OurHealth Roanoke & New River Valleys Jun/Jul 2013 Edition

SALEM RED SOX PITCHER

SUMMER SKIN CARE MORE

why sports are good for kids

JUNE

•

THE CHANGING ROLES OF HOSPITALS IN SWVA

J U LY 2 0 1 3 | S O U T H W E S T V I R G I N I A E D I T I O N | O U R H E A L T H V I R G I N I A . C O M

discuss men’s health, her cancer scare and teaching their children

living a balanced life the importance of

THE 40-YEAR-OLD CHECK UP: IT MATTERS

our health | BASIC

table of contents |june • july 2013

26

COVER STORY MEDI•CABU•LARY.....................12 Local experts define healthcare related terms

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

Governor Bob McDonnell and First Lady Maureen McDonnell discuss men’s health, her cancer scare and teaching their children the importance of living a balanced life

A variety of health questions answered by local professionals

THE LATEST...............................15 A listing of new physicians, providers, locations and upcoming events in Southwest Virginia

HEALTH AND FITNESS ON THE GO..................................19 Health-focused apps you can download to your smartphone or tablet

HEALTHY AT 40..........................21 Turning 40 can be confusing, frustrating and an emotional burden. Our Health shares local experts’ opinions on why it doesn’t have to be

HOSPITAL CHANGES.................31 In sickness and in health: the changing role of hospitals

NUTRITION.................................39 Healthy Eats: seasonal recipes

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45 SKIN

Beware of the sun this summer!

43

KIDS CARE Minor league play. Major league attitude.

CLINICAL TRIALS CORNER.......55 Clinical research studies are looking for participants

THE FOOT...................................58 A new ankle brings a new outlook on life

D-DAY..........................................63 Taps for Evelyn Kowalchuk, RN: Angel of Mercy for D-Day injured

SENIOR LIVING...........................69 Traveling smart

www.ourhealthvirginia.com | 9

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june • july 2013

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McClintic Media, Inc. Stephen McClintic, Jr. | steve@ourhealthvirginia.com Angela Holmes Jennifer Hungate Karrie Pridemore Bron Duncan Laura Scott Adapt Partners and Brain Swell Media

CONTRIBUTING MEDICAL EXPERTS John Buyer, DDS, MPH, MS, PLLC Alan Brijbassie, MD Tina Clements, RST John M. Dovie, OD, FAAO Tricia Foley, MS, RD David Keilman, MD Nicole Kaltz, LAc Joe Grooten, MS Sue Ranson CONTRIBUTING PROFESSIONAL WRITERS Sarah Cox Anika Imajo Susan Dubuque Rich Ellis Rick Piester ADVERTISING AND MARKETING Kim Wood P: 540.798.2504 kimwood@ourhealthvirginia.com

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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher: 305 Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.355.3071 Information in all print editions of Our Health and on all Our Health’s websites, including: www.ourhealthvirginia.com is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions.

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

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our health | MEDI•CABU•LARY & JUST ASK

me d i • ca bu • l ar y

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

What is Cyclic Vomiting Syndrome?

Cyclic vomiting syndrome (CVS) is characterized by cycles of severe nausea and vomiting that last for hours to days that alternate with symptom-free intervals. Episodes tend to resemble prior episodes with the onset usually at the same time of day and lasting the same duration of time. Although the syndrome can begin at any age, it usually commences in children between age 3 and 7 and can affect all age groups thereafter.

CVS can be hard to diagnose as there is no specific blood or imaging investigations that can be done. The doctor must look at the medical history to exclude other common conditions. The diagnosis usually takes time as the pattern or cycle unique to the vomiting has to be identified.

Alan Brijbassie, MD Carilion Clinic Gastroenterology Roanoke | 540.224.5170

What is the Activities in Motion program at LifeWorks Health and Rehab centers?

The Activities In Motion program at LifeWorks Health and Rehab centers is a company exclusive activities program designed to motivate both the mind and the body through dynamic groups.

Integrated with LifeWorks Rehab, Activities In Motion maximizes the patient’s potential to attain the best possible quality of life outcomes.

Each series of therapeutic activities in the program complements the patient’s clinical rehabilitation goals, cultivates good physical health and mental well-being, and continues life-long interests and routines.

The Exercise Series promotes physical health and focuses on energy and movement for strength, endurance, balance, coordination, and flexibility. The Recreation Series focuses on fostering independence, social-interaction, and community living and emphasizes lifelong enrichment, increased activity levels, and personal satisfaction.

The Imagination Series focuses on mental exercise and inspires creativity, individuality, and resourcefulness. This distinctive combination of exercise, recreation, and imagination is part of a complete provision for patient wellness.

Joe Grooten, MS Medical Facilities of America Roanoke | 540.776.7568

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What is an end-of-life doula?

What is a 3-D cone beam?

The word “doula” comes from an ancient Greek word meaning “a woman who serves”. Doulas traditionally are associated with childbirth and provide support to the mother through labor, birth, and even beyond. End of life doulas are specially trained hospice volunteers (men and women) who sit with patients as they are dying when the family requests this special type of supportive presence. Hospice doulas do not perform medical care. Instead, they are helpful by being present and providing a variety of services such as companionship, a listening ear, and a calming presence. If the family desires, the doula may also encourage reminiscing and family rituals, such as prayer, singing, and reading. Doulas affirm to the patient and family that their lives still matter and we are there to share this sacred time together.

Cone Beam or 3D dental imaging is a short term for Cone Beam Computerized Tomography or CBCT. There are other terms but we generally shorten the name to cone beam of CBCT. It is a computer enhanced volumetric analysis of hard tissues. In simple terms, it is an image acquisition system using a narrow cone shaped beam that rotates around the patient where it is collected on a receptor screen.

The computer digests the data and transforms it into a diagnostic image. The sensitivity of the receptor screen allows significantly less radiation dose for a complex diagnostic image. This technology continues to improve. Using additional computer software, we are able to view specific slices of a 3D image and add virtual implants or hardware to plan for dental implants and/or plates for facial reconstruction.

Sue Ranson President/CEO Good Samaritan Hospice Roanoke | 540.776.0198

John Buyer, DDS, MPH, MS, PLLC New River Periodontics Blacksburg | 540.951.4848

our health | MEDI•CABU•LARY & JUST ASK

ju st a sk!

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

What are the signs of sleep deprivation in children?

Do sunglasses really protect my eyes?

In today’s busy world we often forget that sleep is one of the most important functions of the body. Sleep deprivation in children can manifest itself in several ways. Students may exhibit poor performance at school, have problems with attention and focus, and get moody or depressed. Sleep deprivation can cause physical problems such as headaches, blurry vision, dry itchy eyes, aching and weight gain. Your child may become accident prone or get excessively sleepy throughout the day, nodding off in class, or in the car on the way home. To prevent sleep deprivation, limit activities, have them unwind an hour prior to a set bedtime, and create a calm, inviting atmosphere in which to sleep.

Yes! The ultraviolet rays (UV) that we are exposed to from the sun are associated with an increased risk of many ocular diseases, including cataracts and macular degeneration. In addition, the eyes are also one of the most common sites for skin cancer, like basal and squamous cell carcinoma.

Tina Clements, RST Sleep EZ Diagnostic Center Salem | 540.375.7735

UV radiation also contributes to photo accelerated aging, or photoaging. This process damages collagen and elastin, changes pigmentation, and increases wrinkles in skin.

When selecting lenses, look for labeling that insures protection from both UV-A and UV-B rays, and ensure the lenses absorb at least 90% of UV radiation. Remember, more coverage is better—so select frames that cover the eye well and have some wrap to protect the sides.

John M. Dovie, OD, FAAO Blacksburg Eye Blacksburg | 540.953.2020

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Why should I have preventative screenings if I don’t have health problems?

Preventative screenings have been proven to save lives by helping us detect diseases at their earliest stages when they are often easier to treat. In addition, there are many conditions that may not have symptoms early on but can still be taking a toll on your health. High cholesterol, diabetes, and high blood pressure are great examples.

In fact, high blood pressure has been called the silent killer.

Screenings such as mammograms, colonoscopies and pap smears can also help detect cancer at an early stage when there is the greatest chance for a cure.

To determine what screenings you should undergo and at what frequency, it’s important to consult your physician. Your physician can determine what screening tests are appropriate for you depending on your age and other risk factors.

David Keilman, MD LewisGale Physicians Valley View Family Practice Roanoke | 540-265-1607

Can acupuncture help with my seasonal allergies?

