KEEPING MEDS IN CHECK FOR SENIORS
LOCAL ADVANCEMENTS IN HEART HEALTH
HIP REPLACEMENT and KNEE CARE
STEPPING INTO A BRIGHTER FUTURE
FEBRUARY • MARCH 2013 | SOUTHWEST VIRGINIA EDITION | OURHEALTHVIRGINIA.COM
20% of Amer ica ns r. deve lop ski n ca nce i n Ge t a n a n nua l sk check.
Smoking, obesity, and diabetes can adversely affect your sight, so get healthy!
CC-A s, PhD,C A. Icke e l l e h d — Mic peech an Valley S r Roanoke te n Ce Hearing
—Stuart Tims, MD
Vistar Eye Center n, DO _ Chad Johns to Daatolo gy River Ridge Der m ily sunscreen is
a MUST!
—Susan M . Dorsey, Moderate MD cardiovascu Dermatolog y Associa lar exercise is tes essential to overall hea o f R oanoke rt health. –Julie Mo rris, Wellne ss Manager, G reen Ridge Recreation Center
edating s n o n Take during s e n i am antihist creased n i f o times posure. x e y g r alle
hearing Get your r keep you o t d e t s te vested. brain in
Know your numbers: Blood pressure, cholesterol, and blood sugar. —Jeffrey Todd, MD Carilion Clinic Cardiology
Ensure yo u is up to d r family a immunizatio te on all ns. Hugh Cra f Carilion P t, MD ediatric Associates Smokers are four times more likely to deve lop macular degeneratio n – one of the lead ing causes of blindne ss – than nonsmokers.
–David Armstrong , OD, Dr. David L. Armst rong, Optometrist
13. Chiropracti adjustments can redu pain and improve ran inju eye e of % at t 90 s! os sse r p gla y et is saf Wear Heart healt hy motion. . do for ries are preventable g you—Sean in h yt n A . y h lt a he Skinner, AO FA , --John Dovie, OD l il w rt tBlaheckbesbunefrgitEyofe your hea Tuck Chiro
HEALTHY LIVING TIPS FOR SOUTHWEST VIRGINIA
ate. Advice, insight and a also benef it your pr ost lot more from local ennis Gar vin, MD ger y D Diabetes is the leadin — caregivers! g erusethe ro logic Sur U ercise regularly Protect your hearing! Low ca of amputations. Foot , at least f r o 3 othe and 0 % iPod r 0 you m 9 on me in ! Flossing daily and using volu s ca u e t s re es a day, five and regular physician ty glas t im es devices. visits are ve fluoride varnishes twice a a week. . le b ning a liste nt e v e ry pr im e po r rtant sa year prevent most cavities! fo r di O ab A et — A ic F s. K , amran Rasul, -John Dovie, OD —Michelle Mills, DDS MD D Au on, ders C An e ha anic rl e —J es y L E Coulter ewisGale Physi Mills and Shannon Dentistry Blacksburg cians Vi rg in gy ia Prosthetics Anderson Audiolo ide, MD r B c M —Dane and Allergy Asthma Ex Center
table of contents |february • march 2013 MEDI•CABU•LARY.....................12 Local experts define healthcare related terms
JUST ASK!..................................14 A variety of health questions answered by local professionals
HEALTH AWARENESS................32
THE LATEST...............................16
ORTHO SERIES...........................35
A listing of new physicians, providers, locations and upcoming events in the greater Richmond community
HEALTH AND FITNESS ON THE GO..................................20 Health-focused apps you can download to your smartphone or tablet.
A prescription to get fit
Get up. get walking. get healthy
HEART HEALTH..........................39 New heart procedures giving life
42
OUR COMMUNITY CARES Stepping into a brighter future
HEALTH AWARENESS................23 Good health: to keep it, protect it
28
HEALTH AWARENESS
KIDS CARE..................................47 Recurring ear infections and fluid build-up lead to ear tubes for children and adults
NUTRITION.................................53 Best foods to incorporate into your weight loss diet
CLINICAL TRIALS CORNER.......57 Clinical trials: what are they, and are they for you?
SENIOR LIVING...........................65 Keeping meds in check: Friendship Retirement Community reviews charts to consolidate, eliminate prescriptions
8 | www.ourhealthvirginia.com
READ THIS EDITION OF
OUR HEALTH SOUTHWEST VIRGINIA ON YOUR TABLET
february • march 2013 OUR HEALTH’S EXCLUSIVE MEDIA PARTNER
PUBLISHER PRESIDENT/EDITOR-IN-CHIEF ASSOCIATE EDITOR PRODUCTION MANAGER CHIEF DESIGNER ORIGINAL PHOTOGRAPHY ACCOUNTING MANAGER WEBMASTER
CONTRIBUTING MEDICAL EXPERTS
McClintic Media, Inc. Stephen McClintic, Jr. | steve@ourhealthvirginia.com Angela Holmes Jennifer Hungate Karrie Pridemore Amy Nance-Pearman and Bron Duncan Laura Scott Adapt Partners Charles Coulter Tricia Foley, RD, MS Brad Houck, RPh Michelle Ickes, PhD, CCC-A Chad Johnston, DO John Mathis, MD Joseph Nelson, MD Robert Slackman, MD
CONTRIBUTING PROFESSIONAL WRITERS C. Ruth Cassell Sarah Cox Rich Ellis Robyn Smith Ellis, esq Tina Joyce Laura Neff-Henderson Rick Piester ADVERTISING AND MARKETING Kim Wood P: 540.798.2504 kimwood@ourhealthvirginia.com
OR SMART PHONE!
SUBSCRIPTIONS To receive Our Health via U.S. Mail, please contact Jennifer Hungate at jenny@ourhealthvirginia.com or at 540.387.6482
www.facebook.com/ourhealthvirginia
@ourhealthmag
SCAN THE CODE BELOW TO VISIT
www.ourhealthvirginia.com then click on the magazine cover to view the digital edition!
COMMENTS/FEEDBACK/QUESTIONS Our Health Magazine, Inc. welcomes your feedback. Please send your comments and/or questions to: “Letters,” Our Health magazine, Inc. 305 Colorado Street • Salem, VA 24153, 540.387.6482 or you may send via email to steve@ourhealthvirginia.com. Information in this magazine 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 Our Health magazine, Inc. Reproduction in whole or part without written permission is prohibited. Our Health is published bi-monthly by Our Health magazine, Inc. 305 Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthvirginia.com. Advertising rates upon request.
10 | www.ourhealthvirginia.com
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 are image guided therapies?
What is a healthcare proxy?
What is GERD?
What is a blade leg?
Image guided therapy: treatment for disease or conditions that use some form of guidance. An example would be the placement of a medicine in a specific or difficult to access location. Guidance to a particular location may utilize CT, MRI, ultrasound or fluoroscopy. This allows the physician to get a medicine directly into a problematic area safely and avoid injury to adjacent tissues or organs. This method of minimally invasive therapy has increased our ability to direct therapy or treatment while improving safety and efficacy.
A healthcare proxy is a document in which you appoint another person to make health care decisions for you if your physicians determine that you are incapable of making informed decisions for yourself. In Virginia, a health care proxy is usually combined with a living will in a document called an “advance medical directive.” In the absence of a health care proxy, Virginia law establishes an order of priority of persons who can make these decisions: first, a legal guardian; second, your spouse; third, your children by majority vote; and followed by your next closest relatives.
Gastroesophageal reflux disease (GERD) is caused by decreased function of the lower esophageal sphincter resulting in the reflux of stomach contents into the esophagus. Common factors which enhance reflux include the presence of a hiatal hernia, obesity, the use of alcohol, tobacco products, peppermint, spearmint, caffeinated products and higher fat foods. The esophagus can be irritated by both acidic as well as alkaline gastric contents. Medical therapy commonly employs acid reduction medications but this may not be helpful if alkaline reflux is a causative factor.
“Blade leg” is a generic term given to the family of lower extremity prosthetic devices designed specifically for running. Made of carbon fiber, their shape somewhat resembles a “blade.” They gained widespread recognition when worn by Oscar Pistorius, the bi-lateral amputee who became famous first as a Paralympics champion and then as a competitor in the 2012 Summer Olympics. Fans called him the “Blade Runner.”
Robyn Smith Ellis, esq Robyn Smith Ellis, PLC Salem | 540.389.6060
Joseph Nelson, MD LewisGale Physicians Gastroenterology Salem | 540.776.6300
John Mathis, MD Insight Imaging Roanoke | 540.581.0882
Virginia Prosthetics has significant experience working with sportsspecific prosthetic devices and currently sponsors Peter Tainer, a young runner from Botetourt County. He runs on two “blade legs” and hopes to make the Paralympics Team for the Rio 2016 Games after narrowly missing the final cut for last year’s Paralympics team. Charles Coulter, CPA (Certified Prosthetic Assistant) Virginia Prosthetics, Inc. Roanoke | 540.366.8287
12 | www.ourhealthvirginia.com
our health | MEDI•CABU•LARY & JUST ASK
ju st a sk!
T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D
What are the best ways to prevent osteoporosis?
What is the smallest bone in the body, and what does it do?
Weight bearing exercises, like walking with a light backpack, will put stress on the skeleton and help bone maintenance. Ingestion of calcium and vitamin D daily will also help prevent osteoporosis. Although the appropriate doses are controversial, 500 mg of calcium three times a day and 800 IU of vitamin D are a good place to start. Leafy green vegetables are a good natural source of calcium. There are also certain things to avoid. It appears that cigarette smoking and excessive alcohol both contribute to osteoporosis.
The smallest bone in a human body is one of the ossicles (three bones of the middle ear): the Stapes. This bone is more commonly known as the “stirrup”. The Stapes is 2 -3 millimeters in size, which converts to approximately 3/32nd to 1/8th of an inch! Saying that the ossicles transmit sound into the cochlea is an understatement. Each of the ossicles are formed and angled to act together as a lever providing amplification to the sound waves entering our ears. Because of this, a normal hearing cochlea (inner ear) can react to very soft sounds in our environment.
Robert Slackman, MD Carilion Clinic Infertility Roanoke | 540.985.8078
Michelle A. Ickes, PhD, CCC-A Roanoke Valley Speech and Hearing Center Roanoke | 540.343.0165
Can I throw unused prescription and over-the-counter medicines in the trash? Unused medications create a dilemma -- what to do with the things? They obviously shouldn’t be left lying around accessible to bored teenagers or curious kids. Nor should they be flushed; medication traces are already showing up in the water supply. Throwing unused medicines in the trash is better than flushing, but it does not adequately protect people and our environment from exposure to potentially dangerous drugs. If you must dispose via the trash, we suggest you render the meds useless by mixing in some water & old coffee grounds, or kitty litter Many pharmacies are now accepting unused medications for return that will be properly incinerated, which is far more environmentally friendly. Brad Houck, RPh Valley Apothecary Salem | 540.772.3788
Is there any relief from psoriasis? Psoriasis flare-ups can be debilitating. Due to stimulation of the immune system, skin cells grow abnormally fast, creating red or scaly skin that itches and hurts. Over time, this inflammation can cause arthritis and even cardiovascular problems. While there is no known cure for psoriasis, some treatments can help the itching and discomfort and speed up recovery. Prescription steroid creams are one of the most common treatments to reduce inflammation and redness. Dermatologists may also prescribe oral medications that work by decreasing inflammation and slowing the growth of skin cells. New injectable medications can also help skin and joint disease. Laser therapy is a relatively new treatment that I’m really excited about. Results can be seen in as few as four treatments and relief can last 4-6 months — with fewer side effects than some other treatments. It is available at our office, River Ridge Dermatology. Chad Johnston, DO River Ridge Dermatology Blacksburg | 540.951.DERM (3376)
14 | www.ourhealthvirginia.com
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
photo not available
Walter S. Davis Jr., MD Carilion Clinic Physical Medicine & Rehabilitation 540.224.5170 | Roanoke
Jennifer DeForest, CRNA (no picture) Carilion Clinic Anesthesiology 540.483.5277 | Rocky Mount
Stephanie A. Kapfer, MD Carilion Clinic Pediatric Surgery 540.985.9812 | Roanoke
Claudia A. Kroker, MD, PhD Carilion Clinic Internal Medicine 540.224.5170 | Roanoke
Tony W. McClure, DDS Carilion Clinic Pediatric Dentistry 540.224.4380 | Roanoke
Andrea K. Nelson, NP Carilion Clinic Obstetrics and Gynecology 540.484.4836 | Rocky Mount
Sandy M. SandridgeMoser, NP Carilion Clinic Rheumatology 540.224.5170 | Roanoke
Tracy Scott, PA Carilion Clinic General Surgery 540.224.5170 | Roanoke
Chand Singh, MD Carilion Clinic Internal Medicine 540.985.8044 | Roanoke
Edgar N. Weaver Jr., MD Carilion Clinic Neurosurgery 540.224.5170 | Roanoke
Susan Kinnison, MD General Surgery LewisGale Physicians 540.862.7181 | Low Moor
Marie F. Sharkey, MD Gastroenterology LewisGale Physicians 540.772.5970 | Salem
Correction: In the Bedside Manner Awards of the Dec/Jan issue, the first place provider in the New River Valley for Dermatology, Dr. Chad Johnston’s practice was incorrect. Dr. Johnston practices with River Ridge Dermatology and may be contacted at 540.951-DERM.
