LOCAL ADVANCEMENTS IN HEART HEALTH
HIP REPLACEMENT and KNEE CARE
MEDICAL ADVOCATE HELPS OTHERS
JANUARY • FEBRUARY 2013 | GREATER RICHMOND EDITION | OURHEALTHRICHMOND.COM
Not all types of prostate cancer require treatment. However, treatment has saved many lives.
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Tuckahoe Orthopaedics
our health | BASIC
table of contents | january/february 2013
.
MEDI•CABU•LARY.....................10 Local experts define healthcare related terms
JUST ASK!..................................12 A variety of health questions answered by local professionals
THE LATEST...............................14 A listing of new physicians, providers, locations and upcoming events in the greater Richmond community
16
COVER STORY Local options to help you realize healthier 2013
HEALTHY LIVING........................21 Wellness in the workplace
ORTHO SERIES...........................23 Local insight on preventing knee injuries Less invasive hip replacement surgery offers reduced hospital stay and rehabilitation
KIDS CARE..................................30 Tips and advice on reducing injury in children
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BASIC | our health
HEART HEALTH..........................31 Bon Secours combines compassion with advanced technology
BODY BEAUTIFUL......................43 How to protect your skin from the ravages of cold weather
HCA helps ensure the beat goes on for heart patients Heart valve replacement without open-heart surgery Heart assist device improve quality of life and allows more mobility
37
NUTRITION
46
WOMEN’S HEALTH
ADVOCACY..................................51 Guiding patients through the medical maze
SENIOR LIVING...........................57 20/2013: this february 2013, virginia eye institute of richmond will mark it 20th year of providing no cost cataract surgery to those who cannot afford it
A new weapon for hot flashes?
Best foods to incorporate into your weight loss diet
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CONTRIBUTING RICHMOND MEDICAL EXPERTS Stephen Bickston, MD Wayne Browder, DDS John Clore, MD Tricia Foley, RD, MS Kellie Kohstall Truc Lieng, MD Baylor Rice, RPh Melissa Schwartzchild, MD Vivek Sharma, MD
CONTRIBUTING PROFESSIONAL WRITERS Sarah Cox Susie Galvez Anika Imajo Stephanie Taylor ADVERTISING AND MARKETING Richard Berkowitz Senior Vice President, Business Development P: 804.539.4320 F: 540.387.6483 rick@ourhealthvirginia.com SUBSCRIPTIONS To receive Our Health Richmond via U.S. Mail, please contact Jennifer Hungate at jenny@ourhealthvirginia.com or at 540.387.6482
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our health | MEDI•CABU•LARY & JUST ASK
me d i • ca bu • l ar y
T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D
What is Cyclic Vomiting Syndrome? Cyclic vomiting syndrome, or CVS, is a condition in which patients suffer from repeated episodes of severe nausea and vomiting that can last for hours, or even days. Generally the episodes are identical, starting at the same time of day and lasting the same length of time with the similar intensity. Between episodes, patients are symptom free. CVS can occur in all ages. Researchers believe CVS and migraine headaches are related. The only way a doctor can diagnose CVS is by looking at all the symptoms and medical history to rule out any other possible causes. There is good news. Treatments for migraines or anti-acid medicines can help. Better yet, patients who figure out the triggers of their episodes can make lifestyle changes to break the cycle. Stephen J. Bickston MD, AGAF Division of Gastroenterology, Hepatology & Nutrition VCU Medical Center
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What is pre-diabetes? Pre-diabetes means you have blood glucose levels that are higher than normal but not high enough to be called diabetes. If your glucose level, after an overnight fast (10-12 hours), is between 100 and 125 mg/dl or the hemoglobin A1c (HbA1c) is between 5.7-6.4%, this is considered pre-diabetes. If you have pre-diabetes, you have an increased risk of heart disease or stroke and are more likely to develop type 2 diabetes. Many research studies have determined that changes in lifestyle that include weight loss and increased exercise can significantly reduce these risks and prevent the development of diabetes. So diabetes is not inevitable. Prevention is possible and achievable. John N. Clore MD Division of Endocrinology and Metabolism Associate Vice President for Clinical Research VCU Medical Center
What is a compounding pharmacy? The art of compounding pharmacy is the method of mixing 2 or more ingredients to meet the unique needs of prescribers and patients. Compounding pharmacists play a major role in the healthcare setting and work with physicians, nurse practitioners, dentists and even veterinarians to create customized medications for people and pets. It might be as simple as mixing a couple of creams or as complex as mixing 30 powders. Delivery methods vary from customized capsules, gels, sprays and injections to eye drops, rapid dissolve tablets, suspensions, and suppositories. Baylor Rice, RPh, FIACP South River Compounding Pharmacy Midlothian| 804.897.6447
What is TMJ? Anatomically, the TMJ is the joint of the lower jaw approximating the base of the skull (in front of the ear). However, the term “TMJ” is used to describe the discomfort, pain, popping, and clicking of the joint area. “TMJ” can be broken down into two entities: the joint structure itself (bony spurs, disc tear, bony resorption) and the occluso-muscle component (bite problems). Only 2-3% of “TMJ” are true joint problems; the remaining cases are bite related. The causes can be the bite, medications, sleep habits, posture and arthritic conditions, esp. fibromyalgia. Treatment will depend upon which entity is the cause. However, the majority can be successfully treated with a bite adjustment and/ or splint. Wayne J. Browder, DDS Baxter Perkinson & Associates Colonial Heights 804.526.4822
our health | MEDI•CABU•LARY & JUST ASK
ju st a sk!
T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D
What is the difference between osteoporosis and osteoarthritis?
What is the Physician Referred Exercise Program®?
Should I give my child a flu shot or flu mist?
Bone is a living tissue, comprising mainly calcium and protein. Healthy bone is always being remodeled; that is, small amounts are being absorbed in your body and small amounts are being replaced.
The physician referred exercise program (p.r.e.p.) at acac affords participants the opportunity to improve their health by working with medical fitness specialists in a health club environment. acac’s on-site nurse and exercise physiologists oversee the program working with participants in small groups twice weekly. Participants have access to all acac fitness amenities throughout the program. The p.r.e.p. programs can jumpstart a healthy lifestyle at a low cost (60 days for $60). More than 12,000 people have gone through the program and 66% have continued to exercise, either on their own or at acac. The acac team is happy to help those interested obtain a referral from their physician.
The CDC recommends that all children aged 6 months and older get the flu vaccine. The choice to give your child the flu shot or the flu mist depends mainly on the age of your child and his or her health status. The flu shot, which made from an inactivated or killed virus, is given by an injection with a needle and can be given to children as young as 6 months old. It can also be given children who have lung diseases such as asthma or recurrent wheezing in the past year or other medical conditions such as diabetes or renal failure that put them at high risks for complications from the flu. For infants and children with chronic medical illnesses, the flu shot is a good option.
Kellie Kohstall Acac Fitness & Wellness Midlothian 804.378.1600
The flu mist, a live, attenuated (weakened) vaccine, is only recommended for healthy children of age 2 years or older. Children under 5 years of age with recurrent wheezing and children with asthma or other medical conditions that weaken their immune system and put them at high risks for complications from the flu should not get the flu mist.
If more bone calcium is absorbed than is replaced, the density or the mass of the bone is reduced. The bone becomes progressively weaker, increasing the risk that it may break. Osteoporosis means “porous bone.” This condition develops when bone is no longer replaced as quickly as it is removed. Osteoarthritis, also known as “wear and tear” arthritis, is a progressive disease of the joints. With osteoarthritis, the articular cartilage that covers the ends of bones in the joints gradually wears away. Osteoarthritis usually develops after many years of use. It affects people who are middleaged or older. Vivek Sharma, MD Colonial Orthopaedics Richmond | Chester 804.526.5888
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The flu mist also should not be given to children who are taking a daily aspirin. The advantage of flu mist over the flu shot is that it is given by spraying the vaccine up the nostrils and therefore is a convenient option for healthy children 2 years or older who fear needle injections. Some children who have had rare cases of severe allergic reaction to previous flu vaccine or eggs may not be able to get either flu vaccine. Because every child’s health is unique, talk with your child’s doctor to help you decide which flu vaccine is right for your child. Truc Lieng, MD Chesterfield Family Practice Richmond| 804.276.9305
THE LATEST | our health
the l atest
N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S
Brandon Haushalter HCA Virginia Chippenham Hospital Chief Operating Officer Richmond | 804.267.7465
Catherine B. Ham, MD VCU Medical Center Department of Neurology West End | 804.527.4540
Kamran Kabolizadeh, MD VCU Medical Center Department of Neurology Colonial Heights 804.957.6287
Aaron J. Krill, MD Children’s Hospital of Richmond at VCU Division of Urology Downtown and Stony Point | 804.828.9331
David D. Lee, MD VCU Medical Center Hume-Lee Transplant Center Downtown | 804.828.8048
Rachit D. Shah, MD VCU Medical Center Pauley Heart Center Downtown | 804.828.2775
Ranjith Shetty, MD VCU Medical Center Pauley Heart Center Downtown | 804.828.9203
Mohammad Shadab Siddiqui, MD VCU Medical Center Division of Gastroenterology, Hepatology and Nutrition Colonial Heights 804.828.4060
George B. Smallfield III, MD VCU Medical Center Division of Gastroenterology, Hepatology and Nutrition Colonial Heights 804.828.4060
Melissa Collins Smallfield, MD VCU Medical Center Pauley Heart Center Downtown and Williamsburg 804.828.4571
Charles Nathan Webb, MD VCU Medical Center Department of Obstetrics and Gynecology Downtown | 804.828.4409
Ken West HCA Virginia Chippenham and Johnston-Willis Hospitals Associate Administrator Richmond | 804.267.7465
lo cal relo cat ions
Bon Secours Pediatric Lung Care, Bon Secours Pediatric Gastroenterology Associates and Bon Secours Pediatric Infectious Disease Clinic have all moved to the below address: 5875 Bremo Road, Suite 303, MOB South Richmond, VA 23226 804.281.8303
VCU Neuropsychology and Rehabilitation Psychology, part of the Department of Physical Medicine and Rehabilitation, has moved its offices from Downtown Richmond to Stony Point. Emilie E. Godwin, Ph.D., Nancy H. Hsu, Psy.D. and Jeffrey S. Kreutzer, Ph.D., offer comprehensive evaluation and treatment for patients with neurological disorders at their new location, located at 8730 Stony Point Parkway, Stony Point III, Suite 290. Phone: 804.327.1166
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our health | THE LATEST
the l atest
N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S
HCA Virginia and Henrico County Open Crisis Receiving Center Program to offer multidisciplinary care for patients in psychiatric crisis
VCU Health System Awarded Consumer Choice Award for Eighth Time For the second consecutive year, the Virginia Commonwealth University Health System has received a Consumer Choice Award for providing quality health care services based on an independent survey of central Virginia residents. This is the eighth time the health system has received the award. The National Research Corporation presented the award following a nationwide survey of hospital consumers’ perceptions of the local health care facilities they use. Participants rated the facilities on a variety of factors including overall quality of patient care, quality of doctors and nurses and overall image and reputation. The VCU Health System is included in U.S. News & World Reports’ top hospital listings – ranked No. 1 in Virginia in 2012 – and is among an elite group of about 200 healthcare organizations worldwide that have been awarded Magnet status for nursing excellence in national and international health care. The VCU Health System has eight times been named one of the Working Mother 100 Best Companies and four times a Greater Richmond Employer of Choice. It has also received the national Alfred P. Sloan Award for Business Excellence in Workplace Flexibility.
