OurHealth Richmond Aug/Sep 2016 Edition

Part 4: Primary Care Series | How to in Healthcare Series: Graduating to Graduate School | Prostate’s Big 8

table of contents | august • september 2016

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[ back to school ]

health checklist MEDI•CABU•LARY.....................10 Local experts define health related terms

Even though summer is still in full swing, school will be back in session before we know it. Getting a head start on preparing kids for the new school year is always a smart idea, especially when it comes to their health.

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.........................16 Interesting facts and tidbits about health

THE ANATOMY CHALLENGE..................................19 How much do you know about Our Anatomy?

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

ANATOMY ..................................... 20 Don’t let sports injuries sideline your child.

THE FACTS ABOUT YOUR KID’S EAR INFECTIONS....................28 Why do children suffer from ear infections more frequently than adults?

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Prostate’s Big 8

September is Prostate Cancer Awareness Month, a time set aside each year to focus on the disease that is the second largest cancer killer of men in the United States.

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OurHealth | The Resource for Healthy Living in Greater Richmond

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[series: part 4]

The Bridge to Better Health Starts with Primary Care

[ WEB EXCLUSIVE! ]

NUTRITION: HOW TO MAKE A “BETTER FOR YOU” SANDWICH! ourhealthrichmond.com

42

[series: part 3]

How to in Healthcare A year-long series focusing on how to prepare your child for a career in healthcare.

This issue: Graduating to Graduate School

FIT BITS!........................................55 What’s the Hype with ‘HIIT’?

hello, HEALTH!..............................56 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos.

A CLOSER LOOK.......................... 58 Images reflecting the landscape of healthcare in Richmond * PLUS * A chance to win prizes!

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august • september 2016

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OURHEALTH’S EXCLUSIVE MEDIA PARTNER PUBLISHER PRESIDENT/EDITOR-AT-LARGE VICE PRESIDENT OF PRODUCTION PROJECT COORDINATOR AND FITNESS EXPERT ACCOUNTING MANAGER CHIEF DESIGNER GRAPHIC DESIGN COPY EDITOR DIGITAL CONTENT MANAGER/EVENT SPECIALIST ORIGINAL PHOTOGRAPHY

McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Deidre Wilkes Laura Bower Karrie Pridemore Tori Meador Bobbi Hoffman Heidi J. H. McClintic Shawn Sprouse

CONTRIBUTING RICHMOND MEDICAL EXPERTS Alynn Alexander, MD Kelly Dodson, MD

Yogesh Gandhi, MD Robert LeNoir, DDS Jessica Poe, AuD, F-AAA, CCC/A Jayashree Ravishankar, MD, MPH CONTRIBUTING PROFESSIONAL Geri Aston EXPERTS & WRITERS Tina Joyce Rick Piester Suzanne Ramsey Christine Stoddard Deidre Wilkes ADVERTISING AND MARKETING Rob Robb Account Manager P: 804.539.3955 F: 540.387.6483 rob@ourhealthvirginia.com SUBSCRIPTIONS To receive OurHealth Richmond via U.S. Mail, please contact Deidre Wilkes via email at deidre@ourhealthvirginia.com or at 540.387.6482

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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Ext. 1 Information in all print editions of OurHealth and on all OurHealth websites (websites listed below) and social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions.

Copyright © 2016 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. OurHealth Richmond is published bi-monthly • Special editions are also published • McClintic Media, Inc. • 3420 Pump Road, #314 • Richmond, VA 23233 • P: 540.387.6482 F: 540.387.6483 MAIN: ourhealthvirginia.com | ourhealthswva.com | ourhealthlbss.com | ourhealthrichmond.com | ourhealthcville.com | Advertising rates upon request.

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OurHealth | The Resource for Healthy Living in Greater Richmond

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 are Porcelain Veneers?

Porcelain veneers are tooth colored restorations that enable a patient to change the shape, size, and color of their teeth. They are thin, strong and fabricated of either a porcelain or ceramic material giving them a natural appearance that can transform a person’s smile.

Porcelain veneers address issues such as chipping, crowding, spacing and discoloration of the teeth.

A smile analysis, consisting of photographs and study models, details the current conditions.

Porcelain veneers address issues such as chipping, crowding, spacing and discoloration of the teeth.

A smile analysis, consisting of photographs and study models, details the current conditions.

Combining this information with the patient’s desires, a mock-up or wax up of the final smile can be performed prior to preparation.

Teeth must be conservatively prepared in order to have the veneer fit naturally into the smile.

Preparation is often less than a millimeter into the enamel, or outer layer of the tooth. Sometimes veneers can even be placed without any tooth preparation.

Ultimately, porcelain veneers are a great way for the patient to achieve a beautiful and natural smile.

Robert LeNoir, DDS

Drs. Brown, Reynolds, Snow, LeNoir Richmond | 804.288.5324 www.brsdentistry.com

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What is Myringotomy?

What is Sepsis?

Literally, a myringotomy is the procedure in which a small opening is made in the eardrum (tympanic membrane). It is usually combined with the placement of ear tubes to allow the middle ear to ventilate and aerate after either recurrent acute ear infections or chronic fluid buildup causing a conductive hearing loss. In children, the procedure is typically performed under general anesthesia and they are able to resume normal activities the following day. Antibiotic ear drops are usually prescribed for use in the ears for several days following the procedure. Ear tubes typically remain in place for about one year, and usually work themselves out of the eardrum into the ear canal without additional intervention. The majority of children will only need to undergo the procedure once, but some children, particularly those with additional risk factors for ear infections or chronic fluid, may need to have additional sets.

Sepsis is the body’s overwhelming response to an infection. If not recognized and treated quickly, it can lead to tissue damage, organ failure, and even death. Sepsis is always caused by an infection and most often by bacterial infections.

For example, infections like pneumonia, urinary tract infections, or appendicitis can lead to sepsis.

Anyone can get sepsis, but the elderly and very young and people with weakened immune systems, diabetes, AIDS, cancer, and kidney or liver disease are at a higher risk.

Over one million cases of sepsis occur each year, and half of the people who get sepsis die.

Kelly Dodson, MD

VCU Health Department of Otolaryngology Richmond | 804.628.4368 www.ent.vcu.edu

It is important to suspect sepsis early and seek medical care immediately. Some of the symptoms of sepsis include weakness, fever, chills, confusion, lethargy, poor appetite, rapid breathing, low urine output, rapid heart rate, and low blood pressure. Treating sepsis within the first 60 minutes of its onset–the golden hour–is crucial.

Initiating intravenous antibiotics and fluids within the golden hour helps increase the survival rate by 80 percent.

Jayashree Ravishankar, MD, MPH

Infectious Disease Specialists Bon Secours St. Mary’s Hospital Richmond | 804.673.2814 www.bonsecours.com

H E A LT H C A R E QUESTIONS ANSWERED

BY LOCAL PROFESSIONALS

Without estrogen

replacement, women with

POI are at an increased risk of

developing conditions related

to low estrogen levels. Because bone metabolism is somewhat dependent on normal

circulating estrogen, low bone

mass occurs more commonly in

women with POI resulting in an increased fracture risk.

What are some health risks related to premature menopause in women younger than 40?

My child has his earphones on constantly.

Should I be worried about him losing his hearing?

Some women, experience menopause and it symptoms much earlier than expected, which may result in certain long term health effects.

Absolutely! Hearing should be protected as soon as possible. Noise is all around us and if it reaches an unsafe limit, it can begin to wear down the sensitivity of our hearing nerve. If your child is regularly using earphones and you can hear it, that’s a sign that it’s too loud.

This condition, previously described as premature menopause or premature ovarian failure, is now more accurately termed primary ovarian insufficiency (POI). It is the result of a loss of ovarian hormone production. Typical symptoms include the absence of menstrual bleeding and the appearance of symptoms related to low blood estrogen levels including hot flashes, night sweats, fatigue, vaginal dryness and mood changes, all before the age of 40.

Without estrogen replacement, women with POI are at an increased risk of developing conditions related to low estrogen levels.

Because bone metabolism is somewhat dependent on normal circulating estrogen, low bone mass (osteopenia and osteoporosis) occurs more commonly in women with POI resulting in an increased fracture risk. Additionally, there is observational data to suggest an increased risk of cardiovascular disease in women with POI. Sometimes POI can be associated with other problems of the endocrine system including problems of the thyroid gland.

Alynn Alexander, MD

HCA Richmond Women’s Specialists Richmond | 804.267.6931 www.richmondwomens.com

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According to the American Academy of Audiology, a volume of 85 decibels should not be listened to for more than eight hours a day.

The maximum output on a typical music player is 100 decibels. There are products on the market that are designed to limit volume output.

Kid safe earbuds or headphones that have a volume limit can assure parents that the volume will never reach an unsafe limit. It’s important to remember that once damage is done, it cannot be reversed.

Protecting your child’s hearing now will ensure the ability to enjoy music at a safe and enjoyable level for years to come!

Jessica Poe, AuD, F-AAA, CCC/A Virginia Ear, Nose & Throat 804.484.3700 www.virginiaent.com

What are the benefits of using targeted therapies in treating cancers?

Recent advancements in the understanding of molecular genetics have made it possible to pinpoint the disruptions in genetic pathways that initiate and contribute to the progression of cancer. These genetic or molecular abnormalities cause a normal cell to transform into a cancer cell. Fortunately, cancer can now be treated by targeting those specific malfunctioning molecules and pathways.

A targeted therapy can more specifically attack cancer cells and spare or reduce side effects on the healthy functioning cells.

Targeted therapies come in different forms based on the target they are attacking. It can be in the form of antibodies like herceptin for treating breast cancer, or it can target hormone receptors like tamoxifen also for treating breast cancer. These targeted therapies can work alone or with existing conventional therapies to make them more effective.

Yogesh Gandhi, MD

Virginia Cancer Institute Richmond | 804.431.1100 www.vacancer.com

NEW

NOTEWORTHY

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

Bon Secours St. Mary’s Hospital

Earns Advanced Comprehensive Stroke Center Certification Bon Secours St. Mary’s Hospital has been recognized for clinical excellence by earning Advanced Comprehensive Stroke Center status from The Joint Commission and the American Heart Association/American Stroke Association. As the highest level of stroke care certification, Advanced Comprehensive Stroke Center status identifies hospitals that meet standards for treating the most complex stroke cases. Bon Secours St. Mary’s Hospital is the only nonacademic facility to earn this honor in the Commonwealth of Virginia, as well as in a four-state region. There are approximately 100 Advanced Comprehensive Stroke Centers nationwide out of 5,000 hospitals.