Yes! Acupuncture is a noteworthy and effective treatment for allergies.

This time honored tradition works by alleviating the acute symptoms allergies produce, as well as addressing its underlying causes.

In Western medicine we recognize that allergies are the result of a heightened immune response, but under an acupuncture’s care the intention is, “Why is the immune system responding in this way?”

A diagnosis is then determined through observation of each person’s unique constitutional imbalances, which are thought to be at the root of the condition, giving rise to their specific symptoms. In this way the whole body is treated.

Therefore, acupuncture can help control the acute symptoms, strengthen the immune response and prevent future occurrences, all without negative side effects.

Nicole Kaltz, LAc Roanoke Community Acupuncture Roanoke | 540.981.9170

THE LATEST | our health

the l atest

Stefanie Neel, PA-C New River Dermatology Blacksburg | 540.953.2210

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

Ry Bohrnstedt, DO New River Dermatology Blacksburg | 540.953.2210

Aneysa C. Sane, MD Carilion Clinic Allergy and Immunology Daleville | 540.591.9447

Benjamin D. Ernst, DO Carilion Clinic Family Medicine Roanoke | 540.265.5500 Bedford | 540.586.4723

Trevor Johnson, CO Virginia Prosthetic, Inc. Christiansburg 888.366.8287

Newman, Blackstock & Associates has opened a new SW Roanoke County location. They have moved from their Tanglewood mall location into a new facility on Franklin Road. Their new address is 3763 Franklin Road. For appointments call 540.989.6515.

River Ridge Dermatology opens Giles County Office Chad Johnston, River Ridge Dermatology’s lead doctor, is providing medical and surgical dermatology services at the practice’s new location now. Patients may now make appointments by calling 540.951.3376 “I am pleased to expand River Ridge’s service area with our Pearisburg office,” said Johnston. “Our new location will make it easier for residents to Giles County and southwestern West Virginia to receive dermatology care closer to home.”

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our health | THE LATEST

the l atest

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

LewisGale Regional Health System Appoints New Chief Nurse Executive LewisGale Regional Health System is pleased to announce the promotion of Charlotte Tyson, R.N., MBA, to the role of Chief Nurse Executive. Charlotte brings nearly 30 years of healthcare leadership experience to this newly created position, most recently as the Chief Operating Officer for LewisGale Medical Center in Salem, Virginia.

“This new position will give me an even greater opportunity to make a difference in the lives of our patients.” said Charlotte.

“From my early days as a nurse at the bedside to my recent years managing those at the bedside, I’ve always had a passion for delivering exceptional patient care. “ In her new role, Charlotte will be responsible for all nursing services and nursing leadership at LewisGale Medical Center. She will also work in partnership with the Chief Nursing Officers at the other three LewisGale

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hospitals to oversee the ongoing structure and development of nursing and nursing leadership for the market. In addition, she will head up the Chief Nursing Officer’s counsel for the health system. Charlotte will also work closely with LewisGale’s President as well as the Chief Medical Officer to further develop the market’s quality agenda.

“Nurses are the backbone of our health system and often the first encounter our patients have with LewisGale,” said Victor Giovanetti, President, LewisGale Regional Health System. “This new position will allow us to continue to reach new heights in clinical excellence. With Charlotte’s leadership skills, compassion for patients and commitment to high-quality care, we will continue be a healthcare leader in this region and beyond.”

The search for a new Chief Operating Officer for LewisGale Medical Center is underway.

About LewisGale Regional Health System.

LewisGale Regional Health System includes 38 HCA-owned patient care facilities including 4 hospitals, 2 regional cancer centers, 6 outpatient centers and affiliations with nearly 700 physicians, including 135 employed providers and 550 independent physicians. With 3,100 employees, its annual payroll is $220.7 million.

The system also paid $35 million in taxes and provided more than $96 million in uncompensated care to those most in need in 2011 alone. LewisGale is also part of HCA Virginia, the largest and most comprehensive healthcare provider in the Commonwealth with more than 13,000 employees. For more information see www. lewisgale.com.

HEALTH AND FITNESS ON THE GO | our health

Health and Fitness

On the Go

Heading out the door and wondering if you should grab sunscreen, tissues, or both?! In our new Health and Fitness on the Go section, we recommend a variety of health-focused apps you can download to your smartphone or tablet.

Allergy Alert (from Pollen.com)

Plan your day, or even week, with this easy to follow allergy app.

Allergy Alert provides index levels for four different conditions: Allergy (pollen), Asthma, Cold & Cough, and UV Sensitivity. You can also get an idea of what which pollens may affect you the most. You’ll always know when to grab the tissues and sunscreen!

Android

This app features loads of training tools to help you stay on track: »» Today’s allergy forecast »» 4-day extended forecast »» Which pollens are predominant right now »» Allergy and UV index levels

iPhone

»» Free for iPhone and Android

LoveMySkin

SHARE YOUR FAVORITE HEALTH AND FITNESS APP!

LoveMySkin app helps you map your moles for skin cancer prevention! This app makes is easy to track suspicious moles or lesions. Just tag a mole on the figure and edit details to monitor growth and change. Use the ABCD guide (Asymmetry, Border, Color, and Diameter) pictures to shoe the differences between benign and malignant moles. The best part, this app gives you the tools to perform self-skin exams and be more aware of changes to your skin that could indicate the early warning signs of skin cancer. »» $0.99 for iPhone »» Not yet available on Android

iPhone

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

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HEALTHY AT 40 | our health

turning can be confusing words | ANIKA IMAJO

At that age, we’re young enough to remember thinking 40-year-olds were on the express train to decrepitude, but we’re old enough to appreciate how quickly time passes. Many of us are still embarking on monumental new endeavors, but we’re beginning to question whether our bodies can forgive us for the misdeeds of our youth.

Now, when many 40-year-olds are just starting to bloom, it’s especially fitting to embrace the landmark as an opportunity for a thorough health assessment. A good way to start setting the stage for fitness into the next phase of life is to shake off the dread, banish the regrets, and adopt a positive outlook.

“Make sure that the glass is half full,” advises Michael Kennedy, MD, a family practitioner with LewisGale Physicians. “No one’s life is perfect, but you have to be happy with what you’ve got.”

Once you find contentment in the here and now, he says, managing your physical health is often simply a matter of self-analysis. www.ourhealthvirginia.com | 21

our health | HEALTHY AT 40

“Though it has its place, the physical examination beyond vital signs and age-specific exams is not the most important part of my time with patients,” explains Mark Greenawald, MD, a family practitioner at Carilion Clinic. “What’s most important in that precious time with them is focusing on the things that truly matter to their health at age 40.”

Mental and emotional well-being are among the subjects Dr. Greenawald addresses with patients in their 40s, to get a clear picture of their overall health and to guide them in making decisions that will fuel a robust debut into their 50s and 60s.

Talking to a primary care physician about the anxieties and physical challenges that often accompany our 40s can be empowering and reassuring, particularly at a time of life when many of us are seeing our parents — even siblings and peers — face health challenges.

“At that age, people start getting more concerned,” observes Dr. Kennedy “We start finding that our bad habits are catching up with us…and all of a sudden we’re starting to see some medical issues.”

But with some simple lifestyle changes, we can influence the course of our future well-being.

Weight gain is among the most common and vexing side effects of turning 40. Increasingly sedentary lifestyles — combined with unchanging or even worsening eating habits — can cause the pounds to creep on, increasing risk for such conditions as diabetes and high blood pressure.

It makes sense to rethink our food intake and reduce our portions as we get older. But Dr. Kennedy suggests developing reasonable eating habits that are easy to stick with — and allowing yourself to cheat once in a while — rather than plunging into extreme diets that will ultimately fail.

“I try not to use the word ‘diet,’” he says, noting that punishing dietary programs will likely result in only shortterm weight loss, followed by an abrupt reunion with comfortable old habits and even additional weight gain. “So it’s important to choose modifications that will work for you for the rest of your life.”

Exercise is an effective weapon against the mischief of a slowing metabolism. And like diet, it shouldn’t engender misery. In fact, any continual movement that you like – walking, gardening, weight-training, tennis, dancing – is beneficial to overall health if incorporated into daily life.

Whatever form your workout takes, it should be something that you will make at least a little time to do most days, if not every day.

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HEALTHY AT 40 | our health

“To me, the key to exercise is setting some goals and starting slowly and gradually,” Dr. Greenawald counsels. “It doesn’t have to be about spandex and running shoes.

