OurHealth Roanoke & New River Valleys Oct/Nov 2014 Edition by OurHealth Media LLC

table of contents | october • november 2014

The Road to Discovery & Diagnosis

MEDI•CABU•LARY.....................12

After Detection Comes the Battle Cry. There’s more than one kind of barrier to care when it comes to combating breast cancer. The stories of current and former patients Tammy Bryant, Alice West and Michael Willingham represent a few of the many types of journeys.

Local experts define health related terms

JUST ASK!.......................................14 Healthcare questions answered by local professionals

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

HEALTH POINTS........................ 20 Interesting facts and tidbits about health

THE ANATOMY CHALLENGE................................. 23 How much do you about our anatomy? In this issue, test your knowledge when it comes to the amazing MOUTH!

ANATOMY: Your Mouth and Your Health............................. 24 What can travel through your entire system in days, affecting the functioning of your brain, heart, pancreas and other major organs, make your blood sugar skyrocket out of control and cause pre-term birth of your baby? No, it’s not Ebola. Bet you would never guess—it’s infections of the teeth and gums.

OurHealth | The Resource for Healthy Living in Southwest Virginia

featuring the

WOMEN’S CHART for HEALTHY AGING foldout

p.42 FITBITS.......................................... 44 Work the ‘Back’ to Wear the ‘Black’ (Holiday Dress)

NUTRITION.................................. 47 FEATURING HEALTHY, FRESH, LOCAL INGREDIENTS: Diabetic Friendly Fall Recipes—Pot Roast, Green Beans with Mushrooms and Onions & Honey Muffins

The Resource for Healthy Living in Southwest Virginia

[series]

Breaking the Silence: Depression & Suicide

On March 15, 2012, David Andrew Cassell ended his life after suffering years of depression and substance abuse. David’s family shares his story in hopes that others can become more aware of the seriousness of mental health conditions.

[series]

Breaking the Silence: Alzheimer’s Disease

Jerry Villano was a strong and vibrant man—74 years old and still working full time. Then changes started. A forgotten name. Confusion. Eventually, his memory loss became more apparent.

hello, HEALTH!.............................. 74 Capturing the spirit of Southwest Virginians’ working in healthcare and of people leading healthy lives through photos

LOOKING BACK........................... 90 Images reflecting the history of healthcare in Southwest Virginia * PLUS * a chance to win prizes!

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The Resource for Healthy Living in Southwest Virginia

october • november 2014

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OurHealth Southwest Virginia

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CONTRIBUTING MEDICAL EXPERTS

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CONTRIBUTING PROFESSIONAL WRITERS

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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: 305 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Information in all print editions of OurHealth and on all OurHealth websites (www.ourhealthvirginia.com, www.ourhealthrichmond.com and www.ourhealthcville.com) social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2014 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Southwest Virginia edition is published seven times annually by McClintic Media, Inc. 305 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthvirginia.com | www.ourhealthrichmond.com | www.ourhealthcville.com | Advertising rates upon request.

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 gestational diabetes? Gestational diabetes is when diabetes develops during pregnancy. This condition causes high levels of glucose (blood sugar) in the blood. Women become more resistant to insulin as the pregnancy progresses because of the hormonal changes that occur. Insulin helps move glucose out of the blood and into the body’s cells so it can be turned into energy. Some women cannot make the extra insulin required with pregnancy to keep the glucose level normal, and develop gestational diabetes. All women are screened during pregnancy for gestational diabetes. Usually, it resolves after giving birth but women with gestational diabetes are at higher risk of developing diabetes later in life. Gestational diabetes increases the risk of having a large baby, and the babies are at higher risk of having problems with breathing, jaundice and blood sugar problems. With prenatal care and good blood sugar control, the risk of problems decreases. Elizabeth McCuin, MD

Section Chief for the OB/GYN Generalist Division, Carilion Clinic Roanoke | 540.985.9910 www.carilionclinic.org

What is ‘music therapy’ and what role does it play in hospice care? A young father who is agitated, a grandmother with dementia, a teenager in pain…all of these hospice patients have the potential to benefit from music therapy. Music therapy is an established health profession that blends the art and science of sound to improve quality of life for patients and their loved ones. Music therapists use music interventions to accomplish specific goals with patients, such as minimizing agitation, anxiety, and pain. Music itself is a frequent intervention, but therapists also can assist patients in writing their own music or putting together a “music diary” of favorite songs with personal meaning. Instruments such as harp, guitar, or even drums are important therapeutic tools in the hands of a music therapist. I once observed a therapist bring her cello to the bedside of an extremely agitated patient. She began playing along with the “rhythm” of the patient’s agitation. As the therapist slowed down the music, the patient’s agitation also slowed. It was a wonderful example of how “when words fail, music speaks.” Sue Ranson

President/CEO Good Samaritan Hospice Roanoke | 540.776.0198 www.goodsamhospice.org

What is Dementia with Lewy Bodies Disease? Dementia with Lewy Bodies (DLB) is the 3rd most progressive dementia where abnormal microscopic deposits, mainly alpha-synuclein proteins, damage brain cells over time leading to a decline in thinking, reasoning and independent function. There is no definitive diagnosis for DLB. Both diagnosis and treatment are focused on symptom management. Symptoms include: • Changes in thinking, interpreting and reasoning • Alternating confusion and alertness • Memory loss • Sleep disorders • Autonomic nervous system s/s • Delusions and hallucinations • Symptoms similar to Parkinson’s such as hunched posture, balance problems and muscle rigidity • Differences between Alzheimer’s and DLB • Memory loss occurs earlier in Alzheimer’s • Movement symptoms are more likely to be an important cause of disability earlier in DLB than in Alzheimer’s • Hallucinations, delusions, and misidentification of familiar people are more frequent in early-stage DLB than in Alzheimer’s • REM sleep disorder is more common in early DLB than in Alzheimer’s • Symptoms such as orthostatis hypotension, dizziness, falls, and urinary incontinence are more common in early DLB than in Alzheimer’s Anne Prucha, RN

Director of Nursing Friendship Health & Rehab Roanoke | 540.265.2100 www.friendship.us

OurHealth | The Resource for Healthy Living in Southwest Virginia

H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS

Why is it important for children to wear sunglasses? Much like your skin, the earlier you start protecting the eye from damaging UV rays, the better. Children under 10 years old are at a higher risk for UV damage than adults, due to their skin and eyes being more fragile. The lens of the child’s eye transmits about 70% more UV than the adult eye, and the cells of the lens of the eye are never replaced. The lens cannot repair itself, so damage accumulates over a lifetime, starting in early childhood. The earlier kids wear sunglasses, the less damage to their eyes later in life. Also, children tend to be outdoors much more than adults and because of their height and environment, they also tend to be looking up more—getting more direct UV exposure. Get your children started early in sunglasses with 100% UVA/B protection, and build healthy habits that last a lifetime. John M. Dovie, OD, FAAO Optometrist Blacksburg Eye Blacksburg | 540.953.2020 www.blacksburgeye.com

What is Medicare Open Enrollment, and, how do I know if I qualify? (The original question)

What are some benefits of regular exercise and healthy eating, specifically for people age 50 and over?

”The Medicare Open Enrollment, also known as the Annual Election Period or AEP, is a time set aside annually by the Federal Government from Oct. 15 to Dec. 7 for all Medicare beneficiaries to choose, review or change their Prescription Drug Plan (Part D) and Medicare Health Plan (Part C) coverage. Medicare health plans and prescription drug plans can and do change each year and new plans are often offered. So, even if you plan to continue with a health plan in which you’re current enrolled, it’s important to review your plan to make sure it is still the best option. Talk to a trusted advisor such as your physician and local senior service agency when reviewing your options. In addition to monthly premium costs, be sure to understand out of pocket costs, plan benefits (covered services), prescription drug coverage, physician/hospital network and your preferred physician’s participation, and any health benefits that may be available to you through a current of former employer. You can begin reviewing your plan’s Annual Notice of Renewal on October 1st. Remember, the Medicare Open Enrollment period starts on October 15th and ends December 7, 2014.

Incorporating physical activity into daily routines is an important part of healthy aging. Older adults who are physically active have fewer rates of all-cause mortality, heart disease, and high blood pressure than those who are sedentary. Regular exercise also improves overall quality of life by increasing levels of functional health and balance control, enhancing bone health, and improving cognitive abilities. Group exercise classes are a great resources to engage in supervised workouts while being socially engaged, a benefit that can lessen feelings of depression and loneliness.

Lynn Atkinson

Sales Representative Humana Roanoke | 540.520.8414 www.humana.com

OurHealth | The Resource for Healthy Living in Southwest Virginia

Eating a well-balanced diet is an equally important part of healthy aging. Consuming foods in amounts recommended by USDA provides the body’s muscles, bones, and organs with the necessary vitamins, minerals, and nutrients to keep them functioning properly. Activities of daily living are fueled by calories ingested through food and drink; consuming an adequate amount of calories is important for optimal physical and cognitive function. Shannon Boston

Fitness Director Warm Hearth Village Blacksburg | 540.552.9176 www.retire.org

NEW

NOTEWORTHY

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

Interim Healthcare Experiences Remarkable Growth, Relocates to Salem Due to their remarkable growth, Interim Healthcare, a locally-owned business, has relocated to Salem. They will continue to offer the same services at their new address: Interim Healthcare | 1013 E Main Street Salem, VA 24153 | 540.776.8686 www.interimhealthcare.com/roanoke

Urology Associates of the New River Valley Joins Carilion Clinic Carilion Clinic is pleased to welcome Urology Associates of the New River Valley to their team of specialists.. “We are excited to have this exceptional team of specialists join us,” said Charles Bissell, MD, surgery section chief and president of the medical staff at Carilion New River Valley Medical Center. “Carilion looks forward to providing the support they need to diagnosis and treat urological conditions for both men and women. This addition fits well with our goal of providing care for our communities.” Physicians Judy L. Chun, MD, Kevin P. Griffin, MD, and William H. King, MD, will continue to see patients in Christiansburg at 120 Akers Road, N.E. The new name of the practice is Carilion Clinic Urology. “Our team embraces this opportunity to grow and be a part of the Carilion Clinic network of healthcare services,” said Dr. Chun. “This transition will be seamless to our patients and, as always, they will receive the highest level of care and professionalism from us.” For more information, contact Carilion Clinic Urology at 540.382.7321.

LewisGale Imaging Center Brambleton Wins Prestigious Apex Quality Award For the second straight year, LewisGale Imaging Center Brambleton has won the prestigious Apex (Attributes for Patient Excellence) Quality Award for patient satisfaction. The imaging center was one of only three diagnostic imaging facilities nationwide to receive the award for 2013/2014. “This award is the gold standard in service excellence,” said Mike Stoots, Director of Diagnostic Imaging. “It’s an honor to be recognized by your patients for providing high-quality care. We could not have achieved this significant recognition without the hard work and dedication of our employees.” The award is based on patient feedback and overall care during a 12-month period. The award is given out annually by Voyance, a consulting firm that helps health organizations improve performance, and has become incredibly competitive. Each year the Voyance revises the award criteria making it more challenging to achieve. To win the healthcare facility must exceed the 90th percentile of their peer’s overall APEX weighted scores. LewisGale Imaging Center Brambleton is a full service diagnostic imaging facility offering a range of services including digital mammography, MRI, CT and bone density scans.

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Jefferson College of Health Sciences, Virginia Tech Carilion School of Medicine and Radford University Hold “Wall Breaking” Ceremony for New Virginia Intercollegiate Anatomy Lab

Jefferson College of Health Sciences, the Virginia Tech Carilion School of Medicine and Radford University hosted a “wall breaking” ceremony earlier this month for the new Virginia Intercollegiate Anatomy Lab at Carilion Roanoke Community Hospital (CRCH). The lab will be located on the eighth floor of CRCH in downtown Roanoke and will house 15 anatomy tables. Because the $2.5 million project is being completed in the existing CRCH building, there is no ground to break. In place of that symbolic gesture, walls were broken since the space is being rebuilt to suit the needs of the new anatomy lab. Jefferson College and Radford’s Doctorate of Physical Therapy program are housed within the hospital now. “This ceremony marks a key step in the collaborations between our academic institutions,” said Dr. Nathaniel L. Bishop, President of Jefferson College of Health Sciences. “Not only do all of our students learn how to work together in the shared space, but it makes good economic sense to build one dedicated lab for all three schools rather than three separate facilities.” When complete, the shared space will allow the institutions to continue their program of Interprofessional Education and interdisciplinary work, which allows healthcare students to learn how to work collaboratively in clinical settings before entering their professions. “This new lab will be a vital part of our students’ education,” said Michael Wray, Rector of the Radford University Board of Visitors.” Working with the students from the Virginia Tech Carilion School of Medicine and Jefferson College will help our students be better equipped to treat their patients.” The lab is schedule to be completed by late spring 2015.

