OurHealth Lynchburg & Southside Oct/Nov 2013 Edition

CHILDREN DIABETES

WHAT IF I DIDN’T GET MY MAMMOGRAM? Bonus Foldout: Women’s Chart for Healthy Aging

OCTOBER

•

HEALTHY AUTUMN COMFORT FOODS

DENTAL HEALTH

Myths vs. Facts

NOVEMBER 2013 | LYNCHBURG AND SOUTHSIDE VIRGINIA EDITION | OURHEALTHVIRGINIA.COM

Joshua Farmer’s

took a detour to The U.S. Army officer reflects on both the positive lessons learned and challenges experienced while abroad, as well as looking forward to a career in law and being a father for the first time.

table of contents | october • november 2013

HEALTH AND FITNESS ON THE GO..................................17 Health-focused apps you can download to your smartphone or tablet

DENTAL HEALTH FOCUS...........19 Fact or fiction?

24 MEDI•CABU•LARY.....................10 The language of healthcare explained

JUST ASK!..................................12 A variety of health questions answered by local professionals

THE LATEST...............................14 A listing of new physicians, providers, locations and upcoming events in the Lynchburg and Southside community

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COVER STORY Joshua Farmer, of Lynchburg, talks about serving his country, studying law and becoming a first time father.

BASIC | our health

31

WOMEN’S HEALTH SECTION Spreading the word

SPECIAL FOLDOUT! Women’s Chart for Healthy Living Trends in Childbirth: what’s old is new again NUTRITION.................................39 Healthy Eats: Healthy comfort foods!

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DOCS OFF DUTY A look at what doctors do on their own time KIDS CARE..................................47 Its a way of life: Kids living with diabetes Making our children Healthy Virginians

REHAB........................................55 Alter G: A treadmill for the rest of us

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James Lynde, MD Mitchell Magid, DMD Sam Meshkinfam, DO Amber N. Parker, RDH Shannon Sawyer, DMD Summer Sawyer, DMD Sherman Smock, DDS Gary St.Clair, OD Neal Young, MD

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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher: 305 Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.355.3071 Information in all print editions of Our Health and on all Our Health’s websites, including: www.ourhealthvirginia.com 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 © 2013 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The Our Health Lynchburg and Southside Virginia edition is published bi-monthly by McClintic Media, Inc. 305 Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthvirginia.com. Advertising rates upon request.

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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 integrative medicine?

Integrative medicine is a holistic approach to wellness and healthcare. It is a specialty that has grown over the past decade as patients become more aware of the effects of all aspects of their lives on their health and well-being.

This exciting new approach allows the patient and physician to work together to develop a personal plan for long-term physical, mental and spiritual health. Patients learn to develop knowledge, resources and confidence to take more responsibility for their own total health and wellness.

I’ve found my patients manage their overall health better— especially chronic conditions or illness—when they choose to be a proactive part of the process, and when they address their health as but one component of wellness.

With this holistic approach, we help patients to recognize that every aspect of their life relates to their well-being and to understand the synergy among physical, mental and spiritual influences.

David R. Cannon, MD Integrative Medicine Medical Associates of Central Virginia

What is an ocular health assessment?

An ocular health assessment involves examining the structures in the anterior and posterior parts of the eye. It is included in a comprehensive eye exam, which we recommend a patient have once a year.

Some of the conditions that we check for in the anterior part of the eyes are dry eye syndrome, corneal dystrophies and cataracts.

The posterior segment of the eye includes the optic nerve and the retina, which is the back surface of the eye. The retina is the only part of the body where vasculature can be seen without any invasive procedure. This is how we can determine if conditions such as diabetic retinopathy, hypertensive retinopathy and macular degeneration are present.

Glaucoma is another prevalent condition that affects the back of the eye, specifically the optic nerve.

Many of these conditions that affect the posterior segment have no symptoms, which is why a yearly comprehensive eye exam is so important.

Anna H. Farouq, OD St. Clair Eye Care 434.239.2800 & 434.845.6086

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What is vascular dementia?

What is keratosis pilaris?

Dementia is characterized by impairment of memory and thinking that significantly interferes with a person’s usual daily activities. There are arguably five main types of dementia, and vascular dementia (VaD) is the second most common after Alzheimer’s.

Keratosis pilaris is a common, harmless, genetically passed skin condition that affects the skin of the arms (most commonly the back of the arms), thighs, face and buttocks. Most patients will recognize its characteristic pattern of small, dry, rough bumps that are usually normal skin color to white in appearance but may be red as well. Patients may also sometimes complain of itching.

VaD is caused by disease that blocks vessels in the brain. The reduction, or lack, of blood flow damages the brain. The size, location and number of diseased blood vessels make an impact on how, and what kind of, memory and thinking problems will occur.

Risk factors for VaD include increasing age, history of stroke or transient ischemic attack (ministroke), high blood pressure and high cholesterol.

There is no definitive test for VaD. Patients at high risk should undergo professional screening with memory and cognition tests to evaluate for dementia.

Neuroimaging with CT or MRI is helpful in making the diagnosis of VaD. Dr. Neal Young Virginia Vein Specialists Lynchburg | 434.237.4004

Keratosis pilaris is the result of increased production of a skin protein called keratin, which forms a plug and blocks the hair follicles; this leads to the characteristic appearance and feel of the condition. It usually affects women more than men and adolescents more than adults.

If necessary, keratosis pilaris can be treated topically with exfoliating moisturizers such as urea and lactic acid-based creams, as well as topical medications called retinoids that prevent the buildup of skin cells that produce the excess keratin causing the condition.

Peter Gibbs, DO Centra Medical Group - Lynchburg Internal Medicine Lynchburg | 434.200.3908

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

What are symptoms of celiac disease?

What are some nonsurgical treatments for snoring?

Symptoms of celiac disease are triggered by eating gluten, a protein that occurs in grass grains like wheat, barley and rye. Essentially, the gut has an allergy to the gluten and this causes abdominal pain, cramping, bloating and diarrhea. Weight loss and fatigue can also occur from malabsorption of nutrients like iron and other vitamins. The symptoms are very similar to irritable bowel syndrome (IBS) and celiac disease is often mistaken for IBS. There are tests that can be done to help with diagnosis. The only treatment is a strict gluten-free diet.

It might be hard to believe, but the best nonsurgical treatment for snoring is weight loss! Just loosing 10 percent of your body weight (and adding muscle tone) can significantly improve snoring.

Snoring can come from multiple anatomic areas. For the nose, Breathe Right strips seem to help.

However, a larger group of patients snore because of an enlarged/ elongated or floppy uvula. The only treatment for that is a minor surgical procedure. Sometimes it is the backward collapse of the tongue during REM sleep (that is restful sleep we all hope to get) that causes snoring. Mouth devices can be worn at night to hold the lower jaw in place, thereby maintaining an open airway throughout sleep. The key to the right treatment is locating the cause of your snoring.

Leah Hinkle, MD Central Virginia Family Physicians Forest | 434.525.6964

One last thing: if your spouse nudges you because you stop breathing at night, or you find yourself gasping for air, you should seek an ENT evaluation.

Sam Meshkinfam, DO Blue Ridge Ear, Nose, Throat & Plastic Surgery Lynchburg | 434.947.3993

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What are symptoms of inflammatory breast cancer (IBC)?

IBC is a distinct clinical subtype of locally advanced breast cancer. It is characterized by rapid clinical progression, skin erythema (redness) and thickening (edema/ peau d’orange), and rapid breast enlargement.

A diagnosis is made on clinical features alone, or on the unique pathological finding of tumor emboli dermal lymphatics, or on a combination of both. Clinical IBS may be confused with simple mastitis or neglected noninflammatory breast cancer.

IBC makes up one to five percent of all new breast cancers. On average it affects women, ages 57 for Caucasians and 52 for African Americans.

Now, with aggressive neoadjuvant chemotherapy, surgery, radiation and follow-up maintenance chemo, five-year survivors are common, though; unfortunately many women are associated with metastasis recurrence. At this time, one in three women with newly diagnosed IBC may experience long-term survival.

James Lynde, MD Radiology Bedford Memorial Hospital Bedford | 540.586.2441

How do you know if you are at risk for periodontal disease?

