OurHealth Roanoke & New River Valleys Oct/Nov 2013 Edition

SALEM HIGH SENIOR STRIKES OUT DIABETES

WE BEAT BREAST CANCER! Bonus: Women’s Chart for Healthy Aging

OCTOBER

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HEALTHY AUTUMN COMFORT FOODS

DENTAL HEALTH

NOVEMBER 2013 | SOUTHWEST VIRGINIA EDITION | OURHEALTHVIRGINIA.COM

Jeremy Smith has served in the Navy for two decades. But it wasn’t until he was on the ground in Afghanistan that he truly realized the impact of being in battle.

Myths vs. Facts

our health | BASIC

table of contents |october • november 2013

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

Jeremy Smith’s two decades of Navy service didn’t prepare him for what he’d face on the ground in Afghanistan

JUST ASK!..................................14 A variety of health questions answered by local professionals

THE LATEST...............................17 A listing of new physicians, providers, locations and upcoming events in the Southwest Virginia community

HEALTH AND FITNESS ON THE GO..................................21 Health-focused apps you can download to your smartphone or tablet

DENTAL HEALTH FOCUS...........19 Fact or fiction?

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WOMEN’S HEALTH SECTION • Be your own advocate

Women’s Chart for Healthy Living • Trends in childbirth: what’s old is new again

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DOCS OFF DUTY Recently retired after 42 years as an ER doctor, Lucky Garvin, MD is still busier than ever

LIVING WITH PURPOSE.............53 Living with Purpose: Uganda

HEARING.....................................59 SPECIALTY FOCUS: The Hearing Center at HCRI

NUTRITION.................................49 Healthy Eats: Autumn comfort foods!

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SKIN CARE..................................63 New technology in treating psoriasis

KIDS CARE Salem High School senior Andrea Christian doesn’t let diabetes slow her life (or fast pitch) down

www.ourhealthvirginia.com www.ourhealthvirginia.com|| 9

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

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our health | MEDI•CABU•LARY & JUST ASK

me d i • ca bu • l ar y

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

What is oculoplastics?

What is Integrative Medicine?

What is Keratosis Pilaris?

What is sundowning?

“Oculoplastics,” or “Oculofacial surgery,” is a surgical specialty that deals with patients who have problems with the tissues around the eyeball, such as the eyelids, the tear ducts, and the orbits (the bony and soft tissue structures that surround the eyeballs). Patients with these kinds of concerns are often not aware that anything can be done for them: droopy eyelids, overhanging eyelid skin, heavy eyebrows, excessive tearing, bags and dark circles under the eyes, eyelid skin growths, tumors behind the eyes, and severe injuries.

Cosmetic concerns around the eyes and face are also treatable with minor procedures (including “Botox” and “filler” injections) and surgery. Oculoplastic surgeons are board certified Ophthalmologists who pursue additional training in plastic surgery focused around the eyes and face. This type of training allows the surgeon to make decisions that assure the health, safety, and function of the eyes and vision.

The term “integrative medicine” was popularized by Dr. Andrew Weil, one of the earliest and foremost proponents of this form of medicine which combines standard medical practice with evidence-based alternative or complementary medical treatments in caring for the whole patient. Examples of integrative medicine may include acupuncture, treatments for lower back pain, dietary supplements, yoga, and nutritional approaches such as macrobiotic diets. Spinal manipulation, which is practiced by osteopathic and chiropractic physicians, is considered a form of integrative medicine. The National Institutes of Health funds millions of dollars annually for research in this approach through its National Center for Complementary and Alternative Medicine. In 1999, the Consortium of Academic Health Centers for Integrative Medicine was founded to advance the practice of integrative medicine. There are now 56 academic medical centers in the consortium, including Johns Hopkins University, Duke University, Georgetown University, and the Mayo Clinic. Interest in integrative medicine continues to grow as more and more physicians become educated in the use of alternative treatments and how they can be successfully integrated into patient care.

Keratosis pilaris is a very common inherited disorder of the skin. Literally the name means thickening of the hair follicle which appropriately describes the condition. The rash usually starts in early childhood and may improve with age. Typically the rash involves the upper arms, upper thighs and the face with small spiny bumps that feels like sandpaper. Occasionally, the eruption may be more widespread.

Bright redness and a flushed appearance of the cheeks may be associated with the condition.

Patients typically do not complain of any symptoms although occasionally mild itching or burning can be seen. The major concern tends to be the cosmetic appearance. The condition may be improved with treatment but since it is genetically induced, a cure is not available. Moisturizers that contain lactic acid may be effective in alleviating the appearance of the rash but have to be used continuously.

The term “sundowning” is widely known to caregivers of patients with Alzheimer Disease or dementia. It refers to changes in a person’s behavior that occur every afternoon, sometimes lasting for several hours. A person with “Sundown Syndrome” is more anxious, paces, is difficult to redirect, may walk out of the house, or request a ride home. When you think about it, many folks worked for years during the daytime, and around 4 pm, they would be leaving work and returning home.

The demented person knows that this is something they did for years, and they don’t necessarily remember that they no longer work or that they are already at home. Some helpful hints to reduce Sundowning include turning on brighter lights. This will help the person stay more alert, and may reduce their anxiety. If weather permits, escort the person for a long walk, or wheelchair ride, in the afternoon. A good long walk will benefit both the demented person and his caregiver. Both will get a better night’s sleep and that will help them face the challenges for tomorrow.

Nick Ramey, MD Vistar Eye Center Roanoke | 540.855.5100

P. Gunnar Brolinson, DO Edward Via College of Osteopathic Medicine Blacksburg | 540.231.4981 12 | www.ourhealthvirginia.com

Gary P. Gross, MD LewisGale Physicians Department of Dermatology Salem | 540.772.3421

David Graves Woodhaven Nursing and Memory Care Bedford | 540.947.2207

our health | MEDI•CABU•LARY & JUST ASK

ju st a sk!

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

What are symptoms of Inflammatory Breast Cancer (IBC)?

Are there different types of mammograms; how do I know which is best for me?

How much of an impact does computer use have on a child’s vision?

IBC is a distinct clinical subtype of locally advanced breast cancer. It is characterized by rapid clinical progression, skin erythema (redness) and thickening (edema/ peau d’orange), and rapid breast enlargement. A diagnosis is made on clinical features alone or on the unique pathological finding of tumor emboli dermal lymphatics or both.

Clinical IBS maybe confused with simple mastitis or neglected noninflammatory breast cancer.

This is a great question! Most people do not realize that there are two different kinds of mammography procedures.

Children can, and do, experience most of the same computer vision syndrome issues as adults.

Prolonged and frequent computer use can lead to eye discomfort, fatigue, blurred vision, and headaches. Children, in fact, may actually be more susceptible than adults to the development of these problems.

IBC makes up 1-5% of all new breast cancers. On average it affects the young, age 57 for Caucasian women and 52 years of age for African-Americans.

Now with aggressive neoadjuvant chemotherapy, surgery, radiation and follow up maintenance chemo, five year survivors are common, though; unfortunately many are associated with metastasis recurrence. At this time, one in three women with newly diagnosed IBC may experience long term survival.

James Lynde, MD Radiology Bedford Memorial Hospital Bedford | 540.586.2441

Screening mammograms are for patients not having any symptoms.

You go to the screening location for a quick exam which is two images of each breast. A radiologist will read your mammogram and you will receive a letter in the mail with your results.

A diagnostic mammogram is designed to better understand a symptom like a lump or thickening in the breast. It requires an order from your doctor, and a radiologist at the facility will direct your care. You will have tailored mammography views. You will also receive your results before you leave.

James Mullet, MD Carilion Clinic Radiology Roanoke | 540.224.6920

Children often have a limited degree of self-awareness, and don’t realize what they are experiencing is a problem. They are very adaptable, and frequently ignore problems that would likely be addressed by adults.

In addition, because of their smaller size, there can be more issues simply because of positioning (looking up at the screen, instead of down, can cause issues with eye teaming).

To reduce risks of computer vision problems with children, we recommend getting comprehensive eye exams, build in frequent breaks (as little as twenty seconds every twenty minutes), and try to eliminate glare with proper lighting and screen position.

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

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How do you know if you are at risk for periodontal disease?

Some of the factors that we now know as risk factors for periodontal disease are: age, smoking/tobacco use, genetics, stress, medications, clenching or grinding your teeth, poor nutrition/obesity, and other systemic diseases. When you stop and think about it that pretty much affects many of us. According to The Center for Disease Control (CDC), over half the population, in one of their most recent population studies, has treatable periodontal disease.

Some of the warning signs of gum disease include: red, swollen and tender gums or other pain in your mouth; gums that bleed while brushing, flossing or eating hard food, and receding gums. Other signs include, looser separating teeth, plus sores in the mouth, persistent bad breath, and a change in the way your teeth fit together.

One can take the “gum disease risk assessment test” at Perio.org to further learn your individual risk.

