OurHealth Roanoke & New River Valleys Feb/Mar 2015 Edition

OurHealth

•

The Resource for Healthy Living in Southwest Virginia

February • March 2015 | www.ourhealthswva.com

table of contents | february • march 2015

32

The Prequel to Poor Health is OUR good HEALTH MEDI•CABU•LARY.....................12 Local experts define health related terms

JUST ASK!.......................................14

With the first part of the year being the time for resolutions — those promises we make to ourselves to start exercising, stop smoking or lose the extra 10 pounds we put on during the holidays — how about making a resolution to head off poor health at the pass?

Healthcare questions answered by local professionals

NEW & NOTEWORTHY.............16

POOR health is OUR good HEALTH the prequel to

A listing of new physicians, providers, locations and upcoming events in Southwest Virginia

words | SUZANNE RAMSEY

HEALTH POINTS........................ 22

photography | KG THIENEMANN and SHAWN SPROUSE

At the beginning of the year, it’s common for folks to make resolutions, those promises we make to ourselves to start exercising, stop smoking or lose the 10 pounds we put on during the holidays. How about making a resolution to head off poor health at the pass?

Interesting facts and tidbits about health

After all, it’s been said that it’s “easier to stay well than to get well.”

THE ANATOMY CHALLENGE..................................19

During the 2011 holiday season, John McFarland, a local UPS employee, realized he needed to make some serious changes when it came to his health.

He wasn’t feeling well and was short of breath and tired. Eventually, it worried him so much that he went to a local hospital.

    

Once there, he was asked to step on the scale. That’s where things started to head south. John says he was looking down at the scale, knowing the numbers on it went up only so high.

“They couldn’t get my weight on there. I knew they probably couldn’t anyway,” he says, adding that he probably weighed more than 400 pounds at the time. “When I saw that, it was like ‘Wow. Hmm.’ I told myself, ‘I’ve got to lose the weight.’”

How much do you about our anatomy? In this issue, test your knowledge when it comes to the VESTIBULAR SYSTEM!

Reprints To order reprints of the artwork featured on this issue’s cover, contact Deidre Wilkes at 540.387.6482 or via email at deidre@ourhealthvirginia.com.

At the hospital that day, John was diagnosed with congestive heart failure. He also got an ultimatum of sorts from his physicians.

“They told me I had to change my ways, or else,” John says.

So John changed his ways. He started working out, something he hadn’t done for years, and he started eating better, a big change from the drive-thru and take-out meals he was used to. And he started losing weight. Lots of it.

‘Prequel’ —continued on page 34

ANATOMY: A Matter of Balance...................... 20 You’re stepping off a curb and suddenly the world seems to tilt. Or, you’re going down the stairs and there’s no longer a step where you expect it to be. And down you go.

FITBITS.......................................... 42

POLLS OPEN 4/1/15

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OurHealth | The Resource for Healthy Living in Southwest Virginia

p.11

Indoor, at-home circuit workout to fight the winter blues. With minimal space and equipment, you can do an at-home circuit workout that will work all major muscle groups.

Circuit workouts are quick and challenging, and a great alternative to the gym.

The Resource for Healthy Living in Southwest Virginia

2015 Heart Health Resource Guide..............................37 Where do you go for heart care? What are some common heart and cardiovascular conditions? Where can you find knowledge and support if you have heart issues? What questions should you ask your doctor?

OurHealth provides a comprehensive guide to answer these questions and more to help you preserve your heart’s health.

64

New Treatments for Varicose Veins?

The line between healthy and unhealthy gets fuzzier every day. With the line so blurry between seemingly healthy lifestyle choices and the reports of things that are quietly leading to human demise, how does one push forward and make good choices?

NUTRITION...................................59 FEATURING HEALTHY, FRESH, LOCAL INGREDIENTS: Heart Healthy Recipes— Lemon Honey Salmon, Herb Roasted Vegetables and Kiwi Blackberry Creamy Oats

ts Healthy Ea e a lt h heart h rry

and Local Walnuts : Oatmeal From

Blue Mou

s ntain Organic

| 540.745.5040 Floyd, VA 24091 com ntainorganics. www.bluemou organic in provides certified , flours, Blue Mounta d nuts, nut butters located in raw and sproute fruits. They are grains and dried are dedicated to producing and Visit their Floyd, Virginia nutritious foods. healthful and an order! website to place

i Blackbe Dessert: Kiw Creamy Oats

½ 1 ⅔ 1 ¼

ned oats cup old fashio yogurt cup plain Greek tbsp walnuts almond milk cup unsweetened and diced kiwi, peeled erries frozen) blackb cup fresh (or

up to three days.)

s Tricia Foley’ ATS

BERRY KIWI BLACK Tricia Foley

is OurHealth

Veins

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Magazine’s

Carolyn Ward had a serious problem. The veins in her leg were swollen. One was so enlarged and painful it interrupted her sleep at night. She says, “My varicose veins were very painful and one was so popped out it looked awful. I knew I needed help.” Varicose vein treatment used to be dreaded, now it’s one of the easiest medical procedures available.

In the past, women (and men) who suffered from uncomfortable and unattractive distended veins in the leg and thighs, called varicose veins, had few choices. They could try to prevent them from becoming more swollen by using compression stockings or submit to a painful and often unsuccessful technique of tying off or stripping the enlarged veins. This procedure was so painful it required general anesthesia and entailed recovery time. But in the last few years, thanks to new laser and/or radiofrequency technology, the treatment of varicose veins is far less invasive, requires no recovery time and can be almost painless.

t, walnuts Greek yogur Combine oats, almond milk. and unsweetened jars. half pint mason Divide into 2 ight. erate overn Cover and refrig and add to each the fruit in half refrigerate 3. Divide may (You mason jar. Enjoy!

2.

Ingredients ½

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1.

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Varicose

words | DIANE YORK

Directions:

Yield: two servin

New for

Treatments

ionist

resident nutrit

hello, HEALTH!.............................. 72 Capturing the spirit of Southwest Virginians working in healthcare and of people leading healthy lives through photos

LOOKING BACK........................... 74 Images reflecting the history of healthcare in Southwest Virginia * PLUS * a chance to win prizes!

www.OurHealthVirginia.com

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The Resource for Healthy Living in Southwest Virginia

february • march 2015

read this edition of

OurHealth Southwest Virginia

on your tablet or smartphone

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PRESIDENT/EDITOR-IN-CHIEF

VICE PRESIDENT OF PRODUCTION

VICE PRESIDENT OF BUSINESS DEVELOPMENT

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CHIEF DESIGNER

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McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Hungate Kim Wood Deidre Wilkes Karrie Pridemore Dalton Holody Shawn Sprouse/SDS Photography Joe Palotas Next Generation Design Jourdan Markey

CONTRIBUTING MEDICAL EXPERTS

W. Scott Arnold, MD Jose Rivero, MD Molly Rutherford, MD, FACC Robert Solomon, MD, FACP Stephan Vivian, MD

CONTRIBUTING PROFESSIONAL WRITERS

Tricia Foley, RD, MS Rick Piester Suzanne Ramsey Deidre Wilkes Diane York

ADVERTISING AND MARKETING Kim Wood | P: 540.798.2504 kimwood@ourhealthvirginia.com

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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Ext. 1 Information in all print editions of OurHealth and on all OurHealth websites (websites listed below) and social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions.

Copyright © 2014/2015 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Southwest Virginia (SWVA) edition is published six times annually by McClintic Media, Inc. • 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483.

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vote for your favorite senior services in the

Blue Ridge Best of:

Retirement Living Awards to vote, visit www.ourhealthswva.com Winners will be announced in the August/September 2015 edition of OurHealth

VOTING IS OPEN

APRIL 1ST - MAY 1ST 2015 brought to you by

The Resource for Healthy Living in Southwest Virginia

What is Cardiomyopathy?

Cardiomyopathy is a chronic condition of the heart with weakened, thickened, or stiffened muscle function. All cases will ultimately lead to congestive heart failure or life threatening arrhythmias. The four types are dilated, postpartum, hypertrophic and restrictive. The therapy for the first two is similar and uses medications. Hypertrophic and restrictive may require surgical intervention. All 4 types need attention to avoid complications.

LOCAL EXPERTS D E F I N E H E A LT H

Jose M. Rivero, MD

Carilion Clinic Cardiology Christiansburg | 540.382.6711 www.carilionclinic.org

R E L AT E D T E R M S

What is a heart catheterization?

Your cardiologist or your primary care physician will recommend you have a medical procedure known as a cardiac catheterization. The procedure involves the cardiologist threading a small tube known as a catheter through a peripheral artery and/or vein to your heart. The catheter is connected to a pressure monitor and the pressures in your heart chambers are recorded.

X-ray contrast dye is then usually injected to evaluate the efficiency of the contraction of the ventricle or lower chamber of the heart. The same x-ray contrast dye is then injected sequentially into the right and left coronary arteries, which are the arteries by which the heart muscle received its blood supply. The coronary arteries are the vessels, which when they become blocked with cholesterol plaque, are responsible for chest pain and heart attack. The catheterization is generally performed with the use of a local anesthetic and intravenous sedation. The cardiologist will discuss the risks and benefits of the procedure with you prior to it being scheduled.