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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

HCA Gives $1 Million in Aid for Ebola Response to CDC Foundation HCA (the parent company of LewisGale Regional Health System) which operates 164 hospitals and 114 surgery centers in 20 states and England, and the CDC Foundation announced a $1 million cash donation by HCA to the CDC Foundation to help support international Ebola epidemic response efforts involving the U.S. Centers for Disease Control and Prevention (CDC) and their work with partners on the ground in West Africa. HCA is one of the leading providers of healthcare services in the U.S. and has a long history of supporting relief efforts including those following the earthquake in Haiti, the Indonesian tsunami, Hurricane Katrina and Typhoon Haiyan in the Philippines. The $1 million cash donation by HCA was made to the CDC Foundation’s Global Disaster Response Fund. Since the CDC ramped up its Ebola response in early July, more than 700 CDC staff members have provided logistics, staffing, communication, analytics, management and other support functions. The CDC currently has more than 100 staff deployed in Guinea, Liberia, Nigeria and Sierra Leone. The CDC Foundation is working with donors like HCA to provide much-needed supplies and equipment

Monica Cooper, PA-C Internal Medicine LewisGale Physicians Salem | 540.772.3490 www.lgphysicians.com

Dana Garnand, FNP-BC Amanda Family Nurse Practitioner Gillespie-Twardy, MD LewisGale Physicians, Clearbrook | 540.725.3060 www.lgphysicians.com

Brian C. Gross, MD

Otolaryngology LewisGale Physicians Blue Ridge Cancer Care Salem | 540.444.8100 Roanoke | 540.982.0237 www.blueridgecancercare.com www.lgphysicians.com

OurHealth | The Resource for Healthy Living in Southwest Virginia

for use on the ground in West Africa. These items include personal protective equipment, infection control tools, ready-to-eat meals, generators, vehicles and motorcycles, hiring of locally employed staff, exit screening tools and supplies at airports such as thermal scanners to detect fever. The Ebola epidemic in West Africa is a humanitarian crisis. The number of individuals infected with the Ebola virus doubles approximately every three weeks with more than 5,800 cases, based on the latest estimates. Tragically, the number of deaths has increased from 1,500 to more than 2,800 in the same time period. These numbers are only expected to climb without immediate action. “Without additional public health interventions made possible by donations like that from HCA, CDC estimated that the number of Ebola cases in Liberia and Sierra Leone could reach hundreds of thousands or even to over one million people,” said Charles Stokes, President and CEO of the CDC Foundation. “It’s critical that organizations support this vital effort to provide flexible funding that can be used to meet needs on the ground in West Africa. Together, we can all make a difference.”

Jessica Danison, DO Neurology LewisGale Physicians Salem | 540.772.3450 www.lgphysicians.com

Ali Husain, MD

Cardiothoracic Surgery LewisGale Physicians Salem | 540.776.2020 www.lgphysicians.com

Gerald A. Demasters, MD, PhD

Elliot Freed, DO

Brenda May, DO

Jennifer Nelson, MD

Psychiatry (Inpatient Only) LewisGale Physicians Salem | 540.772.3485 www.lgphysicians.com

Gynecologic Oncology LewisGale Physicians Salem | 540.776.4704 www.lgphysicians.com

Family Medicine LewisGale Physicians Blacksburg | 540.552.1246 www.lgphysicians.com

Otolaryngology LewisGale Physicians Blacksburg | 540.443.7400 Radford | 540.639.9023 www.lgphysicians.com

Jonh Pineda-Bonilla, MD Gastroenterology LewisGale Physicians Salem | 540772.5970 www.lgphysicians.com

Ann Shawhan, RN, MSN, FNP

Family Nurse Practitioner LewisGale Physicians Blacksburg | 540.443.3980 Christiansburg 540.381.1882 www.lgphysicians.com

Michael Simpson, DO Family & Sports Medicine LewisGale Physicians Pulaski | 540.980.9660 www.lgphysicians.com

Mary Elizabeth Tekesky, PA-C

Sandra Toensing, PA-C

Orthopedics LewisGale Physicians Blacksburg | 540.951.6000 Pulaski | 540.994.9443 www.lgphysicians.com

Otolaryngology LewisGale Physicians Blacksburg | 540.443.7400 Radford | 540.639.9023 www.lgphysicians.com

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

Fun Facts About

CANDY HHH

October is

Breast Cancer Awareness Month

Early Detection is Crucial When breast cancer is detected early, in the localized stage, the 5-year survival rate is 98%* (*National Cancer Institute) • Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health • Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over • Women should know how their breasts normally look and feel and report any

breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s.

Ways to Reduce the Risk Although you cannot prevent cancer, some habits that can help reduce your risk are: • Maintain a healthy weight • Stay physically active • Eat fruits and vegetables • Do not smoke • Limit alcohol consumption

Happy Halloween!

H Candy accounts for only

6% of the added sugar

in the American diet.

Soft drinks & juice account for

46%.

Candy lacks the “health halo” of granola bars and fruit juice. But, nutritionally there is much less difference among them than would initially seem. It’s unbelievable now, but

candy once was advertised as health food.

Get Your Mammograms! Don’t neglect getting your yearly mammogram due to lack of insurance or resources. Every Woman’s Life (EWL) is a public health program offered through The Virginia Department of Health (VDH) that helps uninsured, low income women gain access to free breast and cervical cancer screening services. Screening and early detection reduces death rates, improves treatment options, and greatly increases survival. In SWVA, contact Jamie Wagner, Carilion Clinic, at 540.224.4964 for screening information.

A TINY truth: The tiniest bone in your body is only 3mm long and is found in your ear! 20

It’s cold and flu season. Did you know? A sneeze generates a wind of 100 mi/hr, and a cough moves out at 60 mi/hr!

OurHealth | The Resource for Healthy Living in Southwest Virginia

“Eat Tootsie Rolls — The Luscious Candy That Helps Beat Fatigue.” Candy is a HEALTH SCAPE-

GOAT – 100 years ago, doctors blamed candy for the spread of polio. In the mid to late 20th century it was blamed for tooth decay. Now it is blamed

for obesity.

November is

National Diabetes Month Diabetes is a problem with the body that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. Type 2 diabetes is the most common form of diabetes. Several factors can increase your risk for developing Type 2 Diabetes, including being overweight. Lifestyle changes can be used as a foundation to help prevent Type 2 Diabetes: • Engage in regular exercise • Eat healthy • Include foods high in fiber such as beans, whole grains, vegetables, fruits and nuts • Eat plenty of whole-grain foods • Eat more fruits and vegetables

• Don’t crash diet. Instead, consider healthy, long-lasting weight loss solutions, and cut out fatty and fried foods that are often high in cholesterol and salt. • Drink plenty of water

DENTAL

BITES:

SUPPORT A GREAT CAUSE!

• Contrary to popular belief, there is no significant advantage of an electric or powered toothbrush over the normal toothbrush except ease of use.

• Saccharine Sodium which is generally used as a sweetening agent in toothpaste is 500 times sweeter than sugar. • Always replace a toothbrush after you had a cold, sore throat or notorious infections. The bacteria plant them on the toothbrush which can lead to reinfection. • You should always maintain a distance of 6 feet between the toilet and where you brush. The air borne particles from the flush can travel up to 6 feet. • There was a sudden massive surge of patients with tooth decay the year coke was launched. • The swallowing of a fluoride containing toothpaste can cause many harmful effects such as fluoride toxicity. Children younger than 5 should be given toothpaste that does not contain fluoride.

move your feet

So Others Can Eat! this Thanksgiving Morning!

2014 Union Drumstick Dash – 5K Run/Walk Support the Rescue Mission - your participation in the Union Drumstick Dash provides food, shelter and clothing for the 350-plus men, women and children who seek their services every day. This year, the Rescue Mission will provide more than 300,000 meals to hungry families.

Date: Thanksgiving morning at 9:00 a.m. Location: Downtown Roanoke Registration: www.drumstickdash.net Contact: 540.343.7227

ON THE WEB

More at ourhealthvirginia.com www.OurHealthVirginia.com

The Anatomy Challenge is proudly sponsored by

the

Anatomy

CHALLENGE

Hereâ&#x20AC;&#x2122;s your chance to see how much you know about your amazing

Mouth! First, find all the hidden words in the word search below. Next, match up the correct word with the part of the body in the illustration.

[ the amazing MOUTH ]

WORD SEARCH canines central incisor frenulu linguae gums hard palate inferior labial frenulum inferior lip lateral incisors

palatoglossal arch palatopharyngeal archs

______________ ______________ ______________

______________ ______________ ______________ ______________

______________ ______________ ______________

premolars soft palate sublingual papilla submandibular gland

molars

superior labial frenulum

oropharunx

superior lip

palatine raphe

tongue

palatine tonsil

uvula

______________ ______________ ______________ ______________ ______________ ______________ ______________

______________

______________ ______________

______________

Visit our Facebook Page for answers

Mills & Shannon Dentistry | Comfort, Confidence & Excellence 3533 Keagy Road | Salem, VA | 540.989.5700 www.millsandshannon.com www.OurHealthVirginia.com

your Mouth and your Health words | DIANE YORK

What can travel through your entire system in days, affecting the functioning of your brain, heart, pancreas and other major organs, make your blood sugar skyrocket out of control and cause pre-term birth of your baby? No, it’s not Ebola. Bet you would never guess—it’s infections of the teeth and gums.

The bacteria, toxins and inflammation from an abscessed tooth or gum disease, (periodontitis), more than most types of infections, has instant access to your bloodstream and can send some of the nastiest bacteria imaginable straight to your organs. The Center for Disease Control (CDC) estimates that at least half of Americans over age thirty have periodontal disease. According to an article in the September 2013 issue of the Journal of Endodontics, more than eight hundred thousand emergency room visits each year are the result of infections of the teeth or mouth, including abscessed teeth. These infections can cause facial swelling, difficulty breathing or the spread of infection into the brain or heart and yes, people have died from that. While those are obvious and dramatic cases, few of us realize the more hidden damage, chronic gum or tooth disease may be causing to our bodies. John Buyer, DMD, is a periodontist, (a dentist who specializes in gum disease,) with the New River Periodontics and Dental Implant Center in Blacksburg, VA. He states: “Chronic oral infections are no longer just an isolated oral malady. Multiple studies in the past ten years suggest numerous correlations of systemic disease, such as: diabetes, heart disease, stroke, ulcers, arthritis, kidney disease and pre-term births, with periodontal disease.” Dr. Buyer adds that he can often tell what diseases a person might have by looking at their mouth. Mouth disease produces C-reactive protein which creates inflammation that causes other health problems. In addition, anaerobic bacteria, multiplying in the mouth,

Periodontitis

or periodontal disease is an

inflammatory disease that affects the soft and hard structures that support the teeth. In its early stage, called gingivitis, the gums become swollen and red due to inflammation, which is the body’s natural response to the presence of harmful bacteria. In the more serious form of periodontal disease called periodontitis, the gums pull away from the tooth and supporting gum tissues are destroyed. Bone can be lost, and the teeth may loosen or eventually fall out. can cause septic infection that can spread through the body. The type of inflammation caused by mouth disease seems to occur concurrently with other systemic chronic diseases. Recent research studies show that untreated mouth infections can increase the risk of stroke, dementia, diabetes, kidney disease, joint problems and even erectile dysfunction. Diabetes, in particular, has a strong relationship with oral health. The high blood sugars of diabetes increase bacteria in the mouth and the resulting infection raises blood sugar levels in a vicious cycle of damage. So for the diabetic, oral health is critical. Dr. Buyer says he has seen many diabetic patients reduce their blood sugars following resolution of gum or mouth disease. The heart, too, is now increasingly connected to oral health. Studies are showing that persons with gum disease are at higher risk for heart disease. Researchers believe that gum disease may contribute to heart disease

John Buyer, DMD, is a periodontist, (a dentist who specializes in gum disease) with the New River Periodontics and Dental Implant Center in Blacksburg

Healthy Teeth and Gums are Part of Your Diabetes Management Plan! Learn more about the connection between dental health and diabetes in Delta Dental’s Oral Health Library. Scan this QR code with your smart phone:

How heart disease and oral health link. Learn more about the connection between dental health and heart disease in Delta Dental’s Oral Health Library. Scan this QR code with your smart phone: because bacteria from infected gums can dislodge, enter the bloodstream, attach to blood vessels and increase clot formation or that inflammation caused by gum disease may initiate clot formation. Clots decrease blood flow to the heart, thereby causing an elevation in blood pressure and increasing the risk of a heart attack. This same research has also indicated a link between gum disease and stroke. “If I see someone who has had a stroke; they are at risk for a second stroke, so I work on them very quickly to reduce the chances of that second stroke,” remarks Dr. Buyer.

Research Studies Link Cancer to Gum Disease While the above connections between oral disease and diabetes, stroke and heart disease have been known for a while, the most surprising recent research is linking oral health with cancer.

