OurHealth Roanoke & New River Valleys Jun/Jul 2015 Edition

JUNE • JULY 2015 | OURHEALTHSWVA.COM

The Resource for Healthy Living in Southwest Virginia

also:

A Closer Look at the Stomach

and

Breaking the Silence on Bipolar Disorder

www.OurHealthVirginia.com

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table of contents | june • july 2015

34

Take Care of Your Health, Man! MEDI•CABU•LARY.....................12 Local experts define health related terms

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

OurHealth speaks with area physicians about health conditions that commonly affect men and how to prevent them. Here’s what they have to say.

Healthcare questions answered by local professionals

NEW & NOTEWORTHY.............16 A listing of new physicians, providers, locations and upcoming events in Southwest Virginia

HEALTH POINTS........................ 22 Interesting facts and tidbits about health

THE ANATOMY CHALLENGE................................. 25 How much do you know about Our Anatomy?

In this issue, test your knowledge when it comes to the STOMACH.

THE ANATOMY ........................... 26 Taking a closer look at the stomach. To learn more about the stomach’s role, how it works and the conditions that affect it, OurHealth turned to experts at LewisGale Physicians and Carilion Clinic Gastroenterology.

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OurHealth | The Resource for Healthy Living in Southwest Virginia

hello, HEALTH!............................................46 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos

The Resource for Healthy Living in Southwest Virginia

48

[series]

Breaking the Silence: Bipolar Disorder

This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now.

62

The Sweetest Smile

A Rocky Mount family finds strength in cleft lip diagnosis

FIT BITS!........................................................................... 72 Stretch it Out! Did you know that regular stretching is just as important as regular exercise?

NUTRITION......................................................................57 HEALTHY EATS: Shop Seasonally for Better Flavor­and Extra Value Greek Country Salad, Crab Cakes, Mango Peach Crisp

SUMMER SUN BRINGS FITNESS AND FUN!...... 74 People of every age, size, and shape often use summer as a prime motivator to get fit. It has been said that the best fitness program is the one you’ll actually do.

LOOKING BACK..............................................................82

BEST THE NINTH ANNUAL

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

BEDSIDE MANNER

AWARDS

IN SOUTHWEST VIRGINIA

WINNERS ANNOUNCED IN THE DECEMBER 2015 ISSUE

www.OurHealthVirginia.com

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The Resource for Healthy Living in Southwest Virginia

june • july 2015

read this edition of

OurHealth Southwest Virginia

on your tablet or smartphone

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PRESIDENT/EDITOR-IN-CHIEF

VICE PRESIDENT OF PRODUCTION

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CHIEF DESIGNER

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ACCOUNTING MANAGER

ORIGINAL PHOTOGRAPHY

McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Hungate Kim Wood Deidre Wilkes Karrie Pridemore Dalton Holody Joe Palotas Next Generation Design Jourdan Markey Laura Bower Brittney Deal/Down Home Country Photography

CONTRIBUTING MEDICAL EXPERTS

Ahmet Burakgazi, MD Gary P. Gross, MD Robert F. O’Brien, MD Chuck Shaffer, MD

CONTRIBUTING PROFESSIONAL EXPERTS

Chelsea Arner Susan Dubuque Ann McGee Green Laura Neff-Henderson Tina Joyce Suzanne Ramsey Edwin Schwartz 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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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 © 2015 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.

GIVINGBACK

Insight Imaging

TO THE COMMUNITY Presented by OurHealth Magazine

Partnering With a Passion

Just as Insight Imaging focuses on providing excellent patient-centered care, their employees are encouraged to take time to focus on their community.

Employees of Insight Imaging in Roanoke took time over the winter volunteering with the local chapter of Habitat for Humanity. Over the course of several weeks, employees enjoyed wall painting, tile floor installation and staining and sealing a back deck. All of this was done in the name of creating a home for a mother and her three children.

“It’s a great project, and we were thrilled to be involved with it this year and hope to do it again next year. We’re just really excited to see the family in their home for Christmas,” says Luci MacCormack, account executive at Insight Imaging in Roanoke.

Caring for their neighbors and actively participating in community development is just one of the many ways Insight Imaging gets a chance to give back to the community.

For more information on services provided by Insight Imaging, call 540.581.0882 or visit www.mycdi.com/roanoke.

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 myasthenia gravis?

Myasthenia gravis (MG) is a treatable disease that involves an autoimmune neuromuscular junction disorder, causing muscles to weaken. Though the disease is treatable, it is a lifelong process.

It affects about 20 individuals per 100,000 in the United States.

Patients with MG typically show signs of weakness in certain muscle groups. Some of the most common symptoms include double vision and drooping eyelids. Muscle weakness can progress and affect swallowing, respiratory and limb muscles as well. Extreme heat, emotional stress, infection, systemic illness, pregnancy, menstrual cycles and drugs that affect neuromuscular transmission can worsen symptoms.

The treatment of MG is tailored according to the extent and severity of disease, but physicians commonly use cholinesterase inhibitors and immunosuppressive therapies.

Ahmet Burakgazi, MD Carilion Clinic Neurology Roanoke | 540.224.5170 www.carilionclinic.org

What is functional fitness?

What is scleroderma?

“Functional training� has become a popular term within the fitness community. Functional fitness can be defined as training your muscles to work together so you can prepare them for daily activities.

These exercises simultaneously use multiple muscles and joints to improve muscular endurance, balance, strength, coordination, posture and agility. Functional training exercises tend to be multi-joint and multi-muscle exercises as opposed to individual muscle isolation. Your limbs move, accelerate, and decelerate allowing you to burn more calories during training. Instead of only moving the knees, a functional exercise may include the hips, ankles, elbows, and shoulders. A squat can be used as a functional exercise because it trains your muscles to sit down, stand up, bend over, jump, or pick something up from the ground.

Functional training will never go away because the benefits are too numerous. If performed properly, functional based exercises can be beneficial by helping improve the daily acts of living.

Scleroderma is an autoimmune disorder of unknown cause where inflammation develops in the supporting structures of the skin and internal organs. There are three recognized variants, localized scleroderma also known as morphea, CREST syndrome, and systemic sclerosis. The localized form causes reddish patches which progressively become thickened and is not associated with any internal problems. CREST syndrome causes thickening of the skin on the hands and face associated with cold fingers and dilated small blood vessels in the skin. There may be associated swallowing problems but no other serious symptoms.

Systemic sclerosis causes skin thickening in many locations and may be associated with significant abnormalities of the kidney, heart, and GI tract. All these disorders are difficult to treat effectively.

Chelsea Arner

Wellness Supervisor Green Ridge Recreation Center Roanoke | 540.777.6310 www.greenridgerecreationcenter.com

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OurHealth | The Resource for Healthy Living in Southwest Virginia

Gary Gross, MD

Dermatologist LewisGale Physicians Salem | 540.772.3421 www.lgphysicians.com

H E A LT H C A R E QUESTIONS ANSWERED

BY LOCAL PROFESSIONALS

What are some services that an elder law attorney can provide that address the unique needs of the senior and disabled population?

An elder law attorney can address typical estate planning issues: wills, trusts, powers of attorney, and medical directives. They can review those documents so that they reflect the necessary provisions and powers for an aging or disabled person, which may be very different from the powers necessary in other situations.

They also discuss the long term issues of concern to a client: how to pay for long term care, how to get the best care and where, what resources are available to help them with their particular concerns and issues.

Public benefits such as Medicaid are often a concern to clients, who want to know how to transfer assets to their children or others. Elder law attorneys can discuss ways to do that and the consequences those transfers may have on their eligibility for public benefits.

Ann McGee Green

Anderson, Desimone and Green, PC Roanoke | 540.776.6434 www.andersondesimone.com

What is MRT/LEAP sensitivity testing used for?

The mediator release test (MRT) is considered one of the most accurate and comprehensive blood tests available for food and food-chemical sensitivities.

Unlike allergies, symptoms from food sensitivities take longer to arise and can therefore make it difficult to identify the foods and/ or chemicals one is sensitive to. If you are suffering from migraines, irritable bowel syndrome, eczema, acid reflux, joint pain or sinusitis you may have a food sensitivity.

Unlike elimination diets where you guess which foods are causing symptoms, MRT accurately identifies 150 problematic foods and food chemicals and allows the individual to focus on less-reactive safe foods to incorporate into their diet.

LEAP (lifestyle eating and performance) therapy is also recommended. LEAP allows the registered dietitian to interpret each unique MRT result and provide dietary recommendations that will help minimize their symptoms and improve their overall health.

Chuck Shaffer, MD

The Weigh Station Roanoke | 540.982.0250 www.weighstation.net

What are the differences between X-ray, CT, ultrasound and MRI, and what is each used to diagnose?

X- ray films are obtained by passing X-rays through a subject and measuring how much reaches the other side. X-rays differentiate tissues of different radio densities.

They can evaluate large areas, but it is like “looking at the forest, rather than the trees.”

CT also uses X-rays, but circles the patient or objects and uses computers to analyze, and form pictures from the data. This is better at seeing more subtle differences in densities, but requires significantly more radiation.

Ultrasound uses sonic waves to bounce off tissue of varying sound densities. Again a computer analyzes the data and forms pictures. It is very time intensive, is generally used for small areas of interest at a time, and is good for soft tissues, not bone or lung.

MRI uses a magnetic field and radio frequencies, which interact with molecules and produces energy that is then analyzed by a computer to make pictures. This is very time intensive, and usually used to evaluate a single small area at a time.

MRI is especially good at evaluating the neural structures, and solid organs as well as orthopedic imaging.

Robert O’Brien, MD

Insight Imaging Roanoke | 540.581.0881 www.mycdi.com/roanoke

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OurHealth | The Resource for Healthy Living in Southwest Virginia

RLY FORME GE ID BLUE R F: BEST O NT ME RETIRE G LIVIN S AWARD

Look for the 2015 Senior Healthy Living Awards in the NEXT issue! brought to you by

www.ourhealthswva.com

The Resource for Healthy Living in Southwest Virginia

NEW

NOTEWORTHY

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

The SBA Richmond District Office Announces Virginia’s 2015 Small Business Person of the Year The U.S. Small Business Administration’s Richmond District Office proudly announces P. Tulane Patterson, the CEO and Owner of Generation Solutions Holdings, Inc. located in Lynchburg and Roanoke, as Virginia’s 2015 Small Business Person of the Year.

“We are very excited to have Tulane Patterson as Virginia’s Small Business Person of the Year. He is the embodiment of an exceptional small business owner,” said SBA Richmond District Office’s District Director Carl Knoblock.

“His leadership and drive have helped Generation Solutions to grow during some of the most challenging economic times. He has never lost sight of his most important asset - his employees - which in turn, give great care to the customers.”

Lynchburg headquarters. A year later, they opened their Roanoke office enabling services to be provided throughout the Shenandoah and Roanoke Valleys.

Generation Solutions was chosen through a competitive selection process. Judging criteria include: staying power, growth in the number of employees, increase in sales, financial performance, innovativeness of products and services offered, response to adversity, and contributions to the community.

Generation Solutions was founded in 1998 at their current

Jefferson College of Health Sciences, Radford University and Virginia Tech Carilion School of Medicine Celebrate Opening of the New Virginia Intercollegiate Anatomy Lab Jefferson College of Health Sciences, Radford University and the Virginia Tech Carilion School of Medicine recently hosted a grand opening and ribbon cutting ceremony for the new Virginia Intercollegiate Anatomy Lab (VIAL) at Carilion Roanoke Community Hospital (CRCH) in downtown Roanoke. VIAL is located on the eighth floor of the hospital.

