APRIL • MAY 2014 | OURHEALTHVIRGINIA.COM
table of contents | april • may 2014
28 MEDI•CABU•LARY.....................12 Local experts define health related terms
JUST ASK!.......................................14
Cover Feature In Loss and Life
Even in their darkest moments, the Myers’ family, of Roanoke, found triumph over tragedy
Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............16 A listing of new physicians, providers, locations and upcoming events in Southwest Virginia
HEALTH POINTS.........................18 Interesting facts and tidbits about health
AMAZING ANATOMY ................21 How much do you about our anatomy? Check your knowledge when it comes to our vascular system!
WHEN SURGERY CAN HELP...................................... 22 The Road map Left Behind
hello, HEALTH!
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Capturing the spirit of those working in healthcare and of people leading healthy lives through photos
THE EXPERIENCE OF SENIORS.................................. 44 Welcome Change: It is inevitable
DOCS OFF DUTY......................... 56 Dr. Dennis Garvin and his Angel Augie
NUTRITION.................................. 43 FEATURING HEALTHY, FRESH, LOCAL INGREDIENTS: Roasted pork loin with green beans, kale and quinoa salad with dates, almonds and citrus dressing, spinach and an apple smoothie
The Resource for Healthy Living in Southwest Virginia
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Growing Up: Cochlear Implants give One-Year-Old Ability to Hear On September 18, 2012, Vinton residents Rick and Laura Scott watched their then 17-month-old son being rolled into an operating room in hopes for a new life for him.
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The Rewards of Working in Healthcare
Healthcare workers trade places for a day. You can’t really appreciate another person’s life until you’ve walked a mile in their shoes.
LOOKING BACK........................... 98 Images reflecting the history of healthcare in Southwest Virginia * PLUS * A CHANCE TO WIN PRIZES!
The Resource for Healthy Living in Southwest Virginia
april • may 2014
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CONTRIBUTING MEDICAL EXPERTS
Maggie Belton, DO Cal Buck Dane McBride, MD Michele Mills, DDS Colleen Mitchell, OD Andrew Pieleck, DO
CONTRIBUTING PROFESSIONAL WRITERS
Becky Blanton Tina Joyce Laura Neff-Henderson Rick Piester
ADVERTISING AND MARKETING Kim Wood | P: 540.798.2504 kimwood@ourhealthvirginia.com
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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor: 305 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Information in all print editions of Our Health and on all Our Health’s websites (www.ourhealthvirginia.com and www.ourhealthrichmond.com) social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2014 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Southwest Virginia edition is published seven times annually by McClintic Media, Inc. 305 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthvirginia.com | www.ourhealthrichmond.com | Advertising rates upon request.
LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is campylobacter?
What is reactive arthritis?
Campylobacter is one of the most common causes of gastrointestinal infections. Symptoms usually include fever, diarrhea, and abdominal pain. Improperly cooked meat and poultry is the most common source of infection but the bacteria can also be found in animal feces, contaminated water, and unpasteurized milk. Exposure can occur several days prior to symptoms. Symptoms last about one week and are usually mild and self-limiting; however in severe cases antibiotics may be prescribed. Staying hydrated is the most important treatment. Your physician may check a stool culture for diagnosis. Children more commonly have bloody diarrhea and vomiting than adults. Children should avoid daycare until asymptomatic. Adults should not handle or prepare food until resolution of symptoms. Tips to avoid campylobacter infections include: wash hands frequently and thoroughly with soap and water. Avoid unpasteurized dairy products, undercooked poultry, and wash all utensils and cutting boards thoroughly if used on raw meats.
Reactive arthritis is an arthritis that happens after an infection. It typically affects people who had food poisoning, another kind of infection of the intestines, or a sexually transmitted infection. Reactive arthritis is very uncommon, and typically occurs in young adults. It can show up with pain and swelling in one or many joints, anywhere from a few days to several weeks after the infection. Reactive arthritis can also cause inflammation and pain of muscles and tendons, irritation of the eye, as well as pain with urinating. There is no test to diagnose reactive arthritis. But if your physician can figure out what germ caused the infection, he can tell if you have reactive arthritis. Initially, it is treated with antiinflammatories but sometimes requires other types of medications, such as a steroid shot. While most people get better quickly, they may continue to notice constant or intermittent symptoms for some time.
Maggie Belton, DO
Medical Associates of Southwest Virginia Blacksburg | 540.552.8564 www.medicalassociatesswva.com
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Andrew Pieleck, DO
Centra Medical Group - Village Bedford Memorial Hospital Bedford | 540.297.7738 www.centrahealth.com
Why do I need an oral cancer screening? Oral cancer is the sixth most common cause of cancer. Of all major cancers, oral cancer has one of the worst five-year survival rates at about 57%. Dentists do oral cancer screening at the patient’s check-up visit. If oral cancer is caught early enough, the chances of survival increase to 80%! Oral cancer is typically painless in its early stages. If you notice a sore, red/white spot or lump in your mouth that persists longer than two weeks, call your dentist to have it checked. While the number of new cases and deaths has slowly decreased, the number of new cases caused by the Human papillomavirus (HPV) is on the rise. We do not yet know the exact cause or oral cancer. However, tobacco products, heavy alcohol consumption and HPV infections are considered risk factors. Michele Mills, DDS
Mills and Shannon Dentistry Salem | 540.989.5700 www.millsandshannon.com
H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
My night vision is awful. What can I do about the “halos” I see around lights at night? The most common cause for poor night vision is related to the size of your pupil. In good lighting, the pupil is small, which helps focus light to a pinpoint. In dim lighting, the pupil is larger. This allows more light to scatter, instead of having a precise focal point. If your glasses are dirty or scratched, or if your prescription is incorrect, the light rays scatter even more, causing blur, glare, and halos. Most night vision problems can be solved with a new pair of glasses with an anti-reflective treatment. Solving halos and glare may be as simple as updating your eyeglass prescription! Keep in mind that poor night vision can be caused by many things. Schedule a comprehensive eye exam to determine what is causing your halos. Colleen Mitchell, OD
Blacksburg Eye and Associates Blacksburg | 540.953.2020 www.blacksburgeye.com
I have bad knees. Are there any cardio-related exercises for me?
Does overly dry air impact allergy symptoms in the winter?
Exercise may be the best medicine for those with knee pain. Strengthening the muscles around the joint actually decreases stress on the knee. Swimming, water aerobics and even low-impact cycling are great ways to strengthen your leg muscles and improve your cardiovascular health, while being gentle on your knees. You can also consider walking on a treadmill, rowing, or low-impact step aerobics. The key is finding an exercise you like that doesn’t cause discomfort. You should pick an activity that keeps you in pain-free ranges of motion, and avoids heavy lifting and high repetitions. Start with just 5 minutes of exercise, and progressively increase in duration. Your goal should be to get up to 30 minutes of cardiovascular activity 3-5 days per week.
For people with allergies, humidity is a two-edged sword.
Cal Buck is the Wellness Director of the Kirk Family YMCA and a National Academy of Sports Medicine (NASM) Certified Personal Trainer. Cal Buck
Wellness Director Kirk Family YMCA | 540.342.9622 www.ymcaroanoke.org
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High humidity enables the growth of molds and tree and grass pollens. However, if humidity falls below 35%, our nasal and other respiratory membranes become dry, and we lose the protective moistness of a thin mucous blanket. Thus, we damage our first line of defense against viruses and other indoor allergens not dependent on humidity. When outdoor humidity drops in the winter, our indoor humidity can drop quite low. What to do? The best solution is to use singleroom humidifiers with a humidity gauge, so that the device can be turned off if humidity exceeds 50-55% and turned on if it falls below 40%. Humidifiers must be cleaned regularly, so that they do not become sources of allergy and disease themselves. Dane McBride, MD
Asthma and Allergy Center Roanoke | 540.343.7331 www.asthmaandallergycenter.net
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Jefferson College of Health Sciences Partners with New River Community College and Virginia Western Community College to Sign Articulation Agreements Jefferson College of Health Sciences recently signed articulation agreements with New River Community College for the Healthcare Management and Respiratory Therapy Programs, and with Virginia Western Community College for the Respiratory Therapy, Health and Exercise Science and Health Psychology programs. These partnerships will help to pave the way for the community colleges’ students to seamlessly enter programs at JCHS, continuing their education to the bachelor’s level and beyond. JCHS is an affiliate of Carilion Clinic. For more information, contact Mark Lambert, Coordinator, Communications and College Relations, Jefferson College of Health Sciences via phone at 540.985.9031 or email at malambert@jchs.edu.
New Name, New Channel and New Time—
But Still the Same Joy Sutton!
The Joy Sutton Show to premiere on WDBJ7. Joy Sutton and her team of lifestyle specialists are proud to announce Season Three of the hit talk show “The Joy Sutton Show.” Formerly “The Hour of Joy”, Joy and her team are proud to announce their new name, new channel and new timeslot. “The Joy Sutton Show” will premiere on the CBS affiliate station WDBJ7 on Sunday, April 6th at 11:30 a.m. This 30 minute show will not only provide women with the weekly inspiration they need to live fulfilling lives, but will allow Joy to return to her hometown station where she worked for over 11 years as an anchor and a reporter. Following suit with the previous seasons, Season Three will feature life-changing stories and the signature “Real Talk” and “You” segments. Expert panelists will participate in shows to discuss topics from all aspects of audience members’ personal and professional life. From beauty, fashion, fitness, career, family, and love—the show is designed with the modern woman in mind. Avid fans have three ways to watch her talk show—Sundays on WDBJ7 at 11:30 am, live streaming on the web at www.wdbj7.com/Joy, or Sundays on MY19 at 6:30 p.m. For more information about “The Joy Sutton Show” please visit website www.wdbj7.com/joy.
Blacksburg Eye Associates has moved to a new facility Blacksburg Eye Associates has moved to a new, larger facility with expanded optical, and the same great service! Visit them in their new location in the First & Main Shopping Center, 1440 South Main Street, Blacksburg, 540.953.2020 www.blacksburgeye.com
Samuel Arnold, FNP
Tina Cadden, PT
Paula Janey, NP
Jenna Kellstrom, PA-C Kennie Koelsch, NP
Colleen Mitchell, OD
Christopher Rippel, MD Michael Rowland, MD
Carilion Clinic Family Medicine Fort Defiance | 540.248.3413 www.carilionclinic.org
Ben Hopkins, DPT
Lucas Therapies, PC Physical Therapy Roanoke | 540.772.8022 www.lucastherapies.com
Carilion Clinic Obstetrics and Gynecology Roanoke | 540.985.9862 www.carilionclinic.org
Blacksburg Eye Associates Optometry Blacksburg | 540.953.2020 www.blacksburgeye.com
Lucas Therapies, PC Physical Therapy Roanoke | 540.772.8022 www.lucastherapies.com
Carilion Clinic Family Medicine Vinton | 540.983.6700 www.carilionclinic.org
Urology Associates Urology Roanoke | 540.343.8066
James Daucher, MD Blue Ridge Urogynecology Urologynecology Roanoke | 540.904.2845 www.brurogyn.com
Abraham Hardee, DO Free Clinic of the New River Valley/Community Health Center | Family Medicine Christiansburg 540.381.0820 www.nrvfreeclinic.org
Keith Heischober, DPT Lucas Therapies, PC Physical Therapy Roanoke | 540.772.8022 www.lucastherapies.com
Carilion Clinic Cardiology Roanoke | 540.981.7268 www.carilionclinic.org
Carilion Clinic Family Medicine Bedford | 540.586.4723 www.carilionclinic.org
Emily Sherburne, PA-C Christopher Carilion Clinic Sullivan, MD Family Medicine Shawsville | 540.268.1400 www.carilionclinic.org
Carilion Clinic Obstetrics and Gynecology Roanoke | 540.985.9862 www.carilionclinic.org
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both
T I P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U
If parents have allergies, their children have
60-80%
a likelihood of developing allergies. People who
do these
neither
4 things
live an average of 14 additional years, compared to
If parent has allergic tendencies, a child’s chances of developing them drop to
about 10%
those who do not. 1. Eat five servings of fruits and vegetables per day 2. Drink alcohol in moderation 3. Don’t smoke 4. Exercise
Source: thehealthyeatingguide.com Source: National Institutes of Health
Truths about
Trauma
• Trauma kills more people beneath the age of 44 than cancer, heart disease, AIDS, and other diseases.