HCA Virginia’s Parham Doctors’ Hospital and Henrico Area Mental Health and Developmental Services have partnered to offer the new Crisis Receiving Center (CRC) – a multidisciplinary program for patients in psychiatric crisis. Based in the Parham Doctors’ Hospital Emergency Room, this is the region’s first center of its kind. The center provides a comprehensive approach to crisis management in the treatment of patients who are brought in by police or EMS in police custody and are experiencing mental health emergencies “The Parham Doctors’ Hospital ER has consistently demonstrated a compassionate and welcoming approach to persons in crisis and has become the preferred site for assessments by police, EMS and Henrico Metal Health,” said Richard Edelman, program manager of Emergency Services at Henrico Area Mental Health and Developmental Services. Parham Doctors’ Hospital operates the CRC from noon to 12 a.m. seven days a week, 365 days a year, to receive patients from EMS providers, law enforcement officers, medical providers, and from walk-in patients that are deemed in need of CRC services by appropriate hospital medical staff in consultation with the Henrico Mental Health and Developmental Services and CRC staff. “When a member of our community is in crisis, it is critical to offer the support they need,” said Pat Farrell, CEO of Henrico Doctors’ Hospitals. “We are proud to partner with Henrico Area Mental Health and Development Services to offer a valuable resource to our Richmond community.” CRC staff ensures that patients have access to medical staff, resources in the ER and necessary screening services for drugs and other medical tests. The center also maintains two dedicated patient rooms as part of its onsite treatment facility.
ACAC Fitness & Wellness Center opens new club in West Broad Village ACAC Fitness & Wellness Center opened its newest club on Monday December 17th, 2012. Located a quarter mile from Short Pump Town Center, the new 62,000 squarefoot club spans three stories. In addition to modern fitness amenities and group class studios, including dedicated yoga and cycle studios, the facility has a threezone indoor aquatics center, singles and doubles squash courts, and functional training space. The club’s rooftop will boast a heated pool, lounge and platform tennis. The West Broad Village club will be ACAC’s second location in the Richmond area. ACAC currently operates a 100,000 square-foot facility in Midlothian.
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HEALTHY LIVING | our health
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our health | GET A SMART START IN 2013
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MAKE
2013
GET A SMART START IN 2013 | our health
words | SUSIE GALVEZ
YOUR SMART START YEAR Imagine yourself 10, 15, 20 or more pounds lighter…in shape, firm & fit, flatter belly, and feeling full of energy and life! Perhaps you have thought about this image for years, maybe even a decade or longer. You might have even started one, two, ten, or more get healthy programs in the past. You maybe have had some luck or even reached your goal—congratulations! However, if you are like most Americans, some, if not all, of your healthy intentions took a detour along the way. Some of the intentions could have suddenly just stopped and refused to continue, other intentions could have held on to help you on your get healthy journey, but as time passed on, so did your healthy ways. It may not be your fault. Whenever we start a new diet, we do so with the best of intentions. We read about all of the diet options available to us and all of the benefits of being on diet A, B, or C, etc., and then we make sure to follow the advice to the letter and to forego all of the forbidden foods from our daily food intake as touted by the decided upon diet program. “The problem,” says Bryan P. Lowry, DC, Clinical Director of The Advanced Wellness Centre, “is though that sadly more often than not, these so-called diet plans don’t work.” “Sure,” Lowry continues, “for the first few days, or week or two, you notice a decrease on the scale, or the way your clothes fit, and you are full of motivation and invigoration to do well, but then after this brief spell of success, the weight loss slows down, your belt buckle stays the same, and life sort of gets in the way…and the motivation wanes and the sure-thing diet falls by the wayside, in a word…fails.” So why is it that so many diets are doomed to failure? And why do so few programs work? How can we know which diet changes will genuinely be effective in dropping the pounds and dress/pants sizes for good? I posed these questions to Dr. Lowry, and his partner, Dr. William U. Roodman, also Clinical Director of The Advanced Wellness Centre, as AWC specializes in treating the complete patient by being proactive rather than reactive. Dr. Roodman says “The diet industry is big business. A recent CBS TV report stated that 20 Billion dollars is spent annually in the US on diets and over 108 million Americans are on a diet program yearly—and of those, the majority of those millions will make four to five diet attempts during the year. It appears that the only thing getting trim is the dieter’s wallet!”
Here are some of the top reasons why diets fail: • Too Ambitious. Sometimes a diet is simply too ambitious and involves too much of a lifestyle change to make the diet work. Eating at home with the plan could work with enough planning, but eating out is a part of American culture that needs to be included in the program as well. If you can’t find anything on an average dining menu to fit your diet plan, then the program most likely will not work for the long
er say aft u o y t a Wh s your e t a e r c “I am” Make it reality. inary! extraord , owry, DC L n a y r B – Wellness d e c n a v Ad Centre
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our health | GET A SMART START IN 2013
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GET A SMART START IN 2013 | our health
RVA Smart Places for 2013 Smart Starts run. Also if you are dining at a friend’s house, and nothing short of taking your own meal will keep you on your meal plan—it might be time to look for another plan! • Too Drastic. If your diet calls for a sudden and dramatic change in your routine, this should be a big red-flag. These so-called diets are usually based on shocking your body with an over-zealous super-cleanse, or eating just one or two food sources a day (ala cabbage or bananas) to ‘clean out your system,’ however these drastic measures will having you cleaning out the ‘new’ diet from your life ASAP! • Cutting out whole food groups. If any program states that you need to completely cut out something out of your diet—be it fats, carbs or anything else doesn’t understand how our body works. Carbs are needed in certain amounts for energy. Fats are used to help absorb and utilize protein, and helps keep skin moisturized as well as improves our cognitive functions. So if the diet calls for “cutting it out completely,” it is a good idea to “cut that program out too!” • Not scientifically sound. The best programs are those that take into account how the body works, precisely which nutrients are needed, how to calculate calories needed based on BMI (body mass index) and BIA (bio impedance analysis) for optimal results as well as a program that is individually designed for each participant. • No support. Sticking to a weight-loss program requires will-power and know-how. While everyone around you is eating like it’s still the end of the Mayan calendar, encouraging you to live a little and you are trying to hold onto your health, you need to call in for reinforcements. Start by telling your family and friends about your 2013 healthy habits plan, and ask them for their support. Then get involved with likeminded people who will support and encourage you along your journey.
• The Advanced Wellness Centre’s Therapeutic Lifestyle Change (TLC) Program. www.AdvancedWellnessRva.com 3536 Grove Avenue Richmond, VA 23221 804-673-WELL • ACAC’s Weight Management for Life Program. www.ACAC.com Two locations in RVA: Midlothian and Short Pump 804-378-1600 • Zacharias-Ganey Health Institute’s ZG Key, Knowledge, Energy, and You Program. www.zghealth.com 1311 Palmyra Avenue Richmond, VA 23227 804-358-1000 • YMCA’s Health, Well Being and Fitness Program. www.ymcarichmond.com 17 RVA locations. • Victory Lady Fitness’Pounds Down Fitness Program. www.victorylady.com two locations in RVA: southside and westend 804-965-9741
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our health | GET A SMART START IN 2013
• No joy. Your program should not zap your joy. If you have to constantly turn down desert, a glass of wine, a few croutons and feta cheese on your otherwise weight-loss worthy salad, then it sounds like that program is void of joy. • Not accompanied with the right lifestyle changes. Think about it. Dieting alone isn’t the answer. To lose weight effectively, your program needs to focus not only on eating less bad for you, and eating more good for you foods, also in order to be successful, your perfect plan needs to have a plan! “A healthy plan, along with patience and persistence is the key to changing your lifestyle for a lifetime,” states Lowry.
