OurHealth Roanoke & New River Valleys Aug/Sep 2013 Edition

INSIGHT ON MEMORY CARE

BLUE RIDGE BEST OF

2013 Retirement Living Awards

AUGUST

•

THE ABCs OF BACK TO SCHOOL HEALTH

NUTRITION: THE HARVEST RECIPES

SEPTEMBER 2013 | SOUTHWEST VIRGINIA EDITION | OURHEALTHVIRGINIA.COM

At 85, Betty Gehlert, a resident at Friendship

Retirement Community in Roanoke, is living life to the fullest during her senior years

our health | BASIC

table of contents |august • september 2013

22

RETIREMENT LIVING FOCUS The New Face of Retirement: Retirement is no longer MEDI•CABU•LARY.....................12 Local experts define healthcare related terms

about resting on your laurels. Our local seniors can attest to this.

JUST ASK!..................................14 A variety of health questions answered by local professionals

THE LATEST...............................17 A listing of new physicians, providers, locations and upcoming events in the Roanoke and New River Valleys

HEALTH AND FITNESS ON THE GO..................................21 Health-focused apps you can download to your smartphone or tablet

2013 blue ridge best of:

RETIREMENT LIVING AWARD

WINNERS

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[SPECIAL ADVERTORIAL SECTION]

RETIREMENT LIVING HIGHLIGHTS...............................28

RETIREMENT LIVING AWARDS This year, nearly 10,000 votes were cast by people in our communities for their favorite senior services. FIND

OUT IF YOUR FAVORITES MADE THE CUT!

37

MEMORY CARE...........................44 • Caring for Families • Fast Facts About Dementia from the Alzheimer’s Association

COMFORT AND PEACE..............51

62

BACK TO SCHOOL ABCs of Back-to-School Health

Healing by Giving to Others

PHARMACY.................................54 Polypharmacy: Lots of Medicine, Lots of Side Effects

58

NUTRITION Healthy Eats! Preparing for the Harvest

MEDICAL EDUCATION ADVANCEMENTS........................70 Southwest Virginia and Lynchburg and Southside colleges are answering the call for needed medical care

MEN’S HEALTH...........................80 PROSTATE CANCER • A controversial issue with no one right answer

www.ourhealthvirginia.com www.ourhealthvirginia.com|| 9

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august • september 2013 OUR HEALTH’S EXCLUSIVE MEDIA PARTNER PUBLISHER PRESIDENT/EDITOR-IN-CHIEF ASSOCIATE EDITOR VICE PRESIDENT OF PRODUCTION CHIEF DESIGNER ACCOUNTING MANAGER WEBMASTER

McClintic Media, Inc. Stephen McClintic, Jr. | steve@ourhealthvirginia.com Susan Sheppard Jennifer Hungate Karrie Pridemore Laura Scott Adapt Partners and Brain Swell Media

CONTRIBUTING MEDICAL EXPERTS Kristi Abraham, AuD, CCC-A Caitlin Cheatham Tricia Foley, RD, MD Gary Gross, MD Kenneth Luckay, DO Dane McBride, MD Syed Raza, MD Rick Seidel, PhD, LCP CONTRIBUTING PROFESSIONAL WRITERS Sarah Cox Rich Ellis, Jr. Anika Imajo Laura Neff-Henderson, APR Jennifer Romeo Edwin Schwartz 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: 305 Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.355.3071 Information in all print editions of Our Health and on all Our Health’s websites, including: www.ourhealthvirginia.com is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions.

Copyright © 2013 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The Our Health Southwest Virginia edition is published bi-monthly by McClintic Media, Inc. 305 Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthvirginia.com. Advertising rates upon request.

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our health | MEDI•CABU•LARY & JUST ASK

me d i • ca bu • l ar y

T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D

What is seborrheic keratosis?

A seborrheic keratosis is an inherited wart-like surface mole that increases in frequency with age. They are often dark brown to black and have a very crusty surface. They are most commonly noted on the trunk but can occur on any location. They grow up from the skin surface and have no roots.

They are easily removed if they cause symptoms or for cosmetic reasons. It is important to have any new or growing skin lesion diagnosed by a physician as early treatment is critical for skin health.

Gary Gross, MD LewisGale Physicians Department of Dermatology Salem | 540.772.3421

What is Auditory Processing Disorder?

What are symptoms of celiac disease?

What is non-exercise activity thermogenesis?

An Auditory Processing Disorder (APD) is a disruption in the auditory processing signal from the ear to the brain. It is also known as a Central APD as the inaccurate coding of the signal occurs centrally (in the brain) as opposed to peripherally (in the ear). It is found to occur in 3-5% of school age children and can also be acquired after a closed head injury. Symptoms of an APD include difficulty focusing in the presence of background noise, misunderstanding or reversing words and sentences, and difficulty understanding sarcasm or subtle intonations. Many symptoms of an APD are similar to ADHD and it is important to have children tested for a possible APD if they have been diagnosed with any form of ADHD. An APD can only be diagnosed by an Audiologist and management and compensatory strategies can be taught at school, home and by a Speech-Language Pathologist.

Celiac Disease is caused by immune hypersensitivity to Gluten in diet, therefore it mainly manifests with signs and symptoms of gastrointestinal mal-absorption, While abdominal cramping, bloating, pale, voluminous and foul smelling diarrhea is fairly common, it sometimes causes skin rashes, oral ulcers, joint pains, muscle aches, fatigue and weakness due to anemia. Mineral and vitamin deficiencies are also noted in people affected with celiac disease also known as Celiac sprue. Due to lack of absorbed vital nutrients in the body it is sometimes accompanied by slow growth in children and failure to thrive in adults.

Non-exercise activity thermogenesis or N.E.A.T. is the daily calorie burn outside of any “formal” exercise. Put simply it is calories used for normal, everyday activity. To increase your N.E.A.T. keep moving as much as possible i.e. foot or finger tapping; leg jiggling; pacing while talking on a cell/cordless phone. This will increase calories burned and in the long run help fight the battle of the bulging waistline. Other techniques to increase your calories burned would be using stairs instead of an elevator; parking far from a building entrance; walking instead of standing; standing instead of sitting. Over time these activities will add up to a slimmer and healthier you!

Syed Raza, MD Valley Internal Medicine Salem | 540.380.3722

Kenneth Luckay, DO The Center for Medical Weight Loss Roanoke | 888.794.5620

Kristi Abraham, AuD, CCC-A Roanoke Valley Speech and Hearing Center, Inc. Roanoke | 540.343.0165

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our health | MEDI•CABU•LARY & JUST ASK

ju st a sk!

T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D

I have old injuries from playing sports; what types of workouts can I do that will not aggravate my injuries?

You should always consult a physician before beginning a workout regimen after injury.

It is never a good idea to begin a workout program that could potentially aggravate a pre-existing injury or cause permanent damage.

You should only perform exercises that feel good to your body. A great place to start would be resistance training with power bands or light weight resistance bands for strength training. There are very effective exercises you can do with power bands that will target specific muscle groups and give you the same results with a lot less force than lifting heavy weights. For cardio, I suggest starting out on a recumbent bike or elliptical. These machines were engineered for low impact use and are a safe way to ease back into cardiovascular workouts.

The important thing to remember is, listen to your body and never push yourself too far after injury.

Take time to properly heal and always be smart about your workouts.

Caitlin Cheatham Fitness Director Sun Medical Roanoke | 540.389.3800

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Is Stress considered a chronic medical condition?

Will eating local honey help with my seasonal allergies?

Emotional stress actually exists along a continuum from no stress to severe stress, or trauma. When we experience a stressful situation, our mind and body prepare to respond to a threat, either real or perceived. Research shows that some stress can actually increase our performance, such as being nervous before taking a test, resulting in improved performance on the test itself. Highly stressful situations, like a bad car accident or ongoing work conflicts, can lead to emotional symptoms such as anxiety and irritability, physical symptoms like muscle tension or headaches, behavioral symptoms like sleep problems, and/or cognitive symptoms such as constant worrying. Severe or prolonged stress leading to symptoms should be discussed with your primary care provider.

A review of medical literature shows a number of positive benefits of eating honey in modest amounts, but no scientific studies show that allergies are helped by eating honey, from either local or distant sources. The concept that it does help is based on a few personal stories, and upon the logical conclusion from the concept of desensitizing someone by giving progressively larger amounts of an allergenic substance, as is done by trained allergy specialists. There are two major errors in the claim. The first is that bees collect pollen mostly from flowering plants, not from nonflowering plants. But the pollens that cause allergic rhinitis and conjunctivitis (hay fever) are principally from the non-flowering plants that rely on their pollens being airborne, rather than relying on insects to transfer the pollens. Bees collect very little grass or oak pollen, for example, so their honey would contain little if any of these pollens. Secondly, effective desensitization requires enough of the allergen to produce serious reactions, so the dose of this has to be built up gradually so as to not produce such reactions. If honey were to contain that much pollen, it would be dangerous.

Fortunately, it does not, so unfortunately, it cannot desensitize a hay fever sufferer either.

Rick Seidel, PhD, LCP Director of Research, Department of Psychiatry and Behavioral Medicine Carilion Clinic Roanoke | 540.981.7000

Dane McBride, MD Asthma and Allergy Center Roanoke/Salem | 540.343.7331

THE LATEST | our health

the l atest

N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S

Breast Care Center at Carilion New River Valley Medical Center Named a Center of Excellence

Anthony BaffoeBonnie, MD Carilion Clinic Infectious Disease Roanoke | 540.981.7715

Erol M. Knott, DO Carilion Clinic General and Pediatric Surgery Roanoke | 540.224.5170

Christofer C. Catterson, MD Carilion Clinic Orthopaedics and Sports Medicine Roanoke | 540.224.5170

PICTURE NOT AVAILABLE

Corey Smock, PA Carilion Clinic Orthopaedic Surgery Christiansburg 540.731.2436

Mary-Ellen Mick, DO Internal Medicine LewisGale Physicians Salem | 540.772.3490

Gretchen S. Glaser, MD Carilion Clinic Gynecologic Oncology Roanoke | 540.224.5170

PICTURE NOT AVAILABLE

Leigh Mann, PA Carilion Clinic Family Medicine Staunton | 540.885.3525

William Thomas, DO Internal Medicine/Sports Medicine LewisGale Physicians Christiansburg 540.382.6148

Patricia Fedorchak, NP Carilion Clinic Family Medicine Floyd | 540.745.2031

William Tung, MD Vascular Surgery LewisGale Physicians Salem | 540.776.2010

Pamela Ruppel, NP Carilion Clinic Pediatric Hematology and Oncology Roanoke | 540.981.7376

Chris Downing, DO General Surgery LewisGale Physicians Pulaski | 540.980.9660

Designation by American College of Radiology shows commitment to high quality patient care The Breast Care Center at Carilion New River Valley Medical Center (CNRV) has been designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR).

The ACR recognizes breast imaging centers that have earned accreditation in all of the College’s voluntary breast-imaging accreditation programs and modules, in addition to the mandatory Mammography Accreditation Program.

The breast imaging services at CNRV are fully accredited in mammography, stereotactic breast biopsy, breast ultrasound, ultrasoundguided breast biopsy and breast MRI. Peer-review evaluations, conducted in each breast imaging modality by board-certified physicians and medical physicists who are experts in the field, have determined that CNRV has achieved high practice standards in image quality, personnel qualifications, facility equipment, quality control procedures, and quality assurance programs.

“From the day I joined CNRV’s breast imaging department, this was my dream and I want to thank the staff, my colleagues and administration for making it happen,” said Leena Grover, MD, CRNV radiologist, who was instrumental in CNRV achieving the Center of Excellence designation.

“We are proud of this achievement,” said Steve Williams, CNRV imaging director.

“Our team has always provided high quality services, meeting the highest standards of the radiology profession.”

Megan Cornwell Thomas, DO Internal Medicine/ Pediatrics LewisGale Physicians Christiansburg 540.382.6148

Heather Brooks, MD Medical Oncologist/ Hematologist LewisGale Physicians Christiansburg 540.381.5291

The ACR, headquartered in Reston, VA is a national organization serving more than 32,000 radiologists in varying programs focusing on the practice of medical imaging and radiation oncology, as well as the delivery of comprehensive health care services.

www.ourhealthvirginia.com | 17

our health | THE LATEST

the l atest

N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S

Marian Kelso, a resident of Warm Hearth Village, was presented with the Volunteer of the Year award for her extraordinary dedication and untiring service to LewisGale Hospital Montgomery.

Kelso started volunteering at the hospital in March of 2012 and has donated more than 200 hours of her time to the hospital. Her nomination for Volunteer of the Year partially stated: “I would like to nominate Marian for volunteer of the year because she goes above and beyond every day that she is at our facility,” said Peg Driscoll, a volunteer at the hospital. “ I have personally seen her sit with a visitor or patient to ease his or her fears. Her genuine concern for others and her dependability, even in the bad weather, makes her my only choice for volunteer of the year.”

This unsung hero continually demonstrates her service to others not only at LewisGale Hospital but also throughout the Blacksburg area.

She reads to children at the Margaret Beeks Elementary School in Blacksburg, VA, and, yes, delights children of all ages as Mrs. Santa Claus. “That’s the best of all,” Kelso said, smiling warmly.

She is also active in the Warm Hearth Community. She volunteers at The Village Center, Warm Hearth’s newest building that serves the community’s meeting space and houses a wellness and fitness center.

Kelso also enjoys a game of Canasta with friends and neighbors, sings in the choir at Warm Hearth, and visits residents at the Kroonjte Health Care Center, which provides memory care, skilled and long-term nursing care.

“I am blessed to have good health,” said Kelso, 87.

Volunteerism is integral to Kelso’s former professional career, as well.

