALTH

Women—continued from page 36

•

Taking healthy steps—literally—will help prevent heart disease and diabetes. Walking and exercise, along with a healthy diet, are modest changes that have the most significant impact on reducing new cardiac and diabetes cases.

Women: These are the Decades of Their Lives

Keeping your blood sugar levels stable and eating a heart-healthy diet gives your body more of a fighting chance as you get older. Moving into your 60s and golden years doesn’t mean you have to lose your health. Seniors today are staying more active than ever, and it’s helping them stay sharp.

your

60s

It’s Not the Years in Your Life, It’s the Life in Your Years

While some of your ‘circuitry’ starts to burn out a little during this time, your brain continues to grow new cells well into your 60s. Even though it may not seem possible because you’re always forgetting why you walked into the kitchen, it’s a fabulous fact that you’re not done yet. Continued neurogenesis in our brain helps us with the capacity to learn new things. In our recent “Guide to Successful Aging Well Into Your 90s,” we talked about the importance of learning new, challenging skills and having fun socially while doing it. As an integral part of “successful aging,” keeping our minds active with more than crosswords is key to maintaining our cognitive abilities. While women have greater resilience to age-related cognitive impairment than men, according to research, a woman’s hormones can affect her cognition. But there are differences between age-related, normal memory loss and cognitive decline. If you can’t find your keys because you left them in the freezer by accident, that’s actually normal. If you continue to leave them in the freezer, that may be MCI (mild cognitive impairment), or the beginning of Alzheimer’s. Although many people in their 60s fear they’re getting Alzheimer’s Disease because they’re forgetful, many things are indicative of normal aging, and not dementia. Do you know the difference between normal forgetfulness and signs of dementia?

Is it normal forgetfulness or is there something more serious going on? Visit ourhealthvirginia.com/va/ women/forgetfulness to find out.

It’s Never Too Early… or Too Late Whether your 25, 45 or 65, you have unique health concerns depending on which decade you’re in. If you’re older, you’ve probably often reflected with a sigh, “If only I knew then what I www.OurHealthRoanokeNRV.com

Health A-Z

• WOMEN'S HEALTH

know now…” And if you’re younger, you’re probably thinking you have all the time in the world. But each decade builds on the previous. You can mitigate the health concerns you do face by being proactive at every age. Know your numbers and the screenings you need in each decade of your life. Live a healthy lifestyle so you can transition smoothly from one decade to the next without wanting to go back and slap that 20-Year-Old.

Whether you’re 25, 45 or 65, you have UNIQUE HEALTH CONCERNS depending on which decade you’re in. You can mitigate the health concerns you do face by being PROACTIVE AT EVERY AGE.

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For a comprehensive list of the screenings you should get during each decade, visit ourhealthvirginia.com/va/women/screenings.

Sources hh hh hh hh hh hh hh

www.skincheck.org/Page1.php www.cdc.gov/std/stats/default.htm www.ncbi.nlm.nih.gov/pmc/articles/PMC3153870/ www.menopause.org/ www.health.harvard.edu/heart-health/gender-matters-heart-disease-risk-in-women www.menopause.org/for-women/menopauseflashes/bone-health-and-heart-health/diabetes-hits-womenhard-at-menopause-beat-it-back www.nia.nih.gov/news/age-related-cognitive-decline-women-are-more-resilient-men

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Health

A-Z

INSIGHT • AWARENESS • MINDFULNESS

what

women

NEED TO

KNOW about their pelvic floor words | KATHARINE PALJUG

Ladies, do you know what your pelvic floor is — or why it’s an essential part of a healthy, functioning body? Eric Swisher, MD, an OB-GYN at Physicians to Women in Roanoke, says he wishes more people were paying attention to this important part of their body. “The pelvic floor musculature is part of our core muscular support,” he explains, “which contributes to balance, agility, mobility, urinary and bowel function.” Unfortunately, Dr. Swisher adds, pelvic floor dysfunction is more common than most women realize.

People are living longer and having amazing responses from diseases that they wouldn’t have before.” Eric Swisher, MD OB-GYN with Physicians to Women

What is the Pelvic Floor? The pelvic floor is the group of muscles that spans the bottom of the pelvis. “Picture a trampoline,” says Dr. Swisher. These muscles attach to your tailbone at the back, your pubic bone at the front and the sitting bones on each side. This creates a floor that supports your bladder, bowel and, in women, uterus. Pelvic floor muscles move up and down, which means they can be exercised. They can also, like every muscle, be damaged.

Symptoms of Pelvic Floor Dysfunction Signs of pelvic floor damage vary from woman to woman. “Some patients report the pain is just an annoyance that limits some activities,” says Dr. Swisher. “Other patients present with incapacitating pain and limited mobility.”

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Health A-Z • What Women Need To Know About Their Pelvic Floor

anatomy of the

PELVIC FLOOR

Symptoms of pelvic floor dysfunction include: • Pain or stiffness in the back, hip or pelvis • Difficulty urinating or having a bowel movement • Leaking urine or stool • Feeling of something sliding down the vagina • Seeing or feeling a bulge in the vagina • Discomfort, aching or fullness in the pelvis • Pressure in the pelvis that gets worse when standing or coughing • Painful intercourse Some women experience multiple symptoms, while others only have one or two. In cases of severe damage, the pelvic organs may begin to slip down through the pelvic floor, which is known as organ prolapse. This is what causes the feeling of something sliding or bulging into the vagina. No matter what signs you notice, they all deserve your attention, because pelvic floor damage can grow worse over time.

Many pelvic floor disorders improve

with

physical therapy. Physical therapists that specialize in treating pelvic floor conditions

use stretches and exercises, often paired with biofeedback, to help

What Causes Damage to the Pelvic Floor Muscles? How can these deep, internal muscles become damaged? Big events, like a car crash or pregnancy, can cause severe and obvious damage. But smaller events are harder to pinpoint. An exercise class or a long car ride can cause strain that you don’t notice until weeks later. No matter how the pelvic floor is damaged, it can impact every area of your life, says Dr. Swisher. “Pelvic floor strain impacts standing, sitting, stair climbing, intercourse, exercise, bladder function and bowel function.”

patients strengthen and heal the pelvic floor. Other

treatments include transcutaneous electrical nerve stimulation (TENS therapy), acupressure and stretching.

But if the pelvic floor affects so many things, why aren’t more people talking about it?

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Health A-Z

• WOMEN'S HEALTH

Why are Pelvic Floor Muscles Overlooked? Many women don’t know enough about their pelvic floor to tell their doctor when there’s a problem, or they don’t know how to describe their symptoms. “The site may be difficult for patients to pinpoint or explain,” explains Dr. Swisher. “These muscles are deep.” Other times, doctors end up on the wrong track because pelvic floor disorders seem like a different problem. For example, an orthopedist that you see for back pain will likely focus on your hips or spine. “It would be uncommon for those specialists to evaluate pelvic floor muscles with a pelvic exam,” says Dr. Swisher. “So the syndrome often goes undiagnosed.” Often, women assume their pain is something everyone experiences. Women who have given birth, for example, are often resigned to discomfort during intercourse or “leaking” after a sneeze. As a result, they go through their adult lives uncomfortable and embarrassed.

But that doesn’t have to be the case.

Treating your Pelvic Floor Many pelvic floor disorders improve with physical therapy. Physical therapists that specialize in treating pelvic floor conditions use stretches and exercises, often paired with biofeedback, to help patients strengthen and heal the pelvic floor. Other treatments include transcutaneous electrical nerve stimulation (TENS therapy), acupressure and stretching. Some cases of organ prolapse may require surgery, but many women see results from less invasive treatments. “Patients with uncomplicated stress urinary incontinence have a 70 percent chance of improvement with physical therapy, especially when biofeedback is used,” says Dr. Swisher.

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Health A-Z •

How to Strengthen

What Women Need To Know About Their Pelvic Floor

Your Pelvic Floor

Whether or not you’ve experienced pelvic floor damage, you can strengthen these muscles with exercise such as:

SQUATS ABDOMINAL CRUNCHES AND BICYCLES CLAMSHELL KNEE-LIFTS BALANCE POSTURES CAT AND COW SPINE STRETCHES

Many women have heard of Kegel exercises, and these “below the belt” squeezes (think of how it feels to stop a flow of urine) are often recommended for strengthening the pelvic floor. But, says Dr. Swisher, they aren’t usually effective because it’s hard for women to trigger the right muscles. Instead, focus on the three B’s: your Belly, Back and Bottom. Exercising these muscles will naturally include your pelvic floor.

For More Information For more information on supporting and maintaining your pelvic floor, visit the American College of Obstetricians and Gynecologists at www.acog.org. And be sure to talk to your primary care provider or gynecologist for recommendations specific to your body, health and stage of life.

Expert Contributor: hh

Eric Swisher, MD with Physicians to Women

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HOW CLOSE ARE WE TO

CURING

CANCER GOOD?

FOR

words | JENNIFER LAMONT

It’s the word we speak in hushed tones, no one wanting to say it aloud because of its frightening implications. Cancer impacts us all. We all know someone who has been affected in some way by this dreaded diagnosis. While it’s scary and confusing, cancer is no longer the death sentence it used to be. A hundred years ago – even 50 years ago – cancer was often not detected until it was too late. And treatments were generic chemotherapy drugs and harsh radiation. Today, advancements in testing, early diagnosis, treatments and research are diminishing the power of this disease so people are living longer, better quality lives.

