OurHealth Richmond Jun/Jul 2015 Edition

JUNE • JULY 2015 | OURHEALTHRICHMOND.COM

The Resource for Healthy Living in Greater Richmond

also:

A Closer Look at the Stomach

and

Breaking the Silence on Bipolar Disorders

table of contents | june • july 2015

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

JUST ASK!.......................................12 Healthcare questions answered by local professionals

Take Care of Your Health, Man! OurHealth speaks with area physicians about health conditions that commonly affect men and how to prevent them. Here’s what they have to say.

NEW & NOTEWORTHY.............14 A listing of new physicians, providers, locations and upcoming events in greater Richmond

HEALTH POINTS.........................18 Interesting facts and tidbits about health

THE ANATOMY CHALLENGE..................................21 How much do you know about Our Anatomy?

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

THE ANATOMY ........................... 22 Taking a closer look at the stomach. To learn more about the stomach’s role, how it works and the conditions that affect it, OurHealth turned to experts at Richmond Gastroenterology Associates and Gastrointestinal Specialists Inc.

hello, HEALTH!............................................40 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos

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OurHealth | The Resource for Healthy Living in Greater Richmond

The Resource for Healthy Living in Greater Richmond

41

[series]

Breaking the Silence: Bipolar Disorder

This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now.

46

The Sweetest Smiles

A Richmond family finds strength in cleft lip and palate diagnoses

NUTRITION............................................................51 HEALTHY EATS: Shop Seasonally for Better Flavor­and Extra Value Tri-Colored Quinoa, Carrot Cake Cupcakes, Apple Cupcakes

FIT BITS!........................................................................... 42 Stretch it Out! Did you know that regular stretching is just as important as regular exercise?

LOOKING BACK.............................................................. 66 Images reflecting the landscape of healthcare in Richmond *

A chance to win prizes!

PLUS *

THE THIRD ANNUAL

BEST B E D S I D E MANNE R AWARDS

WINNERS ANNOUNCED IN THE DECEMBER 2015 ISSUE www.OurHealthRichmond.com

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The Resource for Healthy Living in Greater Richmond

june • july 2015

OURHEALTH’S EXCLUSIVE MEDIA PARTNER PUBLISHER PRESIDENT/EDITOR-AT-LARGE VICE PRESIDENT OF PRODUCTION PROJECT COORDINATOR AND FITNESS EXPERT ACCOUNTING MANAGER CHIEF DESIGNER ORIGINAL COVER ART WORK ORIGINAL PHOTOGRAPHY WEBSITE SOCIAL MEDIA INTERN

McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Deidre Wilkes Laura Bower Karrie Pridemore Joe Palotas Sahsha Kochanowicz, Rubylee Photography Next Generation Designs Jourdan Markey

CONTRIBUTING RICHMOND MEDICAL EXPERTS Christine Bouchard, MD Leslie J. Cloud, MD, MSc Katherine H. Helfrich, DDS Kim Leibowitz, ERYT 200/RYT 500 Gerard Santos, MD Padmini Santosh, MD, FACOG CONTRIBUTING PROFESSIONAL EXPERTS & WRITERS Susan Dubuque Laura Neff-Henderson Suzanne Ramsey Edwin Schwartz Deidre Wilkes ADVERTISING AND MARKETING Richard Berkowitz Senior Vice President, Business Development P: 804.539.4320 F: 540.387.6483 rick@ourhealthvirginia.com SUBSCRIPTIONS To receive OurHealth Richmond via U.S. Mail, please contact Deidre Wilkes via email at deidre@ourhealthvirginia.com or at 540.387.6482

@ourhealthmag

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

Copyright © 2015 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. OurHealth Lynchburg/Southside is published bi-monthly • Special editions are also published • McClintic Media, Inc. • 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483.

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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 ischemic colitis?

Ischemic colitis is a disease affecting the colon, or large intestine, that results from a decrease in blood flow to the bowel. There are a number of causes but two of the most common are; abnormally low blood pressure for a significant period of time, or narrowed or blocked blood vessels (arteries) supplying the colon. This causes the cells in the lining of the colon to get insufficient oxygen, resulting in necrosis or death of the colon tissue. Common symptoms include severe, crampy abdominal pain and bloody diarrhea. Most who seek timely medical treatment recover from ischemic colitis.

However, when severe enough, it can be a life threatening illness, and some require emergency surgery to remove a portion of the colon.

Seek immediate medical care if you have sudden, severe abdominal pain or bloody diarrhea. Abdominal pain that makes you so uncomfortable that you can’t sit still or find a comfortable position is a medical emergency. Early diagnosis and treatment can help prevent serious complications.

Christine Bouchard, MD

Surgical Associates of Richmond Richmond | 804.320.2705 www.thesar.com

What is congenital cytomegalovirus?

Congenital cytomegalovirus is a group of symptoms that occur when a fetus is infected with the cytomegalovirus (CMV) through the placenta of an infected mother. The mother may not have symptoms, and therefore unaware that she is infected. CMV is related to the group of herpes viruses, and infection in infants can be the cause of birth defects. In the U.S., Congenital CMV affects approximately 27,000 newborns annually. Of these, about 20 percent develop permanent disabilities and one percent don’t survive.

Routine screening is not recommended by the Center for Disease Control & Prevention (CDC) or the American College of Obstetricians and Gynecologists (ACOG), however amnioscentesis can be done to rule out fetal infection.

Defects in babies born with CMV may include hearing loss, vision loss, mental disability, small head size, lack of coordination, seizures and in rare cases, death.

Current treatments are in the experimental stage. There is no effective vaccine, and the best means of prevention is through reducing exposure to the virus. The CDC has recommendations to prevent exposure in pregnant women, that include good hygiene and frequent hand washing.

Padmini Santosh, MD, FACOG Virginia Physicians for Women Midlothian | 804.897.2100 www.vpfw.com

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What is Parkinson’s disease and some of its early signs and symptoms?

Parkinson’s disease (PD) is a common neurodegenerative disease that affects movement. Tremor is most often the first symptom, and it is typically an asymmetric tremor affecting one side of the body more than the other.

Other early symptoms related to movement can include stiffness of the muscles, slowness of movement, and changes in walking or balance.

Patients with PD also suffer from a variety of non-motor symptoms, which can sometimes occur years before the onset of the movement disorder. These non-motor symptoms can include loss of sense of smell, urinary dysfunction, constipation, depression, anxiety, cognitive changes, sleep disorders, fatigue, and orthostatic hypotension. While many of these symptoms are common in the general population and are certainly not specific to PD, their presence in conjunction with tremor, stiffness, slowness, or balance trouble may suggest early PD. Leslie Cloud, MD, MSc

Assistant Professor of Neurology Virginia Commonwealth University VCU Parkinson’s and Movement Disorders Center Richmond | 804.662.5304 www.parkinsons.vcu.edu

H E A LT H C A R E QUESTIONS ANSWERED

BY LOCAL PROFESSIONALS

Do whitening toothpastes really work?

To an extent, yes!

Whitening toothpastes effectively remove stains from the enamel layer of our teeth. These surface stains form over time and are commonly caused by coffee, tea, soda, red wine, and tobacco. Whitening pastes contain abrasive particles and chelating chemicals that buff these discolorations away.

If you’re not seeing desired results with toothpaste alone, you may talk to your dentist about using a peroxide-containing bleaching agent. The middle layer of our teeth, dentin, is naturally darker and can yellow over time or from certain medications. Bleaching agents such as strips, trays, or in-office treatments can penetrate this middle layer and brighten your smile from the inside out.

Effective brushing, flossing, and regular dental cleanings can help to maintain a bright white smile. Be careful not to overdo it as sensitivity can sometimes be an uncomfortable side effect. Also understand that fillings, crowns, veneers, and dentures will not whiten.

If you’re considering whitening, consult your dentist first and decide what method is best for you.

Katherine Helfrich, DDS Virginia Family Dentistry Midlothian | 804.739.6500 www.vadentist.com

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What are some health risks for men with obstructed sleep apnea (OSA)?

Obstructive sleep apnea is a breathing condition characterized by repeated episodes of breathlessness caused by narrowing and collapsing of the soft tissue in the back of the throat. The frequency and duration of these episodes each night define the severity of the condition. Significant symptoms and associated health risks are typically seen when these breathless episodes exceed more than five times an hour. More than 100 episodes can occur each night without a sufferer knowing there is a real problem.

OSA is twice as common in men. Health risks for those with sleep apnea are extensive, and relate to organ system stress from diminished oxygen levels as well as chronic sleep deprivation. The heart and the brain are most sensitive to abnormally low oxygen levels.

OSA patients are more prone to heart attacks and strokes. Chronic sleep deprivation creates a heightened ‘fight or flight’ response on the body, which contributes to increased risk of hypertension and diabetes in these patients. Recent studies have also linked sleep apnea with Alzheimer’s disease.

Gerard Santos, MD

Medical Director, Bon Secours Sleep Disorders Centers Richmond | 804.673.8160 www.goodhelpdocs.com

What are some benefits of yoga for older adults?

One of the greatest benefits of yoga is that it is accessible to anyone at any age. If you can breathe, you can practice yoga. As we age, we lose strength, flexibility, muscle mass and balance. Older adults are prone to falling and potentially breaking bones. Aging is also emotionally challenging and potentially isolating.

Yoga counteracts each of these by integration of body, mind and spirit through exercise, breathing and meditation. Some benefits of yoga for older adults include improved posture, increased lung capacity, joint and spine mobility and a sense of well-being and comfort in one’s own skin. Yoga offers a way for older adults to stay active and exercise without the strain some forms of movement can cause. A yoga practice can evolve with a person’s aging body and mind. There are many modifications and props available to keep movements safe and beneficial.

A sense of community, support and belonging can also develop between older adults who practice yoga together.

Kim Leibowitz, E-RYT 200/RYT 500 Glenmore Yoga & Wellness Center Henrico | 804.741.5267 www.glenmoreyoga.com

NEW

NEW PHYSICIANS,

NOTEWORTHY

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

VCU Medical Center verified Level I by the American College of Surgeons Virginia Commonwealth University Medical Center, central Virginia’s only Level I trauma center, has received national verification for the fourth time from the American College of Surgeons (ACS) as a Level I trauma center. VCU Medical Center has been a state-designated trauma center since 1981, making it the longest-standing trauma center in the commonwealth. It received its initial ACS verification in 2005.

VCU Medical Center is the only hospital in the state verified by the ACS as a Level I for both adult and pediatric trauma and is one of only 41 centers in the country verified in adult and pediatric trauma. The ACS assigns five verification levels.

• Level I - A comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I trauma center is capable of providing total care for every aspect of injury – from prevention through rehabilitation.