Forrest S. Rubenstein, MD Vascular Surgery LewisGale Physicians 540.776.2010 | Salem
16 | www.ourhealthvirginia.com
Sanjoy Saha, MD General Surgery/Surgical Oncology LewisGale Physicians 540.772.3620 | Salem
BASIC | our health
LewisGale Hospital Montgomery Welcomes new CEO The New Year brings new leadership to LewisGale Hospital Montgomery with the appointment of Alan Fabian, FACHE, as the hospital’s new Chief Executive Officer. Fabian brings more than 20 years of experience to the position, most recently as the CEO of Dauterive Hospital in Louisiana, an HCA affiliate. Prior to serving six years as the CEO at Dauterive Hospital, he was the Chief Operating Officer at Regional Medical Center of Acadiana in Louisiana. Alan also served as the Division Chief Information Officer for the Delta Division of HCA prior to transitioning to hospital operations leadership.
Alan completed his undergraduate studies at Western New England University in Massachusetts and earned his master’s degree in Business Administration from Tulane University in New Orleans. In addition, Alan is a fellow in the American College of Healthcare Executives. “Alan brings a wealth of senior executive leadership and operational experience to his new role that help us continue to build on the strong foundation we’ve established at LewisGale Hospital Montgomery as well as our health system,” said Victor E. Giovanetti, President, LewisGale Regional Health System. “We are excited to have him as part of the LewisGale family as he shares our commitment to high-quality, compassionate care.”
Quality Study Ranks LewisGale Medical Center Among the Nation’s Top Hospitals LewisGale Medical Center ranked among the nation’s top five percent of hospitals in a recent study of mortality and complication rates for nearly 5,000 hospitals. This achievement earned the hospital a five-star rating and the 2013 Healthgrades Distinguished Hospital Award for Clinical Excellence™. “Nothing is more important to us than providing safe, high-quality care to our patients.” said Victor Giovanetti, President, LewisGale Regional Health System. “We credit our highly-skilled team of dedicated physicians and staff for helping us achieve this recognition. Their commitment to excellence ensures our patients have the best possible outcomes.” Healthgrades, a leading independent healthcare ratings organization, focused on hospital performance for 28 common procedures and conditions from 2009 through 2011. The report found patients treated at five-star rated hospitals, on average, had a 58 percent lower risk of dying and a 42 percent lower risk of experiencing a complication. For 2013, LewisGale Medical Center was also named one of America’s 100 Best Hospitals for Critical Care™ and received a five-star rating for hip fracture treatment, back and neck surgery (spinal fusion), overall pulmonary services, gastrointestinal procedures and surgeries, and appendectomy. The findings are part of American Hospital Quality Outcomes 2013: Healthgrades Report to the Nation. For more information, visit healthgrades.com/quality.
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
Virginia Tech Carilion School of Medicine receives endowment for innovative oral health program The Delta Dental of Virginia Foundation has awarded $1 million to the Virginia Tech Carilion School of Medicine to create an endowment for a comprehensive oral health curriculum, one of the nation’s first for a medical school. “Oral health is a critical part of an individual’s overall health,” said Dr. Cynda Johnson, dean of the Virginia Tech Carilion School of Medicine. “Untreated oral diseases can contribute to an increased risk for serious medical conditions such as heart disease and diabetes, and poor oral health in pregnant women has been associated with premature births and low birth weight. Yet millions of Americans don’t receive the dental care they need. The Delta Dental of Virginia Oral Health Teaching Endowment is intended to help fill that gap.” The million-dollar award, payable over four years, will allow the School of Medicine to weave oral health training throughout its curriculum. The funds will also be used to support clinical rotations, service learning projects, research scholarships, and the development and implementation of standardized patient cases. “One major reason we designed this curriculum was our concern about the impact of delayed diagnoses on oral cancer survival rates,” said Dr. Charles “Bud” Conklin, an associate professor in the Department of Surgery at the Virginia Tech Carilion School of Medicine and section chief for dentistry at Carilion Clinic.
Charles “Bud” Conklin, DDS, teaches VTC School of Medicine students how to perform an oral exam.
“We hope that Virginia Tech Carilion School of Medicine students will use their oral health education to promote the power of healthy smiles and healthy bodies for a healthier life,” said Levicki. “By incorporating the growing body of evidence for the vital connections between oral health and overall health, this new curriculum reflects what I hope will become the future of how medical schools train doctors.” Virginia Tech Carilion is located in a new biomedical health sciences campus in Roanoke at 2 Riverside Circle.
The program represents a significant expansion of the school’s pilot oral health curriculum, which an earlier Delta Dental gift had enabled. The curriculum includes clinical training as well as lectures on general oral health, oral cancer, common pathologies, and oral manifestations of systemic disease. The earlier gift also established an annual public lectureship to highlight integral links between oral health and overall health. The overall curriculum was developed through a collaboration among Johnson, Conklin, and Dr. George A. Levicki, president of the board of directors of Delta Dental of Virginia Foundation.
lo cal relo cat ions DRS. NEWMAN, BLACKSTOCK & ASSOCIATES, a local optometrist practice, will be relocating from their current Tanglewood Mall location. Their new free-standing office will be at 3743 Franklin Road in Roanoke at Townside Festival. The new practice is expected to open in early March. Newman, Blackstock & Associates also has offices at Valley View Mall in Roanoke, Salem, Christiansburg, and Lynchburg.
18 | www.ourhealthvirginia.com
MEDI•CABU•LARY & JUST ASK | our health
Local Home Health Agency Honored With Prestigious National Award Each year, The National Research Corporation (NRC) and DecisionHealth®
available data from the Centers for Medicare and Medicaid Services (CMS)
(DH) review more than 10,000 Medicare-certified home health agencies in
Home Health Compare and CMS cost reports. For more information visit
the United States. Organizations that meet select criteria are recognized by
www.nationalresearch.com or www.decisionhealth.com.
the NRC and DH with the HomeCare Elite™ award. Intrepid USA Healthcare Services, located in Radford, was named as one of the 2012 HomeCare Elite™ award recipients. Intrepid USA Healthcare Services was the only home health agency located in the New River Valley to receive this award. “We were very excited to receive the news about the award,” says Lorrie Johnson, RN, Executive Director, Intrepid USA – Radford. “Our staff continually sets themselves apart by providing the highest quality of care.” Intrepid USA – Radford is located at 520 W. Main Street. Intrepid USA offers home healthcare services to patients throughout the New River Valley. They recently began offering hospice services out of their Radford office and opened a home health branch office in Roanoke. About The HomeCare Elite™ award: this award is given to agencies that excel in the following areas: Quality of Care and Quality Improvement, Patient Experience, Process Measure Implementation, and Financial Performance. The 2012 HomeCare Elite™ was comprised using publically
April • May 2013 features include:
Showcasing healthcare organizations in Southwest Virginia committed to providing a superior workplace environment physical
and
occupational therapy
blood donation
services and
more!
Contact Kim Wood at 540.798.2504 or at kimwood@ourhealthvirginia.com for more information www.ourhealthvirginia.com | 19
our health | HEALTH AND FITNESS ON THE GO
Health and Fitness
On the Go
Want a quick analysis of which foods are the healthiest when you’re grocery shopping or to find out if it may be time to get your eyes tested? In our new Health and Fitness on the Go section, we recommend a variety of health-focused apps you can download to your smartphone or tablet.
Fooducate – Healthy Food Diet Scan and choose healthy groceries. Over 200,000 unique UPCs! Instead of trying to decode nutrition fact labels and ingredient lists, use this app to: »» Automatically scan a product barcode »» See product highlights (both good & bad) »» Select better alternatives Fooducate analyzes information found in each product’s nutrition panel and ingredient list. You get to see the stuff manufacturers don’t want you to notice, such as: »» excessive sugar & high fructose corn syrup »» tricky trans fats »» additives and preservatives
»» controversial food colorings »» confusing serving sizes and calories per serving
(Fooducate is NOT funded or influenced by food manufacturers, supplement companies, diets, or diet pills.) »» Cost: Free for both devices »» Device: Android and iPhone
SHARE YOUR FAVORITE HEALTH AND FITNESS APP!
20 | www.ourhealthrvirginia.com
iPhone
Vision Test for iPhone and B2 Eye Test for Android Having difficulty reading the newspaper or text on your computer screen? Having problems seeing road signs? Do an instant eye exam with these apps. Just follow a few simple and easy steps to check for a number of possible vision defects. These apps offer the following vision tests: »» »» »» »» »» »»
Scan this QR code with your smartphone or tablet to visit and “Like” Our Health’s Facebook page, then post a “Comment” with your favorite health and fitness APP!
Android
Visual Acuity Test »» Astigmatism Test »» Duochrome Test »» Color Test »» Cost: Android Free; iPhone $.99 Device: Android and iPhone
Do not consider the tests in these apps official tests. These tests are only meant to give you an idea of whether or not you should see an eye doctor or go on an eye therapy. Having regular eye examinations promotes eye health.
