HEALTH APPS FOR YOUR SMARTPHONE
LOCAL ADVANCEMENTS IN HEART HEALTH
HIP REPLACEMENT and KNEE CARE
CLINICAL TRIALS CORNER
FEBRUARY • MARCH 2013 | LYNCHBURG AND SOUTHSIDE EDITION | OURHEALTHVIRGINIA.COM
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table of contents | february • march 2013
45
MEDI•CABU•LARY.....................10 Local experts define healthcare related terms
JUST ASK!..................................12
NUTRITION
A variety of health questions answered by local professionals
THE LATEST...............................14 A listing of new physicians, providers, locations and upcoming events in the greater Richmond community
HEALTH AND FITNESS ON THE GO..................................17 Health-focused apps you can download to your smartphone or tablet.
HEALTH AWARENESS................19
33
Best foods to incorporate into your weight loss diet
ORTHO SERIES Weighing the hip and knee factors
Good health: to keep it, protect it
29
HEALTH AWARENESS CLINICAL TRIALS CORNER.......51 Clinical trials: what are they, and are they for you?
SENIOR LIVING...........................55 Keeping meds in check: friendship retirement community reviews charts to consolidate, eliminate prescriptions
HEART HEALTH..........................35 New heart procedures giving life
KIDS CARE..................................35 Peter W. Houck, MD, pioneer in neonatal care
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our health | MEDI•CABU•LARY & JUST ASK
me d i • ca bu • l ar y
T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D
What is a blade leg? “Blade leg” is a generic term given to the family of lower extremity prosthetic devices designed specifically for running. Made of carbon fiber, their shape somewhat resembles a “blade.” They gained widespread recognition when worn by Oscar Pistorius, the bi-lateral amputee who became famous first as a Paralympics champion and then as a competitor in the 2012 Summer Olympics. Fans called him the “Blade Runner.” Virginia Prosthetics has significant experience working with sportsspecific prosthetic devices and currently sponsors Peter Tainer, a young runner from Botetourt County. He runs on two “blade legs” and hopes to make the Paralympics Team for the Rio 2016 Games after narrowly missing the final cut for last year’s Paralympics team. Charles Coulter, CPA (Certified Prosthetic Assistant) Virginia Prosthetics, Inc. Roanoke | 540.366.8287
What is glare; how does it affect my night driving and computer use? Glare is defined as a visual condition in which the observer feels either discomfort and/ or exhibits a lower visual performance in certain light conditions. It can come from a bright source such as the sun or from a car’s headlights. Sunglasses especially polarized lenses greatly reduce glare from the sun or water’s surface. Glare may also result from light reflected off of a wet road, the surface of an eyeglass lens, or a computer monitor. Glare can be a significantly annoying problem for night driving and computer use. If a person has a refractive error such as nearsighted, farsightedness or astigmatism, wearing glasses or contact lens can improve the quality of vision and reduce glare. In addition a “No Glare” lens material such as CRIZAL or CRIZAL ALIZE’ can reduce a glare by making an eyeglass lens less reflective and therefore allowing more “Good” light to pass through to the eye. Certain conditions such as Cataracts, Macular Degeneration, and scratched eyeglass lenses create more glare. Gary H. St. Clair, OD St Clair Eye Care Lynchburg | 434.239.2800
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What Is Diastolic Heart Failure? Heart failure can be classified as systolic or diastolic. Systolic heart failure occurs when the main pumping chamber (left ventricle) is weak. If the heart cannot pump blood forward effectively, fluid can back up in the lungs causing symptoms of congestive heart failure (CHF). Common causes of systolic heart failure include previous heart attacks and viruses that attack the heart. Diastolic heart failure occurs when the main pumping chamber squeezes normally but is unable to relax normally. The abnormal relaxation allows fluid to back up in the lungs causing heart failure symptoms including shortness of breath and leg swelling. Common causes of diastolic heart failure include advanced age, high blood pressure and diabetes. Diastolic heart failure is more common in women. The treatment for diastolic heart failure includes medications to lower blood pressure, improve heart relaxation and increase fluid output. James Warner, Jr., MD The Cardiovascular Group Lynchburg | 434.200.5252
our health | MEDI•CABU•LARY & JUST ASK
ju st a sk!
T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D
Why is good posture important for my overall health? There are many reasons good posture is important for good health. Good postural alignment allows plenty of room in our torso for full capacity breathing which promotes good tissue health throughout the body. It also insures appropriate space and circulation for our vital organs. Good neck and upper back posture promotes shoulder health via ideal shoulder alignment allowing for full mobility and use of the arms for everyday activities. Good postural alignment promotes bone health by reducing stress on spinal bones and discs thereby reducing bone deformity and fracture incidence. Good standing posture/alignment improves balance which is important in reducing incidence of falls. Beth Scott, PT, DPT, GCFP Orthopaedic Center of Central Virginia Lynchburg | 434.485.8500
What is the new dependant age limit mandate under healthcare reform? The dependant age limit mandate is a key provision of the Patient Protection and Affordable Care Act (PPACA) that became effective for plan renewals beginning on or after September 23, 2010. It states that all healthcare insurance plans providing dependent coverage are required to extend that coverage to adult children — both married and unmarried — up to age 26. As of January 2014, the grandfathered restriction to the rule that now applies will be dropped. Along with additional reforms, the primary goal of the revised dependant age limit rule is aimed at decreasing the number of uninsured Americans while improving healthcare outcomes. As a committed healthcare insurance carrier, Piedmont Community Health Plan complies with all federal health care reform initiatives as they become lawful in the state of Virginia. Steve Morton, Product Development Specialist Piedmont Community Health Plan Lynchburg | 434.947.4463
Is an aspirin a day a good habit to start, and if so, when should I start it? Summarizing the U.S. Preventive Service Task Force guidelines: For men age 45 to 79 years whose benefit due to a reduction in myocardial infarctions exceeds the harm because of an increase in gastrointestinal bleeding, there is high certainty that the net benefit is substantial. For women age 55 to 79 years whose benefit due to a reduction in ischemic stroke exceeds the harm because of gastrointestinal bleeding, there is high certainty that the net benefit is substantial. For men and women 80 years or older, the evidence is insufficient to assess the balance of benefits and harms. For men 44 years or younger and women 54 years or younger, the potential benefits of reducing myocardial infarction in men or ischemic stroke in women are small, and there is moderate certainty that the benefits do not outweigh harms. To assess the risk of myocardial infarction and gastrointestinal bleeding for men age 45-79, and women age 55-79, a detailed history and risk assessment must be done by a Health Care Provider, because each case is special. Shawn Hayes, MD Lynchburg Internal Medicine Lynchburg | 434.200.3908
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What are the different types of braces that are used in orthodontics? There are basically 3 different types of braces that are used in orthodontics. The most common are metal braces that utilize very small brackets which are made of surgical grade steel. These are bonded to the outer surfaces of the teeth and are connected by a very thin wire which passes from tooth to tooth and is held in place with tiny elastic rings. The second type is ceramic or clear braces. These work similarly to the metal bracket systems, however, the brackets which are bonded to the tooth are much less noticeable since they are clear. Adults often choose this type of bracket. The third type of braces do not utilize a bracket system, but instead us a series of clear plastic aligners which gradually align the teeth. These aligners must be worn continuously for a specified period of time until the teeth are straight. Although they are less noticeable than traditional braces, there are limitations to the type of problems these aligners can correct. Bruce Bentley, DDS Central Virginia Orthodontics Lynchburg | 434.385.GRIN (4746)
our health | THE LATEST
the l atest
N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S