It doesn’t necessarily have to be about breaking out in a sweat. It’s about staying active.”

Physicians recommend including some resistance training to bolster bone health and muscle mass, which are naturally waning in our 40s. And for those who are starting out cold, it’s a good idea to talk to a physician before starting a new fitness plan.

Offering an additional bonus to a population commonly fraught with conflicting demands, exercise acts as a natural mood elevator and stress reducer.

“Because people are settling into their families, their marriage, and their jobs at around age 40, it tends to be a time of frenetic activity with a lot of stress and pressure. Health is actually fairly vulnerable,” explains Dr. Greenawald, who points out that wellness too often falls by the wayside in tightly scheduled lives. “It’s a very dangerous trend.”

Learning to ease up on ourselves a bit, assessing priorities, and finding constructive outlets for tension are, he says, valuable tools for maintaining health.

“An outlet is not only about blowing off steam, but it has to do with relationships and other things that really give our life deeper meaning. I think meaning is very important in terms of health.”

Sleep deprivation, Dr. Kennedy points out, is another problem that may take a particular toll during that decade.

“People are often still building their career in their 40s, so they don’t take time to sleep,” he explains, pointing out that persistent weariness is not only counterproductive and physically taxing, but it often encourages excessive eating to boost energy.

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our health | HEALTHY AT 40

In some cases, he says, combating ongoing fatigue is a matter of finding balance in life. In others, he recommends testing for sleep apnea.

Michael Kennedy, MD, is a family practitioner with LewisGale Physicians

At age 40, patients are introduced to some new screening procedures. Women are advised at that age to get regular mammograms, and men are encouraged to begin at least discussing prostate health. Cholesterol levels and signs of the onset of diabetes may be monitored more closely after 40.

Depending on inherited predispositions and the age at which problems manifested themselves in affected family members, physicians take additional steps to screen for certain cancers and other genetically-linked conditions. Family history helps inform recommendations for preventive measures, which might include treatment or behavioral modifications or both.

Mark Greenawald, MD, is a family practitioner at Carilion Clinic.

“Good lifestyle changes trump just about any medication that you could put someone on,” notes Dr. Kennedy. “But if there’s a strong family history and high cholesterol (for example), I would still look at medication as an option.”

While health problems within one’s immediate family are significant, they in no way determine a patient’s fate.

Healthy eating can influence cancer, hypertension, and diabetes genes, according to Dr. Greenawald. Cautioning against resignation when it comes to matters of wellness, he explains, “Even with inherited predisposition, whether a gene is expressed has a lot to do with lifestyle choice. The good news is it’s not too late to really impact their future health. 40 becomes the window to 50 and 60.”

For most of us, our health is still very much in our hands when we’re in our 40s. And there’s reason to believe that if we take care of ourselves, really talk to our physicians, and make peace with our lives, we can spring — rather than crawl — into our 50s and beyond.

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words | Stephen McClintic, Jr. photography | Governor’s Photo Michaele White Children in the Garden Kathy Scott

GOVERNOR

Bob McDonnell and FIRST LADY

Maureen McDonnell discuss men’s health, her cancer scare and teaching children the importance of

living a balanced life.

OH: Men tend to lead less healthy lifestyles than women. They are more apt to smoke and drink and more likely to be overweight.

Consequently, the average life expectancy for males in the United States is five years less than for females. In your opinion, how do you feel we can address the men’s health problem?

You are correct that, according to the Centers for Disease Control, (CDC) life expectancy for men both nationally and in Virginia is almost five years less than that for women.

Of course, there are many reasons for that since, throughout the world, males generally have a higher mortality rate than females at every age – including the first year of life.

You mentioned smoking and obesity, which are two of the lifestyle issues that are closely connected to chronic diseases such as heart disease, cancer, emphysema, diabetes, and many more.

[ continued on page 28 ]

our health | GOVERNOR McDONNELL ON HEALTHCARE IN VIRGINIA

Above and at right on page 29: Students from St. Joseph’s Villa spent time at Virginia’s Executive Mansion planting several varieties of vegetables (donated by Southern States) and herbs (donated by Robbins Family Farms). This is one of many activities that highlight Maureen McDonnell’s Health and Wellness initiative.

[ continued from page 26 ]

I think that we have to begin addressing men’s health early by focusing on the health of infants, children, and adolescents. We need to help parents and individuals by promoting healthy communities that provide increased opportunities for healthy food choices and physical activity while striving to prevent the initiation of tobacco use or underage and binge drinking. In addition, health problems can be addressed by developing and reinforcing programs in a variety of settings, including faith based organizations, worksites, as well as traditional healthcare systems. Healthcare providers can also help by screening for risk factors such as obesity, limited physical activity, and/or excessive alcohol use and promoting behavior change.

OH: What advice would you give to men that may help jump start their healthier lifestyle?

I think that the common sense advice to eat a healthy diet, get enough exercise, and eliminate tobacco use and binge drinking remain the most effective means of obtaining and maintaining a healthy lifestyle. These things are both simple though, for many people, incredibly difficult. However, a man who is striving for a healthier way of life can start with small steps – eat more fruits and vegetables and less red meat as well as drink fewer sugary drinks. Go for a walk or take time to participate in a sport that he enjoys. For men who smoke, call the Virginia Tobacco Quitline at 1-800 QUIT NOW (1.800.784.8669) for counseling, information, and self-help materials, and limit alcohol to no more than two drinks per day. Some men may use food, tobacco, or alcohol in a belief that it helps reduce stress while, in fact, a poor diet, tobacco and binge drinking will increase the physical stress in the body.

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GOVERNOR McDONNELL ON HEALTHCARE IN VIRGINIA | our health

In addition, it is important for men to see their physician for regular check-ups and to follow their physician’s instructions. Men should know their health numbers: blood glucose, blood pressure, cholesterol, and weight. For the man that has already developed a chronic disease, he really needs to consult with his healthcare professional to ensure proper medical care and for assistance with lifestyle changes.

OH: Women tend to be the person in the family who orchestrates the “family health calendar” to ensure both children and adults maintain regular visits to the doctor and stay up to date on immunizations and screenings. While it is terrific to have someone help support you and guide you toward a healthy lifestyle, should it really be the responsibility of a spouse or partner to make sure an adult man is keeping up with medical appointments and screenings and other health-related needs?

Good health begins with each of us. I do all that I can, despite all of the travel and meals away from home required of my job, to eat well and exercise when I can. We are all responsible for our own health as no one can be with us every day to remind us of healthy choices. I’ve been fortunate that my wife has always been an advocate for preventive healthcare and wellness efforts in our home. She’s made the issue one of her key focus areas as First Lady, as well. Several times a year she welcomes underserved children from the community to the Executive Mansion to help plant and tend herbs and vegetables. The kids have the opportunity to cook their harvest in the kitchen and further discuss maintaining a healthy lifestyle through proper nutrition and exercise. We hope to demonstrate to these kids that eating healthy can start at home and in their own neighborhoods.

OH: Healthy living should begin at an early age. Many young men think they are invincible, especially through their 20s and 30s. How have you and the First Lady encouraged your children to live a healthy lifestyle early in life?

We’ve always encouraged our children to be active in sports, including swimming, cross-country, cheerleading, soccer and more. In addition, we’ve raised them to make good decisions when it comes to snacking - reaching for an apple, for example, rather than a bag of chips. Maureen and I believe if you develop good habits when you are young, it’s significantly easier to continue them for your entire life.

OH: Have you ever had that “gut check” scare - a time when you thought you might be facing a serious health condition which made you take a different direction in the way you take care of yourself?

When my wife was 17, she learned she had a breast tumor. It was the same year her aunt underwent a complete mastectomy. Going into surgery, Maureen had to sign a consent form allowing doctors to proceed with a complete mastectomy if the on-thespot biopsy proved malignant. Fortunately, the tumor was benign, but the doctors informed Maureen that she was pre-disposed to breast cancer. That event has helped frame our outlook on health, nutrition and exercise - pushing Maureen and I to do all that we can proactively to lead healthy lives. Prevention is often the most important and reliable disease-fighting tool that exists today.

OH: As the Governor for the Commonwealth of Virginia, your schedule clearly stays full. How do you find time to eat well, exercise, maintain regular visits to the doctor, stay emotionally balanced, etc.?