Far Field Vision Test Optician Finder Eye Quiz Eye Advice and Facts
Android
iPhone
HEALTH AND FITNESS ON THE GO | our health
Instant Heart Rate Instant Heart Rate is a heart rate monitor app for any smartphone, and it does not need any external hardware. Use it for optimizing your exercise routine and to track your progress. Keep your heart rate in check before, during, and after your fitness regime. »» Cost: Free »» Device: Android and iPhone Android
iPhone
Stress Check App Stress Check quantifies your level of mental or physical stress. By measuring your heart rate through the camera and light features on your Android/iPhone, Stress Check estimates your level of stress in real time. With the Stress Check App, you can: »» »» »» »» »» »»
Quantify your level of stress Determine the effects of different stressors Control stress and observe progress Reduce your chances of certain chronic diseases known to be correlated with stress Cost: Android Free; iPhone $1.99 Device: Android and iPhone Android
iPhone
www.ourhealthvirginia.com | 21
HEALTH AWARENESS | our health
GOOD HEALTH
to keep it, protect it words | RICH ELLIS
Better to proactive be reactive. than
Benjamin Bowman, DC Tuck Chir opractic
Good health. Everyone wants it and believes they’ll always have it, until they don’t. Health is often taken for granted, with its importance not truly being appreciated or realized until illness strikes and prevents an individual from doing the things they love and living the life they’re accustomed to living. Whether it’s due to a short-term illness, such as a cold or flu, or a debilitating disease, people want to get better, and thanks to continued advancements in medical care and technology, many do. Therein lies a common obstacle to staying well – focusing on treatment rather than prevention. “An ounce of prevention is worth a pound of cure.” There’s significant truth in that old adage. It’s much easier, more comfortable, and less expensive to keep a body well than it is to try to cure one that’s not. The search for lifelong wellness shouldn’t focus solely on a medicine or procedure, but rather on preventing illness in the first place – a philosophy that the vast majority of medical professionals agree with. The basic rules for staying well, particularly during cold and flu season, are wellknown – wash hands, stay home when sick, don’t associate with sick people, cover the mouth and nose when sneezing, and keep hands away from the face. A true, lifelong path to staying well, however, begins with a frank, honest selfassessment of one’s health, lifestyle choices and habits, and it’s a path that can’t be started down until the path of self-destructive behavior is removed. Whether they realize it or not, many people engage in behaviors that threaten good health, with some of the chief culprits being lack of exercise, a bad diet, neglected medical care, poor sleep habits, and risky behavior. Change the self-destructive behaviors and health changes too. www.ourhealthvirginia.com | 23
our health | HEALTH AWARENESS
Exercise Bodies are designed to move. Regular exercise is an important, proactive step toward protecting one’s health. Exercise strengthens the mind, body, and immune system and can help prevent diseases, such as diabetes or heart disease. Too often, people mistakenly think they don’t have time for exercise and understandably so in our highly scheduled society. At first glance, the Centers for Disease Control’s (CDC) recommendations for adults to perform moderate-intensity aerobic exercise for two-and-a-half hours per week might seem like a lot to try and fit into an already jam-packed schedule. Spread those 150 minutes of exercise over four days, however, and suddenly it doesn’t seem so daunting. When it comes to managing schedules, making time for wellness should be at the top of the list. The CDC defines moderate exercise as anything that gets the body working hard enough to increase the heart rate and break a sweat, including brisk walking, biking or even pushing a lawn mower. In addition to the recommended 150 minutes of moderate exercise, the CDC also recommends two days per week of musclestrengthening activity, such as lifting weights, doing pushups and sit-ups, or heavy gardening involving raking and shoveling. For those looking to cut their exercise time commitment in half but still realize the health benefits, the CDC recommends performing vigorous aerobic exercise, defined as “breathing hard and fast….with the heart rate having gone up quite a bit,” for just 75 minutes per week, in addition to the previously mentioned strength training. Some forms of vigorous exercise include running, fast biking, and playing singles tennis or basketball.
fruits e r o m t Ea ables! t e g e v and
MD n Rasul, a r m a K – sicians y h P e l a LewisG
For children ages 6 to 17, the CDC recommends even more aerobic exercise with a minimum of 60 minutes of physical activity per day. Establishing physical activity as a habit early in life can help prevent the growing trend of childhood obesity and lay the foundation for healthy living later in life.
Diet While exercise can have a significant impact in preventing obesity in both adults and children, it’s not the only factor. Diet is the other half of that equation. When it’s a balanced diet, the positive health effects are powerful, and when it’s a poor diet, the results can be deadly. The United States Department of Agriculture (USDA) issues dietary guidelines periodically and recently replaced its well-known but often confusing “food pyramid” with a plate (www.choosemyplate.gov). The main, health-protecting, nutritional messages the USDA wants consumers to take from the new plate-based guidelines include the following: • Balance calories by eating less and avoiding oversized portions • Dedicate half the plate at mealtime to fruits and vegetables
24 | www.ourhealthvirginia.com
HEALTH AWARENESS | our health
• • • •
Ensure that 50 percent of the grain consumed is whole grain Switch to skim or one percent milk Check sodium levels and reduce foods that have high levels Drink water instead of sugary drinks
It’s also important to focus on consuming foods that are lower in fat and added sugar and to balance the amount of calories being consumed with the calories being burned through activity and exercise. Too many calories taken in with not enough calories going out leads to weight gain, which can be the beginning of a slippery slope to becoming overweight or obese, the difference being that the CDC defines “overweight” as having a body mass index (BMI) of 25 or higher and “obese” as a BMI of 30 or more. Regardless, the effects of being either are incredibly detrimental to good health.
t Sleep is the bes hile medicine, but w e to awake, enjoy lif ce we the fullest sin only get one!
y, DO –Kenneth Lucka Medical The Center for Weight Loss
According to the Centers for Disease Control at www.cdc.gov, both conditions can significantly increase risks for “coronary heart disease, type 2 diabetes, cancers, high blood pressure, stroke, liver and gallbladder disease, sleep apnea, and a variety of other health-related problems. In addition to lack of exercise and a poor diet, lack of sleep or poor quality sleep can also cause weight gain because sleep affects hormones that control appetite.
Get to Sleep A good diet and exercise alone aren’t enough to strengthen and protect good health if sleep, and good quality sleep, are missing from the equation. Too little sleep, as well as too much sleep, affects cognitive thinking, weight gain, mental attitude, the body’s ability to resist disease, and a host of other functions.
Know your numbers: Blood pressure, cholesterol, and blood sugar. –Jeffrey Todd, MD Carilion Clinic Cardiology
The National Sleep Foundation recommends that adults get seven to nine hours of sleep, children ages five to 17 should get 10 to 11 hours, and newborns 12 to 18 hours. Based on a recent CDC study, American workers aren’t getting anywhere near enough sleep, with more than 40 million reporting six or less hours of sleep per night. Lack of sleep has been shown to lead to an increased risk for heart disease and cancer, in addition to the risks that come with driving or operating machinery while drowsy. Whether it’s because of the sleep environment, behaviors, or medical problems, such as sleep apnea, factors that prevent someone from getting the sleep they need can often be resolved. The National Sleep Foundation provides some of the following tips to help fall asleep and stay asleep: “establish consistent sleep and wake schedules, even on weekends; create a regular, relaxing bedtime routine such as soaking in a hot bath or listening to soothing music an hour or more before the time you expect to fall asleep; create a sleep-conducive environment that is dark, quiet, comfortable and cool; sleep on a comfortable mattress and pillows; avoid caffeine and alcohol close to bedtime; and exercise regularly.” If sleep quality, as opposed to the amount of hours spent sleeping, is the problem, a sleep study performed at a recognized sleep center might be a recommended course of action to discuss with a physician as it can help determine if there are underlying medical conditions interfering with sleep. Even if there isn’t any reason to suspect that underlying medical conditions are impacting sleep, it’s important to establish and maintain a relationship with one’s healthcare provider in order to stay healthy.
www.ourhealthvirginia.com | 25
Check your birthday ! suit on your birthday our health | HEALTH AWARENESS
DSusan M. Dorse y, M es t Dermatology A ssocia ke of Roano
Know Your Physician and Family Health History Much like a vehicle needs periodic maintenance, so too does the body in order to run well and long. That maintenance schedule begins early in life with childhood immunizations that protect against deadly and crippling diseases and continues throughout life with immunization boosters and regular testing to both prevent disease and detect it early, thereby improving the chances for a cure. There are a number of preventive medical tests that should be part of any proactive health plan, many of which depend on age, sex, and family health history. Because of these variables, a personal physician is often the best guide and most trusted source for information when it comes to determining when and how often routine testing should occur, including cholesterol and blood pressure screenings, mammograms, colonoscopies, or pap smears. A variety of symptomless conditions, such as high cholesterol, can be corrected if caught early – before they lead to more serious, life-threatening health issues. And, just as knowing what conditions are happening within the body, it’s also critically important to know your ancestors’ health histories and the conditions and diseases they may have suffered from. Genetics and lifestyle choices play equally large roles in determining health, but while genetics can’t be changed, lifestyle choices can.
Don’t Be a Risk Taker Taking risks that could ultimately lead to negative health consequences is a losing proposition. Tobacco usage, excessive alcohol consumption, not wearing a seat belt, not using sunscreen, and having unprotected sex are just a few behaviors that put good health and longevity at risk. Coupled with other lifestyle choices that can have significant health implications, such as exercise and diet, these risky behaviors can result in the loss of health – probably not today or even tomorrow, but down the road, when good health is needed more than ever. For many people, good health is an option and a choice, but it’s one that can only be realized through a dedicated commitment to making the right choices, starting early in life and continuing through the years.
26 | www.ourhealthvirginia.com
our health | HEALTH AWARENESS
GET FIT Above: Green Ridge Recreation Center in Roanoke County At right: Just Dance! Roanoke, a danceinspired fitness studio on Apperson Drive in Salem Just Dance photo courtesy of Amy Nance-Pearman, Boyd Photography
28 | www.ourhealthvirginia.com
HEALTH AWARENESS | our health
THE FUN WAY
words | SARAH COX
You’ve seen the gyms in January – they are packed with good intentions. But come March, after discouragement and sore muscles have set in, the crowds start thinning. There are several ways to avoid this burst of short activity and, instead, turn it into a life-long fitness plan for your wellbeing, both mentally and physically.
Green Ridge Recreation Center, a family fitness facility operated by Roanoke County and located on Wood Haven Road, makes sure that exercising is fun, according to Business and Information Manager for Roanoke County Parks, Recreation and Tourism Scott Ramsburg. Green Ridge offers memberships but also allows walk-in daily clients. For more information, see www.roanokecountyparks.com and click on the link for the recreation magazine to find out more about classes. Ramsburg says that there is an indoor pool with water slides, a fitness center, gymnasium, activity room, and rooms for arts and crafts and parties. “You can splash around in the pool and get more exercise than you think,” he points out. “And classes always help because you’re working with a group of peers, so it keeps you motivated.”
Just Dance! Roanoke Photo courtesy of Amy Nance-Pearman, Boyd Photography
One of the more successful programs that this facility offers is Lose Big - a team-based group program that is made up of four to six people per team, and these teams compete with each other as well as work with a personal trainer twice a week. Each time it’s offered – about three to www.ourhealthvirginia.com | 29
our health | HEALTH AWARENESS
Green Ridge Recreation Center in Roanoke County
four times a year – it has proven to have great results. In fact, says Ramsburg, one person lost upwards of 100 pounds. The program lasts about 12 weeks and costs, for anyone – members or non-members, $250. Ramsburg says that group exercise classes will all have a plateau level, where one will work for a while and eventually not see visible results. “A lot of people get discouraged and feel that they’ve only gotten so far, so they should vary their workout,” he suggests. Taking a different class in tandem or simply switching classes helps.
Make healthy food choices and exercise regularly. –Beth Polk, MD Carilion Clinic Family Medicine
One way to switch things up is at Just Dance Roanoke, a dance-inspired fitness studio on Apperson Drive owned and operated by Sara Bremer, who has years of dance and fitness instruction experience. Zumba, which has been around for at least 10 years, is one of the center points of her studio. It incorporates international rhythms and dances into a routine, and because each dance genre uses different muscle groups, it’s a whole-body workout, explains Bremer. She says that many people dance growing up – from preschool programs to high school dances. And then they leave it behind, but they don’t have to. For those who don’t want to go out to bars to dance, but want to get moving, this could be the answer. “Dance fitness is a fun way to get fit,” she says, and an alternative to boring treadmill workouts. “Getting on a treadmill is like pulling teeth to me, but I will dance all night and not think twice about it. I have women that check in for class at 4:30 and take one, two, even three classes per night,” she says. Kim Enochs is a Just Dance Roanoke client who said that the quality of the instructors there is a big draw. “They are attentive to everyone’s needs, regardless of where someone may be in their fitness journey,” she said. “I grew up dancing, was a cheerleader, and have always worked out, so Zumba allows me to combine all of the things I love and get a great dance-inspired workout.” All ages, shapes, and sizes come to dance at her studio, which embodies the message that if you’re moving, you’re doing it right. “My average client is middle age, middle fitness level, and hasn’t taken time for themselves and personal fitness since the kids were born.”