Centra Cancer Care Services has earned a threeyear full accreditation with commendation as a comprehensive community cancer program from the Commission on Cancer of the American College of Surgeons. Only 25 percent of cancer care programs in the United States receive this recognition. The Commission on Cancer accreditation recognizes the quality of comprehensive cancer care available at a facility and means that patients have access to the full scope of services required to diagnose, treat, rehabilitate and support patients with cancer and their families. “Accreditation by the American College of Surgeons Commission on Cancer validates the hard work that so many dedicated people do every day,” said Matthew Foster, M.D., associate medical director, Cancer Care Services. “It is always nice to be recognized as a top comprehensive community cancer center by an organization that counts 1,500 cancer centers in their membership across the United States. We believe true validation of our efforts is in the experience we can bring to the bedside or examination room when we care for the patients we serve every day.” Only facilities that have voluntarily committed to provide the best in diagnosis and treatment of cancers receive approval from the Commission on Cancer. A rigorous evaluation process and performance review by the commission is necessary every three years to achieve and maintain accreditation. For cancer patients and their families, Centra’s approved cancer program means: • Quality care close to home • Comprehensive care offering a range of state-of-the-art services and equipment • A multidisciplinary, team approach to coordinate the best treatment options available to cancer patients • Access to cancer-related information, education and support • A cancer registry that collects data on type and stage of cancers and treatment results and offers lifelong patient follow-up
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• Ongoing monitoring and improvement of care • Information about ongoing clinical trials and new treatment options “When a member of our community receives a diagnosis of cancer, they want to know that the procedures and treatments they will undergo will offer them the best possible outcome,” said Curt Baker, R.N., M.B.A., vice president, Cancer Care Services. “The American College of Surgeons, Commission on Cancer has developed comprehensive quality standards that ensure cancer programs are adhering to up-to-date protocols from diagnosis through survivorship. The process of achieving accreditation requires rigorous attention to detail in every aspect of the patient’s cancer journey and a commitment to the continuous quality improvement of the program. We are pleased to announce that Centra’s cancer program has received a three-year full accreditation with commendation.” From the latest cancer-fighting technology to new state-of-the-art facilities and services, Centra offers cancer care for patients and their families throughout central Virginia. Centra’s comprehensive cancer services and treatments range from the newest da Vinci Surgical System and Trilogy linear accelerator to chemotherapy, biological and targeted drug therapies to genetic testing and clinical trials. Centra treats a broad range of cancers, including lung, prostate, breast, brain, kidney, bladder, ovarian, lymphoma, leukemia, colon, uterine and rectal cancers as well as many others. In 2008, Centra opened the Alan B. Pearson Regional Cancer Center, which brought radiation and medical oncology into one facility for patient convenience. Centra is one of approximately 1,500 Commission on Cancer approved cancer programs in the United States and Puerto Rico, representing close to one-quarter of all hospitals. “By coming to an approved cancer treatment program,” stated the Commission on Cancer, “you can be sure that you will receive the best in diagnosis and treatment of cancer and that full consultative services will be available from all medical disciplines involved in diagnosing and treating cancer. And you can be sure that your condition will be watched carefully through a lifelong program of follow-up care.” Centra also is the first healthcare system in the country to earn national STAR Program Certification for offering rehabilitation care for cancer survivors. In addition, Centra’s comprehensive breast cancer program has recently earned a top national accreditation by The National Accreditation Program for Breast Centers.
THE LATEST | our health
April • May 2013 features include:
New Year Resolution: Be Tobacco Free: Tobacco is the single greatest cause of disease and premature death in the United States and is responsible for more than 440,000 deaths annually. Approximately 23 percent of Americans smoke, and 3,000 adolescents become new smokers each day. More than 70 percent of smokers say they would like to quit, and there are more reasons than ever to do so.
Many people make New Year’s resolutions. If your New Year’s resolution is to stop smoking or using other tobacco products, Centra offers help! The Be Tobacco Free Program is offered by Centra to help you quit smoking. These classes promote behavioral change and education. The Be Tobacco Free Program is available by calling 434.200.3812.
Tobacco use is associated with many cancers, respiratory diseases, and cardiovascular disease. However, these risks start decreasing immediately after quitting. Twenty minutes after quitting, heart rate drops. One year after quitting, the added risk of coronary heart disease is half that of a smoker’s. Five to 10 years after quitting, the risk of stroke is reduced to that of a non-smoker. Ten years after quitting, lung cancer rate is about half that of a smoker’s. The immediate results of quitting are more obvious. People breathe better, smell better and save money.
Virginia has a free quit line offered to all residents. It can be accessed toll free at 1.800.QUIT.NOW. The website address, www.smokefreevirginia.org is also a resource developed by the government. Other websites include: www.lungusa.org and www.cancer.org. Those between the ages of 55 and 74, with no history of cancer (except non-melanoma skin cancer), with a 30 pack year history (1 pack per day for 30 years, or 2 packs per day for 15 years) call Central Virginia Imaging, 434.237.4091, for more information about lung cancer screening.
Showcasing healthcare organizations in Lynchburg and Southside Virginia committed to providing a superior workplace environment physical
and
occupational therapy
blood donation
services and
more!
Contact Cindy Trujillo at 434.907.5255 or at cindy@ourhealthvirginia.com for more information
Generation Solutions Dr. Gene Erb, President of Generation Solutions, has announced his retirement effective December 28, 2012. The role will be transitioned to P. Tulane Patterson, Owner and CEO of Generation Solutions. Dr. Erb has served Generation Solutions in this capacity for 3-1/2 years, and he will remain on staff as a consultant.
Dr. Gene Erb
P. Tulane Patterson
“Gene Erb has been instrumental part of our Executive Team,” said Tulane Patterson. “I am proud to have had him serve alongside of me and our wonderful staff in the work and ministry of caring for seniors. Over his tenure, Gene has made us a better company, and we are thankful for his service.” The Board of Directors of Generation Solutions expresses their sincere appreciation to Dr. Erb for his years of dedication, service, and leadership.
Mr. Darryl Williams, previously the Executive Director of the Roanoke office, has been promoted to Executive Vice President and will assume the responsibility of the Roanoke Office and the Lynchburg Personal Care Office, effective December 28, 2012. “Darryl is a rising star in the healthcare community,” said Tulane Patterson. “We are pleased and fortunate to have him continue as part of the Generation Solutions family.”
Darryl Williams
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our health | THE LATEST
the l atest
N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S
Appalachian Orthodontics of Lynchburg offers latest technology in orthodontics Appalachian Orthodontics of Lynchburg now offers a digital impression system that captures 3-D images of a patient’s mouth in place of using uncomfortable and messy tray and putty impressions. The system works by taking digital impressions using an iOC scanner, powered by iTero technology. The scanner digitally captures the contours of a patient’s teeth, providing an accurate, goop-free digital orthodontic scan within minutes. Appalachian Orthodontics says this new technology offers a more precise scan and it eliminates exposure to radiation during the procedure. For more information, call 434.515.0370 or visit www.lynchburgorthodontics.com
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HEALTH AND FITNESS ON THE GO | our health
Health and Fitness
On the Go
Want a quick analysis of which foods are the healthiest when you’re grocery shopping or to find out if it may be time to get your eyes tested? In our new Health and Fitness on the Go section, we recommend a variety of health-focused apps you can download to your smartphone or tablet.
Fooducate – Healthy Food Diet Scan and choose healthy groceries. Over 200,000 unique UPCs! Instead of trying to decode nutrition fact labels and ingredient lists, use this app to: »» Automatically scan a product barcode »» See product highlights (both good & bad) »» Select better alternatives Fooducate analyzes information found in each product’s nutrition panel and ingredient list. You get to see the stuff manufacturers don’t want you to notice, such as: »» excessive sugar & high fructose corn syrup »» tricky trans fats »» additives and preservatives
»» controversial food colorings »» confusing serving sizes and calories per serving
(Fooducate is NOT funded or influenced by food manufacturers, supplement companies, diets, or diet pills.) »» Cost: Free for both devices »» Device: Android and iPhone
SHARE YOUR FAVORITE HEALTH AND FITNESS APP!
Scan this QR code with your smartphone or tablet to visit and “Like” Our Health’s Facebook page, then post a “Comment” with your favorite health and fitness APP!
