our health | BASIC
table of contents |june • july 2013
20
COVER STORY MEDI•CABU•LARY.....................10 Local experts define healthcare related terms
JUST ASK!..................................12
Governor Bob McDonnell and First Lady Maureen McDonnell discuss men’s health, her cancer scare and teaching their children the importance of living a balanced life
A variety of health questions answered by local professionals
THE LATEST...............................13 A listing of new physicians, providers, locations and upcoming events in the greater Richmond community
HEALTH AND FITNESS ON THE GO..................................17 Health-focused apps you can download to your smartphone or tablet
HEALTHY AT 40..........................18 Turning 40 can be confusing, frustrating and an emotional burden. Our Health shares local experts’ opinions on why it doesn’t have to be
HOSPITAL CHANGES.................27 In sickness and in health: the changing role of hospitals
NUTRITION.................................34 Healthy Eats: seasonal recipes
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38 SKIN
Beware of the sun this summer! KIDS CARE..................................43 Louis “L.J.” Petra, the athletic trainer for the Richmond Flying Squirrels minor league baseball team, not only trains on how to live a healthy lifestyle, he serves as an example as well
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GIVING Turn what you are good at doing into doing good for others: THE STORY OF GIVING TO EXTREMES
SENIOR LIVING...........................53 Bremo Pharmacy’s medication therapy management and the art of being a pharmacist
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OUR HEALTH RICHMOND MAGAZINE
june • july 2013
OUR HEALTH’S EXCLUSIVE MEDIA PARTNER PUBLISHER PRESIDENT/EDITOR-IN-CHIEF ASSOCIATE EDITOR VICE PRESIDENT OF PRODUCTION CLIENT LIAISON CHIEF DESIGNER ORIGINAL PHOTOGRAPHY WEBMASTERS
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CONTRIBUTING RICHMOND PROFESSIONAL EXPERTS Tricia Foley, MS, RD
ON YOUR TABLET
Joe Grooten, MS Prakasam Kalluri, MD Juan Orellana, MD Gerald Neidigh, Jr., OD S. Tyler Perkinson, DDS Christine Rausch, MD Mark Reinke, BS, MAT H. Wayne Sale CONTRIBUTING PROFESSIONAL WRITERS Sarah Cox Susan Dubuque Anika Imajo Edwin Schwartz ADVERTISING AND MARKETING Richard Berkowitz Senior Vice President, Business Development P: 804.539.4320 F: 540.387.6483 rick@ourhealthvirginia.com
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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor: 305 Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.355.3071 Information in all print editions of Our Health and on all Our Health’s websites (www.ourhealthrichmond.com and www.ourhealthvirginia.com) social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2013 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The Our Health Southwest Virginia edition is published bi-monthly by McClintic Media, Inc. 305 Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthrichmond.com | www.ourhealthvirginia.com | Advertising rates upon request.
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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 MOHS surgery?
What is Stargardt disease?
Mohs micrographic surgery is a safe and highly effective technique whereby skin cancers are removed under complete microscopic control, providing the highest cure rate for removal of skin cancers.
Stargardt disease is a rare genetic eye disorder that causes progressive vision loss. This disorder affects the macula, an area of the retina responsible for sharp central vision — needed for tasks like reading, driving and watching television. It typically develops during childhood or adolescence and is inherited when both parents have one gene for the disease paired with one normal gene. The parents are unaffected because they have only one copy of the gene.
In Mohs surgery, a minimal area of skin is removed around the visible cancer. Detailed maps are then drawn of the area, and 100% of the tissue margin is examined under the microscope to ensure all of the cancer and its roots are gone. If any cancer remains, that exact area of involvement is sampled, and the entire process is repeated until the cancer is totally eradicated. This procedure allows physicians trained in Mohs surgery, to see beyond the visible disease, and to precisely identify and remove the entire tumor. It also spares normal skin, leaving healthy tissue intact and unharmed. Mohs surgeons are unique in that they have extra training allowing them to not only be the skin cancer and reconstructive surgeon, but also the pathologist. Christine S. Rausch, MD Skin Surgery Center of Virginia Henrico | 804.282.4940
An ophthalmologist looking at the retina of a person with Stargardt disease will see yellowish flecks in the macula or a more diffused pigment cell irregularity that glistens. The progression of symptoms in Stargardt disease is variable and the loss of vision can be as pronounced as 20/200. Currently, there are no treatments for Stargardt disease and the vision loss is not correctable with prescription eyeglasses, contact lenses or surgery. Juan J. Orellana, MD VCU Medical Center Department of Ophthalmology Richmond | 800.762.6161
What is the Activities in Motion program?
What is degenerative disk disease?
The Activities In Motion program at LifeWorks Health and Rehab centers is a company exclusive activities program designed to motivate both the mind and the body through dynamic groups. Integrated with LifeWorks Rehab, Activities In Motion maximizes the patient’s potential to attain the best possible quality of life outcomes. Each series of therapeutic activities in the program complements the patient’s clinical rehabilitation goals, cultivates good physical health and mental well-being, and continues life-long interests and routines. The Exercise Series promotes physical health and focuses on energy and movement for strength, endurance, balance, coordination, and flexibility. The Recreation Series focuses on fostering independence, social-interaction, and community living and emphasizes lifelong enrichment, increased activity levels, and personal satisfaction. The Imagination Series focuses on mental exercise and inspires creativity, individuality, and resourcefulness. This distinctive combination of exercise, recreation, and imagination is part of a complete provision for patient wellness.
Although the name implies a disease process, degenerative disc disease is the term used to describe the age related and wear and tear changes that occur in the parts separating the spinal bones. The normal spine has soft cushions called discs that sit between the spinal bones and act as shock absorbers during daily activities. In many of us, these discs wear out from even normal use. Smoking, obesity and heavy labor have been implicated in more rapid degeneration of discs. Of course, trauma can also lead to disc herniation which can then progress to degeneration of that disc. Sometimes, disc degeneration can become painful, lead to disc herniations that cause nerve pain or even spinal stenosis, a condition where the spinal canal, which contains the nerves, becomes narrowed. Disc degeneration affects the neck and low back more frequently than the middle spine (thoracic spine). Painful disc degeneration is treated with many modalities including physical therapy, medications, chiropractic treatment, injections and rarely even surgery.
Joe Grooten, MS Medical Facilities of America Roanoke | 540.776.7568 10 | www.ourhealthrichmond.com
Prakasam Kalluri, MD Colonial Orthopaedics Chester and Colonial Heights 804.526.5888
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
Do I need a referral from my doctor to use the services of a home medical supply company? In most instances, the answer is “Yes”. “Therapeutic“ medical equipment is regulated by the Virginia Board of Pharmacy, and as such, requires a prescription to be “dispensed”. Home oxygen, nebulizers, diabetic monitors and other “therapy equipment” come under this law. But, regular wheelchairs, walkers, beds and bedside commodes can be purchased or rented without a doctor’s prescription. These can be considerd like furniture. However, if you expect your insurance company to pay for any of this equipment, it will always require a doctor’s authorization. Reason: insurance companies want to know there is a legitimate medical purpose for the expense. H. Wayne Sale Health First Richmond | 800.247.7636
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Do Sunglasses really protect our eyes?
What are symptoms of gum disease?
Absolutely yes! Sunglasses really do protect our eyes. Think of sunglasses as sunscreen for your eyes. We all know how harmful the sun’s ultraviolet rays are to our skin, and that it prematurely ages our skin. It is also a leading contributor to skin cancer. The UV rays affect the eyes in much the same way. They prematurely age the eye and can contribute to cataract formation at a younger age. Also, overexposure to UV rays can lead to macular degeneration. Wearing sunglasses is very important to protect your eyes and help you maintain healthy eyes and good vision.
Gum disease, or periodontitis, is dangerous because many people have it and are not even aware of it.