To help dry, red eyes: • run a humidifier at night • eat more omega 3s (fish and flax) • and use preservative-free artificial tears
• Each year, trauma accounts for 37 million emergency room visits and 2.6 million hospital admissions. • Annual trauma costs in the U.S. are estimated at more than $700 billion. Source: American Trauma Society, National Trauma Institute
Source: John M Dovie, OD, FAAO, President/ Owner, Blacksburg Eye Associates
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Drink Up!
Fun Facts About Water: By the time a person feels thirsty, his or her body has lost over 1 percent of its total water amount. The weight a person loses directly after intense physical activity is weight from water, not fat. Source: AllAboutWater.org
EARTH DAY 2014
6 Super Snacks Packing 100 Calories*
OR LESS
• The Official Theme for Earth Day 2014 (April 22) is Green Cities • Below are some steps you can take to help your city accelerate its transition to a cleaner, healthier, and more economically viable future!
• Walk, Hike, Ride a Bike • Keep that car in park and put your body in drive instead! Not only will you help save fuel, you will also get to enjoy the great outdoors while getting in some exercise!
6 cups of light microwave popcorn • 100 calories
• Plant a Tree • Trees generate oxygen, control air pollution and soil erosion and provide shade to keep homes and cities cooler!
½ cup of low fat cottage cheese with a small wedge of cantaloupe • 100 calories
• Give Weeds a Hand • Pull weeds by hand instead of using herbicides!
14 almonds • 98 calories 12 rice crackers • 91 calories 8 baby carrots with two tablespoons of hummus • 90 calories ¾ cup of apple slices with thin layer of unsalted peanut butter • 90 calories * Calorie content may vary among different brands
• Lighten Your Energy Bill • Choose Compact Fluorescent Lamps (CFLs) – they last ten times longer than regular bulbs, use one-fourth the energy and produce 90 percent less heat while producing more light per watt! • Reduce, Reuse and Recycle • Return hangers to the cleaners, donate clothing and computers to charity and pack lunches in reusable containers! • Celebrate at Earth Day Roanoke 2014! Saturday, April 26th Grandin Road, Roanoke, VA 10:00 a.m. – 4:00 p.m. • Visit with your Roanoke neighbors from across the city who have community gardens, backyard farms, chickens, bees, gardens, and ponds. See many great ideas for saving money and increasing our health as individuals and as a community! Go to earthdayroanoke.com for more information. Sources: worldpress.com; rustletheleaf.com
ON THE WEB
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Our Amazing Anatomy is proudly sponsored by
our
Amazing ANATOMY
Frank Purpera, MD, Director, Cosmetic Vein Center of Virginia Cosmetic Vein Center of Virginia | www.cosmeticveincenterofvirginia.com 1901 S Main St #2 | Blacksburg, VA 24060 | 540.552.VEIN (8346) info@cosmeticveincenterofvirginia.com www.OurHealthVirginia.com
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words | TINA JOYCE
Remember road trips to the coast? Anticipation, excitement and planning filled the house for weeks prior to the big day. Jeans and fleece were eagerly pushed to the back of the closet while lightweight t-shirts, cotton shorts and swimsuits were carefully escorted to suitcases. Packing the car initiated the first day of summer vacation. A red and white cooler was jam-packed tight with drinks and snacks—special treats made available only for road trips. The trunk was filled with over-stuffed luggage, brightly colored towels and themed boogie boards. There was always a scramble, and an argument or two, as the family unplugged the toaster and double-checked the door locks. The first five minutes of every trip was merely a roll call of items not to forget, and to re-address car etiquette among the back seat passengers. Mom sat in the front passenger seat wearing new sunglasses with the tattered atlas open on her lap. She carefully traced the well-planned route with her freshly painted nails. There was no GPS or Google Maps back then. The trusted roadmap showed it’s age, but gave clear direction to the destination. Twisting blue lines specified interstates, while red indicated highways. Once arriving, the cool breeze rolled off the ocean waters and slid upon the warm shoreline, creating the perfect temperature for evening walks. The smell of seawater filled the air with a distinct, memorable scent, inviting everyone to stay outside just a little longer.
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While most people embraced summer’s invitation to show off bare legs and sun-kissed skin, mom always kept her legs covered. Linen pants, cropped slacks and long cover-ups were a discrete way to hide what she didn’t want to share with the world. Many women and men, find themselves avoiding strolls at the water’s edge, attending summer pool parties and buying the trendiest summer fashions because of a lack of confidence— due to awful-looking, often painful, varicose veins. This was also true for Debbie McElroy of Blacksburg. Debbie first noticed a bulging vein on her shin during her first pregnancy. “At first it was just one. Then, after my pregnancy, it was better. But, by the time I was pregnant with our fourth child, I had noticeable veins all over my legs and they [the varicose veins] were very painful. I had to wear support stockings while I was pregnant,” she explains. Even after Debbie delivered their son, the veins did not go away. Each night her legs would swell and ache. She admits lying down did provide some relief. However, as a mother of four small children, staying in bed was not a feasible option.
She, like many who suffer from varicose veins, became very self-conscious. “I would never wear shorts, other than at home, and rarely put on Capri pants and sandals. My legs literally looked like a road map,” admits Debbie. Eager to bring relief from the pain, Debbie committed to an intense workout plan to drop any residual baby weight and improve circulation. She made the lifestyle changes necessary to improve her condition, and found herself in great shape at age 40—and 20 pounds lighter. However, she was still extremely uncomfortable, and very self-conscious, from the aching and swelling veins. Her husband encouraged her to seek options to treat her varicose veins.
The facts Approximately 30 million Americans suffer from venous disease, including varicose veins.1 Varicose veins are swollen, twisted or enlarged veins just below the skin’s surface; often blue or red in color and are caused by an underlying venous disease called Chronic Venous Insufficiency (CVI). If left untreated, varicose veins can progress to more serious problems including skin damage, swelling, severe pain and ulcers.
What is venous insufficiency and venous reflux disease? Veins in the human body provide the important function of returning blood back to the heart. In healthy veins, valves prevent back flow of the blood and allow the blood to continuously travel from extremities back to the heart against gravity. However, venous insufficiency (or venous reflux disease) occurs when a blood flow in a vein is obstructed due to a blood clot or damaged valve. This failure then leads to backward flow (reflux) of blood in the veins, creating pressure and pooling of blood. The increased pressure causes surface veins to widen or dilate (varicose). Symptoms may include: • Leg pain, aching, or cramping • Restless legs • Leg or ankle swelling • Varicose Veins • Burning or itching of the skin • Heavy feeling in legs • Skin discoloration or texture changes • Open wounds or sores
Veins become varicose due to venous insufficiency, or improperly functioning vein valves. The Vascular Disease Foundation explains that vein valves may fail to close properly due to wall weakness, causing the vein to enlarge and the valves to lea. This can be due to a history of blood clots in the vein, causing damage to the valves, or an absence of vein valves since birth. www.ourhealthvirginia.com
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Who is at risk?
The term varicose simply means dilated or twisted. Varicose veins affect 72% of American women and 43% of American men.2 These bulging, painful veins occur most often in the legs, but may appear in other areas of the body, and worsen with time if left untreated.
Varicose veins can be hereditary, often occurring in several members of the same family. Other factors leading to the development of varicose veins may include:
Debbie completed an application at the Cosmetic Vein Center of Virginia in Blacksburg, but never returned it to the office. “Life happened and I was busy taking care of everybody else. I put it off for almost a year,” she recalls.
• Prolonged standing • Increasing age • Heavy lifting • Prior blood clots in superficial or deep veins • Multiple pregnancies • Limited physical activity • High blood pressure • Obesity
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Finally, on April 3, 2013, she returned the application and scheduled a consultation. “Everybody there [Cosmetic Vein Center] was so kind,” Debbie remembers. “When I first met with Dr. Purpera, he said, ‘No wonder you are so uncomfortable.’”
The diagnosis. The diagnosis of varicose veins is initially made through a physical examination. However, the most thorough test is an ultrasound diagnosis, which can easily determine the source of reflux to decide the best restorative options. Treatments vary depending on the severity of a patient’s condition. A physician, trained in vascular procedures, may suggest conservative treatments to help alleviate symptoms or more aggressive procedures aimed to cure the condition.
Conservative treatments include leg elevation several times a day, or wearing compression stockings. However, these options rely heavily on a patient’s commitment or desired comfort, and may also interfere with an active lifestyle. For patients with severe venous insufficiency, who are looking for permanent results, more aggressive treatments may be recommended. Treatments include surgical options such as vein stripping and ligation, or non-surgical options such as endovenous ablation (Gold Standard), radiofrequency (VNUS) or laser removal.
Outpatient procedure. Frank Purpera, MD, the director of the Cosmetic Vein Center of Virginia, often recommends a minimally invasive treatment alternative, known as the VNUS ClosureTM Procedure to patients with symptomatic superficial venous reflux, resulting in varicose veins. This particular procedure uses a catheter-based approach. After insertion of a small needle, the VNUS generator delivers radiofrequency (RF) waves to the catheter to heat the vein wall along a 7-centimeter segment to contract the vein wall collagen. The heat generated causes the veins to collapse. Then, over time, the body eventually absorbs the vein. Dr. Purpera provides both of the FDA approved non-invasive vein procedures, laser and VNUS closure, in his Blacksburg office. “I’ve been able to do a side-by-side comparison [of the two treatments]. Compared to the laser, the VNUS procedure is significantly more tolerable (less pain, bruising, swelling) for the patients, as it uses 1/10th the energy and has the same effectiveness (98%) of closing the affected vein,” he explains. “Anybody who has CVI, the underlying cause for restless legs, varicose veins, and venous ulcers, would be a good candidate for the procedure.”
The roadmap. Debbie sought Dr. Purpera’s expertise in reducing her roadmap of varicose veins, and scheduled her first appointment on April 23, 2013. She experienced a couple of different office procedures to eliminate multiple veins. “Once we started, I wanted to hurry and finish. They bruised a little, but it was so much better instantly. I had improvement in the way my legs felt immediately,” she reveled. The cleanliness of the center also impressed Debbie saying, “Dr. Purpera’s team was very timely and efficient. My appointments only lasted about 30 minutes, and the office was very clean.” Debbie holds a Master’s Degree in Exercise Physiology, with a minor in Cardiac Rehabilitation. Therefore, she has a concrete understanding of the circulatory system and the importance of www.ourhealthvirginia.com
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“I cannot wait to go to the beach this year! My family cannot get over how great my legs look; I love how they feel!” Debbie marvels.
post-procedure care. “I really don’t think people realize the condition will get worse over time,” she says. “I wish I would have had the treatments when I first completed my application.” The VNUS procedure Dr. Purpera recommends is quick and uneventful. Since the procedures are medically necessary to prevent worsening, most insurance providers cover treatments including Medicare and Medicaid. “I truly enjoy the fact that we can get such dramatic results through one small needle insertion. There’s no incision, or any noticeable scarring. There is zero downtime, so our patients can immediately resume normal activity. They find great relief from their symptoms—swelling, cramping and restless legs, improving their quality of life,” shares Dr. Purpera. Technological advancements allow us to leave behind the aged, folded roadmap, while modern technology also gives many the freedom to live without painful, unattractive bulging veins. Men and women no longer need to suffer from CVI. Treatments are relatively painless and very effective. Patients, like Debbie, can now look forward to family trips to the water’s edge. They can wear the latest summer fashions, including shorts and skirts, leaving behind the unsightly map of varicose veins. Sources: Gloviczki, P., MD., Comerota, A., MD., Dalsing, M., MD., Eklof, B., MD., Gillespie, D., MD., Gloviczki, M., MD., Wakefield, T., MD. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011 May; 53(5 Suppl): 2S-48S.