Android
iPhone
Vision Test for iPhone and B2 Eye Test for Android Having difficulty reading the newspaper or text on your computer screen? Having problems seeing road signs? Do an instant eye exam with these apps. Just follow a few simple and easy steps to check for a number of possible vision defects. These apps offer the following vision tests: »» »» »» »» »» »»
Visual Acuity Test »» Astigmatism Test »» Duochrome Test »» Color Test »» Cost: Android Free; iPhone $.99 Device: Android and iPhone
Far Field Vision Test Optician Finder Eye Quiz Eye Advice and Facts
Android
iPhone
Do not consider the tests in these apps official tests. These tests are only meant to give you an idea of whether or not you should see an eye doctor or go on an eye therapy. Having regular eye examinations promotes eye health. www.ourhealthvirginia.com | 17
our health | HEALTH AND FITNESS ON THE GO
Instant Heart Rate Instant Heart Rate is a heart rate monitor app for any smartphone, and it does not need any external hardware. Use it for optimizing your exercise routine and to track your progress. Keep your heart rate in check before, during, and after your fitness regime. »» Cost: Free »» Device: Android and iPhone Android
iPhone
Stress Check App Stress Check quantifies your level of mental or physical stress. By measuring your heart rate through the camera and light features on your Android/iPhone, Stress Check estimates your level of stress in real time. With the Stress Check App, you can: »» »» »» »» »» »»
Quantify your level of stress Determine the effects of different stressors Control stress and observe progress Reduce your chances of certain chronic diseases known to be correlated with stress Cost: Android Free; iPhone $1.99 Device: Android and iPhone Android
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iPhone
HEALTH AWARENESS | our health
GOOD HEALTH
to keep it, protect it words | RICH ELLIS
Improve mobility and motion no matter what area of the bo dy ails you. Neck, shoulder, back, knee , - physical therapist s have an established history of helping individuals improve th eir quality of life. - Harrison Hunt, PT , DPT Rehabilitation A sso ciates of Central Virginia
Good health. Everyone wants it and believes they’ll always have it, until they don’t. Health is often taken for granted, with its importance not truly being appreciated or realized until illness strikes and prevents an individual from doing the things they love and living the life they’re accustomed to living. Whether it’s due to a short-term illness, such as a cold or flu, or a debilitating disease, people want to get better, and thanks to continued advancements in medical care and technology, many do. Therein lies a common obstacle to staying well – focusing on treatment rather than prevention. “An ounce of prevention is worth a pound of cure.” There’s significant truth in that old adage. It’s much easier, more comfortable, and less expensive to keep a body well than it is to try to cure one that’s not. The search for lifelong wellness shouldn’t focus solely on a medicine or procedure, but rather on preventing illness in the first place – a philosophy that the vast majority of medical professionals agree with. www.ourhealthvirginia.com | 19
our health | HEALTH AWARENESS
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HEALTH AWARENESS | our health
The basic rules for staying well, particularly during cold and flu season, are wellknown – wash hands, stay home when sick, don’t associate with sick people, cover the mouth and nose when sneezing, and keep hands away from the face. A true, lifelong path to staying well, however, begins with a frank, honest selfassessment of one’s health, lifestyle choices and habits, and it’s a path that can’t be started down until the path of self-destructive behavior is removed. Whether they realize it or not, many people engage in behaviors that threaten good health, with some of the chief culprits being lack of exercise, a bad diet, neglected medical care, poor sleep habits, and risky behavior. Change the self-destructive behaviors and health changes too.
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Exercise Bodies are designed to move. Regular exercise is an important, proactive step toward protecting one’s health. Exercise strengthens the mind, body, and immune system and can help prevent diseases, such as diabetes or heart disease. Too often, people mistakenly think they don’t have time for exercise and understandably so in our highly scheduled society. At first glance, the Centers for Disease Control’s (CDC) recommendations for adults to perform moderate-intensity aerobic exercise for two-and-a-half hours per week might seem like a lot to try and fit into an already jam-packed schedule. Spread those 150 minutes of exercise over four days, however, and suddenly it doesn’t seem so daunting. When it comes to managing schedules, making time for wellness should be at the top of the list.
www.ourhealthvirginia.com | 21
our health | HEALTH AWARENESS
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The CDC defines moderate exercise as anything that gets the body working hard enough to increase the heart rate and break a sweat, including brisk walking, biking or even pushing a lawn mower. In addition to the recommended 150 minutes of moderate exercise, the CDC also recommends two days per week of musclestrengthening activity, such as lifting weights, doing pushups and sit-ups, or heavy gardening involving raking and shoveling. For those looking to cut their exercise time commitment in half but still realize the health benefits, the CDC recommends performing vigorous aerobic exercise, defined as “breathing hard and fast….with the heart rate having gone up quite a bit,” for just 75 minutes per week, in addition to the previously mentioned strength training. Some forms of vigorous exercise include running, fast biking, and playing singles tennis or basketball. For children ages 6 to 17, the CDC recommends even more aerobic exercise with a minimum of 60 minutes of physical activity per day. Establishing physical activity as a habit early in life can help prevent the growing trend of childhood obesity and lay the foundation for healthy living later in life.
Diet While exercise can have a significant impact in preventing obesity in both adults and children, it’s not the only factor. Diet is the other half of that equation. When it’s a balanced diet, the positive health effects are powerful, and when it’s a poor diet, the results can be deadly. The United States Department of Agriculture (USDA) issues dietary guidelines periodically and recently replaced its well-known but often confusing “food pyramid” with a plate (www.choosemyplate.gov). The main, health-protecting, nutritional messages the USDA wants consumers to take from the new plate-based guidelines include the following: - continued on page 25
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our health | HEALTH AWARENESS
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CLINICAL TRIALS CORNER | our health
• Balance calories by eating less and avoiding oversized portions • Dedicate half the plate at mealtime to fruits and vegetables • Ensure that 50 percent of the grain consumed is whole grain • Switch to skim or one percent milk • Check sodium levels and reduce foods that have high levels • Drink water instead of sugary drinks It’s also important to focus on consuming foods that are lower in fat and added sugar and to balance the amount of calories being consumed with the calories being burned through activity and exercise. Too many calories taken in with not enough calories going out leads to weight gain, which can be the beginning of a slippery slope to becoming overweight or obese, the difference being that the CDC defines “overweight” as having a body mass index (BMI) of 25 or higher and “obese” as a BMI of 30 or more. Regardless, the effects of being either are incredibly detrimental to good health. According to the Centers for Disease Control at www.cdc.gov, both conditions can significantly increase risks for “coronary heart disease, type 2 diabetes, cancers, high blood pressure, stroke, liver and gallbladder disease, sleep apnea, and a variety of other healthrelated problems. In addition to lack of exercise and a poor diet, lack of sleep or poor quality sleep can also cause weight gain because sleep affects hormones that control appetite.
Get to Sleep A good diet and exercise alone aren’t enough to strengthen and protect good www.ourhealthvirginia.com | 25
our health | HEALTH AWARENESS
health if sleep, and good quality sleep, are missing from the equation. Too little sleep, as well as too much sleep, affects cognitive thinking, weight gain, mental attitude, the body’s ability to resist disease, and a host of other functions. The National Sleep Foundation recommends that adults get seven to nine hours of sleep, children ages five to 17 should get 10 to 11 hours, and newborns 12 to 18 hours. Based on a recent CDC study, American workers aren’t getting anywhere near enough sleep, with more than 40 million reporting six or less hours of sleep per night. Lack of sleep has been shown to lead to an increased risk for heart disease and cancer, in addition to the risks that come with driving or operating machinery while drowsy. Whether it’s because of the sleep environment, behaviors, or medical problems, such as sleep apnea, factors that prevent someone from getting the sleep they need can often be resolved. The National Sleep Foundation provides some of the following tips to help fall asleep and stay asleep: “establish consistent sleep and wake schedules, even on weekends; create a regular, relaxing bedtime routine such as soaking in a hot bath or listening to soothing music an hour or more before the time you expect to fall asleep; create a sleepconducive environment that is dark, quiet, comfortable and cool; sleep on a comfortable mattress and pillows; avoid caffeine and alcohol close to bedtime; and exercise regularly.”