Michele Mills, DMD, with Mills & Shannon Dentistry in Salem

A Harvard University School of Public Health study published in the Journal of the National Cancer Institute, uncovered a strong correlation of advanced gum disease in men to a sixtythree percent higher incidence of pancreatic cancer. A recent report in the journal, Lancet Oncology, confirmed that cancer risk increases when gum disease is present. Even the presence of moderate gum disease contributed to an overall fourteen percent increased risk of cancer. These include lung, kidney and blood cancers in both smokers and non-smokers. A British and American research team at Imperial College in London and Harvard University studied the statistical health records of 50,000 patients from data collected over twenty-one years. There was a thirty-

OurHealth | The Resource for Healthy Living in Southwest Virginia

three percent increase in the risk of lung cancer, fifty percent rise in the risk of kidney cancer, and a thirty percent higher incidence of blood cancers, such as leukemia, among those with gum disease. Chronic advanced gum disease was the most serious, with an additional fourfold increase in head and neck cancer for each millimeter of related bone loss around teeth. While researchers don’t know what the real link is between cancer and oral health, they suspect it is one of three things. First, that inflammation from the mouth is negatively impacting on other organ systems in the body; second, that the bacteria produced by mouth infections is spreading throughout the body, causing damage to other sites; or third, that the inflammation and/or bacteria are affecting the immune system’s ability to fight cancers as they develop.

What Your Dentist Sees Since an infection in the mouth can wreak havoc on your whole system, can a dentist tell if you have other health conditions or diseases by just looking at your mouth? “Yes,” says Michele Mills, DMD, with Mills and Shannon Dentistry in Roanoke, VA.. “If a person has acid reflux, the acid eats at the tooth enamel on the back sides of the front teeth. Also, if a person has bulimia their teeth will often show signs of this kind of enamel loss.” Pregnancy means more visits to doctors and that should include the dentist. Pregnancy affects mouth health and mouth health in turn can have an important effect on the pregnancy. Dr. Mills says, “Pregnancy gingivitis is caused by the increase in progesterone in the mother’s

body. It causes red, puffy or tender gums that bleed easily. ‘Pregnancy tumors’ may appear on the gums usually in the second trimester. They are related to excess plaque.” She adds that pregnant women who have periodontal disease may be more likely to have a baby that is born too early and too small. Research is ongoing in this area. She suggests that pregnant women may benefit from three cleanings (or a gum treatment) during pregnancy. While not an absolute sign of HIV (the aids virus), a white striated patch on the side of the tongue can be an indicator for HIV. In cases of methamphetamine addiction, the dentist may note blackened and often broken teeth, which usually cannot be restored. Dentists have been able to detect possible mouth cancers from red, white or mixed spots in the mouth. Dr. Mills remarks, “We regularly find suspicious lesions and refer our patients

to the oral surgeon or an ear, nose and throat doctor for biopsy. Some of these lesions have been found to be cancerous.”

How do these infections develop? We all know that regular brushing and flossing will prevent cavities, and regular dental checkups are important to prevent more serious mouth problems. But gum disease is more difficult to deal with once it gets a foothold in your mouth. If your dentist suspects it, he will refer you to a specialist in gum disease, a periodontist. There are two kinds of gum disease that can develop. Gingivitis is a mild gum disease that affects only the soft tissue surrounding the teeth. Periodontitis is a more serious version, as it spreads below the gums and damages the tissues and bones that support the teeth. Special treatment is required to treat it.

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Bulimia

is an illness in which a person binges on food or has regular episodes of overeating and feels a loss of control. The person then uses different methods—such as vomiting or abusing laxatives—to prevent weight gain.

Gum disease is caused by the growth of bacteria on the teeth and gums. Bacteria is concentrated and held on the teeth by plaque (a clear sticky film) and/or tartar (a yellowish substance that forms a hard coating on the teeth.) While brushing and flossing daily can keep plaque at bay, once tartar forms, professional dental cleaning is needed to remove it. The bacteria in plaque and tartar produce toxins that irritate your gums, causing redness and swelling and this causes the gums to pull away from your teeth. Smoking or chewing tobacco, sugar intake, high blood sugar levels from diabetes or a weakened immune system, will all contribute to the development of gum disease. While gingivitis may have symptoms such as red, swollen or bleeding gums, peritonitis will also produce bad breath, receding gums, discharge from gums, loose teeth and change in your bite (how your teeth fit together.) Dr. Mills adds this note for boomers; “many boomers have had a lot of dentistry over the years. It is important to maintain your fillings, crowns and other dental work so that you do not get new cavities under your existing restorations. Root decay is common as we age. It can be a side effect of a medication. Dry mouth may make it easier for you to get cavities because the saliva is not there to wash the sugars off your teeth. Some root cavities can be fixed but sometimes we have to extract the teeth. It is important to get annual x-rays, floss once daily, brush twice daily and come for your check-ups. My adult patients that get fluoride varnish treatments at their 6 month cleaning visits have the fewest cavities. I highly recommend asking your dentist for a fluoride treatment. It’s not just for kids anymore!” Now you know that your teeth and gums have a big impact on the health of your whole body. So, do what your mother said; get regular dental checkups, brush and floss, especially before bed, as well as considering fluoride treatments. And if gum disease is suspected, by you or your dentist, see a periodontist. And while you’re in that chair, ask your dentist what he thinks about your general health!

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Discov� and Diagnos� The Road to

words |CHRISTINE STODDARD

After Detection Comes the Battle Cry

There’s more than one kind of barrier to care when it comes to

combating breast cancer. The stories of current and former patients Alice West, Tammy Bryant and Michael Willingham represent a few of the many types of journeys.

A Reason for Every Year Reprints To order reprints of the original artwork featured on this issue’s cover, contact Jenny Hungate at 540.387.6482 or via email at jenny@ourhealthvirginia.com. To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com

Shortly after Tammy Bryant, 56, moved from West Virginia to Virginia, her younger brother was diagnosed with bone cancer. He died within six months. During that sliver of time while her brother was in the throes of treatment, Tammy noticed trouble with her own body: a lump in her breast. “I just knew it was cancer,” she says. “I was really depressed after my brother got sick, and I was taking care of him, so I didn’t think I had time for myself. But I should have taken the time.” Though she had been screened every year for the past twelve years, Tammy skipped three years of screenings once she started her life in Virginia. Tammy scheduled a

mammogram at the free clinic. After an ultrasound and a biopsy, Tammy had her right breast and 17 lymph nodes removed.

What does

‘barrier to care’ mean? Unite for Sight, a global health organization based in Connecticut, identifies

three major barriers that prevent access to medical care. These include transportation barriers, financial barriers, and education and awareness barriers. While transportation and financial barriers may seem obvious, education and awareness barriers may be harder to pinpoint and correct. This may include ‘social determinants,’ including socio-cultural stigmas and beliefs that have more basis in folklore than science.

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“Breast cancer can change from something that is localized to something that is systematic and metastasized in 18 months,” says Catherine C. Hagan, clinical nurse specialist at Carilion Clinic. “So if you are getting a mammogram every 24 months, there is that window where you’re missing the opportunity to stop it from spreading.” Tammy states that her life post-surgery is quite different. Though she feels fortunate to be alive, she admits she’s scared that the cancer will return in five to ten years. “It scares me because I watched my brother, who was healthy as a horse; go from a 170-pound healthy man to a 90-pound stranger.” That’s not the only family history of cancer: Tammy’s grandmother, a nurse and non-smoker, died of lung cancer. Tammy’s mother, a victim of throat cancer, had her voice box removed. Since the surgery, Tammy has not regained full use of her right arm. She has not yet sought reconstructive surgery for her breast, either. “It doesn’t bother me very much to only have one breast because I have always been small-breasted anyway,” Tammy says. “Everything I wear is baggy. To me, it’s just a battle scar...I’m thankful I’m here today.” Tammy is also here today without debt. The free clinic paid for her chemo and doctor’s visits, while Medicaid covered her radiation treatment. Because of the Affordable Care Act, “the free clinic has become the community health clinic, and they now charge on a sliding scale,” explains Jolene Henshaw, MD, a general surgeon with LewisGale Physicians in Blacksburg. She was also Tammy’s surgeon. “Finances should not be a barrier to receiving screening,” says nurse Hagan. “We’re going to find a way to help you.” “If you feel anything, do not hesitate,” says Tammy. “Do not wait. It’s very, very important to go now. It is better to be safe than sorry.”

No Easy Explanation What is the program Every Woman’s Life? Every Woman’s Life is a public health program offered by the Virginia Department of Health. It connects uninsured, low-income women to free breast and cervical cancer screenings as a means of increasing cancer survival throughout the Commonwealth. Find out more at www.vdh.gov/ofhs/ prevention/ewl

Alice West, a wife and mother, was 62 years old when she was diagnosed with breast cancer. Because her mother had also been diagnosed with breast cancer, Alice took care to get screened every year. So when she was not only scheduled for a biopsy but told she had Stage III cancer, she was shocked. “I asked my doctor on a scale of one to ten, where is it?” Alice recalls. “When he said a 9, I wondered how this happened to me.” When Alice received the news, she called her daughter right away. She waited until she went home to tell her husband face-to-face. His response? That they would fight it. “All of my family, that was our declaration: that I was going to fight,” says Alice. “They were going to fight with me. The fight was on.” That night, Alice went to Bible study as usual. When the pastor’s wife, a nurse, inquired about the results of her biopsy, Alice gave her the truth. She, too, encouraged Alice to fight. Thus, the fight began. When Alice went to the surgeon, she did not go alone. Her husband and two children accompanied her. The surgeon outlined a treatment plan of six months of chemotherapy followed by surgery and then six weeks of radiation. She underwent chemo seven days later. “When you start treatment for something that you have no knowledge of, something you have only seen other people go through, you wonder whether you lose weight or get sick,” says Alice. “I never once got sick.” During her treatment, Alice only felt nauseous once or twice. It wasn’t until the second or third treatment she remembers noticing any serious side effects. At that point, her skin began to burn and, much to her chagrin, she began to lose her hair. “I thought, ‘Not my hair. Anything else, but not my hair.’” After witnessing her hair come out on her comb one too many times, Alice paid a visit to her hairdresser. Though her salon is normally packed, that day she found herself among just two other customers. As tears started to roll down Alice’s face, her hairdresser assured her that her hair would grow back. The other customers told her that she looked beautiful. Alice followed the salon appointment with a mother-daughter shopping trip: It had come time to buy a wig. From there, she headed to her women’s fellowship.

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Alice West

OF ROANOKE

How can you get breast cancer if you present few or no risk factors? Breast cancer research is ongoing because there’s still much we have to learn. As the American Cancer Society will tell you, having a risk factor does not mean you will get breast cancer, just as having no apparent risk factors doesn’t mean you won’t.

“I walked into the restaurant with my head held high, and the women began to scream,” Alice says, “They thought I had gotten a haircut trying to make a fashion statement.” Throughout Alice’s model twirling, only the pastor’s wife knew the truth. Following the third or fourth chemo treatment, Alice’s oncologist examined under her left arm and couldn’t find a trace of the lump. Her surgery removed three lymph nodes, requiring no mastectomy. After six weeks of radiation: “I received a clean bill of health,” Alice says. “I have no cancer in my body. I’m grateful to God, and I’m grateful to my family and my church family because they supported me.” Throughout the ordeal, Alice’s husband would swing by the health food store to pick up nutritious drinks because blisters would form on her tongue or she would lose her appetite as a result of her treatment. Alice encourages anyone going through cancer treatment to stay encouraged: “Your thinking is going to determine what you say, and what you say is going to determine what you feel. Every day, even if I didn’t feel that great, I would go to the library or Kroger, anything just to get out of the house, get some fresh air.”

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Michael Willingham OF ROANOKE

Breast Cancer Resources

A Guys’ Game, Too

Foundations Susan G. Komen Virginia Blue Ridge 4910 Valley View Boulevard NW • Suite 212 Roanoke, VA 24012 | 540.400.8222 www.komenvablueridge.org

A year and a half ago, Michael Willingham, 52, was drying off after a shower when he noticed a lump in his chest. The situation quickly unraveled from there. Over the next few days, he showed his wife and then his physician assistant and then his doctor. It turned out that Michael had Stage IV breast cancer.

Medical Facilities /Imaging Centers

“Men get breast cancer, too,” Michael says. “It would be nice if when they run those awareness ads, they showed men.”

Blue Ridge Cancer Care – Bedford

“If I see 200 breast cancers this year, one will be a man,” says William Fintel, MD, an oncologist at Blue Ridge Cancer Care. “Treatment is very similar to what you would do in a woman because you interrogate the tumor, so to speak, and see how it’s driven, what are its driver mutations. From there, you develop a treatment that is tailored to the patient.”

