table of contents | january • february 2016
FIT BITS!........................................ 25
MEDI•CABU•LARY.....................10 Local experts define health related terms
JUST ASK!.......................................12 Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............14 A listing of new physicians, providers, locations and upcoming events in greater Richmond
HEALTH POINTS.........................18 Interesting facts and tidbits about health
2016 Fitness Trend ‘Watch’ Are you wearing it? According to the American College of Sports Medicine (ACSM), who recently published its annual fitness trend forecast, for the first time, exercise pros say wearable technology will be the top fitness trend this year.
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The Bridge to Better Health Starts with Primary Care
THE ANATOMY CHALLENGE..................................21 How much do you know about Our Anatomy? In this issue, test your knowledge when it comes to the PATHWAY OF THE BLOOD THROUGH THE HEART.
THE ANATOMY ........................... 22 Heart Care: How far we have come
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The Resource for Healthy Living in Greater Richmond
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New Procedure Gives Hope to Women with Low Estrogen Vaginal atrophy, also known as “atrophic vaginitis,” is an uncomfortable condition that many women suffer from in silence.
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2016 Nutrition Series
New Kitchen, New Nutrition, NEW YOU
This series puts the focus on helping you get healthier in the kitchen — one ingredient at a time. Each edition will highlight small changes you can make in your food prep and shopping habits that can add up to a major positive impact on your nutrition and health.
hello, HEALTH!................................................................. 42 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos
A CLOSER LOOK............................................................. 50 Images reflecting the landscape of healthcare in Richmond *
A chance to win prizes!
PLUS *
www.OurHealthRichmond.com
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The Resource for Healthy Living in Greater Richmond
january • february 2016
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McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Deidre Wilkes Laura Bower Karrie Pridemore Bobbi Hoffman Joseph Palotas Tyler Darden/www.tylerdardenphotography.com Jourdan Markey
CONTRIBUTING RICHMOND MEDICAL EXPERTS Douglas Allen, MD Hernan Gatuslao, MD Donnovan Miller, M Ed Megha Sheth, PT Daniel Van Himbergen, MD Mitchell Waskin, DPM CONTRIBUTING PROFESSIONAL Cynthia Bement EXPERTS & WRITERS Jeanne Chitty Rich Ellis Tricia Foley, RD Stephen McClintic, Jr. Laura L. Neff-Henderson Deidre Wilkes ADVERTISING AND MARKETING Richard Berkowitz Senior Vice President, Business Development P: 804.539.4320 F: 540.387.6483 rick@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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click on the magazine cover to view the digital edition! 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 Lynchburg/Southside is published bi-monthly • Special editions are also published • McClintic Media, Inc. • 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. MAIN: ourhealthvirginia.com | ourhealthswva.com | ourhealthlbss.com | ourhealthrichmond.com | ourhealthcville.com | Advertising rates upon request.
LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is neuroplasticity?
Because bunions are progressive and worsen with time, it is important to get a proper diagnosis and treatment.
The term is derived from the root words neuron and plastic. Neurons are the nerve cells in the brain and each neural cell is composed of an axon, dendrites and are linked to another neural cell by synapses. Plasticity means the quality of being easily shaped or molded or the adaptability of an organism to changes in its environment. Therefore, neuroplasticity is the potential of the brain cells to reorganize themselves by making new neural pathways to adapt to the individual’s needs. Previously, it was believed that the human brain consists of about 100 billion neural cells that are set from birth to adulthood, and that the brain could not make new cells or generate new neural pathways. Current neuroimaging techniques (PET and MRI brain scanning) reveal that new neural cells and neural pathways are generated throughout life. What this discovery means is that not only is there no end to how much someone can learn through focus, sharpening of skills and concentration throughout their lifetime, it also sheds new hope for patients recovering from a brain injury. Hernan Gatuslao, MD
VCU Health MCV Physicians Richmond | 804.828.9350 www.mcvphysicians.vcu.edu
What is Tetralogy of Fallot?
What are bunions and how can they be treated?
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart lesion found in newborn babies. The defect, which is a major cause of socalled “blue babies,” was first described by pathologists centuries ago.
A bunion, also known as hallux valgus, is a deformity of the big toe joint. A major driver of foot and ankle surgery, bunions are associated with functional disability, foot pain, poor balance, and a risk of falling in older adults. Because bunions are progressive and worsen with time, it is important to get a proper diagnosis and treatment.
There are four components to TOF: • A large hole between the lower chambers of the heart (ventricular septal defect–VSD) • Obstruction of blood flow to the lungs • Shift of the aorta rightward over the VSD and • Eventual thickening of the right ventricle in order to overcome the obstructed flow. The development of this abnormality occurs very early in gestation (before week 7 of pregnancy). The result is a physiologic state where deoxygenated blood mixes with the oxygenated blood that circulates throughout the body. This leads to cyanosis or a bluish discoloration of the skin. Once uniformly fatal, TOF can now be repaired by congenital heart surgeons. With ongoing medical care, these patients can be expected to have a normal life with few restrictions in their activities and an excellent quality of life. Douglas Allen, MD
UVA Pediatric Cardiology Richmond Bon Secours St. Mary’s for Kids Richmond | 804.628.4787 www.bonsecours.com
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Bunions are commonly corrected with surgery and there are more than 100 different surgical procedures to accomplish this. Although surgery is the only way to correct the problem, there are nonsurgical options to reduce the pain. These non-surgical options include wide toe-box shoes, bunion pads, arch supports, custom shoe inserts (orthotics), anti-inflammatories and steroid (cortisone) injections. Since there are other problems that can cause toe pain, the first step should be to visit a podiatrist for an examination and x-rays. From there a diagnosis and treatment plan can be discussed. Mitchell Waskin, DPM The Foot & Ankle Center Richmond | 804.320.3668 www.320-foot.com
www.OurHealthRichmond.com
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H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
Most nosebleeds occur at the front of the nose. Treatment involves keeping your head upright and pinching the nostrils with pressure.
Are there alternative special education services for students who are struggling in public school? For students who do not find success for one reason or another in the public school system, an option might be a private day placement. Any parent or guardian of a student receiving special education services can request consideration from the IEP (Individualized Education Program) team for a private day placement. There are times when a student with special educational needs may be more adequately served in a smaller environment for a period of time, while behaviors are addressed or remediation can be given. Private day schools are designed to address the needs of students with an emotional, intellectual, other health impairment or specific learning disability. Most private day schools will offer instruction in the core subjects aligned with the Virginia Standards of Learning (SOL), physical education, art and career and technical education. Depending on the school, students may be able to participate on athletic teams, take educational fieldtrips, and have an extended school year program during the summer. Donnovan Miller, M Ed
Principal, John G. Wood School Virginia Home for Boys and Girls Richmond | 804.270.6566 www.vhbg.org
What are some causes of nosebleeds, and when should medical attention be considered?
What types of activities should be avoided following a hip replacement surgery?
Epistaxis, or nose bleeding, is a common problem. About 60 percent of people will have an episode. About 10 percent of cases require medical treatment. The cool, dry winter months are the most common time for nosebleeds due to the lack of humidity and resulting nasal mucosal dryness. Other causes include blunt trauma, aspirin or blood thinning medications, hypertension, inflammatory diseases, bleeding disorders, and rarely, tumors. Preventative measures include controlling blood pressure, avoiding nasal trauma, use of nasal saline or gels, and humidification of home air.
After total hip replacement surgery (THR), it is best to avoid any high impact activities like running, tennis, squash, football, basketball, or soccer. Patients should remember to avoid any activities that can put the new hip at risk for dislocation. With a posterior approach hip replacement, it is important to avoid hip flexion greater than 90 degrees, turning in (internal rotation) or crossing your legs (adduction). For patients who have had an anterior approach hip replacement, hip extension and turning out (external rotation) beyond neutral should be avoided, as well as bridging and lying on the stomach. These motions should also be avoided in combination. Keeping these limitations in mind, staying active is the best thing for a new hip.