Stephan Vivian, MD

LewisGale Physicians Cardiology | Cardiac Electrophysiology Salem | 540.772.3815 | www.lgphysicians.com

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H E A LT H C A R E QUESTIONS ANSWERED

BY LOCAL PROFESSIONALS

What is the difference between systolic and diastolic pressure?

Hypertension is the most common cause for office visits in the United States. Monitoring blood pressure yields a systolic and diastolic pressure. The blood pressure reading is recorded as 140/90 with systolic blood pressure on the top and diastolic blood pressure on the bottom. Both values represent the pressure in millimeters in mercury.

The systolic is when the heart pumps the blood through the artery and the blood vessel has its highest pressure. The diastolic pressure is when the heart is between beats and the heart muscle is relaxing. Systolic and diastolic blood pressures are important in determining whether your blood pressure is high, normal, or low. The normal systolic blood pressure is below 120. Systolic blood pressure of 120-139 means that you have pre-hypertension or borderline high blood pressure. A systolic pressure of 140 or higher is considered hypertension. A normal diastolic blood pressure is less than 80. A diastolic blood pressure of 8089 indicates pre-hypertension and a diastolic blood pressure of over 90 is considered hypertension.

Robert Solomon, MD, FACP LewisGale Physicians Internal Medicine Blacksburg | 540.951.6070 www.lgphysicians.com

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What causes a heart to be enlarged?

The term “enlarged heart” can have several meanings. The most commonly thought of type is systolic congestive heart failure due to dilated cardiomyopathy (heart muscle problem). This is a situation where the heart develops a larger diameter than normal. Often the walls of the heart are thicker than normal as well. This type of enlarged heart can happen for several reasons including coronary artery disease, heart valve problems, infection of the heart muscle, infiltration of the heart walls with abnormal substances or genetics (family history).

The more common type of enlarged heart occurs when the heart walls themselves become thicker. This can happen because of uncontrolled blood pressure, infiltrative processes that make the muscle thicker or this could be a consequence of other issues like heart valve problems.

If you are concerned about this diagnosis or if you have been told you have an enlarged heart, please ask your doctor to explain things.

Molly Rutherford, MD, FACC Jefferson Surgical Center Roanoke | 540.283.6000 www.jeffersonsurgical.com

What is the difference between a cardiologist and a cardiovascular surgeon?

While both a cardiologist and a cardiovascular surgeon are trained to treat disorders of the heart, there are some differences in training. A cardiovascular surgeon is trained in general surgery and goes through a surgical residency program in addition to a cardiovascular residency program. They perform surgery on conditions such as; aortic valve replacement, abdominal aortic aneurysms, carotid artery disease, peripheral artery disease.

A cardiologist has expertise in disorders of the cardiovascular system; however, they are trained in internal medicine with fellowship work in Cardiology. They treat conditions involving the heart and blood vessels but do not perform open surgery. They can provide diagnosis and treatment for conditions such as; elevated cholesterol levels, high blood pressure, cardiac chest pain, and myocardial infarctions (heart attack).

W. Scott Arnold, MD Carilion Clinic Roanoke | 540.853.0100 www.carilionclinic.org

www.OurHealthVirginia.com

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NEW

NOTEWORTHY

NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS

Carilion Clinic Renames Athletic Clubs to

Reflect Commitment to Health and Wellness

To reflect Carilion Clinic’s commitment to health and wellness, the organization has a new name for its fitness facilities and wellness/fitness programs: Carilion Wellness.

Carilion Wellness encompasses the fitness clubs (formerly known as the Roanoke and Botetourt Athletic Clubs and RAC Xpress); the FIT Rx and FIT Rx 90 programs, Weight Watchers at Work, TRX at Work, walking clubs, painting classes and group exercise classes. The name clearly reflects that the fitness facilities and programs are Carilion health partners.

In addition to the new name, Carilion is rolling out some exciting changes: • Renovations at the Roanoke fitness facility location (formerly known as the RAC) to include completely renovated locker rooms with whirlpools and steam rooms, a freshened look, an updated lobby area and a new functional training studio.

• A new and improved website, www.carilionwellness.com • An expanded scope of wellness programs to include more programs in 2015 for patients and the community, in addition to members of Carilion Wellness fitness facilities and Carilion employees.

correction In the Best Bedside Manner Awards section of the December 2014/January 2015 issue, information for the first place provider in physical therapy in the New River Valley was incorrect.

Here is the correct information.

PHYSICAL THERAPY (or physiotherapy), often abbreviated PT, is the art and science of physical care and rehabilitation.

First Place– New River Valley Ron Masri, PT, DPT Doctor of Physical Therapy

First Place–New River Valley Ron Masri, PT, DPT Total Motion Physical Therapy | Christiansburg 540.585.4841 www.totalmotionpt.net ”Growing up with parents that ran a successful restaurant business for over 30 yrs, I learned the true value of customer service—‘customers are family.’ That is the culture that I have instilled here at Total Motion Physical Therapy. We provide the best care for our patients as we would our family. A patient may enter our clinic as a stranger, but they leave us being our friend. I am honored to have been chosen for this award by my patients.”

— Ron Masri, PT, DPT

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OurHealth | The Resource for Healthy Living in Southwest Virginia

NEW

NOTEWORTHY

NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS

Local Law Firm makes U.S. News Best

“Best Law Firms” List

Lawyers® 2015

The local law firm, Anderson, Desimone and Green, PC has been named a 2015 “Best Law Firm” by U.S. News & World Report and Best Lawyers.

The U.S. News – Best Lawyers® “Best Law Firms” rankings are based on a rigorous evaluation process that includes the collection of client and lawyer evaluations, peer review from leading attorneys in their field, and review of additional information provided by law firms as part of the formal submission process. To be eligible for a ranking, a law firm must have at least one lawyer listed in the 20th Edition of The Best Lawyers in America© list for that particular location and specialty. Awards were given in 74 national practice areas and 120 metropolitan practice areas.

The 2015 “Best Law Firms” rankings can be seen in their entirety by visiting bestlawfirms.usnews.com.

Carilion Clinic Opens New Physical Therapy Practice in Blacksburg Carilion Clinic is excited to announce the opening of its newest physical therapy practice serving Blacksburg. The new practice, which opened in December, complements the seven existing practices in the New River Valley and far southwest Virginia. Patients seeking physical therapy, occupational therapy, and speech therapy may request appointments Monday – Friday from 8:00 am to 4:30 pm by calling 540.731.2350 Carilion Clinic’s new practice is located in the North End Center, next to VelocityCare at 213 Gilbert Street, Blacksburg, VA 24060.

For more information visit: www.carilionclinic.org

Find and Follow

OurHealth Southwest Virginia 18

OurHealth | The Resource for Healthy Living in Southwest Virginia

www.OurHealthVirginia.com

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NEW

NOTEWORTHY

NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS

Angela Bowman, PA Carilion VelocityCare Roanoke | 540.722.8670 www.carilionclinic.org

Lauren Dorn, PA-C The Spine Center at LewisGale Physicians Salem | 540.725.9771 www.lgphysicians.com

Gregory Howes, DO

Vidas Dumasius, MD

LewisGale Hospital Montgomery Plastic Surgery Blacksburg | 540.951.8885 www.lewisgale.com

Robin Marcus, MSN,

Carilion Clinic Neurosurgery RN, FNP-BC Roanoke | 540.224.5170 LewisGale Physicians www.carilionclinic.org Salem | 540.772.3490 www.lgphysicians.com

Mohamed Elgabaly, MD Leah Franks, PA-C Carilion Clinic Neurological Interventional Radiology Roanoke | 540.985.8000 www.carilionclinic.org

Carilion VelocityCare Daleville | 540.591.9440 www.carilionclinic.org

Debbie McGinn, DO

Amy Neuhs, PA

LewisGale Physicians Valley View Roanoke | 540.265.1607 www.lgphysicians.com

Carilion VelocityCare Christiansburg 540.382.6000 www.carilionclinic.org

Amelia Canright, PA

Carol CdeBaca, PA

Raschid Ghoorahoo, FNP-BC, NP-C

Christopher Hicks, MD

LewisGale Physicians Salem | 540.772.3490 www.lgphysicians.com

LewisGale Physicians Blacksburg and Pulaski 540.552.1353 www.lgphysicians.com

Joshua Nowocin, PA

Kenneth Rogotzke, DO

Carilion Roanoke Memorial Hospital Roanoke | 540.985.8000 www.carilionclinic.org

Carilion Roanoke Memorial Hospital Roanoke | 540.985.8000 www.carilionclinic.org

Carilion Clinic General Surgery Roanoke | 540.224.5170 www.carilionclinic.org

LewisGale Hospital Montgomery Pulaski | 276.227.0922 www.lewisgale.com

Find and Follow

Emily Sanderson, RN, CPNP, NNP-BC LewisGale Physicians Blacksburg | 540.443.3940 www.lgphysicians.com

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Emily Turner, NP Carilion Clinic Family Medicine Floyd | 540.745.2031 www.carilionclinic.org

Philip Wakefield, MD

Dermatology Associates of Roanoke Roanoke | 540.981.1439 www.dermatologyassociates ofroanoke.com

OurHealth | The Resource for Healthy Living in Southwest Virginia

OurHealth Southwest Virginia

T I P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U

February is...