The event commemorated the completion of a $2.5 million, year-long collaboration between the three institutions that was notable for its unique private-public partnership.

The finished VIAL space is approximately 8,000 square feet of laboratory, classroom and storage space, including a 2,816 square foot laboratory that accommodates 15 separate stations, which can be used to teach large anatomy laboratory sections of up to 60 students (four students per cadaver) or multiple small sections. The space includes a cadaveric dissection laboratory, a state-of-the-art classroom/briefing room, and a cool-temperature storage facility.

The prime feature of the classroom is an Anatomage table, which will be connected to five large-screen monitors strategically located throughout the room. The classroom monitors can also display images from the laboratory camera and the laboratory digital storage server. Students will be able to connect their laptops or tablets to the monitors to form localized study groups within the classroom. This will allow images of interest at one station to be displayed to all the students in the room simultaneously.

VIAL supports the three institutions’ individual Interprofessional Education programs, which allow healthcare students to learn to work collaboratively in clinical settings before entering their professions.

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NEW

NOTEWORTHY

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

Carilion New River Valley Medical Center and Carilion Giles Community Hospital receive four-star ratings from the Centers for Medicare and Medicaid Services (CMS) under new rating system “Our doctors and nurses are focused on delivering the best care for our patients and our community,” says Terry Tilley, chief nursing officer at Carilion New River Valley Medical Center. “This is a strong endorsement that we’re offering the care our patients expect and need,” adds Veronica Stump, chief nursing officer for Carilion Giles Community Hospital.

Jefferson College of Health Sciences Hosts Inaugural Education Foundation Luncheon Jefferson College of Health Sciences recently held its inaugural Education Foundation Luncheon with world-renowned poet, author, and Virginia Tech Distinguished Professor Nikki Giovanni.

CMS created the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Star Ratings in order to provide patients quick and easy access to information via the Hospital Compare website about the care hospitals provide. The assessment comes from a hospital rating system based on 11 publicly reported measures of patient experience. The HCAHPS, a survey given to patients following their experience with a hospital, forms the basis of those measures. April’s star ratings are based on patient experience data from July 2013 to June 2014.

“It’s clear to me that Carilion New River Valley Medical Center and Carilion Giles Community Hospital mean a lot to our communities,” says Bill Flattery, Vice President for Carilion Clinic’s Western Region.

“These ratings illustrate a story about neighbors helping neighbors. Our doctors and nurses are focused on providing the best quality health care to our patients, and often enough, those patients are our neighbors.”

For more information about the patient satisfaction star ratings, visit the HCAHPS website at www.hcahpsonline.org

The most prestigious award given by the Jefferson College of Health Sciences Alumni Association, the Distinguished Alumni Award is given to a member of Jefferson College’s alumni body who has achieved national, regional, statewide, or local prominence either in their professional fields or through their involvement in civic, cultural, or charitable activities. Mr. David Hoback, Chief of the City of Roanoke Fire/EMS Department, and Mr. E.W. Tibbs, President and CEO of Centra Health were named the 2015 recipients of the Distinguished Alumni Award. Chief Hoback is a graduate of the College’s Emergency Services program, and Mr. Tibbs is a two time graduate of the College’s Nursing program.

For more information on these recipients and the Alumni Awards Program, visit www.jchs.edu/ alumni.

Kevin Dye, MD, Roanoke gastroenterologist joins Carilion Clinic in June.

“Today’s changing medical climate has encouraged many physicians to seek new practice models that improve communication and collaboration,” says Kevin Dye, MD “Joining with Carilion Clinic offers me an excellent opportunity to accomplish these goals.”

Incorporating Dr. Dye’s gastroenterology practice into Carilion Clinic’s group of physicians will offer several benefits to the practice’s patients, including greater collaboration across health care providers and access to Carilion’s MyChart online patient portal, which allows them to access their medical records at any time and exchange secure messages with their doctors.

“Dr. Dye is no stranger to Carilion,” says Nancy Howell Agee, president and CEO of Carilion Clinic. “We’re excited to continue our long-standing partnership with him and his team to improve the health of the communities we serve.”

Dr. Dye currently operates from his clinic at 1201 Franklin Road in Roanoke and will continue to see patients at that location when the transaction is finalized in June. For the practice’s patients, the transition should be seamless.

For more information visit www.CarilionClinic.org.

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OurHealth | The Resource for Healthy Living in Southwest Virginia

LewisGale Medical Center 2014 Awards of Distinction recipients recognized LewisGale Medical Center recently honored five recipients with its 2014 Awards of Distinction, the highest honor an employee, volunteer or physician can receive at an HCA facility, the parent company of LewisGale. The Awards of Distinction include the annual Frist Humanitarian Awards and a new category this year - the Excellence in Nursing Awards.

The awards were presented at a special recognition ceremony.

Margie Twigg, a licensed professional counselor who has been with LewisGale for more than 35 years, received the 2014 Frist Humanitarian Employee Award; Bill Wingfield, Pictured from left are Margie Twigg, Frist Humanitarian Employee Award Winner; Bill Wingfield, Frist a volunteer Chaplin Associate at LewisGale Medical Center Humanitarian Volunteer Award Winner; Teresa Stowasser, Excellence in Nursing-Professional Mentoring Award Winner; Jon Bartlett, LewisGale Regional Health System President; Amanda Blankenship, Excellence in Nursingfor nearly two decades, as well as an on-call chaplain, was Compassionate Care Award Winner and Nelson Greene, MD, FCCP, Frist Humanitarian Physician Award Winner the recipient of the 2014 Frist Humanitarian Volunteer Award; Nelson Greene, MD, FCCP, a pulmonary physician with LewisGale Physicians received the 2014 Frist Humanitarian Physician Award; Amanda Blankenship, a registered nurse in oncology who has been with LewisGale for nearly a decade was presented with the 2014 Excellence in Nursing – Compassionate Care Award; and Teresa Stowasser, an infection control preventionist with more than 36 years of service at LewisGale received the 2014 Excellence in Nursing – Professional Mentoring Award.

Carilion Roanoke Memorial Hospital is honored for Lactation Care Services The International Board of Lactation Consultant Examiners® (IBLCE®) and International Lactation Consultant Association® (ILCA®) have recognized Carilion Roanoke Memorial Hospital for excellence in lactation care.

The hospital has received the IBCLC Care Award in recognition for staffing professionals who hold the prestigious International Board Certified Lactation Consultant® certification (IBCLC®) and providing a lactation program that is available five to seven days a week for breastfeeding families. In addition, the facility demonstrated that is has provided recent breastfeeding training for medical staff that care for new families, and have recently completed activities that help protect, promote, and support breastfeeding.

In addition to finding IBCLC professionals at Carilion Roanoke Memorial Hospital, mothers can also find an IBCLC near them by visiting the ILCA website at www.ilca.org. Follow the “Find a Lactation Consultant” link and search for an IBCLC by postal code, city and state, or country.

Find and Follow

OurHealth Southwest Virginia www.OurHealthVirginia.com

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NEW

NOTEWORTHY

Angela Algire, PA-C

LewisGale Physicians Family Medicine Roanoke | 540.725.3060 www.lgphysicians.com

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Heather Ball, PA-C

LewisGale Physicians Family Medicine Roanoke |540.265.1607 www.lgphysicians.com

Vicki Clevenger

Vice President of Audit and Chief Compliance Officer Carilion Clinic Roanoke | 540.981.7000 www.carilionclinic.org

OurHealth | The Resource for Healthy Living in Southwest Virginia

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

Lauren Eastridge, PA-C Michael Parish LewisGale Physicians Otolaryngology Roanoke |540.443.7400 www.lgphysicians.com

Vice President of Quality and Patient Safety Carilion Clinic Roanoke | 540.981.7000 www.carilionclinic.org

Shmuel Shapira, MD LewisGale Physicians Interventional Cardiology Salem | 540.772.3640 www.lgphysicians.com

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

A SNAPSHOT

DIABETES IN THE UNITED STATES

MEN’S HEALTH

DIABETES

29.1 MILLION

29.1 million people have diabetes

That’s about 1 out of every 11 people

1 4 OUT OF

do not know they have diabetes

TYPES OF DIABETES

TYPE 1

BODY DOES NOT MAKE ENOUGH INSULIN

More than 18,000 youth diagnosed each year in 2008 and 2009

• Can develop at any age • No known way to prevent it

In adults, Type 1 diabetes accounts for approximately

5%

of all diagnosed cases of diabetes

TYPE 2 BODY CANNOT USE INSULIN PROPERLY • Can develop at any age • Most cases can be prevented

Currently, at least 1 out of 3 people will develop the disease in their lifetime

More than 5,000 youth diagnosed each year in 2008 and 2009

Learn More at www.cdc.gov/diabetes/prevention or Speak to your Doctor

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OurHealth | The Resource for Healthy Living in Southwest Virginia

FACT OR MYTH? Men who wear briefs have fewer sperm.

Myth. Although prolonged high temperatures may affect sperm count, the evidence that wearing briefs leads to lower sperm counts is inconsistent.

Hats and/or blow dryers can cause baldness.

Myth. There’s no evidence that wearing a hat or using a blow-dryer causes baldness.

Men hit their sexual peak at 18.

Fact. This is true, at least regarding a man’s supply of testosterone, which peaks at 18.

The more you shave, the thicker your beard will be.

Myth. The size and shape of our hair follicles determine the thickness and texture of our hair — whether it is thick and coarse or thin and fine.

Men can get breast cancer.

Fact. Men can get breast cancer, but it’s rare. The lifetime risk is estimated to be about one in 1,000 men.

help for

’ ear Swimmers

Swimmer’s ear (also known as otitis externa) is an infection of the outer ear canal. This condition is most prevalent during the summer months, when we tend to spend a lot of time submerged in pools, lakes and oceans. Although all age groups are affected by swimmer’s ear, it is more common in children and can be extremely painful.

*****

FASCINATING

FACT It only takes

Do’s and Don’t’s to Protect Yourself and Your Family from Swimmer’s Ear: Do:

MUSCLES TO

SMILE,

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• Keep your ears as dry as possible. Use a bathing cap, ear plugs, or custom-fitted swim molds when swimming.

• Dry your ears thoroughly after swimming or showering.

• Tilt your head to hold each ear facing down to allow water to escape the ear canal. Pull your earlobe in different directions while the ear is faced down to help water drain out.

• If there is still water left in ears, consider using a hair dryer to move air within the ear canal. Put the dryer on the lowest heat and speed/fan setting; hold it several inches from the ear.

Don’t: • Put objects in the ear canal

(including cotton-tip swabs, pencils, paperclips or fingers).

Date: Saturday, June 13, 2015 Proceeds from this race will be used to fund the Grace Lovegrove Scholarship, which is given to a Patrick Henry High School graduate each year, and to support the PH Cross Country & Track teams. The scholarship was established in 2005 to honor Grace Lovegrove, a PH graduate who was a “student for all seasons”; excelling in her studies, serving the community and PH, and earning 12 varsity letters in cross country, indoor track, and outdoor track. Grace died in January 2005 while on a training run at her college, Christopher Newport University.

To Read about Grace, the race and to download the entry form, visit www.runwithgrace.com.

FROWN *****

DRINK UP!

The human body can only survive for two days without fluids.

• Try to remove ear wax. Ear wax helps protect your ear canal from infection. If you think that the ear canal is blocked by ear wax, consult your healthcare provider.