30 | www.ourhealthvirginia.com
our health | HEALTH AWARENESS
She offers a variety of dance programs, not just Zumba, but all allow clients to leave worries behind and … just dance. These programs give clients a great cardiovascular workout, says Bremer, in which one can burn 500-900 calories in one go. She is launching a new program, Just Burn, which incorporates light hand and body weights with movement. words | SARAH COX
A PRESCRIPTION TO GET FIT Carilion’s Roanoke Athletic Club (RAC), Botetourt Athletic Club (BAC) and RAC Xpress downtown are all sites that participate in FIT Rx, which is a prescription-based fitness program that cooperates with one’s physician who gives a referral for a client to get fit. FIT Rx Program Director Jenna Bartlett says that the referral from a healthcare provider allows a participant full access to all of the above athletic clubs for sixty days, two fitness consults, and six weekly one-onone personal training sessions – all for $60. Bartlett has seen referrals made for those suffering from obesity, stress, depression, Type 2 diabetes, arthritis, and heart disease. “We’ve offered this for about one and a half years now and had almost 800 referrals. It’s a great program that works best for those who have never stepped into a fitness facility before,” explains Bartlett. They are the ones who will feel shy, intimidated, and overwhelmed, but having personal attention from the beginning helps smooth the road and encourages them. “The cool thing is that this has created a referral process for exercise; every doctor tells his patient to exercise, but they don’t have a trusted way to check on it, so this is an exercise prescription,” she says. At the end of the session, the athletic facilities must send a progress report to the doctor; the whole goal of the program is to help give doctors an official method of prescribing a program. One woman who was pre-diabetic found herself so motivated by FIT Rx that she has since talked her husband and 28-year old daughter into joining. The whole family has converted to a membership. It’s also a great stepping stone to take after therapy, says Bartlett, instead of a therapist trusting that a patient will continue on his own. Doctors have liked this so much that there is now no age restriction, so those under 16 years old can now be prescribed FIT Rx. “This is cost-effective and gives physicians a way to start talking about physical activity,” explains Bartlett.
32 | www.ourhealthvirginia.com
“Whatever program you do consistently is good for you. I think that something you are going to make time for is something you will find enjoyable, not a task. One of my favorite things about my studio is seeing the friendships that are being formed.” Enochs agreed, noting that since Zumba is a group fitness routine, it “encourages the development of a community, and the empowerment that comes from being part of it.” Over at the Botetourt Athletic Club, Group Exercise Manager Kim Treadway suggests that those new to a fitness routine start out slowly and not be so “gung-ho, because they feel that they have to do it all, and then they burn out.” She says to take several classes, feel them out, figure out what you like, and don’t be shy. “Don’t be afraid to try something new or different, because you can use low or high options in any class,” she notes. There are two classes that may appear very intense, but still, says Treadway, anyone can take them and just do as much as they are able to. They are Body Attack, a running-based class with plyometrics, or using body weight and going in spurts of energy, and Extreme Training, using running and jump ropes. Don’t be afraid to join in, try it out, and start slowly, she suggests. And figure out what motivates you. Yes, if getting in your zone on the treadmill is what does it for you, then great. But if classes are the way to stay sociable and fit, do that instead.
HEALTH AWARENESS | our health
www.ourhealthvirginia.com | 33
SPECIALIZED SERVICES FOCUS | our health
THE ORTHO SERIES In this two-part series we take a look at local joint replacement and treatment options. Look for our second part in the March/April 2013 edition of Our Health.
GET UP GET WALKING GET HEALTHY words | SARAH COX
Both techniques and technology have changed the way that orthopaedic surgeons are approaching knee and hip care and replacement. Hip Advancements According to Chief of Orthopaedic Surgery at Carilion Clinic Joe Moskal, MD, the most significant advancement in hip surgery is using the anterior, or front approach, rather than the posterior. This allows patients a quicker recovery and rehabilitation because no muscles are cut, torn or stretched, Dr. Moskal explains. “Over 40 to 50 percent of our patients go home the day after surgery,” he says. The current length of stay, on average, is two and a half days, which is a day less than the national average. Dr. Moskal says that care of a hip patient starts before surgery with an education program that teaches them the do’s and don’ts after surgery so that they are prepared for what their recovery will look like. In addition, it’s simply better to get a patient up and moving for blood circulation and mental health, as well as away from the hospital environment. Patients begin therapy in the hospital and are on walkers or canes for one to two weeks. Prior to the use of the anterior approach they would rely on those devices for up to six weeks. “We have patients who go back to work in two to three weeks,” www.ourhealthvirginia.com | 35
our health | SPECIALIZED SERVICES FOCUS
comments Dr. Moskal. “To some, this makes a big difference.” The anterior approach also comes with fewer post surgery precautions such as how patients bend down, sit, etc. Some of this has to do with an improved fit of the implant, which is a result of computers that help position the implants precisely. According to Dr. Moskal, the computer is like a GPS system – he has been using this technique since 2003, and he says that they know by this time that the survivorship and satisfaction of the patient is extremely dependent on putting in the components exactly to avoid dislocation. In addition, the implant simply lasts longer if it is positioned accurately.
Preston Waldrop, MD, an orthopedic surgeon with Virginia Orthopaedic in Salem, performing knee surgery at LewisGale Medical Center
An orthopaedic surgeon with LewisGale Medical Center, Mark Rowley, MD says that in the 17 years he has been practicing, the most significant advancements in hips have been the materials that have evolved. “We’re currently using titanium implants with special coatings that allow in-growth into the femur; we rarely use cement anymore, and when we do, it’s better,” says Dr. Rowley. The titanium with the special coating allows the bone and the prosthesis to bind better, and therefore, it works better. Additionally, these hip implants are lasting longer. The improved designs, with more shapes and sizes, allow for longevity so that an implant that used to last maybe 10 or 12 years now can last up to 20, due to both material and fit.
Knee Advancements Knees, those vulnerable parts of our anatomy, are also seeing improvements in both surgery and materials. Dr. Moskal says that the ability to use the computer to help guide surgery has helped a great deal. But in his opinion, the greatest advancement in knee surgery is the multi-modal pain management protocol, one which he helped to develop. “This is huge – we knew that the longer the patients lay or sat in bed, the higher the risk of blood clots, pneumonia, and difficulties with bowel and bladder. Early motivation is the key,” he explains, and this comes from a patient not feeling excruciating pain. Pain, he says, is the biggest inhibitor to doing exercises and therapy. This protocol allows doctors to preemptively address the pain so that patients are up and walking the day of surgery. Conventional pain management of years ago, by contrast, involved putting the patient to sleep under general anesthesia, and upon waking, getting medication when the patient requested it – thus, when they were in a lot of pain. With this protocol, he says, “we preemptively provide medications that block the nerve endings, and most aren’t narcotics, so they don’t experience extreme pain.”
36 | www.ourhealthvirginia.com
SPECIALIZED SERVICES FOCUS | our health
The protocol is a philosophy that has been adopted and modified worldwide, and, he continues, “has really changed how we address hip and knee surgery.” Additionally, knees are now benefitting from new instruments that help balance the knee and ligaments. The components have more function and last longer, and this is important as the age of the patient continues to drop. “I think the biggest advances I’ve seen in my career are our ability to manage pain better, our ability to get people out of bed the day of surgery, and these musclesparing approaches that allow patients quicker recovery,” Dr. Moskal notes. Dr. Rowley says that the three primary reasons they see patients for knee replacements is degeneration associated with aging, trauma that leads to posttraumatic arthritis, and obesity, which is a growing national problem. He says that the materials that are going into knee replacements are more advanced, and the designs are much better. This concerns him, since he has extensive knee replacement and knee revision experience – the latter involving redoing knee replacements that have become complicated or reached the end of their lifespan. The designs of the implants allow more flexion in the knees, which is wonderful for younger patients who want to stay active. But if you are 30 years old, you also don’t want to have to go through a knee revision anytime soon. Therefore, the materials used are also important. Dr. Rowley notes that knee implants that are now made of plastics are excellent. Another advancement has to do with computers. Pre-operative MRIs or CT scans help create “cutting guides,” which are customized guides for cutting bone during surgery. The newer guides are made specifically for the patient. “I suspect the next step, which I hope to see in my career, is going to be the implants made just for the patient,” says Dr. Rowley. And the better a knee implant fits, he continues, the quicker a patient regains movement, and the better the rehab process will be. LewisGale Medical www.ourhealthvirginia.com | 37
our health | SPECIALIZED SERVICES FOCUS
Center has been named in the top 10 hospitals in Virginia for six years in a row for overall orthopaedic care, according to the latest numbers from Health Grade. Dr. Rowley says that one of the protocols that has been put into place is implementing infection prevention by placing a patient, pre-surgery, on antibiotics. “We’ve been doing this for three months now, and the results of the overall study [a large clinical trial] resulted in lower infection rates.”
For healthy eyes e at more carrots, broc coli, spinach and fish.
The medication post surgery has also been altered to improve mobility. Dr. Rowley is using nerve blocks that last 18 to 24 hours, and as a result, patients require less anesthesia, have a quicker recovery, and require fewer narcotics post surgery.
John Dovie, OD, FA AOBlacksburg Eye Mark Rowley, MD, orthopaedic surgeon at LewisGale Medical Center
38 | www.ourhealthvirginia.com
Joe Moskal, MD, Chief of Orthopaedic Surgery at Carilion Clinic
HEART HEALTH | our health
words | SARAH COX
NEW HEART PROCEDURES GIVING LIFE
There is new hope for those who have been told that there are no options. The transcatheter aortic valve implantation, or TAVI, is the process by which interventional cardiologists working with a team implant a new aortic valve by way of a catheter. It gives those who are not good candidates for heart surgery a new lease on life. If you are too old, too frail, or have significant health issues, finally there is an answer. Carilion Clinic Cardiology, with Chief of Cardiology David Sane, MD, is an approved center for the TAVI program. Dr. Sane says that the average age of the TAVI patient is 83. “In terms of expectations for the patient, they don’t have to have their heart stopped or their chest cracked open. The hospital stay is four to five days,” and in terms of recovery, he continues, it is much quicker. Trials have shown that the mortality risk dropped by half and that the patients’ quality of life improved significantly. Jason Foerst, MD, part of the team of cardiologists at Carilion performing the TAVI, spent a year in Germany learning and performing this procedure. He says that the replacement valves are getting better, as well, and that they are now more durable. Dr. Foerst, who is part of a team that includes one to two heart surgeons, two interventional cardiologists, a general cardiologist, an anesthesiologist, and support staff, performed about 100 TAVI procedures in Germany. “What has changed dramatically,” explains Dr. Foerst, “is that the FDA just approved the trans www.ourhealthvirginia.com | 39
our health | HEART HEALTH
apical approach, so we can now make an incision between the ribs, at the tip of the heart, and deliver the valve by a balloon and stint.” Dr. Foerst says that Carilion Clinic Cardiology is getting ready to start that particular program. Dr. Sane comments that the TAVI is “really cutting edge, and we are one of the few centers in the area to offer this. The Partners Trial [study] showed a 20 percent absolute mortality reduction in patients that had TAVI, compared with those who were just treated with medicines. This is a strong and significant effect.” At LewisGale Medical Center, Stephan Vivian, MD is aggressively treating heart rhythm disorders. He was the first doctor in Southwest Virginia to bring catheter ablation for atrial fibrillation to this area. “This is one of our most common disorders, and it’s becoming so frequent that it’s been called an epidemic. Our population is aging, we’re doing a better job of keeping them alive longer, and as people age we see more and more of this,” says Dr. Vivian. Symptoms of this disorder can be shortness of breath and fatigue, but it can also be life threatening. Dr. Vivian’s success rate is good or better than anywhere else, he says, at 80 to 85 At top: Stephan Vivian, MD in the electrophysiology lab at LewisGale Medical Center Above: Electroanatomical mapping enables Dr. Vivian to get a detailed view of the heart and the arrhythmia percent. This procedure, according to the National Heart Lung and Blood Institute, treats arrhythmias, which are irregular heartbeats, by inserting a catheter into a blood vessel and then into the heart; this then transmits energy that destroys a small area of heart tissue where the abnormal heartbeats are occurring.