“This accomplishment speaks to the expertise, dedication, and service of each individual caring for patients in our facilities,” says Francine Barr, CEO of Bon Secours St. Mary’s Hospital.

“This certification, coupled with Bon Secours primary certified

stroke center network, establishes Bon Secours as the premier provider of cerebrovascular care in the region and across Virginia” adds Barr.

According to the American Heart Association, every 40 seconds someone has a stroke in the United States, with over 500,000 new and approximately 200,000 recurring strokes every year.

Stroke is the fourth leading cause of death in adults and the leading cause of adult disability.

“Every second matters during an acute stroke. Rapid diagnosis and treatment by a neurologist is critical to restore blood flow to the brain and prevent permanent damage,” says Stacey Epps, MD, executive medical director, Bon Secours Virginia Neuroscience Institute. “Bon Secours St. Mary’s Hospital is dedicated to improving the quality of stroke care, and as an Advanced Comprehensive Stroke Center we have the opportunity to continue to greatly improve the care and outcomes for stroke patients, particularly the most severe and complex cases.”

For more information on Bon Secours, visit www.bonsecours.com.

Hadi Anwar, MD

Children’s Hospital of Richmond at VCU Hospital Medicine Richmond | 804.828.2467 www.chrichmond.org

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Mark Astoria, MD

Children’s Hospital of Richmond at VCU Neonatal Medicine Richmond | 804.828.2467 www.chrichmond.org

Kensington Hatcher, OD

Virginia Eye Institute Richmond | 804.287.4200 www.vaeye.com

OurHealth | The Resource for Healthy Living in Greater Richmond

Anthony Herndon, MD Timothy Children’s Hospital Imafidon, DDS of Richmond at VCU Urology Richmond | 804.828.2467 www.chrichmond.org

Pediatric Dentist Dr. Richard Byrd & Associates Richmond | 804.330.0508 www.drBYRDdds.com

Kelly Lastrapes, MD

Children’s Hospital of Richmond at VCU Palliative Care Richmond | 804.828.2467 www.chrichmond.org

CMS Announces Virginia Cancer Institute Selected for Initiative Promoting Better Cancer Care

Tim McManus, President

HCA Capital Division Chesterfield | 804.327.7600 www.hcavirginia.com

David Mohrman, OD Virginia Eye Institute Chester | 804.287.4200 www.vaeye.com

The Centers for Medicare and Medicaid Services (CMS) announces that it has selected Virginia Cancer Institute as one of nearly 200 physician group practices and 17 health insurance companies to participate in a care delivery model that supports and encourages higher quality, more coordinated cancer care. The Medicare arm of the oncology care model includes more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries nationwide.

Practices participating in the five-year oncology care model will provide treatment following nationally recognized clinical guidelines for beneficiaries undergoing chemotherapy, with an emphasis on person-centered care. They will provide enhanced services to beneficiaries who are in the oncology care model to help them receive timely, coordinated treatment.

For more information about the oncology care model, visit www.innovation.cms.gov/initiatives/Oncology-Care.

Shravan Renapurkar, DMD

VCU Dental Care Oral and Maxillofacial Surgery Richmond | 804.628.6637 www.vcudentalcare.com

Matthew Schefft, DO

Children’s Hospital of Richmond at VCU Hospital Medicine Richmond | 804.828.2467 www.chrichmond.org

To learn more about the Virginia Cancer Institute, visit www.vacancer.com.

Virginia Commonwealth University School of Nursing Faculty Member Selected as Fellow of American Academy of Nursing

Mark Sharafinski, MD Children’s Hospital of Richmond at VCU Radiology Richmond | 804.828.2467 www.chrichmond.org

Carlos Smith, DDS, MDiv

VCU Dental Care General Practice Richmond | 804.828.2977 www.vcudentalcare.com

Victoria Menzies, PhD, RN, PMHCNS-BC, associate professor in the Department of Adult Health and Nursing Systems at the VCU School of Nursing, will receive one of the most prestigious honors in nursing this fall when she is inducted as a fellow of the American Academy of Nursing (AAN). The academy recently selected Menzies as one of 164 nurse leaders nationwide to be inducted at the AAN annual meeting in October.

The Academy fellows, with the addition of this newest class, represent all 50 states, the District of Columbia, and 28 countries.

Jaisri Thoppay, DDS, MBA, MS

VCU Dental Care Oral and Maxillofacial Surgery Richmond | 804.628.0310 www.vcudentalcare.com

School of Nursing

Selection criteria include evidence of significant contributions to nursing and healthcare and sponsorship by two current Academy fellows. Applicants are reviewed by a panel comprised of elected and appointed fellows, and selection is based, in part, on the extent the nominee’s nursing career has influenced health policies and the health and wellbeing of all.

New fellows will be eligible to use the credentials FAAN (fellow of the American Academy of Nursing) after their induction in October.

For additional information, visitwww.vcu.edu and vcuhealth.org.

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

SEPTEMBER IS NATIONAL

childhood

OBESITY AWARENESS MONTH

MAN OF STEEL?

OUNCE FOR OUNCE, HUMAN BONES ARE FIVE TIMES STRONGER THAN STEEL!

Not only is September back-to-school time, it is also National Childhood Obesity Month. In the U.S. alone, one in three children is obese or overweight. Obese children are 80 percent more likely to become obese adults, which puts them at risk for associated adult health problems such as heart disease, type 2 diabetes, sleep apnea, stroke, several types of cancer and osteoarthritis.

A SIMPLE WAY TO FIGHT CHILDHOOD OBESITY STARTS IN YOUR CHILD’S LUNCHBOX. Here are some simple lunchbox meals that will be fun to eat, and healthy too!

• Brunchbox – pancakes, strawberries, vanilla yogurt tube, hard-boiled egg

• ABC lunchbox – Applesauce, Berries, Chicken strips with Dipping sauce

Your eyeballs stay the same size your whole life, but your nose and ears NEVER stop growing!

• Orange crush lunchbox – macaroni and cheese, roasted sweet potatoes, Clementine orange, cheddar bunnies.

• Sandwich on a stick – layer a kabob stick with small pieces of bread, deli meat, cheeses and black olives with apple slices and low-fat vanilla yogurt for dipping.

• It’s a ‘wrap’ – tortilla wrap rolled with low fat cream cheese and strawberry jelly with popcorn, sliced cucumbers and grapes.

Encourage kids to come up with their own unique themes and ideas using healthy choices.

Allowing kids to choose and prepare their own lunch piques interest in the meal and makes it more likely they will eat their own creations.

Source: American College of Sports Medicine

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SEND THEM TO THE

BUS STOP! School buses are the safest form of ground transportation – approximately 40 times safer than the family car!

Source: National Safety Council

Let the Kids ‘try a TRI’!

VHBG Youth Triathlon

Healthy Fun for the Whole Family!

The 2016 Children’s Hospital Foundation Four Mile Fun Run features a race format perfect for the whole family. Walkers and runners of all ages are invited to participate in the four mile course, while the Superkid Obstacle Course provides a special opportunity and challenges for children between the ages of 5 and 10. Post-race refreshments, kids’ activities, costume contest, music and more immediately follows the race.

Date:

Time: Location:

Saturday, September 17, 2016 8:30 a.m.

Children’s Hospital of Richmond at VCU 2924 Brook Road Richmond, VA 23220

All proceeds benefit Children’s Hospital Foundation, dedicated to funding and advocating for pediatric initiatives that improve the status of healthcare and the quality of life for children in the RVA region. The foundation provides support for the programs and initiatives of Children’s Hospital of Richmond at VCU and the nearly 60,000 children it serves each year.

Be sure to check out photos from this event in the Hello Health feature in the October/November issue of OurHealth Richmond!

For more information on the event and to register, go to www.chfrace.org. For more information about Children’s Hospital of Richmond at VCU, visit www.chrichmond.org.

The Virginia Home for Boys and Girls co-hosts the 3rd Annual Youth Triathlon presented by Endorphin Fitness. The race is open to kids from 5-14 years old and features a short swim, a bike route closed to traffic, and a run on level playing fields.

All proceeds for this event will go to benefit the children of the Virginia Home for Boys and Girls.

Date: Saturday, August 20, 2016

Time: 8 am Location: Virginia Home for Boys and Girls 8716 West Broad St. RIchmond, VA For more information and to register, go to www.endorphinfitness.com/ races-events For more information about Virginia Home for Boys and Girls, go to www.vhbg.org

What does OM — the mantra or vibration that is traditionally chanted at the beginning and end of yoga sessions — mean?

ever wonder?

It is said to be the sound of the universe. Everything that exists pulsates and creates a rhythmic vibration that the ancient yogis acknowledged with the sound of OM. As a result of its calming effect, practicing yoga can help lower blood pressure and reduce insomnia.

Source: American Osteopathic Association

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Bon Secours Cancer Institute presents...

The 10th Annual

Pink Tie Gala Roaring 20s Flapper Come enjoy dinner, silent auction, live music, dancing, and experience an all new “Celebration of Life” Dance Team.

And our special guest, breast cancer survivor Paulette Leaphart •

•

•

Tickets only $100 and space is limited • • •

Saturday, October 22nd, 2016 7:30 pm to 12:30 am The Greater Richmond Convention Center Ballroom • • • For more information contact Susan Groves 804-745-0006 www.pinktiegala.org

The Anatomy Challenge is proudly sponsored by:

Anatomy

With 10 offices, and three after hours locations to serve you. For a physician appointment, please call 801.915.1910. For a physical therapy appointment, please call 804.285.2645.

How much do you know about ligaments?

Chippenham | Farmville | Hanover Memorial Regional Henrico Parham | Johnston-Willis | Kilmarnock New Kent| Prince George | St. Francis | St. Mary’s

the

CHALLENGE

Complete the word search below. Next, match the correct word with the correct specialty description.

After Hours Hanover | After Hours St. Francis | After Hours St. Mary’s

[ ligaments ]

WORD SEARCH articular cartilage

medial condyle

anterior cruciate ligament

medial meniscus

femur

patella (knee cap)

fibula

posterior cruciate ligament

lateral condyle

tibia

lateral collateral ligaments lateral meniscus medial collateral ligaments

For answers, visit OurHealth Richmond's Facebook page at www.OurHealthRichmond.com

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words | RICK PIESTER

DON’T LET

SPORTS

We’re pretty much a sports-crazy nation. Many children are starting to play sports at a younger age than in the past, and we are ever more serious about our athletic endeavors. But our want to win can sometimes push us past our limits making injuries more and more common.