Some of the risk factors that we now know for periodontal disease are age, smoking/tobacco use, genetics, stress, medications, clenching or grinding your teeth, poor nutrition/obesity and other systemic diseases. This covers many of us. According to the Centers for Disease Control and Prevention (CDC) in one of their most recent population studies, more than half the population has treatable periodontal disease.

Some of the warning signs of gum disease include red, swollen, tender gums or other pain in your mouth; gums that bleed while brushing, flossing or eating hard food; and receding gums.

Some other red flags are looser, separating teeth; sores in your mouth; persistent bad breath; and a change in the way your teeth fit together.

One can take the “gum disease risk assessment test” at Perio.org to further learn your individual risk.

Sherman Smock, DDS Periodontal Health Associates Lynchburg | 434.455.2444

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

Commonwealth Neuro Specialists and South Hill Internal Medicine & Critical Care Join VCU Medical Center

Children’s Dental Health of Lynchburg proudly welcomes Dr. Shannon and Dr. Summer Sawyer.

VCU Medical Center is proud to announce that Commonwealth Neuro Specialists and South Hill Internal Medicine & Critical Care have joined its physician practice group and welcomes Carlos A. Williams, M.D., to the Department of Carlos A. Williams, MD Neurology, and John Strunk, MD to the Department of Internal Medicine.

They have recently moved from Philadelphia, where Dr. Shannon Sawyer completed a two-year pediatric dental residency at Temple University Hospital. He and Dr. Drake Covey work together to serve the children of Lynchburg and the surrounding area.

Bethany Denlinger, MD

John Strunk, MD

Board certified in neurology, Dr. Williams offers expertise and experience diagnosing and treating neurological conditions, including stroke and sleep disorders. Williams offers electroencephalography (EEG) and electromyography (EMG) testing to efficiently assess patients with movement and other neurological disorders. He will continue to see patients at his current location in South Hill, Va., located at 501 Lombardy Street.

Until recently, when children transitioned into adulthood, they would usually move on to another dental office. Now Dr. Summer adds a new dimension to the dental practice by providing dental services to older teens and adults. Everyone is encouraged to stop by the office and make an appointment.

Children’s Dental Health of Lynchburg is located at 7802 Timberlake Rd. in Lynchburg.

For more information, please go to www.cdhlynchburg.com or call the office at 434.239.6928.

Dr. Strunk offers primary and critical care services to the South Hill community and surrounding areas. Dr. Bethany Denlinger, from VCU’s Pauley Heart Center, who provides non-invasive cardiology services, joins him. Both will continue to see patients in South Hill, Va., at their office located at 412 Durant St.

Heritage Green completes renovation project Heritage Green Assisted Living recently completed an extensive six month renovation project. The new open-concept floor plan offers loads of natural light, eye-catching architectural details, and a warm inviting atmosphere.

The new handicap friendly entrance is an added convenience for both residents and guests. New interior finishes and décor have been tastefully selected. Finally, the most important part of the project is the advancement of new technology at Heritage Green. This new technology includes the installation of a new e-MARS (electronic Medication Administration Record) system, a new wireless call bell system, and a state-of-the-art fire system upgrade. Heritage Green Assisted Living welcomes you to stop by and view their new upgrades.

Natural light was brought in via solar light tubes and a skylight in the lobby. Illumination changes include lighting in the new tray ceilings and new chandeliers. Walls were taken down and columns added to open up space and new ceiling treatments installed for the hallways. Residents are enjoying a new set of automatic open and close doors at the entrance.

A fresh coat of paint, new carpets, and decorative décor’ are the icing on the cake. Lastly, electronic MARS, wireless call bell system, and state of the art fire system upgrade rounds out the project with more advanced technology.

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HEALTH AND FITNESS ON THE GO | our health

Health and Fitness

On the Go

Having information at your fingertips; that’s what mobile apps are all about. Empowering users to effectively manage their healthcare and a healthy lifestyle is important to everyone.

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.

WaveSense Diabetes Manager * Reviewed by the American Diabetes Association * Do you want to track your glucose results, carb intake, and insulin doses? The WaveSense Diabetes Manager can help. Enter your information in seconds, review the data with convenient charts and graphs, and gain a new perspective on diabetes management. Watch videos (courtesy of dLife) to learn about healthy eating, lifestyle choices, and hear from others who are living life with diabetes. If you need a second opinion you can email results to your trusted health care team.

Available for iPhone only through iTunes. Cost: free iPhone

iBreastCheck Early detection of breast cancer means you have a better shot at winning, so it’s important to do your self-checks each and every month. iBreastCheck contains a video that shows you how to do an effective breast check and explains why it’s a crucial part of preventive health. Set up your reminder time and choose the frequency that works for you – weekly, every two weeks, or monthly.

SHARE YOUR FAVORITE HEALTH AND FITNESS APP!

Available for iPhone and Android. Cost: free. Link to apps for iPhone and Android: http://www.ibreastcheck.com/

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!

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DENTAL HEALTH FOCUS | our health

DENTAL HEALTH FOCUS

FICTION or FACT? words | JENNIFER ROMEO

A smile is your best accessory, so naturally you’ll want to ensure your pearly whites stay healthy for life. We all know about the basics—brushing, flossing and using mouthwash— but separating fact from fiction isn’t always so easy.

For many, visiting dental professionals for healthcare advice can be a stressful and intimidating experience. In fact, according to a report by the surgeon general’s office, 4.3 percent of Americans are so afraid of going to the dentist that they simply don’t go at all.

Rather than let the dentist’s chair deter you from getting the answers you need, brush up on the facts. We asked the experts to clarify some of the most common misconceptions surrounding your and your family’s oral health. (http://silk.nih.gov/public/hck1ocv.@www. surgeon.fullrpt.pdf)

A child must lose all his/her baby teeth before being fitted with braces.

Jennifer Claiborne, DDS, Central Virginia Orthodontics

Fiction. It is not necessary for a child to lose all his/her baby teeth before starting orthodontic treatment. In our office we prefer to start treatment after most/all the baby teeth are lost, in order to keep treatment time to a minimum for the patient. The average patient has braces for 18 to 24 months, and this time may be extended if adult teeth erupt later into treatment. There are, of course, special circumstances in which treatment must be started early. If a child’s bite may cause damage to the teeth or gums or if a young child is being teased about his teeth, we may propose an early treatment (or phase I). Once this phase of treatment is complete, we would fit the child with a retainer to wear while more adult teeth erupt. Then a second phase of treatment would likely be needed once all the permanent teeth are present.

Jennifer Claiborne, DDS, Central Virginia Orthodontics www.ourhealthvirginia.com | 19

our health | DENTAL HEALTH FOCUS

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DENTAL HEALTH FOCUS | our health

You must floss the teeth you want to keep.

“You don’t have to floss all your teeth, only the teeth you want to keep” is what I tell my patients after they tell me how much they do not like flossing. This usually warrants a second look as they consider what that statement really means. I proceed to explain to them the dynamics behind what flossing is really accomplishing. The whole goal of brushing and flossing is to move around bacteria. Simply put, when bacteria is left undisturbed in the pockets around our teeth, it can initiate gum disease. Floss is one of the only tools that can effectively reach in between the teeth to move around bacteria. Basically two things happen when we do not floss our teeth daily. First, the bacteria will begin to mature and cause disease. Second, it takes only about 24 hours for the minerals in our saliva to harden the plaque and turn it into tartar or calculus. Once calculus is formed, it is very hard to remove and will only make it more challenging to clean. If flossing is used routinely, many of the dental ailments we face could be avoided.

Amber N. Parker, RDH, Periodontal Health Associates

Amber N. Parker, RDH, Periodontal Health Associates

Evolution is the real cause of impacted wisdom teeth and the need for extraction.

There is an ongoing debate on why the third molar, often called a wisdom tooth, becomes impacted and requires removal. A speculation of evolutionary theory has been that the human jaw size has shrunk, due to increasing brain size, thereby causing an enlargement of the skull. It is thought that this process has required the jawbones to adapt to the enlarging skull and reduce the space needed to accommodate the third molar.