Now is the perfect time to make 2013 your Smart Start: • Knowledge—a healthy lifestyle starts with the knowledge to make informed decisions that impact your health every day. • Balanced Eating—eating balanced healthy foods have a direct influence on controlling excess insulin production, body composition, and disease prevention. • Regular exercise/activity—a regular program of aerobic, strength training, and flexibility exercises have been shown to increase vitality and reduce the risk of disease. • Appropriate nutritional supplementation—incorporating a foundational nutrition program with targeted nutrients that help to prevent and/or treat specific conditions is an essential part of a therapeutic lifestyle program. • Stress management—for optimum health, regular stress management programs help keep insulin and other hormone levels balanced, improving vitality. • Sleep—sleep is critical for the proper functioning of the mind and body. Quality and depth of sleep is of primary importance. The amount of sleep needed depends on the person; a good average measure is from 7 to 8 ½ hours per night. Before starting any weight loss program, be sure to research your options, and choose the program that will not only help you reach your desired goals, but keep you at your goal…long after the dieting part is completed! Susie Galvez is a Richmond-based beauty, image, and wellness writer, speaker, and author of nine books. To learn more about Susie, go to www. SusieGalvez.com
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HEALTHY LIVING | our health
wellness IN THE WORKPLACE words | SUZIE GALVEZ
In ancient China, it is said that a doctor was paid as long as his patient was well. When the patient became ill, the doctor was not paid, for he hadn’t done his job. Wellness at work programs can be considered the modern day equivalent of the ancient Chinese physician. A major goal for wellness at work programs is to show employees the path to a healthy lifestyle and encourage health and wellness on a daily basis.
lifestyle l o r t n o c n a c You fluences in y ll a ic t a m a which dr ore than health even m genetics.
an, DC, -William RoosdsmCentre e Advanced Welln
Corporate wellness programs are designed to help employee moral and prevent health issues such as chronic stress, high blood pressure, diabetes, heart conditions, and other illnesses. Many of the diseases that lead to employee disabilities, workers compensation, absenteeism, and inability to perform at optimum levels are related to lifestyle choices. Lifestyle and posture are learned behaviors that can be altered and reconditioned. You might be thinking that it is the employee, not the employer, who should be taking ownership of their health, and that is true, but sedentary lifestyles due to working at a desk for eight or more hours a day without implementing any type of stress relief or exercise certainly haven’t helped. Continuance will only lead to illness, which will affect the company. The trend is catching on, as workplace wellness programs are becoming more widespread throughout the country. The bottom line of such programs is healthy employees who tend to be happier and more productive employees. The benefits for employers are obvious. The company is provided with strategic www.ourhealthrichmond.com | 21
our health | HEALTHY LIVING
online and local health and wellness options • Lots of online companies offer free exercise and dieting tips. The sites www.Sparkpeople. com and www.bodyiqoneline. com are good places to start. • Advanced Wellness Centre (www.AdvancedWellnessRVA. com) offers complimentary lunch & learn workshops on several wellness topics. They also offer on-site wellness programs individually tailored for your company and employees. • YMCA offers diet and exercise programs for children and adults. • Also be sure to check your employer’s insurance carrier to see if wellness services are offered via your plan.
advantages by investing money in a program that will hopefully bring them lowered expenses in return, often in the form of better performing workers, lower absenteeism…and lower healthcare costs. Employees are the most valuable asset any company has. By providing workers with wellness services, companies are improving wellbeing and job satisfaction, as well as raising retention rates. The welfare of the employees has a direct impact on the success of the company. So, why should you, as an employee, take advantage of your workplace wellness program? If you’re already doing the “right stuff,” then wellness at work will help keep you on the healthy path you’ve chosen. And if you are not at your personal best, then a wellness program can help you change in multiple ways—from learning to eat healthy, improving your sleep quality, increasing your exercise, changing habits such as excessive drinking, or helping to quit smoking to lowering your risk for chronic diseases! Using a wellness program can make positive change happen. Not only will you be more able to complete your job responsibilities, but you will also have more energy and vigor to give to your family and friends when you get home. Another great benefit of wellness programs is a built-in sense of camaraderie with your coworkers. You’ll have a chance to experience activities with them that aren’t related to work, whether in a walking club or sports team, by lunch together, or by going to the gym. Social support is a very important part of weight loss and getting fit. By interacting with co-workers, you’ll have others to give you encouragement when you need it, as well as to hold you accountable to your goals. Plus, you’ll be motivated by seeing other’s positive results. By using a wellness program, you will be an important part of the team. If you are fortunate enough to have a workplace wellness program, by all means take advantage of it! If a wellness at work program is not offered at your company, here are some wellness ideas you might want to suggest that are easy to do and are low to no cost for your employer to help you and your company get on the wellness track. And since this is the beginning of 2013 ~ it is the perfect time for fresh starts, healthy new habits, and lifestyle improvements! • Conduct an employee interest survey
Move your body every da y. Every one has the p ower with in to chang e .
—Hillary Hawkins, MD, Sheltering Arms Hos pita l, Hanover
• Post healthy tips on your intranet, company newsletter, and bulletin boards • Host monthly lunch & learns with local health and wellness companies to come in and teach workshops on wellness topics • Hold a health fair with a variety of preventive screenings • Offer ergonomic workspace assessments • Offer health risk assessments • Schedule workshops on relaxation, stress management, and work life balanced topics • Offer free chair massages once a quarter • Encourage employees to sign up for community walks or fitness events • Negotiate corporate discounts to health and wellness companies • Create smoke free grounds So there are a dozen ideas to get your employer started. Feel free to add any ideas that you think would be a healthy way to start 2013 for your company! Remember – your health and wellness matters to you and to your employer!
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SPECIALIZED SERVICES FOCUS | our health
THE ORTHO SERIES
In this two-part series we take a look at local joint replacement and treatment options. Look for our second part in the March/April 2013 edition of Our Health Richmond
TAKE A KNEE words | SARAH COX
The first line of defense against knee injuries is prevention. Vivek Sharma, M.D., specializing in sports medicine, cartilage repair, and shoulder and knee reconstruction at Colonial Orthopaedics, explains that there are two main types of knee injuries. Traumatic injuries occur when playing sports or exercising and are signaled by an acute onset of pain; chronic injuries occur with overuse or overexertion and can happen over time when a person doesn’t give their body’s tissues and muscles enough time to recover. In either case, says Dr. Sharma, the progressive thinking is to create awareness in the public and through sports programs before injuries happen. For instance, the Virginia High School League has recently passed new legislation that limits how often a high school pitcher can throw. According to this legislation, pitchers are not limited to 10 innings on two consecutive days, but rather to nine innings in one day www.ourhealthrichmond.com | 23
SPECIALIZED SERVICES FOCUS | our health
and no more than 14 in a seven-day span. Dr. Sharma is quick to point out that this affects not only the obvious – the arm – but what comes before the arm in the pitch. “When we look at throwing the ball, it’s not just the shoulder and arm – it starts with the leg, the trunk rotation, and then comes the shoulder.” He says that awareness of this kinetic chain and the importance of trunk strength and rotation are essential in prevention of knee injuries. To this end, Colonial Orthopaedics’ sports medicine specialists, who are affiliated with the Richmond Raiders area arena football team, the VCU rugby team, the Virginia State University football and basketball teams, and local high schools, have sponsored injury prevention clinics that include pre-season conditioning exercises and an awareness of correct training. Girls, Dr. Sharma notes, are different than boys when it comes to injuries as well, and using studies that have shown the prevalence of female knee injuries, he works on teaching them balance and agility to help with correct jumping and landing. “Prevention is the smarter way; we know that injuries can be prevented,” he says.
Exercise! Str onger muscles help m aintain healthier joint s. — Jason Hull, MD, Tuckahoe Ort hopaedics
Another awareness factor, according to Dr. Sharma, is to be able to distinguish a serious injury from one that simply needs rest. “If someone sprains a knee and feels a pop, this signifies that something has happened anatomically. If I’m running, and I feel a pop and go down, and an hour later my knee balloons and swells up, that is one sign. If the swelling carries on, I am unable to walk on the leg, and the next day or two it’s worse, I should seek help,” he advises. Always do the RICE – rest, ice, compression, elevation. On the other hand, if the knee starts to feel better over the next day or two, and you can move, the injury may be minor. Colonial Orthopaedics, aware that there is a need for immediate orthopaedic help, has opened OrthoExpress at 13038 Rivers
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SPECIALIZED SERVICES FOCUS | our health
Bend Rd. in Chester. This walk-in immediate care orthopaedic clinic is currently open Monday through Friday, 8 a.m. through 5 p.m., but the hours may be expanded. The older one gets, the types of knee injuries may change. Dr. Sharma points out that as we age, the more common injuries are strains and twists – meniscal injuries – as well as the wear and tear that results in arthritis. “I think that’s where staying active and exercising can help,” he says. “We focus on low-impact exercises and conditioning of the joints. The joints like motion – that’s how the cartilage stays healthy.” He suggests using an elliptical machine or a stationary bike and not bulking up but toning a muscle. “The muscles act like shock absorbers, so they are taking stress away from the joints.” If one has to have surgery, arthroscopic techniques are very successful, minimally invasive, and address the problem “more efficiently,” says Dr. Sharma. In addition, rehabilitation post-surgery has improved immensely over the years. More specialized therapists help people regain better function, and Dr. Sharma and his colleagues also focus on returning athletes to performance level. A specialized sportsmetric program concentrates on returning athletes to pre-injury levels and involves working on body mechanics, balance training, drills, and specialized activities that therapists are specifically trained in. Dr. Vivek Sharma joined Colonial Orthopaedics after finishing his fellowship training at Harvard sports medicine and cartilage repair center in Boston, Massachusetts. His practice, Colonial Orthopaedics, has been in business for 25 years and has offices in Colonial Heights, Chester, and Richmond.
