table of contents | june • july 2014
MEDI•CABU•LARY.....................10 Local experts define health related terms
JUST ASK!.......................................12 Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............14 A listing of new physicians, providers, locations and upcoming events in greater Richmond
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Men and Health: Coaches who
Practice what They Teach
Study the opponent. Recognize your weaknesses. Practice to become better. For VCU's Shaka Smart, LU's Dale Layer and VT's Frank Beamer, this philosophy is not only one each applies on the court or field, but also in their lives.
HEALTH POINTS.........................16 Interesting facts and tidbits about health
THE ANATOMY CHALLENGE..................................19 How much do you about our anatomy? In this issue, test your knowledge when it comes to the human eye!
ANATOMY: Easing the Impact of Arthritis ..................................... 20 Arthritis is much more than the normal aches and pains of advancing age. It’s actually something of an umbrella term, covering about 100 different diseases and conditions of the joints. And it’s not just a disease of old age.
MEN'S CHART FOR HEALTHY AGING........................ 32 FIT BITS!........................................ 52 Health and Fitness On-the-Go: ABSolutely AWESOME Abs
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The Resource for Healthy Living in Greater Richmond
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Don’t Worry! Be Healthy! Tips & Twists in the Pursuit of Happiness
hello, HEALTH!.............................. 50 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos
NUTRITION........................ 55 HEALTHY EATS: Shop Seasonally for Better Flavorand Extra Value—Creek Country Salad, Crab Cakes, Vegan Mango Peach Crisp
MEN, WOMEN, AND THE TOTAL BODY................................. 58 Zach is Back! Many people don't realize that once you leave an acute care hospital, you may not go home. You go someplace else, like skilled nursing, long-term care or an inpatient rehabilitation facility.
LOOKING BACK........................... 66 Images reflecting the history of healthcare in Richmond * PLUS * a chance to win prizes!
GIVING TO THE COMMUNITY What Makes you Happy?............. 38 10 activities to jump-start your journey
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[new series]
Breaking the Silence: Essential Tremors This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now.
www.OurHealthRichmond.com
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june
•
july 2014
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CONTRIBUTING RICHMOND MEDICAL EXPERTS Jordan Frank, MS, LAT, CSCS Mark B. Monahan, MD Baylor Rice, RPh, FIACP Eric Scott, MD Joy Sharma, MD Malcolm K. Sydnor, MD CONTRIBUTING PROFESSIONAL EXPERTS & WRITERS Susan Dubuque Tina Joyce Steve McClintic, Jr. Lynette Mutter Rick Piester 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 Our Health Richmond via U.S. Mail, please contact Jennifer Hungate at jenny@ourhealthvirginia.com or at 540.387.6482
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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor-at-Large: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Information in all print editions of OurHealth and on all OurHealth’s websites (www.ourhealthrichmond.com and www.ourhealthvirginia.com), social media sites and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2014 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Greater Richmond edition is published seven times annually by McClintic Media, Inc. 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthrichmond.com | www.ourhealthvirginia.com | Advertising rates upon request.
LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is Golfer’s Elbow? Medial epicondylitis, or more commonly known as golfer’s elbow, is an overuse injury involving the forearm muscle that attaches to the bony bump on the medial, or inside of the elbow. It is similar to tennis elbow except it is not as common. You do not necessarily have to play golf to develop this condition. Gardening, shoveling, throwing, or activities that require repetitive motions of the wrist and fingers may cause golfer’s elbow. Those affected by golfer’s elbow may experience tenderness and pain on the inner side of the elbow, which may spread down the forearm. Bending the wrist toward the palm and twisting the forearm down with force can increase the pain. Treatment of golfer’s elbow is usually non-surgical and includes rest, activity modification, ice, antiinflammatory pain medications, and therapy. It can also include cortisone injection to reduce pain. However, in some cases when nonsurgical treatment does not help, surgery is required. Joy Sharma, MD
Advanced Orthopaedics Richmond | 804.270.1305 www.advancedortho.me
What is Nephrolithiasis (Kidney Stone)? A kidney stone is a solid piece of material that forms in a kidney when there are high levels of calcium, uric acid, magnesium ammonium phosphates, or cystine in the urine. Up to 80 percent of stones pass on their own, causing little or no pain. Larger stones can block the flow of urine, causing severe pain. You should see your doctor if you have any of the following signs of a kidney stone: • extreme pain in your back or lower abdomen that won’t go away accompanied by blood in your urine; • fever and chills • nausea and vomiting. A CT scan is considered one of the best imaging techniques for evaluating kidney stones. Treatment for kidney stones usually depends on their size and whether they are causing pain or obstructing the urinary tract. The most common treatments are shock wave lithotripsy or ureteroscopy with laser. Kidney stones may be prevented by staying well hydrated and keeping urine production to at least 2 liters per day. Mark B. Monahan, MD Virginia Urology Richmond | 804.288.0339 www.uroc.om
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What is TIBC? Total iron binding capacity (TIBC) is a measure of the ability of the blood to transport iron, chiefly by the protein transferrin. This allows iron to be absorbed from food in the intestines and be transported through the blood to the bone marrow, where iron is used in red blood cell production. Typically, the TIBC test is ordered in the evaluation of anemia (a deficiency of red blood cells). One common cause of anemia is iron deficiency. If the body is iron deficient, more transferrin will be produced to allow more iron to reach the bone marrow. The TIBC is unlikely to be increased in most other causes of anemia. The TIBC can be increased or decreased in a number of other medical conditions. It is best to interpret the result in combination with other tests related to anemia, and by a physician who knows the patient’s medical history. Eric Scott, MD
Commonwealth Laboratory Consultants Johnston-Willis Hospital Richmond | 804.330.2372 www.clcpc.com
H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
What can be done to prevent exercise-related muscle cramps? Exercise related muscle cramps are a common condition found in both the recreational and competitive athlete. The cause of exercise-related muscle cramps is greatly debated and misunderstood. Dehydration/electrolyte imbalance and neuromuscular fatigue are two common theories thought to cause this condition. Dehydration can easily happen when exercise is performed in hot and humid weather. Exercise is intense and thus causes excessive sweating when fluid intake is not adequate before, during, and after exercise. Additionally, intense exercise can cause a decrease in sodium levels thus predisposing someone to muscle cramping. Drinking plenty of fluids throughout the day and especially before, during, and after your workout, is the best way to prevent muscle cramping. Jordan Frank MS, LAT, CSCS
Strength and Conditioning Specialist Graston Technique Provider ACAC Glen Allen | 804.464.0990 www.acac.com
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Why do medications have expiration dates? The expiration date on a drug stands for something, but probably not what you think it does. Since 1979, drug manufacturers are required by law to stamp an expiration date on their products. This date is the final day that the manufacturer guarantees the full potency and safety of a medication. These dates tend to be very conservative to ensure you get everything you paid for. It does not necessarily indicate a point at which the medication is no longer effective or has become unsafe to use. That being said, if the expiration date has passed for a medication that’s essential for a chronic or potentially life-threatening disease, it’s probably wise to get a new prescription once it has expired. If you have any questions about the safety or effectiveness of any drug, ask your pharmacist. He or she is a great resource when it comes to getting more information about your medications. Baylor Rice, RPh, FIACP
President South River Compounding Pharmacy Richmond and Midlothian 804.897.6447 www.southriverrx.com
How is sclerotherapy used in the treatment of small varicose and spider veins? Sclerotherapy is a minor procedure commonly performed to treat unsightly veins in the legs. Unsightly veins include tiny red 'spider' veins and larger bluish 'reticular' veins. When these veins are associated with much larger varicose veins, then there is likely underlying venous disease that can be diagnosed with ultrasound and should be treated first. When the unsightly veins are isolated, they can be treated with sclerotherapy, which involves placing a tiny needle into the individual veins and injecting a chemical to cause them to thrombose, or 'clot off'. They usually then fade away completely over a period of weeks to months. A variety of pharmaceuticals of different concentrations can be used and the injections usually cause minimal to no pain. It is important to stay out of the sun after the injections until the veins are completely gone to ensure the optimal cosmetic result. Malcolm K. Sydnor, MD
Medical Director of VCU Baird Vascular Institute Richmond | 804.828.2600 www.bairdvascular.vcu.edu
T H E
S E C O N D
A N N U A L
Vote for your favorite physicians and/or providers in more than 40 medical specialties by visiting
VOTING IS OPEN June
1s t ~ J u l y 1 0 t h 2 0 1 4
Winners announced in the December 2014 edition of
OurHealth
NEW
NOTEWORTHY
NEW PHYSICIANS, P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
HCA Virginia Announces Acquisition of Neurological Associates, Inc. HCA Virginia has recently acquired Neurological Associates, Inc., a full-range practice specializing in general and specialty neurological care. In addition to providing general neurologic care, specialists will continue to treat seizures, neuromuscular diseases, sleep disorders, neuropathy and neuro-ophthalmology and a full range of neuro-diagnostic tests and other treatments and services such as deep brain stimulation, an infusion center and sleep lab affiliates. “We have had a strong partnership with Neurological Associates for many years and are excited to have them join the HCA Virginia family,” said K. Singh Sahni, MD, chief of neurosurgery and medical director of JohnstonWillis Hospital’s Neuroscience & Gamma Knife Center. “This partnership will allow us to continue to provide Central Virginia with one of the best, most robust neurological and neurosurgical programs in the country.”
HCA Virginia includes more than 130 employed providers in Richmond and Spotsylvania combined. With offices located in Chesterfield and Henrico Counties, Neurological Associates, Inc. serves four hospitals in Richmond including Chippenham, JohnstonWillis, Henrico Doctors’ and Parham Doctors’ Hospitals. About HCA Virginia: As the commonwealth’s most comprehensive provider network, HCA Virginia Health System operates 13 hospitals and 30 outpatient centers and is affiliated with 3,000 physicians. It is one of Virginia’s largest employers, provides $365 million in uncompensated care and pays $72 million in state and local taxes each year. HCA Virginia includes 4 imaging centers, 6 outpatient surgery centers, one freestanding emergency room, and 7 hospitals – Chippenham, Henrico Doctors’, John Randolph, Johnston-Willis, Parham Doctors’, Retreat Doctors’ and Spotsylvania Regional.