Blue Ridge Cancer Care – Blacksburg

Dr. Fintel explains that when Michael came to him, he already had cancer in both breasts. A lack of family history meant that Michael hadn’t been worried. Yet his timing was a key factor in allowing him to live as long as he has already. There’s also the immeasurable ingredient: his upbeat attitude. Today Michael has a port in his chest and is undergoing chemotherapy. He and his wife closely monitor his diet, ensuring that he eats enough proteins to counterbalance his weight loss. He also frequents the gym and strives to do one positive thing a day, no matter how small and no matter how he feels— whether that means doing the dishes or opening the door for somebody. “I’m going down with a baseball bat in one hand and a Bible in the other,” says Michael. “God has given me this problem and I deal with it day by day.”

Blue Ridge Cancer Care www.blueridgecancercare.com

1710 Whitfield Drive | Bedford, VA 24523

2600 Research Center Drive, Suite A Blacksburg, VA 24060 | 540.381.5291

Blue Ridge Cancer Care – Pulaski 2400 Lee Highway | Pulaski, VA 24301 540.994.8545

Blue Ridge Cancer Care – Roanoke 2013 South Jefferson Street Roanoke, VA 24014 | 540.982.0237

Blue Ridge Cancer Care – Rocky Mount 390 South Main Street, Suite 103 Rocky Mount, VA 24151 | 540.489.6522

Blue Ridge Cancer Care – Salem 1900 Electric Road | Salem, VA 24153 540.774.8660

Blue Ridge Cancer Care – Wytheville 590 West Ridge Road, Suite L Wytheville, VA 24382 | 276.228.7665

Carilion Clinic Breast Care Center www.carilionclinic.org/womens/breast-care

Carilion Clinic Imaging – Carilion New River Valley Medical Center

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2900 Lamb Circle | Christiansburg VA 24073 540.731.2720 breast cancer resources continued on page 40

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breast cancer resources continued from page 39

Carilion Clinic Imaging – Carilion Giles Community Hospital 159 Hartley Way | Pearisburg VA 24134 540.922.4182

Breast Care Center – Brambleton 3707 Brambleton Avenue Roanoke VA 24018 | 540.772.7401

Breast Care Center – Jefferson 1211 S. Jefferson Street Roanoke VA 24014 | 540.985.9885

Breast Care Center – Peters Creek 6415 Peters Creek Road Roanoke VA 24019 | 540.265.5545

Carilion Clinic Imaging – Carilion Franklin Memorial Hospital 180 Floyd Ave. | Rocky Mount VA 24151 540.484.8594

LewisGale Breast Imaging Locations www.lewisgale.com/service/lewisgalebreast-imaging-centers

LewisGale Imaging Center Montgomery 813 Davis Street | Blacksburg, VA 24060 540.953.5131

LewisGale Imaging Center Daleville 65 Shenandoah Ave | Daleville, VA 24083 540.966.6620

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

LewisGale Imaging Center Brambleton 4330 Brambleton Ave Roanoke, VA 24018 | 540.283.3700

LewisGale Breast Center 1802 Braeburn Drive | Salem, VA 24153 540.776.4983

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DENTAL

Caroline Wallace, DDS Complete Dental Care 103 S. Colorado Street Salem | 540.387.3844 www.carolinewallacedds.com

Practicing good oral hygiene habits and receiving routine professional care is essential for protecting women of an age’s oral health.

Maintaining good oral health is more important than ever! Women’s oral health needs change during different stages of life as a result of hormone fluctuation. As hormone levels increase during puberty, gum tissue can become swollen, resulting in discomfort and bleeding. Hormone levels surge during pregnancy. This surge greatly increases the risk of gum inflammation and risk of periodontal disease. There is a direct connection between periodontal disease and pre-term, low birth weight babies. Menopause lowers hormone levels. This decrease is associated with dry mouth. The lack of saliva results in sore gums and a increased risk of decay.

Women’s OPTOMETRY

James Lynde, MD Centra 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.

Patrick Curran, OD Drs. Newman, Blackstock & Associates Optometrists 442 Peppers Ferry Road | Christiansburg | 540.382.1731 www.newmanblackstock.com

Routine annual eye exams are especially important for women of all ages. Eye care professionals can detect refractive error (near-sighted or far-sightedness), lazy eye and focusing problems. Dilated eye examinations can reveal cataracts, glaucoma, and ARMD. These exams can also diagnose other conditions that tend to strike women such as hypertension, diabetes (gestational) and autoimmune disorders (MS, Lupus, RA & Sjogrens Syndrome). Yearly exams are highly recommended not just for those who need eyeglasses, but for anyone to minimize the risk of sight threatening eye disease.

CHART for HEALTHY AGING

MAMMOGRAPHY

Molly S. Rutherford, MD, FACC Jefferson Surgical Clinic 1234 Franklin Rd. Roanoke 540.283.6000 www.jeffersonsurgical.com

Heart Disease is often under-recognized in women. I encourage all women to consider their risk factors for heart disease and modify their lifestyle if possible. Pay attention to things like family history, obesity, diabetes, hypertension, hyperlipidemia, and smoking. If you or someone you love have any of these risk factors, see your Doctor or Cardiologist to discuss ways to improve your long term health. Women often have atypical symptoms for heart disease, if you are having shortness of breath, nausea, arm/neck/jaw/upper back pain with or without chest pain or pressure, or other symptoms you think are coming from your heart, please seek medical evaluation.

David B. Alligood, MD Express Family Care | Kroger Square at Bonsack 3960 Valley Gateway Blvd., Suite 1A Roanoke | 540.400.6676

At Express Family Care we believe that preventative care is vital as we age. Aging can be more enjoyable if we take time to exercise regularly. Being aware of our BMI is fundamental to controlling blood pressure, diabetes, and cholesterol. Annual wellness physicals with blood work can serve as mileposts to help us stay on a healthy road. When necessary, our physicians can also recommend thyroid panels, hemoglobin checks and X-ray’s. We offer low cash prices and walk-in hours from Mon-Sat from 8am-8pm.

CARDIOLOGY

Ethan Colliver, DO Valley Sport & Spine Clinic |3706 S. Main Street Suite D | Blacksburg | 540.443.9362 www.valleysportsandspine.com

Both muscle and bone will undergo a normal decline as we age. Decreasing sex hormones leads to loss of muscle, aerobic capacity, strength and power. You can counteract this decline with strength and endurance training. Regular strenuous exercise (20-60min, 3-5days/week) increases muscle strength and power, aerobic capacity, and bone density. Currently, no medications are approved for the treatment of agerelated muscle loss but many medications exist for treating thin bones. Your doctor may prescribe medications and exercise to treat your bone and muscle issues.

Frank Purpera, MD Virginia Vein Institute | 1901 South Main Street, Suite 2 | Blacksburg 540.552.VEIN (8346) | www.virginiaveininstitute.com

Early symptoms, including leg aching and swelling, spider veins, and restless legs, may seem minor and can occur at any age. However, they can become more serious if they are not treated. As the disease progresses, varicose veins, extreme leg heaviness and skin changes may become apparent and eventually lead to non-healing ulcers. If you have any of these symptoms you should see a vein specialist. Evaluations, exams and treatments by a vein specialist are typically covered by all insurances including Medicare and Medicaid.

The veins in your body play an important role in circulation. As we age, problems can develop in the veins and cause a variety of complications. In fact, one in three Americans over the age of 45 has some type of vein disease.

SPORTS MEDICINE VEIN HEALTH

URGENT CARE

FITBITS

H EA LT H A ND F I T NES S O N T H E G O

Work the ‘Back’ to Wear the ‘Black’ (Holiday Dress) The holidays are right around the corner, and that may mean wearing that ‘little black dress’ or taking that holiday ‘getaway’ or cruise. Start working your back now, and see results in time to show it off before that first holiday event! For optimum results, perform three sets of 8-12 repetitions of the following exercises 3-5 times per week:

#1. Back Extension on Exercise Ball This exercise works the lower back muscles (erector spinae), even though these muscles actually run the entire length of the back along the spine. The erector spinae extend the spine backwards and provide torso stabilization.

2. Place the hands behind the head or under the chin - you can also keep the hands resting on the ball if you need a modification. 3. Round down over the ball and then squeeze the lower back to lift the chest off the ball.

1. Lie down with the ball under the belly and hips, legs straight out behind you (or knees bent for a modification).

4. Raise up until the body is straight (don’t hyperextend), lower down and repeat.

#3. Reverse Fly with Dumbbells This exercise trains the back side of the shoulder muscles (rear deltoids). 1. Stand with feet shoulder width apart, bend knees slightly and lean forward. Upper body should almost be parallel to the floor. Look forward and don’t round back. Hold a dumbbell in each hand with palms facing each other. Elbows should be slightly bent. 2. Raise dumbbells sideways and backwards, until arms are parallel to the floor. Move weights slowly and concentrated. Exhale as you lift dumbbells and don’t create momentum. At the end of the movement, palms should face the floor. 3. Then lower dumbbells and return to the beginning position. Don’t let the weights fall. The down-motion should be slower than the up-motion. Inhale as you lower dumbbells.

#2. Reverse Hyperextension on Exercise Ball: The reverse hyperextension targets a number of posterior muscle groups, including the glutes, hamstrings, and lower back. 1. Place the stability ball on the floor, and lie on top of the ball 2. Place hands on the floor for stability. Slowly raise one leg off the floor until it is at least parallel. Try to keep your legs straight.

3. Complete the movement by lowering the leg back to the starting position, and repeat for desired number of repetitions 4. Repeat the movement using the other leg Notes: An advanced variation is to raise both legs at the same time. This exercise should not be done by anyone with existing lower back injuries or conditions. Hand weights and resistance bands courtesy of Sun Medical in Salem. Sun Medical now carries residential and commercial fitness equipment, visit www.sunmedical.com for details.

Notes: Make sure to keep back straight and exhale as you raise arms. The reverse dumbbell fly is not designed for heavy weights.

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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 and a trainer and instructor at the Salem YMCA

OurHealth | The Resource for Healthy Living in Southwest Virginia

Healthy Eats

diabeti c f r i e n d ly fa l l r e c i p e s

Entrée: Pot Roast Serves: 8

Ingredients: 1 tsp dried thyme

Salt and pepper to taste

4 lbs sirloin tip roast (boneless and trimmed)

Directions: 1. Preheat oven to 350º F. 2. In a small bowl, combine thyme, salt and coarsely ground black pepper; use to rub all over roast. 3. In 6-quart pot, heat oil on mediumhigh until hot.

2 tablespoon(s) olive oil

4. Add roast and cook about ten minutes or until browned on all sides.

2 medium onions, chopped

5. Transfer roast to plate.

2 clove(s) garlic, crushed with press

6. Reduce heat to medium.

14 ounces beef broth

7. Add onions and garlic to the pot, and cook eight minutes or until lightly browned, stirring periodically.

2 cup(s) water 2 teaspoon(s) Worcestershire sauce 1 bay leaf

Add broth, water, Worcestershire, and bay leaf then heat to a boil on high heat.

9. Transfer contents in pot to a baking dish with the pot roast; cover with foil and place in oven. 10. Cook 2 hours. 11. Place roast on a large platter, discard bay leaf. Spoon broth over roast and enjoy!

Local beef from: Sandy River Pork Contact: Yvonne and Walter Rieck 5455 Medical Center Rd. | Axton, Va 24054 434.685.4752 | www.sandyriverpork.com

Sandy River Farm has hundreds of hogs as well as a small herd of beef cattle for market. They pride themselves on the way they raise their livestock, allowing an all natural open environment. Their meat is all natural free of antibiotics and steroids. You can find their meat at the Roanoke farmers market as well as at the Roanoke Natural Foods Coop, the Homestead Creamery, and Tinnell’s Market in Roanoke.

Tricia Foley’s

PAN-SEARED POT ROAST Tricia Foley is OurHealth Magazine’s resident nutritionist.

OurHealth | The Resource for Healthy Living in Southwest Virginia

Healthy Eats

diabeti c f r i e n d ly fa l l r e c i p e s

Side Dish: Green Beans with Mushrooms & Onions Serves: 8

Ingredients: 3 tbsp coconut oil 6 cups onion, thinly sliced 15 button mushrooms, halved and sliced 1

teaspoon salt

1/2 teaspoon pepper ¼ cup vegetable broth 8 cups green beans, blanched

Green Beans from: Guthrie Farms

Directions: 1. Heat the oil in a heavy large pan, over medium-high heat.

Contact: Tom and Debbie Guthrie 56 Guthrie Road | Boones Mill, VA 24065 540.334.1584

2. Toss in the onion and sauté for seven to ten minutes, until the onions start to caramelize.

Guthrie farms has been around for six generations and started selling produce in the late 1800s. They have an array of both seasonal fruits and vegetables available for purchase.

3. Add the mushrooms and reduce heat to medium; cook for five minutes. 4. Season with the salt, pepper and add the vegetable broth. 5. Stir in the blanched green beans and cook for 5 minutes. 6. Serve with pot roast.

Tricia Foley’s

DELICIOUS GREEN BEANS Tricia Foley is OurHealth Magazine’s resident nutritionist.