Run With Grace 5K and 1M Fun Walk/Run

TO

Carilion Clinic Life-Guard 5K Rotor Run

Date: Saturday, July 11th, 2015

Time: 9:00 am Location: River’s Edge Sports Complex on Reserve, Roanoke The First

Annual Life-Guard 5K Rotor Run, hosted by Carilion Clinic Life-Guard is designed not only to promote health and wellness within the community they serve, but also to raise awareness on the important service provided by Emergency Medical Services, both air and ground. At the “finish line,” Life-Guard helicopters will be on display as well as local volunteer Fire-EMS vehicles. This will give the public a unique opportunity to learn about these services directly from Fire-EMS providers, pilots, flight paramedics, and flight nurses.

For more information, and to register for the run, visit www.rotorrun.org

www.OurHealthVirginia.com

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the

Anatomy

For answers, visit OurHealth

Southwest Virginia’s Facebook page at

CHALLENGE How much do you know about the

Stomach? First, complete the

word search below. Next, match up the correct word with the part of the body in the illustration.

[ the Amazing Stomach ]

WORD SEARCH Antrum

Longitudinal Layer

Body (of Stomach)

Lower Esophageal Sphincter

Cardia

Mucosa

Circular Layer

Muscularis Propria

Duodenal Bulb

Oblique Layer

Duodenum

Pyloric Sphincter

Esophagus

Pylorus

Fundus

Serosa

Gastric Rugae Greater Curvature

Submucosa

Lesser Curvature

____________________

____________________ ____________________

____________________ ____________________ ____________________

____________________

____________________ ____________________

____________________ ____________________

____________________

____________________

____________________ ____________________

____________________ ____________________ ____________________

____________________ ____________________ www.OurHealthVirginia.com

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taking a CLOSER

LOOK at the

STOMACH words | EDWIN SCHWARTZ

Many people think of the stomach as the organ that digests food. But the stomach mainly serves as a holding tank that only begins the digestive process. To learn more about the stomach’s role, how it works and the conditions that affect it, OurHealth has turned to experts at LewisGale Physicians and Carilion Clinic Gastroenterology.

What is the stomach?

The stomach is a part of the gastrointestinal tract that begins at the mouth and continues through the esophagus, stomach, small intestine, large intestine and rectum and ends in the anus.

The stomach is the only part of the GI tract that is not a long tube. Rather, it is a hollow, muscular, J-shaped reservoir that receives ingested food from the esophagus, retains it and passes it along to the small intestine. The average adult stomach can hold up to 1.5 liters of predigested matter.

The stomach’s role in the digestive process According to Brian J. van der Linden, MD, a board-certified gastroenterologist with LewisGale Physicians, the primary function of the stomach is to hold food, churn it, break it down and, most important, to move a small amount of food at a time to the small intestine. This allows for proper digestion in an orderly fashion.

“In addition to digesting food, the stomach secretes factors that help us absorb certain key dietary elements, such as vitamin B-12,” says M. Jonathan Bern, MD, a gastroenterologist with Carilion Clinic Gastroenterology.

www.OurHealthVirginia.com

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Stomach Sensitivity “One of the most amazing things about the stomach is its sensitivity to noxious chemicals,” says Dr. van der Linden. “The most typical reaction is nausea. We’re not sure we totally understand how it works.”

Parts of the stomach Brian J. van der Linden, MD is a gastroenterologist at Lewis Gale Physicians. He is certified by the American Board of Internal Medicine with a subspecialty in gastroenterology.

The anatomical sections of the stomach are the cardia, fundus, body and antrum, along with the end portion, a muscular valve called the pylorus.

Cardia The cardia is a short section near the top of the stomach where it meets the esophagus.

It is the opening that allows food to pass down into the stomach.

Fundus The fundus is the upper part of the stomach, next to the cardia. Its main function is to send a signal to the brain to stop eating.

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Body The body of the stomach is the midportion, and it is involved with the reservoir function. Most of the stomach’s parietal and chief cells of the stomach are located here in the body. Parietal cells secrete hydrochloric acid and intrinsic factor, which is essential for the proper absorption of vitamin B-12.

This production of hydrochloric acid is the primary secretory function of the stomach. It begins to break everything down and is helpful in killing bacteria or infectious agents.

Chief cells ultimately make pepsin, a potent enzyme for the predigestion of protein. This process occurs as the chief cells secrete pepsin in the form of pepsinogen, an inactive enzyme.

The hydrochloric acid then converts the pepsinogen into the active enzyme pepsin.

Antrum This is the lower portion of the stomach where the food is mixed with gastric juices. The antrum is the motor of the stomach that grinds and smashes food into smaller pieces in a churning cycle that lasts up to four hours after a meal.

Here, the stomach also contains G cells that secrete a hormone called gastrin that travels by blood to regulate acid secretion by cells of the upper portions of the stomach. Gastrin is the most potent stimulator of acid secretion.

Pylorus The pylorus is the end portion of the stomach, located at the junction of the stomach and small intestine. It acts as a valve that regulates the emptying of the stomach contents.

The pylorus usually stays closed but opens periodically to let a small amount of food into the duodenum, the first part of the small intestine. This food is called chyme — a thick, semifluid mass of partially digested food.

Layers of the stomach wall There are four layers to the stomach. The mucosa is the innermost layer. It is secretory in nature and is in contact with the lumen (the open cavity that fills the stomach).

Beneath the mucosa is the submucosa, a layer of dense connective tissue that provides structural support and blood supply. The mucosa and submucosa are responsible for acid and digestive enzyme secretion, intrinsic factor release and digestive hormone release (such as gastrin).

The muscularis propria or muscle layer grinds food into smaller particles and controls the release of these particles into the duodenum. As the muscle relaxes, the stomach distends and stores food. Contraction of the muscle is essential for grinding, mixing and delivering the gastric contents to the small intestine.

The outside layer is the serosa, which is a thin, strong layer of connective tissue that covers the muscle layer. The serosa does not aid in the digestive process, but its slippery surface protects the stomach from friction.

Conditions that affect the stomach Gastritis Gastritis occurs when the mucosa layer of the stomach lining becomes inflamed.

Symptoms may include epigastric (above the stomach) abdominal pain, nausea, vomiting or bloating.

Jonathan Bern, MD is a gastroenterologist at Carilion Clinic Gastroenterology. He is certified by the American Board of Internal Medicine with a subspecialty in gastroenterology.

The most common causes of gastritis are Helicobacter pylori (H. pylori) infection and nonsteroidal anti-inflammatory drugs.

H. pylori is a rod-shaped bacteria that lives in the mucus layer above the stomach lining. It is less common in developed countries like the United States because it is spread by contaminated food or water.

“Treatment of gastritis includes treating any H. pylori and controlling acid, usually with a proton pump inhibitor,” says Dr. Bern. “NSAIDs and alcohol should be stopped as well.”

Common NSAIDS include aspirin and ibuprofen.

Ulcer myths One of the most common stomach myths has to do with ulcer formation. For the record, daily stress will not cause ulcers. Also, hot and spicy foods and beverages will not cause ulcers, but they may irritate an existing one.

Peptic ulcer disease Peptic ulcer disease occurs when the stomach acid and pepsin successfully penetrate the stomach or intestinal lining, causing ulcers to develop.

The disease is defined as a break in the mucosa layer of the stomach lining or the duodenum. Ulcers can cause abdominal pain, nausea and, in some cases, bleeding.

Occasionally the ulceration goes through the full thickness of the stomach or duodenum and causes a perforation in the stomach or intestinal lining.

The two most common causes of ulcers are H. pylori infection and the use of NSAIDs.

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“Peptic ulcer disease is best diagnosed with upper endoscopy, but an upper GI X-ray can also be used to diagnose this condition,” says Dr. Bern. “If a stomach ulcer is identified, a biopsy should be taken to be sure it is benign and not an ulcerated stomach cancer.”

The arrival of proton pump inhibitors has revolutionized ulcer treatment and has almost eliminated the need for surgery. The healing process also includes stopping NSAIDs and eradicating H. pylori infection with antibiotics.

Gastric Cancer Gastric cancer, or stomach cancer, is one of the most common forms of cancer. The disease was the leading cause of cancer death worldwide until being overtaken by lung cancer.

H. pylori infection is a risk factor for stomach cancer. It also runs in families independent of H. pylori infection, which suggests a genetic predisposition to gastric cancer.

“Surgery, often combined with chemotherapy, is the main method used to treat stomach cancer,” says Dr. Bern. “Occasionally, the tumor is discovered early and can be removed endoscopically.”

Gastroparesis

Why does my stomach growl?

No, it isn’t expressing itself. It’s a normal — although sometimes embarrassing — process called “borborygmi.” The rumbling sounds come from the GI tract as the pylorus valve opens, and a mixture of air and fluid pushes chyme through the small intestine.

Gastroparesis is a condition where the stomach empties slowly. Its symptoms can include nausea, vomiting or feeling full after eating a small amount.

“Gastroparesis, or paralyzed stomach, occurs when the churning, motor muscle part doesn’t work,” says Dr. van der Linden.

Normal stomach emptying is a complex process that coordinates the gut’s nervous system, the pacemaker cells of the stomach (called the interstitial cells of Cajal) and the smooth muscle that lines the stomach. With gastroparesis, this coordination is disrupted because the number of pacemaker cells is reduced.

Gastroparesis is most commonly associated with diabetes or past stomach surgery, but its cause may be unknown. It can be diagnosed using a gastric emptying scan www.OurHealthVirginia.com

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Can eating less shrink your stomach?

Contrary to popular belief, reducing portion size will not cause one’s stomach to shrink. Rather, reducing food intake affects the levels of hormones such as leptin and ghrelin — known as the appetite hormone — causing the appetite to decrease.

— a radiology test that measures stomach emptying. Treatment includes avoiding foods that delay gastric emptying, such as fat and fiber. Eating smaller, more frequent meals is also recommended.

Remember the stomach during recovering from activity The reason fat and fiber cause the stomach to empty slower is because fiber requires more churning, and fat must be processed more carefully in the small intestine.

“If you want to recover quicker after training, drink fluids and take carbohydrates with a little protein and no fat,” recommends Dr. van der Linden. “Get your fats — like peanut butter — later.”

Maintaining a healthy stomach Our stomachs are complex reservoirs that hold our food, break it down and regulate its continuation along the GI tract. As with many intricate systems, the stomach has a sensitive nature. So pay attention to the signs it gives and seek assistance from a gastrointestinal specialist if you notice something irregular.

Expert contributors: • Brian J. van der Linden, MD with Lewis Gale Physicians • Jonathan Bern, MD with Carilion Clinic Gastroenterology

Sources: • Mayo Clinic – www.mayoclinic.org • American College of Gastroenterology – www.gi.org

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Take care of

MAN! words | SUZANNE RAMSEY

In a filing cabinet at my house, there’s a 2-inch-thick manila folder labeled “Suzanne Medical” that contains documentation from a decade or so of medical appointments — mammograms, annual physicals, that time I thought I had a gallstone, you name it.

And my husband’s file? What file?

It’s no secret. Men are known for not seeking medical help until a limb is dangling or they’re bleeding to death, or both.

But, like women, they’re not immune to health problems. In fact, WebMD reports that “of the 15 leading causes of death, men lead women in all of them except Alzheimer’s disease, which many men don’t live long enough to develop.”

Reprints To order reprints of the original

So, for all you men out there, OurHealth talked with area physicians about common health conditions that affect you and how to prevent them. Here’s what they had to say:

artwork featured on this issue’s cover, contact Deidre Wilkes at 540.387.6482 or via email at deidre@ourhealthvirginia.com.