She worked as a coordinator of volunteer services at Inova Alexandria Hospital. In addition, she has taught elementary school in Iowa and Virginia.

Marian is truly an ambassador for Warm Hearth Village and an asset to this community,” said Mardy Baker, Director of Events and Volunteer Programs at Warm Hearth.

Warm Hearth is a non-profit senior center living community that provides a continuum of living options from active adult living to longterm nursing care in Blacksburg.

Jefferson College of Health Sciences Physician Assistant Student Named VAPA Student of the Year The Virginia Academy of Physician Assistants (VAPA) chose Caroline Pilgrim, ’13, a current student in the JCHS Physician Assistant (PA) Program as its Student of the Year for 2013.

The annual award is presented to an outstanding senior physician assistant student in good standing attending an accredited PA program in the Commonwealth of Virginia. In addition to the Student of the Year Award, VAPA also presents awards each year for the Physician Assistant of the Year; Physician/PA Partnership of the Year; Outstanding Preceptor of the Year; and Humanitarian of the Year.

The award recipients are selected by VAPA leaders based on specific criteria for each award. To receive the Student of the Year Award, those being considered must be a current VAPA member, must be nominated and must submit a faculty reference that details their exemplary academic skills.

Caroline was informed that she had been named the Student of the Year on June 28, 2013. She accepted the Award at the VAPA President’s Inauguration & Awards Ceremony on July 22 at the Hilton Virginia Beach Oceanfront Hotel.

To learn more about the Master of Science in Physician Assistant Program at JCHS, visit the College website at http://www.jchs.edu/page.php/ prmID/382. To learn more about VAPA, visit their website at http://www. vapa.org/index.php.

For more information about applying to JCHS, contact the JCHS Office of Admissions at 888.985.8483 or via email at admissions@jchs.edu.

Carilion Clinic Now Offering Allergy Services in Botetourt New practice offers services for both adult and pediatric patients Carilion Clinic is proud to now offer allergy services in Botetourt. Aneysa Sane, MD is currently accepting both adult and pediatric patients.

New practice information: 46 Wesley Road | Daleville (shares the building with VelocityCare Daleville) | 540.591.9447 Business hours: Monday 7 am - noon Wednesday and Thursday 7 am - noon Friday 7 am - 5 pm Business hours will change during the school year to: Monday, Wednesday, Thursday, Friday 8:45 am ¬ 2:30 pm.

For more information, visit www.carilionclinic.org.

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HEALTHY AT 40 | our health

Health and Fitness

On the Go

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

In our new Health and Fitness on the Go section, we recommend a variety of health-focused apps you can download to your smartphone or tablet.

iTriage iTriage, founded by two emergency medicine physician, helps users answer the two most common medical questions: “What could be wrong?” and “Where can I go?”. iTriage helps you take charge of your health with simple tools to research problems, take action and live healthier.

Android

This app features loads of training tools to help you stay on track: »» »» »» »» »» »» »» »»

Check symptoms Learn about possible causes Research medications Determine appropriate action Locate and compare nearby care options Choose a medical provider Manage your personal health Free for iPhone and Android

iPhone

Noom Walk

SHARE YOUR FAVORITE HEALTH AND FITNESS APP!

Our new favorite pedometer! Noom Walk is better than your average pedometer. With this app, connect with your Noom friends and cheer each other along in your daily, weekly, or all-time step count! If you’re Android not wild about the social features, just use Noom Walk privately without uploading any information. Not only does it count all your steps, it does it without killing your battery! This is probably our favorite feature. Noom Walk uses less than 2% of your battery in a 24 hour period. You can leave it on all day! Challenge yourself to get a few more steps every day. »» Free for Android »» Not yet available on iphone, but coming soon

Share your favorite health and fitness app! Scan this QR code with your smartphone or tablet to visit and “Like” Our Health’s Facebook page, then post a “Comment” with your favorite health and fitness APP!

www.ourhealthvirginia.com | 21

the new face of retirement Betsy Davis

Betty “Betsy” Davis of Roanoke has been on the go all her life. She raised three children as a single parent and worked in the lab at LewisGale Medical Center. Now, as she approaches 72, it shouldn’t come as any surprise that she’s not slowing down.

Her latest plan? Compete in her first triathlon next June. Betsy’s favorite quote, and one she says to herself frequently, is carpe diem – seize the day. And seize it she does.

“I’ve always exercised off and on,” Betsy explains. “Once I retired from the lab at LewisGale Medical Center, I started exercising regularly at the Kirk Family YMCA in Roanoke.”

Soon after Betsy joined the Y in February of this year, she said her grandson was looking through some YMCA materials and came across information for a 5K race. He said, “You should do this.” So that’s exactly what Betsy did. She competed in her first 5K in April, and came in fourth in her age group.

SEIZE THE DAY! Now her sights are set on the YMCA Sprint Triathlon in Salem in June, 2014, and to prepare, she’s working out at the Y three times a week, lifting weights and taking swim lessons there to become a better swimmer.

words | RICH ELLIS, JR.

“My son laughed when I told him,” Betsy says. “I’m not afraid of hardly anything. I took a self-defense class at the Y. Exercise keeps me mentally and spiritually alive, makes me feel good, and it’s very healthy for you. I see a lot of people that can’t get up two steps. It’s a personal thing for me that I like to exercise. A lot of people my age don’t like to.”

When she’s not training, Betsy said she enjoys reading and new places, things and adventures, like a trip out of town either with friends or on her own. Her children and grandchildren are also very important in her life.

“I think seniors get into trouble when they don’t have something to do or think they can’t,” Betsy explains. “That word ‘can’t’ isn’t in my vocabulary.”

She describes herself as a religious person and believes in God as her savior, and says prayers in the morning and evening. “He’s important in my life and guides my life,” she explains.

When asked why she chose a triathlon, Betsy says it was to test her limits. “ My children didn’t think I could do the 5K. They see me like most seniors – as being limited to what you can do. I just feel there’s no limit.”

www.ourhealthvirginia.com | 23

Kathy Darnell

OFF AND RUNNING Kathy Darnell lost weight and got into shape by watching TV. Well, not solely by watching TV, but that’s where it all started.

“I had watched The Biggest Loser show on TV and wished it could be me,” Kathy recalls. “Then I saw the Lose Big program at Green Ridge and I said ‘I’m ready. I’m tired of feeling bad and feeling overweight and not feeling comfortable with myself.’”

So she decided to do something about it. The 56-year old Botetourt County resident joined Green Ridge Recreation Center’s “Lose Big” program with three other friends and also began running about a year ago with friends from work. In that short time, she’s already completed about 10 5K races and has set her sights on an even bigger goal – the Star City Half Marathon this November in Roanoke, for which she has already began training. She supplements her running by working out at Green Ridge a couple nights a week.

“I never thought I’d run,” Kathy recalls. “I was a good bit overweight and just decided life was passing me by. I want to participate in life.

I’ve already lost 65 pounds and want to lose another 30.”

Kathy said she feels so much better now that she’s lost weight and works out. “I used to come home from work and not want to do anything,” she explains. “Now I can work in the yard five or six hours at a time on the weekend. When I started working out, exercising, losing weight, and running I felt like a whole different person – not just physically but mentally as well.”

In addition to running, Kathy also stays active by playing golf. She’s also started hiking and plans to do some kayaking. “I’ll go anywhere anybody wants to go,” Kathy says. “I’ve done a few hikes over by Craig’s Creek. I also have a small garden that I like to work win and I do yard work.”

Kathy’s also very active at the Salem VA Hospital where she’s worked in the Imaging Department for 35 years and plans to work for several more years.

When asked what advice she might offer others who want to lose weight or become more active, Kathy said it’s like the old saying. “If I can do it, anyone can do it. Life is short and if it’s passing you by, the way to live it is to get active and out there and enjoy things.”

the new face of retirement

words | RICH ELLIS, JR.

the new face of retirement

BOUNCING

BACK words | RICH ELLIS, JR.

In February of 2011, Roanoke resident Skip Carter began taking proactive steps to improve his health by working out at the Green Ridge Recreation Center in Roanoke County. The results were impressive. In just 10 months, he lowered his weight from 260 pounds to 210 pounds and his physician instructed him to discontinue his medication for high cholesterol.

but once they got in there, they had to remove my whole lung.”

“I had a physical in December and it was the best one I’ve ever had,” Carter explains.

The story could have ended there, with Carter left with little more than a wounded body and broken spirit. But it doesn’t, because Carter, it turns out, doesn’t slow down or let life get him down. After he finished chemotherapy in December, Carter and Nancy returned to Florida, and he resumed his workouts.

With winter approaching, Carter and his wife, Nancy, headed to Florida and their second home at Vero Beach. A 22-year Navy veteran — 20 years of which were spent at sea — and then another two decades working for the U.S. Postal Service, Carter says that one of his favorite activities in Florida is surf fishing.

“Where I fish is about 25 minutes away, and we’re on the beach by 10:30 every morning fishing and don’t stop until about 1:30,” Carter says.

Physically fit, doing what he loved and in Florida for the winter, Carter was thoroughly enjoying his retirement. And then he got the phone call.

“My doctor called me and said something showed up on the chest x-ray and that I needed to get a CT scan,” Carter recalls. “I did, and then they said I needed to get a biopsy.”

The news went from bad to worse. It was lung cancer. Stage 3.

“I smoked for 30 years, but I quit smoking 23 years ago, and then I got lung cancer,” Carter says.

“I found out in January 2012 and by February I had surgery to remove the lower lob of my lung

The road to recovery didn’t start there, because as Carter describes it, “Everything that could have gone wrong, did.” He endured six more surgeries in just 24 days and spent 43 days in the Intensive Care Unit at Roanoke Memorial Hospital.

“I started working out down there, and continued when I came back up to Green Ridge,” Carter explains. “I go five or six days a week. I do 2.5 miles on the treadmill, am up to 100 crunches and work on the machines. I feel great.”

Carter gives a lot of credit for his recovery to his positive outlook, and to Nancy, who was by his side every day in the hospital.

“A lot of it is attitude and how you approach it,” Carter says. “You can’t let it beat you. You just have to keep on trucking. They told me I have a 50 percent chance of living (beyond five years), so I’m going to have fun.”

With a big garden at his house, lots of fishing and four grandchildren, Carter has no plans to slow down.

“You have to be active,” Carter says. “You can’t just sit back and do nothing.”

Skip Carter

NURSING AND MEMORY CARE Surrounded by the beautiful Blue Ridge Mountains, Woodhaven

was built with the future of the community and their families in mind. Its rich history and peaceful setting add to the charm and home-like atmosphere that makes Woodhaven a very special place.

Open since 1960, Woodhaven has specialized in caring for families just like yours families that are caring for their loved one as they age, and for those with memory impairment. Woodhaven partners with you, providing care and expertise that make them the Valley Leader in Memory Care.

The study of Alzheimer’s disease and the care required for those diagnosed have greatly advanced during the past 50 years with Woodhaven leading the way. They were the first in the area to have certified dementia practitioners as part of their Care Team, cementing their commitment to excellence in the field of memory care. They were also first in the area with geriatric psychiatry, consultation and evaluation specific to memory impairment.

Among Woodhaven’s experienced team is medical director Daniel Jones, MD, voted the areas #1 physician by the Roanoker Magazine, who has served Woodhaven’s families since 1989. Geriatric psychiatrist David Trinkle, MD, one of the nation’s foremost experts in Alzheimer’s Disease, has helped propel Woodhaven as one of the leading Alzheimer’s and Dementia Care facilities in the area.

Woodhaven’s nursing team is made up of highly skilled registered nurses, practical nurses and certified nursing assistants, always ready to meet the needs of each resident as well as the needs of their families. Additional care services available include: pain management, rehabilitation, music therapy, and daily activities designed to meet needs of those with cognitive impairment. For convenience and timely care, each resident also has access to a number of additional medical services on site such as pharmacy, x-ray, laboratory services, oxygen and medical equipment.

Residents and families may select from private or shared accommodations, vacation stays or long term residency or nursing or assisted living, while enjoying home-cooked meals together and participating in community events and programs.

Since its opening, Woodhaven has undergone renovations to both its interior and exterior, and its richest history remains in its residents and Care Team. In their 50-plus year history, Woodhaven has served more than 1700 people along with thousands of families who agree that Woodhaven proves quality care can be both compassionate and affordable.

Located just a short 14 minute drive east from the heart of Roanoke, Woodhaven Nursing and Memory Care provides a unique experience in a location convenient to families and friends. With more than 50 years of experience, residents and guests alike are sure to find out why Woodhaven is the Valley Leader in Memory Care.

NURSING AND MEMORY CARE

Woodhaven Nursing and Memory Care 13055 West Lynchburg-Salem Turnpike (US Route 460) | Montvale, VA 24122 540.947.2207 | www.WoodhavenNursingHome.com

Friendship Retirement Community At Friendship Retirement Community, residents are only minutes from the Roanoke Valley’s best shopping, dining and entertainment. Friendship offers independent and assisted living accommodations, as well as long term care, conveniently located near family and friends.

Independent living at Friendship is all about the resident. With 26 different floor plans from a studio to three-bedrooms, each resident has the flexibility to personalize his or her accommodations. Living spaces include well-equipped kitchens, individually controlled heating and air conditioning, wall-to-wall carpeting, smoke and fire detectors, and parking in well-lit areas. Friendship’s campus also features a picnic pavilion, resident vegetable gardens, a chapel, as well as transportation services to local events, shopping centers and grocery stores.

The hub of activity on Friendship’s campus is the Residents’ Center, where residents enjoy a virtual golf room, a full service restaurant at Club Friendship, and a fitness center. In addition, the Residents’ Center is where residents can swim a few laps in a heated pool, or do some online shopping in the computer lab.