Dr. Baxter Perkinson & Associates is now
Virginia Family Dentistry Name Change Reflects Team Approach to Dental Care
Dr. Baxter Perkinson & Associates has changed its name to Virginia Family Dentistry. The change reflects the practice’s growth in multispecialty dental care, and its expanded presence in Central Virginia today with 11 locations. “Our practice takes pride using a team approach in the care of each of our patients in all of our locations”, says founder W. Baxter Perkinson, Jr., DDS. “The group now consists of 45 doctors who spend hours of additional training to be at the forefront of dentistry.” “Virginia Family Dentistry is a perfect description of who we are,” according to Gil Roberts, CEO and practice administrator. “We’re a family of more than 300 dental professionals and staff who provide just about every procedure dentistry has to offer. And we focus on the family, from small children to mature adults. Our patients come from across Central Virginia and beyond. The name suits us very well.” Dr. Perkinson says that nothing but the name has changed. Services, the attention to detail and patientcentered dental care are still top priorities.
Colonial Orthopaedics Expands Colonial Orthopaedics is excited to be in the newly completed 25,000 square foot Southpark Center headquarters and the immediate impact it creates for their patients and community in Colonial Heights. In addition to an increase in space which will allow for the continuing recruitment of new providers, it also provides the latest in technology and an increase in efficiency to assure patients receive cutting edge care while enjoying a pleasant experience. This expansion and rejuvenation, however is not limited to just a new office. Colonial Orthoapedics has invested heavily in the latest in radiology, computer systems and software, and in staff training and education to retain their position as a orthopaedic leader. Colonial Orthopaedics is located at 13000 Rivers Bend Blvd., Suite D, Chester, VA 23836
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New Obstetrics and Gynecology Practice Opens in Richmond Wendy S. Bowman, MD, board certified in obstetrics and gynecology, is now accepting patients in her newly opened private practice, Alliance Women’s Health, located in St. Mary’s Hospital on Bremo Road in Richmond. Dr. Bowman serves all aspects of women’s health including infertility and family planning, high risk pregnancies, and menopausal management. She has been in private practice in Richmond for nearly a decade. For more information or to schedule an appointment, visit www. alliancewomenshealth.com or call 804.523.9200
Christa McQuate, MD Virginia Physicians, Inc. Midlothian | 804.379.9255
Rachael Monroe, MD Virginia Physicians, Inc. Midlothian | 804.379.9255
William Piscitelli, DDS Bon Secours Pediatric Dental Associates Richmond | 804.893.8715
www.OurHealthRichmond.com
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T I P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U
Fun Facts ABOUT SOME
FAVORITE
Healthy Activities: Walking: On average, every minute you walk extends your life by one and a half to two minutes.
Swimming: According to the Centers for Disease Control and Prevention, swimming is the second most popular sports activity in the United States.
Cycling: According to Bikes Belong, a bicycleindustry group, the health benefits of cycling are 20 times greater than the safety risks.
Zumba: Zumba was created in the mid1990s when fitness instructor Alberto “Beto” Perez went to teach a group aerobics class and forgot his music. He improvised, using the salsa and merengue tapes he had in his backpack, and a craze was born.
Jumping Rope: Jumping rope involves almost every muscle in your body.
be performed by people of
all age groups, and is helpful in offering an excellent workout, targeting all of the muscle groups of the body. It is a great
choice for those who suffer from arthritis or multiple sclerosis (MS). The buoyancy of the water assists in supporting body weight, and reducing impact on joints. Water aerobics provides additional health benefits: • Strengthens muscles
Yoga: Yoga is thought to have started in India approximately 5,000 to 6,000 years ago.
• Aids in weight loss
Weight Training: Free weights build
• Reduces impact on joints by up to 90%
muscle mass faster than weight machines. That’s because your muscles must balance free weights on their own, without assistance from the machine. Source: An excerpt from an article on www.everydayhealth.com by Beth W. Orenstein Medically reviewed by Farrokh Sohrabi, MD
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Water Aerobics can
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• Improves range of motion • Reduces risk of injury
• Improves flexibility • Improves cardiovascular endurance
Stressed Out
‘Laughter is the best medicine’ as the old saying
at Work? L O L
goes. One of the reasons that it is so good for you is because it is a very effective way of reducing stress. It has been reported that the average person laughs out loud 17 times a day, but people under stress probably laugh a lot less - so you need to change that.
h (Laug
out L
Make a joke of the stressful
situation and laugh about it with oud)!
your colleagues if you can. That will help to build your working relationships as well as relieving everybody’s stress. Or if that is not appropriate, view one of the top 10 funny videos on YouTube, or keep a book that you find hilarious in your desk. If you feel that there is no way that you could laugh right now, then smile. Fake a smile if you need to. It will make you feel better and reduce the tension for everybody.
Summer Hydration
Tips for Workouts
Know the signs. How can you tell if your body is well-hydrated? If your urine is pale, and you require a restroom break at least six times a day, you are probably doing a good job.
Stay hydrated with water during moderate exercise. For a
support your local farmer’s market!
17th Street Farmers Market
moderate hour-long workout, you should consume 4 to 6 ounces of water for every 15 minutes of exercise. If your taste buds need a change of pace every so often, seek out a low-calorie sports drink or sugar-free flavored water option—or add a slice or two of lemon or lime to your water bottle.
Located at the corner of 17th & Main Streets For that special Farmers’ Market blend of coffee or tea, the crusty breads, the homemade goat cheeses, the aromatic and culinary herbs or the colorful displays of fresh local fruits and vegetables, the Farmers’ Market is the place to be. And don’t be surprised if there is conversation or music in the air to sweeten the day! For more information, including upcoming events, visit www.richmondgov.
com/FarmersMarket/History.aspx
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Get a head start on hydration. If you are an early morning exerciser, keep in mind that your body is already in a somewhat dehydrated state when you wake up. Be sure to drink at least 8 ounces of water before you begin your workout.
Consider drinking a sports drink. If you exercise for longer than 60 minutes at a high intensity, or you work out in extreme conditions, consider using a sports drink during and after your workout to replenish your body with the fluid, nutrients and electrolytes it requires. There is a true science behind fluid replacement during exercise, and sports drinks are formulated to meet the needs of athletes.
Beware of energy drinks.
Popular energy drinks are very different from sports drinks. They are full of caffeine and sugar, and can be dehydrating instead of thirst-quenching.
The Anatomy Challenge is proudly sponsored by
the
Anatomy CHALLENGE
Here’s your chance to see how much you know ______________
about the knee! First, find all the hidden words in the word search below. Next, match up the
______________
correct word with the part of the body in the
______________
illustration.
[ the knee joint ]
WORD SEARCH
______________
femur
bursa
synovial membrane
patella
synovial fluid
patellar tendon
meniscus
tibia
articular cartilage
______________
______________
fibula quadriceps muscle fat
______________ ______________
______________
______________
______________
______________
With 12 Offices, including Three After Hours Locations to serve you. For a physician appointment, please call 804.915.4602. For a therapy appointment, please call 804.285.2645. Chippenham | Hanover Memorial Regional | Henrico Parham | Johnston-Willis Prince George | St. Francis | St. Mary’s | Emporia | Farmville | Kilmarnock | New Kent After Hours Hanover | After Hours St. Francis | After Hours St. Mary’s www.OurHealthRichmond.com
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easing the
IMPACT of arthritis words | RICK PIESTER
Turning a doorknob. Flicking a light switch. Shaking hands. Blowing a kiss. Most of us can do these kinds of things without really thinking about it. But people who struggle with arthritis think about those kinds of things a lot, if they can do them at all. Arthritis is much more than the normal aches and pains of advancing age. It’s actually something of an umbrella term, covering about 100 different diseases and conditions of the joints. And it’s not just a disease of old age. According to the Arthritis Foundation, approximately two-thirds of people who have arthritis are under the age of 65. And 300,000 children have arthritis. It’s a serious health problem that is growing more ominous as more and more people live longer lives. Put together, the different forms of arthritis cause more inactivity than heart disease, cancer, or diabetes; and inactivity leads to expanding health problems. It’s the single leading cause of disability in this country, and it places a growing burden on the county’s economy and its health care system. More than 50 million people in America have arthritis now, and forecasts are that the number will grow to 67 million in the next 15 years. Arthritis shows itself in many kinds of ways, and at all ages. Ed Carley, for example, noticed during his mid-40s that he was having trouble maintaining a handgrip on things. “In a previous job, I was doing a lot of classroom training,” the Midlothian resident says, “and I had a lot of trouble holding on to teaching aids. It seemed I was dropping silverware a lot. The grip just wasn’t there. There was also a general stiffness. My joints didn’t seem to be working well.” Playing golf (he calls the game “one of the great joys in my life,”) became so painful that he eventually had to quit. He inherited from his father the love of making 20
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models. But he found over time that he was unable to handle the small tools that he used to craft the model planes and cars. He now feels he also inherited from his family a tendency for arthritis: “My maternal grandmother had arthritis badly, and I saw my dad go through some of the same things that I experienced.” A trip to his family doctor resulted in a referral to orthopaedist Andrew M.I. Bogle, MD, a member of the staff of OrthoVirginia who specializes in arthritis of the upper extremities. “Arthritis is serious, but it’s not a death sentence,” Dr. Bogle notes. “Medicine has made a lot of advances in recent years to learn about arthritis, and to understand how to lessen the impact it makes on the lives of people who have it.” Dr. Bogle, along with most physicians who treat a lot of people with arthritis, sees more patients with osteoarthritis than any other variety of the disease. It’s the most common form of arthritis. Although medicine doesn’t yet fully understand the cause of osteoarthritis — sometimes called “OA” and also ”wear and tear arthritis” — the name refers to the gradual wearing down of cartilage, the material that cushions and serves as something of a shock absorber between the ends of bones in your joints. As the cartilage wears down, the unprotected bones tend to rub against each other, causing pain that can be excruciating, stiffness, and loss of movement in the affected joints. Osteoarthritis can damage any joint in the body, but it most commonly affects joints in the neck, hands, lower back, knees and hips. Symptoms of osteoarthritis are rather classic: pain in the affected joints, sometimes accompanied by redness or swelling. Ed Carley’s difficulty in gripping and holding objects is another classic symptom of osteoarthritis, as is stiffness in your joints, especially in the hips, knees or lower back. Common risk factors for arthritis include age (although it’s not uncommon for arthritis to start showing up in the 30s or 40s in some people,) gender (it’s more
Osteoarthritis: Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease. The name refers to the gradual wearing down of cartilage, the material that cushions and serves as something of a shock absorber between the ends of bones in your joints. As the cartilage wears down, the unprotected bones tend to rub against each other, causing pain that can be excruciating, stiffness, and loss of movement in the affected joints. common in women than in men), and previous injury to joints. When it’s injured, cartilage doesn’t heal well, and once it’s injured, it is seven times more likely to develop arthritis. Even torn ligaments and strains — along with fractures and dislocations — can dramatically increase the risk of osteoarthritis. In fact, roughly half of the people who suffer this type of injury develop arthritis. Lifelong amateur athlete Joe Thomas fits in this category. An avid rugby player, he took a hard hit from the side about 15 years ago and not long after noticed that he was having trouble with his knees and finding it difficult to walk. Like Ed Carley, Joe Thomas found it too painful to play golf, finding that he was unable to walk from the cart to the green by the time he reached the 11th or 12th hole. Now in his late 50s, Joe has had surgery to replace both knee joints. The surgery came well into his treatment by Richmond-area orthopaedist Anthony J. Shaia, MD. For years, Joe Thomas has resisted surgery, opting instead for antiinflammation medicines and cortisone shots to ease the pain in his knees. Cortisone is a powerful antiinflammatory medication
Andrew M.I. Bogle, MD is an orthopaedic surgeon at OrthoVirginia. His expertise is in hand, wrist, elbow and microsurgery and he specializes in general orthopedics and hand and upper extremity issues. Dr. Bogle sees patients in the St. Francis office of OrthoVirginia.