INJURIES SIDELINE YOUR CHILD

Many young people — boys and girls alike — begin playing competitive sports as early as age 5 to 6 or even younger. Estimates are that as many as 25 million young people participate in organized athletic programs at school, and another 20 million or so participate in community-based youth programs.

And that doesn’t include untold millions of youngsters in pickup basketball games, sandlot baseball, backyard touch football, impromptu playground contests — the list goes on and on.

Most kids play sports for the sheer joy of competition, movement and action, but some see sports as a ticket to a college scholarship, or maybe even a career in professional sports.

But for far too many young people, the sports fast track leads to painful, sometimes serious injuries. According to the Centers for Disease Control and Prevention, more than 2.6 million youths age 19 and younger are treated in hospital emergency departments each year for sports- and recreation-related injuries.

Another 5 million young people are seen by their personal physicians or urgent care centers. No one knows how many injuries to young athletes go unreported.

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25 MILLION

There’s not a single sport that bears the bulk of the blame for injuries to young athletes, although youths who participate in high-impact sports such as football, basketball, soccer, wrestling and even cheerleading seem more prone to injury than those who participate in other sports. Experts suspect that choosing to play only one sport all the time or several sports simultaneously are factors leading to what are called overuse injuries.

Common types of injuries Mention the dangers of sports and most folks are likely to think first of concussion, and rightly so. A concussion is a traumatic brain injury. Research shows that younger athletes take a longer time to heal than adults after a concussion because their bodies are still growing. A second concussion can cause even more issues.

Thankfully, however, concussion is not the most common injury on the playing field.

That dubious distinction, according to Richmond orthopaedist Paul G. Kiritsis, goes to strains and sprains. He says he treats more of these injuries than other types in his practice at OrthoVirgina. These include injuries to the body’s tendons and ligaments that can run the gamut from a sprained ankle to the dreaded ACL tear — damage to the anterior cruciate ligament in the knee that can require surgery and sideline an athlete for months.

Sprains versus strains First, some basic definitions. A sprain is a stretched or torn ligament — the tough band of connective tissues that join the end of one bone with the end of another. A strain is an injury to a muscle or tendon. Muscle is made up of bundles of cells that contract and produce movement. A tendon is tissue that connects a muscle to a bone.

Estimated number of young people that participate in organized athletic programs at school

20 MILLION

young people participate in community-based youth programs.

Sprains are usually caused when a fall or a blow to the body knocks a joint out of alignment. Knees, ankles and wrists are the areas of the body most susceptible to sprains, which announce themselves with pain, bruising, swelling and an inability to move a joint or a limb.

Strains happen when a muscle or tendon is pulled or twisted, usually by overstretching.

Muscle and tendon in any part of the body can fall victim to strains, which can be felt as pain, muscle spasm, and weakness in the affected part of the body.

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A sprain is a stretched or torn ligament — the tough band of connective tissues that join the end of one bone with the end of another. A strain is an injury to a muscle or tendon.

A much more serious injury, a rupture or tear in the knee’s ACL, can require surgery to rebuild the joint. Whether the particular injury requires surgery or not, a good physical therapy program should help restore a young person’s range of motion in the knee, as well as his or her sense of balance.

Dr. Kiritsis notes that it’s perfectly normal for young people to suffer bumps and bruises when they engage in any physical activity. “A young person might be playing basketball for three hours a day for a solid week, and he or she may develop sore knees,” he says. That’s more typical of an overuse injury, which is temporary damage to a bone, muscle, ligament or tendon that’s caused by repetitive stress without allowing rest and adequate time for the body to heal.

An overuse injury is damage to a bone, muscle, ligament or tendon due to repetitive stress without giving a growing body time to adequately rest and recover between games or practice sessions. “But when pain comes from a traumatic event, such as a collision, a fall or overextension, it’s something that will require more attention,” Dr. Kiritsis says.

Parents should learn to recognize the differences between a significant injury and more common aches and pains. One major telltale sign would be the inability to bear weight (more than a few steps). Other signs to look for include • Noticeable deformity in the injured joint.

Paul Kiritsis, MD is and orthopaedic physician at OrthoVirginia in Richmond. Dr. Kiritsis is certified by the American Board of Orthopaedic Surgery with a subspecialty in Orthopaedic Sports Medicine.

• Tenderness, swelling or bruising over any bone.

• Any sensation of numbness, tingling or weakness in the injured area.

• Any noticeable difference in temperature between the affected joint and the same joint on the other side of the body.

Delaying Treatment Can Take its Toll on Your Body Taking action as soon as possible after suffering a tendon or ligament injury can be a big help in shortening healing time and preventing further injury. If the injury is to a weight-bearing joint such as a knee or an ankle, employ the RICE mnemonic: rest, ice, compression, elevation. Get off of the injury, wrap the joint in a compression bandage and apply ice. A good way to ice an injury is to apply cold (an ice pack, a bag of frozen ice, even a bag of frozen peas or corn kernels) for 10-20 minutes, remove the ice for 22

OurHealth | The Resource for Healthy Living in Greater Richmond

about 10 minutes, and then reapply it. To avoid tissue damage, protect the skin with a wet cloth. Elevate the injured joint by propping up the joint if possible, preferably higher than the heart.

Of course, it’s best to prevent the injury. Dr. Kiritsis says that strength training and conditioning programs are always important. “Specifically, ACL injury prevention programs have been shown to prevent injury, especially in female athletes.”

Parents can help by making sure their children promptly report injuries or suspected injuries, seeing to it they have the proper protective equipment for the sport they are playing and making sure the playing field is in good condition, free of hazards.

Parents should also complete an emergency medical authorization form and provide parent contact information and permission for emergency medical care should their child need it.

Taking action as soon as possible after suffering a tendon or ligament injury can be a big help in shortening healing time and preventing further injury.

Expert Contributor • Paul Kiritsis, MD is and orthopaedic physician at OrthoVirginia in Richmond.

Dr. Kiritsis is certified by the American Board of Orthopaedic Surgery with a subspecialty in Orthopaedic Sports Medicine.

ON THE WEB

More at ourhealthrichmond.com

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BACK TO SCHOOL CHALLENGE!

HEALTH CHECKLIST words | SUZANNE RAMSEY

Even though summer is still in full swing, school will be back in session before we know it. Getting a head start on preparing kids for the new school year is always a smart idea, especially when it comes to their health.

Some things on the back-to-school checklist can wait until the last minute. Three-ring binders. Pens, pencils and paper. Computers and calculators.

But other things, like a young one’s annual physical, vision test or allergy assessment, require some advanced planning. The following list is a good starting point for parents to use when it comes to checking off back-to-school health needs.

Reprints

Make sure shots are up to date.

Before the first day of preschool or kindergarten make sure your child’s vaccinations are up to date.

Bet ween ages 7 and 10, the CDC recommends children be vaccinated against Hepatitis A and pneumonia. For middleschool-age boys and girls, physicians recommend the human papillomavirus (HPV) vaccine. At that age, children also need a Tdap booster and a vaccine to protect them from meningitis.

At 16, kids need a meningitis booster. The meningitis vaccine is required by colleges, where dorm and dating life puts students at increased risk for the life-threatening disease. Bet ween 16 and 18, the CDC also recommends the serogroup B meningococcal vaccine, which protects students from another t ype of meningitis.

To order reprints of the original artwork featured on this issue’s cover, contact Deidre Wilkes at 540.387.6482 or via email at deidre@ourhealthvirginia.com.

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

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School starts early and kids are known to stay up too late, with or without parental permission. At least a week before school starts, start enforcing those MOM bedtimes, so the first days & DAD of school aren’t spent sleepy.

BONUS! For younger children, doctors recommend the three Bs: Orthodontic Brush, Book, Bed — as consults aren’t just for in brush teeth, read a kids! 25% of orthodontic book, go to bed. treatment is for adults.

Visit w w w.drBYRDdds.com for information about Invisalign and other options and to schedule your free adult consultation.

p sleep schedule.

If your child is on any medication, medical release forms need to be filled out and signed by your child’s doctor.

Pediatricians have these forms in copy or digital format.

If your child is having trouble hearing, getting help as soon as possible can keep them from falling behind, academically and socially. Sometimes kids might not know they don’t hear very well, so getting hearing checked is sound advice.

p Schedule a hearing test.

p Provide list of medications to your child’s school.

At about age 13, many pediatricians start screening their patients for depression. It’s something to think about. Middle school Set a is tough enough.

p Screen for depression.

START HERE

Teachers might be using SMART Boards instead of chalkboards these days, but no matter what kind of board it is you still have to be able to see what’s on it.

Sometimes, kids aren’t quick to speak up when they have trouble seeing.

p Schedule an Eye Checkup.

Teach young children how to dial 9-1-1 in case of an emergency. And Mommy’s name is not Mommy. Kids need to know their parents’ names and their address.

p Make sure kids know how to find help.

HEALTH CHECKLIST

Scoliosis screening isn’t the only thing you need to worry about when it comes to your student’s back health.

How heavy is your kid’s backpack?

Doctors say a child’s backpack, full of books, should weigh no more than 10 percent of their body weight. To help prevent back problems, consider a rolling backpack.

p Think about back health.

p Get a sports physical.

The American Association of Orthodontists (AAO) recommends that all children have a check-up with an orthodontic specialist no later than age 7.

p Orthodontics… sooner than we thought.

Get dental and other medical checkups out of the way before school starts.

That way, kids won’t have to miss school for appointments. Schedule the year’s second dental cleaning during the winter break.

p Schedule dental and other checkups.

p Play with your kids.

Little brains need to be stimulated over the summer, too. Put down the smartphone. Play board games, read books and create things together.

sex, drugs, alcohol and issues like date rape and depression. If you’re not comfortable talking about these things, your child’s pediatrician can have this conversation.

Have “The Talk.” Before leaving for college, there needs to be a discussion about

DIFFICULTY BONUS!

Is your kid playing sports this school year? They’ll need a sports physical. Schools require athletes have one before tryouts or the first practice.

Before preschool or kindergarten, work on developing your child’s independence, so being separated from you at school isn’t such a big deal.

One way to do that is by taking them to your local library’s story time session. There, kids learn to be in a group setting with other kids and aren’t constantly with Mom or Dad. Story time also re-enforces reading every day and gets kids ready for school.

p Develop independence.

