table of contents | august • september 2014
MEDI•CABU•LARY.....................10 Local experts define health related terms
JUST ASK!.......................................12 Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............14 A listing of new physicians, providers, locations and upcoming events in greater Richmond
HEALTH POINTS.........................18 Interesting facts and tidbits about health
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School Times
Schools provide parents with a list of supplies needed for the new school year, but left off that list are steps to ensure a child’s good health. In this issue, OurHealth provides parents with a step-by-step resource full of valuable physical, emotional and social information to consider, as well as tips from local healthcare and healthcare-related providers from Richmond to help your children make healthy choices all year long.
THE ANATOMY CHALLENGE..................................21 How much do you about our anatomy? In this issue, test your knowledge when it comes to the amazing EAR!
ANATOMY: The Aging Ear......... 22 Although grey thinning hair and deep wrinkles are two of the most commonly talked about signs of getting older, age-related hearing loss is a significant concern for many Americans.
FIT BITS!........................................ 42 Health and Fitness On-the-Go: A Right to ‘Bare Arms’
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The Resource for Healthy Living in Greater Richmond
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Drug Recovery.................................61
[series]
Breaking the Silence: Alzheimer’s Disease
This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now.
I Wish I'd Never Started: Real people tell their own addiction stories at iwishineverstarted.org
hello, HEALTH!.............................. 62 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos
NUTRITION........................ 65 HEALTHY EATS: Shop Seasonally for Better Flavorand Extra Value—Corn Salad, Beet Summer Salad, Vegan Gluten-Free Almond Butter Cookies
MEN, WOMEN, AND THE TOTAL BODY................................. 68 Prostate Cancer: The Second Most Common Cancer in Men
LOOKING BACK........................... 74 Images reflecting the history of healthcare in Richmond * PLUS * a chance to win prizes!
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september is national recovery month
Drug Recovery: Heather’s Story From having everything to losing it all. Heather Parke tells her story of drug addiction, and how she found her way out.
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CELEBRATING 16 YEARS OF HEALTH AND WELLNESS
The Resource for Healthy Living in Greater Richmond
august
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september 2014
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Achieving Wellness with Baylor Rice Accept my invitation to one of our FREE Health Seminars in 2014. Optimal Health is just a click away. WEIGHT LOSS Learn and hear about a Healthy Transformation to help revive your metabolism, lose weight and feel great! Saturday, August 23, 9 am, West End Thursday, August 28, 6 pm, Southside AUTISM/ADHD Unlocking your child’s potential with compounded Prescriptions and Nutraceuticals Wednesday, September 24, 6 pm, West End
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CONTRIBUTING RICHMOND MEDICAL EXPERTS Erin G. Adams, MD
Ryan Duffy, MSG Toy E. Newcomb, LALFA S. Tyler Perkinson, DDS Diane Stewart Alan Towne, MD, MPH
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BIO-IDENTICAL HORMONES Not your Mother’s Hormones! Bring a friend and learn about aging gracefully. Tuesday, October 21, 6 pm, Southside Thursday, October 23, 6 pm, West End
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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-at-Large: 303 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’s websites (www.ourhealthrichmond.com and www.ourhealthvirginia.com), social media sites 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.
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Copyright © 2014 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Greater Richmond edition is published seven times annually by McClintic Media, Inc. 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthrichmond.com | www.ourhealthvirginia.com | Advertising rates upon request.
LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is Functional Disconnection Syndrome?
What is a cluster headache?
What is pre-surgery planning?
Both hemispheres of the brain communicate simultaneously, at lightning speed, in a properly functioning brain. In a poorly functioning brain, communications are out of sync or relaying only partial information. This miscommunication is called Functional Disconnection Syndrome (FDS) and is at the root of learning, behavioral and social problems.
Cluster headaches typically occur between the ages of 20-40 years. They are three to four times more common in men than in women. They are characterized by attacks of severe unilateral pain, usually located in the orbital region. The pain is sometimes described, by the patient, as feeling as though they are being stabbed in the eye by a sharp or burning object. The cluster attacks last from 15 to 180 minutes and occur from once every other day to multiple times a day. The attacks are associated with one or more of the following: eye redness, increased tearing, nasal congestion, facial sweating, eyelid droop, small pupils and nasal discharge. Frequently the patient will complain of restlessness or agitation during an episode. During the worst attacks, the intensity of pain is excruciating. Patients are usually unable to lie down and characteristically pace the floor. There are effective treatments for this type of headache.
This is a great question that many people don't ask. Some key points to consider are:
FDS explains the symptoms in many neurological disorders, including ADHD, learning disabilities, sensory processing disorder, Asperger’s, autism, etc. These conditions are the result of either a right- or left-brain deficit. The brain is not damaged, it is simply underdeveloped. Extensive research and in depth study of epigenetics has shown that the brain is remarkably adaptable, able to create new neural pathways in response to stimulus in the environment. Because the brain can change, there is hope for children suffering from Functional Disconnection Syndrome. The Brain Balance Program is the most comprehensive approach to overcoming the symptoms of FDS. We address the fundamental problem by integrating cognitive and sensory-motor stimulation, as well as nutritional training for a drug-free, whole-child approach. Diane Stewart, Owner/Director Brain Balance Achievement Center Midlothian | 804.977.2743 www.brainbalancecenters.com
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Alan Towne, MD, MPH
Professor of Neurology in Virginia Commonwealth University School of Medicine Richmond | 804.675.5127 www.medschool.vcu.edu
• Do your research. Learn as much as you can about your medical condition, the surgical procedure, and what constitutes normal recovery for your age. Don’t be afraid to get a second opinion. Read recent literature about your condition and surgery options. • Ask questions! Once you've decided to have surgery, your surgeon and doctors are your best resources for information. • Discuss post-surgery medications. Which ones will provide maximal benefit with minimal side-effects? • Determine your resources. Who will help you during recovery and rehabilitation? How will you manage transportation to followup appointments, therapy sessions, etc., and plan for it? • Make a calendar with important dates, times, people, and addresses. • Exercise and move your body regularly before surgery. It will facilitate the recovery process. • Ensure your body has the nutrition it needs for recovery and optimal function. Maintain a healthy diet pre and post surgery. Be deliberate and plan your postsurgery diet. Ryan Duffy, MSG
Alternative Aging Fitness and Wellness, LLC Gerontology, Health and Wellness Richmond | 203.241.4825 www.AlternativeAging.com
H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
What is the best way to help a parent adjust to a new assisted living facility? The first week in an assisted living community is very important as it sets the expectations for the duration of the residency. One of the best ways to assist a parent in the transition to assisted living is to limit the number and length of visits. This seems counterintuitive as adult children may experience feelings of guilt and/or fear their parent will feel a sense of abandonment if they do not visit often and for long durations. In reality, when family and friends limit the number and length of visits, the new resident has the opportunity to begin a successful transition to assisted living. This transition encompasses making friends, participating in social activities, establishing a new routine, and developing a trusting relationship with staff. If the parent is preoccupied with family or friends visiting, they rely on familial relationships during the transition rather than creating bonds with their new neighbors and future friends within the community. Toy E. Newcomb, LALFA
Dunlop House Assisted Living and Specialized Alzheimer’s Care Colonial Heights | 804.520.0050 www.dunlophouse.com
What are fillings and crowns made of ? “Silver� fillings, or amalgam, are made from a metal alloy consisting mostly of mercury, silver, tin, and copper. While amalgam was very popular in the past, its use has decreased as patients choose more esthetic tooth colored fillings. Tooth colored dental fillings are usually made from dental composite. The base of composite is polymer resin, most commonly a material called bis-GMA. Suspended in the resin are particles of glass and silica that gives the composite its strength and tooth-like translucency. Crowns have traditionally been made from gold alloys, with gold percentages ranging from 50% to 90%. A crown in which the alloy is covered with tooth colored porcelain is called a porcelain-fused-to-metal crown, or PFM. For the past 30 years, PFMs have been the most popular choice for crowns among dentists and patients, but that is currently changing as new ceramic materials have become available. The materials that are currently revolutionizing dentistry are lithium disilicate and zirconia. Lithium disilicate, which goes under the trade name eMax, is a glass ceramic that produces beautiful crowns without compromising strength. Zirconia is one of the strongest materials ever used in dentistry, producing tooth colored crowns that, while lacking the life-like translucency of eMax, are incredibly strong. S. Tyler Perkinson, DDS
Virginia Family Dentistry Family Dentistry & Orthodontics Midlothian | 804.419.1045 www.vadentist.com
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What is the best way to prevent skin conditions, such as acne? Acne is a multifactorial disease caused by bacteria, occlusion of the follicle openings, hormonal influence and inflammation. Preventing breakouts can be achieved by following a few simple guidelines. Wash with a gentle soap twice daily to remove dirt, bacteria, oil and dead skin build up. Avoid over scrubbing, over washing and too much exfoliation. Look for a noncomedogenic, sunscreen containing moisturizer. People with oily skin think they should wash more and skip moisturizer. Actually, this strips the skin of natural oils and sends oil glands into overdrive. Makeup should also be oil-free and noncomedogenic. Avoid using greasy/oily hair products and touching your face with phones or hands. Avoid high glycemic index foods like chocolate, white bread and pasta and instead incorporate fruits, vegetables and whole grains into your diet. Drink at least 8 glasses of water per day. If these basic steps are not successful, see a dermatologist to determine if you need more treatment to prevent or treat your acne. Erin G. Adams, MD
Dominion Dermatology, P.C Glen Allen | 804.262.6060 www.dominiondermatology.org
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Walkers Take to the Streets to Prevent Suicide More than 400 walkers throughout Richmond and surrounding areas are expected to participate in the upcoming Out of the Darkness Community Walk on September 13, 2014. The fundraising walk supports the American Foundation for Suicide Prevention (AFSP) by helping to support local and national suicide prevention and awareness programs. The Richmond Out of the Darkness Walk is one of more than 300 Out of the Darkness Community Walks (www.outofthedarkness.org) being held this fall nationwide. The walks are expected to unite more than 100,000 walkers nationally and raise more than $9.5 million for suicide prevention efforts. “Much more needs to be done to prevent suicide. Suicide and the underlying mental disorders that can sometimes lead to suicide continue to be surrounded by misinformation and stigma,” says Shirley Ramsey, chairperson for the Out of the Darkness Walk. “This walk is about reducing that stigma, raising awareness and raising needed funds for research and local prevention programs.”
The Richmond community walk will begin at Deep Run Park, in Henrico County, with check in beginning at 8:00am and the program, including several local speakers, followed by the walk, beginning at 9:00am. According to AFSP, close to 700,000 people will make a suicide attempt requiring medical care and more than 38,000 will die by suicide in the U.S. every year. About the American Foundation for Suicide Prevention: The American Foundation for Suicide Prevention is the leading national notfor-profit organization exclusively dedicated to understanding and preventing suicide through research, education and advocacy as well as to reaching out to people with mental disorders and those impacted by suicide. For more information please visit www.afsp.org.
Crater Caregiver Coalition Announces
Free Caregiver Education Day for Family Caregivers The Crater Caregiver Coalition will host its third annual education day for family caregivers. The Crater Caregiver Coalition will host its third annual Family Caregiver Education Day on August 14, 2014, from 4:00pm to 7:00pm at HealthSouth Rehabilitation Hospital located at 95 Medical Park Boulevard, Petersburg, Virginia. The event is free and open to the public; registration is required. The event will focus on three main topic areas: • Understanding choices in healthcare for your loved one • What insurance/Medicare/Medicaid/ Veterans’ benefits cover • Stress Management through Humor – a special session with motivational speaker Barbara Morgan In addition, there will be a special break out session with insurance experts to help answer specific questions of attendees in one-on-one question and answer sessions. The Coalition has also partnered with local massage therapists who have donated their time to offer 10-minute massages to caregivers who win one of numerous raffle drawings for these free mini-massages, which will be done as a part of the program onsite. To register for this event, please call 804.452.3349 or email ccc.caregiver.help@gmail.com.