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HEALTH AWARENESS | our health
If sleep quality, as opposed to the amount of hours spent
regular testing to both prevent disease and detect it early,
sleeping, is the problem, a sleep study performed at a
thereby improving the chances for a cure.
recognized sleep center might be a recommended course of action to discuss with a physician as it can help determine if there are underlying medical conditions interfering with sleep.
There are a number of preventive medical tests that should be part of any proactive health plan, many of which depend on age, sex, and family health history. Because of these variables,
Even if there isn’t any reason to suspect that underlying
a personal physician is often the best guide and most trusted
medical conditions are impacting sleep, it’s important to
source for information when it comes to determining when and
establish and maintain a relationship with one’s healthcare
how often routine testing should occur, including cholesterol
provider in order to stay healthy.
and blood pressure screenings, mammograms, colonoscopies,
Know Your Physician and Family Health History
or pap smears.
Much like a vehicle needs periodic maintenance, so too does
can be corrected if caught early – before they lead to more
the body in order to run well and long. That maintenance
serious, life-threatening health issues. And, just as knowing
schedule begins early in life with childhood immunizations
what conditions are happening within the body, it’s also
that protect against deadly and crippling diseases and
critically important to know your ancestors’ health histories
continues throughout life with immunization boosters and
and the conditions and diseases they may have suffered from.
A variety of symptomless conditions, such as high cholesterol,
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lthy is a e h t r a He healthy. r e t a t s o r p u do fo o y g in h ur Anyt it of yo efit f e n e b e en th l also b il w t r a e h state. your pro icks, MD H r e h p o Christ logic Surgery Uro our health | HEALTH AWARENESS
Genetics and lifestyle choices play equally large roles in determining health, but while genetics can’t be changed, lifestyle choices can.
Don’t Be a Risk Taker Taking risks that could ultimately lead to negative health consequences is a losing proposition. Tobacco usage, excessive alcohol consumption, not wearing a seat belt, not using sunscreen, and having unprotected sex are just a few behaviors that put good health and longevity at risk. Coupled with other lifestyle choices that can have
Children’s chole sterol should be scre ened two times before they reach adulthood be cause by adole scence, their precur sors have alread y be en established . Mark Townsend, MD, The Cardiovascular Gro up
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significant health implications, such as exercise and diet, these risky behaviors can result in the loss of health – probably not today or even tomorrow, but down the road, when good health is needed more than ever. For many people, good health is an option and a choice, but it’s one that can only be realized through a dedicated commitment to making the right choices, starting early in life and continuing through the years.
HEALTH AWARENESS | our health
SHAKE YOUR BODY words | SARAH COX
Get in five servings of fruits and veggies a day, 30 minutes of exercise, lots of water and plenty of sleep. Katherine Nichols, MD F. Read Hopkins Pediatric Associates
Take the Les Mills Body Pump class two to three times a week for two months and you will see positive changes in your body. So says David Gillespie, Manager of the Lynchburg Kinetix Health Club, who explains that the advantage of this class is that one has an instructor, music, and choreography for a full-body workout. “It’s kind of like having your own personal trainer doing the counts, in a group setting, and the hour flies by,” he says. “It’s shaping and toning to the max, but you don’t get big muscles with it.” According to Les Mills, lifting in a one-hour session, you do over 800 repetitions. Gillespie says that those who want to get fit and stay with a fitness program should not do the same old thing, again and again, but change it up. If you do drag yourself into the gym and haul up onto a cardio machine, it gets boring, and you get discouraged and stay at home. The Kinetix Health Club offers over 40 aerobic classes each week and has circuit training, cardio machines with plasma televisions, a separate cycle room, and 4,000 square feet of functional training. This type of training involves huge ropes that have to be flipped, tires that one can hit with a sledgehammer, and jump rope stations – the perfect thing after a stressful day. In lieu of taking classes, Gillespie suggests getting a workout partner who can keep you motivated. Talking and walking the track or running on the treadmill is much more enjoyable because it becomes sociable. Additionally, Gillespie says his health club has some of the best personal trainers he’s ever had in the industry – and he’s been involved in fitness since 1978. “I’m a firm believer that so many fail because they think they can do eight reps, or a certain number of every machine and get great results, but they won’t last. It should be a combination of resistance and cardio,” he says. He thinks people spend too much time on cardio. One way to reduce the time but increase www.ourhealthvirginia.com | 29
our health | HEALTH AWARENESS
the effect is to take an interval approach – do one minute on a cardio machine at a regular pace, then one minute at an accelerated pace, and maintain this pattern for 20 minutes. “You will burn more this way than the regular 30 minutes of cardio,” he notes. Gillespie also suggests mixing up Body Pump classes with yoga, Pilates or Zumba. “These will keep the body more flexible, and we all need that. With Zumba, you are doing a movement class that’s lots of fun. All different ages are in this class, people of all shapes and sizes, and the classes are designed to be fun. We have people that are not the most coordinated, but they have a blast.” Over at the Jamerson YMCA, Fitness Director Jeff Kuhland says that the number one biggest mistake people make when starting a fitness plan is not planning. “Everyone tends to set high goals for themselves, without a lot of thought,” he says. Fitness plans deserve goal setting and consideration – after all, one is making major changes, not only to one’s schedule, but to the body as well. Kuhland notes that when fitness instructors sit down with clients, most respond automatically that they want to lose weight and get fit. But why? It’s important to get to the root of the desire so that goals that are achievable and measurable can be established. Goals that you can see results of are important to avoid discouragement. You might consider starting out slowly and building up from there. Another factor is accountability. Either get a personal trainer who can hold you to your commitment, or tell family and friends. Most importantly, have fun – and that’s where classes or fitness partners come into play. “People like to work together – or at least commiserate!” Kuhland says. “Not every day in the gym is fun, and even people who do this as a career have tough days, but you do it because you have to do it.”
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SENIOR LIVING | our health
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our health | SPECIALIZED SERVICES FOCUS
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SPECIALIZED SERVICES FOCUS | our health
THE ORTHO SERIES In this two-part series we take a look at local joint replacement and treatment options. Look for our second part in the March/April 2013 edition of Our Health.
WEIGHING THE HIP AND KNEE FACTORS words | SARAH COX
Over 60 million Americans suffer from osteoarthritis, and that number grows as their weight does. According to Michael Diminick, MD, an orthopaedic surgeon with the Orthopaedic Center of Central Virginia, this number is not surprising. Obesity, he says, substantially increases the incidence of osteoarthritis. One cannot prevent this common joint disorder, which comes with aging as well as wear and tear on the joints, but weight exacerbates the situation. “Body weight is multiplied by four for weight bearing,” explains Dr. Diminick, “so if you gain 10 pounds, there will be 40 more pounds of weight with every step you take.” And this, he notes, is a modifiable factor.
Good News for Hips The good news is that there are new techniques that are helping with hip replacements, once an operation that kept a patient in the hospital a lot longer than is now necessary with the anterior, or front, approach. Dr. Diminick has been operating in this way for a little over a year, and while it’s a demanding procedure, technically, it has its advantages. There is less tissue damage than taking the posterior approach, less dissection of muscles and tissues, and ultimately, he says, his patients can recover more quickly. “It’s a quicker rehab. In some cases, patients are off their walkers and canes more quickly. And I like it because I am really able to see during surgery and I can take x-rays more easily, so I can better position the components,” he explains. www.ourhealthvirginia.com | 33
our health | SPECIALIZED SERVICES FOCUS
Additionally, there is now a ceramic ball replacement that, in the laboratory, has shown greater longevity over the metal ball for the hip joint. While this ceramic ball is not for everyone, Dr. Diminick says that it is a good option for a younger person who will need a hip joint to last longer than 15 years.
incidence of knee injuries when we are young and some due to wear and tear that comes with age. While the same material is being used – a polyethylene compound that continues to be refined for longevity – the technique of knee surgery is the more important advancement.