According to the American Association for Cancer Research, the five-year survival rates for all adult cancers combined has increased from 50 to 68 percent since 1976. Some cancers – like breast, prostate and testicular – have five-year survival rates of 100 percent if caught early enough.

The numbers for children are even more promising. The five-year survival rate for all childhood cancers combined has increased to nearly 80 percent since 1976, up from 50 percent. In fact, researchers now believe they know what causes most types of childhood leukemia. And they say it’s preventable.

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Health A-Z

• CANCER

“I think the most exciting technology in cancer care today is molecular diagnostics to improve outcomes. It used to take us eight months to text a single gene vs. several weeks now. And now we can text, insetad of one at a time, 17 or 34 genes at a time or more.” MISTI WILLIAMS, LCGC genetic counselor with LewisGale Regional Cencer Center

LewisGale ranks among the top hospitals in Virginia and the nation for benchmarked quality cancer care, patient safety and satisfaction and health outcomes through its two full-service regional cancer centers - LewisGale Regional Cancer Center in Salem and LewisGale Regional Cancer Center Pulaski.

In a landmark study published in May 2018 by London’s Institute of Cancer Research, researchers concluded that the most common form of childhood cancer – acute lymphoblastic leukemia (ALL) – is caused by a genetic mutation coupled with another surprising cause: a too-clean environment in a child’s first year of life. In other words, children who have this genetic mutation and are not exposed to microbes or other children during infancy have a much greater chance of developing ALL. Researchers say stimulating an infant’s immune system can prevent it.

Researchers are Conquering Cancer Through DNA Working with a patient’s own immune system and his or her genetic makeup is key in treating cancer successfully, as opposed to blasting away tumors in a shotgun approach. Cancer is no longer treated as a one-size-fits-all approach. Doctors in the Roanoke and the New River valleys are now treating patients with highly personalized plans through genetic testing and immunotherapies. “I think the most exciting technology in cancer care today is molecular diagnostics to improve outcomes,” says Misti Williams, LCGC, a genetic counselor at LewisGale Regional Cancer Center. Doctors can now find mutations in genes so that, in a cancer patient, this means knowing how the cancer will act and how to best fight it. Combining that with immunotherapies and advanced radiation technology is increasing survival rates and quality of life for cancer patients in Virginia. “It used to take us eight months to test a single gene vs. several weeks now. And now we can test, instead of one at a time, 17 or 34 genes at a time or more, depending on what sort of condition we’re looking for,” says Williams. “The technology is better, so we can look at more information.”

The Future is Here: Finding Cancer Before It Even Shows Up Researchers are investigating the use of liquid biopsies to determine where cancer may be lurking even before it shows up on a CT scan, mammogram or x-ray. The test is a simple Cancer—continued on page 50

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Health A-Z

• CANCER

CANCER TREAMENT HAS COME A LONG WAY In the 1940s and 1950s, the only cancer treatment options were a few types of chemotherapy and radiation. Doctors and researchers are beginning to outsmart cancer through:

Genetic testing

Higher quality screenings and earlier detection

Knowledge of how different cancers respond to different types of therapies

Carilion Clinic serves nearly one million Virginians through its network of hospitals, primary and specialty physician practices and other services, including its cancer treatment program at the Carilion Clinic Cancer Center. In collaboration with the physicians of Blue Ridge Cancer Care, the Carilion Clinic Cancer Center provides a full range of cancer treatments and is widely known as a leader in the specialty.

Cancer—continued from page 48

Chemoprotective agents to protect against side effects

Targeted immunotherapy and radiation techniques

Nanoparticle technology

Breakthroughs and patient participation in clinical trials

Educating patients on lifestyle factors

Improved doctor-patient communication

blood draw, and looks for cancer cells or tiny pieces of tumor DNA circulating in the blood. Useful in cases where a tissue sample is difficult to get, liquid biopsies will give doctors clues about where the cancer is within the body and which treatments are most effective. “The technology we have is simply getting better every day to be able to look at DNA on such a small scale. The biggest thing for people to know is liquid biopsy and liquid screening is hopefully going to be the way of the future compared to what we’re doing now,” says Andrew Fintel, DO, medical oncologist at Blue Ridge Cancer Care (BRCC). Dr. Fintel says liquid biopsies will help diagnose cancer sooner, before they show up during screening. The technology to implement this was born from our ability to successfully sequence the human genome, which was very difficult and even more expensive. “Ten or fifteen years ago, to sequence the human genome cost millions of dollars. Today it’s now in the $1,000 range,” says Dr. Fintel. In fact, just ten years ago in 2008, it

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Health A-Z •

cost $10 million. Before that, the very first genome sequencing cost $2.7 billion and almost fifteen years to create. We’ve come a long way and this rapid advancement has opened the door for gene-based therapies and cures down the road.

How Close are We to Curing Cancer for Good?

Applying the technology to better diagnose and affordably treat patients is just around the corner. “In order to have a good screening test, it has to be affordable, have good sensitivity and it needs to make a difference. A blood sample would certainly be more cost effective,” adds Dr. Fintel. The focus has been on patients with lung, breast or prostate cancer so far but according to the American Cancer Society, the technology is expected to have an impact on all types of cancer.

Can Your Immune System Kill Cancer? The short answer is yes. But there are caveats. Researchers and doctors now understand that cancer is not just one disease. It’s many. And many cancers are good at avoiding detection because cancer cells can hide, effectively becoming invisible to the body’s disease-fighting T-cells. That’s where immunotherapy excels in combating the disease.

Immunotherapy works by using a patient’s own immune cells to search out and destroy intruder cells. The treatment can be a vaccine, general immune-boosting support or highly targeted therapies to fight different types of cancers. One type of immunotherapy doesn’t kill cancer directly. It helps the immune system perform that task with the use of drugs called immune checkpoint inhibitors. These inhibitors simply ‘uncloak’ the cancer cells in hiding so the body’s T-cells can find and destroy them. Another type, adoptive cell transfer immunotherapy (CAR T-cell therapy) engineers the body’s own T-cells to specifically target foreign invaders by collecting and using the patient’s immune cells. This specialized treatment was approved by the FDA in 2017 to treat childhood leukemia and advanced lymphomas in adults. The immune system’s T-cells are “potent killing cells,” says William (Bill) Fintel, MD, medical oncologist at Blue Ridge Cancer Care. With half of his practice spent treating breast cancer patients, Dr. Bill Fintel says the field has changed over the last decade. “Now in my 30 years of practice, close to half the time I’m using a targeted therapy vs. a shotgun method that sprays and kills everything nearby. There’s a huge overlap when you [use targeted therapies]. It affects surgeons who are making smaller incisions. It affects pathologists who are trying to work not on a pound of flesh but on an eighth of an ounce of flesh,” he says. www.OurHealthRoanokeNRV.com

OurHealth | The Resource for Healthy Living in Roanoke and New River Valleys

• CANCER

Health A-Z

•

He tells the story of his father, and Dr. Andrew Fintel’s grandfather, who was diagnosed with lung cancer at 91. Chemotherapy was not effective, so they turned to immunotherapy, which gave him an extra year to live. Says Dr. Bill Fintel, “He had a great year of life that he never would have had without immunotherapy.”

The objective in all types of cancer treatments is to preserve healthy, surrounding cells while destroying the cancer cells and minimizing side effects. Doctors are much better at this than they were 40 years ago. Advanced radiation techniques augment other therapies and increase control over the patient’s cancer. One of the biggest innovations in accomplishing this has been to use x-rays to image the patient’s internal anatomy in real time to deliver a highly targeted dose of radiation that minimizes side effects and damage to healthy cells. These treatments, called image guided radiation therapy (IGRT) and stereotactic body radiation therapy (SBRT), position the patient exactly the way their treatment plan calls for. Higher, more accurate doses mean fewer treatments. Radiopharmaceuticals (a drug that can be used either for diagnostic or therapeutic purposes) are newer technologies being expanded to treat more types of cancer. One such type, Lutathera®, was just approved this year by the FDA. It’s a radioactive isotope that targets rare cancers of the G.I. tract, which are usually slow-growing and don’t respond well to chemotherapy. This radiation treatment infusion is injected into the body where it then binds to targeted receptors on tumors and causes damage to those specific cells. As a new line of defense, it isn’t available everywhere.

Grandfather Norman Fintel, father Bill, and son Andrew, during an infusion of “immune therapy”. Andrew and William are both oncologists at Blue Ridge Cancer Care.

“We are one of the few on the entire east coast and the only one in Virginia using Lutathera®,” says David Buck, MD, Medical Director of Carilion’s Department of Radiation Oncology and President of Blue Ridge Cancer Care. “I think this concept of tagging a radioactive isotope to an antibody will expand in the field of oncology for all types of different tumors.” Dr. Buck says.

Combining new technology, immunotherapy and personalized care is helping saving lives, even patients in Stage IV of cancer. Testing new therapies and technologies in clinical trials – and having patients eager to sign up for them has advanced cancer treatments more rapidly in the last two decades.

No Longer for Guinea Pigs, Clinical Trials Save More Lives

Andrew Fintel, DO medical oncologist with Blue Ridge Cancer Care.

William (Bill) Fintel, MD medical oncologist with Blue Ridge Cancer Care.