Sherman Smock, DDS Periodontal Health Associates Lynchburg | 434.455.2444

MEDI•CABU•LARY & JUST ASK | our health

www.ourhealthvirginia.com | 15

THE LATEST | our health

the l atest

Thomas Conlee, MD Vascular Surgeon Jefferson Surgical Clinic Roanoke | 540.283.6000

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

Nick Ramey, MD Oculoplastics Vistar Eye Center Roanoke | 540.855.5100

Tesia Gardner, LCSW Psychological Health Roanoke Roanoke | 540.772.5140

Linda Snead, LPC Psychological Health Roanoke Roanoke | 540.772.5140

Laura Ely, PhD Psychological Health Roanoke Roanoke | 540.772.5140

Bill Earles, CO Certified Orthotist Virginia Prosthetics, Inc. Christiansburg 540.381.1502

PICTURE NOT AVAILABLE

Wadid Zaky, MD Carilion Clinic Chronic Pain Management Roanoke | 540.224.5170

Sandeep Ravi, MD Carilion Clinic Cardiology Christiansburg 540.731.7600

Curtis Edward Bower, MD Carilion Clinic General Surgery Roanoke | 540.224.5170

Kodanda Valusa, MD Carilion Clinic Family Medicine Rocky Mount | 540.484.4800

Jared D. March, DO Carilion Clinic Internal Medicine Christiansburg 540.639.9071

Kimberly P. Simcox, DO Carilion Clinic Obstetrics and Gynecology Christiansburg 540.731.4578

Mark Schoemann, MD Carilion Clinic Plastic and Reconstructive Surgery Roanoke | 540.224.5170

Eric C. Steen, DO Carilion Clinic General Surgery Pearisburg | 540.921.2158

Alfred J. Beshai, MD Carilion Clinic Chronic Pain Management Roanoke | 540.224.5170

Katie Love Bower, MD Carilion Clinic General Surgery Roanoke | 540.224.5170

Shanthi Dhaduvai, M.D. Carilion Clinic Rheumatology Roanoke | 540-224-5170

R. Parker Slayton, MD Carilion Clinic Family Medicine Vinton | 540.983.6700

Kimberly Orr, DO Carilion Clinic Family Medicine Daleville | 540.966.0400

Sarah Stubbs, MD Carilion Clinic Family Medicine Rocky Mount | 540.483.5168

Russell Melton, MD Carilion Clinic Family Medicine Pearisburg | 540.921.3636

Amrita de Zoysa, MD Carilion Clinic Family Medicine Bridgewater | 540.828.2634

Christofer C. Catterson, MD Carilion Clinic Orthopaedics and Sports Medicine 540.731.2436 Christiansburg

Douglas Kirtley, MD Gastroenterology LewisGale Physicians Salem | 540.772.5970

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our health | THE LATEST

the l atest

Allan McPherron, DO Orthopedic Surgery & Adult Reconstructive Surgery LewisGale Physicians Pulaski | 540-994-9443 Blacksburg | 540.951.6000

Amir Butt, MD Gastroenterology LewisGale Physicians Salem | 540.772.5970

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

Van Der Liden, MD Gastroenterology LewisGale Physicians Salem | 540.772.5970

Henry Burgess, MD Family Medicine LewisGale Physicians Roanoke | 540.977.0900

Carrie Champine, DO OB/GYN Blacksburg 540.951.1550

Albert Tuono, DO Internal Medicine Blacksburg 540.951.3311

Kissito PACE (Program of All-Inclusive Care for the Elderly) Opens Center in Roanoke An alternative to nursing home and assisted living care.

Kissito Healthcare in Roanoke has opened its doors to the new Kissito PACE Center in Roanoke at The Park at Valleypointe.

The Kissito PACE Center overlooks the Blue Ridge Mountains and has an outdoor patio, therapy gym, many areas for activities, and a primary care clinic staffed 5 days a week. At the Center, participants receive healthcare, nutritious meals, and participate in social activities with others so they may remain active and make new friends. The PACE Center provides one location where physicians, nurses, and other healthcare professionals can provide care and monitor changes in an individual’s health. Wheel chair accessible transportation to and from the PACE Center and appointments is included for program participation.

PACE participants remain living in their own homes with access to the Center. They receive the kind of services—like transportation, adult day care, supportive services, 24/7 access to primary care, physical therapists, social workers, dietitians, and activity coordinators they can’t get elsewhere in one all encompassing program. The PACE team serves as a “one-stop” service where participants get all their health care, nutrition and wellness services needs met.

PACE serves individuals who are age 55 or older, are certified by their state to need nursing home level of care, are able to live safely in the community at the time of enrollment, and live in a PACE service area.

Services PACE offers: • Delivering all needed medical and supportive services, the program is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their homes for as long as possible. Care and services include: • Adult day care that offers nursing; physical, occupational and recreational therapies; socialization, meals; nutritional counseling; social work and personal care • Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant • Wheelchair accessible transportation to and from the PACE center and all medical appointments

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• Home health care and personal care • All necessary prescription drugs • Social services • Medical specialists such as audiology, dentistry, optometry, podiatry, and speech therapy • Respite care • Hospital and nursing home care when necessary The PACE Center is located at 5251 Concourse Drive at The Park at Valleypointe. For more information about Kissito PACE contact: Yvette Cantrell, Center Manager, via email at yvette.cantrell@kissito.org or phone at 540.589.5348 or April Jones, Director of Community Relations and Enrollment, via email at april.jones@kissito.org or phone at 540.354.3589.

THE LATEST | our health

New Ophthalmolic Technology at Blacksburg Eye Associates Blacksburg Eye Associates has recently acquired The Daytona retinal imaging system, by Optos. There are currently less than 20 of these units in the Commonwealth of Virginia, and now there is one available to patients in the New River Valley.

The Daytona provides an unequaled panoramic view of the retina in a single capture, through its patented Virtual Point™ technology. The result is a high-resolution, high-contrast image – the optomap. This view captures up to 82% of the retina in one image, and offers John Dovie, OD an opportunity to identify and follow retinal pathology like never before, for conditions including glaucoma, macular degeneration, diabetic retinopathy, and more.

Call 540.953.2020 or visit www.BlacksburgEye.com for more information.

New Medical Practice opens in Southwest Roanoke County Delmas Bolin, MD, PhD, FACSM has established Performance Medicine of Southwestern Virginia (PMSWVA), a new outpatient medical practice focusing on family medicine, sports medicine and sleep medicine.

Practice Relocation New River Valley Hearing has relocated its practice to 616 West Main Street, Radford, VA, suite A. Joanne F. Dillon, MS, CCC_A, FAAA is now accepting appointments. Please call 540.731.4327 or visit www.nrvhearing.com.

PMSWVA is located at 1215 Corporate Circle, Suite 201, Roanoke, VA 24018. To schedule an appointment with Dr. Bolin, call 540.772.1890. You can also visit PMSWVA’s website at www.pmswva.com.

Dr. Bolin previously practiced at the Primary Care Associates (PCA) West Salem location where he served as the director of the PCA Center for Sports Medicine. He is an associate professor of family and sports medicine at the Edward Via Virginia College of Osteopathic Medicine (VCOM). He also serves as team physician for several area high schools and colleges, including Radford University and Roanoke College.

CORRECTION IN the 2013 Retirement Living Awards section of the August/September SWVA edition, Carrington Place in Daleville placed as a “tie” Bronze winner in the “Skilled Nursing Facilities” category.

Carrington Place was inaccurately listed as a “tie” BRONZE place winner in the Independent Living category.

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HEALTH AND FITNESS ON THE GO | our health

Health and Fitness

On the Go

Having information at your fingertips; that’s what mobile apps are all about. Empowering users to effectively manage their healthcare and a healthy lifestyle is important to everyone.

In our new Health and Fitness on the Go section, we recommend a variety of health-focused apps you can download to your smartphone or tablet.

WaveSense Diabetes Manager * Reviewed by the American Diabetes Association * Do you want to track your glucose results, carb intake, and insulin doses? The WaveSense Diabetes Manager can help. Enter your information in seconds, review the data with convenient charts and graphs, and gain a new perspective on diabetes management. Watch videos (courtesy of dLife) to learn about healthy eating, lifestyle choices, and hear from others who are living life with diabetes. If you need a second opinion you can email results to your trusted health care team.

Available for iPhone only through iTunes. Cost: free iPhone

iBreastCheck Early detection of breast cancer means you have a better shot at winning, so it’s important to do your self-checks each and every month. iBreastCheck contains a video that shows you how to do an effective breast check and explains why it’s a crucial part of preventive health. Set up your reminder time and choose the frequency that works for you – weekly, every two weeks, or monthly.

SHARE YOUR FAVORITE HEALTH AND FITNESS APP!

Available for iPhone and Android. Cost: free. Link to apps for iPhone and Android: http://www.ibreastcheck.com/

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

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DENTAL HEALTH FOCUS | our health

DENTAL HEALTH FOCUS

FICTION or FACT? words | JENNIFER ROMEO

A smile is your best accessory, so naturally you’ll want to ensure your pearly whites stay healthy for life. We all know about the basics – brushing, flossing, and using mouthwash – but separating fact from fiction isn’t always so easy.

For many, visiting dental professionals for health care advice can be a stressful and intimidating experience. In fact, according to a report by the Surgeon General’s office, 4.3 percent of Americans are so afraid of going to the dentist that they simply don’t go at all.