OurHealth | The Resource for Healthy Living in Southwest Virginia

Healthy Eats

diabeti c f r i e n d ly fa l l r e c i p e s

Dessert: Honey Muffins Serves: 6

Ingredients: 3 eggs 2 tbsp organic butter 2 tbsp coconut milk 3 tbsp local honey ½ tsp ground nutmeg 1 tsp cinnamon ¼ tsp baking powder ¼ tsp salt ¼ C sifted coconut flour

Directions: 1. Mix together eggs, butter, coconut milk, honey, salt, cinnamon, nutmeg and vanilla.

Local Honey & Eggs from: Indian Valley Farm Contact: Randy Cohen | 824 Indian Valley Rd Indian Valley, VA 24105 | 540.789.4259 info@indianvalleyfarms.com www.indianvalleyfarms.com

Indian Valley Farms has forty acres of farmland and woods located in the Indian Valley area of Floyd County, VA. For more than twenty years they have offered fresh vegetables! They also offer local honey and have a small flock of chickens for fresh eggs.

2. Combine coconut flour and baking powder together and stir into batter until smooth. 3. Pour batter into greased muffin cups. 4. Bake at 400º F for 15 minutes.

Tricia Foley’s

HELLO, HONEY MUFFINS Tricia Foley is OurHealth Magazine’s resident nutritionist.

Breaking depression the Silence words | SUSAN DUBUQUE

with personal insight by: STEPHEN McCLINTIC, JR.

and suicide

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 OurHealth, 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.

PERUSE THE PICTURES IN THIS ARTICLE FIRST. Look at the picture of a

Look at the pictures of a person who grew into

little boy on his father’s lap. Look at the picture

an individual whose character was defined by his

of a little boy posing with his mother. Look at the

remarkable personality and unwavering honesty.

pictures of a little boy with his four siblings. Look

A person who would do anything for anyone else.

at the picture of a college student as a first year

No matter what.

cadet at Virginia Tech.

a magnificent young man. These pictures are of

Keep these pictures in your mind as you read further. Remember what I [McClintic] have said about this person’s character. Most importantly, understand that clinical depression is a topic needing increased awareness. To ensure it is treated as the disease it is and not dismissed as the taboo issue it is not.

Demons Deterred David, But They Didn’t Define Him On March 15, 2012, David Andrew Cassell drove to a remote spot on the Blue Ridge Parkway. He parked his car, walked down a trail and used a gun to take his life. David, despite all he had going for him, had issues that beat him. But as is the case with most suicides, the answers are few and the speculations are many. David’s parents, Scott and Connie Cassell, of Roanoke County, have wrestled with questions of ‘why?’ and ‘what could we have done?’ since that day in March when a police officer knocked on their door and delivered the life changing news. 54

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“It’s one thing to accept it. It’s another thing to understand it,” says Connie. “Scott and I have reflected back on David’s life, trying to understand where things started going wrong. As a young adult, we know alcohol was a significant factor for his deterioration, but that was chemical. In complete retrospect, we believe part of David’s issues started way back, when his twin brother died.”

David and Daniel From the beginning of Connie’s pregnancy, her doctor told her she was carrying one child. As she moved along in her pregnancy, she gained more weight than her doctor preferred. Concerned about the weight gain, her doctor encouraged her to modify her diet. Scott and Connie both had a feeling they were pregnant with twins. When Connie was five months along, an x-ray revealed two perfect little spines. What they suspected was true. Twins. A month later, Connie went into labor. It was July 26, 1975. The day David and his twin brother,

Daniel Arthur, were born. David and Daniel were two months premature, weighing just over three pounds each. While both were in critical condition, David showed signs of improvement. Daniel’s health, however, continued to decline. Five days after their birth, Daniel passed away. “I don’t think David ever got over the feeling that someone very dear to him was missing from his life,” explains Connie. “In his later life, David talked about it more and more. He visited Daniel’s grave often. I think he felt some level of guilt that he survived and his brother didn’t.” Losing Daniel was difficult, but Scott and Connie accepted it as from the Lord. As Christians, they relied on their faith and prayers to see them through. As time passed, the hurt from losing Daniel didn’t numb, but it became understandable. Accepted. They knew Daniel was home with the Lord. They knew one day they would see him again. Scott and Connie also wanted to stay true to their commitment of building a large family.

A Growing Family Two years passed. Then, news of a new miracle arrived. Scott and Connie learned they were pregnant with their first daughter. On August 29, 1977, Lydia Nell Cassell was born. During the next five years, Scott and Connie rounded out their family with another daughter, Charlotte Ruth, and two sons, John Scott and James Percy. All were healthy and happy. In a house in Roanoke County, where the Cassells still reside, Scott and Connie built a home where friends of all their children were welcomed. It remains the same to this day.

David and Friends David developed many life-long friendships at a very young age, as early as four-years-old. Chris Copenhaver. Scott Osborne. Patrick Hart. Jim Dudley. John Bullen. And me [McClintic]. This friendship of brothers, this bond, was never broken, no matter how far away one or the other lived, no matter how long between visits. And despite David’s changes – his reservation, his quietness, his reaching out to the wrong people – each of his friends stood by his side.

The Change in David “Age 12 seemed to be the turning point,” explains Scott. “He became more reclusive, more turned away. We asked him if anything bad had happened to him, but he assured us nothing www.OurHealthVirginia.com

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untoward had occurred. He just seemed different.” As David completed junior high and moved into high school, he continued to transform himself more and more. He embraced the “Gothic fashion”, sullen and dressing in all black. He began making new friends who were into his newfound culture. Nonetheless, he remained steadfast in his studies and maintained exceptional grades throughout high school. In fact, his grades were so good that he received a scholarship to Virginia Tech as a part of the Corps of Cadets. It wasn’t a good fit, though. “David was extremely unhappy at Tech,” explains Scott. “He had a tender heart and just couldn’t deal with the rigors of the militarystyle of education. He refused to return for his sophomore year. But there was more to it than just college and the Core. It ran deeper.” “David was our first child,” says Connie. “We really weren’t sure what was normal teenage angst and what indicated a deeper problem.” For the Cassells, clinical depression was a completely foreign concept. “We knew that David was non-communicative and we knew we couldn’t seem to break through to him,” shares Connie. Following his year at Tech, David spent the next couple of years attending Virginia Western Community College. And along the way, he became more distant. He began drinking more. He didn’t seem to enjoy what he was doing in school. In his mind, he needed a change.

A New Life in Richmond While David was a “natural” at science and math, he gravitated to the arts. At age 21, he moved to Richmond to attend Virginia Commonwealth University where he studied interior design. He engaged a circle of friends that were much like him – dark clothes, dark music and a dark outlook. And a lot more drinking. David was in Richmond for three years. He had not completed his degree. He had no stable work. And he was spiraling down. All the while, Connie and Scott were in Roanoke. Worried beyond belief.

“I traveled to Richmond one day planning to spend a few days with David in hopes that I could convince him to come home,” explains Scott. “He was in a bad place. He was spending time with the wrong people. I just wanted to bring my son home where he would be safe. Where we could protect him.” Scott made a deal with David. Come home, go to work with him (Scott owned a hardware and software training company at the time) and get back on his feet. Most importantly, Scott wanted David to get professional help to overcome his addiction. David resisted. His father pleaded. Finally, David agreed.

Scan the QR code below to download and print the Childhood Depression Checklist.

Home Again “When David returned home, things started out pretty good,” explains Scott. “He did a fantastic job. He knew the business. He always had a knack for computers. And he was attending counseling. We thought he was on the right track.” Then a regression occurred. David picked up old habits. He began drinking heavily again. He lost his job with his Dad. “We tried a lot of different routes,” explains Connie. “We did interventions. We offered financial support. We offered our unconditional love. As a family, we attended Al-Alon. Sure, there were times when it made a difference, but only for a small amount of time. We just felt hopeless.”

Document what you observe in your child and share with your child's doctor or mental health worker.

Another Turnaround When David did try to turn his life around, he did so valiantly. After losing the job at his father’s business, David began working in the insurance industry. He functioned well in this job, despite not entirely enjoying it. Over time, he was able to purchase a home in Roanoke City. He dated regularly, with some relationships lasting longer than others, before meeting a lady named Laura, who became his true love. Eventually, Laura moved into his house and the two began a life together. Not too long after, they were engaged. It seemed like a good start to a good life.

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“Laura was so special to David and they loved each other very much,” says Scott. “But they shared a common demon: alcohol. Although they both functioned during the week in their respective jobs, they spent weekends over-indulging. Eventually, the over-indulgence seeped into to the weekdays. It was a terrible turn.” Like David, Laura likely suffered from clinical depression. And alcohol abuse. The combination didn’t help either of them. It was just a matter of time before the mixture resulted in a most unfortunate situation. That day came on September 15, 2007. Following a night of heavy drinking, Laura walked up the attic stairs and committed suicide. “After Laura’s death, David didn’t show emotion the way one would think or expect,” says Connie. “He held it in. But we knew he was hurting. Everyone in the family knew he was hurting. And we were so worried about him.” David was really never the same again. Although he continued working at the insurance company, his drinking became worse and worse. To help offset his mortgage, he invited people to live with him who were not only enablers to his drinking problem, but who also took advantage of him by not providing their share of the rent on a regular basis. Eventually, David’s drinking problem became such an issue that he began showing up to work late, if at all. This repetitive behavior ultimately cost him his job. With all hope lost, David chose the only option he thought he had. So one night in 2011, he swallowed a slew of newlyprescribed anti-depressants with the intention of ending his life. Fortunately, one of David’s roommates discovered him before it was too late. David was taken to the hospital where he was treated and placed on a ventilator for several hours. When he regained consciousness, he showed some signs of remorse. Some signs of guilt. Perhaps some signs of embarrassment. Although he did not have health insurance at the time, he was still held involuntarily at the hospital for three days. Then, he was transferred to a mental health facility for continued evaluation and treatment. However, with no insurance, he was released much earlier than he needed to be.

A Return Home David did not return to his house. Instead, his parents invited him into their home another time. But there were strict rules. No drinking. Attend Alcoholics Anonymous meetings (AA) several times a week. Purge bad friendships. If he violated these rules, he could no longer live there. For several months, David took the path to recovery. He found a new job at another insurance agency. Not his ideal job, but a job nonetheless. He was a regular at AA. He was doing well. Still reserved and reticent, but seemingly doing well. Then David’s demons re-emerged. And he gave into them. He decided to go out with some old friends one evening and he

resumed some old habits. When he returned to parent’s home late that night, Scott smelled alcohol. “We were so angry, so disappointed,” says Scott. “We had tried everything. Everything. The one thing we hadn’t practiced, the one thing we learned in Al-Alon meetings, was to practice tough love. We had given David one last chance, and he forfeited it. So we decided to practice tough love. We told David he could no longer stay with us.” With nowhere to go, and knowing going back to his house would be a horrific decision, David turned to his sister, Lydia, who let him stay in her home. But David was still fighting his demons. With two young children who she did not want exposed to David’s behavior, she too had to make the decision to practice tough love, and she asked David to leave. Ruth, David’s other sister, let him into her home, but as a single mother, she soon realized she couldn’t expose her son to David’s lifestyle. She also had to practice tough love, and she asked David to leave.

A Return to the Wrong House David returned to the house that haunted him the most, where he had lived with his fiancée. His condition worsened. His good days were bad by everyone else’s account. He lost his job again. And he lost all hope. Once more, he entertained thoughts of suicide but chose to seek help from a local hospital. He stayed there a week, getting therapy and group counseling. It wasn’t enough. The family attended a meeting with a social worker to give David his options and let him know he couldn’t live with any of them. They said they would support him in whatever type of treatment he chose. It wasn’t enough. As with other trips to the psychologist, psychiatrist or hospital, David was diagnosed with depression and prescribed medication. But he never stuck with a treatment consistently enough to determine its effectiveness. He never stayed anywhere long enough for anyone to be able to reach him. It was never enough.

Finding Hope in a Half Way House After considering suicide another time, David found himself in a Half Way House. It wasn’t ideal, but it was safe and he had to follow the rules. He gave himself one more chance at life. Despite his family’s tough love approach, they still offered him emotional support. Lots of emotional support. But David needed to find his own way. It was up to him.

The Unforgettable Goodbye “I remember the last time I spoke with him,” shares Connie. “He was getting ready to start a job at a hotel. He didn’t seem too excited, but he was moving forward. I saw a glimmer of some hope.” So when the police officer knocked on the Cassell’s door that dismal day in March, they knew it was not good. Shocked? Sadly and unfortunately, they weren’t. Sad and defeated? Without a doubt.

Accepting and Understanding Left is a mother and father. Two sisters and two brothers. Three nephews and a niece. www.OurHealthVirginia.com

Below: David with his

Now is also the time to speak out about depression. Let’s talk openly about this disorder—what it is and is not, the signs and symptoms, the faces of depression, how it is diagnosed and treated.