It all comes down to everyday living and the healthy choices we make in our daily diets, exercise programs, annual check-ups, and other tests that are so important. I admit it’s www.ourhealthvirginia.com | 29

our health | GOVERNOR McDONNELL ON HEALTHCARE IN VIRGINIA

not easy - I have an extremely busy schedule - I don’t go on runs as often as I’d like, but maintaining a commitment to living a balanced life is vitally important.

OH: When it comes to diet and exercise, what’s your favorite healthy meal and what type of exercise do you like to do that helps you physically and mentally?

There are few things I find more enjoyable than throwing the football or playing a round of golf with my two sons. Combining family time with physical activities is a great way to build memories with loved ones and stay in shape at the same time. When time allows I greatly enjoy a run around Virginia’s beautiful Capitol Square, which features the capitol building designed by Thomas Jefferson. But a treadmill gets the job done, as well.

When looking for a good, healthy meal thankfully you don’t have to look far. We are blessed to live in a state with so many incredible agriculture producers who provide an abundance of fresh products for Virginians, from Virginia apples to fresh seafood. We try to take advantage of the many healthy food options we have available right here in the commonwealth.

OH: In thinking about your positive health habits, what message do you hope will most resonate with your children as they grow older?

I believe that we have to do all that we can to help our children learn to take responsibility for their own health. I hope that the principles we’ve instilled in our five children will be carried on to the next generation now that they are grown and starting adult lives of their own.

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In Sickness and In Health:

LewisGale Hospital

The Changing Role of Hospitals words | SUSAN DUBUQUE

On March 23, 2010, U.S. President Barack Obama signed the Patient Protection and Affordable Care Act into law and healthcare reform became a reality.

In the wake of all this change, healthcare organizations from across the country are making significant course adjustments and proclaiming, “We are no longer just dedicated to treating you when you’re sick or injured. We are also committed to improving your health—and keeping you out of the hospital.” The healthcare systems throughout Virginia—and right here in our community—are leading the charge— driven by their missions, community needs, strategic plans and above all, the need to control burgeoning healthcare cost.

Before we delve into what’s happening in the commonwealth, let’s pause for a moment to explore what wellness is and—of equal importance—what it is not.

If you are conjuring up images of Richard Simmons in way-too-short shorts and a headband, making loud whooping sounds, banish the thought. Seriously, banish it forever. Wellness is not just about healthy eating and going to the gym. It is not a destination or a static state of being. Wellness is a process designed to help you achieve your optimal level of health and well-being. But it is a fluid process, subject to change over time and as you age and your health circumstances evolve. (see Wellness Spectrum on page 33) So what are our local hospitals doing to incorporate wellness and health promotion into their operations right here in Central Virginia? The answer: a lot!

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THE CHANGING ROLE OF HOSPITALS | our health

The Wellness Spectrum: As demonstrated by this model, wellness is not just for the well. It is for everyone. And it has a place throughout the continuum of care.

Wellness Begins at Home Both LewisGale Regional Health System and Carilion Clinic embrace the principles of wellness with all the enthusiasm of a personal trainer—starting with their own associates.

According to R.J. Redstrom, vice president of human resources for LewisGale, “Employee wellness is something that the entire HCA organization has adopted.”

On a local level, through a partnership with the YMCA, LewisGale employees can take advantage of discount fitness club memberships. Staff members are offered free annual screenings and online health risk assessments. Through this process, if any risk factors are identified, a health coach is available to help turn things around.

Employees who participate in the program receive a $400 contribution to their medical flex plans—funds that can be used to cover any medical or dental expense. As an added benefit, these participants are offered a broader choice of health insurance coverage—including plans that have lower copays and deductibles.

R.J. Redstrom, is Vice President of Human Resources for LewisGale.

Organizations can use a carrot or a stick to encourage changes in lifestyle and healthrelated behaviors. LewisGale opted for the carrot. According to Redstrom, “Our employee wellness programs are completely voluntary. Initially, there was some www.ourhealthvirginia.com | 33

our health | THE CHANGING ROLE OF HOSPITALS

Carilion Roanoke Memorial Hospital

resistance from a few individuals. But the use of incentives has been very successful at getting people onboard—especially those who really need it.”

Bud Grey, Carilion Clinic’s vice president for wellness and fitness, was challenged

by President and CEO Nancy Howell Agee to provide every one of Carilion’s 11,000 employees with access to fitness facilities. Carilion now offers free gym memberships at Roanoke Athletic Club, Botetourt Athletic Club and RAC Xpress. Small fitness studios and on-site exercise classes—like yoga and Zumba®—are provided to all staff members, including those who work in outlying areas.

Throughout Carilion facilities, employees receive little nudges to make healthy choices. Stairwellness is one such initiative. The doorframes and stairwells were painted bright, inviting colors and decorated with motivational posters to remind employees that taking the stairs is a healthier option. An on-site farmer’s market, designation as a Bike Friendly Business and a Choose Wisely cafeteria program are a few more ways Carilion is creating a culture of wellness.

You’ll Feel Right at Home

Mark Watts, MD, is a Family Medicine provider at Carilion Clinic’s Parkway Vinton location.

Carilion Clinic was one of the first health systems in Virginia to adopt the concept of a Patient-Centered Medical Home. A medical home uses a team approach in coordinating care and establishing long-term healing relationships—particularly helpful for patients with chronic medical conditions such as diabetes, pulmonary disease and congestive heart failure. Primary care physicians, nurse practitioners, physician assistants and care coordinators ensure that individuals receive the preventative care, education and support needed to manage their health and well-being.

E. Mark Watts, MD, Carilion Family Medicine, thinks that access to care is what really sets the medical home apart from a traditional primary care practice. “Extended office hours—including evenings and weekends—mean patients can see their

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our health | THE CHANGING ROLE OF HOSPITALS

healthcare providers right away, before a small problem turns into a crisis.”

Dr. Watts further comments that the medical home is making huge strides in shutting down the revolving door of hospitalizations. “Within 48 hours of a discharge, a patient receives a call from a care coordinator, who will make sure they understand their medications and follow-up instructions.” Carilion also gives access to information. Dr. Watts says, “We use MyChart, part of our electronic health record, to give the patient immediate access to test results, lab reports and their medical records. It’s all part of being able to make good health decisions—quickly.”

LewisGale is approaching diabetes care with the same spirit of good health.

Diabetes Care Coordinator Elisabeth Cochrane, MS, RD, says, “We empower our patients to manage their disease and avoid the serious complications of diabetes.”

The Diabetes Self-Management Education program has two parts—an individual session with an educator to assess the patient’s knowledge level, and then group classes covering the basics of diabetes, complications of the disease and nutrition.

The program is very individualized— with each patient setting personal goals.

This is a long-term commitment. “We stay in touch with the patient for an entire year,” says Cochrane. “And if they haven’t met their goals, we invite them to come back.”

Heart patients can also enjoy a wellness boost at LewisGale’s Cardiac Rehab and Wellness Center. According to Madeline Meadows, RN, “These folks are super motivated to make life changes.” Education is key to sustained success. Classes are offered on all facets of heart health—nutrition, stress management, smoking cessation, exercise and even coping with work and life.

Meadows says, “Originally, the program was intended for people who had risk factors or a cardiac event. Now it is open to everyone.”

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THE CHANGING ROLE OF HOSPITALS | our health

Caring for the Community Wellness knows no bounds and our local hospitals are taking it into the communities they serve.

Across the entire HCA system, H2U—Health-to-You—offers health and wellness programs. According to R.J. Redstrom, “Residents of our area can become members of H2U for a nominal fee ($25). They are invited to attend classes and seminars, participate in health screenings and they receive health newsletters.”

Jenna Bartlett is the Director of Wellness Development at Carilion CLinic.

Jenna Bartlett, director of wellness development for Carilion Clinic, coordinates a program called Fit Rx. With a physician prescription for exercise and a $60 fee, any resident can participate in the program, which includes a 60-day membership to the Roanoke or Botetourt Athletic Club, a fitness consultation, six sessions with a personal trainer and an individualized fitness program.

Bartlett says, “The goal of the program is to give participants a jump-start in a safe environment—with the hope that they will learn to enjoy exercising and continue after the program has ended.”