Rather than let the dentist’s chair deter you from getting the answers you need, brush up on the facts. We asked the experts to clarify some of the most common misconceptions surrounding your and your family’s oral health. (http://silk.nih.gov/public/hck1ocv.@www.surgeon.fullrpt.pdf)

Evolution is to blame for the need to have wisdom teeth pulled.

Albert W. Parulis, DMD Roanoke Oral Surgery

I believe there is a lot of fact to this statement, except I would use the term adaptation instead of evolution. Scientific studies clearly show that the vast majority of the adult population do not have adequate space in their mouths for 3rd molars (aka wisdom teeth), and that they can cause significant problems, both locally and systemically. It is reccommended that an evaluation be performed for prophylactic removal in the teenage years as complication rates for removal increase greatly with age, even as early as age 21. The question I often get is: “Why do we even have them?” We know that thousands of years ago the human skull was shaped differently, with a larger face and jaws and a smaller cranial vault, or brain cavity. We did not have processed foods, thus the need for more teeth to masticate, or chew, raw foods was needed. Our skulls have changed over time, so perhaps in another thousand years or so, we won’t have wisdom teeth anymore, no one really knows. For now, most of us do, so having them evaluated early is recommended.

Albert W. Parulis, DMD – Roanoke Oral Surgery www.ourhealthvirginia.com | 23

our health | DENTAL HEALTH FOCUS

Permanent teeth are not affected by the lack of care to baby teeth.

Fiction. Many people think that baby teeth don’t matter because they are just going to fall out.

That simply is not true. Some baby teeth are not lost until you are 10-13 years old. They serve many important functions.

Baby teeth are natural space maintainers for the permanent teeth. If your child loses a baby tooth too early, this could cause crowding of his/her permanent teeth. The permanent tooth could be blocked out and require braces to correct.

Amber N. Parker, RDH, Periodontal Health Associates

The health of your child’s baby teeth can also affect the health of their adult teeth. If you leave dental decay in a baby tooth, it could eventually cause your child pain, abscess, swelling, affect the adult tooth developing under the baby tooth. As a reminder, baby tooth infections can spread to other parts of the child’s body.

Michelle M. Mills, DMD – Mills and Shannon Dentistry

Poor dental health can affect the overall health of the body.

“Yes, this is true. In fact recent studies have shown that when your mouth is healthy, the rest of your body stays healthier too,” answers Dr. George Levicki, president and CEO of Delta Dental of Virginia, the leading dental insurance provider in the commonwealth. “Stroke, heart disease and low birth weight can all be tied to gum disease, which clearly indicates that taking good care of your teeth and gums is a healthy, preventive measure.”

George Levicki, DDS President and CEO of Delta Dental of Virginia

Dr. Levicki, a 40-year veteran of the dental health profession, also notes that “your mouth is one of the first places medical professionals look when searching for symptoms of disease. Many conditions such as diabetes, leukemia, cancer, heart disease and kidney disease can be diagnosed and treated much sooner when discovered during a simple oral examination. For this reason, getting regular oral exams and cleanings, and flossing and brushing twice daily with fluoride toothpaste will not only improve your smile, but may even improve your overall health.

“Routine dental visits are crucial to good health,” emphasizes Dr. Levicki. “Choosing to have dental coverage, and using those benefits, can go a long way to keeping you and your family healthy.”

George Levicki, DDS, president and CEO of Delta Dental of Virginia

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our health | VETERAN CARE

Jeremy Smith’s two decades of Navy service didn’t prepare him for what he’d face on the ground in Afghanistan.

“It kind of woke me up to the fact that war is real,” words | ANIKA IMAJO photography | KEITH THIENEMANN

shares the sailor, whose experience on the frontline proved vastly different from his prior deployments at sea. “I saw a lot of bad things while I was over there that I don’t wish on anybody. In war, nobody wins.”

Now with his combat trials behind him, the married father of two offers this advice to military men and women who are heading to a war zone: “Expect the unexpected and treat war as serious as it is and as terrible as it is.”

Smith was a seafarer, but his specialized set of skills positioned him as a candidate to serve with an Army unit in the war zone. And after four months of training, he headed into the combat theater that would leave an indelible mark on his consciousness.

“Some of the things that you see, your mind’s not ready for,” he explains. “You see things on TV, but when it’s actually put right in front of you so you can reach out and touch it... yes, it definitely has affected me in more ways than one.”

Not only did Smith contend with the “culture shock” of serving within an unfamiliar branch of the armed forces, but he found himself reckoning with threats unlike any he had encountered throughout his maritime career.

“One of our biggest fears in the Navy is having a fire at sea or someone falling over the side,” he shares. “But within the first month that I went to war with the Army, we were shot at. That in itself was an eye-opener and definitely one of those things that wake you up real quick.”

From February 2012 to November 2012, Smith found himself on a bona fide battleground,

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VETERAN CARE | our health

carrying a weapon and absorbing the brutal realities of armed conflict at close range. He doesn’t offer details about his combat experiences, but he does disclose some of the struggles he’s faced in readjusting to life at home.

“When you get shot at, when you get bombed at, you’re on the edge, so to speak. So when you come back, you still have that sense that something’s going to happen.

You’re kind of on guard.”

According to Catherine Wilson, U.S. Navy, retired, who is the executive director of the Virginia Wounded Warrior Program and deputy commissioner of the Virginia Department of Veterans Services, military men and women seldom leave the battlefield unaltered.

Jeremy Smith at home in Roanoke county with his wife, Bobbie and children Jeremiah and Alexandria

“I always make the comment that not all service members come back damaged, but we all come back changed,” she remarks. “The sights, the sounds and the smells of combat really don’t leave you for a long period of time.”

Smith recalls that his strong foundation of faith, prayer and words of encouragement from family members proved invaluable to him as he endured dark moments overseas.

“I probably didn’t talk to them as much as I would like to, but when I was having a bad day, I would get an email from my mother, my wife, my sister or my friends with an inspirational note. Those are the little things that we take for granted in the States. Over there, they can keep you going for months at a time.”

But Smith continues to struggle with residual effects of his experience. Heightened vigilance while driving, an aversion to loud noises and hyperawareness of potential dangers persist in his daily life. Even a year since he returned home, he says, he wakes up throughout the night to check the doors.

“In the environment that we were in for nine months or so, we were constantly under fire so to speak. I don’t think you just come home and reassimilate into the norm without carrying some of it back with you.”

Resuming his job at a Navy Operational Support Center, Smith has found that he has difficulty concentrating and must remind himself to slow down. He finds that the sense www.ourhealthvirginia.com | 27

our health | VETERAN CARE

of urgency and surges of adrenaline to which he became accustomed in Afghanistan are simply not easily left behind.

And although he hasn’t detected any difficulty relating to his family since his return, Smith has noticed that he spends more time isolated in the security of his home.

“Oftentimes I stay secluded. You kind of stay to yourself, because a lot of times while you’re over there, when you go outside of your base, you don’t know if you’re coming back. Your body is tense for nine months. Like it’s wrapped up in plastic, real tight, because you just don’t want to make the wrong move. You don’t know what’s going to happen next.”

Wilson, whose work with the Virginia Wounded Warrior Program represents a robust outreach and support effort, encourages veterans to seek help in addressing any lingering effects of combat experience.

The state-funded program offers five regional networks connecting veterans in need with counseling services and an array of treatment and employment resources.

Left undiagnosed or untreated, she points out, conditions such as posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) may have dire consequences for service members and their families alike, and in some cases lie dormant for many years before manifesting themselves.

“How people readjust from those deployments and reintegrate into their lives can be a real challenge, whether you cope well or whether you choose avenues of poor coping mechanisms, which can lead to substance abuse, family discord, domestic violence and dangerous behaviors,” says Wilson.

Smith has already achieved a significant measure of victory over his residual symptoms. Having acknowledged that he does suffer from the aftereffects of exposure to combat, and having sought assistance to work through these issues, he has taken the courageous first steps toward healing.

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VETERAN CARE | our health

“Sometimes you’ve got to step up and look at yourself and say, ‘Hey, I’m having a hard time dealing with this,’ ” he divulges. “You’ve got to be man enough or woman enough to go and seek medical attention.”

A widespread reluctance to admit the need for professional help, says Wilson, is one of the most daunting hurdles to overcome in providing care for veterans. Military culture in particular can send the message that soldiers and sailors should bear their emotional burdens in silence.

“There’s fear of retribution, fear of not being promoted at the normal rate or of somehow being perceived as weak. So I think the perceived stigma of behavioral health and really getting folks to seek care are true challenges throughout the country.”

In the absence of adequate intervention to address behavioral health problems, veterans may struggle to thrive fully. And in the most tragic situations, this may lead to catastrophically self-destructive conduct. Responding to an alarming rise in the number of military suicides in recent years has become a top priority of the Virginia Wounded Warrior Program, explains Wilson, who notes that roughly half of these heartbreaking cases are among service members who have never been deployed to Iraq or Afghanistan.