Another cited explanation for impacted wisdom teeth centers on natural selection of mutations. Many researchers believe that a dietary shift from abrasive diets to soft processed foods has caused a decrease in the chewing function, resulting in changes in the tooth-jaw relationship, which could lead to misaligned bites and impacted wisdom teeth.

As it stands today there has been no conclusive evidence to prove that evolution is to blame for impacted wisdom teeth. Whatever the explanation, anyone experiencing discomfort in the area at the back of their jaw should consult with a dental professional to determine if they may require removal of their wisdom teeth.

Dr. Mitchell Magid, Diplomate of the American Board of Oral & Maxillofacial Surgery, Mountainview Oral Surgery and Implant Center

Mitchell Magid, DMD, Diplomate of the American Board of Oral & Maxillofacial Surgery, Mountainview Oral Surgery and Implant Center

Permanent teeth are not affected by the lack of care to baby teeth.

The health of permanent teeth is primarily determined by the health of the preceding baby (primary) teeth. Therefore, it is equally important to care for your baby’s teeth from the beginning. A child will not lose his or her last primary tooth until the age of 10 to 13 years. These primary teeth are mixed with newly erupting permanent teeth. Tooth decay that forms on the primary teeth can easily spread and infect your child’s permanent teeth, causing lifelong dental problems.

If the decay in the primary teeth is left untreated, abscesses may form, causing irreversible damage to the underlying permanent teeth. Furthermore, if the primary teeth have to be removed early, due to tooth decay, the spacing of the permanent teeth will be adversely affected—resulting in the need for orthodontic treatment (braces).

Carrington Crawford, DDS, Lynchburg Dental Center

So while it is true that primary, or “baby,” teeth will be lost, neglecting these teeth may set a child up for a lifetime of dental-related concerns and problems.

Carrington Crawford, DDS, Lynchburg Dental Center www.ourhealthvirginia.com | 21

our health | DENTAL HEALTH FOCUS

Poor dental health can affect the overall health of the body.

“Yes, this is true. In fact recent studies have shown that when your mouth is healthy, the rest of your body stays healthier too,” answers Dr. George Levicki, president and CEO of Delta Dental of Virginia, the leading dental insurance provider in the commonwealth. “Stroke, heart disease and low birth weight can all be tied to gum disease, which clearly indicates that taking good care of your teeth and gums is a healthy, preventive measure.”

George Levicki, DDS President and CEO of Delta Dental of Virginia

Dr. Levicki, a 40-year veteran of the dental health profession, also notes that “your mouth is one of the first places medical professionals look when searching for symptoms of disease.

Many conditions such as diabetes, leukemia, cancer, heart disease and kidney disease can be diagnosed and treated much sooner when discovered during a simple oral examination.

For this reason, getting regular oral exams and cleanings, and flossing and brushing twice daily with fluoride toothpaste will not only improve your smile, but may even improve your overall health.”

“Routine dental visits are crucial to good health,” emphasizes Dr. Levicki. “Choosing to have dental coverage, and using those benefits, can go a long way to keeping you and your family healthy.”

George Levicki, DDS, president and CEO of Delta Dental of Virginia

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VETERAN CARE | our health

O

n the road to a promising future, Joshua Farmer took a detour into Iraq.

And now on the other side of his frontline trials, the 31-year-old reflects on how the experience has—and has not—altered his life back at home.

The sense of duty that first beckoned Farmer in the wake of the September 11 attacks, when he was just starting his undergraduate studies, led him into the Army Reserves. And in early 2011, the newlywed law school student was summoned to the war-ravaged country to assist in the dismantling and closure of U.S. military installations.

“We were the last logistics unit in the country,” he explains on a late summer afternoon, taking a break from painting the nursery for the baby he and his wife, Leigh, are expecting this fall.

The Military Intelligence Officer for the 275th CSSB (Combat Sustainment Support Battalion) out of Fort Lee, Farmer was charged with the safe transport of personnel and gear through terrain littered with perils.

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our health | VETERAN CARE

“For people going out on the roads to move supplies, improvised explosive devices (IEDs) were the number one threat, because the majority of our equipment moves by truck,” he says.

By 2011—after eight years of U.S. military presence in Iraq—the routine movements of U.S. forces were hardly a mystery. And potential antagonists had become skilled at setting their remotely detonated, timed or otherwise-activated explosives accordingly.

“Everybody there knows what roads we use. Everybody there knows approximately when the convoys are going to run, what the trucks look like. So there’s not a whole lot you can do to fool people.”

Even in the relative safety of the forward operating base (FOB), Farmer’s battalion remained vulnerable. Under threat of mortar attacks, which he describes as somewhat clumsily executed assaults that usually took place under cover of the night, personnel stayed alert to the sound of early warning systems signaling incoming fire.

“For people who are on the FOB, the scariest thing is hearing that siren go off,” he recalls. “For the most part, if there’s a bunker nearby you get in the bunker. If there’s no bunker nearby, you just kind of lie down and hope.”

As Farmer describes these high-tension circumstances, he acknowledges some of their lingering effects on him.

When he first returned home, for example, he observed that he was excessively startled by unexpected eruptions of fireworks. And certain situations continue to trigger heightened vigilance unlike any he’d experienced before.

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VETERAN CARE | our health

“When I’m driving down the road, particularly on highways, I’m much more attentive to things on the side of the road,” he notes. “Before my deployment, I don’t remember that I would drive down the road and notice a pile of garbage or a cardboard box, but I definitely do now.”

According to Catherine Wilson, U.S. Navy, retired, who is the executive director of the Virginia Wounded Warrior Program and deputy commissioner of the Virginia Department of Veterans Services, service members seldom leave the battlefield unaltered.

“I always make the comment that not all service members come back damaged, but we all come back changed,” she remarks. “The sights, the sounds and the smells of combat really don’t leave you for a long period of time.”

For Farmer, solid friendships forged under the pressures of war were invaluable sources of support during his time overseas, when both the stresses of their immediate environment and the frustrations of not being able to help out with issues that arose at home might otherwise prove demoralizing.

But despite nagging reminders of his days in the war zone, Farmer says that he is managing the residual effects of his experience in productive ways.

Maintaining daily routines, working out regularly and keeping busy—both in his limited downtime in Iraq and during the transitional period when he first found himself at home, abruptly separated from the rigors of active-duty life—were keys to staying fit, body and soul.

After his deployment, losing his sense of purpose was simply not an option for Farmer, a dual major in political science and journalism who had already embarked upon a career as a television reporter before shifting his focus to the study of law. Most challenged during this time in limbo, while he was jobless and awaiting the start of his second term at Liberty University School of Law, the young veteran relied heavily upon self-imposed regimentation and discipline to help him reintegrate into life outside the war zone.

“I always make the comment that not all service members come back damaged, but we all come back changed,” she comments. “The sights, the sounds and the smells of combat really don’t leave you for a long period of time.

— Catherine Wilson, U.S. Navy, retired, executive director of the Virginia Wounded Warrior Program (VWWP) and deputy commissioner of the Virginia Department of Veterans Services

“While I was gone, every day I’d wake up in the morning with a job to do. And then to come back and just have nothing to do, nobody to give direction to, nobody looking to you for direction, it was kind of a weird transition to go from feeling very, very useful to not useful in any way.”

He also observes that the most alienating experiences he’s faced upon his return have come in the form of well-intentioned misgivings about his emotional health— unwarranted concern, which he says breeds some apprehension that he will be forever branded as damaged.

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our health | VETERAN CARE

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VETERAN CARE | our health

sometimes before I’ll tell people I’m in the Reserves and have been deployed to Iraq,” he shares, observing that while far too many veterans do suffer from combat-related maladies, most do not.

Citing a statistic mentioned in a television commercial, he points out, “The fact that one of five people come home with post-traumatic stress disorder (PTSD) means that four out of five people don’t. And I worry about the stigma that’s being created from hyperawareness. It’s almost an assumption that people make when they hear that you’ve been on deployment or that you’ve served overseas. That’s affected me more than anything else because I’m one of the four out of five who were fortunate enough to come back without those kinds of issues.”