The Residents’ Center also includes a large banquet room where residents can host events large or small, from club meetings to family reunions.

Residents needing a little more help have the option of Friendship Assisted Living. Assisted living residents also enjoy the freedom to choose from multiple floor plans, and the award-winning Friendship nursing staff is available to aid in medication management, daily activities such as dressing or bathing, and escorts to and from meals.

To ensure each resident feels relaxed and carefree, Friendship Assisted Living boasts an on-site doctor’s office, full-service beauty salon along with weekly housekeeping and laundry services. A full calendar of activities is also offered for Friendship Assisted Living residents that include outings to local restaurants, men and women’s social clubs and live entertainment.

At the on-site emporium, located in the Health and Rehab Center, each resident can easily pick up anything from their prescription at Friendship Pharmacy to household and toiletry items. On-campus residents can even create a list of necessities and have those items delivered right to their door.

Friendship is also proud to offer home care services, allowing those who need assistance to receive care in the comfort of their own homes, whether they live on Friendship’s campus or out in the community. Whether it’s keeping the house clean, running errands, or simply keeping patients company, Friendship Home Care aides are happy to help.

At Friendship, staff members know staying healthy is a lifelong commitment.

Other services offered on-campus include outpatient therapy at our award winning clinic. In addition to physical, speech and occupational therapy, our outpatient clinic offers aquatic therapy in a heated pool. Wellness classes are also offered to residents and those in the community, these include land and aquatic classes.

Friendship Retirement Community 327 Hershberger Road | Roanoke, VA 24012 | 540.265.2100 | www.friendship.us

Our Lady of the Valley A Legacy of Caring – Serving Generations for more than 20 Years Mountain views. City skyline. Neighborhood streets. That is the vista from Our Lady of the Valley. A visit inside will show a community of seniors who enjoy a renewed retirement lifestyle fostered by a team of caring professionals. Focused on personal well-being, the residents at Our Lady of the Valley are the centerpiece of life in this special place. The life enrichment programs, delicious cuisine, and friendly neighbors all combine to create a community that inspires the individual spirit.

Assisted living services are customized for each resident to preserve independence and to allow everyone to live life to their fullest potential. Engaging programs and activities, caring personalized attention, and an unwavering dedication to excellence enhance the lives of our residents each and every day. We offer spacious apartment plans that feature several large closets, kitchenettes, individual heating and air conditioning, and convenient access to a bustling community center. Our newly expanded front porch, garden patio and rose garden give access to nature in a peaceful neighborhood setting.

In addition to our personalized, quality assisted living care, on-site services include long-term nursing care and skilled rehabilitation services in the Sullivan Center.

Opened in January 2013, the new addition to the Health & Wellness Therapy Center expands the environment where residents receive physical, occupational, and speech therapy. Furthermore, a new, full-community generator has recently been installed to provide an extra level of safety, security, and peace of mind for residents and their families. They can rest-assured knowing that in the event of a power outage residents’ lives will not be interrupted.

Our Lady of the Valley is a nonprofit, nondenominational senior living community sponsored by the Catholic Diocese of Richmond. Since 1989, we have provided comfortable and affordable assisted living, rehabilitation and nursing care. At Our Lady of the Valley, residents come first. It is as simple as that. It is no wonder that we continue a legacy of caring by serving generations of seniors and their family members here in the Roanoke Valley.

Our Lady of the Valley Retirement Community 650 North Jefferson Street | Roanoke, VA 24016 540.345.5111 | www.ourladyofthevalley.com

ONE FLOOR LIVING

at its best!

- Close-in Botetourt County Location - Granite Countertops|Hardwood Floors - Craftsman Style Community with Maintenance Free Exteriors

STARTING AT $234,950

LUXURY ONE & TWO

story townhomes!

- Convenient Roanoke County Location - Open Floor Plans from 1500 to 2600 square feet - Maintenance Free Exteriors | Granite Countertops | Hardwood Floors

STARTING AT $239,950

FOR MORE INFORM CON TACT:CONTACT: FOR MOREATION, INFORMATION,

NATHAN HUNGATE NATHAN HUNGATE 540.309.0266 540.309.0266 nhungate@msn.com nhungate@msn.com www.RoanokeSalem.com www.RoanokeSalem.com

Radford Health & Rehab Center

Radford Health & Rehab Center’s goal is simple: to use innovative techniques and creative thinking to provide efficient, effective treatments. While its lush New River Valley setting may change with every season, Radford Health & Rehab Center provides the same great care year-round.

Opened in 2002, the 90-bed center offers long-term care, short-term rehabilitation services and a state-of-the-art rehabilitation gym. To ensure the highest level of care, the center has partnered with Radford University’s Department of Exercise, Sport, & Health, developing the next generation of therapists and therapy techniques.

In addition to employing the latest technology, the center believes firmly that families are an important part of recovery. Each resident’s family is welcome to visit at any time that is convenient to the resident, and family members are even encouraged to participate in the rehabilitation process by observing scheduled therapy sessions if the resident desires.

Long-term residential care is an important part of the center’s mission. The skilled nursing staff believes in progressive, innovative thinking that is rooted in solid training and customer service.

The center offers creative therapy and exercise programs, such as art therapy and Wii therapy, which utilizes the popular motion-sensitive video game system. Staff members are trained to care for residents with memory loss and in tracheostomy care, among other specialties.

The center also offers on-site laboratory services for quick and convenient medical care, is home to a registered dietitian to promote health and wellness, and offers a full-service pharmacy on-site for convenience.

In addition to these programs, each long-term resident can look forward to a wealth of amenities, such as private and semiprivate rooms with private bathrooms; fine dining programs; small- and large-group activities; and housekeeping, linen and transportation services. The monthly social calendar offers something for everyone, from group exercise to book clubs, pet visits to concerts, tea parties to sporting events and church services to movie nights.

The beautiful grounds and joyful social community areas of the Radford Health & Rehab Center make each resident feel right at home, and families and friends are put at ease knowing the center offers high-quality care by bringing industry-leading technologies to the New River Valley.

Radford Health and Rehab Center 700 Randolph Street | Radford, VA 24141 | 540.633.6533 | www.radford-rehab.com 32 | www.ourhealthvirginia.com

Richfield Retirement Community

Richfield helps people rediscover their quality of life, regardless of where they are in life’s journey. Our beautiful surroundings, combined with a broad range of services and accommodations, provide a setting where individuals become members of a secure, supportive and active community.

Whether it’s recovering from surgery, mending after an injury, living independently or needing support and daily assistance, Richfield makes it possible to remain as independent as possible and age with dignity and compassion.

Richfield is home to about 700 residents with the support of 550 employees on 50 acres of stunning mountain views. From its beginnings as a public health center nearly 80 years ago, Richfield has grown into a leader in retirement living, assisted living and nursing care recognized for excellence both locally and statewide.

There’s a lot happening on our campus: • Our Rehab Center has been remodeled into 48 hotel-like guest rooms featuring quality amenities and hospitality services not found elsewhere in the region.

• We’re introducing a new wellness program to make becoming – and staying – healthy easy, informative and fun.

• We’re embarking on long-term campus renewal initiatives to benefit our residents, patients, visitors and the Roanoke Valley.

• Our goal is to provide a setting that fosters independence, wellness and security so residents may enjoy life to the fullest with a full continuum of healthcare services.

The Rehab Center at Richfield Southwest Virginia’s only post-acute, short-term physical rehabilitation center offering resort-inspired amenities – an ideal environment for those seeking an alternative to a traditional nursing home setting.

Independent living • Knollwood Apartments: Studio, one and two bedroom apartments with a variety of floor plans with transportation and optional housekeeping and meal service plans.

• Richfield Lake Estates: Charming single-story cottages offering two- and three-bedroom floor plans.

• Ridgecrest Apartments: Government-subsidized housing for individuals who are either 62 years of age or have impaired mobility.

Assisted Living At Richfield, we offer two distinct assisted living residences – The Oaks and the Joseph C. Thomas Center. Both are designed for adults over 55 who need assistance with the activities of daily living in a safe, comfortable and nurturing environment.

Richfield Recovery and Care Center Our Recovery & Care Center is equipped to care for 315 patients. We provide comprehensive nursing care ranging from short rehabilitative stays to extended long-term care. Our specialized programs include Memory Care for those with memory impairment.

To learn more, please visit www.richfieldliving.com.

Richfield Retirement Community 540.380.6511 | 3615 West Main Street | Salem, VA 24153 | www.richfieldliving.com www.ourhealthvirginia.com | 33

The Village on Pheasant Ridge

At The Village on Pheasant Ridge, the mission is to allow each resident more time to pursue the activities he or she loves. With maintenance and landscaping staff, scheduled transportation to activities and shopping, and weekly housekeeping and linen service, each resident has the freedom to enjoy daily life without worrying about the little things.

Each month, residents enjoy a full calendar of activities, including birthday parties, fitness classes, car shows, art classes, spa services, lunch outings, socials, and happy hours. Residents are also encouraged to visit the activity and multi-purpose rooms, ice cream parlor, library, and billiards rooms on site and enjoy healthy, nutritious meals provided three times per day in the restaurant-style dining facility on campus.

With multiple opportunities to socialize during the week, each resident can look forward to having a full and personalized social calendar and getting to know the friendly staff and neighbors of The Village.

Across campus, residents, family, and friends enjoy beautiful mountain views, as well as walking trails and outdoor gathering spaces. The pristine landscaping outside is an excellent compliment to the gracious accommodations inside.

The Village offers spacious studio, one-bedroom, and two-bedroom apartments on month-to-month leases. Residents enjoy the privacy of their own individual homes, while the facility staff and friendly neighbors offer a community of support.

Each residence includes a full-size kitchen, a washer and dryer, wall-to-wall carpeting, and access to a parking garage. An emergency response system is also available to connect residents to the 24-hour staff. In addition, each apartment at The Village is licensed by the Virginia Department of Social Services, so should the need for assisted living arise, residents can easily receive care in the comfort of their own homes.

Those who may be interested in visiting The Village to learn about all that the assisted and independent living facilities on campus have to offer can arrange a personal tour and even enjoy a complimentary meal in the beautifully appointed dining facility.

The Village on Pheasant Ridge 4428 Pheasant Ridge Road | Roanoke, VA 24014 540.400.6482 | www.villageonpheasantridge.com 34 | www.ourhealthvirginia.com

Virginia Veterans Care Center The Virginia Veterans Care Center (VVCC) in Roanoke is deeply committed to serving the veterans of our armed forces who so bravely spent a part of their lives serving us.

On Veterans’ Day in 1992, then-Governor Doug Wilder made a trip west from Richmond to participate in the opening ceremonies for a brand-new assisted living and nursing home facility. Much time and effort had gone into building this facility, including considerations for top-level healthcare, as well as on-campus services and activities such as nature trails, library, chapel, barber shop and billiard room.

While many of the area’s retirement living centers offered similar services, there was still something unique about the Center Governor Wilder was visiting. What’s the difference?

This Center was opening specifically for our honorably discharged armed forces veterans who lived or who had enlisted in Virginia.

Today, the VVCC still remains a state-of-the-art model for long-term healthcare and one of only two state homes for veterans in the Commonwealth of Virginia. Housing 240 beds, which includes a 60-bed assisted living area and a 60-bed Alzheimer’s Care unit, VVCC continues to provide comprehensive, high quality care with on-site, x-rays, physical therapy, podiatry care, and many other ancillary healthcare services. As well, nearly all residents of VVCC receive some level of financial assistance that subsidizes their living expenses, making it a much more affordable retirement option.

These services and resources certainly play a role in the quality of life veterans’ living at VVCC have, but according to residents and staff alike, it’s the people that make the biggest difference.

“I can truly say working at VVCC has been the most rewarding job in my career,” explains Patti Smith, VVCC’s Director of Admissions and Public Relations. “The people who work here do so with the purpose to give thanks to our veterans, to show appreciation for their efforts and to make their lives as enjoyable and fulfilling as possible.”

Smith says the camaraderie between residents at VVCC is what’s so special.

“They have so much to share and so much in common, but believe it not, it’s not just about the bond they share from being in the armed forces,” maintains Smith. “They’re like brothers and sisters – it’s such an unconditional friendship among everyone.”

Smith says that VVCC also houses the area’s only “Wander Garden” for Alzheimer’s patients.

The “Wander Garden” is an enclosed, outside area where Alzheimer’s patients can visit unsupervised 24-hours a day without the threat of getting hurt or unknowingly leaving the campus. Plus, the entire area of the “Wander Garden” has been safety-checked to prevent accidental injuries. Even the plants in the area are safe and non-toxic.

“It’s a wonderful place for our residents because it allows them freedom in a safe environment - something many Alzheimer’s and dementia patients rarely enjoy,” says Smith.

The VVCC is supported by the American Legion, the Veterans of Foreign Wars (VFW), AMVETS, Disabled American Veterans (DAV) and community groups. Each of the organizations lend a hand whenever called upon to help out the veterans at VVCC. “I believe VVCC stands for many great things, but above all else, it’s a place where our veterans can receive the care they deserve and be appreciated for all they have done,” concludes Smith. “Everything we do here is our way of saying “thank you” to our veterans.

It’s a great feeling.”

They were there for us when we needed them, and now we will be there for them.

Virginia VeteranS Virginia Veterans Care Center Care Center 4550 Shenandoah Ave. | Roanoke, VA 24017 | 540.982.2860 | 800.220.VETS

Warm Hearth Village Located within view of Virginia Tech, Warm Hearth Village is just minutes away from shopping, cultural events, recreational activities, restaurants, professional services, sporting events, and LewisGale Hospital at Montgomery.