• Level II - Able to initiate definitive care for all injured patients and includes some elements of a Level I trauma center such as 24 hours in-house coverage, referral resources and meets

the minimum requirement of the annual volume of severely injured patients.

• Level III – Demonstrates an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.

• Level IV – Demonstrates an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center. It provides evaluation, stabilization and diagnostic capabilities for injured patients.

• Level V - Provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care.

As a verified Level I trauma center, VCU Medical Center is equipped with comprehensive resources, technology and expertise to handle the most serious types of trauma cases for adults and children.

The recent verification of VCU Medical Center as a Level I trauma center extends through December 2017. The American College of Surgeons is a scientific and educational organization of surgeons, founded in 1913, that works to improve the quality of care for the surgical patient. A list of verified centers is available online at www.facs.org.

For more, see www.vcu.edu.

New Breastfeeding Law in Virginia goes into effect on July 1, 2015 With the passage of House Bill 1499 and Senate Bill 1427, which have been signed into law by Governor Terry McAuliffe, and will take effect on July 1, 2015, mothers in Virginia now have the legal right to breastfeed their children in any location where the mother is lawfully present.

At the time the bills were introduced, Virginia was one of only three states in the country that lacked a law protecting a mother’s right to breastfeed in public. A grassroots coalition of Virginia activists, led by Kate Noon, worked toward turning this legislation into law.

Photo courtesy of Pierre Courtois, Library of Virginia

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OurHealth | The Resource for Healthy Living in Greater Richmond

Numerous health-related organizations have endorsed the bill including the Virginia Department of Health, the American Academy of Pediatrics, the American College of Nurse Midwives, and the Virginia chapter of March of Dimes. Other supporters include ACLU, Catholic Conference, National Organization for Women – VA Chapter, and Women Matter.

Salvatore Bavuso, MD Bon Secours Lively Medical Center Lively | 804.462.5155 www.goodhelpdocs.com

Christine Collins, NP Bon Secours Lively Medical Center Lively | 804.462.5155 www.goodhelpdocs.com

Tamara Hall, NP

Bon Secours Kilmarnock Primary Care Kilmarnock | 804.435.2651 www.goodhelpdocs.com

J. Bryce Lothian, MD

Bon Secours Pediatric Lung Care Richmond | 804.281.8303 www.goodhelpdocs.com

Bon Secours Cardiovascular Associates of Virginia Richmond | 804.288.3123 www.goodhelpdocs.com

Bon Secours Kilmarnock Surgical Associates Kilmarnock | 804.435.1608 www.goodhelpdocs.com

Bon Secours Powhatan Medical Center Powhatan | 804.285.6050 www.goodhelpdocs.com

Bon Secours Cardiovascular Associates of Virginia Richmond | 804.288.3123 www.goodhelpdocs.com

Stephanie Heath, NP

Charles Lovelady, MD, FACS

N. Scott Owens, FNP

Amy Conner, NP

Bon Secours Liver Institute of Virginia Richmond | 804.977.8920 www.goodhelpdocs.com

Bon Secours Memorial Medical Center Mechanicsville | 804.764.1253 www.goodhelpdocs.com

Bon Secours FastCare (walk-in clinic) Midlothian | 804.325.8888 www.goodhelpdocs.com

Bon Secours Reedville Family Practice Reedville | 804.453.4537 www.goodhelpdocs.com

Sarah Hubbard, PA-C

Judith McKenzie, MD

Berna Seabrook, FNP

Harry Doyle, MD

Bon Secours Hartfield Medical Center Hartfield | 804.776.9221 www.goodhelpdocs.com

Bon Secours Lively Medical Center Lively | 804.462.5155 www.goodhelpdocs.com

Bon Secours Senior Care Services Richmond | 804.893.8627 www.goodhelpdocs.com

Bon Secours Kilmarnock Primary Care Kilmarnock | 804.435.2651 www.goodhelpdocs.com

Matthew Jaeger, MD

John Melton, MD

Lynn Simpkins, FNP

Robert Duffer, PA

Kara Foster-Weiss, MD Bon Secours Kilmarnock Primary Care Kilmarnock | 804.435.2651 www.goodhelpdocs.com

Barbara Kahler, MD, FAAP

Bon Secours Kilmarnock Pediatrics Kilmarnock | 804.435.1152 www.goodhelpdocs.com

J. Andrew Mustian, DDS Alysha Nakoneczny, NP Mustian Dentistry Richmond | 804.285.9548 www.MustianDental.com

Christina Slavin, NP Bon Secours Reedville Family Practice Reedville | 804.453.4537 www.goodhelpdocs.com

Bon Secours Freedom Healthcare Associates Petersburg | 804.431.3400 www.goodhelpdocs.com

Darlene Stibal, MD, FACS

Bon Secours Kilmarnock Surgical Associates Kilmarnock | 804.435.1608 www.goodhelpdocs.com

www.OurHealthRichmond.com

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NEW

NOTEWORTHY

Kelly Strickland, PA

Bon Secours Reedville Family Practice Reedville | 804.453.4537 www.goodhelpdocs.com

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

Jaime Thrift, NP

Bon Secours Good Health Clinic (employee clinic) Richmond | 804.977.8915 www.goodhelpdocs.com

AdvanceItUp!

at Advanced Orthopaedics and Ortho On-Call in June

Brigitte Wolf-Small, MD

Bon Secours Hartfield Medical Center Hartfield | 804.776.9221 www.goodhelpdocs.com

Rebecca Wright, NP

Bon Secours Kilmarnock Pediatrics Kilmarnock | 804.435.1152 www.goodhelpdocs.com

Find us on social media. Follow us on Facebook, Twitter, Linked In and You Tube.

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Advanced Orthopaedics and Ortho On-Call are getting kids up and active through the programs of Fit4Kids.

Starting on June 1st, Advanced Orthopaedics and Ortho OnCall will kick off their annual AdvanceItUp! (AIU!) collection. AIU! is a community initiative designed to increase recreation options and active living at home and school for area kids who do not have access to usable sports equipment.

The public is encouraged to gather up sports equipment that they no longer use and that is still in good condition and donate it. This gently used sports gear is then used to fuel sports programs benefiting deserving area children through Greater Richmond Fit4Kids.

Donations will be accepted during the month of June, from June 1 through June 30.

Collection points include Advanced Orthopaedics West End and Southside locations, Ortho On-Call Midlothian, Westbury, and Chester locations, and the Science Museum of Virginia, location of the Greater Richmond Fit4Kids office.

For more information and details, visit www.advancedortho.me/AdvanceItUp.

OurHealth | The Resource for Healthy Living in Greater Richmond

www.OurHealthRichmond.com

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

CELEBRATE NATIONAL

MEN’S HEALTH WEEK JUNE 15-21,2015

Men can make their health a priority. Take daily steps to be healthier and stronger. There are many easy things you can do every day to improve your health and stay healthy.

Get Good Sleep

Tame Stress

• Insufficient sleep is associated with a number of chronic diseases and conditions, such as diabetes, cardiovascular disease, obesity, and depression. Sleep guidelines from the National Sleep Foundation have noted that sleep needs change as we age. In general, adults need between seven to nine hours of sleep each night.

• Sometimes stress can be good.

However, it can be harmful when it is severe enough to make you feel overwhelmed and out of control. Take care of yourself. Avoid drugs and alcohol. Find support. Connect socially.

Stay active.

Toss out the Tobacco

• See your doctor or nurse for regular checkups. Certain diseases and conditions may not have symptoms, so checkups help diagnose issues early or before they can become a problem.

• It’s never too late to quit. Quitting smoking has immediate and longterm benefits. It improves your health and lowers your risk of heart disease, cancer, lung disease, and other smoking-related illnesses.

Stay on Top of Your Game

Source – www.cdc.gov

Move More • Adults need at least two and a half hours of moderate-intensity aerobic activity (such as brisk walking) every week, and muscle strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) on two or more days a week. You don’t have to do it all at once. Spread your activity out during the week, and break it into smaller chunks of time during the day.

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OurHealth | The Resource for Healthy Living in Greater Richmond

MEN’S HEALTH FACT OR MYTH? Men who wear briefs have fewer sperm.

Myth. Although prolonged high temperatures may affect sperm count, the evidence that wearing briefs leads to lower sperm counts is inconsistent.

Hats and/or blow dryers can cause baldness.

Myth. There’s no evidence that wearing a hat or using a blow-dryer causes baldness.

Men hit their sexual peak at 18.

Fact. This is true, at least regarding a man’s supply of testosterone, which peaks at 18.

The more you shave, the thicker your beard will be.

Myth. The size and shape of our hair follicles determine the thickness and texture of our hair — whether it is thick and coarse or thin and fine.

Men can get breast cancer.

Fact. Men can get breast cancer, but it’s rare. The lifetime risk is estimated to be about one in 1,000 men.

help for

’ ear Swimmers

Swimmer’s ear (also known as otitis externa) is an infection of the outer ear canal. This condition is most prevalent during the summer months, when we tend to spend a lot of time submerged in pools, lakes and oceans. Although all age groups are affected by swimmer’s ear, it is more common in children and can be extremely painful.

Do’s and Don’t’s to Protect Yourself and Your Family from Swimmer’s Ear: Do:

• Keep your ears as dry as possible. Use a bathing cap, ear plugs, or custom-fitted swim molds when swimming.

• Dry your ears thoroughly after swimming or showering.

• Tilt your head to hold each ear facing down to allow water to escape the ear canal. Pull your earlobe in different directions while the ear is faced down to help water drain out.

• If there is still water left in ears, consider using a hair dryer to move air within the ear canal. Put the dryer on the lowest heat and speed/fan setting; hold it several inches from the ear.

Don’t: • Put objects in the ear canal

(including cotton-tip swabs, pencils, paperclips or fingers).

• Try to remove ear wax. Ear wax helps protect your ear canal from infection. If you think that the ear canal is blocked by ear wax, consult your healthcare provider.

The James River Splash & Dash

Sponsored by Riverside Outfitters is a one-of-a-kind 5K trail run that includes a flat water tube across the James River. Get ready to navigate an uneven trail with obstacles of all kinds, including rocks, roots, and other natural obstacles.

For more information and to register, visit www.jrsplashanddash.org Date: Saturday, July 11 Time: 2:30 pm Location: Historic Tredegar 500 Tredegar Street Richmond, VA

FASCINATING

FACT

The cirulatory system of ARTERIES, VEINS, and

CAPILLARIES, IS about

60,000 MILES LONG! *****

DRINK UP!

The human body can only survive for two days without fluids.

Inspired by open streets projects all over the world, this event is about closing

streets to cars and opening them to the public — for one day — to create a whole new healthy, sustainable and vibrant city street experience. FREE and open to

everyone to do what you wish – run, walk, bike, roller blade, WHATEVER! Make sure to check out the vendors lining the streets with free activities for the entire family!