Healthy Knees
Dr. Diminick explains that computer navigation used during surgery, much like a GPS, helps the surgeon line up the cuts and the implants “to get them as close to perfect as we can. The whole challenge of this surgery is to have a knee that is well balanced with good stability and good range of motion, and the way to do that is to place implants in an optimal position.”
Knees suffer as much from obesity as hips do – perhaps more so, as Dr. Diminick notes that there are three knee surgeries to every two hip surgeries. Some of this comes from the higher
There are also customized implants, formed by using computers in the preoperative planning stage. However, according to Dr. Diminick, this is costlier and involves an MRI or a CAT scan weeks before surgery. After surgery, what was once a threeweek bed rest that could result in blood clots, bedsores or pneumonia has now improved dramatically. Patients are up and walking the day of surgery, and instead of high doses of narcotics to help alleviate the pain, surgeons are using a multi-model anesthetic approach that involves different medications working in different ways and improving pain management. This way, therapy starts immediately and patients can go home two days after surgery. While watching your weight is the number one preventative measure in both knee and hip troubles, Dr. Diminick also suggests that over-the-counter supplements such as glucosamine and chondroitin sometimes help, although claims that these help rebuild cartilage are unsubstantiated.
Michael Diminick, MD orthopaedic surgeon with the Orthopaedic Center of Central Virginia
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HEART HEALTH | our health
This is a reconstructed 3D image of the left atrium from a CT scan used to guide ablation for atrial fibrillation. The colors displayed reflect differing electrical wave fronts while the green dots represent the sites of ablation. The goal is encircling of the pulmonary veins to eliminate all electrical connections. (LSPV-left superior pulmonary vein, LIPV-left inferior pulmonary vein, RSPV-right superior pulmonary vein, RIPVright inferior pulmonary vein
NEW HEART PROCEDURES
GIVING LIFE According to the Mayo Clinic Health Information website, atrial fibrillation is “an irregular and often rapid heart rate that commonly causes poor blood flow to the body.” Although this condition isn’t usually life threatening, it can be serious, and some of the symptoms include shortness of breath and weakness. Matthew Sackett, MD, Director of Cardiac Electrophysiology Services at Centra Health’s Stroobants Heart Center in Lynchburg, says it is the most common irregular heart rhythm that they treat and that up to 15 percent of the population experiences this by the time they reach 80. Another symptom it can lead to is chest pain, and it can also put people at risk for strokes. “Blood doesn’t pump quickly and can pool and clot, and that’s what causes a fair number of big strokes,” Dr. Sackett explains. But this, he says, is also one of the most common preventable forms of strokes. There are a number of approaches that have been successful in treating atrial fibrillation. One of them is new medication. For 30 years, the go-to drug has been Coumadin, but as Dr. Sackett puts it, “It’s a bit of a hassle.” Specifically, it’s not a one-size-fits-all drug; patients have to
words | SARAH COX
be constantly monitored, and the dosage changes frequently based on whether their blood is thin enough or too thin, as well as taking into consideration their diet and whether they are on other medications. In the last few years, however, three drugs have been approved – some very recently – that take a different approach to thinning blood (and thus helping to prevent clots). The benefit of these new drugs is that they don’t have variations in dosage and they don’t require constant monitoring and testing. The first is Pradaxa, which Dr. Sackett says has resulted in 25 to 30 percent fewer strokes than in patients on Coumadin. “One of the biggest things is a lower risk of neurologic or intracranial bleeding, compared to Coumadin,” explains Dr. Sackett. However, the downside of these new drugs is that, as opposed to Coumadin, the blood thinning can’t be entirely reversed, which is a concern with patients at a higher risk for bleeding. A second new drug is Xarelto, which is shown to be as good as Coumadin in reducing strokes, but not superior; however, the www.ourhealthvirginia.com | 35
our health | HEART HEALTH
benefit is that it is taken once a day, whereas Pradaxa is taken twice a day, and the blood thinning can be partially reversed. There are two doses available with Xarelto – a higher one and a lower one – so it can be tailored to those who are at risk for bleeding. A third drug, Apixaban, has just been approved by the FDA. This, too, is taken twice a day and is safer for those with kidney disease. “The nice thing is that we have three different drugs, with three different sets of side effects, so if someone doesn’t tolerate one, we can use another,” states Dr. Sackett. Another way to approach care of atrial fibrillation is through radiofrequency ablation. The Mayo Clinic calls this “high-frequency electrical energy delivered through [a] needle.” Dr. Sackett explains that in the left atrium of the heart, there is an “outpouching” in the atrial appendage, “kind of like the appendix of the heart. It used to be called the oracle, and in atrial fibrillation, this is where the blood clot forms. If you could remove it, you wouldn’t form nearly as many clots.” One way to take this appendage out of the equation is to block off the opening. During open-heart surgeries, heart surgeons will often remove it, but now there are non-surgical ways to remove or fill it. One method that Dr. Sackett is looking into is a way of delivering a catheter that plugs up this appendage to block off the opening. He says it is a mechanical device of metal and fabric that is delivered to expand and fill up the space. “It was approved last year and has been more widely used within the last six months,” he says. While he is not currently doing this procedure, he says it will make its way to his market within the next year. Dr. Sackett currently uses radio frequency to burn away areas of abnormal signal that trigger atrial fibrillation. “When we do an ablation, we are burning to create scar tissue to block the electrical signals that trigger the atrial fibrillation.” The success rate for one procedure is upwards of 70 percent after one year for normal rhythms that require no drugs. By comparison, the medicine success rate is not as good. This procedure can be done without general anesthesia, and there is no cutting involved.
Matthew Sackett, MD, Director of Cardiac Electrophysiology Services at Centra Health’s Stroobants Heart Center in Lynchburg
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HEART HEALTH | our health
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our health | HEART HEALTH
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OUR COMMUNITY CARES | our health
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our health | KIDS’ CARE
Peterpioneer W. Houck, MD in neonatal care words | RICK PIESTER
The neonatal intensive care unit (NICU) at Centra Virginia Baptist Hospital now bears the name of Peter W. Houck, MD, the well-known physician/historian/author/ publisher who has devoted his career of nearly a half-century to the health of young people, with a special lifelong interest in the care of premature and other at-risk babies. It’s a fitting tribute: the Lynchburg physician was at the center of creating neonatal intensive care in Lynchburg and establishing Virginia’s statewide transportation system for at-risk babies.
Diabetes is the leading cause of amputations. Foot care and regular physician visits are very important for diabet ic s. –C harles C oulter Virginia Pr osthet ic s
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A hospital neonatal intensive care unit is equipped and staffed to take care of sick or premature babies. They greatly increase the survival of very low birth weight and extremely premature infants. A Lynchburg native, Dr. Houck was recruited back to his hometown to help establish a NICU. He had graduated from medical school at the University of Virginia in 1965, going from Charlottesville to two years of service with the U.S. Army at Ft. Polk, LA. Trained as a pediatrician, Dr. Houck took part in the care of several premature babies while at Ft. Polk, and he developed an interest in their special needs. Post-Army, Dr. Houck went into a fellowship for further training in the then-new field of neonatology at Parkland Hospital in Dallas, TX and was later recruited by physicians back home in Lynchburg, who saw the need to establish a neonatal care program. At the time, Dr. Houck was one of only three practicing neonatologists in Virginia. “We had to improvise a lot in those days, the early 1970s,” he remembers. “The proper equipment hadn’t been developed yet, so we adapted existing equipment for special use with premature babies.”
KIDS’ CARE | our health
They also had to be innovative when it came to having a large enough number of tiny patients to justify the costs of maintaining the specialized hospital unit. There was no doubt of the value of the work done in the unit, but there were not enough premature babies in Lynchburg alone to support the expense of the neonatal program. At the same time, other hospitals in the region had no organized, safe way to transport premature and other at-risk babies to the NICU being established at Virginia Baptist Hospital. It was risky business for babies from Danville or Farmville, for example, to be sent to Lynchburg via standard ambulances. Neither the vehicles nor the transport personnel were up to the task of providing appropriate care en route to Lynchburg.