1
Barron HC, Ross BA. Varicose Veins: A guide to prevention and treatment. NY, NY: Facts on File, Inc. (An Infobase Holdings Company); 1995;vii.
2
Frank Purpera, MD, Director, Cosmetic Vein Center of Virginia
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The simple, but extremely harsh truth about automobile accidents is that cars are hard and the bodies inside them are soft. To put the severity of automobile accidents in perspective, it is helpful to note that hospitals rate major trauma on an Injury Severity Scale of 1 to 15. The number 15 often includes death, dismemberment, head trauma, and the extreme likelihood of permanent impairment and impact on quality of life. The average score for people crashing their vehicles into trees or poles? 14.6. Injury severity scores allow for rapid and efficient transmission of information.
words | BECKY BLANTON
Situations where life-threatening injuries are being dealt with sometimes do not allow time for elaborate communications. This scoring system allows healthcare providers to transmit the most important information rapidly, in a standardized fashion. In most traffic accident studies, males tend to be more severely injured than females, partly because they tend to be driving, and partly because they weigh more. When you factor in the weight after gravity multiplies the forces at play in an accident, you will find that the greater the weight of the victim, the greater the injury sustained. When the average vehicle hits a tree, a number of things happen faster than the human mind can comprehend. Experts in crash testing research say, at these speeds and circumstances, the victims in the vehicle literally do not know what hit them and do not suffer. If anything good can come out of this kind of accident, it is this one fact, say emergency rescue personnel who respond to these accidents.
Reprints To order reprints of the original artwork featured on this issue’s cover, contact Jenny Hungate at 540.387.6482 or via email at jenny@ourhealthvirginia.com. To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com
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Steven has some physical issues with his left hand and arm and some stiffness in one leg, but he’s alive, active and hiking again— one of his favorite activities.
Steven with his dad, Carlan
On August 13, 2012, at approximately 11:45 p.m., Aaron and Steven Myers of Salem, ran off of Route 311, north of Route 658, in a pickup truck at approximately 55 mph and hit a tree. Aaron, 26, who was driving, died. Steven, 22, was in such critical condition that rescue crews made another 911 call, and requested an air ambulance, a helicopter transport to take him to Roanoke Carilion Memorial Hospital. There were no apparent contributing factors to the crash. There was no alcohol, speeding, or road rage. Officers believe Aaron either swerved to avoid a deer, or that he may have had brake problems, or gotten distracted at the wrong second. No one knows, and Steven can’t remember. It was just an accident. The standard protocol began for the Myers crash, as it always does when there are witnesses. Someone calls 9-1-1. Within minutes, there are sirens, and the quiet urgency of Emergency Medical Service (EMS) rescue workers arriving on the scene. There are shouts, as crew members bark orders and directions to each other. Then, there is the sound of boots running toward the truck. There is the intake of breath, the heartsinking sadness of what lies before them. In most crashes it’s inevitable that someone will ask:
“Any survivors?” “I don’t think so,” is too often the reply. When truck meets tree, there are almost never survivors. But on the night of Aaron’s and Steven’s accident, there was movement, a pulse and a survivor. 30
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“Call Life-Flight,” someone said. When there is a survivor, there is always hope, and crews are determined to do whatever it takes to get a breathing victim to a trauma center as soon as possible. Survivor or not, the Jaws of Life come out of their metal box on the fire trucks. If there is any intact glass remaining on the vehicle, it is knocked out as rescue crews struggle to extricate survivors and recover bodies. For as long as it takes, the scene is noisy and hectic, as crews work feverishly to pull everyone out. As the ambulances leave the scene, the tow truck waiting off to the side is waved forward. What’s left of the vehicle is pulled up onto a roll-back, secured and hauled away to either an impound lot or junk yard until the official investigation is concluded. The pavement is swept clean of any debris, and within hours, there are no signs that there had ever been an accident. Before that happens, police tape goes up to secure the scene until the county coroner or state medical examiner can be called to confirm a fatality. Officers walk the road, and go down into the ditches or fields to investigate the crash site. Cameras come out. Measurements are taken. Witnesses, if any, are questioned. If a victim is very critical, as Steven was, a Carilion Life Flight helicopter is called. The flight nurse, paramedic and pilot scramble to become airborne. Trauma is a symphony. A hundred instruments, doctors, nurses, pilots, police, ambulance drivers and firefighters, tow truck drivers, dispatchers, emergency room staff, all working together to produce the sweetest sound in the world—saving a life. Miles away from the accident scene, Steven’s and Aaron’s parents were sleeping, not knowing decisions were being made about things that would keep one of their sons alive. They had no idea there was a conversation about who would make the death notification, and who was verifying the name and address of the next-ofkin, the Myers family. Once that was done, two Roanoke County Sheriff’s deputies climbed into their patrol car, drove to the Myers’ house, knocked on the door and www.ourhealthvirginia.com
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changed the Myers’ lives forever more. Things could have gone differently. Had the weather been bad that night, the helicopter might not have flown. Susan Smith, Director of Carilion Clinic Transportation (Air and Specialty Care Divisions), explains that when the helicopter pilot gets the call, he’s never told what kind of accident he’s responding to, or the condition of the patient. “When the call first comes in from the 911 communication center to the comm center, no information about the patient is shared,” Susan said. “They simply say, ‘You’ve been requested to fly to Craig County to pick up a patient.’ The reason they don’t share any information, is so the pilot doesn’t have any self-induced pressure based on the criticality of the patient. He makes his decision to fly or not fly based on weather and wind conditions, not on the patient or their condition.”
(from left) Steven, Aaron,
Norma, and Carlan Myers.
Mother’s Day in May
2012, before the accident.
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That night, the weather was good and the pilot chose to fly. There was another fortunate twist. Flying at night is dangerous. Some pilots will not fly if weather and night conditions combine to create a dangerous flight risk. Carilion makes mostly daytime flights, but does do night flights, weather conditions permitting. Air ambulances, as medical helicopters are called, aren’t just patient transportation. Each flight has a nationally registered paramedic, a registered nurse and an FAA licensed pilot on board. These individuals are among the best of the best in their fields. Each medical flight team member is ACLS, ATLS, PALS, BTLS/PHTLS-certified and has received specialized training in air medical transport. Steven, like most trauma survivors, had already done his part—surviving the crash. Now, Steven had entered the medical trauma system and hundreds of trained professionals would literally take his life in their hands as they stabilized, transported and treated him in the next hours, days and months.
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Level I Trauma Centers A Level I Trauma Center is a hospital that provides the highest level of trauma care available and specializing in the comprehensive diagnosis and treatment for all forms of traumatic injury. Level I is the highest designation given by the American College of Surgeons, which sets the criteria for such credentialing and requires continuous evaluation of the center. A Trauma Center that receives the Level I title is optimally prepared to manage any type of injury 24 hours a day, seven days a week. This requires that the center has in-house acute care surgeons, designated operating rooms, available CT scanners, trauma accredited nursing staff, surgical critical care, 24/7 blood bank operation and immediately available subspecialists like neurosurgeons and orthopedic trauma surgeons. To maintain this designation, the center must also participate in trauma prevention programs, have a quality outcomes program, and provide a trauma education and research program. The Trauma Team is comprised of surgeons and advanced practitioners who care for critically ill and injured patients of all ages.
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Unlike many air ambulance services, Carilion’s Life Flight service has something many air ambulance services do not, something that makes night flights to survivors like Steven possible. “We are very fortunate in that we have three full sets of night vision goggles, not the monocles that crews hold up to their eyes, but the full goggles,” Susan said. “They are attached to the helmets, so no one has to hold them up; they’re always there. The pilot, the medic and the nurse all wear the goggles. We have a system in place where each person scans and watches one area. The pilot and the other person in front each watch an area, and the person in back also watches an area.” Among the hazards of flying into unpopulated areas, such as the fields and rural parking lots along Route 311, are the branches, and telephone wires that
“They are attached to the helmets, so no one has to hold them up; they’re always there. The pilot, the medic and the nurse all wear the goggles. We have a system in place where each person scans and watches one area. The pilot and the other person in front each watch an area, and the person in back also watches an area.” Among the hazards of flying into unpopulated areas, such as the fields and rural parking lots along Route 311, are the branches, and telephone wires that could bring down a helicopter landing at night before they knew what hit them. “You can’t see wire at night,” Susan said, “but you can see the poles and structures that may have wires and cables running to them, so that’s what they watch for. They are trained to look for a pole, then another pole and then to assume there is a wire between those poles.” Because Carilion has goggles, it’s safer to fly in areas many pilots would not go at night. After the helicopter lands safely, a member of the ground crew is stationed near the tail rotor to keep people away from the spinning and deadly rotor. Once a pilot has landed, the helicopter never shuts down. The pilot doesn’t get out, and the helicopter doesn’t even idle, Susan said. They land hot, stay hot and take off as soon as their precious cargo is loaded and secure. They move confidently, quickly and professionally. It most likely took crews longer to extricate Steven from the wreckage, and load him on board the helicopter, than it did to fly him to Carilion. “From Craig County to Carilion?” Susan said, “That’s about a 10-minute flight.” Once the helicopter landed, standard procedure would have been followed. Steven’s gurney would have been immediately loaded into the rooftop trauma elevator as a security officer watched or helped. He would have been in the emergency trauma room within seconds, as doctors and emergency room nurses began assessing his injuries. While all this was happening miles away, Norma Myers and her husband Carlan were sleeping, unaware that their youngest son was fighting for his life, and their oldest had already lost the fight for his. The little things were beginning to add up. Steven had survived an horrific crash. EMS crews reached him within the “golden hour” that makes or breaks recovery time. There was an air ambulance available, and conditions were right for a night flight to get Steven to Carilion. Of the 94 licensed hospitals in Virginia, only 14 are designated trauma centers. Of the three levels of trauma center designation, only five are designated as Level I trauma centers, the highest level of critical care available. Carilion is a Level 1 trauma center. It doesn’t get any better than that. Steven Myers was unconscious and considered critical. He was so critically injured, he needed a Level I facility to survive. But even the best of the best, the trauma doctors at Carillion, weren’t convinced he would live. If he survived, doctors told the www.OurHealthVirginia.com
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“We both heard the knock about 1 a.m.,” Norma said. “It woke us both up at the same time. Carlan thought it was the boys, that they were locked out and wanting in. I’d left the back door unlocked for them because I knew they were going to be late. Carlan is very security conscious and is always going around checking and locking doors. The boys live with us, and he’d locked the back door, so he got up to go let them in. But I knew. I just knew something was wrong. So I stayed upstairs.” Downstairs, Carlan unlocked the front door. Two Roanoke County Police officers were standing there, a man and a woman, Norma remembered later. “I couldn’t tell you their names or even what they looked like,” she said. “I just know one was a female and she was very nice.” “I was still in bed. There was the sound of voices,” she said. “You know how you can hear people talking but you can’t hear all of what they’re saying,” Norma said. “They kept telling Carlan to bring me downstairs. I heard that much, and then I heard Carlan break down. I knew then, but I didn’t want to know. I refused to go downstairs. So, he came upstairs, and told me what they’d told him. “We started wandering around the house trying to figure out what to do. The police were wonderful. They followed us around trying to help. We finally got dressed, and got into the police car, and that’s when reality hit. Then, when we got to the hospital, and people were trying to get a priest and they said, ‘Lets go into the consulting room and I said, ‘Let’s not.’ I didn’t want to hear any more. The priest had on a long black robe and was talking to us and I thought, ‘really’? It was just so strange.” Once they were in the consulting room, doctors told the Myers what they didn’t want to hear: they didn’t expect Steven to live. They told them to prepare to lose their second son. “They gave us no hope,” Norma said. “They told us the next 48 hours would be critical, but that they really didn’t think Steven would survive. They told us to be prepared to lose him.” “He has a traumatic brain injury. I don’t know when we found out that his brother died at the scene, but that amplifies the situation to know that it 36
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room, doctors told the Myers what they didn’t want to hear: they didn’t expect Steven to live. They told them to prepare to lose their second son. “They gave us no hope,” Norma said. “They told us the next 48 hours would be critical, but that they really didn’t think Steven would survive. They told us to be prepared to lose him.” “He has a traumatic brain injury. I don’t know when we found out that his brother died at the scene, but that amplifies the situation to know that it was a bad enough car crash that someone died from it. We said we would do everything we could, but sometimes we have to paint the realistic picture that this may not turn out for the best,” Dr. Collier said. “I know with him (Steven) the first minutes, and hours were important, then it was hey, we’re going to be putting together days. He was one that required the full support, everything from the feeding tube, to taking the skull cap off to give his brain room to swell. That’s the most severe brain injury patient we have,” he said. Add up all the reasons why Steven Myers shouldn’t be alive today, and the only answer Norma has for it is “divine intervention.” By all professional medical accounts, Steven should have died alongside his brother, or shortly thereafter. “He had a higher likelihood of risk that he could die than we like to see,” Dr. Collier said. “People just don’t walk away from a 55 to 60 mile-per-hour crash into a tree,” says Russ Rader, Senior Vice President of Communications for the Insurance Institute for Highway Safety. Russ
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He survived the 48-hour watch. Two days later, Steven was prepped for a cranioctomy, a neurosurgical procedure in which part of the skull flap is temporarily removed to access the brain. Only three days later, the family would attend a celebration ceremony of Aaron’s life, as his younger brother continued to struggle for his. “I don’t remember much about the celebration ceremony,” Norma said. “People still come up to me and tell me they were there. I’m grateful, but I just don’t remember. People don’t expect you to be normal during those times I guess, and thank goodness for that.” For the Myers, trauma was more than losing a son and struggling to ensure another lived. It was the day-to-day efforts to do all they needed to do, including working, taking care of the house, tending to their son and more. “You’re taking care of Steven, then you break down because you’re dealing with losing Aaron,” said Norma. “I can’t explain the roller coaster. Everything stops, your professional life, your personal life. People just come and go in your home, taking care of things, and everything is a blur. You just move through it.” The outpouring of support then, and now, along with prayers and friends, has sustained them, Norma said. It’s been a long road and there’s not really an end in sight. The one bright spot in all of the bad is that the family has gotten to share their Christian faith. Knowing that they’ll see Aaron again, and letting people know God and prayers have gotten them through the toughest of times is important to them. “We’ve been so focused on Steven, we haven’t really had much time to grieve losing Aaron,” she said. “But we always tell people we have hope because we have our faith.” After his craniotomy, Steven was placed into a Pentobarb coma and required ICU-level support until August 29, 2012. He had a cranioplasty to repair his skull on January 10, 2013. He also had an IVC placement and removal. He needed physical, occupational and speech therapy and around-the-clock care.
