february march 2016 ourhealthswva.com
table of contents | february • march 2016
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Heart Care:
How Far We’ve Come
Although heart disease continues to be a leading killer, advancements in science and technology coupled with the expertise of various medical experts in the field have contributed to a significant decrease in heart disease and heart-related conditions.
MEDI•CABU•LARY.....................12 Local experts define health-related terms
JUST ASK!.......................................14 Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............16 A listing of new physicians, providers, locations and upcoming events in Southwest Virginia
HEALTH POINTS........................ 20 Interesting facts and tidbits about health
THE ANATOMY CHALLENGE................................. 23 Are you up for the challenge? In this issue, test your knowledge when it comes to the PATHWAY OF BLOOD THROUGH THE HEART.
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OurHealth presents a new, on-going series about the role primary care providers play in preventative health by emphasizing the importance of the relationship.
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New Kitchen, New Nutrition, New You!
Our New Kitchen, New Nutrition, New You Series puts the focus on helping you get healthier in the kitchen — one ingredient at a time. Each edition of OurHealth highlights small changes you can make that can result in a major impact on your nutrition and health.
hello, HEALTH!.............................. 50 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos
FIT BITS!........................................ 61 AQUA KICKBOXING! This innovative
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A Blood Donor
SAVED His Life
Krislyn Henry speaks with the tenderness of a first-time mom. Her words are sincere and full of gratitude and relief. Henry shares a common, but rarely told story; she knows a blood donor saved her child’s life.
aquatics program combines the benefits of water’s buoyancy and resistance to increase muscle strength, endurance, agility, coordination, balance and core stability.
NUTRITION..................................63 HEALTHY EATS: Check out OurHealth resident nutritionist Tricia Foley’s fantastic recipes!
YOUNG AT HEART...................... 74 Featuring the artwork of young upcoming artists from Salem Art Center’s Zenith program * PLUS * a chance to win prizes!
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february • march 2016
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CONTRIBUTING MEDICAL EXPERTS Emma Catherine Ali, OD Brian Gross, MD Fletcher Matthews, MD Joelle Miller, MD Albert Parulis, DDS Hilary Whonder-Genus, MD, FAAP CONTRIBUTING PROFESSIONAL Cynthia BeMent EXPERTS & WRITERS Jeanne Chitty Tricia Foley, RD Tina Joyce Stephen McClintic Jr. Deidre Wilkes ADVERTISING AND MARKETING Kim Wood | P: 540.798.2504 kimwood@ourhealthvirginia.com SUBSCRIPTIONS To receive OurHealth via U.S. Mail, please contact Deidre Wilkes at deidre@ourhealthvirginia.com or at 540.387.6482
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to view the digital edition! 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 © 2016 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. OurHealth Lynchburg/Southside is published bi-monthly • Special editions are also published • McClintic Media, Inc. • 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. MAIN: ourhealthvirginia.com | ourhealthswva.com | ourhealthlbss.com | ourhealthrichmond.com | ourhealthcville.com | Advertising rates upon request.
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OurHealth | The Resource for Healthy Living in Southwest Virginia
LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is Dry Eye Syndrome?
“
Individuals with RSV who are at increased risk for hospitalization include infants less than six months, infants born premature (at less than 35 weeks gestation), individuals with underlying lung disease (including asthma) and congenital heart disease as well as poor immune systems.
”
Dry eye syndrome is a condition where there is inadequate lubrication of the eye. This can be due to either a reduced amount of tears or poor quality of tears. There are several factors that influence reduced tear production including age, side effects of certain medications and environmental conditions. The most common type of dry eye is reduced production of tears. Poor tear film quality happens when one of the components of the tear film does not function properly. This is often connected to eyelid inflammation that can cause the tear film to evaporate too quickly. Symptoms of dry eye are often described as irritated eyes, a gritty or scratchy feeling, burning and excess watering of the eyes. There are different treatment options ranging from artificial tears to prescription medications. Treatment is dependent on the type of dry present. Dry eye syndrome is a very common and often chronic condition.
Emma Catherine Ali, OD Vistar Eye Center Roanoke | 540.855.5100 www.vistareye.com
- Hilary Whonder-Genus, MD, FAAP
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What is Respiratory Syncytial Virus (RSV)? Respiratory Syncytial Virus (RSV) causes seasonal respiratory illnesses in people of all ages, but is the most common cause of lower respiratory illnesses in children less than one year of age. It usually occurs between November and April, peaking mid-winter. While RSV infections are very common and uneventful among healthy individuals, it is a major cause of pediatric hospitalizations during the winter months. Individuals at increased risk for hospitalization include infants less than six months, infants born premature (at less than 35 weeks gestation), individuals with underlying lung disease (including asthma) and congenital heart disease as well as poor immune systems. RSV is transmitted through coughs or sneezes, which makes hand washing very important. Young children may have a congested cough, wheezing and difficulty breathing, while older children and adults may only display upper respiratory infection symptoms, such as cough and runny nose. RSV infections are usually treated at home without antibiotics, but some patients may worsen and need hospitalization with antibiotics and oxygen.
Hilary Whonder-Genus, MD, FAAP Medical Director, Virginia Premier Medical Home Roanoke | 540.278.1051 www.vapremier.com
What is Tetrology of Fallot? Tetralogy of Fallot is the most common congenital heart defect. Babies born with Tetralogy of Fallot are referred to as “blue babies.” The term “tetralogy” describes four anatomic heart abnormalities: • a large hole between the lower chambers, • obstruction of the right ventricle, • malalignment of the aorta, and • thickening of the right ventricle. These four problems result in obstruction of blood flow to the lungs causing de-oxygenated or “blue” blood to circulate back into the body. Some babies are very blue at birth and require immediate surgery; other babies have milder obstruction and undergo surgery at an older age. In general, children do very well after this surgery but may require replacement of their pulmonary valves later in life.
Joelle Miller, MD
Pediatric Cardiologist Carilion Clinic Roanoke | 540.266.5437 www.carilionclinic.org
H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
“
Many people are under the assumption that, given enough time, wisdom teeth may “come through” and not need to come out. It is estimated that 85 percent of the adult population do not have room for normal eruption of wisdom teeth.
”
- Albert Parulis, DMD
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What causes kidney stones?
What are the functions of tonsils?
When is extraction of wisdom teeth required?
Kidney stones form when urine contains more crystal-forming substances – such as calcium, oxalate and uric acid – than the fluid in the urine can dilute. At the same time, urine may lack substances that prevent crystals from sticking together – creating an ideal environment for kidney stones to form.
Our ‘tonsils’ include the adenoid tissue in the back of the nose, palatine tonsils on the sides of the throat and lingual tonsil on the back of the tongue. Together, this is called Waldeyer’s Ring. Tonsils are lymphatic tissue which, theoretically serves as a first line of defense against exposure to environmental irritants. However, the majority of people do just fine without their tonsils or adenoid.
The American Association of Oral and Maxillofacial Surgery recommends everyone be screened, typically between the ages of 14-21. Early removal of wisdom teeth, before completion of root development, reduces the complication rate significantly. Many people are under the assumption that, given enough time, wisdom teeth may “come through” and not need to come out. It is estimated that 85 percent of the adult population do not have room for normal eruption of wisdom teeth. This can be determined by an oral and maxillofacial surgeon at the time of consultation. Serious acute, as well as long term problems can occur from impacted wisdom teeth. The procedure can be done during times of school breaks, as the recovery is usually 3-5 days. The patients are very comfortable during the procedure, usually done with intravenous sedation. Your local dentist or orthodontist will usually refer you at the appropriate time, but never hesitate to discuss it with them.
Most kidney stones are made of calcium, and can be caused by high levels of the molecule oxalate in the urine. High doses of vitamin D, intestinal bypass surgery and some metabolic disorders can increase the concentration of calcium or oxalate in urine. Oxalate is also a naturally occurring substance found in food, and some fruits and vegetables, as well as nuts and chocolate contain high levels of oxalate. There are also other, less common types of kidney stones such as struvite, uric acid and cystine, which can be caused by a variety of factors including infection, heredity, hydration and diet.