Most nosebleeds occur at the front of the nose. Treatment involves keeping your head upright and pinching the nostrils with pressure. Applying topical vasoconstriction sprays such as Afrin or packing some cotton in the front of the nose soaked in Afrin may also be helpful. If conservative measures fail, a visit to an urgent care facility or emergency room may be necessary. Recurrent nosebleeds should trigger a visit to a primary care doctor or ear, nose, throat specialist (ENT). Often, a relatively painless cauterization with silver nitrate procedure can be performed in the office to significantly improve the bleeding issue. Daniel Van Himbergen, MD Virginia ENT Richmond | 804.484.3700 www.virginia-ent.com
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Any low impact activities like walking, riding a stationary bicycle or elliptical machine, gardening, or golf are recommended to stay active after THR. The best activity after the incision is healed is swimming to maintain and improve range of motion. Megha Sheth, PT
Parham Health & Rehabilitation Center Richmond | 804.264.9185 www.parhamhealthrehab.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
VCU Health earns Top Performer on Key Quality Measures® recognition from The Joint Commission Virginia Commonwealth University Health has been named a 2014 Top Performer on Key Quality Measures® by The Joint Commission, the leading accreditor of health care organizations in the United States. VCU Health was recognized as part of The Joint Commission’s 2015 annual report “America’s Hospitals: Improving Quality and Safety” for attaining and sustaining excellence in accountability measure performance for heart attack, heart failure, pneumonia, surgical care, children’s asthma and perinatal care. The Top
Performer program recognizes hospitals for improving performance on evidence-based interventions that increase the chances of healthy outcomes for patients with certain conditions. “We are committed to becoming America’s safest health system,” says John Duval, vice president for clinical services and chief executive officer, VCU Hospitals, VCU Health System. “Safety and quality improvement is part of our culture and is the core of everything we do. This recognition validates the dedication and commitment each and every team member has to delivering the highest level of safe
care. We are very proud to be recognized by The Joint Commission as a 2014 Top Performer.” For more information about the Top Performer program, visit www.jointcommission.org/ accreditation/top_performers.aspx. For more information about VCU Health, visit www.vcuhealth.org.
VCU Medical Center re-verified as Level I trauma center
Virginia Eye Institute has expanded
The Virginia Department of Health has re-verified Virginia Commonwealth University Medical Center as a Level I trauma center. VCU Medical Center has been a state-designated trauma center since 1981, making it the longest-standing trauma center in the state. As part of the designation review, Children’s Hospital of Richmond at VCU and the EvansHaynes Burn Center received provisional designations as Level I pediatric trauma and burn centers, respectively. This is the first provisional designation offered by the state in burn and pediatric trauma medicine.
Virginia Eye Institute’s cataract mission program is an outreach program designed to help Central Virginians in need of free cataract surgery. Certain eligibility criteria must be met for the application-based program and qualified candidates may schedule an evaluation through the CrossOver Clinic West to receive cataract surgery and other eye care services from Virginia Eye Institute.
“This re-verification is a tribute to the excellence of care that is provided by all our VCU Health teams,” says Marsha Rappley, MD, vice president of VCU Health Sciences and chief executive officer of VCU Health. “Treating burn patients requires a unique set of skills and expertise from wound care to plastic surgery. Treating children is no different. The work of our pediatric trauma team is another way VCU Health continues to advance children’s health in our community. This designation is continued recognition of the leadership in all aspects of patient-centered trauma care, education, research and injury prevention.” VCU Medical Center is the only Level I trauma center in Central Virginia and one of five in the state. The medical center provides comprehensive, specialized care for severely injured patients of all ages.
its annual cataract mission program
To date, Virginia Eye Institute’s cataract mission program has donated over 800 eye exams and 240 surgeries in the program’s 22 year history. Patients also get post-op follow-up at no charge. More than $5,000 worth of services are provided at no charge to each patient undergoing cataract surgery. Through their Access Now partnership, Virginia Eye Institute has been able to serve the community throughout 2015 with 30 surgeries and numerous office visits. “Cataract mission is the most important outreach program at Virginia Eye Institute. I have been fortunate to be the lead physician for 20 of the 22 years this program has been in existence. With hard work from our staff and physicians, we are able to make life-changing differences in these patients’ lives. I am always impressed by the enthusiasm of all of our staff. We have benefitted greatly from being in the Richmond community, and this program allows the physicians and staff to give back to those who most need our help.” says Read F. McGehee, MD, one of Virginia Eye Institute’s partners. For more information on this program as well as other services offered by Virginia Eye Institute, visit www.vaeye.com
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Down Syndrome Association of Greater Richmond hosts Conference The Down Syndrome Association of Greater Richmond (DSAGR), in partnership with the Virginia Department of Education’s Training and Technical Assistance Center (T/TAC) at Virginia Commonwealth University, hosts the 4th Annual From PossAbilities To Practical Applications conference to help strengthen education for all children with disabilities. Discover how to better educate children with disabilities with inclusion strategies, behavior, technology, sensory diets, diploma options, transition IEPs and more! There will be a keynote presentation and several breakout sessions by Cheryl Jorgensen, PhD an inclusive education consultant and former project director with the Institute on Disability at the University of New Hampshire (UNH) and assistant research professor in UNH’s education department for 25 years. The conference features nine break-out sessions, exhibitor displays, educator awards and networking time.
Date: Saturday, January 30 Time: 9:00 a.m. – 4:00 p.m. Location: Hilton Richmond Hotel & Spa/Short Pump Cost: $40/person includes breakfast and lunch Certificates of Attendance available for an additional $10 For additional information on the conference, visit www.dsagr.com.
New Year Brings New Leadership at
Glenmore Yoga & Wellness Center Glenmore Yoga and Wellness Center, the oldest established yoga studio in the Richmond region, announces that, effective January 1, 2016, Kathleen Baker has assumed ownership and management of the center. Baker has served as center manager since 2005 and succeeds Nancy Glenmore Tatum, who founded Glenmore in 1998 along with her husband, Kevin Casey. The center currently serves about 325-350 students ranging in age from 5-90 with a core staff of 18 yoga instructors—all trained at Glenmore— and two massage therapists with a third being added in March 2016. Ongoing weekly classes include options to meet the needs of varying levels of students and with specialty classes such as Yin, Restorative, prenatal/ postnatal yoga and meditative classes. Workshops are offered throughout the year, and individual consultations and private yoga sessions can be scheduled as needed.
Robert Larson, MD
Jeff Laughlin, DDS, MPH Keyur Mavani, MD Virginia Family Dentistry Richmond | 804.364.7010 www.vadentist.com
VCU Community Memorial Hospital | Cardiology South Hill | 434.447.3151 www.vcu-cmh.org
Sara Mears, MD
Peter Meliagros, MD
Rebecca Miller, MD
Colin Mudrick, MD
Scott Putney, MD
Evan Ritter, MD
VCU Health | Vascular Richmond | 800.762.6161 www.surgery.vcu.edu
“I want to take the hallmark of what has made Glenmore so successful and build on that strong foundation,” says Baker, who is a registered yoga instructor herself. “We want to ensure that Glenmore will always be fresh and relevant to our audiences in the yoga market.” Glenmore Yoga and Wellness Center is located at 10442 Ridgefield Parkway in Richmond. You can reach them by phone at 804.741.5267 or visit their website at www.glenmoreyoga.com for studio hours and a complete list services, classes and workshops. For more information, visit www.glenmoreyoga.com.