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What is depression? First of all, let’s look at what depression is not. We’re not talking about having a bad day, a case of the blues or intense sadness associated with the loss of someone or something that is dear—such as the death of a loved one or breakup of a marriage. Depression is not a sign of weakness or a character flaw. You can’t just “shake it off” or “snap out of it.” Most simply stated, depression is a medical condition. It is a mood disorder that is marked by a persistent feeling of sadness and loss of interest in activities that were once enjoyable. Depression can affect how you feel, think and behave and can lead to an array of emotional and physical problems. It may make it difficult to manage routine, day-to-day tasks and make it seem that life is not worth living.

Researchers have found that changes in the brain during an episode of depression resemble the effects of severe, prolonged stress. 60

Countless relatives and friends. All tied together by a bond and memory of a remarkable young man. A memory that is cherished every day. And there’s also guilt. “We ask ourselves over and over again, ‘What if?’”, says Connie. “What if we would have reached out to him one more time? What if we would have brought him home?” There’s no easy answer to these questions. And there may never be. Acceptance? Just as difficult. But it’s not impossible. The Cassells are tied together by their faith and family values. They have weathered this tragedy as best as they can. There’s a lot of healing left to be done, and it will be achieved. “We hope that by sharing David’s story other families will be made aware of the dangers of depression and the importance of getting help early,” says Connie. “No one can ever be prepared for the devastation of a loved one committing suicide.”

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•

Depression can be a lifelong challenge. More than half of the people who experience one episode of major depression will have at least one more. Some people may feel depressed episodically or several times a year and others may have chronic ongoing problems. If untreated, bouts of depression can last anywhere from a few months to many years. And this is no small problem. Depression affects approximately 19 million Americans or 9.5 percent of the population in any given year. At some point in their lives, 10 to 25 percent of women and 5 to 12 percent of men will become clinically depressed. Studies show that rates of depression for Americans have risen dramatically in the past 50 years. In fact, the World Health Organization has classified depression as a worldwide epidemic. Emily DeFrance, PhD, LCP, clinical psychologist with Psychological Health Roanoke, suggests that “better recognition, less stigma and more hopeful treatments may have contributed to this increase.”

Depression exacts an economic cost of over $30 billion each year. It leads to absenteeism from work and decreased productivity and is the leading cause of disability in the United States. And the cost of human suffering is immeasurable. Depression is a deadly disease—resulting in nearly 40,000 suicides a year. But this story does have a bright side. Depression is among the most treatable forms of mental illness and 80 to 90 percent of those who receive treatment get better.

Types of Depression “Depression” is an umbrella term that encompasses gradations of symptoms that are categorized as a number of disorders. And just as symptoms vary from person to person, so do the actual diagnoses. Here are some of the types of depressive disorders: Major Depression. Major depression —also called clinical depression—may include extreme sadness, hopelessness, lack of energy, irritability, trouble concentrating, changes in sleep or eating habits, feelings of guilt, physical pain and thoughts of death or suicide. To be diagnosed with major depression, an individual’s symptoms must last for more than two weeks. Persistent depressive disorder. This type of depression—also called dysthymia—is a milder yet more chronic form of major depression. Think of this like a low-grade fever— individuals can usually function adequately, but not optimally. They may appear to others to have negative personalities. Postpartum depression. More than a case of “baby blues,” postpartum depression can make a new mother feel sadness, loneliness and hopelessness. In extreme cases, the mother may have suicidal thoughts or even thoughts of harming her baby. As many as 10 to 15 percent of women experience postpartum depression after giving birth. Seasonal affective disorder. Seasonal affective disorder—aptly called SAD— typically occurs during the winter months, when there is less natural sunlight. The symptoms tend to be mild and generally lift during spring and summer. Some patients respond www.OurHealthVirginia.com

to treatment with light therapy that simulates natural sunlight. Bipolar disorder. Bipolar disorder—sometimes called manic-depression—involves cycling mood changes—from periods of extreme lows (depression) to periods of elation and excitable behavior (mania). Children who experience their first episode of major depression before puberty are at particularly high risk for bipolar disorder. Psychotic depression. Psychosis is a serious mental illness involving false beliefs, known as delusions, or perceptions of false sights or sounds, known as hallucinations. When these combine with severe mood symptoms it is considered psychotic depression. According to the National Alliance on Mental Illness, about 20 percent of people with depression may have episodes so severe that they see or hear things that are not really there—such as voices telling the individual that he or she is a bad person or doesn’t deserve to live.

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Substance-induced mood disorder. The use of street drugs, alcohol, some prescription medications or other toxins can cause depression. Premenstrual dysphoric disorder (PMDD). A small percentage of menstruating women suffer from PMDD—making them feel irritable and depressed for one or two weeks before their menstrual period each month.

What Causes Depression? The exact cause of depression is not known. But, according to Dr. DeFrance, “It most likely results from a combination of genetic, biological, environmental and psychological factors.” First, climb your family tree. Depression runs in families. If you have a parent or sibling who has had major depression, you may be 1.5 to 3 times more likely to develop a depressive disorder than people who do not have a close relative with the condition. And when one identical twin has clinical depression the other

will also develop depression approximately 76 percent of the time. Even when identical twins are raised apart from each other, they will both become depressed about 67 percent of the time. But unlike with gender or eye color, research has yet to identify a specific gene that directly causes depression. Most likely a number of genes act together to make a person more susceptible to depression. But just because a person inherits a predisposition does not mean that he or she is destined to develop the illness. The genetic influence is only partially responsible for causing depression; other factors also play a role.

Emily DeFrance, PhD, LCP, clinical psychologist with Psychological Health Roanoke

Depression is a disorder of the brain. And brain-imaging studies—like magnetic resonance imaging (MRI)—show that the parts of the brain involved in mood, thinking, sleep, appetite and behavior look different in people who have depression than in those without depression. But these images do not reveal why the depression has occurred. Brain chemistry can play a role in depression. Neurotransmitters are naturally occurring chemicals that transmit messages between nerve cells—or neurons—in the brain. Three primary neurotransmitters—serotonin, norepinephrine and dopamine—affect the parts of the brain that regulate emotions, reactions to stress and the physical drives of sleep, appetite and sexuality. When these neurotransmitters are out of balance, depression may result. Hormones are chemical substances produced by glands of the endocrine system—such as the pituitary glands, thyroid, ovaries, gonads and pancreas. Hormonal imbalances can affect mood, physical development, appetite and energy levels and may be involved in causing or triggering depression. “Teens are hormonal fountains,” notes Dr. DeFrance. “And this is occurring at the same time that they are moving away from the secure influence of family to a less stable influence of their peers.” Traumatic events such as the death or loss of a loved one, divorce, a natural disaster, a serious medical illness or injury, financial problems or childhood trauma can trigger depression in some people. But that is not the same as a direct cause. “Think of it like this,” says Dr. DeFrance, “If an individual has a biogenetic predisposition, a hormonal or brain chemistry imbalance, and then experiences a significant loss or trauma, that event may spark depression.” Depression can lead to pessimistic thoughts. That seems logical. But it may also surprise you to learn that negative thoughts can lead to depression. When an individual habitually experiences negative thoughts—called cognitive distortions—that person’s feelings may follow their thoughts, and they can spiral down into depression. Some types of cognitive distortions are overgeneralization, should statements and disqualifying the positive. You might not be aware that depression can also be a learned behavior. For example, says Dr. DeFrance, “Children can actually model depressive behavior after a parent who is depressed.” www.OurHealthVirginia.com

Depression and alcohol or substance abuse commonly occur together but the relationship between the two disorders seems to be multifaceted. A person suffering from depression may drink or use drugs in an attempt to self-medicate and feel better. Alcohol and some drugs are depressants, which in turn, may intensify the depression. Stress contributes to many serious medical conditions and depression is no exception. Chronic stress leads to elevated hormones including cortisol—called the “stress hormone”— and reduced serotonin and other neurotransmitters in the brain. When these chemical systems are out of balance, depression can be the result. Researchers have found that changes in the brain during an episode of depression resemble the effects of severe, prolonged stress. Let’s consider the mind-body connection. Depression can occur with other serious illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes and Parkinson’s disease. Studies show that treating the depression can help improve the outcome of the co-occurring illness.

Signs and Symptoms of Depression People with depression do not all experience the same symptoms and the severity, frequency and duration of their symptoms may vary. Here are the generally agreed upon symptoms for major depression: • Persistent sad, anxious or “empty” feelings • Feelings of guilt, worthlessness or helplessness • Irritability, restlessness • Loss of interest in activities or hobbies once pleasurable, including sex • Withdrawal from friends and family • Fatigue and decreased energy • Difficulty concentrating, remembering details and making decisions • Insomnia, early-morning wakefulness or excessive sleeping • Overeating or appetite loss • Thoughts of suicide, suicide attempts • Aches or pains, headaches, cramps or digestive problems that do not ease even with treatment • Substance abuse “There are also clues that may indicate that an adolescent or adult is at increased risk of suicide,” further remarks Dr. DeFrance. “Be on the lookout for signals like searching the house for a weapon or a preoccupation with stories about war and/or suicide on the news. Another telltale sign is giving away personal items.” And suicide is “contagious.” That is, one suicide in a high school is a risk factor for more suicides. 64

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Different Faces of Depression Depression is an equal opportunity disorder—no one is immune. Let’s see how different groups of people experience clinical depression. Women are more than twice as likely to be diagnosed with depression as men. Before adolescence, the rate of depression is about the same for girls and boys. However, with the onset of puberty, girls are at greater risk possibly due to changes in hormone levels that occur throughout a woman’s life. Women may also be diagnosed at a higher rate because they are more willing than men to seek treatment.

At right: David as a

freshman cadet at Virginia Tech.

Men are more apt to suppress their emotional distress through the use of alcohol or other substances that “mask” the clinical depression. For women, depression is expressed as sadness. Men who are depressed are more likely to be frustrated, discouraged, irritable, angry and sometimes abusive. Although more women attempt suicide, men are more successful. In the United States, almost four times as many males as females die by suicide. Marriage plays an interesting role in the risk for depression. Married women are more likely to be depressed than unmarried women; however the reverse is true for men. Marriage seems to create a protective buffer against depression for men, but not for women. And if you think depression is a problem that only adults have to face, think again. About 11 percent of all adolescents experience depression by the age of 18. What’s even more staggering is the fact that suicide is the third leading cause of death among youth ages 15 to 24 and the fourth leading cause of death for children between 10 and 14. Depression is not something children outgrow. Childhood depression can continue into adulthood, especially if left untreated. “Depression in children doesn’t necessarily look the same as it does in adults,” says Dr. DeFrance. “A young child may refuse to go to school, cling to a parent or worry that a parent may die or have physical complaints like stomachaches and headaches. Older children may sulk, get into trouble at school, be negative and irritable and feel misunderstood.”

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Because these behaviors may be seen as “phases” children and adolescents go through as they develop, it may be difficult to accurately diagnose a young person with depression. Depression in children and adolescence often occurs with other disorders such as attention deficit disorders, anxiety, eating disorders or substance abuse. Let’s look at the other end of the age spectrum. Depression is not a normal part of aging. But when older adults do have depression, it may be overlooked. Seniors may be less likely to admit that they have feelings of sadness. Older adults have more medical conditions—like heart and vascular disease, stroke and cancer—which may cause depressive symptoms. And they may be taking medications with side effects that contribute to depression. Most people assume that the highest rates of suicide are among young people. But white males age 85 and older actually have the highest suicide rate in the United States.

Diagnosing Depression There is no simple test for diagnosing depression and the process may take a little time and help from several healthcare providers. If you or a loved one is experiencing the signs and symptoms of clinical depression, a good place to start is with your primary care physician. Your doctor will first determine if there are any medical conditions causing your depression— such as thyroid problems, a viral infection, vitamin or mineral deficiencies, hormonal changes or side effects of medications. If there is no apparent reason why you should be experiencing signs of depression, further assessment will be conducted by your physician or by referral to a mental health professional. A thorough evaluation will include asking you a number of questions designed to fully understand the nature of your problem: • What are your symptoms? • How long have you had these symptoms? • How severe are your symptoms? • Have you had these symptoms before? • Have you been treated for depression before?

• Do any of your relatives have depression? • Is there anything happening in your life right now that is particularly upsetting or stressful? • Do you use drugs or drink alcohol? • Have you thought about death or suicide? The findings from this evaluation will be compared to the diagnostic criteria for depression found in a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Treatment Options There are a variety of effective methods for treating depression. Unfortunately, only about one-third of those who are depressed actually receive professional help.

At some point in their lives, 10 to 25 percent of women and 5 to 12 percent of men will become clinically depressed.

