our health | BASIC
table of contents |march • april 2013
.
MEDI•CABU•LARY.....................10 Local experts define healthcare related terms
JUST ASK!..................................12 A variety of health questions answered by local professionals
THE LATEST...............................13 A listing of new physicians, providers, locations and upcoming events in the greater Richmond community
HEALTH AND FITNESS ON THE GO..................................15 Health-focused apps you can download to your smartphone or tablet!
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18
COVER STORY Jody Kerns of Mechanicsville tells why humor helps healing
BASIC | our health
25
CANCER CARE advancements in cancer care
NUTRITION HEALTH..................39 Understanding nutritional values in foods
37
ALLERGIES Misconceptions about allergies
MIND MATTERS .........................43 A brainy matter
PHYSICAL THERAPY..................49 A pain in the neck? Look elsewhere
53
BLOOD SERVICES ORTHO SERIES...........................29 The crux of the matter: elbows and shoulders
Baby, can you spare a pint?
KIDS CARE..................................33 Grove Avenue Eye Center optometrist Tonya Tira, OD helps children see better
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CONTRIBUTING RICHMOND MEDICAL EXPERTS Cora T. Huitt PT, DPT, BCB_PMD
Shaival Kapadia, MD
Julia R. Nunley, MD, FAAD, FACP Richard A. Parisi, MD Melissa W. Schwarzschild, MD, JD Will Voelzke, MD Gary Zeevi, MD CONTRIBUTING PROFESSIONAL WRITERS Sarah Cox Tricia Foley, RD, MS Anika Imajo Tina Joyce Edwin Schwartz
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@ourhealthmag COMMENTS/FEEDBACK/QUESTIONS Our Health Richmond magazine welcomes your feedback. Please send your comments and/or questions to: “Letters,” Our Health magazine, Inc. PO Box 8383, Richmond, VA 23226, 804.539.4320, or you may send via email to steve@ourhealthvirginia.com. Information in this magazine is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright ©2013 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. Our Health is published by McClintic Media, Inc. www.ourhealthrichmond.com. Advertising rates upon request.
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our health | MEDI•CABU•LARY & JUST ASK
me d i • ca bu • l ar y
T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D
What is a fraxel laser?
What is a cancer stage?
What is diastolic heart failure?
Fraxel is a non-invasive laser therapy used to rejuvenate the skin. Lasers are made up of light energy, which stimulates collagen production and resurfaces the top layer of skin. Fraxel lasers lay down micro-columns of light energy, destroying a controlled percentage of tissue. This allows smoother, healthier skin to be formed as a result of the healing process, but because only a fraction of the skin is treated there are fewer side effects and little downtime. Think of it as a digital photo in which pixels make up the image.
To “stage” a cancer is to evaluate the severity of a person’s cancer based on the extent of the primary tumor and whether or not cancer has spread anywhere else in the body. Staging systems for cancer typically involve the TNM system. This system is based on the size/ extent of the tumor (T), spread to lymph nodes (N), and the presence of distant spread /metastasis of the tumor (M). Staging is important since it can help the doctor plan the appropriate treatment and estimate the person’s prognosis.
Diastolic heart failure is an increasingly common form of heart disease. Some 45% of patients now have this form of heart failure. It typically affects older patients with more women than men suffering from the disease. In diastolic heart failure, the squeeze or “ejection fraction” is normal but the heart does not fill normally. This limits the amount of blood pumped per heartbeat or contraction. Diastolic heart failure patients often have a history of inconsistently controlled high blood pressure. Treatment is directed at blood pressure control and medications to limit the buildup of excessive fluid.
Fraxel lasers are effective for the treatment of sun spots, uneven pigment, fine lines, precancerous lesions and for reducing acne scars. Melissa W. Schwarzschild, MD, JD Richmond Dermatology & Laser Specialists Richmond | 804.282.8510
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Will Voelzke, MD Virginia Cancer Institute Richmond | 804.330.7990
Gary Zeevi, MD Medical Director Bon Secours Advanced Heart Failure Center Richmond | 804.281.7840
our health | MEDI•CABU•LARY & JUST ASK
ju st a sk!
T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D
What do your gums have to do with heart disease?
What is Men’s Pelvic Health Physical Therapy?
What are some non-surgical treatments for snoring?
How do I know if a mole is suspicious looking?
Cardiovascular disease is associated with many different medical conditions. There have been a number of observational studies linking periodontitis (gum disease) to increased risk of heart artery plaque (atherosclerosis). Inflammation appears to be a driving force in both conditions but no direct cause and effect relationship has been established as yet, a view supported by the American Heart Association in a statement published last year. Perhaps, the link is really related to the underlying diseases seen in both groups - diabetes, smoking and poor oral hygiene.
Men, in general are unaware of the complexity of the anatomy and physiology involved in pelvic health. Elevated muscle tension, compression and nerve entrapment cause pain, urinary frequency, constipation and erectile dysfunction. Medical doctors often focus on diagnosing and treating in the traditional form as a disease with medications and procedures. If intervention fails, many physicians do not know about the effectiveness or how to locate a specialized pelvic health therapist. Muscle tension, fascial restrictions and decreased nerve glide can cause pain in conditions such as non-bacterial prostatitis and pudendal neuralgia. Published research demonstrates 83% effectiveness of pelvic floor myofascial trigger point release.
In many cases, snoring can be reduced or eliminated with weight loss. Avoiding alcohol, especially within three hours of bedtime, smoking cessation, treatments for nasal congestion, and avoiding sleeping on your back can be helpful also. An oral appliance, properly fitted and adjusted by a dentist, may be very effective. If snoring is severe, and especially if you’re sleep is not restful, you may have obstructive sleep apnea, which is a more significant medical problem that requires further evaluation and may be treated with continuous positive airway pressure (CPAP), a machine that delivers air pressure through the nose to hold the airway open.