MCV Physicians at Ironbridge Road General Medicine/ Primary Care Chesterfield | 804.425.3627 www.vcuhealth.org
Tuckahoe Orthopaedics Richmond | 804.285.2300 www.tuckahoeortho.com
VCU Health Internal Medicine Richmond | 800.762.6161 www.vcuhealth.org
Tuckahoe Orthopaedics Richmond | 804.285.2300 www.tuckahoeortho.com
VCU Health Internal Medicine Richmond | 800.762.6161 www.vcuhealth.org
VCU Health General Internal Medicine Richmond | 800.762.6161 www.vcuhealth.org
www.OurHealthRichmond.com
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NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Bon Secours Takes the Lead in Offering More Low-intervention Birthing Tools for Women Midwifery Programs Team approach & Centering Pregnancy programs empower women to face childbirth with confidence. To meet the increasing requests for midwifery care, The Woman’s Center at Bon Secours St. Francis Medical Center offers a team of certified nurse midwives to support women throughout their entire pregnancy and childbirth. The midwifery program at St. Francis has been in existence since the hospital’s founding in 2005 and is the only program of its kind located south of the James River in Richmond. “Modern midwifery has expanded well beyond just being present to assist when the baby is born,” says Melanie Hartman, CNM, The Woman’s Center at St. Francis. For starters, she and the other midwives are registered nurses with master’s degrees, post-master’s training and board certification by the American College of Nurse-Midwives. Bon Secours’ philosophy on the role of midwifery is another key differentiator. “We take a more holistic familycentered approach to health care during pregnancy that demonstrates our understanding of women’s unique physical, emotional and spiritual needs at this exciting time in their lives,” she adds. According to Hartman, all mothers-to-be will meet every member of the midwifery team at St. Francis— currently there are four—throughout the course of their pregnancy. When labor begins, one of the midwives will support the mother during the entire process and attend the birth at St. Francis. “That’s our firm commitment to the women in our care,” she explains. Along with the team approach, another unique feature of midwifery at St. Francis is the Centering Pregnancy program, which celebrates a woman’s unique pregnancy experience while also helping her to engage with a community of women who have similar due dates. Each two-hour Centering Pregnancy session, led by the midwives and held at routine prenatal care intervals, is dedicated to a particular topic such as nutrition, stress management or lactation, among other topics related to prenatal and infant care. •••••
New Ambulatory Fetal Monitors Devices allow more freedom of movement for mothers-to-be during labor. As part of its ongoing commitment to women desiring a low- intervention birth experience, Bon Secours Richmond Health System now has 11 high-tech ambulatory fetal monitors that allow women to move around freely outside of their hospital room while the baby is monitored wirelessly by health care professionals. The monitors are available at St. Mary’s Hospital, St. Francis Medical Center and Memorial Regional Medical Center. Until recently, pregnant women had to be unhooked from a fetal monitoring system if they wanted to move around, but that’s no longer the case. With these ambulatory fetal monitors, women can be more mobile instead of bedbound during labor. “Patients love it because they can walk around the labor and delivery unit and be assured that the baby’s heartbeat and the mother’s contraction pattern are still being watched carefully,” says Kasondra Miller, RNC-OB, C-EFM, Bon
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Secours St. Mary’s Hospital. “This also helps labor to progress more naturally by letting gravity do the work. A big benefit of the ambulatory fetal monitor is its ability to distract the mother-to-be from labor pain as she strolls the halls of the hospital.” •••••
Expanded Nitrous Oxide Program for Low-Intervention Births Bon Secours Richmond Health System is expanding the availability of nitrous oxide, an effective low-intervention tool for pain management during labor, into several hospitals throughout the Richmond region. Nitrous oxide has been offered at St. Mary’s Hospital since March 2014 and is now in the labor and delivery areas at St. Francis Medical Center and Memorial Regional Medical Center. According to Cara Golish Hartle, OB/GYN with Virginia Physicians for Women, more and more women desire to create a unique birthing experience that includes low-intervention options for handling pain and letting labor progress on its own before medications, such as an epidural, are administered. “Today’s women have grown up feeling empowered to accomplish anything that they set out to do, and for some of them, this includes having a baby in the most natural way, if possible,” she says. “The doctors and nurses at Bon Secours have embraced the low-intervention birth model and wanted to support women by offering safe, proven tools such as nitrous oxide to help them manage pain during labor and delivery.” A year ago, St. Mary’s was the first hospital in Virginia and one of the few hospitals nationwide to offer nitrous oxide to birthing women. A blend of 50 percent nitrous/50 percent oxygen is inhaled as needed, when contractions become more intense, to take the edge off the pain and enable women to stay completely awake and in control throughout labor. “The longer you can go without the epidural, the shorter the labor,” says Dr. Hartle, who was on the medical team that brought nitrous to St. Mary’s after observing it in use at Vanderbilt University Medical Center. “Nitrous can help women accomplish a low-intervention birth if that’s what they want to do. Then, if they choose to use nitrous as a bridge to an epidural, they are satisfied that every option was attempted.” “We are so pleased to be expanding our low-intervention birthing tools into several of our Richmond-area hospitals to support women who are exploring options for less medication during labor,” says Julie Reagan, administrative director for women’s services at Bon Secours Virginia Health System. “Our goal is for every woman having a baby at St. Mary’s, St. Francis or Memorial Regional to create her own personal childbirth story and to feel successful and satisfied about the experience.” For more information on these and other offerings of Bon Secours Richmond Health System, visit www.bonsecours.com.
TI P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U
january
isCERVICAL
HEALTH
awareness month
Heart Trivia in Honor of American Heart Month in February
Fascinating facts about the human heart – see if you can fill in the blanks (flip the magazine upside down to find the answers):
Cervical Health Awareness Month is a chance to raise awareness about how women can protect themselves from HPV (human papillomavirus) and cervical cancer with regular screenings (pap tests) and followup care.
A. The heart beats about ________________ times in one day. In an average lifetime, the human heart will beat more than 2.5 billion times.
Here are some tips to help you remember to schedule your screening, and make it a positive experience:
B. The heart pumps about ________________ barrels of blood during an average lifetime – enough to fill more than 3 super tankers.
For more information on cervical cancer, visit the National Cervical Cancer Coalition at www.nccc-online.org. For information on free or reduced-cost pap test and HPV vaccines, contact the Richmond City Health District at 804.482.5500.
did you know?
Every time you step forward, you use
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For more information on heart disease and how to be heart healthy, schedule a checkup with your local family physician or visit the American Heart Association at www.heart.org D. oxygen
hh Celebrate the good results – treat yourself to a pedicure or massage as a special treat for taking preventative health seriously.
D. Because the heart has its own electrical impulse, it can continue to beat even when separated from the body, as long as it has an adequate supply of ________________ .
C. 45
hh Make it a ‘girls day’ – schedule with a friend and do lunch or dinner afterwards.
B. 1 million
hh Be consistent – making your appointment during the same month each year will make it easier to remember – use your birthday month, or the birthday month of your child.
C. A kitchen faucet would need to be turned on all the way for at least ________ years to equal the amount of blood pumped by the heart in an average lifetime.
Heart Trivia Answers: A. 100,000
hh Put it on the calendar - along with all the other important tasks – games, practices, carpools.
MUSCLES!
FASCIN -ATING
FACT
The surface area of the human lung is LARGE ENOUGH to cover one side of a tennis court!
Beat the Winter Workout
‘BLUES’
Finding the motivation to exercise during the week is already difficult for most people. During the cold, dark weather months, it can be nearly impossible for many to muster up the strength to get off the couch and into their workout gear.
Here are a few tips to boost motivation and avoid a winter workout rut: Find a winter activity you enjoy The winter season is the perfect time to try a new winter sport like skiing, snowboarding, ice skating or snowshoeing.
Looking for a new running distance challenge? Try the
Sweetheart
sponsored by the Richmond Road Runners Club! This annual event features a scenic 8K course through The Grove subdivision, historic Midlothian Coal Mine Park, and surrounding roads and trails. Sign-up individually or as a couple and compete in the Couples Challenge!
2016 Sweetheart 8K
Date: February 7, 2016 Time: 8:00 a.m. Location: The Urban Farmhouse 13872 Coalfield Commons Place Midlothian, VA 23114
For more information and to register, visit the Richmond Road Runners Club at www.rrrc.org.
Mix up your routine When you get the workout “blahs,” aim to challenge yourself by having a workout “adventure” once a week. Try a new group exercise class, sport, a different interval workout or running route.
Try interval training Interval training alternates bouts of high and moderate activity. Another bonus of interval training is that the workout can be completed in a shorter period of time.
American Heart Association 2016 Go Red For Women Luncheon
Running outside is a great way to introduce interval training. Intervals can also be done on any indoor workout machine like the bike, treadmill, rower or elliptical.
Most women don’t notice the symptoms of heart disease until it’s too late. That’s why heart disease has been called the silent killer. Find out how you can raise your voice to end the number 1 killer of women at this year’s Go Red For Women luncheon.
Make working out a social activity – get a workout buddy or join a team Whenever you need some extra motivation, make your workout a social activity. You are less likely to skip if your friends are waiting for you. Join a sports team or make dates with friends to go to exercises classes.
Invest in fun new winter active wear Still trying to figure out what to use that Christmas gift card for? Treat yourself to a new pair of running shoes or a new outfit for inspiration!
Date: Friday, February 26th, 2016 Time: 10:30am-1:30pm Location: The Jefferson Hotel 101 W. Franklin Street Richmond, VA 23220 For more information on this event, contact Lauren Schingh, Go Red For Women Director of Development at lauren.schingh@heart.org, or at 804.965.6522. www.OurHealthRichmond.com
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the
Anatomy
CHALLENGE How much do you know about the
pathway of blood flow
through your heart? Complete the word search below. Next, match the correct word with the part of the heart in the illustration.
[ the pathway of blood ]
WORD SEARCH aorta
pulmonary valve
inferior vena cava
right AV valve
left atrium
right atrium
left AV valve
right pulmonary veins
left pulmonary artery
right pulmonary artery
left pulmonary veins
right ventricle
left ventricle
superior vena cava
For answers, visit OurHealth Richmond's
Facebook page at
____________
____________
____________ ____________
____________ ____________
Follow the numbers and arrows on the diagram to see the
____________ ____________
pathway of blood though the heart.