Anthony J. Shaia, MD is an orthopaedic surgeon at OrthoVirginia. His expertise is in total joint replacement and he specializes in joint replacement, occupational medicine, and shoulder issues. Dr. Shaia sees patients in both the Henrico and Parham offices of OrthoVirginia. www.OurHealthRichmond.com
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Rheumatoid Arthritis:
Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated. And his knees seem to be fine. Joe makes the bulk of his living in insurance sales, but as a sideline refinishes hardwood floors, something that is traditionally tough on knees. But he says that although he still has some “tough” days because of his arthritis, his knees have so far been trouble-free. The jury seems to be out on whether prolonged participation in certain sports leads to arthritis. One thing that is clear, however, is that regular exercise is important to overall health and preventing many illnesses, and it can help ease the pain and stiffness caused by many forms of arthritis. And weight control is almost universally cited as an important factor in both avoiding and treating osteoarthritis. “Excess weight plays a big role in the onset of arthritis,” Dr. Shaia notes, “as well as with the acceleration of arthritis.”
Ed Carley of Richmond, while traveling with his son in 2013
that is injected into areas of inflammation. It relieves joint pain by acting to diminish joint inflammation. “But each cortisone shot seemed to bring relief for less and less time,”Joe says, “and knee replacement was really the only option left.” Dr. Shaia replaced both knee joints on the same day. Joe chose that approach, he says, because “I thought it was better to go through rehab once than to have to do it twice.” With the surgery now well behind him, he says that he still has some arthritis pain in his lower back, but has so far staved of the need for cortisone injections.
The root cause is still a bit murky, but excess weight is an almost universal common factor in many people who have arthritis. Weight bearing joints — such as the hips, knees, ankles — must endure pounds that they are not really designed for. According to the Arthritis Foundation, each extra pound you gain adds nearly four pounds of load to your knees, and each pound increases the stress on your hips nearly six-fold. The cartilage that cushions the joints takes a beating, and it can break down over time. There’s another problem when you are overweight: fat tissue produces proteins — cytokines — that promote inflammation. In the joints, cytokines destroy cartilage tissue. With weight gain, your body makes and release more cytokines that will alter the function of cartilage cells and reduce the cartilage.
Ed Carley now recognizes that his weight may have been a prime factor in his arthritis. He says that he was once “way overweight,” but he has since lost about 120 pounds, most of the loss induced by the medications he had been taking for his diabetes. He feels that the weight loss has helped to reduce the effects of his arthritis, along with medications he takes to counter pain and inflammation, and exercises he’s learned to reduce the impact of his disease. Osteoarthritis is not the only form of the disease. Much less common, but in many ways more alarming, is rheumatoid arthritis. Commonly referred to as “RA,” rheumatoid arthritis is a disease of the body’s immune system. It’s the body attacking itself.
of men. It usually shows up between the ages of 40 and 60, but it can begin at any age. The good news with RA is that it’s no longer a “take no prisoners” disease. Where it was once almost a guarantee of a life spent in a wheelchair or worse, earlier diagnosis and vastly improved treatment has put the absolutely crippling aspects of RA largely in the past. “The thing to remember,” Dr. Shaia notes, “is that the goal of arthritis care is not simply to cope; it is to relieve pain and to keep people moving, active, and leading better lives.”
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The body’s immune system normally protects us from infection by attacking invading viruses and bacteria. Science doesn’t fully understand what happens, but in some cases the immune system goes off-track, and it starts to attack the body’s healthy cells, such as the synovium, a thin membrane that lines the body’s joints. Fluid builds up in the joints — most commonly the hands, feet wrists, elbows, knees and ankles — and causes inflammation and pain, which can in turn erode the protective cartilage and the bone it protects. The inflammation often becomes systemic, also affecting the skin, heart and lungs. As a result, many people with RA feel extremely fatigued and sick all over. Their appetite disappears; they lose weight or run a low-grade fever. RA is usually more difficult than osteoarthritis to diagnose. Where OA can usually be detected by x-ray, diagnosing RA is more often a process of medical history, physician examination, and a battery of laboratory tests. The Arthritis Foundation estimates that about 1.5 million people in the U.S. may have rheumatoid arthritis, with women affected at three times the rate
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men and health
words | TINA JOYCE
Coaches Who Practice what they Teach Study the opponent. Recognize your weaknesses. Practice to become better. For Virginia Commonwealth University's Shaka Smart, Liberty University's Dale Layer and Virginia Tech's Frank Beamer, this philosophy is not only one each applies on the court or field, but also in their lives. There are many seasons of a man’s life, but few are as clearly defined— or judged—as sports seasons. Games are played, scores are tallied and seasons are completed. In the end, both fans and critics are left to determine whether the particular game or the entire season is considered a success. Many people are evaluated, in some way, in their respective jobs. However, very few professions are so highly publicized that the general public can assess the outcome of an appearance based on the ticker, the message bar that is continuously scrolling at the bottom of the television screen providing scores and athletic-related updates.
Reprints To order reprints of the original artwork featured on this issue’s cover, contact Jenny Hungate at 540.387.6482 or via email at jenny@ourhealthvirginia.com. To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com
In the collegiate coaching profession, there are many factors that can adversely affect coaches’ health. What the ticker fails to reveal is these coaches are often husbands, fathers, brothers—and always sons. The ticker displays the score, but their health reflects their lives. Due to the stress of the profession and the demanding schedule, coaches’ proactive attention to their health is vital. They owe it to their families to recognize the importance and need to balance their own emotional, physical and spiritual health throughout the athletic season and through the seasons of their lives. OurHealth was granted a glimpse inside the lives of three of the area’s top collegiate coaches: Shaka Smart, Virginia Commonwealth University's (VCU) head basketball coach, Dale Layer, Liberty University's (LU) head basketball coach, and Frank Beamer, Virginia Tech's (VT) head football coach. Each coach graciously answered questions about life in and outside of sports. www.OurHealthRichmond.com
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OH: Was there a particular season in your life you found it difficult to stay physically healthy? Why? Coach Smart: Anytime you change jobs, it can be difficult to stay healthy because your daily routine is broken. In those situations, you’re usually running around trying to do so many things at once that you’re probably not eating healthy and you’re probably not able to work out much. OH: In your profession, moving to a new location can happen throughout your career. What advice would you offer men to help balance both their physical health and emotional health when transitioning their family? Coach Smart: You just have to make sure you make it a priority to work out and eat right. If you don’t make it a priority then it’s easier for other things to supersede those things. If you wake up in the morning and say, “I’m going to work out today, I’m going to eat right”, then you’re more likely to stay on track. The bottom line is, you have to plan. If you don’t plan, then other things will take over. OH: What was the primary deciding factor in your choosing to accept the VCU Head Men’s Basketball Coaching position? Coach Smart: It was a no-brainer really. It was an unbelievable opportunity for my wife and I. It’s a great university, in a great community, with a great tradition and overwhelming support from the fan base and community. OH: What is the most stressful aspect of the collegiate coaching profession? Coach Smart: Probably the demands on your time. Trying to balance that demand with time with your family, all when you are running on a lack of sleep. OH: What is the most rewarding aspect of your profession? Coach Smart: Being able to develop our players in all aspects of life. OH: What is the most misunderstood aspect of the coaching profession? Coach Smart: Obviously, we’re judged by our wins and losses, but for most of us, that’s really not why we are coaching. We want to see our players develop as people, and be successful in all aspects of their lives. OH: Have you ever had a “gut check” scare – a time when you thought you might be facing a serious health decision and you felt you had to make a health-related change in your lifestyle? Coach Smart: Fortunately, I have not. OH: Was there a particular season in your life where you have felt a healthy balance emotionally, physically and spiritually? What contributed to that balance? Coach Smart: I’m still working toward being able to balance all those elements. It’s all about being able to plan and prioritize. OH: What advice would you give other men that might help them jumpstart a healthier lifestyle despite the rigors of a very demanding profession? Coach Smart: Plan and set your priorities. Decide how you’re going to eat. Decide how and when you’re going to work out and make sure you follow that plan. 26
OurHealth | The Resource for Healthy Living in Greater Richmond
Shaka Smart, Head Coach
Virginia Commonwealth University
Basketball
www.OurHealthRichmond.com
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Frank Beamer, Head Coach Virginia Tech
Football
OH: Was there a particular season in your life you found it difficult to stay physically healthy? Why? Coach Beamer: The 2012 season. Beginning in February 2011, I made an effort to lose weight, and I successfully reached 183 pounds. When we started our 2012 season with a record of 4-6, I found myself not eating and sleeping. As a result, my weight dropped to 168 pounds, which was my college weight. I didn’t mean to lose that extra 15 pounds.