Vivek Sharma, MD Colonial Orthopaedics Richmond | Chester 804.526.5888
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our health | SPECIALIZED SERVICES FOCUS
Listen to your body. If it hurts, don’t do it! –C hris Stanko, P T, Shelter ing Arms, Chester Clinic
Less Invasive Hip Replacement Surgery Offers Reduced Hospital Stay and Rehabilitation words | STEPHANIE TAYLOR AND SARAH COX
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While the vast majority of hip replacements are still done through the posterior (the back as opposed to the front of body) approach, Vincent Dalton, MD of OrthoVirginia/West End Orthopaedic Clinic has found that the anterior approach is much preferable. It is rapidly growing in popularity because of its distinct advantages – for instance, rehabilitation is easier and quicker, the risk of dislocating the hip postsurgery is greatly reduced, leg length is more accurately controlled, and the incision is smaller. “When we do the posterior approach, which is the old, standard approach, we cut everything in the back, so we worry about the hip popping back out. Therefore, we put you through hip dislocation precautions and your moves are restricted. With the anterior approach, dislocation is much lower,” he explained. While he said that the surgical learning curve is steeper with the anterior approach, he is now completely comfortable with it and only offers this approach to his patients. “It is more anatomically correct, with fewer complications,” he said.
SPECIALIZED SERVICES FOCUS | our health
To begin with, the incision made with the anterior approach for hip replacement surgery is about three to four inches, as compared to the posterior approach, which requires splitting the gluteus maximus and detaching several of the muscles that attach to the back of the femur. This incision can be 10 to 12 inches. Rehabilitation for the anterior hip replacement is much faster, because the hip is replaced without detaching any muscles from the femur or pelvis. In fact, it is a one- to two-day hospitalization and a two- to eight-week recovery, as compared to the posterior’s two- to four-day hospitalization and up to a four-month recovery. “In the anterior approach, the hip is exposed through a natural interval between muscles. This results in a persistent limp after surgery,” commented Dalton. He said that the limp in posterior hip surgery patients is pronounced for three months, compared to the anterior patients’ limp, which is minimal at six weeks. “It is what we do to the muscles, tendons, and bones that truly affects postoperative pain and recovery,” said Dalton about the posterior surgical approach. “The incision must be large enough to perform the procedure properly. With the anterior approach, the patient is positioned on their back on the HANA table. Fluoroscopic X-ray is used during the procedure to ensure correct position, sizing and fit of the components, as well as to measure leg length.” In addition to the limp after the posterior hip surgery, patients would have to follow strict precautions for the rest of their lives, such as restricting hip flexion and internal rotation, which are common motions required in getting up from a low chair, into a car, bending over, stooping and squatting. Anterior hip surgical patients are up and walking that afternoon as part of their physical therapy. Most patients go home after one or two nights stay, and physical therapists and a visiting nurse come to their home for several weeks after surgery. Most patients use a walker or crutches for a week or so, and then a cane for another week or two.
The anterior approach to hip
After almost 20 years of using the posterior approach, Dalton began doing all of his hip replacements through the anterior approach in 2010. He said that patient satisfaction has been extremely high -- including over 15 patients that have had a posterior approach on one side and then an anterior approach on the other side. “All these patients have reported a dramatic improvement in postoperative pain and recovery,” said Dalton.
a high failure rate because of his
Vincent Dalton, certified by the American Board of Orthopaedic Surgery, previously served as chairman of Orthopaedics at Bon Secours St. Mary’s Hospital. He attended the Medical College of Virginia, and did his residency and training there as well, after earning undergraduate and graduate degrees from Emory University. He also holds bachelors and masters degrees in physics. Dr. Dalton is a member of the American Academy of Orthopaedic Surgeons, American Board of Medical Specialists, American Academy of Medicine, Medical Society of Virginia, Virginia Orthopaedic Society, Richmond Academy of Medicine and Richmond Orthopaedic Club.
However, in 1996 Dr. Matta began
replacement surgery is not new. In fact, Dr. Judet began doing hip replacements through the anterior approach in France in 1947, but had choice of prosthesis. The posterior approach was done by Dr. Charnley in the 1950s in England, who had excellent results, and his technique has been the standard since then. using the anterior approach in California and designed the HANA table in 2005. This operating table positions the patient to enable the surgeon to replace the hip through a single incision, without detaching muscles from the pelvis or femur. This has has made the technique much simpler for the average surgeon.
Vincent Dalton, MD of OrthoVirginia/West End Orthopaedic Clinic
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our health | KIDS’ CARE
children:
ACTIVE, BUT SAFE
Even if the age group is limited to pediatric orthopaedics, the range of patients who bring their challenges to Tuckahoe photography | ??????? ???????? Orthopaedics varies widely. The doctors see patients from newborns to age 21, and a few that are older, with both acute injuries and neurologic problems. These conditions range from wrist and elbow fractures to scoliosis, club feet, hip dysplasia, cerebral palsy and spinal bifida. words | AINE NORRIS
words | SARAH COX
When you he ch ild, you c lp a the world. hange C hes ter Sha Tuckah oe O rps, MD, r th opaed i cs
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The acute injuries, says Chad Aarons, MD, mostly occur from falling, and the number one cause of these accidents is the monkey bars. Number two – trampolines. Close behind those are skateboards and off-road ATV and dirt bikes, which are rising nationally. “I’m not against children being active,” he says. “Don’t be afraid to let kids participate, but you are going to have some fractures. I broke six bones growing up. There is a happy medium between being a happy, healthy active child and being someone who chooses higher-risk activities.” Most of these fractures can be treated non-surgically, but Dr. Aarons encourages the use of wrist guards and helmets. If surgery is necessary, he uses arthroscopic surgery, if possible, which is less invasive, done on an outpatient basis, and employs computer navigation for more accuracy. The neurological problems are a different story, but they also represent a lot of wonderful technological advances. Early identification and treatment can help considerably. For instance, Dr. Aarons uses pedicle screws for scoliosis to make the spine more stable. Children with hip dysplasia are put into a Pavlik Harness, which aligns a baby’s hips to the joints and keeps the joints secure. For children with clubfeet, surgery is no longer the only option. Dr. Aarons explains that he uses Ponseti casting to stretch out the foot. “If treated early enough, these patients can avoid surgery,” he notes. Tuckahoe Orthopaedics has three clinic locations, at St. Mary’s, in Innsbrook, and in Midlothian and has been operating in the Richmond area for 40 years.
HEART HEALTH | our health
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words |SARAH COX
Bon Secours Richmond cardiac surgeons participated in the clinical trials that led to the FDA-approved da Vinci Surgical System, which is the most advanced robotic surgery system available today.
Mark Bladergroen, MD, cardiac surgeon and chief medical information officer at Bon Secours.
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Bon Secours Combines Compassion with Advanced Technology With Bon Secours’ mission of bringing compassion to healthcare, the cardiac surgery specialists have found that the emerging team approach has made the most difference over the years. Mark Bladergroen, MD, cardiac surgeon and chief medical information officer at Bon Secours, says that he works not only with two other surgeons, but often with a team that can include a cardiologist, surgeon and radiologist, all in a hybrid operating room with sophisticated imaging. Years ago, patients were referred to him, and he operated with surgeons. Now, he often consults with subspecialists to make sure that patient care is of the utmost priority. In addition, he and his team take advantage of emerging technologies that provide much more minimally invasive techniques while giving them clearer computer images. For instance, the Bon Secours Richmond cardiac surgeons participated in the clinical trials that led to the FDA-approved da Vinci Surgical System, which is the most advanced robotic surgery system available today. Dr. Bladergroen says that the advantage of the da Vinci system is that it offers mitral valve repair or replacement with a smaller surgical incision, avoiding a larger sternum incision and thus giving patients a quicker recovery. In addition, this system gives a more optimal repair because of improved visualization. The surgeons at Bon Secours have also performed the first minimally invasive repairs of abdominal and thoracic aortic aneurysms. As Dr. Bladergroen explains, “aneurysms grow and once they reach a certain size, can rupture and result in an emergency operation or death. He notes, “Advances have been made over the last several years so that we can stint with internal grafts and stabilize or limit the growth and expansion of aneurysms. We insert these stints through the groin. The trend is to be less invasive and take advantage of safe and evolving technologies.” He says that this, again, allows his patients a more rapid return to a fuller recovery. “We try and balance innovation with other priorities – the most important thing is the patient,” he concludes.