____________ ____________ ____________ The Anatomy Challenge is proudly sponsored by:
_____________ ____________ www.OurHealthRichmond.com
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Heart
Care
words | RICH ELLIS
how far we have come
The evolution of the subspecialty of cardiology is widely considered being responsible for the greatest prolongation of life in industrialized nations. Advancements in science and technology coupled with the expertise of various medical experts in the field have contributed to a significant decrease in heart disease and heart-related conditions. Although heart disease continues to be a leading killer, the death rate by age and impact to population per capita during the 21st century is markedly less than during the 20th century. To learn more about cardiovascular care, OurHealth turned to two Richmond specialists.
Cardiologists versus Cardiovascular Surgeons Patients often confuse the roles of cardiologists and cardiovascular surgeons, mistakenly believing that there are no discernable differences in the types of services they provide, the conditions they treat or the procedures they perform. It’s a popular misconception and understandably so because both focus on caring for, diagnosing and treating conditions related to the heart and vascular system — but that’s where the similarities end. 22
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“Although cardiologists and cardiovascular surgeons work together as a team to manage cardiac patients, they’re actually completely separate disciplines,” says Christine Browning, MD, a cardiologist with Cardiovascular Associates of Virginia in Richmond who also works at St. Mary’s Hospital and Memorial Regional Medical Center, hospitals affiliated with Bon Secours Richmond Health System. “When you finish medical school, you basically make the decision to be a medical doctor or a surgical doctor, and from day one, each is a completely different training track.” The separate tracks take about seven years to complete, Dr. Browning says, as both cardiologists and surgeons progress through internships, residencies and fellowships specific to their discipline. Cardiologists typically manage cardiovascular disease, Dr. Browning explains, while a cardiovascular surgeon has a short episode of care that is limited to the surgical intervention. For example, a patient with high cholesterol, high blood pressure and diabetes might first be referred to a cardiologist for a stress test. Depending on the results, the stress test could be followed by a
cardiac catheterization to examine the arteries supplying the heart in order to diagnose whether those arteries are obstructed. If they are, the cardiologist might treat the blockage with a stent. If, on the other hand, the stent isn’t a treatment option, the patient would usually be referred to a cardiovascular surgeon. The surgeon decides whether the patient is a candidate for surgical intervention and if they are, which approach is right for them. It could be a valve repair performed through a traditional open surgery, a minimally invasive valve repair or even a transcatheter valve replacement, Dr. Browning says. The surgeon manages the patient during the acute pre- and postoperative phases of care and typically for 30 days following surgery, at which point the patient returns to the care of a cardiologist, who follows the patient indefinitely.
Minimally Invasive Procedures Marc Katz, MD, a cardiac surgeon and the medical director for Bon Secours Heart & Vascular Institute in Richmond, performs many of these surgical procedures using the latest medical technologies. “Right now it’s a great time for patients because more and more procedures are being done in a less invasive way,” says Dr. Katz. “For example, we’re performing a lot of valve repairs and replacements through a needle stick. This has opened up a whole new opportunity for patients by making this type of care available to patients who would not previously have been considered a candidate for any type of heart surgery.” Procedures such as transcatheter valve repair or transcatheter valve replacement, in which the catheter is inserted through an artery or vein, are used to repair the heart’s leaking mitral valve or to repair the aortic valve, which tends to narrow. Both conditions increase in incidence with age, and by age 65 to 70, approximately 10 percent of the population experiences a problem with one of these valves. Before the availability of minimally invasive procedures, a typical mitral valve repair would have included an incision through the breast bone, use of a heart-lung machine to
compensate for the heart’s stoppage during the procedure and a lengthy hospital stay and recovery. Dr. Katz shared the example of a 96-year old patient who recently had a mitral valve repair and was able to return home the following day. “In an article written by the president of the American College of Cardiology and the president of the Society of Thoracic Surgeons, they used analogies to these two technologies being as groundbreaking as the development of anesthesia or the discovery of penicillin,” says Dr. Katz. “A third area we’re doing a lot of work in is with patients experiencing end-stage heart failure who are either candidates for a heart transplant but a heart isn’t available yet or who have a heart that’s weak, but for one reason or another they’re not a candidate for a heart transplant,” continues Dr. Katz. “For those patients, an assist pump called an LVAD, a left ventricular assist device, can be the solution.”
Christine Browning, MD is a cardiologist with Bon Secours Cardiovascular Associates of Virginia. She is certified by the American Board of Internal Medicine with a subspecialty in cardiovascular disease.
Continuing Improvement with LVAD’s In 1990 Dr. Katz was the first surgeon in Virginia to implant an LVAD in a patient, and 25 years later he was the first surgeon in Virginia to implant the Thoratec HeartMate 3 Left Ventricular Assist Device — a new advance in mechanical circulatory support. The patient was selected as part of the prestigious MOMENTUM 3 clinical trial, with Bon Secours being one of 60 locations in the United States — and the first in Central Virginia — chosen as part of the evaluation for people with advanced heart failure.
Marc Katz, MD is a cardiac surgeon with Bon Secours Cardiac Surgery Specialists. He is certified by the American Board of Thoracic Surgery.
What is a stent? A stent is a tiny wire mesh tube. It props open an artery and is left there permanently. When a coronary artery is narrowed by a buildup of fatty deposits called plaque, it can reduce blood flow, causing chest pain. If a clot forms and completely blocks the blood flow, a heart attack results. Stents help keep coronary arteries open and reduce the chance of heart attack.
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Nearly 6 million people in the U.S. are afflicted with congestive heart failure. Of these, more than 250,000 are advanced cases with an annual mortality rate of 80 percent.
The HeartMate 3 LVAD is an implantable mechanical device that helps circulate blood throughout the body. Sometimes called a “heart pump,” it is designed to supplement the heart’s pumping function for patients whose hearts are too weak to pump blood adequately on their own. “What makes it unique is that the rotor that pumps the blood is magnetically levitated so it has no bearings — there’s nothing to wear out,” Dr. Katz explains. For people who aren’t candidates for a heart transplant, the HeartMate becomes their new heart. “Patients who undergo the LVAD procedure experience a dramatically improved quality of life because an LVAD can pump blood throughout the body as well as a healthy heart can,” says Dr. Katz. “An LVAD restores circulation and improves the efficiency of other organs that had been adversely impacted by diminished blood flow.”
Be Heart Smart While medical technology is certainly improving cardiac care, avoiding cardiovascular disease through diet, exercise and preventive care and by avoiding tobacco use should be every patient’s primary goal. When that isn’t possible because of genetics or the presence of disease or other conditions, a patient’s primary care physician could refer them to a cardiologist as the next step in the diagnosis and treatment sequence, with a subsequent referral to a cardiovascular surgeon, depending on the diagnosis.
Expert Contributors: • Christine Browning, MD is a cardiologist with Bon Secours Cardiovascular Associates of Virginia. • Marc Katz, MD is a cardiac surgeon with Bon Secours Cardiac Surgery Specialists.
Sources: • American Heart Association – www.heart.org
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FIT BITS
H EA LT H A ND F I T NES S O N THE GO
2016 Fitness Trend ‘Watch’
Are you wearing it? words | DEIDRE WILKES
Are you tracking steps, running mileage, calories burned or average heart rate using a wearable device? If so, you are part of the top trend in fitness for 2016. According to the American College of Sports Medicine (ACSM), who recently published its annual fitness trend forecast, for the first time, exercise pros say wearable technology will be the top fitness trend this year. Wearable technology includes fitness trackers, smart watches, heart rate monitors and GPS tracking devices.
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.
With technology taking hold of our daily lives, it has also changed the way we plan and manage workouts. Wearable devices also provide immediate feedback that can make one more aware of their activity level as well as provide motivation to achieve health and fitness goals. Whether tracking steps, run times or calories, wearable devices provide ways to monitor and analyze data either through the device itself or on apps that can be downloaded on a computer, tablet or phone. Some apps even offer interactive communities or blogs where information can be shared between members. To read the complete Worldwide Survey of Fitness Trends for 2016: 10th Anniversary Edition, visit www.acsm.org.
Visit these local Richmond retailers to learn more about wearable technology:
3Sports, Inc.
• 6241 River Road Henrico, VA 23229 804.288.4000 www.threesports.com
Fleet Feet Sports
• 5600 Patterson Avenue Richmond, VA 23226 804.282.6600 www.fleetfeetsports.com
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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
+++ words | JEANNE CHITTY and STEPHEN McCLINTIC, JR.
know
YOUR
care
An apple a day keeps the doctor away. This age-old proverb
march
| april
DO YOUR CARE:
Understanding your health and how to maintain it
certainly carries its share of credibility. It’s spawned several studies by researchers about the health benefits of apples. People around the world live by it by keeping their crispers crammed with the tasty treat. No doubt about it, loyalty to the apple is long lived because this proverb professes how good it is for us.