Fletcher Matthews, MD
Southwest Virginia Nephrology Medicine Roanoke | 540.904.5366 www.swvanephrology.com
OurHealth | The Resource for Healthy Living in Southwest Virginia
Brian Gross, MD
LewisGale Physicians ENT Salem | 540.444.8100 www.lgphysicians.com
Albert Parulis, DMD
Roanoke Oral Surgery Roanoke | 540.362.5900 www.roanokeoralsurgery.com
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Springtree Health & Rehabilitation Center Celebrates New World Class Gym Opening 120-bed rehab, skilled nursing center opens a 3,500 square foot state-of-the-art gym Springtree Health & Rehabilitation Center recently opened the doors on a brand new, state-of-the-art rehabilitation gym for patients. The opening of the gym celebrates a new era in rehabilitation recovery services in the Roanoke Valley. It introduces modern equipment, coupled with a unique patient-centric design that together, can only be found exclusively at LifeWorks Rehab centers. One revolutionary piece of equipment included in the new space is the AlterG anti-gravity treadmill. This device, designed by NASA, uses advanced unweighting technology that provides support, safety, and stability for patients during rehabilitation. It has been proven to help stroke and orthopedic patients get back on their feet faster. Also in the gym, patients will find interactive CyberCycles, a HUR iBalance interactive training system, strength and cardiovascular training equipment, a Dynamic Stair Trainer, and more. Patients come to the facility with medical conditions including cardiovascular illness, hip or knee replacement, stroke, heart failure, pneumonia, and post-surgical care. The new space with high ceilings, wide therapy areas, and the new equipment, help enhance patient experience and outcome. “When patients see the size of the new gym and the equipment, they are always impressed,” says Phillip Dick, Administrator of Springtree Health & Rehabilitation Center. “We get asked often if we have memberships to our gym. This entire project was all about the patients and their success. We want to get them home healthy and strong.” For more information, visit www.springhealthrehab.com.
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Kristina Abraham, AuD
Troy Baker, DO
Shannon Bishop, PA-C Molly Camper, CCRN Carilion Clinic Roanoke | 540.981.7000 www.carilionclinic.org
LewisGale Physicians Neurology Salem www.lgphysicians.com
Ryan Carlton, NP
Carilion Clinic Roanoke | 540.981.7000 www.carilionclinic.org
Lorianne Giovanniello, PA-C Carilion Clinic Roanoke | 540-981.7337 www.carilionclinic.org
Roy Habib, MD, FACP
Peter Hayes
Shannon Johns, NP
Tike McGuiness, MS, RN, FNP-BC LewisGale Physicians Cardiology Blacksburg | 540.961.0218 www.lgphysicians.com
Alisha Oliver, PA-C
Amanda Page, PA-C
Jordan Reed, PA-C
Crista Saunders, NP
Kathryn (Casey) Self, MD Carilion Clinic Pediatric Medicine Rocky Mount | 540.982.8230 www.carilionclinic.org
Carilion Clinic Otolaryngology (ENT) Roanoke | 540.224.5170 www.carilionclinic.org
LewisGale Physicians Internal Medicine Salem | 540.772.3490 www.lgphysicians.com
Asthma & Allergy Center Roanoke | 540.343.7331 www.asthmaandallergycenter.net
Assistant Administrator Our Lady of the Valley Retirement Community Roanoke | 540.345.5111 www.ourladyofthevalley.com
Carilion Clinic Roanoke | 540.981.7337 www.carilionclinic.org
Carilion Clinic Giles | 540.921.6000 www.carilionclinic.org
Carilion Clinic Family and Community Medicine Roanoke | 540.772.0555 www.carilionclinic.org
LewisGale Physicians Cardiology Salem | 540.772.3430 www.lgphysicians.com
LewisGale Physicians Orthopedics Dublin | 540.440.3170 www.lgphysicians.com
Megan Smith, FNP-C LewisGale Physicians Pediatrics Salem | 540.772.3580 www.lgphysicians.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
LewisGale First to Bring Genius 3D Mammography to the Roanoke Valley Women no longer have to travel outside of the Roanoke Valley to get 3D Mammography, also called tomosynthesis. LewisGale Regional Health System now offers this advanced technology at the LewisGale Breast Center Salem, Southwest Virginia’s only Breast Imaging Center of Excellence accredited by the American College of Radiology. “As a leading provider of imaging services in the region, we are excited to be the first in the Roanoke Valley to give more women convenient access to this advanced technology,” says Jon Bartlett, President, LewisGale Regional Health System. “Bringing Genius 3D Mammography to our community is about saving lives and giving our doctors one more tool in the fight against breast cancer.” Research has shown Genius 3D Mammography detects 41 percent more invasive breast cancers and reduces the need for callbacks by up to 40 percent compared to traditional 2D Mammography. This technology works by capturing three-dimensional images of the breast, making it possible for doctors to examine breast tissue layer by layer. To learn more about this technology, visit www.genius3Dmammography.com or call 540.776.4983 to schedule an appointment for a 3D mammogram.
FROM LEFT TO RIGHT: Joe Sheffey, Chairman, Pulaski County Board of Supervisors; Jeff Kurcab, CEO, LewisGale Pulaski; Kevin King, Project Superintendent, R.L. Price Construction; Jeff Worrell, Mayor, Town of Pulaski; Linda Shepherd, CNO, LewisGale Pulaski; Don Stowers, Chairman, LewisGale Pulaski Board of Trustees; Dr. Karanita Ojomo, Chief of Staff, LewisGale Pulaski; Derek Vance, CEO, LewisGale Pulaski; Dr. Jack Knarr, President, Pulaski County Chamber of Commerce; Gary Hancock, LewisGale Pulaski Board Member; Dr. Will Hale, LewisGale Pulaski Board Member; and Peggy White, Executive Director, Pulaski County Chamber of Commerce.
LewisGale Hospital Pulaski Renovates Emergency Room The newly renovated emergency room at LewisGale Hospital Pulaski is now open. The hospital held a ribbon-cutting ceremony recently to mark the completion of the $2.5 million expansion and renovation project. “Our ER has undergone a major transformation that will enhance the patients’ experience and allow us to meet the growing demand for high-quality emergency care in our community,” says Derek Vance, CEO, LewisGale Hospital Pulaski. “The ER was designed to enhance patient privacy, improve patient flow for timely and efficient care, and create a more inviting environment for our patients.” The newly renovated ER includes 2,200 square feet of new space, three additional treatment rooms, a dedicated trauma room, and a bariatric room to accommodate larger patients. It also includes 12 private exam rooms. For more information, visit www.lewisgale.com.
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Carilion Clinic Opens New Institute for Othopaedics and Neurosciences Carilion Clinic’s new Institute for Orthopaedics and Neurosciences is now open. In keeping with Carilion’s initiative to offer integrated patient care, the center brings specialists in orthopaedics together with those in neurosurgery, physical medicine and rehabilitation, pain management, physical and occupational therapy, and imaging. This collaborative model allows leading specialists consult on diagnosis and treatment and is expected to reduce the need for patients to make multiple visits. Along with Carilion’s affiliation with the Virginia Tech Carilion School of Medicine, the institute will also serve as a regional hub for education, leading-edge research, and future innovation. The Institute is located at 2331 Franklin Rd., SW, Roanoke, VA. To learn more, visit www.carilionclinic.org/ion.
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TI P S , T I D B I T S A ND MO R E TO I NF O R M A ND ENT ERTA I N YO U
Heart Trivia in Honor of American Heart Month
?
February is American Heart Month! Here are some fascinating facts about the human heart! See if you can ‘fill in the blanks’ (answers below):
A
The heart beats about ________times in one day. In an average lifetime, the human heart will beat more than 2.5 billion times!
B
The heart pumps about ________barrels of blood during an average lifetime – enough to fill more than three super tankers!
C
A kitchen faucet would need to be turned on full blast for at least ____ years to equal the amount of blood pumped by the heart in an average lifetime.
D
Because the heart has its own electrical impulse, it can continue to beat even when separated from the body, as long as it has an adequate supply of _________.
?
g n i t ina
c
Fas
FACT:
e e area of th The surfac ng is large human lu cover enough to a one side of rt! tennis cou
For more information on heart disease and how to be heart healthy, schedule a check-up with your primary care provider or visit the American Heart Association’s website at www.heart.org. Answers:
A: 100,000
B: 1 million
C: 45
D: oxygen
March is National Nutrition Month! A healthy lifestyle includes nutrition – what we put in our body for fuel and protection from disease and illness. Here are some helpful tips to keep you on track:
Eat more whole foods
Avoid foods with more than five ingredients.
Plan healthy menus as a family
Work together to make healthy choices you all will enjoy.
Don’t skip breakfast
It really is the most important meal of the day.
Support your local farmer’s market
It is a great source for fresh fruits, vegetables and nuts. For additional resources on nutrition and healthy eating, visit the Academy of Nutrition and Dietetics at www.eatright.org.
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OurHealth | The Resource for Healthy Living in Southwest Virginia
Be sure to check out the historic Roanoke City Market, open year-round, seven days a week! You can purchase fresh fruits, vegetables and plants from local vendors. Visit their website at
www.downtownroanoke.org for more information, hours and special events.
Beat the Winter Workout ‘Blues’
Finding the motivation to exercise during the week is already difficult for most people. During the cold, dark weather months, it can be nearly impossible for many to muster up the strength to get off the couch and into their workout gear. Here are a few tips to boost motivation and avoid a winter workout rut:
Find a winter activity you enjoy. The winter season is the perfect time to try a new winter sport like skiing, snowboarding, ice skating or snowshoeing.
Mix up your routine.
Did you know?
Every time you
step forward, you use
When you get the workout “blahs,” aim to challenge yourself by having a workout “adventure” once a week. Try a new group exercise class, sport, a different interval workout or running route.
