OurHealth Roanoke & New River Valleys Oct/Nov 2015 Edition by OurHealth Media LLC

www.OurHealthswva.com

OurHealth | The Resource for Healthy Living in Southwest Virginia

table of contents | october • november 2015

Growing Emotionally Healthy Children MEDI•CABU•LARY.....................12 Local experts define health-related terms

What more could a parent ask for than a happy, well-adjusted child? We explore tips and techniques to help parents, grandparents and educators nurture the development of emotionally healthy and resilient children.

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 communities

HEALTH POINTS........................ 24 Interesting facts and tidbits about health

THE ANATOMY CHALLENGE................................. 27 Are you up for the challenge? In this issue, test your knowledge when it comes to the LYMPHATIC SYSTEM.

ANATOMY...................................... 29

NUTRITION.................................. 53

Exploring how the lymphatic system keeps us healthy.

HEALTHY EATS: Check out OurHealth resident nutritionist, Tricia Foley’s cancer fighting recipes including peach pumpkin oatmeal, kale salad and quinoa crepes!

THE NINTH ANNUAL BEST BEDSIDE MANNER AWARDS 8

coming December 2015 OurHealth | The Resource for Healthy Living in Southwest Virginia

The Resource for Healthy Living in Southwest Virginia

The Faces of Cancer

It’s a reunion. 26 women altogether. Some are young in age. Some young at heart. I see happiness. Some sadness. A bit of eagerness and anxiety. I see satisfaction. I see fear and doubt and certainty...

hello, HEALTH!.............................. 82 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos

UROLOGIC HEALTH..................84 Leaking is not a Normal Part of Aging

BREAST HEALTH....................... 67 Technology adds a new dimension to breast care.. The History of Physicians to Women

FIT BITS!........................................71 COUCH TO 5K! Have you ever dreamed of running a 5k but didn’t know how to start? OurHealth resident fitness specialist, Deidre Wilkes can show you how.

Interprofessionalism takes Center Stage

YOUNG AT HEART.....................90 Featuring the artwork of young upcoming artists from Salem Art Center’s Zenith program

* PLUS * a chance to win prizes!

Roanoke hosts the International Collaborating Across Borders Conference

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The Resource for Healthy Living in Southwest Virginia

october • november 2014

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PUBLISHER PRESIDENT/EDITOR-IN-CHIEF VICE PRESIDENT OF PRODUCTION VICE PRESIDENT OF BUSINESS DEVELOPMENT PROJECT COORDINATOR CHIEF DESIGNER ORIGINAL PHOTOGRAPHY ORIGINAL COVER ART WEBMASTER

McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Hungate Kim Wood Deidre Wilkes Karrie Pridemore Shawn Sprouse/SDS Photography Joe Palotas Next Generation Design

CONTRIBUTING MEDICAL EXPERTS

David B. Alligood, MD Lynn Atkinson Shannon Boston Ethan Colliver, DO Patrick Curran, OD John M. Dovie, OD, FAAO James Lynde, MD Elizabeth McCuin, MD Anne Prucha, RN Frank Purpera, MD Sue Ranson, CEO Molly S. Rutherford, MD, FACC Caroline Wallace, DDS

CONTRIBUTING PROFESSIONAL WRITERS

Susan Dubuque Tricia Foley, RD Steve McClintic, Jr. Christine Stoddard Deidre Wilkes Diane York

ADVERTISING AND MARKETING Kim Wood | P: 540.798.2504 kimwood@ourhealthvirginia.com SUBSCRIPTIONS To receive OurHealth via U.S. Mail, please contact Jennifer Hungate at jenny@ourhealthvirginia.com or at 540.387.6482

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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor: 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.

NOW NEW MANNER PATIENTS AWARD AND EMERGENCIES 2014ACCEPTING BEST BEDSIDE WINNER

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 ‘prediabetes’?

What is BRCA2?

Before people develop type 2 diabetes, they almost always have ‘prediabetes’, a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with prediabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. Other names for prediabetes are impaired glucose tolerance and impaired fasting glucose. Since there are no clear symptoms of prediabetes, it may go undiagnosed at first. Some people with prediabetes may suffer from symptoms of diabetes or even problems from diabetes already. Prediabetes is usually diagnosed when being tested for diabetes. A person with prediabetes should be checked for type 2 diabetes every one to two years.

BRCA2 (and BRCA1) gene is the most common cause of hereditary breast and ovarian cancer. It is important to know that only 5-10 percent of breast cancer is hereditary. Therefore the majority of families with breast cancer do not need to consider genetic testing. Genetic testing of these genes should only be considered in families with: young onset of breast cancer (typically before age 50), multiple women with breast cancer, male breast cancer and ovarian cancer. Women who are found to have mutations in one of these genes are recommended to begin breast surveillance at age 25 and ovarian surveillance at age 30 due to the increased cancer risks. If a person has a BRCA gene mutation, there is a 50 percent chance that each of their children (sons and daughters) could inherit the mutation.

Robin Marcus, MSN, FNP-BC LewisGale Physicians Salem | 540.772.3490 www.lgphysicians.com

Thuy Vu, MS, CGC

Carilion Clinic Genetic Counseling Roanoke | 540.525.2195 www.carilionclinic.org

What is conductive hearing loss? Conductive hearing loss is considered the second most common type of hearing loss, with sensorineural being the most common. A conductive hearing loss can be the result of a blockage in the external ear canal (excessive earwax, swelling of the canal) or can be caused by any disorder that affects the middle ear’s ability to transmit sound to the inner ear. Examples include disorders resulting in middle ear fluid, eardrum perforation or stiffening of the middle ear bones. In most cases, the cause of conductive hearing loss can be identified and treated medically or surgically resulting in a complete or partial improvement in hearing. An audiologist can assist in identifying the type of loss and provide appropriate referral for treatment. Following the completion of medical treatment for conductive hearing loss, hearing aids are effective in correcting any remaining hearing loss. Douglas Cameron, AuD

Hearing Health Associates Roanoke | 540.774.4441 www.hearinghealthassoc.com

OurHealth | The Resource for Healthy Living in Southwest Virginia

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

What are some hobbies or activities that can stimulate the mind and help with memory as a person ages? The brain is a muscle that needs continual exercise to remain strong and healthy. It is important to stimulate the mind and enhance memory, at any age, but particularly with the senior population. Consider the following: • Be active in community and social circles. • Foster healthy relationships and group engagement. • Learn a new skill, take an educational class, and play mathematic, logic and reasoning games to build new brain cells and help maintain memory function. • Creative activities such as arts and crafts, reading, music, puzzles, dancing, and writing stimulate the brain, especially when the activity has never been done before. • Eat a healthy diet – it’s not only good for your body, but also helps keep the brain in tip-top shape. • Physical exercise is one of the best ways to keep the body strong and flexible. Exercise also plays an important role in protecting and improving memory. Paula L. Harder, MA ACC

Regional Director of Resident Programs Commonwealth Assisted Living Christiansburg | 540.724.0579 www.commonwealthal.com

OurHealth | The Resource for Healthy Living in Southwest Virginia

When should I bring my teenage daughter in for her first gynecological exam? While it was previously recommended that women have a first gynecologic exam and pap smear at age 18, the current protocols state that a woman’s first pap smear should be at age 21. This is not to say that a younger woman should not visit a gynecologist prior to this age, only that a pap smear (a collection of cells from the cervix) should not occur until age 21. Visits at an earlier age are recommended if the patient is sexually active, or having menstrual related issues or any other gynecologic concerns. Early screening for sexually transmitted diseases (such as chlamydia) is strongly encouraged for women under age 21 who are sexually active. There are also a multitude of contraception options that can be discussed. The participation of the patient’s mother or guardian is encouraged in the first consultation visit. Some initial visits prior to age 21 may not require a pelvic exam, which is always a relief to younger patients. Barbara Moore, MD

Drs. Moore & Stockstill, PC Roanoke | 540.904.7710 www.mooreandstockstill.com

What are some examples of mobility assistance solutions that can help seniors keep their independence and stay in their homes longer? To remain independent, one of the most important factor for seniors to consider is how they will be getting in and out of their homes safely. Without this, they will be restricted and dependent on the help of others to go anywhere. Ramps are the simplest solution to getting in and out of the home. It is recommended that ramps be one foot long for every inch that has to be climbed. The more steps the more ramp and space are needed. Some people may not have enough space for a ramp. Other options are vertical platform lifts and stair glides. Vertical platform lifts are like an open elevator. They can accommodate all types of mobility devices including scooters and wheelchairs. A stair glide has a seat and follows the path of the stairs. These are commonly used to go in between floors of the home, but they will not carry a mobility device and do require a person be able to get in and out of the chair. David Todd, President

EZ Rampz/Mobility Solutions Roanoke | 540.357.7679 www.ezrampz.com

NEW

NOTEWORTHY

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

Blue Ridge Urogynecology opens new office James Daucher, MD, FACOG of Blue Ridge Urogynecology expands his practice to a new location in Martinsville. Dr. Daucher is the first urogynecologist to practice at Memorial Hospital of Martinsville and Henry County. Urogynecology is a subspecialty of gynecology and urology that treats pelvic floor dysfunction in women. Dr. Daucher has clinical expertise in urinary incontinence, accidental bowel leakage, overactive bladder and vaginal prolapse (dropped bladder). He specializes in Interstim® Therapy, Reconstructive Pelvic Surgery, Removal Vaginal Mesh and Urodynamics/Endoanal Ultrasound and Manometry. Dr. Daucher is now seeing patients at his new office located at 2696 Greensboro Road, Martinsville, VA 24112. For a referral or to schedule an appointment, please call 540.904.2845. For more information, please visit www.blueridgeurologynecology.com

2015 Virginia Veterans Parade Mark your calendar! The 2015 Virginia Veterans Parade is just around the corner. Roanoke’s Virginia Veterans Parade is one of the largest veteran’s events in the state. Come early for a ‘Meet and Greet’ with local veterans in the Roanoke City Market Building. Parade participants include military units from across Virginia, military marching units and individual veterans and college and high school bands.

Date: Saturday, November 7th

Greet a Veteran: 9:30 am in the Market Building Parade Start: 11:00 am Parade Route: Begins at the intersection of Elm Avenue and Jefferson Street, continues South on Jefferson, then East on Campbell past Market Square. If you are a caregiver organization and would like to coordinate bringing a disabled veteran to the parade, please contact Patti Smith, Director of Admissions and Public Relations at Virginia Veterans Care Center, 540.982.2860.

OurHealth | The Resource for Healthy Living in Southwest Virginia

Jefferson College of Health Sciences Named a Top School in

Capital Improvements by Virginia Living Magazine

Jefferson College of Health Sciences (JCHS) has been named one of the top colleges in Virginia in the category of Capital Improvement by Virginia Living Magazine. The recognition highlights the completion and opening of the Virginia Intercollegiate Anatomy Lab (VIAL) on the JCHS campus at Carilion Roanoke Community Hospital in downtown Roanoke. The $2.5 million VIAL space opened in May 2015, and was the result of a collaboration between JCHS, Virginia Tech Carilion School of Medicine and Radford University. The recognition appears in Virginia Living State of Education, a special bound-in supplement to Virginia Living’s October 2015 issue, which celebrates excellence and innovation in Virginia’s schools. This is the second consecutive year Virginia Living magazine has recognized JCHS. In 2014, the publication named JCHS one of the top Health and Medicine colleges in the commonwealth. For more information about Jefferson College of Health Sciences, visit www.jchs.edu.