David Sane, MD, Chief of Cardiology, Carilion Clinic
Stephan Vivian, MD LewisGale Medical Center,
“This is as good as it gets, anywhere in the world,” notes Dr. Vivian. “It’s very satisfying to give somebody their life back.” He says that one of the reasons he came to LewisGale was to set this program up and that LewisGale was willing to commit to an electrophysiology lab for catheter ablation. One of the necessary tools in treating this problem is an electroanatomic mapping system, which LewisGale has just upgraded to. This, he explains, is a group of sophisticated computers that help him diagnose and treat a variety of heart rhythm problems. “My goal with every patient is to attempt to cure the problem with a single procedure,” he says, explaining that he has a more comprehensive approach and a very low rate of relapse. His patients are usually in the hospital for about 48 hours, and he credits the advances in technology and catheter and delivery system design with making the procedure possible.
40 | www.ourhealthrvirginia.com
HEART HEALTH | our health
www.ourhealthvirginia.com | 41
our health | OUR COMMUNITY CARES
STEPPING BRIGHT words | TINA JOYCE
Anderson’s feet prior to surgery.
Anderson with Dr. Zelen
42 | www.ourhealthrvirginia.com
OUR COMMUNITY CARES | our health
INTO A ER FUTURE
One Boy’s Dream Becomes a Reality A Roanoke team of professionals recently came together to enrich the life of one young boy and impact an entire community. Anderson Mambwe, a teenager from Zambia (a country in southern Africa), showed a sweet and sincere smile that warmed the hearts of many this past November when he prepared to travel home.
17EEEEEEE vs men’s average size 9
Just nine months prior, Anderson boarded his first plane and embarked on a 22-hour flight to see a place he had vaguely heard about through others—the United States. The U.S. was home to a team of healthcare providers and a mission-affiliated staff who offered his only hope for a life with mobility and less pain—a chance to walk. A Roanoke-based surgeon offered to attempt to correct the severe and progressive malformation of Anderson’s feet. Anderson, approximately age 17*, was born with congenital macrodactyly, an extremely rare condition causing malformation in the hands or feet (as in Anderson’s case). The disorder is characterized by the enlargement of both the soft-tissue and the osseous (bony) elements of the foot.1 The condition is often progressive and accompanied by swelling and unremitting pain. Without surgery, in Anderson’s case, walking became difficult and ultimately impossible. Although several theories exist for the exact cause, Dr. Charles M. Zelen, a Roanoke foot and ankle surgeon, explains that the growth plates in Anderson’s feet never closed, causing his feet to continually grow. Because of swelling and the massive size of his feet, Anderson was no longer able to walk for any length of time. His feet had grown to a size 17 EEEEEEE. Sadly, his impairment kept him from participating in youth activities and contributing to the daily needs of his family. If his growth plates were to remain open, his feet could continue to grow, causing further degeneration of the joints and severe pain. Dr. Zelen explains that this condition would almost never go unchecked for a child in www.ourhealthvirginia.com | 43
our health | OUR COMMUNITY CARES
the U.S. because symptoms are diagnosed at a young age, and treated effectively. A local pediatric facility or Shriners Hospital2 would, in most cases, take care of the child’s needs regardless of the family’s ability to pay. Unfortunately, medical providers in the landlocked country of Zambia offered no solution other than a risky, above-the-knee amputation of both legs. The loss of both limbs would, more than likely, lead to a bleak fate for Anderson. If he survived, there would be little assistance for mobility and even less acceptance among his peers, causing more isolation. His widowed mother works in the fields to pay for Anderson’s schooling and cares for him and his four siblings. The permanent loss of mobility would cause even greater hardship on the family. Fortunately, Seeds of Hope Children’s Ministry3 director, John Chalkias, learned of Anderson’s needs. He invited Anderson to come to live at a Seeds of Hope residence in Zambia. Chalkias had exhausted all of his options to find assistance for Anderson’s medical needs through local hospitals. It was at that point he reached out to Karen ReMine, a Roanoke-based nurse and Orphan Medical Network International (ONMI) Co-founder and President. Since OMNI was founded to provide medical care, education, and community development for orphans and vulnerable children around the world, the partnership was ideal. “We knew how much potential Anderson had,” explains a compassionate ReMine. “We were not going to let him have the drastic, amputation surgery.” If Anderson could obtain the proper medical treatment, not only would he survive, he might thrive in his environment and grow to be a well-educated, productive citizen of his community. His intellectual capacity is far above what one might expect, and healthy leaders in these communities are critical in assisting with the basic needs of families and the country’s progression. ReMine contacted Dr. Zelen for assistance. “Dr. Zelen had operated on our Zambian-adopted son 10 years ago and did an excellent job correcting his club foot, which he could not walk on, but in less than a year after surgery, he was running track,” shares Dr. Zelen performing surgery on Anderson ReMine. She was confident Dr. Zelen’s skills and expertise could aid in this very rare case. Dr. Zelen agreed to take Anderson’s case completely sight unseen, making early assessments with the aid of only email x-rays. “Because of my residency and training, my practice gravitates toward the most complex foot and ankle conditions for both limb salvage and deformity correction in diabetics, trauma patients, and pediatric patients with congenital deformities like club feet,” shares Dr. Zelen. “However, Anderson’s case took the cake because of its complexity and rarity.” ONMI and Seeds of Hope representatives were able to partner to obtain a medical Visa for Anderson. Dr. Zelen wrote letters on behalf of Anderson to help facilitate the process. 44 | www.ourhealthrvirginia.com
Seeds of Hope Children’s Ministry3 is an educational facility for intellectually gifted children with physical disabilities. The ministry was started in 1995 after hearing about the plight of children orphaned because of disease. Seeds of Hope began several projects in Zambia hoping to break the cycle of poverty by providing children with education, mentoring programs, and homes for orphans.
OUR COMMUNITY CARES | our health
At Right: An x-ray following surgery shows 20 implants used to reconstruct the left foot.
Luthur Beazley III, MD, a pediatrician at LewisGale Physicians, also agreed to see Anderson to ensure he was healthy enough to undergo surgery. Ironically, because Anderson was isolated from his community due to his deformity, he was surprisingly healthy, despite his low body weight. “His mother took great care of him to the best of her ability,” explains Dr. Zelen. “He never had any systemic issues to prevent surgery.” Additionally, Dr. Zelen consulted with Muddasar Chaudry, MD, an infectious disease specialist at LewisGale Physicians, who recommended many tests to ensure Anderson had none of the unusual aliments often found in African countries. Dr. Chaudry also made recommendations to prevent infection after Anderson’s surgery. Anderson’s first surgery took place in March 2012 and lasted nearly six hours. His second surgery, conducted in September 2012, lasted four hours. Following the second surgery and extensive recovery time, Anderson’s foot fit into a size 14 New Balance shoe. Special orthotics, provided by Virginia Prosthetics, Virginia’s oldest and largest prosthetic and orthotic services provider, were created to aid in his gait (the pattern of movement of the limbs). Dr. Zelen remembers the week that Anderson left to return to Africa as an emotional time.
“Seeing Anderson walk out of my office was a true blessing,” he shares. “He limped into our country with a dream of confidently walking out. His dream was realized. I am humbly honored to know him.” Anderson returned home with Karen ReMine and two members of OMNI’s board of directors and in-country missionaries, Robert and Emily Krauss, accompanying him. His story received national attention in Zambia, and many officials are coming together to ensure his future success.
Anderson came to the U.S. in March 2012 and spent nine months with the ReMine family. The ReMine’s provided all of his post-operative care. Karen served as his nurse and primary caretaker while her husband, a local physician, provided valuable consultation. During Anderson’s stay, he gained 30 pounds and grew nine inches. The loving family atmosphere provided to Anderson was critical as he endured his two surgeries – one on each foot.
This past January, Anderson was able to walk to his classes for the first time at the Seeds www.ourhealthvirginia.com | 45
our health | OUR COMMUNITY CARES
Anderson and Karen watch closely as Dr. Zelen removes the cast.
of Hope Children’s Ministry school where he will reside and continue his education. During his stay in the U.S., Anderson gained much more than the ability to walk. He gained care, nutrition, connections, and most importantly, a newly found stride. The efforts of the team of dedicated professionals that volunteered time, funding and resources to assist Anderson helped more than one young person. They brightened the future for Anderson’s family and those in his community and country that he will most certainly impact in the future. *Due to rural Zambia’s poor recordkeeping, the ages of children often have to be estimated based on their teeth. Sources: 1. Macrodactyly of the Foot. The Journal of Bone and Joint Surgery, Inc. http://jbjs.org/data/Journals/JBJS/846/ JBJA084071189.pdf 2. www.shrinershq.org 3. www.seedsofhopecm.com
46 | www.ourhealthrvirginia.com
Local and Worldwide Experts Came Together to help Anderson Realize a Better Life Stryker, one of the world’s leading medical technology companies, donated the implants required for Anderson’s surgeries. LewisGale Medical Center also donated more than $100,000 in medical care for Anderson, and Dr. Zelen donated his clinical and surgery expertise.
KIDS’ CARE | our health
Charlie Lundy, age 2, of Roanoke County
Recurring ear infections and fluid build-up lead to ear tubes for children and adults words | LAURA NEFF-HENDERSON, APR
For Roanoke County resident Nicole Lundy and her husband Scott, the decision to have tubes put into their one-year-old son Charlie’s ears last April was life changing. By the time Charlie was about five months old, he had already begun to get recurring ear infections, says Lundy. Within days of finishing an antibiotic for an ear infection, Charlie would develop another ear infection.
The simple trut h: tadke care of your eyes an t hey wil l help take care of you. Amber Hur ley, OD V istar Eye Center
Despite the fact that her father is a Roanoke ear, nose, and throat doctor, the first time mother was worried about the surgery. After all, Charlie was still a baby. She and her husband were certain though, that the back-to-back ear infections and side effects of the antibiotics were making Charlie miserable. Since the surgery nearly a year ago, Charlie has been ear infection free. The very next day [after the surgery], he was a completely different child, in such a positive way,” says Lundy who now says she would recommend the surgery to anyone who’s child has recurring ear infections. “He became a much happier child when he wasn’t in pain anymore.” ••••• Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia,” according www.ourhealthvirginia.com | 47
KIDS’ CARE | our health
to the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNSF). The average age for ear tube insertion is one to three years old. Geoffrey T. Harter, MD, with Jefferson Surgical Clinic has performed the surgery on children as young as five months old. Harter is Lundy’s father; Charlie’s grandfather. Swelling from an upper respiratory infection or allergy can block the eustachian tube (a narrow tube that runs from the middle ear to the back of the throat, behind the nasal passage) preventing air from reaching the middle ear. When that happens, a vacuum is created which allows fluid and germs to travel from the nose and throat to travel into the middle ear. This problem is especially common in children whose eustachian tubes are thinner and more horizontal. Ear tubes are tiny cylinders that mimic the role of the eustachian tube, allowing air to enter the ear canal. They also prevent buildup of fluid in the ear while they are in place, which normally eliminates pain and restores any hearing loss. In addition to children with recurring middle ear infections, tubes are often recommended for children who have persistent fluid buildup behind the eardrum, especially when the condition causes hearing loss and affects speech development, says Harter. Occasionally Harter sees adults who need tubes because of problems resulting from the radiation therapy used to treat cancers of the brain or back of the throat. Most tubes stay in place for about 12 months, according to Harter who has put tubes into children as young as five months old. Tubes in adults tend to come out much more quickly. “In the normal process of the eardrum renewing itself, the tube [sometime] pushes out and the hole heals shut on its own,” says Harter. “Most parents don’t even know it’s happened.” For some adults, the need for tubes is the result of Eustachian tubes that never fully developed; however, occasionally, Harter sees adults who need tubes because of problems resulting from the radiation therapy used to treat cancers of the brain or back of the throat. Tubes in adults tend to come out much more quickly. www.ourhealthvirginia.com | 49
our health | KIDS’ CARE
50 | www.ourhealthvirginia.com
KIDS’ CARE | our health
The warning signs 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.