For more information, visit www.sportsbackers.org Date: Saturday, June 20th Time: 10:00 am Location: The streets of Byrd Park www.OurHealthRichmond.com

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BEST THE THIRD ANNUAL

BE D S I D E M A N N E R

AWARDS

IN

T H E G R E AT E R R I C H M O N D A R E A

Vote for your favorite physicians and/or providers in more than 40 medical specialties by visiting

www.ourhealthrichmond.com

VOTING ENDS JUNE 15TH The Resource for Healthy Living in the Greater Richmond Area

Winners announced in the December 2015 edition of OurHealth

the

Anatomy

For answers, visit

OurHealth Richmond's Facebook page at

CHALLENGE How much do you know about the

Stomach? First, complete the

word search below. Next, match up the correct word with the part of the body in the illustration.

[ the Amazing Stomach ]

WORD SEARCH Antrum

Longitudinal Layer

Body (of Stomach)

Lower Esophageal Sphincter

Cardia

Mucosa

Circular Layer

Muscularis Propria

Duodenal Bulb

Oblique Layer

Duodenum

Pyloric Sphincter

Esophagus

Pylorus

Fundus

Serosa

Gastric Rugae Greater Curvature

Submucosa

Lesser Curvature

____________________

____________________ ____________________

____________________ ____________________ ____________________

____________________

____________________ ____________________

____________________ ____________________

____________________

____________________

____________________ ____________________

____________________ ____________________ ____________________

____________________ ____________________ www.OurHealthRichmond.com

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taking a CLOSER

LOOK at the

STOMACH words | EDWIN SCHWARTZ

Many people think of the stomach as the organ that digests food. But the stomach mainly serves as a holding tank that only begins the digestive process. To learn more about the stomach’s role, how it works and the conditions that affect it, OurHealth turned to experts at Richmond Gastroenterology Associates and Gastrointestinal Specialists Inc.

What is the stomach?

The stomach is a part of the gastrointestinal tract that begins at the mouth and continues though the esophagus, stomach, small intestine, large intestine, and rectum and ends in the anus.

The stomach is the only part of the GI tract that is not a long tube. Rather, it is a hollow, muscular, J-shaped reservoir that receives ingested food from the esophagus, retains it and passes it along to the small intestine. The average adult stomach can hold up to 1.5 liters of predigested food.

The stomach’s role in the digestive process According to Robert S. Flynn, MD, a board-certified gastroenterologist with Richmond Gastroenterology Associates, the stomach serves three essential functions: (1) it acts as a storage reservoir for food, (2) it grinds and digests food into small particles, and (3) it releases these particles in a controlled manner into the small intestine for further digestion and absorption.

“Digestion of food in the stomach helps with the absorption of iron, calcium and vitamin B-12,” says Andy J. Thanjan, MD, also a board-certified gastroenterologist who is with Gastrointestinal Specialists Inc.

www.OurHealthRichmond.com

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Parts of the stomach The anatomical sections of the stomach are the cardia, fundus, body and antrum, along with the end portion, a muscular valve called the pylorus.

Breaking down how the stomach breaks down food Digestion begins in the mouth with chewing, to form smaller particles and increase their surface area and saliva, which begins the breakdown of carbohydrates. Once food reaches the stomach, strong muscular contractions (peristalsis) further grind the contents and mix them with stomach (gastric) juices.

This forms a liquid mixture of particles (chyme) that is released into the small intestine in a regulated manner for further digestion and absorption.

Cardia The cardia is a short section near the top of the stomach where it meets the esophagus.

It is the opening that allows food to pass into the stomach.

Fundus The fundus is the upper part of the stomach, next to the cardia. Its main function is to signal the brain to stop eating.

Body The body of the stomach is the midportion, and it is involved with the reservoir function. Most of the stomach’s parietal and chief cells are located in the body.

Parietal cells secrete hydrochloric acid and intrinsic factor, which is essential for the proper absorption of vitamin B-12.

This production of hydrochloric acid is the primary secretory function of the stomach.

It begins to break everything down and is helpful in killing bacteria or infectious agents.

“The major product of the stomach is acid to digest food,” says Dr. Thanjan. “The stomach also makes mucus to protect its cells from the acid, ingested substances, bacteria and viruses.”

Chief cells ultimately make pepsin, a potent enzyme for the predigestion of protein.

This process occurs as the chief cells secrete pepsin in the form of pepsinogen, an inactive enzyme. The hydrochloric acid then converts the pepsinogen into the active enzyme pepsin.

Antrum This is the lower portion of the stomach where the food is mixed with gastric juices.

The antrum is the motor of the stomach that grinds and smashes food into smaller pieces in a churning cycle that lasts up to four hours after a meal.

Here, the stomach also contains G cells that secrete a hormone called gastrin that travels by blood to regulate acid secretion by cells of the upper portions of the stomach. Gastrin is the most potent stimulator of acid secretion.

Pylorus The pylorus is the end portion of the stomach, located at the junction of the stomach and small intestine. It acts as a valve that regulates the emptying of the stomach contents.

It usually stays closed but opens periodically to let a small amount of food into the duodenum, the first part of the small intestine. This food is called chyme — a thick, semifluid mass of partially digested food.

Layers of the stomach wall Robert S. Flynn, MD is certified by the American Board of Internal Medicine with a sub-specialty in gastroenterology. He sees patients in the Midlothian location of Richmond Gastroenterology Associates.

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There are four layers to the stomach. The mucosa is the innermost layer. It is secretory in nature and is in contact with the lumen (the open cavity that fills the stomach).

Beneath the mucosa is the submucosa, a layer of dense, connective tissue that provides structural support and blood supply. The mucosa and submucosa are responsible for

OurHealth | The Resource for Healthy Living in Greater Richmond

acid and digestive enzyme secretion, intrinsic factor release and digestive hormone release (such as gastrin).

The muscularis propria is the muscle layer. It grinds food into smaller particles and controls the release of these particles into the duodenum. As the muscle relaxes, the stomach distends and stores food. Contraction of the muscle is essential for grinding, mixing and delivering the gastric contents to the small intestine.

The outside layer is the serosa, which is a thin, strong layer of connective tissue that covers the muscle layer. The serosa does not aid in the digestive process, but its slippery surface protects the stomach from friction.

Conditions that affect the stomach Gastritis

Andy J. Thanjan, MD, with Gastrointestinal Specialists Inc., is certified by the American Board of Internal Medicine with a subspecialty in gastroenterology.

Gastritis occurs when the mucosa layer of the stomach lining becomes inflamed.

Symptoms may include epigastric (above the stomach) abdominal pain, nausea, vomiting or bloating.

“There are many causes, but the most common include Helicobacter pylori (H. pylori) infection, medications such as nonsteroidal anti-inflammatory drugs and the ingestion of toxic substances, including alcohol,” says Dr. Flynn.

H. pylori is a rod-shaped bacteria that lives in the mucus layer above the stomach lining. It is less common in developed countries like the United States because it is spread by contaminated food or water.

Treatment for gastritis may include antibiotics for an H. pylori infection, an acidsuppression medication such as a proton pump inhibitor or discontinuing the use of NSAIDs like aspirin and ibuprofen.

Why does my stomach growl?

No, it isn’t expressing itself. It’s a normal — although sometimes embarrassing — process called “borborygmi.” The rumbling sounds come from the GI tract as the pylorus valve opens, and a mixture of air and fluid pushes chyme through the small intestine.

Peptic ulcer disease Peptic ulcer disease occurs when stomach acid and pepsin successfully penetrate the stomach or intestinal lining, causing ulcers to develop.

The disease is defined as a break in the mucosa layer of the stomach lining or the duodenum that can be fairly deep. Ulcers can cause abdominal pain, nausea and, in www.OurHealthRichmond.com

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Ulcer myths One of the most common stomach myths has to do with ulcer formation. For the record, daily stress will not cause ulcers. Also, hot and spicy foods and beverages will not cause ulcers, but they may irritate an existing one.

some cases, bleeding. Occasionally the ulceration can go through the full thickness of the stomach or duodenum and cause a perforation in the stomach or intestinal lining.

The two most common causes of ulcers are H. pylori infection and the use of NSAIDs. The arrival of proton pump inhibitors has revolutionized ulcer treatment and has almost eliminated the need for surgery. The healing process includes stopping NSAIDs and eradicating H. pylori infections with antibiotics.

Gastroparesis Gastroparesis, or stomach paralysis, is a condition where the stomach empties slowly.

Its symptoms can include nausea, vomiting or feeling full after eating a small amount.

Normal stomach emptying is a complex process that coordinates the gut nervous system, the pacemaker cells of the stomach (called the interstitial cells of Cajal) and the smooth muscle that lines the stomach. With gastroparesis, this coordination is disrupted because the number of pacemaker cells is reduced.

Gastroparesis is most commonly associated with diabetes or past stomach surgery, but its cause may be unknown. It can be diagnosed using a gastric emptying scan — a radiology test that measures stomach emptying. Treatment includes avoiding foods that delay gastric emptying, such as fat and fiber. Eating smaller, more frequent meals is also recommended.

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Gastric Cancer Gastric cancer, or stomach cancer, is one of the most common forms of cancer. The disease was the leading cause of cancer death worldwide until being overtaken by lung cancer. H. pylori infection is a risk factor for stomach cancer. It also runs in families independent of H. pylori infection, which suggests a genetic predisposition to gastric cancer. Surgery, often combined with chemotherapy, is the primary method of treatment for stomach cancer.

Maintaining a healthy stomach Dietary and environmental factors can affect stomach health. Obesity, tobacco use and high-salt diets are all associated with an increased risk of gastric cancer.

“There is also a potential correlation between the consumption of nitrates in processed meats and higher rates of gastric cancer,” says Dr. Flynn. Nitrates are also used for treating chest pain caused by heart disease. “Fruits, vegetables and antioxidants such as green tea appear to have a protective effect and are associated with lower rates of gastric cancer.”

The stomach – In conclusion Our stomachs are complex reservoirs that hold our food, break it down and regulate its continuation along the GI tract. As with many intricate systems, the stomach has a sensitive nature. So pay attention to the signs it gives and seek assistance from a gastrointestinal specialist if you notice something irregular.

Expert contributors:

Can eating less shrink your stomach?

Contrary to popular belief, reducing portion size will not cause one’s stomach to shrink. Rather, reducing food intake affects the levels of hormones such as leptin and ghrelin — known as the appetite hormone — causing the appetite to decrease.

• Robert Flynn, MD, of Richmond Gastroenterology Associates • Andy J. Thanjan, MD, with Gastrointestinal Specialists Inc.