Today, Steven is a part-time student at Virginia Western Community College. (VWCC), pursuing a degree in Information
While still in a critical stage of healing, Steven’s doctors Systems Technology with a concentration and nurses advised the Myers that they needed to consider transferring him to what is considered the best traumatic brain in Computer Security injury facility in the country - The Shepherd Center in Atlanta. In September, Steven was transferred to Shepherd Inpatient Rehab, under the care of Gerald Bilsky, MD. For the next month, he was in intensive physical, occupational and speech therapy, learning how to walk, how to move, how to eat, how to regain control of his body and balance. Steven was discharged to Shepherd Pathways Outpatient Rehab in Atlanta on October 6. He shared an apartment with his mother, and attended rehab daily. Two months later, on November 30, he was discharged from Shepherd Pathways Outpatient and arrived home on December 1, just in time for Christmas. It had been almost six months since the crash. www.ourhealthvirginia.com
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Steven’s journey has been arduous, but ultimately positive as he’s been able to heal and continues to heal. Today, Steven is a part-time student at Virginia Western Community College. (VWCC), pursuing a degree in Information Systems Technology with a concentration in Computer Security. He has some physical issues with his left hand and arm and some stiffness in one leg, but he’s alive, active and hiking again—one of his favorite activities. Due to his TBI, he had to take placement tests to get into VWCC, but he scored well. According to Norma, “He did awesome last semester in his English class, and is exceeding this semester in Business.” It’s an outcome the Myers never imagined a year ago. Not all trauma survivors do as well as Steven has done, but the systems, which include EMS, hospitals, air ambulances, medical staff and the love and prayers of friends and family, are in place. We can be thankful that they give every traumatic brain injury survivor the opportunity to heal. Dr. Collier summed up the miracle of Steven’s recovery by saying: “There are things we know that do predict a patient’s outcome. We are also amazed by the patient’s that we say, ‘Well, we allowed them to survive and go to rehab, but you never know what’s going to happen.’ When Steven came back it was one of those stories that provides us more than just hope. It gives us the very positive feedback that says sometimes when we work hard, and do everything right, patients get back to the person they were prior to their accident. That’s the type of story you hang onto for the rest of the time you practice medicine, because it gives you hope that if I do these four or five things they’re going to get better, and be talking and being with their family, just like Steven, when he easily could have died from this.”
Bryan R. Collier, DO Trauma/Surgical Critical Care Chief, Trauma Surgery Carilion Clinic
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3
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4
2 OurHealth
captures Roanokers at their healthy, happy best participating in
National Wear Red Day at Carilion Roanoke Memorial Hospital in February.
National Wear Red Day at Carilion Roanoke Memorial Hospital in February.
5 National Wear Red Day, recognized by Carilion since 2003, raises awareness of the many risk factors associated with heart disease – high cholesterol, high blood pressure, smoking – and ways to reduce those risk factors. 1. Some important facts from Event Coordinator, Melanie Johnson of HeartNet of the Virginias, with Katie Johnson of CRMH/CCN and Debbie Huddleston of CTV Services 2. Learning some facts about diabetes: Vicki Baker, RN Diabetes Manager; Kimberly Coleman, RDCS Cardiac Services and McKenzee Walker, Echo Student Cardiac Services 3. Posing for the ‘paparazz’i: Megan Barbour, MOA; Celia Harris, MOA; Ashley Taylor, MOA and Clarissa Dailey, LPN from Ortho-R3 4. Learning how to stay ‘heart healthy’: Jessica Lind, Representative from AHA (American Heart Association); Donna Bradshaw, RN and Kimberly White, RN from HeartNet of Virginias 5. Representing stroke awareness: JoAnn Tarbot, RN and Brittany Madson, RN of 12 West.
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YMCA Kids Marathon — Training
with Becky Freemal of Fox 21/27 News
Becky Freemal (wearing pink), anchor for the Fox 21/27 10 o’clock news, visits the YMCA Magic Place afterschool program at Highland Park Elementary school earlier this year to log a few miles with a few marathon participants! Becci Sisson (in orange) was our super hero trainer for the day. Participating ‘marathoners’ are logging miles and working towards their 26.2 mile goal. They will run their Final Mile at the YMCA Super-Kids Marathon on Saturday April 26th!
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Welcome Change.
It is inevitable.
words | BECKY BLANTON
Christine Slade failed hospice last summer.
“Not dying really screwed things up,” she said. After she had given away everything she owned, including her business and apartment, her doctors released her from Good Samaritan Hospice. She had been admitted to the Richfield Nursing home in Salem for several months, then transferred to hospice in November of 2012. It was now August of 2013 and she was obviously no longer considered imminently terminal, they told her. “It was a shock,” she said. “If I’m not going to die then what am I supposed to do now?” Christine had said her goodbyes to friends, and planned her own memorial. She held her own wake and gracefully placed one foot in the grave, fully expecting to see her other foot and the rest of her join it there shortly. She had made her peace with 61 years of living. Then she failed to die and had to start thinking about how to live. “Not dying complicates things. You have to step back into life, buy new furniture, and more stuff,” she said. Christine checked into a hotel for several months after leaving hospice, planning to get an apartment, and then apply to PACE. A staff member at Richfield had told her about a new PACE (Program of All-Inclusive Care for the Elderly) center opening in Roanoke in October. She found an apartment, applied and waited to be accepted into the PACE program.
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“I can stand on my tip toes, balance on the balance ball and overall I’m doing much better,” she said. Her physical therapy is part of the PACE patient plan. Everyone who becomes a participant gets an individualized healthcare plan with specific goals.
Unlike nursing homes, PACE is not a residential center. It is a center comprised of an adult day care, a clinic, and a therapy gym for seniors who meet a nursing home level of care and are able to function and live in their community, or with family members or caregivers with the additional assistance and services of the program. PACE is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. PACE serves individuals who are age 55 or older, who are certified by their state to need nursing home care, and are able to live safely in the community at the time of enrollment, and live in a PACE service area. Although all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants nationally reside in a nursing home. If a PACE enrollee does need nursing home care, the PACE program pays for it and continues to coordinate the enrollee’s care. PACE provides a team of medical care experts who do provide what the participant needs. That team includes doctors, nurses, occupational and physical therapists, as well as home health aides who go into the home to help seniors maintain their independence by helping them shower, cook, clean or shop. Other services PACE delivers all needed medical and supportive services. They are able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their homes for as long as possible. 46
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Care and services include: »» Adult day care that offers nursing; physical, occupational and recreational therapies; meals; nutritional counseling; social work and personal care »» Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant »» Home healthcare and personal care »» All necessary prescription drugs »» Social services »» Medical specialists such as audiology, dentistry, optometry, podiatry, and speech therapy »» Respite care »» Hospital and nursing home care when necessary Participants utilize the PACE Center as few as one day a week or as many as five days a week. It provides a safe, warm, homelike environment for participants who come to socialize, see their doctor, do physical therapy, read, watch movies, play games or get help showering, and changing dressings. A hot lunch and snacks are served in the day room during their visits. Transportation to PACE is provided as part of the all-inclusive program with home pickup by bus or van.
PACE uses Medicare and Medicaid funds to cover all medically necessary care and services. You can have either Medicare or Medicaid or both to join PACE.
Frequently Asked Questions Some of the most commonly asked questions about PACE (From the PACE website) are:
How do people qualify for PACE?
In order to be eligible for PACE a person must be aged 55 or older, certified by the state to need nursing home care, and be found safe in the community by the interdisciplinary team with the programs services.
Are prescription drugs covered?
Yes. All prescription and non-prescription drugs deemed necessary by the PACE interdisciplinary care team are paid for by the PACE program.
Are people who do not qualify for Medicaid eligible for PACE enrollment?
Yes. If a person meets the income and assets limits to qualify for Medicaid, the program pays for a portion of the monthly PACE premium. Medicare pays for the rest. If a person does not qualify for Medicaid, he or she is responsible for the portion of the monthly premium Medicaid would pay. PACE program staff can help determine a person’s financial eligibility.
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PACE provides all the care and services covered by Medicare and Medicaid, as authorized by the interdisciplinary team, as well as additional medically necessary care and services not covered by Medicare and Medicaid. PACE provides coverage for prescription drugs, doctor care, transportation, home care, check ups, hospital visits, and even nursing home stays whenever necessary. With PACE, your ability to pay will never keep you from getting the care you need.
How do people get to the day health center?
PACE programs provide transportation to the day health center. Transportation is a key part of the PACE benefit. Transportation is not only provided between the home and the day health center, but also to appointments with specialists and other activities.
Do PACE participants attend the day health center every day?
No. On average, PACE participants attend the day center three times a week. Day center attendance is based on individual needs and can range from once a week, or every month, to several days a week, as needed.
What happens if a PACE participant needs nursing home care?
The goal of PACE is to keep participants out of a nursing home as long as possible. If at some point it is in the best interest of the participant to receive care in a nursing home, PACE will pay for the care and the supervision of the interdisciplinary team will continue.
What happens if a person wants to leave PACE?
A PACE participant is free to dis-enroll from PACE and resume their benefits in the traditional Medicare and Medicaid programs at any time.
Timing is Everything For Christine, the timing of PACE opening just as she needed them, was everything. Not everyone has a fulltime caregiver. Christine didn’t. 48
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Like many seniors without caregivers or family she needed PACE to be able to remain in her new apartment and out of a nursing facility.