OH: Have you ever had a “gut check” scare – a time when you thought you might be facing a serious health decision and you felt you had to make a health-related change in your lifestyle? Coach Beamer: My biggest scare has been with my heart. Having some blockages and knowing the seriousness of that made me realize I need to change my way of eating and living.
OH: What is the most rewarding aspect of your position?
OH: What advice would you give other men that might help them jumpstart a healthier lifestyle despite the rigors of a very demanding profession?
Coach Beamer: Seeing a young person come in as a freshman and trying to influence him in a positive way. The end results, which are so different from the beginning, are very rewarding.
Coach Beamer: Take time to take care of yourself. It all starts with sleeping and eating, but taking time to [exercise] during the day is important, as well. I’ve found that I make better decisions when I am in a healthy state of mind. www.OurHealthRichmond.com
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Dale Layer, Head Coach Liberty University Basketball OH: What is the most stressful aspect of the collegiate coaching profession?
OH: What is the one thing you hope your players, leaving your program, remember you taught them?
Coach Layer: There is significant stress in meeting the demands of winning, while treating the people around you in a way that would represent Christ.
Coach Layer: I want them to know that a relationship with Christ matters. It should influence every aspect of any profession, under any amount of stress.
OH: What is the most rewarding aspect of your profession?
OH: What advice would you give other men that might help them jumpstart a healthier lifestyle despite the rigors of a very demanding profession?
Coach Layer: I find great reward in seeing young men mature, improve, graduate and become successful workers, husbands and fathers. OH: Was there a particular season in your life where you have felt a healthy balance emotionally, physically and spiritually? What contributed to that balance? Coach Layer: There are times during the stresses of a season that I feel in balance and times when I do not. Eating and exercising definitely help. Spending time reading inspirational books, including the Bible, help. Seeking counsel from those who can give you fresh ideas and perspectives also helps. 30
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Coach Layer: Find a physical, emotional and spiritual routine. Routine is important. Feed your body, soul and mind with good food, exercise, wise counsel and God’s Word. I am in need of all of it—all the time.
ON THE WEB
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UROLOGY
Michael Franks, MD Virginia Urology | 804.288.0339 www.uro.com
Prostate Cancer is a common cancer found in men. A digital rectal exam and the PSA blood test are necessary for clinical evaluation of prostate cancer. It is recommended that men ages 40-50 talk to a urologist about their risk of developing prostate cancer and get a baseline exam and PSA test. African American men and those with a family history are at increased risk and should be followed regularly. American Urologic Association guidelines also feel men 55-69 should have a prostate exam & PSA test every 2 years, with a PSA >3 ng/dl being abnormal. Lastly, only those men with good health and 10-year life expectancy should consider screening evaluation.
UROLOGY
Jean Calhoun, MD Dominion Dermatology | 5201-A Hickory Park Drive – Glen Allen 804.262.6060 | www.DominionDermatology.com
Skin cancer is very common in Richmond. Bald scalps, ears, arms and face are the most common areas. These should be treated early to avoid disfigurement. Premalignant lesions called actinic keratoses can be treated to prevent skin cancer. Any lesion that is new or changing should be checked by a dermatologist. In addition, cosmetic concerns are often brought up by men including their appearance as they age. Some want to look “less” old and others feel their appearance on the job matters. There are many brands of “BOTOX.” Men are increasingly taking advantage of this product to decrease lines/wrinkles and that “angry” look when deeper lines between the eyebrows appear. Numerous fillers are available to fill in deeper frown lines. Brown spots on the back of the hands can be removed with lasers. And if you are a patient developing red round bumps on the face, back, neck or torso, these can now be removed with a laser without scarring.
DERMATOLOGY
Patrick Ryan, OD Ryan Vision Center | 3410 Pump Road – Henrico 804.364.1837 | www.ryanvisioncenter.com
There are many different options to consider for this change. Glasses, contacts or even LASIK may be an option for this gradual loss of focus up close (farsightedness). These years are when the greatest changes to sight occur. Exams once a year past 60 is suggested because of the many eye health related conditions that may also occur with increased frequency as we age. These conditions include glaucoma, cataracts, dry eye syndrome and macular degeneration. It is helpful in most cases if these are caught early as the treatment outcomes are more promising.
Presbyopia or the need for reading glasses is the reasoning for exam frequency increases as we age.
An exam at 30, 35 and 40, then every 2 years in your 40’s through age 60.
As we age, it is important to maintain good eye health. A base line eye exam is recommended at age 20 to 25. This will establish the baseline acuity, i.e. how clear you see and equally important, to establish if there are any general eye health issues that should be tracked at a more frequent rate. If that exam is normal in all areas, particularly eye pressure and with no significant correction then the frequency should be as follows:
OPTOMETRY
CHART FOR HEALTHY AGING
MEN’S
ORTHOPAEDICS
GASTROENTEROLOGY
DERMATOLOGY
OPTOMETRY
Exercise can make bones stronger and help slow the rate of bone loss. Practice muscle-strengthening activities. Balance and coordination exercises, such as Tai chi, can help reduce the risk of falls. Physical activity in later life may delay the progression of osteoporosis. Weight-bearing exercise, such as walking or weight training. Stretching is another excellent way to help maintain joint flexibility.
Vivek Sharma, MD Colonial Orthopaedics | Chester and Colonial Heights | 804.518.1300 | www.colonialortho.com
»» »» »» »» »» »»
Preventative tips for bone and joint health:
Ligaments, which bind joints together, and tendons, which bind muscle to bone, tend to become less elastic, making joints feel tight or stiff. Thus, most people become less flexible. Ligaments tend to tear more easily and heal more slowly. These changes occur because the cells that maintain ligaments and tendons become less active.
The cartilage that lines the joints tends to thin, partly because of the wear and tear of years of movement. The surfaces of a joint may not slide over each other as well as they used to, and the joint may be slightly more susceptible to injury. Damage to the cartilage due to lifelong use of joints or repeated injury often leads to osteoarthritis, which is one of the most common disorders of later life.
As we age, the structure of bone changes and this results in loss of bone tissue. Low bone mass means bones are weaker and places people at risk of breaks from a sudden bump or fall.
ORTHOPAEDICS
S. Mubashir A. Shah, MD Richmond Gastroenterology Associates | 8262 Atlee Road, Suite 202 Mechanicsville | 804.559.6194 | www.RichmondGastro.com
Colorectal cancer is the second leading cause of cancer death in the U.S. Most men should be screened for colorectal cancer at age 50 and every 10 years thereafter. African Americans need early screening at age 45. Proper screening may prevent cancer because we often find polyps before they turn into cancer. A screening colonoscopy offers the most thorough and complete examination of the entire colon and is the only screening option that allows us to immediately biopsy/remove polyps completely. We offer a painless colonoscopy experience for our patients. Please call us to learn more about this important screening test.
GASTROENTEROLOGY
FITBITS
H EA LT H A ND F I T NES S O N T H E G O
ABSolutely Awesome Abs!
The summer season is upon us! Now is the time to work on ‘summer-ready’ abs. These three exercises are great for shaping and strengthening the abdominal area. These exercises require no equipment, and, can be done anywhere — even on vacation!
#3. Forearm Plank
#2. Bicycle Crunch
1. Lie on your stomach on the floor. 2. Place legs about hip-width apart, flex your feet and tuck toes under so the balls of your feet press into the floor.
How to properly perform a bicycle crunch:
3. Bend elbows and place forearms on the floor, facing palms toward each other and make your hands into fists.
1. Lie on your back, bend your knees, placing your hands gently behind your head for support This is the same setup as for the basic crunch
4. Tighten your abdominals, look down at the floor and keep your back straight -- imagine pulling your navel to your spine.
2. Lift your shoulder blades about six inches off of the ground, resting your weight on your lower and mid-back.
#1. Basic Crunch
3. Extend one leg straight out from your body, six inches off of the ground.
4. Extend the other leg upward, bending at the knee with your thigh extended up from the mid section.
How to properly perform a basic crunch: 1. Lie on your back, bend your knees, placing your hands gently behind your head for support.
5. Begin the exercise by bringing the knee towards the chest and extending the opposite leg straight out. At the same time, bring the shoulder opposite the bent knee across your body towards your knee. Both should meet at your chest, right knee and left elbow or left elbow and right knee.
2. Contract your abs and flatten your lower back against the floor. 3. Slowly lift your shoulder blades one or two inches off the floor. 4. Exhale as you lift, keep your neck straight and chin up. 5. Hold for a few seconds (don’t hold your breath).
6. Reverse the process by straightening the bent knee and bringing the opposite knee up, meeting it with the reverse shoulder.
6. Slowly lower while keeping your abs contracted.
7. Repeat up to 20 reps (right/left equaling one rep), keeping good form.
7. Repeat up to 20 reps, keeping good form.
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Tip: Be sure not to pull on head or neck. Focus on lifting shoulders each time, while keeping abdominal muscles contracted.
OurHealth | The Resource for Healthy Living in Greater Richmond
Tip: Be sure not to pull on head or neck. Focus on lifting shoulders off the ground each time, and think about bringing opposite knee toward shoulder, keeping elbows wide and abdominal muscles contracted.
How to properly perform a forearm plank:
5. Contract your glutes and legs and lift your hips and thighs off the floor. Avoid pushing your hips up too high or letting them sag to the floor -- your body should form a straight line from your head to your feet. 6. Breathe normally and hold this position for up to 30 seconds. If you feel pain or can’t maintain perfect form, lower yourself to your knees and relax your muscles.