AMERICAN

HEART MONTH

During the month of February, Americans see the human heart as the symbol of love.

February is American Heart Month, a time to show yourself the love. Learn about your risks for heart disease and stroke and stay “heart healthy” for yourself and your loved ones.

Are YOU at Risk for Heart Disease?

Cardiovascular disease (CVD)—including heart disease, stroke, and high blood pressure—is the number 1 killer of women and men in the United States. It is a leading cause of disability, preventing Americans from working and enjoying family activities.

Take it One Step at a Time You can control a number of risk factors for CVD, including: • High blood pressure • Diet • Physical activity

• High blood cholesterol

• Obesity

• Diabetes

• Tobacco use

For more information, visit www.heart.org

***** You can burn 400 calories per hour* shoveling snow (*Assuming a body weight of 150 lbs)

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OurHealth | The Resource for Healthy Living in Southwest Virginia

Physical Activity is Anything that Makes You Move Your Body...

AND BURN CALORIES • Physical activities that burn more calories than you might think: climbing

stairs, doing housework & shoveling snow!

• Aerobic exercise benefits your heart, and includes playing sports, walking, jogging, swimming or biking.

• The American Heart Association recommends 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week to lower the risk for heart attack and stroke.

*****

FASCINATING

FACT

During an average lifetime,

the heart pumps million gallons of blood

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– enough to fill New York’s Central Park 50 feet deep!

Be Tobacco Free

Tobacco Facts

Tobacco is the single

greatest cause of disease and premature death in the U.S.

Smoking is responsible for more than

440,000 deaths annually

5-10 yeaRS after quitting your risk of stroke is reduced to that of a nonsmoker.

1 year after quitting your added risk of coronary heart disease is half that of a smoker’s.

23% of Americans smoke, Approximately

20 MINUTES

and 3,000 adolescents become new smokers each day

10 years after quitting

after quitting

your lung cancer rate is about half that of a smoker’s.

your heart rate drops.

Other resources: www.quitnow.net/virginia | www.lungusa.org | www.cancer.org

Check out these ‘heart-healthy’ events and activities!

RACE 13.1 • Roanoke Title Sponsor, Friendship Retirement Community presents the debut of Race 13.1 Roanoke, VA Sunday, March 1 7:00 am River’s Edge Sports Complex 302 Wiley Drive Roanoke, VA

The race will start and finish in beautiful downtown Roanoke along the river at Rivers Edge North. The course will feature beautiful stretches of greenway along the picturesque Roanoke River. 13.1, 10K and 5K distances offer something for every runner!

Benefiting Carilion Clinic Hospice, Race 13.1’s charity partners will receive 100% of the proceeds from donations by participants at registration. The focus of the Carilion Clinic Hospice team is to provide patient comfort and family support during the final stage of life’s journey. The experienced and compassionate caregivers are there to provide comfort care, to meet the needs of the entire family, and to help all recognize and experience rewarding moments during this time.

For more information on Carilion Clinic Hospice, visit www.carilionclinic.org/hospice

2015 Roanoke Heart Ball Saturday, February 14, 2015 5:30 pm Hotel Roanoke 110 Shenandoah Ave. Roanoke, VA 24016

The Heart Ball is one of the premier American Heart Association fundraising events both locally and across the nation. Our evening celebrates the lives saved and improved because of everyone’s countless efforts.

This event promises to be an engaging evening of fun and passion, bringing community and philanthropic leaders together. By attending, you have the opportunity to become a critical part of our mission.

For more information, visit roanokevaheartball.ahaevents.org

ON THE WEB

More at ourhealthswva.com (new website debuts mid-2015) www.OurHealthVirginia.com

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OurHealth | The Resource for Healthy Living in Southwest Virginia

the

Anatomy

CHALLENGE

Here’s your chance to see how much you know about your Vestibular

System! First, fill in the word search puzzle below. Next, match up the correct word with the part of the body in the illustration.

[ the VESTIBULAR system ]

WORD SEARCH static equilibrium

otoliths

cupula

otolithic membrane

sensory nerve fibers

nerve fibers

hair cell

dynamic equilibrium

_______________________ _______________________

_______________________ _______________________

_______________________ For answers, visit OurHealth Southwest Virginia’s

Facebook page at

_______________________ _______________________

_______________________ _______________________

www.OurHealthVirginia.com

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abaofl r e t t a m words |RICK PIESTER

ance

It seems like a usual day. Everything’s normal. Then it comes out of nowhere.

You’re stepping off a curb and suddenly the world seems to tilt. Or, you’re going down the stairs and there’s no longer a step where you expect it to be.

And down you go.

In a flash, before you can even think about it, you’re among the one in three adults over 65 who will suffer a fall each year, more than 2.4 million older Americans treated in hospital emergency departments in 2012.

Maybe you’ll be lucky enough to escape serious injury, although there’s still a 50 percent chance that you will fall again soon, and next time you probably won’t be as lucky.

But the chances are that you will suffer serious injury, serious enough to prevent your ability to walk a city block. And if you break a hip in the fall, as many do,

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OurHealth | The Resource for Healthy Living in Southwest Virginia

Falls and the fear of falling are among the most serious health issues facing the growing population of older adults. there’s a pretty good chance (1 in 4) that you will die within a year.

Aging is no guarantee of a fall, but experts say that because of the aging process, the chances do increase dramatically.

“As we age, our sense of balance does get worse,” notes Carilion Clinic physical therapist Ashley Supanich, who works at Carilion Wellness and treats balance difficulties among all age groups.

“As time goes on, our muscles tend to be not as effective as they were,” she says, “and we see deterioration of vision and the inner ear as well. All are important factors in maintaining good balance.”

She says that most of the patients she and her colleagues see for balance issues “have something going on in their core,” the muscles in the back, side, pelvis and abdomen that form a strong central link between the upper and lower body. A weak core drains the power and stability from many of the body’s movements. The strength of knees and ankles also plays a role in maintaining balance, she says.

Lindsay Carhart, a physical therapist at LewisGale Regional Health System, agrees with the weakness in the body’s core strength. She also notes that balance difficulties can arise from joint pain, high or low blood pressure, or problems with medications.

There’s a difference between dizziness and imbalance, healthcare professionals note. Dizziness, or vertigo, is

when the world seems to be going ‘round and ‘round.

It’s often associated with disorders of the inner ear (see the OurHealth Anatomy Challenge feature on page 19.)

Imbalance is usually not announced by a feeling of dizziness. It’s a case of failures in the transmission of signals between your brain and your body, although the gradual, age-related decline of the vestibular system (the complex structure of fluid-filled tubes in the inner ear) can also result in problems with balance without a feeling of dizziness.

Either way, it can be a serious problem. Falls and the fear of falling are among the most serious health issues facing the growing population of older adults. And people who restrict their activities can further reduce their independence. It’s a vicious cycle — the more inactive you become, the less you are eventually able to do, and that can well damage your overall health.

Supanich explains that our sense of balance depends on a complicated combination of sensory factors that allow us to walk a straight line. There’s the inner ear, a sort of compass that keeps us on an even keel. There’s our vision, which provides continual clues as to where we are in space. And there is the somatosensory system, the complex interplay between our brain and our muscles.

As we become older, particularly in people who are inactive, our muscle mass deteriorates and joints and ‘Falls’ —continued on page 28

Fall Statistics Among Older Adults • In 2012, 2.4 million nonfatal falls among older adults were treated in emergency departments and more than 722,000 of these patients were hospitalized.

• Among older adults, falls are the leading cause of both fatal and nonfatal injuries.

• One out of three older adults (those aged 65 or older) falls each year but less than half talk to their healthcare providers about it.

• In 2012, the direct medical costs of falls, adjusted for inflation, were $30 billion. *Source: CDC.gov www.OurHealthVirginia.com

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‘Falls’ —continued from page 27

ligaments lose strength, limiting our range of motion.

VERTIGO is a sensation of whirling or spinning and loss of balance. It can be associated with looking down from a great height or caused by disease affecting the inner ear or vestibular nerve.

Aging eyes can and often do develop problems such as cataracts and glaucoma, which can curb vision dramatically. Diseases like diabetes and kidney ailments can produce peripheral neuropathy, the loss of sensation in our feet.

A combination of medical causes — “co-morbidity” in medical-speak — can further accelerate the body’s inability to respond to the brain’s commands.

And medicines, particularly blood-pressure medications, can sometimes have a profound effect on our sense of balance.

Sometimes, we don’t really have a sense of deteriorating balance. We create unconscious accommodations to make up for it, such as lightly touching a piece of furniture while walking through a room. We don’t recognize the signs, or simply ignore them, until that first fall.

So what are some of the signs?

Physical therapists often ask new patients to stand on one foot for a short time, sometimes with their eyes closed. If you are unable to do that, you should speak with your physician about a possible problem with your balance.

Try walking a short distance backwards. If that doesn’t work, it may be a sign of diminished balance. Or try to walk a short distance using what’s called “tandem” walking. That’s walking with the toes of the back foot touching the heel of the front foot with each step.

Or, simply, talk with your physician about ordering a baseline physical evaluation, often done by physical therapists. Having the evaluation done, even in your 40s or 50s, can go a long way toward spotting little problems that may turn into big ones later on, and can set you on your way to helpful exercises that very likely will help avoid many problems as you grow older.