To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com

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Low dose CT screening A clinical strategy for lung cancer that has shown promise is low-dose computed tomography screening. The purpose of a CT screening test is to identify the presence of cancer in an individual who does not demonstrate any symptoms. In August 2011, the National Cancer Institute released results from its National Lung Screening Trial — a randomized clinical trial that screened at-risk smokers with either low-dose CT or standard chest X-ray. The study found that screening individuals with low-dose CT scans could reduce lung cancer mortality by 20 percent compared to chest X-ray.

Source: American Lung Association

Lung Cancer The American Cancer Society says 1 in 13 men will be diagnosed with lung cancer during his lifetime. This includes smokers and nonsmokers, although a smoker’s risk is much higher than a nonsmoker’s.

When asked about risk factors, physicians say smoking is most often to blame. Other risk factors include overexposure to radon, asbestos, air pollution, radiation therapy for the lungs and a family history of lung cancer.

Unfortunately, symptoms of lung cancer may not be noticed until the disease has progressed into later stages. Once the symptoms are noticeable, they include the things one might expect, such as coughing up blood and shortness of breath, and more subtle things like unexplained weight loss, chronic pneumonia, chest pain or a cough that won’t go away.

To prevent lung cancer, physicians say the best thing men can do is quit smoking or never start in the first place and avoid exposure to secondhand smoke and other cancer-causing chemicals.

•••••

Heart Disease and Stroke According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for men in the U.S. — killing 307,225 men in 2009 —which translates to 1 in every 4 male deaths. The CDC reports that 70 to 80 percent of sudden cardiac events occur in men and that half of the men who die suddenly of coronary heart disease had no previous symptoms.

There are symptoms, however, including chest pain, pressure or discomfort.

Molly Rutherford, MD, is a cardiologist at Jefferson Surgical Clinic. She is certified by the American Board of Internal Medicine with a subspecialty in cardiovascular disease.

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“Men can also have atypical symptoms, like nausea and arm pain or indigestion and shortness of breath,” says Molly Rutherford, MD, of Jefferson Surgical Clinic. “If you have severe symptoms like these that persist more than a few minutes, call 911. If you are having any of these symptoms consistently, please seek medical attention as soon as possible.”

Risk factors for heart disease range from obvious things, such as being overweight, to simply being male.

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“I don’t think you can pin it on any one thing,” says Dr. Rutherford, a board-certified cardiologist. “It’s the conglomeration of controllable and uncontrollable risk factors that one must be aware of. For example, we have control of over what we eat — protein or veggies or fried chicken, potatoes and biscuits — and what we do — exercise or sit on the couch. We can control that.

What we can’t control, we try to modify. By taking medications such as aspirin, statins, beta blockers and ace inhibitors, the development of disease processes like coronary artery disease and heart attack can be short-circuited.”

In other words, when it comes to heart health, you have to be proactive.

“My biggest message to men is if you have high cholesterol or a history of vascular disease, take a statin if at all possible,” Dr. Rutherford advises. “Otherwise, stay informed about your health and find a doctor you are comfortable talking to. Control your risk factors and talk to your doctor about your heart disease risk. Find out if you should be taking an aspirin daily.

Something as simple as that can reduce your risk of death from a heart attack.”

Heart disease also puts men at risk for stroke.

“Be aware of the main risk factors for stroke,” says Sidney Mallenbaum, MD, a neurologist with Carilion Clinic Neurology.

“If you have any of them, take them seriously and monitor them closely.” Dr. Mallenbaum also mentions aspirin, “If cleared by your doctor, a baby aspirin (81 mg) taken once daily reduces the risk of stroke by about 25 percent.”

“It is difficult to pick a single risk factor that causes stroke in men,” says Dr. Mallenbaum. “Ignoring known risk factors such as hypertension, diabetes, tobacco use, hyperlipidemia, atrial fibrillation and sleep apnea is a major issue,” he warns. “If you

What is a Statin Drug?

Statins are drugs that can lower cholesterol by blocking a substance the body needs to make cholesterol. Statins may also help the body reabsorb cholesterol that has built up in plaque on the artery walls, preventing further blockage in blood vessels and heart attacks.

Source: Mayo Clinic www.OurHealthVirginia.com

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Be FAST to recognize stroke FAST is an easy way to remember the sudden signs of stroke. When you can spot the signs, you’ll know that you need to call 9-1-1 for help right away.

FAST is: F — Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile.

Is the person’s smile uneven?

A — Arm Weakness: Is one arm weak or numb?

Ask the person to raise both arms. Does one arm drift downward?

S — Speech Difficulty: Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence like, “The sky is blue.” Is the sentence repeated correctly?

T — Time to Call 9-1-1. If someone shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.

Source: American Stroke Association

have any of these conditions, they need to be treated and controlled. It is important to realize that all of these conditions are worsened by physical inactivity and obesity, so regular exercise is extremely important.”

To prevent stroke, Dr. Mallenbaum offers the following: “If you smoke, quit. Exercise regularly, ideally at least 30 minutes each day. Exercise lowers blood pressure, lowers blood sugar, lowers cholesterol and improves sleep apnea.”

Seeking immediate medical attention is essential.

“Treating an acute stroke within one hour after it starts results in a better outcome than treating after two hours or longer, so the sooner you get to the hospital, the better the result,” says Dr. Mallenbaum.

•••••

Sidney Mallenbaum, MD, is a neurologist at Carlion Clinic Neurology. He is certified by the American Board of Psychiatry and Neurology.

Depression and Suicide While women are more likely to report a suicide attempt, men are more likely to kill themselves. The CDC reports that men are about four times more likely than women to die from suicide, accounting for more than 79 percent of suicides in the U.S. Why do approximately 31,600 men kill themselves each year in the U.S.? The online support group Suicide.org points to untreated depression — sometimes called major or clinical depression — as the leading cause of suicide.

Suffering from depression is not the same as feeling sad or unhappy due to normal life occurrences.

“Unhappy moods are something we all experience during our lives,” says Brian Wood, DO, director of psychiatric education for the Veterans Affairs Medical Center in Salem. “Unhappiness is to be expected in response to difficult life events, such as loss, failure to achieve things that we want, etc., but when it becomes severe, sustained or out of proportion to what we would normally experience, we identify depression as a psychiatric illness.”

To minimize the risk of depression and improve emotional health in general, Dr. Wood has some recommendations.

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What are symptoms of depression?

• Low mood or irritable mood most of the time.

• Trouble sleeping or sleeping too much.

• A big change in appetite, often with weight gain or loss.

• Tiredness and lack of energy.

Brian Wood, DO, is the director of psychiatric education at the Veterans Affairs medical Center (VA) in Salem. He is certified by the American Board of Psychiatry and Neurology.

• Feelings of worthlessness, self-hate and guilt.

• Difficulty concentrating.

• Slow or fast movements.

• Lack of activity and avoiding usual activities.

• Feeling hopeless or helpless.

• Repeated thoughts of death or suicide.

• Lack of pleasure in activities you usually enjoy, including sex.

Source: U.S. National Library of Medicine

What is psychotherapy?

Psychotherapy, or “talk therapy,” is a way to treat people with a mental disorder by helping them understand their illness. It teaches strategies and tools to deal with stress and unhealthy thoughts and behaviors. Psychotherapy helps patients manage their symptoms better and function at their best in everyday life.

Source: National Institute of Mental Health

“True health is never unidimensional,” he says. “It involves not only diet and exercise but many aspects of our lives, including things like emotional support, stress reduction and simply engaging in enjoyable activities. Understanding what makes and keeps us happy is key, and it varies from individual to individual.

“One universal truth is that we all need connection to other humans in some way or another, and we all need their support in some form at some time. Building and maintaining those connections is vital to our happiness and therefore our health. We all build relationships with others in different ways, but one of the goals should always be to establish a diverse and flexible support system that adapts to the unexpected life events we all experience.”

Fortunately, there are a variety of treatment options for depression — everything from medication and psychotherapy to yoga, meditation and exercise. Dr. Wood recommends working with a physician who knows you and is familiar with mental health treatment to decide which treatment options are best.

“Don’t be afraid to try something different if your first attempt at treatment is less than completely successful,” he says. “Many patients and even some doctors are more reluctant to pursue psychotherapy than medications. Multiple studies, however, have indicated that the most successful treatment for depression is the combination of psychotherapy and medications, more so, in fact, than either alone.

“Psychotherapy also often addresses those life changes that may be vitally important in preventing relapses of depression. So be careful not to overlook the treatments that can help you the most and also perhaps lessen your risk of depression in the future.”

•••••

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What is diabetes?

Diabetes mellitus refers to a group of diseases that affects how the body uses blood sugar (glucose). Glucose is vital to health because it’s an important source of energy for the cells that make up muscles and tissues.

It’s also the brain’s main source of fuel. Diabetes, no matter what type, means there is too much glucose in the blood, although the causes may differ. Too much glucose can lead to serious health problems.

Source: Mayo Clinic

Diabetes According to the 2014 National Diabetes Statistics Report, more than 29 million people — more than 9 percent of U.S. adults — have diabetes. Of these, 15.5 million are men, and most cases are Type 2, what used to be called adult-onset diabetes.

“Type 2 diabetes occurs in genetically predisposed individuals and is precipitated by environmental factors, like dietary indiscretion, obesity, a sedentary lifestyle and lack of exercise,” says Kamran Rasul, MD, an endocrinologist with LewisGale Regional Health System, says,

Kamran Rasul, MD is an endocrinologist with LewisGale Physicians. He is certified by the American Board of Internal Medicine with a subspecialty in endocrinology, diabetes and metabolism.

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While there may not be symptoms in early diabetes, sometimes called “prediabetes,” Dr. Rasul says symptoms of diabetes may include frequent urination, fatigue, slowhealing wounds, blurry vision and excessive thirst even after drinking water.

To prevent diabetes, Dr. Rasul recommends the following: »» Maintain a healthy weight.

Warning signs of diabetes • Increased thirst.

• Increased hunger (especially after eating).

• Dry mouth.

• Frequent urination or urine infections.

• Unexplained weight loss (even though you are eating and feel hungry).

• Fatigue (weak, tired feeling).

• Blurred vision.

• Headaches.

Source: WebMD

»» Make healthy eating choices, like green vegetables, beans, poultry and fish (grilled or baked, not fried), whole grains, nuts, lean meats and more importantly, controlling portion size and the total amount of food consumed. »» Adopt a healthy routine, which involves more physical activity, like parking your car a little farther away from your place of work and, if possible, doing some work while standing instead of sitting most of the day. »» Exercise 30 minutes a day, five days a week. »» Have blood glucose checked once a year, because if glucose is abnormal, early treatment with some medications and lifestyle interventions can prevent fullblown diabetes.

“Eating healthy and eating less, along with increasing physical activity and exercising regularly is the most effective treatment along with medications; adherence to a treatment plan is key,” Dr. Rasul says. “There are a number of options for treatment now, including oral and injectable medications.

“New medications are very effective, and some diabetes medications also help you lose weight. Bariatric surgery is an option for very obese diabetics and can reverse diabetes in many cases.”

What is bariatric surgery?

Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption.

Source: American Society for Metabolic and Bariatric Surgery

•••••

Skin Cancer The Skin Cancer Foundation estimates that melanoma, a deadly form of skin cancer, will kill 6,640 men in 2015. The culprit: overexposure to the sun.

Susan Dorsey, MD, is a dermatologist at Dermatology Associates of Roanoke, PC. She is certified by the American Board of Dermatology.