Some people with mild depression do well with psychotherapy or counseling alone, while individuals with moderate to severe depression most often benefit from antidepressant medications. “Patients tend to have the best outcome with a combination of treatments,” observes Dr. DeFrance. “Medication to provide relief from symptoms and psychotherapy to learn more effective ways of dealing with the challenges of life.” Although antidepressants can help ease the feelings of sadness and hopelessness associated with depression, they are not “happy pills.” Medications are not designed to cover up problems. Rather, they modify the neurotransmitters—or brain chemical—that regulate mood. “But these medications don’t work overnight. It can take several weeks before a patient begins to feel significant relief,” cautions Dr. DeFrance. There are a number of antidepressants available and they each work in a slightly different way. The side effects also vary from one antidepressant to another and from person to person. They range from dry mouth and constipation to weight gain and sexual dysfunction. With so many options now available, a doctor can help each patient find just the right medication—or combination of medications—to achieve the greatest relief of symptoms with the fewest side effects.

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At right : pictured from left: James,

David, John, Lydia and Ruth

Below : pictured from left: David, John,

James, Lydia and Ruth

“...if you think depression is a problem that only

adults have to face, think again. About 11 percent of all adolescents experience depression by the age of 18. Suicide is the third leading cause of death among youth ages 15 to 24 and the fourth leading cause of

”

death for children between 10 and 14. There are several types of psychotherapy— or “talk therapy”—that can help people with depression. Interpersonal therapy (IPT) helps people understand and work through troubled relationships that may set off their depression or make it worse. Cognitive-behavioral therapy (CBT) approaches emotional problems by changing the way a person thinks about his or her life. “People coping with depression tend to have negative thoughts, “ Dr. DeFrance explains. “CBT provides a mental tool kit that can be used to challenge these negative thoughts and reframe the worldview. This type of therapy can also help patients modify behaviors that come from dysfunctional thinking. When patterns of thought and behavior are changed, so is mood.” For young children who lack the ability to express themselves verbally, play therapy may provide a helpful way for the child to share feelings and experiences. And even young children can benefit from learning coping strategies to handle stress. Electroconvulsive therapy (ECT) may be useful for individuals whose depression is severe or life threatening and when antidepressant medications are not effective. In recent years, ECT has improved a great deal. Patients receive a muscle relaxant before treatment and the procedure is done under anesthesia. Electrodes are placed at precise locations on 68

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the head to deliver electrical impulses that cause a brief—about 30 seconds—seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. ECT may cause some side effects, such as confusion, disorientation and memory loss, but usually these are short-term. In 2008, the U.S. Food and Drug Administration (FDA) approved the use of transcranial magnetic stimulation (TMS) for patients with major depressions who do not respond to medication. This is not an experimental treatment; it has been studied by researchers for more than 20 years. TMS works by stimulating the nerve cells in the part of the brain that is linked to depression and mood regulation—reducing the duration and severity of depressive episodes. Treatments are given on an outpatient basis five days a week over a six- to nine-week period— typically for a total of 36 treatments. There are several important benefits to TMS compared to other treatment modalities. No sedation or anesthesia is required so the patient can drive and return to work or other daily activities immediately following the treatment. And TMS does not have side effects that are common with antidepressant medication and ECT. TMS offers significant improvement for about 60 percent of the patients and complete remission for about a third of the patients.

What does the future hold? Genetics and the brain are the two final frontiers of medicine—and both areas of research will contribute to more effective ways of preventing, diagnosing and treating depression. Here are a few of the new and exciting developments that are on the horizon: • A recent study shows that people with a certain genetic mutation that causes them to produce less of the brain chemical neuropeptide have a more intense negative emotional response to stress and may be more inclined to develop depression. • Deep brain stimulation (DBS)— which has been historically used to treat Parkinson’s disease and essential tremor—is now being investigated as a promising new treatment for severe depression. DBS uses a tiny electrode that is surgically implanted to stimulate the part of the brain that regulates mood. • One of the most innovative studies is a clinical trial using botulinum toxin (Botox) for the treatment of major depressive disorder. There are a number of theories how this works. The facial feedback hypothesis states that facial expressions feed back to the brain and influence emotions. Botox has been tested for many medical conditions— ranging from chronic migraine and psoriasis, to restless legs syndrome and tennis elbow just to name a few. • Another novel area of investigation is the use of anti-inflammatory drugs to treat depression in people who do not respond to antidepressant medications and psychotherapy.

The last great stigma of the twentieth century is the stigma of mental illness. —Tipper Gore Individuals who suffer from depression face many challenges—but perhaps the worst is social stigma. No one is embarrassed to admit that they have 70

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heart disease or that a family member has cancer. People are not reluctant to get help for their diabetes or asthma. Yet, depression is still talked about in hushed voices. The mere mention of mental illness makes people feel uncomfortable. It evokes a sense of shame and humiliation. It is imperative that we all play a role in conquering depression and the stigma that surrounds it. Be aware of the signs. If you experience these symptoms, and they continue for more than two weeks, don’t be embarrassed or ashamed to seek treatment from your personal physician, a counselor or mental health professional. Similarly, if you believe that a family member, friend or associate may be suffering from depression, let that individual know you are concerned and encourage them to get help. Clinical depression is a major illness with serious consequences. But the good news is that depression is eminently treatable. The medications we have available today are just as effective as medications used to treat other physical disorders. Hopefully, as more strong and brave people like the Cassells tell their stories and as we increase understanding that depression is a medical condition with a genetic and biological basis, the barriers that prevent people from seeking treatment and giving support to those who are struggling with this disorder will come down.

Medical Experts • Emily DeFrance, PhD, LCP Psychological Health Roanoke 540.772.5140 www.psychhealthroanoke.com

Sources: • Centers for Disease Control and Prevention (CDC) • National Alliance on Mental Illness (NAMI) • National Institutes of Health (NIH) • National Institute of Mental Health (NIMH)

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OurHealthâ&#x20AC;&#x2122;s staff photographer, Deidre Wilkes, captures a variety of healthy activities at Green

Ridge Recreation Center.

Green Ridge Recreation Center Staff photographer, Deidre Wilkes, recently spent a morning at Green Ridge Recreation Center, capturing many healthy activities and classes taking place within the Center. There truly is something for everyone at Green Ridge! Next up, the popular 12-week Lose Big Program, which kicks off in October. For more information about the Lose Big Program, contact Chelsea Arner at 540.777.6310.

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Breaking the Silence

Alzheimer’s Disease 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 OurHealth, we bring these diseases 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.

He was a strong and vibrant man—74 years old and still working full time as a regional sales executive. The changes started slowly, with small things. A forgotten name. A bit of confusion. A little difficulty following conversations. But gradually, Jerry Villano’s memory loss became more apparent and more alarming.

“The tipping point occurred the day we had our carpets cleaned,” recalls Jerry’s wife, Becky Barney-Villano. “Before he left the house to run some errands, Jerry had a very pleasant 20-minute conversation with the carpet cleaner. When he came home later in the day, Jerry asked me if the carpet man had come yet. I was dumbstruck. But most of all I was scared to death.”

"...we are very grateful for every day we share, for every memory we create and hold dear" says Becky, with husband Jerry.

Becky immediately made an appointment for her husband to see his personal physician. And on January 9, 2009, based on a mini-mental status exam, the doctor diagnosed Jerry with mild dementia. Jerry’s doctor prescribed Aricept®, a medication used to improve memory and cognitive function associated with Alzheimer’s disease. “The doctor also suggested that Jerry do brain exercises to keep his mind alert. We were heartsick,” says Becky, “but determined to fight this in every way we could.” Becky and Jerry began attending an Alzheimer’s support group—seeking information, guidance and, most of all, the comfort and solace of other families coping with the same issues. It was through these contacts that they realized that Jerry had not received a thorough evaluation. In fact, his diagnosis was based entirely on a 30-question screening tool. So the next stop in their journey was further testing. Jerry was given a comprehensive evaluation by a team of specialists. This included a complete physical, blood work, an MRI, a neurological examination and in-depth interviews with Becky and Jerry. “The most startling part of the evaluation was the brain scan,” says Becky. “I could see it right there on the screen—part of the brain was atrophied. It suddenly became crystal clear—Jerry’s really not doing these things to annoy me. There is an organic reason for his behavior.” As a result of the assessment, Jerry’s diagnosis was revised to mild cognitive impairment (MCI). “This new diagnosis gave us some hope,” recalls Becky. “We were told that MCI can increase Jerry’s risk of later progressing into Alzheimer’s disease. But some people never get worse, and a few eventually get better.” Becky and Jerry are determined to be among the group that “gets better” and they are making progress in that direction. Jerry continues taking medication—including two classes of drugs used for Alzheimer’s disease. Becky encourages him to exercise, and Jerry now plays golf once a week and works out with a personal trainer twice a week. He regularly engages in activities to stimulate his brain. And through the support group, the couple enjoys socializing with many close friends.

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“It’s wonderful to spend time with people who understand what we’re going through and never judge,” says Becky. Becky offers the following advice to other families facing this challenge: »» At the very first sign of memory or cognitive problems, get help. Have a complete evaluation by a highly trained specialist. »» Alzheimer’s is not a simple disease—and you have to tackle it from many directions—medication, physical and mental exercise, diet and a strong social network. »» If you are the caregiver, don’t forget to take care of yourself. When you are caring for an Alzheimer’s patient, everything in your life changes. Ask for help. Take time for yourself. Renew and refresh. You can’t take care of anyone if you are sick or exhausted. “Alzheimer’s is a cruel disease,” reflects Becky. “It robs you of your past, your present and your hope for the future. Jerry and I feel blessed that he has stabilized and even improved, thanks to all the right interventions. And we are very grateful for every day we share. For every memory we create and hold dear.”

It’s time to stop whispering about Alzheimer’s disease. Let’s have a frank and open conversation about this disorder—the nature of the disease, risk factors, current treatments and what the future holds.

What is Mild Cognitive Impairment? Mild cognitive impairment (MCI) is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of

Understanding Alzheimer’s Disease We’ll start with the most basic question: What is Alzheimer’s disease? Alzheimer’s is an irreversible, progressive brain disease that results in loss of memory, language, intellectual functioning, judgment and complex motor skills, as well as behavioral, mood and personality changes. The symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. An estimated 5.1 million Americans are afflicted with this disease, including about a half million who are under the age of 65 (called early onset). Alzheimer’s disease is the most common cause of dementia among people age 65 and older and accounts for about 60 percent of all dementias. Dementia is not a specific disease—rather it describes a group of symptoms that are associated with decline in mental ability. According to Michael Camardi, MD, a geriatrician at Carilion Clinic, “Most people think that Alzheimer’s is the only form of dementia, but in fact a spectrum of cognitive disorders can result in dementia including mental dysfunction associated with alcoholism, Parkinson’s disease, repeated head trauma, sleep apnea, vascular disease, vitamin deficiencies, adverse drug reactions and thyroid disease among others. The good news is that many of these are treatable.”

dementia. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes.

“It is still not clear how the Alzheimer’s disease process begins, but it is likely that damage to the brain starts a decade or more before symptoms become apparent,” says Clement Elechi, MD, a neurologist with LewisGale Physicans. During this preclinical phase, toxic changes are taking place in the brain. “Sticky clumps of protein called www.OurHealthVirginia.com

beta-amyloid plaques begin to form outside and around the brain’s nerve cells. And twisted fibers called neurofibrillary tangles—composed largely of the protein tau— build up inside nerve cells.” Although tangles and plaques are hallmarks of the disease, researchers are unsure if they cause it or are a byproduct of it. Scientists have known about plaques and tangles since 1906, when a German physician, Dr. Alois Alzheimer, identified these abnormalities in the brain tissue of a 51-year-old woman who died from an unusual mental illness that involved memory loss, language problems and unpredictable behavior. As Alzheimer’s disease progresses, nerve cells—called neurons—in several areas of the brain shrink and die, including cells that normally produce neurotransmitters, the chemical messengers that relay brain signals from one neuron to another. Acetylcholine is a neurotransmitter that is deficient in people with Alzheimer’s. As nerve cells continue to die, the brain itself shrinks and the wrinkles along its surface become smoother.

Risk Factors and Causes of Alzheimer’s Disease Like all types of dementia, Alzheimer’s disease is caused by brain cell death. “But the exact cause is still unknown,” observes Dr. Camardi. “The disease may be triggered by a variety of factors including age, genetics, serious head injury, brain inflammation, environmental factors and damage to neurons from overproduction of toxic free radicals.” Alzheimer’s is not a normal part of growing older, however the greatest risk factor for the disease is increasing age. The risk of Alzheimer’s doubles every five years after age 65, and reaches nearly 50 percent after age 85. Family history is another Alzheimer’s risk factor. Research has shown that individuals who have a parent, sibling or child with Alzheimer’s disease are more likely to develop the disease and the risk increases if more than one family member has the illness. Alzheimer’s disease that clearly runs in families is called Familial Alzheimer’s disease (FAD) and accounts for less than five percent of all cases. FAD usually occurs between the ages of 30 and 60. In recent years, scientists have zeroed in on three gene mutations that cause early-onset Alzheimer’s. Other studies suggest that specific genes may increase an individual’s risk for developing late-onset Alzheimer’s but do not definitely signal that the person will develop the disease.