Dr. Bill Fintel talks about a clinical trial using one of the very first inhibitor drugs approved by the FDA to impede the escape pathway for breast cancer fed by estrogen. “I had the privilege of having one of the first women who went in that trial and has now just passed her five-year anniversary on the drug and has been in remission for the entire time. And this is Stage IV breast cancer,” he says. David Buck, MD

According to the American Society of Clinical Oncology (ASCO), more patients are participating in clinical trials than ever before. Donating tissue samples and clinical information, they’re helping design research studies and providing valuable perspectives. This contributes to better care and increased survival rates for all cancer patients. In fact, as of 2005, 64 percent of U.S. patients diagnosed with cancer lived 10 years beyond diagnosis, compared to 35 percent of those diagnosed in 1975. This number is even higher for many types of cancers.

Medical Director of Carilion's Department of Radiation Oncology and President of Blue Ridge Cancer Care.

www.OurHealthRoanokeNRV.com

How Close are We to Curing Cancer for Good?

2 Ways Technology Saves Lives

Health A-Z

• CANCER

In a clinical trial, doctors test new treatments before they’re available to the public. Whereas it was a ‘guinea pig’ mentality in the past, patients nowadays are actively participating in clinical trials to make a difference in their own care, and for others in the future.

For many patients, a clinical trial will be covered by insurance if it involves an already approved standard of care. Other costs get picked up by the drug companies running the trial. Padmaja Mallida, MD medical oncologist with Blue Ridge Cancer Care.

And the more trials, the better. Oncologists can treat patients effectively today because of trials in the past. Clinical trials can change the shape of a doctor’s practice because they answer important clinical questions. They also help advance personalized treatments that are more effective for patients right from diagnosis and beyond.

Personalized Care: Before, During and After Jennifer Vaughn, MD, MSPH medical oncologist and hematologist with Blue Ridge Cancer Care.

Karanita Ojomo, MD, FAAR radiation oncologist with Blue Ridge Cancer Care.

When she first entered the oncology field, Padmaja Mallidi, MD, a medical oncologist at Blue Ridge Cancer Care, never dreamed the field would get so exciting and integrated in the fifteen years since she’s been at the center. “It used to be chemotherapy drugs, surgery and radiation,” says Dr. Mallidi. Now, the medicine is personalized, starting with the diagnosis. Treatments are more tailored toward the patient with targeted therapies, immunotherapy and personalized ‘survivorship’ care. Patients are living longer so this brings up a new opportunity, which is providing the best care for them as survivors,” she says. Jennifer Vaughn, MD, MSPH, medical oncologist and hematologist at Blue Ridge Cancer Care, explains: “We’re seeing more and more people doing well from their cancer and are actually treating more people for cures – but also the exposure to things like radiation and chemo – those people can have more long-term health problems,” she says. So, personalizing both medical care and survivorship care is integral to helping patients and survivors increase their quality of life and live longer. Advancements in cancer treatment are also extending to rural communities, including those here in southwestern Virginia. At LewisGale Regional Cancer Center Pulaski, oncologycertified occupational therapists work with patients before they even have a problem. Patients can often develop swelling and edema due to treatments. “We get the patient to our occupational therapists prior to the patient even having a problem with lymphedema. That significantly improves outcomes when it comes to quality of life,” says Karanita Ojomo, MD, FAAR, radiation oncologist at the center.

After All This, is Cancer Preventable? Taking an active role in their own treatment may give patients an immune boost that strengthens their cancer-fighting abilities. But while doctors and researchers have been hot on the heels of groundbreaking cures, technologies and treatments during the last few decades, the one factor that can make the battle an uphill one is lifestyle.

While the overall cancer rate has dropped by more than 25 percent since 1990, according to the National Cancer Institute, lifestyle habits have gotten worse. Obesity is on the rise again with more than 35 percent of the population affected. Associated with several types of cancers including liver, pancreatic, breast, endometrium and bladder cancer, excess weight is linked to higher death rates from all diseases including cancer. 54

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Health A-Z •

There are no guarantees, of course, but the single best action adults can take to reduce cancer risk is keep a healthy weight and maintain a strong immune system. Survivors especially need to quit smoking, becoming more engaged in exercise to help improve their outcomes,” says Dr. Vaughn.

How Close are We to Curing Cancer for Good?

The big thing is the physical activity and focusing on nutrition for cancer survivors and others to prevent new cancers or to stop them from coming back,” says Dr. Mallidi. “Diet, exercise and sleep are important factors. There are more and more studies coming out that shows how exercise impacts cancers,” she notes. Meanwhile, doctors and researchers – including here in the Roanoke and New River valleys – continue to make life-saving advances in cancer detection and treatments. But lifestyle factors cannot be ignored even in the face of advancements. Researchers now say that up to 40 percent of cancer cases can be prevented with lifestyle improvements, and while this isn’t new news or insight, it is perhaps the most important we can learn from in the fight against this disease.

Expert Contributors hh hh hh hh hh hh hh

David Buck, MD, Medical Director of Carilion’s Department of Radiation Oncology and President of Blue Ridge Cancer Care Andrew Fintel, DO, Medical Oncology, Blue Ridge Cancer Care William (Bill) Fintel, MD, Medical Oncology and Hematology, Blue Ridge Cancer Care Padmaja V. Mallidi, MD, Medical Oncology, Blue Ridge Cancer Care Karanita Ojomo, MD, FAAR, Radiation Oncology, LewisGale Regional Cancer Center Jennifer Vaughn, MD, MSPH, Medical Oncology, Blue Ridge Cancer Care Misti Williams, LCGC, Genetic Counselor, LewisGale Regional Cancer Center

Sources hh hh hh hh hh hh hh hh hh

www.aacr.org/AdvocacyPolicy/GovernmentAffairs/Documents/Facts_ About_Cancer___9DB83D.pdf www.ncbi.nlm.nih.gov/pmc/articles/PMC2553205/ www.cancer.gov/about-cancer/understanding/statistics blog.aacr.org/experts-forecast-cancer-research-and-treatment-advancesin-2018/ www.cancer.gov/sites/nano/cancer-nanotechnology/treatment www.webmd.com/diet/obesity/news/20180612/us-obesity-rates-risingagain#1 www.aicr.org/reduce-your-cancer-risk/smoking-and-other-lifestylefactors/cancer-prevention.html www.genome.gov/27565109/the-cost-of-sequencing-a-human-genome/ www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ ucm594043.htm www.OurHealthRoanokeNRV.com

My paternal grandmother died of ovarian cancer in her 50s — before I was even born.

My father is a carrier of the

BRCA1 gene mutation, and that means there is a

50% CHANCE

of passing it on to his children.

And, as a carrier, I have a 50% CHANCE of passing it on to my children.

10 years ago, my aunt died of the same cancer as my grandmother. We call it the ‘family curse’. 56

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BREAKING

SILENCE

hereditary

BREAST

OVARIAN cancer and

words | SUSAN DUBUQUE

This series explores medical conditions and procedures that can be devastating to the patients and families they affect — yet no one is talking about them. That is, until now. We will talk openly about these issues and dedicate these stories to the courageous individuals living with them as well as the healthcare providers and researchers committed to treating and seeking cures for these enigmatic diseases.

A planner by nature, Brittany Madonna’s life was right on track. By age 34, she had a happy marriage, two adorable children, and a fulfilling career. Everything was unfolding perfectly until May 2017, when a simple blood test revealed a ticking time bomb — the BRCA1 gene mutation. With that revelation, Brittany now knew she was at high risk for developing ovarian and breast cancer, which took her lifeplanning to a whole new level. “My paternal grandmother died of ovarian cancer in her 50s — before I was even born,” says Brittany. “And 10 years ago, my aunt passed away from the same thing.

We call it the ‘family curse.’” But far from being angered or immobilized by her family history, Brittany was empowered. She set out to learn everything she could about her risk factors and preventive options. And then she took action. “My father is a carrier of the BRCA1 gene mutation, and that means there is a 50 percent chance of passing it on to his children. So, last spring I decided to find out my status,” says Brittany. “My mom urged me to have the test and Dr. [Jamie] Buck, my OB-GYN, agreed. It’s better to know.” “I had blood drawn at my doctor’s office and she sent it to the lab. Three weeks later, Dr. Buck called me with the results. I tested positive for the BRCA1 mutation,” recalls Brittany. “Dr. Buck was surprised by the outcome. But I was stunned. My mind was a complete blur. It wasn’t until later that I

really comprehended the implications that the doctor shared with me — a 46 to 87 percent chance of developing breast cancer by age 70 and about a 39 to 63 percent chance of ovarian cancer.” Subsequently, Brittany’s sister was tested and learned that she carried the BRCA1 gene mutation as well. Within a week of getting the results, Brittany was in her doctor’s office for her first mammogram. Fortunately, the test showed no evidence of breast cancer. Her doctor explained several options for moving forward. A conservative approach would mean having a mammogram and breast MRI done annually. More assertive action would involve having a bilateral (double) mastectomy as well as removal of the ovaries. The second options would significantly reduce Brittany’s risk of breast and ovarian cancer. www.OurHealthRoanokeNRV.com

In her usual takecharge style, Brittany made her decision. On January 24, 2018, she underwent a double mastectomy.

LEFT: Mark and Brittany before her first surgery; MIDDLE: Brittany training for the Claytor Lake Triathlon; RIGHT: Brittany with her kiddos at the start of the triathlon.