Try interval training. Interval training alternates bouts of high and moderate activity. Another bonus of interval training is that the workout can be completed in a shorter period of time. Running outside is a great way to introduce interval training. Intervals can also be done on any indoor workout machine like the bike, treadmill, rower or elliptical.
Make working out a social activity – get a workout buddy or join a team. Whenever you need some extra motivation, make your workout a social activity. You are less likely to skip if your friends are waiting for you. Join a sports team or make dates with friends to go to exercises classes.
Invest in fun new winter active wear. Still trying to figure out what to use that Christmas gift card for? Treat yourself to a new pair of running shoes or a new outfit for inspiration!
Looking for more?
Scan here to check out the OurHealth calendar for more healthy activites in your area.
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muscles!
12 Explore th Annual
Your Limits 5K & 10K Presented by Runabout Sports Roanoke, the Explore Your Limits 5/10K was started in 2005 as the first annual trail run in the Roanoke Valley. The 5K is a great race to introduce runners to trail running, and will include both trails and gravel roads in Explore Park. The 10K will run the 5K course to the finish line, and then continue out onto the intermediate biking trails. DATE: TIME:
March 5, 2016 9:00 am
LOCATION:
Explore Park Blue Ridge Parkway Milepost 115 Roanoke, VA
For additional information and to register, go to www.mountainjunkies.net.
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the
Anatomy
CHALLENGE How much do you know about the
Pathway of Blood Through
the Heart? First, complete the word search below. Next, match up the correct word with the part of the body in the illustration.
[ the Heart ]
WORD SEARCH aorta
right atrium
aortic valve
right AV valve
inferior vena cava
right pulmonary artery
left atrium
right pulmonary veins
left AV valve
right ventricle
left pulmonary artery
superior vena cava
left pulmonary veins left ventricle pulmonary valve
10
5
_________________
_________________
1 _________________
_________________
9
6
4
5
7
_________________ _________________
_________________ _________________
6
2
8
_________________
_________________
_________________ _________________
_________________
1
3
_________________
_________________
For answers, visit OurHealth Southwest Virginia’s Facebook page at /OurHealthswva
Follow the numbers to see the pathway of blood through the heart! www.OurHealthswva.com
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OurHealth | The Resource for Healthy Living in Southwest Virginia
The evolution of the subspecialty of cardiology is widely considered being responsible for the greatest prolongation of life in industrialized nations. Advancements in science and technology coupled with the expertise of medical experts in the field have contributed to a significant decrease in heart disease and heart-related conditions. Although heart disease continues to be a leading killer, the death rate by age and impact to population per capita during the 21st century is markedly less than during the 20th century. To learn more, OurHealth turned to cardiologists in Southwest Virginia for their expert opinion on how far we’ve come in the field of heart care.
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Q : How far has drug therapy come during the last decade in preventing heart failure and high cholesterol?
David Sane, MD
Chief of Cardiology Carilion Clinic Roanoke | 540.982.8204
The first statin was FDA approved in the United States in 1987, and the latest generation — potent statins — have been approved for more than a decade. Over the years, we have refined our criteria for eligible patients with several iterations of guidelines and have shown that statins have benefits in patients without marked elevation in cholesterol, but with other markers of risk, such as inflammation. We have raised questions about the usefulness of other types of lipid lowering therapies, for example niacin, when the patient is on an optimal statin and the LDL-cholesterol is at target.
What is statin? A class of drugs that help reduce levels of fats, including triglycerides and cholesterol, in the blood. By lowering these levels of fats, they help prevent heart attacks and stroke. Source: American Heart Association
The latest breakthrough is the approval of two agents in a completely novel class: the PCSK9 inhibitors. These drugs inhibit the action of an enzyme that breaks down the LDL receptor. Both of the FDA-approved drugs are remarkably potent in reducing LDL cholesterol and offer a novel approach to patients whose cholesterol is not adequately controlled by statin therapy or who are intolerant to statins.
The best way to prevent heart failure is to reduce risk factors for coronary artery disease such as: •
smoking
•
diabetes
•
high cholesterol
•
and blood pressure.
Reducing blood pressure is especially important as this risk factor can produce heart failure by increasing the risks for heart attacks or by leading to thickening of the heart (ventricular hypertrophy). The traditional threshold for defining hypertension has been a blood pressure greater than 40/90 but a recent study suggested that the threshold should be significantly lower. If these findings are incorporated into the next guidelines, there will be more patients who are labeled “hypertensive” and more medication therapy will be required to meet targets. For the patient who already has heart failure, two new medications were recently approved. The first is a combination of an old medication with a new class of medication that inhibits the degradation of an enzyme that breaks down certain peptides that are protective in heart failure. The second is a novel drug that slows the heart rate by acting on the intrinsic pacemaker of the heart. This drug can be used for patients who cannot tolerate beta blockers or who do not achieve the desired effect. 26
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Matthew Bowles, PA-C
Cardiology LewisGale Physicians Salem | 540.772.3430
Q : How has an
increased awareness in preventive care affected Cardiology? What is Preventive Cardiology? Preventive cardiology focuses on preventing or better managing risk factors that increase their risk of cardiac disease. An increased awareness of preventive care has helped patients to better prevent or manage these risk factors such as, •
diabetes
•
high cholesterol
•
tobacco abuse
•
high blood pressure
•
and obesity.
Through education and routine yearly physical exams patients can significantly reduce their risk of cardiac disease. Increased education for smoking cessation, management of obesity and increased exercise for a healthy lifestyle have also moved in the direction of decreasing risk of cardiac disease. By having patients obtain yearly physicals and educating patients on healthy lifestyle choices and risk factor reduction we as a community can reduce the overall number of patients that develop cardiac disease. Continued development of improved procedures, medications, and treatment that reduce risks of cardiac disease will further reduce development and progression of cardiac disease for better long term patient outcomes. Patients and practitioners are encouraged to embrace Preventive Cardiology methods for better outcomes in the future. 28
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Scan Here
Q : How does
Carilion Clinic’s hybrid operating room affect cardiovascular care in Southwest Virginia?
Timothy Ball, MD, PhD
to watch a video on the hybrid OR.
Cardiology Carilion Clinic Roanoke | 540.982.8204
The hybrid operating room at Carilion Roanoke Memorial Hospital offers the functional capacity of a cardiac catheterization laboratory and a fully functional operating room. The hybrid operating room gives us an environment where we can perform endovascular procedures, but have the ability to switch to an operative approach if needed.
What is a hybrid operating room? A specially designed operating space that allows a variety of different specialists, including cardiac surgeons, interventional cardiologists, vascular surgeons and interventional radiologists to work together at one time, performing minimally invasive procedures on patients. This means that patients who might have otherwise required open heart surgery can now be effectively treated with a far less invasive catheterization procedure. Source: Carilion Clinic
It offers a full suite of the radiographic imaging technology in a surgical environment, which means we can perform more complex procedures on site. For patients, this means we don’t need to refer them to hospitals that may be a few hours away. We are regularly performing procedures such as pacemaker lead extractions, Transcatheter Aortic valve replacement (TAVR) and complex aortic endograft and vascular surgical procedures.
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David Sane, MD
Chief of Cardiology Carilion Clinic Roanoke | 540.982.8204
Q : What is
sensor-technology in cardiovascular care and how is it changing the way doctors interact with their patients? Broadly speaking, a medical sensor is any device that transduces physiological information into an electric or optical signal. Sensors are used to measure heart rate, blood pressure, oxygen saturation, rhythm disturbances, and other important parameters. The coupling of sensor technology with wireless transmission is now allowing transmission of important data from the patient to the physician from remote sites— such as the patient’s home—without direct patient contact. For example, most pacemakers and defibrillators transmit to a receiver that allows remote patient monitoring of heart rhythm issues. The pulmonary artery pressure of patients with heart failure can be followed by a sensor placed in the pulmonary artery. The data can be transmitted from the patient’s home, allowing the physician to detect important trends that correlate with fluid retention. That information will allow them to make adjustments that reduce patient symptoms without requiring hospitalization or even an outpatient visit. In the near future, data analysts may monitor physiological parameters from multiple patients, reporting the data to a physician who then makes clinical decisions. Though direct patient contact will remain essential, the ability to remotely monitor physiological parameters may decrease the frequency of office visits and, more importantly, of hospitalizations.
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OurHealth | The Resource for Healthy Living in Southwest Virginia
Q : How is
bio-monitoring impacting heart failure and high cholesterol?
Timothy Ball, MD, PhD Cardiology Carilion Clinic Roanoke | 540.982.8204
Over the last decade numerous advances have been made with respect to medical therapy and monitoring to treat patients with heart failure. The addition of bio-markers and biosensors have improved our ability to better predict when a patient may be in declining health or a worsening fluid balance. With that information, we initiate more aggressive medical therapy sooner, potentially preventing a full blown exacerbation of heart failure.