Tip: Attempt to keep back as straight as possible, us a mirror if available. Keep shoulders relaxed, and, drop to knees for a modified version, keeping toes on ground.
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 Richmond
, don t worry...
be healthy! Tips and Twists in the Pursuit of Happiness Happiness Defined:
words | LYNETTE MUTTER
• good fortune; prosperity • a state of well-being and contentment; joy • a pleasurable or satisfying experience Although the first known use of the word “happiness” debuted in the 15th century, we have likely been on a quest for more of it since the dawn of time. The word is believed to be derived from joy, akin to the Greek word for rejoice. Throughout the ages, we have sought success and wealth and surrounded ourselves with stuff, yet often sustained happiness has eluded us as time takes its inevitable toll on our lives and our health. It is widely accepted that “Laughter is the Best Medicine.” Research has shown that frequent giggles and guffaws can help lower stress levels. And this is important. Chronic stress can weaken our immunity and increase inflammation in the body, setting the stage for heart attacks, colon cancer, Alzheimer's and a host of other diseases. Intervening in the inflammatory process might even reverse some of the effects of diabetes. And there's more.
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Laughter FACT!
one good BELLY LAUGH burns about 3.5 calories!
Laughter FACT!
the
sound of LAUGHTER isn't associated with any one language
Happy = Healthy? In recent years, the topic of the health and happiness (or emotional resilience) connection has been thoroughly explored and medically proven, but other recent research findings may surprise you: • There is a 50% genetic component to the happiness equation: people who are not excessive worriers, and who are sociable and conscientious tend to be happier. This personality mix can act as a buffer when bad things happen, according to UK and Australian psychologists. So give yourself a little break if you aren't as happy as you want to be, and still be encouraged that you do have control of about 50% of your happiness factor. • The relentless pursuit of happiness might be counter-productive. Pleasure and feeling positive can be fleeting, and is far less important than the well-being that comes from doing something meaningful. New evidence from a University of Wisconsin Study suggests that people who focus on a sense of purpose as they age are more likely to remain cognitively intact and have better mental health. So, as we are mindful that the pursuit of purpose is as important as the hunt for happiness, there are some cool tools to guide our journey of discovering exactly what contributes most to our well-being, and how to nurture those aspects of our lives.
Laughter FACT!
In Groups, Women en Laugh More Than M
The Happy Challenge Maybe you need a convenient technology tool to help increase the joy in your life? Consider taking the 100happydays.com challenge, during which you pledge to submit a photo of something that made you happy that day. You can pick your platform – post it on Facebook, Twitter or submit on myhappydays@100happydays.com. Sounds simple enough, right?
As it turns out, 71% of the people who tried to complete the challenge didn't, citing “lack of time” as the main reason. Think about this a minute... are you someone who equates being busy to being important – and are proud of your super-packed schedule? As life passes swiftly by, we are losing time to just enjoy the moment. Could stopping to reflect on the now be a key to living on purpose and longterm happiness? Some of the things people who did complete the 100happyday challenge reported were: • more self-awareness about what makes them happy • being in a better mood and more optimistic • appreciating their good fortune to have the life they have
Happy Habits But if the word “challenge” and “happiness” don't mesh in your world, check out The Happiness Project, Gretchen Rubin's book and blog on her “daily adventures in the pursuit of happiness and habits” where she uses technology and social media to engage and create discussion about this hot topic. With a background in law, the heroine of happiness takes well-researched intellectual ideas from business, novels, science and ancient philosophers and translates them into practical solutions or happiness habits.
For instance, Gretchen recommends that you: • “Fake it till you make it” – just smiling and acting happy will have a positive effect on your emotions and your day. 38
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• Take baby steps – come up with short-term strategies that can be celebrated, giving you a feeling of accomplishment along the way to well-being. • Before you resort to venting and spewing the negative, bite your tongue – Mom was right after all. If you don't have anything good to say, don't say anything at all. • Get up an hour earlier and minimize the clutter in your home – clutter=chaos, which is not a formula for inner peace • Keep an easy diary – just one sentence is enough. Write more if you feel inspired, but keep it simple. No need to overwhelm yourself. Bonnie Ware, a palliative care nurse who shares the final days of her dying patients, wrote a wellcirculated article and then a memoir about how her own life was transformed by their regrets. The five most common themes when asked if they had any regrets were: • Lacking the courage to fulfill their dreams, often because of the expectations of others. • Wishing they hadn't devoted so much time to their work life and had spent more time with their children and mate. • Wishing they had the courage to express their feelings, rather than suppress them to keep the peace. Never experiencing their full potential led to a mediocre existence, and the bitterness and resentment many felt as a result led to illness. • Not nurturing friendships and letting them slip away. • Last but not least: They wish they had let themselves be happier. Many of Bonnie's patients did not realize until the end that happiness was a choice and they stayed stuck in the comfort zone of old patterns. “Fear of change had them pretending to others, and to their selves, that they were content. When deep within, they longed to laugh properly and have silliness in their life again,” says Bonnie.
“Life is a choice. It is YOUR life. Choose consciously, choose wisely, choose honestly. Choose happiness.” —Bonnie Ware ON THE WEB
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What Makes You Happy? 10 activities to jump-start your journey
Laughter FACT!
Most People can't laugh on command
Get outdoors! Take advantage of great weather and
fresh air. Go for a walk or hike. Visit the James River Park System in Richmond. Whether you prefer a stroll in the park, a lengthy trail run or a mountain biking work-out, there are JRPS trails to suit you. Visit their website at www.jamesriverparksystem.org for more details.
Eat healthy. Richmond offers great seasonal fresh fruits and vegetables. Visit the
historic 17th Street Farmer’s Market in Downtown Richmond, and experience the local flair while stocking up on fresh fruit and veggies!
Enjoy time with friends. The Richmond Region is brimming with seasonal events and activities. Grab some friends and ample Virginia wines at the Virginia Wine Expo, release your inner child at the Henrico Kite Festival, enjoy world-class musicians at the Richmond Jazz Festival, relive life in colonial America at Publick Days or watch boats race down the James River at the Dragon Boat Festival. No matter what time of year, there's always a festival to be found in the Richmond Region!
Read a book. Looking for a unique book experience? Check out Chop
Laughter FACT!
Healthy People laugh
100 to 400 times a day! That's about 2,800 times a week or 146,000 times a year.
Suey Books, and go on a ‘Blind Date with a Book’. In between books? With an okay-for-now book, but still looking? Seeking true love? Or maybe just a little somethin' on the side? Chop Suey Books puts titles through a rigorous personality analysis, and are ready to blindly mingle. Browse their descriptions, then take a chance! You never know how love might find you. Visit their website at www. chopsueybooks.com for more information, and for the calendar of events that include book signings by local authors.
Be decadent (with dessert).
Looking to satisfy your sweet tooth? Shyndigz dessert café in the Fan District is Richmond’s award-winning dessert café. Enjoy a sweet evening and chose from their selection of cakes, pies, cobblers and more. Treat the whole family, and bring something home from the to-go menu. Visit their website at www.shyndigz.com for their full menu of sweetness.
Go for a run.
The Richmond area is host to a variety of 5K’s, 10K’s, half and full marathons. The Sports Backers organize five different training programs to encourage walking and running at more than 30 locations around the region to prepare individuals for events ranging from 4 miles up to a 26.2 mile marathon. Visit their website at www.sportsbackers.org for more information.
4-legged friends. There are four off-leash dog parks in Richmond. Take your ‘best friend’ out for an afternoon of exercise and fun! Visit www.bringfido.com and search for dog parks in Richmond.
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OurHealth | The Resource for Healthy Living in Greater Richmond
!
Laughter FACT
Attend a sporting event. Attend a Richmond Squirrels
e Gelotology is th & study of humor laughter
Laughter FACT!
to LAUGHTER is said S, improve ALERTNES CREATIVITY and MEMORY
baseball game or check out the Washington Redskins during their spring training. Game information, ticket prices and special events for the Squirrels can be found on their website www.squirrelsbaseball. com The Bon Secours Washington Redskins Training Center is home to the Redskins Spring Training Camp. Admission is free for all fans. Visit the Redskins website at www.redskins.com for the upcoming Spring Training Camp schedule and additional details.
Get your workout on. Fitness trails are a great way to get a workout in,
while enjoying the outdoors. Richmond is home to 3 parks that offer fitness trails that incorporate trail walking/running with various exercise stations. Each station includes exercise instructions. Fitness trails are located at Byrd Park, Canon Creek and Pine Camp Arts and Community Center.
Create a masterpiece! Art can be a great stress reliever and source of
happiness. Unleash your inner artist at Spirited Art in Richmond. They offer adult classes as well as special events such as Laugh. Sip. Paint! Visit their website at www.myspiritedart.com/ richmond for details on their studio, programs and event calendar.
ON THE WEB
More at ourhealthrichmond.com
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Breaking the Silence
Essential Tremors words | SUSAN DUBUQUE
This series will explore medical conditions that are not well known— disorders that may affect many people yet no one is talking about them. That is, until now. We will bring these “orphan diseases” into the light, and dedicate these stories to the courageous people living with them and the providers and researchers who commit their lives to treating and seeking cures for these enigmatic conditions.
All she ever wanted to be was a nurse. Caring for people was far more than a job—it was her calling. But after practicing for a number of years, Teri Yeatts
“At first I thought it was just nervous energy. After all, I am an ADDtype person,” recounts Teri. But over time, the shaking began to notice a trembling in her fingers.
intensified and began to interfere with her life and her career. “My tremors got so bad that I could no longer draw blood or give shots.” A physical and neurological evaluation confirmed that Teri’s trembling hands were more than nerves—and she was diagnosed with essential tremor. Still committed to nursing, Teri shifted to working in a hospice and as a wellness coach. For nearly 20 years, Teri tried to manage her condition with medication. But by 2011, she was on massive amounts of Inderal—roughly six times the typical dosage. Still, her tremors became progressively worse. Teri began working in her husband’s family medicine practice. “But by this time,” says Teri, “all I could do was call in test results and council diabetic patients.” 42
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Now that Teri’s ET is under control, she can resume one of her passions—travel. In February 2014, she and her husband enjoyed a trip to Israel
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Teri Yeatt’s husband Don was her biggest source of support when she made the decision to try DBS surgery.