“I talked with several friends who are doctors, and I made an appointment with a breast surgeon and a gynecologic oncologist. I also looked at online support groups. Every medical professional I talked to recommended surgery,” says Brittany. “I felt like a ticking time bomb, and I realized that if I didn’t have surgery, my anxiety level would continue to be sky high.” In her usual take-charge style, Brittany made her decision. On January 24, 2018, she underwent a double mastectomy performed by Carilion Clinic breast surgeon Roxanne Davenport, MD, at Carilion Roanoke Memorial Hospital. During that same operation, Carilion Clinic plastic and reconstructive surgeon Kurtis Moyer, MD, performed the first of two procedures required to reconstruct Brittany’s breasts. “I wasn’t super nervous about the surgery,” says Brittany. “In fact, once everything was scheduled, I felt a huge sense of relief.” Her mother, Leslie Warrington, and her husband, Mark Madonna, were with Brittany before and after the three-hour operation. By the next afternoon, she was resting at home, having spent only 23 hours in the hospital.

Kurtis Moyer, MD

Carilion Clinic plastic and reconstructive surgeon

“I applaud any individual who—like Brittany—is willing to share part of life’s journey to positively influence others.” Roxanne Davenport, MD

Carilion Clinic breast surgeon

“The first week was a bit of a blur,” says Brittany. “Thankfully, my mother-in-law took care of Chase (age 6) and Lola (age 4) on multiple nights, and I had a lot of support from coworkers who helped by setting up a meal train. And my husband was with me every step of the way. He attended my doctor’s appointments and took pages of notes. And he helped me keep track of my medications after surgery. He was my true superhero!” “The most challenging part of my recovery was dealing with surgical drains and sleeping upright in a recliner for three weeks,” she says. For the first stage of reconstruction, Dr. Moyer placed tissue expanders in Brittany’s chest. “The device felt a little like an iron bra or a really tight bear hug,” she remembers. For four weeks following surgery, saline was injected each week into the expanders through a port in order to stretch Brittany’s breast tissue and make room for permanent breast implants. “After only four weeks, I was able to ease back into working,” says Brittany, who is the marketing and communications director for the YMCA of Virginia's Blue Ridge. “My boss and all my colleagues were amazing throughout this whole ordeal.” Brittany credits her speedy recovery to her young age and good physical condition, as well as the fact that she did not have cancer and had not been undergoing chemotherapy or radiation. “By having the surgery now, before cancer had a chance to take hold, I was able to bounce back faster and get on with the rest of my life.” Brittany’s surgery to remove the expanders and insert the permanent breast implants was initially scheduled for April. But due to an unusual occurrence – a spot of thinning skin on

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Brittany and her colleagues Tricia Reynolds and Jill Glasgow competed in the Claytor Lake Triathlon this past September.

Brittany’s chest wall – Dr. Moyer decided to perform the second reconstructive surgery a little earlier, on March 12, 2018. “It was a relief to get the expanders out, and compared to the first surgery, this was a piece of cake,” says Brittany. “I had no pain, just a little feeling of tightness in my arms. I had surgery on Monday, and by Thursday, I was feeling really good. The only restriction was no raising my arms over my head for a week and no heavy lifting for two weeks.” And how does Brittany now feel about her decision? “It was definitely the right thing for me to do,” she declares without hesitation. “It has been well over a year since I discovered I had the gene mutation. And I thought about it every day. Now, the worst part is over.” Before having her surgery, Brittany set an aspirational goal for herself. “I always wanted to complete a sprint triathlon, and I set my sights on the Claytor Lake Tri that I successfully completed this past September. I even had the support of a group of friends from the YMCA who committed to doing the race with me.” Brittany is now mapping out her last surgical procedure. “I will have my ovaries removed in the next few years, definitely before I turn 40,” she says. “We don’t plan on having more children and I want to reduce my risk of ovarian cancer.” For Brittany, sharing her story is an important part of her journey. Learning about her family history and the steps she could take to protect herself has made her a true warrior in the fight against breast and ovarian cancers. “Most people are simply unaware. They don’t know that their fathers can be the carrier of a harmful gene mutation or that men can also develop breast cancer,” she says. “But thanks to all the advances in DNA testing, we can learn about our risk www.OurHealthRoanokeNRV.com

EVERYONE has two BRCA1 and BRCA2 genes, but when one gene in a BRCA pair is mutated, it can't fix DNA damage in breast cells. This can lead to breast cancer.

• Breaking the Silence: Hereditary Breast and Ovarian Cancer

•••••

Health A-Z

factors and then make informed personal decisions. I didn’t take the decision to have preventive surgery lightly. But I did feel empowered knowing the choice was mine. And I choose to put the lingering fear of breast and ovarian cancer behind me.”

DID YOU KNOW?

It’s time to get this conversation started. Let’s talk frankly and openly about hereditary breast and ovarian cancers — the causes, treatments and what you need to know to protect yourself.

What are the BRCA1 and BRCA2 Gene Mutations? BRCA1 and BRCA2 are human genes that produce tumor-suppressing proteins. These proteins help repair DNA and play a role in ensuring the stability of each cell’s genetic material. When these genes are changed — or mutated — in some way, the protein is not made or does not function properly. As a result, the DNA is not repaired and the cells are more likely to develop genetic alterations that can lead to cancer. Not all gene mutations are harmful, but specific inherited mutations in BRCA1 and BRCA2 are known to increase the risk of breast and ovarian cancers. It may surprise you to learn that a harmful BRCA1 or BRCA2 mutation can be inherited from either a person’s mother or father. Each child of a parent who carries a mutation in one of these genes has a 50 chance of inheriting the mutation.

CANCER RISK BREAST CANCER AVERAGE RISK

BRCA RISK

12%

80%

Fortunately, these gene mutations are relatively rare in the general population — occurring in about 1 in 400 people. However, there are differences among various ethnic groups. For example, about 1 in 40 Ashkenazi Jewish men and women carry a BRCA1 or BRCA2 mutation. If you have inherited a harmful BRCA mutation, your risks are not insignificant. Let’s look at the numbers. • About 12 percent of women in the general population will develop breast cancer at some time during their lifetimes. “Approximately 10 percent of breast cancers are genetic or familial in nature,” says Dr. Davenport. “And of these, 80 percent are caused by the BRCA1 or BRCA2 gene mutations.” Women with one of these mutations are more likely to be diagnosed with breast cancer at a younger age, as well as to have cancer in both breasts.

OVARIAN CANCER AVERAGE RISK

BRCA RISK

1.7%

50%

• About 1.3 percent of women in the general population will develop ovarian cancer sometime during their lives. By contrast, it is estimated that about 44 percent of women who inherit a harmful BRCA1 mutation and about 17 percent of women who inherit a harmful BRCA2 mutation will develop ovarian cancer by age 80. In women, the harmful mutations increase the risk of several types of cancer in addition to breast and ovarian, including cancers of the fallopian tubes and the peritoneum (the thin layer of tissue that lines the abdomen). Men with BRCA2 mutations — and to a lesser extent, BRCA1 mutations — are at increased risk of breast cancer and prostate cancer. Both men and women with harmful BRCA1 or BRCA2 mutations are also at increased risk of pancreatic cancer.

Who Should Be Tested? If you have a personal or family history of breast or ovarian cancer, your physician or a genetic counselor can help you determine if testing is right for you. Women who have close blood relatives with breast cancer have a higher risk. Having a first-degree relative — a mother, www.OurHealthRoanokeNRV.com

Health A-Z

• BREAKING THE SILENCE

sister, or daughter — with breast cancer almost doubles a woman’s risk, and having two first-degree relatives increases her risk about three-fold. Most women — about 8 out of 10 — who get breast cancer do not have a family history of the disease. Therefore, regular breast screening is important even if you do not have a harmful genetic mutation.

What if Your Test is Positive?

EMPOWER YOURSELF WITH KNOWLEDGE

MANY WOMEN ARE CONFUSED by the conflicting and ever-changing guidelines for screening mammography. The physicians at Carilion Clinic support the American College of Surgeons’ recommendation that women

begin having annual screening mammograms at age 40. Most of my patients would prefer to risk a false positive

Women who have the BRCA1 or BRCA2 gene mutations have several options. “Removal of the breast and ovaries before cancer occurs greatly reduces — but does not completely eliminate — the risks for breast and ovarian cancers,” notes Dr. Davenport. “Since not all the tissue can be removed, this type of surgery is referred to as ‘risk-reducing’ surgery. Removal of the ovaries reduced the risk of ovarian cancer by 50 percent. As a physician, my job is to educate my patients so they can make an informed decision—one that is right for them.” Chemoprevention is the use of medication to reduce the likelihood of developing cancer. The U.S. Food and Drug Administration (FDA) has approved two chemoprevention drugs for women at high risk for breast cancer — tamoxifen and raloxifene. “This type of therapy can reduce the risk of developing cancer by about 40 percent,” adds Dr. Davenport. Intensified breast screening is recommended for women with an identified harmful gene mutation or high breast cancer risk based on family history alone. Your doctor can help you determine which course of action is right for you, but some basic guidelines include: Clinical breast exam every 6 to 12 months beginning at age 25. Annual breast MRI beginning at age 25. Annual breast MRI and mammogram from ages 30 to 75. Screening after age 75 should be considered on an individual basis.

What Does Reconstructive Surgery Involve? “The emotional and physical trauma of losing one’s breasts — whether due to cancer or a choice to prevent cancer — is tremendous. But reconstructive surgery can offer a woman the opportunity to restore her physical image and avoid the constant reminder of a gene mutation or cancer,” says Dr. Moyer.

finding than miss a diagnosis of cancer.