“This isn’t about selling club memberships,” says Bud Gray. “We are happy to build a fitness program that uses whatever they have available—from running around the block, to a home gym, even a competitor. We just want them to exercise.” And it appears to be working—with more than 1,100 people filling their prescriptions for better health with Fit Rx. While there are far too many wellness programs to mention them all, there is one little activity that is sure to make you smile—Physicians on Foot. Every Saturday morning at 8 am, Dr. Elizabeth Polk, Carilion Family Medicine, is setting the example that wellness is available to us all. It doesn’t take a ton of money or even an amazing degree of physical fitness. Dr. Polk just walks—and she invited others to join her. When the weather is nice, you can find this merry www.ourhealthvirginia.com | 37

our health | THE CHANGING ROLE OF HOSPITALS

Susan Dubuque is principal and co-founder of Neathawk Dubuque & Packett, a marketing and advertising firm based in Richmond, VA, that has a special group dedicated to healthcare and wellness.

A nationally recognized speaker, Susan has published more than 100 articles on healthcare and service marketing, and has assisted more than 200 hospitals and healthcare organizations with marketing and branding initiatives. Author of two books, A Parent’s Survival Guide to Childhood Depression and Kid Power Tactics for Dealing with Depression, she launched a national campaign to increase public awareness of childhood depression.

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band of walkers at the Roanoke River Greenway. And when it is inclement they head to Tanglewood Mall.

So come on, everyone. Time to put down that bowl of chips and get off the sofa.

Wellness isn’t a fad, it’s a mindset that tells us all that our health and well-being are in our own hands. We are responsible for the choices we make each and every day.

But we’re not alone. Carilion Clinic and LewisGale Regional Health System are here to care for us when we’re ill—and if you take advantage of the opportunities they offer, they’ll help you move a little further along in your journey to a longer, healthier life.

HealthyEats RILLING G R E M SUM

Grass Fed Beef on the Grill: Ingredients: 1-2 tablespoons coarse sea salt 1-2 teaspoons ground black pepper 1-2 cloves garlic, minced 1

16 ounce tenderloin (filet mignon) steak at least 1 ¼ - 1 ½ inches thick.

Note: The amount of seasoning you will use depends on the size of your steak. If it is close to one pound, use less. If it is closer to two pounds, use more.

2. Start the grill, and allow it to get hot. If you’re using a gas grill, turn off all but one of the burners after it has gotten up to temperature. If you’re using charcoal, rake all the coals to one side. When you can’t hold your hand three to four inches above the metal for more than three seconds, you know the temperature is hot enough.

4. Sear the steaks for two to three minutes on each side directly over the flame, with the lid down. Then, move the steaks to the part of the grill that’s not lit. Set the lid in place and allow the steaks to cook, without flipping them, until they reach 120-135 degrees, about ten to twenty minutes, depending on the size of the steak.

3. Cut a sixteen ounce steak into four different steaks.

5. Remove the steaks to a platter, and allow them to rest a few minutes before serving.

Directions:

1. Combine the salt, pepper, and garlic in a small bowl. Rub the mixture into both sides of the steak, and then allow the meat to come to room temperature while you prepare the grill.

Tricia Foley’s

GRILLED STEAK Tricia Foley is Our Health Magazine’s resident nutritionist.

our health | NUTRITION HEALTH

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HealthyEats RILLING G R E M SUM

Vegetable Medley: Makes 4 servings

Ingredients: 2 red bell peppers, seeded and halved 2 yellow squash, sliced lengthwise into 1/2-inch-thick rectangles 2 zucchini (about 12 ounces total), sliced lengthwise into 1/2-inch-thick rectangles 1 bunch (1-pound) asparagus, trimmed 10 green onions, roots cut off 3 tablespoons olive oil, plus 2 additional tablespoons

Salt and freshly ground black pepper

3 tablespoons balsamic vinegar 2 garlic cloves, minced 1 teaspoon chopped fresh basil leaves 1/2 teaspoon finely chopped fresh rosemary

Directions:

1. Place a grill pan over medium-high heat or prepare the barbecue (medium-high heat).

2. Brush the vegetables with three tablespoons of the oil to coat lightly.

Sprinkle the vegetables with salt and pepper.

4. Arrange the vegetables on a platter. The key to getting those great grill marks is to not shift the vegetables too frequently once they’ve been placed on the hot grill.

3. Working in batches, grill the vegetables until tender and lightly charred all over – about eight to ten minutes for the bell peppers, seven minutes for the yellow squash and zucchini, four minutes for the asparagus and green onions.

5. Whisk the remaining two tablespoons of oil, balsamic vinegar, garlic, basil, and rosemary in a small bowl to blend.

6. Add salt and pepper to taste. Drizzle the herb mixture over the vegetables.

7. Serve the vegetables, warm or at room temperature.

Tricia Foley’s

SUMMER VEGGIES Tricia Foley is Our Health Magazine’s resident nutritionist.

HealthyEats RILLING G R E M SUM

Grilled Peaches: Makes 4 servings

Ingredients: 1/4 stick unsalted organic (grass-fed) butter, at room temperature 1 teaspoon cinnamon 2 tablespoons Stevia

Pinch salt

4 ripe peaches, halved and pitted

Mint leaves, for garnish

Directions:

1. In a small bowl, add the butter and stir until smooth. Add the cinnamon, Stevia, and salt and mix until combined.

2. Heat grill to high. Brush peaches with butter and grill until golden brown and just cooked through. Garnish with mint leaves.

Tricia Foley’s

FRUIT ON THE GRILL Tricia Foley is Our Health Magazine’s resident nutritionist.

BEWARE

OF THE SUN words | SARAH COX

First thing: Anyone can get skin cancer, and they get it from the UV, or ultraviolet rays of the sun as well as sun lamps and tanning booths. Light-skinned, fair-haired and light-eyed people do have a greater risk, but dark-skinned people get it as well. The National Cancer Institute estimates that 76,690 men and women (45,060 men and 31,630 women) will be diagnosed with and 9,480 men and women will die of melanoma of the skin, the most serious type of skin cancer, in 2013. More than 3.5 million cases of basal and squamous cell skin cancer are diagnosed in this country each year.

Cancers are caused by a combination of both environmental and genetic factors, but with skin cancer, environment makes the more significant impact. So those with a history of skin cancer in their family should be extra diligent when preventing exposure to the sun. Did you know that about 10 percent of all patients with melanoma have family members that also have had the disease?

There are several types of skin cancers, according to the National Cancer Institute. All form in the tissues of the skin. Melanoma is cancer that forms in the melanocytes, or skin cells that make up our pigment. Basal cell carcinoma forms in the lower part of the epidermis, which is the outer layer of the skin. Squamous cell carcinoma forms in squamous cells, and neuroendocrine carcinoma is formed in the neuroendocrine cells.

While most skin cancers are detected after the age of 50, the damage begins far earlier, and that is why everyone should be aggressive in their prevention of exposure to the sun’s UV rays.

Some tips to protect one self are as follows: • Research your sunscreen. The SPF, or sun protection factor, of a sunscreen does not indicate how strong it is, but rather how long it will keep you protected. It is calculated by how many minutes it takes a person to burn, multiplied by the number that tells you how long it should last. So if you burn in 10 minutes, multiply that by SPF 30 and that will keep you protected for 300 minutes – theoretically. So, if you burn in 10 minutes of sun exposure without any protection, SPF 30 will keep you protected for 300 minutes (in theory!).

• Apply one ounce generously to all exposed skin, and reapply often every few hours, or more often. It is suggested that one reapply every two hours, even

our health | SKIN

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SKIN | our health

on cloudy days, and after swimming or sweating, as sunburns significantly increase one’s lifetime risk of developing skin cancer, especially for children.

• Be careful about what is in your sunscreen. Some chemicals are allergens and potential hormone disrupters. Watch for a PABA-free, (one that has no para-aminobenzoic acid) brand. It can cause allergic reactions.

• Additionally, avoid sunscreens that contain Vitamin A (retinyl palmitate), which the FDA has found may make your skin photocarcinogenic, or at greater risk of turning cancerous when exposed to sunlight.

• And avoid sunscreens with added insect repellent.

Choose a sunscreen because it protects you from the sun.

• Wear protective clothing in addition to putting on sunscreen. Light layers of clothing are suggested, as light colors reflect heat. To remain comfortable in the heat, try wearing a tank top, and then a light camp shirt open over that. Natural fibers like cotton are coolest. However, be aware that an ordinary t-shirt is only the equivalent of SPF 5. An alternative is to buy clothing designed to block sun, even up to SPF 50.

• Do not use tanning beds. The UV radiation from tanning beds and the sun causes skin cancer and wrinkling.

• If your family has a history of cancer, moles, or is fair skinned and fair haired, be more diligent about sun protection.

• Drink plenty of water, but if one is exercising vigorously, a sports drink can replace electrolytes.