Sources: • Mayo Clinic – www.mayoclinic.org • American College of Gastroenterology – www.gi.org

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Take care of

MAN! words | SUZANNE RAMSEY

In a filing cabinet at my house, there’s a 2-inch-thick manila folder labeled “Suzanne Medical” that contains documentation from a decade or so of medical appointments — mammograms, annual physicals, that time I thought I had a gallstone, you name it.

And my husband’s file? What file?

It’s no secret that men are known for not seeking medical help until a limb is dangling or they’re bleeding to death or both.

But like women, they’re not immune to health problems. In fact, WebMD reports that “of the 15 leading causes of death, men lead women in all of them except Alzheimer’s disease, which many men don’t live long enough to develop.”

So why the aversion to the physician’s office? Joel Silverman, MD, chairman of Virginia Commonwealth University Medical Center’s Department of Psychiatry, has some insight.

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

To view additional work by our artist, Joe Palotas, visit

“When your self-image and the expectations of others are that you are strong, in charge, invincible, then you do not ask for help,” Dr. Silverman says. “Why would you need it? This, of course, is paradoxical because the strongest, most successful people do surround themselves with smart, strong people who help them succeed.”

So, for all the wannabe Supermen out there, OurHealth talked with area physicians about health conditions that commonly affect men and how to prevent them. Here’s what they had to say.

www.salemartcenter.com

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What is ionizing radiation?

Ionizing radiation can damage living tissue by disrupting and destroying individual cells at the molecular level. All types of nuclear radiation — X-rays, gamma rays and beta rays — are potentially ionizing. Sound waves physically vibrate the material they pass through but do not ionize it.

Source: Gale Encyclopedia of Medicine

Lung Cancer The American Cancer Society estimates about 115,610 men will be diagnosed with lung cancer in 2015, and that 1 in 13 men will be diagnosed with the disease during his lifetime. These numbers include smokers and nonsmokers, although a smoker’s risk is much higher than a nonsmoker’s.

As for risk factors, physicians say smoking is most often to blame.

Attique Samdani, MD, is certified by the American Board of Internal Medicine with a sub-specialty in medical oncology. He serves patients primarily at the JohnstonWillis and St. Francis locations of Virginia Cancer Institute.

“The primary risk factor for the development of lung cancer is cigarette smoking, and that accounts for approximately 90 percent of all lung cancers,” says Attique Samdani, MD, a board-certified medical oncologist with the Virginia Cancer Institute. “Other factors include radiation therapy and environmental factors, including exposure to second-hand smoke, asbestos, radon and ionizing radiation. The role of dietary and genetic factors is not well-established but may have some impact.”

Symptoms of lung cancer include things one might expect, such as coughing up blood or a chronic cough, for example, but other indications aren’t so straightforward.

“Cough is present in 50 to 70 percent of lung cancer patients at presentation,” Dr. Samdani says. “Hemoptysis [blood in sputum], chest pain and shortness of breath are present in approximately 25 to 40 percent of patients with lung cancer at the time of diagnosis.

“Lung cancer can spread to any part of the body,” Dr. Samdani continues. “Therefore, patients can present with headache, vomiting and seizures if there is involvement of the brain, and bone pain with bony involvement.”

Recognizing the symptoms and heeding them could mean the difference between life and death. “The majority of patients with lung cancer have advanced disease at clinical presentation. Overall survival decreases significantly with advanced-stage disease and for those who have poor performance and weight loss.” says Dr. Samdani.

The American Cancer Society estimates that 86,380 men will die of lung cancer in 2015.

•••••

Heart Disease and Stroke Heart disease is the leading cause of death for men in the United States. According to the Centers for Disease Control and Prevention, heart disease killed 307,225 men in 2009, which translates to 1 in 4 male deaths. The CDC reports that 70 to 80 percent of sudden cardiac events occur in men.

Despite these numbers, Antonio Abbate, MD, a cardiologist with the VCU Pauley Heart Center, says the risk of heart disease is underrated.

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“I think one of the major problems is underestimating the risk of heart disease,” he says. “We are frightened about many things that are highly unlikely to occur — a terrorist attack, for example — but we don’t fear enough the No. 1 killer in the United States: heart disease. The risk is high.”

Among the risk factors for heart disease, Dr. Abbate lists genetics, an unhealthy diet, alcohol and drug use, stress, lack of exercise, diabetes, high blood pressure, high cholesterol and generally not taking care of oneself.

“Most men would never use low-grade gasoline for their car or give their dog bad food,” he says, “but they’ll poison themselves with fast and junk food.”

As for ways to avoid heart disease, Dr. Abbate recommends dealing with risk factors — “Tackle them hard,” he says — and recognizing and reacting to symptoms.

According to the CDC, half the men who die suddenly of coronary heart disease have demonstrated no previous symptoms, but there are symptoms to watch out for.

Antonio Abbate, MD, PhD is vicechairman in the division of cardiology at VCU Pauley Heart Center. He is certified by the American Board of Internal Medicine.

“Chest pain, pressure and discomfort are typically symptoms,” Dr. Abbate says, adding that men also need to be aware of pain in the arm, jaw or back. “Other symptoms that are very important are shortness of breath, fatigue, tiredness and dizziness.

Remember that risk factors are usually silent, so get checked.”

Heart disease also puts men at risk for stroke.

“Risk factors for stroke are divided into those an individual can control and those he cannot,” says Stacey Epps, MD, a neurologist with Bon Secours Neurology Clinic.

“Men are already at a higher risk for stroke than females. In addition to gender, those that cannot be controlled are age (high risk with advancing age), race (African Americans are at higher risk), and family history of stroke. We tell folks to be aware of these risk factors, but they cannot be changed.”

Risk factors that men might have some control over include smoking, high blood pressure, high cholesterol, diabetes, an unhealthy diet and excessive alcohol consumption. A daily aspirin regimen might reduce heart attack and stroke risk, but Dr. Epps says this approach is not appropriate for everyone. “Speak with your doctor about whether you should take a daily aspirin. Never start an aspirin regimen without speaking to your doctor first.”

Stacey Epps, MD, is a neurologist with Bon Secours Neurology Clinic in Chester and Midlothian. He is certified by the American Board of Psychiatry and Neurology.

Dr. Epps also recommends regular checkups with your physician and knowing the warning signs and symptoms of stroke. Recognizing symptoms quickly is very

BE FAST to recognize stroke The acronym BE FAST is a good way to remember stroke symptoms.

B — Balance difficulty.

E — Eye trouble (double vision, losing vision, etc.).

F — Face (drooping of a side of the face).

A — Arm (weakness/numbness of arm, leg or side of body).

S — Speech (difficulty with speaking or understanding speech or written words).

T — Time. Time is critical. If you suspect you or someone you are with is having a stroke, call 911 immediately for transport to the nearest certified stroke center. No matter the location, stroke treatment begins with emergency medical services. EMS will quickly identify a potential stroke in progress and call ahead to the hospital emergency department. This advance warning allows the emergency department and other staff to be ready and waiting to expedite treatment.

Source: Stacey Epps, MD www.OurHealthRichmond.com

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important, he says, because 1.9 million brain cells are lost every minute during a stroke, and some treatments are dependent on quick reaction time.

“Stroke symptoms typically come on without warning,” Dr. Epps explains. “Never ignore symptoms suspicious for stroke. There are treatments available, but one still has to get to the hospital as soon as [symptoms] are recognized in order to be eligible for treatment.

“The sooner a stroke is treated, the better the potential outcomes,” he says. “The passing of time could make some patients ineligible for some treatments. Strokes typically don’t cause pain and therefore people will tend to ignore the symptoms.”

•••••

Depression and Suicide

Joel Silverman, MD, is chairman of VCU Medical Center’s Department of Psychiatry. He is certified by the American Board of Psychiatry and Neurology.

While women are more likely to report a suicide attempt, men are more likely to succeed in killing themselves. This is according to the CDC, which reports that men are about four times more likely than women to die from suicide. Men represent more than 79 percent of all U.S. suicides.

As for why an estimated 40,000 people — about 31,600 of them men — kill themselves each year in the U.S., the online support group Suicide.org reports that untreated depression is the No. 1 cause of suicide. But why so many men?

“There are many factors, including that women ask for help with their depression and other things more readily than men,” VCU’s Dr. Silverman says. “Men employ more lethal methods, like firearms, whereas women tend to employ less lethal methods, like overdose.

According to Dr. Silverman, “Men are more likely to have substance abuse problems, which worsen their depression and make them impulsive. Some men have poor levels of social support, which is a protective factor against suicide. Men may be more vulnerable to the depressing effects of job loss.”

Warning Signs of Depression • Insomnia.

Among the risk factors, he says, are lack of social support, alcohol and drug abuse, job loss and genetics.

• Poor mood.

“We know that mental illnesses, like many other illnesses, have their risk increased by genetic factors,” he says. “A family history of depression is an important predictor.”

• Crying spells.

To avoid depression, Dr. Silverman recommends a healthy lifestyle, including a good balance of play and work. Substances such as alcohol should be used in moderation; having friends and exercising regularly are also important.

“Lastly, when depression starts, recognize that it is an illness and seek diagnosis and treatment from an experienced professional,” says Dr. Silverman.

Fortunately, there are a variety of treatment options for depression, everything from medication and psychotherapy to yoga, meditation and exercise.

• Reduced energy.

• Feelings of hopelessness and helplessness.

• Changes in appetite.

• Loss of sexual energy.

• Thoughts of suicide or thoughts that life just isn’t worth it.

Source: Joel Silverman, MD

“There are many effective treatments for depression,” Dr. Silverman says, “but patients must realize that they are dose-dependent, which means you have to have enough of the treatment in order for it to be effective. Penicillin may be the best drug for your pneumonia, but if you don’t take enough for long enough, it won’t work.

There are effective medications and psychological treatments. Each works, and often both together work better than either alone.”

The problem, however, can be getting men to seek treatment. www.OurHealthRichmond.com

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“Men often feel shame and reluctance to seek help and would rather just suffer, which is not a smart strategy,” says Dr. Silverman. “The strongest people recognize their problems and get help. Most of us get a lot of help in our lives. We don’t grow our own food, make our own cars or do our own legal work, etc. Seeing the doctor makes sense.”

•••••

Diabetes According to the 2014 National Diabetes Statistics Report, more than 29 million people — more than 9 percent of U.S. adults — have diabetes, a disease caused by having too much glucose, or sugar, in the blood. Of these, 15.5 million are men.

Warning Signs of Diabetes • Increased thirst.

• Increased hunger (especially after eating).

• Dry mouth.

• Frequent urination or urine infections.

• Unexplained weight loss (even though you are eating and feel hungry).