Tricia Foley’s

CLUB SANDWICH

Regular Ingredients:

Healthy Swap Ingredients:

2

slices white bread

SWAP FOR

2

slices sprouted-grain bread, such as Ezekiel brand

1

tablespoon mayonnaise

SWAP FOR

1

tablespoon nonfat plain Greek yogurt

1

ounce provolone cheese

SWAP FOR

1/4

avocado, sliced

2

slices bacon, cooked

SWAP FOR

2

slices reduced-sodium turkey bacon, cooked

11/2

ounces deli-style, thin-sliced smoked ham

SWAP FOR

3/4

ounce reduced-sodium, deli-style, thin-sliced smoked ham

11/2

ounces deli-style thin-sliced roasted turkey breast

SWAP FOR

11/2

ounces reduced-sodium deli-style thin-sliced roasted turkey breast

Directions:

Directions:

Spread mayonnaise onto one slice of bread, add cheese and bacon. Top with ham, turkey and the second slice of bread.

Spread Greek yogurt onto one slice of bread and add turkey bacon. Top with avocado slices, ham, turkey and the second slice of bread.

Nutrition Facts per serving:

Nutrition Facts per serving:

• • • • • • •

• • • • • • •

528 calories 30 g fat (10 g saturated fat) 1,909 mg sodium 32 g carbohydrate 2 g fiber 4 g sugar 23 g protein

385 calories 15 g fat (1 g saturated fat) 832 mg sodium 37 g carbohydrate 10 grams fiber 2 grams sugar 25 g protein

Swap Notes: Ezekiel bread:

Greek yogurt:

We swapped the white bread that’s devoid of fiber with Ezekiel bread, which is made from sprouted grains and legumes and contains no added sugar. The sprouted grain bread is richer in vitamins C and E, soluble fiber and folate. Legumes also add protein, so the swap sandwich has a similar protein content, but it contains less processed meat, which means less saturated fat and sodium.

Swapping out regular mayonnaise for Greek yogurt decreases both saturated fat and sodium while providing a similar flavor.

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OurHealth | The Resource for Healthy Living in Greater Richmond

Reduced-sodium products: Using reducedsodium meats allows for a similar taste without as much salt. The American Heart Association recommends no more than 1,500 mg of salt per day.

Avocado:

Fiber:

Using avocado instead of cheese adds flavor and texture without the unhealthy saturated fat and sodium.

Avocados are high in heart-healthy monounsaturated fat and fiber.

The swap has much more fiber, so the net carbs are 27 grams on the healthy swap (carbohydrates minus fiber) compared to 30 net carbs on the original sandwich.

Tricia Foley’s

POTATO CHIPS

Regular Ingredients: (serves 1)

Healthy Swap Ingredients: (serves 3)

Potatoes

SWAP FOR

Vegetable oil

SWAP FOR

Salt

SWAP FOR

Directions: These are the ingredients for a bag of regular potato chips.

Nutrition Facts per once: • • • • • •

160 calories 10 g fat (2 g saturated fat) 170 mg sodium 15 g carbohydrate 1 g fiber 2 g protein

Swap Notes:

1

large sweet potato Olive oil spray

1/4

teaspoon sea salt

OPTIONAL: garlic powder, onion powder or dried rosemary to taste

Directions: Heat the oven to 300 F. Line a baking sheet with parchment paper and place a wire cooling tray on top of the parchment.

Slice the sweet potato as thinly as possible, using a mandolin if you have one. Try to cut the chips the same size and thickness to help them bake evenly.

Fill a medium bowl with water and place potato slices in the water to soak for 10 minutes (this will allow them to get crispier).

Pat dry with a paper towel, place in a large bowl and lightly coat with olive oil spray. Toss with salt and seasonings, if desired.

Arrange the slices on a single layer on the cooling tray, and place on the middle rack in oven.

Bake 40 minutes, flipping chips after 20 minutes. Remove any chips that are starting to get crispy.

Continue baking remaining chips, regularly checking the chips and removing any that are starting to brown and get crispy. They will crisp more after sitting a few minutes. Allow chips to cool.

The swap uses sweet potatoes, which are rich in beta carotene. Keeping the skin on adds a boost of fiber to the chips. We also save on unhealthy fats by lightly coating our chips with olive oil spray and baking them instead of frying.

Nutrition Facts per serving: • • • •

108 calories 9 g fat (2 g saturated fat) 3 g carbohydrate Adds 1 g fiber

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words | RICK PIESTER

PROSTATE’S

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OurHealth | The Resource for Healthy Living in Greater Richmond

September is Prostate Cancer Awareness Month, a time set aside each year to focus on the disease that is the second largest cancer killer of men in the United States. The good news, however, is that if prostate cancer is caught early, the five-year survival rate is almost 100 percent. To help observe this special month, we talked with some local experts about prostate cancer, its detection, and its treatment. Here’s what they say to help you keep ahead of the game, and possibly avoid prostate cancer.

Am I at higher risk to develop prostate cancer based on my race?

There are only three known factors that increase the risk for having and dying from prostate cancer: increasing age, having a relative who had the disease, and African-American ancestry. African Americans have both a higher rate of getting prostate cancer and dying from it. Specifically, compared to Caucasian men, African Americans are nearly 1.6 times more likely to be diagnosed with prostate cancer.

Even more concerning, African Americans have a risk of dying from the disease that is 2.4 times higher. Studies have been performed to determine whether these differences are due to the disease itself or other factors such as limited access to healthcare or reluctance to seek care or undergo screening. These studies have shown that it is the nature of the disease itself that is causing these differences.

Prostate cancer is more prevalent and more aggressive in African Americans. For this reason, African American men are encouraged to undergo screening beginning at age 40, ten years earlier than men of other racial groups. With screening, early detection, and treatment urologists should be able to decrease the prostate cancer death rate in African Americans.

Paul Roberto, MD is a urologist with Chesterfield Urology in Midlothian.

Dr. Roberto is certified by the American Board of Urology.

Paul Roberto, MD

Chesterfield Urology | Midlothian | 804.639.7777

Prostate cancer is most common in men age 65 and older, although younger men can be diagnosed with it as well.

Source: National Cancer Institute, www.cancer.gov

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31

If I have a family history of prostate cancer, should I get checked more often?

Men with a family history of prostate cancer should start annual screening earlier (age 40 instead of 50), but not more frequently. A family history of prostate cancer generally doubles the risk of being diagnosed with cancer. The more relatives and the closer they are to you genetically, the higher the risk. A patient with a single first degree relative (father, brother, son) has double the risk. The risk triples for folks with two first-degree relatives. A patient with three second degree relatives (grandfather, uncles) has double the risk. Likewise, the risk triples when the number of second degree relatives with the disease increases to five.

The American Cancer Society estimates about 1 in 7 American men will receive a diagnosis of prostate cancer in their lifetime.

Despite this increased risk, however, annual screening is still the standard. If the rectal exam is normal and the PSA is low and stable, there is no reason to perform these tests more frequently than once a year. However, if the PSA begins to rise in a patient with a strong family history, the patient may opt for more frequent PSA testing or just proceed with a biopsy. Individual evaluation and intervention is essential in these circumstances. Decisions should be based on the actual PSA, the rate of rise, the race and age of the patient, and his other medical problems (i.e. his overall prognosis - risk of dying from other issues rather than prostate cancer).

Paul Roberto, MD

Chesterfield Urology | Midlothian | 804.639.7777

Are there self-tests I can perform to check for prostate cancer? (Similar to self-breast exams women can perform for breast cancer.)

Unfortunately the prostate gland location prevents effective self-examination.

Urinary symptoms such as weak stream, voiding frequently during the day or night, and urine stream hesitancy may be signs of an enlarged prostate. Prostate enlargement can be the result of benign or cancerous change. A change in a man’s urinary pattern is an indication to have a prostate exam. A PSA blood test can also be useful regarding the diagnosis of prostate cancer.

James Ratliff, MD Virginia Urology | Richmond | 804.330.9105 | www.uro.com

At what age should I start getting a prostate exam?

Virginia Urology recommends evaluation of the prostate in men without urinary symptoms starting at age 50. Men with urinary symptoms or men with risk factors for prostate cancer should undergo evaluation at age 40. Risk factors include African American ancestry, a family history of prostate cancer, and a change in urinary symptoms.

James Ratliff, MD is a urologist with Virginia Urology in Richmond.

Dr. Ratliff is certified by the American Board of Urology.

32

James Ratliff, MD

Virginia Urology | Richmond | 804.330.9105 | www.uro.com

OurHealth | The Resource for Healthy Living in Greater Richmond

Kumar Abhishek, MD is a physician with Bon Secours Cancer Institute Medical Oncology at Memorial Regional in Mechanicsville. Dr. Abhishek is certified by the American Board of Internal Medicine with subspecialties in Hematology and in Medical Oncology.

As I age, does the recommendation for a prostate exam change?

Prostate cancer screening recommendations have changed recently. The United States Preventive Services Task Force recommends against prostate cancer screening. However, prostate cancer is the most commonly diagnosed cancer among men in this country, making it difficult to unilaterally accept this recommendation.

The American Urological Association takes a more nuanced approach, which I favor. Per AUA guidelines: • Men 40 years or younger should not undergo prostate cancer screening.

• For men between the ages of 40 and 55, decisions regarding prostate cancer screening should be individualized based on family history and ethnicity of the patient.

• For men ages 55 to 69 years, AUA recommends that the decision to undertake a PSA screening involve weighing the benefits of preventing prostate cancer mortality (1 man for every 1,000 men screened over a decade) against the known potential harms associated with screening and treatment.

• PSA screening in men ages 70 and older or any man with less than a 10 to 15 year life expectancy should not be done.

Kumar Abhishek, MD

Bon Secours Cancer Institute Medical Oncology at Memorial Regional Mechanicsville | 804-764-7220

www.OurHealthRichmond.com

33

What are the treatment options for prostate cancer?

Patients with very early stage, localized prostate cancer or those whose life expectancy is less than 10 years can undergo surveillance only. Radical prostatectomy is appropriate for patients who have cancer localized to the prostate who may have a higher risk of recurrence. Patients with localized prostate cancer could also receive external beam radiation therapy. Radical prostatectomy and external beam radiation therapy for the treatment of localized prostate cancer are equally effective. For low risk localized prostate cancer, patients may undergo radiation seed implant in the prostate.

Prostate cancer is the 2nd most common cancer in men right behind skin cancer.

Source: American Cancer Society

For patients with advanced prostate cancer there are a variety of treatment options.