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NOW UNDER CONSTRUCTION
The Memory Center of Richmond The Memory Center is pleased to announce the construction of The Memory Center of Richmond, a state of the art, residential community serving individuals with Alzheimer’s and other related dementias. The facility will be located on a four acre site immediately contiguous to Bon Secours St. Francis Medical Center in the growing community of Midlothian (Chesterfield County). The Memory Center of Richmond is scheduled to open by the beginning of 2015 and upon completion it will be one of the few stand-alone, assisted living communities in the Commonwealth of Virginia dedicated exclusively to memory care. The facility is comprised of 48 residential units designed and constructed around an innovative “Town Center” concept.” The Town Center is a centralized amenity area that will feature a movie theater, library, general store, bank, tavern, library, ice cream stand and salon. Each wing within the community will serve as a separate ‘neighborhood’ equipped with unique common areas and a corresponding theme. The philosophy behind the design concept is to offer residents the freedom to enjoy areas of interests suitable to their preferences. In addition to the unique layout, the interior spaces will encompass a stylish yet comfortable design incorporating modern fixtures and finishes. The Memory Center of Richmond will also be equipped with the latest technologies offering full medical over-site, a 4 to 1 resident to staff ratio and coordinated therapy services. “Memories in Motion” is a comprehensive activities program which provides the residents with multiple activities every day of the week. The facility will feature secured entrances and camera monitoring systems. Also the property will feature over 1000 sq.ft. of walking trails along with convenient parking for visitors and staff. The Memory Center of Richmond represents the company’s second community. For additional information please visit www.thememorycenter.com
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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
Johnston-Willis Hospital Achieves Designation as a Level III Trauma Center HCA Virginia’s Johnston-Willis Hospital has been designated a Level III trauma center by the State Health Commissioner from the Commonwealth of Virginia Department of Health. As a Level III trauma center, Johnston-Willis Hospital is prepared to serve as an access point for immediate, comprehensive, skilled medical and nursing care to seriously injured patients with 24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons, orthopedic surgeons, and anesthesiologists. The designation also will allow Johnston-Willis to incorporate a comprehensive quality assessment program focused on trauma care; stabilize and transfer patients requiring more comprehensive care to a Level I or Level II trauma center; provide continuing education for the trauma response team, including nursing, allied health and pre-hospital personnel; and provide active outreach to referring communities through injury prevention efforts. In Virginia, the trauma designation process is voluntary and intended to identify the various levels of capability available at participating hospitals.
Chad Christianson
Chief Operating Officer HCA Virginia’s Chippenham Hospital | Richmond www.hcavirginia.com
Crystal Farmer, RN
Chief Nursing Officer HCA Virginia’s Retreat Doctors’ Hospital | Richmond www.hcavirginia.com
Keefe Lobb, DO Bon Secours Ironbridge Family Practice Chester | 804.717.5300 www.bonsecours.com
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Brenda Woodcock, RN, NP
Chief Nursing Officer HCA Virginia’s Parham Doctors’ Hospital | Richmond www.hcavirginia.com
Matthew Paine, MD
Bon Secours St. Francis Family Medicine Center Midlothian | 804.739.6142 www.bonsecours.com
OurHealth | The Resource for Healthy Living in Greater Richmond
There are three levels in the state. These include: Level I - a comprehensive regional source that is capable of providing total care for every aspect of injury from prevention to rehabilitation. Level II – facilities that are able to initiate definitive care for all injured patients. Level III – centers that have demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations. Metro Richmond’s only other Level III trauma center is located at HCA Virginia’s Chippenham Hospital. The VCU Medical Center is designated a Level I trauma center. There are no Level II trauma centers in the region. The emergency department at Johnston-Willis Hospital treated over 33,000 patients in 2013 and has seen consistent year-over-year growth in ED visits. Johnston-Willis also has an advanced primary stroke accreditation. In addition, HCA Virginia completed a multi-phase quality improvement initiative in 2013 to ensure that its emergency departments are fully prepared to provide effective care for children.
Jennifer Myers, MD
VCU Massey Cancer Center Medical Oncology, Gastrointestinal Malignancies Downtown Richmond and Stony Point | 804.828.7999 www.massey.vcu.edu
Asena Madison, MD
Bon Secours Sports Medicine & Primary Care Richmond | 804.325.8801 www.bonsecours.com
Wendy Evans, DO
Bon Secours CrossRidge Pediatrics & Internal Medicine Glen Allen | 804.755.7581 www.bonsecours.com
Ann Marie Tuohy, MD
Bon Secours Lee Davis Pediatrics Mechanicsville | 804.730.4690 www.bonsecours.com
Christina Harner, DO Bon Secours Brook Run Family Physicians Glen Allen | 804.266.7611 www.bonsecours.com
Joycelyn Sabino-Akins, MD
Bon Secours Lee Davis Pediatrics, Bon Secours Laburnum Medical Center Mechanicsville | 804.730.4690 www.bonsecours.com
[ Photos Unavailable ]
Colin Wozencraft, MD
Vincent Lawson, MD
Jacqueline Stewart, MD
Seema Patel, MD
Bon Secours Palliative Medicine Richmond | 804.288.COPE (2673) www.bonsecours.com
Bon Secours CrossRidge Pediatrics & Internal Medicine Glen Allen | 804.755.7581 www.bonsecours.com
Bon Secours West End Internal Medicine Richmond | 804.282.7857 www.bonsecours.com
Bon Secours Glen Allen Internal Medicine Glen Allen | 804.612.2980 www.bonsecours.com
Jonathan Avula, MD
Bon Secours Laburnum Medical Center Richmond | 804.226.2444 www.bonsecours.com
Peter Reynolds, MD
Bon Secours St. Francis Family Medicine Center Midlothian | 804.739.6142 www.bonsecours.com
Sylvia Gonsahn-Bollie, MD
Bon Secours West End Internal Medicine Richmond | 804.282.7857 www.bonsecours.com
CORRECTION In the May issue of OurHealth, William D. Brickhouse, MD was honored by HCA Parham Doctor’s Hospital with the Frist Humanitarian Award. A misprint made it appear to be the First Humanitarian award. Awarded in memory of the humanitarian spirit and philanthropic work of the late Dr. Thomas F. Frist, Sr., a founder of Hospital Corporation of America, recipients are chosen for their demonstration of extraordinary concern for the welfare and happiness of patients, co-workers and their communities.
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T I P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U
TS BACKPACK FAC
shopping for school year includes w ne e th r fo ing ar Prep se, backpacks. supplies and of cour new clothes, shoes, nt way
for ideal and convenie an e ar s ck pa ck Ba llege – to carry rgarten through co de kin m fro – ts all studen backpacks that ver, her materials. Howe their books and ot at risk for erly can put a child op pr im rn wo or y are too heav nsider: me helpful tips to co injury. Below are so
e than ould weigh no mor sh ck pa ck ba ed ad A lo ght. ent’s total body wei 10 percent of a stud
from approximately pack should extend The height of a back slightly s to waist level or the shoulder blade low be s he inc o tw above the waist.
eight is be used to ensure w Both straps should o A waist belt can als distributed evenly. t more evenly across help distribute weigh the body.
dded backing not Backpacks with pa ed comfort, but only provide increas s n from sharp edge also offer protectio d an s pencils, ruler on objects such as notebooks.
ultiple Backpacks with m compartments can help distribute weight more evenly. Source: The American Aca
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OurHealth | The Resource for Healthy Living in Greater Richmond
demy of Pediatrics
September is National Childhood Obesity Childhood Obesity Facts Month and Figures* Obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. The percentage of obese children
in the U.S. between the ages of six and eleven increased from 7% in 1980 to nearly 18% in 2012.
More than 1/3 of children and adolescents are currently overweight or obese. Children and adolescents who are obese are likely to be obese as adults.
Healthy lifestyle habits, such as maintaining a proper diet and engaging in regular physical
activity, can lower the risk of
becoming obese and developing related conditions such as diabetes, high blood pressure and heart disease. *Source: www.cdc.com
CataractAwareness You Don’t Have to Live in a Fog
A cataract is a clouding of the normally clear lens of the eye. For people who have cataracts, seeing through cloudy lenses is a bit like looking through a frosty or fogged-up window. Cataracts are diagnosed during an eye exam performed by an ophthalmologist or optometrist. Removal of cataracts is performed through an outpatient surgery procedure.
More than half of all Americans age 65 and older have cataracts.
Signs and Symptoms of Cataracts • Cloudy, fuzzy, foggy, or filmy vision • Variations in color appearance • Difficulty driving at night • Increased glare from lamps or the sun
Remember: schedule routine eye exams with an ophthalmologist or optometrist to stay on top of your eye health.
September is
Prostate Cancer Awareness Month
Ways to Reduce the Risk Although there is no proven prostate cancer prevention strategy, there are steps men can take to reduce their risk of developing the disease. Consider these healthy choices: • Maintain a low-fat diet • Increase the amount of fruits and vegetables consumed daily • Replace red meat with fish, chicken and other lean meats • Reduce intake of dairy products • Replace sodas with water and green tea • Incorporate soy into your diet • Limit consumption of alcohol • Maintain a healthy weight • Exercise most days of the week Age, gender and family history all play a role when it comes to prostate cancer. Maintaining regular appointments with a primary care physician and having necessary testing performed are important steps to take to ensure early diagnosis.
The
2014 Walk to
END Alzheimer’s® The Alzheimer’s Association Walk to End Alzheimer’s® is the world’s largest event to raise awareness and funds for Alzheimer’s care, support and research. Held annually in more than 650 communities nationwide – including Richmond – this inspiring event calls on participants of all ages and abilities to reclaim the future for millions. Mark your calendars to participate in Richmond’s 2014 Walk to End Alzheimer’s® Event to help in the fight to end Alzheimer’s.
Richmond Walk Information Date: Saturday, October 18th Location: Innsbrook (Markel Plaza), 4600 Cox Road, Glen Allen, VA 23060 Registration: 8:30 am Ceremony: 9:30 am Walk: 10 am Route Length: One or three mile route options For details on how to donate or register for the Richmond event, visit http://tinyurl.com/kx8g85p For further information about the event, contact Sandy Grady via email at sgrady1@alz.org or at 804.967.2517.
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the
Anatomy CHALLENGE
Here’s your chance to see how much you know about the
amazing EAR! First, find all the hidden words in the word search below. Next, match up the correct word with the part of the body in the illustration.
[ the amazing EAR ]
WORD SEARCH antihelix
incus
cartilage
malleus
cochlea
scapha
cochlear nerve
semicircular canals
concha
stapes
ear canal
temporal bone
eardrum
temporal muscle
earlobe
triangular fossa
eustachian tube
tympanic cavity
helix
vestibular nerve
______________ ______________
______________ ______________
______________ ______________ ______________
______________
______________
______________ ______________
______________ ______________
______________ ______________ ______________ ______________ ______________
______________
______________ www.OurHealthRichmond.com
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aging the
EAR words | LAURA NEFF-HENDERSON, APR
Experts with the Administration on Aging expect that, by 2030, there will be about 72.1 million persons 65 years or older. This will account for more than 19 percent of the population, and will be more than double the number of older Americans than in the year 2000. Although grey thinning hair and deep wrinkles are two of the most commonly talked about signs of getting older, age-related hearing loss is a significant concern for many Americans. Age-related hearing loss, presbycusis, is one of the most common conditions affecting older and elderly adults. Approximately one in three people between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). There is no known single cause of age related hearing loss, according to the National Institutes of Health, and the damage is permanent. Having trouble hearing can make it hard to understand and follow a doctor’s advice, to respond to warnings, and to hear doorbells and alarms. It also makes the most basic interaction with friends and family difficult. Individuals with hearing loss tend to shy away from social activities, including going out to dinner with loved ones. They often report being embarrassed to ask others to repeat themselves and, as a result, remove themselves from the work around them because of it.