Warm Hearth is a nonprofit community with a mission to serve seniors from all socioeconomic backgrounds. The 220 acre woodland campus offers a full continuum of living options, from independent living to long-term nursing care.

Rehabilitative or skilled care and care management in your home round out the comprehensive list of offerings.

At the heart of Warm Hearth is the Village Center. As the hub of activity, the Village Center brings together residents from across the campus and enhances both physical and social wellness. Here, residents and the community can utilize the welcome center, fitness center, cafĂŠ, and community gathering spaces.

The fitness center promotes healthy aging and is staffed by trained professionals who assist in developing personal exercise and nutrition plans. Featuring an indoor, saltwater pool and a cardio and strength training room, the fitness center provides a range of personalized assistance and group exercise classes, including aerobics, yoga, Pilates, tai chi, and dance. In addition, the fitness center includes treatment rooms for massage, chiropractic care, and acupuncture therapy.

Residents even have access to complimentary guest passes each month so family and friends can join in the fun.

The new Huckleberry CafĂŠ features a unique variety of fresh food and drink options for residents. In partnership with Good Food, Good People, a network of over 50 local producers of fresh fruits and vegetables, herbs, pasture-raised meats, free-range eggs, farm cheeses, and freshly baked goods, menu options regularly change with the season. The Village Gourmet provides the same fresh approach to catered events and features beautiful indoor and outdoor venues on campus.

At Warm Hearth, there are many opportunities to be engaged and active. A variety of activities that cater to a wide range of interests and activity levels are offered throughout the community and include music, theater, arts, fine dining, games, and continuing education programs.

Residents of Warm Hearth receive priority admission to the next level of care should the need arise. This list of services and amenities available to residents is abundant and includes home and grounds maintenance; transportation, on-site dining; 24-hour emergency response; evening security; physical, occupational, and speech therapies; and home care to name a few.

Warm Hearth Village’s wide range of choices for housing, services, and care provide each resident with the options and freedom he or she needs to live the life he or she desires.

Warm Hearth Village 2603 Warm Hearth Drive | Blacksburg, VA 24060 | 540.552.9176 | www.retire.org

Blue Ridge Best of:

Retirement Living Awards

our health | BLUE RIDGE BEST OF: RETIREMENT LIVING AWARDS

Independent Living

Real Estate Services

GOLD

GOLD

Warm Hearth Village 2603 Warm Hearth Drive | Blacksburg, VA 24060 540.552.9176 | www.retire.org

MKB 3801 Electric Road | Roanoke, VA 24018 540.989.4555 | www.mkbrealtors.com

SILVER

SILVER

Friendship Retirement Community 327 Hershberger Road | Roanoke, VA 24012 540.265.2230 | www.friendship.us

RE/MAX Valley, Realtors 2350 Electric Road | Roanoke, VA 24018 540.989.3000 | www.homesinroanoke.com

BRONZE (TIE)

BRONZE

Richfield 3737 W. Main Street | Salem, VA 24153 540.380.2986 | www.richfieldliving.com

Thomas and Wall Real Estate 120 Wilson Street | Floyd, VA 24091 540.391.0206 | www.thomaswallre.com

The Village on Pheasant Ridge 3328 Pheasant Ridge Road Roanoke, VA 24014 | 540.400.6482 www.villageonpheasantridge.com Carrington Place 290 Commons Parkway | Daleville, VA 24083 540.966.0056 | www.carringtonplaces.com

Skilled Nursing Facilities GOLD Friendship Health and Rehab Center 327 Hershberger Road | Roanoke, VA 24012 540.265.2100 | www.friendship.us

SILVER Brandon Oaks Nursing & Rehabilitation Center 3804 Brandon Avenue | Roanoke, VA 24018 540.776.2600 | www.brandonoaks.net

BRONZE (TIE) Our Lady of the Valley 650 North Jefferson Street Roanoke, VA 24016 | 540.345.5111 www.ourladyofthevalley.com Richfield 3737 W. Main Street | Salem, VA 24153 540.380.6511 | www.richfieldliving.com

Companion Care GOLD Home Instead 6349 Peters Creek Road | Roanoke, VA 24019 540.966.3399 | www.homeinstead.com

SILVER Warm Hearth at Home 2607 Warm Hearth Drive Blacksburg, VA 24060 | 540.808.8817 www.whvathome.org

BRONZE Helpful Hands Home Care Services 2302 Colonial Avenue, suite D Roanoke, VA 24015 | 540.342.3434 www.helpfulhands.net

Comprehensive Rehab (outpatient) GOLD Friendship Health and Rehab Center 327 Hershberger Road | Roanoke, VA 24012 540.265.2100 | www.friendship.us

SILVER University Physical Therapy 115 Akers Farm Road | Christiansburg, VA 24073 540.381.9100 | www.universityptonline.com

Assisted Living GOLD Friendship Retirement Community 327 Hershberger Road | Roanoke, VA 24012 540.265.2100 | www.friendship.us

SILVER (TIE) Carrington Place 290 Commons Parkway | Daleville, VA 24083 540.966.0056 | www.carringtonplaces.com Salem Health and Rehabilitation Center 1945 Roanoke Blvd | Salem, VA 24153 540.345.3894 | www.salemhealthrehab.com

BRONZE (TIE) Salem Terrace 1851 Harrogate Drive | Salem, Virginia 24153 540.444.0343 | www.salemterrace.com 38 | www.ourhealthvirginia.com

BLUE RIDGE BEST OF: RETIREMENT LIVING AWARDS | our health

Warm Hearth 2603 Warm Hearth Drive | Blacksburg, VA 24060 540.552.9176 | www.retire.org

Insurance Agent GOLD

Senior Relocation/Moving Services

Lynn Atkinson – Humana 3800 Electric Road, suite 406 Roanoke, VA 24018 | 540.266.1994 www.humana.com

SILVER

GOLD Crowning Touch 6704 Williamson Road | Roanoke, VA 24019 540.982.5800 | www.crowningtouchusa.com

Lew Thompson – State Farm 5929 Williamson Road Roanoke, VA 24012 | 540.362.9471

BRONZE Larry Wills & Associates Insurance 158 W 4th Street | Salem, VA | 540.389.8500 www.progressiveagent.com

Local Pharmacy (delivery) GOLD Valley Apothecary 1802 Braeburn Drive | Salem, VA 24153 540.772.3788 | www.valleyapothecary.com

SILVER Virginia Varsity Transfer 2087 Apperson Drive | Salem, VA 24153 540.982.2202 | www.virginiavarsity.com

BRONZE Smooth Transitions of the Blue Ridge 2231 Woodcliff Road Roanoke VA, 24014 | 540.797.2354 www.smoothtransitionsroanoke.com

Palliative Care GOLD Carilion Clinic 1615 Franklin Road | Roanoke, VA 540.224.4753 | www.carilionclinic.org

SILVER Friendship Retirement Community 327 Hershberger Road | Roanoke, VA 24012 540.265.2100 | www.friendship.us

BRONZE Richfield 3737 W. Main Street | Salem, VA 24153 540.380.6511 | www.richfieldliving.com

Medical Equipment GOLD Sun Medical 1807 Murry Road | Roanoke, VA 24018 540.389.3800 | www.sunmedical.com

SILVER Commonwealth Home Health Care 1900 Apperson Drive | Salem, VA 24153 540.380.3383 | www.commonwealthcare.com

BRONZE Trustcare Home Medical Equipment 117 Goodwin Avenue | Salem, VA 24153 804.262.9001 | www.trustcarehme.com

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our health | BLUE RIDGE BEST OF: RETIREMENT LIVING AWARDS

SILVER Brooks Byrd Pharmacy 2 E Main Street | Salem, VA 24153 | 540.389.8111

BRONZE Fort Lewis Pharmacy 3737 W Main Street, suite 106 | Salem, VA 24153 540.380.4681

Fitness Centers GOLD Green Ridge Recreation Center 7415 Wood Haven Road | Roanoke, VA 24019 540.777.6300 | www.roanokecountyva.gov

SILVER

Restaurants GOLD The Roanoker 2522 Colonial Avenue | Roanoke, VA 24015 540.344.7746 | www.theroanokerrestaurant.com

SILVER K&W Cafeteria Hershberger Road and Tanglewood Mall Roanoke, VA | 540.989.3369 www.kwcafeterias.com

BRONZE The Farmhouse 285 Ridinger Street | Christiansburg, VA 24073 540.382.3965 | www.thefarmhouseonline.com

YMCA of Roanoke Valley 520 Church Avenue | Roanoke, VA 24016 540.342.9622 | www.ymcaroanoke.org

BRONZE Roanoke Athletic Club 4508 Starkey Road | Roanoke, VA 24018 540.989.5758 | www.carilionfitness.com

After Life Services GOLD Lotz Funeral Home 1001 Franklin Road | Roanoke, VA 24016 540.982.1001 | (Also in Salem and Vinton) www.lotzfuneralhome.com

SILVER Oakey’s Funeral Services 6732 Peters Creek Road | Roanoke, VA 24019 540.362.1237 | (additional locations) www.oakeys.com

BRONZE Simpson Funeral Home and Crematory 5160 Peters Creek Road | Roanoke, VA 24019 540.366.0707 | www.simpsonfuneral.com

Lawn Care Services GOLD Roanoke Landscapes 183 Shane Lane | Fincastle, VA 24090 540.992.4845 | www.roanokelandscapes.com

SILVER Lawncare Solutions, LLC 540.387.0015 www.lawncaresolutionssalem.com

BRONZE Happy Grass Mowing & More, Inc. P.O. Box 10002 | Blacksburg, VA 24062 540.200.8372 www.happygrassmowingandmore.com

Financial Advisor GOLD Renee Sherman (Greystone MetLife) 3800 Electric Road, suite 210 Roanoke, VA 24018 540.989.4538 www.roanoke.metlife.com

SILVER Mike Pendleton – Edward Jones 5440 Peters Creek Road Roanoke, VA 24019 540.366.5539 | www.edjones.com

BRONZE Ellis-Summers Group 15 S. College Avenue Salem, VA 24153 | 540.765.2585 www.ellissummers.com

Barber GOLD Ed’s Barber Service 2933 Brambleton Avenue Roanoke, VA 24015 540.774.5885

SILVER R&R Barbers – Roanoke 4323 Appleton Avenue Roanoke, VA 24017 | 540.562.9823 40 | www.ourhealthvirginia.com

BLUE RIDGE BEST OF: RETIREMENT LIVING AWARDS | our health

BRONZE Hollins Barber Shop 7545 Williamson Road | Roanoke, VA 24019 540.366.9574

Jewelry GOLD Fink’s Jewelers 3545 Electric Road | Roanoke, VA 24018 540.342.2991 | www.finks.com

Beauty Salon GOLD The Country Hair Saloon 3110 Brambleton Avenue | Roanoke, VA 24018 540.774.6974

BRONZE Zee’s Hair Salon 121 Duke of Gloucester Street Roanoke, VA 24014 | 540.345.7737 www.zeessalon.com

SILVER Elite Style Salon 110 Country Club Drive | Blacksburg, VA 24060 540.552.9100 | www.elitestylesalon.com

SILVER AmRhein’s 2740 Ogden Road | Roanoke VA 24018 540.989.7100 | www.amrheins.com

BRONZE R Johnson and Sons 10 S College Avenue | Salem, VA 24153 540.389.4783 | www.rmjohnson.com

Grocery Store GOLD Kroger Locations throughout SW Virginia www.kroger.com

SILVER (TIE) Fresh Market 2207 Colonial Avenue | Towers Shopping Center Roanoke, VA 24015 540.344.5490 | www.thefreshmarket.com Tinnell’s 2205 Crystal Spring Avenue Roanoke, VA 24014 | 540.345.7334 www.tinnells.com

BRONZE Food Lion Locations throughout Southwest Virginia www.foodlion.com

Country Club GOLD Blacksburg Country Club 1064 Clubhouse Road | Blacksburg, VA 24060 540.552.9165 | www.blacksburgcc.com

SILVER Hidden Valley Country Club 2500 Romar Road | Salem, VA 24153 540.389.8146 | www.hiddenvalleycc.com

BRONZE Water’s Edge Country Club 1825 Waters Edge Drive | Penhook, VA 24137 540.576.1556 | www.watersedgecc.com

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our health | BLUE RIDGE BEST OF: RETIREMENT LIVING AWARDS

Spa GOLD Les Cheveux Salon and Day Spa 306 McClanahan Street | Roanoke, VA 24014 540.343.7211 | www.lescheveauxsaloninc.com

SILVER

SILVER Robyn Smith-Ellis 220 Roanoke Boulevard | Salem, VA 24153 540.389.6060 | www.robynsmithellis.com

BRONZE Mark Dellinger 318 Washington Avenue | Roanoke, VA 24016 540.342.0888 | www.rhodesandbutler.com

Pampered Healing 207 W Main Street | Christiansburg, VA 24073 540.641.0152 | www.pamperedhealing.com

Elder Law Attorney GOLD Ann Green 4923 Colonial Avenue | Roanoke, VA 24018 540.776.6434 | www.andersondesimone.com

Comprehensive Rehab (inpatient) GOLD (TIE)

Salon Del Sol 2601 Franklin Road | Roanoke, VA 24014 540.387.1900 | www.salondelsolandspa.com

BRONZE

Salem Health and Rehabilitation Center 1945 Roanoke Boulevard | Salem, VA 24153 540.345.3894 | www.salemhealthrehab.com

Speech Therapy GOLD Roanoke Valley Speech and Hearing Center 2030 Colonial Avenue | Roanoke, VA 24015 540.343.0165 | www.rvshc.com

SILVER Friendship Retirement Community 327 Hershberger Road | Roanoke, VA 24012 540.265.2230 | www.friendship.us