- Roxanne Davenport, MD -

Most women, including Brittany, have reconstruction in two stages,” explains Dr. Moyer. “The first surgery is to place the tissue expanders. The second operation, which typically occurs about three months later, involves removing the expanders and either inserting breast implants or creating breasts from the patient’s own tissue. This can be performed through microsurgery and is called a DIEP flap. With this procedure fat, skin, and blood vessels are removed from the wall of the lower belly and moved up to the chest to rebuild the breasts. A select number of women are able to have a single-stage reconstruction where the final implant is inserted at the same time that the breast is removed.”

Most women — about 8 out of 10 — who get breast cancer do not have a family history of the disease. 62

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www.OurHealthRoanokeNRV.com

Health A-Z

• BREAKING THE SILENCE

1 in 8

women will have breast cancer in her lifetime—and the numbers keep growing. But, that believe it or not, that may be for some positive reasons. “Improved breast imaging technology means we’re able to identify carcinoma in situ—cancers at the earliest stage which has not spread and can be most successfully treated,” indicates Dr. Davenport. “Additionally, women are living longer, have better access to healthcare and may no longer feel the stigma associated with admitting that you have breast cancer. Regardless of your genetic makeup or family history, regular breast health screenings offer the best protection against breast cancer.”

“Many women take the opportunity to change something about their breasts that they didn’t previously like. It’s not uncommon for a patient to request larger or smaller breasts through reconstruction,” Dr. Moyer says. “There have been many advances in breast reconstruction in recent years, like the DEIP flap and nipple-sparring surgery. We’re proud to offer these types of services to the patients living in our region,” he adds. But perhaps the greatest point of pride for Dr. Moyer is simply caring for women who are breast cancer survivors or who opt for surgery in an effort to prevent breast cancer in the first place. “I consider it an honor and a privilege to take care of patients like Brittany,” he says. “It’s gratifying to know that breast reconstruction can make a difficult decision like a risk-reducing mastectomy just a little easier.”

Expert Contributors hh hh

OurHealth | The Resource for Healthy Living in Roanoke and New River Valleys

Kurtis Moyer, MD, Carilion Clinic Plastic and Reconstructive Surgery

Source hh

Roxanne Davenport, MD, Carilion Clinic General Surgery

National Cancer Institute

17th Annual Education Conference

ENHANCING

Quality of Life

IN DEMENTIA CARE

GOTO www.alz.org/crf 1) Search Alzheimer’s Association Programs and Events 2) Click Education Program and add Roanoke, VA 3) Register yourself or your group for the Roanoke Conference and/or Professionals Pre-Conference. Or call 1.800.272.3900 to register and pay by phone.

A conference that brings together health professionals and families to understand a person-directed approach to caring for those living with Alzheimer’s and other forms of dementia. Thursday, November 15, 2018 | Holiday Inn Roanoke– Valley View | 3315 Ordway Dr. NW | Roanoke, VA 24017

FEATURING:

KEITH FARGO, PhD Director of Scientific Programs & Outreach, Alzheimer’s Association

LORETTA VENEY Author & Speaker

MONICA MORENO Senior Director, Care and Support, Alzheimer’s Association

$95 person $85 person group of 5+ $35 family caregiver

Sponsored By:

$20 CEU KAREN GARNER Virginia Advocacy Manager, Alzheimer’s Association

ANDERSON, DESIMONE & GREEN, PC Attorneys at Law

CHRIS DESIMONE Attorney, Anderson Desimone & Green PC

KATE TAMARKIN, PhD Program Coordinator, Hospice of the Piedmont

ANN ASHBY MCKISSICK, RPh, CGP, FASP Consultant Pharmacist

(purchase day of the conference.)

Pre-Conference Workshop for Healthcare Professionals

DEMENTIA PRACTICE RECOMMENDATIONS

A Deep Dive!

Wednesday, November 14 - $45 per person | 1:00pm - 4:00pm www.OurHealthRoanokeNRV.com

Health A-Z • 5 Ways to Maximize Family Time During Cancer Treatment

words | TIM WENDEL

Ways to Maximize Family Time During Cancer Treatment A diagnosis of cancer can be devastating to any family. Still, when my brother contracted acute lymphoblastic leukemia (ALL) in the mid-1960s, my parents did a remarkable job of making sure we lived life to fullest. Such an approach can benefit families today. HONEST TALK: It wasn’t that long ago that some people wouldn’t even say the word “cancer” aloud. Instead it was the “C-word” or not even mentioned at all. Adults and even older siblings need to be more open and ready to answer younger ones’ questions, too. STAY ACTIVE AND INVOLVED: Despite Eric’s eight-year battle against ALL, he played ice hockey, touch football and sandlot softball. He sometimes was away from our family, being treated at Roswell Park, one of the top cancer research centers in the country. But when Eric rejoined us, my parents urged him to pick up where he had left off. Tim Wendel is a Charlottesville-based journalist and the author of “Cancer Crossings: A Brother, His Doctors and the Quest to Cure Childhood Leukemia.”

DON’T BE AFRAID TO LAUGH: My brother briefly wore a wig after losing his hair due to chemotherapy treatments. That lasted until the first family swimming outing when it kept coming off in the swimming pool. When he opted to go without the wig, we applauded his decision. STAY IN THE MOMENT: Concerns about the past and certainly the future can overshadow everything else when a loved one has cancer. That said, try to stay in the moment. Squeeze as much as you can into every single day that you’re together. FIND A COMMON ACTIVITY: In my family’s case, we all learned to sail. I didn’t realize until years later that this was my father’s response to having a son diagnosed with ALL. Under his guidance, we became expert enough to travel across miles of open water on Lake Ontario, repeatedly to the Canadian side. We haven’t sailed as a family in some time, but those crossings and those adventures rank among our favorite times together.

www.OurHealthRoanokeNRV.com

Health

A-Z • OPIOID CRISIS

INSIGHT • AWARENESS • MINDFULNESS

from

HEARTBREAK

HOPE:

How One Mother is FIGHTING the Opioid Crisis

Janine Underwood recalls the year her son, Bobby, made her a decadent seven-layer chocolate cake for her birthday. “It was a little tilted to one side,” she laughs, “but it tasted amazing. Bobby loved to cook. His dream was to get degrees in both business and culinary arts so he could open his own restaurant.”

words | JENNIFER LAMONT

But the kind-hearted, caring kid who always looked out for his brother and sister grew into a man who struggled with opioid addiction for years after he had ACL surgery during his first year of college. After the surgery, he was prescribed a 90-day supply of OxyContin. That tangled him in a web of addiction, recovery, and relapse. “That summer changed the course of his life forever,” says Janine. “He had the surgery, recuperated, and went back to college in the fall, but ended up dropping out at the end of his sophomore year. I still didn’t know at that time he had become addicted to pain medication. It was six months after being home when I realized what was happening.”

The Surprising Speed at Which Our Brains Become Trapped Janine says Bobby’s addiction escalated from pain medications and other prescription drugs to heroin within a year. In 2015, Janine lost her son. Bobby died in his bedroom at only 28 years of age from an overdose of heroin laced with fentanyl, an opioid that can be up to 100 times stronger than morphine. Experts are now saying that it only takes a few days to become addicted to opioids.

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Health A-Z

• OPIOID CRISIS

LEFT: Bobby celebrating his third birthday; MIDDLE: A young Bobby (right) with his younger brother, Ricky. RIGHT: Bobby’s senior high school picture.

Now, Janine wants other parents to know “what they don’t know.” She says she didn’t realize then that painkillers can lead to heroin use, or how easily it can happen to anyone. So, through her grief, she tells her story to parents and children through Community Conversations and awareness events in Roanoke County Public Schools in conjunction with Roanoke’s Heroin Task Force and the Prevention Council. “Bobby was a good kid in school. He played sports and he loved the outdoors. I didn’t know that taking pain medication could lead to addiction, or even that addiction was a disease. And this can happen in your family, to anyone. No one is immune,” says Janine. And she’s right.

The Faces of Addiction “The current opioid crisis is like this: 100 people die from opioid overdoses every day. If one hundred people died every day in a plane crash, people would notice. They’d stop flying. And while prescriptions for opioids have dropped, the crisis is still severe. We’ve been slow to act, and it’s catching up with us.”

Like Bobby, these are college students. Moms and dads. Kids in middle school and people with dreams. The face of the opioid epidemic is everyone. Individuals from all ages, races, and walks of life are being affected, and we all know at least one person who is addicted.

In August 2017, the president declared the opioid crisis a national emergency, with one American dying of a drug overdose every nine minutes. Here in Virginia, the Department of Health reports that more than 1,200 people die each year from drug overdoses – and that number is only going up.

Jitendra Desai, MD

founder and medical director at Avenues to Wellness in Roanoke

Jitendra Desai, MD, founder and medical director at Avenues to Wellness in Roanoke, describes it this way. “The current opioid crisis is like this: 100 people die from opioid overdoses every day. If one hundred people died every day in a plane crash, people would notice. They’d stop flying. And while prescriptions for opioids have dropped, the crisis is still severe. We’ve been slow to act, and it’s catching up with us.” Board-certified in addiction psychiatry, Dr. Desai says the problem started in the nineties with doctors overprescribing medications. Then the rise of pill mills worsened the problem. As the issue has grown from bad to worse, he says, medical doctors need to state the dangers of currently abused drugs to their patients.