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There is a much higher incidence of depression, anxiety, cognitive decline and psychosocial disorders in hearing impaired persons, as well as an increased risk of dementia. “Hearing loss is much more than an inconvenience,” says Melissa Albright, AuD with Virginia Ear Nose & Throat Associates, in Richmond. It affects every aspect of our lives because it interferes with our ability to communicate, work, socialize, maintain personal relationships, and function in the public domain, she explains.
Symptoms Early signs of hearing loss include difficulty understanding certain speech sounds when in the presence of background noise, consistently turning the television to a higher level than other people in the same listening environment, ringing or buzzing in the ear (tinnitus), and the tendency for an individual to ask people to repeat themselves often. In most cases, hearing loss begins gradually, according to Michael Armstrong, Jr., MD, with Richmond Ear, Nose and Throat in Richmond, Va. And, he says, it often goes unnoticed by the patient until a family member or friend has noticed that the person has the volume on the television up very loud, or asks others to repeat themselves often.
Causes The onset of age-related hearing loss begins to affect most people in people in their early 60’s, though it can be seen earlier, particularly if there is a genetic predisposition in the family. “Most adults will have some measurable hearing loss by the age of 60 or 65,” says Dr. Armstrong. Noise and age-related hearing loss usually is most pronounced in the higher frequencies, which make it difficult for the hearing impaired individual to understand women and children’s voices, explains Dr. Armstrong. “Men’s voices are an octave lower and are usually better heard and understood. Patients often complain that the speaker
Individuals, who think they may have a hearing problem, or answer yes to three or more of the following questions, should seek professional advice from an otolaryngologist or an audiologist. • Do you have a problem hearing on the phone? • Do you have trouble hearing when there is noise in the background? • Is it hard to follow a conversation when more than one person is talking at the same time? • Do you have to strain to understand a conversation? • Do people seem to be mumbling when they talk to you? • Do you misunderstand what others are saying? • Do you ask people to repeat themselves often? • Do people complain that you turn the television volume up too high? is mumbling, because the high frequency consonant sounds are often poorly heard, while the low frequency vowels may be normally heard,” says Dr. Armstrong. Individuals who listen to extremely loud music and/or work in certain professions where they are exposed to loud noise for prolong periods of time (factory workers, musicians, construction workers, farmers, chefs, musicians, airport workers, yard and tree care workers, and people in the armed forces) are especially susceptible for sensorineural hearing loss. Michael Armstrong, Jr., MD has practiced otolaryngology and facial plastic surgery in Richmond for nearly 20 years. Dr. Armstrong created Richmond Hearing Aids in July 2009 to provide physician supervised hearing rehabilitation.
“There are many causes of hearing loss, such as hereditary causes, that are beyond our control. However, noise- induced hearing loss is 100 percent preventable,” says Dr. Albright. “Anyone who comes into contact with loud noise (machinery, power tools, gunfire, music, etc.) should wear ear protection without exception,” she explains.
Melissa Albright, AuD is a board certified audiologist. Dr. Albright has practiced with Virginia Ear Nose & Throat for nearly 15 years.
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The Experts
In fact, it’s critical to slowing down the rate at which the patient is losing hearing.
Several different types of professionals are available to help with hearing loss. Each has a different type of training and expertise. A hearing instrument specialist is a state-licensed professional salesperson who is trained to perform hearing tests, take measurements of the ear canal, fit hearing aids, program hearing aids, and make routine repairs. The hearing instrument specialist is not licensed to diagnose or treat any medical illness, and is required by state law to recommend a medical examination by a physician prior to selling a hearing aid. An audiologist is a hearing professional who is trained not only to manage hearing aids but also to perform more detailed examinations of the hearing using sophisticated electronic equipment. The audiologist is also trained to evaluate and test the balance system. All audiologists have a college degree and at least a master’s degree plus one year of clinical training. Recent graduates now complete a four year doctoral program after college. An otolaryngologist, also known as an ear, nose, and throat specialist, is a medical doctor and surgeon trained to provide comprehensive care of the ears nose and throat, including the hearing. The otolaryngologist is the most highly trained physician for diagnosing and treating hearing loss and is the only physician trained to perform surgery in the ear. Many patients with ear complaints, hearing loss or ringing in the ears will be referred to an otolaryngologist for initial evaluation and treatment planning. Most otolaryngologists employ or collaborate with hearing instrument specialists or audiologists to provide the diagnostic testing and programming of hearing aids.
Prolonged exposure to loud noise destroys nerve endings (hair cells), which results in permanent hearing loss. Hearing loss can also be caused by viral or bacterial infections, cardiovascular problems, head injuries, tumors, and certain medications. Other medical issues including diabetes, heart disease, and multiple sclerosis can have a significant impact on hearing as well. More obvious cases of hearing loss include earwax buildup, an object in the ear, injury to the ear or head, ear infection, a ruptured eardrum, and other conditions that affect the middle or inner ear.
Getting Help As with most health conditions, early intervention is the key to a positive prognosis. 24
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Protection against hearing loss begins in childhood,” says Dr. Armstrong. “Babies are screened for hearing loss at birth, before leaving the hospital. Children who are identified with hearing loss should be fitted with hearing aids within the first six months of life and considered for cochlear implantation during the second year of life, if necessary.” He often cautions parents to monitor their children’s use of headphones when listening to music or video gaming. “If you can hear the music from across the room when your child is wearing a headset, it is probably too loud,” he explains. Adults should use caution when working around noisy machinery, including backyard tools. Occupational noise exposure is regulated by the Occupational Safety & Health Administration (OSHA), which requires employers to provide hearing exams and hearing protection to employees who work in environments with sustained high levels of noise. “Proper use of required protective equipment depends upon the worker wearing it,” cautions Dr. Armstrong. He advises his patients to use industrial or hunting earmuffs since they provide the best protection against loud noises, but admits that foam rubber earplugs also provide substantial benefit. In addition to wearing ear protection in noisy environments, one of the most effective ways to mitigate the effects of hearing loss is the use of hearing aids, which can significantly impact a person’s quality of life. Medical professionals can tell pretty quickly via a simple hearing test, also known as an audiogram, whether that’s the case. Finally, explains Dr. Armstrong, people should never put cotton swabs in their ears. “They tend only to pack the wax deeper, making it more difficult to remove,” he says.
Treatment Options Because there is no cure for age-related hearing loss caused by nerve damage, treatment is focused on improving everyday function, and reducing some of the risks associated with hearing loss.
The first line of treatment for hearing loss should be a medical evaluation to determine whether or not the hearing impairment can easily be resolved through medical intervention, according to Dr. Albright. One of the most common options for patients with hearing loss caused by nerve damage to the inner ear is hearing aids. In addition to making it hard to hear, sensorineural hearing loss frequently causes distortion of the sounds that the person does hear. Hearing aids can improve speech understanding by selectively amplifying the frequencies that have been damaged resulting in significantly improved speech quality.
Warning Signs of Hearing Loss in Adults
• Inattentiveness • Buzzing or ringing in their ears • Failure to respond to spoken words • Persistent ear discomfort after exposure to loud noise (regular and constant listening to electronics at high volumes) • Muffled hearing • Constant frustration hearing speech and other sounds • Avoiding conversation • Social isolation • Depression
Nearly all hearing aids used today are digital and are programmed specifically for the individual user, according to Dr. Albright. “Noise reduction algorithms, directional microphones and advanced signal processing strategies are utilized to provide the best possible listening experience,” she explains. “In addition, wireless compatibility allows for direct streaming of Bluetooth enabled devices.” Additionally, advancements in telephone technology utilizing Bluetooth landline and cell phone adaptability to hearing aids have offered an improved approach to improving telephone communication for the hearing impaired. Many local specialists allow patients to evaluate the effectiveness of hearing aids through a trial period, before they actually purchase them. Patients have to be seen regularly for fittings and cleanings. In recent years, hearing aid technology has improved significantly and patients are now able to control a variety of settings that maximize hearing potential. The most basic models begin at about $1,000 for a pair, with the more advanced options topping out at $7,000. They do generally have to be replaced every three to five years; however, some patients are able to wear them for much longer before buying a new pair. While hearing aids are believed to be one of the most effective ways of treating age related hearing loss, there are other options available to people. For individuals with profound hearing loss, for whom hearing aids offer no significant benefit, cochlear implants are an option. Cochlear implants are small electronic devices surgically implanted in the inner ear. Implementation surgery is the very beginning, and often the easiest part, of learning to live with and maximize cochlear www.OurHealthRichmond.com
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The Cardiovascular Connection Recent research reveals a strong connection between hearing loss and cardiovascular health. Studies have shown that a healthy cardiovascular system—a person’s heart, arteries, and veins—has a positive effect on hearing. Experts believe that because the inner ear is extremely sensitive to blood flow, it is sometimes the first area of the body to respond to abnormalities in the cardiovascular system. In one study published in “The Laryngoscope,” researchers found that patients with low-frequency hearing loss should be regarded as at risk for cardiovascular events, and appropriate referrals should be considered.
implants. Patients often undergo years of programming sessions and therapy following the surgery. Assistive listening devices can also help those with hearing loss. Some of these devices include telephone and cell phone amplifiers, smart phones or tablet “apps,” and closed circuit systems in large venues, including places of worship, theaters, and auditoriums. Friends and family can also help by making minor accommodations to make the situation most ideal for the hearing impaired person. To help those with hearing loss, friends and family can speak louder, without shouting, and should speak directly to the person with the hearing impairment. Be sure to make an effort to repeat yourself instead of saying “never mind” when the person doesn’t hear you or understand. It’s also a good idea to turn off the television and/or radio and move away from any other background noise when possible. Avoid sitting near the kitchen at a restaurant or near a band playing music at an event. Even without hearing loss, background noise makes it hard to hear people talk. One of the most common ways that people cope with hearing loss is by learning to read lips and body movement to piece together pieces of the conversation they are unable to hear. It’s nearly impossible for a person with a hearing impairment of any level to understand what’s been said when the speaker talks as they are walking away.
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SCHOOL
TIMES
words |MICHELLE STEPHENSON
Thankfully, schools provide parents with a list of supplies needed for the new school year, but left off that list are steps to ensure a child’s good health. That’s where OurHealth comes in. This step-by-step resource provides parents with valuable physical, emotional and social information to consider, as well as tips from local healthcare and healthcare-related providers from Richmond to help your children make healthy choices all year long.
The First Alarm If you haven’t already done so, this is the perfect time to schedule your child’s check-up or sports physical. These appointments are a great way to ensure that your child is up-to-date on immunizations and is ready to start school. Also, if your child suffers from allergies, asthma, diabetes, or other chronic conditions, make sure to refill all medications so you can check them in with the school nurse before the first day. You may also want to schedule an eye exam so that new glasses and contacts can be ordered and delivered before the first day of school.
Reprints To order reprints of the original
A week or two before the start of school is also a good time to encourage your children to move from their summer schedule, or lack thereof, to a more structured schedule.
artwork featured on this issue’s cover, contact Jenny Hungate at 540.387.6482 or via email at jenny@ourhealthvirginia.com. To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com www.OurHealthRichmond.com
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The pre-participation physical for middle school and high school sports is an important way for the student athlete to be evaluated for any previous injury or congenital malformation that would make them vulnerable to further injury in athletics.
Immunizations have contributed to the improved health of children for more than 50 years and the evidence is clear that vaccines have helped to reduce the number of preventable diseases by more than 90 percent.
— Douglas Cutter, MD, HCA Virginia Sports Medicine
— N. Romesh Wijesooriya, MD, assistant professor and interim chief, general pediatrics, Children’s Hospital of Richmond
One of the most difficult transitions can be moving to an earlier bedtime. A commonly used way is to move children’s bedtime back 15 minutes each night or every other night until they are back on their school-year schedule. For younger children, it can be helpful to write down their morning routine and how long each task should take. They can even start practicing the morning routine before the first day. This helps children become more independent and can free up parents who are trying to get ready for work or get other children ready for school or daycare.