Health professionals say that there are a number of measures older people can take to manage difficulties with balance and prevent falls. Among the first things health experts recommend is to get into an exercise program tailored to improve or preserve balance.

The American Geriatrics Society, in fact, recommends tai chi — the slow-motion Chinese exercises — as an effective way to prevent falls. Tai chi is based in part upon the correct alignment of the chest, pelvis and head to provide strength and maintain balance. The slow, controlled motions of tai chi are also a non-impact form of exercise ‘Falls’ —continued on page 29 28

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Yoga: it may make a difference In addition to doing wonders for your flexibility, stress levels and muscle tone, yoga has been shown in research to improve both balance and confidence.

Stroke survivors who completed an eight-week course of twice-weekly yoga classes showed an impressive 15% increase on balance scores, according to study author Arlene Schmid, PhD, a rehabilitation research scientist at the Roudebush VA Medical Center and assistant professor at Indiana University. They were also more confident in their ability to perform everyday tasks, too.

How does yoga do this? Yoga improves balance because it’s complex—it includes the mind and the body, and helps to coordinate movements. Whereas, simple strengthening exercises usually just work on one plane of movement. Source: Prevention.com ‘Falls’ —continued from page 28

that builds strength without raising the fear of falling.

Yoga is also great, because it too lowers the stress and anxiety felt by people with balance problems.

Daily supplements of vitamin D is increasingly recommended for a constellation of health reasons, muscle strength and balance among them. In a review of nine research projects, the United States Preventive Services Task Force found that a daily dose of 800 international units (I.U.) of vitamin D reduced the risk of falling by 17 percent, compared to people who did not take the vitamin. (As with all things medical, check with your physician or pharmacist before taking any kind of medication, to avoid the risk of harmful drug interactions.)

Every health professional who works with older patients can recite a laundry list of things to be done at home to decrease the risk of falls.

Among them: Drink plenty of fluids during the day. A dehydrated body can suffer dramatic drops in blood pressure, which in turn can play havoc with your sense of balance.

Slow down a bit. Take a beat or two between standing up and further movement to be sure that you have your bearings. This is especially important when getting up in the mornings. All night, you’ve been lying flat, with blood pumping nicely to your brain. You wake up in the morning and sit up, and all ‘Falls’ —continued on page 30 www.OurHealthVirginia.com

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Fall-Related Deaths • The death rates from falls among older men and women have risen sharply over the past decade.

• In 2011, about 22,900 older adults died from unintentional fall injuries.

• Men are more likely than women to die from a fall. After taking age into account, the fall death rate in 2011 was 41 percent higher for men than for women.

Source: CDC.gov

‘Falls’ —continued from page 29

of a sudden the heart has to pump against gravity. That’s one of the danger times for falls. So take a minute or two for the heart and blood vessels to become adjusted so that they’re moving blood to your brain efficiently.

Be careful on stairs. Not surprisingly, stairs are among the most likely places for a serious fall. Put up handrails, on both sides of the stairs. It’s best for stairs to have no coverings, no carpet or runners. And keep them clear.

Use good lighting. Deploy plenty of night lights, and even motion-sensor lighting through the house, especially between bed and bathroom.

Be careful in the bathroom. Bathrooms are a big fall zone. Surfaces in the bathroom are hard and often slippery, an awful combination for bones of any age, but especially bad for the fragile bones of older adults. Install grab bars — the kind that are securely screwed in to wall studs, not the type with suction-cups — at easy-to-grab spots in the bathroom. Commodes that are built higher make sitting down and standing up easier and reduce the chance of losing balance.

Use a cane and, if you need it, a walker. There’s a lot of old-age stigma attached to them, but try to think of them as just another way to maintain contact with the floor or ground.

Keep floors clear. Newspaper and magazines, even pet toys and feeding dishes can be hazardous, as well as the pets themselves. Putting a bell on a pet’s collar or even ‘Falls’ —continued on page 31 30

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Fall Injuries • People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.

• Over 95% of hip fractures are caused by falls. In 2010, there were 258,000 hip fractures and the rate for women was almost twice the rate for men.

• Rates of fall-related fractures among older women are more than twice those for men.

Source: CDC.gov

‘Falls’ —continued from page 30

a glow-at-night collar can reduce the chances of being tripped up by Fido or Fluffy.

Despite what some folks think, falling isn’t a natural part of aging.

“I get so frustrated,” says Carhart, “when patients and families will say ‘well, I’m a certain age, and I’ve fallen a lot, and I’m not going to get better.’ That so not right.”

You can avoid falls by taking stock of your risk factors, getting the right kind of exercise, and removing the hazards that can cause trips and slips.

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POOR health is OUR good HEALTH the prequel to

words | SUZANNE RAMSEY photography | SHAWN SPROUSE

At the beginning of the year, it’s common for people to make changes to their lifestyles, such as promises we make to ourselves to start exercising, stop smoking or lose the 10 pounds we put on during the holidays. How about making a resolution to head off poor health at the pass?

After all, it’s been said that it’s “easier to stay well than to get well.”     

During the 2011 holiday season, John McFarland, a local UPS employee, realized he needed to make some serious changes when it came to his health.

He wasn’t feeling well and was short of breath and tired. Eventually, it worried him so much that he went to a local hospital.

Once there, he was asked to step on the scale. That’s where things started to head south. John says he was looking down at the scale, knowing the numbers on it went up only so high.

“They couldn’t get my weight on there. I knew they probably couldn’t anyway,” he says, adding that he probably weighed more than 400 pounds at the time. “When I saw that, it was like ‘Wow. Hmm.’ I told myself, ‘I’ve got to lose the weight.’”

Reprints To order reprints of the artwork featured on this issue’s cover, contact Deidre Wilkes at 540.387.6482 or via email at deidre@ourhealthvirginia.com.

At the hospital that day, John was diagnosed with congestive heart failure. He also got an ultimatum of sorts from his physicians.

“They told me I had to change my ways, or else,” John says.

So John changed his ways. He started working out, something he hadn’t done for years, and he started eating better, a big change from the drive-thru and take-out meals he was used to. And he started losing weight. Lots of it.

‘Prequel’ —continued on page 34

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‘Prequel’ —continued from page 33

“I wasn’t starving myself,” says John, who has lost 280 pounds to date. “I was just going to the gym, working out and eating right.”

John had one setback, a 2013 bout with pancreatitis that landed him in the hospital for a month, but after that was unstoppable. Six days a week, he works out at Carilion Wellness, lifting weights and taking cycle, strength and other classes. On Sundays, he walks in his neighborhood.

“I never get tired of going to the gym at all,” he says.

When asked about his advice for others, John says it’s important not to get discouraged or listen to criticism, from yourself or others.

“I tell anybody, once you’re getting in the gym and working out, you’re taking the first step,” he says. “Just keep it up. You’re taking the first step by going in the doors and working out. Don’t try to compare yourself with other people.”

When he was diagnosed with congestive heart failure, John says his physician told him his heart was functioning at 22 percent and that he “would probably never get it back into the highest range again.” Today, John reports his heart is “the strongest I’ve ever had it in my life.”

‘Prequel’ —continued on page 36

What is Congestive Heart Failure?

Heart failure, sometimes known as congestive heart failure (CHF), occurs when your heart muscle doesn’t pump blood as well as it should. Conditions such as narrowed arteries in your heart (coronary artery disease) or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

Source: www.mayoclinic.org

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‘Prequel’ —continued from page 34

“I thank God every day,” he says. “My health is good. I’m losing weight. I haven’t been gaining weight. Sometimes, I’m just barely losing a pound after two weeks and then boom, it starts coming off again. It takes time. Like the commercials, you can’t put a cream on there or take a pill.”

“You have to work at it. It’s a lifestyle. It’s something you have to continue doing to have good health. When I saw my weight, I made up my mind that I’m going to be healthy. You can’t take your health for granted. You have to realize, this is your body. You have to take care of it.’”      Local physicians say there are a lot of things people can do to try to avoid serious health issues, such as heart attack, stroke and lung disease.

Controlling your cholesterol is one of them. Jim Buriak, a professor and athletic training director at Roanoke College, says he started worrying about a number of things, including his cholesterol, after visiting his physician a few years ago.

“Over the years, my weight had started to creep up,” Jim says. “When I had a routine physical in 2011, my numbers started to creep up. My cholesterol was 194, [with] 64 HDL and 111 LDL.” Jim’s numbers weren’t too bad.

After all, the Mayo Clinic calls total cholesterol, measured in milligrams ‘Prequel’ —continued on page 38

Delmas Bolin, MD, of Performance Medicine of Southwestern Virginia in Roanoke

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Jim Buriak is a professor and athletic training director at Roanoke College.

‘Prequel’ —continued from page 36

per deciliter of blood, of less than 200 “desirable.” Jim’s LDL was “near ideal” and his HDL ranked in the “best” category.

Still, he wasn’t satisfied.

“I knew I could do better than this,” Jim says. “I started to work on it, changed my diet and exercise habits and got my cholesterol down to where I thought it should be.”

Jim started using the smartphone app “Lose It!” to track his daily calories and exercise, among other things. He changed his diet, but says it was more about counting calories than avoiding certain foods. He also changed up his exercise routine, going from jogging three times a week to walking seven days a week, along with push-ups, squats and other exercises.