What is a bio-marker? A characteristic that is measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. Typically describes substances detectable in blood, urine, or other bodily fluids. Source: American College of Cardiology
If I peer ahead a few years, I believe the greatest advances to be made will be related to bio-monitoring. The amount of information we can get from personal bio-monitoring is immense, and access to that real-time data will allow us to make great strides in cardiac care. I believe the goal should be to improve preventative therapies and deliver aggressive risk factor reduction sooner, preventing long-term problems.
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Molly Rutherford, MD
Cardiology Jefferson Surgical Clinic Roanoke | 540.283.6000
Q : How has
recent gender specific research affected heart disease detection in women? The most important thing that has been learned from research on cardiac disease in women is that women are not simply “little men”. We experience symptoms of heart disease differently and it is a well-known fact that a woman is more likely to die of her first heart attack than a man. The important thing that we need to take from this is that we need to listen to our bodies. If you don’t feel well, you need to see a doctor. If you suddenly feel terrible and are experiencing, shortness of breath, chest pain or pressure, nausea with arm, neck or upper back pain or a combination of these symptoms and it doesn’t resolve within a few minutes you need to call 9-1-1 and get checked out.
Expert Contributors: Timothy Ball, MD with Carilion Clinic Cardiology in Roanoke. Matthew Bowles, PA-C with LewisGale Physicians in Salem and Westlake in Moneta. Molly Rutherford, MD, FACC with Jefferson Surgical Clinic in Roanoke. David Sane, MD with Carilion Clinic Cardiology in Roanoke.
Sources: American College of Cardiology – www.acc.org American Heart Association – www.heart.org Carilion Clinic – www.carilionclinic.org
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the 2016 OurHealth Southwest Virginia Primary Care Series: an issue-by-issue overview
+++ february
| march
KNOW YOUR CARE: understanding your health and how to maintain it
+++ words | JEANNE CHITTY and STEPHEN McCLINTIC, JR.
know
YOUR
care
An apple a day keeps the doctor away. This age-old proverb
april
| may
DO YOUR CARE:
Understanding your health and how to maintain it
certainly carries its share of credibility. People around the world live by it and keep their crispers crammed with the tasty treat. And it has spawned several studies by researchers about the health benefits of apples. No doubt about it, loyalty to apples is long-lived because this proverb professes how good they are for us.
Know what else is good for us? Going to a primary care doctor. Not keeping him or her away. Yes, doctors can help heal us when we’re sick, but they can also help us stay healthy, empower us with preparedness, and beat the bugs before they have a chance to bother us. Primary care doctors promise to be our health’s greatest advocate, our partner in prevention, our companion in care. OurHealth Southwest Virginia is pleased to introduce a yearlong series focusing on the role of primary care. In each issue throughout 2016, we will take a detailed look into the specialty, providing information that expands on some of what we might already know and much about what we might not. We will deliver insight from local doctors and other healthcare providers and share personal stories of people living in our communities. We will confirm what is correct and dispel what is not. Our commitment to you — our readers in the communities of Southwest Virginia — is this: We will help close the gap between your knowledge and your desire to learn more
taking action with your health
+++ june
| july
SHARE YOUR CARE: setting good examples for others to learn and live by
+++ august
| september
INSPIRE YOUR CARE: keeping creative with fresh care ideas
+++ october
| november
MEASURE YOUR CARE:
tracking your efforts to ensure you’re on the right path
+++ december
| january
CELEBRATE YOUR CARE:
rejoicing the rewards realized from taking good care of yourself
about primary care with the hope that you and your loved ones can cross the bridge toward a healthier life.
Angie’s Lesson on
the Importance of Primary Care That was Angie’s way of thinking. And why not? From the looks of her, she was more than the picture of good health — she was the poster child. A weekend and weekday warrior. We’re talking 5 miles at the track every morning before most people tap the snooze button. Daily diet? Dynamite. Body fat? Best it could be. Aches and pains? Free and clear. Sneezes and sniffles? Forget about it.
“I’m not going to a doctor unless I’m sick.”
It’s safe to say that Angie was fanatical about staying fit. She felt fantastic, looked fantastic. Her formula was foolproof. This lady was in control of her life, and she knew it. Fast forward four months. Angie still looks and feels as fabulous as ever. But her life has a taken a different direction. It all started over the course of a couple of weeks this past October.
“All of a sudden, I was just completely and utterly exhausted, so much so that I could hardly keep my eyes open on the drive home from work,” says Angie. “I found myself falling asleep at 7 in the evening and waking up at 5 in the morning, and I would still feel like I hadn’t slept for days.” Angie’s lethargy lingered for several days. Next came nausea, followed by the start of a sore throat. While she hated to admit it, Angie says she felt like she had the flu. “I hadn’t been sick since sixth grade,” Angie shouts. She consulted her best friend, Evan, a nurse, to get some care advice. He told her to do exactly what she already knew. “WelI, I always believed you only go to the doctor when you’re sick,” says Angie. “I couldn’t argue with myself, I supposed.” Evan helped Angie get an appointment the next day with the doctor he works for in Blacksburg. “Evan had been on me for years to get a checkup,” Angie admits. “I think he was a little excited I was sick so that I would finally go!” So at age 28, and for the first time since she was in middle school, Angie walked through the doors of a doctor’s office. Following a thorough physical exam complete with a battery of blood tests, Angie learned that pregnancy was the cause of her constant fatigue. “Ecstatic, overjoyed and still tired” is how Angie says she felt after finding out her good news. “Honestly, after I got to the doctor’s office, it kind of crossed my mind that I might be pregnant. My husband and I had been trying to start a family. I wasn’t completely surprised, but I was super excited!” She learned something else, however, that did completely surprise her. “My lab results came back showing that my cholesterol was through the roof,” she says. “At first, I thought it must have been a mistake. I mean, how could I have high cholesterol? I did everything the right way.”
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WHERE DO YOU PLACE YOUR PERSONAL CARE? Going to the doctor for an annual check-up seems like a stretch for so many people. It really isn’t though. A check-up is the best way to measure health and make adjustments if needed. Surprisingly, most people are more structured about properly maintaining items they own than they are about themselves. This measuring stick shows just a few examples. Shouldn’t your personal health be measured as well?
?
AUTO OIL CHANGE: Every year, vehicles are taken to a professional for state inspection. They are entrusted to an expert who ensures they are safe for the road. Oil changes every 3000 miles. Another check-up, another preventative step. On average, a car’s oil is changed five times a year to keep it running for the long term.
CAR TIRE ROTATION: Tires need preventative care too. To maximize their life, they get balanced and rotated by professionals every 5000 miles, or an average of three times a year.
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x|year
5
LAWNS:
x|year
4 x|year
3 x|year
1
x|year
The grass is greener and more weed-free than on the other side of the fence because it is entrusted to a lawn service professional to keep it that way through regular treatments. On average, lawns are serviced four times a year to remain picture perfect.
PETS: Annual shots and check-ups ups for the family dog, cat and other critters are the norm to keep them healthy and active.
Continued from page 36
Turns out that some things are out of our control, even if you’re a super woman like Angie. Additional testing revealed that Angie has a condition called “familial hypercholesterolemia,” an inherited genetic abnormality that can raise cholesterol levels despite a carefully managed diet and ample exercise. Left untreated, the condition can lead to serious heart disease and even death. Familial hypercholesterolemia affects about 1 in 500 people and is considered the most common type of inherited high cholesterol. It is treated with lifestyle changes and medication. “I spent a lot of time discussing my family’s health history with the doctor, and after finding out some facts from my parents, I learned that heart disease is what killed my grandfather, aunt and cousin,” Angie explains. “I also found out that my dad has been on cholesterol medicine since he was 29 and his sister since she was 22. None of us knew this hereditary condition was in our family until I was tested. It bothers me so much that it’s too late for those we’ve lost.” Learning she has familial hypercholesterolemia when she did was incredibly timely for Angie. During pregnancy, a woman’s cholesterol levels can increase by 25 to 50 percent, and most cholesterol-lowering medications are not recommended during this time. For women with familial hypercholesterolemia, it’s especially important to have their cholesterol levels closely monitored throughout pregnancy. Angie’s wake-up call has not only given her a new lease on life, it has also taught her one of the most important lessons in her life. “Knowing what I do now, I am actually a little ashamed that I was being so shortsighted about the importance of having a relationship with a doctor,” Angie shares. “I looked at going to one as a weakness, as a result of me not taking care of myself. It was such an inaccurate way of thinking. I get it now, though, and fortunately before it was too late. Going to the doctor is a part of a healthy routine. A physical gives you a baseline, an understanding of where you are in your health and where you need to be. It’s the most important information you need to know. I am so happy I learned such a valuable lesson that I can pass on to my child.”
There are numerous studies in medical journals that support the notion that having a primary care physician is beneficial to long-term health. A particular research paper in the International Journal of Health Services indicates that U.S. states with more primary care providers per capita have better health outcomes, including fewer deaths from cancer, heart disease or stroke.