Gerald R. Neidigh, Jr. OD Grove Avenue Eye Center Richmond | 804.353.EYES (3937)
As it begins, tartar builds up underneath the gums, creating inflammation and infection. Over time, this deteriorates the bone that provides the foundation for the teeth. While brushing and flossing are good ways to prevent gum disease, once bone loss starts, pockets form under the gums that can only be cleaned by a professional hygienist. Gum disease can only be diagnosed by a dentist, but there are some warning signs that you can look out for. Gum disease often causes bad breath. Affected gums appear red and puffy. As the disease worsens, gums recede around the teeth and eventually become loose. In severe cases, painful abscesses can form.
I suffer from arthritis. Is there an exercise program that I can benefit from? Plenty of recent research suggests that both cardio and strength exercise are outstanding ways to improve symptoms of osteo and rheumatoid arthritis. Aerobic exercise can help manage body weight and improve range of motion and flexibility for those who suffer from arthritis. Great choices are low impact aerobics, water based exercise (like Arthritis H2O, a water class certified by the Arthritis Foundation), gentle yoga and Tai Chi.
See your dentist regularly to maintain a healthy mouth and catch gum disease before it becomes a problem.
Strength training too has been shown to improve function and reduce pain in those with hip and knee osteoarthritis. Pay particular attention to improving strength and mobility in the muscles around the hip and knee, namely the quadriceps, hamstrings, adductors and gluteals. Straight leg raises, leg curls and squats are most effective for improving strength and range of motion in these muscle groups. It is of particular importance to work with a qualified healthcare or exercise professional to develop a program that is built around individual limitations, and to establish appropriate techniques for those exercises.
S. Tyler Perkinson, DDS Dr. Baxter Perkinson & Associates Ashland | 804.550.3324
Mark A. Reinke, BS, MAT ACAC Fitness & Wellness Center Richmond | 804.378.1600
Some people are more susceptible to gum disease than others. If your parents or grandparents lost their teeth early, you may be at higher risk. Other risk factors include smoking and having uncontrolled diabetes.
the l atest
Christina P. Blottner, DNP, FNP Bon Secours Laburnum Medical Center Richmond | 804.226.2444
Donna Snyder, FNP Bon Secours Blackstone Family Practice Center Blackstone | 434.292.7261
Ruth C.A. Latham, MD Bon Secours Memorial Medical Center Mechanicsville 804.764.1253
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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
Bon Secours Names Guest House in Honor of Evelyn D. Reinhart Supporters contribute more than $3 million to build the Bon Secours Reinhart Guest House Leaders of Bon Secours Virginia Health System, St. Mary’s Hospital and community supporters gathered to celebrate construction and recognize key contributors to the Bon Secours Reinhart Guest House. The 14,000-square-foot residence, offering overnight accommodations to visiting families, is located on the St. Mary’s campus. The name of the guest house was unveiled at the groundbreaking ceremony. Situated along Libbie Avenue on property owned by Bon Secours, the Bon Secours Reinhart Guest House is named in honor of Evelyn D. Reinhart, a former St. Mary’s nurse and volunteer who succumbed to cancer in 1986, and whose family has contributed $1 million to the fundraising effort.
in nearby neighborhoods and offers landscaped gardens and grounds, also for reflection. “Bon Secours and St. Mary’s have long demonstrated a commitment to providing excellence in care and services,” said Peter J. Bernard, CEO, Bon Secours Virginia Health System. “Greater numbers of patients are traveling longer distances to receive surgery or cancer treatments, and having family nearby is essential to their healing. Through the Bon Secours Reinhart Guest House, we are helping to restore not only patients, but entire families, to wholeness.”
Evelyn D. Reinhart, former St. Mary’s nurse and volunteer
Designed by Odell Associates, the Bon Secours Reinhart Guest House is the first major building project on this section of Libbie Avenue in more than 45 years. Completion is projected for May 2014. “Today marks an exciting milestone in St. Mary’s campus development,” said Toni Ardabell, CEO, Bon Secours St. Mary’s Hospital. “Building a campus guest house has been an important component of our campus master plan, which was set in motion after our community charrette planning process was held in 2009. We are very grateful to this community, and especially the Reinhart family, for their commitment in helping to provide families with a home-like place on our campus, enabling them to stay close to their loved ones.” A place for families to eat, relax, work and pray, the Bon Secours Reinhart Guest House will offer 16 guest rooms with private baths, common areas, a reflection room, two kitchens, large gathering rooms, a playroom and a sun porch. Its two-story, brick Colonial design complements the homes
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A $3 million fundraising campaign, initiated in 2011 by the Bon Secours Richmond Health Care Foundation, resulted in support from physicians, volunteers, patients and families who were committed to creating a home-like, comforting environment for visiting families. In addition to the Reinhart family, other key supporters include the Ronald McDonald House Charities of Richmond, whose gift of $175,000 will establish a pediatrics wing at the guest house, creating three sleeping rooms and a playroom dedicated to families of pediatric patients. Other support came from the St. Mary’s Volunteer Auxiliary, as well as from the physician community. Fundraising chairs of the Bon Secours St. Mary’s Guest House Fundraising Committee are Carmella Bladergroen and Nancy Plageman. “I am pleased that so many supporters, including individual donors, members of the physician community and organizations like the Ronald McDonald House, contributed to this special house,” said Nancy Plageman, co-chair of the Guest House Fundraising Committee. “It is the Reinhart family’s sincere wish that Evelyn Reinhart’s memory is honored by providing out-of-town families with a comfortable home away from home, where they may gather and rest, share their worries, prayers, frustrations and hopes with one another, and easily attend to their hospitalized loved ones. Their wish is now a reality.”
HEALTH AND FITNESS ON THE GO | our health
Health and Fitness
On the Go
Heading out the door and wondering if you should grab sunscreen, tissues, or both? In our new Health and Fitness on the Go section, we recommend a variety of health-focused apps you can download to your smartphone or tablet.
Allergy Alert (from Pollen.com)
Plan your day, or even week, with this easy to follow allergy app. Allergy Alert provides index levels for four different conditions: allergy (pollen), asthma, cold and cough, and UV Sensitivity. You can also get an idea of which pollens may affect you the most. You’ll always know when to grab the tissues and sunscreen!
Android
This app features loads of training tools to help you stay on track: »» Today’s allergy forecast »» 4-day extended forecast »» Which pollens are predominant right now »» Allergy and UV index levels
iPhone
»» Free for iPhone and Android
LoveMySkin
SHARE YOUR FAVORITE HEALTH AND FITNESS APP!
LoveMySkin app helps you map your moles for skin cancer prevention! This app makes is easy to track suspicious moles or lesions. Just tag a mole on the figure and edit details to monitor growth and change. Use the ABCD guide (Asymmetry, Border, Color, and Diameter) pictures to shoe the differences between benign and malignant moles. The best part, this app gives you the tools to perform self-skin exams and be more aware of changes to your skin that could indicate the early warning signs of skin cancer. »» $0.99 for iPhone »» Not yet available on Android
iPhone
Share your favorite health and fitness app! Scan this QR code with your smartphone or tablet to visit and “Like” Our Health’s Facebook page, then post a “Comment” with your favorite health and fitness APP! www.ourhealthrichmond.com | 17
our health | HEALTHY AT 40
turning can be confusing words | ANIKA IMAJO
It’s an age when we’re young enough to remember thinking 40-year-olds were on the express train to decrepitude, but we’re old enough to accept that time does pass quickly. At this point in life, we may be embarking on monumental new endeavors, while questioning whether our bodies can forgive us for the misdeeds of our youth. Talking to a primary care physician about the fears and physical challenges that often emerge in our 40s can be empowering and reassuring, particularly at a time when many are seeing their parents - even siblings and peers - face health challenges. “People are anxious about the fact that they’ve turned 40, and I try to determine the cause of their anxiety,” explains Jay Shah, MD, a family practice physician at St. Francis Family Medicine and Residency Program. “The first thing our patient needs to do is come through our door and have a conversation with us.” Today, when many 40-year-olds are just starting to bloom, it’s especially fitting to embrace the landmark as an opportunity for a thorough health assessment.