Sports physicals provide an opportunity to promote health and injury prevention to children and teens who do not see the doctor on a routine basis. — Shaw, MD, general pediatrics and sports medicine, Children's Hospital of Richmond
Wake Up! The key to a successful and stress-free morning is to plan ahead. Check the weather on school nights and lay out appropriate clothes for the weather and temperature. Make sure children pack up their backpacks at night, and start thinking about breakfast. Possibly the single most important thing your child can do in the morning is to eat breakfast. Eating breakfast has been associated with better memory, test scores, and attention span, as well as decreased irritability, healthier body weights, and improved overall nutrition. Many families choose to skip breakfast because they don’t have time in the morning. Quick fixes include cereal or a bagel with low-fat cream cheese. Another solution is to make breakfast the night before. For example, hard boil eggs and cut up fruit are ideal options. If there is simply no time to eat breakfast at home, be sure to ask what breakfast options are available at your child’s school or daycare provider, or pack a breakfast for the bus or car ride to school. Good options include fresh fruit, high-fiber unsweetened cereal, nuts, reduced-fat cheese, peanut butter, bagels, pretzels, low-fat granola bars, dried fruit, rice cakes, whole-grain crackers, and cut veggies. 30
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Eating a healthy breakfast fuels our bodies and has been linked to maintaining a healthy body weight. — Ashley Cappel, RD, Healthy Lifestyles Center, Children's Hospital of Richmond
Before leaving the house, make sure your child has a jacket and athletic shoes for physical education. But always make sure tat his or her backpack is not overstuffed. Many children suffer from back pain because they are lugging around too many books and supplies. Physicians and physical therapists recommend that backpacks should not be heavier than 10 percent of a child’s body weight. Also, make sure that your child wears the backpack with both straps in place, rather than over just one shoulder. Children who wear a backpack incorrectly typically lean to one side to offset the extra weight. This can cause back pain as well as shoulder and neck strain.
Reminder to brush 2 minutes...twice a day everyday! — Tegwyn H. Brickhouse, D.D.S., Ph.D., Department chair, associate professor, research director with VCU School of Dentistry and a Pediatric dentist with VCU Dental Care and Children’s Hospital at VCU
Overstuffed backpacks are not the only cause of back pain in children. Poor posture is also a contributor, so encourage your children to sit or stand up straight. Establishing good posture during childhood may prevent back issues later in life.
Strengthening back and core muscles can improve posture and prevent pain from added stress on the back and neck muscles. —Victoria G. Kuester, MD, associate professor, orthopaedic surgery, Children’s Hospital of Richmond
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Do You Know the Rules for Motorists & School Bus Safety? tt TWO LANE: When approaching a school bus with flashing signals and/or extended stop sign on a public or private road, vehicles traveling in both directions must stop
At the Bus Stop Even if your children have been riding the school bus for years, it’s a good idea to revisit bus safety every year before the start of school: • Wait for the bus to come to a complete stop before approaching it. • If there are seatbelts, buckle up. • Stay seated at all times to avoid injury if the driver has to stop or swerve suddenly.
tt MULTI-LANE Paved Across: When approaching a school bus with flashing signals and/or extended stop sign on a public or private road, vehicles traveling in both directions must stop
DIVIDED HIGHWAY unpaved space u (min 5ft.) OR any raised median/ physical barrier: When approaching a school bus with flashing signals and/or extended stop sign on a public or private road, vehicles behind bus MUST stop. Vehicles traveling in the opposite direction proceed with caution.
• If your child has to cross the street to enter or exit the bus, he or she should cross at least 10 feet in front of the bus and look both ways before crossing. Don’t just assume that all drivers will stop. If you have teenagers who are driving to school, remind them to wear their seatbelts, and when it comes to passengers, the fewer, the better. Virginia law says that teenagers who are under 18 and turned 17 after July 1, 2013 may only carry one passenger under age 21, unless accompanied by a licensed parent or other adult acting in place of a parent in the front passenger seat. However, if a teen has had his or her license for a year, he or she may carry up to three passengers under the age of 21 to and from a school-sponsored event. Encourage teens to minimize distractions: phones and other electronic devices, as well as eating and drinking, should not be allowed while driving.
The First Bell In addition to academics, children experience significant social-emotional learning opportunities at school, particularly in their classroom community. Through work and play, they will be building friendships for the school year and beyond. Talk with your children about the importance of being nice to others and developing strong bonds with classmates. Extra steps may be necessary to help quieter children foster connections. Encouraging them to join youth organizations or sports teams creates an opportunity for building friendships.
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These friendships can be great buffers when bad things do happen at school. Responding appropriately to classroom challenges with friends and other peers is important. Talk to your children about the importance of reporting bullying to you and a trusted adult at school if it does occur. Learn the differences between bullying and other forms of aggression so you can help your children learn the differences and respond best to each. Some boys and girls both engage in bullying behaviors towards others and become the target of bullying behaviors. These children are at a much higher risk for disengaging in school and for other negative academic, social, mental, and physical health outcomes. Help your children learn appropriate ways to meet their needs and engage with other students effectively. Returning to school in the fall is for some teens exciting and for others a transition from the sweet summer respite from educational and social pressures to the returning torment of anxiety and bullying — Karen Rice, LCSW, Clinical Supervisor, Outpatient Services at Virginia Home for Boys and Girls
There are three types of bullying: • Physical: hitting, kicking, pushing, etc. • Verbal: threatening, taunting, name-calling • Social: excluding peers from activities or starting rumors about them. (Cyber bullying is often classified as verbal, social, or both verbal and social.) If you find out that your child is engaging in bullying behavior, take it seriously. Get his or her perspective on the event, suggest alternative ways to have needs or desires met, and be clear that bullying behavior is never an acceptable strategy. Use logical consequences, linking the consequence to the aggression when possible. Use nonphysical discipline and remain consistent in your expectations. Model the behaviors you want your child to exhibit at home and at school.
Parents purchase backpacks, notebooks, and pens that our teens need to be prepared for the school year ahead, and usually forget to help them make the non-tangible resources priorities as well, ‘Do you have a trusted teacher at school?’, ‘Do you
know how to handle any confusion with your schedule?,’ or ‘Do you have any worries about this school year?
— Karen Rice, LCSW, Clinical Supervisor, Outpatient Services at Virginia Home for Boys and Girls
The Mid-Morning Stretch Physical education class is a very important part of a student’s schedule. With childhood obesity issues at an all-time high, physical activity, along with a balanced and nutritious diet, are essential to maintaining a healthy weight during the early stages of life. On days that your child has gym, make sure that he or she is wearing comfortable clothes and shoes that fit well and have good support. Physical activity is a key component of a healthy lifestyle and should begin in early childhood. In addition to the health benefits, it promotes psychological well-being, increases self-esteem and capacity for learning, and helps children and adolescents cope with stress. Higherintensity physical activity generally provides more benefits than moderate-intensity physical activity, but any activity is better than none. The U.S. Department of Health and Human Services and the
U.S. Department of Agriculture’s Dietary Guidelines for Americans recommends that children and adolescents engage in at least 60 minutes of moderate to vigorous physical activity on most days of the week, preferably daily.
Rather than “pushing” your child into an activity, try to “pull” them into something by providing a fun, enjoyable environment. Try adding physical activity by creating and participating in functional challenges such as bagging grass clippings and hauling them to the corner of the yard as fast as possible. — Mark Reinke, BS, MAT, ACAC Fitness & Wellness Center Personal Training Director, NSCA Certified Strength and Conditioning Specialist, NASM Corrective Exercise Specialist
The Lunch Whistle If your child buys lunch at one of our local schools, there is typically a good variety of food offerings in appropriate portions. However, if your child usually brings a lunch from home, there are a few keys to making sure that he or she has a healthy lunch. First, avoid caffeinated soda and energy drinks. Research has shown that caffeine increases blood pressure and decreases heart rate in people of all ages. The American Academy of Pediatrics maintains the position that stimulant-containing energy drinks have no place in the diets of children and adolescents. Additionally, make sure to pack a variety of healthy foods. Children between the ages of four and eight should eat/drink the following daily: • 1.5 cups of fruit • 4 to 5 ounces of grains • 2 cups of milk • 1.5 cups of vegetables
• 3 to 4 ounces of meat and beans
Pack a nutritional punch in your child’s school lunch with low fat proteins that will help keep your child full throughout the day. — Ashley Cappel, RD, Healthy Lifestyles Center, Children's Hospital of Richmond
• 4 tsp of oils
Girls between the ages of nine and 13 should consume: • 1.5 cups of fruit • 5 ounces of grains • 3 cups of milk • 2 cups of vegetables
• 5 ounces of meat and beans
• 5 tsp of oils
Boys between the ages of nine and 13 should consume: • 1.5 cups of fruit • 6 ounces of grains • 3 cups of milk • 2.5 cups of vegetables
• 5 ounces of meat and beans
• 5 tsp of oils
Girls between the ages of 14 and 18 should consume: • 1.5 cups of fruit • 6 ounces of grains • 3 cups of milk • 2.5 cups of vegetables
• 5 ounces of meat and beans
• 5 tsp of oils
Boys between the ages of 14 and 18 should consume: • 2 cups of fruit • 7 ounces of grains • 3 cups of milk • 3 cups of vegetables
• 6 ounces of meat and beans
• 6 tsp of oils
This equates to 1,000 calories per day for children aged 2 to 3 years, 1,400 calories a day for children aged 4 to 8, 1,600 calories for girls aged 9 to 13, 1,800 calories for boys aged 9 to 13 and for girls aged 14 to 18, and 2,200 calories for boys aged 14 to 18. It is important to note that active children may require more calories. To keep caloric intake in check, encourage your child to eat slowly. People who eat quickly typically take longer to feel full, and they often have no idea how much they have actually eaten. Children need to eat slowly enough to give their brain the chance to recognize that they have eaten enough to no longer feel hungry. Slowing down and chewing food more thoroughly also makes food more enjoyable. www.OurHealthRichmond.com
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Children should be encouraged to drink plenty of water. Half of kids’ body weight is made up of water, so water is required to keep bodily systems functioning properly. It’s a good idea to offer water throughout the day and not just when they are thirsty. Children should be encouraged to drink more than usual when it’s hot or when they are taking part in physical activity. Fruits and vegetables are also excellent sources of water.
Fuel your mind and body for success by stressing healthy snack-packing ideas.
— Frances Elwood, clinical dietician, Chippenham and Johnston-Willis Hospitals
School’s out! Many Richmond families have two working parents, so after-school care can be a challenge. There is no hard and fast rule on when children are old enough to be left home alone after school, and children mature at very different rates, so parents need to make this call. One consideration may be how long the child will be home alone before a parent or older sibling arrives home. As a rule of thumb, most children are not able to handle stressful or emergency situations until they are about 11 or 12 years old. If you are considering leaving your child alone for a few hours after school, make sure that he or she is prepared for knocks on the door, emergency situations, and injuries. Richmond-area YMCAs offer babysitting courses that can help prepare children to stay home alone. How do you know if your child is ready? Consider the following: • A child who is home alone needs to know his or her full name, address, and phone number as well as how to reach you. You might consider having him or her call you once inside the house each day so that you will know that he or she has arrived home safely. Children also appreciate the security of knowing that they will be able to talk to you when they get home from school. • Establish a routine so that he or she knows what to do during the time he or she is alone. Do you expect that homework and/or chores will be done before you arrive home? • Make sure your child knows how to lock the door when he or she arrives home and that it should be kept locked. • Is there a neighbor nearby that he or she could check in with if needed? • Does your child know never to enter your home if a door or window is open or broken?
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• Explain what to do if someone knocks on the door (tell the person knocking that you are busy and are unable to come to the door, not that you are not home). Whether a parent is home or not, make sure to have healthy snacks on hand in the afternoon, and make sure your child has a designated homework space. This space should be quiet and distraction-free with comfortable seating and good lighting.