Preventative Care Well/Sick Visits Minor Injuries Disease Management Including Patient Education Plans Serving VA Premier Members of All Ages
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What are the different types of primary care providers? The National Institutes of Health and the U.S. National Library of Medicine have designated these different types of primary care providers: » Internal Medicine physicians: Board-certified or board-eligible doctors who have completed a residency in internal medicine. They provide care for adults of all ages with numerous medical conditions. » Family Practice Physicians: Board-certified or board-eligible doctors who have completed a family practice residency. Their patients include children and adults of various age groups. They may also practice minor surgery and obstetrics. » Pediatricians: Board-certified or board-eligible doctors who have completed a pediatric residency. Their patients include newborns, infants, children, and adolescents. » Obstetricians/gynecologists: Board-certified or board-eligible doctors of this specialty may serve as a primary care physician for women. » Geriatricians: Board-certified doctors who have completed a residency in either internal medicine or family practice. They may serve as primary care physicians for elderly adults with complicated problems related to the aging. » Nurse practitioners (NPs) and physician assistants (PAs): These skilled health professionals go through different training and certification procedures than physicians do, but they are qualified to manage many of your health issues.
THE IMPORTANCE OF HAVING A PRIMARY CARE PROVIDER WHO KNOWS YOU AND YOUR HEALTH Think about having to go to a physician or healthcare provider who knows nothing about you when you’re feeling more tired than usual. That provider might not think it’s anything urgent, but your regular doctor would be more likely to see that your thyroid medication needs adjusting. Similarly, your primary care provider can reassure you in the event that you’re concerned about the freckles on your nose because they haven’t changed in the past several years. This kind of attentive relationship can make a big impact on the quality of your health because it establishes a continuity of care. Being able to deliver an accurate diagnosis and an appropriate treatment plan becomes much easier for a primary care provider who has thorough information about a patient. Having adequate data also eliminates the need for unnecessary tests and procedures. If the patient’s condition
requires a consultation with a specialist, the primary care provider will be able to coordinate cost-effective healthcare services for patients. Primary care providers promote health and prevention and strive to develop a sustained partnership with their patients. They are highly educated in the treatment of common medical conditions and offer long-term management of chronic conditions, which is important for patients whose conditions affect multiple organs, such as diabetes, hypertension and cancer. They also provide appropriate medical tests and screenings to develop a baseline of your health. Using their findings, they can recommend further testing, changes in medication, therapy, healthy diet and lifestyle choices and safe health behavior. If additional tests and treatments are needed, primary care providers are skilled in assessing the severity of medical conditions and can refer their patients to consulting specialists.
DEFINITIONS THE PRIMARY CARE PROVIDER CIRCLE OF
PRIMARY PREVENTION [pri mar y pre ven tion] noun: keeping patients healthy by preventing disease.
HEALTH
SECONDARY PREVENTION [sec on dary pre ven tion] noun: identifying diseases early to prevent complications. www.OurHealthswva.com
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THE PRIMARY CARE PARTNERSHIP What are your needs and wants in a primary care provider? »»
Would you feel more comfortable with a provider of the same or different sex as you?
»»
Do you prefer someone older or younger?
»»
Would you like your primary care provider to use alternative medicine?
»»
How easily accessible should your primary care provider’s office be?
»»
How convenient should their office hours be for your schedule?
»»
Does the doctor fall within your health insurer's “in-network” providers?
It’s all about trust between you and your provider. As in any partnership, there should be open communication between the patient and primary care provider. Most doctors will ask you to bring in the bottles for any medications you take (also any herbs or alternative medical products), in addition to asking you about the medical conditions, procedures, surgeries and hospitalizations you have had. In order to gain a better understanding of your lifestyle, they will question you about your use of drugs, alcohol and tobacco; your sexual preferences; and your exercise, diet and sleep habits. Your provider will listen to your specific concerns and conduct a thorough physical exam.
Dr. Dickens adds, “Ideally, the physician should elicit from the patient a list of health goals and concerns from which to work on subsequent visits.”
Honesty when it comes to one’s private health matters can be quite difficult for people of all ages. “Some patients don’t want to admit that they have a problem; some don’t believe in modern medicine; and some are afraid of what their families will think when they reveal what they’ve been doing,” says Dr. Joseph Baum of Floyd. Whatever the case, the physician needs to find the best way to overcome misperceptions and establish a comfort level for a truthful dialogue.”
By law, your health information cannot be disclosed to anyone else without your signed consent. During the first visit, Dr. Habib suggests touching on a sensitive subject that many people are reticent to discuss, saying, “I would recommend a discussion about end of life wishes such as resuscitation and intensive care. Not everybody shares the same views. For example, a 98-year-old patient or somebody with a terminal condition may not want to be resuscitated or treated in an intensive care unit but would rather spend the end of their life at home with their family.” Joseph Baum, MD is a family physician with Carilion Clinic Family Medicine in Floyd. Dr. Baum is certified by the American Board of Family Medicine.
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Along with regular checkups and screening tests, this data will provide a foundation upon which a continuity of care can be established over time.
OurHealth | The Resource for Healthy Living in Southwest Virginia
Rev. William Lee, pictured in front of the New Horizon Healthcare building in Roanoke.
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YOUR PRIMARY CARE PROVIDER AND SPECIALIST If you happen to require a consultation with an outside specialist for a new or chronic condition, your primary care provider has access to a vast network of highly qualified specialists who can give you a second opinion and the benefit of their expertise. What qualifies a doctor as a specialist? To be certified in a medical specialty, a physician must complete the traditional four years of medical school, followed by up to seven years of concentrated study in a specific field and a certification exam in that field. Joe Baum, MD, with Carilion Clinic Family Medicine in Floyd stresses the importance of board certification as a key factor when evaluating physicians. “Physicians who undergo board certification improve their core competencies for quality care by acquiring extensive clinical knowledge, mastering new skills, refining their communication abilities and participating in coordinated team care. This type of focused learning improves the outcome of your experience,” he says. In the event that you require additional testing, your primary care physician will make sure that you are promptly informed of your test results. The specialist typically communicates the findings to the primary care provider within two to seven days of the visit. “Doctors should work as a team,” says Roy Habib, MD, internal medicine specialist with LewisGale Physicians in Salem. “We communicate directly by phone or through electronic medical records. If a patient requires hospitalization, I will be directly involved in his care at the hospital where I have admission privileges,” he says.
Brian Dickens, DO is a family physician with Academic Primary Care Associates in Blacksburg. Dr. Dickens is certified by the American Osteopathic Association in Family Medicine and Osteopathic Manipulative Medicine.
“Primary care physicians will communicate with specialists when their patients are hospitalized, along with the hospitalist caring for them,” says Brian Dickens, DO, with Academic Primary Care Associates in Blacksburg. “Care coordinators are a fairly new member of the medical team who have significantly helped the transition from hospitalization to outpatient follow-up and restoration of health, acting as a liaison and advocate for patients as they make this transition.” Thus, the chain of communication is strengthened by a network of health professionals dedicated to supporting, maintaining and improving your health.
Roy Habib, MD, FACP specializes in Internal Medicine with LewisGale Physicians in Salem. Dr. Habib is certified by the American Board of Internal Medicine. www.OurHealthswva.com
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WHAT YOU SHOULD EXPECT DURING A TYPICAL FIRST VISIT WITH YOUR PRIMARY CARE PROVIDER “During the initial visit, the patient and physician get to know each other. It is important for the physician to know about the patient’s job, habits and personal and family history because this will help him to screen for certain diseases and to recommend specific treatment,” says Dr. Habib. Screenings and diagnostic labs may also be recommended. When it comes to these screenings and diagnostic labs, they “should always be patient-specific. Having said that, certain baselines only need to be established for certain patients,” says Wallisa Vaughn, MD, with Virginia Premier Health Plan Medical Home in Roanoke. “For example, an 18-year-old living in a college dorm will benefit from a vaccine for meningitis, while a 65-year-old adult or an asthmatic adult may need a vaccine for pneumonia,” says Dr. Habib. “A retired mine worker may need a screening for lung disease, while a person with a family history of colon cancer will need a referral
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OurHealth | The Resource for Healthy Living in Southwest Virginia
for a colonoscopy at a younger age than the usual recommended age for this test.” According to Brain Dickens, DO, “Baseline tests will vary depending on age group and risk factors. Some of the more common tests are a complete blood count, which checks for anemia; a comprehensive metabolic panel, which checks blood sugar, electrolytes, liver and kidney function; and a lipid (cholesterol) profile.” Years ago, it was considered customary to have a yearly physical and to undergo a series of standardized tests. But the current thought is that because each person is unique and has different health requirements, it is not cost-effective, affordable or sensible to have every patient see a doctor at the same time each year and take the same tests on the same schedule. Consequently, your primary care provider will tailor your checkup and subsequent tests and/or treatments based exclusively on the factors that define your life.
Finding a Primary Care Provider who is right for you Once you have analyzed your wants and needs, you have several ways in which to select a primary care provider. The easiest is to ask your friends and family for their suggestions, as well as other doctors. and nearby hospitals. most insurance companies
offer
an
online
database
of
local
in-network
and
out-of-network providers. You can also find providers who have been voted on by
What are some screenings that may be performed during a check-up to establish a patient’s baseline of care? »»
Blood pressure screening
»»
Cholesterol screening (for adults
the community, such as in OurHealth’s Best Bedside Manner Awards issue, which comes out every December.