While sweeping generalizations might cause discomfort among veterans who are coping well, wider recognition of behavioral health issues commonly confronting servicemen and -women is essential to helping the multitudes who are in need. Left unaddressed, these enduring conditions may have dire consequences.

“How people readjust from those deployments and reintegrate into their lives, I think that can be a real challenge, whether you cope well or whether you choose avenues of poor coping mechanisms, which can lead to substance abuse, family discord, domestic violence or dangerous behaviors,” says Wilson.

For the many veterans who struggle with injuries they cannot overcome alone, seeking help is critical.

The survival rate on the battlefield has really improved,” Wilson observes. “But whether it’s a physical or an invisible wound, some individuals face a lifetime of struggle and hardship.

“The survival rate on the battlefield has really improved,” Wilson observes. “But whether it’s a physical or an invisible wound, some individuals face a lifetime of struggle and hardship.”

Wilson, whose work with the Virginia Wounded Warrior Program represents a robust outreach and support effort, encourages veterans to seek help in addressing any lingering effects of combat experience. The state-funded program offers five regional networks connecting veterans in need with counseling services and an array of treatment and employment resources.

Undiagnosed or untreated, she says, conditions such as PTSD or traumatic brain injury (TBI) may have dire consequences for service members and their families alike, and in some cases lie dormant for many years before manifesting themselves.

A widespread reluctance to admit the need for professional help, says Wilson, is one of the most daunting hurdles to overcome in providing care for veterans. Military culture in particular can send the message that soldiers and sailors should bear their emotional burdens in silence.

“There has been a negative stigma for many in seeking healthcare. There’s fear of retribution, fear of not being promoted at the normal pace or of somehow being perceived as weak. So I think changing the perceived stigma and really getting folks to seek behavioral healthcare are true challenges throughout the country.”

The absence of adequate intervention to address behavioral health problems may have consequences ranging from a failure to fully thrive to the most catastrophically self-destructive consequences. Wilson, who says that responding to the alarming rise in military suicides has become a top priority of the Virginia Wounded Warrior Program, notes that roughly half of these cases are among service members who have never been deployed to Iraq or Afghanistan.

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our health | VETERAN CARE

But the veterans of those conflicts who do find themselves in crisis, Wilson observes, may suffer from the stress of their combat experiences, often compounded by the rigors of multiple deployments in rapid succession.

During his 11½ months in Iraq, Farmer wasn’t insulated from the realities of these tragedies.

“We didn’t lose anybody to a combat injury while we were there. But we did unfortunately have a couple of suicides in the battalion, which is way too common right now.”

Pointing out that the health of communities throughout Virginia— whose population comprises a relatively high percentage of veterans—is enhanced when the critical needs of service members are served, Wilson remarks: “I think that in Virginia, we’ve really been a vanguard in trying to get integrated support services for our veterans and their families, because I think we’re just seeing the tip of the iceberg.” She adds, “We’ve been touted as a national model, but I think—more importantly—we’re just making a difference in the lives of our Virginia veterans and their families.”

For Joshua Farmer, now the Military Intelligence Officer for the 359th Transportation Battalion out of Fort Eustis, memories of the war zone will remain. But rather than looking back, he eagerly looks forward to being a first time father and his graduation from law school next May, offering this advice to veterans who have shared his experience:

“The most important thing is to keep yourself busy. If your mind and your hands are occupied, then I think that’s a big step in the right direction.”

For more information about the Virginia Wounded Warrior Program, please visit http://www.wearevirginiaveterans.org/

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WOMEN’S HEALTH | our health

Sharon Brown (left) and Ingrid Dunnaville at The White Hart Cafe in Lynchburg.

Spreading the Word words | SARAH COX

Sharon Brown and Ingrid Dunnaville are avid supporters of the Witness Project.

They both are survivors of breast cancer, and through this health education program go out into the community to help others.

Dunnaville is a 15-year survivor of breast cancer. She had had a mammogram in October 1998, and it came back fine. Then, the following March, she felt a lump through a breast self-examination. She went to the doctor the next day, and the cancer was confirmed.

Brown, the special events coordinator for the City of Lynchburg, was diagnosed on August 10, 1999. Her breast cancer was found through a routine mammogram. After her mastectomy she went for further testing and was found to have a gene that gave a 90 percent chance of the cancer reoccurring. Subsequently, she had her other breast removed.

The second recovery was more difficult. She was older, in a lot of pain and had an upset stomach. “I personally believe that my diagnosis was to help other people,” she says. “If I can encourage anyone to get a mammogram or check themselves, this is my mission in life. I have seen too many not survive, and I’m not here to sit around and do nothing.” www.ourhealthvirginia.com | 31

WOMEN’S HEALTH | our health

Dunnaville says she has had a hand in saving a life through the Witness Project, a program that was started in rural Arkansas, where the women were mostly African American. “Years ago, breast cancer was a hush-hush disease, and the people who started this program felt that they needed to go out in the community to witness to save lives. They trained us in Lynchburg to educate women on the importance of taking care of themselves.”

One evening, a group from the Witness Project in Lynchburg went to the Salvation Army. One of the ladies in the room went home that evening, did a self exam and discovered a lump.

“She said if we hadn’t come, she would never have checked herself,” says Dunnaville.

Brown, Dunnaville and others in the Witness Project go to churches, health fairs, colleges and women’s organizations.

They tell their stories, says Brown; they show a video about the original Witness Project and help spread the word.

According to the Witness Project, it is a “community-based program designed to increase breast cancer screening and promote the practice of mammography among underserved African American women.”

Witness Project has recognized that “among ethnic minority groups such as African American women, particularly in rural areas, there are barriers to participation in these screening activities.” Some of the barriers are economic, difficulty with transportation, lack of time, but also “psychological factors such as fear and fatalism, lack of knowledge and awareness of breast cancer, and misunderstanding of recommended screening frequency.

Factors such as these contribute to African American women’s higher rates of mortality in all stages of breast cancer, despite the fact that they have a somewhat lower incident rate of breast cancer overall.”

Women such as Dunnaville and Brown intend to change that.

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Summer Sawyer, DMD Children’s Dental Health of Lynchburg 7802 Timberlake Road • Lynchburg VA 434.239.6928 • www.cdhlynchburg.com

Routine dental checkups and standard home care will prevent a majority of severe dental problems. Sometimes patients will need treatment, and it is important that treatment is followed through. Addressing a dental situation at its earliest diagnosis is the key to keeping your mouth healthy, feeling great, and looking wonderful for a lifetime.

The health of your mouth reflects on the health of your body.

There are two big aspects of oral health: gums and teeth. Research has shown that gum disease is associated with several other diseases, such as diabetes, heart disease, and osteoporosis.

In addition, tooth decay is very destructive and can have serious implications. Both gum disease and tooth decay can destroy a beautiful smile and ruin self-confidence.

ADULT DENTAL HEALTH

James Lynde, MD Bedford Memorial Hospital 1613 Oakwood Street, Bedford 540.586.2441 www.bedfordmemorial.org

Mammography can potentially find life threatening breast cancer before it is clinically apparent. Pre clinical detection offers the greatest potential for cure. A woman's chance of getting breast cancer increases with age. Mammography screening should begin at age 40 unless you have strong family history of breast cancer, specifically mother, daughter, or grandmother. According to the American Cancer Society a woman's chance of developing breast cancer during her lifetime is 1 in 8.

MAMMOGRAPHY

*** P ick up the October/November 2013 PRINT edition of Our Health for the complete foldout!

Gary St.Clair, OD St. Clair Eye Care • serving 3 locations in Lynchburg, VA • 434.239.2800 www.stclair-eye.com

The rules for eye care are not gender specific. What is recommended for women also holds true for men and children. Our first eye exam should be between the ages of three and five. This is not solely for the purpose of prescribing eyeglasses, but primarily to rule out muscle imbalances, amblyopia(lazy eye) and eye disease. During the pre-teen and teenage years, we often see hereditary vision problems such as nearsightedness, farsightedness and astigmatism. These conditions can be corrected with eyeglasses and contact lenses. By the early to mid-forties presbyopia starts to sit in.