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Health A-Z •

And parents need to educate themselves. “Opioids are the drugs right now that parents need to worry about the most. They’re easily accessible in the medicine cabinet. That’s the first place they look,” says Dr. Desai.

From Heartbreak to Hope

How Community Conversations is Trying to Curb the Opioid Crisis During Community Conversations, Janine tells her story alongside law enforcement and members of the medical community who talk about what’s out there, what parents need to look for, the prevalence of overprescribing, how to use safeguards with prescriptions, and the need for locking up meds. She says if she were to sum up what she really wants parents to know, it’s this: “The first thing I say is, ‘I didn’t know what I didn’t know.’ I didn’t know the signs to look for and I didn’t know that addiction is a disease, not a moral failing. We have to realize that. And learn all we can.”

“‘I didn’t know what I didn’t know.’ I didn’t know the signs to look for and I didn’t know that addiction is a disease, not a moral failing. We have to realize that. And learn all we can.” – Janine Underwood

“Second, if your kids are experimenting with marijuana or pills, don’t just brush it off. Ask why. Get some support from the schools, your church, and other family members, and build a support system. And finally, never say, ‘It’s not my child.’” www.OurHealthRoanokeNRV.com

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But there is hope. There are resources out there. Through the Prevention Council’s Community Conversations and addiction programs, people – including parents – need to know they have somewhere to turn. “A lot of places will take you if you don’t have insurance. Some are faith-based. There are work programs,” says Janine. One such program is the Roanoke Valley Hope Initiative (RVHI) run by the Bradley Free Clinic in Roanoke, where Janine serves as executive director. “I’m very passionate about our community and the patients we serve – the low income and uninsured. I’m very fortunate to be in this position,” she adds. “The RVHI gives people hope that there is a place to go if they’re willing,” Janine says. Through their group of volunteer “Angels,” they serve as the connection between professional help and those suffering from substance use disorders (SUDs) within the greater Roanoke area. “We have a directory of services and volunteers that helps anyone whether they have Medicaid, private insurance, or no insurance. I would say, statistically, we have 75 percent who don’t have insurance. And of the people who have come to the RVHI seeking help, we’ve been able to link 82 percent of them to detox, intensive outpatient, or residential programs.”

To learn more about recovery programs and community resources in the greater Roanoke and New River Valley area, visit www.ourhealthvirginia.com/roanoke While most people who seek help through Hope Initiative are adults, Janine says it becomes harder to help your child or loved one once they turn eighteen. Parents have to be educated about what their children can be exposed to, and how quickly a wisdom tooth extraction or sports injury can turn into an addiction if they’re prescribed painkillers. And most importantly, she says, know the signs of addiction. She talks about the clues she missed. Her son was lethargic and dope-sick at times. She mistook those symptoms as just a typical, tired teenager who was possibly coming down with the flu. She didn’t know then what she knows now, she says.

From Heartbreak to Hope

Where to Turn for Hope in Roanoke

•

School counselors are now becoming much more aware of the epidemic and are good sources to go to initially, she says. However, experts say that despite awareness programs and national attention, the number of people being admitted to emergency rooms for opioid overdoses in Virginia and around the U.S. is rising.

Health A-Z

Part of the problem with drug addiction is the stigma. “Many times, parents keep it to themselves as if it’s just a family problem. That’s why I’m out there speaking about all this. We have to talk about it. This is a big deal, and we can’t arrest our way out of it,” says Janine.

Health A-Z

• OPIOID CRISIS

What Parents Should Know About Drug Addiction Dr. Desai says that parents must be consistent with their children and mindful if their kids are withdrawing from activities, changing friends, becoming isolated, or failing in school. “Stay consistent with expectations and draw the line. Let them know they will have to take a drug test if parents suspect a problem,” he advises. He also talks about what parents should know:

Experts say that despite awareness programs and national attention, the number of people being admitted to emergency rooms for opioid overdoses in Virginia and around the U.S. is rising.

Show kids the science behind addiction with nonjudgmental dialogue. Dr. Desai is careful to tell parents that if they lecture kids or call them an addict, kids will tune them out. Instead, he shows his patients struggling with addiction how they have created an “intimate relationship” with that substance and how it will hurt them in the end.

Parents can help teach their kids resiliency by modeling healthy behavior, helping their kids increase their self-esteem, and keeping them busy with sports and other activities.

Look for signs of addiction in your child early on. It isn’t just high school kids who experiment or succumb to drug addiction. “Middle school is the time that’s scariest because of the neurological damage to a child’s brain while it’s still forming. With habitual drug or alcohol abuse, they don’t form the necessary connections within their brains. It’s particularly harmful for that population,” says Dr. Desai.

Talk with your child often. One talk is not enough. Know the signs that your child may be suffering from low self-esteem or looking for coping mechanisms, and seek help.

An important first step is to lock up all medications and never let your child self-administer any prescriptions, advises Janine. She says that in many cases, there’s probably not much of a need for heavy painkillers. (See Proactive Tips for Parents to Prevent Abuse on next page.) In fact, she recalls with anger the day her 15-year old daughter sprained her thumb playing softball. In urgent care, the doctor put a brace on it, telling her to take ibuprofen and ice it. On her way out, he handed her a prescription to “help her sleep.” It was for 24 tablets of oxycodone. “I could not believe he had just prescribed her oxycodone for a sprained thumb. I talk about that with parents,” says Janine. Evidently, it’s taking a while for some in the medical community to catch up. But they’re also working within a culture that is highly conditioned to take pills for most conditions. Janine says that’s why she’s out there talking to parents as much as she can. “I know the more we talk about this, the more educated we will be – both parents and the community. Hopefully we’ll erase the stigma of addiction and start treating this as a disease.” “Bobby looked out for his friends, and he had a great sense of humor,” says Janine. “I know when he was at the height of his addiction, he wasn’t the Bobby we all knew. I was really fortunate to see him turn his life around and get a good job and see how happy he was before he relapsed for the last time.”

Personal Interview: hh

Janine Underwood, Roanoke

Expert Contributor: hh

Jitendra Desai, MD, Medical Director, Avenues to Wellness, Roanoke

Sources: hh hh

www.justice.gov/usao-wdva/pr/roanoke-valley-opioidheroin-task-force-present-community-conversationabout-opioid-pain www.heraldcourier.com/news/virginia-researchers-seek-rapid-way-to-treat-opioid-addiction/ article_9069f664-db4a-11e7-bf1f-433764dcdac1.html

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PROACTIVE TIPS for Parents to PREVENT DRUG ABUSE Secure and Dispose Medicine Properly Two-thirds of teens who report abusing prescription medication get it from friends, family and acquaintances. Use proper storage and disposal to help prevent abuse. Start by taking note of how many pills are in each of your prescription bottles or pill packets, and keep track of refills. You need to be especially vigilant with medicines that are known to be addictive and commonly abused by teens, such as opioids, benzodiazepines and stimulants.

Talk With Your Kids Take action by having frequent conversations with the teens and young adults in your life about the dangers of medicine abuse. According to a national study called Partnership Attitude Tracking Study, only 14 percent of teens indicated that during the last conversation they had with their parents regarding substance use, the misuse or abuse of any type of prescription drug was discussed. Learn more by visiting www.DrugFree.org/article/talk-withyour-kids/ and download a free Parent Talk Tool Kit.

Get Help For A Loved One Think your child might have a problem with prescription medicine abuse? For one-on-one help getting started, you can call Partnership for Drug-Free Kidâ&#x20AC;&#x2122;s free Parent Helpline at 855.DRUGFREE (866.303.7992) to speak with a caring, masterâ&#x20AC;&#x2122;s-level counselor who will listen and help you make a plan.

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HEALTHY OBSERVATIONS

More than Just

THE BLUES

words |TINA JOYCE

October 11 2018 NationaL Depression Screening Day th

is held annually during Mental

Illness Awareness Week October 7th-13th, 2018

Sometimes the cloud won’t lift. Sometimes the burdens are too heavy to carry alone. Sometimes the unseen trauma haunts the mind. Early awareness, proactive treatment, and consistent follow-up are key to fighting depression. Major depressive disorder is a common mood disorder, but can be very serious. Depression may affect how a person thinks, feels, acts, sleeps, and eats; the disorder is estimated to impact more than 16 million adults in the US every year. October 11, 2018, National Depression Screening Day (NDSD), is held annually during Mental Illness Awareness Week, to educate and screen people who are suspected of fighting depression or related mood and anxiety disorders. NDSD is the nation’s oldest, voluntary community-based screening program that gives access to validated screening questionnaires and provides referral information for treatment.

Depression is More Than Sadness The American Psychiatric Association categorizes depression based on the intensity, duration, and frequency of symptoms, or a combination of these symptoms. • Persistent sad, anxious moods

• Moving or talking slowly

• Feelings of hopelessness

• Difficulty sleeping

• Irritability

• Appetite and/or weight changes

• Feelings of guilt or worthlessness

• Thoughts of death or suicide

• Loss if interest in activities

• Aches or pains without clear physical cause

• Decreased energy or fatigue 76

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NATIONAL DEPRESSION SCREENING DAY OCTOBER 11th 2018

Fortunately, depression can be treated, usually with medication and/or psychotherapy (counseling). It’s important to remember no two people are affected by depression in the same way. Depression may be experienced at any age, but is more prominent in adults, especially if the adult suffered from anxiety as a child due to genetics or environmental factors. The severity and stage of the disorder will impact the recommended treatments.