One of Teri’s neurologists, Matthew Boyce, MD, Neurological Associates of HCA Virginia, suggested a more aggressive approach to treatment—deep brain stimulation (DBS). DBS uses a surgically implanted device to deliver electrical stimulation to the part of the brain that controls movement, blocking the signals that cause tremors.
Teri “Grammy” Yeatts’ biggest thrill following successful surgical treatment for ET was to be able to safely hold her new granddaughter Lily.
“This was a huge decision,” recalls Teri. “I read articles and watched videos on DBS.” During one office visit, when the doctor presented the pros and cons of deep brain stimulation, Teri broke down crying. “Dr. Boyce thought I was crying because I was afraid. But I was simply overwhelmed just imagining my life without tremors.” If there was a glimmer of hope, Teri was ready to try. On March 12, 2012, Teri underwent a nine-hour DBS surgery performed by K. Singh Sahni, MD, neurosurgeon. Teri had to remain awake throughout the procedure, but Dr. Boyce stayed by her side for the duration. “My entire head was shaved,” says Teri, “but I didn’t care. Hair grows back—what I really wanted…was my life back.” Ten days following the initial operation on her brain, Teri returned to Johnston-Willis Hospital to have the neurostimulator—the “battery-pack”—implanted in her chest. And one month later she came back as an outpatient to have the unit turned on for the first time. “It was truly an amazing feeling,” beams Teri. “When I got home I tried out all the little things that I was unable to do for so long. I ate soup with a spoon. I carried a cup and saucer across the room. I drank a can of soda without wearing it. All the activities you take for granted—I could now do.” And life just kept getting better. Teri returned to nursing the way she wants to practice. “I can give shots, draw blood, and administer TB tests. I am thrilled that I can once again care for my patients.” As much as Teri loves nursing, there is perhaps an even greater joy that she experienced thanks to her DBS surgery. Nothing could be sweeter for Teri than being able to pick up and hold her newborn granddaughter in steady, loving arms.
Understanding Essential Tremor Essential tremor (ET) is the most common “movement disorder”—affecting as many as 10 million people in the United States alone. Yet this condition is largely unknown, misunderstood and often misdiagnosed. 44
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Let’s start with the most basic question—what is essential tremor? According to Claudia M. Testa, MD, PhD, VCU Department of Neurology, “Essential tremor is a neurological condition that causes a tremor or rhythmic shaking. Most patients experience tremor in their hands, but the head, voice, arms or legs can also be involved.” Tremor of the hand is typically an “action” or “kinetic” tremor. In other words, the tremor becomes worse when the hand is in motion. Head tremor may be seen as a “yes-yes” or “no-no” motion. ET may also be accompanied by mild gait problems. “Many factors can trigger or intensify tremors,” says Dr. Testa, “including stress, strong emotions, fatigue and some medications.” And the pressure to “perform”—such as giving a presentation—is likely to make the tremor worse. The onset of ET can occur at any age, but is most common after 40. Although usually not life-threatening, essential tremor can worsen over time. “ET used to be referred to as ‘benign’ essential tremor,” says Dr. Testa. “But this disorder can be severe and disabling in some patients, so the word benign has been dropped.” “Many people associate tremors with Parkinson's disease, but the two disorders are distinct,” says Dr. Testa. Here are some of the key differences: • Parts of body affected. Essential tremor may affect the head and voice. Head tremor is uncommon in early Parkinson’s disease. • When tremor occurs. Essential tremor of the hands is usually worse when the hands are in motion—such as drinking from a glass, eating, tying shoelaces, writing or shaving. Tremors from Parkinson’s disease are most prominent when the hands are at rest. • Speed of tremor. Essential tremor is faster than the tremors of Parkinson’s disease. • Effects of alcohol. Small amounts of alcohol can noticeably reduce an essential tremor but usually have no effect on tremors caused by Parkinson’s disease. • Family history. Essential tremor sometimes runs in families, while Parkinson’s disease does not. • Beyond the tremor. Individuals with Parkinson’s disease may experience www.OurHealthRichmond.com
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stiffness, slowness and other motor symptoms along with tremors, while these additional symptoms do not typically appear in ET. Many people with Parkinson’s disease do not have tremor at all, but do have other symptoms, while ET is defined by the tremor. “We do have new technology called DaTscan,” says Dr. Testa. “This is an FDA-approved imaging study that can help us try to distinguish essential tremor from Parkinson’s disease. However, these are both still ‘clinical diagnoses’—meaning there is no specific test to give a definitive diagnosis. That can only be made through a careful history and physical exam by a movement disorders specialist. To further confound matters, some people have both ET and Parkinson’s disease, and a patient’s diagnosis may change over time as the symptoms evolve.”
Causes of Essential Tremor “The cause of essential tremor is not known,” observes Dr. Testa. “There is strong evidence that changes in genes play a big role, as essential tremor often runs in families. Researchers are trying to identify genetic changes that increase risks or even directly cause essential tremor. Until specific gene changes are identified, it is difficult to predict how essential tremor will be inherited—or not—within a family. Partnerships between researchers and people with ET are critical to finding causes and developing effective treatments.” Richard Justice comes by his ET honestly. “My father shook and my grandparents on both sides had tremors. And my mother had Parkinson’s disease,” says Richard. So when he was diagnosed with the disorder in 2010, it didn’t come as a terrible surprise. “I wasn’t even aware of my tremor. It was my wife and children who noticed my hand shaking.” Understanding essential tremor and the genetic implications has become a mission for Richard. “It may not help me, but it is important for my children and their children that we document our family medical history.”
Diagnosing Essential Tremor People can live with ET for years, without ever being diagnosed. They may not realize that they have an actual medical condition or they may simply attribute the shaking to aging. When Richard and his wife first suspected that his trembling hands were due to more than fatigue and the pressures Richard felt from losing his job, they decided to attend a seminar sponsored by VCU Medical Center at Lewis Ginter Botanical Garden. “Everything Dr. Testa said reinforced our fears that I had essential tremor.” “When the tremor begins to interfere with basic activities of living, that’s when people seek help,” says Matthew Boyce, MD, a neurologist at HCA Virginia. “There is no screening test for this disorder—it is often a matter of ruling out other conditions that could be causing symptoms.” The journey to diagnosis often begins with a visit to a primary care physician. A detailed family history may point to a hereditary cause of the tremor, and a physical exam will determine whether the tremor occurs primarily during action or at rest. Blood or urine tests can detect thyroid malfunctions, metabolic problems or abnormal levels of chemicals that can cause tremor. These tests may also help identify contributing factors such as drug interaction and chronic alcoholism. 46
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Drawing an Archimedes' spiral is one test used to evaluate essential tremor. The spiral on the left simulates one drawn by an individual affected by ET. The spiral on the right was drawn by an individual who is not affected by ET. As more and more causes for tremor are eliminated, the patient is likely to be referred to a neurologist for more advanced evaluation. Diagnostic imaging using computerized tomography or magnetic resonance imaging can reveal if the tremor is the result of a structural defect or degeneration of the brain. A neurological evaluation will assess tremor, reflexes, muscle strength, sensation, posture, coordination and gait. The patient may be asked to perform certain tasks to evaluate the tremor itself such as: • Holding arms outstretched • Moving a finger on the tip of the nose to the neurologist’s finger • Writing • Drawing a spiral “Achieving a definitive diagnosis of ET is not a flash in time,” reflects Dr. Boyce, “rather, the disease may define itself over many years, even decades.” And since ET can be progressive, continual monitoring is vital. “Every time I see Dr. Testa she evaluates me head-to-toe,” says Richard. “From checking my vision to watching me walk.”
Treatment Options Some people with essential tremor do not require treatment if their symptoms are mild. But in those cases in which symptoms are severe or progressive, a variety of treatment options are available. Medication. Normally used to treat high blood pressure, beta blockers help relieve tremors in some people. However, this class of medication may not be an option for individuals with asthma or certain heart problems. Also, only some beta blockers help with tremor, while others have no impact or may even worsen tremor. Particular anti-seizure drugs may also effectively suppress tremor, and anti-anxiety medications may be used for individuals whose tremors are made worse by tension or anxiety. Perhaps the most novel treatment for essential tremor is botulinum toxin (Botox) injections, which may be useful in treating some types of tremors, especially those affecting the head and voice. Botulinum toxin injections can improve tremors for up to three months at a time. “The response rate to medications in most clinical trials is about 50 percent of my ET patients,” www.OurHealthRichmond.com
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says Dr. Boyce. “Medication may not completely eliminate their tremors, but it allows these patients to manage the disease at an acceptable level.” Medication management can be particularly challenging if there are coexisting conditions. “ET isn’t even my worst medical problem,” exclaims Richard. More than 18 years of working in a box plant has left Richard with chronic obstructive pulmonary disease (COPD), and steroid treatments for his lungs have in turn resulted in osteoporosis in his back and neck. “When I have severe pain in my back, my tremors get worse, but there are certain medications I can’t take due to my breathing problems. It is a vicious cycle.” Therapy. Physical therapy may be recommended to improve balance, control and coordination, and occupational therapy may help patients adapt to living with essential tremor. “Therapists can offer wonderful adaptive devices that help patients reduce the effects of tremors on daily activities,” remarks Dr. Boyce, “such as heavier glasses and utensils, wide-grip pens and wrist weights. Surgery. Surgery may be an option for people whose tremors are severely disabling and who don’t respond to medications. “When my patients’ lives are severely impacted—functionally, occupationally, emotionally or socially—it is time to consider more aggressive treatments,” says Dr. Boyce. One such procedure is deep brain stimulation (DBS). “With DBS, a long, thin lead—also called an electrode—is inserted through a small opening in the skull into the thalamus, the portion of the brain that causes tremors,” describes Dr. Testa. “A wire from the lead runs under the skin to a pacemaker-like device—called a neurostimulator—which is implanted in the chest. When this device is turned on using a remote control, it transmits painless electrical impulses that interrupt signals from the thalamus that may be causing tremors.” Deep brain stimulation is very effective for severe essential tremor. Side effects are rare and often go away after some time or adjustment of the device. Gamma Knife is a newer treatment that is used for advanced cases of essential tremor. “Gamma Knife,” explains Dr. Boyce, “is a non-invasive procedure that uses a precise beam of radiation to make a lesion in the brain that interrupts the ‘circuit’ that causes the tremor. For those patients who for medical reasons may not be an ideal candidate for DBS, this procedure is an acceptable alternative.” The long-term effects of Gamma Knife are being evaluated.