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“My main concern regarding men’s skin is their typically abundant sun exposure,” says Susan Dorsey, MD, of Dermatology Associates of Roanoke. “Many have activities that take them outside for work and fun. Outside occupations and recreations such as golfing or fishing involve many hours in the bright sun and increase the risk of skin cancer.”

“Two areas that concern me quite a bit for men are the back, which is the most risky area, statistically, for men to develop melanoma, and also the scalp,” Dr. Dorsey says.

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What does melanoma look like?

Melanoma usually looks like a flat mole with uneven edges and a shape that is not the same on both sides. It may be black, brown or more than one color. Most melanomas show up as a new spot or skin growth, but they can form in an existing mole or other mark on the skin.

Source: WebMD

“Men are often outside with light T-shirts or perhaps even shirtless, which gives them a lot of overexposure on their upper body, which would lead to an increased skin cancer risk.

“Another problem is thinning of hair on the scalp that makes skin at the top of the scalp more vulnerable to sun exposure.

This is something men may not notice for several years because of the difficulty of seeing the top of one’s scalp.”

Because the back and scalp are difficult to see, Dr. Dorsey recommends regular dermatological checkups and also wearing hats and sunscreen.

“There are physical sunscreens available that provide protection without that stinging quality found with chemical sunscreens, and I encourage my patients to seek those out,” she says.

“Physical sunscreens, such as zinc oxide or titanium dioxide, are now ‘particalized,’ so they do not give the skin that overly white look that we used to see on lifeguard’s noses.”

Dr. Dorsey adds, “The ears and the neck are vulnerable to sunburn as well, so don’t forget to protect them too.”

•••••

Prostate Cancer Turn on the television and you’re bound to see ads touting the latest treatments for erectile disjunction, low testosterone and other men’s health issues. It appears, at least on TV, that men are all too happy to visit their urologist — at least when it comes to taking care of ... well, you know. www.OurHealthVirginia.com

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What is prostate cancer?

Prostate cancer occurs in a man’s prostate gland — a small, walnutshaped gland that produces the seminal fluid that nourishes and transports sperm.

Source: WebMD

Charles Daniel, MD, is an urologist at Jefferson Surgical Clinic. He is certified by the American Board of Urology.

While sexual dysfunction gets wide media exposure, there are other conditions that should prompt a visit to the urologist, among them prostate cancer, which the American Cancer Society estimates will kill 27,540 men in 2015. According to the ACS, 1 in 7 men will be diagnosed with prostate cancer at some point in his life, 1 in 38 will die from the disease, and about 220,800 men will be diagnosed with prostate cancer this year.

Regarding risk factors, Charles Daniel, MD, a urologist at Jefferson Surgical Clinic, says, “Family history plays an important role, including a family history of breast cancer. Recent studies suggest that a lower-fat diet, daily exercise and use of cholesterol-lowering drugs may prevent its reoccurrence after primary treatment.”

Dr. Daniel says there’s no way to prevent prostate cancer, and there are often no symptoms until the later stages, when men may experience problems with urination or bone pain. That said, early detection is key.

“Regular checkups with a prostate exam and an annual prostrate-significant antigen test between the ages of 50 and 70 can detect prostate cancer earlier,” he says.

Once diagnosed, the treatment for prostate cancer depends on its stage of development.

What is PSA? A prostate-specific antigen test measures the amount of prostate-specific antigen in the blood. PSA is released into a man’s blood by his prostate gland. Healthy men have low amounts of PSA in the blood. The amount of PSA in the blood normally increases as a man’s prostate enlarges with age.

Source: WebMD

“Surgery, radiation and brachytherapy may be equally effective for some cancers,” Dr. Daniel says. “The appropriate treatment requires careful, prolonged discussion with your urologist.”

What is brachytherapy?

Prostate brachytherapy (brak-e-THER-uh-pee) is a form of radiation therapy used to treat prostate cancer. It involves placing devices containing radiation in the prostate gland close to the cancer cells.

Prostate brachytherapy procedures vary based on the type of radiation being received. Temporary prostate brachytherapy involves placing radioactive wires in the prostate gland for several minutes. With permanent prostate brachytherapy, radioactive seeds are placed in the prostate gland where they will remain, slowly releasing radiation.

Source: Mayo Clinic

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OurHealth staff photographer, Shawn Sprouse caught up with area runners and walkers and captured some great highlights of the morning!

The Appalachian Power Festival Run in Roanoke is one way Appalachian Power gives back to the entire community. This annual race in Downtown

Roanoke, produced by Virginia Amateur Sports is the premiere running event for western Virginia, and offers a little something for everyone. Whether a seasoned competitor or a first time runner, the 5K and 10K courses alongside the Roanoke River and through downtown Roanoke highlight some of the best views in the region!

The highlight of this year’s event was the spectacular weather!

With warm temperatures and sunshine, walkers and runners were treated to a great start to a long Memorial Day Weekend!

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Breaking the Silence Bipolar Disorder words | SUSAN DUBUQUE

This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them. That is, until now.

In each edition of Our Health, we bring these medical issues into the light—and dedicate these stories to the courageous patients and families living with them and the providers and researchers who commit their lives to treating and seeking cures for these silent killers.

Claire’s Story “Hi, how many for dinner? Please come this way.” With a bright smile and sunny disposition, Claire Wenzel greets her guests in her role as hostess for a local chain restaurant—a job that she greatly enjoys and is very good at performing. But such confidence and competency weren’t always the case.

“Claire was evaluated for the first time when she was just six years old,” shares her mother, Donna Wenzel. “She would cry over the smallest thing, and her temper tantrums were way out of proportion to whatever was happening at that time.” Most frightening of all, even at that young age, Claire had suicidal thoughts.

Matters went from bad to worse. As an adolescent, Claire exhibited extreme mood swings, impulsivity and poor judgment. She repeatedly got in trouble in school and at home—fighting with classmates and her siblings. By 10th grade her behavior was so out of control that she had to be hospitalized. It was during this inpatient stay that Claire’s diagnosis as bipolar disorder was confirmed. “What looked like defiant behavior,” recalls Donna “was actually the result of manic episodes and psychosis.” While Claire’s behavior seemed outrageous, she simply couldn’t help it.

The family can now look back with humor at some of Claire’s antics when she was in a manic state. One summer, Claire went on Craig’s List and started adopting pets.

Seven or eight cats and a dog were delivered to the family’s home before Claire’s parents realized what was going on. And then there was the home-buying spree. At age 10, Claire filled out a loan application online for the purchase of a luxury home.

“The real estate agent was sorely disappointed when he called the house asking for Ms. Claire Wenzel, only to be told she was outside playing,” says Donna.

Humor and loving support have been ongoing survival strategies for the Wenzel family. “When you have 11 children—now ranging in age from 13 to 30—you better have a sense of humor,” remarks Donna. Along the way the family has had to cope with its share of tragedy. In 2012, Claire’s 21-year old brother, Luke, died unexpectedly and one month later Neil Wenzel, the children’s father, passed away.

According to Donna, “Claire comes by her bipolar disorder honestly.” Donna suspects that Claire’s father, although undiagnosed, experienced similar issues and three of Claire’s brothers have also been diagnosed with bipolar disorder.

Despite the challenges and heartaches, today Claire is thriving. She attributes her stability and healthy outlook to finally achieving the right combination of medications and sticking with it—even when annoying side effects occur.

Claire has graduated from high school and is now working full time. She is looking forward to a bright future, full of promise. With a wink of one of her huge blue eyes, Claire declares that if not veterinary medicine, maybe she’ll go into real estate after all.

It’s time to bring bipolar disorder into the light—and learn what this disorder is, the signs and symptoms, how it is diagnosed and treated and advances that may provide support and relief for those coping with this insidious disorder.

What is bipolar disorder?

Bipolar disorder—also known as manic-depressive illness—is a brain disorder that causes unusual shifts in mood, energy and activity levels that occur in distinct periods called “mood episodes.” An individual may go from an overly joyful or excited state, called a manic episode, to an extremely sad or hopeless state, called a depressive episode. Sometimes symptoms of both mania and depression occur during the same episode, which is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

“Everyone experiences highs and lows,” says Richard Leggett, MD, psychiatrist with LewisGale Regional Health System. “Normal fluctuations in mood are like the kiddie roller coaster, while bipolar is like the Loch Ness Monster roller coaster—with symptoms that impair one’s ability to function. If left untreated, bipolar disorder can result in damaged relationships, poor job or school performance and even suicide.” .

Above: Claire, with siblings, Teresa, Emily and Joey - Waiting for the bus on the first day of school. At Left: Claire with her dad, Neil in 2012.

Bipolar disorder is not only a serious medical condition, but it is also one that affects many people. According to the World Health Organization, bipolar disorder is the sixth leading cause of disability in the world, affecting approximately 5.7 million adult Americans. To put that in perspective, more people lose productive time due to bipolar disorder than all forms of cancer combined.

“Bipolar is an equal opportunity illness,” observes Dr. Leggett. “Roughly the same number of men and women develop the disorder and it occurs in all ages, races, ethnic groups and social classes—affecting approximately one to two percent of the population of all cultures.” The disorder typically emerges in late teens or early adult years, with at least half of all cases starting before age 25. Some people have their first symptoms during childhood, while others may develop symptoms later in life.

While there is no single gene identified with bipolar disorder, the family ties are definitely apparent. More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with major depression, and if one identical twin has the illness, there is a 40 percent chance that the other twin will too.

Signs and Symptoms So what does bipolar disorder look like? Well, it all depends. According to Marvin Gardner, PhD, DMin, psychologist with Psychological Health Roanoke, “The signs and symptoms will vary depending upon the type of episode an individual is experiencing at that time.”

Richard Leggett, MD is a forensic psychiatrist, seeing patients out of his LewisGale Pavilion location in Salem.

Symptoms of mania or manic episodes include: »» A long period of feeling “high,” or an overly happy or outgoing mood. »» Extreme irritability. »» Talking very fast, jumping from one idea to another, having racing thoughts. »» Being easily distracted.

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»» Increasing activities, such as taking on new projects. »» Being restless. »» Sleeping little or not feeling tired. »» Having an unrealistic belief in one’s abilities. »» Behaving impulsively and engaging in pleasurable, high-risk behaviors.

Signs of hypomania—or a less severe form of mania—include: »» Feeling euphoric, energetic and productive. (To others this may simply looks like the individual is unusually happy).

Claire’s high school graduation, 2014, with mom, Deborah (left).

»» Being able to carry out day-to-day activities and never lose touch with reality. »» Acting on bad decisions that harm relationships, careers and reputations. »» Often escalates to full-blown mania or is followed by a major depressive episode.

And depression or depressive episode symptoms include: »» A long period (two weeks or longer) of feeling worried or empty. »» Loss of interest in activities once enjoyed, including sex. »» Feeling tired or “slowed down”. »» Having problems concentrating, remembering and making decisions. »» Being restless or irritable. »» Changing eating, sleeping or other habits. »» Thinking of death or suicide, or attempting suicide.

Diagnosing Bipolar Disorder “Bipolar disorder may not be recognized as an illness, and people may be misdiagnosed by a qualified mental health professional for five, 10 and even 15 years from the first onset of symptoms,” says Dr. Gardner. Perhaps the most important diagnostic tool is talking openly with a healthcare provider about mood swings and changes in behavior and lifestyle habits such as in diet, sleep and use of drugs and alcohol.

A useful screening tool for bipolar disorder is the Mood Disorder Questionnaire.