Most cases of diabetes are Type 2 — what used to be called adult-onset diabetes — which has been linked to being overweight or obese. Physicians say improved diet and exercise habits can go a long way in the fight against diabetes.

“You can do plenty to help avoid or delay the development of diabetes with simply a healthier diet and plenty of physical activity,” says Stephen P. Crossland, MD, a wound care specialist at the Chippenham Hospital Wound Healing Center and Diabetic Limb Salvage Program. “It has been shown that 90 percent of cases of Type 2 diabetes could be prevented or significantly delayed through healthier diet, physical activity and weight loss, when needed.”

If diagnosed with Type 2 diabetes, Dr. Crossland says there are numerous treatment options, among them, lifestyle changes, diet and exercise; oral medications; insulin, inhaled and/or injected; and new drugs that work in combination with insulin to improve blood sugar.

• Fatigue (weak, tired feeling).

Diabetes risk factors

• Blurred vision.

• Headaches.

• Overweight or obese.

Source: WebMD

• Sedentary lifestyle.

• Diet high in sugar and refined carbohydrates and low in fiber and whole grains.

• History of Type 2 diabetes in your immediate family (mother, father, sister, brother).

Stephen P. Crossland, MD, a wound care specialist at the Chippenham Hospital Wound Healing Center and Diabetic Limb Salvage Program. He is certified by the American Board of Family Medicine.

• Risk increases with age.

• Ethnicity – increased risk for AfricanAmericans, Native American, Alaska Natives, Asian-Americans and PacificIslanders.

Source: Stephen Crossland, MD

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Quick Facts from the American Diabetes Association • Diabetes is a group of diseases that result in too much sugar in the blood, or high blood glucose.

• Nearly 30 million Americans have diabetes – almost 900,000 (or 13percent of the population) here in Virginia.

• Another 36 percent of Virginians have prediabetes, putting them at increased risk for the disease.

• Men who are overweight or obese are at an increased risk of developing type 2 diabetes, high cholesterol, stroke, high blood pressure and coronary heart disease.

• Testosterone deficiency is common in men with diabetes – both type 1 and type 2 – and one-third of men with type 2 diabetes have low testosterone.

• 1 in 4 people with type 2 diabetes don’t even know they have this disease.

• Diabetes can lead to serious complications like blindness, kidney disease, heart attack and stroke and amputations.

Diabetes Calls to Action • Eat a varied diet rich in fruits, vegetables, whole grains and low-fat foods.

• Get at least 30 minutes of exercise at least five times a week.

• Get your blood glucose level checked regularly, as advised by your doctor.

• Know your family’s diabetes history and discuss it with your doctor.

• Seek information and resources at www.diabetes.org or 1-800-DIABETES. Source: American Diabetes Association

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•••••

Skin Cancer Studies have shown that men are at higher risk than women for getting skin cancer.

“Statistics from 2008 showed that 35,000 American men would develop the deadliest form of skin cancer, melanoma, compared to 27,000 women,” says Jean Calhoun, MD, a dermatologist with Dominion Dermatology. A recent study showed incidence rates for men to be more than five times greater than they were 30 years ago, according to Dr. Calhoun.

Why more men than women? According to Melissa King, MD, a board-certified dermatologist with Richmond Dermatology & Laser Specialists, men are not genetically or inherently more likely to get skin cancer, but they are less likely to use sunscreen and don’t get the added sun protection from makeup, which often is the case with women.

Jean Calhoun, MD, is a dermatologist with Dominion Dermatology in Glen Allen. She is certified by the American Board of Dermatology.

Dr. King says that men are most commonly affected on the face, especially the nose and ears. “Ears stick out of baseball caps and most people don’t think to apply sunscreen there. Also, scalps of older men, due to hair thinning and hair loss. Third is the backs of hands and forearms. A very interesting and important fact is that statistically there are more skin cancers on the left side of the face, left hand and left forearm because sun comes through the car window.”

The Skin Cancer Foundation estimates melanoma will kill 6,640 men in 2015, but there are ways men can reduce their risk.

Dr. King recommends avoiding the sun between 10 a.m. and 2 p.m., when its rays are strongest, and opting for shade when possible. “Also, it’s possible to have car windows tinted for UV protection,” she says. “That’s very important, especially for people whose work requires them to be in the car a lot, sales people, etc.”

Physicians also say to avoid tanning beds, use sunscreen, and wear hats and clothing that have a sun-protective rating similar to the SPF in sunscreen.

“One survey showed 47 percent of men never use sunscreen, while only 34 percent of women said they never use sunscreen,” Dr. Calhoun says. “This also includes sunprotective clothing.”

Men also are more likely to put off going to the doctor.

“Men are more likely to be diagnosed at a more advanced stage,” Dr. Calhoun says.

“They may seek medical advice later. Since men have a high incidence of skin cancer on their back, this may make it more difficult for them to spot.”

What are common signs of skin cancer?

• An enlarging bump or red scaly area that has gotten bigger.

• A lesion that bleeds with minimal trauma.

• A mole that changes color.

Source: Jean Calhoun, MD

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•••••

Prostate Cancer and Other Urological Issues The American Cancer Society reports that other than skin cancer, prostate cancer is the most common cancer in American men. The organization estimates that 220,800 U.S. men will be diagnosed with prostate cancer in 2015, and about 27,540 men will die from the disease. Further, the ACS says that 1 in 7 men will be diagnosed with prostate cancer at some point in his life.

“Prostate cancer typically occurs as men age,” says Michael Franks, MD, a board-certified urologist with Virginia Urology. “There are genetic and environmental factors that play a role in developing prostate cancer. African— Continued on page 38

What is prostatespecific antigen testing?

A prostate-specific antigen test measures the amount of prostate-specific antigen in the blood. PSA is released into a man’s blood by his prostate gland — a small, walnutshaped gland that produces the seminal fluid that nourishes and transports sperm. Healthy men have low amounts of PSA in the blood, but the amount of PSA in the blood normally increases as a man’s prostate enlarges with age.

Source: WebMD

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What is benign prostatic hyperplasia?

Prostate gland enlargement is a common condition as men age. Also called benign prostatic hyperplasia (BPH), prostate gland enlargement can cause bothersome urinary symptoms. Untreated, prostate gland enlargement can block the flow of urine from the bladder and cause bladder, urinary tract or kidney problems.

Source: Mayo Clinic

— Continued from page 37

American men are at a higher risk, 1 in 4, of developing prostate cancer than Caucasian men, 1 in 6. There is no one factor that causes someone to develop prostate cancer.”

Unfortunately, physicians say there’s not much that can be done to avoid prostate cancer if one is genetically predisposed to it. Most men also don’t experience symptoms of prostate cancer unless the disease has progressed, Dr. Franks says, so knowing your family’s history of prostate cancer is imperative.

“Men that have a sibling or father that has had prostate cancer have a two or three times greater risk of developing prostate cancer,” he says, adding that men who have a family history or are African-American should have prostate-specific antigen testing and a rectal exam in their 40s. “This information can be invaluable should prostate cancer develop in the future.”

Michael Franks, MD, is certified by the American Board of Urology. He serves patients primarily at the Stoney Point location of Virginia Urology.

Dr. Franks also recommends diet and exercise as important factors in managing inflammation in the body, which can play a part in developing prostate cancer. “We recommend that men eat a heart-healthy diet, avoid fatty foods and try to reduce stress. All play an important role in overall general health,” he says.

There are other conditions that should prompt a visit to the urologist as well, among them benign prostatic hyperplasia, commonly referred to as enlarged prostate.

“About half of the men over age 50 will have prostate enlargement,” Dr. Franks says.

“Urinary symptoms, such as getting up frequently during the night to urinate or [having] a slow urine flow can be signs of BPH. Medications are available to help with BPH. We also offer laser treatments that allow men to urinate better.

“Bottom line is that a man’s urinary and sexual function can be indicators of various problems and therefore should not be ignored. As with any medical issue, it’s best to catch it early so it can be treated property.”

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CARY TOWN

10K

A rainy Saturday morning didn’t stop nearly 1,000 runners, walkers and spectators from hitting the pavement in the Carytown 10K race! In its 11th year, there were over 100 dedicated volunteers who came out to lend a hand. The race, supported by the Carytown Merchants Association and the Road Runner Running Store is one of 15 races put on by the Richmond Road Runners Club, whose mission is to support running in the Richmond area. Participants enjoyed the scenic route through Richmond’s Historic Carytown.

Photos courtesy of the Carytown 10K and Richmond Road Runners Club

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Breaking the Silence Bipolar Disorder words | SUSAN DUBUQUE

This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them. That is, until now. In each edition of Our Health, we bring these medical issues into the light—and dedicate these stories to the courageous patients and families living with them and the providers and researchers who commit their lives to treating and seeking cures for these silent killers.

Claire’s Story “Hi, how many for dinner? Please come this way.” With a bright smile and sunny disposition, Claire Wenzel greets her guests in her role as hostess for a local chain restaurant—a job that she greatly enjoys and is very good at performing. But such confidence and competency weren’t always the case.

“Claire was evaluated for the first time when she was just six years old,” shares her mother, Donna Wenzel. “She would cry over the smallest thing, and her temper tantrums were way out of proportion to whatever was happening at that time.” Most frightening of all, even at that young age, Claire had suicidal thoughts.

Matters went from bad to worse. As an adolescent, Claire exhibited extreme mood swings, impulsivity and poor judgment. She repeatedly got in trouble in school and home—fighting with classmates and her siblings. By 10th grade her behavior was so out of control that she had to be hospitalized. It was during this inpatient stay at the VCU Virginia Treatment Center for Children that Bela Sood, MD, child psychiatrist, confirmed Claire’s diagnosis as bipolar disorder. “What looked like defiant behavior,” recalls Donna, “was actually the result of manic episodes and psychosis.” While Claire’s behavior seemed outrageous, she simply couldn’t help it.

The family can now look back with humor at some of Claire’s antics when she was in a manic state. One summer, Claire went on Craig’s List and started adopting pets.

Seven or eight cats and a dog were delivered to the family’s home before Claire’s parents realized what was going on. And then there was the home-buying spree. At age 10, Claire filled out a loan application online for the purchase of a luxury home.

“The real estate agent was sorely disappointed when he called the house asking for Ms. Claire Wenzel, only to be told she was outside playing,” says Donna.

Humor and loving support have been ongoing survival strategies for the Wenzel family. “When you have 11 children—now ranging in age from 13 to 30—you better have a sense of humor,” remarks Donna. Along the way the family has had to cope with its share of tragedy. In 2012, Claire’s 21-year old brother, Luke, died unexpectedly and one month later Neil Wenzel, the children’s father, passed away.