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HEALTHY AT 40 | our health
“People are waiting to have kids at later ages,” observes Steve Crossman, MD, a family practice physician with the Department of Family Medicine and Population Health at Virginia Commonwealth University Medical Center. “And you want to be healthy and active at the critical junctures in their lives.” According to Dr. Crossman, a good way to set the stage for fitness into the next phase of life is by confronting any remaining bad habits – such as smoking and heavy drinking – and getting a handle on some basic indicators. “Know what your blood pressure is and get it under control if it’s high. Know what your cholesterol is and develop a plan with your physician to address that if it’s high.” At age 40, patients are commonly introduced to some new screening procedures. Women are advised to start getting regular mammograms, and men may be encouraged to begin discussing prostate health. Depending on inherited predispositions and the age at which conditions were diagnosed in affected family members, physicians take additional steps to screen for certain cancers and other genetically-linked conditions. “I think a lot of patients at 40 start thinking about family members who have had medical illnesses,” Dr. Shah notes. When it comes to family history, he explains, “I would say the most important things to look for would be heart-related conditions and cancer-related conditions, because we find that these are preventable if we monitor them appropriately.” Some issues of particular significance, he says, would be diagnoses among immediate relatives of diabetes or high blood pressure, breast, ovarian, and cervical cancers for women, prostate cancer for men, and colon cancer for both. Dr. Crossman notes that early awareness of developing problems -- pre-diabetes, pre-hypertension, glucose intolerance, and elevated cholesterol levels – may prompt physicians to recommend more aggressive lifestyle modifications that can halt the progression into full-blown illnesses. Weight gain is among the most common and vexing side effects of turning 40. Increasingly sedentary lifestyles -- combined with unchanging or even worsening eating habits -- can cause the pounds to creep on, increasing risk for such conditions as diabetes and high blood pressure. Dr. Shah recommends a well-balanced diet that is high in protein and low in carbohydrates. Limiting saturated fats and concentrated sweets is also advisable, according to Dr. Crossman. Exercise is an effective weapon against the mischief of a slowing metabolism. And like diet, it shouldn’t feel www.ourhealthrichmond.com | 19
our health | HEALTHY AT 40
like punishment. In fact, any continual movement that you enjoy – swimming, weighttraining, tennis, dancing – is beneficial to overall health if done on a regular basis. “We recommend a goal of 150 minutes a week, every week, of moderate activity,” says Dr. Shah, “and we ask patients, depending on their fitness level, to gradually get to that goal and maintain it.” A combination of cardiovascular activity and resistance training, which bolsters bone and muscle health, is encouraged. “Start low, go slow,” cautions Dr. Crossman, pointing out that exercise novices should check in with a physician before diving into a fitness regimen. Offering an additional bonus to a population commonly fraught with conflicting demands, exercise acts as a natural mood elevator and stress reducer. The association between vigorous activity and stress hormones, Dr. Crossman says, is a time-honored human tradition that dates back to our caveman ancestors’ response to threats. “Your body is telling you that you need to beat something up or run. So what do you do? You go out and punch a punching bag at the gym, you pound a tennis ball across the net, or you run on the treadmill.” While he describes the 40s as a particularly demanding time when it comes to career, relationships -- and in many cases caring for both young children and aging parents 20 | www.ourhealthrichmond.com
HEALTHY AT 40 | our health
-- he observes a high level of stress among patients of all ages these days, and a lack of resources for constructively coping with it. “I don’t think we as a society have done as a good a job as we can of talking about stress management,” he explains. Meditation, music, yoga, and prayer, he suggests, are among the healthy forms of respite from life’s demands. Emphasizing the impact of environmental stressors on health, Dr. Shah encourages his patients to talk to him about whatever’s going on in their lives.
Jay Shah, MD is a family practice physician at Bon Secours St. Francis Family Medicine.
“Stress is huge to us, whether it be at work or at home. A lot of 40-year-olds are coming to us and opening up about stress factors, about their health in general, and they’re very open to advice. That’s encouraging to me as a relatively young practitioner.” In our 40s, developing a comfortable relationship with a primary care physician may be one of the most important steps we can take when it comes to both maintaining wellness and preparing for any medical challenges the future may hold. “Finding that medical home, where you really feel comfortable and cared for, is something you should really start working on in your 40s,” Dr. Crossman recommends, “because we’re all going to need it sooner or later.”
Steve Crossman, MD is a family practice physician with the Department of Family Medicine and Population Health at VCU Medical Center.
But that time of urgent need can certainly be later. If we, in our 40s, really talk to our physicians, take care of ourselves, and make peace with our lives, we can spring – rather than crawl – into our 50s and beyond.
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INTERVIEW BY | Stephen McClintic, Jr. photography | Governor’s Photo Michaele White Children in the Garden Kathy Scott
GOVERNOR
Bob McDonnell and FIRST LADY
Maureen McDonnell discuss men’s health, her cancer scare and teaching their children the importance of
living a balanced life. OH: Men tend to lead less healthy lifestyles than women. They are more apt to smoke and drink and more likely to be overweight. Consequently, the average life expectancy for males in the United States is five years less than for females. In your opinion, how do you feel we can address the men’s health problem? You are correct that, according to the Centers for Disease Control, (CDC) life expectancy for men both nationally and in Virginia is almost five years less than that for women. Of course, there are many reasons for that since, throughout the world, males generally have a higher mortality rate than females at every age – including the first year of life. You mentioned smoking and obesity, which are two of the lifestyle issues that are closely connected to chronic diseases such as heart disease, cancer, emphysema, diabetes, and many more.
[ continued on page 24 ]
our health | GOVERNOR McDONNELL ON HEALTHCARE IN VIRGINIA
Above and at right on page 25: Students from St. Joseph’s Villa spent time at Virginia’s Executive Mansion planting several varieties of vegetables (donated by Southern States) and herbs (donated by Robbins Family Farms). This is one of many activities that highlight Maureen McDonnell’s Health and Wellness initiative.
[ continued from page 24 ]
I think that we have to begin addressing men’s health early by focusing on the health of infants, children, and adolescents. We need to help parents and individuals by promoting healthy communities that provide increased opportunities for healthy food choices and physical activity while striving to prevent the initiation of tobacco use or underage and binge drinking. In addition, health problems can be addressed by developing and reinforcing programs in a variety of settings, including faith based organizations, worksites, as well as traditional healthcare systems. Healthcare providers can also help by screening for risk factors such as obesity, limited physical activity, and/or excessive alcohol use and promoting behavior change.
OH: What advice would you give to men that may help jump start their healthier lifestyle? I think that the common sense advice to eat a healthy diet, get enough exercise, and eliminate tobacco use and binge drinking remain the most effective means of obtaining and maintaining a healthy lifestyle. These things are both simple though, for many people, incredibly difficult. However, a man who is striving for a healthier way of life can start with small steps – eat more fruits and vegetables and less red meat as well as drink fewer sugary drinks. Go for a walk or take time to participate in a sport that he enjoys. For men who smoke, call the Virginia Tobacco Quitline at 1-800 QUIT NOW (1.800.784.8669) for counseling, information, and self-help materials, and limit alcohol to no more than two drinks per day. Some men may use food, tobacco, or alcohol in a belief that it helps reduce stress while, in fact, a poor diet, tobacco and binge drinking will increase the physical stress in the body. In addition, it is important for men to see their physician for regular check-ups and to follow their physician’s instructions. Men should know their health numbers: 24 | www.ourhealthrichmond.com
GOVERNOR McDONNELL ON HEALTHCARE IN VIRGINIA | our health
blood glucose, blood pressure, cholesterol, and weight. For the man that has already developed a chronic disease, he really needs to consult with his healthcare professional to ensure proper medical care and for assistance with lifestyle changes.