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our health | KIDS’ CARE
Dr. Houck, who seems the perfect example of a person who identifies a need and takes steps to fill it, began working with the Lynchburg Life Saving and First Aid Crew to design and outfit a vehicle that would serve as a mobile neonatal unit. It contained an incubator along with equipment and space for a physician or nurse to monitor and see to the baby’s needs. By 1973, the vehicle was ready to go anywhere in the region to pick up babies and give them uninterrupted care on the way to the hospital. The vehicle was expensive. To pay for the $30,000 in vehicle costs, Dr. Houck turned to the local Jaycees. He was a member of the service organization, and knowing that Jaycees look for projects that will make a difference in the lives of people, he convinced the Lynchburg-area chapters to support the mobile NICU. “We sold a lot of apple butter in those days,” he remembers, and the money was raised. The mobile unit was successful from the outset, transporting about 100 babies a year to the NICU at Virginia Baptist. And the concept, detailed in statewide pediatric journals in articles written by Dr. Houck, caught on as well, both in the medical community and among other Jaycee chapters statewide. Large hospitals in other Virginia cities were establishing their own NICU units and looking for ways to safely transport 42 | www.ourhealthvirginia.com
KIDS’ CARE | our health
babies to those new units. Jaycee chapters statewide launched the efforts to support vehicles being outfitted in their localities. Dr. Houck worked with others to create regions within the state, each anchored by a hub hospital containing a NICU, as a way to organize the transport and care of premature and sick babies. Those regions, and many of the protocols developed at that time to create standard approaches to the transport efforts, are still in place now, some 40 years later. To staff the vehicles on their trips, Dr. Houck and others worked to train neonatal nurse practitioners, already a highly specialized field of nursing, in the methods of neonatal transport.
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Continuing to practice in Lynchburg for the next 40 years, Dr. Houck also exercised his long-standing interest in history. He is the author of a number of books on local history, including a masterful work on Lynchburg’s life as a major hub for the care of ill and injured soldiers during the Civil War. The book, A Prototype of a Confederate Hospital Center in Lynchburg, Virginia, was published by Dr. Houck’s Warwick House Publishing, which specializes in works on local history. He also serves as publisher of Lynch’s Ferry magazine, the official publication of the Lynchburg Historical Society. In addition, he served as medical director of the Johnson Health Center, which provides health services to families regardless of their ability to pay, and he sees pediatric patients at the Johnson Pediatric Center. Last fall, Dr. Houck was invited to be the principal speaker at a gathering to celebrate the 40th anniversary of the NICU at Centra Virginia Baptist Hospital. He might have been curious that event organizers made special efforts to be sure that Dr. Houck’s entire family would be there. After giving a talk on the steps involved in establishing the NICU and the transport service, he was surprised when hospital officials unveiled a plaque designating the NICU in his name. So now Dr. Peter W. Houck, who has left an indelible stamp on the care of at-risk babies statewide, will leave his name on one of the first specialized neonatal units to be established in his native Virginia.
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Best Foods to Incorporate into Your Weight Loss Diet words | TRICIA FOLEY, RD, MS
Orthodontically correcting misaligned teeth has been proven to increase self esteem. Jennifer Claiborne, DDS Central Virginia Orthodontics
Losing weight can be quite a challenge. After all, there are many different “diets” to choose from. Whichever you decide to follow, most likely calories will be cut back and certain foods will be off limits. To ensure your body is getting what it really needs, follow these tips: 1. Fill your plate with non-starchy vegetables. Non-starchy veggies are packed with nutrients, including essential vitamins and minerals your body needs, but are low in calories and carbohydrates. They also provide a healthy dose of fiber that will fill you up so you aren’t hungry. These veggies include foods like spinach, peppers, onions, broccoli, cauliflower, green beans, asparagus, brussel sprouts, and celery. If you are a picky eater, these vegetables can be incorporated into healthy soups or casseroles to “disguise” the taste. Seasonings can also be added to enhance flavor. Changing the way you eat can change your tastes as well. Give it some time, and foods you didn’t think you liked may become some of your favorite choices over the course of a few weeks. This is especially true if you ate a lot of processed foods prior to starting your diet. 2. Fruits are your friends. Think of them as nature’s candy. Of course, not all fruits are created equal. Just like vegetables, you want to choose the fruits that are lowest in natural sugars and highest in fiber. Berries are always a great choice since they are packed with vitamin C. Crash diets can often lower your immune system if you aren’t fueling the right way; vitamin C gives your immune system a boost. If you find that they aren’t in season, buy them frozen. From a nutrition perspective, they are the same as fresh and last a lot longer. Apples make a great grab and go snack. However, beware of the large apples that offer a two for one serving size. Instead go with the smaller apples that are about the size of a baseball. Fruits to www.ourhealthrichmond.com www.ourhealthvirginia.com | 45
our health | NUTRITION HEALTH
avoid would be those that come packed in juice or worse, syrup, since they add unnecessary sugar to your intake. You also want to limit melons and bananas since they are higher in natural sugars and offer little fiber. The best rule of thumb is to think thin! Look for fruits with the thinnest skin – these are the best choices due to their high antioxidant content and low sugar content. 3. Don’t underestimate the importance of fat. Fats do NOT make you fat! Fats are responsible for the proper hormone function of your thyroid and other important bodily processes responsible for keeping you healthy. They also keep you full longer minimizing food cravings and keeping you on track. Lastly, many diets cause hair loss and brittle nails; fats can help prevent this from happening. Be sure to include smart fats in your diet. Avoid trans fats found in baked and prepackaged foods. Instead, focus on healthy fats like nuts, olive oil, avocados, and olives that can add flavor and improve your heart health. 4. The final tip to remember is to incorporate protein with every meal. Whether you are on a low fat diet or low carbohydrate diet, protein should always be first priority. Choose quality meat if possible, since many of today’s meats are full of hormones and chemicals. Although it may cost a little more, it’s worth it to your overall health. Look for local, grass fed beef or free-range organic poultry. Omega three eggs are also a good choice. Keep in mind that the yolk is where the fat is, so if you only eat egg whites, you’re missing out on these important nutrients. Also remember that portion control is key to weight loss success. A proper portion for meat lies in the palm of your hand, literally. Once protein is cooked, simply measure a portion that is equivalent to your palm size. You need approximately this much protein with each meal every day! This is important because protein paired with starches will help to stabilize blood sugar and keep you from feeling hungry. It will also help maintain the muscle you already have, which is important since many times losing weight means losing a combination of both fat and muscle. Once you’ve lost weight, the same principles listed above should be applied, but you do have a little more wiggle room. After all, no one is perfect! If you do get cravings, splurge on dark chocolate instead of milk chocolate for a tasty treat. Use an air popper to pop your own popcorn instead of eating it at the theater for a salty treat. Using plant based sweeteners like Stevia instead of sugar can also save you a ton of 46 | www.ourhealthvirginia.com
NUTRITION HEALTH | our health
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unwanted empty calories. Consider sprinkling a little Stevia on plain Greek yogurt with added fruit for a sweet treat instead of ice cream. Little changes like this can make a big difference in long term successful weight maintenance. Remember, you are what you eat. Body Mass Index (BMI) does not tell the whole story. Even if you’re at a healthy weight or BMI, it doesn’t necessarily mean you’re healthy if you aren’t
eating right! Countless people at their ideal body weight still suffer from high cholesterol, high blood pressure, and diabetes. By eating fresh, unprocessed foods many of these health conditions can be reversed. Unfortunately, all too often people choose pre-packaged, processed foods that come laden in salt, which can damage blood vessels and cause hypertension (high blood pressure). Simple carbohydrates like pastries, cookies, crackers, and white bread, which are also popular commodities, can raise triglycerides and lower HDL, your good cholesterol. By avoiding these foods and flavoring fresh foods with herbs and spices, you will be healthy both inside and out!