PACE Covers Prescription Drugs PACE organizations offer Medicare Part D prescription drug coverage. If you join a PACE program, you’ll get your Part D-covered drugs and all other necessary medication from the PACE program. If you are in a PACE program, you don’t need to join a separate Medicare drug plan. In fact, if you do, you will lose your PACE health and prescription drug benefits.
Whether a person or even a couple have family or not, PACE steps in to help people remain in their homes, even with severe diseases or disabilities. Being alone isn’t the only criteria for admittance into the program. Caretakers often get overwhelmed, or are too tired or unable to care for their parents or loved ones. They can’t leave them at home alone, so often the only alternative is to place them in a nursing home. But not everyone who qualifies for a nursing home should be there. “There’s a place and a time for nursing homes, but until then, PACE is a better alternative for so many,” Sean Pressman, Chief Operating Officer for Kissito said. Kissito owns five nursing homes in Virginia as well as the only PACE facility in the area. In fact, many nursing home residents would fare better living at home and utilizing PACE’s services, which cost about 50 percent less than a nursing home and provide more one-onone and personalized care.
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PACE serves individuals who are age 55 or older, who are certified by their state to need nursing home care, and who are able to live safely in the community at the time of enrollment, and who live in a PACE service area. Although all PACE participants must be certified to need nursing home care to enroll in PACE, nationally only about seven percent of PACE participants actually live in a nursing home. If a PACE enrollee does need nursing home care while in the program, the PACE program pays for it and continues to coordinate the enrollee’s care. “In a very short time since the program has started, our Kissito PACE team has positively changed the lives of so many people like Christine. It’s incredible to think about the wider impact that PACE will have as more people across the Roanoke and New River Valleys begin to take advantage of this resource.”
her independence. She has a slowly shrinking tumor on her left breast the size of a small grapefruit. The weight of it pulls her off balance. Working with a Kissito PACE occupational therapist has been remarkably helpful as well. It’s not the kind of help she’d get in a nursing home, she said. “I can stand on my tip toes, balance on the balance ball and overall I’m doing much better,” she said. Because the weight of the tumor causes her to walk unevenly, physical therapy that improves her balance helps. It’s part of the PACE patient plan. Everyone who becomes a participant gets an individualized healthcare plan with specific goals. One of Christine’s was improved balance.
PACE was originally founded in the China Town, North Beach communities of San Francisco in the early 70s. A local dentist and several medical professionals wanted to create a local community center that would help their Asian and Hispanic cultures care for their elderly without having to place them in a nursing home setting. The result was a federal program with Medicaid and Medicare waivers that allowed hospitals and private organizations to operate the program once they are approved. In Roanoke, Kissito PACE is that organization. “Our team thrives on finding creative ways to work with families and participants to keep them safe and independent at home. They love a challenge,” Sean said. “Kissito PACE contracts with all types of healthcare providers in their coverage area to enhance PACE services,” Josh McGilliard, Vice President of Business Development for Kissito said. Those services include local hospital services, home healthcare, specialists, dentists and other providers. For Christine, being in the Kissito PACE service area is another miracle. It is PACE that allows her to stay out of the one place she has vowed never to return to again—a nursing home. “They (PACE) are what makes my independence possible,” she said. “I can live in the community, in my own apartment, with a home health aide. I can come in here a couple of times a week and I can keep my independence.” Because of balance and other issues Christine depends on PACE to help her shower, to change her dressings, and to provide her with the assistance and medical care she needs to live in her own place. PACE offers all their participants services like transportation to the grocery, assistance with shopping, home health, and medical supplies. PACE provides a comfortable, safe environment, free transportation to and from their homes, or their caregivers’ home. PACE provides a hot lunch and two snacks a day as well. At age 61 Christine is still a stage four terminal cancer patient. She needs the kind of help with shopping, bathing, cleaning and other day-to-day demands, PACE provides. But she gets to keep www.ourhealthvirginia.com
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PACE’s Focus is on the participant! You have a team of health care professionals to help you make health care decisions. Your team is experienced in caring for people like you. They usually care for a small number of people. That way, they get to know you, what kind of living situation you are in, and what your preferences are. You and your family participate as the team develops and updates your plan of care and your goals in the program.
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“She protects that left side, so she’s a little more tense there. It affects her balance some,” Carr said. Christine nodded. “It’s true. I do guard it,” she said. But she guards it for a reason. “Bumping it can make it bleed, and that requires a dressing change.” As healthy as she seems, and as active as she is, she says she knows she’s still going to die, “Aren’t we all,” she said. “No one is guaranteed tomorrow,” she said, so she focuses on living. Everything from environmental concerns to food, DNA, and smoking can cause cancer. It’s very individualistic, very personal and very much a unique disease. It’s a roll of the dice, experts say, based on a variety of things, including a person’s DNA, or diet, or even a physical trauma to a part of the body. Christine says she knows where her cancer probably originated—from a physical trauma she experienced decades ago. “It was a hardball, fouled into the stands by a semi-pro ballplayer,” she said. “I was holding my son, cradled up on my left breast, sitting in the stands of this baseball game when it happened.”
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“It was a hardball, fouled into the stands by a semi-pro ballplayer,” she said. “I was holding my son, cradled up on my left breast, sitting in the stands of this baseball game when it happened.” She said she had laid her right hand over her breast. She looked up, smiled and her eyes teared up as she remembered the moment. “I laid him down to tickle his belly, because he liked that, and that’s when the ball hit me.” It didn’t just hurt. The ball hit so hard it knocked her back in her seat. The resulting injury sent her to the emergency room with deep, deep bruising and pain. The only good thing was she had just lowered her son seconds before the ball hit where his head had been. “When I got the (cancer) diagnosis years later, I knew,” she said. “I remembered immediately being hit with the ball way back when. My first thought when I got the cancer diagnosis was, ‘Oh, not my breast! I fed my babies with my breast.” Christine paused, looked down at her chest, and then out of the bank of windows where sunlight was streaming in. She shrugged. “I’m ready to go,” she said. “I’m ready to stay. I’m ready to be wherever I am in the moment.” Has the cancer changed her? “Yes, and in a positive way,” she said. “Dying has shown me how to live more fully. If I could tell people anything, it’s that it’s important to live in the moment, not in the fear of the future.” In the meantime she’s happy to be independent, yet have a place to go, transportation, and a place where she’s able to call on medical help, dressing changes, and physical therapy as needed.
Josh McGilliard, VP of Business Development
Sean Pressman, Chief Operating Officer
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words | RICK PIESTER
You would have thought that
Dennis Garvin, MD had it made. By his late 30s, he had accomplished just about everything he set out to do. He was a successful physician specializing in urology; he had nice kids and a great family. The works. But he felt instead a nagging emptiness. He says his life was something like a black-and-white television picture. It wasn’t in color. “I wasn’t depressed,” he says now, looking back at that time some 28 years ago. “It was an emptiness—somewhat like Alexander the Great, when he realized that he had no more worlds to conquer. What next?” This led him to start challenging the things that, up to that time, he had believed to be true. Prime among his beliefs was that he felt the Bible ”was a collection of fairy tales.” Inspired as he was by the sciences he had studied in college and during his medical training, he accepted—at face value—that science disproved Scripture. The earth created in six days? Impossible, he thought. Civilization starting with Adam and Eve? Darwin and his theories of evolution neatly gutted that notion, he was convinced.
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“I was a scientific Darwinist,” he says, meaning that he was committed to the biological concept that life evolves over multiple generations — evolution and the survival of the fittest. It’s the polar opposite of the view of “intelligent design” that is at the center of so much socio-religious debate today.
“Not only had I been a Darwinist,” he remembers, “but I was even a predatory atheist, the guy who took joy in knocking down the views of people who were uninformed enough to be believers.” But then, in rethinking all that he thought he knew about science and life, he could not resolve for himself the idea of altruism, the unselfish love and concern some people have for others. He could not make that fit the mold of Darwinism:
“Why, for example, would a grown man risk his life to dash into traffic to save a young person he doesn’t know? The man doesn’t know the child, or whether the kid will grow up to be good or evil, yet he saves the child. Why does the combat soldier throw his body over a hand grenade to save his buddies? Why would people do these things, when to do them runs counter to the idea of survival of the fittest?” To answer this and other questions that now plagued him, he turned to his study of quantum physics, the branch of science that describes the nature of the universe as being much different then the world we see in terms of space and time. It’s complex. He was accustomed to challenging his own beliefs. He spent many of his formative, teenage years in Stephentown, NY, a tiny logging town in rural upstate New York near the Massachusetts border. His family was Unitarians, a theological movement known for the rejection of several conventional Christian doctrines and almost constant debate of Christian dogma. “I had no knowledge of Jesus Christ, but I also had no ill feelings about Him. I simply was uninformed.” He started to reinvestigate the miracles in the Bible — the creation, the birth of 58
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Jesus, the Trinity and more — in the light of what he now understood about modern science. “I was astonished,” he says, “to learn that when viewed properly through the lens of modern science, the Bible was an accurate physics textbook.” For him, modern science made the Bible comprehensible, and accurate.
Time went on, and at the age of 38, Dr. Garvin became a committed Christian. To get there, he had to do something very difficult. He had to set aside everything that he thought he knew. “Very intelligent people are at a disadvantage when it comes to understanding spiritual things,” Dr. Garvin says. “That’s because we process matters of faith through what we already know, through our own brains. It’s kind of like a child in his or her oral phase, trying to know everything they encounter by putting those things in their mouths. That’s what intellectuals do — they put everything through the filter of what they already know. And if an idea does not make sense in terms of what you know, you dismiss it. But you have to get out of your own way.” Fast forward to today, and Dr. Garvin is still in practice with his partner Christopher M. Hicks, MD, at Urological Surgery in Salem. He is also an author. Encouraged by his brother, John “Lucky” Garvin, MD, a recently retired emergency medicine physician (Dr. Lucky Garvin is a frequent contributor for
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The Roanoke Star newspaper). He and his brother are also the authors of Growing Up in Stephentown: Tales From Our Early Days, a collection of reminiscences of their days in that New York town. A third Garvin brother, Bruce, is a nuclear medicine specialist in Florida. More recently, Dr. Dennis Garvin published Case Files of an Angel, a highly readable, highly thought-provoking work of religious fiction based on many of the issues Dr. Garvin encountered during his own search for faith.
The book is written from the point of view of Augie, a streetsmart working angel. Augie is assigned by his superiors to encounter humans in various roles as messenger, guardian, avenger, chaperone, debunker of conventional wisdom, and more. Augie’s superiors have selected him to write narratives of his encounters with humans — the case files of the title — followed by after-action reports that provide something of a higher altitude view of the broader meaning of each of Augie’s encounters. Each of the book’s early chapters also includes FAQAAs (Frequently Asked Questions About Angels). These are included, Augie writes, “in the hope that lights might come on in the average human craniums, and that they will correct their viewpoints about angels and what we do.” We learn that Augie — and all angels, in fact — have a rather dim view of humans. “...it has to do with fundamental human foolishness,” Augie explains. “The last Bible I looked at contained over two thousand pages, and you humans managed to get yourselves kicked out of Paradise by page 5.” “I think my superiors want you to get to know angels better,’ Augie says, “and, after learning how God uses us, perhaps to know yourselves a little better. Lord knows, you need help.” Augie assumes various guises on earth. He’s a bartender, a cab driver, a man in the street, and an angel who at times is 62
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visible only to people who he wants to see him. He can be very funny at times, and very violent at other times. He can be both profound and profane. We see Augie in action in widely differing scenarios. He escorts a slain Union solder to the afterlife during the brutal Battle of Cold Harbor northeast of Richmond on June 3, 1864. He has a chat with Jesus during Jesus’ mysterious 40 days and 40 nights of temptation in the wilderness. He makes a gift of a song to a young girl whose father had been killed in Afghanistan. In a later case file, the song becomes a hit for a gospel singer whose faith is shattered when she loses her brother to suicide because he is unable to vanquish the demons from his own service in Afghanistan. Augie gives encouragement to a Hollywood street preacher, and later has a heartto-heart chat with Joseph, the largely overlooked husband of Mary, Jesus’ mother. The reader may or may not agree with some of Augie’s views, particularly on political and social flashpoints such as abortion, the role of government in our lives, and the role of religion in government. Both political liberals and conservatives are subject to their share of reproach and reprimand. There’s something for everybody in the book. One of the more inventive ideas in the book is Augie’s revelation of the angels’ practice of calling God “Papa.” “Jesus calls Him Papa,” Augie tells one of his human contacts, “so we call Him Papa.” Like many of the incidents in the book, the idea is rooted in Dr. Garvin’s experiences in life: “I was in Israel, in a rest room, and a young Orthodox Jewish boy ran into the room, obviously frightened, and calling ‘Abba! Abba!’ “ He later asked about the word, and learned that although there is no direct English translation of Abba, the word combines the respect connoted in the word “father” and the intimacy of the word “daddy” or “papa.” “That appealed to me,” says Dr. Garvin. “It personalizes the Creator. And talking to Papa is how I’ve come to pray. I envision myself crawling up on this huge set of knees, putting my head to Papa’s chest, and telling Him what’s on my mind.” Dr. Garvin wrote the book over a five-month period, researching and writing mostly at night. He writes www.ourhealthvirginia.com
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a first draft by hand on yellow legal pads, and then enters what he’s written into computer, doing a first edit as he goes. “I write by hand with a pen, because that’s the speed of my brain,” he notes. “I honestly feel that this book was dictated to me, except for looking up historical stuff that’s in the book.” The book captures some two dozen or so of Augie’s adventures, inspired for the most part by issues that had been bothering Dr. Garvin in his search for faith, and what he learned as a result.