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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

Shedding New Light on Depression Researchers from the Department of Psychiatry at Virginia Commonwealth University in Richmond, Va., working in collaboration with scientists from the University of Oxford and throughout China, have identified genetic clues to the underlying causes of clinical depression. VCU’s Virginia Institute for Psychiatric and Behavioral Genetics was a key participant in the research that successfully isolated specific changes in DNA that increase risk for major depression. This study was published online in the journal Nature in July of this year. “This type of genetic study is the first step in uncovering specific biological pathways to the illness. The findings could potentially lead to new ways to predict hereditary risk for depression and more effective treatments for the disease” says Kenneth S. Kendler, MD, joint-senior author and professor of psychiatry and human and molecular genetics at VCU School of Medicine.

Kenneth S. Kendler, MD, professor of psychiatry and human and molecular genetics at VCU School of Medicine—part of a team that is uncovering the genetic links to clinical depression.

Depression is no small problem. It affects approximately 19 million Americans and 350 million people worldwide. 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. But thanks to this type of innovative research conducted by Dr. Kendler and his associates, one day we may even uncover the secret to preventing this devastating disease. To learn more, watch this video on the breakthrough research at www.VCUDepressionDiscovery.com.

Carilion Dental Residents Offer Services at Rescue Mission Shelter guests at the Rescue Mission were treated to brighter smiles recently, when Carilion dental residents and dental assistants worked on patients in the G. Wayne Fralin Free Clinic. “This is such a great opportunity for many of our patients to be seen,” says Director of Programs, Helen Ferguson. “The last four visits Carilion dental residents made totaled over $10,000 in services.” The G. Wayne Fralin Free Clinic opened its doors to the homeless, uninsured and unemployed in 2010 and continues to supply quality care to its patients. The clinic, an extension of the Rescue Mission, is the home to four different free clinics including dental, vision, mental health and general medicine. In 2014, 271 dental patients were seen by 39 volunteer dental providers, including Carilion’s dental residents, providing close to 900 hours of care. Free care provided in 2014 to all patients of the Clinic was valued over $3 million. Carilion plans to send their dental residents and dental assistants once each quarter to continue to see and treat patients at the G. Wayne Fralin Free Clinic. For more information about the Rescue Mission, please visit www.rescuemission.net, or call 540.343.7227. For more information on the Carilion Clinic dental program, visit www.carilionclinic.org/dentistry.

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OurHealth | The Resource for Healthy Living in Southwest Virginia

THE NINTH ANNUAL

COMING December 2015

w w w. o u r h e a l t h v i r g i n i a . c o m

NEW

NOTEWORTHY

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

New Local Business Benefits Mom and Baby The anticipation of expecting a new baby is an amazing feeling, but it can also be overwhelming. Peas & Carrots Diaper Cakes was born from the realization that an expecting mom needs more than just diapers. She needs trusted products and information that will give her and her baby what they need to thrive! As a mother of two and a registered dietitian, Tricia Foley, owner of Peas & Carrots, is passionate about nutrition and health. “Many diaper cakes are cute and functional, however I wanted mine to be something more,” says Foley. Peas & Carrots Diaper Cakes are a way to deliver information to expecting moms about nutrition, special products, website resources, and best practices I wish I had known when I had my first baby.” Foley wishes she had known the difference hypoallergenic diapers could make when it came to avoiding diaper rash. “This is why we only offer hypoallergenic diapers for all our cakes,” continues Foley. As an added bonus, the diapers come in adorable patterns. Health oriented accessories like Mother’s Milk Tea was chosen after receiving questions from new moms on how to increase milk supply. Other homeopathic products to help soothe baby’s tender gums, calm baby, or even help mom in postpartum recovery are also available. The icing on the cake is that each contains a “message in the (baby) bottle” with a nutrition tip and code to access additional material on the website. The website offers links to resources on nursing, formula feeding and making homemade baby food. Peas & Carrots Diaper Cakes exists to offer expecting moms a practical and fun baby shower gift that provides a wealth of vital information, trusted products, and important resources intended to get mom and baby started on their way to a healthy, thriving, lifestyle. For more information, visit www.peasandcarrotsdiapercakes.com.

OurHealth | The Resource for Healthy Living in Southwest Virginia

NEW

NOTEWORTHY

Carilion Clinic Psychiatry and Behavioral Medicine Christiansburg 540.731.7311 www.carilionclinic.org

Mary-Ellen Mick, DO Carilion Clinic Internal Medicine Radford | 540.639.9071 www.carilionclinic.org

Charles Tyree, PA-C, MPAS LewisGale Physicians Pediatrics Salem | 540.772.3580 www.lgphysicians.com

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

Jamie King, MD

Jonathan Maher, MD

Eric Marvin, DO

Terrance May, MD

Nnenna Kalaya Okereke, MD

W. Hampton Pasley, MD

Kelly Rebkovich, DO

Robert Schopf, DPM

Jennifer Wells, MD

Brandon White, DDS

Elias Woldegabriel, MD

Andrew Wong, MD

Carilion Clinic Family Medicine Galax | 276.236.5181 www.carilionclinic.org

Megan McPhee, MD

NEW PHYSICIANS,

Carilion Clinic Psychiatry and Behavioral Medicine Christiansburg 540.731.7311 www.carilionclinic.org

Carilion Clinic Psychiatry and Behavioral Medicine Roanoke | 540.981.7417 www.carilionclinic.org

OurHealth | The Resource for Healthy Living in Southwest Virginia

Carilion Clinic Orthopaedics Christiansburg 540.731.2436 www.carilionclinic.org

LewisGale Physicians General Surgery Salem | 540.772.3620 www.lgphysicians.com

Carilion Clinic Dental Care Roanoke | 540.981.7128 www.carilionclinic.org

Carilion Clinic Neurosurgery Roanoke | 540.224.5170 www.carilionclinic.org

Carilion Clinic Family Medicine Tazewell | 276.988.8850 www.carilionclinic.org

LewisGale Physicians Infectious Disease Salem | 540.772.3407 www.lgphysicians.com

Carilion Clinic Cardiology Roanoke | 540.982.8204 www.carilionclinic.org

Carilion Clinic Orthopaedics Roanoke | 540.725.1226 www.carilionclinic.org

LewisGale Physicians Neurology Salem | 540.772.3450 www.lgphysicians.com

TI 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

OCTOBER

Breast Cancer Awareness Month »» Breast cancer is the second most common cancer diagnosed in women in the U.S., next to skin cancer. It is the second leading cause of death in U.S. women, after lung cancer.

But don’t be afraid, be proactive!

»» Be self-aware in your breast health. Know your risk. Get screened. Know what is normal for you. Make healthy lifestyle choices. »» For more information visit www.cancer.org. For answers to all your breast health questions, schedule an appointment with your local physician.

The chance of a woman having invasive breast cancer some time during her life is about 1 in 8. The chance of dying from breast cancer is about 1 in 37.

Source: www.cancer.org

NOVEMBER

American Diabetes Month

Diabetes can strike anyone, from any walk of life. And it does, in increasing numbers every year. Raising awareness of this ever-growing disease is one of the main efforts behind the mission of the American Diabetes Association (ADA). November is American Diabetes Month. This month and every month, encourage people to make healthy changes. Eat healthy, don’t smoke, increase physical activity and have regular check-ups with your local physician. »» Of the nearly 30 million people in the US with diabetes, 90-95 percent are type 2 diabetics. »» Another 86 million Americans have prediabetes and are at risk for developing type 2 diabetes. »» The ADA estimates that the total national cost of all diagnosed diabetes in the U.S. is $245 billion.

»» There is hope. People who are at high risk for type 2 diabetes can lower their risk by more than half by making healthy changes. »» Are you at risk? Visit www.diabetes.org to take the ‘Ryan’s Challenge’ type 2 diabetes risk test or visit your local healthcare provider and ask about your risk for type 2 diabetes and heart disease.

29.1 MILLION people in the United States have diabetes. About

9.3%

of the population.

Source: www.diabetes.org OurHealth | The Resource for Healthy Living in Southwest Virginia

Enjoy the Fall Foliage and Crisp Autumn Air with Two Great Running Events!

Tempting Treats!

Scared of Halloween candy? Don’t be! These Halloween treats are so low in calories you’ll think you’re being tricked. In addition to calories, be mindful of both fat and sugar grams when selecting your special treat. calories

grams of fat

grams of sugar

10 Whoppers

100

2 Mini Size Snickers Bars

1 Tootsie Roll Pop

2 Mini Size Reese’s Cups

1 Fun Size 3 Muskateers Bar

11 pieces of candy corn

1 Fun Size Package of M&M’s

100

4.5

1 Fun Size Almond Joy Bar

100

source: www.sparkpeople.com

Healthy Eats On the Go Healthy and fast-food are usually not in the same sentence together…until now.

Valley View

outside Valley View Mall

Both the 5K and 10K courses are challenging with several steep inclines and declines through the historic town of Fincastle. Participants of all levels of ability are welcome. The streets will be closed from 9:00 to 10:30 AM and the course will be marked and staffed by volunteers. Traffic will be controlled by county officials. Splits are given at each mile marker. Water stops will be at 1.5, 3, and 5 mile markers. Fresh fruit and drinks are provided to all runners at the finish line. Bathroom facilities will be available at Central Academy Middle School. Date: Time: Location:

Saturday, October 17th 9:00 a.m. Central Academy Middle School Fincastle, VA

For more information, visit www.bankoffincastle.com

Move Your Feet so Others Can Eat The 10th Annual Union Drumstick DASH 5K race and family walk on Thanksgiving morning is sure to start your holiday off on the right foot! Come out for the region’s best and most loved family friendly charity event, benefiting the Rescue Mission. This year, the Rescue Mission will provide more than 300,000 meals to hungry families.

Chick-fil-A now offers the Superfood Salad at both its Valley View and Southern Hills locations. The salad is a delicious mix of chopped broccolini and kale blend, tossed in a sweet and tangy maple vinaigrette and topped with flavorful dried sour cherries. Try it today!

The 29th Annual Bank of Fincastle 5K and 10K Run

Southern Hills

Next to Home Depot, Route 220

Date: Thursday, November27th Time: 9:00 a.m. Location: Downtown Roanoke, Williamson and Franklin Roads For more information and to register, visit www.drumstickdash.net www.OurHealthswva.com

the

Anatomy

CHALLENGE How much do you know about the

Lymphatic System? First,

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

[ the Lymphatic System ]

WORD SEARCH appendix

spleen

axillary lymph nodes

subclavian vein

cervical lymph nodes

thoracic duct

inguinal lymph nodes

tonsil

popliteal lymph nodes

thymus gland

red bone marrow

____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

For answers, visit OurHealth Southwest Virginiaâ&#x20AC;&#x2122;s Facebook page at

/OurHealthswva www.OurHealthswva.com

Exploring how the

LYMPHATIC SYSTEM keeps

usHealthy words | EDWIN SCHWARTZ

The lymphatic system plays a vital part in the body’s ability to fight disease. Its role is two-fold — refuse collector and police force. To learn more about how the lymphatic system protects us from the spread of infection and cancer, OurHealth consults an expert at Jefferson Surgical Clinic.