But the veterans of those conflicts who are in crisis, Wilson observes, may suffer from the stress of their combat experiences, often compounded by the rigors of multiple deployments in rapid succession.

Smith says he can only imagine the toll that these circumstances might take on his fellow service members.

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our health | VETERAN CARE

“Everybody dreads deployment, but for the guys who have been to Afghanistan on three or four tours, I don’t know how they do it and keep their sanity.”

“I always make the comment that not all service members come back damaged, but we all come back changed,” she comments. “The sights, the sounds and the smells of combat really don’t leave you for a long period of time.

— Catherine Wilson, U.S. Navy, retired, executive director of the Virginia Wounded Warrior Program (VWWP) and deputy commissioner of the Virginia Department of Veterans Services

Disclosing that he was initially embarrassed to accept assistance, Smith expresses concern for veterans who try to overcome serious problems on their own, as he attempted to do when he first returned home.

“I tried to beat the problem, but the problem can definitely be stronger than you are if you can’t get your hands around it. Deep down inside, it can eat you from within.”

While Smith confines discussion of his wartime trials to a very small circle of confidantes, such as his wife—who has also served in the Navy—and a select group of veterans who share similar recollections, he has come to appreciate the value of finding safe outlets for the disturbing images that haunt him.

“I kind of alienated myself, because lots of times I didn’t want to talk about some of the things that I experienced. But come to find out, by not getting it off my chest, some of the issues were affecting me even more.”

And he has been more than satisfied with the care he has received.

“Now that society has recognized that people do have issues when they come back from war, they want to treat them accordingly. I couldn’t ask for any better medical assistance coping with some of those things that I personally dealt with and that I’ve seen some of my fellow sailors and Army men deal with.”

Pointing out that the health of communities throughout Virginia—whose population comprises a relatively high percentage of veterans—is enhanced when the critical needs of service members are served, Wilson remarks: “I think that in Virginia, we’ve really been a vanguard in trying to get integrated support services for our veterans and their families, because I think we’re just seeing the tip of the iceberg.” She adds, “We’ve been touted as a national model, but I think— more importantly—we’re just making a difference in the lives of our Virginia veterans and their families.”

Smith, who looks forward to retiring from the Navy in the near future, would like to believe that his recent rendezvous with combat was his last.

And he empathizes with all service members who may face the ordeal of combat.

“If the call comes, of course I have to answer that bell. But for myself and a lot of other men and women out there, I hope the call doesn’t come, because war is a terrible thing.”

For more information about the Virginia Wounded Warrior Program, please visit http://wearevirginiaveterans.org/.

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BE YOUR OWN ADVOCATE

Pictured above: Hunter Johnston, (left) of Roanoke and Decca Knight, of Floyd

A message that is universally emphatic among women who have had breast cancer: Know your own body. Be your own advocate. Trust your gut. words | SARAH COX

photography | KEITH THIENEMANN

Decca Taliaferro Knight, age 36, was diagnosed four years ago. She had just had her son, who at the time was a little over one year old. She realized that she hadn’t gotten a reminder postcard about having her yearly checkup, so she called the doctor’s office, made an appointment and went through an exam, during which, she recalls, her doctor felt something “that was pretty big.”

She says that he presented her with two options—wait a few months and see if the mass he detected would change, or go in for an ultrasound. She opted for the latter—luckily, she says—and chose to go to a breast surgeon. What they discovered was stage 3 breast cancer, also in her lymph nodes, and very aggressive. She had a biopsy and then a double mastectomy very quickly, but all was still not well.

First, the decision to have a double mastectomy was Knight’s. She says she didn’t want to constantly worry about the breast cancer coming back. Second, the biopsy that was done during surgery didn’t reveal any cancer in the central node, so preliminary reconstructive surgery was started. www.ourhealthvirginia.com | 31

our health | WOMEN’S HEALTH

While women who have a family history of breast cancer are in a higher risk group, most women who have breast cancer have no family history.

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But the next day, when the biopsy had undergone a complete pathology test, they were able to detect cancer in one of the other nodes. So started the radiation, six weeks of it done every day. Knight also underwent six rounds of chemo, and to complicate the procedure, she also had to have latissimus flap, or lat flap, reconstruction that uses muscle and skin tissue from the upper back to reconstruct the breast.

A year and a half after being diagnosed, Knight was on her way to complete recovery. She was lucky, she says. She was and still is in good physical condition and young. While her range of motion in her arm is not complete—she says she can’t, for instance, lift her son from the swimming pool, and her strength on her left side is not back to pre-operative condition—she bounced back quickly. She will be on the endocrine therapy medicine tamoxifen for 10 years, but she has gone back to work and is doing well.

She had no history of breast cancer in her family. But she is quick to point out that “90% of women diagnosed with breast cancer have no family history of the disease. There is a big, big, big misperception that most young women who get breast cancer have a family history. That is not true. I had not once in my life done a breast self-exam, because I am really healthy, ate well, never drank or smoked, and didn’t think it was necessary. If women have that perception, they are doing themselves a big disservice,” she says.

She had to take one and a half years of leave from her job as a child counselor in a school system. She is now in private practice at her business, Blue Ridge Parenting. She is one of the lucky ones, she says, because she was able to take time off work. She knows of women in her informal breast cancer survivors women’s group, composed of younger women, who have had to work while in active treatment.

Members of her group are younger than 40. The cancer, she says, was found either by themselves, their physicians or some fluke—one of her friends was laying down breastfeeding her baby, she says, and noticed something.

“Women need to advocate for themselves. If they feel that something is not right, they need to get it checked out,” says Knight.

Hunter Johnston, age 34, did. She was 29 when she found her lump through a breast self-exam. She went to her family doctor, who told her that she had to have an ultrasound, not a mammogram, because of insurance. That revealed nothing too threatening, so she waited for a few months. By that time, the pea-size lump had grown to a marble size, and she wanted it removed.

She remembers that when she had taken an epidemiology class, the professor had passed around a fake breast with cancer tissue, and it felt like that. The surgeon she met with in October wasn’t concerned, but she directed the surgeon to schedule the surgery.

Then she got a call. “When I got that call, I didn’t tell anybody, but when I went in that Monday, the doctor said, ‘This is not what we expected, and you have cancer.’ With everybody that’s been diagnosed, they don’t remember much after being told they have cancer,” says Johnston. She had brought her father with her to the doctor’s office, and together they went directly to a geneticist, where she had blood work done. Then waited for three weeks, which she says were the longest weeks in her life.

Five years ago in November, she had surgery. The first was a lumpectomy, but since the location of the cancer would necessitate reconstruction, she decided to have a mastectomy after that. She started her six rounds of chemotherapy in February of that year, and completed them in July 2010. She now sees her oncologist and surgeon every six months, has an MRI or a mammogram (alternating) every six months and has opted out of taking drugs.

She wants children. She was married in April 2011 and is now expecting her first child in March 2014. Johnston’s advice? “Absolutely trust your gut and believe in yourself. You know your body. Fight for what you need.”

According to the National Breast Cancer Foundation, “while women who have a family history of breast cancer are in a higher risk group, most women who have breast cancer have no family history. Statistically only about 10% of individuals diagnosed with breast cancer have a family history of this disease.”

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James Lynde, MD Bedford Memorial Hospital • 1613 Oakwood Street, Bedford 540.586.2441 • www.bedfordmemorial.org

Mammography can potentially find life threatening breast cancer before it is clinically apparent. Pre - clinical detection offers the greatest potential for cure. A woman’s chance of getting breast cancer increases with age. Mammography screening should begin at age 40 unless you have strong family history of breast cancer, specifically mother, daughter, or grandmother. According to the American Cancer Society a woman’s chance of developing breast cancer during her lifetime is 1 in 8.

MAMMOGRAPHY

D. Kyle Fitzgerald, DDS General Dentistry • 6220 Peters Creek Road Roanoke • 540.366.3999

Dentists have stressed prevention for decades. Prevention begins at home with proper brushing, flossing and diet.

Regular visits to the dentist for a checkup and cleaning are also preventive in nature in that problems are detected early and taken care of before they get out of hand. Also, the cleaning and scaling help to prevent gum disease and let’s not forget the importance of the “pep talk” from the hygienist! The American Dental Association (ADA) recommends that the dentist attempt to examine a child’s teeth and mouth by 1 year of age; most dentists do not clean a child’s teeth until age 3.

DENTAL HEALTH

Women’s

Moriah Krason, MD Lewis Gale Physicians • Pediatrics 1802 Braeburn Drive • Salem 540.772.3580 • www.lewisgale.com

It is important to regularly review your child’s immunization schedule with your child’s doctor.

Have your child immunized as recommended by the CDC vaccine schedule.

Delaying, or not vaccinating will leave your child at risk for many serious, life-threatening illnesses.

PEDIATRICS

Kara Lee Matala, DO Roanoke Partners in Health •3239 Electric Road, suite A Roanoke • 540.904.7912 • www.roanokepih.com

I encourage patients to take ownership of their health. Have a yearly physical, which should include blood pressure reading, blood work to check cholesterol and a comprehensive metabolic panel, mammogram, bone dexa scan and colonoscopy. Make sure all your immunizations are up to date, including Tdaptetanus booster, pneumonia and shingles vaccine, and get a yearly flu shot. You should eat a well-balanced diet and get plenty of exercise to maintain a normal weight. Unfortunately, nearly 78 million U.S adults are obese today.