Family Time Set a family atmosphere that is informative and respectful -- always encourage your children and teens to talk about their concerns. — Stephanie Crewe, MD, MPH, assistant professor, Adolescent Medicine, Children's Hospital of Richmond
Family time on school nights typically revolves around preparing and eating dinner, although many families are unable to have meals as a family due to children’s extracurricular activities or parents’ job schedules. Even though it can be challenging, try to have as many meals together as a family as possible. During family meals, turn the TV off, and don’t allow electronics at the table. In addition to the relationship benefits of family meals, research has shown children eat more fruits and vegetables and fewer fried foods and sugary drinks when they eat with the entire family.
Wind Down While some children focus best on homework right after school, other children are better able to focus after dinner. Some parents choose a specific time for children to start homework (by 4 pm), while others give guidelines (no video games or TV watching until homework is complete). After dinner is also a great time for families to read together. This can further nurture your child’s love of reading and help him or her wind down for bedtime. The importance of sleep cannot be overstated. Well-rested children are more focused, and poor sleep habits can also increase the risk of obesity. According to the Centers for Disease Control and Prevention, school-aged children require at least 10 hours of sleep each night, and teens require 9 to 10 hours a night.
If sleep debt becomes too great, it causes sleepiness and can negatively affect performance, concentration, reaction time, memory, mood, and behavior control. A teen’s physical growth can even be affected by a chronic lack of sleep, since growth hormone is most active during sleep. — Sleep Centers at HCA Virginia Parham and Chippenham
24/7 Be Aware In addition to bullying, children can also be introduced to drugs, alcohol, violence, and sex at school. Unfortunately, although safer than most, Richmond schools are no exception. Most parents of teenagers are concerned about the use of tobacco, alcohol, and drugs in this student population, because there is tremendous peer pressure to experiment with these substances during high school, and even middle school. Parents should take steps to ensure that teens are aware of the dangers involved with their use. For example, smoking often becomes more than a high school habit. In fact, it can turn into a lifelong addiction that can be extremely difficult to break. When talking to your teen about smoking, emphasize the more undesirable effects, including bad breath, stained teeth, wrinkles, a long-term cough, and decreased athletic performance. Other forms of tobacco, such as chew or snuff, can also lead to nicotine addiction and cause the same health problems as smoking cigarettes, with the addition of mouth sores. Alcohol is the most socially accepted drug in our society, and even small amounts can impair judgment and provoke risky and violent behavior. Drinking can also slow reaction time, and many teenagers are unaware that alcohol use can have deadly consequences. Inform your teen that alcohol-related car crashes are the leading cause of death for those aged 15 to 24 years. Another concern of parents is teenage sex. Even more concerning is unprotected teenage sex. Encourage abstinence, and encourage your teen to avoid situations that can lead to sexual activity. Choosing not to use alcohol or drugs can help your teen make clearer choices about sex. If you know that your teen is having sex, it is important for him or her to know the facts about birth control and sexually transmitted diseases. Encourage the use of condoms; however, remind them that only abstinence is 100% effective in preventing disease and pregnancy. Although Richmond elementary, middle- and high-schools have not seen a major act of violence, such as a deadly school shooting, students have occasionally been known to fight and to bring weapons to school. While it is difficult to pinpoint exactly which children will engage in violence at school, there are some risk factors: • A prior history of violence • Drug and/or alcohol abuse • Association with delinquent peers • Poor family functioning • Poor grades in school • Poverty in the community. The keys to a successful school year are encouraging your children to make healthy choices and maintaining open communication with them. A little planning can ease the transition back and can provide a stress-free first day for kids and parents alike. Sources:
www.aap.org www.cdc.gov www.dmv.virginia.gov
www.healthychildren.org www.kidshealth.org www.pediatriccareonline.org
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The structure inherent in returning to school brings out all sorts of issues that have gone unnoticed or unaddressed during the summer. — Martin Buxton, M.D., Chief of Psychiatry at Chippenham and Johnston-Willis Hospitals and medical director of Tucker Pavilion
FITBITS
H EA LT H A ND F I T NES S O N T H E G O
A Right to 'Bare Arms'
Get ready to show off your shapely and toned arms! Here are three exercises that will target the muscles of the upper arms and shoulders to give you that well-defined look! For optimum results, perform three sets of 8-12 repetitions of the following exercises three - five times per week.
#1. Bicep Curl 1. Stand in an upright position with your knees slightly bent. Contract your abdominal muscles to support your back and relax your shoulders. 2. Grasp the dumbbells with an underhand grip, palms facing up. Fully extend your arms, keeping them tight against your sides. Your elbows must be loose and not locked. 3. Lift the weights slowly until your hands reach your shoulders. Your arms should be the only muscles working during the exercise. At the top of the motion, contract your bicep muscles. Keep your abdominals tight and shoulders relaxed during the exercise. 4. Lower the dumbbells back to your starting position, arms extended and elbows loose. Repeat the exercise for a desired number of repetitions and sets.
#3. Upright Shoulder Row with Fitness Tubing 1. Step on the tube with both feet, holding one handle in each hand. 2. Cross the tubing to form an X shape. Palms should face your legs. 3. Raise your elbows toward the ceiling, pulling on the tube.
#2. Tricep Kickback 1. Grab a dumbbell in one hand and put the other hand on your knee. 2. Point your elbow as high as you can towards the ceiling while leaving the dumbell hanging by your side.
4. Keeping your wrists in a neutral position and raise to shoulder height. 5. Slowly lower to starting position and repeat for desired number of repetitions.
3. Slowly extend your arm until it is as straight as it will go. (DO NOT change the position of your elbow!) 4. Pause for a second, then lower back to starting position. 5. Repeat steps 3 and 4 for desired reps 6. Your upper arm and elbow should not move at all during the entire set. This is very important in order to target the tricep muscle.
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Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer Deidre is a certified personal trainer with more than 15 years experience in the health and fitness industry. She is the resident fitness specialist for OurHealth.
Local health. Anywhere you go. OurHealth magazine is Richmond’s only resource entirely dedicated to delivering information about local healthcare services and healthy living topics. Pick up our print edition at more than 900 locations throughout Richmond or get the digital edition by visiting www.ourhealthrichmond.com.
Breaking the Silence
Alzheimer’s Disease words | SUSAN DUBUQUE
This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them. That is, until now. In each edition of OurHealth, we bring these diseases into the light—and dedicate these stories to the courageous patients and families living with them and the providers and researchers who commit their lives to treating and seeking cures for these silent killers.
He was a strong and vibrant man—74 years old and still working full time as a regional sales executive. The changes started slowly, with small things. A forgotten name. A bit of confusion. A little difficulty following conversations. But gradually, Jerry Villano’s memory loss became more apparent and more alarming.
“The tipping point occurred the day we had our carpets cleaned,” recalls Jerry’s wife, Becky Barney-Villano. “Before he left the house to run some errands, Jerry had a very pleasant 20-minute conversation with the carpet cleaner. When he came home later in the day, Jerry asked me if the carpet man had come yet. I was dumbstruck. But most of all I was scared to death.”
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"...we are very grateful for every day we share, for every memory we create and hold dear" says Becky, with husband Jerry.
What is dementia? Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia.
Becky immediately made an appointment for her husband to see his personal physician. And on January 9, 2009, based on a mini-mental status exam, the doctor diagnosed Jerry with mild dementia. Jerry’s doctor prescribed Aricept®, a medication used to improve memory and cognitive function associated with Alzheimer’s disease. “The doctor also suggested that Jerry do brain exercises to keep his mind alert. We were heartsick,” says Becky, “but determined to fight this in every way we could.” Becky and Jerry began attending an Alzheimer’s support group—seeking information, guidance and, most of all, the comfort and solace of other families coping with the same issues. It was through these contacts that they realized that Jerry had not received a thorough evaluation. In fact, his diagnosis was based entirely on a 30-question screening tool. So the next stop in their journey was further testing. Jerry was given a comprehensive evaluation by a team of specialists. This included a complete physical, blood work, an MRI, a neurological examination and in-depth interviews with Becky and Jerry. “The most startling part of the evaluation was the brain scan,” says Becky. “I could see it right there on the screen—part of the brain was atrophied. It suddenly became crystal clear—Jerry’s really not doing these things to annoy me. There is an organic reason for his behavior.” As a result of the assessment, Jerry’s diagnosis was revised to mild cognitive impairment (MCI). “This new diagnosis gave us some hope,” recalls Becky. “We were told that MCI can increase Jerry’s risk of later progressing into Alzheimer’s disease. But some people never get worse, and a few eventually get better.” Becky and Jerry are determined to be among the group that “gets better” and they are making progress in that direction. Jerry continues taking medication—including two classes of drugs used for Alzheimer’s disease. Becky encourages him to exercise, and Jerry now plays golf once a week and works out with a personal trainer twice a week. He regularly
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engages in activities to stimulate his brain. And through the support group, the couple enjoys socializing with many close friends. “It’s wonderful to spend time with people who understand what we’re going through and never judge,” says Becky. Becky offers the following advice to other families facing this challenge: • At the very first sign of memory or cognitive problems, get help. Have a complete evaluation by a highly trained specialist. • Alzheimer’s is not a simple disease—and you have to tackle it from many directions—medication, physical and mental exercise, diet and a strong social network. • If you are the caregiver, don’t forget to take care of yourself. When you are caring for an Alzheimer’s patient, everything in your life changes. Ask for help. Take time for yourself. Renew and refresh. You can’t take care of anyone if you are sick or exhausted. “Alzheimer’s is a cruel disease,” reflects Becky. “It robs you of your past, your present and your hope for the future. Jerry and I feel blessed that he has stabilized and even improved, thanks to all the right interventions. And we are very grateful for every day we share. For every memory we create and hold dear.” It’s time to stop whispering about Alzheimer’s disease. Let’s have a frank and open conversation about this disorder—the nature of the disease, risk factors, current treatments and what the future holds.
What is Mild Cognitive Impairment? Mild cognitive impairment (MCI) is an intermediate stage between the expected cognitive decline of normal aging and the more serious
Understanding Alzheimer’s Disease We’ll start with the most basic question: What is Alzheimer’s disease? Alzheimer’s is an irreversible, progressive brain disease that results in loss of memory, language, intellectual functioning, judgment and complex motor skills, as well as behavioral, mood and personality changes. The symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. An estimated 5.1 million Americans are afflicted with this disease, including about a half million who are under the age of 65 (called early onset).
decline of dementia. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes.
Alzheimer’s disease is the most common cause of dementia among people age 65 and older and accounts for about 60 percent of all dementias. Dementia is not a specific disease—rather it describes a group of symptoms that are associated with decline in mental ability. According to James Bennett, MD, PhD, department of neurology at VCU Medical Center, “There are various forms of dementia including vascular dementia, alcoholism dementia, dementia from repeated head trauma, dementia with Lewy bodies and frontotemporal dementia, among others.” Alzheimer’s-type symptoms can be caused by various medical conditions from thyroid disorders and vitamin deficiencies to medication reactions. Most people with Parkinson’s disease will develop dementia as a late-stage complication.” “It is still not clear how the Alzheimer’s disease process begins, but it is likely that damage to the brain starts a decade or more before symptoms become apparent,” says Jonathan Bekenstein, MD, PhD, a neurologist at VCU Medical Center. www.OurHealthRichmond.com
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During this preclinical phase, toxic changes are taking place in the brain. “Sticky clumps of protein called beta-amyloid plaques begin to form outside and around the brain’s nerve cells. And twisted fibers called neurofibrillary tangles—composed largely of the protein tau—build up inside nerve cells.” Although tangles and plaques are hallmarks of the disease, researchers are unsure if they cause it or are a byproduct of it. Scientists have known about plaques and tangles since 1906, when a German physician, Dr. Alois Alzheimer, identified these abnormalities in the brain tissue of a 51-year-old woman who died from an unusual mental illness that involved memory loss, language problems and unpredictable behavior. As Alzheimer’s disease progresses, nerve cells— called neurons—in several areas of the brain shrink and die, including cells that normally produce neurotransmitters, the chemical messengers that relay brain signals from one neuron to another. Acetylcholine is a neurotransmitter that is deficient in people with Alzheimer’s. As nerve cells continue to die, the brain itself shrinks and the wrinkles along its surface become smoother.