Defining the lymphatic system As part of the body’s defense network, the lymphatic system collects fluid, waste material and organisms (such as bacterial viruses) in the body’s tissues and rids them of damaged cells. The system is mostly composed of lymph vessels and lymph nodes. Lymph vessels are similar to the veins that carry blood throughout the body, but instead of transporting blood, lymph vessels carry a fluid called lymph.

The purpose of the lymphatic system The lymphatic system serves two primary functions. First, in its role as refuse collector, the lymphatic system drains about 15 percent of the plasma (the liquid part of blood) that accumulates in the tissue between blood cells — called interstitial tissue — back into the circulatory system. The circulatory system moves blood throughout the body; it comprises the heart, arteries, capillaries and veins.

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What is lymph? Lymph is a clear, watery fluid that circulates in the lymphatic system. In addition to carrying the lymphocytes, it also contains cellular debris gathered from either dead cells within the body or bacteria from within the lymphatic system.

Second, the lymphatic system functions as the primary defense network of the immune system. The lymphatic vessels are connected by hundreds of lymph nodes that filter the lymph fluid of foreign substances such as bacteria, viruses or cancer cells. These organisms are then destroyed by special white blood cells called lymphocytes. In this policing function, the lymphatic system can be seen as a network that scans the blood plasma for enemies, both foreign (infection) and domestic (cancer).

Other parts of the body that work with the lymphatic system The network of lymph vessels reaches the entire body. The vessels become larger as they meet at the center of the body and drain into two ducts near the heart. All the lymph fluid that drains from the body circulates through the lymph nodes several times before returning to the general blood circulation of the heart. The spleen (in the left upper abdomen) and the thymus (in the upper chest) are connected to the lymphatic system. They regulate the white blood cells that combat disease and infection.

Diseases and conditions that affect the lymphatic system Swelling of the lymph nodes may result from any disease that involves infection, injury or cancer. This occurs as the lymph nodes try to filter abnormal cells that have entered the system. Some lymphatic diseases result from the blocking of lymph drainage. When lymph channels are blocked or cut, the lymph fluid canâ&#x20AC;&#x2122;t flow out of the tissue. This fluid causes the tissue to swell, resulting in a condition called lymphedema.

How can we care for our lymphatic system? The lymphatic system draws little attention when it is working properly. However, most people have at one time felt a small nodule either along their neck or under their jaw. This is normal because whenever lymph nodes are fighting infection or handling excess fluid, they become enlarged. The swelling should subside over time.

What are lymph nodes? Lymph nodes are small, bean-shaped organs that filter harmful substances within the lymphatic system. They are located throughout the lymphatic network and may form junctions where damaged cells, infectious organisms (e.g., bacteria or viruses) and cancer cells are filtered and destroyed. If multiple infectious organisms or cancer cells are present, the lymph nodes typically become swollen. 30

OurHealth | The Resource for Healthy Living in Southwest Virginia

Rev. William Lee, pictured in front of the New Horizon Healthcare building in Roanoke.

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According to Thomas Conlee, MD, a surgeon who specializes in general and vascular surgery with Jefferson Surgical Clinic, lymphedema is a relatively common disorder of the lymphatic system and most often affects the extremities. In the United States, the primary disease that affects the lymphatic system is cancer. This can originate in the lymphatic system in the form of lymphoma, which is caused by cancerous lymph nodes or cancer lymphocytes that reside in those nodes. Cancer can enter the lymph nodes in two ways — it can originate there, or it can start somewhere else and spread to the lymph nodes. Thomas Conlee, MD practices general and vascular surgery at Jefferson Surgical Clinic in Roanoke. He is certified by the American Board of Surgery with subspecialty in both General Surgery and Vascular Surgery.

“Most but not all cancers spread to other parts of the body via the lymphatic system,” says Dr. Conlee. Cancer in the lymph nodes has a dual significance. First, it means the body’s immune system has failed to contain or destroy the cancer. And it indicates that the cancer cells are able to live away from their primary site. For example, breast cancer cells were originally normal cells that were only able to live in the breast. Once cancer cells are able to live away from “home,” the ability to destroy them becomes more difficult.

OurHealth | The Resource for Healthy Living in Southwest Virginia

Find

Did you know the human body has approximately 500 lymph nodes?

OurHealth on social media

Typically they can’t be felt until they become swollen. In addition to the lymphatic vessels and lymph nodes, the lymphatic system includes the spleen, thymus, tonsils and adenoids. These organs also protect our bodies from invading pathogens that can cause disease.

“A cancer becomes more complex and threatening when uncontrolled replicating cells are found in the lymph nodes,” says Dr. Conlee. “Metastasis — the process by which cancer spreads from its primary site to distant locations in the body — from a cancer is often an indicator of advanced disease.”

Treatment options for lymphatic system diseases If the lymph nodes are swollen due to an infectious condition, antibiotics may be used for treatment. If cancer has invaded the lymph nodes, treatment is based on the stage of the cancer. Treatment for lymph node involvement may include surgery, chemotherapy, biological therapy and/or radiation therapy, depending on the given situation. In cases of lymphedema (insufficient drainage of lymph fluid), treatment usually involves increasing the pressure on the tissue to push the lymph fluid out and back into circulation. This can usually be accomplished with a compressive extremity garment and physical therapy. Because lymphedema is irreversible and effective therapy is limited, cancer surgery now focuses on removing as few lymph nodes as possible. This is because when cancerous lymph nodes are removed, lymph channels are cut. If the ends of the channels can’t heal with each other, lymphedema can result. (continued on page 35)

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(continued from page 33)

“It is important for patients to understand this and mention any similar findings to their doctors,” says Dr. Conlee, “especially if these nodules or lymph nodes persist in size and remain enlarged in multiple locations.” Since there is no specific screening tool for cancers that begin in the lymph nodes (as with lymphoma), the best way to prevent cancer in the lymphatic system is to practice good health maintenance and screening. This includes maintaining an appropriate weight for one’s height, along with regular exercise. Prevention should include colonoscopies and annual mammograms, especially for people with a family history of cancer.

Expert Contributers: • Thomas Conlee, MD with Jefferson Surgical Clinic in Roanoke.

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Growing Emotionally Healthy Children words | SUSAN DUBUQUE

What more could a parent ask for than a happy, well-adjusted child? Today, health and family magazines abound with valuable information on children’s mental health issues — from attention deficit hyperactivity disorder and autism to bipolar disorder and youth suicide. But let’s approach the subject from a different perspective. We will explore tips and techniques to help parents, grandparents and educators nurture the development of emotionally healthy and resilient children.

At the foundation of emotional health you will find the combined effects of our genes and environment — nature and nurture. We can’t control our genetic makeup, but there are many ways we can influence a child’s state of emotional wellbeing through our behaviors, interactions, communications and the environment we create at home, at school and in our communities.”

Look in the mirror Children tend to reflect the emotional status of their parents, and it goes beyond the hereditary implications. Make an honest assessment of your own emotional status. Are you generally happy, stable and able to cope with the trials and tribulations of everyday life? Or are you depressed, anxious, angry or struggling with some other form of mental distress? In any case, you serve as an emotional role model for your child. When you gaze into the emotional looking glass, if you don’t like what you see, get help. If you had diabetes, cancer or the flu, you wouldn’t hesitate to seek medical attention so you could be there for your family. Only if you are mentally healthy can you truly be available to your child. And your child will learn an important lesson too — that it is OK to ask for help when life becomes emotionally overwhelming.

According to national nutrition expert and registered dietitian Eileen Meyers, “Perhaps the best rules to follow regarding your child’s nutrition are driven by common sense.” • Provide three well-balanced meals a day. That may sound too fundamental to even bother mentioning, but it’s essential to make this point in light of the busy schedules that many families maintain. • Allow some sugar and fats, but not in excess or in place of a wholesome diet. • Watch out for caffeine, sodium and chemical additives, which are abundant in kids’ favorite snack foods. But don’t be a fanatic — an occasional Twinkie is really all right. • Serve as a role model for good eating habits.

• Stock your refrigerator and cupboards with healthy, fun treats like fresh fruit, yogurt, carrot sticks and fruit juice. • Don’t use food as a means of nurturing your child. Rather than rewarding your child with a cookie, give him a hug. Instead of a piece of cake, take a walk together. • Most importantly, don’t allow food to become a source of stress in your child’s life. Mealtime should be relaxed and enjoyable. This is a time for sharing the day’s events, not fighting over uneaten Brussels sprouts.

Focus on the whole child “A child’s physical and emotional health are intertwined. In fact, they are really one and the same,” says Aradhana “Bela” Sood, MD, a pediatric psychiatrist with the VCU Medical Center’s Virginia Treatment Center for Children. So let’s start with the basics — the things your grandmother would have endorsed.

Nutrition The relationship between a balanced diet and emotional well-being has been recognized for a number of years. The literature is filled with articles on the consequences of inadequate nutrition, including social withdrawal, decreased concentration, sleep disturbances, irritability, apathy and depression.

Forty winks Inadequate and poor sleep can lead to mood swings and behavioral problems, as well as difficulty concentrating and poor performance at school. But how much sleep is enough? While every child is different, the National Sleep Foundation offers the following guidelines: »» Newborns (0 to 3 months) – Up to 18 hours around the clock on an irregular schedule »» Infants (4 to 11 months) – 9-12 hours at night and 30 minute to two-hour naps, one to four times a day, fewer as the child reaches age 1 Bela Sood, MD, FAACAP is a psychiatrist with Virginia Treatment Center for Children in Richmond. She is certified by the American Board of Psychiatry with a subspeciality in Child and Adolescent Psychiatry.

»» Toddlers (ages 1-2) – 11-14 hours of sleep in a 24-hour period; when the child reaches about 18 months of age, naps will decrease to once a day, lasting about one hour »» Preschoolers (ages 3-5) – 11-13 hours per night; most children do not nap after 5 years of age

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»» School-age children (ages 6-13) – 9-11 hours per night »» Teens (ages 14-17) – 8-10 hours per night

Just do it Provide your child with plenty of opportunities for exercise. Physical exertion releases natural endorphins that have an emotionally uplifting effect. And there are lots of other benefits from specific activities, so find one that meets your child’s needs. Martial arts can help children gain confidence as well as selfcontrol and discipline. Soccer, softball and baseball are great sports that children of any age, size and physique can play. There are plenty of youth leagues that emphasize skill development, fitness, teamwork and sportsmanship. Weightlifting can help teens who aren’t particularly competitive build self-esteem while they build muscles. Running and walking are activities that can be done pretty much anywhere, anytime. When your child is feeling stressed or anxious, suggest a fiveminute “power break.” Jumping rope, running around the block or bouncing a ball 100 times can provide a needed bit of relief, especially during a demanding homework session. “Without mental health, there is no health,” says Dr. Sood. Perhaps this should be our new mantra. — ‘Children’ continued on page 40

Tips for avoiding the bedtime drama include: • Encourage your baby to fall asleep independently and to become a “self-soother.” • Allow toddlers and young children to use a security object such as a blanket or stuffed toy. • Develop regular daytime and bedtime schedules. • Create a consistent and enjoyable bedtime routine, such as reading a book or sharing a story. • Establish a sleep-friendly environment — cool, quiet and dark. • Keep TVs and computers out of the bedroom. • Avoid caffeine. www.OurHealthswva.com

— ‘Children’ continued from page 39

Express yourself Help your child develop a “feeling vocabulary” so she can express what’s really going on inside. Otherwise she is may resort to throwing a temper tantrum, acting out, sulking or just holding it all inside and feeling miserable. Feelings are neither good nor bad, they just are. Acknowledge and accept your child’s feelings even when she is sad, angry, hurt, jealous, insecure, lonely, afraid — whatever. Build a safe place where your child is free to openly express her full range of emotions.