HEART HEALTH | our health
HCA Helps Ensure the Beat Goes On for Heart Patients words |SARAH COX
HCA Virginia Heart Network is now offering two wonderful options for heart patients. The Ventricular Assist Device (VAD) Program, explains cardiothoracic surgeon Thomas Christopher, MD, is for end-stage heart failure patients. “These are people that are pretty miserable, and this can be almost magical for them,” he says. There is a growing population of chronic heart failure patients that have a high rate of hospital re-stays and have failed standard medical therapy. The VAD program is indicated as a bridge for those who are on the heart transplant list and for those who may not be candidates but need a permanent support device. The HCA Virginia team at Levinson Heart Hospital at Chippenham gives a “new lease on life” to those who have been sickest. As of November, Dr. Christopher has been part of a team of cardiologists and surgeons who bring different areas of expertise to the program. According to the National Heart Lung and Blood Institute, the VAD is “a mechanical pump that’s used to support heart function and blood flow in people who have weakened hearts. The device takes blood from a lower chamber of the heart and helps pump it to the body and vital organs, just as a healthy heart would.” The New England Journal of Medicine stated that the “use of a left ventricular assist device in patients with advanced heart failure resulted in a clinically meaningful survival benefit and an improved quality of life. A left ventricular assist device is an acceptable alternative therapy in selected patients who are not candidates for cardiac transplantation.” To Dr. Christopher’s patients, it means great relief and fewer hospital admissions. To him, it has been a great blessing to be able to offer the VAD. Another HCA Virginia Heart Network program that has been offered since July 2012 is the TAVR, or Transcatheter Aortic Valve Replacement Program, a biological valve replacement for patients with aortic stenosis, or a diseased heart valve. The valve was approved about a year ago in the United States, and the patients who qualify for the TAVR are those who are “deemed inoperable or very borderline,” says Dr. Christopher. He notes that HCA has been “supportive in bringing these programs to our patients. We tend to do the lion’s share of heart surgery in this area, so it’s important to be able to offer these options to people.” HCA cares for more hearts, performs more heart surgeries, and treats more heart attacks than any other place in Central Virginia.
Influenza is associa vaccination t reduced ed with a r heart at ate of first tack! -Stuart M Virginia otley, II, MD Physician s, Inc
ssure e r p d o o l b r Get you rol checked. and choleste ilent killers. These are s D, M , k o o h S -Zachary ia Physicians Virgin www.ourhealthrichmond.com | 33
our health | HEART HEALTH
Virginia Cardiovascular Specialists designed a specialized hybrid room to perform the TAVR procedure.
words |SARAH COX
Charles Zacharias, Jr., MD of Virginia Cardiovascular Specialists in Richmond.
Heart Valve Replacement without Open-Heart Surgery It’s literally a new life for some. The TAVR, or transcatheter aortic valve replacement, offered through Virginia Cardiovascular Specialists, is a new way to have a fresh biological heart valve – not a repaired one – without undergoing open-heart surgery. Charles Zacharias, Jr. MD, Charles Phillips, MD, and James Garnett, MD have been approved to perform the TAVR procedure, bringing new hope to patients. “In the past, when people had aortic stenosis (a diseased heart valve), we either couldn’t treat it or had to open up the chest, which is a big procedure. Now, it’s just a small incision, we go up with a catheter, and it’s a minimally invasive approach with great outcomes,” explain Dr. Zacharias. Severe aortic stenosis is serious and can result in death within an average of two years. The TAVR procedure involves inserting a new valve inside the diseased one and is intended for patients with age-related aortic stenosis. If medicine isn’t working, or if a cardiac surgeon determines that the patient is at a high risk or too sick for open-heart surgery, the TAVR is an excellent option. Dr. Zacharias explains that this procedure takes one to two hours compared to open-heart surgery’s four hours; the TAVR requires a two to three-day stay as compared to a minimum of one week for open-heart surgery; and recovery from the TAVR is better. “This is an evolving technique that is revolutionary,” notes Dr. Zacharias. Virginia Cardiovascular Specialists has designed and built a specialized hybrid room
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HEART HEALTH | our health
that incorporates a catheter lab and an operating room. “We were the first in Richmond to offer this,” Dr. Zacharias says. The hybrid room includes state-of-the-art fluoroscopy, which, according to the U.S. Food and Drug Administration, is “a type of medical imaging that shows a continuous x-ray image on a monitor, much like an x-ray movie. During a fluoroscopy procedure, an x-ray beam is passed through the body. The image is transmitted to a monitor so that the body part and its motion can be seen in detail.” In addition, the doctors use an echocardiography, a type of ultrasound, to see the aortic valve. Dr. Zacharias has done 10 TAVRs since July 2012, all with excellent results. The operation involves a team approach of five, including cardiologists and cardiovascular surgeons.
and an increased survival rate. In contrast, the reoccurrence rate with open-heart surgery is about 50 percent. Reported in Forbes Magazine in October, the mortality advantage of the TAVR continues to grow over standard therapy – 80.9 percent for the standard group, versus 54.1 percent for TAVR patients.—should this be opposite? Not sure the numbers are right. “The patients are so appreciative – they are very grateful. Longterm survival is very good,” says Dr. Zacharias. He attended the Medical College of Virginia, where he completed his internship, residency, and fellowship. He is board certified in internal medicine, cardiovascular disease, and interventional cardiology.
The TAVR gives patients a brand new valve, not a repair, thus increasing recovery and longevity rates. According to UCLA. org, the immediate benefits are improved blood circulation
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our health | HEART HEALTH
Heart Assist Device Improves Quality of Life and Allows More Mobility words |SARAH COX
The cardiologists and cardiac surgeons at Virginia Commonwealth University Pauley Heart Center/VCU Medical Center get to watch their LVAD patients breathe a sigh of relief, literally. The LVAD, or left ventricular assist device, can improve the quality and duration of life for patients and allows them more mobility. These patients fall into three categories: those who use the LVAD as a bridge while waiting for a heart transplant; those who use it for “destination therapy,” or as a last resort; and a few who use it as a bridge to recovery so that the heart is given a bit of a break and can recover with the help of medicine. Keyur Shah, MD, a cardiologist, pointed out in one of his papers that the newer-generation LVADs are “re-engineered to minimize the interaction of moving parts, which has significantly prolonged pump durability. The smaller design of continuous-flow devices has also extended LVAD therapy to smaller individuals (notably women and children). It has also been associated with decreased perioperative morbidity during implantation.” With the LVAD device, a tube or cannula is inserted into the left ventricle and draws blood out of the heart by a pump, injecting it into the aorta. He explains that it augments blood flow for people who have weak hearts. These are the people who get out of breath just sitting and talking. They are frequently in the hospital. They are always fatigued. They often need IV drips. They swell and have edema. They can’t go to work, play with grandchildren, or even go shopping. The goal of Dr. Shah and cardiac surgeons such as Daniel Tang, MD, is to improve quality of life. Dr. Tang says from a surgeon’s perspective, “This has been a long time in coming. From a success standpoint, this is marked in leaps and bounds.” He cautions that there is still a lot of post-operative patient care, because these people are the sickest of the sick. Their bodies need to recovery from years of heart disease. And, he says, “It’s not nothing,” referring to the 11-pound device that patients now carry around. “The devices are quite intrusive to the lives of the patients, but on the horizon are smaller, less intrusive pumps without the external cable connection from inside to outside,” notes Dr. Tang.
Keyur Shah, MD, cardiologist
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Before the LVAD, patients would die waiting for a heart transplant. Those who didn’t qualify for a transplant were, in Dr. Shah’s words, “miserable.” Their only option would have been hospice. Still, it’s a major operation, Dr. Shah says, with a hospital stay of three to four weeks and then months of recovery as the body regains its strength. But the benefits of the LVAD greatly outweigh the risks. “It has certainly changed the paradigm for treating late-stage heart failure patients,” he finishes.
Set a weekly fitness goal that is realistic for your schedule.