Different phases of life can bring on depression for a variety of reasons. Major life changes, trauma, or stress are risk factors and should be closely monitored. Also, certain illnesses or medications are known to cause depression. Depression is a Common Condition Affecting Seniors For these reasons, it is not surprising that seniors may experience depression. The Hermitage Roanoke Retirement Community is well aware of the risks that senior residents may face. “When coming to an assisted living facility, seniors face life challenges that may lead to depression. They may be dealing with health issues, loss of independence, loss of their home and personal belongings, social isolation, monetary concerns, and loss of self-worth,” explains Susan Painter, Director of Marketing at Hermitage Roanoke. To keep residents from falling victim to depression, Painter notes, “It’s our job to give residents a sense of belonging and purpose. Learning about their life and the things they once used to enjoy and try to recreate some of these activities for them. We offer them a sense of security knowing they are in a safe environment and will be cared for. We give them a way to interact socially and become part of our Hermitage family.”

The Hermitage Roanoke Retirement Community offers different levels of security so residents can seamlessly move from independent living to assisted living with as little stress as possible, reducing the risk of depression.

HERMITAGE ROANOKE

AT-A-GLANCE p

1009 Old Country Club Road Roanoke, VA

c w

540.449.0071 www.hermitageroanoke.org SERVICES:

Health Care Independent/Residential Living Assisted Living Nursing Care Rehab Therapy Respite Care Hermitage Roanoke is CARF certified

Everyone feels the blues every now and then. This is not depression. National Depression Screening Day allows questions to be answered and people to support others who may need a gentle nudge to have their symptoms professionally evaluated.

Health Screenings are Often the First Step in Getting Help Health screenings provide an anonymous, preliminary self-assessment to those who may not otherwise seek professional assistance. Often this is the first step in getting help. However, it’s important to remember screenings are not a professional diagnosis. To locate a local screening site near you or a loved one, visit www.HelpYourselfHelpOthers.org. If you don’t see a location close to you, take a general online screening to help plan your next steps, including consulting your primary care physician.

Susan Painter

Director of Marketing with Hermitage Roanoke

If you or someone you know has prolonged symptoms of depression, suggest a screening this October 11th. You may save a life.

Expert Contributor:

Sources:

Susan Painter, Director of Marketing atHermitage Roanoke

hh hh

www.nimh.nih.gov www.mentalhealthscreening.org www.helpyourselfhelpothers.org www.OurHealthRoanokeNRV.com

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HEALTHY OBSERVATIONS

Celebrating Quality and Compassionate Caregivers in Home Care and Hospice words |TINA JOYCE

In November,

the healthcare community honors and celebrates those who serve in home care and hospice:

nurses, therapists, home care aides, social workers, patient advocates, and family members.

No words can express the gratitude families feel when sensitive, compassionate caregivers provide home care services in a safe home environment or offer a dignified passing of a loved one with tender support through hospice care.

A Professional Support Network for 33,000 Home Care and Hospice Caregivers The National Association for Home Care & Hospice (NAHC) offers education, support and resources to its members, representing 33,000 home care and hospice organizations. The NAHC asks the medical and social community to celebrate Home Care and Hospice Month in November in a unified effort to show respect to those committed to this noble profession.

Warm Hearth Village Provides Support and Services to Seniors Across the Continuum of Care Many aging or disabled adults may desire and choose to receive in-home care so they can continue to age in place in their own home. However, there are times when assisted living is the safest option. Warm Hearth at Home and Warm Hearth Village in Blacksburg collaborate to offer different levels of security so residents can seamlessly move from their own home, to independent living, or to assisted living if needed with as little stress as possible. “We are pleased to be able to serve seniors in their own homes throughout the New River Valley.” Says Elaine Smith, Outreach Coordinator for Warm Hearth at Home. “We also provide them with care and services on our campus if they are no longer able to live independently. Our full continuum of living options was a vision of our Founder, Wybe Kroontje more than 40 years ago.”

Elaine Smith

Outreach Coordinator with Warm Hearth at Home

Warm Hearth at Home Offers New and Innovative Offerings in Home Care Services A decline in health or a medical crisis can impact both the individual stricken with the illness or injury as well as his or her family that is responsible for ensuring their loved one’s www.OurHealthRoanokeNRV.com

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HOMECARE AND HOSPICE MONTH NOVEMBER 2018

safety and well-being. Providing the level of care that an ill or injured person requires can sometimes be overwhelming for family members trying to balance their loved one’s care needs with their own responsibilities and obligations.

Helping Families Develop a Strong Support Network for Their Loved Ones Home Care services like those offered by Warm Hearth at Home help families to develop a support network, solve everyday problems and

Warm Hearth at Home A Medicare-licensed provider, Warm Hearth at Home provides Home Health and Home Care services to clients age 55 and up throughout the entire New River Valley.

WARM HEARTH AT HOME

AT-A-GLANCE p

1901 South Main Street, Suite 7 Blacksburg, VA

c m w

540.443.3428 smccroskey@warmhearth.org www.whvathome.org MEDICAL SERVICES

provide needed companion and caregiver services and resources to ensure their affected loved one’s needs are completely met. Warm Hearth at Home’s new and innovative offerings in home health services provide a solid and trusted foundation for the care and services an individual needs when recovering from illness or injury or managing chronic health conditions. Should a person’s condition require inpatient treatment, the staff at Warm Hearth at Home can step in to help transition a loved one from the hospital to home with ease and comfort. Warm Hearth provides Skilled Nursing, Rehabilitative Therapies, Home Health Aides, Care Management, Medication Management, Companion Care and Personal Care. Its nurses, therapists and aides provide dependable and quality care to help loved ones remain in their home and living as independently as possible. Attentiveness to aging loved ones and seeking professional advice early will aid in a timely diagnosis. Consistent mental stimulation and gentle reminders allow a dignified progression for those who continue to suffer. To learn more about Alzheimer’s awareness events in your community, visit www.alz.org/cwva.

Expert Contributor: hh hh

Tambra Dixon, Director of Marketing and Development, Warm Hearth Village Elaine Smith, Outreach Coordinator for Warm Hearth at Home

Sources: hh hh hh

www.nahc.org www.retire.org www.whvathome.org

SKILLED NURSING: licensed nurses providing curative, restorative and preventative care with an emphasis on teaching patients and family members how to take charge of a loved one’s condition and health. REHABILITATIVE THERAPIES: trained therapists who use a care plan to design a program especially for a patient’s recovery including: physical therapy, occupational therapy and speech therapy. HOME HEALTH AIDES: certified nursing aides who provide assistance with activities of daily living andsupport with prescribed exercise and mobility.

NON-MEDICAL SERVICES CARE MANAGEMENT: Registered Nurse assess patients’ needs and develop a customized plan of care to meet their goals. If needed, staff can arrange for services home to provide ongoing monitoring and assistance. MEDICATION MANAGEMENT: assurance of proper dosing, scheduling and safety of medications for optimal recovery and wellbeing. COMPANION CARE: assistance with household activities as well as providing transportation, meal preparation and housekeeping as needed. PERSONAL CARE: assistance with activities of daily living so patients can remain at home. SMART CARE EMERGENCY PENDANT CARE SENIOR CALLING SERVICE: CARE is an automated calling service that uses a computerized phone message to do well checks on seniors living in their own home.

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TIPS TO EAT SMART

DURING THE HOLIDAYS

Seasonal sweet treats and multi-course meals tempt even the most dedicated healthy eaters during the holidays. Thatâ&#x20AC;&#x2122;s why the American Heart Association (AHA) has designated November as Eat Smart Month. To receive nutrition tips and healthy recipes to help you eat smart during the holidays and year-round, visit www.heart.org/HealthyForGood or check out the New AHA Cookbook on www.ShopHeart.org.

Weight Gain is Often Highest During the Holiday Season We often rationalize poor eating habits over the holidays with the promise of correcting them with New Yearâ&#x20AC;&#x2122;s resolutions. However, holiday weight gain is the main contributor to annual weight gain, especially among those already struggling to achieve a healthy weight.

To help you stay on track with your nutritional goals during the holidays, consider these 5 tips from the AHA:

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MINI MIZE Practice moderation, not deprivation. Opt for a small plate, help yourself to a reduced portion or ask for a to-go box in advance and place half your order out of sight in the container before you begin eating your meal.

Itâ&#x20AC;&#x2122;s easy to over-indulge on snacks while in social settings such as holiday parties. To help resist temptation, eat a healthy snack or meal before heading out. High-fiber foods like avocados are smart options because they keep you full longer. Our Oat Avocado Berry Breakfast Bars found on page 89 make a great anytime snack at home or for on the go.

A recent study found that people who enjoy spicy foods appear to eat less salt and have lower blood pressure. Kick up the heat with our recipe for Spicy Oven-Roasted Chickpeas found on page 84.

It takes time for your stomach to signal your brain that youâ&#x20AC;&#x2122;re full. Slow your pace by setting down your fork between bites, taking frequent sips of water and pausing to talk with friends and family. Not only are bright colors donning shop windows during the holiday season, they are also at the supermarket and on the holiday buffet. From red apples and orange pumpkins to green pears, adding just one cup of fruits and vegetables a day is a significant step toward a more vibrant life. Consider adding a burst of color to your holiday spread with our Maple Glazed Sweet Potatoes recipe found on page 87. www.OurHealthRoanokeNRV.com

HOT CHICKS SPICY OVENROASTED CHICKPEAS

This Middle Eastern appetizer ecipe is best served right out of the oven when the chickpeas are at the height of their crispiness. They also make a great, fiber-friendly afternoon snack!