Hope Tobey, DO, FAAP, FACOP, is a pediatrician with Academic Primary Care Associates in Blacksburg. She is certified by the American Board of Pediatrics.

While all feelings are OK, the behaviors that follow may or may not be. Let your child know that while she is entitled to be angry when her little brother breaks her favorite toy, it is not OK to retaliate by hitting him or breaking his toys.” As a parent, you are entitled to your feelings too. If you are sad, it is fine to share that with your child. In fact, it gives you the perfect opportunity to demonstrate the best way to deal with negative feelings. For example, you could share, “I am very disappointed that we didn’t get to go to the beach today because it rained. But let’s see what else we can do that’s fun. Why don’t we bake some cookies or make a dress for your doll.” Show your child how to look for plan B — a great tool to build resiliency. While it is important for your child to understand and express his own feelings, it is equally important that he learn to interpret other people’s feelings. In the aftermath of a dispute between your child and a sibling or friend, take a moment for a little

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lesson in empathy. Ask “How do you think that made Billy feel when you called him a fatty pants? How does it make you feel when someone calls you a name?” There are excellent books, posters, games and even flashcards devoted to decoding other’s feelings. Children will adopt the family’s attitudes toward other people. Be aware of disparaging comments — even when made in jest — regarding others. Show respect for people who may be different from your family, and your child will acquire a sense of acceptance and openness.

Be an active listener “Busy parents are often half-hearted listeners. Take a few minutes to really connect with your child,” says Dr. Sood. — ‘Children’ continued on page 42

The components of active listening are as follows • Eye contact. Look at your child, not the TV, your phone or the morning newspaper. • Attentive body language. Lean toward your child. Sit close. Nod your head to let him know you’re listening. • Be quiet. Resist the temptation to offer an immediate solution. Ask your child if she would like a suggestion or if she just wants you to be a sounding board. • Verbal following. Make little “I’m listening” sounds, like “oh,” “really?” or “hmm.” Or restate what you heard your child say, like, “It made you feel really sad when Becca didn’t invite you to her party.” Simply paraphrase, rather than getting into deep interpretations. This lets your child know you are really hearing her and allows her to clear up any miscommunications. • Make sharing time a priority. Set aside time to talk with your child on a regular basis — not just when something’s wrong. It may only be 15 minutes every Saturday morning over a cup of hot chocolate, but make sure that time is sacred. Even if your child isn’t in the mood to talk, let him know that time is reserved just for him. www.OurHealthswva.com

— ‘Children’ continued from page 41

Look for positives How will your child know what good behavior looks like if you only tell him when he is being bad? “Make it a point to catch your child in the act of being good. Reinforce the behaviors you would like to see with praise. Thank your child for not interrupting you while you were on the phone or remark how nice it was to see him share with a friend.”

Wesley Brusseau, LCSW is a licensed clinical social worker with Psychological Health Roanoke. He treats both children and adults.

When your child does slip, as all kids will, provide opportunities to turn things around. Help your child find activities or talents where she can succeed and shine. If your daughter has two left feet, don’t insist that she continue with the ballet classes that she dreads. Instead, find something that will help her build her sense of accomplishment and self-confidence.

Instead of praising your child for his accomplishments and achievement, you can also emphasize his: »» Intrinsic goodness. Your child’s goodness comes from within and is not attached to any external measure of success. Reinforce positive attributes like kindness, patience, gentleness and humor. Give love unconditionally. Like Mr. Rogers used to say, “I like you just the way you are.” »» Effort. Praise your child for trying something new or sticking with a tough assignment, regardless of the outcome. »» Intentions. Your daughter drops and breaks a dozen eggs along with your favorite serving dish. OK, so you want to scream. Before sending her to her room, take a deep breath and ask what she was doing. Her answer: She wanted to make breakfast for Mrs. Smith next door who is sick in bed. There isn’t a plate in the world worth more than that act of kindness. Give her a hug and work together to clean up the mess and make Mrs. Smith’s breakfast.

A routine matter “Children thrive on having a daily routine and an understanding of boundaries,” says Hope Tobey, DO, a pediatrician with Academic Primary Care Associates of Blacksburg. “Knowing what to expect each day provides stability, and consistency helps with behavior issues. With separated and blended families, it is even more important to provide a consistent schedule that stays the same in every home that the child lives in.” 42

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Establish clear and consistent rules and routines with preset consequences and then stick to them. But this doesn’t mean you should be rigid or dictatorial. You want your home to feel like a fair place. And as your child grows, you will want him to assume more responsibility and control over his destiny.” Author’s note: When I was a teenager, my parents did not give me a set curfew. Instead they told me to “be home at a reasonable hour.” When I asked what that hour was, they would reply, “We trust you to use good judgement.” I came home an hour before any of my friends. Of course, I had to earn their trust, but that lesson stuck with me all these years.

Establish family traditions “Family traditions can create an opportunity for children to feel a sense of belonging and connection to their family,” says Wesley Brusseau, a licensed clinical social worker with Psychological Health Roanoke. “Traditions establish a unique trademark for a family, which can help family members form a sense of identity. While growing up, children can be influenced by these traditions, helping to give them feelings of safety and security.” However, Brusseau notes, “As children grow into adolescents and young adults, it is important to allow them to express their personal thoughts and feelings about the traditions and decide if they are comfortable maintaining them. Attempting to force children to adopt particular traditions may create the opposite desired effect.”

Eileen Myers, MPH, RDN is Vice President, Affiliations and Patient Centered Strategies with The Little Clinic. The Little Clinic is a retail health clinic company operating inside select Kroger stores in the Greater Richmond area.

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All together now “Chores create a sense of responsibility for children,” says Brusseau. “Children need tasks they can successfully execute in order to build self-confidence and gain trust in their abilities to succeed in life.” Furthermore, chores help children feel a sense of belonging to a family and household. Children may fuss about completing chores, but the immediate and long-term benefits on how they feel will outweigh any complaining.” As children get a little older, they can also be encouraged to contribute to their community. A child can recycle, donate money to a charity or volunteer to work for a worthy cause. These are wonderful ways to foster giving, build empathy and help children be less self-centered.

Natural consequences Your child is late for dinner for the fifth night in a row, and you’re tired of being treated like a short-order cook. First, you lecture him for 15 minutes about being inconsiderate. Next, you take away a privilege or ground him after school. Then you cook dinner — all while continuing the verbal assault. Finally, you swear this will be the last time you will ever prepare a second meal if he is late. Sound familiar? Next time this happens, allow natural consequences to prevail. If your child misses dinner, either he doesn’t eat or he prepares his own meal and cleans up afterward. He made the choice; let him live with the consequences. It is a far less combative approach. It puts your child in control of the outcome and removes you from being “the enforcer.”

Maybe yes, maybe no “Saying ‘no’ to your child is a necessary evil for a parent,” says Brusseau. Always giving in to your child’s wishes creates the misconception that he will always be able to get what he wants in life, when he wants it. 44

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Adults often take the stance, “I’m the adult, you’re the child; therefore, you need to do what I say.” But there are ways to communicate with children to help them feel understood versus feeling powerless. “In order to help a child feel understood, it is important to validate how they feel,” says Brusseau. “If your child is having a tantrum because he wants a cookie before dinner and you say, ‘no,’ you can also say, ‘I understand you are very upset right now because you want a cookie, but cookies are not something we eat before dinner. Is there anything I can do to help you feel better?’ Your child is likely to say, ‘Give me a cookie, and I’ll feel better.’ Don’t worry—he is just testing the boundaries. Just repeat your statement in a calm voice. If you need to take a short break to get it together, allow yourself that time so that you can remain as calm as possible.” In the example above, three points were clearly communicated: validating the child’s feelings, explaining the parameters decision, and offering support. This formula of communication can work with a person of any age. Everyone likes to feel that they are understood, that they have some control and that they have somewhere to turn for support. Validation does not mean you have to agree with your child. You are simply letting your child know you understand how he feels and are allowing him to exert some appropriate control by offering the option of support. But remember, behavior change takes time and repetition. It’s not going to happen overnight.

Limit screen time Let’s face it. We’re living in a digital age, surrounded by gadgets. We even refer to our children as digital natives. But what are the effects of spending hours each day in front of a computer or television? And how much screen time is too much? Dr. Tobey offers guidance from the American Academy of Pediatrics on this important subject. “Children under age 2 should have no screen time at all. Older children should limit their screen time to less than two hours a day total. This includes computers, video games, phones and, of course, TV.” www.OurHealthswva.com

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In a recent study conducted at UCLA, results indicate a relationship between screen time and social skill development in children. When screen time was limited, the children’s ability to read other peoples’ emotions improved. Other studies suggest that screen time can have a variety of negative effects on kids, including childhood obesity, irregular sleep patterns and behavioral problems. As an alternative to screen time, provide opportunities for children to spend more time interacting with the family. “It is important for a child’s physical, mental and spiritual health to be encouraged to turn off the screen and read a book, play outside or develop a new hobby,” says Dr. Tobey.

Cut your losses Even a happy, well-adjusted child can face a very real and devastating loss such as the death of a beloved grandparent or family pet. Or it may be less obvious, such as the loss of self-esteem when your daughter does not make the cheering squad. You can help your child through the grieving process by: »» Letting her know that losing someone or something special hurts. Give her permission to grieve. »» Encouraging your child to talk about her full range of feelings, such as anger, sadness, denial, guilt, jealousy and fear. »» Holding on to the good feelings. Help your child create a memory box or memory book. Give him photos of his grandfather and memorabilia like a class ring or medals from military service. Help him capture and preserve the warm loving feelings he had for his loved one. »» Taking on a loved one’s positive characteristics. Let’s say a close friend or relative dies or moves away. Or perhaps your child is feeling the loss of a favorite teacher when it’s time to move to the next grade. Ask your child what he liked or admired most about that person. Then encourage him to adopt that trait. Your child can keep the memory alive by being as nice as grandma, as funny as Jason or as courageous as Mr. Jones.

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»» Letting go. If your daughter is deeply saddened that she didn’t make the basketball team, help her let go of those feelings and move on. Rather than dwelling on the loss, encourage her to focus her energies on a new activity. While it is important to recognize the pain your child is feeling, it is equally important to help her learn coping mechanisms and regain her sense of control.