Know what else is good for us? Going to a primary care doctor. Not keeping him or her away. Yes, doctors can help heal us when we’re sick. But they can also help us stay healthy. Empower us with preparedness. Beat the bugs that can bother us before they have a chance to do so. Primary care doctors promise to be our health’s greatest advocate. Our partner in prevention. Our companion in care. OurHealth Richmond is pleased to introduce a year-long series focusing on the role of primary care. In each edition throughout 2016, we will take a detailed look into the specialty, providing facts that further expand on some of what we may already know and much about what we may not. We will deliver insight from local doctors and providers. We will share personal stories of people living in our communities. We will confirm what is correct. We will dispel what is not.
taking action with your 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
Our commitment to you, our readers in the greater Richmond community, is this: we will help close the gap between your knowledge and desire to learn more about primary care with the hope that you and your loved ones can cross the bridge toward a healthier life.
Angie’s Lesson on
the Importance of Primary Care “I’m not going to a doctor unless I’m sick.” —Angie
This was Angie’s* way of thinking. And why not? From the looks of her, she was more than the picture of good health – she was the poster child. A weekend and WEEKDAY warrior. We’re talking 5 miles at the track every morning before most people tap the snooze button. Daily diet? Dynamite. Body fat? Best it could be. Aches and pains? Free and clear. Sneezes and sniffles? Forget about it. It’s safe to say that Angie was fanatical about staying fit. She felt fantastic. Looked fantastic. Her formula was fool proof. This lady was in control of her life and she knew it.
Fast forward four months. Angie, who asked that her last name not be used to protect her privacy, still looks and feels as fabulous as ever. But her life has a taken a different direction. It all started over the course of a couple of weeks this past October. “All of a sudden, I was just completely and utterly exhausted, so much so that I could hardly keep my eyes open on the drive home from work,” says Angie. “I found myself falling asleep at 7 in the evening and waking up at 5 in the morning, and I would still feel like I hadn’t slept for days.” Angie’s lethargy lingered on for days. Next came nausea, followed by the start of a sore throat. While she hated to admit it, Angie says she felt like it was the flu. “I hadn’t been sick since sixth grade,” Angie shouts. She consulted her best friend, Evan, a nurse, to get some care advice. He told her to do exactly what she already knew. “Well, I always believed you only go to the doctor when you’re sick,” says Angie. “I couldn’t argue with myself, I supposed.” Evan helped Angie get an appointment the next day with the doctor he works for in Short Pump. “Evan had been on me for years to get a check-up,” says Angie. “I think he was a little excited I was sick so that I would finally go!” So at age 28, and for the first time since middle school, Angie walked through the doors of a doctor’s office. Following a thorough physical exam, complete with a battery of blood tests, Angie learned that being pregnant was the culprit of her constant tiredness. “Ecstatic, overjoyed and still tired,” is how Angie says she felt after finding out her good news. “Honestly, after I got to the doctor’s office, it kind of crossed my 28
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mind that I might be pregnant. My husband and I had been trying to start a family. I wasn’t completely surprised, but I was super excited!” She learned something else, however that did completely surprise her. “My lab results came back showing that my cholesterol was through the roof,” she says. “At first, I thought it must have been a mistake. I mean, how could I have high cholesterol? I did everything the right way.” Turns out that some things are out of our control. Even if you’re a super woman like Angie. Additional testing revealed that Angie has a condition called familial hypercholesterolemia, an inherited genetic abnormality that can raise cholesterol levels despite maintaining a carefully managed diet and ample exercise. Left untreated, it can lead to serious heart disease and even death. Familial hypercholesterolemia affects about one in 500 people and is considered the most common type of inherited high cholesterol. It is treated with lifestyle changes and medication. “I spent a lot of time discussing my family’s health history with the doctor, and after finding out some facts from my parents, I learned that heart disease is what killed my grandfather, aunt and cousin,” Angie explains. “I also found out that my dad has been on cholesterol medicine since he was 29 and his sister since she was 22. None of us knew this hereditary condition was in our family until I was tested. It bothers me so much that it’s too late for those we’ve lost.” Angie learning she has familial hypercholesterolemia when she did was incredibly timely. During pregnancy, women’s cholesterol levels can increase by 25–50 percent, and nearly all cholesterol lowering medications are not
WHERE DO YOU PLACE YOUR PERSONAL CARE? Going to the doctor for an annual check-up seems like a stretch for so many people. It really isn’t though. A check-up is the best way to measure health and make adjustments if needed. Surprisingly, most people are more structured about properly maintaining items they own than they are about themselves. This measuring stick shows just a few examples. Shouldn’t your personal health be measured as well?
?
x|year
AUTO OIL CHANGE: Every year, vehicles are taken to a professional for state inspection. They are entrusted to an expert who ensures they are safe for the road. Oil changes every 3000 miles. Another check-up, another preventative step. On average, a car’s oil is changed five times a year to keep it running for the long term.
CAR TIRE ROTATION: Tires need preventative care too. To maximize their life, they get balanced and rotated by professionals every 5000 miles, or an average of three times a year.
5
LAWNS:
x|year
4 x|year
3
The grass is greener and more weed-free than on the other side of the fence because it is entrusted to a lawn service professional to keep it that way through regular treatments. On average, lawns are serviced four times a year to remain picture perfect.
x|year
1
x|year
PETS: Annual shots and checkups for the family dog, cat and other critters are the norm to keep them healthy and active. www.OurHealthRichmond.com
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advised to be taken during this time. For women who have familial hypercholesterolemia, it’s especially important for them to have their cholesterol levels closely monitored throughout pregnancy. Angie’s wake-up call has not only given her a new lease on life. It has also taught her one of the most important lessons in her life. “Knowing what I do now, I am actually a little ashamed that I was being so shortsighted about the importance of having a relationship with a doctor,” Angie shares. “I looked at going to one as a weakness, as a result of me not taking care of myself. It was such an inaccurate way of thinking. I get it now, though, and fortunately, before it was too late. Going to the doctor is a part of a healthy routine. A physical gives you a baseline, an understanding of where you are in your health and where you need to be. It’s the most important information you need to know. I am so happy I learned such a valuable lesson that I can pass on to my child.”
What are the different types of primary care providers? The National Institutes of Health and the U.S. National Library of Medicine have designated these different types of primary care providers: »» Internal Medicine physicians: Boardcertified or board-eligible doctors who have completed a residency in internal medicine. They provide care for adults of all ages with numerous medical conditions. »» Family Practice Physicians: Board-certified or board-eligible doctors who have completed a family practice residency. Their patients include children and adults of various age groups. They may also practice minor surgery and obstetrics. »» Pediatricians: Board-certified or board-eligible doctors who have completed a pediatric residency. Their patients include newborns, infants, children, and adolescents. »» Obstetricians/gynecologists: Board-certified or board-eligible doctors of this specialty may serve as a primary care physician for women. »» Geriatricians: Board-certified doctors who have completed a residency in either internal medicine or family practice. They may serve as primary care physicians for elderly adults with complicated problems related to the aging. »» Nurse practitioners (NPs) and physician assistants (PAs): These skilled health professionals go through different training and certification procedures than physicians do, but they are qualified to manage many of your health issues.
THE PRIMARY CARE PROVIDER CIRCLE OF HEALTH
PRIMARY PREVENTION \'prī- mer-ē\ \pri-'ven(t)-sh n\ [noun]: ' keeping patients healthy by preventing disease.
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SECONDARY PREVENTION \se-k
n-der-ē\ \pri-ven(t)-sh n\ [noun]: identifying diseases early to prevent complications.
THE IMPORTANCE OF HAVING A PRIMARY CARE PROVIDER WHO KNOWS YOU AND YOUR HEALTH Think about having to go to a physician or provider who knows nothing about you when you’re feeling more tired than usual. That physician or provider may not feel it’s anything urgent, but your regular doctor or provider may see that your thyroid medication needs adjusting. Equally, your primary care provider can reassure you in the event that you’re concerned about the freckles on your nose, since they haven’t changed in the past several years. Simply put, a primary care provider watches over you for the long run in numerous healthcare settings, such as in his or her office, under the care of a specialist, critical care, long-term care, home care, etc. Knowing your health history, lifestyle, habits, and personality can help your primary care provider gain a more comprehensive overview of your health. This kind of attentive relationship can make a big impact on the quality of your health by establishing continuity of care. The ability to deliver an accurate diagnosis and an appropriate treatment becomes much easier for a primary care physician when he or she has thorough information about the patient. Having adequate data also eliminates the need for unnecessary tests and procedures. If the patient’s condition should require a consultation with a specialist, the primary care physician will be able to coordinate cost-effective healthcare services for the patient. Primary care providers promote health and prevention, and strive to develop a sustained partnership and personal relationship with us. Each is highly educated in the treatment of common medical conditions and provides applicable medical tests and screenings to develop a baseline of your health. Based on their findings, they can recommend further testing, changes in medication, therapy, healthy diet and lifestyle choices; and safe health behavior. If additional tests and treatments are needed, they are skilled in assessing the importance of your medical conditions and can refer you to consulting specialists. Primary care providers provide long-term management of chronic conditions, which is important for patients whose conditions affect multiple organs, such as diabetes, hypertension, and cancer.