“I started my exercise and diet routine and haven’t missed a day of walking since I started in 2011,” he says. “It doesn’t matter what the weather is, I’m going. My wife thinks I’m crazy, but she walks with me, and she lost about 10 pounds. She didn’t need to lose any weight. It was just because of my habits.”

In addition to losing about 50 pounds, Jim says his cholesterol levels came down. In January, he reported that his total cholesterol was 170, LDL 73 and HDL 88.

“Pretty big difference,” he says.

Delmas Bolin, MD of Performance Medicine of Southwestern Virginia in Roanoke, compared what happens in the arteries, if cholesterol is too high, to a pipe that corrodes after years of use.

“The net result is that you begin to corrode your arteries,” Dr. Bolin says. “You start out with a four-inch pipe and after 10 years you have one inch of water flow. Everything else is corroded.

“It’s the same as your blood stream. What you find is large deposits of this cholesterol-laden fat that is under the surface of the arteries, closing the arteries off. If that happens in your ‘Prequel’ —continued on page 39

What is cholesterol anyway?

Cholesterol is a type of fat that circulates in your blood.

Cholesterol comes from two sources: • Your body makes some cholesterol on its own, regardless of what you eat.

• Cholesterol also comes from the foods you eat.

Cholesterol is found only in animals products. Foods from plants don’t contain cholesterol.

Source: www.clevelandclinic.org

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What are LDL, HDL and total cholesterol?

Cholesterol can’t travel in the blood on its own. It’s carried by special proteins.

Combinations of cholesterol and protein carriers are called “lipoproteins.”

There are two types of lipoproteins: • Low-density lipoproteins (LDLs, or “bad” cholesterol) • High-density lipoproteins (HDLs or “good” cholesterol) Think of LDLs as delivery trucks and HDLs as garbage trucks. LDLs pick up cholesterol from the liver and deliver it to cells. HDLs remove excess cholesterol from the blood and take it to the liver. A person’s total cholesterol level is a combination of LDL and HDL cholesterol.

Source: www.clevelandclinic.org

How do I keep cholesterol numbers in check?

• You can take several steps to maintain a normal cholesterol level.

• Get a blood test.

• Eat a healthy diet.

‘Prequel’ —continued from page 38

brain, you’ll slowly develop a problem with that part of your brain. What typically happens, just like with a garden hose when you pinch it off, blood has to flow faster through the artery and it shears off the fat or the lining of the artery and you get a blood clot there.”

“When that happens, all blood flow after that spot ceases. If that happens in a heart blood vessel, you have a heart attack. If it happens in your brain, you have a stroke.

If it happens in your kidney, you develop kidney failure. This is all about restricting blood flow to organs. That’s the issue.”

• Maintain a healthy weight.

• Exercise regularly.

• Don’t smoke.

• Treat high cholesterol.

Source: www.cdc.gov

Dr. Bolin recommends patients have their cholesterol checked for the first time between ages 15 and 25. If it’s OK, he recommends rechecking at age 30 and then every two to five years after that. If levels are high, he says, his “first line treatments are changes in diet and changes in exercise profile.”

If that doesn’t work, there’s medication.

As for what causes high cholesterol, Dr. Bolin says it’s part genetics and part diet.

“There’s just no question,” he says. “There are two components to it and the cholesterol tends to go up as we age. Age is not a cause of high cholesterol, but in general, as we age, we become less active and that seems to correlate with changes in cholesterol.”

To lower cholesterol or keep it at a healthy level, Dr. Bolin recommends the kinds of things one might imagine — a healthy diet and exercise — and one thing that might be surprising: getting enough sleep.

He recalled a study that looked at two groups of middle-aged men, all of who wanted to lose weight. Both groups dieted for three weeks, but one group got eight hours of sleep each night while the other got five and a half. In the end, both groups lost the same amount of weight, but the ones who got more sleep lost more fat. The ones with less sleep lost what Dr. Bolin describes as “lean body mass.”

Davis Killeen, DO, FCCP specializes in pulmonary critical care and pulmonary diseases at LewisGale Physicians in Salem.

“That becomes important when you talk about how you try to diet to lose weight,” ‘Prequel’ —continued on page 40 www.OurHealthVirginia.com

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‘Prequel’ —continued from page 39

What is arthrosclerosis?

Hardening of the arteries, also called atherosclerosis, is a common disorder. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques. Over time, these plaques can block the arteries and cause problems throughout the body.

Source: U.S. National Library of Medicine

he says. “It has everything to do with how sleep controls the hormones that turn off and on your body’s ability to store and get rid of excess energy, and that’s what fat is. So, part of what I’m working on with a patient [is] I’m looking at all those things in an effort to get a person to adopt a better lifestyle and exercise profile to get their cholesterol profile and numbers to change.”

Over the past decade or so, researchers have also found that it’s not only the amount of cholesterol that matters, but also the size of the particles. While Dr. Bolin admits it’s a “relatively new technology,” he explains that large LDL particles — researchers call them “fluffy” — are too big to get into the arteries and cause arthrosclerosis, while “very small and very dense ... particles tend to be particles that more easily become incorporated in arthrosclerosis and they promote hardening of the arteries.”

Similar things can be said of HDL, Dr. Bolin says, with some types being “much more protective” and others less so.

“So, if the story is just about numbers,” he says, “that’s not correct.”      Another thing people can do to reduce the risk of serious diseases, such as chronic obstructive pulmonary disease or lung cancer, is quit smoking.

The National Cancer Institute calls tobacco use “the leading cause of preventable illness and death in the United States” and blames it for various cancers, along with heart disease and lung diseases such as emphysema and chronic bronchitis.

The NCI also reports that “smoking causes an estimated 443,000 deaths each year, including 49,000 deaths due to exposure from secondhand smoke.”

David Killeen, DO, of the Pulmonary Department of LewisGale Physicians in Salem, says he’s treated several patients over the years who, while not smokers themselves, lived with smokers and suffered from emphysema, asthma, bronchitis and other problems.

“It matters,” he says.

LewisGale Medical Center offers lowdose computed tomography screening — commonly referred to as “CT” or ‘Prequel’ —continued on page 43

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Jeff Hubbard, is a Roanoke-area mechanic’s garage owner

‘Prequel’ —continued from page 40

“CAT” scans — to those it describes as “current smokers and former heavy smokers.”

The test costs $150 and is sometimes covered by insurance.

The National Cancer Institute reported in 2011 that “scientists have found a 20 percent reduction in deaths from lung cancer among current or former heavy smokers who were screened with low-dose helical [CT] versus those screened by chest X-ray.”

But what if you’ve been smoking for decades? Does quitting really matter at that point? Dr. Killeen says it does.

“Once you quit, the lung function can improve a little bit, but the big thing is that after the age of 30 we all lose some lung tissue over time and that loss is accelerated if you smoke,” he says. “It returns to the rate of a nonsmoker’s decline if you quit.”

Smoking also can cause what Dr. Killeen describes as a “magnifying response” with certain hereditary disorders, particularly alpha-1 antitrypsin deficiency, a condition that increases a person’s risk for developing lung disease.

According to the National Heart, Lung, and Blood Institute, “Alpha-1 antitrypsin deficiency, or AAT deficiency, is a condition that raises your risk for lung disease (especially if you smoke) and other diseases. Some people who have severe AAT deficiency develop emphysema — often when they’re only in their forties or fifties. Emphysema is a serious lung disease in which damage to the airways makes it hard to breathe.”

Jeff Hubbard, who owns a Roanoke-area mechanic’s garage, was diagnosed with AAT deficiency several years ago. He was in his mid-40s at the time and, at the urging of his physician, had quit smoking. For the next six or eight months, Jeff says he felt so good that, as he puts it, “I could run a marathon.”

What is chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases.

It makes it difficult to breathe.

There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus; Emphysema, which involves destruction of the lungs over time.

Source: U.S. National Library of Medicine

But then, like many of the cars he sees at his shop, that came to a screeching halt.

“All of a sudden, I got worse than I ever was when I smoked,” he said. “I went back to the doctor and found out that I was an alpha-1 antitrypsin deficiency patient.”

As Jeff describes it, it’s sort of like hardening of the arteries, except in your lungs. He describes it as a “hardening of the lung capillaries,” and says, “I can take in air but I can’t get it back out of my chest. I can breathe in all I want to, but I can’t get it back out because my lungs won’t squeeze. I can’t deflate my lungs. They got hard.”

According to Dr. Killeen, Jeff’s physician, people with the AAT deficiency gene have an increased risk for developing COPD, even if they’ve never smoked. Smoking and exposure to other contaminants, such as chemicals or dust, causes the damage to be done sooner.

Dr. Killeen says having the gene doesn’t guarantee someone will develop COPD, however, and that treatments are available for those with AAT deficiency. The drugs are expensive — weekly infusions run about $19,000 a month — but financial assistance is available. Patients must have the infusions for the rest of their lives.

Jeff, who’d never heard of AAT deficiency before his diagnosis, says “it’s essentially a death sentence” but he refuses to give up. “If you’re going to lie down, it’ll kill you,” he says, “but I’ve never stopped.”

Anthony Stavola, MD, of Carilion Family Medicine, North Roanoke

When it comes to smoking, it’s best to never start.