Is Body Mass Index (BMI) really accurate? Body Mass Index is a weight to height ratio that was developed in eighteen thirty-two by Adolphe Quetelet. Originally, it was not designed to be a measure of weight status but was developed to define the “normal man.” It was not until the nineteen seventies that the medical community began using BMI as a tool for defining normal weight, overweight, and obese for insurance billing purposes. Today, a BMI between 18.5 and 24 is considered a healthy or normal weight. Anything under that is considered underweight, 25 to 29 is considered overweight, and 30 and over is considered obese. Because it was not originally designed to be a measure of weight status, BMI does have some limitations. To begin with, BMI does not account for muscle mass. If a very muscular person is measured on a BMI scale, they could appear obese. In addition, body fat distribution is also not accounted for, which can have a great impact on health risk. Abdominal adiposity, for example, carries a larger health risk than fat that is centered on the hips. Finally, BMI does not differentiate between genders nor does it adjust for age. While simple and inexpensive, it should not be used as a sole diagnostic tool for health professionals. Diet history, exercise patterns, family history, body fat distribution, and body fat percentage should also be taken into consideration. 48 | www.ourhealthvirginia.com
NUTRITION HEALTH | our health
Unfortunately, it’s difficult to provide an ideal weight for each person’s height. This number will vary vastly depending on the factors listed above including the person’s bone structure, fat mass, and lean mass. The best way to determine your ideal weight would be by having your body fat percentage measured. The gold standard for measuring body fat is under water weighing or a machine called the Bod Pod. These can be cumbersome and costly measurements, which is why using BMI is a popular alternative. For sedentary young and middle aged adults, BMI can be a good marker of health risk. A simple equation can also be used to determine a weight range for your height. For men, this formula is 106 pounds for the first five feet plus six pounds for each inch over five feet. For women, the formula is 100 pounds for five feet plus five pounds for each inch over five feet. Both should be adjusted by ten percent more or less based on whether you have a large or small frame. For example, a female who is five feet six inches tall would weigh 130 pounds plus or minus 10 percent based on her frame. If she has a small frame, she could weigh as little as 117 pounds, or with a large frame, she could weigh as much as 143 pounds.
HEART: • H: Hummus; E: Eggs; A: Apples; R: Roughy T: Tomatoes To keep a healthy heart, be sure to incorporate healthy fats, protein, fruits, and non-starchy vegetables. Hummus, made of chick peas and olive oil (a healthy fat), makes a great dip for vegetables!
It also provides lots of flavor and texture to make foods more interesting and less bland. Eggs are a great food, packed with protein and a healthy dose of fat. They are both versatile and delicious. Look for omega three or farm fresh eggs for the best nutritional quality. Fruits are also wonderful for your heart! They are compact and make a great snack. Apples are an easy, grab and go food that add a nice crunch of sweetness. Protein is important because it helps to maintain muscle, and since your heart is a muscle, naturally it’s a great choice. Fish is the perfect heart healthy food! Not only is it rich in protein, it also has a healthy dose of omega three heart healthy fat. Not a seafood fan? Orange roughy is buttery in flavor and does not have a fishy taste, so give it a try! Finally pack your plate with vegetables. Tomatoes are great to throw in salads or make into salsa. They’re also full of antioxidants! By incorporating these foods and others from these food groups into your diet, you’ll be well on your way to a heart healthy lifestyle! Check out the recipes below for ways to incorporate these into your family’s meals.
Check out our healthy heart and better living recipes! on page 50
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Recipes:
Immunizations! The best type of preventive healthcare! Katherine Nichols, MD F. Read Hopkins Pediatric Associate s
Homemade Hummus
“Baked” Apples
Ingredients:
Ingredients:
»» 1 can of chickpeas/garbanzo beans (15 ounces)
»» 1 apple
»» 1/3 cup tahini
»» 1 packet Stevia
»» 1/4 cup lemon juice
Directions: Slice the apple, removing seeds. Microwave for approximately 45 seconds until soft. Sprinkle with cinnamon and Stevia. Enjoy.
»» 2 tablespoons olive oil »» 2 garlic cloves, crushed »» 1/2 cup roasted red pepper Preparation: In a food processor or blender, combine beans, tahini, lemon juice, and olive oil. Blend until smooth. Add red peppers and garlic until you reach desired consistency. Serve warm or cold with fresh veggies.
»» cinnamon to taste
Orange Roughy Ingredients: »» 1 1/4 lbs orange roughy fillets »» 1 teaspoon seasoning salt (or to taste) »» pepper to taste
Egg Frittatas in Muffin Tins
»» paprika to taste
Ingredients:
Directions: Put fish fillets in a greased 11x7 inch baking dish.
»» nonstick olive oil cooking spray »» 8 large eggs »» 1/2 cup unsweetened almond milk »» 1/2 teaspoon freshly ground black pepper »» 1/4 teaspoon salt »» 4 ounces thinly sliced turkey, chopped »» 1/4 cup freshly grated parmesan »» 2 tablespoons chopped fresh Italian parsley leaves Directions: Preheat the oven to 375 degrees F. Spray 2 mini muffin tins (each with 24 cups) with nonstick spray. Whisk the eggs, almond milk, pepper, and salt in a large bowl to blend well. Stir in the turkey, cheese, and parsley. Fill muffin tins almost to the top with the mixture. Bake until the “frittata” puffs and is just set in the center, about 8 to 10 minutes. Using a spatula, loosen the frittatas from the muffin cups and slide the frittatas onto a platter. Enjoy.
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Sprinkle with seasoned salt, pepper, and paprika. Cover and bake at 400 degrees for 15 to 20 minutes or until fish flakes easily.
Tomato Salsa Ingredients: »» 6 Roma tomatoes, chopped »» 4 garlic cloves, minced »» 2 seeded and minced jalapenos »» 1 red bell pepper, diced »» 1/2 red onion, finely chopped »» 1 tablespoon olive oil »» 1 lime, juiced »» chili powder, salt, and pepper, to taste »» fresh scallions and cilantro to taste Directions: In a bowl, combine all ingredients. Place in refrigerator for up to 12 hours.
CLINICAL TRIALS CORNER | our health
CLINICAL TRIALS:
What are they, and are they for you?
words | RICK PIESTER
You may not even think about it, but when you use an over-the-counter or prescription remedy, chances are it has already been tested for safety and
Have any unusual sore or discoloration appearing in your mouth or lips for more than two weeks checked by your dentist. Mitchell Magid, DMD Mountainview Oral Surgery & Implant Center
effectiveness in a process called clinical trials. Clinical trials are conducted to determine what works, and what doesn’t work when it comes to new medical approaches or products. Each trial is intended to answer two questions — does the product work? And is it safe? All prescription drugs and devices sold in America go through a rigorous, long, and expensive schedule of testing and retesting before they get to a pharmacy. Many — but not all — over-the-counter products also go through clinical trials. People who participate in a clinical trial use new products before they are available in stores — usually medications or devices — under carefully controlled conditions. The variations are unlimited: in some trials (also called “studies”) separate groups of participants may use differing dosages of a medication under study; in others, some www.ourhealthvirginia.com | 51
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of the participants may use the actual product, while others may use a placebo that has no active ingredients. Although the notion of clinical trials has been part of medicine for centuries (scientists conducted what would now be considered some form of clinical trials beginning in the late 1700s,) the approach was not widely used until about the mid-1950s. There were actually not that many medications to be tested until that era — penicillin was not even developed until early during World War II. Until then, physicians pretty much relied on their own experience with medications, and on the experiences of their peers and those who came before them. But as medicine learned more about antibiotics and other drugs, and as more and more medications became available, the medical community needed formalized, organized methods to learn what was effective and safe, and what was not. In this country, the Food and Drug Administration (FDA) became the standard-bearer when it came to oversight of new medications and treatments during the 1930s. It was not until the 1960s, however, that methods were established and requirements set to prove that medications actually worked as promised. Today, most medications and medical devices (not dietary supplements, however) must be approved by the FDA before they can be offered to the public. Health experts advise that you check a product’s packaging for mention of “doctor approved” or “doctor tested” or information about FDA approval. And, whenever in doubt, ask a pharmacist for her or his opinion. Clinical trials are conducted through hospitals, physician offices, and by independent businesses established for that specific purpose. In the Lynchburg area, for example, the Education and Research Foundation enjoys a national reputation for its conduct of clinical trials — almost exclusively testing dermatological remedies and devices — for the past 40 years. Julie Doyle, president and executive director of the Education and Research Foundation, notes that clinical 52 | www.ourhealthrvirginia.com
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trials offer multiple advantages for the healthcare consumer.