OH: Women tend to be the person in the family who orchestrates the “family health calendar” to ensure both the children and adults maintain regular visits to the doctor and stay up to date on immunizations and screenings. While it is terrific to have someone help support you and guide you toward a healthy lifestyle, should it really be the responsibility of a spouse or partner to make sure an adult man is keeping up with medical appointments and screenings and other health-related needs? Good health begins with each of us. I do all that I can, despite all of the travel and meals away from home required of my job, to eat well and exercise when I can. We are all responsible for our own health, as no one can be with us every day to remind us of healthy choices. I’ve been fortunate that my wife has always been an advocate for preventive healthcare and wellness efforts in our home. She’s made the issue one of her key focus areas as First Lady as well. Several times a year she welcomes underserved children from the community to the Executive Mansion to help plant and tend herbs and vegetables. After planting in the garden, the kids have the opportunity to cook their harvest in the kitchen and further discuss maintaining a healthy lifestyle through proper nutrition and exercise. We hope to demonstrate to these kids that eating healthy can start at home and in their own neighborhoods.
OH: Healthy living should begin at an early age. Many young men think they are invincible, especially through their 20s and 30s. How have you and the First Lady encouraged your children to live a healthy lifestyle early on in life? We’ve always encouraged our children to be active in sports, including swimming, cross-country, cheerleading, soccer and more. In addition, we’ve raised them to make good decisions when it comes to snacking – reaching for an apple for example, rather than a bag of chips. Maureen and I believe if you develop good habits when you are young, it’s significantly easier to continue them for your entire life.
OH: Have you ever had that “gut check” scare - a time when you thought you might be facing a serious health condition which made you take a different direction in the way you take care of yourself? When my wife was 17, she discovered she had a breast tumor. It was the same year her aunt underwent a complete mastectomy. Going into surgery, Maureen had to sign a consent form allowing the doctors to proceed with a complete mastectomy if the onthe-spot biopsy proved malignant. Fortunately, the tumor was benign, but the doctors informed her she was pre-disposed to breast cancer. That event has helped frame our outlook on health, nutrition and exercise - pushing Maureen and I to do all that we can proactively to lead healthy lives. Prevention is often the most important and reliable disease-fighting tool that exists today.
OH: As the Governor for the Commonwealth of Virginia, your schedule clearly stays full. How do you find time to eat well, exercise, maintain regular visits to the doctor, stay emotionally balanced, etc.? It all comes down to everyday living and the healthy choices we make in our daily diets, exercise programs, annual check-ups, and other tests that are so important. I admit it’s not easy - I have an extremely busy schedule - I don’t go on runs as often as I’d like, but maintaining a commitment to living a balanced life is vitally important. www.ourhealthrichmond.com | 25
our health | GOVERNOR McDONNELL ON HEALTHCARE IN VIRGINIA
OH: When it comes to diet and exercise, what’s your favorite healthy meal and what type of exercise do you like to do that helps you physically and mentally? There are few things I find more enjoyable than throwing the football or playing a round of golf with my two sons. Combining family time with physical activities is a great way to build memories with loved ones and stay in shape at the same time. When time allows I greatly enjoy a run around Virginia’s beautiful Capitol Square, which features the capitol building designed by Thomas Jefferson. But a treadmill gets the job done as well. When looking for a good, healthy meal thankfully you don’t have to look far. We are blessed to live in a state with so many incredible agriculture producers who provide an abundance of fresh products for Virginians, from Virginia apples to fresh seafood. We try to take advantage of the many healthy food options we have available right here in the commonwealth.
OH: In thinking about your positive health habits, what message do you hope will most resonate with your children as they grow older? I believe that we have to do all that we can to help our children learn to take responsibility for their own health. I hope that the principles we’ve instilled in our five children will be carried on to the next generation now that they are grown and starting adult lives of their own.
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THE CHANGING ROLE OF HOSPITALS | our health
The Wellness Spectrum: As demonstrated by this model, wellness is not just for the well. It is for everyone. And it has a place throughout the continuum of care.
In Sickness and In Health:
The Changing Role of Hospitals words | SUSAN DUBUQUE
On March 23, 2010, U.S. President Barack Obama signed the Patient Protection and Affordable Care Act into law and healthcare reform became a reality. In the wake of all this change, healthcare organizations from across the country are making significant course adjustments and proclaiming, “We are no longer just dedicated to treating you when you’re sick or injured. We are also committed to improving your health—and keeping you out of the hospital.” The healthcare systems throughout Virginia—and right here in our community—are leading the charge— driven by their missions, community needs, strategic plans and, above all, the need to control burgeoning healthcare costs. Before we delve into what’s happening in the commonwealth, let’s pause for a moment to explore what wellness is and—of equal importance—what it is not. If you are conjuring up images of Richard Simmons in way-too-short shorts and a headband, making loud whooping sounds, banish the thought. Seriously, banish it www.ourhealthrichmond.com | 27
our health | THE CHANGING ROLE OF HOSPITALS
Virginia Commonwealth University Medical Center MCV Campus, Goodwin Research Laboratory, and Massey Cancer Center, the heart of downtown Richmond.
forever. Wellness is not just about healthy eating and going to the gym. It is not a destination or a static state of being. Wellness is a process designed to help you achieve your optimal level of health and well-being. But it is a fluid process, subject to change over time and as you age and your health circumstances evolve. (see Wellness Spectrum on page 27) So what are our local hospitals doing to incorporate wellness and health promotion into their operations right here in Central Virginia? The answer: a lot!
Wellness Begins at Home: Caring for Employees Bon Secours Health System, HCA Health System and VCU Medical Center embrace the principles of wellness with all the enthusiasm of a personal trainer—starting with their own associates. According to Misty Turner, director of human resources for Chippenham and Johnston-Willis Hospitals, “Employee wellness is something that the entire HCA organization has adopted.” Staff members are offered free annual screenings and online health risk assessments. Through this process, if any risk factors are identified, a health coach is available to help turn things around. Employees who participate in the program receive a $400 contribution to their medical flex plans—funds that can be used to cover any medical or dental expense. HCA also subsidizes an employee’s membership to a health club. “But we only cover the cost if the individual actually uses the health club,” said Turner. “We all have to be responsible and do our part to stay well.” Who says good help is hard to find? For the employees of Bon Secours Virginia and their families, it has just gotten a lot easier—thanks to the Good Health Clinic and Good Health Pharmacy, located on the site of St. Mary’s Hospital. 28 | www.ourhealthrichmond.com
THE CHANGING ROLE OF HOSPITALS | our health
With walk-in appointments and extended weekday and weekend hours, the Good Health Clinic offers urgent care for minor medical needs—from colds and coughs to bumps and bruises—and the Good Health Pharmacy provides a convenient place to fill prescriptions and consult with pharmacists. Kara Weaver, RN, BSN, OHN, wellness program manager for Bon Secours Virginia, reports that the clinic provides “good help” to 300 to 400 employees and their family members each month. Organizations can use a carrot or a stick to encourage changes in lifestyle and health-related behaviors. VCU Medical Center opted for the carrot, when it was discovered that a significant number of its employees were not having regular screening mammograms. Geoff Chestnut, business development manager for the department of radiology, said, “We pulled together a team of employees and asked what would entice our female staff members to have a needed mammogram?” The answer was unanimous—the chance to win an iPad® complete with a pink leather cover. “In the first three months of the program, we saw a 40 percent increase over the same period the previous year in our eligible staff members and their dependents having mammograms—with many employees “catching up” with missed screenings,” said Chestnut. Throughout our area hospitals, employees receive little nudges to make healthy choices. Bon Secours’s Step-It-Up is one such initiative. The stairwells have been painted bright, inviting colors to remind employees that taking the stairs is a healthier option. Even Peter Bernard, CEO of Bon Secours Virginia, regularly takes the stairs to and from his seventh-floor office. Bon Secours Public Health System - St. Francis Medical Center, hospital and emergency The associates of CJW Medical Center also are stepping up receiving. [ Photo by David L. Everette ] their wellness efforts by participating in WalkAmerica. Using company-issued pedometers and an online program to track their progress, participants are racking up enough miles to “walk” to every state capital in the country.