— Lauren Richardson, PA , Primary Health Group - Retreat
Best Foods to Incorporate into Your Weight Loss Diet words | TRICIA FOLEY, RD, MS
Losing weight can be quite a challenge. After all, there are many different “diets” to choose from. Whichever you decide to follow, most likely calories will be cut back and certain foods will be off limits. To ensure your body is getting what it really needs, follow these tips: 1. Fill your plate with non-starchy vegetables. Non-starchy veggies are packed with nutrients, including essential vitamins and minerals your body needs, but are low in calories and carbohydrates. They also provide a healthy dose of fiber that will fill you up so you aren’t hungry. These veggies include foods like spinach, peppers, onions, broccoli, cauliflower, green beans, asparagus, brussel sprouts, and celery. If you are a picky eater, these vegetables can be incorporated into healthy soups or casseroles to “disguise” the taste. Seasonings can also be added to enhance flavor. Changing the way you eat can change your tastes as well. Give it some time, and foods you didn’t think you liked may become some of your favorite choices over the course of a few weeks. This is especially true if you ate a lot of processed foods prior to starting your diet. 2. Fruits are your friends. Think of them as nature’s candy. Of course, not all fruits are created equal. Just like vegetables, you want to choose the fruits that are lowest in natural sugars and highest in fiber. Berries are always a great choice since they are packed with vitamin C. Crash diets can often lower your immune system if you aren’t fueling the right way; vitamin C gives your immune system a boost. If you find that they aren’t in season, buy them frozen. From a nutrition perspective, www.ourhealthrichmond.com | 37
our health | NUTRITION HEALTH
g Make t wo healt hy livin eep k n ca ou y t a h t s e g n a h c t hr oughout t he year. , — Lar ry Benson, MD CJW Sports Medicine Quit sm people oking – w pack o ho smoke a f cigar ett have tw ice the es a day heart a risk of ttack. — Gan Dun Virgin nington, MD ia Card iovascu , l Specia ar lists
they are the same as fresh and last a lot longer. Apples make a great grab and go snack. However, beware of the large apples that offer a two for one serving size. Instead go with the smaller apples that are about the size of a baseball. Fruits to avoid would be those that come packed in juice or worse, syrup, since they add unnecessary sugar to your intake. You also want to limit melons and bananas since they are higher in natural sugars and offer little fiber. The best rule of thumb is to think thin! Look for fruits with the thinnest skin – these are the best choices due to their high antioxidant content and low sugar content. 3. Don’t underestimate the importance of fat. Fats do NOT make you fat! Fats are responsible for the proper hormone function of your thyroid and other important bodily processes responsible for keeping you healthy. They also keep you full longer minimizing food cravings and keeping you on track. Lastly, many diets cause hair loss and brittle nails; fats can help prevent this from happening. Be sure to include smart fats in your diet. Avoid trans fats found in baked and prepackaged foods. Instead, focus on healthy fats like nuts, olive oil, avocados, and olives that can add flavor and improve your heart health. 4. The final tip to remember is to incorporate protein with every meal. Whether you are on a low fat diet or low carbohydrate diet, protein should always be first priority. Choose quality meat if possible, since many of today’s meats are full of hormones and chemicals. Although it may cost a little more, it’s worth it to your overall health. Look for local, grass fed beef or free-range organic poultry. Omega three eggs are also a good choice. Keep in mind that the yolk is where the fat is, so if you only eat egg whites, you’re missing out on these important nutrients. Also remember that portion control is key to weight loss success. A proper portion for meat lies in the palm of your hand, literally. Once protein is cooked, simply measure a portion that is equivalent to your palm size. You need approximately this much protein with each meal every day! This is important because protein paired with starches will help to stabilize blood sugar and keep you from feeling hungry. It will also help maintain the muscle you already have, which is important since many times losing weight means losing a combination of both fat and muscle. Once you’ve lost weight, the same principles listed above should be applied, but you do have a little more wiggle room. After all, no one is perfect! If you do get cravings, splurge on dark chocolate instead of milk chocolate for a tasty treat. Use an air popper to pop your own popcorn instead of eating it at the theater for a salty treat. Using plant based sweeteners like Stevia instead of sugar can also save you a ton of unwanted empty calories. Consider sprinkling a little Stevia on plain Greek yogurt with added fruit for a sweet treat instead of ice cream. Little changes like this can make a big difference in long term successful weight maintenance. Remember, you are what you eat. Body Mass Index (BMI) does not tell the whole story. Even if you’re at a healthy weight or BMI, it doesn’t necessarily mean you’re healthy if you aren’t eating right! Countless people at their ideal body weight still suffer from high cholesterol, high blood pressure, and diabetes. By eating fresh, unprocessed foods many of these health conditions can be reversed. Unfortunately, all too often people choose pre-packaged, processed foods that come laden in salt, which can damage blood vessels and cause hypertension (high blood pressure). Simple carbohydrates like pastries, cookies, crackers, and
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NUTRITION HEALTH | our health
white bread, which are also popular commodities, can raise triglycerides and lower HDL, your good cholesterol. By avoiding these foods and flavoring fresh foods with herbs and spices, you will be healthy both inside and out!
Is Body Mass Index (BMI) really accurate? Body Mass Index is a weight to height ratio that was developed in eighteen thirty-two by Adolphe Quetelet. Originally, it was not designed to be a measure of weight status but was developed to define the “normal man.” It was not until the nineteen seventies that the medical community began using BMI as a tool for defining normal weight, overweight, and obese for insurance billing purposes. Today, a BMI between 18.5 and 24 is considered a healthy or normal weight. Anything under that is considered underweight, 25 to 29 is considered overweight, and 30 and over is considered obese.
Take a minimum of 10 ,000 steps per day - 12,0 00 for gains in fitness. — Timothy Silver, M D Sheltering Arms Hosp ital, Midlothian
Because it was not originally designed to be a measure of weight status, BMI does have some limitations. To begin with, BMI does not account for muscle mass. If a very muscular person is measured on a BMI scale, they could appear obese. In addition, body fat distribution is also not accounted for, which can have a great impact on health risk. Abdominal adiposity, for example, carries a larger health risk than fat that is centered on the hips. Finally, BMI does not differentiate between genders nor does it adjust for age. While simple and inexpensive, it should not be used as a sole diagnostic tool for health professionals. Diet history, exercise patterns, family history, body fat distribution, and body fat percentage should also be taken into consideration. Unfortunately, it’s difficult to provide an ideal weight for each person’s height. This number will vary vastly depending on the factors listed above including the person’s bone structure, fat mass, and lean mass. The best way to determine your ideal weight would be by having your body fat percentage measured. The gold standard for measuring body fat is under water weighing or a machine called the Bod Pod. These can be cumbersome and costly measurements, which is why using BMI is a popular alternative. For sedentary young and middle aged adults, BMI can be a good marker of health risk. A simple equation can also be used to determine a weight range for your height. For men, this formula is 106 pounds for the first five feet plus six pounds for each inch over five feet. For women, the formula is 100 pounds for five feet plus five pounds for each inch over five feet. Both should be adjusted by ten percent more or less based on whether you have a large or small frame. For example, a female who is five feet six inches tall would weigh 130 pounds plus or minus 10 percent based on her frame. If she has a small frame, she could weigh as little as 117 pounds, or with a large frame, she could weigh as much as 143 pounds.
HEART: • H: Hummus; E: Eggs; A: Apples; R: Roughy T: Tomatoes To keep a healthy heart, be sure to incorporate healthy fats, protein, fruits, and non-starchy vegetables. Hummus, made of chick peas and olive oil (a healthy fat), makes a great dip for vegetables! It also provides lots of flavor and texture to make foods more interesting and less bland. Eggs are a great food, packed with protein and a healthy dose of fat. They are both versatile and delicious. Look for omega three or farm fresh eggs for the best nutritional quality. Fruits are also wonderful for your heart! They are compact and make a great snack. Apples are an easy, grab and go food that add a nice crunch of sweetness. Protein is important because it helps to maintain muscle, and since your heart is a muscle, naturally it’s a great choice. Fish is the perfect heart healthy food! Not only is it rich in protein, it also has a healthy dose www.ourhealthrichmond.com | 41
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of omega three heart healthy fat. Not a seafood fan? Orange roughy is buttery in flavor and does not have a fishy taste, so give it a try! Finally pack your plate with vegetables. Tomatoes are great to throw in salads or make into salsa. They’re also full of antioxidants! By incorporating these foods and others from these food groups into your diet, you’ll be well on your way to a heart healthy lifestyle! Check out the recipes below for ways to incorporate these into your family’s meals.
Recipes: Homemade Hummus Ingredients:
»» 1 apple »» cinnamon to taste »» 1 packet Stevia Directions: Slice the apple, removing seeds. Microwave for approximately 45 seconds until soft. Sprinkle with cinnamon and Stevia. Enjoy.
»» 1/3 cup tahini
Ingredients:
»» 2 garlic cloves, crushed »» 1/2 cup roasted red pepper Preparation: In a food processor or blender, combine beans, tahini, lemon juice, and olive oil. Blend until smooth. Add red peppers and garlic until you reach desired consistency.
»» 1 1/4 lbs orange roughy fillets »» 1 teaspoon seasoning salt (or to taste) »» pepper to taste »» paprika to taste Directions: Put fish fillets in a greased 11x7 inch baking dish.
Serve warm or cold with fresh veggies.
Sprinkle with seasoned salt, pepper, and paprika. Cover and bake at 400 degrees for 15 to 20 minutes or until fish flakes easily.
Egg Frittatas in Muffin Tins
Tomato Salsa
Ingredients:
Ingredients:
»» nonstick olive oil cooking spray
»» 6 Roma tomatoes, chopped
»» 8 large eggs
»» 4 garlic cloves, minced
»» 1/2 cup unsweetened almond milk
»» 2 seeded and minced jalapenos
»» 1/2 teaspoon freshly ground black pepper
»» 1 red bell pepper, diced
»» 1/4 teaspoon salt
»» 1 tablespoon olive oil
»» 4 ounces thinly sliced turkey, chopped
»» 1 lime, juiced
»» 1/4 cup freshly grated parmesan
»» chili powder, salt, and pepper, to taste
»» 2 tablespoons chopped fresh Italian parsley leaves
»» fresh scallions and cilantro to taste
Directions: Preheat the oven to 375 degrees F. Spray 2 mini muffin tins (each with 24 cups) with nonstick spray. Whisk the eggs, almond milk, pepper, and salt in a large bowl to blend well. Stir in the turkey, 42 | www.ourhealthrichmond.com
Ingredients:
Orange Roughy
»» 2 tablespoons olive oil
— John Goreczny, M Ches terfie ld Fa mily Prac ti ce Cen ter
“Baked” Apples
»» 1 can of chickpeas/garbanzo beans (15 ounces) »» 1/4 cup lemon juice
h 1. Ea t more fres bles. fru i ts a nd ve ge ta tes a 2. Wa lk 30 mi nu da y . D,
cheese, and parsley. Fill muffin tins almost to the top with the mixture. Bake until the “frittata” puffs and is just set in the center, about 8 to 10 minutes. Using a spatula, loosen the frittatas from the muffin cups and slide the frittatas onto a platter. Enjoy.