Individuals can complete this brief instrument online and share the results with their healthcare providers for further evaluation.

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to ensure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania. “A significant number of patients are discovered to have bipolar disorder when they present with symptoms of depression, are prescribed an antidepressant and flip into a manic state,” indicates Dr. Leggett.

Marvin Gardner, PhD is a licensed clinical psychologist at Psychological Health Roanoke. His specialties include psychological evaluation, adult and senior adult psychotherapy, marriage counseling, problematic sexual behavior, sexual addiction, chronic mental illness and disability issues.

The healthcare provider will also conduct a physical exam and take a complete family history. Although bipolar disorder cannot be identified through a blood test or a brain www.OurHealthVirginia.com

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scan, these tests may help rule out other medical issues that may contribute to mood problems, like a stroke, brain tumor or thyroid condition.

There are challenges to diagnosing bipolar disorder. “We’re not dealing with a single disease,” explains Dr. Gardner, “Bipolar syndrome occurs across a spectrum.” Three forms of the disorder along this continuum are:

Bipolar I Disorder.

A severe form of the illness that is characterized by episodes of both mania and depression.

During the manic phase a patient may become psychotic—that is, have a break with reality. This may involve delusions (false beliefs) and hallucinations (seeing or hearing things that aren’t there).

Bipolar II Disorder.

The individual experiences hypomania—milder than full-blown mania—and episodes of severe depression. This form of the illness is more common than bipolar I disorder, but it may be misdiagnosed as major depression.

Cyclothymia. Characterized by mood swings that cycle

between hypomania and mild depression. You might think of cyclothymia as “low grade” bipolar disorder. The cycles between moods tend to happen more quickly and be of shorter duration, and overall this form of the illness is less debilitating.

Bipolar disorder can co-occur with other medical and mental health conditions. “The co-occurrence of bipolar disorder and drug or alcohol abuse may be as high as 60 percent and appears to be genetically linked,” indicates Dr. Gardner. Substance abuse may trigger or prolong bipolar symptoms and the lack of judgment and problems with behavioral control that are associated with mania can result in excessive drinking.

Anxiety disorders—like post-traumatic stress disorder (PTSD) and social phobia—often appear with bipolar disorder.

And attention deficit hyperactivity disorder (ADHD) has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted.

People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity and other physical illnesses. These illnesses may cause symptoms of mania or depression, and they may also result from treatment for bipolar disorder.

Treatment Options There is no cure for bipolar disorder, however, there are a number of treatments available to help people gain better control of their mood swings and manage their symptoms.

There are three general types of medication used to treat bipolar disorder—mood stabilizers, antipsychotics and antidepressants. Not everyone responds to medication the 52

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same way. So patients may have to try several different drugs or combinations of drugs before finding what works the best.

The kids at the Wenzy-Frenzy (Wenzel Family Reunion) in Laguna Beach, CA, 2012.

The initial choice for medication is usually a mood stabilizer. Lithium was the first mood stabilizer approved by the FDA, in the 1970s, for treating both manic and depressive episodes. Individuals who take lithium must have regular blood tests to monitor thyroid and kidney function. Anticonvulsant medications, originally developed to treat seizures, are also beneficial in controlling moods.

Antipsychotic medications, often taken in combination with an antidepressant, can treat manic or mixed episodes or psychosis. These medications can cause major weight gain and changes in metabolism, which may increase the risk of getting diabetes and high cholesterol. Patients taking this type of medication must have their weight, glucose levels and lipid levels monitored regularly.

Antidepressants are sometimes prescribed to treat symptoms of depression in bipolar disorder. However, taking an antidepressant alone can increase the patient’s risk of experiencing a manic or hypomanic episode. To prevent this mood swing, it is recommended that doctors also prescribe a mood stabilizer, even if depression is the predominant mood state.

Treating bipolar disorder requires patience and tenacity. It takes time for medications to produce results, and once a patient is feeling better there may be a tendency for them to think that treatment is no longer needed. Some patients don’t like the slowdown in energy level or flatness in mood that medications can cause. “Patient education is needed to help patients understand the risks of not treating mania or hypomania. Different medications used to treat bipolar disorder may have a variety of side effects—ranging from dry mouth, dizziness and drowsiness to blurred vision and rapid heartbeat. It is important that patients talk with their physicians if they are experiencing any annoying or worrisome side effects—and not just stop taking their medications,” advises Dr. Leggett.

“Bipolar disorder may not be recognized as an illness, and people may be misdiagnosed by a qualified mental health professional for five, 10 and even 15 years from the first onset of symptoms,” says Dr. Gardner.

Talk therapy, when used in combination with medication, can provide education and support to people with bipolar disorder and their families. “Frequently, a person with bipolar disorder will have personality traits, interpersonal difficulties and www.OurHealthVirginia.com

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normal human problems that can trigger bipolar symptoms,” comments Dr. Gardner. “Like anyone else, these individuals can benefit from psychological help to understand and manage emotions and untangle present and past relationships. A ‘talk’ therapist can also help patients develop a sense of when they need to be evaluated for a medication adjustment.”

Family members are significant resources to an individual being treated for bipolar disorder. They often can assist the patient with tracking and predicting mood and behavior changes, and are usually extremely aware of the patterns exhibited and potential triggers to mood shifts.

Including supportive family members in a comprehensive treatment plan is essential for the patient and for the continued healthy involvement of the family.

When medication and therapy are not sufficient to manage the symptoms of bipolar disorder, electroconvulsive therapy (ECT) may be tried. Formerly known as shock therapy, ECT had a negative, frightening reputation in the past. But the treatment has improved dramatically in recent years and is performed under brief general anesthesia, making it very tolerable.

ECT is effective in providing relief for patients suffering from severe depressive, manic or mixed episodes who have not responded to medications.

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What does the future hold?

When we look to the future, there are several areas of exciting development in our effort to conquer bipolar disorder. New medications may offer relief for patients who can’t tolerate lithium. Advanced neuroimaging techniques mean we will eventually be able to see what is happening in the brain. This may be particularly beneficial in distinguishing bipolar disorder from major depression and may help doctors predict who will respond to which type of medications and brain stimulation therapies.

Genetic testing offers the promise of earlier identification for individuals at risk for bipolar illness. And starting treatment earlier means a better chance for a positive outcome. Bipolar is a “neurodegenerative” disease. “Without proper treatment, a patient’s episodes may become more frequent or more severe over time. That means it is important to get a patient into treatment early and maintain symptom control.

But bipolar is a chronic condition, just like diabetes—and treatment is a life-long journey,” says Dr.Leggett.

Medical Experts

Bipolar Disorder is an equal opportunity illness—roughly the same number of men and women develop the disorder and it occurs in all ages, races, ethnic groups and social classes.

»» Richard P. Leggett, MD, Psychiatrist, LewisGale Regional Health System »» Marvin Gardner, PhD, DMin, Clinical Psychologist, Psychological Health Roanoke

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Resources »» Centers for Disease Control and Prevention (CDC) – www.cdc.gov »» Depression and Bipolar Support Alliance – www.dbsalliance.org »» National Alliance on Mental Illness – www.NAMI.org »» Mental Health America – www.nmha.org »» National Institute of Mental Health – www.nimh.nih.gov

“Without proper treatment, a patient’s episodes may become more frequent or more severe over time. That means it is important to get a patient into treatment early and maintain symptom control. But bipolar is a chronic condition, just like diabetes—and treatment is a life-long journey,” says Dr. Leggett.

»» Mood Disorder Questionnaire - www.healthyplace.com/psychological-tests/ mood-disorder-questionnaire-mdq

Bipolar Disorder Facts and Figures »» Bipolar disorder affects approximately 5.7 million adult Americans every year, or about 2.6 percent of the U.S. population age 18 and older. »» The median age of onset for bipolar disorder is 25 years, although the illness can start in early childhood or as late as the 40s and 50s. »» An equal number of men and women develop bipolar illness, and it is found in all ages, races, ethnic groups and social classes. »» More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component.

Children and Adolescents »» Bipolar disorder is more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the risk to each child is l5 to 30 percent. When both parents have bipolar disorder, the risk increases to 50 to 75 percent. »» Bipolar disorder may be at least as common among youth as among adults.

In a recent National Institute of Mental Health (NIMH) study, one percent of adolescents ages 14 to 18 were found to have met criteria for bipolar disorder or cyclothymia in their lifetime. »» Some 20 percent of adolescents with major depression develop bipolar disorder within five years of the onset of depression. »» Up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder. »» Manic children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric.

When depressed, there may be many physical complaints such as headaches, stomachaches or tiredness; poor performance in school; irritability; social isolation; and extreme sensitivity to rejection or failure.

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HealthyEats Fruits and vegetables have a prime time when they are at their seasonal best. Some are great for over half of the year; others only hit their peak for a month. Either way, peak season means extra flavor, extra crunch, extra juiciness—all super-fresh and

Greek Country Salad 3 cucumbers 1 red pepper 1

yellow pepper

1 pint Cherry tomatoes 1 red onion diced 1 tablespoon mint, minced

great value. Shopping seasonally not only helps your budget, but offers a great way to add variety to you diet. Visit your local health food store or farmers market to find farm ripened, fresh picked produce.

Dressing:

Directions:

1 cup olive oil

1. In a medium bowl, prepare salad ingredients and set aside.

1/3 cup red wine vinegar 1 tablespoon Dijon mustard 1 tablespoon garlic 1 teaspoons basil

2. In a small bowl, combine dressing ingredients and stir.

3. Pour over salad ingredients and toss.

Can be served at room temperature.

Salt and pepper to taste.

Âź cup Kalamata olives, pitted & halved 1 cup feta cheese diced.

OurHealth Staff Favorite

GREEK COUNTRY SALAD for more recipes follow us on Pinterest or visit our website at ourhealthswva.com

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HealthyEats Crab Cakes Ingredients: 3 cans lump crab meat 1 egg ¼ cup gluten free bread crumbs 1 teaspoon dill ¼ cup mayo 1 tablespoon lemon juice ¼ cup onion ¼ cup celery 1 tablespoon olive oil 1 teaspoon Old Bay ¼ teaspoon onion powder ¼ teaspoon garlic powder 1 teaspoon Worcestershire sauce

Handful of chopped scallions and parsley

A pinch of black pepper

A pinch of cayenne pepper

Directions: 1. Preheat oven to 350º F. 2. Sauté the onion and celery in the butter over medium heat until onions are clear.

3. Squeeze the crab meat and place in a medium bowl.

4. Add the egg, bread crumbs, mayo and remaining ingredients.

5. Mix in sautéed onions and celery.

6. Form into 2 ½” patties.

7. Bake on middle rack for 15 minutes.

OurHealth Staff Favorite

YUMMY CRAB CAKES for more recipes follow us on Pinterest or visit our website at ourhealthswva.com

HealthyEats Vegan Mango Peach Crisp (Gluten Free)

3. There should be no pockets of butter.

Filling Directions:

4. Set aside while preparing filling.

1. Preheat oven to 350º F. 2. Toss fruit with cornstarch and spices, coating evenly.

Crumb Topping Ingredients: 4 cups Gluten Free oats

Filling Ingredients:

2 cups Bob’s Gluten Free Flour

2½ pounds frozen mango

1 teaspoon cinnamon ½ teaspoon salt

2½ pounds frozen peaches, cut into

smaller pieces

2 tablespoons orange juice

3 tablespoons cornstarch

15 ounces Earth Balance Vegan Butter

1

1 teaspoon salt

Zest of one orange

Crumb Topping Directions: 1. Toss together dry ingredients.