This is when we begin to have difficulty reading and seeing near objects. Multifocal glasses and contacts are often used to solve these vision problems. The sixties often bring on sight restricting opacities known as cataracts. If we all live long enough, we all will likely develop cataracts. Surgical removal is the only treatment for cataracts. Other aging maladies of the eye include glaucoma and macular degeneration.

Macular degeneration is usually a disease of the elderly; however, glaucoma can occur at any age.

Yearly exams are highly recommended not just for those who need eyeglasses, but for anyone to minimize the risk of sight threatening eye disease. I tell my patients the worse time to see me is when they can’t see!

OPTOMETRY

CHART for HEALTHY AGING

Women’s

Trends in Childbirth: WHAT’S OLD IS NEW AGAIN words | SUSAN DUBUQUE

Trends come and go. From skirt lengths and hairdos, to colors and music. Similarly, there are trends in childbirth. Although women have basically been giving birth the same way since the beginning of time, the environment and practices that surround the birth of a baby are ever-changing—and in some cases cyclical. Let’s zip back in time and explore the developments in childbirth in the U.S. through the last century.

In 1900, fewer than five percent of women gave birth in hospitals.

Physicians attended about half of all the nation’s births, including nearly all births to middle- and upper-class women. Lay midwives took care of women who could not afford a doctor.

The first maternity clothes were introduced in 1904 by Lane Bryant.

In 1914, “twilight sleep”—use of morphine and scopolamine to wipe out the memory of the pain of childbirth— was introduced into the United States and upper-class women formed “Twilight Sleep Societies” in an effort to force hospitals to offer the procedure. At this time, obstetrical anesthesia became a symbol of progress in medicine and women flocked to the hospital seeking pain-free childbirth.

The 1920s saw the establishment of professional training programs for nurse-midwives.

By the late 1930s, 50 percent of all women and 75 percent of urban women gave birth in hospitals.

The medical profession engaged in hot debate over the use of pain medications for childbirth.

During the 1950s, the concept of “family-centered maternity care” was first introduced, the La Leche League

our health | WOMEN’S HEALTH

was founded as the leading advocate for breastfeeding and Robert Bradley, MD, and Ferdinand Lamaze, MD, introduced their approaches to natural childbirth.

Christine Marraccini, MD with Women’s Health Services of Central Virginia

In the early 1970s, a combination of feminism and the back-to-nature movement led to a revival of midwifery. Many women proclaimed that childbirth is not a disease and that normal deliveries do not require hospitalization or supervision by an obstetrician. Husband demanded to be present for labor and birth—serving as “coaches” for their wives.

In 1980, midwives attended only 1.1 percent of births. By 2011, 7.8 percent of all births and 11.7 percent of vaginal births were managed by midwives—many with master’s degrees in nurse-midwifery.

The 1990s, brought another wave of painless childbirths with the introduction of epidurals. In 1995, Cesarean sections (C-sections) accounted for 21 percent of all births, trending upward to a high of 33 percent in 2009. Since 2011, the C-section rate has stabilized at 31 percent.

With so many developments in the past 100 years, let’s now explore the latest innovations—as well as tried-and-true childbirth practices—occurring right here in our community in 2013.

Sources: National Vital Statistics Reports; Center for Disease Control; The History of Midwifery and Childbirth in America: a Time Line, Midwifery Today; research on the History of Cesarean Sections conducted

by Dr. Sumac Diaz and presented at Wayne State University in August 2013.

Empowering Women Today, women have very decided opinions about childbirth—and Centra Health is responding to these consumer needs and wishes in a variety of ways.

Centra delivers more than 3,000 babies a year—2,600 at Centra Virginia Baptist Hospital in Lynchburg and 500 at Centra Southside Community Hospital in Farmville—each one providing an opportunity for a customized birth experience.

Christine Marraccini, MD, an OB/GYN who practices at Centra, notes, “One of the first choices an expectant mother will make is who will guide her through pregnancy and delivery.” Centra boasts an impressive cadre of 15 obstetricians and eight certified nurse-midwives who work in a collaborative practice.

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WOMEN’S HEALTH | our health

“Midwives specialize in natural childbirth—low-medical intervention, high-touch deliveries,” says Erin Baird, certified nurse-midwife. Obstetricians attend the full range of deliveries—from uncomplicated births to high-risk patients.

Throughout their hospital stays, patients are cared for by a team of experienced mother-baby nurses. Women are also welcome to have doulas and other support persons with them through labor and delivery.

Erin Baird is a certified nursemidwife in Centra’s Women’s Center

Safe and Warm Many mothers prepare detailed birth plans as a means of communicating their wishes to their healthcare providers. The birth plan might include the specific people whom the mother would like to support her through labor, soft lighting, soothing music, pain management techniques and the like. The plan could also articulate how the mother would like the baby treated—such as delayed cord clamping.

“We make every effort to support each patient’s preferences,” says Kim Price, RN, MSN, director of women and children’s services, “but always with an eye to safety for mother and baby.”

In addition to safety, comfort is also a high priority at Centra. Spacious birthing suites offer warmth and comfort in the security of a hospital.

Rooms feature private labor pools and showers. Intermittent and remote fetal monitoring ensure that baby’s progress can be tracked, while allowing the mother to walk around, use a birthing ball or even relax in the water during labor. Immediate access to a Level III neonatal intensive care unit (NICU) gives an added measure of assurance.

The use of pain medication is a very personal choice, and the doctors and midwives at Centra respect the decision a woman makes. “With or without

Kim Price, RN, MSN, is the Director of Women and Children’s Services at Centra

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our health | WOMEN’S HEALTH

medication, sometimes being patient and allowing nature to take its course can be the difference between a vaginal and a Cesarean delivery,” indicates Beard. Centra has achieved an enviable C-section rate of 21 to 23 percent—well below the national average.

Stacy Tribbett, RN, MSN, manager of Centra’s Birth Center

Similarly, Marraccini says, “We encourage women who wish to attempt a vaginal delivery after previously having C-section (VBAC). With anesthesia on hand 24/7, this truly is the safest environment for a VBAC.” “Skin-to-skin contact is the perfect way for mother and baby to bond in the first precious moments after birth,” says Stacy Tribbett, RN, MSN, manager of Centra’s Birth Center. “Rooming-in allows the new family to spend time together and to gain confidence in caring for the newborn.”

Getting Ready for Baby There are a multitude of ways for new parents to learn about and prepare for pregnancy and beyond, thanks to a broad selection of educational programs offered by Centra— from Great Expectations, Preparing for Childbirth and Breastfeeding, to Baby Care and Infant Safety. There is even a special class just for siblings.

Centra recently established a new Center for Childbirth and Family Education—a facility offering space for classes and support groups to meet and a kitchen for nutrition classes. Soon a garden will add even more opportunities to learn about healthy eating.

Centra’s Family Education Center

Certified lactation consultants and nurses are available to assist mothers with breastfeeding education before delivery and support while in the hospital. They will even provide telephone or in-person consults after discharge.

Centra was selected to participate in Best Fed Beginnings, a national initiative to encourage breastfeeding.

Soon Centra will be offering another leading-edge childbirth program called CenteringPregnancy®. Brenda Osterhus, RN, IBCLC, childbirth education coordinator, explains, “CenteringPregnancy is an innovative form of group prenatal care facilitated by a certified nurse-midwife, where women have an opportunity to learn and share with other expectant moms.”

Susan Dubuque is principal and co-founder of Neathawk Dubuque & Packett, a marketing and advertising firm based in Richmond, VA, that has a special group dedicated to healthcare and wellness. A nationally recognized speaker, Susan has published more than 100 articles on healthcare and service marketing, and has assisted more than 200 hospitals and healthcare organizations with marketing and branding initiatives. Author of two books, A Parent’s Survival Guide to Childhood Depression and Kid Power Tactics for Dealing with Depression, she launched a national campaign to increase public awareness of childhood depression.

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Personalization is the hallmark of a progressive childbirth service—and today women are fortunate to have abundant choices. But if you think the latest trends like birthing balls and laboring pools are mere fads, think again. Women are reaffirming the notion that childbirth is a beautiful, natural occurrence—not an acute medical event. They are playing an active role in planning their pregnancies and deliveries.