Surgery The surgery to insert ear tubes is very minor and is typically done in a surgery center, according to Harter. The patient is given general anesthesia through a mask. Using a surgical microscope, the surgeon makes a 3 mm incision in the eardrum, suctions out any fluid, and inserts the tube in the hole. The actual surgery takes about five minutes to complete, says Harter. The tubes don’t cause any pain, and any discomfort from the surgery is usually gone within 24 hours. Children can usually go home an hour or two after the surgery and are normally able to return to school or daycare the next day.
After surgery After the surgery, children may be a little fussy and parents are advised to given their children overthe-counter pain medication like Tylenol or Advil. Within a day, Harter says, most children are fine. And, by the time patients come back for their twoweek post-operative appointment, Harter often finds many parents wondering why they waited so long to schedule the surgery. To avoid infection from any bacteria that may enter the tube, Harter advises his patients to avoid submerging their heads under water without using ear plugs or Vaseline coated cotton balls. ••••• Parents who are concerned about recurring ear infections should consult their family pediatrician or schedule an appointment with an ear, nose, and throat doctor.
Protect your hearing! Lower the volume on your iPod and other listening devices. —Janice Anderson, AuD Anderson Audiology
www.ourhealthvirginia.com | 51
52 | www.ourhealthvirginia.com
F loss daily and get your teeth professionally cleaned every six months . – Gavin M. Aaron DD S, MS, Aaron Periodontics and Dental Implants
Best Foods to Incorporate into Your Weight Loss Diet words | TRICIA FOLEY, RD, MS
If you wear a prosthesis (art ificial limb) you should see your prosthet ist annually. – Char les Coulter, CPA Virginia Prosthet ics, Inc.
Losing weight can be quite a challenge. After all, there are many different “diets” to choose from. Whichever you decide to follow, most likely calories will be cut back and certain foods will be off limits. To ensure your body is getting what it really needs, follow these tips: 1. Fill your plate with non-starchy vegetables. Non-starchy veggies are packed with nutrients, including essential vitamins and minerals your body needs, but are low in calories and carbohydrates. They also provide a healthy dose of fiber that will fill you up so you aren’t hungry. These veggies include foods like spinach, peppers, onions, broccoli, cauliflower, green beans, asparagus, brussel sprouts, and celery. If you are a picky eater, these vegetables can be incorporated into healthy soups or casseroles to “disguise” the taste. Seasonings can also be added to enhance flavor. Changing the way you eat can change your tastes as well. Give it some time, and foods you didn’t think you liked may become some of your favorite choices over the course of a few weeks. This is especially true if you ate a lot of processed foods prior to starting your diet. 2. Fruits are your friends. Think of them as nature’s candy. Of course, not all fruits are created equal. Just like vegetables, you want to choose the fruits that are lowest in natural sugars and highest in fiber. Berries are always a great choice since they are packed with vitamin C. Crash diets can often lower your immune system if you aren’t fueling the right way; vitamin C gives your immune system a boost. If you find that they aren’t in season, buy them frozen. From a nutrition perspective, www.ourhealthvirginia.com | 53
our health | NUTRITION HEALTH
h Start each mor ning wit all t he t hings you are grateful f or. – Logan Br ooke, DC Tuck C hir opract ic
they are the same as fresh and last a lot longer. Apples make a great grab and go snack. However, beware of the large apples that offer a two for one serving size. Instead go with the smaller apples that are about the size of a baseball. Fruits to avoid would be those that come packed in juice or worse, syrup, since they add unnecessary sugar to your intake. You also want to limit melons and bananas since they are higher in natural sugars and offer little fiber. The best rule of thumb is to think thin! Look for fruits with the thinnest skin – these are the best choices due to their high antioxidant content and low sugar content. 3. Don’t underestimate the importance of fat. Fats do NOT make you fat! Fats are responsible for the proper hormone function of your thyroid and other important bodily processes responsible for keeping you healthy. They also keep you full longer minimizing food cravings and keeping you on track. Lastly, many diets cause hair loss and brittle nails; fats can help prevent this from happening. Be sure to include smart fats in your diet. Avoid trans fats found in baked and prepackaged foods. Instead, focus on healthy fats like nuts, olive oil, avocados, and olives that can add flavor and improve your heart health. 4. The final tip to remember is to incorporate protein with every meal. Whether you are on a low fat diet or low carbohydrate diet, protein should always be first priority. Choose quality meat if possible, since many of today’s meats are full of hormones and chemicals. Although it may cost a little more, it’s worth it to your overall health. Look for local, grass fed beef or free-range organic poultry. Omega three eggs are also a good choice. Keep in mind that the yolk is where the fat is, so if you only eat egg whites, you’re missing out on these important nutrients. Also remember that portion control is key to weight loss success. A proper portion for meat lies in the palm of your hand, literally. Once protein is cooked, simply measure a portion that is equivalent to your palm size. You need approximately this much protein with each meal every day! This is important because protein paired with starches will help to stabilize blood sugar and keep you from feeling hungry. It will also help maintain the muscle you already have, which is important since many times losing weight means losing a combination of both fat and muscle. Once you’ve lost weight, the same principles listed above should be applied, but you do have a little more wiggle room. After all, no one is perfect! If you do get cravings, splurge on dark chocolate instead of milk chocolate for a tasty treat. Use an air popper to pop your own popcorn instead of eating it at the theater for a salty treat. Using plant based sweeteners like Stevia instead of sugar can also save you a ton of unwanted empty calories. Consider sprinkling a little Stevia on plain Greek yogurt with added fruit for a sweet treat instead of ice cream. Little changes like this can make a big difference in long term successful weight maintenance. Remember, you are what you eat. Body Mass Index (BMI) does not tell the whole story. Even if you’re at a healthy weight or BMI, it doesn’t necessarily mean you’re healthy if you aren’t eating right! Countless people at their ideal body weight still suffer from high cholesterol, high blood pressure, and diabetes. By eating fresh, unprocessed foods many of these health conditions can be reversed. Unfortunately, all too often people choose pre-packaged, processed foods that come laden in salt, which can damage blood vessels and cause hypertension (high blood pressure). Simple carbohydrates like pastries, cookies, crackers, and white bread, which are also popular commodities, can raise triglycerides and lower HDL, your good cholesterol.
54 | www.ourhealthvirginia.com
NUTRITION HEALTH | our health
By avoiding these foods and flavoring fresh foods with herbs and spices, you will be healthy both inside and out!
Is Body Mass Index (BMI) really accurate? Body Mass Index is a weight to height ratio that was developed in eighteen thirty-two by Adolphe Quetelet. Originally, it was not designed to be a measure of weight status but was developed to define the “normal man.” It was not until the nineteen seventies that the medical community began using BMI as a tool for defining normal weight, overweight, and obese for insurance billing purposes. Today, a BMI between 18.5 and 24 is considered a healthy or normal weight. Anything under that is considered underweight, 25 to 29 is considered overweight, and 30 and over is considered obese. Because it was not originally designed to be a measure of weight status, BMI does have some limitations. To begin with, BMI does not account for muscle mass. If a very muscular person is measured on a BMI scale, they could appear obese. In addition, body fat distribution is also not accounted for, which can have a great impact on health risk. Abdominal adiposity, for example, carries a larger health risk than fat that is centered on the hips. Finally, BMI does not differentiate between genders nor does it adjust for age. While simple and inexpensive, it should not be used as a sole diagnostic tool for health professionals. Diet history, exercise patterns, family history, body fat distribution, and body fat percentage should also be taken into consideration.
The simple truth: take care of your eyes an d they will help take care of you. Amber Hurley, OD Vistar Eye Center
Unfortunately, it’s difficult to provide an ideal weight for each person’s height. This number will vary vastly depending on the factors listed above including the person’s bone structure, fat mass, and lean mass. The best way to determine your ideal weight would be by having your body fat percentage measured. The gold standard for measuring body fat is under water weighing or a machine called the Bod Pod. These can be cumbersome and costly measurements, which is why using BMI is a popular alternative. For sedentary young and middle aged adults, BMI can be a good marker of health risk. A simple equation can also be used to determine a weight range for your height. For men, this formula is 106 pounds for the first five feet plus six pounds for each inch over five feet. For women, the formula is 100 pounds for five feet plus five pounds for each inch over five feet. Both should be adjusted by ten percent more or less based on whether you have a large or small frame. For example, a female who is five feet six www.ourhealthvirginia.com | 55
our health | NUTRITION HEALTH
inches tall would weigh 130 pounds plus or minus 10 percent based on her frame. If she has a small frame, she could weigh as little as 117 pounds, or with a large frame, she could weigh as much as 143 pounds.
HEART: • H: Hummus; E: Eggs; A: Apples; R: Roughy T: Tomatoes To keep a healthy heart, be sure to incorporate healthy fats, protein, fruits, and non-starchy vegetables. Hummus, made of chick peas and olive oil (a healthy fat), makes a great dip for vegetables! It also provides lots of flavor and texture to make foods more interesting and less bland. Eggs are a great food, packed with protein and a healthy dose of fat. They are both versatile and delicious. Look for omega three or farm fresh eggs for the best nutritional quality. Fruits are also wonderful for your heart! They are compact and make a great snack. Apples are an easy, grab and go food that add a nice crunch of sweetness. Protein is important because it helps to maintain
muscle, and since your heart is a muscle, naturally it’s a great choice. Fish is the perfect heart healthy food! Not only is it rich in protein, it also has a healthy dose of omega three heart healthy fat. Not a seafood fan? Orange roughy is buttery in flavor and does not have a fishy taste, so give it a try! Finally pack your plate with vegetables. Tomatoes are great to throw in salads or make into salsa. They’re also full of antioxidants! By incorporating these foods and others from these food groups into your diet, you’ll be well on your way to a heart healthy lifestyle! Check out the recipes below for ways to incorporate these into your family’s meals.
with 24 cups) with nonstick spray. Whisk the eggs, almond milk, pepper, and salt in a large bowl to blend well. Stir in the turkey, cheese, and parsley. Fill muffin tins almost to the top with the mixture. Bake until the “frittata” puffs and is just set in the center, about 8 to 10 minutes. Using a spatula, loosen the frittatas from the muffin cups and slide the frittatas onto a platter. Enjoy.
Recipes:
Directions: Slice the apple, removing seeds. Microwave for approximately 45 seconds until soft. Sprinkle with cinnamon and Stevia. Enjoy.
Homemade Hummus Ingredients:
Ingredients: »» 1 apple »» cinnamon to taste »» 1 packet Stevia
»» 1 can of chickpeas/garbanzo beans (15 ounces)
Orange Roughy
»» 1/3 cup tahini
Ingredients:
»» 1/4 cup lemon juice »» 2 tablespoons olive oil »» 2 garlic cloves, crushed »» 1/2 cup roasted red pepper Preparation: In a food processor or blender, combine beans, tahini, lemon juice, and olive oil. Blend until smooth. Add red peppers and garlic until you reach desired consistency.
»» 1 1/4 lbs orange roughy fillets »» 1 teaspoon seasoning salt (or to taste) »» pepper to taste »» paprika to taste Directions: Put fish fillets in a greased 11x7 inch baking dish.
Serve warm or cold with fresh veggies.
Sprinkle with seasoned salt, pepper, and paprika. Cover and bake at 400 degrees for 15 to 20 minutes or until fish flakes easily.