»» 1/2 red onion, finely chopped
Directions: In a bowl, combine all ingredients. Place in refrigerator for up to 12 hours.
To stop it ching in co ld weather, apply pet roleum jelly imme diately aft er showering . — Willia m Farrar , MD, ealth Gro up—Brem o
Primary H
how to protect your skin from the RAVAGES OF COLD WEATHER
PERSONAL ADVICE FROM A RICHMOND DERMATOLOGIST
words | MELISSA SCHWARZCHILD, MD
When temperatures and humidity drop and the thermostat rises, your body responds with cracked heels, flaky skin, and a dry, irritated feeling. Dry skin is the result of a lack of water in the skin’s outermost layer, the epidermis, which can come about in a number of ways. Long or frequent baths and showers, especially in hot water, are drying because they break down the lipid barrier in the epidermis, allowing water to escape. Deodorant and antibacterial soaps are also extremely drying. Plus, our skin naturally becomes drier with age. To help your skin survive winter, use a humidifier in your home; take short baths or showers (less than 10 minutes) in warm, not hot, water; and use a mild soap, such as Dove or Neutrogena, or nonsoap cleanser, such as Aveeno®, CeraVe, Cetaphil® or Oil of Olay®. Now, here’s the most important part: moisturize immediately after getting out of the shower to prevent water evaporating from your skin. I have to admit that because I’m always so cold during the winter, I indulge in extralong hot showers. I try to make up for it by applying a moisturizer both in the morning, after showering, and at night before going to bed. But with the array of moisturizers out there, where do you start? www.ourhealthrichmond.com | 43
TM
Eileen Kitces, MD, FAAD
Medical, Surgical and Cosmetic Dermatology
Edward Kitces, MD, PhD, FAAD
State-of-the-Art Laser Center Melissa Schwarzschild, MD, JD, FAAD Victoria Gross, MD, FAAD
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BODY BEAUTIFUL | our health
There are three major types of moisturizers: reparative, which give important missing or damaged components back to the skin; humectants, which draw moisture into the epidermis; and sealants, which coat the epidermis to prevent water loss. Aveeno® moisturizers are reparative in nature. They contain ceramides, the most abundant lipids in the epidermis, thus enhancing our skin’s ability to retain moisture. Humectants include urea, lactic acid, glycerin, propylene glycol, and panthenol. Sealants include petrolatum (think of Vaseline® petroleum jelly) and dimethicone (your hairdresser has probably told you to look for this substance in hairstyling products because it seals the hair’s cuticle). Richmond Dermatology & Laser Specialists, Richmond, Virginia
Generally speaking, creams and ointments are much more hydrating than lotions. So anything liquid-y enough to come out of a pump bottle is mostly water, which will simply evaporate off your skin. For me, the perfect moisturizer is a cream that contains several humectants to attract moisture and a sealant to hold in that moisture. For skin that is dry and flaky, I recommend using an exfoliating cream, such as glycolic acid, in addition to a strong moisturizer.
What about dry, cracked hands and the dry, thick, calloused heels we often have during the winter months? Here’s my solution: first, make sure you have a urea-based humectant, Vaseline® petroleum jelly or aquaphor, and a pair of cotton gloves and cotton socks. Next, smooth a layer of urea cream all over your skin and then a thick layer of Vaseline® petroleum jelly or aquaphor on top of that to seal in the moisture. Finally, slip your hands into the gloves and your feet into the socks and go to bed. While this may not be your best bedtime look, if you follow this routine a few nights in a row, your skin will look and feel wonderful. So go ahead and treat your body right this winter — your skin will be smooth and ready after the long hibernation. Dr. Schwarzschild is a board-certified dermatologist practicing with Richmond Dermatology Specialists and a fellow of the American Academy of Dermatology. Her special areas of interest include laser and dermatologic surgery and cosmetic dermatology. To contact Dr. Schwarzschild, please call 804.282.8510. For additional information, please visit www.richmonddermlaser.com. Dr. Schwarzschild is a board-certified dermatologist practicing with Richmond Dermatology Specialists www.ourhealthrichmond.com | 45
A NEW WEAPON FOR
WOMEN’S HEALTH | our health
Women are mor e likely to have heart at tack symptoms unre lated to chest pain. Gan Dunnington, MD, Virginia Cardiov ascular Specialists
HOT FLASHES? Before she became personally acquainted with hot flashes, Marjorie Gordon recalls, “I would never have believed people really go through that.”
words | ANIKA IMAJO
Ranging in intensity from vexing to incapacitating, hot flashes insinuate themselves into the lives of up to 90 percent of women who are perimenopausal, the time when a woman’s body shifts from more-or-less regular cycles of ovulation and menstruation toward permanent infertility, or menopause. But for Gordon and many other breast cancer survivors, managing these prickly menopausal symptoms can be especially challenging. “Right now, in the United States, there are about 240,000 new cases of breast cancer each year,” explains oncologist Mary Helen Hackney, MD, an associate professor at Massey Cancer Center (MCC) and the Division of Hematology, Oncology and Palliative Care in the Department of Internal Medicine at Virginia Commonwealth University. Many of these women, she says, will be treated with either chemotherapy or hormonal therapy. According to Dr. Hackney, women in the 40-50 age range whose breast cancer is treated with chemotherapy often experience the rapid onset of menopause, which may be accompanied by significant hot flashes. Hormonal therapies, such as tamoxifen and aromatase inhibitors, may also produce hot flashes in patients. “The drugs that are used to treat hormonally sensitive breast cancer have hot flashes as a side effect in about 40 percent of people,” she says. To complicate matters, breast cancer survivors have fewer safe options for treating hot flashes. As Dr. Hackney explains, the established method of treating hot flashes with estrogen is simply not a good choice for breast cancer survivors. “There are a few exceptions to that rule, but overall we are concerned that estrogen might promote additional breast cancer development,” says Dr. Hackney. Gordon initially turned to her obstetrician/gynecologist for relief, but professionals there were reluctant to prescribe anything for the hot flashes. So she was referred to her oncologist, Dr. Hackney, to seek treatment instead. www.ourhealthrichmond.com | 47
WOMEN’S HEALTH | our health
Dr. Hackney notes that clinical trials and anecdotal evidence have indicated that other treatments – including certain antidepressants, an anti-seizure medication, an anti-hypertension medicine, and select variations on hormones – have been effective in reducing hot flashes in some women. But all medications have the potential of side effects that may not be acceptable, she says. Confronting these challenges, VCU MCC developed a pilot study to test oral magnesium supplements as an affordable treatment alternative for hot flashes. While it’s possible that all women who suffer from hot flashes stand to benefit from this research, the study focuses on the impact this potential course of therapy may have on women who have undergone breast cancer treatment. Gordon, 48, was diagnosed with breast cancer when she was 32, and she had chemotherapy treatment. The severe hot flashes, which she began to experience at the end of last year, would sometimes strike 10-15 times a day, impacting her daily life around the clock and disrupting both her days and her nights. “During the night, I was waking up maybe every hour,” she remembers. “You’re cold and you’re hot and you’re cold and you’re hot.” Sleep deprivation, combined with episodes of often overwhelming discomfort and anxiety, put her on edge throughout the day and interrupted whatever she was doing.
Instead of only treadmill, machines, or calisthenics, explore new fun exercise activities, like dancing or sports, to find something you will be likely to keep doing long term. Jean Wisgarda, MD, Commonwealth Ob/Gyn Specialists
“It’s important to control hot flashes for quality of life,” says Dr. Hackney, who is also the director for VCU MCC’s Rural Cancer Outreach Program. Two small studies involving around 25 breast cancer survivors, including Gordon, yielded promising results. With 56 percent of subjects experiencing over 50 percent
www.ourhealthrichmond.com | 49
our health | WOMEN’S HEALTH
reduction in their hot flashes, Dr. Hackney remarks, “We realized that it was making a difference; it was making side effects safe and manageable.” Pointing out some of magnesium’s merits, she says, “It’s not hormonal, it’s cheap, and the biggest side effect is loose bowels or occasionally some diarrhea. So it’s very well tolerated by most people.” Largely through the efforts of Haeseong Park, MD, a hematologyoncology fellow instrumental in presenting the findings, the study is progressing to national Phase 3 trials or widespread national testing to measure effectiveness and safety before the treatment is put on the market. Dr. Hackney and Dr. Park – in conjunction with the Mayo Clinic – will be at the helm of this new level of testing. Gordon says she is more than happy to continue her participation during the larger clinical trial phase, which will be conducted at multiple sites across the United States: “I’m doing much better. I’m not really even having that many hot flashes, and when I do have them, they’re so mild that they don’t really bother me.” “I’m grateful,” she says, noting that she sought Dr. Hackney’s advice about hot flash treatments at just the right time to become involved in the study. According to Dr. Hackney, trial subjects are still being recruited, both locally and nationally. Participants must be postmenopausal women who have had breast cancer, do not have diabetes, and are not on estrogen. Women who have estrogen-negative breast cancer and who aren’t on hormonal based therapy are eligible for the trial. While the entire field of trial subjects will be breast cancer survivors, Dr. Hackney adds, “One of the things that we’re still sorting out is how well this hot flash remedy translates to somebody who has not been through breast cancer or who is not on the breast cancer drugs like tamoxifen and aromatase inhibitors.” Such findings, she says, will help researchers determine what effects magnesium treatment might have on women in general who suffer from hot flashes and don’t want to take estrogen.