SCAN HERE for the complete list
of certain ages or higher risk) »»
Colorectal cancer screening (adults over age 50)
»»
Depression screening
»»
Diabetes (Type 2) screening (for adults with high blood pressure)
»»
Lung cancer screening (for adults 55-80 at high risk for lung cancer)
»»
Obesity screening
Additional screening, testing or labs may include: »»
Complete blood count (may identify conditions such as anemia, infection, and other disorders)
»»
Comprehensive metabolic profile (a broad screening test used to check for conditions such as diabetes, and liver or kidney disease and provide an overall picture of your body’s metabolism and chemical balance)
»»
Thyroid studies
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What can you do to best prepare in advance of your first visit to a primary care provider? Your primary care provider will need the following information to best develop your care plan. Going to your doctor with this information already in hand is a good way to be ahead of the curve. » A list of all prescribed and over-the counter (OTC) medications and supplements you are currently taking. Bring the bottles of medications and supplements with you so the doctor can note all information needed, such as the number of milligrams for each, how often each is taken, etc.
“Patients should feel free to ask the doctor anything and everything that is important to their health.” -Wallisa Vaughn, MD
» A list of your family’s health history – parents, grandparents and other immediate family members — who have or had conditions such as heart disease, cancer, arthritis, depression, etc. This can require you to do some research. Asking your family members is the best way to start gathering this information. » A list of all known medical conditions, as well as procedures you have had, such as surgeries and hospitalizations and their dates. Come prepared with a list of questions about your general health, diet, exercise, sleep, medications, alcohol or drug use, etc. This is how you establish yourself as a partner in your healthcare, and it also helps you develop your relationship with your physician by demonstrating your willingness to learn and share. “Patients should feel free to ask the doctor anything and everything that is important to their health,” Dr. Vaughn, with VA Premier Health Plan, states. “Health begins and ends with the individual patient, not the work done by others. So it is important for patients to be ‘in the know’ regarding their own circumstances.”
Build your bridge to better health with
OurHealth’s Primary Care Series Wallisa Vaughn, MD is a family physician with VA Premier Health Plan Medical Home in Roanoke. She is certified by the American Board of Family Medicine.
The bridge to better health starts with Knowing Your Care and the options available to you. The information and resources available in this article should help you start your journey. Throughout this series, we will provide additional information on each series’ topic on our website, www.ourhealthswva.com. If you have questions that you would like to see highlighted in this series, please reach out to us anytime by email at steve@ourhealthvirginia.com. We are proud to be a resource in your plan for better health.
* Names and location have been changed for the privacy of the patient.
Expert Contributors: Joseph Baum, MD with Carilion Clinic Family Medicine in Floyd. Brian Dickens, DO with Academic Primary Care Associates in Blacksburg. Roy Habib, MD with LewisGale Physicians in Salem. Wallisa Vaughn, MD with VA Premier Health Plan in Roanoke.
Sources: National Institutes of Health – www.nih.gov
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Original Photography: Shawn Sprouse
Growler Gallup 5K at Soaring Ridge Craft Brewers
OurHealth staff photographer, Shawn Sprouse, captured some great images during the Inaugural Growler Gallup 5K held recently at Soaring Ridge Craft Brewers in Roanoke! The air was crisp and dry – making the conditions perfect for a fun race from start to finish! Music, food and beverages were on tap making it a fun and social end to the day! If you missed it, no worries! Did you know there are weekly pub runs sponsored by area restaurants and breweries? Featured runs can be found on the calendar of events at www.ourhealthswva.com. Walk, jog or run – whatever the pace, these runs are all about fun, fellowship, and food! 50
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New Kitchen New Nutrition New You! words | CYNTHIA BEMENT and TRICIA FOLEY, MS, RD
In 2016, our New Kitchen, New Nutrition, New You Series puts the focus on helping you get healthier in the kitchen — one ingredient at a time. Each edition of OurHealth will highlight small changes you can make in your food prep and shopping habits that can add up to a major positive impact on your nutrition and health. Our goal is to present you with suggestions you can use and build on that will help you create a healthier kitchen — and life — by year's end. Winter invites us to burrow under blankets, linger by the fire and enjoy warm, wonderful comfort food at every opportunity. Casseroles and soups spring to mind — the bigger the flavor, the better. However, these homey dishes can call for ingredients that — while meant to boost flavor and save prep time — might not be the best choices for your health. You can have it all, though, with dishes like the tasty One-Pan Taco Casserole, made healthier with a few tweaks. Read on to see how we've removed the nutritional pitfalls in this recipe and substituted healthier ingredients, and learn why making these changes (in this recipe and others) will create instant improvements in your wintertime nutrition. www.OurHealthswva.com
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Casserole
WATCH
It's that time of year again, casserole season! Assessing the following key ingredients can reveal the impact your favorite casserole recipe can have on your health.
Sodium
Ditch the Canned Goods & Invest in Spices
A lot of casseroles recipes are very high in sodium because they call for canned goods. To lower sodium content, opt for the fresh or frozen alternatives to canned ingredients. Another sodium trap can be premade spice packets. You can decrease sodium while adding lots of flavor by using herbs and spices.
Saturated Fat
Leaner Meat & Less Cheese
Most casserole recipes containing meat (specifically ground beef) and cheese are high in saturated fat. The leaner the meat you can buy the better. Also, cut back on the amount of cheese called for and use 2 percent instead of full-fat cheese.
Sugar
Reduce Sugar Whenever Possible
Casserole recipes are often very high in sugar. Watch premade tomato-based products such as ketchup and tomato sauce. Look for the ingredient listing on a product. 54
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A recipe for success: Scrutinize ingredients Whenever you try out a new (or reinstate an old) casserole recipe, assessing its key ingredients can reveal the true measure of the dish’s impact on your health. One of those ingredients is sodium. “A lot of casserole recipes are very high in sodium because they call for canned goods,” says Tricia Foley, a registered dietitian and board member of the Southwest Virginia Academy of Nutrition and Dietetics. “For example, a cup of tomato sauce has 1,284 milligrams of sodium, and Americans only need about 1,500 milligrams a day according to the American Heart Association, so that's almost the full amount in that one cup.” To lower sodium content, opt for fresh or frozen alternatives to canned ingredients whenever possible, such as dicing your own fresh tomatoes or using frozen instead of canned green beans. Another sodium trap can be premade spice packets, such as taco seasoning, used here in our pretweaked, original recipe. Instead, Foley suggests investing in individual spices as alternative seasonings in your recipes. “People can decrease their sodium and still have lots of flavor by using herbs and spices. And unlike baking, cooking isn't a scientific thing. You can play around, and it probably won't be a disaster.” Next on the offender list is saturated fat. Meats — ground beef in our recipe — and cheeses can be big culprits, so study nutritional labels for these ingredients to make sure they’re not taking your dish into the danger zone. For ground beef, Foley suggests going as lean as possible. “Even 85-percent lean is very fatty. You want to limit your saturated fat to about 5 to 6 percent of your daily caloric intake. Buying 95-percent-lean ground beef and draining it after browning helps to reduce saturated fat.” Cheese is often over-loaded in casserole recipes, according to Foley. She suggests cutting back on the amount of cheese called for and using 2-percent fat instead of full-fat cheese, which will cut saturated fat and allow other flavors to shine through. Sour cream is another common high-fat ingredient. Swapping it for plain or Greek yogurt lowers saturated fat while adding protein, she says. The third big nutritional downfall of many casserole recipes, which may be surprising, is sugar. One
WATCH FOR IT IN OUR NEXT ISSUE
frequently used ingredient category to analyze is premade tomato-based products like ketchup and tomato sauce. “Look for tomato sauce with less than 3 grams of added sugar per serving,” Foley suggests, and buy reduced-sugar versions when possible. Also look at the ingredient list on the product to make sure it does not contain high fructose corn syrup. Premixed seasoning packets can also contain high amounts of sugar.
Celebrating Spring with Healthier Salads
One last healthy swap that’s beneficial to any recipe, especially casseroles, is bringing in a higher-fiber alternative to pasta. In the updated One-Pan Taco Casserole, we’ve replaced white rotini pasta with black beans, which, according to Foley, will add more fiber as well as vitamin B, magnesium and folate. Substituting whole-wheat pasta for white pasta is also a good move if it’s accompanied by an overall reduction in the amount of pasta called for (example, reduce 1 cup of regular, white pasta to 1/3 cup whole-wheat pasta). One last healthy swap that’s beneficial to any recipe, especially casseroles, is bringing in a higher-fiber alternative to pasta. Here, we’ve replaced white rotini pasta with black beans, which according to Foley will add more fiber, as well as vitamin B, magnesium and folate. Substituting whole-wheat pasta for white pasta is also a good move if it’s accompanied by an overall reduction in the amount of pasta called for (example: reduce 1 cup of regular, white pasta to 1/3 cup whole wheat).