The American Cancer Society reports that about 18 percent of adults in the U.S. — ‘Prequel’ —continued on page 44

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‘Prequel’ —continued from page 43

about one in five — smoke cigarettes. These numbers, reported in 2012, don’t include other forms of tobacco use, such as cigars, smokeless tobacco and electronic cigarettes.

“The doctors tell kids not to put anything smaller than their elbow in their ear,” Dr. Killeen says. “You shouldn’t put anything in your lungs other than air. If you follow that rule, you’ll do pretty well. ... If it’s not air that you’re inhaling, you probably shouldn’t be doing it.”

After finding links between excessive sitting and chronic diseases like obesity, type 2 diabetes and heart disease, researchers are calling sitting “the new smoking.” They even coined a term for it — “sitting disease” — which basically encompasses all of the terrible things that can happen to your body from too much sitting.

Anthony Stavola, MD, of Carilion Family Medicine, North Roanoke, says too much sitting or a sedentary lifestyle has been linked to an increased risk of diabetes, heart disease and even certain cancers. He says there are some theories about why this happens.

“A more physically active body is found to be more sensitive to the insulin it produces on its own,” Dr. Stavola says. “We all have insulin that our bodies produce internally to regulate blood sugar. When we’re more active, what happens is the body becomes more sensitive to that insulin [and you’re] less likely to develop insulin resistance.

Insulin resistance, in and of itself, is a high risk for diabetes and heart disease and ‘Prequel’ —continued on page 47

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‘Prequel’ —continued from page 33

cardiovascular disease in general.

“Also, if we’re sitting more [there’s] a tendency to have other hormonal changes that cause more inflammatory activity in the body. That can affect the circulation. Inflammation is something that’s seen as increasing the risk of plaque material in the blood vessels, particularly in the heart muscles, increasing the risk of heart disease and stroke.”

Obesity can also become an issue, and lead to other problems.

“It’s a vicious circle, actually,” Dr. Stavola says. “People who are significantly overweight are susceptible to joint and muscle problems because of stress on the frame. Sitting [and] not burning the calories they would be [burning] if they were standing or moving around makes it much easier for the obesity problem to increase.”

You might think you don’t sit all that much, but the website www.active.com reports that the average American sits or is at least sedentary for about 23 hours a day. This includes eight hours sleeping, seven and a half hours at work, three hours eating, and an hour and a half each of watching TV, sitting in front of the computer and sitting in a car.

To put that in perspective, as it relates to disease, the American Cancer Society commissioned a study that found women who sit more than six hours a day have a “37 percent greater risk of death as compared with those who sat for three hours or less.”

For men, that number is 17 percent. For those who sit for long periods and don’t exercise, those numbers go up to 94 percent for women and 48 percent for men.

Dr. Stavola recommends a few things to get people more active during the workday, including taking the stairs, rather than using the elevator, and, if possible, walking to a restaurant for lunch, instead of driving. Other suggestions include getting up five or six times a day, for five or 10 minutes at a time, and stretching at your workstation.

On a personal note, Dr. Stavola — who admits to being “a little on the hyper side” — says he tries to stand as much possible at the office and often walks around while making phone calls. One day, while wearing a pedometer, he says he walked nine miles. He also encourages his office staff to be more active throughout the day by doing things like putting office equipment, such as printers, out of reach, so you have to get up once in a while.

“We have to get moving,” Dr. Stavola says. “We just have to move more. Our bodies are not designed to be sedentary. They were not put together to work that way and when we force our bodies to be sedentary, we pay a price for it.”

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47

FITBITS

H EA LT H A ND F I T NES S O N Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer

THE GO

INDOOR, AT-HOME WORKOUT

Deidre is a certified personal trainer with more than 15 years experience in the health and fitness industry.

She is the resident fitness specialist for OurHealth Southwest Virginia and a trainer and instructor at the Salem YMCA

to Fight the Winter Blues

One day there’s snow and the next there’s rain. There may be days when getting out of the house to go to the gym is impossible. With minimal space and equipment, you can do an at-home circuit workout that will work all major muscle groups. Circuit workouts are quick and challenging, and a great alternative to the gym.

At-Home Circuit Workout

1.

Rest 20 seconds in between each exercise and do up to three sets total, resting a full minute in between set.

15 squats 20 second rest

2.

5.

Beginner:

Go through once.

Intermediate: Go through twice.

Advanced:

Go through three times.

15 medicine ball back extensions 20 second rest

6.

15 push-ups 20 second rest

20 side leg lifts on medicine ball right, then left 20 second rest

3.

1 minute plank 20 second rest

4.

7.

1 minute abdominal crunch 1 minute rest

15 bicep curls with weights 20 second rest

20 alternating lunges 20 second rest

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8.

OurHealth | The Resource for Healthy Living in Southwest Virginia

Hand weights and resistance bands courtesy of Sun Medical in Salem.

Sun Medical now carries residential and commercial fitness equipment, visit www.sunmedical.com for details.

2015 Heart Health Resource Guide

Where to Go for Heart Health Care

Carilion Clinic Heart and Vascular www.carilionclinic.org/heart-vascular

Locations for Care:

• Carilion Clinic Cardiology Blacksburg

901 Plantation Road Blacksburg, VA 24060 | 540.557.5585

• Carilion Clinic Cardiology Christiansburg 1201 Elm Street Christiansburg, VA 24073 | 540.382.6711

• Carilion Clinic Cardiology – Crystal Spring 2001 Crystal Spring Avenue, Suite 203 Roanoke, VA 24014 | 540.982.8204

• Carilion Clinic Cardiology – Franklin 180 Floyd Avenue Rocky Mount, VA 24151 | 540.982.8204

• Carilion Clinic Cardiology – Giles 159 Hartley Way Pearisburg, VA 24134 |540.382.6711

• Carilion Clinic Cardiology – Martinsville 1107B Brookdale Street Martinsville, VA 24112 | 276.634.4400

• Carilion Clinic Cardiology – New River Valley 2900 Lamb Circle, Suite 301 Christiansburg, VA 24073 | 540.731.7600

• Carilion Clinic Cardiology – Westlake 35 Medical Court Hardy, VA 24101 | 540.982.8204

• Carilion Clinic Cardiology Wytheville 1150 Holston Road Wytheville, VA 24382 | 844.252.2268

• Carilion Clinic Cardiothoracic Surgery 2001 Crystal Spring Avenue, Suite 201 Roanoke, VA 24014 | 540.853.0100

Cardiology - LewisGale Regional Health System www.lewisgale.com www.lgphysicians.com

Locations for Care:

• LewisGale Hospital Montgomery 3700 South Main Street Blacksburg, VA 24060 540.951.1111

• LewisGale Physicians Cardiology Blacksburg 809 Davis Street, Suite 1 Blacksburg, VA 24060 540.961.1590

• LewisGale Physicians Cardiology Alleghany Highlands Medical Office 1 ARH Lane, Suite 200 Low Moor, VA 24457 540.772.3430

• LewisGale Physicians Cardiology Westlake 400 Scruggs Road, Suite 2300 Moneta, VA 24121 540.719.0424

• LewisGale Hospital Pulaski 2400 Lee Highway Pulaski, VA 24301 540.994.8509

• LewisGale Physicians - Cardiology Internal Medicine and OBGYN Peters Creek 6136 Peters Creek Rd Roanoke, VA 24017 540.283.3660

• LewisGale Medical Center 1900 Electric Road Salem, VA 24153 540.776.4000

• LewisGale Physicians - Salem Campus East 1802 Braeburn Drive Salem, VA 24153 540.772.3400 ‘Where to Go’ —continued on page 50 www.OurHealthVirginia.com

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‘Where to Go’ —continued from page 49

Heart & Cardiovascular

Disease

Questions to Ask Symptoms vary depending on what kind of heart or cardiovascular disease you have, but informing your doctor of any chest pain, shortness of breath, or pain or numbness in your limbs could save you from having a heart attack, stroke, or worse. If you haven’t yet been formally diagnosed with heart or cardiovascular disease, and you suspect your may, talk to your doctor about arranging a cardiac evaluation.

Independent Cardiology Medical Practices • Ajaykumar Acharya, MD 4291 Lee Highway Pulaski, VA 24301 | 540.980.1802

• Cardiology of Southwest Virginia 3142 Brambleton Avenue Roanoke, VA 24018 | 540.776.8255

• Heart of Virginia Cardiology, PC 2762 Electric Road, Suite A Roanoke, VA 24018 | 540.283.2710 www.heartofvirginiacardiology.com

• Jefferson Surgical Clinic Cardiology 1234 Franklin Road Roanoke, VA 24016 | 540.283.6000 www.jeffersonsurgical.com

Once you have a formal diagnosis and know which type of heart or cardiovascular disease you have, your doctor will give you information about the condition and recommend a course of treatment. You'll probably have questions and concerns about your diagnosis and how heart or cardiovascular disease will affect your overall health and your life. Consider asking your doctor the following:

• New River Valley Heart Clinic

• I have a family history of heart disease; how might that affect my health?

• Roanoke Heart Institute, PLC

• Are there any pretest restrictions I need to know about? For example, do I need to fast if I’m going to have a cholesterol test?

• What form of heart or cardiovascular disease do I have? What is the severity?

What is my prognosis?

• What does high blood pressure (hypertension) have to do with heart and cardiovascular disease? Should I be concerned about high blood pressure? Do I need to lower my blood pressure? If so, how?