FAMILY PRACTICE

CHART for HEALTHY AGING

Aubrey Knight, MD Carilion Center for Healthy Aging 2001 Crystal Spring Avenue, suite 302 • Roanoke 540.981.7653 • www.carilionclinic.org

Women in their 60’s and 70’s should continue to get screened for hypertension, diabetes, breast cancer and colon cancer. Some screenings over time may cause harm or the disease for which is being screening is likely to not become evident during the individual’s life expectancy. Because of that, it is important to talk with your physician about screenings that are appropriate for you.

GERIATRICS

Kenneth Luckay, DO Osteopathic Physician and Hormone Balancing 4515 Brambleton Avenue, suite B • Roanoke 540.777.6808 • www.cmwl.com

You should have your hormone levels checked when you can’t recall the last time you felt “great!” When you experience: unexplained weight changes; poor sleep; alteration in mood or change in energy level. If you have “brain fog”, no longer interested in sex, or feel increasingly stressed out you should have your hormone levels checked. In other words when you no longer feel like “you”.

BARIATRIC MEDICINE

Trends in Childbirth: WHAT’S OLD IS NEW AGAIN words | SUSAN DUBUQUE

Trends come and go. From skirt lengths and hairdos, to colors and music. Similarly, there are trends in childbirth. Although women have basically been giving birth the same way since the beginning of time, the environment and practices that surround the birth of a baby are ever-changing— and in some cases cyclical. Let’s zip back in time and explore the developments in childbirth in the U.S. through the last century.

In 1900, fewer than five percent of women gave birth in hospitals.

Physicians attended about half of all the nation’s births, including nearly all births to middle- and upper-class women. Lay midwives took care of women who could not afford a doctor.

The first maternity clothes were introduced in 1904 by Lane Bryant.

In 1914, “twilight sleep”—use of morphine and scopolamine to wipe out the memory of the pain of childbirth—was introduced into the United States and upper-class women formed “Twilight Sleep Societies” in an effort to force hospitals to offer the procedure. At this time, obstetrical anesthesia became a symbol of progress in medicine and women flocked to the hospital seeking painfree childbirth.

The 1920s saw the establishment of professional training programs for nurse-midwives.

By the late 1930s, 50 percent of all women and 75 percent of urban women gave birth in hospitals. The medical profession engaged in hot debate over the use of pain medications for childbirth.

During the 1950s, the concept of “family-centered maternity care” was first introduced, the La Leche League was founded as the leading advocate for breastfeeding and

our health | WOMEN’S HEALTH

Robert Bradley, MD, and Ferdinand Lamaze, MD, introduced their approaches to natural childbirth.

In the early 1970s, a combination of feminism and the back-to-nature movement led to a revival of midwifery. Many women proclaimed that childbirth is not a disease and that normal deliveries do not require hospitalization or supervision by an obstetrician. Husband demanded to be present for labor and birth—serving as “coaches” for their wives.

In 1980, midwives attended only 1.1 percent of births. By 2011, 7.8 percent of all births and 11.7 percent of vaginal births were managed by midwives—many with master’s degrees in nurse-midwifery.

The 1990s, brought another wave of painless childbirths with the introduction of epidurals. In 1995, Cesarean sections (C-sections) accounted for 21 percent of all births, trending upward to a high of 33 percent in 2009. Since 2011, the C-section rate has stabilized at 31 percent.

With so many developments in the past 100 years, let’s now explore the latest innovations—as well as tried-and-true childbirth practices—occurring right here in our community in 2013.

Laura Godfrey, with her daughter Avery, in the Birthing Suite at Carilion Roanoke Memorial Hospital

Sources: National Vital Statistics Reports; Center for Disease Control; The History of Midwifery and Childbirth in America: a Time Line, Midwifery Today; research on the History of Cesarean Sections conducted by Dr. Sumac Diaz and presented at Wayne State University in August 2013.

Empowering Women Today, women have very decided opinions about childbirth—and Carilion Clinic and LewisGale Regional Health System are responding to consumer needs and wishes in a variety of ways.

Kris Conrad, certified nursemidwife at CNRV

Carilion Clinic has more than 4,600 births annually—3,400 at Carilion Roanoke Memorial Hospital (CRMH) and 1,250 at Carilion New River Valley Medical Center (CNRV). LewisGale averages 1,400 deliveries each year—900 at LewisGale Medical Center (LGMC) and 500 at LewisGale Hospital Montgomery (LGHM)—with a steady increase over the last four years. At both hospital systems, every effort is made to provide each mother with a truly customized birth experience.

One of the first choices an expectant mother will make is who will guide her through pregnancy and delivery. LewisGale offers a choice of obstetricians in multiple groups— including male and female providers. Carilion Clinic has a cadre of obstetricians and three certified nurse-midwives who work in a collaborative practice.

“Midwives specialize in natural childbirth—low-medical intervention, high-touch deliveries,” explains Kris Conrad, certified nurse-midwife at CNRV. Obstetricians attend the full range of deliveries—from uncomplicated births to high-risk patients.

Elizabeth Barwick, DO, an OB/GYN practicing at LewisGale

Throughout their hospital stays, patients are cared for by teams of experienced motherbaby nurses. Patients are also welcomed to have doulas—a woman trained to assist another woman during childbirth and who may provide support to the family after the baby is born.

Safe and Warm “We encourage women to prepare a written birth plan to make sure her delivery physician is fully aware of her preferences,” says Elizabeth Barwick, DO, an OB/GYN practicing at LewisGale. The birth plan might include the specific people whom the mother would like to

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WOMEN’S HEALTH | our health

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our health | WOMEN’S HEALTH

support her through labor, soft lighting, soothing music, pain management techniques and the like. It could also express how the mother would like the baby to be treated—such as delayed cord clamping and choice of diapers.

Marjorie Young, Director of Women’s Services at LGHM

Comfort is a high priority when it comes to childbirth. In response, Southwest Virginia hospitals provide mothers with accommodations that you would expect to find in a fine hotel. Amenities range from spacious patient rooms with private labor tubs and showers to intermittent and remote monitoring that ensure baby’s progress can be tracked, while allowing mother to walk around, use a birthing ball or bar or even relax in the water during labor.

LGMC, LGHM and CNRV boast spacious LDRPs—labor, delivery, recovery and postpartum suites—that allow the mother to remain in one room throughout her hospital stay. Marjorie Young, director of women’s services at LGHM, notes, “Our goal is to offer the warmth of home delivery in the security of a hospital.” Flexible visiting policies further enhance the family-friendly nature of obstetrical care.

Patrice Weiss, MD, chair of the Department of OB/GYN at Carilion Clinic

“We do everything we can to meet each woman’s desires,” says Patrice Weiss, MD, chair of the Department of OB/GYN at Carilion Clinic, “but always with an eye to safety for mother and baby.” Access to a neonatal intensive care unit (NICU) can provide an added degree of assurance. CRMH’s Level III NICU cares for about 600 babies each year and is the thirdlargest NICU in Virginia.

Patients with risk factors—such as diabetes, preterm labor, high blood pressure or being over the age of 40—will be reassured knowing that both CRMH and LGMC have maternalfetal medicine physicians, specialists in high-risk pregnancies and deliveries.

The use of pain medication during labor and delivery is a very personal choice.

“With or without medication, sometimes being patient and allowing nature to take its course can be the difference between a vaginal and a C-section delivery,” says Claudia Newton, RNC, director of labor and delivery at CRMH. Although Carilion Clinic’s C-section rate is comparable to the national average, Newton notes, “We are initiating efforts to make it even lower.”

Special efforts are made to provide positive birth experiences for women having C-section deliveries. “We have a dedicated operating room and mother is allowed to recover right here in the unit—so she can be reunited with her baby immediately after a C-section,” says Tina Osborne, clinical coordinator at LGMC. Similarly, Barwick notes, “At LewisGale, we encourage women who wish to attempt a vaginal delivery after previously having a C-section. With anesthesia on hand 24/7, this is a safe environment for a VBAC (vaginal birth after Cesarean).”

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WOMEN’S HEALTH | our health

“Skin-to-skin contact is a wonderful way for mother and baby to bond in the first precious moments after birth,” says Cleo Williams, RNC, director of women’s services at CNRV. Rooming-in allows new families to spend time together and to gain confidence in newborn care. Young remarks, “Our nurses use bedside, in-the-moment teaching to help our parents go home feeling well prepared to care for their new babies.”

Getting Ready for Baby

Cleo Williams, RNC, Director of Women’s Services at CNRV

Our local hospitals provide a multitude of ways for new parents to learn about and prepare for pregnancy and beyond with a broad selection of educational programs—from childbirth preparation, breastfeeding, nutrition and exercise, to infant CPR and newborn care.

Funded by a three-year grant from March of Dimes, the Carilion Clinic-sponsored Baby Basics Moms Club is an in-depth educational program designed to provide low-income expectant mothers with the best possible preparation for a healthy pregnancy.