It’s Never Too Early to Start The Healthy Lifestyles Center at Children’s Hospital of Richmond at VCU (CHoR) is taking on one of our nation’s biggest health issues—childhood obesity. Today, about one in three American kids and teens is overweight, nearly triple the rate in 1963. Obesity is causing a broad range of health problems that previously weren’t seen until adulthood, including high blood pressure, type 2 diabetes and elevated blood cholesterol levels. There are also psychological effects—obese children are more prone to low self-esteem, negative body image and depression.* At the Healthy Lifestyles Center, a team of dietitians, exercise specialists, psychologists, pediatric medical and surgical specialists and nurses work closely with the children and their families to promote healthy eating, exercise and positive lifestyle habits that can translate into lifelong change. “ChoR provides a place where Richmond children and teens can go for guidance and support to tackle obesity,” said Edmond Wickham III, MD, associate director of the Healthy Lifestyles Center. “Ultimately, we’re making our community healthier, and hopefully turning the tide on the growing epidemic.”
Edmond Wickham III, MD, FAAP is the Associate Director of the Healthy Lifestyles Center at Children’s Hospital of Richmond at VCU.
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our health | THE CHANGING ROLE OF HOSPITALS
The center is housed in a 4,000-square-foot facility including a gym, exercise testing areas, consultation rooms and research space. This unique facility is the first of its kind in Central Virginia. *Sources for information on childhood obesity, American Heart Association.
You’ll Feel Right at Home: Wellness for Patients Bon Secours was one of the first health systems in Virginia to adopt the concept of a Patient-Centered Medical Home. A medical home uses a team approach in coordinating care and establishing long-term healing relationships—particularly helpful for patients with chronic medical conditions such as diabetes, pulmonary disease and congestive heart failure. Primary care physicians, nurse practitioners, physician assistants and care coordinators ensure that individuals receive the preventative care, education and support needed to manage their health and well-being. “Care coordination and proactive health management are at the heart of the medical home,” said Irene Zolotorofe, administrative director for clinical operations, Bon Secours Medical Group Virginia. “Our RN navigators are embedded in the medical practices—evaluating each patient’s needs and ensuring that they have the necessary support to achieve optimal health and well-being.” That support may involve medication education, nutritional counseling, home health visits, remote monitoring of vital signs or referrals to specialists, among other services. Zolotorofe thinks that access to care is what really sets the medical home apart from a traditional primary care practice. “We offer same-day appointments and extended office hours—including evenings and weekends—so our patients can see their healthcare providers right away, before a small problem turns into a crisis.” The medical home model is one way that Bon Secours is making huge strides in shutting down the revolving door of hospitalizations. “After being discharged from the hospital, patients are called by an RN navigator who makes sure they understand their medications and follow-up instructions,” noted Zolotorofe. “The RN navigators also contact patients who regularly use the emergency department for nonemergency care—to reconnect the patients with their primary care providers.” Bon Secours Virginia has more than 40 Patient-Centered Medical Homes from Richmond to Hampton Roads. VCU Medical Center uses a patient-centric approach to provide care for adults with the most complicated medical needs. The Complex Care Clinic serves low-income, uninsured individuals who have five or more chronic medical conditions. “These are the sickest-of-sick patients, and their multiple issues significantly increase the overall cost of their healthcare,” said Barbara Harding, RN, MPA, CCM, PAHM, director of Virginia Coordinated Care Program, which operates the clinic at VCU Medical Center. “We’re empowering our patients to take charge of their health—by giving them confidence, knowledge and skills, as well as access to coordinated primary care and an array of fitness services,” said Harding. 30 | www.ourhealthrichmond.com
THE CHANGING ROLE OF HOSPITALS | our health
The expression “It takes a village…” is aptly applied to caring for this population. An entire team of providers—physicians, clinical nurses, social workers, pharmacists, nurse case managers and psychologists—“wraps” services around the patient’s needs. Harding said one grateful patient described the clinic’s care as, “A circle of support that helped me get healthier.” While these measures may sound extreme, the results are impressive. In the first year of the clinic’s operation, there was a 66 percent reduction in inpatient hospital expenses and 36 percent reduction in emergency room expenses among participants. Presently, there are 450 patients enrolled in the program.
Esther Desimini, RN, MSN, BC, APRN, vice president of oncology services for HCA Capital Division
Cancer patients can also enjoy a wellness boost at HCA hospitals. Esther Desimini, RN, MSN, BC, APRN, vice president of oncology services for HCA Capital Division, said, “Cancer is now treated as a chronic illness, and our rehab and wellness approach tailors services to meet the physical, psychosocial and emotional needs of each individual.” “Exercise, nutrition and stress management activities—like yoga—all help our cancer patients focus on healthy living and their survivorship,” said Desimini.
Beyond the Hospital: Wellness for the Community Wellness knows no bounds and our local hospitals are taking it into the communities they serve. Savvy employers have come to appreciate the benefits of a healthier workforce—with an eye to productivity, profitability, fewer workers’ comp claims and lowered healthcare costs. HCA’s Workplace Wellness program is helping employers achieve all that—and more. A cadre of 30 nurses travels to companies throughout Central Virginia, conducting health risk assessments and health screenings and developing customized Health Solution Plans for each organization. “A wellness program can create a more positive and healthier environment in which to work,” said Nolie Barnes, vice president for business health services for HCA Capital Division. “In time, the employer can expect positive outcomes and the employee will have a sense of being genuinely cared for by the employer.” Bon Secours takes its mission to heart with its Care-A-Vans—mobile health units that travel around the Greater Richmond area www.ourhealthrichmond.com | 31
our health | THE CHANGING ROLE OF HOSPITALS
and provide free primary care to uninsured adults and children. Lucie Ferguson, administrative director of community health advocacy, said, “The Care-A-Vans are one very tangible way that Bon Secours delivers good care to those in the greatest need.”
An Ounce of Prevention Prevention is an expected component of any wellness effort, and our local hospitals all have a vast array of programs in place for the prevention of heart disease, diabetes, cancer, pulmonary disease and more. But what about preventing the two top causes of death of American teenagers? VCU Medical Center has taken on the challenge of reducing deaths due to accidents—often caused by risky behavior—and homicides, through its multifaceted Injury and Violence Prevention Program (IVPP). A group of nurses on the Neuroscience Intensive Care Unit felt compelled to take action after caring for innumerable teens who suffered serious— sometimes fatal—head injuries in car crashes where the teens were drinking or using drugs. That frustration led to the creation of After the Party’s Over—one offering of VCU Medical Center’s IVPP. This interactive educational program has been presented in high schools throughout Central Virginia for more than 20 years. Richmond has much to be proud of—but its extraordinarily high rate of youth deaths due to firearm homicides is not one of them. Bridging the Gap—a second IVPP program—seeks to change this. Youths who suffer one injury due to violence are very likely to be reinjured in the future. That’s where Bridging the Gap steps in with education, skill development and social interventions for the young people and their families—
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allowing the cycle of violence to be broken. More than 50 youths have benefitted from this program. “It is clear that our efforts must extend beyond a ‘treat and street’ solution,” said Michel Aboutanos, MD, MPH, FACS, division chair for trauma, critical care and emergency surgery. “This new approach to hospital-community-based injury and violence prevention programs can serve as a model for other hospitals in the community and throughout Virginia.” *Source: Top causes of death as reported by the Centers for Disease Control and Prevention
While there are far too many wellness programs to mention them all, there is one activity that is sure to make you smile. Each February for the past three years, HCA has sponsored a Day of Dance. Last year, more than 2,000 individuals participated in this free event offered at 11 locations throughout the Greater Richmond area. They took advantage of health screenings and the opportunity to “Ask-the-Doctor” healthrelated questions. But, best of all, they enjoyed the chance to kick up their heels and dance their way to a healthier heart. So come on, everyone. Time to put down that bowl of chips and get off the sofa. Wellness isn’t a fad. It’s a mindset that tells us all that our health and well-being are in our own hands. We are responsible for the choices we make each and every day. But we’re not alone. Bon Secours Health System, HCA Health System and VCU Medical Center are here to care for us when we’re ill—and if you take advantage of the opportunities they offer, they’ll help you move a little further along in your journey to a longer, healthier life.