2900 Lamb Circle, Suite 230 Christiansburg, VA 24073 | 540.731.3172 www.newrivervalleyheartclinic.com 201 McClanahan Street, SW Roanoke VA 24014 | 540.981.2105 www.roanokeheart.net

• Southwest Virginia Cardiology 2850 Keagy Road Salem, VA 24153 | 540.375.9375 www.southwestvirginiacardiology.net

• What role does cholesterol play in heart and cardiovascular disease? Do I have high cholesterol? Do I need to lower my cholesterol? If so, how?

• What role does diabetes play in heart disease? Do I have diabetes? Do I need to lower my blood sugar? If so, how?

• What caused my heart condition? Did I do something to cause it? Is heart disease a hereditary condition?

• Am I at risk for a heart attack? What symptoms would indicate a heart attack?

• What is the best method of treatment for my heart or cardiovascular disease?

• What are the risks of not treating my heart or cardiovascular disease?

Heart attack and stroke are

• How will my heart or cardiovascular disease affect me over the long term?

life-and-death emergencies —

• Do I need surgery for my cardiovascular disease? Will I need surgery in the future?

every second counts. If you

• What should I do if my symptoms worsen?

Source: www.everydayhealth.com

see or have symptoms (see list on page 40), immediately call 9-1-1 to get help right away!

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OurHealth | The Resource for Healthy Living in Southwest Virginia

Where to Find

Knowledge & Support Heart Health Resources • American Heart Association – Local Chapter 3140 Chaparral Drive | Building C, Suite 106 Roanoke, VA 24018 540.989.2810 | www.heart.org

• Heart Rhythm Society 1325 G Street, NW, Suite 400 | Washington, DC 20005 202.464.3400 | www.hrsonline.org

Local Heart Health Support Groups • Mended Hearts

Chapter 144 | Roanoke | 540.366.8416 Chapter 148 | Rocky Mount | 540.483.7822 www.mendedhearts.org The purpose of Mended Hearts is to offer help, support, and encouragement to heart disease patients and their families in Southwest Virginia.

• Bradley Free Clinic 1240 3rd Street SW | Roanoke, VA 24016 540.344.5156 | www.bradleyfreeclinic.com

Beginning Mid-2015 For a complete listing of local screenings and health events, be sure to check the

OurHealth Southwest Virginia Calendar of Events on our website at

ourhealthswva.com

www.OurHealthVirginia.com

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Helpful Tips for

Heart Health

Some risk factors for heart disease are beyond our control. But the good news is that there are many lifestyle choices you can make to help you take charge of heart health and reduce your risk of heart disease.

• Maintain Regular Doctor Visits Even if you feel healthy and have few risk factors for heart disease, you should still make regular appointments with your doctor. It’s important to take control of your health. An important part of doing this includes being proactive about preventive care.

• Quit Smoking It’s a well-known fact that smoking is bad for your health. In fact, smokers can be at two to three times greater risk of developing heart disease than nonsmokers. So if you smoke, be sure to make time to talk to your doctor about how to quit.

• Eat Smart By eating a diet low in saturated fat and cholesterol, you can reduce your risk for heart disease. This includes foods such as fish, poultry, lean meats, low-fat or nonfat dairy products, and plenty of fruits and vegetables. In addition, to help lower blood pressure, strive to limit your daily sodium intake to less than 1500 mg per day.

• Be Active* Just as eating well is important to your health, it’s just as important to make exercise part of your daily routine. Regular physical activity not only can help people lose weight, it’s also good for your heart! Studies show that physically active people have a lower risk of heart disease than sedentary ones. The American Heart Association recommends 40 minutes of aerobic exercise, at a moderate to vigorous intensity, three to four times per week.

• Watch Your Alcohol Intake Although many studies have debated the connection between drinking alcohol and heart health, drinking too much can have a negative impact on your health. Overindulging in alcohol can put you at risk for high blood pressure, obesity, stroke, and breast cancer. If you plan to drink alcohol, do so in moderation.

• Take Charge It’s important to set realistic and achievable goals that can become part of your life and routine.

‘Tips’ —continued on page 53

.

Warning Signs of

Heart Attack, Cardiac Arrest & Stroke Signs of Heart Attack

Signs of Cardiac Arrest

• Chest Discomfort

• Sudden loss of responsiveness • No response to tapping on shoulders • No normal breathing

Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.

• Discomfort in Other Areas of the Upper Body • Shortness of Breath

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Stroke Warning Signs • Face Drooping Does one side of the face droop or is it numb? Ask the person to smile.

• Arm Weakness Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

OurHealth | The Resource for Healthy Living in Southwest Virginia

• Speech Difficulty Is speech slurred, are they unable to speak, or are they hard to understand?

Ask the person to repeat a simple sentence, like “the sky is blue.” Is the sentence repeated correctly?

TIME TO CALL 9-1-1

If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

‘Tips’ —continued from page 52

• Make yourself a priority By maintaining your health, you’ll be better prepared to be your best at work, at home with family, or anywhere else.

• Tackle your health as a team It’s essential to have open communication and regular dialogue with your doctors to identify the best approach to supporting your health.

• Seek out support Partner with friends and family to help you accomplish your goals.

Support a healthy lifestyle by connecting with other people who enjoy similar activities, such as biking or sharing health recipes.

• Celebrate your success.

Feeling good about yourself and reinforcing the positive steps you’re taking will help you stay on track for success.

Source: www.truheart.com *Be sure to check with your doctor before starting any kind of exercise routine.

Common

Heart & Vascular Conditions *

Aneurysm: The bulging of an artery caused by uncontrolled blood pressure, injury or weakness. As the aneurysm continues to grow, it may rupture or leak and cause massive internal bleeding.

Aortic Dissection: A tear in the lining of the aorta (the largest blood vessel in the body) which can cause it to rupture, causing serious internal bleeding.

Atrial Fibrillation: A disorder in which the heart beats in an irregular, chaotic rhythm.

Atrial or Ventrical Septal Defect: When a hole in the wall that separates the right and left lungs causes excess blood flow to the lungs.

Blood Clot (thrombosis): A hardened glob of blood within an artery or vein which breaks away and blocks the flow of blood to a particular area of the body.

Chest Pain (angina): Pain in the chest, arms, shoulders, neck or jaw caused by narrowing of the coronary arteries, thus resulting in an insufficient supply of blood and oxygen to the heart.

‘Common Conditions’ —continued on page 54 www.OurHealthVirginia.com

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‘Common Conditions’ —continued from page 53

Coarctation of the Aorta: Constriction of the large blood vessel (aorta) as it curves down to supply the lower body, thus causing an elevation in blood pressure before the narrowed area.

Coronary Artery Disease: When the arteries that carry blood to the heart become blocked or narrowed by a gradual buildup of fat (cholesterol).

Diabetes: A disease in which the amount of sugar (glucose) in the blood is too high, because the pancreas either cannot produce or use insulin. When blood sugar is not turned into energy, it can accumulate in the bloodstream and damage the heart.

Heart Attack (acute myocardial infarction): A complete blockage of blood flow in an artery leading to the heart.

Heart Failure: When the heart loses its ability to pump enough blood, because the heart muscle has been weakened or injured by high blood pressure or a heart attack.

Heart Rhythm Disorder (arrhythmia): An unusual rhythm of the heartbeat, either too fast or too slow.

High Blood Pressure (hypertension): When the pressure of the blood is so great against the walls of the artery, it causes the heart to work harder to pump blood throughout the body.

Mitral Valve Prolapse: A leak in the mitral valve, which controls blood flow through the left side of the heart.

Patent Ductus Arteriosus (PDA): When the PDA artery present in the fetus fails to close properly, causing an excess blood flow to the lungs.

Peripheral Vascular Disease: When the same fat buildup that causes coronary artery disease occurs in arteries and veins supplying blood to other areas of the body.

Stroke: The condition that occurs when an artery or vessel that supplies blood to the brain either bursts or is blocked by a clot. Within minutes, the nerve cells in that area of the brain are damaged, and they may die within a few hours.

Sudden Cardiac Death: Death caused by dangerously fast electrical signals that limit the heart’s ability to pump blood to the body and brain.

Tetralogy of Fallot: Four cardiac malformations that appear together.

Due to a hole in the wall between the ventricles and a narrowing in the outlet, blood lacking in oxygen is directed away from the lungs until the baby becomes increasingly blue. *Source: healthwise.net

ON THE WEB

More at ourhealthswva.com (new website debuts mid-2015)

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OurHealth | The Resource for Healthy Living in Southwest Virginia

The Resource for Healthy Living in Southwest Virginia

Local health. Anywhere you go.

OurHealth magazine is Southwest Virginia’s only resource entirely dedicated to delivering information about local healthcare services and healthy living topics. Pick up our print edition at more than 500 locations throughout Southwest Virginia or get the digital edition by visiting www.ourhealthswva.com.

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OurHealth | The Resource for Healthy Living in Southwest Virginia

Healthy Eats

h e a r t h e a lt h y r e c i p e s Entrée: Lemon Honey Salmon Yield: 6 servings

Ingredients: 6

6 oz salmon fillets

1 lemon 1 tsp rosemary 1 tsp basil 1 tsp black pepper 1

clove garlic, sliced

1/2 red onion, sliced 2 tbsp olive oil 2 tbsp honey

Directions: 1. Zest and squeeze the juice from the lemon.