At all local hospitals, certified lactation consultants and nurses are available to assist mothers with breastfeeding while in the hospital, and breastfeeding classes provide ongoing support after discharge. LGMH is in phase three of four on the pathway to becoming a Baby-Friendly Hospital—a designation by Baby-Friendly USA, part of the World Health Organization’s efforts to support breastfeeding throughout the world.

Little Things Mean a Lot Personalization is the hallmark of a progressive childbirth service—and the women of this community are fortunate to have an abundance of options from which to choose.

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our health | WOMEN’S HEALTH

Susan Dubuque is principal and co-founder of Neathawk Dubuque & Packett, a marketing and advertising firm based in Richmond, VA, that has a special group dedicated to healthcare and wellness. A nationally recognized speaker, Susan has published more than 100 articles on healthcare and service marketing, and has assisted more than 200 hospitals and healthcare organizations with marketing and branding initiatives. Author of two books, A Parent’s Survival Guide to Childhood Depression and Kid Power Tactics for Dealing with Depression, she launched a national campaign to increase public awareness of childhood depression.

While there are far too many examples to enumerate, here are two little extra touches worth mentioning.

Carilion Clinic literally offers a caring touch in the form of massage. At CNRV, a massage therapist is on hand to provide an added measure of pain relief during labor or a relaxing treat for mom during her postpartum stay. An infant massage class gives mothers an additional means of bonding with her newborn or soothing an irritable baby.

Who says hospital food is bad? LewisGale provides moms with a special treat the night before discharge. Parents enjoy a lovely gourmet dinner—called the Marquis Meal—just before heading home to start life with the newest member of the family.

Having a baby is one of the most memorable moments in any woman’s life. Today, women are reaffirming the notion that childbirth is a beautiful, natural occurrence—not an acute medical event. But if you think the latest trends like birthing balls and laboring pools are mere fads, think again. Women are playing an active role in planning their pregnancies and deliveries. They are conducting thoughtful research and doing their homework. And along with childbirth professionals, they are continually seeking better ways to ensure the safe delivery of healthy babies. And that’s a trend we can all embrace.

Here’s how you can learn more about the innovative, family-friendly childbirth services available in our community.

Carilion Clinic: Visit carilionclinic.org/maternity or carilionclinic.org/cnrv/the-birthplace LewisGale: Visit lewisgale.com/maternity or call Consult-A-Nurse® team 24/7 at 877.2HCADOCS (242.2362) to schedule a tour.

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our health | DOCS OFF DUTY

words | RICH ELLIS, JR. photography | KEITH THIENEMANN

When asked, or rather told, to leave an emergency department, most young, easily intimidated first-year medical students would probably comply hastily, returning only with great reluctance.

Not Lucky Garvin.

“When I got to medical school, I kept going to the emergency department and getting kicked out because I didn’t know what I was doing. I was told I asked too many questions.”

Many of those medical students who made it through to become emergency department physicians would later leave, this time without being asked, because emergency medicine has one of the highest physician burnout rates in the medical field.

Unless, again, you’re Lucky Garvin.

Dr. John “Lucky” Garvin retired in April from LewisGale Medical Center as an emergency medicine physician. Considering that there are countless emergency medicine physicians nationwide, that on its own isn’t really an amazing feat, until you consider that he lasted 42 years despite the industry’s high burnout rate, and in doing so may have set a national record for the longest tenure in emergency medicine.

Dr. Garvin spent his entire career in emergency medicine at LewisGale. But if it hadn’t been for his perseverance, he might never have entered the field in the first place.

“I always wanted to do medicine,” Dr. Garvin explains. “When I got to medical school, I kept going to the emergency department and getting kicked out because I didn’t know what I was doing and I asked too many questions. Then I would go back the next night and hope that another chief resident wasn’t there like the one who had kicked me out the night before. In my fourth year of medical school, they said, “you’re now in charge.”

He wasn’t actually in charge, but at least now he was higher up on the food chain, having probably set a record for the number of times he was kicked out of the ER while still a student. Medical students, it turns out, weren’t supposed to be hanging out in the ER. But Dr. Garvin couldn’t stay away.

“There was something about [the emergency room],” he explains. “Perhaps it fits my obsessive compulsiveness—there are no two cases just the same.”

When asked how he survived for so long in a field known for burning through its physicians, Dr. Garvin says there were two things he loved about the medicine.

“Solving the problems that get the person better, and close on the heels of that is I always went in assuming that they [the patients] were going to teach me something I didn’t know.

Once we got done with the medical end of things, when time permitted, we would sit and chat and I’d learn from them. I just always loved the folks and they seemed to love me back.”

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DOCS OFF DUTY | our health

As much as he loves emergency medicine, however, Dr. Garvin doesn’t want his love of the field to be misleading, because he says it can be a frightening profession for a doctor.

“You never know what’s coming in the door,” he explains. “And you have to do all your studying a priori—you don’t have time in a life-threatening emergency to look up data; you better know it ahead of time. And that, over time, got to be burdensome—the amount of studying. You literally studied every day. You’d go to work, do your eight or 10 or 12 hours, and then you’d study what you just left.”

The studying, though, isn’t the only aspect of the profession that helped Dr. Garvin decide it was time to retire. He says there were a variety of factors that, when combined, helped him decide. He says you can call emergency medicine a young man’s game. There are many regulations. Administrators gradually took over more and more of the way physicians practice medicine. And there are an increasing number of patients seeking drugs.

Dr. John (Lucky) Garvin with then First Lady Barbara Bush, at the dedication of the Bradley Free Clinic building on April 12, 1990

“Although the vast majority of the people that I treated I loved, I began to notice, if you will, my expiration date had been expired. The Garvin bottle was getting dusty, and it was time to come off the shelf.”

Dr. Garvin doesn’t know for a fact whether he holds any type of longevity record for length of service in emergency medicine because, he says, it was actually his brother,

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our health | DOCS OFF DUTY

Dennis Garvin, MD, a urologist in Salem, VA, who looked into the record.

Regardless of whether he does hold a record, Dr. Lucky Garvin says that the field certainly has changed during his more than four decades of service.

“Technology is huge—not only the machines we use but also the medicines we use,” Dr. Lucky Garvin explains. “The second thing is administrative involvement. The third is patient expectations, and then there’s the rise of medicine abuse—people who are there [in the emergency department] not because they’re sick but because they want to make me think they are. Then I have to guess how much pain you’re really having and are you really having pain and I have no way to do that. Those are things that probably, over time, wore me out. But the broader thing is it may have just been time for me to go.

I never really thought of things in those terms.”

A flying squirrel rehabilitates at the Garvins’ Southwest Virginia Wildlife Center

Somewhere along the line, Dr. Lucky Garvin says he developed the notion that the happiest person you’ll find is the one who has discovered the reason he or she was put on this earth. And Dr. Lucky Garvin says he’s fortunate to count himself among those “happiest” people, having found and fulfilled what he sees as his life’s purpose.

Given his passion for and outlook on life, it would be a surprise if Dr. Lucky Garvin just quietly slid into retirement and inactivity, which is why he isn’t. He doesn’t play golf and he isn’t a big sports fan, leaving him plenty of time to pursue his 40-year passion for writing. He’s already published 10 books, and just finished writing a collaborative with his brother about growing up in a small town in New York.

He also rescues and rehabilitates wildlife with his wife, Sabrina, through their Southwest Virginia Wildlife Center organization, which they’ve been operating for 16 years, and they’re now performing volunteer work at the SPCA. He also enjoys woodworking, as well, and frequently donates his creations to area organizations that use them in fundraisers.

While he might have more time to pursue these volunteer activities now that he’s retired, volunteering has always been a way of life for him.

He played a pivotal role in the growth of the Roanoke Valley’s Bradley Free Clinic, which provides free medical, dental and pharmaceutical care, and served as the board’s first president for 23 years.

Whether inside or outside the ER, Dr. Lucky Garvin always found, and will undoubtedly continue to find, a way to give back.

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HealthyEats LT HEA

T OMFOR C Y H

FOODS

Pumpkin Soup makes 4 servings

5. Remove any rosemary and bay leaves then pour a third of the soup in the blender with a third of the yogurt and puree.

Directions:

1. In a large saucepan, heat olive oil and cook the onion without browning, for three to four minutes.

2. Add pumpkin, carrot and rosemary and cook, stirring for two to three minutes.

6. Transfer into a large bowl. Repeat with the remaining soup and yogurt and pour the whole lot back into the saucepan, heat through and serve.

3. Add stock and bay leaves.

Ingredients: 1 tablespoon olive oil 1 onion, chopped

4. Bring to a boil, cover and simmer for twelve to fifteen minutes until vegetables are tender.

16 ounce can of unsweetened pumpkin puree 1 carrot 3 sprigs fresh rosemary 4 cups chicken stock 3 bay leaves ¾ C plain Greek yogurt

Tricia Foley’s

HEALTHY PUMPKIN SOUP Tricia Foley is Our Health Magazine’s resident nutritionist

our health | KIDS CARE

Andrea Christian is an outstanding high school senior. She is a right-handed pitcher for Salem High School’s softball team, she’s seriously looking at two Division II universities where she wants to continue her sport and she checks her insulin levels many times a day. For Andrea, having type 1 diabetes is a way of life—one that she’s had since she was four years old.