Warning Signs of Alzheimer’s Disease Alzheimer’s disease appears differently in every case, but there are a number of common warning signs that prompt patients and family members to seek medical assessment. The most prominent complaint is memory loss, particularly the inability to recall names, recent events, new information and the placement of objects. Here are other indications that may indicate Alzheimer’s disease:

Becky offers the following advice to other families facing this challenge: • At the very first sign of memory or cognitive problems, get help. Have a complete evaluation by a highly trained specialist. • Alzheimer’s is not a simple disease—and you have to tackle it from many directions—medication, physical and mental exercise, diet and a strong social network. • If you are the caregiver, don’t forget to take care of yourself. When you are caring for an Alzheimer’s patient, everything in your life changes. Ask for help. Take time for yourself. Renew and refresh. You can’t take care of anyone if you are sick or exhausted.

»» Confusion about time and place »» Struggling to complete familiar actions such as brushing teeth, getting dressed and other daily activities »» Trouble finding appropriate words, completing sentences, following directions and conversations www.OurHealthVirginia.com

»» Poor judgment when making decisions »» Changes in mood and personality, such as increased suspicion, rapid and persistent mood swings, withdrawal and disinterest in usual activities »» Difficulty with complex mental tasks, such as balancing a checkbook Source: Alzheimer’s Foundation of America

What is dementia? Dementia is a general term for a decline in

“We shouldn’t be too hasty to label every older adult who is experiencing memory or cognitive problems with Alzheimer’s disease or dementia,” says Dr. Camardi. “First, we have to evaluate sensory problems. After all, thinking and memory formation are predicated on our five senses. Sleep deprivation can also have a significant impact on cognitive function. We shouldn’t jump to conclusions.”

How is Alzheimer’s Disease Diagnosed? There is no simple screening test for Alzheimer’s disease and a number of medical conditions can cause dementia—some of which are temporary or reversible with proper treatment. Therefore, it is important to have clinical evaluation by a highly trained physician in order to arrive at an accurate diagnosis.

mental ability severe

A comprehensive evaluation for Alzheimer’s disease when performed by an experienced clinician is about 90 percent accurate and typically includes the following:

enough to interfere with

• A detailed medical and social history. Past medical records and information provided by the patient or a family member will help identify or rule out other possible causes for symptoms. The physician will ask about the patient’s ability to carry out daily activities and any changes in behavior or personality. Family history of Alzheimer’s disease will be considered and special attention will be paid to the onset of the patient’s symptoms. The symptoms of Alzheimer’s disease typically appear gradually and become more persistent over time.

daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia.

• A medication inventory. A complete list of prescription and over-thecounter medications will be reviewed to determine if a particular drug or drug interaction may be causing dementia. A urine screen may be used to detect the presence of some drugs. • A history of substance abuse or misuse. Chronic drug or alcohol abuse can cause cognitive and memory impairment. • A complete physical examination. A thorough physical examination is essential since disease in many organ systems may lead to dementia. Special emphasis and attention is given to the neurological evaluation. • A mental status examination. Mental status includes an evaluation of attention, orientation, short- and long-term memory, language ability, thought processes, judgment and more. • Laboratory tests and screenings. A variety of tests may be ordered including a complete blood cell count, electrolyte panel, screening metabolic panel, thyroid gland function tests, vitamin B-12 and folate levels, urinalysis and tests for syphilis. Depending on the patient’s history, tests may be requested for human immunodeficiency antibodies, an electrocardiogram (ECG), chest x-ray, brain MRI scan and an electroencephalogram (EEG). A lumbar puncture may also be performed.

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• Psychiatric assessment. The effects of emotional problems must also be taken into account when evaluating a patient for Alzheimer’s disease. Stress, depression or anxiety—as well as adjusting to a major life change such as the death of a spouse— can cause confusion and forgetfulness that may be mistaken for dementia. To further confound matters, depression may be present with Alzheimer’s disease and other forms of dementia. NOTE: Criteria for evaluation established by the National Institute of Neurological and Communicative Disorders and the Alzheimer’s Disease and Related Disorders Association Work Group.

Treatments for Alzheimer’s Disease At this time there is no cure for Alzheimer’s disease but researchers are continually testing various new treatments and combinations of drug therapies to control symptoms, slow the progression of the disease and improve the quality of life. The U.S. Food and Drug Administration (FDA) has approved a number of medications that offer some relief to patients with varying degrees of impairment. “The prescription medications used treat Alzheimer’s symptoms in early to moderate stages are a class of drugs called cholinesterase inhibitors—which treat symptoms related to memory, thinking, language, judgment and other thought processes,” explains Dr. Elechi. “These medications work by preventing the breakdown of acetylcholine—the neurotransmitter or chemical messenger important for learning and memory.” They delay the worsening of symptoms for six to 12 months for about half the people who take them.

Clement Elechi, MD, Neurology, LewisGale Physicians

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A second type of medication called memantine is used to treat moderate to severe Alzheimer’s. Memantine is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks by regulating the activity of glutamate, a different messenger chemical involved in learning and memory. Some patients also benefit from psychiatric care—including treatment for depression, paranoia and hallucinations—and behavioral management interventions. “Alzheimer’s disease and other forms of dementia affect more than just the patient,” observes Dr. Camardi. “Education, counseling, support and respite care are vital to family members and caregivers.”

Michael Camardi, MD, a geriatrician at Carilion Clinic

Prognosis of Alzheimer’s Disease Not every Alzheimer’s patient experiences the same symptoms or at the same rate but the disease tends to advance through the following general stages:

During the mild stage of Alzheimer’s disease,

memory loss worsens and changes in other cognitive abilities become apparent. Typical problems include getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, using poor judgment, and some mood and personality changes. People often are diagnosed in this stage.

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As the disease advances to a moderate stage, damage occurs in

areas of the brain that control language, reasoning, sensory processing and conscious thought. Memory loss and confusion grow worse, and people begin to have problems recognizing family and friends and may have difficulty carrying out tasks that involve multiple steps such as getting dressed. They may experience hallucinations, delusions and paranoia and may behave impulsively.

By the final severe stage, plaques and tangles have spread throughout the brain and brain tissue has shrunk significantly. Individuals need help with even the most basic tasks including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. In the later stages, Alzheimer’s disease damages parts of the brain that control breathing, swallowing and the ability of the body to fight off infections—the majority of Alzheimer’s disease-related deaths are due to infections such as pneumonia. The average life expectancy for someone with Alzheimer’s is eight to 10 years after the onset of symptoms. However, individuals with Alzheimer’s have been known to live up to 20 years after the first signs appear.

Implications In light of the aging population, Alzheimer’s disease will impact a greater percentage of Americans. “This is truly a public health crisis in the making,” says Dr. Elechi. By the year 2050, the number of people age 65 and older will more than double to 88.5 million—and those 85 and older will increase three-fold to 19 million. “Right now, we’re spending $220 billion a year for medical treatment and care for dementia patients. In 20 years we expect that number to increase to $550 billion—exceeding our nation’s defense budget.” The critical importance of conquering Alzheimer’s disease is widely recognized. In May 2012, the U.S. Department of Health and Human Services released the National Plan to Address Alzheimer’s Disease, which calls for preventing and effective treatment of Alzheimer’s disease by 2025.

What Does the Future Hold? In the past, a definitive diagnosis of Alzheimer’s disease—seeing the tangles, plaques and deterioration of nerve cells—was only possible through examination of the brain after death. “Now, brain imaging studies offer promise for more accurate diagnosis

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and the early detection of Alzheimer’s disease,” remarks Jackson W. Kiser, MD, Radiology Associates of Roanoke. Here are a few examples: A positron emission tomography with fluorodeoxyglucose (FDG-PET)—involves injecting the patient with a radioactive tracer and then using a PET scan to determine how glucose—or sugar—is being metabolized in the brain. The brain uses sugar as fuel and when certain areas of the brain are not able to utilize glucose, this is consistent with Alzheimer’s disease. PET scanning can be used with a tracer that reveals amyloid plaques. This tracer was developed by two researchers from the University of Pittsburgh and is commonly called Pittsburgh compound. The FDA has approved other amyloid imaging agents for PET scans.

Jackson W. Kiser, MD, Radiology Associates of Roanoke

An MRI can show evidence of brain atrophy associated with Alzheimer’s disease and additional causes of dementia, such as disease of small blood vessels in the brain. Studies presented at the Alzheimer’s Association International Conference suggest that earlier signs of Alzheimer’s disease may be evident in the eyes and nose. The beta-amyloid plaques that accumulate in the brain of Alzheimer’s patients also can build up in the eye and can been seen in the retina when the plaque is “stained” with curcumin, a component of the spice turmeric. A laser can also be used to detect the beta-amyloid in the lens of the eye. Other studies are evaluating the possibility of using a smell test for Alzheimer’s. “There are many innovative research efforts related to Alzheimer’s disease and dementia taking place around the country and around the world,” says Dr. Camardi. One study taking place at a major medical center is identifying certain proteins in the spinal fluid of Alzheimer’s patients that are present 15 to 20 years before symptoms appear. Another is looking at specific lipid levels—or fats—that are elevated in the blood of Alzheimer’s patients. “This type of research will lead to earlier diagnoses, more effective treatments and, dare we hope, ultimately a means of curing and preventing Alzheimer’s disease.”

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Alzheimer’s Disease:

Arm Yourself with Knowledge words | SUSAN DUBUQUE

Take Charge: Protect Your Brain The best way to prevent most lifethreatening diseases is to pick your parents carefully. Unfortunately, only a fraction of Alzheimer’s disease cases have direct genetic causes. But there are lifestyle changes—choices you can make—to reduce your risk for Alzheimer’s disease and help you maintain mental acuity. And every one of them is grandmother approved. “The same things you should do to reduce your risk of heart disease, cancer and diabetes also offers a degree of protection from Alzheimer’s disease and dementia,” notes Dr. Camardi. Eat a healthy diet. “There is a growing body of research that shows the value of the Mediterranean diet in reducing risk for Alzheimer’s disease and maintaining cognitive performance. The Mediterranean diet is based on eating plenty of vegetables, fruits, legumes, fish and cereals; high intake of unsaturated fats (specifically olive oil) and low intake of saturated fats; and moderate amounts of dairy, meat and poultry. Even making simple changes to your diet can have a positive effect. Here are a few ideas: »» Reduce the packaged, processed and “fast” foods you eat »» Shop around the outer aisles of the grocery store—this is where you will find the fresh produce, meats, fish, eggs and dairy »» Try out your local farmer’s market »» Stay away from “white” foods—such as white bread, pasta, sugar and potatoes

Maintain your weight. Some researchers actually refer to Alzheimer’s disease as “type 3 diabetes” because of its strong link to obesity, which elevates brain proteins that are linked to the development of the disease. Further, brain imaging has shown that people with obesity have smaller brain volumes, which increases the risk for Alzheimer’s. Exercise your body. “Moderate exercise clearly has a positive impact on cognitive function and memory among older adults,” states Dr. Elechi. “It actually increases the size of the parts of the brain that shrink with age. So find something you enjoy doing— biking, running, swimming, tennis, brisk walking—and do it regularly.” Get that heart beat up and your blood pumping. The benefits of movement are cumulative throughout the day—so take the stairs and park your car at the far end of the lot and walk a little farther. And it’s never too late. A Finnish study found that Alzheimer’s disease patients who engaged in 30 minutes of exercise three times a week experienced a slower rate of cognitive decline than those who did not. Exercise your brain. Increasing evidence suggests brain workouts play a role in maintaining cognitive health. “While mental exercise won’t prevent Alzheimer’s disease,” clarifies Dr. Elechi, “it can delay its onset.” So flex those neurons by reading, Sudoku, word games. Stretch those brain cells by learning something new—like a foreign language or musical instrument. Do math in your head. Stimulate your taste buds by using new herbs and spices. Refine your handeye abilities with knitting, drawing, painting and assembling puzzles. Engage your senses by taking in the world around you. As a side benefit, all these

things will make you a more interesting person to be around—and social contact has also been found to support good cognitive health and lowered rates of depression. Manage your health. Work with your healthcare provider to keep your blood pressure, cholesterol and glucose under control. And consider taking a daily vitamin B—which has been shown to reduce brain shrinkage associated with Alzheimer’s disease by lowering levels of the amino acid homocysteine. But always check with your physician before taking supplements.

Expert Contributors: »» Michael Camardi, MD, Geriatrics, Carilion Clinic »» Clement Elechi, MD, Neurology, LewisGale Medical Center »» Jackson W. Kiser, MD, Radiology Associates of Roanoke, PC, practicing at LewisGale Medical Center

Sources: »» Alzheimer’s Association »» Alzheimer’s Foundation of America »» National Academy of Sciences »» National Institute on Aging »» National Institutes of Health »» National Institute of Neurological Disorders and Stroke

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