Egg Frittatas in Muffin Tins
Tomato Salsa
Ingredients:
Ingredients:
»» nonstick olive oil cooking spray
»» 6 Roma tomatoes, chopped
»» 8 large eggs
»» 4 garlic cloves, minced
»» 1/2 cup unsweetened almond milk
»» 2 seeded and minced jalapenos
»» 1/2 teaspoon freshly ground black pepper
»» 1 red bell pepper, diced
»» 1/4 teaspoon salt
»» 1 tablespoon olive oil
»» 4 ounces thinly sliced turkey, chopped
»» 1 lime, juiced
»» 1/4 cup freshly grated parmesan
»» chili powder, salt, and pepper, to taste
»» 2 tablespoons chopped fresh Italian parsley leaves
»» fresh scallions and cilantro to taste
Directions: Preheat the oven to 375 degrees F. Spray 2 mini muffin tins (each 56 | www.ourhealthvirginia.com
“Baked” Apples
»» 1/2 red onion, finely chopped
Directions: In a bowl, combine all ingredients. Place in refrigerator for up to 12 hours.
CLINICAL TRIALS CORNER | our health
CLINICAL TRIALS:
What are they, and are they for you? words | RICK PIESTER
You may not even think about it, but when you use an over-the-counter or prescription remedy, chances are it has already been tested for safety and effectiveness in a process called clinical trials. Clinical trials are conducted to determine what works, and what doesn’t work when it comes to new medical approaches or products. Each trial is intended to answer two questions — does the product work? And is it safe? All prescription drugs and devices sold in America go through a rigorous, long, and expensive schedule of testing and retesting before they get to a pharmacy. Many — but not all — over-the-counter products also go through clinical trials.
Chiropractic adjustments can reduce pain and improve range of motion. —Sean Skinner, DC Tuck Chiropractic
People who participate in a clinical trial use new products before they are available in stores — usually medications or devices — under carefully controlled conditions. The variations are unlimited: in some trials (also called “studies”) separate groups of participants may use differing dosages of a medication under study; in others, some of the participants may use the actual product, while others may use a placebo that has no active ingredients. Although the notion of clinical trials has been part of medicine for centuries (scientists conducted what would now be considered some form of clinical trials beginning in the late 1700s,) the approach was not widely used until about the mid-1950s. There were actually not that many medications to be tested until that era — penicillin was not even developed until early during World War II. Until then, physicians pretty much relied on their own experience with medications, and on the experiences of their peers and those who came before them. But as medicine learned more about antibiotics and other drugs, and as more and more medications became available, the medical community needed formalized, organized methods to learn what was effective and safe, and what was not. www.ourhealthvirginia.com | 57
CLINICAL TRIALS CORNER | our health
In this country, the Food and Drug Administration (FDA) became the standard-bearer when it came to oversight of new medications and treatments during the 1930s. It was not until the 1960s, however, that methods were established and requirements set to prove that medications actually worked as promised. Today, most medications and medical devices (not dietary supplements, however) must be approved by the FDA before they can be offered to the public.
research say that the broader benefit is that participants help medical professionals learn more about treating and curing disease, which in turn makes for a healthier society. Note: For much more detail on clinical trials, including information that you might need to know as a participant, check the Web site of the Center for Information and Study of Clinical Research Participation, at www.csrip.org.
Health experts advise that you check a product’s packaging for mention of “doctor approved” or “doctor tested” or information about FDA approval. And, whenever in doubt, ask a pharmacist for her or his opinion. Clinical trials are conducted through hospitals, physician offices, and by independent businesses established for that specific purpose. The trials are divided into four phases with each phase having a different purpose aimed at helping scientists understand different aspects of the product being tested. Phase I trials allow researchers to test a new drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine safe dosage levels, and look for possible side effects. In Phase II trials, the drug or treatment being evaluated is given to a larger group of people (about 100-300) to measure its effectiveness and to further judge its safety In Phase III, the drug or treatment being evaluated is given to large groups of people, sometimes thousands at multiple locations, to again confirm its effectiveness, look for side effects, compare it to other treatments already on the market treatments, and collect more information aimed at safe use of the drug or treatment. And Phase IV trials are usually conducted after the product goes on the market to gather yet more information on benefits, risks and best use of the drug. The trials period comes at the end of what is usually a yearslong process of original “bench” research. A new drug, for example, must be created, or discovered. It must be purified and prepared for larger scale production, compared against other drugs already on the market, and tested repeatedly in the laboratory. A big challenge facing any clinical trials procedure is finding enough people — often times divided by gender, age, health status, etc. — to participate in the testing. Some of the trials include compensation for participation, and participants get a variety of top-level medical attention while they are participating, but people involved in medical www.ourhealthvirginia.com | 59
our health | CLINICAL TRIALS CORNER
Carilion Clinic — Clinical Trials Carilion Clinic has multiple clinical trials available, including: • Leg Ulcer Study • Coronary Artery Disease Diagnostic (CAD) Study • Pediatric Eosinophilic Esophagitis (EoE) Study • Emphysema Study • Chronic Obstructive Pulmonary Disease (COPD) Study • Major Depressive Disorder (MDD) Study
Leg Ulcer Study This study is examining a new medicated spray to determine if it helps improve leg ulcer healing. Compensation is available for time and travel.
Coronary Artery Disease Diagnostic (CAD) Study This study is for participants that may have CAD. It seeks to compare two types of imaging to determine which one is better at diagnosing CAD.
Pediatric Eosinophilic Esophagitis (EoE) Study EoE is characterized by symptoms including difficulty eating, heartburn, vomiting, and abdominal pain. This study is examining a new substance to determine how well it can reduce these symptoms. Compensation is available for time and travel.
Emphysema Study This trial is studying a new system for treating emphysema to determine if it can reduce lung volume, improve lung function, and improve quality of life. Compensation is available for time and travel.
Chronic Obstructive Pulmonary Disease (COPD) Study This trial is studying a marketed medication for the treatment of COPD to gather additional information on how well it reduces the frequency and severity of COPD related events. Compensation is available for time and travel.
Major Depressive Disorder (MDD) Study This trial is studying a new product that is added to the medication that participants already use to treat their MDD symptoms that are not fully controlled on their current medication alone. Compensation is available for time and travel. For more information about clinical trials at Carilion Clinic, please contact:
60 | www.ourhealthrvirginia.com
Jeannie Miranda Perkins, MS, CCRP Clinical Trials Director, Carilion Clinic Office: 540-224-6751 jlmiranda@carilionclinic.org
Virginia Tech Carilion Research Institute Studies Needing Volunteers The Virginia Tech Carilion Research Institute offers a range of opportunities for participating in research studies aimed at improving our understanding of the human brain. These studies, all of which are compensated, take place in the institute’s state-of-the-art facility at 2 Riverside Circle in Roanoke. For some studies, participation is also possible in the institute’s Blacksburg facility. For more information, visit http://research.vtc.vt.edu/volunteer.
Roanoke Brain Study The Roanoke Brain Study is a longitudinal research project designed to study the types of decisions that people make every day using a combination of neuroimaging, genetics, and behavior. Our goal is to engage volunteers across the greater Roanoke Valley to participate in a series of tasks designed to better understand decisions that lead to healthier lives.
Bargaining The Human Neuroimaging Laboratory is conducting a brain imaging study that investigates the brain response to reward and decision-making. While receiving a functional magnetic resonance imaging scan, which uses a magnet and radio waves (no x-rays!), you will be asked to play a game.
Behavioral Economic Methods for Assessing Tobacco Product Abuse Liability: Studies 1 & 2
Drug Valuation This research is being conducted to understand decision-making by assessing how individuals purchase food, alcohol, nicotine, and other drugs at various prices.
Effects of Brain Stimulation (tDCS) on Resistance to Smoking This research study looks at the effects of a non-invasive brain stimulation technique (transcranial direct current stimulation) on decision-making, working memory, and delay of smoking gratification tasks.
Executive Function Therapy This research is assessing the effects of training programs for executive function skills (e.g., memory and planning) among alcohol and/or stimulant users who are in treatment.
Functional MRI Study of Traumatic Experiences among Veterans The Virginia Tech Carilion Research Institute is currently recruiting OEF/OIF veterans for research studies. These studies use functional MRI to understand how deployment can impact the biology of the brain. Why participate? Deployment experiences can have a profound impact on the lives and well-being of the people who experience them. While the effects can be a tremendous burden both for those experiencing the difficulties and for their loved ones, little is known about the causes and treatments of deployment-related difficulties. For this study, we are interested in veterans who either have or have not experienced symptoms of post-traumatic stress disorder, depression, or traumatic brain injury.
Human Neuroimaging Laboratory— General Recruitment
These research projects aim to understand the potential effects of the use of different nicotine products.
The Human Neuroimaging Laboratory accepts, on an ongoing basis, volunteers interested in joining the general recruitment pool for a range of studies.
Brain Responses to Sensory Stimulation
International Quit & Recovery Registry
We are studying the response of the human brain to common sensory stimuli. Volunteers will receive small squirts of a flavored sauce in their mouth while they lie in a magnetic resonance imaging scanner and their brain is scanned. Volunteers will lie still in the scanner for up to one hour while they receive squirts of flavored sauces. By participating, you will be contributing to our understanding of how the brain responds to variable sensory stimulation. It is also hoped that this will lead to a better understanding of subjective sensory experiences.
By tapping the insights and experiences of people who are in recovery from an addiction— whether to tobacco, alcohol, drugs, or a harmful behavior—the International Quit & Recovery Registry seeks to further scientific understanding of recovery and to inspire those struggling with addiction. Participation in the registry involves an online registration process, which includes a brief questionnaire about the individual’s recovery process.
CLINICAL TRIALS CORNER | our health
Intertemporal Trade-offs in the Risky Decisions of Cocaine Addicts This research project seeks to understand, through fMRI, the decision-making processes of individuals who do and do not use cocaine. Currently recruiting recreational cocaine users and individuals who have never used cocaine
MRI Research Study on Depression Depression is a common condition that can be a tremendous burden both for those experiencing the difficulties and for their loved ones. If you have been feeling down for more than a week, and you notice that these feelings interfere with your social relationships or with your ability to work, sleep, or eat, then you may be suffering from depression. We study how the brain functions during depression to improve our understanding of the causes of these episodes and develop new therapies for people with clinical depression.
Risk Dilution The Human Neuroimaging Laboratory is conducting a brain imaging study that investigates the brain response to reward and decision-making. While receiving a functional magnetic resonance imaging scan, which uses a magnet and radio waves (no x-rays!), you will be asked to play a game.
Understanding Individual Differences in Decision Marking This brain imaging study investigates the response of the normal brain to patterns of stimuli, rewards, and decision-making. Volunteers will play a simple video game while they lie in a magnetic resonance imaging scanner and their brain is scanned.
Visual Perception We are studying the response of the human brain to common sensory stimuli. Volunteers may view pictures, videos, or hear sounds while they lie in a magnetic resonance imaging scanner and their brain is scanned.