Don’t drink too much, and avoid sugary drinks and alcohol, which can dehydrate you.

• Wear sunglasses. They will protect your eyes from UV rays, the tender skin around your eyes, and reduce the risk of cataracts.

Look for those that block both UVA and UVB rays, and consider wrap-around sunglasses.

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MINOR LEAGUE PLAY MAJOR LEAGUE ATTITUDE words | SARAH COX

photography | KEITH THIENEMANN

Michael McCarthy’s nickname is Google, and for good reason. Yes, he’s a crack baseball player, a right-hand pitcher for the minor league team, the Salem Red Sox. But he’s also a good student who earned a bachelor of science degree in biology and plans to start on his MBA soon.

McCarthy gets his motivation honestly – he grew up playing sports, eating right, and studying hard.

McCarthy, who is 25 years old, 6’3” and 185 pounds, struggles to maintain this weight through 142 games in a little over five months. That means that

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KIDS’ CARE | our health

LewisGale Field at Salem Memorial Ballpark

he has to be very cognizant of what he eats, which is usually a protein-packed diet. He and his parents have bonded over cooking, he says, enjoying trying out new and nutritious foods. “For a long time, I thought cooking veggies and staying healthy was hard, but once you try it and make it a habit, it starts to become easy,” he explains. “I’m not afraid of using spices and failing, just as in a sport. You’re not going to succeed the first time, but continue to try it.”

He says that YouTube is a great resource for learning how to deal with, for example, bok choy or kale. “I started cooking for my parents, who eat healthy as well, and then we started to bounce ideas off each other. It became a bond,” he notes.

He describes himself as a “true omnivore,” and says he has to eat a proteinpacked diet because he is also a “hard gainer,” meaning that he is a pretty thin guy for his sport. Add to that fact the challenge that he and his teammates are on the road a lot, getting in sometimes at 4 a.m.. He has to focus on his diet while he’s traveling, but he says it’s become a fun task that he has been able to meet better every day.

Growing up, McCarthy’s dad taught him that in team sports, your coach is the boss and you are out there to fill the need of the team. “When you are a part of things bigger than yourself, you learn to trust, and you learn the responsibility of having someone else’s trust. As I’ve continued to grow up and play at high levels, that’s even truer.” www.ourhealthvirginia.com | 51

KIDS’ CARE | our health

McCarthy says that despite having players from Puerto Rico, the Dominican Republic, Venezuela, the U.S., Australia, New Zealand, Japan and the Netherlands, they all come together as a team. That means whether one player eats rice and beans, or another eats a sandwich, they’ve learned how to interact despite significant differences in language and cultures.

It also means staying in shape for the team. His perspective is that baseball is very unique. Each batter is up every nine times, so it’s very much a team sport. Then, he says, the pitcher relies on his fielders to back him up, no matter how good he is. “I think that baseball provides an opportunity to experience success and failure, but teammates are right there to pick you up,” he explains. “The next time around, you may be the one picking a teammate up. Failure is something you experience for the rest of your life – jobs you won’t get, moments you want to teach children a life lesson you can’t teach them, moments you can’t succeed, from cooking dinner to how you perform your job.”

McCarthy, who transferred from the University of Redlands in California, where he had an academic scholarship, to California State University in Bakersfield, knows how to roll with those opportunities and setbacks. Yes, he wanted to study medicine. But now he’s a ball player with his sights set on pursuing the major leagues. Meanwhile, he knows the virtue of failure and

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our health | KIDS’ CARE

how to turn those moments into success.

“I really believe baseball provides the opportunity to learn from failure how to achieve something. It’s an extremely positive feeling that comes out of that, because of the delayed gratification,” he says.

He adds that he sees how he has an impact on the world around him and wants to translate that into working with kids and baseball in pitching camps.

“This will be an opportunity to show kids how to meet challenges and incorporate discipline into their daily lives,” he says.

According to an article, “Benefits of Teamwork in Sports,” research has shown that children and teens that play sports are more likely to have a positive selfimage over those who don’t. This is especially true for girls, who will be less overweight and at the same time, be a part of the team that gives compliments for performance.

It is also a means of teaching accountability and responsibility, as McCarthy pointed out. Failing to execute a play teaches taking responsibility but also learning what went wrong, why, and how to improve.

According to a 2010 New York Times article, separate studies from two economists point out that women’s team sports “can result in lifelong improvements to educational, work and health prospects.” Today, 41 years after Title IX was enacted, research has shown that the increase in girls’ athletic participation is associated with a seven percent lower risk of obesity in women.

Both sexes benefit from team sports in the way of health, resiliency, team building, discipline and friendship. And these advantages carry on throughout life.

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CLINICAL TRIALS CORNER | our health

CLINICAL RESEARCH STUDIES: HypothTest, LLC, the office of Dr. Richard Eckert, is accepting volunteers in clinical research studies for: »» Low Back Pain »» Osteoarthritis of the hip or knee.

Qualified participants will receive at no cost: study medication, study related exams, and travel compensation. If you are interested in volunteering, please call 540.989.4100 for more information. 4370 Starkey Road, Roanoke VA 24018

BRAIN PATTERN STUDY The Human Neuroimaging Laboratory at Virginia Tech Carilion Research Institute (VTCRI) located in Roanoke, Virginia would like to invite you to participate in a variety of groundbreaking studies! »» Eligibility: healthy adults, age 18-64 »» Compensation: at least $20.00 »» Primary goal: To study the response of the normal brain to patterns of stimuli, rewards, and decision-making »» Institute sponsor: Human Neuroimaging Laboratory labs.vtc.vt.edu/hnl »» Study timeframe/duration: 1-3 hours per visit If you are interested in volunteering, please visit: http://vtcri.info/jkzexq To contact us via e-mail: signup@vtc.vt.edu; or call 540.526.2034 www.ourhealthvirginia.com | 55

our health | HEALTH AND FITNESS ON THE GO

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CLINICAL TRIALS CORNER | our health

CIGARETTE SMOKERS The Virginia Tech Carilion Research Institute is conducting a brain imaging study on cigarette smokers. Eligible participants must meet the following criteria: »» Current smokers, age 18-55 »» Smoke at least 5 cigarettes per day »» Have been smoking for the past year You will be compensated for your time. Eligible participants typically make $50 for the first session and $30 for the second session, with the potential to earn an additional $75. We have two locations, Blacksburg and Roanoke, and scheduling is very flexible to best accommodate your schedule. If interested, please contact Andre at 540.526.2068 orajplate@vtc.vt.edu for more information.

OEF/OIF VETERANS NEEDED FOR FMRI STUDIES WHY PARTICIPATE? »» Deployment impacts veterans in many ways »» We use new FMRI technology to understand how deployment can affect the biology of the brain PARTICIPANTS WILL: »» Have the study described and questions answered by study staff before deciding to participate »» Participate in a videotaped interview about your life experiences »» Fill out some questionnaires »» Complete computer tasks during an fMRI scan which may include: »» Viewing positive, negative, & neutral images- including some that are combat related »» Playing simple computer games »» Be asked to provide a saliva sample for genetic analyses »» Receive a CD copy of your structural brain scan »» Be compensated $15 per hour for the interview & questionnaire session and $20 or more for the fMRI scan depending on how you play the game WHO IS ELIGIBLE? »» OEF/OIF Veterans who are: »» Between 18 & 64 years old »» Free from metal in their body »» Not claustrophobic CONTACT: 540.526.2032, vets@vtc.vt.edu, http://info.vtc.vt.edu/vets

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our health | THE FOOT

Butch Davidson can enjoy evening walks again with his wife, thanks to ankle replacement surgery.

Zimmer Trabecular Metal Ankle, with a unique and low risk outside approach that allows for minimal bone to be removed

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THE FOOT | our health

a New Ankle brings a New Outlook on life

Total ankle replacements restore mobility, end crippling pain.

words | RICH ELLIS

C.E. “Butch” Davidson, 70 and a Salem resident, loved to dance with his wife at the Moose Lodge. In fact, it’s where the two of them met. But severe arthritis in both ankles put an end to his dancing days, or so he thought.

Roanoke City resident Virginia Balserak faced a similar situation. She was an avid hiker and yoga instructor until arthritis in her ankle gradually worsened over the course of about a year and half and she could barely place any weight on the ankle.

Their debilitating ankle injuries curtailed once active lifestyles and forced them to live in pain, despite seeking a variety of treatment options. They both found hope, and solutions, in Charles Zelen, DPM and a total ankle replacement.