What Does the Future Hold Promising new developments are happening on a variety of fronts when it comes to essential tremor. • The National Institute of Neurological Disorders and Stroke (NINDS)—part of the National Institutes of Health—is evaluating the effectiveness of 1-octanol and octanoic acid, substances closely related to alcohol but not intoxicating, for treating essential tremor. Dr. Boyce remarks, “It is noteworthy that this is the first medication being developed specifically for ET—other medications currently in use were discovered incidentally when being used to treat unrelated medical conditions.” • An experimental procedure employing “Focused Ultrasound Radiosurgery” may soon offer ET patients a new surgical treatment modality. 48
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• Perhaps the most exciting developments are those involving collaborative research to find the specific gene changes responsible for ET and then targeting therapies to correct those genetic defects.
Living with Essential Tremor Essential tremor isn’t life-threatening, but the disorder can greatly impact the quality of one’s life. There are a number of lifestyle choices that can reduce the intensity of the symptoms associated with ET. Suggestions include: • Get plenty of rest. • Avoid caffeine. • Learn to relax. Deep breathing, medication or just a brief “time out” can help create a sense of focus and calm. • Exercise. Whether walking, yoga, gardening or time in the gym, exercise improves balance, reduces anxiety and enhance mood. • Adapt. Simple adjustments like using online banking and debit cards rather than writing checks, preprinted address labels for correspondence and voice-activated phone dialing can make life with ET less challenging. • Use alcohol sparingly, not as a treatment. Some people notice that their tremors improve after they drink alcohol, but drinking isn’t a good solution for people with ET. Tremors tend to worsen once the effects of alcohol wear off. Larger amounts of alcohol eventually are needed to relieve tremors, which can lead to chronic alcoholism, and over time, can actually damage the brain areas and cause or worsen tremors. Equally as important as the physical impact is the emotional toll that essential tremor can take on patients and their families. It’s not surprising that in addition to being treated for ET and an array of other medical problems, Richard has experienced some depression. Fortunately, his ET symptoms are now well managed and after three years of appeals, he has finally been approved for Social Security disability—offering substantial relief to Richard and his wife, Cheryl. Not everyone is so fortunate. Just imagine not being able to hold a glass without spilling. Finding it difficult to put on makeup or shave. Being unable to write legibly or speak clearly. That’s exactly what many individuals with ET live with every day.
Phil and Diana Campbell with their grandson Deejay Gray (center) working at the first annual Movin’ & Shakin’ 5k, sponsored by VCU’s Movement Disorder’s Center. Deejay’s diagnosis with ET served as Diana and Phil’s inspiration to help start at ET support group in Richmond. (Photo by Multisyncpro Photographers.)
“Your doctor might not notice what a big impact an action tremor has when you are sitting quietly in the office, but ET has an enormous impact on life and work,” notes Dr. Testa. “I’ve treated auto mechanics, chefs, jewelry makers and artists, but the toughest are the students looking forward to a career in dentistry or medicine who are trying to figure out how to pursue their passion even with ET.” Diana Campbell suffers the pain of essential tremor not firsthand, but vicariously through her grandson. “My grandson Deejay was 19-years old when he was diagnosed with ET, but even as a little boy his little fingers shook when he colored or tried to put puzzles together,” recalls Diana. In 2008, in an effort to help her grandson, Diana agreed to help start an ET support group in Richmond. “And now six years later we have a thriving group that meets each month,” says Diana. “Our programs are designed to educate, inform and entertain. We offer seminars and have speakers on an array of topics—from medical information and coping techniques, to nutrition and improving your balance.” “And we make fun a priority,” says Diana. About once a quarter the group has a social get-together. “Many people who live with ET are embarrassed to socialize or go out to eat in a restaurant. Here, www.OurHealthRichmond.com
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we can enjoy a meal and no one cares if your drink spills or your food falls off your fork.” One Valentine’s Day, the group sipped sparkling cider through straws from stemmed flutes. Diana and her husband Phil had the idea to celebrate March as National Essential Tremor Awareness Month along with the birthday of the ET Support Group—and what better way than with a party. The Annual Birthday Bash with BBQ & Bluegrass has become the highlight of the year. “We can’t cure ET,” reflects Diana, “but we can help raise public awareness and make life just a little better for people living with ET.”
Where to Get More Information Richmond ET Support Group • Diana Campbell, group leader • ET.RichmondVA@yahoo.com • Meets the 3rd Tuesday of each month at 6:30 PM • Our Lady of Hope 13700 North Gayton Road Henrico, VA 23233
International Essential Tremor Foundation • essentialtremor.org • 913.341.3880 or 888.387.3667 The International Essential Tremor Foundation (IETF) helps raise awareness and provide educational programs for patients, families and medical providers. The IETF also sponsors scholarships for students living with ET and new research on ET to draw more scientists into the field.
HCA Virginia HCA Virginia’s Neuroscience and Gamma Knife Center at Johnston-Willis Hospital has a dedicated 12-bed Neuroscience ICU with highly trained nurses providing specialized care to patients with stroke, brain tumors and deep brain stimulation cases. The hospital is home to Richmond’s only Gamma Knife, a non-invasive technique used for the treatment of brain tumors, trigeminal neuralgia and some movement disorder patients. Johnston-Willis is the only hospital in Virginia to receive the Gold Seal for Brain Tumor Certification by the Joint Commission. Essential tremor Patients who are either on anticoagulants or with major cardiac issues may be appropriate candidates for non-invasive Gamma Knife, since it does not involve incisions or burr holes as needed for DBS. Gamma Knife also is used to treat breast cancer and lung cancer patients who have brain metastasis. For more information, visit HCAVIRGINIA.COM
VCU Medical Center The VCU Parkinson’s & Movement Disorders Center offers interdisciplinary care for Essential Tremor (ET) and other movement disorders to meet our patients’ individual needs. We strive to integrate top clinical care with clinical research that advances knowledge of ET. Our care team will create a personalized treatment plan for each patient, which can be shared with your primary physician and any local care providers to help coordinate ongoing follow-up. The team will help patients and families assess pros and cons of surgical treatments, medications and other non-medication treatments, to find the best treatment approach for each person. Team members participate in community outreach programs to help educate families and other health care providers about ET. For more information visit parkinsons.vcu.edu.
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Expert Contributors Matthew Boyce, MD, Neurological Associates of HCA Virginia. Dr Boyce earned his bachelor’s degree from UVA and attended the VCU School of Medicine. He received his neurology training at UNC Chapel Hill where he also completed a fellowship in movement disorders. Dr. Boyce serves as the medical director for the deep brain stimulation program at CJW Medical Center. Claudia Testa, MD, PHD, VCU Medical Center Neurology. Dr. Testa is an associate professor of neurology at Virginia Commonwealth University (VCU) specializing in movement disorders. She is vice president of the Tremor Research Group, a member of the international Movement Disorders Society Task Force on Tremor and founder of a multi-center North American Essential Tremor Consortium for collaborative essential tremor genetics research. She serves on the medical advisory boards of the International Essential Tremor Foundation (IETF), and HopeNET, a non-profit ET advocacy group.
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Photographer, Alan Farley, captured Richmonders “supporting the movement�
at the first annual Movin' & Shakin' 5K, Saturday May 3, 2014!
The inaugural Movin' & Shakin' 5K through Innsbrook Office Park was held on Saturday, May 3, 2014. This new event provided a wonderful opportunity both for the community and those with a movement disorder, along with their friends and families, to gather and share hope, resources and the joy of movement. All funds raised through the event will go directly to the VCU Parkinson's and Movement Disorders Center, a premier model for improving the lives of individuals with movement disorders, their families and the community by commitment to excellence in comprehensive interdisciplinary clinical care, transitional research, education and outreach.
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HealthyEats Fruits and vegetables have a prime time when they are at their seasonal best. Some are great for over half of the year; others only hit their peak for a month. Either way, peak season means extra flavor, extra crunch, extra juiciness—all super-fresh and
Greek Country Salad 3 cucumbers 1
Dressing:
Directions:
1 cup olive oil
1. In a medium bowl, prepare salad ingredients and set aside.
1 T. Dijon mustard
yellow pepper
1 pt. Cherry tomatoes
1 T. garlic 1 t. basil
1 red onion diced
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great value. Shopping seasonally not only help your budget, but offers a great way to add variety to you diet. At Good Foods Grocery, we work closely with local farmers to bring you farm ripened, fresh picked produce.
1/3 cup red wine vinegar
1 red pepper
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2. In a small bowl, combine dressing ingredients and stir. 3. Pour over salad ingredients and toss. Can be served at room temperature.
Salt & pepper to taste.
1 T. mint, minced ¼ c. Kalamata olives, pitted & halved 1 cup feta cheese diced.
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GREEK COUNTRY SALAD
Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodsgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | (804) 740-3518 & Stony Point Shopping Center (Southside) | 3062 Stony Point Road | (804) 320-6767
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Crab Cakes Ingredients: 3 cans lump crab meat 1 egg ¼ c. gluten free bread crumbs 1 t. dill ¼ c mayo 1 T. lemon juice ¼ cup onion ¼ cup celery 1 T. olive oil 1 t Old Bay ¼ t onion powder ¼ t garlic powder 1 t Worcestershire sauce
Handful of chopped scallion & parsley
A pinch of black pepper
A pinch of cayenne pepper
Directions: 1. Preheat oven to 350º F. 2. Sauté the onion & celery in the butter over medium heat until onions are clear. 3. Squeeze the crab meat and place in a medium bowl. 4. Add the egg, bread crumbs, mayo and remaining ingredients. 5. Mix in sautéed onions & celery. 6. Form into 2 ½” patties. 7. Bake on middle rack for 15 minutes.