Risk Factors and Causes of Alzheimer’s Disease Like all types of dementia, Alzheimer’s disease is caused by brain cell death. “But the exact cause is still unknown,” observes Dr. Bennett. “The disease may be triggered by a variety of factors including age, genetics, serious head injury, brain inflammation, environmental factors and damage to neurons from overproduction of toxic free radicals.” Alzheimer’s is not a normal part of growing older, however the greatest risk factor for the disease is increasing age. The risk of Alzheimer’s doubles every five years after age 65, and reaches nearly 50 percent after age 85. Family history is another Alzheimer’s risk factor. Research has shown that individuals who have a parent, sibling or child with Alzheimer’s disease are more likely to develop the disease and the risk increases if more than one family member has the illness. Alzheimer’s disease that clearly runs in families is called Familial Alzheimer’s disease (FAD) and accounts for less than five percent of all cases. FAD usually occurs between the ages of 30 and 60. In 48
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recent years, scientists have zeroed in on three gene mutations that cause earlyonset Alzheimer’s. Other studies suggest that specific genes may increase an individual’s risk for developing late-onset Alzheimer’s but do not definitely signal that the person will develop the disease.
Warning Signs of Alzheimer’s Disease Alzheimer’s disease appears differently in every case, but there are a number of common warning signs that prompt patients and family members to seek medical assessment. The most prominent complaint is memory loss, particularly the inability to recall names, recent events, new information and the placement of objects. Here are other indications that may indicate Alzheimer’s disease: • Confusion about time and place • Struggling to complete familiar actions such as brushing teeth, getting dressed and other daily activities • Trouble finding appropriate words, completing sentences, following directions and conversations • Poor judgment when making decisions • Changes in mood and personality, such as increased suspicion, rapid and persistent mood swings, withdrawal and disinterest in usual activities • Difficulty with complex mental tasks, such as balancing a checkbook Source: Alzheimer’s Foundation of America
How is Alzheimer’s Disease Diagnosed? There is no simple screening test for Alzheimer’s disease and a number of medical conditions can cause dementia—some of which are temporary or reversible with proper treatment. Therefore, it is important to have clinical evaluation by a highly trained physician in order to arrive at an accurate diagnosis. A comprehensive evaluation for Alzheimer’s disease when performed by an experienced clinician is about 90 percent accurate and typically includes the following:
Becky offers the following advice to other families facing this challenge: • At the very first sign of memory or cognitive problems, get help. Have a complete evaluation by a highly trained specialist. • Alzheimer’s is not a simple disease—and you have to tackle it from many directions—medication, physical and mental exercise, diet and a strong social network. • If you are the caregiver, don’t forget to take care of yourself. When you are caring for an Alzheimer’s patient, everything in your life changes. Ask for help. Take time for yourself. Renew and refresh. You can’t take care of anyone if you are sick or exhausted.
A detailed medical and social history. Past medical records and information provided by the patient or a family member will help identify or rule out other possible causes for symptoms. The physician will ask about the patient’s ability to carry out daily activities and any changes in behavior or personality. Family history of Alzheimer’s disease will be considered and special attention will be paid to the onset of the patient’s symptoms. The symptoms of Alzheimer’s disease typically appear gradually and become more persistent over time. A medication inventory. A complete list of prescription and over-the-counter medications will be reviewed to determine if a particular drug or drug interaction may be causing dementia. A urine screen may be used to detect the presence of some drugs. www.OurHealthRichmond.com
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A history of substance abuse or misuse. Chronic drug or alcohol abuse can cause cognitive and memory impairment. A complete physical examination. A thorough physical examination is essential since disease in many organ systems may lead to dementia. Special emphasis and attention is given to the neurological evaluation. A mental status examination. Mental status includes an evaluation of attention, orientation, short- and long-term memory, language ability, thought processes, judgment and more.
The
2014 Walk to
END Alzheimer’s® The Alzheimer’s Association Walk to End Alzheimer’s® is the world’s largest event to raise awareness and funds for Alzheimer’s care, support and research. Held annually in more than 650 communities nationwide – including Richmond – this inspiring event calls on participants of all ages and abilities to reclaim the future for millions. Mark your calendars to participate in Richmond’s 2014 Walk to End Alzheimer’s® Event to help in the fight.
Richmond Walk Date: Saturday, October 18th For additional details see healthPoints on Page 17.
Laboratory tests and screenings. A variety of tests may be ordered including a complete blood cell count, electrolyte panel, screening metabolic panel, thyroid gland function tests, vitamin B-12 and folate levels, urinalysis and tests for syphilis. Depending on the patient’s history, tests may be requested for human immunodeficiency antibodies, an electrocardiogram (ECG), chest x-ray, brain MRI scan and an electroencephalogram (EEG). A lumbar puncture may also be performed. Psychiatric assessment. The effects of emotional problems must also be taken into account when evaluating a patient for Alzheimer’s disease. Stress, depression or anxiety—as well as adjusting to a major life change such as the death of a spouse— can cause confusion and forgetfulness that may be mistaken for dementia. To further confound matters, depression may be present with Alzheimer’s disease and other forms of dementia. NOTE: Criteria for evaluation established by the National Institute of Neurological and Communicative Disorders and the Alzheimer’s Disease and Related Disorders Association Work Group.
Treatments for Alzheimer’s Disease At this time there is no cure for Alzheimer’s disease but researchers are continually testing various new treatments and combinations of drug therapies to control symptoms, slow the progression of the disease and improve the quality of life. The U.S. Food and Drug Administration (FDA) has approved a number of medications that offer some relief to patients with varying degrees of impairment. “The prescription medications used treat Alzheimer’s symptoms in early to moderate stages are a class of drugs called cholinesterase inhibitors—which treat symptoms related to memory, thinking, language, judgment and other thought processes,” explains Dr. Bekenstein. “These medications work by preventing the breakdown of acetylcholine—the neurotransmitter or chemical messenger important for learning and memory.” They delay the worsening of symptoms for six to 12 months for about half the people who take them. A second type of medication called memantine is used to treat moderate to severe Alzheimer’s. Memantine is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks by regulating the activity of glutamate, a different messenger chemical involved in learning and memory. Some patients also benefit from psychiatric care—including treatment for depression, paranoia and hallucinations—and behavioral management interventions. “Alzheimer’s disease and other forms of dementia affect more than just the patient,” observes Dr. Bekenstein. “Education, counseling, support and respite care are vital to family members and caregivers.”
Prognosis of Alzheimer’s Disease Not every Alzheimer’s patient experiences the same symptoms or at the same rate, but the disease tends to advance through the following general stages: During the mild stage of Alzheimer’s disease, memory loss worsens and changes in other cognitive abilities become apparent. Typical problems include getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, using poor judgment, and some mood and personality changes. People often are diagnosed in this stage. As the disease advances to a moderate stage, damage occurs in areas of the brain that control language, reasoning, sensory processing and conscious thought. Memory loss and confusion grow worse, and people begin to have problems recognizing family and friends and may have difficulty carrying out tasks that involve multiple steps such as getting dressed. They may experience hallucinations, delusions and paranoia and may behave impulsively. By the final severe stage, plaques and tangles have spread throughout the brain and brain tissue has shrunk significantly. Individuals need help with even the most basic tasks including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. In the later stages, Alzheimer’s disease damages parts of the brain that control breathing, swallowing and the ability of the body to fight off infections—the majority of Alzheimer’s diseaserelated deaths are due to infections such as pneumonia. The average life expectancy for someone with Alzheimer’s is eight to 10 years after the onset of symptoms. However, individuals with Alzheimer’s have been known to live up to 20 years after the first signs appear.
Implications In light of the aging population, Alzheimer’s disease will impact a greater percentage of Americans. “This is truly a public health crisis in the making,” says Dr. Bennett. By the year 2050, the number of people age 65 and older will more than double to 88.5 million—and those 85 and older will increase three-fold to 19 million. “Right now, we’re spending $220 billion a year for medical treatment and care for dementia patients. In 20 years we expect that number to increase to $550 billion—exceeding our nation’s defense budget.” The critical importance of conquering Alzheimer’s disease is widely recognized. In May 2012, the U.S. Department of Health and Human Services released the National Plan to Address Alzheimer’s Disease, which calls for preventing and effective treatment of Alzheimer’s disease by 2025.
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What Does the Future Hold? In the past, a definitive diagnosis of Alzheimer’s disease—seeing the tangles, plaques and deterioration of nerve cells—was only possible through examination of the brain after death. “Now, brain imaging studies offer promise for more accurate diagnosis and the early detection of Alzheimer’s disease,” remarks Dr. Bennett. Here are a few examples: • A positron emission tomography with fluorodeoxyglucose (FDG-PET)—involves injecting the patient with a radioactive tracer and then using a PET scan to determine how glucose—or sugar—is being metabolized in the brain. The brain uses sugar as fuel and when certain areas of the brain are not able to utilize glucose, this is consistent with Alzheimer’s disease. • PET scanning can be used with a tracer that reveals amyloid plaques. This tracer was developed by two researchers from the University of Pittsburgh and is commonly called Pittsburgh compound. The FDA has approved other amyloid imaging agents for PET scans. • An MRI can show evidence of brain atrophy associated with Alzheimer’s disease and additional causes of dementia, such as disease of small blood vessels in the brain. • Studies presented at the Alzheimer’s Association International Conference suggest that earlier signs of Alzheimer’s disease may be evident in the eyes and nose. The beta-amyloid plaques that accumulate in the brain of Alzheimer’s patients also can build up in the eye and can been seen in the retina when the plaque is “stained” with curcumin, a component of the spice turmeric. A laser can also be used to detect the beta-amyloid in the lens of the eye. Other studies are evaluating the possibility of using a smell test for Alzheimer’s. James P. Bennett Jr., MD, PhD, Director, VCU Parkinson’s Disease Center, and Bemiss Professor, VCU Department of Neurology
There are many innovative research efforts related to Alzheimer’s disease and dementia taking place around the country and around the world. Dr. Bennett says, “One study taking place is identifying certain proteins in the spinal fluid of Alzheimer’s patients that are present 15 to 20 years before symptoms appear. Another is looking at specific lipid levels—or fats—that are elevated in the blood of Alzheimer’s patients.” This type of research will lead to earlier diagnoses, more effective treatments and, dare we hope, ultimately a means of curing and preventing Alzheimer’s disease.