Susan Dubuque is principal and co-founder of Neathawk Dubuque & Packett, a marketing and advertising firm based in Richmond, VA, that has a special group dedicated to healthcare and wellness. A nationally recognized speaker, Susan has published more than 100 articles on healthcare and service marketing, and has assisted more than 200 hospitals and healthcare organizations with marketing and branding initiatives. Author of two books, A Parent’s Survival Guide to Childhood Depression and Kid Power Tactics for Dealing with Depression, she launched a national campaign to increase public awareness of childhood depression.
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HealthyEats L R EC A N O S SEA
IPES
Lemon-Herb Baked Rainbow Trout Rainbow trout is an excellent source of omega 3s, which are heart healthy fats, and needs little more than a fresh squeeze of lemon to make it delicious. It also cooks quickly and can liven up a fresh summer salad. Makes 3 servings
Ingredients: 1 large rainbow trout fillet (16 oz.) 1 lemon (sliced) 1 tbsp tarragon 1.5 tsp marjoram 1 tbsp extra virgin olive oil
salt and pepper to taste
2. Sprinkle fish with salt and pepper to taste. Arrange lemon slices on top of fish fillets. Sprinkle tarragon and marjoram on top of fish fillet and then drizzle on the olive oil. 3. Place in oven and bake for 14 minutes, or until fish is flaky and opaque in the center. Remove from oven and enjoy!
Directions: 1. Place the oven rack centered in the oven. Preheat oven to 400 degrees. Line a baking sheet with aluminum foil and coat with nonstick spray. Cut the fish fillet into 3 pieces, and place them on the baking sheet.
Tricia Foley’s
BAKED RAINBOW TROUT Tricia Foley is Our Health Magazine’s resident nutritionist.
HealthyEats S
O EAS
CIPES N A L RE
Directions:
Ingredients: ½ head green cabbage ½ head red cabbage
Cabbage Salad
1 onion
Cabbage is a wonderful source of B vitamins, is rich in minerals like potassium, manganese, iron, and magnesium and contains powerful antioxidant properties. This wonderful summer salad makes a great side to any dish.
2-3 stalks celery 2-3 carrots or ½ bag of shredded carrots
1. Chop up all the ingredients. Try to get them all of uniform size so that the dressing coats them easily. 2. Mix the honey and vinegar together until the honey is dissolved into the vinegar and then pour over the vegetables. This recipe can store in the fridge for a week.
1 red pepper 1
cup apple cider vinegar
1-3 tbsp raw honey
Makes 12-15 servings
Tricia Foley’s
CABBAGE SALAD Tricia Foley is Our Health Magazine’s resident nutritionist.
HealthyEats RECIPES L A N SO SEA
Melon, Avocado & Strawberry Salad This fresh fruit salad makes a refreshing start to any dinner. Nutty with a hint of sweet, red wine vinegar pairs great with strawberries. Makes 4 servings
Ingredients: 1/4 cup local honey 2 tablespoons red wine vinegar 2
tablespoons finely chopped fresh mint
ground pepper to taste
pinch of salt
4 cups baby spinach 1 small avocado, peeled, pitted and cut into 16 slices 16 thin slices cantaloupe (about 1/2 small cantaloupe), rind removed 2 cups hulled strawberries, sliced 1 tablespoon sesame seeds, toasted
Directions: 1. Whisk honey, vinegar, mint, pepper and salt in a small bowl. 2. Divide spinach among 4 salad plates. Arrange alternating slices of avocado and cantaloupe in a fan on top of the spinach. 3. Top each salad with strawberries, drizzle with dressing, and sprinkle with sesame seeds. Enjoy!
Tricia Foley’s
FRUIT SALAD
Tricia Foley is Our Health Magazine’s resident nutritionist.
BEWARE
OF THE SUN words | SARAH COX
First thing: Anyone can get skin cancer, and they get it from the UV, or ultraviolet rays of the sun as well as sun lamps and tanning booths. Light-skinned, fair-haired and light-eyed people do have a greater risk, but dark-skinned people get it as well. The National Cancer Institute estimates that 76,690 men and women (45,060 men and 31,630 women) will be diagnosed with and 9,480 men and women will die of melanoma of the skin, the most serious type of skin cancer, in 2013. More than 3.5 million cases of basal and squamous cell skin cancer are diagnosed in this country each year. Cancers are caused by a combination of both environmental and genetic factors, but with skin cancer, environment makes the more significant impact. So those with a history of skin cancer in their family should be extra diligent when preventing exposure to the sun. Did you know that about 10 percent of all patients with melanoma have family members that also have had the disease? There are several types of skin cancers, according to the National Cancer Institute. All form in the tissues of the skin. Melanoma is cancer that forms in the melanocytes, or skin cells that make up our pigment. Basal cell carcinoma forms in the lower part of the epidermis, which is the outer layer of the skin. Squamous cell carcinoma forms in squamous cells, and neuroendocrine carcinoma is formed in the neuroendocrine cells. While most skin cancers are detected after the age of 50, the damage begins far earlier, and that is why everyone should be aggressive in their prevention of exposure to the sun’s UV rays.
Some tips to protect one self are as follows: • Research your sunscreen. The SPF, or sun protection factor, of a sunscreen does not indicate how strong it is, but rather how long it will keep you protected. It is calculated by how many minutes it takes a person to burn, multiplied by the number that tells you how long it should last. So if you burn in 10 minutes, multiply that by SPF 30 and that will keep you protected for 300 minutes – theoretically. So, if you burn in 10 minutes of sun exposure without any protection, SPF 30 will keep you protected for 300 minutes (in theory!). • Apply one ounce generously to all exposed skin, and reapply often every few hours, or more often. It is suggested
that one reapply every two hours, even on cloudy days, and after swimming or sweating, as sunburns significantly increase one’s lifetime risk of developing skin cancer, especially for children. • Be careful about what is in your sunscreen. Some chemicals are allergens and potential hormone disruptors. Watch for a PABA-free, (one that has no paraaminobenzoic acid) brand. It can cause allergic reactions. • Additionally, avoid sunscreens that contain Vitamin A (retinyl palmitate), which the FDA has found may make your skin photocarcinogenic, or at greater risk of turning cancerous when exposed to sunlight. • And avoid sunscreens with added insect repellent. Choose a sunscreen because it protects you from the sun. • Wear protective clothing in addition to putting on sunscreen. Light layers of clothing are suggested, as light colors reflect heat. To remain comfortable in the heat, try wearing a tank top, and then a light camp shirt open over that. Natural fibers like cotton are coolest. However, be aware that an ordinary t-shirt is only the equivalent of SPF 5. An alternative is to buy clothing designed to block sun, even up to SPF 50. • Do not use tanning beds. The UV radiation from tanning beds and the sun causes skin cancer and wrinkling. • If your family has a history of cancer, moles, or is fair skinned and fair haired, be more diligent about sun protection. • Drink plenty of water, but if one is exercising vigorously, a sports drink can replace electrolytes. Don’t drink too much, and avoid sugary drinks and alcohol, which can dehydrate you. • Wear sunglasses. They will protect your eyes from UV rays, the tender skin around your eyes, and reduce the risk of cataracts. Look for those that block both UVA and UVB rays, and consider wrap-around sunglasses.
SKIN | our health
Christine Rausch, MD, with Skin Surgery Center of Virginia says that melanoma is the number one cancer in ages 25-29 and is the second most common cancer in ages 15-29. It is the deadliest of all skin cancers, and is on the increase. “We don’t know why it is increasing, but may have to do with our sun exposure habits and ozone layer, and there a clear connection with tanning beds,” she says. She says those at risk are the fair-skinned, fair-eyed folks, but if you have a history of sunburns or freckling, numerous moles (25-50), or a history of melanoma, either yourself or your family, these are factors to take into consideration. “Anybody can get it, and unfortunately, African Americans are in the highest mortality rates because they are less aware,” she points out. Dr. Rausch says there are preventive measures, beyond the genetics that are out of our control. “Really the only thing you can do is minimize sun exposure, and never, ever go in a tanning bed. People have to start loving their own skin,” she says.