Dr. Garvin says he is now fully guided by the faith he has found. As a physician, he says that he views all of his patients as children of God, miracles who have bumped up against the world and come away bruised. “I am privileged to take care of this physical need that my patients have” he says, “and that’s the view of all of the Christian doctors that I know.” Asked about how sales of the book are going, Dr. Garvin says that while sales are satisfactory, he was counseled by his brother Lucky to stay away from the standard metrics, such as numbers of volumes sold. “Lucky taught me that if the book has benefited just one life, that’s not a book sale,” he says. “It’s a human being whose life I’ve helped to change.” Case Files of an Angel is the sort of book that many will want to keep handy, to return to for inspiration and for comfort. In the last paragraph Augie writes, he has some advice for us: “Now put down this book, and go out and get some exercise. Tuck your shirt in, treat your body with respect. Oh, and while you are at it, fall in love with your Creator, your Papa. He can’t bless you if you keep getting in his way. Allow yourself to feel his love. Then hang on to your hat.” Good guidance from the angel Augie, and from Dr. Dennis Garvin. •••••
Case Files of an Angel is available from its publisher, the West Bow Press, at www.westbowpress.com, in soft cover, hard cover, and ebook formats. It’s also available from Amazon.com in print form and as a Kindle download, and from Barnes and Nobel in both hard copy and Nook digital version.
ON THE WEB
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Hermitage in Roanoke
Rich in History and Natural Beauty From the minute you pass through the grand gates of the Hermitage in Roanoke and catch a glimpse of the Georgian mansion, a lifestyle of peaceful luxury comes to mind.
Hermitage in Roanoke’s main house is a mansion, nestled in a grove of centuries-old Mockernut Hickories and Magnolia Rosies. Built in 1916 by James Calder Cassell, a superintendent with Norfolk & Western, it was originally and aptly named Cassellwold, meaning “home in the woods.” Cassell started his railroad career at age 14 as a telegraph operator for the Pennsylvania Railroad Company. He eventually became a train master, who rode on the first train into Roanoke in 1880, and ultimately built one of Roanoke’s finest homes. Cassellwold was sold in 1921 to Elmore Heins, a Virginia League baseball player turned capitalist. The Heins were known for their Saturday night parties, and the stately residence was well-suited for entertaining with its grand entrance hall, library, sun porch, extensive kitchen, servant hall, three-car garage, stables, and mountain and golf course views. In 1964, Elmore’s widow sold the 10-acre estate to the Roanoke United Methodist Conference. Shortly thereafter, it became part of the Virginia United Methodist Homes, Inc. A retirement community, the Virginia United Methodist Homes was formed in the 1940s to “provide a Christian home or homes for aged men and women.”
Country Club Estate Finds New Meaning In 1964, six lucky residents were fortunate enough to call the mansion home when it first opened as the Roanoke United Methodist Home. Today, the estate is home to 82 seniors who enjoy just the right mix of services, space, solitude and social activity that makes the Continuing Care Retirement Community so appealing.
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1964
Casselwold, the Georgian-style mansion on 10-acres adjacent to the Roanoke Country Club, becomes the Roanoke United Methodist Home (RUMH) for six residents.
1965 RUMH entered the Virginia United Methodist Church system and construction began for a $1 million addition.
CLICK HERE to view the entire spread!
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The groundbreaking ceremony for the new three-story wing. The addition added 60 units or studio rooms and a wide variety of housing options depending on the level of care required or independence desired.
1971 Ten spacious two-bedroom apartments were built, each with a patio overlooking the golf course, to accommodate the growing demand of active seniors who wished to live independently and have the option to participate in meal plans and social activities.
Healthy Eats Roasted Pork Loin with Green Beans Makes 8 servings
Ingredients for Roasted Pork Loin: 1 3-4 pound boneless, center-cut pork loin 4 garlic cloves, minced 1 Tbsp sea salt 1 Tbsp fresh sage, minced 1 Tbsp fresh rosemary leaves, chopped 1 Tbsp fresh thyme leaves, chopped 1 tsp freshly ground black pepper 2 Tbsp olive oil
Ingredients for Green Beans: 2 lbs green beans, ends trimmed 2 tbsp extra virgin olive oil 2 large garlic cloves, minced 1 tsp red pepper flakes 1 tbsp lemon zest
Salt and pepper to taste
Pork Directions:
Green Bean Directions:
1. Prior to roasting, take the pork out of the fridge and let it sit at room temperature (30 minutes).
11. In a large stock pot of boiling water, add green beans until bright green.
2. Preheat oven to 450°F.
13. Next, heat a large skillet over medium heat.
3. In a small bowl, combine the oil, garlic, salt, pepper and herbs; then mix until a paste forms. 4. Pat the pork dry with a paper towel, and coat with the seasoning paste. 5. Set on a rack in a shallow roasting pan 6. Roast for 15 minutes, and then turn the oven temperature down to 300°F. 7. Let the loin continue roasting for another 30-40 minutes. 8. Use a meat thermometer to ensure the internal temperature reaches 135°F. 9. Remove the roast from the oven and cover with foil. 10. Allow ten to fifteen minutes of resting time. Then slice and serve.
12. Drain and shock beans in ice water.
14. Add oil, garlic and red pepper flakes. 15. Sauté for about thirty seconds, and then add beans and continue to sauté until beans are coated and heated throughout. 16. Add lemon zest and salt and pepper, as desired.
Local Pork Loin from:
Riverstone Farm | 708 Thompson Road Floyd, VA 24091 | Phone: 540.745.7700
About Riverstone Farm: Located in Floyd County, Virginia, Riverstone Organic Farm sells pasture raised lamb and pork to the community. In addition they grow an array of produce that is USDA certified organic to local retail customers. Their produce is also available through Good Food Good People, a farm share program serving the Blue Ridge Mountains and Piedmont area.
Tricia Foley says
USE LOCAL INGREDIENTS Tricia Foley is OurHealth Magazine’s resident nutritionist.
HealthyEats
12. Wash thoroughly and spread on a towel to dry. 13. Dice the figs and chop the almonds.
Directions for Dressing: 14. Whisk the juices together (you should have about 1/4 cup total of juice).
Kale & Quinoa Salad with Dates, Almonds & Citrus Dressing Makes 6 servings
Salad Ingredients: 1 tablespoon coconut oil 1 large white onion, diced
Salt to taste
1/2 cup white quinoa
3. Cook, stirring occasionally, for about 20 minutes; or until the onion has a toasty brown appearance and smells caramelized. 4. Remove from the heat and set aside. 5. Rinse the quinoa in a fine mesh strainer. 6. In a pan, add garlic and quinoa and sauté over medium-high heat for about a minute. 7. Add 1 cup water and 1/2 teaspoon salt, and bring to a boil. 8. Cover and turn the heat to low; cook for 15 minutes.
1 bunch kale (3/4-1 pound, with stems)
9. Remove from heat, but leave the lid on for an additional 5 minutes.
1/2 cup dried fig, diced
10. After 5 minutes, remove the lid & stir.
1/2 cup roasted salted whole almonds
11. Meanwhile, slice off the bottoms of the kale stems, and slice the leaves into fine strips.
1 small clove garlic, minced
Dressing Ingredients: 1 Clementine, juiced 1/2 lime, juiced 2
teaspoons local honey
15. Whisk in the honey and olive oil. The dressing will be thin. 16. Stir about 2 tablespoons of the dressing into the quinoa after it finishes cooking.
Making the Salad: 17. Mix the kale with the quinoa and caramelized onions. 18. Toss with about half the dressing and taste. 19. If desired, add the remaining dressing, and then toss in the figs and almonds.
1/4 cup extra-virgin olive oil
Salt and freshly ground black pepper
Directions: 1. Heat the coconut oil in a wide sauté pan over medium heat. 2. Add the onion and sprinkle lightly with salt.
Tricia Foley says
GREENS ARE POWERFUL Tricia Foley is OurHealth Magazine’s resident nutritionist.
HealthyEats
Spinach, Kale and Apples from: Roanoke City Market, Vendors: Ferguson’s Farm & Woods Farm Roanoke City Market 213 Market Street | Roanoke, Va 24011 Phone: 540.342.2028 www.downtownroanoke.org/city-market
Woods Farm
Spinach & Apple Smoothie Makes 1 serving
½ apple, chopped 2-3 mint leaves
Ingredients Step One:
2921 Naff Road Boones Mill, Va 24065 Phone: 540.420.9391 www.franklincountyfreshfoods.org/woodsfarms-james-mark-woods/
About Roanoke City Market, Ferguson’s Farm and Woods Farm
Truvia to taste
2 Cup organic spinach
Directions:
1/2 apple, chopped
For step one: mix spinach, milk, ice cubes,
1/2 Cup milk (or milk substitute: almond, coconut, rice, etc)
½ apple and the lime juice together,
4 ice cubes
Rinse blender and then combine all
1 lime, juice only
of the ingredients from step two and blend.
Ingredients Step Two:
Add this to your glass and enjoy!
Roanoke City Market’s hours are from 8:00 am through 5:00 pm Monday through Saturday and from 10:00 am on Sunday.
and blend. Pour in a glass and set aside.
¼ Cup milk (or substitute) ½ C plain Greek yogurt
Tricia Foley says
DRINK YOUR SPINACH! Tricia Foley is OurHealth Magazine’s resident nutritionist.
Evan Scott of Vinton, age 2
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words | LAURA NEFF-HENDERSON, APR
e to Scott said goodby ra au L d an k ic R s pital , 2012, Roanoker nurses roll his hos of am te On September 18 a ed ch at th-old son, and w Health System. ia n gi ir V their then 17-mon of ty si iver ating room at Un ess bed into an oper rvived many sleepl su d ha le up co e y, th s of ading up to this da ne endless amount do d an s, In the months le ar te of are ically than their fair sh ashisaki, MD, surg H T. e rg nights, shed more eo G at ts th e cochlear implan research about th day. eir baby ’s ears that implanted into th
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Evan with his mom, Laura, and Lorin Bobsin, PhD, during a recent auditoryverbal therapy session at the University of Virginia Health System
They had consulted with numerous medical professionals, gotten a second, third, and even fourth opinion, and shared their thoughts and concerns with family and friends. This was, after all, a huge decision. And the stakes were even bigger. If the surgery didn’t work, their baby, who was born with profound hearing loss in both ears, would lose the very little bit of hearing he did have. P
Approximately three in 1,000 babies are born with permanent hearing loss.