4. Pour filling into ungreased pan 9 x 13 distributing evenly.

5. Sprinkle crumb topping over filling, lightly pressing down.

teaspoon cinnamon

2/3 cup agave syrup (can substitute

maple syrup if desired)

3. Add syrup and juice. Mix evenly to coat.

6. Bake about an hour to an hour and 15 minutes until bubbling around edges.

Juices will thicken upon cooling.

Remaining juice of zested orange

2. Work butter, zest and juice into dry, using hands until it forms a uniform dough.

OurHealth Staff Favorite

VEGAN MANGO PEACH CRISP for more recipes follow us on Pinterest or visit our website at ourhealthswva.com

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words | LAURA NEFF-HENDERSON, APR original photography | BRITTNEY DEAL

Rocky Mount family finds strength in cleft lip diagnosis In recognition of July being National Cleft & Craniofacial Awareness & Prevention month, OurHealth magazine offers the story of a local family impacted by this lifechanging diagnosis.

Learning that your child has a cleft lip and/or palate is a diagnosis no parent-to-be wants to hear. That’s especially true for Rocky Mount native Lauren Cooper, who had no idea her son Lane Bush had a cleft lip until the day he was born in January 2014. Lane is Lauren’s first and only child.

Cleft lip and cleft palate are common birth defects in the United States.

The Cleft Palate Foundation, reports that one of every 600 newborns is affected by cleft lip and/or cleft palate.

In Virginia, about 100 babies are born with a cleft each year.

Orthodontists play an important role in the treatment of children with clefts from a very early age.

Cleft lip and cleft palate birth defects occur in the first trimester of pregnancy when a baby’s lip or mouth doesn’t form properly. Because the lip and palate develop separately, it is possible for babies to have one or both deformities.

Boys are more likely than girls to have both cleft lip and palate, according to Cleft Kids, Inc., a non-profit organization founded to provide affected families with information, support and resources.

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When only one side of the lip or palate is affected, it’s called a unilateral cleft. That was the case for Lane whose cleft is on the left side of his face and does not extend into the nose.

A bilateral cleft affects both sides of the lip or palate. A cleft lip is also classified as either complete or incomplete. An incomplete cleft lip does not extend into the nostril, while a complete cleft lip is a split that extends all the way into the nostril.

Some cleft lips and palates are detected during routine ultrasounds during the 16th through 20th week of pregnancy, according to Mark Schoemann, MD, a plastic and reconstructive surgeon with Carilion Clinic’s Cleft and Craniofacial Center.

Cleft palates however, are typically difficult to detect on an ultrasound and may go undetected until the baby is born.

When a cleft is detected during an ultrasound, the parents are typically referred to their local cleft and craniofacial center.

That’s the best-case scenario, explains Dr. Schoemann because it gives the parents-to-be the opportunity to start learning about clefts and gives them a chance to really get prepared to meet their baby for the first time.

Lauren admits she was not prepared.

“I had no idea. I was in total shock,” says Lauren. “No one in my family or his dad’s family has ever had a cleft.”

Babies born with clefts at Carilion’s locations are immediately referred to the Cleft and Craniofacial Center in Roanoke.

A specialist from the center visits the baby and parents immediately after birth so they can establish care and provide support and education for the family.

The severity of a cleft lip or palate can vary widely according to Dr. Schoemann. Some clefts can be relatively minor; while others can leave a gap so large it affects the lip and nostrils.

Lane has a unilateral cleft lip, one of the mildest variations of the defect.

Causes The exact cause of clefting is unknown though the Cleft Palate Foundation reports that the majority of isolated clefts—when the patient has no other related health problems—appear to be caused by an interaction between genetic predisposition and environmental factors that may or may not be specifically identified.

Mark Schoemann, MD is a pediatric plastic and reconstructive cosmetic surgeon at Carilion Clinic Plastic and Reconstructive Surgery. He is certified by the American Board of Surgery and by the American Board of Plastic Surgery.

The Center for Disease Control and Prevention cites several factors are known to increase the odds of a baby being born with a cleft. including: »» Smoking during pregnancy. »» Diabetes before pregnancy. »» Use of certain medicines, including those used to treat epilepsy during the first trimester.

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»» Heredity also plays a role, and the odds of clefting often increase with each generation of a family who has a child born with a cleft.

About 15 percent of babies born with a cleft also have at least one or more of the 300 associated syndromes and anomalies, including: »» Van der Woude Syndrome »» Stickler’s Syndrome »» Hardikar Syndrome »» Pierre Robin Sequence »» 22Q11 Deletion Syndrome »» Treacher Collins Syndrome Rates for cleft lip with or without cleft palate and cleft palate alone vary within different ethnic groups. It is most common for Native Americans and Asians and least common with Africans.

Surgery Babies with clefts are monitored closely from the time they are born. Those with cleft lips normally have their first surgery to repair the lip at between six and eight weeks of age, when it is safer for babies to undergo anesthesia.

Meet Lane Bush One-year-old Lane Bush is “all boy” according to his mom, Lauren Cooper. He loves to play outside and especially likes to get dirty working in his garden. His toy tractor is one of his most prized possessions and his favorite color is green.

Lane also enjoys playing with his pet Yorkies and shooting hoops with his Little Tikes basketball hoop and has picked up his mom’s love of music by the Grateful Dead.

What is Cleft Lip and Palate?

Cleft lips and palates occur during the first few weeks of pregnancy when body tissue and special cells from each side of the head grow toward the center of the face and join together, forming many facial features, including the lips and mouth.

Cleft Lip

Cleft Palate

The lip forms between the fourth and seventh weeks of pregnancy. A cleft lip happens if the tissue that makes up the lip does not join completely before birth. This results in an opening in the upper lip. The opening can be a small notch or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely. A cleft in the lip affects the shape of the base of the nose and nostrils.

The roof of the mouth (palate) is formed between the sixth and ninth weeks of pregnancy. A cleft palate happens if the tissue that makes up the roof of the mouth does not join together completely during pregnancy.

A cleft palate is an opening in the roof of the mouth that can include the hard palate (the bony front portion of the roof of the mouth), the soft palate (the soft muscular back portion of the roof of the mouth) or both.

Source: Centers for Disease Control and Prevention

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Cleft palate repairs are normally done when the child is between 10 to 12 months old, just before most children begin speaking.

Lane had his cleft lip repair done just before he turned four months old. Dr. Schoemann performed the surgery.

While some doctors used internal and external stitches to repair a cleft lip, Dr. Schoemann prefers to use stitches underneath the skin to hold the muscle together and glue on the external skin to reduce scarring.

Lauren couldn’t be happier with the results and says that although Lane does have a scar it’s not very noticeable.

“That’s how great a doctor he is,” says Lauren who admits that the incredible quality of care they’ve received is a big part of the reason she believes Lane has done so well.

At this time, Lane’s doctors do not believe he will need any additional surgeries.

Clefts can cause physical abnormalities that need to be corrected to avoid problems with feeding, hearing, speech, jaw and tooth development.

“We’re very lucky,” explains Lauren. “He doesn’t have any other complications.”

Depending on the severity of the cleft palate, some children are seen by an orthodontist or pediatric dentist and fitted for a temporary artificial covering (called a palatal obturator) made to fit the roof of the mouth covering the gap. The prosthetic device is held in place with denture adhesive and is typically removed, cleaned, and replaced at least once a day. It helps with feeding issues until the palate can be surgically closed.

In some cases, orthodontists are also able to fit babies with an external nasoalveolar molding (NAM) device. The NAM helps close the gap in the palate and gums, which may improve the results of the baby’s upcoming lip and palate repair surgeries.

For many children with clefts, this is a diagnosis they grow up with. Beginning with their first surgery at just a few months old and not typically ending until they are fully grown at about age 66

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18. Some children have as many as eight surgeries. Some surgeries are fairly minor to adjust for growth or insert ear tubes, while others are performed to close the cleft(s) or expand the upper jaw.

Children and adults can live with an unrepaired cleft, but it dramatically impacts their quality of life, according to Dr. Schoemann who spent a year in India repairing cleft lips and palates.

During that time, he had the opportunity to meet with many adults who never had their clefts repaired.

“It’s very difficult to talk with a cleft palate – when you speak all air comes out of the palate into the nose,” said Dr. Schoemann.

“It’s very difficult to talk with a cleft palate – when you speak all air comes out of the palate into the nose,” said Dr. Schoemann. “It’s cosmetic, but it’s also functional.” Many of the adults he met, he explains, had been outcast from their towns because of the defect.

Team approach Typically, babies with clefts are treated by a team of specialists who work together to make sure all of the child’s needs are being met. When Lauren travels to Roanoke to meet with Lane’s craniofacial team, she normally sees about seven different specialists.

Most teams include a craniofacial plastic surgeon; an otolaryngologist (ears, nose and throat doctor); an audiologist; dental specialists including an orthodontist; pediatric dentist and oral and maxillofacial surgeon; a speech pathologist or therapist; a geneticist; a psychologist and a team coordinator.

Lauren has been pleased with the team approach and is confident in the care her son is receiving. Seeing all of the specialists at one time, and knowing that they are all watching every aspect of his development is reassuring to her.

Complications Children with cleft lip and cleft palate may have feeding difficulties, speech problems, or hearing loss. Depending on the type of cleft and if a syndrome is involved, some children may also have breathing issues. Most babies born with cleft lip and palate end up needing orthodontic work.

Though some clefts are fairly minor, babies and children with cleft lip and/ or cleft palate are more likely to face a number of challenges, including:

Difficulty feeding A cleft in the palate prevents babies from being able to suck effectively from bottle or breast and may cause milk and other liquids to come out of their nose during feedings. There are special bottles and nipples that allow www.OurHealthVirginia.com

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babies to bottle-feed successfully. Babies with clefts need a feeding evaluation from a cleft feeding specialist as soon as they are born to insure a good start with feeding.

Their weight needs to be monitored closely in the first few months of life.

Frequent ear infections Babies with cleft palate are more likely to have fluid build up in their middle ear, causing ear infections. Frequent ear infections may lead to hearing loss. Ear, nose and throat specialists can insert special tubes in the baby’s ears during one of the first surgeries to allow the fluid from ear infections to drain. The tubes lessen the pressure on the eardrum, which reduces the chance of the eardrum bursting.

Speech challenges Children with clefts may have a nasal sounding voice and have problems making certain sounds when they talk. Many children with clefts work with speech pathologists who help to correct these problems or refer to the craniofacial surgeon in cases where more surgery is needed.

Dental problems Children with clefts may have extra or missing teeth, or teeth that erupt in the wrong place. Children with cleft lip often have a gap in the bony part of the upper gum, which can cause a number of problems with the teeth and jawbone. These defects require extra dental and orthodontic treatments.

Prevention While clefts are not caused by anything the mother did or didn’t do during pregnancy, there are actions, that can limit the risk of having a baby with a cleft. »» Take a prenatal vitamin containing folic acid, before trying to conceive and early in pregnancy. »» Avoid alcohol, tobacco and illegal drugs when trying to conceive and throughout the pregnancy. »» Begin the pregnancy at a healthy weight. »» Keep weight gain during pregnancy to between 25 and 35 pounds. »» Be wary of all medications taken when trying to conceive and throughout the pregnancy.

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Financial impact “Raising a child In the U.S. with a cleft costs approximately $100,000 more than raising a child without a cleft,” according to Cleft Kids, Inc. “The cost of a single cleft repair surgery often exceeds $25,000, with most cleft children needing multiple surgeries.”