Often the first sign of melanoma, the most serious type of skin cancer, is a new mole (if you’re 50 or older) or a change in the size, shape or color of any mole. Use this “ABCDE” guide to help you remember what to watch for:
In any case, it is still important to take care of your gums and teethbrushing at least twice daily, daily flossing, a healthy diet limiting sugar intake and regular dental checkups. Shaival Kapadia, MD Bon Secours Heart & Vascular Institute Richmond | 804.554.3880
Cora T. Huitt PT, DPT, BCB_PMD Men’s Pelvic Health Richmond | 804.379.3002
Richard A. Parisi, MD Sleep Disorders Center of Virginia Richmond | 804.285.0100
• A for asymmetrical shape. Look for moles with irregular shapes, where one half does not match the other. • B for border. Look for moles with ragged, blurred or irregular edges. • C for color. Look for uneven color that may include shades of black, brown, pink and tan. • D for diameter. Look for an increase in size. • E for evolving. Look for changes that develop over time or new symptoms like itchiness or bleeding. Early detection is key. The best way to catch potential problems is to perform self-examinations and become familiar with your moles. If you’re concerned about a mole or spot, check with your doctor. It’s better to be safe than sorry. Julia R. Nunley, MD, FAAD, FACP VCU Medical Center Department of Dermatology Richmond | 800.762.6161
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THE LATEST | our health
the l atest
N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S
Joyce Beltran Keeling, MD Internal Medicine Associates of Chesterfield Midlothian | 804.423.8470
LaChelle Y. Campbell, MD St. Francis Family Medicine Center Midlothian | 804.739.6142
Julie Judge, NP Ironbridge Family Practice Chester | 804.717.5300
Ashley McMurtry, PA Associated Internists Richmond | 804.288.3079
Mark N. Farmer, MD Bon Secours Cancer Institute Medical Oncology at St. Mary’s Richmond | 804.287.7804
Hillary Locklair, NP Bon Secours Cancer Institute Medical Oncology at St. Mary’s Richmond | 804.287.7804
Megan Cannon, NP Bon Secours Cancer Institute Medical Oncology at St. Mary’s Richmond | 804.287.7804
Sarah Grant, NP Bon Secours Cancer Institute Medical Oncology at St. Francis Midlothian | 804.893.8717
Jana Hanny, NP Bon Secours Cancer Institute Medical Oncology at Memorial Regional Mechanicsville 804.764.7220
Jessica Wester, NP Bon Secours Pediatric Gastroenterology Associates Richmond | 804.281.8303
Thomas A. Smith, MD Bon Secours Neurology Clinic at Memorial Regional Mechanicsville 804.325.8720
Noma A. Rehman, MD Bon Secours Neurology Clinic at Memorial Regional Mechanicsville 804.325.8720
Meghan F. Rodden, MD Bon Secours Neurology Clinic at Memorial Regional Mechanicsville 804.325.8720
Waqas Sohail, MD Bon Secours Neurology Clinic at Memorial Regional Mechanicsville 804.325.8720
Mudassar Asghar, MD Bon Secours Neurology Clinic Chester | 804.325.8750
John J. Hennessey IV, MD Bon Secours Neurology Clinic Chester | 804.325.8750
lo cal relo cat ion CORRECTION – In the Heart Valve Replacement article of Jan/Feb Richmond issue, it was incorrectly noted that Virginia Cardiovascular Specialists designed and built a specialized hybrid room to perform the TVAR procedure. The room was built by HCA Henrico Doctor’s Hospital on the Forest Campus, who supported the training efforts of the Virginia Cardiovascular Specialists’ physicians.
Virginia Group Benefits and Virginia Senior Services have moved from their Parham Road location to their new offices at 707 North Courthouse Rd, North Chesterfield, VA 23236 in the Windsor Executive Park. Lee Biedrycki is President of Virginia Senior Services and Kelly Shelton is one of the Senior Benefits Advisors. They offer free Medicare 101 talks to help answer the many questions about Medicare benefits. Contact them at 877.276.3772 or 804.381.4604.
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our health | THE LATEST
the l atest
N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S
Washington Redskins to Join Bon Secours and City of Richmond for Bon Secours Washington Redskins Training Center Groundbreaking Leaders from the City of Richmond, Bon Secours Virginia Health System and the Washington Redskins, amongst others, broke ground on the Bon Secours Washington Redskins Training Center located at the Leigh Street (Science Museum) site on Thursday, Feb. 14. Virginia Governor Bob McDonnell, Richmond Mayor Dwight C. Jones, Bon Secours Virginia Health System CEO Peter Bernard and Washington Redskins Executive Vice President/General Manager Bruce Allen, amongst other Richmond-based partners, were in attendance. As the new home of the Redskins three week summer training camp beginning this year, the world-class training facility will bring an estimated $40 million investment to Richmond, in addition to hundreds of new jobs. The economic impact of the camp alone is estimated to be $8.5 million per year. In addition to enhancing and supporting the city’s economic goals, Bon Secours will bring health-care services and educational programs to Richmond’s underserved areas surrounding the facility, furthering the health system’s long-established Healthy Communities initiative. Healthy Communities focuses activity in Richmond’s East End and Church Hill neighborhoods and will now include communities around Leigh Street. “Today’s groundbreaking further acknowledges the strength of the partnership between the Commonwealth, the City, Bon Secours, and the Washington Redskins,” said Mayor Jones. “This effort will not only stimulate new economic development and jobs, but also generates business expansion all while providing health-care services and education to Richmond residents.” When camp is not in session, the Bon Secours Washington Redskins Training Center’s playing fields and locker rooms will be made available to the public for youth programs and competitions. The training facility will also house Bon Secours Sports Medicine, rehabilitation services, men’s health, fitness and education programs and movin’ mania, Bon Secours’ Healthy Kids Initiative. The Bon Secours Washington Redskins Training Center is expected to open doors for camp this summer and is expected to attract more than 100,000 fans. For more information on the Bon Secours Washington Redskins Training Center, visit www.redskinsrva.bonsecours.com.