BRONZE (TIE) Pulaski Health and Rehabilitation Center 2401 Lee Highway | Pulaski, Virginia 24301 540.980.3111 | www.pulaskihealthrehab.com

Carilion Clinic 1615 Franklin Road | Roanoke 540.224.4753 | www.carilionclinic.org LewisGale Medical Center 1900 Electric Road | Salem, VA 24153 540.776.4000 | www.lewisgale.com

SILVER Salem Health and Rehabilitation Center 1945 Roanoke Boulevard | Salem, VA 24153 540.345.3894 | www.salemhealthrehab.com

Geriatric Care (physician) GOLD Bradley Goad, MD 249 Stone Brook Drive | Galax, VA 24333 276.237.6660

SILVER Sohier Boshra, MD Carilion Center for Healthy Aging 2118 Rosalind Avenue | Roanoke, VA 24014 540.981.7653 | www.carilion.com

BRONZE Richard Williams, MD 2900 Lamb Circle, Suite 250 Christiansburg, VA 24073 | 540.639.9071

Nursing Home GOLD Berkshire Health and Rehabilitation Center 705 Clearview Drive | Vinton, VA 24179 540.982.6691

SILVER Friendship Retirement Community 327 Hershberger Road | Roanoke, VA 24012 540.265.2230 | www.friendship.us

BRONZE (TIE) Raleigh Court Health and Rehabilitation Center 1527 Grandin Road | Roanoke, VA 24015 540.342.9525 | www.raleighcourtrehab.com Woodhaven Nursing Home 13055 W Lynchburg Salem Turnpike Montvale, VA 24122 | 540.947.2207 www.woodhavennursinghome.com

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BLUE RIDGE BEST OF: RETIREMENT LIVING AWARDS | our health

Hospice GOLD Good Samaritan Hospice 2408 Electric Road | Roanoke, VA 24018 540.776.0198 | www.goodsamhospice.com

SILVER Carilion Clinic Hospice 1615 Franklin Road | Roanoke, VA 540.224.4753 | www.carilionclinic.org

BRONZE Gentle Shepherd 6045 Peters Creek Road | Roanoke, VA 540.989.6265 www.gentleshepherdhospice.com

Senior Transportation GOLD RADAR P.O. Box 13825 | Roanoke, VA 24037 540.343.1721 | www.radartransit.org

GOLD Salem Terrace 1851 Harrogate Drive | Salem, Virginia 24153 540.444.0343 | www.salemterrace.com

SILVER Friendship 327 Hershberger Road | Roanoke, VA 24012 540.265.2230 | www.friendship.us

BRONZE (TIE) Woodhaven Nursing Home 13055 W Lynchburg Salem Turnpike Montvale, VA 24122 | 540.947.2207 www.woodhavennursinghome.com Virginia Veterans Care Center 4550 Shenandoah Avenue | Roanoke, VA 24017 540.982.2860 Emeritus Roanoke 1127 Persinger Road | Roanoke, VA 24015 540.343.4900 | emeritus.com

Senior Community Centers GOLD Brambleton Recreation Center 3738 Brambleton Avenue | Roanoke, VA 24018 540.772.7529 | www.roanokecountyparks.com

New River Valley Community Services 2B Corporate Drive | Radford, VA 24141 540.831.5911 | www.nrvcs.org

BRONZE Valley Metro 1108 Campbell Avenue | Roanoke, VA 24013 540.982.2222 | www.valleymetro.com

GOLD Interim Healthcare 4395 Electric Road | Roanoke, VA 24018 540.774.8686 | www.interimhealthcare.com

BRONZE Christiansburg Recreation Center 100 E. Main Street | Christiansburg, VA 24073 540.382.2349 www.christiansburg.org

Coffee House GOLD Panera Bread Locations in Roanoke and Blacksburg www.panerabread.com

SILVER Mill Mountain Coffee and Tea Locations throughout Southwest Virginia www.millmountaincoffee.com

BRONZE Bollo’s Café and Bakery 206 Draper Road | Blacksburg, VA 24060 540.953.1669 | www.bolloscafe.com

Florist

SILVER Horizon Home Care Supplies 1003 S Jefferson Street | Roanoke, VA 24016 540.343.0298 | www.horizondme.com

BRONZE Generation Solutions 3825 Electric Road | Roanoke, VA 24018 540.776.3622 | www.generationsolutions.net

Golf Course GOLD Hanging Rock 1500 Red Lane | Salem, VA 24153 540.389.7275 | www.hangingrockgolf.com

SILVER Blue Hills 2002 Blue Hills Drive | Roanoke, VA 24012 540.344.7848 | www.bluehillsgc.com

BRONZE Draper Valley 2800 Big Valley Road | Draper, VA 24324 540.980.4653 | www.drapervalleygolf.com

Places of Worship

SILVER Anchor of Hope Community Center 2302 Florida Avenue | Roanoke, VA 24017 540.627.5067 www.anchorofhopecommunitycenter.com

First Church of God 110 Roanoke Street | Blacksburg, VA 24060 540.552.3404 | www.bfchog.org

SILVER

Home Health Memory Care

BRONZE

GOLD Fellowship Community Church 1226 Red Lane | Salem, VA 24153 540.387.3200 | www.fcclife.org

GOLD Best Wishes Flowers and Gifts 210 Prices Fork Road | Blacksburg, VA 24060 540.953.2715 | www.bestwishesflowers.com

SILVER Stritesky’s 6614 Peters Creek Road | Roanoke, VA 24019 540.362.1293 | www.striteskysflowershop.com

BRONZE Kroger Locations throughout Southwest Virginia www.kroger.com

Post-Acute Rehabilitation Services GOLD Pulaski Health and Rehabilitation Center 2401 Lee Highway | Pulaski, Virginia 24301 540.980.3111 | www.pulaskihealthrehab.com

SILVER Salem Health and Rehabilitation Center 1945 Roanoke Boulevard | Salem, VA 24153 540.345.3894 | www.salemhealthrehab.com

BRONZE Spring Tree Health and Rehabilitation Center 3433 Springtree Drive | Roanoke, VA 24012 540.981.2790 www.springtreehealthrehab.com

SILVER First Baptist Church Roanoke 515 3rd Street | Roanoke, VA 24016 540.224.3300 | www.firstroanoke.com

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Salem Terrace at Harrogate Location of the Dogwood Memory Care Center

Caring for Families words | SARAH COX

FOR A COMPLETE LISTING OF MEMORY CARE FACILITIES IN THE SOUTHWEST VIRGINIA AREA, PLEASE VISIT WWW.OURHEALTHVIRGINIA.COM

Patti Smith at the Virginia Veterans Care Center (VVCC) is devoted to caring for honorably discharged veterans. Within the 240-bed facility are four units — an assisted living 60-bed unit, a secure unit with 60 beds, and a long-term care and rehab facility of 120 beds. The secure unit specializes in caring for those with dementia and in recent years has added a “Wander Garden,” with a courtyard, a covered area, murals and a Virginia Tech designed horticultural garden. This is in keeping with the now-accepted approach that those with dementia deserve to lead out their lives in dignity and joy.

Smith, director of admissions and marketing for VVCC, which is now a state-run, nonprofit facility, says that veterans have to meet three criteria to be accepted there — they have to have served in active duty with an honorable discharge; lived in Virginia at the time of enlistment; and have medical and emotional conditions that the facility can take care of.

“We have to make sure our guys are taken care of. I am extremely proud of the care we provide.”

The garden was built in response to a common habit of many dementia patients — they become agitated and wander at dusk. This is called sundowning. According to the Mayo Clinic, sundowning “refers to a state of confusion at the end of the day and into the night. Sundowning isn’t a disease but a symptom that often occurs in people www.ourhealthvirginia.com | 45

our health | MEMORY CARE

with dementia, such as Alzheimer’s disease.” The garden gives veterans a secure area in which to wander; it is lit 24 hours a day.

Sundowning is one of the many compelling reasons that a family member should look into the care center early on and not wait until the last minute, explains Smith. She said that the center takes care of family members, as well, as they are the ones who make the hard decisions.

The Federal Veterans Administration subsidizes this facility, says Smith, so the cost is very reasonable. She urges families to come take a tour before they are faced with making an immediate decision.

Another facility in Southwest Virginia, this one in the New River Valley, is The Arbor, part of Warm Hearth Village that was established in 1974. The Arbor is part of what Director of Marketing and Development Tambra Meredith calls “our full continuum of care, designed to provide a safe and appropriate environment for those in middle to late stages of Alzheimer’s.”

Meredith says that defining it as appropriate includes safe physical surroundings, the general environment and the care that is given to residents.

“For example, our building is small, not large and overwhelming, with lots of things specifically designed to cue people with dementia. They need constant cues to keep them on task and comfortable,” she says.

One such cue is memory boxes at the entrance of each doorway; family members are encouraged to put memorabilia in them. Meredith says this helps residents know that that is their space. They are also given wristbands, have a secure outside space and a sunroom. In addition, activities include memory kits, which can be something as simple as a laundry basket with items that need folding or a basket filled with items associated with a baby.

“For residents with dementia, it’s all about connecting with the past, because they don’t have short-term memory,” says Tambra Meredith.

Kristi Blake, administrator of the Kroontje Health Care Center, which includes The Arbor, says one of the things that makes this facility stand out is the longevity of its staff. The staff is well trained, experienced — some have been at this facility for more than 10 years — and above all, they know the residents’ aversions. Some are experts at talking residents into taking a bath when they have fear of water, for example.

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MEMORY CARE | our health

“Our CNAs are with them every day, and know that one may like walks outside, someone else may like looking at the view and another likes a quiet game. They paint nails, talk about engineering and set up activities,” she says of her staff.

While residents may not remember who people are from day to day, what they do remember, says Blake, is the way someone makes them feel.

Another memory care facility in Southwest Virginia is Salem Terrace’s Dogwood Memory Care Center, where an individualized care plan is designed to help residents get as much out of life as they can. It has a secure walking garden, crafts, natural light and lots of room for activities, meals, wandering and pacing. Susan O’Malley, RN and administrator, says that natural light is very important.

“It affects all of our moods, and there is thought that it helps to control some of the depression or negative things that happen to folks with memory care issues,” she says.

O’Malley says that the Dogwood Memory Care Center offers physical, occupational and speech therapy “because we want to keep them independent as much as possible.”

The therapies are designed to keep them from losing abilities that they have, but once they no longer have those abilities, O’Malley says that the staff strives to promote quality of life.

She says that each type of dementia presents different challenges, and that the staff is cognizant of what patients have so that they can work with them specifically.

Additionally, Azziza Bankole, MD, a geriatric psychiatrist with Carilion Clinic’s Center for Healthy Aging, sees residents in the memory care unit and assists with medications, along with their primary care physicians.

Salem Terrace also recognizes the needs of the family support network and tries to work with them to meet their needs and allay their concerns.

“It is very difficult,” says O’Malley.

“The caregiver just cannot manage any longer.” She also says that they encourage families to seek out hospice care, which comes directly to the unit and offers counseling and help to both the resident and the family.

Woodhaven Nursing Home is also a facility that recognizes the particular needs of its residents.

Located in Montvale, it has been under the ownership of David Graves and his wife since 1993.

It is very small — 48 beds — and a locked facility with an outdoor area that is fenced. Graves makes the distinction that they are a www.ourhealthvirginia.com | 47

nursing home, as opposed to an assisted living facility, with about 20 dementia-certified practitioners on the staff. They care for mid- to late-stage dementia and include hospice care.

Since there are frequent behavior challenges — many of them due to sundowning — Woodhaven keeps a generous staff in the afternoons and at dusk. They also offer a seven-day activities program with two directors and volunteers, says Graves.

“We are very homelike,” he says, and refers to his own two dogs that are regulars at the nursing home. “Each room is unique, we have an aviary, and both my wife and I are involved with the Alzheimer’s Association.”

Graves says that Woodhaven is unique in a number of ways, one of which is that they have a geriatric psychiatrist, Dr. David Trinkle, and another in that they offer respite care, which is temporary care of a family member while their caregiver goes out of town.

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our health | MEMORY CARE

FAST FACTS! ABOUT DEMENTIA FROM THE

ALZHEIMER’S ASSOCIATION »» According to the Alzheimer’s Association’s 2013 “Alzheimer’s Disease Facts and Figures,” Alzheimer’s disease is the most common type of dementia, which is a general term used to describe a variety of diseases and conditions that result when brain nerve cells die or no longer function correctly. When this happens, changes to memory, behavior and clear thinking occur. Alzheimer’s disease is ultimately fatal.

50 | www.ourhealthvirginia.com

»» Other types of dementia than Alzheimer’s include vascular dementia and Parkinson’s disease. »» New, as of 2011, diagnostic criteria for Alzheimer’s, proposed by the National Institute on Aging and the Alzheimer’s Association, include the three stages of Alzheimer’s — preclinical Alzheimer’s disease, mild cognitive disease and dementia due to Alzheimer’s disease. »» The two main treatments of Alzheimer’s disease are divided into pharmacologic and non-pharmacologic therapy. No drugs can slow or stop the death or malfunction of brain neurons, but five drugs can temporarily improve symptoms.

Non-pharmacologic treatment goals are to improve the quality of life and reduce symptoms such as depression, apathy, wandering, sleep disturbance, agitation and aggression.