procedure is finding enough people — often times divided by
“Clinical trials are actually divided into four phases,” she
gender, age, health status, etc. — to participate in the testing.
notes, “with each phase having a different purpose aimed at
Most (but not all) of the participants in studies performed by
helping scientists understand different aspects of the product
the Education and Research Foundation must have particular
being tested.”
dermatological conditions to be eligible. A new medication
Phase I trials allow researchers to test a new drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine safe dosage levels,
aimed at clearing acne, or dandruff, or psoriasis, must be tested on people having those conditions. Other clinical trials, for skin moisturizers as an example, can be tested on healthy
and look for possible side effects. In Phase II trials, the drug or treatment being evaluated is given to a larger group of people (about 100-300) to measure its effectiveness and to further judge its safety In Phase III, the drug or treatment being evaluated is given to large groups of people, sometimes thousands at multiple locations, to again confirm its effectiveness, look for side effects, compare it to other treatments already on the market treatments, and collect more information aimed at safe use of the drug or treatment. And Phase IV trials are usually conducted after the product goes on the market to gather yet more information on benefits, risks and best use of the drug. The trials period comes at the end of what is usually a years-long process of original “bench” research. A new drug, for example, must be created, or discovered. It must be purified and prepared for larger scale production, compared against other drugs already on the market, and tested repeatedly in the laboratory. A big challenge facing any clinical trials www.ourhealthvirginia.com | 53
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people. The company’s Web site carries a listing of clinical trials for which participants are being sought.
Know your fa health history. mily’s eye member who h A family or macular deg as glaucoma places you at eneration risk also. Darin K. Bow Piedmont Eye ers, MD Center
Some of the trials include compensation for participation, and participants get a variety of top-level medical attention while they are participating, but people involved in medical research say that the broader benefit is that participants help medical professionals learn more about treating and curing disease, which in turn makes for a healthier society. Donna Washburn, RN, MSN, a clinical nurse specialist at the Centra Pearson Cancer Center in Lynchburg, works closely with participants involved in a variety of clinical trials for cancer research. She notes that people who do participate in clinical trials will be receiving extremely high quality care, because their health are being closely monitored by people trained in the research and watching closely or any change in the participants’ health. “All the treatments for cancer we have today,” she notes, “are because of the people who participated in clinical trials that were done years ago. The study participants
Stay active and refrain from tobacco use. Lori McVay, PA The Cardiovascular Group
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are the real heroes of medical research. Trials participants are very unselfish people because they are taking part in a process from which they cannot be sure they will get direct benefit as individuals, and they know that.” Note: For much more detail on clinical trials, including information that you might need to know as a participant, check the Web site of the Center for Information and Study of Clinical Research Participation, at www.csrip.org. The Education and Research Foundation Web site is www.educationandresearch.com.
SENIOR LIVING | our health
words | C. RUTH CASSELL
Keeping Meds in Check Friendship Retirement Community reviews charts to consolidate, eliminate prescriptions words | C. RUTH CASSELL
A senior citizen shows signs of dementia and early onset Alzheimer’s, but her family reports no history of the disease and wonders why it’s affecting their loved one. A rehabilitation patient progressively heals from a total knee replacement, but he still doesn’t participate in or enjoy daily activities. Instead of seeking another medical reason for declining health concerns such as these, Friendship Retirement Community in southwestern Virginia has begun looking at how the patient was already being treated. Friendship launched a new program—Polypharmacy Committee—which reviews medication lists and makes recommendations. “We found that our residents and our patients feel better,” says Russ Barksdale, president and chief executive officer of Friendship Retirement Community. “They are in better health; they can participate in more activities; and it saves money as well for those who have large insurance co-pays.” www.ourhealthvirginia.com | 55
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Friendship Retirement Community, based on Hershberger Road, serves 1,000 senior citizens through its campus as the largest rehabilitation center and retirement community in Virginia. The Polypharmacy Committee began six months ago, because of concerns over the national increase in the number of hospitalizations for adverse drug events. Barksdale also indicates a study that found among adults 65 and older, 40 percent take five to nine medications and 18 percent take 10 or more. Bill Cundiff, director of pharmacy at Friendship, says most patients admitted to the retirement community or rehabilitation center are taking over 16 medications. Polypharmacy is the practice of administering many different medicines, especially at the same time for the treatment of the same disease. It often means the prescribing of more medication than necessary or prescribing one medication to counteract the side effects of another. Cundiff explains that each month Friendship administrators analyze the patient population and review patient charts to determine the number of medications listed. They then choose patients for polypharmacy review. Using a team approach to review patient records in an uninterrupted setting, the committee is comprised of a medical director, physician, nurse and pharmacist. Based on a peer review model, in which a physician often reviews patient records of another physician, the polypharmacy review committee often makes multiple recommendations for ways to reduce, eliminate, consolidate or re-prescribe prescription and/or over-the-counter medications. “Every situation is different and there are certain medications that are worse for certain problems,” Cundiff says.” The committee is really just taking a fresh approach and taking a look at medications that the patient has been on for a long time.” 56 | www.ourhealthvirginia.com
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According to Barksdale, Friendship is also reviewing medications for all patients admitted to the rehabilitation center, as well as residents who self-report a concern that they are taking too many medications. Barksdale says Friendship sees it as part of their mission to offer the service to not only residents and rehab center patients, but also home care patients and referring physicians in the Roanoke Valley. The retirement community runs a retail pharmacy on campus, and serves not only the resident and rehabilitation population, but also the community.
F loss your teet h at least one a day. Elena B lack, DDS, P hD Appalachian Orthodontics of Lynchburg
“We’re looking at it from our mission, which is to make our seniors feel better and to make our rehab patients feel better,” he says. “Putting 15 to 16 meds into your body at any given time has an impact on your system physically and has an impact on you and your family financially.” Barksdale and Cundiff say younger patients are as likely to have issues of too many medications as senior citizens. Cundiff says through the polypharmacy review, recommendations in pain therapy may be made for rehab patients. He says the patient often sees a benefit from taking a scheduled dose of pain medication rather than taking it as needed. The pharmacy director explains that eliminating or changing medications can reduce urinary tract infections and lessen stress on the body’s filtration systems. Barksdale says chronic ailments in another major area in which residents and consumers have a polypharmacy issue. “Our national healthcare plan talks about coverage for everyone and cost savings, and we felt like this was one area where we could really make a difference.” Cundiff says since the program began the committee has conducted 500 poly pharmacy reviews, with a 72 percent www.ourhealthvirginia.com | 57
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acceptance rate by the prescribing physician. In a recent polypharmacy review, the committee made 48 recommendations with the assistance of the team, as well as a physician and pharmacist in training. “We’re training the next generation of prescribers and practitioners to consider this issue as just as important as adding or prescribing new medications,” he says. Barksdale says prescriptions are often written by primary care physicians under intense time constraints and without the pharmacological expertise needed to analyze the interactions between medications. Or, multiple sub-specialists treating the same patient are not given the opportunity to review the patient’s entire prescription history. “We’ve developed our own process, with the polypharmacy review, and it’s helped our residents out tremendously,” he says.
If you choose to chew gum, choose sugarless! Karen Kenny, DDS Lynchburg Dental Center
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