Jonathan W. Bekenstein, MD, PhD, Neurology, VCU Medical Center
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Alzheimer’s Disease:
Arm Yourself with Knowledge words | SUSAN DUBUQUE
Take Charge: Protect Your Brain The best way to prevent most lifethreatening diseases is to pick your parents carefully. Unfortunately, only a fraction of Alzheimer’s disease cases have direct genetic causes. But there are lifestyle changes—choices you can make—to reduce your risk for Alzheimer’s disease and help you maintain mental acuity. And every one of them is grandmother approved. “The same things you should do to reduce your risk of heart disease, cancer and diabetes also offers a degree of protection from Alzheimer’s disease and dementia,” notes Dr. Bennett. Eat a healthy diet. “There is a growing body of research that shows the value of the Mediterranean diet in reducing risk for Alzheimer’s disease and maintaining cognitive performance,” says Dr. Bennett. The Mediterranean diet is based on eating plenty of vegetables, fruits, legumes, fish and cereals; high intake of unsaturated fats (specifically olive oil) and low intake of saturated fats; and moderate amounts of dairy, meat and poultry. Even making simple changes to your diet can have a positive effect. Here are a few ideas: • Reduce the packaged, processed and “fast” foods you eat • Shop around the outer aisles of the grocery store—this is where you will find the fresh produce, meats, fish, eggs and dairy • Try out your local farmer’s market • Stay away from “white” foods—such as white bread, pasta, sugar and potatoes
Maintain your weight. Some researchers actually refer to Alzheimer’s disease as “type 3 diabetes” because of its strong link to obesity, which elevates brain proteins that are linked to the development of the disease. Further, brain imaging has shown that people with obesity have smaller brain volumes, which increases the risk for Alzheimer’s. Exercise your body. “Moderate exercise clearly has a positive impact on cognitive function and memory among older adults,” states Dr. Bekenstein.“It actually increases the size of the parts of the brain that shrink with age. So find something you enjoy doing—biking, running, swimming, tennis, brisk walking—and do it regularly.” Get that heart beat up and your blood pumping. The benefits of movement are cumulative throughout the day—so take the stairs and park your car at the far end of the lot and walk a little farther. And it’s never too late. A Finnish study found that Alzheimer’s disease patients who engaged in 30 minutes of exercise three times a week experienced a slower rate of cognitive decline than those who did not. Exercise your brain. Increasing evidence suggests brain workouts play a role in maintaining cognitive health. “While mental exercise won’t prevent Alzheimer’s disease,” clarifies Dr. Bekenstein, “it can delay its onset.” So flex those neurons by reading, Sudoku, word games. Stretch those brain cells by learning something new—like a foreign language or musical instrument. Do math in your head. Stimulate your taste buds by using new herbs and spices. Refine your hand-eye abilities with knitting, drawing, painting and assembling puzzles. Engage your senses
by taking in the world around you. As a side benefit, all these things will make you a more interesting person to be around—and social contact has also been found to support good cognitive health and lowered rates of depression. Manage your health. Work with your healthcare provider to keep your blood pressure, cholesterol and glucose under control. And consider taking a daily vitamin B—which has been shown to reduce brain shrinkage associated with Alzheimer’s disease by lowering levels of the amino acid homocysteine. But always check with your physician before taking supplements.
Expert Contributors: • James P. Bennett, Jr., MD, PhD, Neurology, VCU Medical Center • Jonathan W. Bekenstein, MD, PhD, Neurology, VCU Medical Center
Sources: • Alzheimer’s Association • Alzheimer’s Foundation of America • National Academy of Sciences • National Institute on Aging • National Institutes of Health • National Institute of Neurological Disorders and Stroke
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heather's words | RICK PIESTER
story She did it to save her marriage.
You would think that Heather Parke had it all: the attractive youngest daughter of a wealthy family, who graduated second in her high school class. A master’s degree in accounting. Owner of one of the most successful restaurants in her small West Virginia town of Buckhannon. Married and the mother of two young daughters. Expansive 5,000-square-foot home. The works. But she also had major problems. Her marriage was in trouble, in part because of her husband’s growing abuse of the drug OxyContin. A highly addictive painkiller, it’s the drug of choice in West Virginia, where death by drug overdose surpasses fatalities from auto accidents. West Virginia leads the country in fatal drug overdoses, and Oxycontin — nicknamed “hillbilly heroin” — is king. It’s one of the most abused prescription drugs available today. Within the West Virginia drug culture, a common way of using OxyContin is by heating the pills over a flame and inhaling the fumes. “I became obsessed with my marital problems,” she says now. “At that point, I would have done anything to keep my husband.” To mark their anniversary in September 2010, desperate to salvage her marriage, she suggested to her then-husband that they smoke OxyContin together. “It took some convincing,” she remembers, “but he finally agreed.”
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“I loved it the minute I did it,” she continues. “It was almost like being drunk, but there was a calmness to it. There was no feeling. I wasn’t worried about anything anymore. There were no problems. It was just calm.” That’s a common refrain among abusers of the drug. OxyContin is a synthetic drug that contains the painkiller oxycodone, similar to morphine. It is one of a class of drugs that science calls opiods, or— slightly less accurate, but more common—opiates. No matter what it’s called, it’s one of the most addictive, most abused, and more expensive drugs available. Poor people do not turn to drugs like OxyContin. “That first time, we smoked maybe 2 or 3 pills. And then I started looking forward to him coming home from the restaurant every night and that’s what we would do. And then I started going to the restaurant during the day and we would sit in his truck and smoke.” Their lifestyle made it easy to use drugs. The kids were in day care. They had access to a lot of money. And before long — perhaps three months, Heather estimates —up to $1,500 in OxyContin went up in smoke each and every day, over a period of about three years. You can do the math. Heather and her older sister Lisa tell of the family dinner one Thanksgiving when Heather’s husband (now ex-husband) took a call from their dealer, who had a fresh supply of OxyContin. They left the Thanksgiving table to go make a buy. “He left to get the pills,” she says now. “And I left because I needed one.” The money came from the restaurant. Even on a slow day, it would gross $3,000. Heather, who kept the books for the restaurant, eventually stopped paying the bills, taxes included. The party was on. Actually, the party only lasted about six months, and then the restaurant closed. “After the restaurant closed, there was no money coming in to buy pills. There was a tiny bit of pleasure in getting the pills, but then you start seeing your supply dwindling, and you start having to think how you’re going to get the money to get more pills.” Heather started pawning her belongings — her husbands guns, her jewelry, “anything,” she says “that wasn’t bolted down that was worth any amount of money.” When that was gone, Heather turned to her father’s extensive gun collection, and then to some of her mother’s jewelry. Everything was pawned, and her father routinely spent thousands to get it all back from the pawnshop. Doing it this way, he felt, was better than having her steal from people outside the family. She burned through $30,000 that her parents had salted away for her two daughters’ college educations. The family tried intervention. They tried talking to her. They tried drug testing her periodically, but she would put her daughter’s urine in the sample bottle, rather than her own. “There was a long time when we didn’t 56
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believe anything Heather said,” according to Lisa. Heather agrees: “Everything I said was a lie. You can’t maintain that lifestyle and tell the truth.” “My dad bought a gun safe one day, and the cash flow stopped,” Heather says. “He kept saying that it was rehab or jail, rehab or jail,” Heather says. “On one level, I knew that jail was definitely down the road for me.” But Heather had a Plan B. She had heard — from one of her drug dealers, of all people — of a place called the Coleman Institute in Richmond: “Although the dealer didn’t stay in rehab, she told me that she had never felt better than the time she spent under their care. And I had that in the back of my mind — that one day, if I really had to quit, I just kind of knew that I could go there.”
The Coleman Institute The Coleman Institute (www.thecolemaninstitute.com) is the creation of Peter R. Coleman, MD, who also maintains a family medical practice in Richmond and is himself a recovering addict, clean and sober since 1984. The Richmond location is the headquarters for eight similar practices scattered throughout the US, each of them operated by independent physicians who have strong interests in helping people recover from addictions.
The Coleman Institute, Advanced Center for Addiction Treatment in Richmond
The Institute has made a specialty of what it calls “accelerated detoxification”, a way to flush narcotics from the brain and body without the hellish physical symptoms of unaided withdrawal. Detoxification is the first step in recovery from drug addiction, followed by what professionals call aftercare, most often a tailored process to give recovering addicts the skills that they need to help them deal with cravings for alcohol or drugs, and to help them recognize and avoid the triggers that set off cravings. The opiate detoxification process at the Coleman Institute claims a 99 percent success rate, much higher than other approaches to “detox,” and it’s followed by implants of Naltrexone, a non-narcotic medication that blocks off the receptors in the brain that are the usual targets of narcotics. Dr. Coleman explains that the human brain is equipped with cells that function as receptors for endorphins, which are chemicals produced naturally by the body in response to stimuli — pleasure, pain, fear, and the like. Common pleasurable feelings produced by endorphins include a runner’s high, satisfaction after having a good meal, and more. But opiate drugs such as OxyContin also go to the endorphin receptors, and these drugs turn the pleasure switch on so strongly that the abuser feels an overwhelming sense of calm, energy, and euphoria. The drugs also shut down the body’s production of natural endorphins. Without the natural endorphins, an abuser has to use drugs just to feel normal and to avoid the terrible experience of withdrawal.
Peter R. Coleman, MD, is the founder of The Coleman Institute, and also maintains a family medical practice in Richmond www.OurHealthRichmond.com
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Patient detoxification and procedure room
“So the first thing we have to do is to get the drugs out of the brain,” Dr. Coleman says. “And for the past dozen years or so, we have been using a pretty amazing way to get people detoxified safely and comfortably, on an outpatient basis, usually over 3 days.” The Institute staff asks that patients stop using the day before they start their treatment, so that patients are in a mild form of withdrawal when they arrive. Patients receive medications to make them comfortable while the drugs are being flushed out of their bodies over what is normally a three-day period. On the final day of their outpatient treatment, patients receive an implant of the opiate-blocking drug naltrexone, which is placed under the skin in the area Medical staff at The Coleman Institute, from left: Daniel Jannuzzi, MD, Peter Coleman, MD, of the stomach. Naltrexone is a non-addictive drug Joan Shepherd, FNP and Courtney Harden, FNP that blocks the effects of dangerous opiate drugs. The Coleman staff prefers to use implanted pellets of the drug, which is released into the system over a 6-12-week period, and eliminates the need for patients to remember to take the drug, and the ability to refuse the drug. “The Naltrexone gives us a significant head start in helping our patients remain drugfree,” notes Dr. Coleman, while also emphasizing that recovering addicts “have to do the rest of the rehabilitation, the aftercare, to learn how to stay away from drugs, what their vulnerabilities are, why they became addicted in the first place, and how to deal with whatever triggered their need for drugs.” Aftercare is the daily territory of Chris Newcomb, who since 2009 has been the Coleman Institute’s director of aftercare coordination services. It’s his responsibility to design and implement an individualized treatment plan to get free of drugs and to stay that way. “We try to match our patients’ rehab to their needs,” he says. “It may be a stay in an inpatient facility, or intensive treatment by an outpatient facility. It can include a 12-step group that will put the recovering addict with people who have had similar experiences, psychiatric counseling, a general medical practice, whatever each patient needs.” “People need to not see themselves as only drug addicts,” Newcomb cautions. “They need to see themselves as sons or daughters, fathers or mothers, sisters or brothers. And as a person who has a problem with drugs.” The people at Coleman Institute are quick to debunk the conventional wisdom that people who find themselves addicted are lowlifes, or the dregs of society. “It really is a brain issue,” says Chris Newcomb. “But most people see addicts as 58
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someone who’s a ne’er-do-well or of low moral character or whatever. Do people do dumb things on drugs? Absolutely. Do people have lapses of character on drugs? Absolutely. But they don’t do drugs because of those things. Drugs cause them to do those things.”
So will Heather Parke, clean since last October, start using again? “I don’t plan on it,” she says after giving the question some thought. “I would love to say no, that I will never go back to using. But that little voice is always there... It’s a lifelong disease.” Heather has a lot going for her. She fully accepts responsibility for what she did. She has a loving, committed family who has put what sister Lisa calls “the drug addict Heather” behind them. She and her husband have separated and she is living with her daughters in a smaller house, and she is working for a family business in West Virginia. ”I have way less of everything now,” she says, “but I’m much happier.”
Chris Newcomb is the Recovery Coach and Aftercare Coordinator for The Coleman Institute
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Drug Recovery:
I Wish I Never Started words | RICK PIESTER
Real people tell their own addiction stories at iwishineverstarted.org. Imagine an airplane crash one day that kills 50 people. That would get our attention. Next, imagine a second crash the very next day that also kills 50 people. That would really get our attention. And on the third day, another plane crash, and another 50 people dead. Then, every single day thereafter, the same. We’d be outraged. But we don’t have to imagine it. It’s happening each and every day in America. It’s not people dying on airplanes, however. It’s people dying from drug overdoses. From OxyContin. From heroin. From Methadone, Percocet, Vicodin and all the other highly addictive drugs that medicine calls opiates. And people do not seem to know it. Case in point: in an annual survey of high school seniors, 35 percent said that heroin use once or twice does not pose a great risk. They’re wrong. It’s incredibly addictive, it’s relatively cheap, and it ruins lives and kills. Young people of high school and college age did not grow up when Jimi Hendrix died of heroin addiction. When Janis Joplin died of heroin addiction. Or Jim Morrison. Or John Belushi. The list goes on and on.