According to Donna, “Claire comes by her bipolar disorder honestly.” Donna suspects that Claire’s father, although undiagnosed, experienced similar issues, and three of Claire’s brothers have also been diagnosed with bipolar disorder.

Despite the challenges and heartaches, today Claire is thriving. She attributes her stability and healthy outlook to finally achieving the right combination of medications and sticking with it—even when annoying side effects occur.

Claire has graduated from high school and is now working full time. She is looking forward to a bright future, full of promise. With a wink of one of her huge blue eyes, Claire declares that if not veterinary medicine, maybe she’ll go into real estate after all.

It’s time to bring bipolar disorder into the light—and learn what this disorder is, the signs and symptoms, how it is diagnosed and treated and advances that may provide support and relief for those coping with this insidious disorder.

Bela Sood, MD, is a child psychiatrist at the VCU Virginia Treatment Center for Children.

She is certified by the American Board of Psychiatry and Neurology with a sub-specialty in Child and Adolescent Psychiatry.

What is bipolar disorder?

Bipolar disorder—also known as manic-depressive illness—is a brain disorder that causes unusual shifts in mood, energy and activity levels that occur in distinct periods called “mood episodes.” An individual may go from an overly joyful or excited state, called a manic episode, to an extremely sad or hopeless state, called a depressive episode.

Sometimes symptoms of both mania and depression occur during the same episode, which is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

“Everyone experiences highs and lows, but when ups and downs become times of lifealtering and regrettable decision making and horrible moments of self-loathing and loss, bipolar disorder may need to be considered,” notes Karen Rice, licensed clinical social worker with the Virginia Home for Boys and Girls. If left untreated, bipolar disorder can result in damaged relationships, poor job or school performance and even suicide.

Karen Rice is a licensed clinical social worker with the Virginia Home for Boys and Girls.

Above: Claire, with siblings, Teresa, Emily and Joey - Waiting for the bus on the first day of school. At Left: Claire with her dad, Neil in 2012.

Bipolar disorder is not only a serious medical condition, but it is also one that affects many people. According to the World Health Organization, bipolar disorder is the sixth leading cause of disability in the world, affecting approximately 5.7 million adult Americans. To put that in perspective, more people lose productive time due to bipolar disorder than all forms of cancer combined.

According to Anand Pandurangi, MD, psychiatrist with VCU Medical Center, “Bipolar is an equal opportunity illness.

Roughly the same number of men and women develop the disorder and it occurs in all ages, races, ethnic groups and social classes.” The disorder typically emerges in late teen or early adult years, with at least half of all cases starting before age 25. Some people have their first symptoms during childhood, while others may develop symptoms later in life.

While there is no single gene identified with bipolar disorder, the family ties are definitely apparent. More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with major depression, and if one identical twin has the illness, there is a 40 percent chance that the other twin will too.

Signs and Symptoms So what does bipolar disorder look like? Well, it all depends. The signs and symptoms will vary depending upon the type of episode an individual is experiencing at that time.

Anand Pandurangi, MD, is a psychiatrist with VCU Medical Center.

He is certified by the American Board of Psychiatry and Neurology.

Symptoms of mania or manic episodes include: • A long period of feeling “high,” or an overly happy or outgoing mood • Extreme irritability • Talking very fast, jumping from one idea to another, having racing thoughts • Being easily distracted • Increasing activities, such as taking on new projects

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• Being restless • Sleeping little or not feeling tired • Having an unrealistic belief in one’s abilities • Behaving impulsively and engaging in pleasurable, high-risk behaviors

Signs of hypomania—or a less severe form of mania—include: • Feeling euphoric, energetic and productive. (To others this may simply looks like the individual is unusually happy.)

• Able to carry out day-to-day activities and never lose touch with reality • May lead to bad decisions that harm relationships, careers and reputations • Often escalates to full-blown mania or is followed by a major depressive episode

And depression or depressive episode symptoms include:

Claire’s high school graduation, 2014, with mom, Deborah (left).

• A long period (two weeks or longer) of feeling worried or empty • Loss of interest in activities once enjoyed, including sex • Feeling tired or “slowed down” • Having problems concentrating, remembering and making decisions • Being restless or irritable • Changing eating, sleeping or other habits • Thinking of death or suicide, or attempting suicide

Diagnosing Bipolar Disorder “Bipolar disorder may not be recognized as an illness, and people may suffer for as long as 10 years from the first onset until an accurate diagnosis is made,” says Martin Buxton, MD, psychiatrist at Chippenham and Johnston-Willis Hospitals. Perhaps the most important diagnostic tool is talking openly with a healthcare provider about mood swings and changes in behavior and lifestyle habits such as in diet, sleep and use of drugs and alcohol.

“A useful screening tool for bipolar disorder is the Mood Disorder Questionnaire,” notes Dr. Buxton. “Individuals can complete this brief instrument online and share the results with their healthcare providers for further evaluation.”

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to ensure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania. “A significant number of patients are discovered to have bipolar disorder when they present with symptoms of depression, are prescribed an antidepressant and flip into a manic state,” indicates Dr. Buxton.

Martin Buxton, MD, is certified by the American Board of Psychiatry and Neurology with a sub-specialty in Child Psychiatry. He serves patients in Chippenham and Johnston-Willis Hospitals.

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The healthcare provider will also conduct a physical exam and take a complete family history. Although bipolar disorder cannot be identified through a blood test or a brain scan, these tests may help rule out other medical issues that may contribute to mood problems, like a stroke, brain tumor or thyroid condition.

There are challenges to diagnosing bipolar disorder. “We’re not dealing with a single disease,” explains Dr. Pandurangi. “Bipolar syndrome occurs across a spectrum.” Three forms of the disorder along this continuum are:

Bipolar I Disorder. A severe form of

the illness that is characterized by episodes of both mania and depression. During the manic phase a patient may become psychotic—that is, have a break with reality. This may involve delusions (false beliefs) and hallucinations (seeing or hearing things that aren’t there).

Bipolar II Disorder. The individual

experiences hypomania—milder than fullblown mania—and episodes of severe depression. This form of the illness is more common than bipolar I disorder, but it may be misdiagnosed as major depression.

Cyclothymia. Characterized by mood

swings that cycle between hypomania and mild depression. You might think of cyclothymia as “low grade” bipolar disorder. The cycles between moods tend to happen more quickly and be of shorter duration, and overall this form of the illness is less debilitating.

Some researchers suggest that there are more varieties, such as manic temperament, which is a personality type with behaviors that appear like a continuous mild mania.

Bipolar disorder can co-occur with other medical and mental health conditions. “The co-occurrence of bipolar disorder and drug or alcohol abuse may be as high as 60 percent and appears to be genetically linked,” indicates Dr. Gardner. Substance abuse may trigger or prolong bipolar symptoms, and the lack of judgement and problems with behavioral control that are associated with mania can in excessive drinking.

Anxiety disorders—like post-traumatic stress disorder (PTSD) and social phobia—often appear with bipolar disorder. And attention 46

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deficit hyperactivity disorder (ADHD) has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted.

The kids at the Wenzy-Frenzy (Wenzel Family Reunion) in Laguna Beach, CA, 2012.

People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity and other physical illnesses. These illnesses may cause symptoms of mania or depression, and they may also result from treatment for bipolar disorder.

Treatment Options There is no cure for bipolar disorder, however there are a number of treatments available to help people gain better control of their mood swings and manage their symptoms.

“There are three general types of medication used to treat bipolar disorder--mood stabilizers, antipsychotics and antidepressants,” says Dr. Pandurangi. “Not everyone responds to medication the same way. So patients may have to try several different drugs or combinations of drugs before finding what works the best.”

The initial choice for medication is usually a mood stabilizer. Lithium was the first mood stabilizer approved by the FDA, in the 1970s, for treating both manic and depressive episodes. Individuals who take lithium must have regular blood tests to monitor thyroid and kidney function. Anticonvulsant medications, originally developed to treat seizures, are also beneficial in controlling moods.

Antipsychotic medications, often taken in combination with an antidepressant, can treat manic or mixed episodes or psychosis. These medications can cause major weight gain and changes in metabolism, which may increase the risk of getting diabetes and high cholesterol. Patients taking this type of medication must have their weight, glucose levels and lipid levels monitored regularly.

Antidepressants are sometimes prescribed to treat symptoms of depression in bipolar disorder. However, taking an antidepressant alone can increase the risk of switching into mania or hypomania. To prevent this mood swing, it is recommended that doctors also prescribe a mood stabilizer, even if depression is the predominant mood state.

“When we look to the future, there are two areas of exciting development in our effort to conquer bipolar disorder,” predicts Dr. Pandurangi. “New neuroimaging techniques mean we will eventually be able to see what is happening in the brain.

This may be particularly beneficial in distinguishing bipolar disorder from major depression.”

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“Treating bipolar disorder requires patience and tenacity,” advises Dr. Pandurangi.

“It takes time for medications to produce results. And once a patient is feeling better, there is a tendency for them to think that treatment is no longer needed. Some patients, especially high achievers, don’t like the slowdown in energy level or flatness in mood that medications can cause. Patient education is needed to help patients understand the risks of not treating mania or hypomania. Different medications used to treat bipolar disorder may have a variety of side effects—ranging from dry mouth, dizziness and drowsiness to blurred vision and rapid heartbeat. It is important that patients talk with their physicians if they are experiencing any annoying or worrisome side effects—and not just stop taking their medications.”

Talk therapy, when used in combination with medication, can provide education and support to people with bipolar disorder and their families. “Cognitive behavioral therapy helps patients explore their thoughts and perceptions of their illnesses,” comments Bela Sood, MD, pediatric psychiatrist with the Virginia Treatment Center for Children at VCU Medical Center, “and change negative thought patterns and behaviors.”

“Family members are significant resources to an individual being treated for bipolar disorder,” says Ms. Rice. “They often can assist the patient with tracking and predicting mood and behavior changes, and are usually extremely aware of the patterns exhibited and potential triggers to mood shifts. Including supportive family members in a comprehensive treatment plan is essential for the patient and for the continued healthy involvement of the family.”

When medication and therapy are not sufficient to manage the symptoms of bipolar disorder, electroconvulsive therapy (ECT) may be tried. Formerly known as “shock therapy,” ECT had a negative, frightening reputation in the past. But the treatment has improved dramatically in recent years and is performed under brief general anesthesia, making it very tolerable. ECT is effective in providing relief for patients suffering from severe depressive, manic or mixed episodes who have not responded to medications.

What does the future hold?

“When we look to the future, there are two areas of exciting development in our effort to conquer bipolar disorder,” predicts Dr. Pandurangi. “New neuroimaging techniques mean we will eventually be able to see what is happening in the brain. This may be particularly beneficial in distinguishing bipolar disorder from major depression. It may also help doctors predict who will respond to which type of medications and brain stimulation therapies.”