VCU Massey Cancer Center and Children’s Hospital of Richmond at VCU First in Virginia to Receive Advanced Certification for Palliative Care Virginia Commonwealth University Massey Cancer Center and Children’s Hospital of Richmond at VCU (CHoR) have jointly earned The Joint Commission’s Gold Seal of Approval® for their palliative care programs, making them the first and only certified palliative care programs in Virginia. Palliative care provides specialized, multidisciplinary care for patients with serious illnesses, including but not limited to cancer, by addressing physical, emotional, social and spiritual needs. Together, Massey and CHoR’s palliative care programs underwent a rigorous onsite review and satisfied The Joint Commission’s palliative care-specific standards, which focus on patient and family-centered care in order to optimize the quality of life for patients with serious illness. Massey’s program serves adults, and CHoR’s program serves children. The Joint Commission is a not-for-profit organization that accredits and certifies health care organizations and programs in the United States. The Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. “In achieving this advanced certification, VCU Massey Cancer Center and Children’s Hospital of Richmond at VCU have demonstrated their commitment to the highest level of care for patients with serious illness,” said Michele Sacco, executive director, Advanced Certification for Palliative Care, The Joint Commission. “Certification is a voluntary process and I commend Massey and CHoR for successfully undertaking this challenge to elevate their standards of care and instill confidence in the community they serve.” “This certification affirms the clinical excellence of our palliative care program. We are the first in Virginia and one of only two dozen in the nation to receive this designation, and we couldn’t be more proud,” said Egidio Del Fabbro, M.D., nationally recognized expert in palliative care and director of the palliative care program at Massey. An integral part of Massey’s internationally award-winning palliative care program is the 11-bed Thomas Palliative Care Unit, which is the only dedicated palliative care unit in Central Virginia. The unit has been providing inpatient care in a unique, home-like atmosphere since its opening in 2000. In addition to the inpatient unit, the Massey palliative care program offers supportive care outpatient clinics as well as a consult service for physicians throughout VCU Medical Center. The Pediatric Palliative Care Program at CHoR is a consult service dedicated to providing children and families with seamless, interdisciplinary and holistic care. The program optimizes quality of life while providing children with relief from the symptoms, pain and stress related to serious illness – whatever the diagnosis. “Pediatric palliative care is about life. This accreditation is a testament to quality of life that our team of pediatric physicians, specialists, surgeons, nurses and therapists provide to children,” said Fisher. For more information about the palliative care program at VCU Massey Cancer Center, visit http://www.massey.vcu.edu/palliative-care.htm.
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HEALTH AND FITNESS ON THE GO | our health
Health and Fitness
On the Go
Want a quick analysis of which foods are the healthiest when you’re grocery shopping or to find out if it may be time to get your eyes tested? In our new Health and Fitness on the Go section, we recommend a variety of health-focused apps you can download to your smartphone or tablet.
Fooducate – Healthy Food Diet Scan and choose healthy groceries. Over 200,000 unique UPCs! Instead of trying to decode nutrition fact labels and ingredient lists, use this app to: »» Automatically scan a product barcode »» See product highlights (both good & bad) »» Select better alternatives Fooducate analyzes information found in each product’s nutrition panel and ingredient list. You get to see the stuff manufacturers don’t want you to notice, such as: »» excessive sugar & high fructose corn syrup »» tricky trans fats »» additives and preservatives
»» controversial food colorings »» confusing serving sizes and calories per serving
(Fooducate is NOT funded or influenced by food manufacturers, supplement companies, diets, or diet pills.) »» Cost: Free for both devices »» Device: Android and iPhone
SHARE YOUR FAVORITE HEALTH AND FITNESS APP!
Scan this QR code with your smartphone or tablet to visit and “Like” Our Health’s Facebook page, then post a “Comment” with your favorite health and fitness APP!
Android
iPhone
Vision Test for iPhone and B2 Eye Test for Android Having difficulty reading the newspaper or text on your computer screen? Having problems seeing road signs? Do an instant eye exam with these apps. Just follow a few simple and easy steps to check for a number of possible vision defects. These apps offer the following vision tests: »» »» »» »» »» »»
Visual Acuity Test »» Astigmatism Test »» Duochrome Test »» Color Test »» Cost: Android Free; iPhone $.99 Device: Android and iPhone
Far Field Vision Test Optician Finder Eye Quiz Eye Advice and Facts
Android
iPhone
Do not consider the tests in these apps official tests. These tests are only meant to give you an idea of whether or not you should see an eye doctor or go on an eye therapy. Having regular eye examinations promotes eye health. www.ourhealthrichmond.com | 15
our health | HEALTH AND FITNESS ON THE GO
Instant Heart Rate Instant Heart Rate is a heart rate monitor app for any smartphone, and it does not need any external hardware. Use it for optimizing your exercise routine and to track your progress. Keep your heart rate in check before, during, and after your fitness regime. »» Cost: Free »» Device: Android and iPhone Android
iPhone
Stress Check App Stress Check quantifies your level of mental or physical stress. By measuring your heart rate through the camera and light features on your Android/iPhone, Stress Check estimates your level of stress in real time. With the Stress Check App, you can: »» »» »» »» »» »»
Quantify your level of stress Determine the effects of different stressors Control stress and observe progress Reduce your chances of certain chronic diseases known to be correlated with stress Cost: Android Free; iPhone $1.99 Device: Android and iPhone
Android
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iPhone
BEATING CANCER ONE PUNCHLINE AT A TIME | our health
BEATING CANCER ONE PUNCH [LINE] AT A TIME Jody Kerns knows first hand how important humor and a positive outlook can make a difference in living life to the fullest, even when facing cancer.
this past fall to compete for the title. She was escorted from the airport to
words | TINA JOYCE photography | ED IP
her hotel and then to ABC studios via Jody Kerns, a Richmond comedian,
first-class limousine and given celebrity
recently appeared on ABC Daytime’s
treatment. “It was the best time of my
The View. Kerns has made stand-up
life!” Kerns exclaimed.
comedy her profession for the last 20 years, appearing on a multitude of stages in 42 different U.S. states, as well as in Canada, The Grand Cayman Island, and The Atlantis Resort in Nassau Bahamas. However, her appearance on The View allowed her to meet and make awardwinning comedian and The View co-host, Whoopi Goldberg, laugh and say, “Girl, I love you!”