Dr. Zelen, who has been practicing in the Roanoke valley for 14 years is Board certified by the American board of podiatric surgery in foot and reconstructive rearfoot and ankle surgery and practices at Foot and Ankle Associates of Southwest Virginia, with offices in Salem and Roanoke.

He is also the medical director of The Professional Education and Research Institute in Roanoke, a private research organization that was established in 2005 to educate surgeons in lower extremity surgery and to perform clinical research in foot and ankle surgery and diabetic limb salvage. Dr. Zelen performed the total ankle replacement, or total ankle arthroplasty as it’s formally known, on both Butch and Virginia, and has been performing similar surgeries to save, and replace ankle joints over the past decade since coming to Southwest Virginia.

Yoga instructor, Virginia Balserak, enjoys being back with her students after total ankle replacement surgery . www.ourhealthvirginia.com | 59

our health | THE FOOT

Total ankle replacements aren’t that new. Total ankle replacements that are effective and reliable, however, are. First introduced in the 1970s, those early ankles proved unreliable over the long term, and as a result, led to a period from about the mid-1980s to approximately 1999 when physicians were reluctant to recommend the procedure to patients. All that changed in 1999 with the introduction of the Agility implant, Dr. Zelen explains. “It was a good ankle, but technology has gotten even better and now implants are expected to last greater than 10 years, with the newest generation ankles showing great promise for reliability far past the 10-year mark in greater than 90% of patients.”

Butch’s ankle with severe arthritis prior to replacement surgery

The procedure typically takes about two hours to complete but can take as long as three to four hours if other procedures are required at the same time. Presently, all total ankle replacements are performed through a long incision on the front of the leg. The implant is constructed of titanium, cobalt-chromium and a highly durable plastic polymer, similar in most cases to a total knee or hip, Dr. Zelen explains. Most are coated so that the bone will grow into them and cement is used to help keep the replacement in place. The recovery period typically requires the patient to wait approximately six weeks before any weight is placed on the ankle.

“What’s unique is that with arthritis of the ankle, this procedure allows you to regain and maintain motion of the ankle joint,” Dr. Zelen explains, “allowing you to walk normally again. Most people with arthritic ankles will have a limited ability to walk and may have a limp.”

Butch after his first successful year with his total ankle

That was certainly the case with Butch. He had his left ankle replaced in 2001 and the right ankle in 2004.

“The arthritis was very, very painful,” Butch explains.

“My wife liked to walk and get a little exercise as much as possible and I tried to walk with her and my neighbor and unfortunately I’d get about halfway and my darn ankle would just lock up on me. And you talk about pain – I thought I was going to have to get my wife to walk to the house and get the vehicle to come and get me.”

Butch after 10 years of success with his total ankle

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Because of the arthritis, the cartilage in Butch’s ankle was completely gone. Prior to his first ankle replacement surgery, Butch had been receiving steroid shots in the ankle frequently in an attempt to alleviate the pain and restore some mobility. Several physicians who evaluated Butch recommended an ankle fusion as his only option, but that would have left him with limited mobility. Instead, he turned to Dr. Zelen, who recommended the ankle replacement.

THE FOOT | our health

“The arthritis is either from prior trauma – someone injuring their ankle – or simply degenerative arthritis from someone aging,” Dr. Zelen explains. “It’s very debilitating because the ankle joint is a small joint and you’re placing all of your body weight through it, so when arthritis occurs across that joint, it can cause extreme pain and limited motion.”

While Butch’s arthritis was degenerative in nature and occurred slowly during his long tenure at GE, Virginia believes hers resulted from a traumatic injury.

“The ankle was totally eaten away with osteoarthritis,” Virginia explains. “The only thing I can figure out is that about 10 years before the replacement, I had fallen on a hike and gotten my ankle stuck between two rocks. It was a real bad sprain, it swelled and I took care of it but I never went to the doctor or hospital. The swelling went away and I continued my life. Dr. Zelen believes that original injury may actually have been a fracture.” She chose Dr. Zelen to perform her ankle replacement as she felt most comfortable with him and her research showed he had the most experience in the Roanoke Valley with this procedure.

In the year prior to her ankle replacement surgery in 2009, Virginia could place barely any weight on the ankle and tried a number of remedies, including a chiropractor, At top: Virginia’s ankle before surgery Bottom image: Virginia’s ankle x-rays after nearly 4 successful years acupuncture, massage therapy, ankle braces and support footwear, all to no avail. She wasn’t alone in her suffering as ankle surgery is somewhat common simply because of the injury’s prevalence.

“Ankle arthritis is a common condition, especially in the industrial worker, the athlete, or someone who has had an ankle injury in the past,” Dr. Zelen explains. “All efforts are made to save the ankle, including anti-inflammatories, shots, braces and even arthroscopy to clean out the joint . But, if all else fails, the procedure that’s done eight times out of ten is a fusion – in other words, you put bolts across the ankle as many patients may not be a candidate for replacement . Fusion or bolting the ankle together is a very debilitating procedure that leaves the patient with a limp in many cases.”

A total ankle replacement, at least for Butch and Virginia, was a better alternative.

Virginia is back to hiking, swimming and yoga, both as an instructor and student.

Butch, meanwhile, said he gets around great and has no regrets whatsoever about choosing the surgery – twice.

Charles Zelen, DPM is a Podiatric Surgeon at Foot and Ankle Associates of Southwest Virginia.

While total ankle replacements are becoming more popular in the U.S., Dr. Zelen cautions that not every patient is a candidate. “You can’t have had an infection in that area. Morbidly obese people wear out the replacement faster than others, and it’s also not recommended in unstable diabetics, smokers, or patients with peripheral vascular disease.” www.ourhealthvirginia.com | 61

our health | THE FOOT

Interestingly, the younger a patient is, the more likely a physician will recommend against a total ankle replacement.

“Younger patients may want to look for other alternatives, because the implant will have to be replaced in time,” Dr. Zelen explains. “The average age for implantation is around 50 years old, however I’ve performed the procedure in patients in their 90s as well as in patients as young as 40.”

The two most popular implants on the market today are the Tornier Salto-Talaris, and the STAR, both of which tout a greater than 90% success rate at 10 years. Just recently, Zimmer came out with the Trabecular Metal Total Ankle that has a lower-risk incision on the outside of the ankle and minimal bone removal to save as much normal bone as possible for the patient. Dr. Zelen is one of the few surgeons trained on the Zimmer implant, and in clinical practice currently uses each of the implants, choosing the one that best matches his patients’ needs.

On the medical horizon are more implants for patients whose original implants have worn out and need to be replaced. Currently there is only one implant that is used commonly for these “revisions” – the INBONE from Wright Medical Technology, Inc. “There’s no reason to suffer with chronic ankle pain and discomfort.

Ankle replacements are getting better and more popular and it’s definitely something a person with arthritis in their ankle should consider,” Dr. Zelen says – a statement with which both Virginia and Butch would wholeheartedly agree.

Dr. Zelen welcomes those with arthritis to the ankle to come in for a consultation and see if ankle replacement surgery is the best option for them. His local office number is 540-344-FOOT (3668).

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D-DAY | our health

words | RICK PIESTER photography | NATIONAL D-DAY MEMORIAL MUSEUM

Taps for

Evelyn Kowalchuk, rn

Angel of Mercy for D-Day Injured Most people who work in healthcare are heroes in their own right, but some exhibit a special kind of heroism. Some practice their craft under horrid circumstances, even under the threat of gunfire from an armed enemy army, and a few of those are honored for their bravery.

Evelyn “Chappy” Kowalchuk, RN

One of those few was Evelyn “Chappy” Kowalchuk, RN, one of 25 flight nurses to brave the hell of Omaha Beach three days after the initial D-Day invasion.

Her mission was to rescue and evacuate wounded soldiers, often under fire from German forces, and keep them alive until they could be transported to safety and further care. This year marks the 69th anniversary of the D-Day invasion. www.ourhealthvirginia.com | 63

our health | D-DAY

Evelyn and her husband Andrew became Bedford County residents in 1988, moving to Huddleston after her retirement from a lifelong career in nursing.

She became a fixture as a volunteer for many community activities.

One of her involvements included escorting then President George W. Bush to the dedication of the National D-Day Memorial on June 6, 2001, 12 years ago this year. And on Memorial Day, 2012, she was part of the program dedicating a new narrative plaque at the D-Day Memorial commemorating the role of flight nurses during World War II. Bedford County and the country lost Evelyn on April 7, 2013 at the age of 93. Predeceased by her husband and their son Ivan, her family is planning her burial at Arlington National Cemetery.