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Evan Michael Scott was born on April 21, 2011, at 9:03 p.m. at Lewis Gale Hospital in Salem. His mother Laura’s pregnancy was normal and his delivery was routine as well. Evan passed the newborn APGAR test with flying colors. At 9 pounds, 9 ounces and 41 weeks, he was a healthy baby boy. In fact, he was the fourth healthy baby boy that Laura Scott had given birth to. It wasn’t until nearly a day later, when a nurse came into Laura’s hospital room in the second floor labor and delivery unit that the Scott’s learned that something was wrong. Seriously wrong. Evan had failed the newborn hearing screening. Not quite sure how that one test would change their lives, the Scott’s were discharged by the hospital a day later with
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instructions to come back to LewisGale for follow-up testing. The hope was that Evan’s hearing difficulty was temporary, perhaps the result of extra fluid in the ears that would soon dissipate. Although most babies can hear normally, approximately three in 1,000 babies are born with permanent hearing loss. This makes hearing loss one of the most common birth defects in America, according to the American Speech-Language-Hearing Association (ASHA). In infants, that hearing loss is most often detected during the newborn hearing screening required in 30 states. About half of the children with hearing loss have no risk factors for it, and 92 percent of children with permanent hearing loss are born to two hearing parents. That was certainly the case for Evan. The Scott’s have no genetic predisposition for hearing loss. They both hear, and none of their three older children were born with any hearing loss. During the first 12 months of Evan’s life, the Scott’s relentlessly pursued doctors and specialists who could help them with answers – answers about how this had happened, why this had happened, what it would mean for their sweet little boy, what it would mean for their family, and what they could do to “fix” this. The first step had the Scott’s taking Evan, just two months old, back to Lewis Gale for additional hearing testing . “We knew he couldn’t hear like he was supposed to because that’s what the doctors were telling us, but we didn’t know anything else,” said Laura. Shortly thereafter, the family turned to Roanoke Valley Speech and Hearing for a second opinion. After the tests were inconclusive, they were referred to the Carilion Clinic Ear, Nose, and Throat Doctor Kurt Y. Chen, MD, who confirmed that there was no fluid buildup and nothing lodged in Evan’s ears. One medical professional after another told them Evan’s testing was inconclusive. There was too much pressure in his ears, they said, to get a good reading on where exactly his hearing levels were. “Just hang in there, it takes time, was the mantra they kept hearing over and over again,” according to Laura.
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On the advice that they might help, Evan was fitted with a pair of hearing aids. After four months, it was clear that they were not helping. Incredibly frustrated that nothing was working, and still with no answers, the Scott’s were sent to the University of Virginia (UVA) Health System in Charlottesville, Va., for additional testing. At about 14-months-old, Evan was given general anesthesia and put to sleep so doctors could conduct one more test. Within hours, the Scott’s had the answers they had been waiting for – at least some of them. His hearing loss was profound. According to Laura, Evan was 95 percent deaf in one ear and 94 perfect deaf in the other ear. The test results, Laura explains, indicated that Evan could hear extremely loud noises, but could not distinguish one sound from another. And that noise had to be as loud as a jackhammer, at just 50 feet away, in order for him to be able to hear it at all. The testing also determined that Evan was a perfect candidate for the cochlear implants. “It all just sounded like noise to him. He heard something but he didn’t know if it was someone talking, yelling, or a blast from a car horn,” says Laura. The cause of his hearing loss is an answer they’ll probably never get. “His ears are formed perfectly. Everything is there and built right, it just so happens that the little cochlear hairs don’t work,” says Laura. Why they don’t work is a mystery. The Scott’s met with Audiologist Lori Grove, Ph.D. to discuss the only option Evan had left—cochlear implants. Grove works in the Department of Otolaryngology - Head and Neck Surgery at UVA. 76
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Cochlear implants are small, complex electronic devices that can help provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of a portion that is surgically implanted into the cochlea, or inner ear, and an external portion that sits behind the ear. The external device stimulates the electrodes, allowing the patient to hear.
Evan travels to UVA weekly for therapy.
Adults with hearing loss can also benefit from the implants. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), “Adults who have lost all or most of their hearing later in life often can benefit from cochlear implants. They learn to associate the signal provided by an implant with sounds they remember.� The hearing aids had not worked for Evan because they simply amplified sound. Given the severity of his hearing loss, traditional hearing aids did not provide the necessary clarity for Evan to hear and understand speech sufficiently for development of spoken language. The cochlear implants, on the other hand, bypass damaged portions of the ear and directly stimulate the auditory nerve according to the NIDCD. www.ourhealthvirginia.com
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“Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn.” “I broke down when Lori was explaining the process of the surgery. How it worked, what they would do,” explains Laura. “I was thinking - you want to do what to my baby?” Anatomically, Evan had formed in utero exactly as he was supposed to. His ears had formed just fine and he was a healthy baby, without any other complicating medical issues. He was an ideal candidate, and while he still seemed incredibly young, the Food and Drug Administration (FDA) has approved cochlear implants in children as young as 12 months old and given surgeons latitude to perform the surgery on even younger children, when the circumstances dictate doing so. According to the FDA, as of December 2012, approximately 324,200 people worldwide have received implants. In the United States, roughly 58,000 adults and 38,000 children have received them. “Good pediatric candidates for cochlear implantation are determined by the severity of the child’s hearing loss, limited benefit from appropriately fitting hearing aids, motivation and appropriate expectations of the family, and access to appropriate education and rehabilitation services,” says Lorin Bobsin, PhD, CCC-SLP, Cert. AVT. Bobsin is the coordinator of the Aural Habilitation Program for the Cochlear Implant Team at the University of Virginia. She’s one of approximately 600 certified LSLS (listening and spoken language specialists) in the world. “The earlier the better for detection, optimal fitting of hearing technology, and appropriate rehabilitation. There are critical periods of language development, and in order for us to access those critical periods, we want to get the children hearing optimally as soon as possible.”
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Making the decision to move forward with the surgery took some time for the Scott’s. It was a huge decision that would have permanent effects. Surgical implantations are almost always safe, although complications are a risk factor, just as with any kind of surgery. Children, and adults, who receive the implants have to undergo intensive auditory therapy to learn to interpret the sounds created by the implant. The process takes extensive time and practice. “It was terrifying to know what he would have to go through. You want to protect your children from everything, and then you are put in a situation where you are choosing to have something done to them,” says Laura.
Seeing a child respond to his or her parents’ voices for the first time is amazing and it never gets old.
“The surgery is often the scariest part for parents, but the rehabilitation afterward is the hardest part,” says Bobsin. The Scott’s were aware that it was possible that the surgery wouldn’t work at all, which would mean the hearing Evan did have would be destroyed. They also knew they could have the surgery done on one ear first, but that wasn’t really an option for them, says Laura. “God gave us two ears for a reason,” she explains. “We knew that if this didn’t work, Evan wouldn’t really be any worse off than he already was.” P
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Six hours after they watched their child wheeled into the operating room, they met him in the recovery room. His entire head was wrapped in gauze, and his ears were covered with a hard bandage shaped like a cup to protect his ears. “He was so pitiful,” says Laura. “He couldn’t hold his head up because he was so little, and the bandages were so heavy.” Twenty-four hours later, just after the family made the two hour drive from Charlottesville to their home in Vinton, the Scott’s were able to take off the bandages and take a good look at the incision sites. Within hours, Evan was up and running around, playing with his older brothers, who had stayed at home with Laura’s parents during Evan’s surgery. “It was amazing to watch how easily he got over the surgery and went back to his normal routine,” says Laura. “Kids are so resilient, and we are sure it is something he won’t even remember happening. His brothers were curious about what happened, but they were so good about being easy with him and watching out for the stitches behind his ears.” www.ourhealthvirginia.com
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Evan’s implants were activated on Oct. 23, 2012 – a day his parents will never forget. “It was phenomenal to see that it actually worked and he could hear,” says Laura. “You could tell the first moment that he actually could hear. He stopped playing and started to cry. He immediately wanted mommy, but after that initial surprise, he did great. His dad and I wanted to cry too, it was such a beautiful moment!” That, says Bobsin, is a completely normal response for the children she sees who go through the surgery. Some children; however, act like nothing has happened. “Responses are individual to each child,” says Bobsin. “Working with cochlear implant recipients is the best part of my job as an audiologist,” says Grove. “Seeing a child respond to his or her parents’ voices for the first time is amazing and it never gets old.” P
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The Scott’s travel to Charlottesville every week for Evan’s auditory-verbal therapy sessions. The implant has to be mapped every three to six months. A mapping is a reprogramming of the cochlear implant, to readjust the electrical stimulation limits of the electrodes, as each user’s brain adapts to sound and fibrous tissue grows over the internal implant. The Scott’s aggressive approach to therapy has been met with tremendous success in the 15 months he’s been a hearing child. Evan is quickly catching up with his
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As of December 2012, approximately 324,200 people worldwide have received implants.
hearing peers, and it’s the hope and expectation of his therapists, doctors, and parents that he’ll enter mainstream kindergarten. “I think the biggest thing we were worried about was that he wouldn’t have the opportunities his brothers had,” says Laura who admits she worried immensely about how she would communicate with her youngest son. The idea that Evan would never hear her voice, or know what his daddy sounded like, was incredibly upsetting. “We always knew we wanted him to have a “normal” life, and we’d do whatever it would take to make that happen for him”, says Laura. That success hasn’t come without sacrifice though. The Scott’s have had to learn to juggle life with their older children at home, and Laura’s busy work schedule, with Evan’s needs. A large part of Evan’s therapy program, according to Bobsin, involves the work Laura and Rick do with their son at home. During Evan’s weekly sessions, Bobsin works with them to teach them what they need to do to meet Evan’s goals for the week. “He needs to be exposed to language like a typically hearing child – everyday normal experiences that can be adjusted to be language-learning opportunities,” says Bobsin. P
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By all accounts, Evan is now a happy, healthy three-year-old. He’s talkative, and inquisitive. He loves to play outside and adores his big brothers. He has also learned how to work his “ears” - that’s how he refers to the pieces of the cochlear implants that go on the 82
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outside of his head. He knows how to take them off and set them down when he doesn’t want to listen to someone. While they used to get lost in the cushions of the couch, or set aside in the grass in the front yard, that rarely happens now. And, when it does happen, Evan’s pretty good about knowing where he left them, says Laura. When he can’t remember where they are, the family relies on the blinking light on each device or the programmed remote control to find them. P Lorin Bobsin, PhD, CCC-SLP, Cert. AVT is the coordinator of the Aural Habilitation Program for the Cochlear Implant Team at the University of Virginia Health System
Lori Grove, PhD is an Audiologist in the Department of Otolaryngology at University of Virginia Health System
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The road ahead is very long. The Scott’s expect to continue traveling to Charlottesville for Evan’s weekly appointments for several years. And, it’s possible that Evan will have to have another surgery in the future as technology changes. But, for now, the Scott’s are adjusting to life with cochlear implants and counting their blessings that Evan will have the same opportunities as his brothers after all.
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words | BECKY BLANTON
the rewards of
Hea LTHcare You can’t really appreciate another person’s life until you’ve walked a mile in their shoes, or so the saying goes. May is traditionally the month when healthcare organizations recognize their employees; both clinical and nonclinical. They recognize them for the work they do to improve the health of our communities, and for the contributions they make to their own organizations as well. This year, OurHealth Virginia decided to let healthcare organizations discover for themselves just how valuable their employees are by encouraging them to swap places to see what their coworkers really do during their shift. So, we created a “role reversal for a day” of sorts. Healthcare organizations were asked to select two employees in different areas within their organization. Each employee would either “work” or shadow the other employee during their job to see exactly what they did during the day. The overlying theme of the resulting articles is this:
it takes eVeRY person in the health organization working together to deliver quality care.
We expected each employee to learn something new, but even we were surprised at what came out of this short and simple swap. So were the employees themselves. The best thing about the swaps is that almost every participant learned something new that they say will help them do their own jobs better. From a nurse practitioner who learned that writing more detailed test requests could result in quicker test scheduling, to an administrator suggesting that families designate one spokesperson to communicate with nurses to ensure continuity of information, the experiment was educational and job changing. Read the interviews to see what each of the job swap participants learned, and were surprised by in the process.