Interestingly, the manner in which Kerns learned of the competition was far less glamorous. Unfortunately, last August, Jody Kerns was diagnosed with breast cancer. She was lying on the couch after an intense round of chemotherapy treatments.
Feeling
rundown
and
understandably lethargic, she could hear the distant voices of The View on the television. Then, one of the hosts
Kerns became a finalist in the “Funniest
said, “Do you think you are funny?” That
Housewife in America” contest, hosted
question prompted Kerns to turn her
by The View, and was one of a select few
head to catch the details of the contest.
chosen to make the trip to New York
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our health | BEATING CANCER ONE PUNCHLINE AT A TIME
radiation oncology ad full page
20 | www.ourhealthrichmond.com
BEATING CANCER ONE PUNCHLINE AT A TIME | our health
The “Funniest Housewife in America” was soliciting clips of American women dishing out their best comedy routines. Finalists would win a trip to New York, NY to appear on The View and compete for the number one spot on stage.
“
JODY ON FAMILY TIME: We do family night every Wednesday! They all come over for a home cooked meal and get together. They help me to stay positive because I can feel
Kerns spirits lifted and she prepared to send in a pre-recorded video of one of her
their love and know that they care.
sets. Since her cancer diagnosis she had not performed on stage because she, and her
They help me in ways that they are
husband of 27 years, were busy planning her treatment and recovery path.
not even aware. Listening to their stories about what they’ve been
It was just a few weeks later and Jody Kerns was on a plane to New York to prepare for dress rehearsals. Meeting with producers, passing celebrities, and reworking sets made Kerns stressed, but she remained calm on the exterior. The experience she
doing helps me not to dwell on any
“
The day she received the call from The View she remembers vividly. The caller explained the show’s producers may want her to appear on the show, but warned her not to get too excited. “Too late!” exclaimed Kerns. A call the next day confirmed her ticket to the Big Apple.
negatives in my life. And they are all comedians! Each and every one of them make me laugh! It’s just the very best part of my week! They are my rock!
explains “was fast paced, confusing and absolutely fantastic!”
This appearance was the first time she had spoke in front of an audience since losing her hair from chemotherapy treatments. At one www.ourhealthrichmond.com | 21
TAKING A STAND [UP] APPROACH TO BEATING CANCER
Jody Kerns performing her stand-up routine on stage during a taping of The View television show in New York City on November 13, 2012.
BASIC | our health
point, Kerns even placed her wig on the microphone and joked, “Boy, I am having a bad hair day.” Decisively, Kerns has made the choice to find humor each day through her treatments. “It is important to keep a smile on your face,” explained Kerns. She has endured 16 treatments over the past five months and knows many of the staff at Virginia Cancer Institute well. James L. Khatcheressian, MD is her chemotherapy doctor. “I like to call him ‘Special K’ because he is a true Rock Star as far as I’m concerned.” He always listened to me and answered all questions that I had in a way that I could understand, he was wonderful when it came to making medical adjustments to keep me comfortable. Plus, he and his staff always laughed at my jokes!” she shares. “Special K” broke the ice immediately and allowed Kerns to be her witty self at each appointment. “They kept it light and I could joke with the staff. I never messed with the patients though; you never know where someone is physically, emotionally or spiritually,” empathetically explains Kerns. “I would never want to make light of their situation.” The staff at the Virginia Cancer Institute off of Glenside enjoys Jody’s humorous persona as well. They don’t often see joy-filled patients and are uplifted by her visits. “She has been an utter joy to work with. When she comes to the office she is all smiles,” shares Dr. Khatcheressian. “Humor is incredibly healing. I wish we could teach people to embrace it.” Her upbeat attitude is contributing to the positive direction her treatments are heading. Unfortunately, Kerns was not completely surprised by her diagnosis. The disease has attacked many in her immediate family. Fortunately, breast cancer is one of the
very serious and my first thought was, oh no, I’m gonna need some humor in this situation and was thinking more about that than I was the chemo and all of the statistics he was throwing at me about survival rates on his flip chart. Then I asked him if I would be able to continue working during treatment, he asked me what I do for a living and I told him that I am a standup comedian. His demeanor changed
“
“
JODY ON ‘SPECIAL K’: (Special K to me.) When we first met he was all business and
completely. He whirled around on his office stool, rolled across the examining room to
his computer and immediately googled me! It was like we were now looking at each other as real people and we became fast friends. He’s a great listener and responds immediately to any medical adjustments I may need. I simply adore this man!
www.ourhealthrichmond.com | 23
our health | BASIC
“
JODY ON MIKE: My husband Mike has been a wonderful caregiver. I know that this has been just as
more treatable forms of cancer and early detection is key for full recovery. Kerns was
difficult for him as it has for me.
adamant about scheduling regular mammograms until the last year—she admits to
And it has really brought us closer
skipping a year. “Don’t do it,” she warns. Regular mammograms and self-exams are
together. I hope this doesn’t sound
critical in detecting early abnormalities in breast tissue.
weird, but having cancer does make you appreciate everyone and everything so very much. Mike keeps me grounded and yet at the very same time; he let’s me be me. He is the most positive person
“
I have ever known. He wakes up happy and stays that way 24/7
Kerns encourages others battling cancer to have a great support system. “Let them love you. If they don’t do it naturally, then tell them what you need. People do not want to go out of this world not being remembered.” Additional advice she offers is, “Try your best to make someone else happy. For a minute, it will make you happier too.” Kerns has a contagious spirit that keeps her grounded but lifts up those around her.
365 days a year to the point that
She will undergo a lumpectomy soon and radiation five days per week for 6 weeks.
it’s sometimes annoying! LOL!
Kerns explains, “You just live your life and don’t dwell on it (sickness).”