Genetic testing offers the promise of earlier identification for individuals at risk for bipolar illness. And starting treatment earlier means a better chance for a better outcome. “Bipolar is a ‘neurodegenerative’ disease,” explains Dr. Sood. “Without proper treatment, a patient’s episodes may become more frequent or more severe over time. That means it is important to get a patient into treatment early and maintain symptom control. But bipolar is a chronic condition, just like diabetes— and treatment is a life-long journey.”

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Medical Experts • Martin Buxton, MD, Chief of Psychiatry, Chippenham and Johnston-Willis Hospitals and Medical Director of Tucker Pavilion • Anand Pandurangi, MD, Vice Chair, Department of Psychiatry, VCU Medical Center • Karen Rice, LCSW, Supervisor, Outpatient Services, Virginia Home for Boys and Girls • Aradhana Bela Sood, MD, MSHA, Senior Professor of Child Mental Health Policy, Pediatric Psychiatrist, Virginia Treatment Center for Children at VCU Medical Center

Resources • Centers for Disease Control and Prevention (CDC) – cdc.gov • Depression and Bipolar Support Alliance - dbsalliance.org • National Alliance on Mental Illness - NAMI.org • Mental Health America - nmha.org • National Institute of Mental Health - nimh.nih.gov

Bipolar Disorder is an equal opportunity illness—roughly the same number of men and women develop the disorder and it occurs in all ages, races, ethnic groups and social classes.

• Mood Disorder Questionnaire - www.healthyplace.com/psychological-tests/ mood-disorder-questionnaire-mdq/

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Bipolar Disorder Facts and Figures • Bipolar disorder affects approximately 5.7 million adult Americans every year or about 2.6 percent of the U.S. population age 18 and older.

• The median age of onset for bipolar disorder is 25 years, although the illness can start in early childhood or as late as the 40’s and 50’s.

• An equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic groups and social classes.

• More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component.

Children and Adolescents • Bipolar disorder is more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the risk to each child is l5 to 30 percent. When both parents have bipolar disorder, the risk increases to 50 to 75 percent.

• Bipolar Disorder may be at least as common among youth as among adults. In a recent National Institute of Mental Health (NIMH) study, 1% of adolescents ages 14 to 18 were found to have met criteria for bipolar disorder or cyclothymia in their lifetime.

• Some 20 percent of adolescents with major depression develop bipolar disorder within five years of the onset of depression.

• Up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder.

• When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric. When depressed, there may be many physical complaints such as headaches, and stomachaches or tiredness; poor performance in school, irritability, social isolation, and extreme sensitivity to rejection or failure.

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Carrot Cake Cupcake (white icing with crumbs) Cupcake Ingredients:

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Apple Cake Cupcakes with Caramel Glaze Cupcake Ingredients: 1 cup sugar 1½ cups whole wheat flower 1½ teaspoon baking soda ¼ teaspoon salt 1½ teaspoons cinnamon 1½ teaspoons nutmeg ½ teaspoon cloves ¼ cup egg replacer ¾ cup hot water 1/3 teaspoon vanilla extract ½ cup safflower oil

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CUPCAKES

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Icing Directions: 1. Apply icing (from carrot cupcake recipe above) liberally to cooled cupcakes in any style you prefer.

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words | LAURA NEFF-HENDERSON, APR original photography | SAHSHA KOCHANOWICZ, RUBYLEE PHOTOGRAPHY

Richmond family finds strength in cleft lip and palate diagnoses In recognition of July being National Cleft & Craniofacial Awareness & Prevention Month, OurHealth offers the story of a local family impacted by this life-changing diagnosis — not once, but twice.

Learning that your child has a cleft lip and/or palate is a diagnosis no parent-to-be wants to hear, but for Ed and Heidi Stello of King George County, Virginia, it’s a diagnosis they have faced not once, but twice with their own children and multiple times with close family members.

Ed and Heidi’s two children were both born with clefts.

The diagnoses for now 6-year-old Charlie and 3-year-old Abbie didn’t come as a complete surprise to the family, which has a maternal genetic predisposition to clefts.

Heidi Stello, 33, was diagnosed with a cleft palate at age 3. Her younger brother also has a cleft palate, although his was minor and never impacted his physical appearance or speech. Heidi, on the other hand, has faced a lifetime of related problems, including significant hearing loss that requires her to wear two hearing aids.

Ed, Heidi, Charlie, and Abbie Stello of King George County. www.OurHealthRichmond.com

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Above: Charlie, prior to his first of many surgeries. At left: Charlie after surgery

Cleft lip and cleft palate are common birth defects in the United States. The Cleft Palate Foundation reports that one of every 600 newborns is affected by cleft lip and/or cleft palate.

In Virginia, about 100 babies are born with a cleft each year, estimates Dr. Steven J. Lindauer, orthodontist, professor and chair of the Department of Orthodontics in the VCU School of Dentistry. Orthodontists play an important role in the treatment of children with clefts from a very early age.

Cleft lip and cleft palate birth defects occur in the first trimester of pregnancy when a baby’s lip or mouth doesn’t form properly. Because the lip and palate develop separately, it is possible for babies to have one or both deformities.

Some cleft lips and palates are detected during routine ultrasounds from the 16th through the 20th week of pregnancy, says Dr. Lindauer. Cleft palates, however, are typically difficult to detect on an ultrasound and may go undetected until the baby is born.

Heidi Stello’s own cleft palate went undetected until she was 3 years old, when her parents sought medical treatment for what she calls a “serious speech delay.” Her cleft is not visible (called a submucous cleft), which made it difficult to diagnosis.

Ruth M. Trivelpiece, program coordinator for the Center for Craniofacial Care at the Children’s Hospital of Richmond at VCU, says that Heidi’s late diagnosis is uncommon.

Many of those who come to the center are referred during pregnancy when a cleft is detected on an ultrasound. That’s the best-case scenario, explains Trivelpiece, because it gives parents the opportunity to start learning about clefts and preparing to meet their baby.

Steve J. Lindauer, DMD, MDSc, is certified by the American Board of Orthodontics. He is professor and chair of the VCU School of Dentistry, department of orthodontics.

“Most newborns are referred to our team immediately after birth, so we can see them right away in the birthing hospital and establish care and provide support and education for the family,” says Trivelpiece.

The severity of a cleft lip or palate can vary widely. Some clefts can be relatively minor, while others can leave a gap so large it affects the lip and nostrils.

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Charlie Stello has a bilateral complete cleft lip and a cleft palate, one of the most severe variations of the defect. “He was basically born with no upper lip,” says Heidi.

Heidi recalls when, during Charlie’s first surgery at 12 weeks old to repair his cleft lip, craniofacial plastic surgeon Jennifer L. Rhodes, MD, told her that his cleft was one of the widest she had seen. Dr. Rhodes is an associate professor and the medical director of the Center for Craniofacial Care the Children’s Hospital of Richmond at VCU. “The medical staff at VCU is like none other we’ve dealt with,” says Heidi. “Something that’s this pervasive can be discouraging, but the staff there doesn’t allow us to be discouraged. They’re very good about addressing what we are managing now and setting the expectations for what’s coming next.”

Daughter Abbie also has a cleft palate, and although it’s much less medically significant than Charlie’s, both children face many years of medical intervention and monitoring. The Stellos expect Charlie to have major oral maxillofacial surgery in the next 12 to 18 months.

Ruth M. Trivelpiece, Med, CCC-SLP, is the program coordinator for the Center for Craniofacial Care at Children’s Hospital of Richmond at VCU.

Causes The exact cause of clefting is unknown, though the Cleft Palate Foundation reports that the majority of isolated clefts — when the patient has no other related health problems — appear to be caused by an interaction between genetic predisposition and environmental factors that may or may not be specifically identified.

What is Cleft Lip and Palate?

Cleft lips and palates occur during the first few weeks of pregnancy when body tissue and special cells from each side of the head grow toward the center of the face and join together, forming many facial features, including the lips and mouth.

Cleft Lip

Cleft Palate

The lip forms between the fourth and seventh weeks of pregnancy. A cleft lip happens if the tissue that makes up the lip does not join completely before birth. This results in an opening in the upper lip. The opening can be a small notch or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely. A cleft in the lip affects the shape of the base of the nose and nostrils.

The roof of the mouth (palate) is formed between the sixth and ninth weeks of pregnancy. A cleft palate happens if the tissue that makes up the roof of the mouth does not join together completely during pregnancy.

A cleft palate is an opening in the roof of the mouth that can include the hard palate (the bony front portion of the roof of the mouth), the soft palate (the soft muscular back portion of the roof of the mouth) or both.

Source: Centers for Disease Control and Prevention

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The Centers for Disease Control and Prevention cites several factors that are known to increase the odds of a baby being born with a cleft, including • Smoking during pregnancy.

• Diabetes before pregnancy.

• Use of certain medicines, including those used to treat epilepsy, during the first trimester.

• Hereditary also plays a role, and the odds of clefting increase with each generation of a family with a child born with a cleft, says Trivelpiece.

Jennifer L. Rhodes, MD, FACS, FAAP, is an associate professor and the director of the Center for Craniofacial Care at Children’s Hospital of Richmond at VCU. She is certified by the American Board of Surgery and the American Board of Plastic Surgery.

• Boys are more likely than girls to be born with both cleft lip and cleft palate, according to Cleft Kids Inc., a nonprofit organization founded to provide affected families with information, support and resources.

• Rates for cleft lip with or without cleft palate and cleft palate alone vary within different ethnic groups. It is most common for Native Americans and Asians and least common for Africans, according to Mayo Clinic.

Surgery

Charlie at age 1.

Babies with clefts are monitored closely from the time they are born. Those with cleft lips normally have their first surgery to repair the lip at between 6 and 8 weeks of age, when it is safer for babies to undergo anesthesia.

Cleft palate repairs are normally done when the child is 10 to 12 months old, just before most children begin speaking.

Closely monitoring speech, says Trivelpiece, is a critical component of having a cleft palate repair. “It’s not done for cosmetic reasons. The cleft of the palate is repaired to allow for normal speech.”

Depending on the severity of the cleft palate, some children are seen by an orthodontist or pediatric dentist and are fitted for a temporary artificial covering — called a palatal obturator — that fits the roof of the mouth and covers the gap. The prosthetic device is held in place with denture adhesive and is typically removed, cleaned and replaced at least once a day. It helps with feeding issues until the palate can be surgically closed.

In some cases, orthodontists are also able to fit babies with an external nasoalveolar molding device. The device helps close the gap in the palate and gums, which may improve the outcomes of their lip and palate repair surgeries.