»» About 5.2 million Americans have Alzheimer’s disease in 2013, and 5 million of those are people ages 65 and older. Consider, as well, that by 2030 an estimated 72 million older Americans will make up 20 percent of the total population, which would be up from 13 percent in 2010. »» Alzheimer’s disease is the sixth leading cause of death in the United States. »» More than 15 million Americans provide unpaid care for people with Alzheimer’s disease and other dementias. In 2012, these unpaid caregivers provided an estimated 17.5 billion hours of unpaid care, which is valued at more than $216 billion.

words | EDWIN SCHWARTZ

Healing

By Giving to Others

The loss of a spouse is one of life’s most stressful events, especially for seniors. But in recent years research has recognized older adults’ adjustment to widowhood varies considerably. The nature of the relationship, cause of death and available social support are all factors that can account for the range in recovery ability.

Although spousal loss can occur at any age, widowhood in the United States is mostly experienced by those 65 and older. Nearly three-quarters of the 900,000 people who become widowed annually in the United States fall in this category. Today life expectancy at birth for men is 76, compared to 80 for women. So women are much more likely to outlive their spouse.

This September it will be two years since Judie Lilley of Hiwassee lost her husband to melanoma, a form of skin cancer. Judie and Bob had been married 48 years and dated for two. “We were mutually bonded and we became one,” says Lilley. “He had his strengths, and I had mine. We combined them and had a mutual understanding that we were both in charge of our marriage.”

“We depended on each other through communication,” she adds. “Before any major decision was made we both came to a mutual understanding. It wasn’t my way or the highway.”

our health | COMFORT AND PEACE

Dr. Elisabeth Kübler-Ross, a renowned psychiatrist who specialized in near-death studies, identified the five common stages of grief as denial, anger, bargaining, depression and acceptance. While not everyone experiences every stage, others may endure one or more several times, or enter multiple stages simultaneously. But however a person grieves, Kübler-Ross believed most individuals experience at least two of these stages.

“The most difficult adjustment is being alone — the solitude,” says Lilley. “When two become one, it becomes extremely difficult and still is.”

“To pick up the pieces of my life I had to place my hand in God’s and ask him to lead me,” Lilley says. “I asked Him to help me be strong, to have courage, to not become discouraged and to not give up. Also, to know I’m not going through this alone. That gets me through the long nights.”

Lilley owes a great deal of gratitude to Good Samaritan Hospice. “They felt like family and were compassionate, caring and got down on my level,” she says. “They did what would make me feel comfortable with my spouse. Bob’s departure was the way I would like to go, very peaceably. In his own house, his own bed and bedroom, and with his family close by.”

“Because I am a nurse it would have been easy to become critical of the care,” adds Lilley.

“Being a nurse has its plusses and minuses. But I have since recommended Good Samaritan for two friends of mine. They really were top notch.”

Lilley also relied on those closest to her. “I couldn’t have done it without my supportive family, my church family and my neighbors,” she says. “It’s not the kind of thing you go through repeatedly. And they were all there for me. It taught me a lot.”

Women’s intimate social relationships prove to be a significant resource as they adjust to spousal loss. Many researchers agree one reason older widows often adapt better than widowers is because of their closer ties with their children, siblings and friends.

In describing the most helpful service Good Samaritan Hospice provided, Lilley sums it up with one word — continuity. “It wasn’t just the nursing department. It was the chaplain, the nurses, the social worker — they all communicated so well,” she says. “The communication was first class. They did what they said they would do. I had the total peace that if I had forgotten something, I knew they would pick up on it and follow through.”

Spousal loss will happen to nearly all married seniors. And many may experience symptoms of grief, loneliness, anxiety and distress. However, no two individuals grieve the exact same way.

As for anyone who thinks it may be time to consider hospice care, Lilley says, “Don’t hesitate or delay. Call and talk with someone from hospice to see if the timing is right for a professional to guide you through this journey so you won’t have to go it alone.”

For widows dealing with the loss of their husbands, Lilley says, “Don’t rush the recovery. Yes, you must pick up the pieces of your life and carry on. But take the time for recovery over your spouse’s death.”

Lilley’s recovery has depended heavily on service to others.

Her advice is to go and give of your time and energy. “My hope is by sharing and giving to others, they may have a better understanding of life and compassion,” she says. “Giving to others softens my loss.”

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our health | PHARMACY

Lots of Medicine, Lots of Side Effects words | SARAH COX

Cathy Daily moved from Friendship Retirement Community’s Independent Living housing to its Rehabilitation Services quarters after her latest broken bone and subsequent knee surgery.

Since she relocated in November 2012, she has been reviewed by Friendship’s Polypharmacy Committee, made up of a pharmacist, an RN, one of the medical directors at Friendship and sometimes pharmacy interns or medical residents.

The result has been wonderful: as Daily comments, “Now I’m up and flying.”

She was originally on 22 medications; she is now on 10 and feeling much better.

The Polypharmacy software flags those Friendship residents who are on 16 or more medications, explains Bill Cundiff, pharmacist.

Pharmacist, Bill Cundiff of Friendship Retirement Community meets with resident, Cathy Daily, to review her medications.

Friendship Retirement Community’s Polypharmacy program was instituted about a year ago, with the intention of improving lives by examining adverse drug interactions, those medicines no longer needed or those that may cause dizziness and thus falls. By meeting once a month with the primary care physician as well as the medical directors on staff at Friendship Retirement Community — Anthony Stavola, MD; Kirk Nottingham, MD; and Soheir Boshra, MD — the committee can get and give an objective perspective to residents’ medication lists. The program has met with great success, having about a 60 percent approval rating from patients’ primary care physicians or family on their recommendations.

By reviewing Daily’s medicines through the Polypharmacy program, Cundiff has been able to help Daily on a day-to-day basis with her overall health. He says that one of Daily’s drugs, a psychoactive medicine, did have the propensity to make falls more likely; Daily was sent to a specialist as a result of the review and was put on an alternative medication that was safer. The next issue, says Cundiff, was Daily’s blood pressure, which was resistant to her medicines. These were reviewed and bumped up, and currently her blood pressure is responding favorably.

Four more medicines were eliminated completely, because Daily no longer needed them; these included allergy medicines and one for stomach issues.

Cundiff adds that the committee was also able to reduce Daily’s pain medications from a “very strong Schedule 2 narcotic to Lortab.”

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PHARMACY | our health

Dr. Stavola, one of the medical directors at Friendship Retirement Community since 1980, as well as a Carilion Clinic family practice physician, says that the geriatric population is at a particular risk of drug interactions as well as toxic accumulations in the bloodstream.

“The issue is that as we get older, we become more vulnerable to side effects,” says Dr. Stavola, adding that as we age, our bodies do not clear out the medication as effectively. And, he says, the elderly tend to have more chronic conditions, which then leads to having more medications prescribed.

indigestion. “It’s been proven that if you take this for too long, the normal bacteria in the stomach will die off, and then you can get chronic diarrhea,” says Cundiff.

There are also drugs that can cause dizziness, resulting in falls. “This can be life-threatening,” says Cundiff. “What we are trying to do is look for drugs that don’t cause dizziness or changes in blood pressure that make you lose balance, or muscle relaxants that don’t allow you to get around as well.” He says that the Beer’s List,

a list of medicines that should be avoided in geriatric patients, was put together by Dr. Mark Beers, a geriatrician. According to the American Geriatrics Society, the Beer’s List catalogues medicines that could cause adverse effects in older adults.

One of the unfortunate issues is memory, and there are some anticholesterol drugs as well as some used to control the bladder that will interfere with dementia drugs such as Aricept.

“Every time you add medication, you are multiplying the potential for interactions, because when you have four drugs, this is more complex that when you have two — it becomes geometrically more complex, because there are so many different ways that drugs can affect each other,” says Dr. Stavola.

This may mean that drugs can accumulate to toxic levels, but this can also be a hard thing to identify.

Cundiff says that people aren’t always aware of the adverse interactions that can occur when multiple medications are taken. For example, one drug may be used to control the side effects of another, but in turn causes an adverse reaction with one or more of the patient’s other medications. .

Cundiff said that in some cases, patients who are on a lot of medications may suffer from interactions among those drugs, not be alert and suffer from dizziness as well as stomach problems due to the healthy bacteria’s being eliminated through drugs.

Of the overall drugs, one category that has been closely scrutinized by the committee is preventative antibiotics to control urinary tract infections, common among both male and female elderly. Instead, Cundiff has tried cranberry capsules, which is an herbal remedy but has shown great results.

Another common trend was for residents to take daily doses of Prilosec to control acid www.ourhealthvirginia.com | 55

PHARMACY | our health

“Aricept will cause some improvement,” he says, “but then there are drugs that will interfere and cloud the brain back up again, so then the patient is having two symptoms.”

“We have found we get better pain control with a scheduled dose,” says Cundiff.

The Basal-Bolus Insulin program, a sideline to the Polypharmacy program, has also been instituted. Friendship Manor will receive residents who are being dismissed from the hospital and may be on medicine to manage high blood sugars. But, says Cundiff, longterm use of what he called “sliding scale” insulin is on the Beer’s List.

“We worked with a local endocrinologist to make the insulin regime more like a normal one, but with a big dose at bedtime and a little dose with each meal. This way, we have the blood sugars under control. It makes people feel better almost immediately,” he says.

Another resident, 85-year-old Betty Gehlert, who has been an independent living resident for three years, says she settled in Friendship Retirement Community after trying a number of other area options, because “the people looked like they were alive!” She also has come without a car, but finds no inconvenience, due to Friendship’s shoppers’ bus, RADAR and a taxi service that can be reserved. Although Gehlert doesn’t take a lot of medications, she said that she knows that the doctors and pharmacists at Friendship Retirement Community are very careful.

“I had to get blood pressure medication, and I know they work with my doctor (Quasir Raza, MD, of LewisGale), and they do monitor and care. They also deliver medicines, which is kind of neat, because I don’t have a car,” says Gehlert.

Cundiff says that Friendship Retirement Community is on the cutting edge in starting several new programs that examine the use of drugs and their complicating effects. One

such program involves a thorough screening that all new residents go through within a few days of moving in. The pharmacy then shares a list of the resident’s drugs with their primary care physician, along with alternative suggestions that may eliminate dangerous side effects.

“We have just received a grant and are working with Carilion Clinic’s Center for Healthy Aging to measure the benefit of this early screening program,” says Cundiff.

The ability to have somebody review not only what the residents’ prescriptions are but also what else they have been taking over the counter has given Friendship Retirement Community a tremendous advantage. Dr. Stavola points out that having a pharmacist sit on this committee has provided an added safety feature; “they have a lot of specialized expertise in medication interactions and they can be helpful in providing and suggesting alternatives.”

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HealthyEats AR P E PR

OR THE F G N I

HARVEST

Corn and Tomato Salsa: Makes 4 servings

Ingredients: One of the best things about summer is the fresh produce you can enjoy from your garden! If your garden is anything like mine

2 ears of fresh corn

Directions: 1.

Season the corn with olive oil, salt and pepper.

2.

Place the corn over a grill and cook for about one to two minutes on all sides.

Drizzle of olive oil

Sea salt to taste

3.

Remove and cool.

Freshly ground black pepper to taste

4.

Remove the kernels from the cob.

5.

Combine the corn, tomatoes, onions, peppers, cilantro, lime juice and lemon juice. Mix well.

6.

Season the salsa with salt and pepper.

during these dog days of summer, you are

4 ripe tomatoes, sliced and then diced

often left with a surplus of produce that

¼ cup minced red onions

you are unsure how to use. Here are some

1 teaspoon minced jalapeno peppers

delicious recipes, full of flavor, that are sure

2 tablespoons chopped fresh cilantro

to satisfy any palate.

Juice from 1 freshly squeezed lime

Juice from 1 freshly squeezed lemon

Tricia Foley’s

CORN & TOMATO SALSA Tricia Foley is Our Health Magazine’s resident nutritionist.

HealthyEats P

FOR TH G N I AR R EP

E HARVEST

Zucchini “Pasta” and Fresh Tomato Sauce:

4.

Using a spatula, push the zucchini to the side so a portion of the bottom of the pan is clear. Add the garlic, and cook for 15 to 30 seconds. Mix the garlic into the zucchini.

5.

Stir in the tomatoes, lemon zest, salt, pepper and Parmesan cheese. Cook until softened, about two minutes.

6.

Add ground turkey to mixture and divide into four servings.

Makes 4 servings

Ingredients: 16 ounces lean ground turkey

Directions:

¼ cup grated Parmesan cheese

1.

In a large skillet, coat with cooking spray and then brown turkey until no longer pink (about 10 minutes). Set aside.

2.

In another large skillet, heat the olive oil over medium-high heat.

3.

Add the zucchini and cook just until wilted, flipping them over occasionally with a spatula. (The zucchini will be soft and somewhat see-through.)

1 teaspoon grated lemon zest ¼ teaspoon sea salt ¼ teaspoon ground black pepper 1 tablespoon olive oil 6 medium (8-ounce) zucchini, peeled with potato peeler 2 garlic cloves, thinly sliced ½ pint grape or cherry tomatoes, halved lengthwise

Tricia Foley’s

ZUCCHINI “PASTA” Tricia Foley is Our Health Magazine’s resident nutritionist.

our health | NUTRITION HEALTH

60 | www.ourhealthvirginia.com

our health | BACK TO SCHOOL

of Back-to-School Health words | LAURA NEFF-HENDERSON, APR

It’s long been known that classrooms are meccas for germs. According to WebMD a 2005 study of germs in schools found that classroom water fountain spigots and plastic cafeteria trays were the germiest spots in school. While toilet seats get cleaned regularly, trays and water fountains do not.

So it’s no surprise that, for many children and their parents, as well as their teachers, backto-school often means spending more than a handful of weekends on the couch with a box of tissues and cough drops.