2. Mix all other ingredients together with the exception of the salmon in a sealable freezer bag.

3. Add the fish and toss to coat.

Place in refrigerator for six to eight hours.

4. Bring grill pan to a mediumhigh heat.

5. Allow salmon to come to room temperature as the pan heats.

Local salmon from: Indigo Farms Susan and Teresa | 540.763.2323 www.indigofarmsseafood.com | indigo@swva.net Indigo Farms Seafood offers fresh seafood from North Carolina’s crystal coast, right here in the New River Valley. Established in 1993 by Susan Handy and Teresa Nester, the two are focused on top quality products and service while being sensitive to environmental issues. Indigo Farms Seafood also supplies fresh seafood to local restaurants including Chateau Morrisett in Floyd County and Mountain Lake Resort in Giles County. Check their website for drop points in our area.

6. Place the fish on the grill for about six minutes per side or until it begins to flake.

7. Remove from grill and serve.

Tricia Foley says

LEMON HONEY SALMON Tricia Foley is OurHealth Magazine’s resident nutritionist

Healthy Eats

h e a r t h e a lt h y r e c i p e s

Roasted Vegetables from:

Riverstone Farm

Bret Nichols | 540.577.8218 592 Paradise Lane, Floyd VA 24091 www.riverstoneorganicfarm.com Riverstone Farm is a certified organic farm in Floyd County. Riverstone offers an array of fresh vegetables, cut flowers, herbs, free range eggs and pastured lamb and pork. They offer a CSA, have weekly deliveries and drop off points in the New River Valley and are also present at the Blacksburg and Floyd Farmers Markets.

Side: Herb Roasted Vegetables

1/4 teaspoon sea salt

Ingredients:

Directions:

2 medium sweet potatoes cut into 1-inch cubes 2 carrots, cut into 1-inch chunks 1 cup cauliflower, chopped 1 medium red onion, quartered 1 tbsp olive oil 3 cloves garlic, minced 2 tsp dried herbs (including thyme, rosemary, and oregano)

1/4 teaspoon pepper

1. Place sweet potatoes, carrots, cauliflower and red onion in a 13-inch x 9-inch x 2-inch baking pan.

2. Combine oil, garlic, mixed herbs, salt, and pepper.

3. Drizzle over vegetables and toss to coat.

4. Cover with foil. Bake in a 425ÂşF oven for 30 minutes.

5. Remove foil; mix vegetables.

6. Bake, uncovered for five to ten more minutes or until tender.

Tricia Foley uses

HERB ROASTED VEGGIES Tricia Foley is OurHealth Magazine’s resident nutritionist

Healthy Eats

h e a r t h e a lt h y r e c i p e s

Local Walnuts and Oatmeal From:

Blue Mountain Organics Floyd, VA 24091 | 540.745.5040 www.bluemountainorganics.com Blue Mountain provides certified organic raw and sprouted nuts, nut butters, flours, grains and dried fruits. They are located in Floyd, Virginia and are dedicated to producing healthful and nutritious foods. Visit their website to place an order!

Dessert: Kiwi Blackberry Creamy Oats

Directions:

Yield: two servings

1. Combine oats, Greek yogurt, walnuts and unsweetened almond milk.

Ingredients

2. Divide into 2 half pint mason jars.

Cover and refrigerate overnight.

½ cup old fashioned oats ½ cup plain Greek yogurt 1 tbsp walnuts ⅔ cup unsweetened almond milk

3. Divide the fruit in half and add to each mason jar. Enjoy! (You may refrigerate up to three days.)

1 kiwi, peeled and diced ¼ cup fresh (or frozen) blackberries

Tricia Foley’s

KIWI BLACKBERRY OATS Tricia Foley is OurHealth Magazine’s resident nutritionist

New Treatments for

Varicose

Veins

words | DIANE YORK

Carolyn Ward had a serious problem. The veins in her leg were swollen. One was so enlarged and painful it interrupted her sleep at night. She says, “My varicose veins were very painful and one was so popped out it looked awful. I knew I needed help.” Varicose vein treatment used to be dreaded, now it’s one of the easiest medical procedures available.

In the past, women (and men) who suffered from uncomfortable and unattractive distended veins in the leg and thighs, called varicose veins, had few choices. They could try to prevent them from becoming more swollen by using compression stockings or submit to a painful and often unsuccessful technique of tying off or stripping the enlarged veins. This procedure was so painful it required general anesthesia and entailed recovery time. But in the last few years, thanks to new laser and/or radio frequency technology, the treatment of varicose veins is far less invasive, requires no recovery time and can be almost painless.

Treatment Today

Endovenous Laser Ablation Varicose vein treatment, or thermal endovenous ablation, is a minimally invasive treatment that uses ultrasound guided radio frequency (RFA) or laser energy (ELA) to cauterize (burn) and close abnormally enlarged veins in the legs.

Two friends of Carolyn had similar problems and they recommended Thomas Conlee, MD, a vascular surgeon at Jefferson Surgical Clinic in Roanoke. She says, “I felt at ease with the staff right away and with Dr. Conlee. I appreciated that he explained in detail what the procedure would involve.”

Dr. Conlee says: “We try compression therapy first. Sometimes this alone can solve the problem. It keeps pressure in the veins low. But if the vessels are diseased, if the valves have become incompetent and the blood pressure increases in the veins, then we can offer ablation. Over the last ten to fifteen years, “tying off or stripping” has been essentially replaced by endovenous ablation. These procedures are associated with high success and low complication rates. The procedures are generally performed on an out-patient basis with local anesthetic and typically require no sedation. The patients are can walk immediately following treatment, and the recovery time is short.“

Patients are asked to bring their compression stockings when they come for the procedure. Following the procedure, they will initially wear them for forty-eight hours. After that, they wear them only during the day for the next twenty days. Dr. Conlee adds, “We will do follow-up ultrasound in a week to 66

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67

Varicose Veins?

Varicose veins are veins that have become noticeably enlarged due to pressure caused by increased blood flow, usually in the legs. Most veins in the body have what are known as leaflet valves, which help blood flow from the extremities to the heart. When these valves no longer work properly, blood can flow backward in the vein—and this is what causes the vein to become enlarged and painful. They can be unsightly for some people, as well as painful and sometimes dangerous if ulceration develops. ensure everything is going well. This is a permanent treatment and we have been one hundred percent successful.” Exercise is encouraged both before and after treatment.

Thomas Conlee, MD is a vascular and general surgeon at Jefferson Surgical Clinic.

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Before her procedure, Carolyn had four shots of Lidocaine in her leg. She says, “I could not feel the laser, it took less than thirty minutes. I had no pain after the Lidocaine wore off. Dr. Conlee did a great job. My leg looks great. I would recommend it to anyone.”

OurHealth | The Resource for Healthy Living in Southwest Virginia

Who Gets Varicose Veins?

Follow Jefferson Surgical Clinic on Facebook for upcoming events related to vein health and more!

Individuals with jobs that require long periods of sitting or standing, who are pregnant, are overweight or have a family history of this disorder, are more at risk for developing varicose veins. The valves in the veins in the leg that permit blood flow break down; resulting in blood flow being interrupted. The blood can back up causing swelling and pain. Severe disease could lead to ulceration of the skin and ultimately threaten the leg.

Covered by insurance?

Insurance will not cover this procedure if it is for cosmetic purposes only. However, if the varicose veins are causing lifestyle changes, i.e. if you cannot stand long enough to work, you cannot exercise or are having serious swelling or ulcerations that require medical attention then ask your doctor for a referral. Dr. Conlee adds, “This is an undertreated disease and we have a highly successful way of treating it.�

ON THE WEB

More at ourhealthswva.com (new website debuts mid-2015)

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OurHealth | The Resource for Healthy Living in Southwest Virginia

OurHealth’s

Deidre Wilkes captures a variety of healthy activities at the

Carter Athletic Center Winter Health Fair.

OurHealth’s Deidre Wilkes was on hand to photograph the 2015 Carter Athletic Center Winter Health Fair held in January. A variety of vendors, representing a wide range of health and fitness needs, were in attendance to share information. There were also several group exercise class demonstrations, guest speakers, and free health screenings.

The Carter Athletic Center (CAC), on the campus of North Cross School, provides a convenient, year-round workout facility, wellness center, and gym for the community.

Memberships are available to the public. For more information about CAC, visit www.ncscac.org.

Roanoke USAPA Ambassador, Judy Bowman, conducted a pickleball clinic and facilitated play for attendees. For more information, visit www.virginiapickleball.org.

Local Pickleball Play Locations: CAC, Green Ridge Recreation Center and the Kirk Family YMCA in downtown Roanoke.

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OurHealth | The Resource for Healthy Living in Southwest Virginia

ON THE WEB

More at ourhealthswva.com (new website debuts mid-2015)

www.OurHealthVirginia.com

73

where is this?

Post the correct answer on our Facebook page by March 12, 2015. You could win a prize pack for 4 from Chick-fil-A. Cool, right? The winner will be announced on our Facebook page March 21, 2015.

Redeemable at these Roanoke locations: Chick-fil-A Valley View and Chick-fil-A on 220 South next to the Home Depot

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