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Get label-literate Even with all the information currently available on food packaging, making sense of it is still an issue for most of us. In order to successfully make healthy changes in your cooking and food shopping habits, being able to understand food labels will serve you well, says Foley. “Take the time to check the ingredients list, not just the nutrition label,” she says. Ingredients are listed by weight, most to least, so pay close attention to the first five ingredients, while also looking for those ending with “-ose,” which are what Foley calls “sugar words,” such as sucrose, fructose and dextrose. On the label portion, it can be tough to conceptualize the amount of each nutritional component listed. Foley’s trick: think visually. “Everything is in grams, and our brains don't think in grams,” she says, citing sugar as an example. “Four grams of sugar is equal to 1 teaspoon of sugar. That's an easy way to convert it in your mind and give yourself a visual.” Taking time to analyze each recipe in your current casserole repertoire as well as any new recipe you consider trying takes practice and attention to detail. “It’s multifactorial,” says Foley, “you have to look at the whole recipe and each ingredient in it.” Start incorporating these healthy swaps into your comfort mainstays now, and by next winter, you’ll be making the healthiest, most delicious casseroles at any potluck — not to mention at your own table.
Continues with the Healthy SWAP recipe on page 58... 56
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Tricia Foley’s
ONE-PAN TACO DISH Tricia Foley is OurHealth Magazine’s resident nutritionist.
Looking for more? For more healthy recipes with similar ingredients, scan here or visit our website at www.OurHealthswva.com! 58
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Healthy Regular Ingredients
SWAP
Healthier Ingredients
1.5
pounds ground beef
1.5
pounds 95% LEAN ground beef or turkey
2
tablespoon canola oil
2
tablespoon olive oil
½
of a large white onion, diced
½
of a large white onion, diced
8
ounces uncooked rotini pasta (8 ounces = 2.5 cups)
1
15.5 ounce can of black beans
2
tablespoons low sodium chicken broth
2
cups low sodium chicken broth
1
15 ounce can of diced tomatoes
1
15 ounce can of diced tomatoes
1
8 ounce can tomato sauce
1
8 ounce can tomato sauce
2
heaping tablespoons plain Greek yogurt
2
heaping tablespoons of sour cream
1
teaspoon garlic powder
1
package of taco seasoning
2
teaspoon chili powder
1.5
teaspoon salt
1
teaspoon paprika
2
cups shredded Colby-jack cheese
2
teaspoon cumin
ground pepper to taste
salt and ground pepper to taste
1
cup shredded 2% Colby-jack cheese
Toppings
Avocado
Toppings
Green onions
Avocado
Black olives
Green onions
Hot sauce
Black olives
Colby-jack cheese
Hot sauce
2% Colby-jack cheese
Instructions: Sauté onions in oil over medium heat, just until softened. Add ground beef to pan and brown, breaking up meat as it cooks. Season meat with one packet of taco seasoning (follow directions on back of package). Once beef is cooked, add tomatoes (un-drained), tomato sauce, chicken broth, dried pasta, and seasoning as well as an additional ½ teaspoon salt. Bring to a simmer, cover and reduce heat to low. Cook 12-15 minutes, or until pasta is tender. Meanwhile, prep toppings by shredding cheese, dicing tomatoes, green onion and avocado. Once pasta is tender, remove from heat and stir in two heaping tablespoons of sour cream and one cup of cheese. Top with additional cheese, and cover to allow cheese to melt. Once melted, add toppings (tomatoes, avocado and green onion).
Instructions: Sauté onions in oil over medium heat, just until softened. Add ground beef to pan and brown, breaking up meat as it cooks. Once beef is cooked, add tomatoes (un-drained), tomato sauce, chicken broth, black beans, and spices as well as salt and pepper to taste as needed. Bring to a simmer, cover and reduce heat to low. Cook an additional 1-2 minutes. Meanwhile, prep toppings by shredding cheese, dicing tomatoes, green onion and avocado. Remove contents from heat and stir in two heaping tablespoons of Greek Yogurt and one cup of cheese. Add toppings (tomatoes, avocado and green onion and sprinkle additional cheese on top as desired).
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OurHealth | The Resource for Healthy Living in Southwest Virginia
FIT BITS WHERE LAND MEETS WATER
AQUA KICKBOXING Have you ever tried a kickboxing class? It’s an energizing, powerful, uplifting and effective way to burn calories and tone muscles – but, it is also very tough on the joints. Kickboxing in water helps prevent injuries by lessening joint impact, but the additional resistance created by the water strengthens and tones muscles for an extremely intense and effective workout!
F I T NES S O N THE GO
GREEN RIDGE RECREATION CENTER 7 4 1 5 WO O D H AV EN ROA D ROA NO K E, VA 2 4 0 1 9 | 5 4 0 . 7 7 7.6300 W W W. G R EENR I D G ER ECR EAT I ON CEN TER.COM
SCAN HERE
TO V I S I T T H EIR W EBS ITE
This innovative aquatics program combines the benefits of water’s buoyancy and resistance to increase muscle strength, endurance, agility, coordination, balance, and core stability.
IO CA RD
GT H EN ST R
G TO NI N
BA L
AN
CE
Aqua Kickboxing classes are now being offered at Green Ridge Recreation Center. This innovative aquatics program combines the benefits of water’s buoyancy and resistance to increase muscle strength, endurance, agility, coordination, balance, and core stability. The class incorporates traditional kickboxing moves – kicks and punches wearing weighted gloves – in the water. Work at your pace while gaining new skills to boost overall fitness. This class is suitable for all fitness levels.
H EA LT H A ND
MODERATE INTENSITY
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OurHealth | The Resource for Healthy Living in Southwest Virginia
HealthyEats Doe Creek Farm 412 Doe Creek Farm Road Pembroke | 540.922.2705 www.doecreekfarm.com Doe Creek Farm is a family owned apple orchard located in Giles County. They are committed to continuing their tradition of offering a wide variety of pick-your-own apples and homemade apple products throughout the fall season. In addition, they also offer wine and have weddings on their farm.
Tricia Foley’s Fabulous
FRENCH TOAST CASSEROLE Tricia Foley is OurHealth Magazine’s resident nutritionist.
Ingredients: (serves 9)
Filling Ingredients:
3
3 3
cups finely diced uncooked apple pieces (Honey Crisp or Gala recommended) tablespoons local honey
1
teaspoon lemon juice
whole eggs (omega 3 rich preferably)
1 1/2 cups organic 1% milk 2
tablespoon, local honey
1
teaspoon vanilla extract
1/2 teaspoon cinnamon 9
slices 100% whole wheat bread
1/3 cup diced raw pecans 1/2 teaspoon cinnamon ½ teaspoon nutmeg
Directions: Add the first six ingredients to a medium sized bowl, whisk to combine. Lightly coat the inside of the slow cooker with nonstick cooking spray. Combine all of the filling ingredients in a small bowl and mix to coat apple pieces, set aside. Cut bread slices in half, as triangles. Place one layer of bread (six triangles) on the bottom of the slow cooker, add ¼ of the filling and repeat until there are 3 layers of bread. Add the remaining filling to the top. Pour egg mixture over bread. Cover and cook on high 2 to 21/2 or low 4 hours, or until bread has soaked up the liquid.
Optional: Drizzle with 100% pure maple syrup if desired.
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HealthyEats
A Taste from
Black Sheep Family Farm 1378 Shooting Creek Road Floyd | 828.989.7715 www.facebook.com/blacksheepfamilyfarm Black Sheep Family Farm grows a variety of delicious vegetables on four acres in Floyd County. Their mountain farm uses creek water for irrigation and is operated by local families. Black Sheep foods are Certified Naturally Grown - fertility is generated by compost applications. Their beautiful, tasty, and nutritious produce reflects the care they put into building healthy soil.
Tricia Foley’s Creamy
SWEET POTATO & CAULIFLOWER MASH Ingredients: (serves 4-6) 6
sweet potatoes
1
pound cauliflower florets
3
tablespoons organic milk of choice
¼ cup plain Greek yogurt ½ teaspoon garlic powder Salt and pepper to taste Fresh chopped parsley as desired
Tricia Foley is OurHealth Magazine’s resident nutritionist.
Directions: Peel and cut sweet potato into 1 ½ -inch chunks. In large pot, steam sweet potato and cauliflower with one inch of water in bottom of pot. Allow to steam for approximately 10 to 12 minutes, or when fork tender. Place in large bowl and mash the potato and cauliflower with the milk. Stir in the greek yogurt, garlic powder, salt and pepper. If too thick, add additional milk one tablespoon at a time, until desired consistency is accomplished. Sprinkle with chopped fresh parsley.
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HealthyEats
Local Maple Syrup from:
Big Lick Farm and Community Market 1626 10th Street, NW Roanoke | 540.728.1767 www.lickrun.org Lick Run is a community center located in the Washington Park neighborhood. Their goal is to provide fresh, healthy, and affordable produce to their neighbors and surrounding community. They have an onsite public market every Saturday from 2:00 pm - 5:00 pm where you can come out and join the community.