Learn more about some of the most common childhood illnesses:

Asthma and Allergies An estimated five million children have asthma, making it the most common chronic disease of childhood, according to the Asthma and Allergy Foundation of America. Asthma is a chronic (long-term) illness in which the airways become blocked or narrowed, causing shortness of breath, trouble breathing and other symptoms. Allergies, also a prevalent childhood illness, occur when the immune system overreacts to a substance that’s harmless to most people. This overreaction can leave children coughing and sneezing, with itchy eyes, a runny nose and a scratchy throat. In severe cases it can also result in rashes, hives, lower blood pressure, difficulty breathing, asthma attacks and even death. Although allergies have no cure, they can be managed with proper prevention and treatment.

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our health | BACK TO SCHOOL

Bronchitis Children who suffer from repeated lung infections often develop bronchitis, an inflammation of the lining of the bronchial tubes, the airways that connect the trachea (windpipe) to the lungs. Children who have bronchitis often have a difficult time breathing when air passes in and out of the lungs. The most common symptom is usually a cough.

Chickenpox Caused by the varicella-zoster virus (VZV), chickenpox used to be a common illness among kids in the United States, particularly among those under 12 years old. The telltale sign of the virus is the itchy rash of spots that look like blisters and can appear all over the body.

The rash is extremely contagious and is generally accompanied by flulike symptoms. The Centers for Disease Control and Prevention (CDC) recommends that children receive the chickenpox vaccine at between 12 and 15 months old and between four and six years old.

The vaccination is 98 percent effective at preventing chickenpox.

Diabetes Type 1 diabetes, often called juvenile diabetes, develops when the pancreas can’t make the insulin that the body needs to break down glucose/sugar necessary to have energy.

Without insulin, too much sugar stays in the blood. Type 2 diabetes used to be called adultonset diabetes, but is increasingly common in children and teens as a result of obesity.

Children with type 1 diabetes may need to take insulin, while those with type 2 diabetes manage their illness with diet and exercise, medication and/or insulin.

Ear Infection In children, the signs of an ear infection often include ear pain, especially when lying down; tugging or pulling at the ear(s); difficulty sleeping; fussiness; difficulty hearing or responding to sounds; loss of balance; and a fever. For adults, the symptoms usually include ear pain, drainage of fluid from the ear, diminished hearing and a sore throat.

Flu Flu is highly contagious, particularly when people share close quarters, like children do in school classrooms. Flu is spread among children when a child either inhales infected droplets in the air or when the child comes in direct contact with an infected person’s secretions. This happens most often when children share utensils and cups. The symptoms usually start abruptly and cause kids to feel the worst during the first two or three days. The symptoms typically include a high-grade fever; chills; exhaustion; headache and body aches; a dry, hacking cough; a sore throat; vomiting; and belly pain. The number one way to prevent flu is to get an annual influenza vaccination.

Gastroesphageal Reflux Disease/GERD Like in adults with the condition, gastroesophageal reflux — GERD, for short — is the upward movement of stomach contents into the esophagus and sometimes into or out of the mouth. It is usually the result of an immature digestive system and most infants with the condition outgrow it by the time they are one year old. In older children, obesity, overeating, constipation, and certain foods, beverages, and medications can be the cause of the condition. The most common symptoms of reflux in kids are frequent or recurrent vomiting, frequent or persistent cough, refusing to eat or difficulty eating (choking or gagging with feeding), and heartburn, gas, or abdominal pain.

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BACK TO SCHOOL | our health

Hand, Foot and Mouth Disease The Hand, foot and mouth disease most often occurs in children under 10 years old and is characterized by a rash of small blisterlike sores on the palms of the hands and soles of the feet and in the mouth.

Symptoms include fever, sore throat and headache. The disease is spread from person to person through saliva, fluid from blisters or the feces of an infected person. Outbreaks occur most often in the summer and early fall in classroom settings, where large groups of children congregate. The illness typically lasts for about a week.

Impetigo Impetigo, one of the most common skin infections among kids, usually produces blisters or sores on the face, neck, hands and diaper area. This contagious, superficial skin infection usually affects preschool and school-age children. The infected areas appear in plaques ranging from dime to quarter size, starting as tiny blisters that break and expose moist, red skin. After a few days, the infected area is covered with a grainy, golden crust that gradually spreads at the edges.

Juvenile Idiopathic Arthritis Nearly 300,000 children in the United States have some sort of arthritis, an inflammation of the joints. The most prevalent form of juvenile arthritis is juvenile idiopathic arthritis, also known as juvenile rheumatoid arthritis. It affects about 50,000 U.S. kids and is very different from adult rheumatoid arthritis. Arthritis can be short-term — lasting for just a few weeks or months, then going away forever — or it can be chronic and last for months or years. Symptoms include joint pain, swelling and stiffness, leading to irritability, refusal to walk or protecting or guarding of a joint. Children who suffer from this condition may have periods with no symptoms in between flare-ups.

Kawasaki Disease Kawasaki disease is an illness that involves the skin, mouth and lymph nodes, and most often affects kids under the age of five. Kawasaki disease occurs in 19 out of every 100,000 kids in the United States. It is most common among children of Japanese and Korean descent, but can affect all ethnic groups. The cause is unknown, but if the symptoms (a fever lasting at least five days, red eyes, a body rash, swollen, red cracked lips and tongue, swollen, red feet and hands and/or swollen lymph nodes in the neck are recognized early, kids with Kawasaki disease can fully recover within a few days. Untreated, it can lead to serious complications that can affect the heart.

Lice Lice aren’t dangerous and they don’t spread disease, but they are contagious. Itching, the most common symptom of all types of lice infestation, is caused by an allergic reaction.

Lice bite the skin to feed on a person’s blood. The saliva from these bites causes the allergic reaction and itching. Lice are a very common problem, especially for kids between the ages of three and 12 and are more common in girls than boys. Itching may occur right away in some people that are very sensitive to lice bites. Others build up a tolerance to the bites and have little or no itching, even with repeated infestations.

Mononucleosis Known to teenagers all over the country as the “kissing disease,” mononucleosis is caused by the Epstein-Barr virus (EBV), a type of herpes virus. Most people who get mono are between the ages of 15 and 25, but younger kids can get it too. The mono virus affects the lymph nodes, throat, salivary glands, liver, www.ourhealthvirginia.com | 65

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spleen and blood. Symptoms include extreme tiredness and an achy body, as well as a decrease in appetite.

Otitis Externa (Swimmer’s Ear) Otitis externa, also known as swimmer’s ear, is an inflammation and infection of the ear canal. It occurs when the protective film that covers the ear canal is removed. Swimmer’s ear often develops when excess water enters the ear canal. But other conditions can cause swimmer’s ear, including allergies, forceful ear cleaning and skin problems. Symptoms can include itching, pain and a feeling of fullness in the ear.

Pinkeye (Conjunctivitis) Pinkeye (also called conjunctivitis) is the most common problem children have. Symptoms include itching, inflammation or swelling and a clear, white, yellow or greenish gooey liquid collecting in the eyes.

Adults, especially parents and teachers who spend a lot of time with kids, can get conjunctivitis too. The condition usually lasts about a week or less, and then goes away by itself or after treatment.

Query Fever Q fever, or Query fever, is an infectious disease transmitted from animals to humans that can affect the heart, lungs and other body parts and cause flulike symptoms. Although rare, it can affect children and adults who drinking raw, infected, unpasteurized milk; come into contact with infected animals; or are bitten by ticks. In some people Q fever may not

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cause any symptoms. Symptoms that may appear include fever, headache, cough, joint and muscle pain, nausea, vomiting and diarrhea. In rare cases, symptoms can last for longer than six months. This form of the disease (chronic Q fever) can lead to serious complications if it goes untreated.

Reye Syndrome Reye syndrome is an extremely rare but serious illness that can affect the brain and liver. It occurs most commonly in children recovering from a viral infection and predominantly affects children between the ages of four and 14 years old. Common symptoms include frequent vomiting, lethargy or sleepiness, and irritability or aggressive behavior. Other symptoms include changes in vision, difficulty hearing and abnormal speech.

Strep Throat Strep throat is one of the most common childhood illnesses. It’s contagious and painful, and typically happens during the school year when children are in close contact with one another. A strep infection can be spread through sneezing, coughing and shaking hands. Symptoms include a severe and sudden sore throat without coughing, sneezing or other cold symptoms, pain or difficulty swallowing, a fever above 101 degrees F, swollen lymph nodes in the neck, white or yellow spots or coating on the throat or tonsils and/or a bright red throat or dark red spots on the roof of the mouth at the back near the throat.

Tonsillitis Tonsillitis is an inflammation of the tonsils, tissue that sits on both sides of the back of the throat. They help in the immune system to protect the body from infections that may enter the body through the mouth. When the tonsils become infected they become enlarged and red and have a yellow or white coating. Tonsil infections may be contagious and can spread from person to person by contact with the mouth, throat or mucous of someone who is infected. Tonsillitis symptoms include a sore throat, fever, swollen glands in the neck and trouble swallowing.

Urinary Tract Infection Urinary tract infections (UTIs) are common in kids, especially girls and uncircumcised boys.

According to ww.kidshealth.org, about 8 percent of girls and 2 percent of boys have had at least one UTI before their fifth birthday. These infections occur when the kidneys, ureters, bladder or urethra become infected.

Symptoms include pain when urinating; changes in frequency, appearance or smell of urine; fever; chills; loss of appetite; nausea; vomiting; lower abdominal pain; and lower back pain or discomfort.

Viral Pneumonia Pneumonia is a general term that refers to an infection of the lungs, which is most often caused by a virus. Often, pneumonia begins after a person has had an upper respiratory tract infection (an infection of the nose and throat). Symptoms vary depending on the age of the child and the cause of the pneumonia, but the most common include fever, chills, cough, nasal congestion and difficulty breathing, as well as vomiting, chest pain, abdominal pain and lethargy.

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Whooping Cough (Pertussis) Whooping cough is a bacterial infection of the respiratory system, characterized by severe coughing spells, which can sometimes end in a “whooping” sound when the person breathes in. It primarily affects infants younger than six months old before they’re adequately protected by immunizations, and kids 11 to 18 years old whose immunity has started to fade. The first symptoms of whooping cough are similar to those of a common cold, including a runny nose, sneezing, mild cough and low-grade fever. After a few weeks, the dry, irritating cough evolves into coughing spells that can last for more than a minute and leave the child red or purple in color. At the end of a spell, the child may make a characteristic whooping sound when breathing in or may vomit.

Xerophthalmia (Dry Eyes) Xerophthalmia, also known as dry eyes, is a medical condition that occurs when the eye fails to produce tears. It is caused by a vitamin A deficiency and is common in developing countries around the world. Symptoms include dry, itchy, painful eyes.

Yeast Infection Yeast infections usually occur in warm, moist parts of the body, such as the mouth and moist areas of skin. Vaginal yeast infections are particularly common in girls and boys during the summer months, when children spend an increased amount of time wearing wet bathing suits. Also, recent use of prescription antibiotics or steroid medication can cause yeast infections to develop in children. Infants and toddlers who use an infected pacifier or bottle nipple can develop a yeast infection. Symptoms vary wildly depending on the location of the infection.

Zoonotic Disease Zoonotic diseases are those that can be transmitted from animals to humans. These diseases are caused by bacteria, viruses, parasites, and fungi that are carried by animals and insects. Examples are anthrax, dengue, Ebola hemorrhagic fever, Escherichia coli infection, Lyme disease, malaria, Plague, Rocky Mountain spotted fever, salmonellosis, and West Nile virus infection. People can get zoonotic diseases from contact with infected live poultry, rodents, reptiles, amphibians, insects, and other domestic and wild animals. A common way for these diseases to spread is through the bite of a mosquito or tick. People can get diseases in most places where they might have contact with infected

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animals and insects, including: animal displays, petting zoos, pet stores, nature parks, wooded and bushy areas, farms, county or state fairs and/or childcare facilities and schools.

To help prevent zoonotic diseases, wash hands thoroughly and frequently, avoid direct contact with certain animals and their environment, closely supervise children to ensure they wash their hands properly and avoid hand–to–mouth activities (thumb–sucking, eating, and use of pacifiers) after animal contact, use EPA– registered insect repellents that contain 20% or more DEET (N, N–diethyl–m– toluamide) on the exposed skin for protection that lasts up to several hours, use products that contain repellents (such as permethrin) on clothing (treat clothing and gear, such as boots, pants, socks and tents), look for and remove ticks from the body and limit the number of places around your home for mosquitoes to breed by getting rid of items that hold water.

- Sources: Centers for Disease Control, the World Health Organization and WebMD

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The Health Sciences Building Virginia Western Community College

MEDICAL EDUCATION ADVANCEMENTS | our health

Southwest Virginia and Lynchburg and Southside Virginia Colleges are Answering the Call for Needed Medical Care words | ANIKA IMAJO

As pressure mounts on the nation’s thinly stretched healthcare workforce, educational programs throughout Southwest and Southside Virginia are stepping up in response to the increasing demands.

Area schools — both emerging and established — are training professionals to meet challenges at the intersection of a growing aging population, underserved rural communities and a shortage of primary care physicians.

FOR A COMPLETE LISTING OF MEDICAL EDUCATION PROGRAMS OFFERED THROUGH LOCAL COLLEGES AND UNIVERSITIES IN THE SOUTHWEST AND CENTRAL VIRGINIA COMMUNITIES, PLEASE VISIT WWW.OURHEALTHVIRGINIA.COM

Edward Via Virginia College of Osteopathic Medicine (VCOM), chartered in 2002, has already established itself as an effective training ground for primary care practitioners committed to treating areas of need.

According to William King, associate vice president for student services, VCOM boasts the nation’s largest number of scholarship awardees from the National Health Service Corps, a U.S. Department of Health and Human Services program that provides financial aid to students pursuing careers in primary care with the intention of practicing in underserved locales.