Conducting thoughtful research and doing their homework. And along with childbirth professionals—they are continually seeking better ways to ensure the safe delivery of healthy babies. And that’s a trend we can all embrace.

To learn more about the innovative, family-friendly childbirth services available in our community visit centrahealth.com.

HealthyEats LT HEA

T OMFOR C Y H

FOODS

Pumpkin Soup makes 4 servings

5. Remove any rosemary and bay leaves then pour a third of the soup in the blender with a third of the yogurt and puree.

Directions:

1. In a large saucepan, heat olive oil and cook the onion without browning, for three to four minutes.

2. Add pumpkin, carrot and rosemary and cook, stirring for two to three minutes.

6. Transfer into a large bowl. Repeat with the remaining soup and yogurt and pour the whole lot back into the saucepan, heat through and serve.

3. Add stock and bay leaves.

Ingredients: 1 tablespoon olive oil 1 onion, chopped

4. Bring to a boil, cover and simmer for twelve to fifteen minutes until vegetables are tender.

16 ounce can of unsweetened pumpkin puree 1 carrot 3 sprigs fresh rosemary 4 cups chicken stock 3 bay leaves ¾ C plain Greek yogurt

Tricia Foley’s

HEALTHY PUMPKIN SOUP Tricia Foley is Our Health Magazine’s resident nutritionist

HealthyEats LT HEA

FORT FOODS M O C HY

Cauliflower “Mac” & Cheese: makes 8 to 10 servings

Ingredients: 2

16-ounce bags of frozen cauliflower or two heads of cauliflower

8 ounces 2% cream cheese 4 tablespoons light, unsweetened coconut milk 3 cups reduced fat (2%) shredded cheddar cheese

salt & pepper to taste

Directions:

1. Steam the cauliflower until tender and drain the extra water.

2. In a 9x13 casserole dish soften the cream cheese in the microwave.

3. Whisk in the coconut milk until smooth then stir in two cups of the reduced fat cheddar cheese.

4. Microwave until the cheese is melted.

5. Add salt and pepper and mix well.

6. Add the cauliflower and stir to coat.

7. Top with the remaining one-cup of cheese and bake at 350º degrees for thirty-five minutes until brown crust is present.

Tricia Foley’s

CAULIFLOWER “MAC” Tricia Foley is Our Health Magazine’s resident nutritionist

HealthyEats LT HEA

FORT FOODS M O C HY

Pork and Veggie Stir Fry: 4 Servings

Ingredients: 1 cup water 4 Mandarin Orange Flavor Tea Bags 2 Tbsp. low sodium soy sauce 2.5 teaspoons honey 1/2 teaspoon molasses 2 Tbsp. coconut oil, divided 16 ounces pork tenderloin, cut into thin strips 1 package (16 oz.) frozen stir-fry vegetables, thawed (including your choice of sugar snap peas, water chestnut, peppers, onions, baby corn, carrots, etc 1 clove garlic, finely chopped 1/2 teaspoon ground ginger

Directions:

1. Bring water to a boil over high heat in a large saucepan. Remove from heat.

2. Add mandarin orange flavor tea bags; cover and brew five minutes. Remove tea bags and squeeze; cool slightly.

3. Stir in soy sauce, honey and molasses and set aside.

4. In a twelve-inch nonstick skillet heat one-tablespoon coconut oil over mediumhigh heat. Then add the pork, stirring occasionally, four minutes or until lightly brown; remove and set aside.

5. Heat the remaining coconut oil in same skillet and cook vegetables, stirring frequently, four minutes or until crisp.

6. Add garlic and ginger and cook, stirring occasionally, about one minute.

7. Stir in tea mixture. Bring to a boil over high heat and cook, stirring occasionally, 1 minute or until sauce is thickened.

8. Return pork to skillet. Reduce heat to low and simmer 2 minutes or until pork is done.

9. Serve, if desired, with brown rice.

Tricia Foley’s

PORK & VEGGIE STIR FRY Tricia Foley is Our Health Magazine’s resident nutritionist

DOCS OFF DUTY | our health

Healing Words

words | RICH ELLIS, JR.

“Kate is a brilliant trauma surgeon. She has dedicated her life to working to save others in a quest to atone for a tragic mistake in her past.

A recovering alcoholic, estranged from her father, she has closed herself off from others, afraid to hurt them or be hurt by them. But when she is forced to help one of her patients, a prisoner, break out of the hospital, her carefully built walls begin to crumble.”

Write what you know. That’s the advice Huddleston, VA, resident Elizabeth Cook, MD, followed when she penned her first novel— Dirty Wounds—the synopsis for which appears in the two paragraphs above, written by her. The book is self-published and debuted in July. In addition to being an author already at work on Dirty Wounds’s sequel,Dr. Cook is also a physician at Medical Associates of Central Virginia in Lynchburg—neither of which would seem all that unique until you realize that she didn’t set out to be either.

In the bio appearing on her book’s website—docnovelist. com—Dr. Cook says that being a physician was never a lifelong dream. In fact, she hated science in school. She also never thought she’d be a novelist, preferring instead to write shorter screenplays.

“I wasn’t sure I’d have the attention span to write an entire novel,” she explains. “I decided this past year just to tackle it and see what happens, see what came out, and what came out is pretty decent, according to the feedback I’ve been getting.”

Dr. Cook says that writing the novel didn’t turn out to be as hard as she thought it would be, despite having some initial concerns about whether she would be able to get it to the length that her editor was recommending. Her first draft, which she

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our health | DOCS OFF DUTY

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DOCS OFF DUTY | our health

wrote in only about four months, was 36,000 words, but 60,000 words are generally considered commercial fiction length.

“Once I got the ball rolling and really got into the characters and fleshing out details and that kind of thing, it really just expanded and I was pleasantly surprised at how easy it was,” Dr. Cook explains.

Writing a book wasn’t something she’d always wanted to do, even though she enjoyed writing in high school and college.

“I wasn’t like, ‘Someday, I’m going to write the great American novel.’ I get these characters and stories in my head and they just develop and I think that’s why I was drawn to television—I just love to tell stories. Whether they’re true stories about funny things that happen at work or things that I make up, it’s just fun to tell stories and entertain people.”

The story, she explains, began with the character and what drives people.

“We all have our hidden agendas and paths that play a role in who we are today,” Dr. Cook explains. “It explores that and is a story of redemption and a reluctant hero. It started with the main character and the story just was a way to explore that character further.”

Sales, to date, have been primarily via word of mouth, and Dr. Cook says she’s been overwhelmed by the response.

“It’s been really humbling and touching to see how much people are enjoying it and having fun with it, which is really what I wanted. It’s not one of these great literary masterpieces, and it’s not going to change the world. It’s just a fun little story that’s easy to read and reads fast. I wanted people to really like the characters and engage with them.”

I didn’t have any type of timeline. I didn’t have any high expectations. It was fun to write it. I could just disappear into this world and create it, although I didn’t know if it was going to see the light of day.

I was just having fun putting it on paper.”

The book is available on the various e-reader platforms as well as at docnovelist.com.

When she isn’t writing or practicing medicine, Dr. Cook can probably be found on or near her 145-acre farm, trail running, kayaking on Smith Mountain Lake, mowing the grass or watching her two husky-shepherd mixes play in the pond. She also likes to drive fast—without the threat of receiving a ticket—which is how she recently found herself in Atlanta participating in a high-performance driving event, where she hit 130 mph on the straightaways. “It’s a good adrenaline rush and a way to have some fun.”

The most difficult part of writing the book, Dr. Cook says, was actually having the courage to write and publish it.

“I had a few people read it and tell me that it was really good. But to actually put it out there feels very personal. It’s you and your book, your story, for a long time and you’re really invested in these characters; you care about them but you don’t know if anyone else will care about these people. That’s really the most scary and intimidating part for me—putting it out there.” www.ourhealthvirginia.com | 45

our health | DOCS OFF DUTY

Not finishing the writing of Dirty Wounds was never a consideration. However, there were weeks when she wouldn’t work on it at all, simply because she’s not good at forcing her writing, and then other weeks when she’d write every night for two or three hours.

“I didn’t have any type of timeline. I didn’t have any high expectations. It was fun to write it. I could just disappear into this world and create it, although I didn’t know if it was going to see the light of day. I was just having fun putting it on paper.”