Prostate cancer grows under the influence of testosterone, so testosterone suppression is the most effective initial treatment of advanced prostate cancer. There are other treatments such as chemotherapy, radiation emitting small particles such as Ra-223, immunotherapy such as Sipuleucel-T, and finally newer hormonal therapies in pill form.

Kumar Abhishek, MD

Bon Secours Cancer Institute Medical Oncology at Memorial Regional Mechanicsville | 804-764-7220

What are symptoms of prostate cancer?

Prostate cancer does not cause any symptoms in early stages.

That’s why early screening and detection is so important. In later stages it can cause urinary frequency, weak stream, and inability to urinate.

Eugene Park, MD

Urology Specialists of Virginia | Richmond | 804.323.0226

Can prostate cancer be prevented?

Unfortunately, according to the American Cancer Society, prostate cancer cannot be prevented because these risk factors (age, race, and family history) cannot be controlled. But there are some things you can do that may lower your risk of prostate cancer. Keeping healthy servings of fruits and vegetables in your diet, staying physically active, and maintaining a healthy weight can help lower your risk of prostate cancer. Schedule a visit with your local provider to make sure you are on the right track.

ON THE WEB

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35

series

the 2016 OurHealth Richmond Primary Care Series: an issue-by-issue overview

+++ january

| february

KNOW YOUR CARE: understanding your health and how to maintain it

+++ march

| april

DO YOUR CARE:

INSPIRE

taking action with your health

YOUR

care

+++

words | GERI ASTON

Keeping Creative with Fresh Care Ideas!

Getting on the road to good health is often easier than staying on it. Today, many people have — or are at risk of developing — common chronic conditions such as diabetes, high blood pressure or heart disease.

Oftentimes, those health concerns prompt them to visit a primary care physician. That’s a great first step. Primary care doctors work with their patients to develop a plan of action specific to each patient’s health needs and goals.

Those patients often start out eager to make the lifestyle changes — like losing weight or exercising — that are necessary to prevent or combat most chronic conditions. But as the months go by, many formerly motivated individuals begin to lose steam. Sometimes they fall back into old, unhealthy habits. Sometimes people don’t see the results they expected, so they throw up their hands and quit trying.

Regardless of why people falter, their primary care physician can help get them back on track.

This article, the fourth in a yearlong OurHealth series about primary care, will focus on “inspiring your care.” In it, primary care physicians offer ideas on how to overcome the obstacles that might sidetrack people on their path to better health.

june

| july

SHARE YOUR CARE: setting good examples for others to learn and live by

+++ +++ august

| september

INSPIRE YOUR CARE: keeping creative with fresh care ideas

+++ +++ october

| november

MEASURE YOUR CARE:

tracking your efforts to ensure you’re on the right path

+++ december

CELEBRATE YOUR CARE: rejoicing the rewards realized from taking good care of yourself

“Celebrate your success with something other than food.”

– Susan Wolver, MD

Reach for a helping hand People are known to bite off more than they can chew by overestimating what they can accomplish when they first set their diet and exercise targets.

The first thing patients should do if they find themselves floundering is to ask their primary care doctor for help. If it’s been months since your last appointment and you’ve lost momentum to stick with your exercise or healthy eating plans, it’s worth it to schedule a follow-up appointment.

“Losing weight is hard, and often people expect dramatic and sustained weight loss and are discouraged when it takes a long time and success is slow,” says Susan Wolver, MD, a primary care doctor and obesity medicine specialist with VCU Health in Richmond.

Susan Wolver, MD, is a primary care doctor and obesity medicine specialist with VCU Health in Richmond. Dr. Wolver is certified by the American Board of Internal Medicine.

For big health goals, such as losing weight or quitting smoking, it’s often helpful to turn to friends and family for encouragement. “Get support in as many ways possible: friends, family, social media groups,” Dr. Wolver suggests.

Ideas to Eat Right Without an Official Diet The general public gets bombarded with dietary advice, food advertising and myriad diets from a variety of sources: Eat less, move more. Eat a low-fat diet. Count your calories. Eat small meals throughout the day. Atkins, Weight Watchers, South Beach, Jenny Craig and more.

“With all the advice and different diets out there, is it any wonder that people are confused about how best to lose weight?” asks Susan Wolver, MD, a primary care physician and obesity medicine specialist with VCU Health in Richmond.

Because obesity is an underlying issue in most of the conditions she treats, especially diabetes and high blood pressure, Dr. Wolver decided to get additional certification in obesity medicine.

There are different paths to weight loss, and Dr. Wolver has developed some tips she says have helped hundreds of her patients lose weight.

Eat real food. This recommendation includes the fat that is contained in

real food because fat makes people feel full and satisfied and is an important part of a healthy diet. The 2015-2020 Dietary Guidelines for Americans (from the U.S. Department of Health and Human Services and the U.S. Department of Agriculture; available at www.health.gov/dietaryguidelines/2015) doesn’t encourage low-fat diets (diets that are low in total fats) because not all fats are created equal. Although there is some disagreement among experts, current guidelines encourage eating styles that emphasize unsaturated fats and are lower in saturated fat. Trans fat is known to be particularly problematic and should be avoided. Processed foods (food made in a factory) should be minimized.

Reduce or eliminate added sugar. Up to 80 percent of our foods have

added sugar, Dr. Wolver says. Eating a diet high in sugar can keep you hungry, — Eat Right without a “Diet”, continued on page 39

38

OurHealth | The Resource for Healthy Living in Greater Richmond

When patients have chronic health conditions, Joshua Storm, a physician assistant at Primary Health Group at Ironbridge, tries to stress the importance of maintaining a healthy lifestyle without discouraging his patients.

When it comes to diabetes, for example, it’s important for patients to understand the long-term complications that can occur as a result of poorly controlled blood sugar. According to Storm, patients recognize that high blood sugar is a sign their diabetes isn’t controlled, but they might not know that longterm, uncontrolled diabetes increases their risk for neuropathy (nerve damage), nephropathy (kidney disease), retinopathy (damage to blood vessels in the eye), cardiovascular disease, stroke, erectile dysfunction and diabetic foot wounds.

“Although these potential complications may seem scary, I reassure patients that together we can create an attainable path toward a healthier lifestyle,” he says.

When people don’t reach their end goals, some fail to recognize the progress they’ve made or the positive effect it can have. “For example, as little as a 5 percent weight loss can make a significant improvement in your health,” Dr. Wolver says.

Change your mindset Sometimes a person’s way of thinking can become a barrier to practicing healthier habits. The words “diet” and “exercise” can sound like chores and quickly erode a person’s determination.

Instead of focusing on following a diet, think about making better food choices.

Storm suggests eating whole-grain instead of white bread; steering away from starchy foods like rice, pasta and white potatoes; substituting lean meats like chicken or fish for red meat; and cutting back on sodas and alcohol.

— Eat Right without a “Diet”, continued from page 38

and the evidence increasingly indicates that sugar is addictive. The American Heart Association recommends that men eat no more than 9 teaspoons of added sugar per day, with a maximum of 6 teaspoons daily for women.

Starting in 2018, new food labeling rules will require that labels clearly state the amount of added sugar. Try to avoid the myth of “one little bite won’t hurt you” because it can awaken sugar cravings that you might have been able to suppress otherwise.

Stay away from drinks with calories. Studies have shown that sugar-

sweetened beverages like soda can be especially problematic. However, substituting juice or an energy drink is not much healthier. Alcoholic beverages can also be a problem when trying to lose weight. Overall, water is the best bet.

Don’t drink your food. Smoothies touted as healthy can serve up a whopping

“I also remind patients that they don’t have to go hungry,” he says. “There are countless tasty, filling and healthy foods they can enjoy.”

carbohydrate load. It is unlikely that you would be able to eat all of the fruits and vegetables in a smoothie that can take just a few minutes to drink. Also, chewing your food actually helps you to feel full.

Storm recommends that patients check out the websites www.diabetes.org and www.nutrition.gov because they provide important information and healthy meal plan suggestions.

potatoes should generally be reduced because they can cause fluctuations in blood sugar that lead to hunger and weight gain.

Dr. Wolver encourages patients to read food labels. “I often say that people look more at the gas they are putting in their cars than the food they are putting in their bodies,” she says. Pay attention to the number of servings on the label.

“Often what you eat is more than one serving, so you have to do some math to see what you are actually getting.”

Watch your carbohydrates. Consumption of bread, pasta, cereal, rice and

Choose your fruit wisely. Some people with great metabolism do not

have issues with fruit, but for others, it can inhibit weight loss and increase sugar cravings. The fruits we eat today look nothing like the fruits we ate years ago because they’ve been bred to be bigger and sweeter. Tropical fruits like bananas, pineapples and mangos have the highest sugar content. Berries have the lowest.

Eat only when you are hungry. Ask yourself if you are hungry before you

eat. Many of us have lost the ability to really feel hunger and satiety because we let our minds tell us when we are hungry (for example, “it’s noon, time for lunch”), rather than a rumble in our bellies. If you think you are hungry, drink water and see if you still feel hungry.

It’s about time For those who find exercise a chore, doctors recommend that patients think instead about how to incorporate additional regular movement into their lives.

“I encourage patients to work on time management and find ways to create free time — even if only 15 to 30 minutes a day — for physical activity,” Storm says.

Even standing up from your desk and walking around or taking the stairs during the workday can be a good start “Patients often mention that they don’t have time to exercise or they have other obligations that prevent them from exercising,” Storm says. “But I try to impress upon my patients that they have an obligation to themselves to lead a healthier life and that they deserve that better life.”

Keep tabs on yourself Life can be chaotic, so tracking results — positive and negative — and keeping them in one location can help a patient in the short term as well as down the road.

Joshua Storm, PA, is a physician assistant at Primary Health Group at Ironbridge in Chester.

www.OurHealthRichmond.com

39

Dr. Wolver advises people to weigh themselves once a week to stay accountable and to record the results. She also points out that it’s important to think beyond pounds.

“Measure yourself because sometimes you will see results other than on the scale,” she says. “Talk with your doctor about your plan and see him or her often.”

When people falter, Storm asks them to walk him through a typical day, including what types of food they eat, their exercise habits and their sleep habits. Based on their answers, he recommends changes he thinks could help.

If one approach isn’t working, your doctor can likely recommend something else. For example, a diabetic patient whose blood glucose is higher than it should be even after they’ve made the recommended lifestyle changes might need medication.

Storm encourages patients to use health apps on their cell phones and computers.