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Amanda Melvin, Social Worker & Susan Wade, Registered Nurse Carilion Clinic
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Amanda Melvin Susan Wade Social Worker Registered Nurse Carilion Clinic Communication, plus timely and informative patient updates, is the heart of their jobs. That’s what Amanda Melvin, a social worker, and Susan Wade, a nurse with 31 years of experience, learned during their job swap. Both women work on 12 West at Carilion Roanoke Memorial, and both are committed to ensuring peace of mind for the families they serve. What they discovered, when they swapped places recently, were two new ways to improve communication with family members. “We decided encouraging families to select a single spokesperson to interact with the nurse and the social worker would ensure there’s less confusion overall,” Amanda said. “Having one central person to relay information, ask questions and report back to the family is less confusing than having every family member calling and getting different reports,” Susan said. “Having a morning, or shift huddle, with both nurses and social workers to touch base on any potential concerns, issues or updates before each shift helps too,” Susan said. Huddles allow nurses and social workers to head off any problems, and provide a better response to questions that may arise about a patient during a shift. As far as what each learned about their coworker during the swap: Amanda considers herself an extrovert - a people person. But, she said she was surprised by the number of phone calls Susan got throughout the day from families wanting updates on their family member’s condition. “I get update requests and calls too, but I had no idea how many calls Susan gets 88
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throughout the day,” Amanda said. “I didn’t realize she had to answer so many calls on top of everything else she does. I kind of feel bad now about how I was documenting cases. I see now how I can document things so when people do call, she can give them a better idea of how the person is doing both medically and emotionally.” Amanda also said she thought going up and down the floor, helping dispense medications, was the hardest part of Susan’s job. “It was demanding,” she said. “I was only on my feet for an hour, but it was hard. I hurt.” She was also surprised by how patients reacted to medication time. “Some of them took their medications, some of them refused; and Susan had to document all of that, and return the medication if patients didn’t take it. It was more work than I thought it would be,” she said. What impressed her most about Susan’s job was the amount of time Susan spent talking to each patient, checking on how they were feeling and getting to know them. “My job involves a lot of interaction and talking with patients, but in a different way and for different reasons,” she said. “I have a new respect for nurses and the amount of work they have to do,” Amanda said. “They have a lot of work to do in a short amount of time.” Susan had an equally newfound respect for Amanda. “I was surprised at how much time Amanda spends at the computer,” Susan said. “We (nurses) see her in the patient rooms a lot, talking to the families and the patients, but then she spends a lot more time online updating cases and going through records, checking with doctors and scheduling discharges for a lot of people. “It’s nonstop documentation. What Amanda does is very detail oriented, very complex and she’s often here very late. I was impressed with how much multi-tasking and how many details and patients she has to deal with.”
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Kim Roe Mark Greenwald, MD
VP of Hospital Operations Physician Carilion Clinic What Mark Greenwald, MD appreciated most about his job swap with Kim Roe, Vice President of Hospital Operations at Carilion, was that she is “medically bilingual.” “She is fluent in both doctor-speak and administrator-speak,” he says. That’s unusual in a world where doctors look at administrators the way labor looks at management—with suspicion. “Traditionally, and generally, in the medical structure there’s distrust on the part of physicians about the role of administrators,” Dr. Greenwald says. “The mythology is that administrators are always out to save money and clinicians are out to do the noble work. That’s not true at Carilion,” he says. Dr. Greenwald’s time invested in his job swap and job shadowing with Kim Roe, VP of Hospital Operations, reinforced his original perception of Kim as a uniquely qualified administrator experienced in the culture, lingo and job demands of physicians. “I had an appreciation of Kim’s job before we did this, or so I thought,” Dr. Greenwald says. “But now I really, really appreciate Kim’s job. It’s just incredible to see all the behind the scenes pieces that go into her job. Just the amount of meetings she goes to, and how many touchstones she has to so many people is astounding.” Rather than look for ways to cut resources to save money, Kim looks for ways to utilize and find resources to enhance patient care, while also keeping an eye on the financial side as well, Dr. Greenwald says. “Kim has a skill set and ability to relate to both the business and medical aspects of Carilion,” he says. That comes from her long relationship with the hospital “I spent about 29 years with Carilion before this (current job),” Kim says. “From the clinic side, working as a bedside therapist right beside the doctors, I learned a lot about what they deal with. That was mostly with the inpatient side. Knowing all the changes that are coming down, all the regulations that they’re faced with, the practice environment as it is today plus knowing the administrative side of what we’re trying to do with Carilion makes for a nice mix with my abilities to work with this group.”
Kim says over the years she’s been with Carilion she has seen how a lot of doctors interact with patients, but was particularly impressed when she shadowed Dr. Greenwald. “What impressed me the most about Dr. Greenwald was how he listens to and interacts with his patients? He also listens to his residents. He helps them think critically about what they’re doing as they progress from first year students to third year residents,” she says. “He’s teacher, mentor and so much more.” Kim recently became Vice President of Family and Community Medicine at the hospital. She now manages 50 medical practices across Carilion’s medical footprint, including five urgent care sites in the area and an occupational medicine practice. “She has a huge, complex job with a lot of responsibility,” Dr. Greenwald says. “I couldn’t do it. She’s the touchstone for so many people and practices, it’s astounding. It requires such a unique skillset.” Both Dr. Greenwald and Kim keep coming back to Carilion’s “medical home” concept of medicine, a new system of patient care in the United States. It means hospitals and medical practices are moving away from focusing on the management of health care “episodes” and looking more at long-term management of population health and integrated delivery of health services. It means working with families and individuals to promote regular health care practices, check-ups and health maintenance before a crisis. It’s about preventing, heading off or maintaining health rather than waiting and reacting to an event or crisis when it happens. “What that means for Carilion is that we want patients to know they have a medical home they can come to. We want to provide them with services they can access in a timely manner. People want convenience and access quickly, and we’re looking at how we can provide that,” Kim says.
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Richard Ruble Seth Walters
Prosthetist Healthcare Relations Manager Excel Prosthetics The only thing that surprised healthcare relations manager, Seth Walters, about Richard Ruble’s job was the extent of gratification Richard gets to experience. Because Richard spends the greatest part of his time working with patients, he also earns their trust and shares in their hard won successes. “You not only have to be a practitioner to do what he does,” Seth says. “You have to be a confidant. You have to earn that patient’s trust. The patient has to believe that you can help them meet their life goals. You have to be more than an engineer and prosthetist. You have to be a good person because you have to relate to the patient.” “Rich has the more rewarding part. He has patients that come in that can’t walk, and then they leave walking. Those of us on the back end of that process don’t get to see that too much. I help patients with insurance and talk to them, but that’s not the same as talking about a person’s life goals, and helping them get their life back.” Seth may not get to celebrate every patient win in the rehab process, but he does get to help make the wins possible. His official title is “Healthcare Relations.” That, he says, is more of a catchall term for all he really does by ensuring the company is in compliance, that operations run smoothly, that administrative tasks are completed and that even the occasional human relations (HR) challenge is met. It makes it easier for him because he, too, is a prosthetist and he understands both the practice and the administrative aspects of the business.
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A, ever y . “We have our certifying board, OSH “A lot of what I do overlaps,” he says there’s then and ns, latio r own rules and regu individual insurance company has thei . HIPPA, Medicare, Medicaid,” he says er and prosthetist/orthotist. He designs low Richard is an American board certified its the adm He gs. thetic limbs among other thin upper extremity orthotics, and pros day staggers his mind. amount of detail Seth tends to each Policies and sure all seven offices are compliant. “We have seven offices, so he makes s up with all that.” regulations change annually. He keep wledge is Richard says. “Seeing how much kno “It’s not a few, simple changes either”, surprised been doing this for 14 years. I’m not required to do his job is amazing. I’ve e I started complicated things have become sinc about his job. I’m surprised at how doing this.” with all the titioners must submit to be compliant Seth agrees that the paperwork prac complex. ngly easi incr prosthetics is getting rules and regulations for orthotics and a detailed for a diabetic means you have to get “Getting approval for a pair of shoes worth of ths’ mon ed off by the doctor, and six prescription, a certified letter sign and nt, eme stat match that up to the search doctor’s notes. Then you have to in three months, the the search statement has to be with to do an evaluation, notice within six. The doctor has top of that,” Seth and has to have a correct diagnosis on says.
who gets to see Seth makes that happen, but it’s Rich patient’s face. Seth the gratitude and appreciation on the ct of Richard’s job. says he’d like to be closer to that aspe enjoyed the job swap. Richard and Seth both say they p participants said, Both acknowledged what all the swa best patient care that teamwork is what makes the possible. thetics “I couldn’t get patient’s the pros ard. Rich says they need without him,” what ing “See s, Appreciatively, Seth respond making of part g bein Richard can do to change lives, doing.” love I t wha is that happen, and sharing in it
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Samantha Arnold Karen Scalf-Benham Patient Services Coordinator Nurse Practitioner Blue Ridge Cancer Care Karen Scalf-Benham was drawn to oncology during a medical rotation while in nursing school. Karen is a nurse practitioner with Blue Ridge Cancer Care. She says the patients she saw during her internship always intrigued her. “I just realized how much I loved these patients,” she said. “Other than a few breaks, I’ve always had my hand in oncology.” Karen was a nurse with Blue Ridge Cancer Care before becoming a Nurse Practitioner. She said there’s just something different about people who are dealing with cancer. “The gratitude patients have for every birthday, every holiday, every moment they have with a loved one, they don’t take it for granted anymore,” Karen said. “For patients that know they’re facing their own mortality, it can be a very humbling disease,” Karen said. “It typically allows people time to re-prioritize what’s important to them, and see what’s important to them, while maintaining a quality of life.” Being part of that journey makes her job special not only to her patients, but it’s what impressed co-worker Samantha Arnold as well. Samantha is the Patient Services Coordinator for Blue Ridge Cancer Care. “The one thing that really surprised me was the personal relationship Karen builds with her patients,” Samantha said. “A lot of time, when people go back and forth with their primary care physician, they’re in and out. There’s no real time spent with a patient. With Karen, she knows things like six months ago a patient got married, or what they’re doing in their life. If I were her patient, I’d feel like I was talking to a friend, not just in and out. I don’t have time to do that in my job. I have a lot of people waiting, and don’t have that luxury of 30 minutes at a time, or the privacy. I wish I did. I like that about her job.” Karen’s success relies a great deal on what Samantha’s job entails— including customer service, reassuring patients, answering questions, and scheduling a variety of procedures. Not every patient who shows up at Samantha’s desk has cancer, but many of them assume they do because they’re at a cancer care center.
“My first job is often calming them down,” Samantha said. “I try to be positive, and let them know just because they’re here they may have a health issue that is not cancer.” That positive, calming attitude is part of what makes Karen’s job easier. The amount of scheduling and getting people where they need to be for the tests they need is also helpful, she said. “There’s a lot of attention to detail with Samantha’s job. If she’s scheduling an appointment for a patient, it’s not just one schedule. She has to coordinate with the nursing staff, or the outside facility or doctor’s office and logistically everything takes a lot of time. The multitasking and attention to detail, the customer service skills, there’s a lot going on. She has a very busy job,” Karen said. “I was surprised by all the multi-tasking, and the number of things she has going on in any one moment.” Perhaps the best realization Samantha had was how important her job truly is. A lot of times people don’t think an administrative job is important, she said. But it is. “I got to see that without every department doing their jobs, clinical or nonclinical, things wouldn’t run smoothly,” Samantha said. “It shows me that what I do on a daily basis, even though I don’t have that patient interaction like they do, it shows me how important my job is and how it impacts what they do. My job helps people heal by my helping Karen and the nurses be able to do what they do.” That realization made the swap worth it to her, she said. “Everyone’s job matters, no matter how small or insignificant they may think it is, it’s important.
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Courtesy of DBHHS, Commonwealth of Virginia
where is this? Post the correct answer on our Facebook page by May 7, 2014.
You could win some great food from The Fresh Market! Cool, right? The winner will be announced on our Facebook page May 14, 2014.
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