“Most people have no clue about how addictive heroine and other opiates are,” says Peter R. Coleman, MD, founder and medical director of the Richmond-based Coleman Institute. “People don’t realize that trying something like heroin even once or twice can lead to addiction. Most of our patients report that from the time they first tried an opiate to the time they physically had to have it was less than a month. And then they are committed to a life of horror. People have no clue about that.” Dr. Coleman is out to change the way young people think about drugs. He and the Coleman Institute staff have launched I Wish I Never Started, a nonprofit organization that maintains a Web site (www. iwishineverstarted.org) that they hope will inform students, parents, and communities about the highly addictive nature of opiates. The site contains information about opiates and facts and figures about addiction, but, most dramatically, there are a growing number of videos in which recovering addicts tell their personal stories. In its’ first three weeks of operation this summer, the site had already registered about 8,000 people who had signed up (at no cost) to receive email updates as more videos are added. “We hope that if more people see and share these videos of real people telling their stories, maybe we can get the word out,” notes Dr. Coleman, “and make a difference.”
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OurHealth’s guest photographer, Helen Stoddard, spent a recent Saturday morning at
South of the James Farmers Market in Forest Hill Park.
South of the James Farmers Market, a GrowRVA market, is an open-air producer only market where farmers and artisans sell locally grown and handmade items. From fresh seasonal produce and prepared foods to pottery, jewelry, and soaps, South of the James has a little local something for everyone. Located in beautiful Forest Hill Park, South of the James Market is open on Saturdays, May through early December from 8am to 12pm.
GrowRVA’s markets are rain or shine events. Check out Grow RVA on Facebook for weekly updates, www. facebook.com/GrowRVA
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HealthyEats
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Good Foods Grocery
Corn Salad Ingredients: 1 lb. frozen corn ½
cup minced red onion
1 tsp. minced fresh garlic 1½ Tbl. fresh basil minced ¼ cup balsamic ¼ cup olive oil 1 cup halved cherry tomatoes 8 oz. cubed fresh mozzarella ½ tsp. salt ½ tsp. pepper
Directions: 1. Combine top three ingredients then roast at 375 degrees until slightly brown. 2. Mix last 7 ingredients together and let marinate while corn cooks. Once corn is cooled mix all ingredients together. 3. Serve and enjoy!
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SWEET CORN SALAD
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Beet Summer Salad Ingredients: 1 lb. cubed beets ½ yellow pepper sliced ½ small red onion sliced ¼ cup crumbled feta ¼ cup toasted almonds 1
Directions: 1. Roast cubed beets at 375 degrees until tender. Let cool. 2. Lay all ingredients on bed of spring mix. 3. Serve and enjoy!
12 oz. bag of spring mix
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BEET SUMMER SALAD
Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodsgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | (804) 740-3518 & Stony Point Shopping Center (Southside) | 3062 Stony Point Road | (804) 320-6767
HealthyEats Vegan Gluten-Free Almond Butter Cookies Ingredients: 1 cup almond flour 1 cup Bob’s Gluten Free flour ½ tsp. salt
Directions:
1. In a food processor, combine both flours, salt, and baking soda. Process into a fine flour. 2. Add almond butter and continue to process. Scrape down sides. 3. Stream in maple syrup. Scrape down sides. Process one more time.
1 tsp. baking soda
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Good Foods Grocery
4. Dump dough into a bowl, finish mixing by hand to combine. 5. Scoop and press dough onto greased cookie sheets. 6. Bake at 325 degrees for 10-15 minutes, depending on size.
1 cup almond butter ½ cup maple syrup
Good Foods Grocery’s
ALMOND BUTTER COOKIES
Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodsgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | (804) 740-3518 & Stony Point Shopping Center (Southside) | 3062 Stony Point Road | (804) 320-6767
PROSTATE
C NCER words | RICH ELLIS photography | LEW FRAGA
The Second Most Common Cancer in Men One Richmond man’s journey from prostate cancer discovery, through treatment and on to recovery spurred him to develop a non-profit organization dedicated to raising awareness about and providing education about prostate cancer detection and treatment.
A Dreaded Vacation Phone Call. Three years ago, Bert Jones of Richmond received the call that no one ever wants to get. He had cancer. His physician on the other end of the line wanted to see him the moment he returned from vacation. Bert’s problems actually began several years prior to receiving his prostate cancer diagnosis with a determination that his prostate was enlarged. It hadn’t caused him any major problems until one day when he was completing a round of golf and realized he hadn’t urinated all day. Not thinking there was any problem, he figured he’d just go home and use the bathroom there. But when he returned home and still couldn’t go, that’s when Bert realized he had a problem. He went first to an urgent care center. They couldn’t locate a catheter because they were in the middle of remodeling so they sent him instead to Virginia Urology on Stony Point Drive in Richmond.
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Bert Jones, of Richmond, is a cancer survivor, and one of Richmond’s biggest advocates for prostate cancer awareness and education.
www.OurHealthRichmond.com
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Thanks to current treatment options and early detection, over 90 percent of prostate cancer patients diagnosed today with cancer that hasn’t spread beyond their prostate will still be alive in five years. “By this time, I was in serious pain,” Bert recalls. “The nurses at Virginia Urology were fabulous. They helped me with my paperwork and shepherded me through the process. I got back to the room and the nurse came in with the catheter and said, ‘Mr. Bert, this is going to be a little uncomfortable.’ and I said, ‘I passed uncomfortable three hours ago. Let’s just get this thing drained.’” Difficulty urinating is a common occurrence with an enlarged prostate because it can press on the urethra and block the urine’s flow. To correct the problem, Bert’ physician recommended the GreenLight® Laser Therapy Treatment. This procedure uses a laser inserted through the urethra to vaporize the enlarged prostate tissue that’s blocking the urine flow. Before that procedure can be performed, however, they needed to ensure he didn’t have prostate cancer. Then one of the prostate tissue samples removed during the biopsies came back positive for cancer.
Prostate Cancer Diagnosis Prostate cancer, according to Kinloch Nelson, MD, a urologist with Virginia Urology in Richmond, is an abnormal, cancerous growth of the small gland that sits around the base of the bladder surrounding the urethra in men. It’s a gland important in semen production, and cancer of the prostate gland is the most commonly diagnosed cancer, behind skin cancer, in American men. The path leading to a prostate cancer diagnosis often begins with a Digital Rectal Exam or PSA test, Dr. Nelson explains. The PSA test indicates the level of Prostate Specific Antigen – a protein produced by the prostate’s cells – present in the blood. During the DRE, a physician feels for any abnormality, such as a growth, on the 70
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prostate. The PSA level and also whether it’s changed from previous exams, and/ or results from the DRE guide physicians on whether to order a prostate biopsy to determine cancer’s presence.
“When a man is diagnosed with prostate cancer, there are three important things we want to look at,” says Dr. Nelson. “You want to look at the stage of the cancer, meaning is it still confined to the prostate or has it started to spread beyond the prostate. The second thing is the grade of the cancer. The grade gives a sense of what the behavior of this cancer is going to be like, whether it is aggressive or more slow-growing. The last thing you want to look at and what’s probably most important is the patient himself. We’re going to have a different discussion about treatment options with a person who is 50 and in perfect health versus someone who is 80 with other conditions.”
Prostate Cancer – Treatment Those treatment options hinge on the three factors mentioned previously, and according to Dr. Nelson, can include: • Active surveillance – during which the cancer isn’t treated but it is monitored closely, and if it becomes more aggressive, treatment begins. • Hormone therapy – used for patients whose cancer has started to spread beyond the prostate. To treat the cancer, medication is administered that slows the body’s production of testosterone, a male hormone that “feeds” the prostate cancer cells. • Surgery – known as a prostatectomy, this procedure is used to remove the entire prostate. • Radiation therapy – administered in one of several forms, including implanted seeds or external beams. “Those are the mainstream treatment options at this point,” Dr. Nelson says. “There are some other options but those are the big four.” Because cancer was detected in only one of his multiple biopsies, Bert said he was seriously considering the surveillance, or “do nothing” option as he calls it, until a comment from a co-worker changed his mind. Bert said that because of the size of his prostate, the minimally-invasive robotic surgery using the da Vinci® surgical system wasn’t an option and that radiation also wasn’t an option because it exacerbates urinary problems. He opted instead for the open procedure to have his prostate removed.
My friend at work said, ‘You know, the guy that used to be in the position that you’re in now died from prostate cancer 15 years ago. I don’t want to see you do that. You need to do something, Bert.’ That motivated me to look at other treatment options.
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A Commitment to Recovery, and to Raising Awareness Bert said that the prostate’s removal relieved all of his symptoms and that his recovery progressed very well, something he attributes in part to being as fit as he could possibly be and at an ideal body weight. Cancer-free, back to work as the associate vice chancellor for facilities management services with the Virginia Community College System and playing golf again, one would assume prostate cancer is the furthest thought from his mind. It isn’t. His prostate cancer experience motivated him to set up the Prostate Cancer Educational Institute of Virginia, a 501-c-3 non-profit organization, www.pceiva.org, to provide information and education about prostate cancer’s symptoms, treatment and survivorship.
Kinloch Nelson, MD is a physician at Virginia Urology. Dr. Nelson specializes in general urology and urologic oncology, robotic surgery. www.OurHealthRichmond.com
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“When I found out I had it, I had never even heard of prostate cancer much less considered that I might be someone who would ever be affected by it,” Bert says. “Through the organization, we hold two or three educational seminars a year, participate in cancer awareness meetings in Richmond and conduct fundraising to raise awareness. I want people to get tested. I want people to be aware that prostate cancer exists. My goal is to make sure that men know prostate cancer exists and that they should be tested for it.” There has been a significant decline in the overall mortality rate associated with prostate cancer over the last 20 years and Dr. Nelson attributes that reduction to PSA testing and the earlier detection of cancer.
Presently, there is a great deal of controversy surrounding screening for prostate cancer, in part because of a recommendation issued by The U.S. Preventive Services Task Force against screening for prostate cancer. Meanwhile the American Urological Association modified its recommendations about who should receive a PSA test or Digital Rectal Exam, at what age, and how often. To receive the latest information and understand how it may apply to your unique situation, talk with your urologist. 72
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“There are still too many men who die because they present [symptoms] late,” Dr. Nelson explains. “At this point, 29,000 men die of prostate cancer annually. That’s a number I’d like to see go way down.” So too would Bert Jones.
Additional information For more information or to schedule an appointment with a physician/provider at any of Virginia Urology’s locations, call 804.330.9105 or visit www.uro.com
Virginia Urology Locations Virginia Urology – Stony Point 9105 Stony Point Drive Richmond, VA 23235 | 804.330.9105 Virginia Urology – Reynolds Crossing 6900 Forest Avenue, suite 200 Richmond, VA 23230 | 804.288.4137 Virginia Urology – St. Francis 14051 St. Francis Blvd., suite 2201 Midlothian, VA 23114 | 804.521.8700 Virginia Urology – Hanover Medical Park 8220 Meadowbridge Road, suite 202 Mechanicsville, VA 23116 804.730.5023 Virginia Urology – Puddledock 2025 Waterside Road, suite 105 Prince George, VA 23875 804.524.8959 Virginia Urology – Emporia 301 Market Drive, unit I Emporia, VA 23847 | 434.336.9906 Virginia Urology – Tappahannock 1396 B Tappahannock Blvd. (rt.17) Tappahannock, VA 22560 804.443.5393
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