One of his favorite free apps is Fooducate (www.fooducate.com), which allows users to track their food intake and activities to see their progress. Patients can scan the barcodes of packaged foods with their phone, and the app provides food grades (A through D) and information regarding the foods entered. It also provides healthy alternatives and suggestions for similar food items.

Carrots, not sticks To keep up your momentum, acknowledge your achievements.

“Celebrate your success with something other than food,” Dr. Wolver says.

Sometimes treating yourself to something small is enough. For example, if you’re trying to quit smoking and have gone two weeks without a cigarette, do an activity that you enjoy, such as going to a movie. When larger goals are met, the reward could be more significant. When you recognize your achievements, you’ll be more likely to stay motivated.

On the flip side, doctors encourage their patients not to beat themselves up over their mistakes and slips.

“Know that despite your best intentions, you will slip once in a while,” Dr. Wolver says. “Rather than throwing in the towel, look at it as a learning opportunity. Why did it happen? What can you do differently if the same situation presented itself again?”

Don’t sabotage yourself by saying, “I just ate something I shouldn’t, so I’ll forget about the rest of the day and start again tomorrow,” Dr. Wolver says. “The problem is, tomorrow becomes the next day, then the next week and the next month.

After recognizing a slip, make your very next bite a good one.”

Next in our series Part V of OurHealth magazine’s six-part series, “The Bridge to Better Health Starts with Primary Care,” examines ways you can track your efforts to ensure you’re on the right path. The ability to measure your care will make it easier to see your success. Be on the lookout for Part V in the October/November issue!

40

OurHealth | The Resource for Healthy Living in Greater Richmond

Sources • Fooducate, http://www.fooducate.com • “2015-2020 Dietary Guidelines: Answers to Your Questions,” US Department of Agriculture, www.tinyurl.com/z9ldywl • “Added Sugars,” American Heart Association, www.tinyurl.com/zqpcu4x • “Changes to the Nutrition Facts Label,” US Food and Drug Administration, www.tinyurl.com/hrrggdf

Expert sources

[ WEB EXCLUSIVE! ]

• Susan Wolver, MD, is a primary care physician and obesity medicine specialist with VCU Health in Richmond.

• Joshua Storm, PA, is a physician assistant at Primary Health Group at Ironbridge in Chester.

ON THE WEB

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NUTRITION: HOW TO MAKE A “BETTER FOR YOU” SANDWICH! ourhealthrichmond.com

www.OurHealthRichmond.com

41

42

OurHealth | The Resource for Healthy Living in Greater Richmond

HOW TO IN

HEALTHCARE part SERIES

the 2016

OurHealth Richmond

HOW TO IN HEALTHCARE SERIES: an issue-by-issue overview

words | TINA JOYCE

GRADUATING TO GRADUATE

SCHOOL

OurHealth’s four-part healthcare education series is a step-by-step guide for those interested in pursuing a career in healthcare.

Imagine a career that has the potential to save lives each and every day. From emergency medical technicians and anesthesiologists to physical therapists and trauma surgeons, those who work in the healthcare field come together to save lives or improve the quality of life for their patients.

OurHealth is exploring numerous healthcare employment opportunities and sharing expert advice on ways to reach career goals in healthcare.

In Part I, the March/April issue, we shared tips for families of students interested in exploring collegiate opportunities with a medical focus in mind.

In Part II, the June/July issue, OurHealth asked college and university representatives to share insights on certificate and degree programs that transition students directly into the healthcare workforce as well as tips to help students successfully pursue a four-year degree.

In this issue, we explore healthcare careers requiring postgraduate studies, including graduate school, professional school, residency programs and fellowships. We also offer planning considerations to assist students who are currently pursuing a bachelor’s degree but looking to further their education.

part one

Preparing for a Career in Healthcare as Early as High School |

march

april

part two

Choosing The Right Undergraduate School For Your Healthcare Specialty |

june

july

part three

Entering Graduate School and Residency/ Fellowship/Clinical Training august

|

september

part four

Insight on How to Find the Right Job in One’s Field of Specialty october

|

november

ACRONYMS RELATED TO ADVANCED DEGREES AND LICENSURE PROGRAMS As a reminder and to help alleviate confusion, acronyms related to advanced degrees and some licensure programs are listed below hh MSN – Master of Science in Nursing hh MNA – Master of Nurse Anesthesia

hh CRNA – Certified Registered Nurse Anesthetist hh NP – Nurse Practitioner

hh DNP – Doctor of Nursing Practice

hh PhD – in nursing, psychology and other healthcare areas hh PharmD – Doctor of Pharmacy hh PA – Physician’s Assistant hh MD – Doctor of Medicine

hh DO – Doctor of Osteopathic Medicine hh DPM – Doctor of Podiatric Medicine hh DPT – Doctor of Physical Therapy

hh LCMHC – Licensed Clinical Mental Health Counselor hh LCP – Licensed Clinical Psychologist

hh LCPC – Licensed Clinical Professional Counselor hh LCSW – Licensed Clinical Social Worker hh PsyD – Doctor of Psychology hh DC – Doctor of Chiropractic

hh DPM – Doctor of Podiatric Medicine hh DrPH – Doctor of Public Health

hh DDS – Doctor of Dental Surgery

hh DMD – Doctor of Dental Medicine hh AuD – Doctor of Audiology hh OD – Doctor of Optometry

hh DVM – Doctor of Veterinary Medicine 44

OurHealth | The Resource for Healthy Living in Greater Richmond

Previous OurHealth issues have revealed that career opportunities in healthcare are numerous, and each program of study has different requirements. Understanding the complex world of graduate school includes comprehending undergraduate requirements, entrance exams and waiting lists — a potentially overwhelming process if it is conducted without guidance.

The best plan of action is to conduct thorough research — as early as possible — about programs and colleges with specific career interests in mind.

Undergraduate students who are considering an advanced degree in healthcare must begin preparing well in advance of receiving their bachelor’s degree. This includes maintaining a high GPA and taking required and advanced courses. For example, a student who wants to attend medical school is likely to be enrolled in a premed undergraduate program, taking a course load with a heavy concentration in math and science.

When it comes to graduate programs in the healthcare field, students can either attend a graduate school or a professional school. Graduate schools offer master’s and doctoral degrees.

Medical schools fall into a category called professional schools, which also includes dental schools, pharmacy schools, chiropractic schools, etc.

THERE ARE MULTIPLE QUESTIONS STUDENTS SHOULD

CONSIDER WHEN MAKING DECISIONS ABOUT ADVANCED EDUCATION: • What career am I seeking?

• What graduate degree do I need for that career?

• Does location matter?

• Which colleges/universities offer the program or degree I want?

• What are my financing needs and options?

• Is the school accredited?

• What is the reputation of the school or program I am considering?

• What is the school’s placement rate for graduates?

• Do I have the needed undergraduate requirements to apply to the program?

• Are entrance exams required for admission?

• Is work experience required for admission?

• When is the application deadline?

The best resource for a student beginning to look into graduate schools would typically be the institution’s website. Most, if

not all, programs have extensive descriptions of the application process, entrance requirements and deadlines on their websites.

Once an online search has narrowed down which colleges and universities offer the chosen graduate program of study, students can begin to dissect the steps needed to apply to their school(s) of choice. Graduate programs are usually quite competitive; therefore, it is recommended that students apply to more than one. Each school has its own requirements, and every program within the school has yet another set of criteria for admission.

“My advice [to students looking to apply for graduate school], is to start the process as soon as possible. Do your research, do your homework. You have to find an area you are passionate about.” If you can work in the field in some capacity, it helps. You don’t have to go directly into graduate school. Experience in the field can be very helpful. Look for internships and assist faculty when possible…and of course, keep your grades up,” advises Dr. F. Douglas Boudinot, Dean of Graduate School at Virginia Commonwealth University.

F. Douglas Boudinot, PhD is dean of the Graduate School at Virginia Commonwealth University.

Additionally, undergraduate schools generally have pre-graduate and pre-professional advising programs that students can access, either online or in person. If there are specific questions an applicant has about a program, an email or phone call will likely prompt a helpful response from someone in the department.

“I would not suggest calling professional programs with general career advising questions — they have neither the expertise nor time to answer those types of questions. But if there is a specific question to which an answer cannot be found on the website, then contact is appropriate,” explains R.J. Canterbury, MD, senior associate dean for education at the University of Virginia School of Medicine.

EXPLORING

POSSIBILITIES

It is important to realize there are numerous, highly sought after and lucrative healthcare opportunities besides becoming a physician. Students can explore many different facets of healthcare — both clinical and administrative — that require graduate work. For example, Virginia Tech offers a professional Master of Public Health degree. “We also offer graduate programs in biochemistry; biomedical engineering; consumer health; human nutrition, foods, and exercise; psychology; genetics; bioinformatics; and computational biology — all health sciences fields,” says Cathy Grimes, communications manager for Virginia Tech Graduate School.

Virginia Commonwealth University offers a Master of Health Administration degree and a graduate concentration in healthcare management as part of a Master of Business Administration degree. Liberty University also offers a Master of Public Health and a Master of Science in biomedical sciences.

UNDERSTANDING

THE DIFFERENCE

The healthcare field is immense. Exploring careers can be overwhelming to even the most astute students. Unless students have personal experiences with a particular health www.OurHealthRichmond.com

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professional, they might misunderstand the differences between common medical professionals. For example, the differences between psychologists and psychiatrists; optometrists and ophthalmologists; and dentists, orthodontists and periodontists.

Confusion often exists between Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) degrees. Both degrees mean the doctor is a licensed physician, but their training and approach to healthcare differs slightly. Medical doctors generally focus on one condition or area of the body, whereas osteopathic physicians are dedicated to treating and healing the patient as a whole.

Randolph Canterbury, MD is senior associate dean for education at the University of Virginia School of Medicine.

Another point of clarification has to do with a specialization. An orthodontist has completed dental school and gone on to receive further training to specialize in the prevention and correction of misaligned teeth and jaw. A psychiatrist is a medical doctor who specializes in mental health. In contrast, a psychologist has earned a master’s or doctorate degree but focuses on studying and evaluating mental processes.

It is important for students to research and learn as much as possible about the careers they are considering prior to investing time, money and energy in academic pursuit. During undergraduate studies, summer internships or part-time jobs allow students to explore careers and interview people working in the field of interest.

Refer to the March/April issue of OurHealth for other recommendations.

APPLICATION AND

ENTRANCE EXAMS

The application process varies from school to school and program to program.

Sometimes there is a common application form. For example, students applying to medical school complete a national application, the American Medical College Application Service® (AMCAS®).