Pull together, even when you’re apart When parents separate or divorce, children suffer. If you and your spouse have made the decision to end your marriage, do not drag your child into the battleground. Allow him to maintain a close and loving relationship with both parents. A child’s self-image is in large part a reflection of both parents. If you tell a child that Mommy is bad, he will think he is bad. If you tell him that Dad is a creep, he will assume he is one too. So set aside your differences and put the needs of your child first.” The concept of positive co-parenting is not limited to parents who live apart; it also applies to intact families. Even moms and dads who live together can unknowingly pull and tug at their child’s emotions.

Here are some ways to be good co-parents: • Refrain from making disparaging comments about each other • Avoid blaming and finger-pointing • Give your child free access to the other parent • Try to maintain consistency in parenting styles and household rule • Make major decision about your child as a team

Bullying Bullying can be deeply hurtful to a child, leaving her feeling frightened, angry, helpless, embarrassed and even guilty that the bullying is somehow her fault. “Children who are bullied are more likely to skip school, feel depressed or isolated, have low self-esteem and a poor self-image,” says Dr. Tobey. “Often early signs of a child being bullied are school avoidance and decreased grades.”

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Encourage a child who is being bullied to: »» Understand bullying. Explain that bullies are really unhappy, frustrated and insecure people. They try to make themselves feel better by controlling other people and making them feel lousy. »» Walk away. Bullies want to know they have control over your emotions, so don’t react with anger or retaliate with physical force. If you walk away, ignore them or calmly and assertively tell them you’re not interested in what they have to say, you’re demonstrating that they don’t have control. »» Find the humor. If you relax and comment on the bullying situation with humor, you’ll likely no longer be an interesting target for a bully. »» Control what you can. Many things in life are beyond our control, including the behavior of other people, so focus on the things you can control, such as the way you choose to react to bullies. »» Report the bullying to a trusted adult. Unless bullies are reported and stopped, they may become even more aggressive. »» If your child is not able to resolve the bullying on her own, get involved. Tell the teacher, contact the bully’s parents, and if you have to, call the police. Your child must feel confident that you will step in to protect her. “There is no simple recipe for raising an emotionally healthy child,” says Dr. Sood. “The best advice I can offer is to love and accept your child unconditionally. Focus on your child’s strengths and positive attributes. Keep your sense of humor. And, finally, remember: Before you blink, your child will be grown. So enjoy every moment of the toughest job you will ever love.”

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Medical Experts • Wesley Brusseau, Licensed Clinical Social Worker, Psychological Health Roanoke • Eileen Myers, MPH, RD, LDN, FADA, national expert on nutrition and eating disorders • Aradhana “Bela” Sood MD, MSHA, Senior Professor of Child Mental Health Policy, Professor of Psychiatry and Pediatrics, Virginia Treatment Center for Children at VCU Health • Hope Tobey, DO, pediatrician, Academic Primary Care Associates of Blacksburg

Resources • Stop Struggling with Your Child by Evonne Weinhaus • Stop Struggling with Your Teen by Evonne Weinhaus and Karen Friedman • The Optimistic Child: A Proven Program to Safeguard Children Against Depression and Build Lifelong Resilience by Martin Seligman • Transforming Teen Behavior: Parent -Teen Protocols for Psychosocial Skills Training by Mary Nord Cook • SOS: Help for Parents by Lynn Clark • 1-2-3 Magic: Effective Discipline for Children 2–12 by Thomas Phelan • Magic Years: Understanding and Handling the Problems of Early Childhood by Selma Fraiberg • Online - stopbullying.gov

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HealthyEats Fresh Peaches from:

Jamison’s Orchard

Peach Pumpkin Oatmeal (Makes 2-3 servings)

5635 Grandin Road Extension Roanoke | 540.885.3590 Jamison’s Orchard Farm Market was established in 1875. They offer fruits and vegetables, grown on the premises. Fruit and gift baskets are also available.

Ingredients:

Visitors can choose their own apples, peaches, nectarines, vegetables, apple butter, peach butter, mountain honey, hard candy and Amish country cheese.

¼ teaspoon ginger

Located one mile west of Route 419 and Oak Grove School.

½ cup unsweetened pumpkin puree ½ cup unsweetened coconut milk 1 cup fresh peaches, peeled and chopped ½ teaspoon cinnamon ¼ teaspoon nutmeg ¼ teaspoon sea salt

9 am – 6 pm Monday – Thursday

1 cup steel cut oatmeal

9 am – 7 pm Friday

¼ cup chopped walnuts

9 am – 4 pm Saturday Closed on Sundays

Directions: 1. In a medium saucepan, whisk together the pumpkin puree, unsweetened coconut milk, peaches, spices and salt until smooth. 2. Bring to a boil. 3. Add the oatmeal, and then turn down the heat to a simmer. 4. Stir occasionally, until the oats are tender, about 25-30 minutes.

Tricia Foley’s Cancer Fighting

PEACH PUMPKIN OATMEAL Tricia Foley is OurHealth Magazine’s resident nutritionist. www.OurHealthswva.com

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HealthyEats Local Kale from:

Stonecrop Farm 267 Sassafras Rd Newport | 540.599.0839 www.stonecropfarmers.com Stonecrop Farm has been in Giles County for 13 years and provides seasonal greens, tomatoes, onions and other vegetables as well as strawberries and beautiful flowers. Stonecrop also hosts weddings and other special events. Find their produce Saturdays from April thru November at the Blacksburg Farmers Market and local health food stores and restaurants.

Kale Salad

Ginger Tahini Dressing

(Makes 2 servings)

Ingredients:

2 cups of kale leaves

¼ cup olive oil

1 medium carrot, julienned

1/3 cup apple cider vinegar

¼ of one medium purple onion, diced

2 tablespoons tahini

2 tablespoons sesame seeds, for sprinkling

1½ teaspoons fresh ginger ½ teaspoon lemon juice

Directions:

sea salt & pepper to taste

1. Wash kale leaves in a colander under cool water, and allow water to drain.

1 small garlic clove, diced

2. Let kale air dry while you rinse the carrot, cut off ends and julienne. Set aside.

1. Combine all ingredients in a high-speed blender or food processor.

3. Remove skin from onion, cut in half, and dice into small pieces.

2. Once well mixed, pour into a covered glass jar (for storing easily in the fridge).

4. Combine kale, julienned carrots and diced onions in a bowl. 5. Toss together. Refrigerate until ready to serve. Sesame seeds will be added after dressing.

Directions:

3. Makes just over a cup worth of dressing (2 tbsp/serving). 4. Reserve extra dressing for future use.

To Serve: 1. Pour dressing onto the kale salad, and toss with the tongs until everything is evenly coated. 2. Sprinkle with sesame seeds.

Tricia Foley’s Cancer Fighting

KALE SALAD Tricia Foley is OurHealth Magazine’s resident nutritionist. www.OurHealthswva.com

HealthyEats Local Apples from:

Quinoa Crepes

Ikenberry Orchards

(Makes 6 servings)

2557 Roanoke Road Daleville | 540.992.2448 www.ikenberryorchards.com

Ingredients:

Apples aren’t the only thing you’ll find here! Ikenberry Orchards stocks local veggies, beef, honey, wine, coffee and more. Located just minutes from I-81 and open every day of the week.

11/2 cups quinoa flour 1/2 cup wheat flour 1 teaspoon baking soda 1 teaspoon cinnamon 2 cups carbonated or soda water 3 tablespoons olive oil 3 apples, sliced

Directions: 1. In a medium bowl, mix together quinoa flour, whole wheat flour, baking soda, and cinnamon. 2. Add carbonated water and oil and whisk until well combined. Preheat a large nonstick skillet over medium heat. 3. Add a few drops of olive oil. 4. For first crepe, pour about 1/3 cup of batter into skillet, rotating skillet quickly until bottom is evenly coated. 5. Cook crepe on medium high heat until bottom is light brown. Flip over and briefly cook other side. 6. Repeat previous step until batter is gone. 7. Serve with sliced apples.

Tricia Foley’s Cancer Fighting

QUINOA CREPES

Tricia Foley is OurHealth Magazine’s resident nutritionist.

Reprints To order reprints of the original artwork featured on this issueâ&#x20AC;&#x2122;s cover, contact Deidre Wilkes at 540.387.6482 or via email at deidre@ourhealthvirginia.com. To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com

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I see pretty ladies painted in pink. Breast cancer must be the connection. But as I look closer, look deeper, I see more. Notice more. I want to understand… more. It’s a reunion.

words | STEPHEN C. McCLINTIC, JR. original art | JOE PALOTAS

26 women altogether. Some are young in age. Some young at

heart. I see happiness. Some sadness. A bit of eagerness and anxiety. I see satisfaction. I see fear and doubt and certainty. I see

Autumn. Autumn will turn 40 in October. She is very excited about her big

day. And what’s her first order of business? A trip to her doctor for a mammogram. This is especially important to Autumn. It was on her birthday three years before that she lost her mother to breast cancer. www.OurHealthswva.com

Foundations & Support Groups Susan G. Komen Virginia Blue Ridge 4910 Valley View Blvd, NW | Suite 212 Roanoke | 540.400.8222 www.komenvablueridge.org

Every Woman’s Life (EWL) Carilion Clinic

It’s hard not to see, um, I mean, not hear,

Belle. Belle is really excited.

She just hit a huge milestone: five months cancer free! And she loves to shout her excitement from the highest towers. Rightfully so. Because for Belle, celebrating every second she is cancer free is worth doing. I see

Christina’s passion. It’s helping people, notably those with breast

cancer. As a patient advocate, she connects women with resources they need and otherwise may not have access to, such as medical care, counseling and

Roanoke | 540.985.8196 | www.carilionclinic.org

even a pillow to lay their head on. Christina is a true godsend.

Virginia Breast Cancer Foundation Region 6 Support Group

Meets the third Wednesday of each month from 7:00-8:30 p.m. | Montgomery Regional Hospital 3700 South Main Street Blacksburg | 540.443.3932 | www.vbcf.org

Breast Cancer Support Group

Meets the first and third Tuesday of each month from 6:30-8:30 p.m. | Carilion Clinic Breast Care Center Roanoke | 540.224.6939 | www.carilionclinic.org

Dawn, I see someone with a sunny disposition who loves being

a night owl. Dawn’s day starts at the stroke of every midnight. She’s an oncology nurse at the hospital where she works the late shift. Dawn believes her patients’ nights need brightened up while being treated, and she’s the perfect person for the job. I see

Eve waiting. Tomorrow is a big day for her and she doesn’t know what

to expect. Will it hurt? Will it help? Eve begins radiation in the morning. I

Blue Ridge Cancer Care Medical Facilities & Imaging Centers www.blueridgecancercare.com

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hope tonight is not too tough on her. I can’t see

Faith, but I know she’s there. Faith fought breast cancer

for five years. And while her fourth bout with the disease may have taken her life, it didn’t take her spirit. Faith’s legacy of strength and courage is as present as ever. I love how I see

Grace. Make-up’s a mess. Hair’s frazzled. Filth’s beneath

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her fingernails. But Grace feels amazing today. No nausea. No tiredness. No

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pain. Grace is the picture of gratefulness.