Another son, Peter Andrew, survives.

A New Jersey native born as Evelyn Chaychuk, she earned her RN degree from Newark Memorial Hospital in 1941 and enlisted in the U.S. Army the following year.

After entering the Army, she told the Bedford Bulletin, she saw a notice on a bulletin board in the military hospital where she was working. The Army was 64 | www.ourhealthvirginia.com

D-DAY | our health

Memorial Arch: Located in Bedford, Virginia— the town suffering the highest per capita D-Day losses in the nation. The National D-Day Memorial honors the Allied forces that participated in the invasion of Normandy on June 6, 1944 during World War II.

looking for nurses to volunteer as flight nurses.

Kowalchuk and some others asked the head nurse what flight nurses were.

“I have no idea,” the head nurse replied.

But she volunteered anyway, and found herself riding in C-46 and C-47 cargo planes flying across the English Channel to land on improvised runways on the Normandy beachhead in the days following D-Day. The planes ferried badly wounded men to hospitals in Great Britain. It was the job of the flight nurses to take care of the 24 wounded soldiers as they were transported to hospitals. The men were missing arms, missing legs and had head and chest wounds.

“My C-47 landed on Omaha Beach,” Kowalchuk told the Bulletin. “Although a number of planes were shot down, that particular danger was not very worrisome at the time. Our real concern was to get the wounded boys on the planes and to a hospital.” www.ourhealthvirginia.com | 65

Invasion Pool located at the National D-Day Memorial in Bedford.

“When we got those boys on the plane,” she continued “we had the worst shock. We had nurses that were training in New York and California. They had never, never seen the injuries and the blood and the pain these boys were going through.”

Flight nurses served in all embattled theaters during World War II, and they did so with distinction. It is a testament to their training and dedication that of the 1,176,048 patients air evacuated during the war, only 46 died en route. Seventeen flight nurses were killed during the war.

After her military service, Evelyn continued her nursing career, first as a school nurse in the Newark Board of Education and Health, then becoming the first female school nurse at Newark Academy in Livingston, NJ. She finished her nursing career in the Irvington, NJ, Board of Education.

Moving to Bedford County, she became active as a volunteer with community organizations and made numerous speaking engagements about her military and nursing experiences. She was also recognized for many more accomplishments and achievements, but

D-DAY | our health

most of all was known for her sense of humor, her courageous ambitions, her remarkable smile and loving nature, all of which served her well as a pioneer flight nurse who took care of so many.

Editor’s note: stories such as Evelyn Kowalchuk’s and many more are included in Volume III of the History of Healthcare in Lynchburg. Look for free copies of the history at many locations in the summer.

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SENIOR LIVING | our health

Traveling

SMART

words | SARAH COX

When Thomas Kerkering, MD, Section Chief of Infectious Disease, Medical Director of Infection Control, and Director of the International Travel Clinic for Carilion Clinic, advises people on how to travel overseas, he does so from experience. After all, Dr. Kerkering has traveled extensively, has worked for the American Red Cross’ International Committee, and has been a health advisor for an international non-governmental organization. He has worked in Africa, Southeast Asia, Eastern Europe, and Central America. And for most of his career, he says, he spent three to six months each year overseas.

Dr. Kerkering advises seniors traveling overseas to visit the Carilion Clinic Tropical Medicine & Travel Clinic about a month before they travel because, he says, “it takes at least two to three weeks to develop a response from vaccinations.” And in some cases, those vaccinations will help ward off infections such as typhoid, www.ourhealthvirginia.com | 69

our health | SENIOR LIVING

tuberculosis, HIV, hepatitis, malaria, and dengue fever.

Sound frightening? That’s what the travel clinic is there for, and besides, says Dr. Kerkering, just because a traveler happens to be a senior doesn’t mean he or she is more prone to catching an illness.

Most of the issues are simply due to risk-taking. The difference in seniors traveling will lie with underlying conditions, such as rheumatoid arthritis drugs, that affect the immune system.

When a person contacts the clinic, they are asked a series of questions over the phone that helps determine what kind of shots they will receive when they come in for an examination. For instance, they are asked where their travel plans will take them because there are different types of diseases they may catch, depending on which country or region they will visit. Once they are in the clinic for their appointment, the patient is given complete country information in terms of types of health problems they could possibly encounter, and they are briefed on issues with food and water, insect-borne diseases, issues with people and animal contact, and extreme activities.

For instance, malaria may be a factor and is an insect-borne disease. Travelers are given vaccinations and prescriptions for malaria (pills) and are briefed on dos and don’ts.

First off – don’t drink water from the tap. Drink bottled water, and make sure that the plastic seal around the cap is still secured.

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SENIOR LIVING | our health

And remember, says Dr. Kerkering, ice comes from water that comes from a tap so do without it. Food must be cooked, which means that salads are off limits because fresh vegetables are washed in tap water. Dr. Kerkering points out that there is a 30 percent probability that a traveler will come down with traveler’s diarrhea. The management of this involves taking in fluids and dealing with it with an Imodium-type product. If that doesn’t work, you can pull out the antibiotics from the prescription you were given before leaving.

Dengue fever, more common that malaria in some countries and called “break bone fever,” says Dr. Kerkering, will last for about three weeks. In parts of Africa and South America, you can also encounter yellow fever, which is mosquito-borne.

Take high-powered insect repellent with 35 percent DEET, which can be found in outdoor sports stores. It is perfectly safe for those who are not newborns.

In addition, he says to spray clothing and mosquito netting with permethrin.

Take prescription drugs in your travelon bag, and have a complete list of your prescriptions in case they are stolen or lost. But beware: some counterfeit drugs are manufactured in India, says Dr. Kerkering, so check to make sure that they are manufactured in Europe.

For the long flight to where you are vacationing, Dr. Kerkering says to take baby aspirin (81 milligrams) before you get on your flight to ward off DVT, or deep vein thrombosis, walk around when you can, and wear comfortable shoes.

Quasir Raza, MD, an internal medicine physician with LewisGale Physicians, says that finding out where a person is traveling often dictates their preventive care. “Learn which part of the country they are going to be traveling in, what the climate is like, the risk factors of the country, and what kind of activities they are going to be doing,” he says.

He, too, advises seeing a physician ahead of your travel date – in fact, he suggests four to six weeks out. During a patient’s pre-health evaluation, underlying conditions such as heart disease and diabetes are assessed.

Are you planning to use public www.ourhealthvirginia.com | 71

transportation? Will you be driving? Additionally, if you are immune-compromised due to an organ transplant or HIV, special precautions need to be taken. “For example, if your spleen has been taken out because of an accident, you may be predisposed to meningitis or malaria,” he says.

For those who have had recent surgeries – orthopaedic joint operations, for instance – or head or eye injuries, it may not be possible to fly. Other factors that can prevent one from traveling may include chest pains or a recent heart attack or stroke, severe COPD, a fever greater than 100 degrees, a persistent cough, and bleeding or diarrhea that doesn’t go away.

Dr. Raza adds that you must be up-to-date on all routine vaccinations (tetanus, pneumonia, flu), and then, over and above that, you must take specific vaccinations and get prescriptions to start taking before traveling.

One thing that Dr. Raza cautions about is taking for granted that once you arrive back home to the

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our health | SENIOR LIVING

United States, you assume you’re healthy. Not so.

“You have to pay attention to your health,” he says, and take prophylaxis, or preventive drugs, up to four weeks after coming back.

Dr. Raza also suggests taking out travel insurance.

“When you fall sick in another country, you will have to pay for health care. Consider getting medical evacuation insurance, as well,” he says.

Another precaution is with your prescription medicine, which should always be taken in your carryon. Injectables for diabetes and other diseases should be accompanied by a letter of explanation from a physician so that you can take needles on board the plane.

“Being prepared and protected is the best way to have an enjoyable trip,” Dr. Raza notes. Pack smart. Keep travel documents and medications accessible. Take antibiotics, malaria pills, cough drops, sunscreen, aloe gel, a thermometer, rehydration solution such as Pedialyte, and water purification tablets. And for those who are going back to their country of origin, don’t assume you are immune. Take the same precautions as others, for you are at the same risk as everyone else.

Thomas Kerkering, MD is Section Chief of Infectious Disease, Medical Director of Infection Control, and Director of the International Travel Clinic for Carilion Clinic.

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