Judith McKenzie, MD is a physician with Bon Secours Memorial Regional Medical Center in Mechanicsville. She is certified in internal medicine by the American Board of Internal Medicine.
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There are numerous studies in medical journals that
What are your needs and wants in a primary care provider?
have supported the notion that having a primary care physician is beneficial to long-term health. A particular research paper in the International Journal of
»» Would you feel more comfortable with a provider of the same or different sex as you?
Health Services indicates that U.S. states with more
»» Someone older or younger?
outcomes, including fewer deaths from cancer, heart
»» Would you like your primary care provider o utilize alternative medicine? »» How easily accessible should your primary care provider’s office be? »» How convenient should his or her office hours be for your schedule? »» Does the doctor fall within your health insurers ‘in-network’ providers?
primary care providers per capita have better health disease, or stroke.
The Primary Care Partnership:
it’s all about trust between you and your provider
As in any partnership, there should be open communication between both people. When you first meet your primary care provider, he or she is going to need to know a lot of information about you, including your past and current health history, your family history, current and past lifestyle habits and medications. It is important to be completely open and honest with the doctor, no matter how private or embarrassing. While certain tests and labs can provide a lot of details, the information in a person’s head is the most important for a doctor to know. Without honest and open dialogue, a treatment plan may not be as effective as possible. Remember, you can trust your doctor or provider with your personal information. It remains completely confidential between the two of you and any consulting specialist who is involved in your care.
By law, your health information cannot be disclosed to anyone else without your signed consent. Along with regular checkups and screening tests, this data will provide a foundation upon which a continuity of care can be established over time.
Finding a Primary Care Provider who is right for you Once you have analyzed your wants and needs in your health partner, you have several ways in which to select a primary care provider. The easiest is to ask your friends and family for their suggestions, as well as other doctors and nearby hospitals. One of the best websites to use in identifying doctors by their location, specialties, and medical training is on the American Medical Association’s website as www.ama-as sn.org. You can also find providers that have been voted on by the community, such as in OurHealth’s Best Bedside Manner Awards edition that comes out every December. Scan the QR code above to view Richmond award winners. 32
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SPECIALTY PRIMARY CARE FOR WOMEN With the hectic lives we lead these days, many women are choosing their OB/GYN providers as their primary care providers. Wendy Bowman, MD, an OB/GYN specialist with Alliance Women’s Health in Richmond, optimizes her patients’ appointments by arranging annual screening mammograms for 40-year-old patients at the time of their annual exams. “When patients turn 50, we discuss and schedule a screening colonoscopy,” she says. Several people also like the convenience of having her conduct lipid testing and diabetes screening as part of their annual exam right in the office, as well as other tests for genetic types of breast, colon, ovarian, and other GI cancers. As in any partnership, you have to be willing to make it work with full disclosure. “The patient should be prepared to be completely open and honest about any health concerns or health needs, so that the provider can better customize the dialog and the focus of the annual exam to meet the patient’s individual needs. Open dialog between the patient and provider allows more Wendy Bowman, MD is an OB/GYN time to be spent on with Alliance Women’s Health in strategic planning Richmond. Dr. Bowman is certified by the American Board of Obstetrics for the patient’s and Gynecology. healthcare needs of the future,” concludes Dr. Bowman.
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What should you expect during a typical first time visit to a primary care provider? Years ago, it was considered customary to have a yearly physical and to undergo a series of standardized tests. But now the current trend of thought is that because each person is unique and has different health requirements, it is not cost-effective, affordable, or sensible to have every patient see a physician or provider at the same time each year and take the same tests on the same schedule. Your physician or provider will now tailor your checkup and subsequent tests and/or treatments based exclusively on the factors that define your own life. Each physician or provider has his or her own strategy for getting to know you by using guidelines to define your parameters. Judith McKenzie, MD, an internal medicine physician with Bon Secours Memorial Regional Medical Center in Mechanicsville says, “I try to convey respect and “A new patient visit is extremely important. It is a longer, compassion to my patients. more in-depth visit during which the healthcare team and patient get to know each other. This is the beginning of This is what they deserve.” our relationship and therefore, it is critical for establishing – Lynn Woodcock, NP, Family Practice our goals.” Dr. McKenzie continues, “Initially, a nurse will gather information on past history, medications, and Specialists of Richmond. current concerns, then the physician or provider will review pertinent history and go over current conditions in depth.” The examination will vary from patient to patient depending on his or her needs. “After a thorough review of the medications with the patient, the examination is tailored to the specific issues to be addressed,” says Dr. McKenzie. “In-office testing, like laboratory studies, may be performed if required. At the end of the new patient visit, all information is summarized for the patient, and plans are made for our next visit.” When establishing a baseline for new patients, Lynn Woodcock, NP, a nurse practitioner with Family Practice Specialists of Richmond, takes into account a patient’s current symptoms or concerns, previous medical history, family history and social history. Lynn Woodcock, FNP is a nurse practitioner with Family Practice Specialists of Richmond in Midlothian.
“These factors influence what tests will be performed,” Woodcock explains. “For example, if a patient has never had elevated blood sugar, but has a family history of diabetes, I will order more specific screening tests.” Woodcock also advises patients of specialty services and procedures that are offered inhouse such as colonoscopy and endoscopy, bone density testing, and cosmetic procedures. Depending on the practice, more and more services are being offered under one roof. “We draw labs in house, perform dermatologic procedures, X-rays, and minor surgeries. While we do provide generalized care for patients, each of us also has a specialty that we are passionate about. This way, we can provide better and multi-focused care,” says Woodcock. In order to gain a better understanding of your lifestyle, your primary care provider will also ask you about your use of drugs, alcohol, tobacco, sexual preferences, exercise, diet, and sleep.
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What can you do to best prepare in advance of your first visit to a primary care provider?
What are some screenings that may be performed during a check-up to establish a patient’s baseline of care? »» Blood pressure screening »» Cholesterol screening (for adults of certain ages or higher risk) »» Colorectal cancer screening (adults over age 50) »» Depression screening »» Diabetes (Type 2) screening (for adults with high blood pressure)
Your primary care provider will need the following information to best develop your care plan. Going to your doctor with this information already in hand is a good way to be ahead of the curve. »» A list of all prescribed and over-the counter (OTC) medications and supplements you are currently taking. Bring the bottles of medications and supplements with you so the doctor can note all information needed, such as number of milligrams of the medication and OTC supplements, how often it is taken, etc. »» A list of your family’s health history – parents, grandparents and other immediate family members – who have or had conditions such as heart disease, cancer, arthritis, depression, etc. This may require you to do some research. Asking your family members is the best way to get started gathering this information. »» A list of all known medical conditions, as well as procedures you have had, such as surgeries, and hospitalizations.
»» Lung cancer screening (for adults 55-80 at high risk for lung cancer) »» Obesity screening
Additional screening, testing or labs may include: »» Complete blood count (may identify conditions such as anemia, infection, and other disorders) »» Comprehensive metabolic profile (a broad screening test used to check for conditions such as diabetes, and liver or kidney disease and provide an overall picture of your body’s metabolism and chemical balance) »» Thyroid studies
Build your bridge to better health with
OurHealth’s Primary Care Series The bridge to better health starts with Knowing Your Care and the options available to you. The information and resources available in this article hopefully help you start your journey. Throughout this series, we will provide additional information on each series’ section on our website, ourhealthrichmond.com. If you have additional questions that you would like to see highlighted in our series, please reach out to us anytime by email at steve@ourhealthvirginia.com. We are proud to be a resource in your plan for better health.
Expert Contributors: • Wendy Bowman, MD, an OB/GYN specialist with Alliance Women’s Health in Richmond. • Judith McKenzie, MD, an internal medicine specialist with Bon Secours Memorial Regional Medical Center in Mechanicsville. • Lynn Woodcock, FNP, a nurse practitioner with Family Practice Specialists of Richmond in Midlothian.
Sources: • National Institutes of Health – www.nih.gov * Name changed to protect the privacy of the patient.