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Blue Ridge Cancer Care – Pulaski 2400 Lee Highway | Pulaski | 540.994.854

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

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

Blue Ridge Cancer Care – Salem 1900 Electric Road | Salem | 540.774.8660

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

I see

Harmony hard at it. She’s a mother of five. A wife. Works full-time.

Harmony balances baseball games and bagged lunches and board meetings and bedtime stories, all in perfect union. She never misses a beat. Not even with Stage 3 breast cancer. In

Iris, I see a woman who is focused. Iris is near the end of this life. Her

body is beaten, but her will remains unworn. She is determined to see her son graduate from high school in two weeks. I believe she will. I can see it in her eyes. I see one side of

Jade. She sees two: one she loves and embraces and

the other she detests. Jade works at an insurance company where she is responsible for letting clients know if their claim is approved or declined. She knows she’s just the messenger, but makes it her mission to help people any way she can. Sometimes, she can’t. This is the side of herself that she

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dislikes. I see Jade trying. I see Jade hoping. I see Jade being

be there for the little ones. And she’s making good on it with

a shining beacon and doing bigger and better things in the

gusto.

future. I see total selflessness in

Kara. It’s evident in her motto:

‘Give First’. Kara’s always putting the needs of others before

I see

Olive reaching out for peace. It’s already been two days,

and she’s holding on by a limb. How can she possibly find out sooner? Could her doctor fast track the results? Olive is waiting

her own. Always willing to offer her assistance at a moment’s notice. I can’t imagine her working anywhere else than in her job at the hospice center. She embodies the meaning of compassion and care. In

Liberty, I see justice. Or, justice

as she sees it. Liberty made the decision to beat breast cancer at its own game by killing its chances of ever killing her. She had a double mastectomy. Case closed. Let freedom ring. I see someone deserving in After

her

doctor’s

Mea.

appointment

yesterday, Mea made her way over to the mall and had a massage and makeover. Why not? Anyone fighting breast cancer deserves a little “me” time. Including Mea. I see a lot of energy in

Nana. A

LOT. And Nana needs it. She has 14 grandchildren and four greatgrandchildren. Every Sunday, the whole brood – children, grandchildren and great-greatchildren – come over after church for a home cooked dinner. But as evening approaches and the crowd dwindles, Nana’s day is not done. That’s because she’s raising her great-granddaughter’s

three

girls.

You see, Nana’s daughter passed away from breast cancer. So did her granddaughter. Nana made a promise to both of them that she would always www.OurHealthswva.com

Carilion Clinic Breast Care Medical Facilities & Imaging Centers

on the results from her biopsy. She promises she will never delay getting her mammogram again. She promises she will do self-breast exams regularly. She promises she will take better care of herself. She promises to do anything, just to get good news this one time. I see someone who never throws caution to the wind in

Prudence.

That’s why this is a markedly difficult time for her. Prudence does everything www.carilionclinic.org/womens/breast-care

Carilion Clinic Imaging Carilion New River Valley Medical Center

by the book. Dots every ‘i’ and crosses every ‘t’. Her mantra in life is to never be caught by surprise. So finding out she had breast cancer - despite having a genetic testing, despite having routine mammograms, despite doing self

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breast exams EVERY DAY, despite exercising and eating healthy and taking

Carilion Clinic Imaging Carilion Giles Community Hospital

her vitamins and balancing her work and life - was the shock of her life. How

159 Hartley Way | Pearisburg | 540.922.4182

will Prudence handle the unexpected?

Breast Care Diagnostic Center

I see true beauty in

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Breast Care Center – Brambleton

3707 Brambleton Avenue | Roanoke | 540.772.7401

Breast Care Center – Daleville

Queena. She knows it and owns it. And she should.

Yet, Queena doesn’t put herself on a throne. She’s humble and kind and spirited and happy. Her beauty is her positive attitude. It starts from within and powers her belief that good can help overcome anything, including her

150 Market Ridge Lane | Daleville | 540.966.0454

breast cancer.

Breast Care Center – Jefferson

I see a sharp person in

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Breast Care Center – Peters Creek

6415 Peters Creek Road | Roanoke | 540.265.5545

Carilion Clinic Breast Surgery

3 Riverside Circle | Roanoke | 540.224.5170

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

Rose. Rose has her soft side, but be careful how you

handle her. Rose has been a breast surgeon for nearly 18 years. Her mission in life is to beat the disease, one patient at a time. She will do anything for her patients and each will tell you they owe their lives to her. One thing to remember about Rose: never, ever get in her way of trying to find a cure. I no longer see

Scarlett wearing the burden of the big ‘C’. Scarlett

didn’t deserve to get breast cancer. No one does. But that’s not how she saw it. As Scarlett tells it, she lived a fast life for most of her early years. Like many do. She didn’t take care of her body. Like many don’t. She didn’t go to the doctor regularly. Like many should. But she wasn’t being punished by getting breast cancer. It took Scarlett some time, but she now knows she won’t be defined by guilt. She will be defined by victory. When I see

Temple, I can’t help but look up to her. She commands a

presence like no one else. People flock to her for guidance. For support. For hope. Although Temple is only 21 years old, she has more wisdom and life experience than most women twice her age. Having breast cancer before your 19th birthday has a way of making you grow up fast. Oh,

Unni. What a down to earth person I see. I only wish Unni knew

what it meant to celebrate your own accomplishments. She takes the word ‘modesty’ to a whole other level. Overcoming breast cancer for the third time? It was all because of the doctors, according to Unni. Overcoming depression? 62

OurHealth | The Resource for Healthy Living in Southwest Virginia

It was all because of the counselors. Unni is so much stronger than she realizes. She was the leader in her fight and the reason she won. Modesty is magnificent. So is celebration. I can see

Venus coming from a, well, you know. Venus

knows she’s in charge. No one’s messing with her. She’ll let you know if she needs your help. But just in case breast cancer rears its ugly head, watch out. Venus is a good one to have in your corner. I see a whimsical wave from

Willow. Quiet and reserved.

She’s always been well taken care of. Never had a care in the world. I don’t believe Willow has ever been challenged in life like she is being challenged now. And it is now that she needs more support than ever. With open arms. That’s how I see

Xena. She’ll prepare a

place for anyone. Anytime. Anywhere. Comfort food cures all woes, she believes. A handmade quilt and a hot cup of cocoa refuels the tired and weary. Xena’s a good soul to know. I see a warrior in

Yaawar. She’s battle tested. A keen

strategist. A true motivator. If your down, she’ll pick you up. Yaawar wears many wounds with pride and dignity. One trip through her boot camp and you will be quickly reminded what you’re fighting for. Lastly, it’s

Zora I see. Is it coincidental that Zora’s name

means alive? Zora is special. She is not just alive. She comes alive when we need her most. I not only see her individually, but I see her in every one of these women. And I see her in all women who fight breast cancer. All men who fight breast cancer. All men, women and children who fight any cancer. Family, friends, doctors, nurses, caregivers… everyone who offers support to those in the fight against cancer. Remembering Zora when cancer is first diagnosed is the most important time to do so. It is then when we must come alive. Be alive. Be prepared to fight. Be prepared to win. Be prepared to live. I love these women and all they symbolize.

LewisGale Breast Care Medical Facilities & Imaging Centers www.lewisgale.com/service/ lewisgale-breast-imaging-centers

LewisGale Imaging Center – Montgomery 813 Davis Street | Blacksburg | 540.953.5131

LewisGale Imaging Center – Daleville 65 Shenandoah Ave. | Daleville | 540.966.6620

LewisGale Hospital – Pulaski

2400 Lee Highway | Pulaski | 540.994.8509

LewisGale Imaging Center – Brambleton 4330 Brambleton Ave | Roanoke | 540.283.3700

LewisGale Breast Center

1802 Braeburn Drive | Salem | 540.776.4983

Events Worship in Pink

October 9-11, 2015 | Virginia Blue Ridge churches, synagogues, mosques. For details, visit www. komenvablueridge.org

Robynn Jaymes Pajama Jam

October 30, 2015 | 6:00 p.m. | Hotel Roanoke To purchase tickets, visit www.949starcountry.com

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Technology adds a NEW

words | TINA JOYCE

DIMENSION Routine health exams and preventive care save many lives. OurHealth spoke to professionals at Physicians to Women in Roanoke to gain a better understanding of the importance of proactive initiatives and how new technology is enhancing screenings to offer women peace of mind. The word “cancer” sends a paralyzing fear through the minds of many. Although it comes in many forms, the potentially deadly disease does not discriminate. Cancer affects all ages, body types, skin colors and ethnicities. However, research continues and advances in technology bring hope. According to the National Cancer Institute, breast cancer is the second most common form of cancer, behind skin cancer, among women. Although many have lost their lives to the disease, survival rates continue to improve, especially with early detection. An early diagnosis allows treatment to begin sooner in the course of the disease, permitting doctors to target cancerous cells before they spread. This is particularly true for women between the ages of 40 and 74.

»» »»

We asked the doctors at Physicians to Women a series of questions about Women and their Breast Health. Here’s what they had to say. ••••• How important is it for all women to receive regular mammogram screenings and why? Annual screening mammography is important because it allows for early detection. The earlier a breast cancer is detected, the more likely the disease will be caught during a curable phase. — Q&A continued on page 68

In 2015, it is estimated there will be 231,840 new diagnoses. This startling statistic has experts engineering new, improved methods for early detection. Mammography is commonly used as a proactive measure for detecting abnormal cells. A mammogram is simply an X-ray image of the breast tissue. In the past, X-rays were captured on film. Now the images are usually stored digitally and can be lightened or darkened to provide technicians with clearer pictures. Digital images can also be shared electronically, allowing better communication among technicians, physicians and hospitals. As recommended by the American Cancer Society, women over the age of 40 are encouraged to have annual mammograms.

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— Q&A continued from page 67

What is the difference between screening mammograms and diagnostic mammograms? Screening mammography is intended for patients without symptoms. Diagnostic mammograms are performed on patients with symptoms. Symptoms can include a new lump, nipple discharge or a nipple inversion. Changes within the breast should be reported to your physician because a diagnostic mammogram would be appropriate.

••••• How do the new 3-D mammography screenings at Physician’s to Women differ from traditional digital mammography procedures? 3-D mammography is similar to computed tomography in that it takes visual slices of the breast, allowing for better visualization. The normal 4-view mammogram will still need to be performed, but the 3-D procedure will allow for additional, more precise information. — Q&A continued on page 69

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Introducing more advanced technology, Physician’s to Women in Roanoke will soon be offering three-dimensional mammography. “3-D mammograms are believed to detect more invasive tumors and to decrease false readings, compared to traditional digital scans,” explains Julien Meyer Jr., MD, a gynecologist at Physicians to Women. An article published last year reported on a study of 13 U.S. hospitals whose research suggested that 3-D mammography, used along with standard digital mammograms, bumped up breast cancer detection rates by more than 40 percent. As technology develops and local healthcare providers, such as Physicians to Women, continue to follow the trend of advancing proactive care, many lives will be improved or spared. Make a commitment to schedule regular annual mammograms and ask if a 3-D screening is right for you.