The main thing that people need to know, and is surprising to people, is that this little brown spot could have killed them if caught too late.
The SPF of a sunscreen is tricky, and a great marketing tool, she points out, but one only needs between SPF 15 and 30. Beyond that, the benefit is minimal. “Most people do not get enough protection because they do not reapply, and most put one quarter to one-half of what they need.” She says this is one ounce, or approximately the size of a shot glass. She points out that the FDA has enforced new guidelines for sunscreens that make it easier to shop for. If a sunscreen contains UVA and UVB, it is labeled broad spectrum. This is what you want. Additionally, sunscreens are no longer labeled waterproof – they are water water-resistant, with as span of 40-80 minutes of resistance on the label. “The other thing is that I really preach about shade, avoiding day sun, and wearing protective clothing, hats, and sunglasses. Sun exposure to the eyes can cause cataracts and ocular melanoma,” she says. Dr. Rausch suggests buying sunglasses with UV protection, and doing outdoor activities early in morning or later in day. “I try to preach that you can go outside, enjoy the sun, but do it wisely,” she says. “The main thing that people need to know, and is surprising to people, is that this little brown spot could have killed them if caught too late. It is important for www.ourhealthrichmond.com | 41
young people to be aware of their skin, make wise choices when in the sun, and get their skin checked. If you are uncertain, get it checked,” she says. Dr. Rausch says to get acquainted with the moles on your body. Look for a mole that is now changing, but has been there, or a completely new mole. She spelled out the ABCDE’s of melanoma, which are as follows »» A = mole is asymmetric; »» B = border irregularity – you want a nice, smooth border; »» C = color; it may have a multitude of colors, but not one uniform one; »» D = diameter – is it bigger than a pencil eraser (6 mm)? »» E = evolution, if the mole is changing; cancer changes – normal, benign things do not. “If you are suspicious, get a biopsy to make determination,” she says. Caught early, melanoma can be cut out before it grows too big or too deep. The deeper it is, the greater the mortality rate.
Christine Rausch, MD is a specialist in skin cancer, Mohs micrographic surgery and reconstructive surgery at Skin Surgery Center of Virginia.
KIDS CARE | our health
L.J. Petra is the athletic trainer for the Richmond Flying Squirrels.
BATTER
UP
Louis “L. J.” Petra, the athletic trainer for the Richmond Flying Squirrels minor league baseball team (an affiliate of the San Francisco Giants), not only trains players in how to lead a healthy lifestyle, he serves as an example as well.
Petra, who earned a Bachelor of Science degree from the University of Connecticut in sports medicine and is certified in strength and conditioning, as well as being a corrective exercise specialist, played three sports growing up. Golf, baseball, and hockey kept him busy and, as he says, “always outside with my friends.” That’s what he suggests that children and high school athletes do today – get involved in a team sport, stay active, and develop life skills.
in Richmond words | SARAH COX
“Looking back, I was very fortunate,” he says. “I have no bad memories of interactions with coaches. The guys that were on my teams growing up remain my friends. Part of being on a team, working towards a goal, and competing together teaches us how to push each other and better ourselves. It’s a great bonding experience.” The same translates to today, on a team with players from the United States, Canada, Venezuela, Mexico and the Dominican Republic. Diets vary wildly, for instance, but at the Flying Squirrels clubhouse, fresh fruits and vegetables are kept stocked, and those who prefer a large quantity of rice in their diet have learned to modify the amounts and embrace what Petra calls a “sports-specific diet.” That includes www.ourhealthrichmond.com | 43
KIDS CARE | our health
eliminating sodas or candy (none in the clubhouse), eating whole grain pastas and breads, and choosing leaner cuts of meat. “They are building muscle and need that protein,” he says of his players. For the athlete still in middle or high school, Petra suggests cutting all sugary snacks and energy drinks. He explains that kids that eat those things will feel an initial buzz from the caffeine and sugar, but then feel lethargic for the rest of the day, which is going to affect their performance in the classroom and on the field. “Avoid processed stuff,” Petra continues. “Kids can have a treat, but anytime you consume high quantities of sugar and caffeine, you will feel that lull and it’s a slippery slope. You get back to that high feeling by consuming more sugar and caffeine. That’s going to cause problems with kids in the future.” Those problems, most specifically, are high insulin levels, bad teeth, stomach ulcers, and obesity. The Centers for Disease Control and Prevention (CDC) states, “The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12– 19 years who were obese increased from 5% to 18% over the same period.” The short-term fallout from this is high cholesterol and blood pressure, pre-diabetes, bone and joint problems, sleep apnea, and social and psychological problems. The long-term effects, according to the CDC, are heart disease, type 2 diabetes, stroke, cancer, and osteoarthritis. Contrary to popular myth and the butt of many jokes over the years, baseball players are true athletes, says Petra. In their off season, they have a personalized regime to follow as they scatter off to their various hometowns. The players check in www.ourhealthrichmond.com | 45
KIDS CARE | our health
with Petra, and he reports to the staff about their off-season workouts. While in season, the guys work out together, building motivation. Petra says he tries to practice what he preaches, along with the strengthening and conditioning coach. “Hopefully, the players see our activity level and match that and push themselves harder,” he says. Trying to better yourself every day is a great bonding experience and one of the perks of being on a team. At the end of the day, no matter what language is spoken or what country is home, the common thread is baseball, explains Petra. “There may be a language barrier, but each tries to learn the other language. It’s a family atmosphere. This is a great opportunity to learn about yourself and how to treat others. It’s learning how to work with people. If you can work with them, you can work with anybody. I certainly believe that.”
Petra not only takes care of himself, but his players too.
Being on a team translates to being successful working with others later in life. It means exercise. And it means that there is no room for sugar and caffeine if you are going to get up and perform to the best of your ability day after day. The Flying Squirrels usually play over 140 games each season, which lasts from April to the first of September. That’s a lot of exercise, a lot of eating right, and a lot of getting along with teammates.
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“Turn what you are good at
Dr. Rapp with Dr. Grewall (fellow GTE board member), Mt Blanc, France
doing into doing good for others”
GIVING TO EXTREMES
the story of
It may just be the perfect charity for a doctor. Giving to Extremes (givingtoextremes.org) was founded by David Rapp, MD, a urologist with Virginia Urology, just about a year ago and has been joined by three other doctors, an accountant and a lawyer for his board of directors. The premise is raising money for medical missions through the challenges of extreme activities – 5K’s, marathons, Ironmans, and as is Dr. Rapp’s case this June 26, an expedition up the 20,320-foot Mount McKinley in Alaska.
words | SARAH COX
Giving To Extremes does several things. It raises money for medical missions that its own members go on; it supports other medical missions of non-profits, many that are too small to manage significant missions on their own; and it tells the stories of these missions and those they have helped. These accounts are found on their website. It is a venue that can tell stories through well-put together videos that, says Dr. Rapp, bring the accounts of medical missions into the 21st century. One of the recent affects that these videos has had is inspiring others to become involved, particularly medical and undergraduate students. Dr. Rapp says this is perfect; when he was a med student at George Washington University, he didn’t find much opportunity to become involved in a volunteer activity that tied into medical work, but through Giving To Extremes, students can challenge themselves physically and get involved in medical missions. “My belief is that all you have to is go on one medical mission and that’s if for the rest of your life,” says Dr. Rapp. “That’s all it takes to inspire you to make this a staple in your medical career.” Dr. Rapp has gone on several missions. He was an undergraduate Spanish major and while in med school, he traveled to Honduras and has been to Belize three times – the most recent time since the charity was founded. He says that in general, the urological issues he encounters are untreated. These are debilitating conditions such as kidney stones, bladder tumors and enlarged prostates in older men.
our health | GIVING
Dr. Rapp is a urogynecologist, so he also deals with incontinence due to prolonged deliveries in lieu of caesarians. What results are vaginal prolapses and fistulas, which is a connection between the bladder and the vagina that leaves the woman completely incontinent.