Pictured above: from left at back: Josh and Taylor Crowley, Mike, Jody and the family dog, Loki and Kasey Crowley. from left at front: Jacob, Drew and Mackenzie Wells.
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CANCER CARE | our health
advancements IN CANCER CARE words | SARAH COX
Cancer has been receiving a spotlight in advances at both VCU Massey Cancer Care Center and the Bon Secours Cancer Institute. New technologies, new research scientists, and cutting edge treatments are now available to patients in Central Virginia. According to John Wallace, Communications Coordinator of the VCU Massey Cancer Center, the top three promising technologies that their center is offering are a BioProtect device, a new radiation device called the Contura, and a Phase II clinical trial. • The BioProtect device is a biodegradable balloon that, when inflated, would allow for more targeted radiation treatment of prostate cancer with less damage to the healthy areas surrounding the prostate. VCU Massey Cancer Center was the first in the U.S. to test the Israeli-created product in a clinical trial led by Mitchell Anscher, MD. The trial proved the device to be extremely effective and, as a result, the balloon is now beginning to be implemented worldwide for the treatment of prostate cancer. • Another new radiation device was co-developed at VCU Massey Cancer Center, and Douglas Arthur, MD and Dorin Todor, PhD were part of the group involved in the clinical development and dosimetric verification of this new applicator. Called Contura, the device’s purpose is to better target cancerous tumors in the www.ourhealthrichmond.com | 25
our health | CANCER CARE
breast to spare crucial nearby organs like the lungs and heart and to deliver higher doses of radiation to the tumors to shorten the treatment time. The Contura device is a balloon that is inserted into the cavity where the lump was removed and is inflated to fill the cavity. Connected to it are four catheters that surround a central catheter – all of which provide radiation through a process called brachytherapy. Brachytherapy delivers the radiation internally, whereas standard radiation beam therapy is delivered externally. The trial seeks to shorten treatments to four doses over two days (in the morning and at night each day) from the six weeks of treatment typically required with standard external beam therapy. Early results of the trial have been so encouraging that researchers hope to test the potential of further shortening the treatments to occur overnight – with just one treatment in the evening and one the following morning. Bon Secours Cancer Institute at St. Francis Medical Center.
• Researchers have sought to create cancer “vaccines” for many years, looking for a way to cause the immune system to attack numerous cancer targets simultaneously instead of just one or two. A Phase II clinical trial recently completed at VCU Massey Cancer Center suggests that this type of therapy is not only possible, but could be relatively inexpensive and replicated anywhere in the world without the need for specialized equipment or facilities. Using widely available and safe FDA approved medicines, doctors reprogrammed patients’ multiple myeloma cells to make them better targets for the immune system cells to attack. The hope is that this will provide patients lasting protection against relapse following a stem cell transplant. Additionally, the researchers believe the concept could be successful in a variety of solid tumors and have even started developing mathematical models that could potentially predict the immune system’s response to this treatment in individual patients, allowing optimization of therapeutic effect. Bon Secours is investing $250 million to develop a world-class cancer institute, with the goal of attaining National Cancer Institute designation. The Bon Secours Cancer Institute offers patient care through four acute-care hospitals, two freestanding outpatient radiation oncology centers, two outpatient infusion centers, and the Cullather Brain Tumor Quality of Life Center. Cutting edge technologies include: • A brain lab for the treatment of brain tumors; From back left; Timothy J Wallace, MD, PhD; George A Trivette, MD; Jo Anne Walker, MD; Taryn Torre, MD, MBA; and Judy Chin, MD, FACRO of Radiology Oncology Associates at Bon Secours Cancer Institute.
• The Trilogy Treatment System for conventional and stereotactic radiation therapy treatment; • Varian Linear Accelerators with GE CT simulators; • Mobile PET/CT services; • Breast MRI and digital mammography; • And other new technologies for pancreatic and breast cancer.
Itzhak Avital, MD, Medical Director of the Bon Secours Cancer Institute. Dr. Avital specializes in hepatobiliary, pancreatic and gastric cancers.
Joshua J. McFarlance, MD is a physician at Virginia Cancer Institute.
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Bon Secours Cancer Institute is the first place in Virginia to have fellowshiptrained breast surgeons, having recently added Rashmi Vaidya, MD, the only female fellowship trained breast surgeon in Richmond, who comes from the Cleveland Clinic, and Itzhak Avital, MD, a surgical oncologist and executive medical director of the Bon Secours Richmond Cancer Institute, who comes from the National Cancer Institute and Memorial Sloan Kettering Cancer Center. Dr. Avital is a nationally known scientist, surgeon, and leader in clinical trials who runs a lab with more than 10 people and is section head at the National Cancer Institute. The institute plans to build a new cancer hospital to be located near the West Hampton School in Richmond. The Virginia Cancer Institute’s Joshua J. McFarlane, MD points out that today “we are learning more and more about differences in the mechanisms that drive different types of cancer.” In the past, he says, cancer treatment was less specific and certain combinations of medicines were known to be better for certain kinds of cancers
CANCER CARE | our health
than others. However, today doctors can target cancer-driving mechanisms directly, yielding tailored treatments that are more effective and less toxic. Dr. McFarlane points to specific advances: • Chronic myelogenous leukemia is a dramatic example where a fatal disease has been turned for many patients into a controllable problem. • Recognition of HER2 as an important target has improved therapy for breast and esophageal cancers. • Similar advances have improved therapy in a wide range of cancers including colon, lung, brain, lymphatic, and kidney cancers. • Another way cancer therapy is improving is through improved understanding of the immune system. New treatments are helping patients with melanoma and prostate cancers through sensitizing or ‘unblocking’ the immune response to cancer.
Different types of chemotherapy at Virginia Cancer institute. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity or delivered orally in the form of a pill. Image from Virginia Cancer Institute.
Blood lab at Virginia Cancer Institute.