One aspect of the book that was very important to her was that it be medically accurate.

“One of my pet peeves with medical fiction, on TV or in books, is if it’s wrong or inaccurate and you’re like, ‘that would never happen.’ So I went to great lengths to ensure that everything in the book that’s medically based is accurate and could really happen in real life. I’ve received great feedback from medical people who’ve read it.”

When asked if she has any final thoughts about the book or about writing it, Dr. Cook says, “I’m just kind of a simple girl having fun in life. And if people ask me my great advice in life, it’s just to go for it. If it’s something you care about and love to do, don’t worry about what people think, just do it. Don’t wait. Just put it out there and see what the world’s response is. And if they don’t like it, who cares, if you had fun doing it—as long as it’s not illegal!”

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KIDS CARE | our health

It’s a Way of Life

Karsen Burgess of Lynchburg is a student at James River Day School

words | SARAH COX

These children are active, sassy, athletic and, well, normal. Except that they have Type 1 diabetes. The American Diabetes Association explains Type 1 as “usually diagnosed in children and young adults, and was previously known as juvenile diabetes.

In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.”

For Karsen Brooke Burgess, age 11, and Sam Hall, age 10, life is not as simple as it used to be. But both children have learned to live with this great life alteration—well, they have to—as nonchalantly as possible.

Sam had gone on a trip to Great Wolf Lodge in Charlotte, NC, an indoor water park, where his mother noticed that he was using the bathroom a lot. She thought he might have a urinary tract infection. Three or four days later, recalls Sam’s dad, Daren Hall, Sam was staying with Hall’s father, who is 77 years old and has type 2 diabetes. The grandfather also noticed Sam was using the restroom a lot. He checked Sam’s blood www.ourhealthvirginia.com | 47

our health | KIDS CARE

sugar, which was “through the roof,” says Hall, and the grandfather took him to the emergency room.

He stayed in the hospital that day, and was later discharged with an instruction manual and insulin. Hall was at a loss. He got in touch with a specialist out of Greensboro, took Sam to see him, and the specialist readmitted him to the hospital for a week.

Things have settled down now, a year and a half later, but there are challenges. Sam is growing rapidly—he was 4’2” and 55 pounds when he was diagnosed and is now 4’8” and almost 80 pounds. To further complicate matters, Sam goes between his dad and stepmother’s house, his grandparents’ house and his mother’s. While all are working cooperatively and closely to monitor Sam’s insulin level, they are all on-call 24/7, says Hall, who has missed a lot of work to go to education and training sessions.

He keeps up with Sam’s supplies, makes sure he has what he needs when he goes to school or his grandfather’s or on vacation out of town. It’s not a disease that goes away; it is a disease that is always with Sam. This year, Sam switched from taking shots to using the insulin pump. For Sam, it’s nice not having to leave the cafeteria or the classroom or the ball field to give himself a shot. But when his sugar is high during a game, “I have to plug up,” he says.

Hall says his son is very active, playing basketball, baseball and golf. He also swims

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KIDS CARE | our health

and rides bikes. Sam says he tries not to let the diabetes get in his way too much, “but sometimes it’s kind of hard.”

Karsen, who is in sixth grade at James River Day School, was diagnosed two years ago. Karsen, as her dad, Todd Burgess, explains, had always been a happy-go-lucky child, but suddenly she was irritable and had extreme thirst.

One night Burgess did an Internet search for these symptoms and what he found was devastating. Karsen’s mother took her to the doctor the next day, and then called her husband sobbing. Karsen was sent straight to the emergency room; her blood sugar was over 400.

“When your blood sugar is that high, you’re not in a very good mood. Her attitude had gotten so bad that we had actually decided to cancel my vacation that was coming up the next week,” he says.

Karsen recalls that she was always tired.

“I didn’t want to do much. I went out one day to play tennis with my mom, and within 10 to 15 minutes, I was ready to go,” she says.

What followed changed the family’s routine and their lives. Her mother cut back on her work hours and took Karsen’s lunch to school daily. Karsen’s older brother, who was 12 at the time, was really upset. “It was an end-of-the-world type of feeling,” says Burgess. “You are constantly walking an insulin-tightrope. My wife, after two years, is just now coming out of that fog. It is non-stop, hour by hour, day by day.”

Sam Hall of Lynchburg with his dad, Daren Hall

He says now that the first six months were a tragedy to his family. But the family’s diet has completely changed, for the better says Burgess. A lot more organic, a lot less carbs. Karsen was also diagnosed with an inflammation of the eyes as well as something that lay people refer to as “leaky gut.”

Karsen sees a nutritionist due to these other complications. She has no dairy in her diet now, and six months after eliminating dairy her eye inflammation was gone.

She has to count her carbs every day, puts snacks (SweeTarts) and juice boxes in her www.ourhealthvirginia.com | 49

our health | KIDS CARE

backpack and checks her insulin several times a day. She is now on the pump, which she changes every three days.

Karsen says her friends have been very accepting of this. While she likes the pump, which is much more convenient than shots, sometimes it gets “kind of annoying in gym.” If her sugar gets low, she has to sit out gym. And she has learned to be responsible, checking her sugar and counting her carbs 45 minutes after her snack. Karsen, who has thought about having this the rest of her life, says she hopes they will find a cure. Her message to other children out there who have been diagnosed is to “stay strong and take care of yourself.

Don’t let it take away from anything.”

“Team Hall”, made up of Sam’s friends and family, at the Juvenile Diabetes Research Foundation walk in Danville this past September

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According to the Juvenile Diabetes Research Foundation (JDRF), of which Burgess is on the Greater Blue Ridge Chapter’s board of directors, “the prevalence of [type one diabetes] in Americans under age 20 rose by 23 percent between 2001 and 2009. The rate of [type one diabetes] incidence among children under age 14 is estimated to increase by three percent annually worldwide. [Type one diabetes] accounts for $14.9 billion in healthcare costs in the U.S. each year.”

MAKING OUR CHILDREN HEALTHY VIRGINIANS words | EDWIN SCHWARTZ

In 2004 Governor Mark Warner’s administration launched the Healthy Virginians initiative. The program’s mission is to promote healthy lifestyles in state government offices, in Virginia schools and among families who receive healthcare through Medicaid.

Healthy Virginians was created in part to allow schools to address the epidemic of childhood obesity. Over the past 20 years, the number of overweight children nationwide has almost doubled, while the number of overweight teens has tripled.

Each year in Virginia more than one in three people diagnosed as obese are children.

Other alarming trends have developed as well. More than a third of young people in grades 9–12 do not regularly engage in vigorous physical activity. Chronic diseases such as hypertension and Type 2 diabetes now appear in children as young as eight years old. And overweight children now have a 70% chance of being overweight as adults.

Healthy Virginians addresses these issues with two initiatives to create better nutritional and physical environments for students — the Governor’s Nutrition and Physical Activity Award program and the School Breakfast Program.

Under the Governor’s Nutrition and Physical Activity Award program, Virginia’s public schools can earn a bronze, silver or gold award for best practices that promote healthy lifestyles. These practices include providing a daily minimum of 30 minutes of www.ourhealthvirginia.com | 51

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physical activity; encouraging students to design individualized exercise plans; selling only 100% fruit juice, low-fat milk or water; creating Fitness or Nutrition Nights; and during the school day providing or selling only foods that meet minimum nutritional standards. Data for the most recent school year show 278 awards have been earned — 35 gold, 123 silver and 120 bronze.

The Department of Education administers this program, which includes an interactive, web-based scorecard that allows schools to measure their progress and receive recognition for meeting their goals. Schools may also compete locally and statewide as they earn points to see which is healthiest.

“More than 900 public schools in 114 school divisions in Virginia have participated in the Governor’s Award program,” says Joe Hilbert, director of Governmental and Regulatory Affairs at the Virginia Department of Health. “The scorecard for the award serves as a resource for best practices in physical activity and nutrition for schools. And school divisions have used it to assist in the development and implementation of their local wellness policy.”

“The best practice standards for nutrition will be revised in the near future to incorporate new research and regulations,” says Hilbert, “including the recently released federal ‘Smart Snacks in Schools’ standards and the revisions to the state regulations for the sale of à la carte foods.”