APPLYING TO GRADUATE SCHOOL?

FOLLOW THESE GUIDELINES Applying to graduate school? When planning, it’s helpful to work backward from the application deadline and follow these steps: hh Research schools with your program of study.

Cathy Grimes is the communications manager for Virginia Tech Graduate School.

hh Consider visiting the schools you are applying to and make contact with staff/ professors. hh Take a practice GRE or other entrance exam if required or recommended for admission. hh Sign up for a GRE prep course.

hh Register for the GRE general test if necessary.

hh Begin drafting your statement of purpose for your application. hh Complete and submit applications by deadlines.

hh Request that undergraduate transcripts be sent.

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Information about the application and medical careers can be found on the website of the Association of American Medical Colleges. The organization provides valuable information for all students seeking admission to medical schools across the country.

Most clinical postgraduate programs require some type of entrance exam. For example, most graduate programs in clinical psychology require the Graduate Record Exam (GRE) for application. The GRE is widely regarded as an entrance exam for many postgraduate programs, not just for medical fields.

Some healthcare graduate programs require both an entrance exam and work experience.

For example, if a student receives a Bachelor of Science in nursing and wants to pursue a Master of Science in nursing, the tests required to get into a school that offers an MSN vary.

Christine Kueter, communications coordinator at the University of Virginia School of Nursing explains, “A year’s worth of clinical experience is required for the Clinical Nurse Specialists (CNS) master’s and Nurse Practitioner (NP) master’s tracks, but the Clinical Nurse Leader (CNL) master’s program — that’s the one degree for non-nurses pivoting into the profession who have at least a bachelor’s degree in another field — has no such requirement. Students who already have a bachelor of science in nursing (BSN) and are applying to an Master of Science in Nursing (MSN) program must have passed the National Council Licensure Examination (NCLEX) and have at least a year of clinical experience, but GREs are not required for entry. All students applying to a master’s program must have completed a statistics course within the last five years.”

Similarly, students seeking admission to a medical school might be required to take the Medical College Admissions Test (MCAT). However, not all programs require the MCAT for admission, and some require the test but do not have a minimum score to be considered for admission, according to College Admissions Partners, a college admissions counseling service provider.

For admission to Liberty University College of Osteopathic Medicine, the MCAT is a factor, as are grades, but it is not an overriding factor in the selection process. “We establish a high enough level for test scores and grades that it demonstrates with 95 percent probability they can do the work of medical school, but it is not a determining factor,” says Ronnie Martin, DO and professor of family medicine. “The MCAT predicts how the students will do on national boards like the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) or United States Medical Licensing Examination (USMLE) but not the type of doctor they will be or how they will perform in medical school.”

Similar to deciding on an undergraduate college or university, choosing the “best fit” graduate school is extremely important

DOCTOR OF PHILOSOPHY

(PHD)

A PhD is an advanced, post-graduate academic degree awarded by universities to a candidate who has submitted a thesis or dissertation that is based on extensive and original research in his/her chosen field. In general, the PhD is the highest level of degree a student can achieve, and usually follows a master’s degree. In most cases, a PhD involves three to four years of full-time study.

REQUIREMENTS FOR PHD PROGRAMS:

In order to be accepted into a PhD program, a student must have a master’s degree from an accredited college or university. In addition, most universities will require several letters of recommendation, a research proposal for the thesis or dissertation, letter of motivation from the application specifying his or her objections and determination to work hard on a project, and a face-to-face interview. Some universities also require a PhD entrance exam.

DOCTOR OF HEALTH

(DHS OR DHSC)

SCIENCE

A Doctor of Health Science (DHS or DHSc) is a postprofessional academic degree for those with a master’s degree who intend to pursue or advance a professional practice career in health arts and sciences and healthcare delivery systems, to include clinical practice, education, administration and research. Individuals who complete the DHS/DHSc face the particular challenge of understanding and adapting scientific knowledge in order to achieve health gain and results. This degree leads to a career in high-level administration, teaching, applied research, or practice, where advanced analytical and conceptual capabilities are required. The Doctor of Health Science is a degree that prepares scholarly professionals in healthcare.

ENTRANCE EXAM REQUIREMENTS FOR DOCTOR OF HEALTH SCIENCE:

DHS and DHSc programs require a master’s degree from an accredited college or university, as well as related work experience in a clinical or healthcare-related educational setting. An interview may also be required as part of the admission process. There are no specific entrance exams required for this program.

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PROFESSIONAL DEGREE PROGRAMS ENTRANCE EXAM REQUIREMENTS FOR

PROFESSIONAL SCHOOL PROGRAMS:

A professional degree is a graduate level degree that is offered upon completion of necessary undergraduate components, followed by additional study in a specialized field. In this model, the undergraduate portion generally lasts five or more years, followed by four years at the graduate level.

CHIROPRACTIC SCHOOL The educational requirements for chiropractors specify a minimum of two years of pre-chiropractic study and four years of chiropractic school, after which the Doctor of Chiropractic degree is awarded. However, the majority of successful applicants have completed three or four years of college work before entering chiropractic school.

There is no entrance exam required for admission into chiropractic school.

DENTAL SCHOOL The Dental Admissions Test (DAT) is a timed multiplechoice exam conducted by the American Dental Association (ADA) that is used as part of the admissions process for dental school. The DAT measures the general academic ability, comprehension of scientific information, and perceptual ability of the prospective dental student.

MEDICAL SCHOOL The Medical College of Admission Test (MCAT) is a computer-based standardized exam required for prospective medical students. It is designed to assess problem solving, critical thinking, written analysis and knowledge of scientific concepts and principles.

NURSING SCHOOL For graduate students entering nursing school, the required exams include the Graduate Record Exam (GRE), The Test of Essential Academic Skills (TEAS) and the National Council Licensure Examination (NCLEX).

Exams can vary by institution, and some may require only one test.

OPTOMETRY SCHOOL All schools of optometry require the Optometry Admission Test. The OAT is a standardized examination, sponsored by the Association of Schools and Colleges of Optometry (ASCO), designed to measure general academic ability comprehension of scientific information.

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PHARMACY SCHOOL The Pharmacy College Admission Test (PCAT) is a specialized test that helps identify qualified applicants to pharmacy colleges. It measures general academic ability and scientific knowledge necessary for the commencement of pharmaceutical education. The PCAT is constructed specifically for colleges of pharmacy.

The PCAT consists of 232 multiple-choice items and one writing topic. Candidates are given approximately four hours to complete the test (including administrative time for instructions and time for a short rest break about halfway through the test).

PHYSICIAN ASSISTANT SCHOOL Physician assistant schools may vary when it comes to which exam they require. For example, some schools require the Graduate Record Examination (GRE), which is also often required for various types of master's degree programs. Other schools will accept the Medical School Admissions Exam (MCAT) instead of the GRE.

PHYSICAL THERAPY SCHOOL Most physical therapy (PT) programs require applicants to complete the Graduate Record Examination (GRE).

Programs may have minimum acceptable scores and last acceptable test dates. Policies regarding the consideration of multiple sets of GRE scores vary by institution.

PODIATRIC MEDICAL SCHOOL Almost all podiatric medical schools require applicants to take the Medical College Admissions Test (MCAT).

SPEECH-LANGUAGE PATHOLOGY SCHOOL Applicants are required to submit scores earned within the last five years from the general test portion of the Graduate Record Examination (GRE). The general test of the GRE measures verbal reasoning, quantitative reasoning, and writing skills. The test is available year round in a computer-based format.

VETERINARY SCHOOL The Graduate Record Examination (GRE) is required by most veterinary schools, and some also require the Biology GRE. The Medical College Admission Test (MCAT) is also accepted by some schools in place of the GRE.

ENTRANCE EXAM REQUIREMENTS FOR POST-GRADUATE SCHOOLS

for success. Expending energy to apply to schools that a student has no interest in attending or has a low probability of being admitted can be unwise. Conduct the research first and then apply to schools that are a good fit academically, socially and professionally.

According to Stephen M. Workman, PhD, associate dean for admissions at Virginia Tech Carilion School of Medicine, “Generally, students should pick their home state to apply to public graduate and professional schools because a larger number of in-state students are accepted each year. Student have a better chance of being accepted outside of their state of residence if they apply to a private school.”

Students shouldn’t overlook schools close to home. Virginians are fortunate to have outstanding colleges and universities within a few hours drive. Graduate schools are plentiful and diverse, while medical schools are competitive and wellrespected in the state.

RESIDENCY PROGRAMS Once students have completed four years of medical school, they enter the next stage of training called “residency.” During residency, students practice medicine under the direct or indirect supervision of an attending physician in a hospital or clinic setting.

Third-year medical students complete electronic applications to apply for a residency match. The residency placements are typically coordinated by the medical school’s student affairs office.

According to the American Academy of Family Physicians, all students seeking a residency position should enroll in “The Match.” Once enrolled, students are bound to abide by the terms of the National Resident Matching Program.

Applying to a graduate or professional school often requires taking a standard entrance exam. Standardized exams are designed to measure an applicant's potential to succeed in graduate or professional school. While a high grade point average (GPA) indicates success at an undergraduate college or university, standardized tests permit fair comparisons of students from a variety of universities and colleges with potentially differing grading standards. Below is an overview of the different types of graduate and professional schools entrance exams.

GRADUATE RECORD EXAMINATION (GRE) The GRE is the general test that is used for admission into most graduate school programs. Administered by the Educational Testing Service (ETS), the GRE tests verbal reasoning, quantitative reasoning (math), and analytical writing (essay section). This computer-based test is available year-round at locations across the United States.

Scores are available at the test center and you have the option of sending the scores to whichever schools you choose. There is a fee to take the GRE, and registration can be completed online.

GRADUATE MANAGEMENT ADMISSIONS TEST (GMAT) The GMAT exam is primarily used for admissions decisions by business school graduate programs. If you’re considering a Master’s in Healthcare Administration degree, you may also be required to take the GMAT. It consists of a 30 minute analytical writing assignment, 12 integrated reasoning questions (30 minutes), 37 quantitative questions (75 minutes) and 41 verbal questions (75 minutes). These questions are designed to measure the skills needed to succeed in business school. The GMAT is given year-round and there is an average of fee of $250 to take the exam. While unofficial scores are available at the test center, your official scores will be sent to you within 20 days of completing the exam. Registration can be completed online.

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“MCAT scores are very important predictors of United States Medical Licensing Examination scores and standardized test taking abilities.