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— Q&A continued from page 67

HISTORY OF

PHYSICIANS TO WOMEN

Celebrating its 75th anniversary, Physicians to Women first opened its doors in Roanoke in 1940 when Dr. Julien H. Meyer moved to the area with his wife, Dorothy, who was also his first nurse. Dr. Meyer became the first board-certified OB-GYN in Roanoke.

What sets Physicians to Women apart? Physicians to Women is committed to the individualized care we provide our patients. We have dedicated, well-trained breast imagers and technologists meeting the needs of our patients and physicians. With the addition of our new 3-D technology, our staff will have the ability to offer more specific services and recommendations to our patients.

Dr. Meyer’s first partner was hired in 1950, and in 1972 the practice incorporated as Physicians To Women Inc. — the first professional corporation in Virginia. Other young obstetricians and gynecologists, including Dr. Meyer’s son, Julien Meyer Jr., soon joined the practice, adding to its ongoing success. Dr. Meyer Sr. delivered more than 6,000 babies before he retired in 1993. Today the practice has 11 physicians. Physicians to Women continues to be involved in Roanoke’s cultural, philanthropic and social activities, and its physicians have held many leadership positions in the community. It sponsors or supports numerous women’s health events, and its doctors are frequently asked to give lectures to women’s groups.

540.982.8881

PHYSICIANS TO WOMEN, INC.

»» »»

Office Hours: 8:30 am - 5:00 pm 21 Highland Avenue SE, Suite 200 Roanoke, Virginia 24013 www.ptow.com

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OurHealth | The Resource for Healthy Living in Southwest Virginia

FIT BITS Couch to 5K

CHALLENGE

Deidre Wilkes, AFAA, ACSM

Certified Personal Trainer

Have you ever thought the idea of participating in your first 5K sounded enticing, but just didn’t know how to get started? Then the Couch to 5K Challenge may be right for you! The 10-week Couch to 5K Challenge program* gradually integrates different intervals of walking and jogging with adequate rest and recovery time to help you reach a goal of jogging an entire 5K! Follow the chart at the right to guide you on your journey. Start your Couch to 5K Challenge by October 10, 2015 and be ready to participate in the Jingle Bell for Arthritis 5K in Downtown Roanoke on Saturday, December 12, 2015.

2015 Jingle Bell Run for Arthritis Race Date: December 12, 2015 Race Time: 9 am Location: Downtown Roanoke

To register and for more information: www.jbr.org

As the weather turns colder and darker, be sure to visit Green Ridge Recreation Center to take advantage of their indoor track, so there is no need to miss a day of training! Green Ridge offers one of the longest indoor tracks in the area (1/8 mile), with fantastic views of the surrounding mountains in all seasons. Visit the Green Ridge website at: www. greenridgerecreationcenter.com for more information about the track, and other amenities they offer. *Before starting any new diet and exercise program, please check with your doctor.

Deidre is the resident fitness specialist for OurHealth Southwest Virginia

WEEK WEEK

DAY 1 DAY 2

DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

5 min walk 2 min jog 5 min walk

REST

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30 min jog

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RACE DAY!

CELEBRATE! You did it!

RUNNING TIPS »»

STRETCH IT OUT: Stretch after every

»»

KNOW YOUR LIMITS: If you start

»»

workout to avoid injuries.

developing an injury, STOP running before it gets worse and take a few days off.

TRY IT OUT: This is only a rough outline of the perfect plan for you. You can change it as you need to.

TAKE IT EASY: Don’t push yourself too hard when you jog. Go at a comfortable pace.

HYDRATE: Hydrate properly and energize yourself at least an hour before you run.

»»

GEAR UP: Make sure you have the proper running shoes. Most local running stores can assist with fitting and recommending the right shoe.

Photos courtesy of Mark Lambert, Senior Consultant for Communications & College Relations, Jefferson College of Health Sciences.

OurHealth | The Resource for Healthy Living in Southwest Virginia

Interprofessionalism

CENTER STAGE

Roanoke hosts the international

words | RICH ELLIS

Collaborating Across Borders conference

In nearly every profession, team members who don’t collaborate, encourage communication, or respect others’ expertise and opinions either won’t reach their goals or will be significantly delayed in attaining them. In healthcare, teams that don’t work together face a much more ominous consequence — someone could die. That knowledge makes collaboration an increasingly important subject in academic and healthcare arenas, and it’s a topic that’s receiving a lot of attention as Roanoke hosts the fifth Collaborating Across Borders conference (CAB V), Sept. 29 through Oct. 2. CAB V bills itself as, “the premier North American conference on interprofessional education and interprofessional collaborative practice in health and social care.” Presented by the American Interprofessional Health Collaborative and the Canadian Interprofessional Health Collaborative, this year’s conference theme is “The Interprofessional Journey: Advancing Integration and Impact.” A focus on collaboration and interprofessionalism leads to higher-quality healthcare and improved patient outcomes — results that many local professionals and organizations in the healthcare and education realms have historically embraced and championed. That long-standing commitment to advancing interprofessionalism is one of several reasons Roanoke was selected to host this year’s international conference over other, larger cities. www.OurHealthswva.com

The Virginia Tech Carilion School of Medicine and Research Institute — in collaboration with Jefferson College of Health Sciences, Virginia Tech, and Carilion Clinic — share hosting duties for CAB V. They too are eager to show off the region’s many attributes and, more importantly, the local work and commitment that help further understanding and adoption of interprofessionalism.

Nancy Howell Agee is President and CEO of Carilion Clinic.

“In addition to being more effective, interprofessionalism is also more efficient so the patient experiences care more quickly and gets to the right answer faster. And I think in today’s world, we’re all interested in effective, efficient, high-quality care.” — Nancy Agee, president and CEO, Carilion Clinic

Nancy Agee is president and CEO of Carilion Clinic — a not-for-profit, Roanokebased healthcare organization that provides care for nearly 1 million Virginians through its network of hospitals, primary and specialty physician practices and other complementary services. Her thoughts on Roanoke being selected to host the conference and the importance of interprofessionalism reflect what many in the Roanoke Valley are already feeling. “It’s an enormous tribute to the amazing work happening right here in the region, and to have this recognition through an international conference is thrilling. We’re humbled by it and excited as well,” says Agee. “Interprofessionalism is fundamental to the whole team coming together and surrounding the patient so that the patient becomes part of the team. By having all that expertise together, I think you can achieve a lot more and improve health. It’s a great way to work together.”

A commitment to interprofessionalism Interprofessionalism in the Roanoke Valley has a long history, including Jefferson College of Health Sciences’ Quality Enhancement Plan that focuses on improving the college’s interprofessional education initiatives. The Virginia Tech Carilion School of Medicine and Research Institute, established in 2010, chose interprofessionalism as one of the four pillars of its curriculum, making it a natural fit for the Jefferson College of Health Sciences and the medical school to bring their students together to learn interprofessionalism. “The conference host team has a long history of collaboration and interprofessional practices. Jefferson College of Health Sciences recognized the importance of interprofessional education two decades ago when it implemented interprofessional courses in its undergraduate core curriculum,” says Cynda Johnson, MD, dean of the medical school. “From its opening in 2010, the Virginia Tech Carilion School of Medicine has been part of a learning partnership with the Jefferson College of Health Sciences, and this has been a spectacular collaboration. In fact, in some ways it has culminated in our institutions’ ability to work with Carilion Clinic and Radford University to create our new shared anatomy lab.” Nathaniel Bishop, president of Jefferson College of Health Sciences and chair of interprofessionalism for both the college and the medical school, agrees. “It was a special and wonderful coincidence that these two institutions — already so close in proximity and with a close relationship — would place interprofessionalism in such a prominent role,” says Bishop. “When Cynda Johnson and I recognized this, we knew it made sense to parlay it into a unique experience to enhance both our academic institutions.”

Dr. Nathaniel Bishop, is President of Jefferson College of Health Sciences. Dr. Bishop also serves as the Chair of Interprofessionalism at the Virginia Tech Carilion School of Medicine.

Cynda Johnson, MD is President and Dean of Virginia Tech Carilion School of Medicine.

OurHealth | The Resource for Healthy Living in Southwest Virginia

“Our interprofessional approach aims to nurture our students as thought leaders both in their careers and in their communities,” says Dr. Johnson. “By studying alongside students in other health professions, medical students learn how to be key members of effective healthcare teams.

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Interprofessionalism in action The relationship between Jefferson College of Health Sciences and the Virginia Tech Carilion School of Medicine and their focus on interprofessionalism continue to grow, along with collaboration and involvement with Roanoke’s ever-expanding healthcare community. For example, earlier this year the college, the medical school, and Carilion Clinic hosted the seventh annual Interprofessional Education Simulation Day. The simulation brings students and healthcare professionals together to gain experience working as a team during an emergency situation.

Issac Wilson is a current Jefferson College of Health Sciences Surgical Technology student.

Issac Johnson from Bent Mountain in Roanoke County is a Jefferson College of Health Sciences student who participated in the simulation. The surgical technology major says the experience taught him the importance of working together as a team and that it’s crucial that everyone does their part — without any one person trying to do too much individually — in order to make the surgery run smoothly. “The simulation was a great learning experience all the way around,” Issac Johnson says. “After going through it, I learned how to work with other people and be prepared for complications that could happen. It’s a very collaborative effort to ensure the patient emerges with a good outcome.” Someone who knows all too well about the importance of working together in the real world is Stephen Ausband, MD, a board-certified emergency medicine physician at Carilion’s Roanoke Memorial Hospital and assistant professor in the medical school’s Department of Emergency Medicine.

OurHealth | The Resource for Healthy Living in Southwest Virginia

“When you work in isolation, you miss out on the breath of services that could come into play for a patient’s condition,” Agee explains. “Through interprofessionalism, the patient really experiences the best of all the professionals involved in their care and that quite naturally leads to better outcomes.”

“In my job in the Emergency Department and working with emergency medical services out in the field, we’re dealing with lots of colleagues with all sorts of different skill sets, backgrounds, and knowledge bases,” Dr. Ausband explains. “Being able to work as a team, whether it’s together at the patient’s bedside with physicians, nursing staff and techs and everybody else, or coordinating with EMS or with in-patient services with the transition of care, the interprofessional relationships there are extremely important because everybody’s watching out for the patient. You have to work together as opposed to folks working in isolation.” To illustrate that point, Dr. Ausband says it’s important that everyone realize that each person involved with patient care has a voice and that every team member pays attention to other team members. They need to function as a team and use the resources everyone possesses. Dr. Ausband offers the example of a patient coming into the emergency department. “When EMS comes in with a patient, you get a lot of information about what the situation with the patient was like prior to arriving at the ED — what the home situation was like, what it was like at the scene of the accident, how the patient changed over time. There’s a lot of insight there.” It’s a similar situation to what Dr. Ausband experiences at the hospital: If he sees something that can help the EMS crews, he communicates it, much the same way that he engages in two-way communication when working with specialists with inpatient services. “You provide information, and you get feedback,” says Dr. Ausband. “The twoway communication is so important, and it’s important to keep an open mind and an open ear with everyone giving and receiving feedback.”