Tricia Foley’s Sweet and Light
PUMPKIN ICE CREAM Ingredients: (serves 6) 4
medium bananas, sliced and frozen overnight
1
cup pumpkin puree
1/3 cup maple syrup 2
teaspoons pumpkin spice, no sugar added
Tricia Foley is OurHealth Magazine’s resident nutritionist.
Directions:
Using a food processor, blend the bananas, pumpkin, maple syrup, and pumpkin spice thoroughly. Transfer to a freezer-safe container and freeze for 24 hours.
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The Henry Family of Roanoke
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OurHealth | The Resource for Healthy Living in Southwest Virginia
A Blood Donor
SAVED
His Life!
words | TINA JOYCE
Krislyn Henry speaks with the tenderness of a first-time mom. Her words are sincere and full of gratitude and relief. Henry shares a common, but rarely told story; she knows a blood donor saved her child’s life. Born prematurely at only 26 weeks, tiny Parker Henry came into this world as a 2-pound, 3-ounce Valentine’s Day gift in 2015. His early arrival created much concern for his parents, Krislyn and Michael Henry of Roanoke, and for the medical team at Carilion Roanoke Memorial Hospital. The Henrys knew the days and weeks ahead would be difficult for their first child. As with most premature infants, Parker’s organs and body systems were unable to function on their own, still needing almost three more months to properly develop. Lifesaving technology helped keep his organs progressing. His weak body worked hard each day to provide enough oxygen to his tissues. “Doctors came and asked us if we were OK with a blood transfusion,” remembers Henry. “‘A transfusion is really the best thing for him,’ they said. From that point, there was really no second guessing.” The transfusion immediately helped restore color to the infant, and physicians in the neonatal intensive care unit saw significant improvements. “Without the transfusion, things could have been very bad; his body would have used up everything he had,” says Henry. Parker received two transfusions during his 82-day stay in the NICU.
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Kim Ramsey, neonatal clinical nurse specialist in Carilion’s NICU, explains, “Infants do not begin to make their own red blood cells for several weeks after birth, and because premature infants are often born before the third trimester of gestation [like Parker], they do not receive the iron transported from the mother, which occurs late in the pregnancy.” Of course Parker is only one example of countless recipients who need lifesaving transfusions. Bryan Collier, DO, section chief and medical director of Carilion Clinic Trauma Services, explains, “Transfusions are not everyday events, but at least one patient each day is being evaluated. We are always evaluating the need, and I would estimate that more than 500 patients a year receive transfusions here.” According to Dr. Collier, a patient needing a blood transfusion usually falls into one of three categories: a trauma patient who is likely to bleed to death, a patient requiring multiple surgeries (who might also be a trauma patient) or a patient who has thin blood (often from medication). “A trauma patient, a victim of a car accident for example, might require 10 to 20 units of blood. The reserve could be gone in one incident,” explains Dr. Collier. Typically a donor provides one unit of whole blood (approximately 1 pint) in a single donation. Therefore, several donors are required to meet the needs of one trauma patient. “Our population majority is growing older and sicker. The use of blood thinners is increasing; therefore, bleeding trouble is also increasing. Donors are always needed. Donated blood is rarely wasted. Blood banks and hospitals work diligently to use resources efficiently.” - Bryan Collier, DO
A blood bank or blood center is a facility, sometimes located within a hospital, where blood is processed. The donor’s blood type is determined (O positive, for example) and then the donated blood is separated into components, stored and prepared for transport to hospitals and clinics to be used for patient transfusions. Blood collection can take place at permanent donation centers or mobile blood drives. Bryan Collier, DO specializes in trauma and surgical critical care with Carilion Clinic. Dr. Collier is certified by the American Board of Surgery with a subspecialty in Surgical Critical Care.
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Kim Ramsey, RNC is a Neonatal Clinical Nurse Specialist with Carilion Clinic.
OurHealth | The Resource for Healthy Living in Southwest Virginia
According to the American Society of Hematology, approximately one-third of the American population is eligible to donate blood, but only 10 percent donates. With nearly 5 million people receiving blood transfusions every year, donors are in constant demand.
Interestingly, Krislyn Henry has been a regular blood donor for years. She has worked for companies that held blood drives, and as a child, she accompanied her father when he donated blood. “My dad always donated blood, and I looked up to him. It is just what we did. I remember observing him and the whole process. The first time I gave blood was in high school,” remembers Henry. “It never really dawned on me that all those years that I was donating blood, I could be saving the lives of babies. The need does not discriminate.” - Krislyn Henry
According to Chelsea Sheppard, MD medical director of Virginia Blood Services, blood banks consider two things when seeking a blood donor: whether the person healthy enough to donate and whether his or her blood is safe enough to be donated. The American Association of Blood Banks Donor History Task Force developed a uniform donor history questionnaire — approved by the FDA for use and required for licensed facilities — that is given to donor prospects early in the screening process.
Once the initial screening takes place and the donor’s eligibility is confirmed, the process of whole blood donation can be completed in about 30 minutes. 1. Donors schedule an appointment or find a blood drive at www.vablood.org. 2. They then undergo a mini-physical that includes checking temperature, pulse, blood pressure and hemoglobin levels. 3. Next donors recline for eight to 10 minutes (longer for specific donations) with trained staff from the organization drawing blood intravenously. 4. Finally donors enjoy light refreshments for 10 to 15 minutes in a reception area to be sure your body has no adverse reaction to the blood loss. Once a donor’s blood is collected, it undergoes a thorough screening process and is tested for numerous viruses and diseases until determined safe. It is important to understand that donating blood should never be used as a way to test for viruses. Local health departments offer testing, as do primary care physicians. Many towns also offer free testing clinics for those without insurance. One donation can help support up to three patients’ lives www.OurHealthswva.com
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Find OurHealth on social media according to Virginia Blood Services. “We have no artificial substitute, so we require blood donors in order to procure this valuable resource for people in need.” - Chelsea Sheppard, MD
Parker Henry is now a healthy and vibrant child approaching his first birthday. His rapid turnaround resulted primarily from two transfusions along with the excellent care he received. Without the generous contributions of anonymous blood donors, blood products and services provided by Virginia Blood Services and the medical team, Parker wouldn’t have his optimistic prognosis. To learn more about becoming a lifesaving hero by donating blood, visit www.vablood.org or call 800.989.4438.
Expert Contributors: Bryan Collier, DO with Carilion Clinic Trauma Services. Kim Ramsey, RN with Carilion Clinic NICU. Chelsea Sheppard, MD, Medical Director of the Virginia Blood Services.
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Chelsea Sheppard, MD medical director for Virginia Blood Services provides answers to some commonly asked questions.
Q:
What blood type is in the greatest need or used most often?
All blood types are always needed. The need for blood remains constant. With our mission to collect responsibly and collect to the need of our patients, different blood types are encouraged to donate for these varying needs. O-negative blood type is the universal blood type, meaning anyone can receive this blood type. Only 7 percent of the population is O-negative, making this a rare and desirable blood type. Whole Blood: contains red cells, white cells, and platelets suspended in plasma.
[
]
Double red cell donation is similar to whole blood donation, except a special machine is used to allow you to safely donate two units of red blood cells during on donation while returning your plasma and platelets to you.
Platelets: small colorless cell fragments in blood with the main function of aiding clotting to stop or prevent bleeding. Plasma: the clear liquid portion of blood containing water, salts, enzymes, antibodies and other proteins.
Below are the most needed blood types and components. A-positive: Platelet donation A-negative: Whole blood donation or double red cell donation B-positive: Platelet donation B-negative: Whole blood donation or double red cell donation O-positive & O-negative: Whole blood donation or double red cell donation
Q:
How often do you face blood shortages?
Traditionally, holidays and summer months are great times of need. There is increased demand and less supply, given a decrease in donations being made due to travel and other holiday-related activity.
Q:
What steps should a person take when considering a blood donation?
Donors must be at least 16 years old and weigh at least 110 pounds. (Written consent is required for 16-yearold donors.) Our donor history form and mini-physical quickly tell donors if there is any reason why they should not give blood. If you question your ability to donate, you should sign up and talk to a blood service representative. It is important to hydrate and eat before donating. Do not donate on an empty stomach and be in good health.
Q:
What complications are most commonly experienced during a typical blood donation?
Occasionally, donors may feel light-headed after a donation. Our staff is fully experienced and equipped to help with any reaction that may occur.
Q:
If you could put out a plea to the public about donating blood, what would you say?
Patients rely on this generous gift every day. The act of blood donation extends beyond the patient; a donation impacts the patient’s extended network — a mother, a father, a brother, a sister and other friends and family. Donating blood can help prevent a loss and gives patients hope, strength and courage.
AB-positive & AB-negative: Plasma donation 73
YOUNG AT HEART Brought to you by the Salem Art Center
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