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new procedure
gives HOPE to WOMEN with
words | LAURA L. NEFF-HENDERSON
LOW estrogen
Retired nurse finds relief after suffering for four years
The news was devastating. Just months after retiring from a successful 41-year career in nursing, Richmond resident Patricia Smith* was diagnosed with breast cancer. Her doctor caught it early though, and Smith was otherwise healthy. After a double mastectomy in November 2011, the cancer was gone. Things were going well on most fronts, but Smith had one issue that many women her age deal with: vaginal dryness, itching, burning and painful intercourse caused by hormonal changes.
Vaginal atrophy Vaginal atrophy, also known as “atrophic vaginitis,� is an uncomfortable condition that many women suffer from in silence. It is often caused by hormone changes associated with menopause, but it also occurs in women who experience decreased estrogen production due to cancer or breastfeeding. It is characterized by thinning and shrinking of the vaginal tissues as well as decreased lubrication.
A woman can experience one or several of the symptoms of atrophic vaginitis to varying degrees: vaginal dryness; pain during sex (“dyspareunia”); changes in the appearance of the labia and vagina (it looks paler and thinner); irritation when wearing certain clothes, such as tight jeans, or when doing certain activities; an increase in urinary tract infections; blood in the urine; increased frequency of urination and incontinence.
“I was uncomfortable on a daily basis,” says Smith. For her, painful urination was one of the worst symptoms. In addition to blood in her urine, the burning sensation was almost unbearable, and she worried constantly about developing urinary tract infections. Even walking can be painful for some women who find the dryness leads to a painful chaffing, says Kristin Schraa, MD, a gynecologist who works in the Mechanicsville and Tappahannock offices of the Virginia Women’s Center. An estimated 10 to 40 percent of postmenopausal women have symptoms of atrophic vaginitis, but despite the prevalence of symptoms, only 20 to 25 percent of symptomatic women seek medical attention, according to the American Family Physician medical journal. Medical News Today reports that, “a large number of postmenopausal women suffer from at least some degree of vaginal atrophy; however, many women do not actively ask that medical attention be paid to this, possibly because it is naturally caused or because of the taboo that still exists surrounding aging and sexuality.” For most women, hormone replacement therapy is the most logical choice of treatment, and it has proven to be effective. The therapy comes in the form of creams applied externally to the vagina, oral medications and hormonereleasing rings — none of which are viable options for women who have had cancer. Hormone replacement therapy has been linked to cardiovascular problems (blood clots and pulmonary embolisms, for example) and breast cancer. After going through menopause but before her breast cancer diagnosis, Smith had been on an estrogen cream to help prevent urinary tract infections and dryness. “I had to discontinue use of the estrogen vaginal cream because my breast tumor was estrogen related/ sensitive,” says Smith. “I kept asking my doctor because I just couldn’t believe there was nothing else that would work for me. I didn’t feel like there was much hope,” says Smith.
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Smith suffered for four years before learning about a minimally invasive yet incredibly effective new procedure approved by the FDA in December 2014 and now available in the Richmond area.
MonaLisa Touch
healthy skin in the most natural way possible, but instead of on the face, it’s in the vagina.” Dr. Schraa and her colleague at Virginia Women’s Center, Peter Wilbanks, MD, have performed the procedure hundreds of times. Dr. Wilbanks is Smith’s doctor.
MonaLisa Touch is an Italian-built laser device that has been available to women in Australia and Europe for several years. The medical laser delivers controlled energy to the vaginal tissue, which causes cells to produce more collagen.
“We are pleased to be able to offer this service to the women of Central Virginia,” says Dr. Wilbanks. “This procedure is one of the most revolutionary changes in gynecology that I’ve seen during my career. It’s groundbreaking.”
The procedure is said to be painless, and no anesthesia or painkillers are required. It is normally performed in a doctor’s office by an OB-GYN. It consists of three three-minute treatments, performed six weeks apart, and physicians expect most patients to need an annual booster treatment.
How does it work?
The procedure, says Dr. Schraa, is similar to the procedure plastic surgeons use to stimulate collagen in the face. “We’re actually creating
A swab is inserted into the vagina to dry out the inside as much as possible prior to insertion of the laser. This is the uncomfortable part of the procedure. The laser probe is then inserted into the vagina. Patients should expect to feel a low-grade vibration inside the vaginal canal that is virtually painless. This process lasts about five minutes.
Kristin Schraa, MD is a gynecologist with Virginia Women’s Center, practicing in the Mechanicsville and Tappahannock locations. She is certified by the American Board of Obstetrics & Gynecology.
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The laser works by optically splitting a laser beam into a series of very small dots that are aimed at the inside wall of the vagina. The laser pulses for less than a 10th of second, and a computer moderates the intensity of the laser to match the characteristics of the vaginal wall. At the point of contact, the laser dot removes a tiny area of tissue. This creates a pinhole about the diameter of a human
hair. As the body repairs itself, it naturally stimulates cells to create new healthy tissue at the site of the dot and the flesh immediately surrounding it. The laser also heats the area between the dots, stimulating the activity of specialized cells that create elastin and collagen, which are said to be the building blocks of healthy tissue. “The nice thing is that it enlists the body’s own natural processes to correct the problem. We’re not adding chemicals, hormones or medications. We’re making the body respond to a stimulus and heal itself. It’s fascinating,” says Dr. Schraa. “We’re actually creating healthier skin in the most natural way possible.” Drs. Scrhaa and Wilbanks have found that their patients can return to their normal daily activities immediately following treatment, although they are advised to refrain from strenuous exercise, hot baths and sex for five days after treatment to allow the vaginal canal surface to heal properly. Their patients have been pleased with the results. The improved blood flow and tissue tone reduces pain, improves sexual and urinary function and can increase sexual gratification. That has been the case for Smith, who admits that, at age 71, she is finally able to enjoy sex with her husband of 51 years without pain. She completed her third treatment in December. “The ability to have an enjoyable intimate relationship is especially important for women who are suffering with these symptoms and sometimes have low self-esteem and depression as a result,” says Dr. Wilbanks.
Benefits Aside from any unusual medical conditions, most women with vaginal atrophy are candidates for the treatment. Patients have reported improved sexual relations and better orgasms as a result of improved vaginal tightness and increased lubrication.
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What is menopause? Menopause marks the time in a woman’s life when menstruation stops and she is no longer able to become pregnant. It’s a normal part of life, like puberty. In the United States, the average age for menopause (the time of the woman’s last period) is 51 according to the National Institute of Aging. Symptoms can begin years earlier and last for months, or even years, afterward. Perimenopause is the three- to five-year time period before menopause when a woman’s estrogen levels begin to drop. Specific benefits of the treatment can include increased tissue quality and elasticity, increased blood flow to the vagina, tightening of the vaginal canal and the rejuvenation of aged, damaged and irritated tissue. The treatment can also help reduce recurrent infections for many women. “There are few things in medicine that have a 90 percent success rate with no serious side effects,” says Dr. Wilbanks, who admits that he’s heard his patients describe the procedure as life-changing and miraculous. “This is a huge win for women’s health.”
Cost The procedure is not yet covered by insurance, so the cost can be a barrier for some women. At Virginia Women’s Center, the cost for the treatment is $2,400, which includes the first three treatments and the annual booster treatment. “The preliminary research out of the U.S. and Europe are that 70 to 85 percent of patients have good results,” says Dr. Schraa. “I’m finding with my patients that everybody has had improvement in their symptoms — some more dramatic than others.
“I have not had a patient yet who hasn’t responded to the treatment at all. Most are delighted with the improvement in their symptoms.” Smith says it was absolutely worth every penny, and she encourages women who are living with the symptoms of vaginal atrophy to find a way to have treatment with the MonaLisa Touch device. For her, the results have been life-changing. She will have her fourth procedure in a year and then once a year moving forward. “I feel normal again,” says Smith. “The quality of my daily living has improved.
Sources: • American Family Physician – www.aafp.org • Medical News Today – www.medicalnewstoday.com
Expert Contributors: • Kristin Schraa, MD, a gynecologist with Virginia Women’s Center
Peter Wilbanks, MD is a gynecologist with Virginia Women’s Center in Richmond. He is certified by the American Board of Obstetrics & Gynecology.
• Peter Wilbanks, MD, a gynecologist with Virginia Women’s Center * Name changed to protect the privacy of the patient.
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2015 Jingle Bell Run/Walk for Arthritis The Arthritis Foundation’s annual Jingle Bell Run is a festive race that helps champion arthritis research and brings people from all walks of life together. This years’ event took place on a bright Saturday morning in early December, and was a great way to kick off the holiday season! Always a great family event, human and canine participants dressed in ugly Christmas sweaters, while some dressed as Santa or in other festive costumes and tied jingle bells to their shoes! Check out the fun photos – you might even spot yourself or someone you know!