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According to Dr. Ausband, patients benefit from the interprofessionalism because each person working with the team is working for the patient’s benefit. If something occurs that one person doesn’t see or consider, there are other people with different views, skills sets, backgrounds, or pieces of information that they bring to the table that help the patient. By working as a team, one person doesn’t try to take on all the tasks at once or be the one making all the decisions. “I feel that it benefits the patient, and the end result is better because working together helps catch errors before they happen.” It helps to ensure that all of the therapeutic and diagnostic considerations are taken into account,” says Dr. Ausband. “The key thing with interprofessionalism is that everybody who helps care for the patient — regardless of their title or position or official role — brings something valuable to the table to help that patient,” explains Dr. Ausband. Michael Friedlander is the executive director of the Virginia Tech Carilion Research Institute, associate provost for health sciences at Virginia Tech and senior dean for research at the Virginia Tech Carilion School of Medicine. Those roles, coupled with his research on the brain and learning, provide him with a unique perspective when it comes to students learning about interprofessionalism. “When it comes to the education of the medical students, they have a very defined and distinct component of their curriculum where they actually learn together with other healthcare professionals in training, such as nurses and physicians assistants,” says Friedlander. “They learn in a real-world, day-by-day basis to appreciate, understand, respect and value the perspectives of other healthcare professionals.”

Michael Friedlander, PhD, is the Executive Director of the Virginia Tech Carilion Research Institute and Senior Dean for Research of the Virginian Tech Carilion School of Medicine.

Friedlander continues, “Another component of our medical education program that is unusual is that the medical students work together in some of their programs with graduate students who are studying at Virginia Tech for their PhDs as part of a program there called Translational Biology, Medicine, and Health. As a result of the immersion in the interprofessional experience, the medical students have a very rich and highly unusual, if not unique, experience working with people across the healthcare spectrum and even in the research spectrum, where discoveries are being www.OurHealthswva.com

made that the physicians will utilize when they practice the medicine that comes from the science.” That early exposure to the importance of working together will yield better results for team members throughout their careers, and more importantly, for their patients. “When you work in isolation, you miss out on the breadth of services that could come into play for a patient’s condition,” says Agee. “Through interprofessionalism, the patient really experiences the best of all the professionals involved in their care and that quite naturally leads to better outcomes.” Regardless of the team you’re on or the industry you’re in, embracing interprofessionalism and working together simply yields consistently better results — a goal everyone wants to achieve.

A collaborative effort helps bring CAB V to the Star City It all started with an email.

David Trinkle, MD, is the associate dean for community and culture at the Virginia Tech Carilion School of Medicine and Research Institute in Roanoke. One of his roles at the school is teaching interprofessionalism and helping medical students understand the importance of teamwork among healthcare teams, leadership and followership to improve patient care, quality and safety. As a geriatric psychiatrist, Dr. Trinkle has a longstanding interest in interprofessional education and collaborative care. He has attended previous Collaborating Across Borders conferences, so when an email requesting proposals from cities to host CAB V showed up more than two years ago, he couldn’t resist applying. 80

OurHealth | The Resource for Healthy Living in Southwest Virginia

“Given that we are a unique school, that we have Jefferson College of Health Sciences with its long dedication to interprofessional education, and Carilion Clinic as a great model of collaborative care and putting interprofessionalism into practice, I thought it was a perfect fit,” Dr. Trinkle explains. Also spurring his interest in bringing the conference to Roanoke was the economic development hat he wears as Roanoke’s vice mayor and city council member. “I think the city is primed to host some really nice, mid-sized health conferences, and I thought this would be a great opportunity, particularly given that leaders representing many different disciplines attend the CAB conferences,” Dr. Trinkle explains. With less than three weeks to develop a proposal to host the conference, Dr. Trinkle said people really dedicated themselves to the effort, citing Virginia Tech’s professional approaches to attracting conferences, as well as significant efforts made by the City of Roanoke, Roanoke Valley Convention & Visitors Bureau, Carilion Clinic and Jefferson College of Health Sciences. In addition to developing a well-written application, Dr. Trinkle also conducted oncamera interviews with leaders from the collaborating organizations and with U.S. Sen. Mark Warner — who happened to be in town that day — about why the Roanoke Valley would be an excellent choice to host the conference. Dr. Trinkle incorporated the personal interviews into a 10-minute video highlighting the region’s many attractions. “The video helped show that we’re really excited about hosting the conference and that we can do so successfully,” Dr. Trinkle says. “Attracting and planning the conference has been an amazing interprofessional collaboration in and of itself. To me, it just goes to show what a great community we live in that all our partners are eager, that they think out of the box and that everybody is participating in trying to make this a really amazing experience.

David Trinkle, MD is Chief of Geriatric Psychiatry at Carilion Center for Healthy Aging. Dr. Trinkle is also Associate Dean for Community and Culture at Virginia Tech Carilion School of Medicine and sits on the executive committee of the Collaborating Across Boarders Conference series.

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“At the end of the day, we’re going to provide a spectacular conference.”

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Blacksburg Farmer’s Market Check out some recent photos from The Blacksburg Farmers Market offering local foods, crafts, flowers, music, and more in the heart of

downtown Blacksburg! Come support your local farmers and artists and enjoy the benefits of a strengthened community, healthy living, and support for responsible business practices. Each week, the vendors at The Blacksburg Farmer’s Market offer a veritable spread of farm fresh goodness, using creative methods to lengthen the Appalachian growing season. All farms represented are located within 50 miles of downtown Blacksburg. Shopping here means supporting local and sustainable agriculture in your own backyard! The Blacksburg Farmer’s Market is open on Wednesdays and Saturdays at Market Square Park, located on the corner of Roanoke Street and Draper Road in the heart of downtown Blacksburg. Parking is available at metered lots around town, Kent Square parking garage, and the Virginia Tech media lot (on Saturdays).

OurHealth | The Resource for Healthy Living in Southwest Virginia

Photos courtesy of Blacksburg Farmers Market.

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Leaking

is NOT a normal part of aging!

words | LAURA NEFF-HENDERSON, APR

For lifelong Salem resident Erica Foote, the onset of symptoms was subtle and gradual until one day when she realized that she was waking up three to four times a night to use the bathroom. It was also affecting her during the day when she’d find herself visiting the restroom every two to three hours. “I was going to the bathroom way too much,” says Foote, who works as a certified medical assistant at Vistar Eye Center in Salem. With a referral from her primary care physician, Foote scheduled an appointment with board-certified physician James A. Daucher, MD, at Blue Ridge Urogynecology in Roanoke. A relatively new specialty, urogynecology combines medical issues of the bladder, vagina and bowel. Traditionally these three areas of the body have been handled by urologists, gynecologists and gastroenterologists, respectively.

The Conditions There are two major diagnoses when it comes to the bladder, according to Dr. Daucher — overactive bladder and urinary incontinence.

James Daucher, MD is a urogynocologist with Blue Ridge Urogynocology in Roanoke and Martinsville. He is certified by the American Board of Obstetrics and Gynocology with a subspecialty in Female Pelvic Medicine and Reconstruction Surgery.

Overactive bladder is a problem with bladder-storage function that causes frequent, sudden urges to urinate. The urges may be difficult to stop, and overactive bladder may lead to the involuntary loss of urine (urinary incontinence). Sixty percent of Dr. Daucher’s patients have a combination of overactive bladder and urinary incontinence. Neither condition is preventable, but both are treatable. The severity of both conditions ranges from occasionally leaking urine during a cough or sneeze to having an urge to urinate that’s so sudden and strong it’s

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“It has changed the quality of my life tremendously. I can actually travel in a car for eight hours and only stop once to use the bathroom. That is absolutely amazing to me.“ — Erica Foote of Salem

impossible to get to a toilet in time. Some people experience occasional, minor leaks of urine. Others wet their clothes frequently. Many patients are embarrassed by the symptoms and wait until their quality of life has significantly diminished before they seek medical attention. “Patients who come in earlier when the symptoms are not as severe often have a better outcome,” says Dr. Daucher. “We have options from super simple — including diet and behavioral changes — to very complex, but they are all simple and highly effective. And they are the same regardless of age.” For many women, urinary incontinence is the result of vaginal childbirth, and the symptoms begin when patients are in their 40s and 50s. “There’s no way your body can fully recover from a vaginal delivery,” says Dr. Daucher. And having an injury at the time of delivery (like an episiotomy) can make things worse. Simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence for most people. Overactive bladder, on the other hand, has nothing to do with pregnancy and can be caused by other inflammatory conditions like irritable bowel and stress. These symptoms also come on much earlier, when patients are in their mid-20s.

Foote urges other women who are experiencing the symptoms of overactive bladder or urinary incontinence to see a doctor immediately.

Management of overactive bladder often begins with behavioral strategies, such as fluid schedules, timed voiding and bladder-holding techniques using the pelvic floor. Other treatments include medication and Botox injections. When injected into the bladder wall, Botox deadens the nerves, controlling the impulse to urinate. It’s fairly simple to do, but the procedure is uncomfortable and has to be repeated every four to six months.

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“Despite the commercials for diaper-like products for woman with these symptoms that make overactive bladder and incontinence seem normal, this is not a normal part of aging,” says Dr. Daucher. “There’s no acceptable leakage, and women shouldn’t need a diaper.”

Foote, who was diagnosed with overactive bladder and a pelvic floor prolapse in July 2014, first tried medication. When it didn’t work, she and Dr. Daucher discussed the other available options.

Electrical stimulation therapy Regulating the nerve impulses to the bladder can improve overactive bladder symptoms. In one procedure that Dr. Daucher finds particularly successful, electrical stimulation therapy, he places a thin wire close to the sacral nerve, which carry signals to the bladder. One of the biggest advantages of this procedure is that patients can determine whether this option will work for them by having a temporary wire placed using a local numbing agent during an in-office procedure. Within three days of having the temporary wire placed, Foote saw a significant reduction in her symptoms and decided to have a permanent electrode and a batterypowered pulse generator surgically implanted. As part of the therapy, Dr. Daucher uses a device connected to the wire to deliver electrical impulses to Foote’s bladder, similar to what a pacemaker does for the heart. The electrical stimulation sends a mild electric current to nerves in the lower back of the pelvic muscles that are involved in urination. The stimulation alters the way the brain perceives the impulses from the bladder and changes the threshold in which the brain tells the bladder how often to empty. Now, a year after the surgery, Foote says things couldn’t be better. “It has changed the quality of my life tremendously,” says Foote. “I can actually travel in a car for eight hours and only stop once to use the bathroom. That is absolutely amazing to me.” Foote urges other women who are experiencing the symptoms of overactive bladder or urinary incontinence to see a doctor immediately. “There is help, and this is a problem a lot of us have,” Foote says. “Despite the commercials for diaper-like products for woman with these symptoms that make overactive bladder and incontinence seem normal, this is not a normal part of aging,” says Dr. Daucher. “There’s no acceptable leakage, and women shouldn’t need a diaper.”

Medical Expert • James Daucher, MD with Blue Ridge Urogynocology in Roanoke.

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