Applicants who score in the less than 55 percentile usually have a more difficult time with medical school course work and exams. But nothing is absolute and that is why we view each applicant holistically.”

—Dr. Michelle Whitehurst-Cook, the Associate Dean for Admissions, VCU School of Medicine

During the fourth year of medical school, students participate in residency interviews.

Based on the interviews and applications, the National Resident Matching Program places applicants for postgraduate medical training positions into residency programs at teaching hospitals throughout the U.S. Match results are made public in March.

“The state where you practice residency very often becomes where you are likely to end up residing,” Dr. Workman says. “National Match Day is a very anticipated day for medical students.”

Graduation from medical school happens in May, and students begin their residencies in the summer. A residency is a minimum of three years. Not all students will receive a match for placement. Student who graduate at the bottom of their class or are not competitive might not receive a residency match.

FELLOWSHIP

TRAINING

A fellowship is post-residency education that provides training in an area of specialization, ultimately allowing students to also teach or work in a large hospital.

Students gain additional knowledge and expertise in a particular area, which might or might not include a certificate of added qualification.

According to the website of the American Academy of Orthopaedic Manual Physical Therapists, “A fellowship is designed for the graduate of a residency or a board-certified therapist to focus on a subspecialty area of clinical practice, education or research.”

CHANGING

DIRECTION

A question looming in the minds of some graduate students may be, “I feel like I might be heading in the wrong direction. What do I do now?”

Some students question their program path often throughout undergraduate studies, causing a change of majors, while others have known their career choice from high school or earlier.

Several factors can contribute to a change in academic direction heading into graduate school or after a couple of semesters. Test scores, work and personal experiences, finances and advisor recommendations continue to shape a student’s career direction. For example, a student might not get accepted into the graduate or professional school of choice. “They may apply a second time or choose to go into a more research-based program,” Dr. Workman says.

Michelle Whitehurst-Cook, MD is the associate dean of admissions at VCU School of Medicine.

Dr. Canterbury recommends that “a medical student who is unhappy with his or her choice generally should not continue. Medicine is a great career and many would say a ‘calling,’ but it’s very hard work with many challenges. If a student does not find it gratifying, it will be difficult to be a good physician. There are many other wonderful careers that might make the person happier.”

To continue down a path of rigorous academic challenge, students must be completely committed to the profession they are pursuing. Doubts and fatigue may seep into their minds, but relying on strong relationships with advisors, professors and supportive family members will provide the support necessary to finish strong.

Because there are so many options in healthcare, it is possible for a student to change directions but still remain in pursuit of health-related profession. However, changes cost time and money.

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“Since the graduate programs are smaller here at VCU, we have a high retention and success rate. Also, assistantship funds are available to many students in healthcare programs,” shares Dr. Boudinot at VCU.

SEEKING

BALANCE

In addition to supportive relationships, diet and exercise play an important role in the mental, physical and social health of students. Inadequate sleep is common and often leads to chronic fatigue for students completing residencies and other intense work experiences.

Fatigue in turn leads to illness and can have an adverse affect on course work and personal relationships. Competitive programs have very little room for error, and grades falling below a B can result in dismissal from the program. Therefore, it is vitally important for students to stay physically active, eat a healthy diet with limited use of stimulants such as energy drinks and excess caffeine and get as much rest as possible.

Stephen Workman, PhD is the associate dean for admissions at Virginia Tech Carilion School of Medicine.

U.S. News & World Report has reported that many medical schools are initiating wellness and social programs to help students achieve work-life balance.

Last year, Psych Central (www.psychcentral.com) recommended 12 tips for surviving graduate school, commenting that unlike college, grad school is a full-time job.

THE TOP SIX TIPS FOR SURVIVING GRADUATE SCHOOL: 1. Know your work.

2. Read smarter, not harder.

3. Focus less on grades and more on learning.

4. Pick opportunities wisely.

5. Consult others.

6. Manage your time well.

Also, taking study breaks every few hours optimizes the retention of information. This is a good time to take a walk, have dinner with a friend or take a nap. If these breaks are not built into their schedule, students soon find themselves working or studying 24/7 and ultimately experiencing burnout.

Professional healthcare careers require planning and discipline to complete. Those with a heart to serve and a desire to continually learn will likely have the mindset for this type of career. Researching, planning, studying and finding balance will help make the student’s transition to graduate school a success.

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SOUTH UNIVERSITY RICHMOND RICHMOND AREA GRADUATE AND PROFESSIONAL SCHOOLS

OFFERING HEALTHCARE RELATED PROGRAMS COLLEGE OF WILLIAM & MARY

The College of William & Mary offers the master of arts (MA) in psychology) and master of science (MS) in biology. They also offer a doctor of philosophy (PhD) program through the department of applied science.

For more information visit www.wm.edu. *****

South University Richmond offers the master of arts (MA) degree in clinical mental health counseling, master of science in nursing (MSN), and master of science in physician assistant degrees.

For more information visit www.southuniversity.edu/richmond. *****

VIRGINIA COMMONWEALTH UNIVERSITY (VCU) The Virginia Commonwealth University (VCU) School of Allied Health Professions offers the master of science (MS) degree in health administration, nurse anesthesia, occupational therapy, and rehabilitation counseling. PhD programs are offered in health sciences organization and research and rehabilitation and movement science. Other doctorate programs are offered in nurse anesthesia, occupational therapy, and physical therapy.

The VCU School of Dentistry, located on VCU’s MCV Campus, offers the master of science in dentistry (MSD), with concentrations in endodontics, pediatric dentistry, and periodontics. They also offer a PhD in oral health research and the doctor of dental surgery (DDS) degree.

The VCU School of Medicine offers the medical doctor (MD) degree program.

Master of science (MS) degrees are offered in the following concentrations: hh Addiction studies

hh Anatomy and neurobiology

hh Biochemistry and molecular biology hh Biostatistics

hh Epidemiology and community health

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hh Genetic counseling

hh Human and molecular genetics hh Medical physics

hh Microbiology and immunology hh Pharmacology and toxicology hh Physiology and biophysics

Also offered at the VCU School of Medicine are doctor of philosophy (PhD) programs in the departments of anatomy and neurobiology, biochemistry and molecular biology, biostatistics, family medicine and population health, healthcare policy and research, human and molecular genetics, radiation oncology, microbiology and immunology, pharmacology and toxicology, physiology and biophysics, and social and behavioral health.

The VCU School of Nursing offers the master of science (MS) degree program with concentrations in adult-gerontology nurse practitioner, psychiatric and mental health nurse practitioner, family nurse practitioner, and nursing administration and leadership. They also offer the doctor of nursing practice (DNP) program.

The VCU School of Pharmacy offers the master of pharmaceutical sciences (MPS) degree, doctor of philosophy (PhD) in pharmaceutical sciences, and doctor of pharmacy (PharmD) degree.

The VCU School of Social Work offers the master of social work (MSW) degree and the doctor of philosophy (PhD) in social work degree programs.

For more information visit www.vcu.edu. *****

VIRGINIA STATE UNIVERSITY Virginia State University offers master of science (MS) degrees in biology, counselor education, family and consumer sciences, and psychology.

They also offer a doctor of philosophy (PhD) in health psychology.

For more information visit www.vsu.edu.

A day in March is known as National Match Day — the day medical students find out where they will complete their residency.

SOURCES: • • • • •

Association of American Medical Colleges - www.aamc.org College Admissions Partners - www.collegeadmissionspartners.com The National Resident Matching Program - www.nrmp.org American Academy of Family Physicians, AAFP - www.aafp.org American Academy of Orthopaedic Manual Physical Therapists - www.aaompt.org

Ronnie Martin, DO is dean and professor of family medicine at Liberty University College of Osteopathic Medicine.

EXPERT CONTRIBUTORS: • F. Douglas Boudinot, PhD with Virginia Commonwealth University Graduate School.

• R.J. Canterbury, MD with University of Virginia School of Medicine.

• Cathy Grimes with Virginia Tech Graduate School.

• Christine Kueter with University of Virginia School of Nursing.

• Ronnie Martin, DO with Liberty University College of Osteopathic Medicine.

• Dr. Michelle Whitehurst-Cook with VCU School of Medicine.

• Stephen M. Workman, PhD with Virginia Tech Carilion School of Medicine.

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FIT BITS

what’s the

HEALTH AN D F ITN ES S ON THE GO

HYPE with

words | DEIDRE WILKES

‘HIIT’?

HIIT – no, it’s not a typo, and there isn’t any actual hitting involved – stands for high-intensity interval training. It is a training technique that involves one hundred percent effort through quick, intense bursts of exercise, followed by short, sometimes active, recovery periods.

A high-intensity workout increases the body’s need for oxygen during the effort and creates an oxygen shortage, causing the body to ask for more oxygen during recovery. This after burn effect is referred to as excess post-exercise oxygen consumption (EPOC) and is the reason why intense exercise will help burn more calories in less time than aerobic and steady-state workouts. An additional benefit from EPOC is the metabolism boost that will last for up to 48 hours after a complete HIIT workout!

Workout Stats: strength balance toning cardio

Find a HIIT Class: Midlothian Athletic Club

Intensity: high

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 Greater Richmond

• Richmond www.macrichmond.com

YMCA of Greater Richmond

• Richmond Area www.ymcarichmond.org

* membership and/or class fees may be required

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Thanks Dad 5K — sponsored by Richmond Road Runners Club It was a beautiful, sunny Sunday for the Thanks Dad 5K, sponsored by the Richmond Road Runners Club. This Father’s Day run is designed to highlight the special relationship between fathers and their sons and daughters. The run was originally created in the memory of Pete Neal, who served as the Richmond Road Runners Club’s volunteer coordinator before succumbing to multiple myeloma, a form of blood cancer, in 2014. The 5K course, starting at The Urban Farmhouse Market and Café, offers rolling terrain through public roads, subdivisions and parts of Midlothian Mines Park. The scenery added to the gorgeous weather to mark a spectacular start to Father’s Day! There were several award categories for fathers with sons or daughters, as well as grandparents running with their grandsons and granddaughters.

Check out the awesome photos, courtesy of Ed Kelleher, you may spot a few familiar faces!

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take a closer

LOOK

CAN YOU IDENTIFY WHICH LOCAL HEALTHCARE FACILITY THE IMAGE BELONGS TO?

Post the correct answer on our Facebook page by SEPTEMBER 26th for a chance to WIN a Free Magazine Subscription!

The winner will be announced on our Facebook page by September 30th so make sure you check it out!

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