INGREDIENTS 2

(15.5-ounce) cans of no-saltadded chickpeas (garbanzo beans), drained and rinsed

Tbsp. canola oil

tsp. sodium-free chili powder

1/2

tsp. sweet paprika

1/4

tsp. garlic powder

1/4

tsp. salt

1/4

tsp. ground black pepper

1/8 tsp. ground cayenne pepper

NUTRITION FACTS

Calories: 192; Total Fat: 6 g; Saturated Fat: 0.4 g; Trans Fat: 0.0 g; Polyunsaturated Fat: 1.9 g; Monounsaturated Fat: 3.5 g; Cholesterol: 0mg; Sodium: 146 mg; Total Carbohydrate: 27 g; Dietary Fiber: 6 g; Sugars: 1 g; Protein: 8 g

DIRECTIONS

A Preheat oven to 425Â°F. B Line a large, rimmed baking sheet with foil. C Drain and rinse chickpeas; add to the baking sheet. Using a few paper towels, blot the chickpeas to remove excess liquid.

D In a small bowl, combine the oil and spices. Mix to combine. Pour oil over chickpeas; using a spatula or hands, mix together so all chickpeas are coated with the oil and spices.

E Roast chickpeas in the preheated oven until crispy, about 35 minutes, rotating and

shaking the pan halfway through the cooking process. Remove from oven and serve.

QUICK TIPS

COOKING TIP: Increase the amount of chili powder and cayenne pepper depending on your desired spice level. Note: the spiciness of chili powders vary, so make sure to taste before using.

KEEP IT HEALTHY: If no-salt-added chickpeas are unavailable, opt for those with reduced-sodium, making sure to drain and rinse well to remove any excess sodium.

TIP: Cannellini beans can also be used in this recipe in place of the chickpeas.

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Local health. Anywhere you go. OurHealth magazine is Southwest Virginiaâ&#x20AC;&#x2122;s only resource entirely dedicated to delivering information about local healthcare services and healthy living topics. Pick up our print edition at more than 900 locations throughout the area or get the digital edition by visiting

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MAPLE SYRUPGLAZED

SWEET POTATO CASSEROLE

Slash the calories of a classic dish and welcome a new holiday favorite. Whipping up egg whites and folding into the mashed sweet potatoes is an easy, healthy way to create lightness.

INGREDIENTS 1

40 oz. canned, chopped sweet potatoes in light syrup, drained

1 1/4 tsp. pumpkin pie spice (divided) 1/4

tsp. salt

tsp. vanilla extract

large egg whites

1/4

cup unsalted pumpkin seeds (also called pepitas)

Tbsp. olive oil

Tbsp. maple syrup

Tbsp. all-purpose flour

NUTRITION FACTS

Calories: 249; Total Fat: 5.5 g; Saturated Fat:0.9 g; Trans Fat: 0.0 g; Polyunsaturated Fat: 1.6 g; Monounsaturated Fat: 2.0 g; Cholesterol: 0 mg; Sodium: 176 mg; Total Carbohydrate: 46 g; Dietary Fiber: 5 g; Sugars: 13 g; Protein: 5 g

DIRECTIONS

A Preheat oven to 400°. B Drain the sweet potatoes and add them into a large bowl. Using a potato masher

or fork, mash well. (Alternatively, let kids help prepare the dish! Add drained sweet potatoes into a large zip-top bag, seal it, and let them use their hands to mash the sweet potatoes before transferring to a bowl.) Stir in 1 teaspoon of pumpkin pie spice with the ¼ teaspoon of salt and 1 teaspoon of vanilla extract.

C Add egg whites into the bowl of a stand mixer. Using a whisk attachment (or a

hand mixer, alternatively), whip the egg whites on high speed until firm peaks form, about 3 to 4 minutes. Use a spatula to gently fold egg whites into the sweet potato mixture.

D Coat a 1 ½-quart baking dish with cooking spray. Transfer the sweet potato mixture into the baking dish. In a small bowl, stir together pumpkin seeds, oil, maple syrup, flour, and remaining ¼ teaspoon pumpkin pie spice. Sprinkle over the sweet potatoes.

E Bake in preheated oven until sweet potatoes are fluffy and topping is golden-brown, about 20 to 25 minutes.

QUICK TIPS

TIP: Pumpkin pie spice is a combination of cinnamon, ginger, nutmeg, and allspice. A little shake adds a desserty sweetness and flavor into recipes like sweet potato casserole or pumpkin pie in place of sugar.

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OAT AVOCADO BERRY BREAKFAST BARS

This is the perfect breakfast bar for any busy morning. Make ahead and refrigerate to enjoy the next day or individually wrap and freeze them for a grab-and-go treat later in the week.

INGREDIENTS CRUST/TOPPING INGREDIENTS

Cooking spray

DIRECTIONS

A B.

Preheat oven to 350Â°F. Lightly spray a 13 x 9 x 2-inch baking pan with cooking spray.

Using a pastry blender or large fork, blend the mixture until it resembles pea-size crumbs.

Set aside one-half of the granola mixture. Press the other half into the baking pan to form a crust.

Bake the crust for 20 minutes, or until slightly browned. Transfer to a cooling rack. Let cool to room temperature.

Meanwhile, in a food processor, process the dates until smooth. Add the avocado, processing until smooth. Add the blueberries, orange zest, and cornstarch, processing until smooth.

Spoon the filling onto the cooled crust. Use a spatula to spread it. Sprinkle the reserved granola mixture over the filling. Bake for 15 minutes, or until the topping is slightly browned and the filling is set.

Transfer the baking pan to a cooling rack. Let cool. Cut into 15 bars.

1 3/4 cups low-fat, low sugar granola 1 1/2 cups whole-wheat flour 2

Tbsp firmly packed brown sugar

tsp ground cinnamon

1/4

tsp salt

1/2

cup fat-free sour cream

Tbsp canola oil

FILLING INGREDIENTS 1/2

cup pitted, coarsely chopped dates

1/2

cup avocado

cup frozen, unsweetened blueberries

Tbsp grated orange zest

tsp cornstarch

Put the granola in a food processor. Pulse three times to break apart the large pieces (it should look like rolled oats). Transfer the granola to a large bowl. Stir in the flour, brown sugar, cinnamon, and salt until combined. Add the sour cream and oil.

NUTRITION FACTS Calories: 152; Total Fat: 4.0 g; Saturated Fat:0.5 g; Trans Fat: 0.0 g; Polyunsaturated Fat: 1.0 g; Monounsaturated Fat: 2.3 g; Cholesterol: 1 mg; Sodium: 76 mg; Total Carbohydrate: 28 g; Dietary Fiber: 4 g; Sugars: 10 g; Protein: 4 g

QUICK TIPS

TIP: Store these bars in an airtight container in the refrigerator for up to two days or wrap them individually and freeze them for up to three months.

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Funny BONE HUMOR • SEARCH • CHECK

pot the Differences Can you spot the SEVEN differences between the two cartoons? Be the first reader to email us describing what the seven differences are and you will earn the satisfaction (and bragging rights) of having your name in print in the next edition. OK, START YOUR SEARCH! Email info@ourhealthvirginia.com with the subject line Funny Bone RoanokeNRV.

OURHEALTH ADVERTISER DIRECTORY 65 Alzheimer’s Association 37 American Heart Association 13 Anderson Audiology 6 Asthma & Allergy Center 29 Blacksburg Eye Associates 11 Blue 5 Restaurant 5 Blue Ridge Cancer Care 49 Carilion Clinic 52 Carrington Cottage Memory Care Center 72 Carrington Place of Botetourt 51 Center for Neurorehabilitation Services

78 Crowning Touch

39 Inspire MedSpa

40 Physicians to Women

67 Virginia Farm Bureau

64 Cundiff Heating & Air

52 Excel Prosthetics & Orthotics

72 Jefferson College of Health Sciences

19 Primary Solutions Physical Therapy

25 Virginia Prosthetics & Orthotics

30 Rader Funeral Home

46 Virginia Urology

80 Fork Union Military Academy

38 LewisGale Medical Center

51 Radford Health and Rehab Center

88 Virginia Veteran Care Center

35 Luckay Doc

15 Reproductive Medicine and Surgery Center of Virginia, PLC

92 Vistar Eye Center

2 Friendship Living

4 Interim Healthcare

59 Good Samaritan Hospice

19 Marks-Tiller Insurance

68 Harmony Senior Services

91 Medical Facilities of America

9 Heartland Home Health Care and Hospice

63 Mills and Shannon Dentistry

76 Hermitage of Roanoke 17 HomeTown Bank 15 Humana, Lynn Atkinson

75 New Beginnings Pediatrics 29 New River Periodontics 55 Our Lady of the Valley 41 Paul C. Kaiser, Ltd. Orthodontics

OurHealth | The Resource for Healthy Living in Roanoke and New River Valleys

88 Viva La Cupcake

85 Richfield Living

39 Ward Transitional Services

60 Roanoke County Parks and Recreation

79 Warm Hearth Village

80 Roanoke Valley Speech and Hearing Center, Inc. 45 Sunnyography 33 Susan G. Komen Virginia Blue Ridge 85 Total You Health 27 VCOM

67 YMCA of Virginia’s Blue Ridge