Mary Helen Hackney, MD, oncologist, and associate professor at Massey Cancer Center (MCC) and the Division of Hematology, Oncology and Palliative Care in the Department of Internal Medicine at Virginia Commonwealth University.
Editor’s Note: Women who meet the eligibility criteria and are interested in participating in the national trial should contact clinical research nurse Gwendolyn Parker, RN, at (804) 828-5090.
Haeseong Park, MD, a hematology-oncology fellow
50 | www.ourhealthrichmond.com
ADVOCACY | our health
guiding patients through the
Medical Maze
words | ANIKA IMAJO photography | ED IP
Dread and bewilderment are the companions that escort many of us into and out of the doctor’s office. And self-reproach often joins us later when we realize we don’t really comprehend what we were told and we failed to ask important questions. When facing complicated medical scenarios involving what seem to be inscrutable instructions, overwhelming options, and byzantine billing practices – and when avoidance isn’t an option – even the most independent among us may long for the support of a trusted and knowledgeable ally. That ally can be found in Bonnie Shelton, MD, who provides such support. Dr. Shelton, formerly a general surgeon, brings more than medical savvy into her work as a patient advocate. Years of shepherding friends and family through assorted medical mazes have cultivated in her a profound understanding of challenges facing both patients and caregivers. www.ourhealthrichmond.com | 51
ADVOCACY | our health
Though Dr. Shelton ended her active medical practice when her first child was born, her appetite for new medical knowledge, and her drive to use that knowledge to help others, never lay dormant. When she established Shelton Medical Advocate in the Richmond area in October 2011, she embraced a role that would tap into her breadth of experience. Dr. Shelton is equipped to guide her clients through a range of healthcare processes. Accompanying patients to medical appointments, she interprets the information presented by physicians, assesses the treatment options, and asks the questions that many of us wouldn’t think to – or in some cases, dare to – ask. She functions as the informed authority who has studied the unabridged version of the patient’s medical history and is familiar with personal circumstances. “I totally understand, because I can’t advocate for myself when I’m seeing a doctor,” she says, noting that it’s common for patients to leave medical appointments feeling more confused than informed. “But, ultimately, you want to empower the patient. You want them to learn how to speak for themselves and think of the questions to ask.” When Meda Lane, a certified public accountant, took on power of attorney responsibilities for a client who suffers from short-term memory loss, she turned to Dr. Shelton.
Seeing y our doctor is bette r than an apple a day. -Walter Foliaco, MD, Chester field Fa mily Practice Center
“It’s been a godsend to have her available,” Lane says. Lane’s client represents a population that Dr. Shelton is especially interested in helping. Although Dr. Shelton’s services can help clients of any age group, she has realized through her work that advocacy can play a particularly significant role in the lives of the elderly. To better address the issues facing seniors, she’s pursuing a Master’s degree at Virginia Commonwealth University in gerontology, a multidisciplinary field that focuses on the social, biological, and psychological aspects of aging. Lane’s client, like many elderly people, has no family in town and is unable to grasp and retain information pertaining to her healthcare. A resident at an assisted living facility specializing in memory loss care, the client has been admitted to the hospital four times and has seen multiple specialists since Lane became the agent responsible for her medical decisions. “Dr. Shelton has been there all of those times and has asked the questions that I would have no idea to ask,” the accountant explains, noting that Dr. Shelton has also addressed emergency situations that have arisen when she herself was unavailable. “She’s very caring,” Lane says of Dr. Shelton. “She’s concerned about the patient and she’s also concerned about me, in that she wants to make sure I totally understand what’s going on.” Steadily involved and keenly observant, Dr. Shelton has the thorough knowledge of her client’s medical background that also enables her to enhance physicians’ understanding of the full picture. Reflecting on the difficult times when Lane navigated through her own parents’ healthcare issues, she says she would have been grateful to have an advocate such as Dr. Shelton at her side to translate the medical jargon, distill information, get through to physicians, and be certain that all options were fully explored and fully understood. A voracious reader and researcher, Dr. Shelton takes an open-minded approach to www.ourhealthrichmond.com | 53
our health | ADVOCACY
healthcare. Open to alternative forms of treatment, she believes in exploring all avenues in search of the solutions that make the most sense in any given case.
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“Whatever works, works,” she says. Dr. Shelton embraces functional medicine, which she explains is an approach that looks at the body as a whole system, rather than a collection of parts. Examining medical conditions through this lense allows her to look beyond the treatment of individual symptoms in order to identify their underlying cause. “Why do you keep replacing the carpet,” she asks, “when there’s a hole in the roof?” Dr. Shelton also stresses the importance of preventive measures and offers nutritional counseling as one of her services. In addition, she provides support with the headache-inducing tasks of reviewing medical bills for errors and disputing denied claims. Familiar with the workings of health insurance, she helps to make sure that her clients maximize their benefits.
Nurture your relat ionships with fam ily and fr ie nds. This will lead to a healthier and happie r you!
— Bryan M Chester W axwell, DO, omen’s H ealth, CJW
Dr. Shelton explains that as a patient advocate, she also engages in shared decision making, weighs potential benefits and risks related to treatment recommendations, and helps the client figure out “what best suits their needs and expectations in that particular situation.” While championing the patient’s cause in the physician’s office may be part of Dr. Shelton’s role as an advocate, she recognizes the mounting pressures that medical professionals face. Noting the sheer volume of information that today’s physicians must digest and the time constraints imposed on them, she says she could not imagine herself as an active physician at this point. “Because I’m an MD, I can understand where doctors are coming from in their practices. It’s become very hard to practice medicine. They’re given less and less time to be with patients. They’re overworked,” she says, explaining that these circumstances contribute to the expanding need for patient advocates. And with this awareness, she adds, “I’m not going to be the kind of advocate who is attacking doctors…I just want to come alongside and be a partner.” More information on Dr. Shelton’s services is available at her website, sheltonmedical.com. For general information on medical advocates, see advoconnection.com.
up straight. Stand and sit rotects your Good posture p spine! rn, MD, ho c a hk ic n a V d e —J paedics Tuckahoe Ortho
54 | www.ourhealthrichmond.com
SENIOR LIVING | our health
20/2013 This February 2013, Virginia Eye Institute of Richmond will mark it 20th year of providing no cost cataract surgery to those who cannot afford it.
words | SARAH COX photography | ED IP
For the past 19 years, the Virginia Eye Institute (VEI) has donated over 800 eye exams and 240 cataract surgeries, in addition to post-operative exams and new, temporary lenses – all at no charge. With 80 volunteers and Read F. McGehee, MD at the helm, the 20th annual Cataract Mission program will reach out to help Virginians who need cataract surgery but lack insurance or the financial means to pay for the surgery. Dr. McGehee, whose credentials include a medical degree from the University of Virginia, residency in ophthalmology at the University of Minnesota, board certification by the American Board of Ophthalmology, and a fellowship at the American Academy of Ophthalmology, says the Cataract Mission is the most important outreach program at the Virginia Eye Institute. “With our volunteers, we are able to make life-changing differences in these patients’ lives. This program allows the physicians and staff volunteers to give back to those who most need our help,” he explains. Cataracts, a condition defined by the American Academy of Ophthalmology as a “clouding of the lens of the eye that occurs with age,” affect nearly 22 million www.ourhealthrichmond.com | 57
our health | SENIOR LIVING
Americans age 40 and older. VEI surgeons and staff members volunteer their time on two consecutive Saturdays to complete eye examinations and surgery. Each year, the Institute takes applications to screen for those qualified. This year the applications much be received with required documentation by Friday, February 1, 2013, and the clinic will be held on Saturday, February 16 (the screening day) and Saturday, February 23 (the surgery day). For more information, or to apply, call 804.287.4905 or send an email to: vaughanm@vaeye.com.
About VEI: VEI is a comprehensive eye care organization with 11 locations throughout the Richmond community. Their range of services includes care for corneas, glaucoma, retinas, oculoplastics, pediatrics, refractive surgery (LASIK) and general surgery. VEI (Virginia Eye Institute) Staff
20th Annual Cataract Mission: Top Ten Facts 1. The 20th annual Cataract Mission at the Virginia Eye Institute will be held Saturday, February 16th, 2013 (Screening Day) and Saturday, February 23rd, 2013 (Surgery Day).
Read F. McGehee, MD
2. Program to provide free cataract surgery for residents of Central Virginia of all ages who have no insurance – Medicare and Medicaid included – and no other means to pay for surgery. 3. Call the Cataract Mission Hotline at 804-287-4905 to request a free application. 4. Completed applications must be received with required financial documentation by the deadline on Friday, February 1st , 2013 for consideration.
Not all types of prostate cancer require treatment. However, treatment has saved many lives. — Michael Franks, MD, Virginia Urology
5. This service is by appointment only. Walk-ins will not be accepted. 6. Cataracts are the leading cause of curable blindness. 7. Cataracts are a clouding of the lens of the eye that occurs with age. Surgery takes about 20 minutes, and the patient is usually ready to go home within an hour of surgery. 8. According to the American Academy of Ophthalmology, cataract affects nearly 22 million Americans age 40 and older. 9. Virginia Eye Institute surgeons and staff members volunteer time on two consecutive Saturdays to complete eye examinations and surgery. 10. Virginia Eye Institute has donated over 800 eye exams and 240 surgeries in the program’s history.
58 | www.ourhealthrichmond.com