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The KIDS COUNT Data Center reports that millions of children in the U.S. are not covered by health insurance, while millions more don’t have adequate coverage. Even those families with insurance may not be able to obtain coverage for all necessary procedures.

Families with health insurance may still face significant out-of-pocket costs, such as deductibles, co-pays, co-insurance and prescription costs.

In the past, orthodontics were not considered medically necessary and, thus, was not covered by insurance. However, the law recently changed to require that all insurance companies incorporated in Virginia cover orthodontic treatment for children born with clefts. Orthodontics can easily cost $10,000 for a child with a cleft. Some craniofacial programs have funding to provide for some of these costs.

Travel costs for families who commute to get the best medical care for their children, can add up quickly. The added costs of gas, mileage, airfare, hotels, meals out, childcare for siblings during medical appointments, and time off work can seem insurmountable.

Caring for a child with a cleft can also be incredibly time consuming and many families find that one parent has to stay home or reduce their work hours to manage the child’s care.

Emotional impact Beyond the obvious medical costs are the emotional costs. Being a child can be hard enough in this world. Imagine growing up with what amounts to a problem that not only makes you look different, but can also significantly impact your quality of life.

“Children with clefts are often teased at school and may suffer from low self esteem,” the Cleft Kids website states. “Meanwhile, their parents may be stressed out over the mounting medical bills, the challenge of coordinating doctor appointments, and the never-ending insurance hassles. “ Having a baby born with a cleft lip and cleft palate can feel like the end of the world, but Lauren tries hard to stay positive and keep things in perspective.

Of all of the medical conditions a child could be born with, clefts are one of the least severe and what her family is going through, she says, is nothing compared to what many other families who are facing much more serious illnesses and diseases deal with every day.

“It was upsetting, but it was fixable,” says Lauren. “There are so many more serious problems that could have happened.”

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Surgical Repair Overview of Cleft Lip and Palate Procedures that may be included in the surgical repair of cleft lip and cleft palate.

• Nasoalveolar molding: 1week-3 months • Cleft lip repair: 3-6 months • Cleft palate repair: 9-18 months • Palatal expansion: 5-7 years • Alveolar bone graft and fistula repair: 6-9 years • Tip Rhinoplasty: 6-9 years • Phase I orthodontics: 6-9 years • Phase II orthodontics: 14-18 years • Orthognathic surgery (jaw surgery): 14-18 years • Final touchup surgery: adolescence or adulthood Source – Children’s Hospital of Philadelphia

She credits her positive outlook to her incredible support system. She’s fortunate, she admits, to have family who are very involved.

While Lane isn’t old enough yet to know what could be ahead for him in the way of childhood teasing and bullying, Lauren is certain he’ll get through it like the “little trooper” he is. Besides, she says, “his scar gives him character.”

She enjoys the opportunity to share their story and wants other families impacted by clefts to know what the situation is really like.

“I had no idea of all the things that happen when a baby is born with a cleft,” says Lauren. “There are so many problems and complications and most people don’t realize what a struggle it can be for families.”

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FITBITS

H EA LT H A ND F I T NES S O N THE GO

S tretch i t Ou t !

Did you know that regular stretching is just as important as regular exercise?

Many people neglect this aspect of their fitness regime, because they don’t understand that stretching has major benefits. Hopefully these reasons will inspire you to make it part of your schedule!

Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer Deidre is a certified personal trainer with more than 15 years experience in the health and fitness industry.

She is the resident fitness specialist for OurHealth Southwest Virginia.

*Consult with your physician/provider before beginning any new fitness program.

Benefits of stretching: • Improves flexibility (increases range of motion).

• Assists in correct posture by lengthening tight muscles that pull areas of the body away from their intended position.

Here are a few simple stretches for the core and lower body that can be done after each workout:

Cat/Cow stretch • back and abdominals

• Reduces risk for injury by keeping muscles loose.

Cobra stretch

• Increases blood and nutrient supply to muscles, thereby possibly reducing muscle soreness.

• abdominals

Tips for effective stretching: Skip the Pre-Workout Stretch

Seated side stretch

• Muscles should be warm before you begin your stretching. Do a warmup before a workout that simulates the movements you’ll be doing in order to prepare your body. Movements such as walking or marching in place are great examples. Stretch after the workout when your muscles are already warm.

• obliques (side of abdominals)

Focus on the Muscles That Need the Most Help

Hamstring stretch • back of legs

• Instead of trying to stretch your whole body after every workout, focus on a key area of the body each time. Spend longer on each stretch and include more stretches for that specific area.

If you are aware of muscles that are tight, then focus on those.

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sponsored by Green Ridge Recreation Center

Child’s pose • shoulders, chest and abdominals

Summer

SUN

BRINGS

FITNESS and FUN words | TINA JOYCE

People of every age, size, and shape often use summer as a prime motivator to get fit. It has been said that the best fitness program is the one you’ll actually do.

Welcome to summer! Pools open, beaches begin to fill, hiking trails get busier and tennis courts see activity. Everyone seeks to carve out much needed time to relax and participate in recreational activities. However, a couple of pesky problems often exist. First, how do we keep our out-of-school children occupied and physically active? Second, how do we fit into the swimsuits and shorts that our post-hibernation bodies struggle to squeeze into?

Roanoke County Parks, Recreation and Tourism has just the answers—fitness and summer activities geared toward keeping residents occupied and healthy.

Roanoke County Parks (RCP) encourages everyone to move, splash, learn and explore this summer.

Check out the Explore Park map of trails right here.

The vast variety and range of classes offered through RCP encourages individuals seeking specific fitness goals, as well as supports families committed to pursuing a healthy and active lifestyle. Everyone can find something to enhance his or her overall health.

The department offers public health and safety sessions, membership fitness classes, and family wellness seminars. Their commitment to the health of youth to seniors is obvious—offering 175 weeks of summer programs targeting ages 3-17 and fitness and special interest classes geared toward adults year round.

Summer opens the door for outdoor enthusiasts of all ages to explore many opportunities to grow and learn through various camps. The public can choose between several weeks of camps ranging from half-day, full-day, and overnight programs with a variety themes such as art, music, dance, travel, athletics, swimming, pop culture, and outdoor education. According to the department’s website, being a county resident is not a requirement to register.

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“Roanoke County Parks maintains 30 park sites, dozens of trails and greenways, as well as several popular recreation destinations including: Green Ridge Recreation Center, Brambleton Center, Camp Roanoke, and Explore Park. These facilities are home to numerous classes and activities throughout the year designed to meet the recreation needs of both our citizens and the Roanoke Valley at large,” explains Scott Ramsburg, Business and Information Manager, Roanoke County Parks, Recreation & Tourism.

For the Tots Specifically targeting toddlers, Tiny Bubbles pre-school swimming lessons are available. This parent participation class encourages discovering the world of water.

Registration information explains toddlers will experiment with arm and leg action, floating and going under water. Repetition will help them become very comfortable and confident in the water.

Also targeting tots, a unique opportunity to enroll in mini camps called Creative Play Camps reaches children ages 3-5. These programs introduce this young age group to the camp experience, through three-hour activities on several consecutive days. Children are engaged through crafts, music, games and fun with a low staff to camper ratio. Each program has a unique theme based on pop culture and age appropriate interest.

“Roanoke County Parks, Recreation and Tourism is committed to family fun, and summer is a great time of year to get out and explore our parks and facilities. From kids activities such as summer camps and Splash Valley Water Park, to adult programs like paddleboarding, hiking, pottery and dance—there’s something for everyone!”

—Scott Ramsburg, Business and Information Manager, Roanoke County Parks, Recreation & Tourism

For the Youth Reaching youth, ages 6-17, numerous specialty camps are available this summer.

These youth camps range in interest and activity and include: Lego Camp, All Sports Camps, Stop Motion Film Camp, Hip Hop and Creative Dance Camp, Archery Camp, and a Mad Science Camp.

If interested in camps targeting fitness, kids can register for Kid Fit Bootcamp. This camp is a fun and challenging fitness class for those seeking to improve overall fitness www.OurHealthVirginia.com

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or increase athletic performance.

The class combines games, dance movements, core work, aerobics and partnering with a light stretch, according to the department’s website.

For a complete listing of classes, events, and activities, download the Roanoke County Parks’ magazine, Explore Recreation right here.

Another unique activity geared toward youth this summer is the Kids in the Kitchen Camp. Youth will be learning how to make breakfast, lunch, and dinner. Campers will have hands-on experiences working with measurements for cooking, different ingredients, and the joy of eating their own creations.

Team Sports One of the best ways to be active and enjoy the benefits of recreational play is to join a sports team. Both youth and adult teams compete in a variety of sports throughout the year. This summer marks the third season for offering flag football for youth ages 6-12 years old. Also in the summer months, extended hours for pickleball courts give senior athletes more openings for play.

Family Fun Families have plenty of opportunities as well. This summer a new 4-part seminar is being introduced on Thursday evenings in June. The Eating for Health series will include the expertise of a local physician and his top ten tips for improving your family’s health through diet and nutrition. This is part of the family wellness programs offered this summer.

Other summer activities for families include: Family Pottery classes, swimming at Splash Valley including Friday Night Lights which offers extended late night hours at the pool every Saturday in July; and you won’t want to miss Touch-a-Truck at Green Hill Park on Saturday July 25th where families can touch, interact with, and climb on hundreds of cool vehicles!

Enjoy the benefits of being outdoors by exploring trails or greenways with www.OurHealthVirginia.com

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your entire family. Explore Park offers over 14 miles of hiking and biking trails, right here in our own backyard!

Adult Weight-loss For those adults looking to shed a few winter pounds, consider gathering a team for the Summer Slim Down contest. This six-week contest is a spin off of the Loose Big contest held a couple of times a year. Teams of 3-4 compete— not only for prizes—but the satisfaction of watching the numbers on the scale dip as summer progresses.

Whether you decide to join a family member or friend and reach for pickleball paddles, your hiking boots, or swimming pool noodles, make your summer adventures filled with fun— and a little sun. Allow the community of friends at Roanoke County Parks to recommend activities that best suit your family’s summer interests.

Admission to events, cost of registration, and class/ camp dates and times can be found at:

Five Good Reasons to Get Outdoors:

»» Increase vitamin D. Studies suggest that higher levels of this vitamin helps fight certain conditions, from osteoporosis to depression and even heart disease. However, be sure to limit extensive sun exposure that leads to skin damage. »» More exercise. Time outside results in less time in front of the television and computer. By stepping out your front door, you’ll be more likely to get your body in motion. »» Reduce stress. An oxygen boost from fresh air encourages the production of the feel-good brain chemical, serotonin. Being in a natural environment can also give you a feeling of relaxation that combats anxiety and stress. »» Better focus. Spending time outside has been linked to improved attention spans, both short and long term. Giving your mind a break from inside distractions and mental clutter can actually help you re-focus. »» Reduce appetite. Believe it or not, people who spend more time outside spend less time mindlessly snacking. Logistically snacking outside is more difficult than devouring a bag of chips in front of the television

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Roanoke County Parks website: www.roanokecountyparks.com.

For registration information call 540.772.PLAY (7529). *Always consult your physician or healthcare provider before beginning an exercise program.

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The first operation to be performed in the new Roanoke Hospital took place February 3rd of what year?

Post the correct answer on our Facebook page by

July 12, 2015. You could win a prize pack for 4 from

Chick-fil-A. Cool, right? The winner will be announced on our Facebook page July 21, 2015.

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

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