• Some drugs in development, while not yet proven or available, are very exciting and have the potential to dramatically change cancer care. “Regarding early detection,” he notes, “we know that routine studies such as mammograms and colonoscopies are effective, and recently, we learned that smokers at high risk for lung cancers can benefit from screening by chest CT. Even better, the development of vaccination for HPV is expected to dramatically decrease HPVrelated cancers such as cervical cancer.” In conclusion, there have been significant gains in prevention, early detection, and treatment of cancers.
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our health | CANCER CARE
The Ellen Shaw de Paredes Institute for Women’s Imaging was established in 2005 by Dr. Ellen Shaw de Paredes, a nationally recognized expert in breast imaging and breast cancer diagnosis. This radiology practice offers comprehensive breast imaging, including digital mammography, breast ultrasound, breast MRI, and breast biopsy. Bone densitometry and gynecology services are also offered. According to Dr. Shaw de Parades, screening mammography performed annually from age 40 on reduces breast cancer deaths by at least 30 percent. “The annual interval is so important and relates to the growth rate of breast cancer,” she explains. “Breast cancer can be detected at an early and curable stage through screening mammography.” For higher risk women, additional screening using other modalities is now performed. Specifically, for high-risk women, screening breast MRI has “huge benefits in detecting breast cancers not visible on mammography and not felt. We now also perform screening breast ultrasounds for
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women who have dense breast tissue and some additional risk factors,” says Dr. Shaw de Parades. She points out that the data on detection of breast cancer is as follows: »» Mammography detects four to six cancers per 1000 women screened per year. »» Screening ultrasound in women with dense breasts finds an additional three to four cancers per 1000 women screened per year. »» And screening MRI finds an additional 15 cancers per 1000 high risk women screened per year. “We are so fortunate to have these additional tools that help us to find breast cancers and precancers at an early stage when patients can be cured,” she concludes.
SPECIALIZED SERVICES FOCUS | our health
THE CRUX OF THE MATTER words | SARAH COX photography | LEW FRAGA AND JOE MAHONEY
Ah, those pesky elbows and shoulders just won’t behave. But with the help of orthopaedic doctors such as Julius Smith, MD at Ortho Virginia, new techniques and technologies have helped the procedures and recoveries of both problem areas. Dr. Smith, while an elbow specialist, says that shoulders are by far the more common problem. Shoulder difficulties fall into two main categories – rotator cuff problems and instabilities. The need for surgery, he explains, is based on the severity of the issue. If one tears their rotator cuff, surgery is likely. However, surgery for an instability, such as cartilage tears or SLAP tears (Superior Labrum Anterior and Posterior), or an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint, is based on how much one has problems and pain. “Some will go with the surgery, some will tough it out,” says Dr. Smith. But new arthroscopic technologies have reduced the severity of the surgeries and recovery time. Less muscle and tissue is cut and the shoulder is less disrupted, so recovery from the true problem is expedited. According to Dr. Smith, “It’s getting to the point where there is very little we cannot do with arthroscopic shoulder surgeries, except shoulder replacement, and we’re getting close to that. Most of these advancements are in techniques.” Dr. Smith says that better instruments enable advancements in techniques; in addition, doctors have learned that not everything has to have a surgery. “We’ve become better at deciding,” he explains. Elbows, Dr. Smith’s specialty, have also benefitted by surgical advancements. A surgery most commonly called Tommy John surgery repairs an injured elbow ligament and is performed mostly on college and pro athletes, especially baseball pitchers. It is named after former Los Angeles Dodgers pitcher Tommy John, who underwent the www.ourhealthrichmond.com | 29
SPECIALIZED SERVICES FOCUS | our health
Ortho Virginia’s Jody Smith III, MD discusses options with a patient.
first surgery of this type in 1974. It is also known as UCL, or ulnar collateral ligament, reconstruction. During Tommy John surgery, a surgeon replaces the injured UCL with a tendon taken from somewhere else in the patient’s body. Dr. Smith explains that it has gotten to the point that much younger baseball players are also requiring this surgery, because they are allowed to pitch too many times in a week. “Initially, back in the ‘70s, this was a complicated and difficult technique resulting in numbness and muscle function loss for a period of time,” he says. “Now, it’s gotten to the point where we can use much smaller incisions, two holes, and interference screws.” This is called the docking procedure, which results in a tighter tendon and a better repair. The docking procedure has been done in the last three to four years, and while it still takes seven to 12 months of recovery, some pro athletes, such as the Washington, D.C. Nationals’ pitcher Stephen Strasburg, have made excellent recoveries. Dr. Smith’s concern is that younger pitchers are able to play for their high school teams, a travel team, and American Legion, and the number of pitches they throw can go under the radar. In December 2012, the Virginia High School League voted to restrict the number of innings that high school pitchers can throw within certain time frames, which will hopefully cut back on the injuries due to overuse in such young players.
Julious “Jody” Smith III, MD is a physician at Ortho Virginia specializing in Sports Medicine, shoulder and knee, and Arthroscopic surgery. (photo courtesy of Joe Mahoney)
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KIDS’ CARE | our health
Improving VISION IN CHILDREN | NORRIS | ??????? ????????
words | ANIKA IMAJO photography | LEW FRAGA
The eye chart gracing the pediatrician’s office wall is as familiar to children as the dreaded needle. But the standard vision test we all know and love may not tell the whole story about visual health. According to Tonya Tira, OD, of Grove Avenue Eye Center (GAEC), even a child who has 20/20 vision may suffer from visual challenges. And commonly overlooked vision problems can interfere with academic performance as well as overall development.
“Vision plays such an important role in learning,” Dr. Tira explains. “Studies show that 80% of what children learn is through vision, and there’s just a real lack of awareness of the importance of comprehensive eye care for children.” In addition to providing primary eye care at GAEC’s two Greater Richmond locations, Dr. Tira is one of few specialists in the Richmond area who offer optometric vision therapy to correct problems related to visual skills. Using a program of eye-training exercises, she strengthens the tools that contribute to perception, focus, and even attention span. It makes sense that children who are straining to overcome visual skill impairments may become fatigued from a few minutes of reading or writing and may have difficulty maintaining concentration on a blackboard. Simply put, they have to exert themselves more to engage in routine activities.