Kids with clefts typically undergo five to eight surgeries before they are fully grown. Some surgeries are fairly minor to adjust for growth or insert ear tubes, while others are performed to close the cleft or expand the upper jaw.

“This is a diagnosis that these children grow up with,” says Dr. Lindauer.

“Patients typically have multiple surgeries beginning at about 6 to 8 weeks old when we repair the lip and not ending until they are headed to college.”

“We tell our families that we’re going to grow up together,” Trivelpiece says. “And we do. We watch them grow up.”

Clefts can cause physical abnormalities that need to be corrected to avoid problems with feeding, hearing, speech, and jaw and tooth development.

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Children and adults can live with an unrepaired cleft, but it would dramatically impact their quality of life, Dr. Lindauer notes. “The treatment of these children is managed by the craniofacial team and is actually very well-planned and methodical. From the patient’s standpoint, however, I’m sure the process may appear overwhelming.”

“The best part and the hardest part is that you deal with a little bit at a time, but you never quite know what you’ll be dealing with and when — and it’s never really done,” says Heidi, who underwent several surgeries as a teen and had her last surgery at age 21.

Team approach Typically, babies with clefts are treated by a team of specialists that works together to make sure all of the child’s needs are being met. When Heidi travels to Richmond to meet with Charlie and Abbie’s team, she normally sees about seven different specialists.

Most teams include a craniofacial plastic surgeon; an otolaryngologist (ear, nose and throat doctor); an audiologist; dental specialists, including an orthodontist, pediatric dentist and oral and maxillofacial surgeon; a speech pathologist or therapist; a geneticist; a psychologist and a team coordinator.

“Being seen by a team is the most important thing for families,” says Trivelpiece.

“There’s not one single doctor or surgeon who can take care of children with all of these different needs. It’s very complex.”

Complications Children with cleft lip and cleft palate may have feeding difficulties, speech problems or hearing loss. Depending on the type of cleft and if a syndrome is involved, some children may also have breathing issues. Most babies born with cleft lip and palate end up needing orthodontic work.

Though some clefts are fairly minor, babies and children with cleft lip and/or cleft palate are more likely to face a number of challenges.

Difficulty feeding A cleft in the palate prevents babies from being able to suck effectively from bottle or breast and may cause milk and other liquids to come out of the nose during feedings.

There are special bottles and nipples that allow babies to bottle-feed successfully.

Babies with clefts need a feeding evaluation from a cleft feeding specialist as soon as they are born to ensure a good start with feeding. Their weight needs to be monitored closely in the first few months of life.

Frequent ear infections Babies with cleft palate are more likely to have fluid buildup in their middle ear, causing ear infections. Frequent ear infections may lead to hearing loss. Ear, nose and throat specialists can insert special tubes in the baby’s ears during one of the first surgeries to allow the fluid from ear infections to drain. The tubes lessen the pressure on the eardrum, which reduces the chance of the eardrum bursting.

Speech challenges Children with clefts may have a nasal-sounding voice and have problems making certain sounds when they talk. Many children with clefts work with speech pathologists who help to correct these problems or refer them to craniofacial surgeons in cases where more surgery is needed.

Dental problems Children with clefts can have extra or missing teeth or teeth that erupt in the wrong place. Children with cleft lip often have a gap in the bony part of the upper gum, which can cause a number of problems with the teeth and jawbone. These defects require extra dental and orthodontic treatments.

Prevention While clefts are not caused by anything the mother did or didn’t do during pregnancy, there are actions that can limit the risk of having a baby with a cleft.

• Take a prenatal vitamin containing folic acid before trying to conceive and early in pregnancy.

• Avoid alcohol, tobacco and illegal drugs when trying to conceive and throughout the pregnancy.

• Begin the pregnancy at a healthy weight.

Surgical Repair Overview of Cleft Lip and Palate

• Keep weight gain during pregnancy to 25-35 pounds.

Procedures that may be included in the surgical repair of cleft lip and cleft palate.

• Be wary of all medications taken when trying to conceive and throughout the pregnancy.

• Nasoalveolar molding: 1week-3 months

Financial impact

• Cleft lip repair: 3-6 months

“Raising a child In the U.S. with a cleft costs approximately $100,000 more than raising a child without a cleft,” according to the Cleft Kids website. “The cost of a single cleft repair surgery often exceeds $25,000, with most cleft children needing multiple surgeries.”

• Palatal expansion: 5-7 years

The KIDS COUNT Data Center reports that millions of children in the U.S. are not covered by health insurance, while millions more don’t have adequate coverage. Even those families with insurance may not be able to obtain coverage for all necessary procedures.

Families with health insurance may still face significant out-of-pocket costs, such as deductibles, co-pays, co-insurance and prescription costs.

In the past, orthodontic treatment was not considered medically necessary and, thus, was not covered by insurance. However, the law recently changed to require that all insurance companies incorporated in Virginia cover orthodontic treatment for children born with clefts. Orthodontics can easily cost $10,000 for a child with a cleft. Some craniofacial programs have funding to provide for some of these costs.

• Cleft palate repair: 9-18 months • Alveolar bone graft and fistula repair: 6-9 years • Tip Rhinoplasty: 6-9 years • Phase I orthodontics: 6-9 years • Phase II orthodontics: 14-18 years • Orthognathic surgery (jaw surgery): 14-18 years • Final touchup surgery: adolescence or adulthood Source – Children’s Hospital of Philadelphia

Travel costs for families like the Stellos, who commute to get the best medical care for their children, can add up quickly. The added costs of gas, airfare, hotels, meals, child care for siblings during medical appointments and time off from work can seem insurmountable.

Caring for a child with a cleft can also be incredibly time-consuming, and many families find that one parent has to stay home or reduce their work hours to manage the child’s care.

Emotional impact Beyond the obvious medical costs are the emotional costs. Being a child can be hard enough in this world. Imagine growing up with what amounts to a problem that not only makes you look different but also can also significantly impact your quality of life. www.OurHealthRichmond.com

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“Children with clefts are often teased at school and may suffer from low self-esteem,” the Cleft Kids website states. “Meanwhile, their parents may be stressed out over the mounting medical bills, the challenge of coordinating doctor appointments and the never-ending insurance hassles. “ Parents often think that with cleft lip and palate, you just fix them both surgically and you’re done,” observes Trivelpiece, “but there’s so much more than that. Clefts affect many areas, and any issues have to be addressed with proper timing and coordination, keeping the overall development of the child in mind.”

Meet the Stello’s Ed and Heidi Stello Ed, 38, is a software engineer with Northrop Grumman. Heidi, 33, works two days a week as a historian/ researcher with the University of Mary Washington on the Papers of James Monroe project, takes care of Abbie and home schools Charlie.

Charlie Stello First-grader Charlie Stello loves trains and books and is very attentive to details. The 6-year-old wears two watches to make sure he’s always on time. “He’s one of the kindest, most compassionate children I’ve ever met,” says Heidi. “He’s unabashed that he looks different.

He’ll figure that out, but it doesn’t stop him from being this kind and compassionate child.”

Abbie Stello At 3 years old, Abbie is whimsical and loves many of the same things as other little girls her age: princesses, dressing up, playing pretend, singing and dancing. “It’s not uncommon for me to find her having made a blanket fort under a table, with a pile of books reading, or dancing and singing down the hallway,” says Heidi.

“It’s not comfortable to go through all those procedures,” says Dr. Lindauer. “It’s traumatic, but that builds a lot of strength. A lot of these kids mature really fast because they have to do all these grown up things, and a lot adjust very well. You have to admire their strength and ability to get through it all.“ Having a baby born with a cleft lip and cleft palate can feel like the end of the world, but the Stellos try hard to stay positive and keep things in perspective.

Of all of the medical conditions a child could be born with, clefts are one of the least severe. Heidi Stello believes that what her family is going through is nothing compared to what other families, who face much more serious illnesses and diseases, deal with every day.

“This is manageable — so much more manageable than, say, childhood leukemia or open-heart surgery,” says Heidi, who credits her positive outlook to her incredible support system. She’s fortunate, she admits, to have parents who are very involved and help her shuttle kids to and from doctors appointments and speech therapy sessions in Midlothian — more than 90 minutes from her home.

Heidi and Ed Stello have been very upfront with their children about what they are facing, especially Charlie.

“If he’s got to go through his, we want him to be comfortable talking about it,” says Heidi, who encourages her children to pursue their interests in spite of their challenges. “My hope is that Charlie and Abbie will never run into a barrier they have imposed on themselves.

“Charlie definitely knows he looks different,” Heidi continues. “What I don’t think he realizes is that the level of treatment he has to deal with is so different from a ‘normal’ child. He considers it totally normal to have surgery every year, great relationships with a half dozen doctors because you see them many times throughout the year and to have to work hard to make people understand you when you speak. Abbie is still young enough that she is happily unaware that she is largely unintelligible to those around her.”

She credits Charlie’s compassionate nature and kindness to the fact that, like other children with clefts, “he’s dealing with things you can’t hide from. It’s right on their faces. You can’t pull your sleeve down and hide the scar.”

“Their clefting does not define them,” says Heidi of her children. “They are who they are, and they happen to have clefting as well.”

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FITBITS

H EA LT H A ND F I T NES S O N THE GO

S tretch i t Ou t !

Did you know that regular stretching is just as important as regular exercise?

Many people neglect this aspect of their fitness regime, because they don’t understand that stretching has major benefits. Hopefully these reasons will inspire you to make it part of your schedule!

Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer Deidre is a certified personal trainer with more than 15 years experience in the health and fitness industry.

She is the resident fitness specialist for OurHealth Greater Richmond

*Consult with your physician/provider before beginning any new fitness program.

Benefits of stretching: • Improves flexibility (increases range of motion).

• Assists in correct posture by lengthening tight muscles that pull areas of the body away from their intended position.

Here are a few simple stretches for the core and lower body that can be done after each workout:

Cat/Cow stretch • back and abdominals

• Reduces risk for injury by keeping muscles loose.

Cobra stretch

• Increases blood and nutrient supply to muscles, thereby possibly reducing muscle soreness.

• abdominals

Tips for effective stretching: Seated side stretch

Skip the Pre-Workout Stretch • Muscles should be warm before you begin your stretching. Do a warmup before a workout that simulates the movements you’ll be doing in order to prepare your body. Movements such as walking or marching in place are great examples. Stretch after the workout when your muscles are already warm.

Focus on the Muscles That Need the Most Help

• obliques (side of abdominals)

Hamstring stretch • back of legs

• Instead of trying to stretch your whole body after every workout, focus on a key area of the body each time. Spend longer on each stretch and include more stretches for that specific area.

If you are aware of muscles that are tight, then focus on those.

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Child’s pose • shoulders, chest and abdominals

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