Type 1 diabetes means that the “pancreas is no longer capable of producing insulin.

Through multiple daily injections with insulin pens or syringes or an insulin pump, it will be up to you to monitor your blood glucose levels and appropriately administer your insulin,” states the American Diabetes Association. And so Andrea does checks her blood sugar five to eight times a day with her pump, which she has had since she was seven years old. No matter if she’s in a game, in the cafeteria, in a classroom, it’s up to her, and next year, when she goes to college, it’ll be her responsibility completely.

She says that neither college she’s looking at—UVA-Wise and Bluefield College—knows about the diabetes, nor has she brought it up. It certainly hasn’t affected her playing or her way of life. She’s the typical teenager, eager to go off to college, but knowing that doing so “will teach me to be even better with [managing diabetes]. Now, I still live with my parents and they help out a lot, and it’s able to be managed. Going to college will help me grow up and pay more attention,” she says.

PITCHING A MESSAGE OF words | SARAH COX

photography | KEITH THIENEMANN

According to the Mayo Clinic, type 1 diabetes “can affect major organs in your body, including heart, blood vessels, nerves, eyes and kidneys. Keeping your blood sugar level close to normal most of the time can dramatically reduce the risk of many complications.”

She needs to. According to the Mayo Clinic, type 1 diabetes “can affect major organs in your body, including heart, blood vessels, nerves, eyes and kidneys. Keeping your blood sugar level close to normal most of the time can dramatically reduce the risk of many complications.”

Andrea can’t remember life before diabetes, and maybe that’s why she takes this disease on the chin, the way she may strike out the next batter. “It really doesn’t affect me too much.

Sometimes I have to take time away to stop and check my sugar, or eat something. I usually carry a pack of crackers, a juice box, glucose tablets and my meter in my bat bag,” she says.

She has to let her teachers know at the beginning of the school year that she may have to leave the room and go to the nurse’s office. Her friends don’t really ask too much about it, because they’re used to it, too. But Andrea does reach out to a particular crowd. Through the Juvenile Diabetes Research Foundation’s Greater Blue Ridge Chapter, she speaks to parents who have children recently diagnosed with type 1.

“I assure them it’s okay, and I’ve been able to conquer it. You have to always stay positive.

Sometimes I do have a hard time, but the more aggravated you get with it, the more time you have with it, so it’s better to stay positive,” she says.

Her message to those who have been recently diagnosed is to work hard and conquer the disease that “some of us have been given in life.”

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STRENGTH

LIVING WITH PURPOSE | our health

Living with Purpose

words | TINA JOYCE

Nothing contributes to greater spiritual health than living with purpose. Just as healthy foods, regular exercise and adequate rest fuel our physical bodies, living and serving with purpose are energy for our souls.

Many of us long to live our lives knowing we have made a difference in some way, while others commit to living without being imprisoned by worldly possessions and focus daily efforts on simply serving people. Roanoke residents Steven and Katrenna Sandy are taking action to live out the purpose they feel called to embrace.

Above: Katrenna holding a child waiting to be seen by the doctor for malaria treatment Top, right: Phillip playing and spending time with children at the orphanage

Steven, a local county planning director, and Katrenna, a school teacher, have had a heart for Africa for many years, but their tangible journey intensified when Katrenna, also a mother of three, embarked on a short-term medical mission trip to Uganda almost three years ago. During Katrenna’s stay in Uganda, she explains, “I fell even more in love with the country and its people.”

Prior to arriving in the landlocked country of East Africa, she and Steven had already initiated the adoption process for two orphaned Ugandan children. The Sandys felt compelled to open their home and family to two children whose father was deceased and mother was sick and could no longer care for their basic needs—forcing them to live in a local orphanage. The Sandy family began the 15-month, costly adoption process and took steps to integrate the children into their new home. Steven and Katrenna already had three biological children, Ryan, Katelyn and Phillip, now ages 22, 18 and 13, respectively.

In May of 2012, the preparation of their home, finances and spiritual conviction were coming together. The children’s room was ready and clothes were hung neatly in the closet.

Katrenna and their son Phillip boarded a plane, equipped to spend three weeks preparing the children for adoption and transition to the States. The rest of the Sandy family joined www.ourhealthvirginia.com | 53

our health | LIVING WITH PURPOSE

them shortly before the court date, ready to welcome their growing family. Unfortunately, the court date was delayed; then delayed again and again. After weeks of court delays, and significant financial sacrifice and emotional strain, the final court date was established. Sadly, on this day, the court ruled against the adoption for the Sandys, saying the children’s biological mother changed her mind and would no longer give consent allowing her children to be available for adoption; they were to remain in the orphanage. This news devastated Steven and Katrenna. “One of the most difficult things was, I didn’t realize it was so hard on our son Phillip.

He was sobbing over our loss,” shares Katrenna.

Due to the lengthy delays and Steven’s employment, he had to return to Virginia. Katrenna and Phillip stayed to try to piece things back together with their attorney and the orphanage but after a month returned home without the children or much hope of ever seeing them again.

Although the Sandys were dispirited by their experience, they still had a heart for the country and felt led to stay connected and prayerfully sought direction for their next steps, both together and independently. “We had both been praying that if Uganda wasn’t in our future, that the Lord take it off our hearts. The burden was never lifted,” Steven explains.

The Sandys’ two older children are now in college, and the failed adoption of the two Ugandan children left Steven and Katrenna deciding to downsize and sell their home this year. Within a week of this decision, they visited family and attended a church service where Steven and Katrenna had attended as children, New Life Christian Ministries. On this day, two seemingly independent paths began to merge together to weave a remarkable, inspiring story.

Beginning in June 2012 (not long after the failed adoption for Steven and Katrenna), Pastor Tony Atkinson, of New Life Christian Ministries in Roanoke, began working with several members of his congregation on an amazing, God-directed project. Pastor Tony was invited to Butiru, a small village in Eastern Uganda (about 45 miles south of Mbale), to share in a vision of a few individuals. A nine-acre complex with a hospital, initially built by a German organization, was now underutilized due to a lack of funding by its local organization.

Kissito Healthcare International was given an opportunity to run the private hospital in an effort to try and to meet the medical needs of the community and surrounding villages.

Kissito Healthcare International is an organization committed to facilitating sustainable solutions to health-related challenges throughout the world. “We are focused on building a program with the university in Uganda, Busitema University, to improve rural medicine,” explains Tom Clark of Kissito.

“More than money, the people of Uganda need education in ways to provide medical care within their own communities and how to utilize agriculture to sustain healthier living.”

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our health | LIVING WITH PURPOSE

Clark, Don Eckenroth of Gentle Shepherd Hospice, Pastor Tony Atkinson of New Life Christian Ministries and the Shenandoah Pentecostal Church bring a collaborative initiative and a shared vision. The experience and background of these organizations, combined with many other individuals who possess a heart for missions work, are collaborating and have presented an opportunity to lease, expand and operate a critically needed healthcare facility in Butiru. Thus, The Uganda Project was born.

An empty hospital, scarcely trained staff and a nearly deserted campus, more than 8,500 miles from Roanoke, seem like an unlikely success story. “We have great faith. If God leads us in a direction, we will rely on him to provide the resources,” confidently explains Pastor Tony. People have come forward with tremendous expertise and foresight for the exact needs of such a monumental project.

Steve offering assistance in weighing children at the outpatient malnutrition clinic

The church has now signed a 99-year lease with the Ugandan government for the complex and created a separate, 501(c)(3) partnership to manage and utilize the existing hospital building, living quarters and kitchen facilities. The project is also expanding construction in two phases to ultimately include a church, inpatient acute malnutrition center, administrator’s residence home and a labor and delivery ward in the hospital.

An immediate need for the project was finding an individual, or preferably a family, who can administratively oversee the construction and day-to-day operational needs of the project as it expands—in Uganda.

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LIVING WITH PURPOSE | our health

At right: Nurse at the Butiru Hospital treating a young infant with malaria; Far right: Butiru Hospital

Pastor Tony presented to his congregation a message introducing The Uganda Project and the upcoming needs on the same day Steven and Katrenna happened to visit his church. That message prompted Steven to email Pastor Tony that evening and share a portion of their story and heart for Uganda.

The next day a meeting was established and Pastor Tony invited Steven to accompany him on his next scheduled trip—in only two weeks.

As though their future in Uganda was divinely orchestrated and written, Steven and Katrenna have committed to moving to Butiru to oversee the administrative duties of the project. Within a short time, two parallel paths intersected at a precise time to fulfill a struggling community’s need and a family’s purpose. Steven, Katrenna and Phillip will be raising their own monthly financial support and moving to Uganda after the sale of their home and construction of their new residence on the Butiru compound is complete.

The Uganda Project is about providing spiritual, physical and medical support to an impoverished area. It’s about aiding and helping humanity through a holistic approach. It’s also about noble efforts bringing people together to use their talents and resources to help others in a way that provides no other personal gain than the intrinsic reward received when pursuing a purpose greater than one’s self.