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YUMMY CRAB CAKES
Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodsgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | (804) 740-3518 & Stony Point Shopping Center (Southside) | 3062 Stony Point Road | (804) 320-6767
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Vegan Mango Peach Crisp
3. There should be no pockets of butter.
Filling Directions:
(Gluten Free)
4. Set aside while preparing filling.
1. Preheat oven to 350º F.
Crumb Topping Ingredients:
Filling Ingredients:
4 c. GF oats
2½ pounds frozen mango
2 c Bob’s Gluten Free Flour
2½ pound frozen peaches, cut into smaller pieces
1 t cinnamon
3 T cornstarch
½ t salt
1
2 T. orange juice 15 oz Earth Balance Vegan Butter
Zest of one orange
Crumb Topping Directions:
t cinnamon
1 t salt 2/3 c agave syrup (can substitute maple syrup if desired)
2. Toss fruit with cornstarch and spices, coating evenly. 3. Add syrup and juice. Mix evenly to coat. 4. Pour filling into ungreased pan 9 x 13 distributing evenly. 5. Sprinkle crumb topping over filling, lightly pressing down. 6. Bake about an hour to an hour and 15 minutes until bubbling around edges. Juices will thicken upon cooling.
Remaining juice of zested orange
1. Toss together dry ingredients. 2. Work butter, zest & juice into dry, using hands until it forms a uniform dough.
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VEGAN MANGO PEACH CRISP
Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodsgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | (804) 740-3518 & Stony Point Shopping Center (Southside) | 3062 Stony Point Road | (804) 320-6767
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ZACH IS
words | LYNETTE MUTTER photography | TOM VEAZEY
BACK! Just a few weeks ago, 18-year-old Zachary Niles was working parttime at Polo Ralph Lauren, in his second semester studying business at Thomas Nelson Community College and enjoying life being “single and ready to mingle,” as he puts it. Zach is the fourth of six kids comprising a blended family of “his, mine and ours,” according to matriarch Carol Niles, “and there's never a dull moment.” That's a huge understatement considering that on February 3, a serious car accident riddled Zach with some serious broken bones, many with multiple fractures – his left wrist, right ankle, both hips, three vertebrae in the neck and five in his back. He was in the hospital for 10 agonizing days, five spent in the intensive care unit. “That time in the hospital was the most traumatic and horrific time of our lives,” says Charles Niles, Zach's father, still shuddering to think about it. “We knew then that we needed to prepare ourselves for a marathon, so to speak. This was not going to be a sprint.” When Zach left the hospital, he was encased in casts and braces, unable to stand and could only use one arm. Hospital specialists told the family that it could be three months until Zach had any mobility, which was required to qualify for inpatient rehabilitation. The family was also advised that once he was in rehab, it could still take six or more months for recovery.
“Zach uniquely engaged in his therapy and he pushed to the point of exhaustion”, says David Cashwell, CEO www.OurHealthRichmond.com
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'Always having a good time' Zach with staff at HealthSouth during his stay
The hospital staff was having a difficult time placing him in rehab. Most places are simply not equipped for someone with Zach's physical capabilities, or lack thereof. And, if the family had to bring him home to get mobile enough for inpatient rehab, they would need to outfit their house with ramps and lifts, among other things. Enter HealthSouth, an inpatient rehabilitation facility in the Near West End area of Richmond with 40 inpatient beds and 90 clinicians. “We decided to take a shot with Zach, believing that because of his young age, he would improve and become ambulatory quickly,” says David Cashwell, CEO of the facility in Richmond and its sister facility in Petersburg, VA. “Many people don't realize that once you leave an acute care hospital, you may not go home. You go someplace else, like skilled nursing, longterm care or an inpatient rehabilitation facility (IRF),” according to David. “In the greater Richmond metropolitan area, HealthSouth is one of only two freestanding IRFs. The others are located within acute care hospitals. At the time of discharge, hospitals are required to give patients information about rehabilitation. HealthSouth also has hospital 60
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liaisons who work with hospital staff and perform patient assessments to determine what level of care they need. After they get insurance approval, the patient has the choice to determine which place will give them the appropriate level of care.” “All IRFs are required to offer patients at least three hours of therapy a day,” says David. “This is an intense level of therapy, and they must qualify by having strength and capability to do it. Patients at HealthSouth have a care team that consists of a physical therapist, an occupational therapist and a speech therapist, if necessary, and their therapy is tailored to meet their individual needs. This team stays with them through their entire stay at HealthSouth, which for most patients is about 15 days.” For Zach it was much longer, but far less than the Niles family was warned it could be. They were overwhelmed with relief when they found HealthSouth, even though it was an hour drive one-way from their home, according to Carol. “I can't imagine how long it would have taken Zach to get better if he were lying in bed at home. It was God's decision to put Zach where he needed to be.”
It certainly appears that there could have been a grand plan at work. David describes Zach as being “quite a character and an old soul who is genuinely caring. He is an amazing, incredibly charismatic kid with a unique philosophy on life for a young man. There are no strangers in his world. He is inherently positive with the natural ability, and inclination, to make other people smile.” HealthSouth rigged a wheelchair for Zach, which gave him the freedom to move around, and within no time, he knew everyone in the place. “He was like a celebrity here and everyone loved Zach,” says David. The first few days of his five-week stay at HealthSouth “was a bummer and a drag not being able to do anything,” Zach says. “I was all broken up. The fact that they were able to give me that little bit of freedom with the wheelchair really helped me emotionally and physically.”
According to Zach, ever since he was a little kid, he has enjoyed making people smile and helping others. He stood out as one of a few young people at HealthSouth and he made a point to always be smiling and in a good mood. “I tried to bring a good, strong vibe to the place – and it worked!” Not only did Zach make remarkable progress with his recovery, but apparently his attitude was contagious. “It was so cool that little 'ole me could make an impression on the whole staff. Even the chefs and janitors would smile and say hello!” His ability to relate to others also led to forming a close friendship with another young man, who had severe neurological damage from a traumatic brain injury and was just re-learning to talk and stand. “Zach was playful,” says David, “and his therapy incorporated activities like playing corn hole and basketball.” He also had a remote control car that he drove around the gym, improving
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(from left) Charles Niles
(Zach’s father), Dr. Roger Giordano, Zach, Carol Niles (Zach’s mom), and David Cashwell, CEO of HealthSouth Richmond
his fine motor skills, so to speak, and passing the down time. David recalls one funny story... “We had another patient here at the same time Zach was, a 95-year-old woman who had never driven a car. Zach taught her to “drive” his remote control car, even jumping ramps with it! He joked with her that her first car was a Ferrari! It was really something to watch how comfortable he was with her. Zach's ability to relate and care for other patients made a difference, not only in his rapid recovery, but in the outcomes of the other patients around him.” Outside of the mandatory three hours of therapy and cruising around in some form or another, Zach says he spent his free time resting and “watching a lot of Duck Dynasty.” He attributes one of the reasons he responded so well to therapy is that prior to the accident, he managed to stay fit and was used to pushing himself and doing things that were uncomfortable during his workouts. According to David, some patients push to the point of discomfort, and then they stop. “Zach uniquely engaged in his therapy and he pushed to the point of exhaustion.”
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Zach says he just kept remembering what the therapists told him – “that if I did it and kept doing it, I would get stronger.” And that he did! Charles acknowledges Zach's self-motivation and credits the attentive staff who pushed and challenged him, keeping him motivated so he could go home quickly. He praises all of the staff in every position who were all very attentive and helpful. “They established a rapport with him and helped him feel comfortable during the many hours he spent outside of therapy. The care at HealthSouth was comprehensive and consistent, with everyone focused on Zach's recovery.” The young man's rehabilitation experience made such an impression on Zach that he has decided to pursue a career in physical therapy. David believes “the healthcare industry would be lucky to have him” and says he “would hire him in a minute.” In the meantime, Zach continues with outpatient physical therapy and since being home, he has tried to pick back up where he left off, with friends visiting to keep him occupied. “I'm ready to get back to 'the regular',” says Zach.
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Far sooner than anyone thought possible, just over a month after completing inpatient rehabilitation, Zach was starting back to work with plans to return to school in the summer or fall. He's looking forward to working because he doesn't like not having any money. “I need to put gas in the car, and (brief pause) I have sort of a sneaker fetish... I LOVE tennis shoes!” Zach says. And apparently, he has a closet full of them. According to his mother, “Zach's accessories and shoes put his sisters' to shame! He says he needs his 'lids and kicks'.” (Translation: hats and shoes.) Zach is one class act! And no doubt has a big, fat wonderful future ahead of him. One could say that it's a miracle he's alive, that a rehab facility stepped up to take him in and that he walked out so well-restored in just a handful of weeks. Actually, that makes three miracles. “As with other families during times of crises, there were many people saying lots of prayers for Zach,” Charles says. “For him to go to HealthSouth was an answered prayer.” Carol adds that “what is truly a miracle is having Zach home and knowing we have another day to spend with him. And also hearing him and his brother, Chance Muniz, upstairs laughing like crazy!” The family is incredibly grateful to the HealthSouth clinicians and staff for the profound impact they have had on their lives. Zach sums it up by saying that “words can't describe what it was like there... there was no awkwardness... it was just like family. They have their own special place in my heart. And, they have the best banana pudding on the East Coast! Really! The nurses were great and they would hook me up with seconds – because they love me.” “Just one more thing,” he added, “and put this in all caps... HEALTHSOUTH IS THE BEST!” Consider it done, Zach. And welcome back. Note: At the time this article went to press, Zach was applying to be a Therapy Assistant at HealthSouth Richmond.
Lydia Windle, a case manager at HealthSouth worked with Zach throughout his stay
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where is this? Post the correct answer on our Facebook page by July 7, 2014.
You could win some great food from Good Foods Grocery! Cool, right?
The winner will be announced on our Facebook page
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