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KIDS’ CARE | our health
Some children with visual skill problems exhibit telltale signs, such as rubbing eyes, covering one eye while reading, eye redness, and excessive blinking. Some may complain of blurred or double vision. But many, Dr. Tira notes, don’t even realize they’re experiencing double vision because their brains have learned to adapt, however inefficiently, to get a clear picture. “You start getting these clues in school that they’re struggling, and often it comes back to the eye,” explains the optometrist. “One in four children has undiagnosed vision problems, which may just be near-sightedness or far-sightedness or astigmatism, but they might actually be in one of these visual skill areas. That’s what I specialize in and look at very closely.” Beyond the basic concerns addressed in primary eye care lies another level of considerations, which she says don’t often get adequate attention. This is where visual therapy comes in, developing skills that fall under three main categories: eye teaming, the process by which the eyes converge and diverge depending on the distance of the object; coordination, the function that allows us to synchronize our eyes for activities like tracking a ball in sports; and focus, which naturally declines as we age. Although Dr. Tira points out that focus, or “accommodative,” problems cannot be trained away in adults, children with focus issues can benefit from therapy.
Tonya Tia, OD during an in-office vision therapy session.
“We can improve their accuracy and flexibility of vision. Those are the children who might have 20/20 vision, but they’re complaining that the board is blurry because they have trouble changing their focus from up close to far away.” All of these skills play a role in perception -- the ability to process visual information -- and visual discrimination -- the ability to tell the difference between shapes, she explains. According to Dr. Tira, the eye-teaming problem of convergence insufficiency is one of the most common binocular problems (relating to how the two eyes work together) that she sees, and even in adults it responds most positively to vision therapy. Her program generally consists of 10 to 15 45-minute office sessions, supplemented by 20- to 30-minute nightly homework exercises. Three months after the course of therapy is completed, she follows up to check for any signs of regression, which she says is rare. Providing parents with an evaluation and prognosis before she begins treating their children, she generally estimates the success rate of therapy in treating convergence insufficiency to be at least 90%. Although she’s more cautious with her prognoses for conditions such as eye turn (or misalignment), which is not always visible and may require surgery, she says all therapy subjects will see some improvement. Within the first five to ten weeks of therapy, children generally begin to sense alleviation of symptoms and will often see progress in their drawings and written work. Some specialized therapy equipment Dr. Tira uses include filters, polarized glasses, and prisms, which can either compensate -- to provide relief from symptoms -- or challenge – to train the eyes to converge properly. Through challenging the eyes, Dr. Tira says, “You’re not actually strengthening the eye muscles. The eye muscles are strong. You’re changing the neurological impulse to the brain.”
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our health | KIDS’ CARE
While Dr. Tira does provides therapy to some adult patients -- particularly to those recovering from traumatic brain injury -- she mainly works with children, whose visual skills have more impact on their development. “Vision can change a lot, especially as children are growing. And the distance vision screening that they get at the pediatrician’s office just isn’t adequate for picking up other problems that can affect their learning.” Dr. Tira conducts optometric visual therapy sessions at the Grove Avenue Eye Center location in Midlothian and practices primary eye care at both the Grove Avenue and Midlothian locations.
Tonya Tira, OD of Grove Avenue Eye Center specializes in Vision Therapy, Rehabilitation and Pediatric Optometry.
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ALLERGIES | our health
Misconceptions About Allergies words |EDWIN SCHWARTZ
Spring allergy season is coming and with it, some confusion. Part of the uncertainty lies in whether we are suffering from allergies or have caught a cold. The question makes sense because both allergies and colds share common symptoms of nasal congestion, sneezing, and fatigue. According to Ananth Thyagarajan, MD, of Allergy Partners of Richmond, fever points toward an infection, which indicates some sort of common cold or flu. Symptoms like itching in the nose, ears, and eyes can point toward allergies. Also, symptoms lasting more than two weeks are most likely caused by allergies. “With colds and flu, people usually start to feel better after a two-week period as the body’s defenses have fought it off,” says Dr. Thyagarajan. “An additional factor to consider is if you were around anyone with a cold. Colds are contagious, but allergies are not.” “If you see pollen on your car and begin to itch, sneeze or get watery eyes, this most likely points to some sort of seasonal allergy,” according to Dr. Thyagarajan. “If that is something you’re concerned about, even in the non-pollen months, you can take an over-the-counter (OTC) antihistamine. Zyrtec, Claritin, and Allegra are all medications that work pretty fast. If you take one and in a couple of hours you feel better, this may be a sign you suffer from an allergy and not a cold. If you don’t feel better, you could have a cold or severe allergy.” A related question is whether people with allergies are more sensitive to getting the flu. “Patients with any sort of respiratory disease like asthma have a higher chance of having more severe symptoms after contracting the flu,” says Dr. Thyagarajan, “but we all have an equal chance of getting it.” www.ourhealthrichmond.com | 37
our health | ALLERGIES
When discussing treatment of allergic disease, there are three categories to consider – avoidance, medications, and immunotherapy. “With avoidance, you stay away from what you’re allergic to. Determining this requires some testing,” says Dr. Thyagarajan. “If you know what you are allergic to, you know what to avoid.” In regard to medications, there are many options, including several kinds of prescription nasal sprays and OTC pills. “Learning the very best combination takes time with trial and error while also accounting for the patient’s preference,” Dr. Thyagarajan notes. The third treatment, immunotherapy, usually requires allergy shots. “This involves taking the actual allergen – such as animal dander, mold or dust mites – sterilizing it and slowly increasing the amount you give the patient,” explains Dr. Thyagarajan. “As the therapy continues, the body builds up a natural immunity to the allergen so the individual stops having allergic reactions. The advantages are two-fold, because it is the most effective treatment at decreasing symptoms and offers the greatest potential for cure.” Another popular question is whether allergies can be treated with natural remedies. “When the National Institute of Health investigated natural therapies as a means of treating allergic disease, it found many claims by manufacturers but very little data to back them up,” says Dr. Thyagarajan. “So maybe they do and maybe they don’t. Just because something is natural doesn’t mean it’s necessarily good for you. After all, poison ivy is natural.” Dr. Thyagarajan maintains a blog through the Allergy Partners website where he has written about the common myth that eating local honey can cure allergies. The idea is based on the same concept behind immunotherapy. That is, by eating honey one can build up immunity to pollen. But the theory is flawed. Much of the pollen in honey is not the kind that causes allergic reaction. Also, local honey contains many substances patients are not allergic to and frequent consumption can actually create an allergy to these other allergens. Despite whatever questions the coming allergy season may bring, Dr. Thyagarajan’s approach is straightforward. “If you feel you are experiencing any allergens, it’s really important to talk with your trusted medical provider to see if there’s any help you can get,” he says. After this, his rule of thumb is simple – do what makes you feel better.