VCOM also placed ninth in the country on U.S. News and World Report’s 2013 ranking of schools with the largest percentage of graduates entering residencies in primary care.

Linda Frasca, MD, chair of VCOM’s Appalachian Medical Mission, credits the school’s success in these areas in part to its educational outreach efforts, which include volunteer opportunities at remote free clinics, a new partnership with AARP to provide health screenings at six area sites and a mentorship program that pairs students with rural family physicians. Four of the young college’s graduates, she points out, are currently practicing and teaching in the region’s underserved areas.

Poised to welcome its inaugural class in fall of 2014, Liberty University’s new College of Osteopathic Medicine (LUCOM) represents another step toward fulfillment of the institution’s historical mission to serve community, according to Dean Ronnie Martin, DO. Pointing out that 67 percent of Virginia’s regions are federally designated HPSAs (Health Professional Shortage Areas) — with primary care physicians particularly scarce in the southern part of the state — Dr. Martin explains that LUCOM will both actively recruit candidates from underserved areas and train them in real-life environments, while demonstrating the value of primary care.

Ronnie B. Martin, DO is the dean of the new School of Osteopathic Medicine.

“If the only people who ever train you are specialists and subspecialists, and if the only place that you ever do your training is in a centralized academic healthcare center, the lesson you’re learning is that this is the only way you can be a real doctor,” he observes, noting that an ongoing relationship between physician and patient, rather than episodic care, is critical to general well-being.

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physicians and reevaluate their role in a changing healthcare landscape, according to VTCSOM’s founding dean, Cynda Johnson, MD, MBA. In VTCSOM’s inaugural class, which will graduate in May 2014, of its 42 students, 22 have already presented their research at the national level and, according to Dr. Johnson, all 42 passed Step 1 of the U.S. medical licensing exam on their first attempt and exceeded the national mean substantially.

“The whole idea of starting with a clean slate has really allowed us to stretch and do new and different things,” she explains, adding that a strong emphasis on applied research, interprofessionalism and cultivation of leadership skills to guide both treatment teams and policy will position graduates to successively navigate today’s complex healthcare waters.

“You can think about this as not just 42 doctors, but 42 extended healthcare teams, and that’s really the difference,” Dr. Johnson remarks. “These aren’t just people in isolation that will do what has been traditional for physicians. But rather, in our physician thought leader model, they will really be able to take care of a large population. I think that population health is really the major focus of where we need to be going, to understand how to take care — good care — of large groups of people.”

This growing reliance on teamwork to serve communities in need will require skilled professionals of all stripes. Through a host of initiatives, from adding or revamping relevant courses of study to facilitating rapid transitions to higher degree programs, area schools are responding to these related demands.

“As they begin to retire, we’re losing a great number of qualified nurses,” notes Anne Prucha, MSN, BSN, RN, head of the nursing department at Virginia Western Community College (VWCC).

She counts aging, health insurance issues and national politics among the considerations that influence how and when people seek care and how progressed their conditions might be before they receive treatment.

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“The Roanoke Valley is seeing more cultures come into the area in larger numbers annually. To meet this need, our nursing program has to infuse cultural teaching into each nursing class so students are prepared to work in rural areas with diverse patient populations. This is very important since preventive healthcare is so important.”

According to Prucha, the nursing school at VWCC has taken several measures to increase its number of nursing graduates. Expanding yearly admission to its associate’s degree program in nursing from 90 to 115, VWCC is also reaching out to high schools to identify and nurture potential nursing candidates at early ages, and is partnering with other institutions to facilitate their graduates’ advancement toward higher nursing degrees.

Jefferson College of Health Sciences (JCHS) is also introducing an intensive program through which candidates holding bachelor’s degrees in various fields can obtain a Bachelor of Science in Nursing in four consecutive semesters, says Dean Lisa AllisonJones, PhD. “To help meet the shortage of primary care physicians, Jefferson currently offers a very successful physician assistant program and is opening a family nurse practitioner program in fall 2014. Graduates of these programs will work with their physician colleagues to address the growing healthcare needs of the region.”

Miller-Motte Technical College has recently established a five-week program to train nurse aides at its Roanoke campus. Darlene Jeffrey, program director for the certified nursing program, explains that this development resulted directly from a needs assessment that indicated a growing call for certified nurse aides, particularly in nursing homes.

Across the board, institutions offering healthcare education are placing greater emphasis on the needs of the aging population in training professionals ranging from physicians to paramedics and administrators.

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According to Carole Graham, dean of health professions at VWCC, her department’s response to these needs includes the introduction of additional courses of study and the construction of an innovative facility.

“We’re just getting ready to move into a new state-of-the-art health science building and we feel like it’s allowing us the opportunity to look at our current programs and expand them,” she explains, noting that training in radiation sciences is becoming increasingly relevant, especially in caring for the aging.

In addition to launching a computerized tomography program this fall and a magnetic resonance imaging program in 2014, VWCC is developing a medical lab technician program, which they hope to offer in 2014.

American National University (ANU) will add health information technology/medical records to its wide selection of healthcare-related curricula this September.

Students at Jefferson College of Health Sciences (JCHS)

“This is a huge area for healthcare for all of Southwest Virginia,” says Gail van Duursen, academic dean at ANU. “And with everybody going to electronic medical

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records, there’s a need for certified information technology people to input these medical records and keep them moving.”

Producing graduates trained in ICD-10, the new diagnosis coding system, will benefit healthcare providers and patients alike.

“It’s more the administrative side to help the aging population, making sure it’s coded right, getting the doctors paid faster and illuminating a lot of the questions about what’s covered,” she notes, pointing out that Medicare will use only ICD-10 coding going forward. “We’re trying to help the government to get a little easier to deal with.”

ANU’s paramedic program is also responding to the increased need by creating a new course of study, to begin this fall, which will accelerate EMT and paramedic certification among intermediary responders.

Alan Brie, department chair of paramedic studies at ANU — whose 2013 class in the associate’s degree program had a 100 percent pass rate for the National Registry of Emergency Medical Technicians exam — explains that a course in geriatrics and a nursing home rotation have been added to the program’s curriculum.

And skilled paramedics are also critical to the frontline of rural healthcare, which presents its own set of challenges. People living in remote locales, Brie points out, may wait until their conditions are particularly acute before they seek medical help, and are often involved in severe farming accidents.

In addition, paramedics responding to remote sites are often called upon to administer extensive care as they carry patients long distances to medical centers.

“With rural medicine the acuity level is high, the transport times are long,” says Brie, “and they do an awful lot in the ambulance when they’re trying to get to the hospital.”

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Dental hygienists are also among the specialists playing an important part in the region’s healthcare, particularly given the paucity of dentists moving into rural areas. However, because dental hygienists are generally required to practice under the supervision of dentists, this shortage has limited the impact they can make independently on a community’s oral health.

“So while we’re still continuing to graduate dental hygienists, there are no new dentists, or very few new dentists, coming into the Roanoke Valley and virtually none in the Southwest Virginia area, which is even more rural,” explains Marty Sullivan, program head of dental hygiene at VWCC. But the Virginia General Assembly has offered some relief, she says, by allowing hygienists working for the Health Department to function as independent practitioners in high-need areas.

Remotely supervised, they can provide preventive services without a dentist present.

“That could be implemented throughout the state because it’s a working model that has worked very well,” she observes.

“It’s a national model, and Virginia is only using it in the Cumberland Plateau and the Lenowisco Health District.”

According to Sullivan, VWCC is also developing more collaborative training between departments, recognizing that students in different fields may benefit greatly from each other’s specialized knowledge and ultimately address each patient’s care from a much broader perspective.

In general, healthcare educational programs are focusing more on these preventative and interdisciplinary approaches to the escalating challenges their graduates will face.

“The emphasis is on proactive and preventative care in family medical practices and centers and less dependence on reactionary or emergency care,” explains Dr. Allison-Jones. “Together with Virginia Tech Carilion School of Medicine, Jefferson has recognized the need to educate our students in an 78 | www.ourhealthvirginia.com

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atmosphere that encourages all of the healthcare disciplines to respect and to work together to meet our patients’ needs.”

Still, while evolving, the primary care physician’s role remains essential to each patient’s overall health. As innovative leaders and thinkers committed to serving their communities, they will adapt to the dynamic healthcare climate and tackle the issues of today and tomorrow.

“For thousands of years, doctors were the keepers of knowledge,” reflects Dr. Martin. “That’s not true today. You can get on the Internet and find out as much knowledge as I have.

So we have to train doctors to be the interpreters of knowledge, the people that apply knowledge. It’s not so much the what today; it’s the why.”

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our health | MEN’S HEALTH

Prostate Cancer A Controversial Issue with Many Answers

Prostate cancer is the most common form of cancer in men and the third leading cause of men’s cancer deaths with nearly 239,000 men diagnosed in 2013, according to the American Urological Association. But when prostate cancer is detected early, the prognosis for long-term survival is excellent. The key is an early diagnosis, making screening for prostate cancer extremely important because there typically aren’t any symptoms in the disease’s early stages.

Screening Screening for prostate cancers includes a test to measure the amount of Prostate Specific Antigen (PSA) in the bloodstream and a Digital Rectal Exam (DRE) to feel the prostate for any abnormalities, such as tumors.

As for when to screen for prostate cancer, the answer has become a complicated one. There is a significant and somewhat recent controversy within the last year and a half surrounding screening because of guidelines issued by The U.S. Preventive Services Task Force that recommend against screening for prostate cancer. The American Urological Association, on the other hand, came out in May of this year with modified recommendations and currently recommends a PSA test and DRE for someone with normal risk parameters at ages 55 through 59, every one to two years.

Charles Daniel, MD is a urologic surgeon with Roanoke’s Jefferson Surgical Clinic. He says that those screening recommendations are different for patients who fall into a high-risk category. Being African American or having a positive family history of prostate cancer places someone in the high-risk category, in which case the screening should be initiated earlier and as discussed with the patient’s urologist.

If the rectal exam or the PSA screening, or both, are abnormal, the next step will, in all likelihood, be a prostate biopsy – an outpatient procedure to remove tissue samples from the prostate so cells can be examined to determine if prostate cancer is present.

Dennis Garvin, MD of Urologic Surgery, PC in Salem says that when it comes to symptoms of prostate cancer, most of the problems men encounter related to urination are benign. “It’s unfortunate that a lot of agencies out there including the American Cancer Society, suggest that voiding symptoms that men experience might be a sign of cancer. The stage that we are now accustomed to diagnosing prostate cancer is at a point where there are no symptoms.”

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Dr. Daniel also says that prostate cancer usually isn’t accompanied by symptoms. “Generally speaking, most men who present with prostate cancer are asymptomatic. Only 10 percent of men have trouble voiding because of prostate cancer.”

Stages Prostate cancer is measured in four stages. Dr. Daniel explains that stage 1 is low-risk disease that is confined to the prostate. The outlook in terms of survival long term is good with a high cure rate with therapy. He adds that this is where some of the recent confusion comes in as there is a movement afoot to consider more active surveillance with this group of patients by having their physician follow them semi-annually. At this stage, the disease can be either followed or patients can receive definitive therapy. At stage 2 the cancer is confined to the prostate but it is a moderate to high-risk disease with intervention either through radiation or surgery and a good long-term survival rate. Stage 3, Dr. Daniel says, the cancer is no longer confined to the prostate but it has not metastasized. It’s a local spread of the disease just outside the prostate capsule or involving the seminal vesicles. At Stage 4, the cancer has metastasized to the lymph nodes or bone or spread to adjacent organs. With each progressive stage comes decreased survival.

Treatments Treating prostate cancer depends on a wide variety of factors unique to each patient.

Generally speaking, Dr. Garvin says that the major treatments now fall into four categories. “Surveillance, surgery, radiation, and number four is what I would group under ‘experimental,’” he explains. “Surveillance basically makes sense for someone who is at an age or is so sick from other illnesses that they will probably die from something else before they die from the prostate cancer. Radiation is available in a variety of forms – external beam, radioactive seeds, and proton beam therapy. Surgery is available in a variety of means, including through an abdominal incision, laprascopically, or through a perineal procedure, and results in the removal of the prostate. “There are pros and cons to all of those surgical approaches,” Dr. Garvin explains. The fourth treatment category he calls ‘experimental’ simply because there aren’t enough years of data showing results as compared to a patient’s life expectancy. He uses the example of a patient whose average life expectancy is another 15 years, but there are only treatment results spanning eight years. Proton beam therapy and high intensity focused ultrasound also fall into this category.

Who’s at risk, future developments.

The statistics on prostate cancer are sobering. Dr. Daniel points to data that shows African Americans and those with a family history of the disease at a higher risk, followed by Caucasians and Hispanics, with a much lower www.ourhealthvirginia.com | 81

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prevalence in Asians and American Indians. “There are 206,000 patients diagnosed with prostate cancer annually,” he explains. “28,000 die of the disease annually and it’s one of the most common cancers of men behind skin cancer.”

Charles Daniel, MD is a urologic surgeon with Roanoke’s Jefferson Surgical Clinic

Some potential developments in diagnoses and treatment are on the horizon, Dr. Garvin explains. “From the standpoint of diagnosis, we have a urine test called a PC83 that will help us determine who needs biopsy and who can avoid biopsy.” As far as treatments are concerned, Dr. Garvin thinks that chemotherapy’s advancement has been very helpful, compared to 10 years ago when there was no chemotherapy for prostate cancer. There is also a vaccination to try and stimulate the body’s immune system to kill a cancer.

Prostate cancer’s diagnosis and treatment is, admittedly, not a clear-cut path to one decision that’s either right or wrong, particularly in light of the recent differences in opinions regarding PSA levels and treatment. What is clear, however, is the undeniable importance of regular screening for prostate cancer, particularly for men in a high-risk category.

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