More Detailed Information Roanoke Brain Study
The Roanoke Brain Study is a longitudinal research project designed to study the types of decisions that people make every day using a combination of neuroimaging, genetics, and behavior. Our goal is to engage volunteers across the greater Roanoke Valley to participate in a series of tasks designed to better understand decisions that lead to healthier lives. The primary task will be an fMRI scan, a noninvasive imaging tool that allows us to capture images of the brain and its activity while volunteers view images, play games, or
interact with other people. Volunteers may also be asked to provide a small sample of DNA, fill out questionnaires, play simple games on the computer, or interact with other people inside or outside the MRI scanner. Visit www.roanokebrainstudy.org for more information, or sign up for the Roanoke site by visiting https://subjex.vtc.vt.edu/signup/rbs_roa or the Blacksburg site by visiting https://subjex. vtc.vt.edu/signup/rbs_bb
Bargaining The Human Neuroimaging Laboratory is conducting a brain imaging study that investigates the brain response to reward and decisionmaking. While receiving a functional magnetic resonance imaging scan, which uses a magnet and radio waves (no x-rays!), you will be asked to play a game. Payment is at least $20, and you will get a copy of your brain images on CD. Visit https://subjex.vtc.vt.edu/signup/barg or email us at signup@vtc.vt.edu, or call 540.526.2034
Behavioral Economic Methods for Assessing Tobacco Product Abuse Liability: Studies 1 & 2 These research projects aim to understand the potential effects of the use of different nicotine products. • Multiple session studies • Compensation can range from $500 to 870 in dollars and/or nicotine products • Must be 18 years of age or older • Must be a daily cigarette smoker • Call 540.315.0205 or email ARRC@vtc.vt.edu
Brain Responses to Sensory Stimulation We are studying the response of the human brain to common sensory stimuli. Volunteers will receive small squirts of a flavored sauce in their mouth while they lie in a magnetic resonance imaging scanner and their brain is scanned. Volunteers will lie still in the scanner for up to one hour while they receive squirts of flavored sauces. By participating, you will be contributing to our understanding of how the brain responds to variable sensory stimulation. It is also hoped that this will lead to a better understanding of subjective sensory experiences.
purchase food, alcohol, nicotine, and other drugs at various prices. • One session study (approximately 1 hour) • Compensation for study completion is $20 • Must be 18 years of age or older Call 540.315.0205 or email ARRC@vtc.vt.edu
Effects of Brain Stimulation (tDCS) on Resistance to Smoking This research study looks at the effects of a non-invasive brain stimulation technique (transcranial direct current stimulation) on decision-making, working memory, and delay of smoking gratification tasks. • • • •
3-4 session study Maximum compensation of $150 Must be a daily cigarette smoker Must not be dependent on any substance other than tobacco Call 540.315.0205 or email ARRC@vtc.vt.edu
Executive Function Therapy This research is assessing the effects of training programs for executive function skills (e.g., memory and planning) among alcohol and/or stimulant users who are in treatment. • • • •
Multiple session studies Maximum compensation is $690 Must be between 18 to 65 years of age Must be in treatment for alcohol and/or stimulant (cocaine and/or methamphetamine) dependence • Treatment may include outpatient therapy/ counseling, group therapy/counseling, regular AA/NA meeting attendance, etc. Call 540.315.0205 or email ARRC@vtc.vt.edu
Functional MRI Study of Traumatic Experiences among Veterans
Visit https://subjex.vtc.vt.edu/signup/sauce or email us at signup@vtc.vt.edu, or call 540.526.2034
The Virginia Tech Carilion Research Institute is currently recruiting OEF/OIF veterans for research studies. These studies use functional MRI to understand how deployment can impact the biology of the brain. Why participate? Deployment experiences can have a profound impact on the lives and well-being of the people who experience them. While the effects can be a tremendous burden both for those experiencing the difficulties and for their loved ones, little is known about the causes and treatments of deployment-related difficulties. For this study, we are interested in veterans who either have or have not experienced symptoms of post-traumatic stress disorder, depression, or traumatic brain injury.
Drug Valuation
Contact Rob McNamara at vets@vtc.vt.edu or 540.526.2091
This research is being conducted to understand decision-making by assessing how individuals
www.ourhealthvirginia.com | 61
Human Neuroimaging Laboratory—General Recruitment The Human Neuroimaging Laboratory accepts, on an ongoing basis, volunteers interested in joining the general recruitment pool for a range of studies. Visit our subject sign page at https://subjex.vtc.vt.edu/signup or email us at signup@vtc.vt.edu, or call 540.526.2034
International Quit & Recovery Registry By tapping the insights and experiences of people who are in recovery from an addiction—whether to tobacco, alcohol, drugs, or a harmful behavior—the International Quit and Recovery Registry (https://quitandrecovery.org/) seeks to further scientific understanding of recovery and to inspire those struggling with addiction. Participation in the registry involves an online registration process, which includes a brief questionnaire about the individual’s recovery process. Participants are also encouraged to share their success stories by visiting https://quitandrecovery.org/ success_stories/
Intertemporal Trade-offs in the Risky Decisions of Cocaine Addicts This research project seeks to understand, through fMRI, the decision-making processes of individuals who do and do not use cocaine. • • • • •
Two-session study involving brain imaging Maximum compensation is $400 Must be 18 years of age or older Must be eligible for fMRI scanning Currently recruiting recreational cocaine users and individuals who have never used cocaine Call 540.315.0205, email ARRC@vtc.vt.edu, or sign up online at https://subjex.vtc.vt.edu/signup/ito
MRI Research Study on Depression Depression is a common condition that can be a tremendous burden both for those experiencing the difficulties and for their loved ones. If you have been feeling down for more than a week, and you notice that these feelings interfere with your social relationships or with your ability to work, sleep, or eat, then you may be suffering from depression. We study how the brain functions during depression to improve our understanding of the causes of these episodes and develop new therapies for people with clinical depression. Email participate@vtc.vt.edu
Risk Dilution The Human Neuroimaging Laboratory is conducting a brain imaging study that investigates the brain response to reward and decisionmaking. While receiving a functional magnetic resonance imaging scan, which uses a magnet and radio waves (no x-rays!), you will be asked to play a game. Payment is at least $20, and you will get a copy of your brain images on CD. Visit https://subjex.vtc.vt.edu/signup/rd3 or email us at signup@ vtc.vt.edu, or call 540.526.2034
Understanding Individual Differences in Decision Marking The Human Neuroimaging Laboratory is now recruiting subjects
62 | www.ourhealthvirginia.com
CLINICAL TRIALS CORNER | our health
for a brain imaging study that investigates the response of the normal brain to patterns of stimuli, rewards, and decision-making. Volunteers will play a simple video game while they lie in a magnetic resonance imaging scanner and their brain is scanned. Afterward, you may be asked to answer some simple questions regarding your experience. The whole process will take about 1 hour. Payment is $20-40 and you will receive a copy of your brain images on a CD.
contains a monoclonal antibody and a novel chemotherapy drug. The medication is designed to specifically target the tumor cell without harming healthy tissue. A new medication for the treatment of colon cancer. The medication contains a monoclonal antibody and an immune enhancer that is found naturally in mushrooms. This medication is designed to enhance the immune system to help it better fight off the cancer cells.
A new formulation of an older chemotherapy medication for the treatment of breast cancer. This new version of the drug is released more slowly in the body, theoretically making it more effective and less toxic to the patient. Visit BlueRidgeCancerCare.com for more information on these and other available trials.
Visit https://subjex.vtc.vt.edu/signup/emi5 or email us at signup@vtc.vt.edu, or call 540.526.2034
Visual Perception Wanted: Healthy volunteers, 18–64 years of age to participate, in a functional brain imaging study at the Virginia Tech Carilion Research Institute. We are studying the response of the human brain to common sensory stimuli. Volunteers may view pictures, videos, or hear sounds while they lie in a magnetic resonance imaging scanner and their brain is scanned. They may also answer questions about their experiences. Pay is $20 to $200. Volunteers will lie still in the scanner for up to one hour at a time or perform tasks on a computer. By participating, you will be contributing to our understanding of how the brain responds to various sensory stimuli. It is also hoped that this will lead to a better understanding of personal points of view. Visit https://subjex.vtc.vt.edu/signup/ VisuPerc or email us at signup@vtc.vt.edu, or call 540.526.2034
LewisGale Clinical Trials Cardiology LewisGale Medical Center is involved in a phase 3 clinical trial comparing traditional imaging with a new option for detecting blocked arteries of the heart in patients with known or suspected coronary artery disease. The new method uses Positron Emission (PET) imaging with flurpiridaz F 18 to detect these blockages.
Oncology LewisGale Medical Center is involved in a clinical trial through the National Oncology Pet Registry (NOPR) utilizing Sodium Fluoride (Na-F) to detect the presence of cancer that has spread to the bone.
Oncology Blue Ridge Cancer Care at LewisGale Regional Cancer Center Salem is involved in several clinical trials for cancer patients. A new medication for the treatment of Hodgkin’s Lymphoma. The medication www.ourhealthvirginia.com | 63
our health | SENIOR LIVING
64 | www.ourhealthvirginia.com
words | C. RUTH CASSELL
Keeping Meds in Check Friendship Retirement Community reviews charts to consolidate, eliminate prescriptions A senior citizen shows signs of dementia and early onset Alzheimer’s, but her family reports no history of the disease and wonders why it’s affecting their loved one.
Bill Cundiff, Director of Pharmacy at Friendship, says most patients admitted to the retirement community or rehabilitation center are taking over 16 medications.
A rehabilitation patient progressively heals from a total knee replacement, but he still doesn’t participate in or enjoy daily activities.
Polypharmacy is the practice of administering many different medicines, especially at the same time for the treatment of the same disease. It often means the prescribing of more medication than necessary or prescribing one medication to counteract the side effects of another.
Instead of seeking another medical reason for declining health concerns such as these, Friendship Retirement Community has begun looking at how the patient was already being treated. Friendship launched a new program—Polypharmacy Committee— which reviews medication lists and makes recommendations. “We found that our residents and our patients feel better,” says Russ Barksdale, President and Chief Executive Officer of Friendship Retirement Community. “They are in better health; they can participate in more activities; and it saves money as well for those who have large insurance co-pays.” Friendship Retirement Community, located on Hershberger Road, serves 1,000 senior citizens on its campus, the largest rehabilitation center and retirement community in Virginia. The Polypharmacy Committee began six months ago because of concerns over the national increase in the number of hospitalizations for adverse drug events. Barksdale also indicates a study that found among adults 65 and older, 40 percent take five to nine medications and 18 percent take 10 or more.
Cundiff explains that each month Friendship administrators analyze the patient population and review patient charts to determine the number of medications listed. They then choose patients for polypharmacy review. Using a team approach to review patient records in an uninterrupted setting, the committee is comprised of a medical director, physician, nurse, and pharmacist. Based on a peer review model, in which a physician often reviews patient records of another physician, the polypharmacy review committee often makes multiple recommendations for ways to reduce, eliminate, consolidate, or represcribe prescription and/or over-the-counter medications. “Every situation is different and there are certain medications that are worse for certain problems,” Cundiff says.” The committee is really just taking a fresh approach and taking a look at medications that the patient has been on for a long time.” According to Barksdale, Friendship is also reviewing medications www.ourhealthvirginia.com | 65
our health | SENIOR LIVING
for all patients admitted to the rehabilitation center, as well as residents who self-report a concern that they are taking too many medications. Barksdale says Friendship sees it as part of their mission to offer the service not only to residents and rehab center patients, but also to home care patients and referring physicians in the Roanoke Valley. The retirement community runs a retail pharmacy on campus and serves not only the resident and rehabilitation population, but also the community.
“We’re looking at it from our mission, which is to make our seniors feel better and to make our rehab patients feel better,” he says. “Putting 15 to 16 meds into your body at any given time has an impact on your system physically and has an impact on you and your family financially.” Barksdale and Cundiff say younger patients are just as likely to have issues of too many medications as senior citizens. Cundiff says through the polypharmacy review, recommendations in pain therapy may be made for rehab patients. The patient often sees a benefit from taking a scheduled dose of pain medication rather than taking it as needed. The pharmacy director explains that eliminating or changing medications can reduce urinary tract infections and lessen stress on the body’s filtration systems. Barksdale notes chronic ailments are another major area in which residents and consumers have a polypharmacy issue. “Our national healthcare plan talks about coverage for everyone and cost savings, and we felt like this was one area where we could really make a difference.” Cundiff says since the program began the committee has conducted 500 polypharmacy reviews, with a 72 percent acceptance rate by the prescribing physician. In a recent polypharmacy review, the committee made 48 recommendations with the assistance of the team, as well as a physician and pharmacist in training. “We’re training the next generation of prescribers and practitioners to consider this issue as just as important as adding or prescribing new medications,” he explains. Barksdale says prescriptions are often written by primary care physicians under intense time constraints and without the pharmacological expertise needed to analyze the interactions between medications. Or, multiple sub-specialists treating the same patient are not given the opportunity to review the patient’s entire prescription history. “We’ve developed our own process, with the polypharmacy review, and it’s helped our residents out tremendously,” he concludes.
66 | www.ourhealthvirginia.com