To learn more about The Uganda Project or to contribute to the cause visit http://www. newlifecm.com/2013/02/uganda-project/ or contact New Life Christian Ministries at 540.563.4989. You can also support the Sandys and follow their journey on their blog at thesandysinuganda.blogspot.com or contact them by email at smsandy@gmail.com or at ksandy813@gmail.com.

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our health | THE HEARING CENTER AT HCRI

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THE HEARING CENTER AT HCRI | our health

The Hearing Center at HCRI words | JENNIFER ROMEO photography | KEITH THIENEMANN

Hearing loss affects nearly 12 percent of Americans – roughly 38 million people – including newborns, children, adults, and seniors. In fact, the disease is so prevalent that it is the third most common medical condition among seniors, just behind arthritis and hypertension.

Hearing loss can have a big impact, both physically and emotionally, on one’s quality of life.

Linked to stress and depression, among other health concerns, untreated hearing loss can have lasting consequences.

Yet, The Hearing Center at Hollins Communications Research Institute (HCRI) is making a marked difference in the lives of people in the Roanoke Valley who experience hearing problems. One of the area’s best-kept secrets, The Hearing Center is a nonprofit organization that conducts research on hearing loss – and offers a unique clinical program.

The Hearing Center is located at 7851 Enon Drive, Roanoke, VA 24019.

As the name indicates, The Hearing Center is part of Roanoke, Virginia-based HCRI, which was founded by Ron Webster, PhD in 1972. HCRI is nationally recognized for expertise in communications disorders and pioneering work in the treatment of stuttering. Integral to HCRI’s mission is providing better solutions for people with hearing issues.

For more information or to schedule a complimentary hearing evaluation, call 540.265.5665 or visit www.hcrihearing.org

M. Duncan MacAllister, PhD is the Department Head for The Hearing Center. Dr. MacAllister has more than 40 years of experience in the hearing field and a doctorate in psychoacoustics, the study of sound. He also has been awarded 14 patents in hearing aid technology.

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From Left to Right: The Hearing Center Department Head Dr. M. Duncan MacAllister, HCRI President Dr. Ron Webster, Office Manager Kathy Overstreet and Licensed Hearing Specialists Patty Kaufman and Jason Wells.

Along with his professional team, Dr. MacAllister is dedicated to “helping patients attain the best hearing quality available.” The Hearing Center measures success by the ability to improve the quality of life for patients through better hearing.

What Makes The Hearing Center Unique?

Staff expertise and proprietary technology at The Hearing Center maximize the accuracy of hearing evaluations, provides better fittings, and helps make hearing aids more comfortable to wear.

The Hearing Center carries hearing instruments from all major manufacturers – not simply one brand or style of hearing aid. As a result, patients have a full range of options at their fingertips to address their hearing condition.

Patients at The Hearing Center receive complimentary hearing assessments in a friendly, no-pressure setting.

Hearing professionals take time to fully understand each patient’s needs – and then work to find the best hearing solution. They also assist patients in making informed, value-based decisions by sharing advancements in hearinginstrument form and function.

New Hearing Technology Improves User Satisfaction The Hearing Center specializes in offering the latest device technology. This is key since hearing aids have changed dramatically in recent years. Today’s devices are much smaller and offer greater capability to adjust to each patient’s unique hearing-loss profile.

“These instruments function like mini computers, using an autopilot technology that automatically adjusts for greater sound quality and word distinction in different noise environments,” says Dr. Webster.

New developments also allow patients to sync hearing www.ourhealthvirginia.com | 61

instruments with cell phones and televisions. Wirelessly and with the touch of a button, the sound from these devices can flow directly through a hearing aid, allowing patients to adjust the volume and listen while others in the room listen at a different sound level.

As technology improves, so does the user experience. Now, devices are made of more durable materials. Features like water resiliency and smaller sizes enhance comfort. Moreover, many of these hightech hearing aids have up to a two-week battery life.

More Points of Difference With so many choices, selecting the right hearing equipment may seem daunting. That’s why The Hearing Center focuses on a highly personalized approach to optimize hearing for each client.

“We spend a lot of time with our patients to learn about their hearing needs and get an idea of what type of device will fit their lifestyle,” says Jason Wells, hearing aid specialist. “And, we always try to recommend the least expensive option. After all, some people may not need or want all the bells and whistles.”

Once fitted, patients use their hearing aids on a trial basis to determine whether the devices meet their requirements for hearing capability, comfort, and convenience. The 90-day trial period offered at The Hearing Center – three times longer than the typical 30-day trial period – allows patients to fully experience the device in daily living before committing to it.

“Our system for hearing aid fittings is so effective that returns are extremely low. Our return rate is roughly half that of the industry average,” adds Dr. Webster.

In contrast to many providers, hearing aid sales at The Hearing Center are not commission-based. This allows the professional staff to solely focus on patients’ hearing needs and make recommendations that provide the best outcomes.

The individualized approach to hearing-loss treatment at The Hearing Center offers patients a unique opportunity to explore new device capabilities. Additionally, the advanced technology onsite enables The Hearing Center team to customize or reengineer hearing devices when needed.

SKIN CARE | our health

River Ridge Dermatology in Blacksburg now offers a new treatment for treating psoriasis.

New Technology in Treating Psoriasis words | JENNIFER ROMEO

The effects of psoriasis are more than just skin-deep.

Those suffering from psoriasis, the most common autoimmune disease in the U.S., often experience pain and itchiness from red patches that develop on the skin. But, what many don’t know is that the disease is also linked to diabetes, heart disease, arthritis, and depression, making prompt treatment even more important.

A chronic, non-contagious inflammatory disease, psoriasis is characterized by recurring red patches on the body covered with silver scales of dead skin. It develops when the immune system goes haywire, sending faulty signals telling skin cells to grow too quickly.

The disease can show up anywhere – the scalp, nails, and eyelids, among others – and each of these sites is different and requires different treatments.

In recent years, new treatments for psoriasis have made great impacts on the nearly 7.5 million Americans suffering from the disease.

Depending on the severity of their symptoms, patients can often manage their psoriasis using topical creams, typically including steroids, coal tar, or vitamin D. www.ourhealthvirginia.com | 63

SKIN CARE | our health

For more severe cases, biologics – protein-based drugs used to suppress key parts of the immune system – and injectables play a major role in blocking the cells that develop psoriasis.

The latest advancement, however, comes in the form of laser light therapy treatment. Especially effective in spot treating targeted areas, the XTRAC® excimer laser provides patients today with even more options in relieving psoriasis discomfort.

For decades, dermatologists have used ultraviolet light therapy to effectively and safely treat psoriasis. Similar to the broad-band UVB treatments many patients already receive, the excimer laser delivers therapeutic levels of UVB light to areas of the skin affected by psoriasis. The UVB therapy slows and even reverses the growth of affected skin cells.

The main difference is that the narrow-band technology of the excimer laser releases a smaller range of ultraviolet light and does not impact surrounding tissue. This means patients can avoid premature aging of healthy skin, skin thinning, serious infections, and bruising, which are all possible side effects of exposing healthy skin to treatment through the uses of prescriptions, topical ointments, and broad-band UVB light, among others.

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our health | SKIN CARE

“The light from the excimer laser acts as an anti-inflammatory, suppressing symptoms,” says Chad Johnston, DO, dermatologist at River Ridge Dermatology located in Blacksburg, VA. “It is safe and effective and has a lower risk of side effects than many of the alternatives.”

Chad Johnston, DO of River Ridge Dermatology

It’s true. The procedure is painless, and patients experience no discomfort during its administration. Plus, research shows that patients can expect 75 percent or greater improvements after six to 10 treatments, each one lasting only five to 10 minutes.

“The excimer laser isn’t uncomfortable. Even young patients do very well with it,” adds Dr. Johnston. “Patients also like that they can get in and get out of the office quickly.”

Dr. Johnston is board certified by the American Board of Dermatology and a Fellow of the American Academy of Dermatology. Over the past year, he has seen a number of successes in patients using the excimer laser to manage chronic psoriasis flare-ups.

Using the excimer laser, dermatologists are able to treat both large and small affected areas located anywhere on the body, including hard-to-reach spots, like elbows, knees, and parts of the scalp.

“Patients have very positive responses,” adds Dr. Johnston.

“Most seem to really like it, especially those who do not want to use systemic treatments.”

Excimer laser treatment, covered by Medicare and major medical insurance companies, is typically administered two to three times per week, depending on the severity of the symptoms. After three to four regular visits to the dermatologist’s office for treatment, patients often already see a noticeable improvement.

“It is important to remember the excimer laser is not cosmetic,” Dr. Johnston points out. “It is a medical laser approved by most insurance plans, making it very affordable.”

While there is no cure for psoriasis, the disease can be controlled. Patients typically experience long periods of relief from psoriasis symptoms after completing an excimer laser treatment regimen.

“Unfortunately, we can’t cure psoriasis, but for many patients, especially those who do not respond to topical treatments, the excimer laser can put them into remission for many months,” says Dr. Johnston.

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