Dr. Rapp with Nurse Courtney Cole, operating on female patient on the GTE mission to Belize, April 2013
Dr. Rapp says that in Rwanda, there is an overwhelming problem with fistulas, and his organization supported the International Organization for Women and Development during its medical mission there. According to Giving To Extremes’ mission statement, “Many of those affected are merely girls in their early teens, and what follows is abandonment by their families and communities. Without the prospect of work or support of their families, they face shame, divorce, isolation, depression, malnutrition, and poverty. Similarly, stricture is a common condition affecting men, which, if not surgically corrected, can result in bladder deterioration, nonfunctioning kidneys, and life-threatening urinary tract infections. The resulting emotional and social toll can be equally devastating. And these are only two of many heartbreaking -- but easily repairable -- conditions that destroy lives in developing countries.”
By pairing up athletes who are willing to raise money for this organization with doctors – many of who are the athletes – the mission matches personalities that tend to push themselves to extremes in many ways. Dr. Rapp, who grew up an athlete playing tennis, wrestling and skiing in high school, says he was always attracted to extreme sports. He learned to scuba dive, rock climb, white water kayak and fly. “I’ve always been drawn to activities that required learning,” he Dr. Rapp with patient after successful surgery to correct a fistula, Belize 2011 explains. He had just finished his residency and had gone to Seattle for his fellowship when a former UVA fraternity brother who was a mountaineer got Dr. Rapp involved in this sport. At the end of the fellowship year, Dr. Rapp and his friend summited 14,411foot Mr. Rainier in Washington State, and he started thinking that some day he would do one of the big ones. That day has come. While Dr. Rapp says that only 40 percent of those who start summit Mt. McKinley – also known as Denali – he’s going to give it a shot and try to raise $1 for every 20,320 foot of the stratovolcano. The climb can take up to three weeks, and he anticipates weathering glacier melt, winds up to 100 miles per hour, and temperatures dipping to 40 degrees below zero. 50 | www.ourhealthrichmond.com
This will make a story as compelling as the reason why he’s climbing. It is as inspiring as every 5K that a doctor runs, every Ironman triathlon one goes through, and every marathon that’s taken on. As a doctor, he feels that he has a great ability to help people. “You become passionate about doing this again and again,” he says of the medical missions. “One of the most rewarding aspects of medicine is that there are so many people in great need, and you have been given a great gift by being fortunate enough to have the medical education offered to you in the United States.”
David Rapp, MD on Mt. Blanc, France (15,781 ft, highest mt in western Europe)
He says it’s important for those to understand that Giving To Extremes is not only a surgical mission, but also a storyteller and an educator to inspire others. You can find Dr. Rapp’s expedition page at www.givingtoextremes.org then by clicking the recent fundraisers link on the home page.
David Rapp, MD is Co-Director, Virginia Urology Center for Incontinence and Pelvic Floor Reconstruction, Assistant Clinical Professor, Virginia Commonwealth University School of Medicine, and President of Giving to Extremes.
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SENIOR LIVING | our health
Bremo Pharmacist, Jennifer Helmke, consults with a patient.
the Art of Being a Pharmacist
Bremo’s Medication Therapy Management and
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To help patients manage their medications, Bremo Pharmacy has created a new program for seniors called Medication Therapy Management (MTM). As part of this innovative plan, patients meet with pharmacists one-on-one for a complete medication review (CMR). “The program is above and beyond usual pharmacy services as we’re able to sit down with you and help manage your medications,” says Jennifer Helmke, PharmD, of Bremo Pharmacy.
The CMR is a personalized and private meeting where the pharmacist, patient and their loved ones discuss all of the customer’s prescription, non-prescription and herbal medications. The goal of the program is to maximize their medications’ effectiveness and improve patients’ overall health. www.ourhealthrichmond.com | 53
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“The in-depth MTM offers very separate services but reaches the same goal of properly caring for patients,” says Emily Peron, PharmD, MS, Assistant Professor at the VCU School of Pharmacy. In many cases, enrolling in MTM allows the pharmacist to find prescription redundancies and reduce patients’ number of prescriptions. Bremo pharmacists can sit down with customers to identify unnecessary medications, potential drug interaction issues, unwanted side effects and insufficient medication doses. They then create strategies to improve overall medication use . “It’s part of the art being a pharmacist,” says Peron, “being able to look at a complex medication list and identify the problems.” After the meeting, Bremo will contact the patient or their loved one’s physician and make them aware of any issues or concerns identified during the review. Patients then receive a personal medication list to bring to all appointments. This ensures all of the patient’s doctors have their most up-to-date medication list of what to take and how to actually take them. In one case, Bremo conducted a medical review for a customer’s mother who was moving into an assisted living facility. Her mother’s prescription labels were subject
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to interpretation with regard to her pain medications. And her new caretakers were not allowed to dispense any medications without clear instructions. “We we’re able to sit down, go through all her medications and create an accurate medicine list,” says Helmke. “We contacted her physician so the instructions would be more explicit to make sure she was being properly cared for. Her daughter was then able to put her in that place and feel comfortable about it.” A major benefit of MTM is cost savings. As part of the medication review, pharmacists can identify potential treatment failures. These problems can occur even when patients take their medications exactly as prescribed. Resolving these potential issues can result in less hospitalizations, improved independence and decreased nursing home admissions – all of which translates into saving money for patients. “The greatest benefit is improved outcomes,” says Helmke. “And in the long run it will decrease medical costs as there will be fewer hospital visits and eliminate unnecessary medications. It’s part of the overall concept of preventive health.” Other benefits are improved health and safety. As patients develop a better understanding of their medication strategy, they will practice better adherence to their prescription instructions. “Patients don’t always feel their medications are working,” says Peron. “That’s something we can teach. Adherence has to do with education.” “Older people are the most eligible,” says Helmke. “And often there are certain medications that are no longer appropriate and can be dangerous if refilled. This can create what’s known as a pharmacy cascade.” Pharmacy cascades form when a medication’s side effect is mistakenly treated as a symptom of a new disease condition. “If we identify the top of the cascade we can eliminate all medications associated with that issue,” says Helmke. In addition to providing high quality care, these sessions serve as the beginning of a strong relationship between the Bremo staff and their patients. “They have never made a mistake. And that’s critical,” says longtime customer Helen Ryan, of Richmond. “They are extremely diligent, precise and are like extended family to me.” An invaluable benefit of the program is peace of mind as patients adhere to a personalized medication strategy. “It’s www.ourhealthrichmond.com | 57
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really for anyone who’s looking to expand their medication knowledge and wants to feel more comfortable taking their medications,” says Helmke. “We try to focus on high-risk patients who are taking five or more medications.” “We offer MTM in addition to fulfilling prescriptions and doing monthly follow-ups,” says Helmke. “Standard services at Bremo include a medicines list, medical review and a quick review of how patients are feeling at pickup.” Helmke adds, “In addition to standard pharmacy services and the MTM program, we can help identify additional products you may find useful – from vaccines and home health aides to wheelchairs.” “Another feature is the convenience of home delivery,” says Ryan. “It has helped a number of times, and I can always count on the prescription being there when they say it’s going to arrive.” “We can do it all at Bremo,” says Peron. “It depends on what patients are interested in and what they need. Some may just want more information, and we’re happy to provide that.” Polypharmacy, or the use of multiple medications by a patient, extends beyond an art form. “We’re also investigators as we examine all the issues with patients and their experience with their medication,” says Helmke. “We see from the lens of the drug expert or the medicine’s point of view.” All of this comes together to serve the goal of properly caring for patients. “They show compassion and concern,” says Ryan. “You’re not just a number. The quality of service and interaction of the whole team is exceptional.”
Bremo Pharmacist, Jennifer Helmke
Emily Peron, PharmD, MS, BCPS, FASP is the Assistant Professor of Geriatrics in the Department of Pharmacotherapy & Outcome Science at VCU School of Pharmacy is a partner with Bremo Pharmacy.
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