Photos courtesy of Nicki Metcalf
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In 2016,
our New Kitchen,
New Nutrition, New You series puts the focus on helping you get healthier in the kitchen — one ingredient at a time. Each edition of OurHealth will highlight small changes you can make in your food
2016 Nutrition Series
prep and shopping habits that can add up to a major positive impact on your nutrition and health. Our goal is to present you with suggestions you can use and build on that will help you create a healthier kitchen — and life — by year’s end.
NEW KITCHEN, NEW
words | CYNTHIA BEMENT
NUTRITION, Winter invites us to burrow under blankets, linger by the fire and enjoy warm, wonderful comfort food at every opportunity. Casseroles and soups spring to mind — the bigger the flavor, the better. However, these homey dishes can call for ingredients that — while meant to boost flavor and save prep time — might not be the best choices for your health. You can have it all, though, with dishes like the tasty One-Pan Taco Casserole, made healthier with a few tweaks. Read on to see how we’ve removed the nutritional pitfalls in this recipe and substituted healthier ingredients, and learn why making these changes (in this recipe and others) will create instant improvements in your wintertime nutrition.
NEW
YOU
A recipe for success: Scrutinize ingredients Whenever you try out a new (or reinstate an old) casserole recipe, assessing its key ingredients can reveal the true measure of the dish’s impact on your health. One of those ingredients is sodium. “A lot of casserole recipes are very high in sodium because they call for canned goods,” says Tricia Foley, a registered dietitian and board member of the Southwest Virginia Academy of Nutrition and Dietetics. “For example, a cup of tomato sauce has 1,284 milligrams of sodium, and Americans only need about 1,500 milligrams a day according to the American Heart Association, so that’s almost the full amount in that one cup.” To lower sodium content, opt for fresh or frozen alternatives to canned ingredients whenever possible, such as dicing your own fresh tomatoes or using frozen instead of canned green beans. Another sodium trap can be premade spice packets, such as taco seasoning, used here in our pretweaked, original recipe. Instead, Foley suggests investing in individual spices as alternative seasonings in your recipes. “People can decrease their sodium and still have lots of flavor by using herbs and spices. And unlike baking, cooking isn’t a scientific thing. You can play around, and it probably won’t be a disaster.” Next on the offender list is saturated fat. Meats — ground beef in our recipe — and cheeses can be big culprits, so study nutritional labels for these ingredients to make sure they’re not taking your dish into the danger zone. For ground beef, Foley suggests going as lean as possible. “Even 85-percent lean is very fatty. You want to limit your saturated fat to about 5 to 6 percent of your daily caloric intake. Buying 95-percent-lean ground beef and draining it after browning helps to reduce saturated fat.”
Tricia Foley is a registered dietitian and a certified LEAP (Lifestyle Eating and Performance) therapist with The Weigh Station in Richmond.
Cheese is often over-loaded in casserole recipes, according to Foley. She suggests cutting back on the amount of cheese called for and using 2-percent fat instead of full-fat cheese, which will cut saturated fat and allow other flavors to shine through. Sour cream is another common high-fat ingredient. Swapping it for plain or Greek yogurt lowers saturated fat while adding protein, she says. The third big nutritional downfall of many casserole recipes, which may be surprising, is sugar. One frequently used ingredient category to analyze is premade tomato-based products like ketchup and tomato sauce. “Look for tomato sauce with less than 3 grams of added sugar per serving,” Foley suggests, and buy reduced-sugar versions when possible. Also look at the ingredient list on the product to make sure it does not contain high fructose corn syrup. Premixed seasoning packets can also contain high amounts of sugar. One last healthy swap that’s beneficial to any recipe, especially casseroles, is bringing in a higher-fiber alternative to pasta. In the updated One-Pan Taco Casserole, we’ve replaced white rotini pasta with black beans, which, according to Foley, will add more fiber as well as vitamin B, magnesium and folate. Substituting whole-wheat pasta for white pasta is also a good move if it’s accompanied by an overall reduction in the amount of pasta called for (example, reduce 1 cup of regular, white pasta to 1/3 cup whole-wheat pasta).
Get label-literate Even with all the information currently available on food packaging, making sense of it is still an issue for most of us. In order to successfully
WATCH FOR IT: In our next issue, celebrate spring with healthier salads (yes, there are unhealthy versions!) in part 2 of New Kitchen, New Nutrition, New You.
make healthy changes in your cooking and food shopping habits, being able to understand food labels will serve you well, says Foley. “Take the time to check the ingredients list, not just the nutrition label,” she says. Ingredients are listed by weight, most to least, so pay close attention to the first five ingredients, while also looking for those ending with “-ose,” which are what Foley calls “sugar words,” such as sucrose, fructose and dextrose. On the label portion, it can be tough to conceptualize the amount of each nutritional component listed. Foley’s trick: think visually. “Everything is in grams, and our brains don’t think in grams,” she says, citing sugar as an example. “Four grams of sugar is equal to 1 teaspoon of sugar. That’s an easy way to convert it in your mind and give yourself a visual.”
Healthy swap ingredient shopping list:
Taking time to analyze each recipe in your current casserole repertoire as well as any new recipe you consider trying takes practice and attention to detail. “It’s multifactorial,” says Foley, “you have to look at the whole recipe and each ingredient in it.”
11/2 pounds 95%-lean (or leaner) ground beef
Start incorporating these healthy swaps into your comfort mainstays now, and by next winter, you’ll be making the healthiest, most delicious casseroles at any potluck — not to mention at your own table.
Cumin
Expert Contributor: • Tricia Foley, RD, with The Weigh Station in Richmond, www.weighstation.net.
Garlic powder (granulated garlic)
Chili powder
Paprika
1 bag shredded 2% colby jack cheese 151/2 ounces reduced-sodium, diced canned tomatoes 151/2 ounces reduced-sodium canned black beans 1 carton plain Greek yogurt 8 ounces reduced-sodium or no-salt-added canned tomato sauce
One-Pan Taco Casserole Unhealthy Recipe — One-Pan Taco Casserole (SERVINGS: 6) 2 tablespoons canola oil
swap for this
1/2 large white onion, diced
Healthy Swap — One-Pan Taco Casserole (SERVINGS: 6) 2 tablespoons olive oil 1/2 large white onion, diced
11/2 pounds ground beef
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11/2 pounds lean ground beef or turkey
15 ounces canned diced tomatoes
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15 ounces reduced-sodium, diced canned tomatoes
8 ounces canned tomato sauce
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8 ounces reduced-sodium canned tomato sauce
2 cups low-sodium chicken broth
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2 tablespoons low-sodium chicken broth
8 ounces uncooked rotini pasta
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151/2 ounces reduced-sodium canned black beans, rinsed and drained
1 package taco seasoning
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2 teaspoons chili powder 2 teaspoons cumin 1 teaspoon garlic powder 1
teaspoon paprika
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salt and ground black pepper to taste
2 heaping tablespoons sour cream
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2 heaping tablespoons plain Greek yogurt
2 cups shredded colby jack cheese, divided
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1½ cups shredded 2% colby jack cheese, divided
11/2 teaspoons salt
ground black pepper to taste
avocado, chopped
avocado, chopped
green onions, diced
green onions, diced
black olives, sliced
diced tomatoes
hot sauce
hot sauce
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Directions:
Directions:
1. In a frying pan over medium heat, heat oil.
1. In a frying pan over medium heat, heat oil.
2. Add onions and saute just until softened.
2. Add onions and saute just until softened.
3. Add ground beef and brown, breaking up meat as it cooks. Add taco seasoning (follow directions on back of package).
3. Add ground beef or turkey and brown, breaking up meat as it cooks.
4. Once beef is cooked, add undrained tomatoes, tomato sauce, chicken broth, dried pasta and an additional 1/2 teaspoon salt.
4. Once meat is cooked, add undrained tomatoes, tomato sauce, chicken broth, black beans, chili powder, cumin, garlic powder, paprika and salt and black pepper to taste.
5. Bring to a simmer, cover and reduce heat to low. Cook 12-15 minutes, or until pasta is tender.
5. Bring to a simmer, cover and reduce heat to low. Cook an additional 1-2 minutes.
6. Remove from heat and stir in 2 heaping tablespoons sour cream and 1 cup shredded cheese.
6. Remove contents from heat.
7. Top with remaining 1 cup cheese and cover to allow cheese to melt. 8. Top with black olives, avocado and green onions.
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7. Stir in Greek yogurt and 1 cup of cheese. 8. Top with tomatoes, avocado and green onions. 9. Sprinkle remaining cheese on top if desired.
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