The School Breakfast Program was designed to help improve academic performance, quality of nutrition and attendance. In 2003–2004, less than 28 million breakfasts were served, while that number increased to more than 44 million in 2011–2012.

Since the Healthy Virginians breakfast incentive funding began, the number of public schools that offer breakfast and lunch has increased by nearly 11%.

Since 2004 the Healthy Virginians has also allowed for collaborative activities among numerous state government agencies, local school divisions and community organizations. “In addition to the Governor’s Nutrition and Physical Activity Award Program administered by the Department of Education, the Virginia Foundation for Healthy Youth (VFHY) and the Virginia Department of Health (VDH) have both engaged in extensive programmatic efforts,” says Hilbert.

“The mission of VFHY is to lead statewide efforts to reduce and prevent youth tobacco use and childhood obesity,” says Hilbert. VFHY hosts the Weight of the State conference, where national, state and local experts share the latest community-based approaches to childhood obesity prevention.

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On May 15, 2013, VFHY hosted the first Rev Your Bev Day. “Throughout the day, more than 175 events were held across Virginia with the purpose of encouraging youth, families and communities to revamp their drinks and increase awareness of sugar-sweetened beverages,” says Hilbert. “Events were held by public schools, YMCAs, faith-based organizations, healthcare providers, afterschool programs and universities.”

In 2012 Governor Bob McDonnell signed a proclamation to recognize the first week in May as Screen-Free Week in Virginia. This measure is meant to help unplug children from televisions, computers and electronic devices. “VFHY has led the annual celebration encouraging schools, families and communities to turn off screens and explore other ways to spend free time together,” says Hilbert.

Each October since 2010 VFHY partners with the Virginia Department of Transportation to focus on Walk to School Day. In 2012 VFHY partnered to host 50 events throughout the commonwealth.

“Hosting events across the state, VFHY has emphasized safe walking and biking to and from school as a way to create environments that promote physical activity for students and communities,” says Hilbert.

The VDH administers the Healthy Eating and Active Living (HEAL) program to prevent obesity and other chronic diseases. “In 2013, the HEAL program awarded 17 mini-grants to local health districts to implement evidence-based or evidence-informed programs designed to promote healthy eating and active living and to prevent obesity,” says Hilbert. Partnering with the Department of Education, HEAL provided funding to pilot WELNET, an online fitness assessment and Five for Life, a K–12 physical education curriculum for students.

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prevention efforts and strategies. “It is developed as a modified version of the Youth Risk Behavior Survey to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability and social problems among youth and adults within the commonwealth of Virginia,” says Hilbert.

The survey is voluntary and measures behaviors related to unintentional injuries and violence, physical activity, alcohol and drug use, dietary behaviors and tobacco use.

“According to the 2011 survey, 11.1 percent of Virginia public school students in grades 9–12 were obese, compared to the national rate of 13%,” says Hilbert.

Looking forward, the Healthy Virginians initiative continues to innovate to meet the physical and nutritional health needs of Virginia’s public school children. In 2010, at the direction of the secretary of Health and Human Resources, VDH and VFHY convened an interagency Childhood Obesity Task Force. “The Task Force recognizes that state government has a role to play in promoting the health of all Virginians because obesity and poor nutrition are significant public health issues with wide-ranging implications,” says Hilbert. “The Task Force is in the process of finalizing a Plan for Obesity Prevention and Healthy Nutrition that will include strategic goals, key principles, objectives and potential initiatives.”

In addition to children’s health, the commonwealth is focused on improving Virginians’ health at all ages. The Virginia Department for Aging and Rehabilitative Services’ Chronic Disease Self-Management Program “You Can! Live Well, Virginia” empowers individuals with chronic diseases to improve their overall health and maintain an active lifestyle. Also, the Department of Human Resource Management administers the CommonHealth program to promote health and wellness among state employees.

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REHAB | our health

AlterG: A treadmill for the rest of us words | RICK PIESTER Rehab Therapists Demonstrate AlterG anti-Gravity Treadmill. Left to Right: Michelle Davidson, Case Manager at Lynchburg General Hospital; Cynthia Smith, Administrator of Appomattox Health & Rehabilitation Center; Bartlett Gowen, Rehab Therapist; Drew Gowen, Rehab Therapist; and Dr. Al Abaidoo, Rehab Therapist.

Dianne Eanes defied gravity in Lynchburg.

When she spent a month at the Lynchburg Health & Rehabilitation Center following the simultaneous replacement of both of her knees this year, a portion of her physical therapy routine was spent on an AlterG AntiGravity Treadmill, a centerpiece of the center’s brand new therapy gym.

The AlterG is pretty much the treadmill for people who can’t use treadmills.

It looks very similar to a conventional treadmill, complete with a wide moving belt and a panel of electronic controls to alter the speed of the belt, the incline of the treadmill’s bed, and other variables. But the big difference is that the AlterG also has an airtight chamber that encases the hip area of the user’s body. To use the apparatus, you step into a pair of neoprene shorts — something like the material used for wetsuits that skin divers wear. The shorts are zipped into the airtight chamber, which www.ourhealthvirginia.com | 55

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looks something like a very well made rubber bag. Then the chamber is inflated with air, and your body suddenly takes on a pleasant buoyancy. In effect, you become lighter as more and more air is inflated.

The “reduced” body weight allows the user to walk, jog or run pain-free because the impact of movement on joints and muscles is greatly reduced. It removes a lot of obstacles in the way of recovering from such surgeries as knee or hip replacement.

Developed by NASA to help astronauts stay fit in zero-gravity atmosphere, it’s the only equipment of its kind within hundreds of miles of Lynchburg.

Mrs. Eanes first came to know of the capabilities at Lynchburg Health & Rehab when her late husband Walter was a patient there. During a lengthy illness, her husband suffered a fall, broke a hip and went there for rehabilitation.

“The people here were so good to him,” she says of her late husband’s stay, “in many ways, it was the best part of his life during his final years. I don’t think there’s any other place like it.”

As her husband’s caregiver during his eight-year illness until his death in January 2012, Dianne Eanes punished her already-bad knees. “I never had been good to my legs,” she says. “I loved dancing, and I had arthritis in my hips and knees for quite some time.” She walked very gingerly, planning her steps to avoid falling. But still, she fell several times within three months, dislocating her shoulder with a fall.

“It got to the point where I had bone-tobone contact in my right knee, which was the worst knee, and my doctor said that if I just had that one knee operated on, my left knee would not be strong enough to carry me.”

So she and her physician, orthopaedist Robert W. Sydnor, MD, scheduled her surgery (medicine calls it “bilateral” because it was to be surgery on both knees at the same time) for June of this year at Centra Lynchburg General Hospital, leaving her some time to plan her recovery.

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“I had about two months before the operation,” she says “I took the knee replacement classes at Centra, and I tried to check out every place I could go for rehabilitation.”

She learned that many of the same people who had cared for her late husband were still at Lynchburg Health & Rehabilitation, and she carried many glowing memories of Walter Eanes’ care there.

Her stay at the center began on June 29. Along with daily exercises to build range of motion, strength and balance, part of every day was spent on what she came to call her “bubble machine” because the inflated air chamber on the AlterG does resemble a bubble.

The AlterG can reduce body weight by as much as 80%, with the highest reduction coming at the start of a recovery, and then Mrs. Eanes bore more of her own weight as her treatment progressed over time. “It took a little getting used to,” she says with a smile, “but it does help your overall demeanor to lose 50 pounds all of a sudden.”

She seemed to take well to the therapy, even doing a little running with the help of the AlterG. “At least it was my kind of running,” she laughs. “I hadn’t walked that fast in many, many years.”

Discharged from the rehab center and still going to therapy twice a week in late summer, she says that she feels she did exactly the right thing. Her physician, Dr. Sydnor, was “amazed at my progress,” she notes. The experience has given her inspiration to stay more active and physically fit. But she still has to take it easy a little bit: “Being with four young grandchildren at my daughter’s house almost makes me forget that my knee’s aren’t perfect yet.”

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COMFORT AND PEACE | our health

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