Ananth Thyagarajan, MD is a physician with Allergy Partners of Richmond. Board Certified in Pediatrics and Allergy and Immunology, he has a special interest in environmental allergy, asthma and food allergy.
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NUTRITION HEALTH | our health
UNDERSTANDING NUTRITIONAL VALUES IN FOODS words | TRICIA FOLEY, RD, MS
There is a lot of misinformation when it comes to nutrition, which can sometimes make products seem healthier than they really are. To ensure you are making the healthiest choices possible, below are some nutritional explanations to help keep you on track. Have you ever wondered what enriched fiber really means? It sounds healthy, but unfortunately, it means that many of the good nutrients that were originally
in the food have been stripped out through refinement and then some of these components have been added back in an unnatural way. Since our bodies do not know how to process these foods as well as whole, unprocessed foods, they should be avoided. The term fortified is equally confusing. Eating fortified foods means that companies have artificially added vitamins or minerals. A good example is orange juice. It is often fortified with calcium. Although not harmful, getting calcium from naturally occurring calcium rich foods is always preferable over getting calcium from fortified foods. www.ourhealthrichmond.com | 39
A few additional misleading tag lines include “no sugar added,” “trans fat free,” and “net carbs.” Please don’t confuse “no added sugar” with not having any sugar. It simply means that no additional sugar, on top of the naturally occurring sugars already in the food, has been added. Depending on the food, there may be plenty of sugar already in it. Trans fat is made by adding hydrogen to vegetable oil through a process called hydrogenation, making it last longer on the shelves. For this reason, it’s also seen on the ingredients label as hydrogenated oil. When the label claims the food is “trans fat free,” take time to check the ingredients list. You may be surprised to still find it there. Products containing trans fat can label them “trans fat free” if there is less than half of a gram per serving. The problem here is many people consume more than an actual serving. If a serving is one tablespoon, but someone is using more than that, he is going to consume more trans fat than he bargained for. In fact, the 2010 dietary guidelines suggest keeping trans fat as low as possible. Eating more than a few grams on a regular basis can result in increased heart disease risk. Also popular on the food labels are net carbs. These are the carbohydrates left over once the fiber and sugar alcohols have been subtracted from the total carbohydrates on the label. The thought is that fiber and sugar alcohols are not fully absorbed, so they do not need to be counted. This isn’t a perfect science. The true absorption rate varies depending on the type of fiber and sugar alcohol used. Many products keep their net carbs down by adding artificial sweeteners, which increase the number of sugar alcohols, thereby reducing the net carbs. Be careful with high levels of sugar alcohols because they are hard for the body to process and are not real food. Net carbs may be helpful in guiding you in the right direction since low net carbs normally means the product has more fiber. However, net carbs should not solely be used in determining whether or not the food is healthy. Why is fiber important in the first place? Fiber can help with a number of things. It can enhance satiety, improve texture, reduce calorie absorption, slow the absorption of sugar into the bloodstream, improve cholesterol, encourage the growth of friendly bacteria in the gut, and reduce colon exposure to potential carcinogens (cancer causing agents). Soluble fibers are known for their ability to lower cholesterol and slow the movement of food through the small intestine. Examples of soluble fiber include oats, peas, beans, apples, citrus fruits, carrots, and barley. Insoluble fibers are known to be protective against colon cancer since they help to increase stool bulk and relieve constipation. Examples of insoluble fiber include nuts, beans, and vegetables such 40 | www.ourhealthrichmond.com
NUTRITION HEALTH | our health
as cauliflower, green beans, and potatoes. Aim for at least twenty five to thirty grams of fiber per day, ideally from whole foods. Check the nutrition facts to see how many grams per serving your foods contain. How many calories should you eat daily? This number will be different for everyone. Calorie needs are very much dependent on sex, age, activity level, and goals (are you trying to lose, gain or maintain your weight). Depending on these factors you may need more or less than the “average� person. For a complete chart of calorie recommendations, please visit: http://www.webmd.com/diet/calories-chart. There are formulas that can be used to help calculate your estimated calorie needs. The most commonly used is the Harris Benedict equation. Keep in mind though that these are still estimates and do have room for error. Knowing your estimated calorie intake is helpful to ensure you’re giving your body what it needs. Of course, not all calories are created equal. Remember, 100 calories of broccoli will provide you with much more nutritional value than 100 calories of potato chips. Since calories are not created equal, what foods are the best for getting the nutrients you need? The answer is simple, fresh, unprocessed, local whole foods. Some examples include organic fruits, especially those with thin skin like blueberries, apples, and plums. These fruits are packed with even more nutrients (antioxidants, vitamins, and minerals) than their thick peel cousins (bananas, oranges, etc). Buying organic is also important since eating fruits laden with pesticides may undo some of the health benefits. Non-starchy vegetables such as broccoli, peppers, and mushrooms are also going to provide more nutrition per calorie than starchy vegetables like potatoes and corn. Beans and lentils are great starch choices providing a healthy dose of fiber, iron, and even protein. Looking for fresh produce and products that have labels and taking time to read the ingredients will keep you from falling for nutritional misinformation.
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our health | NUTRITION HEALTH
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MIND MATTERS | our health
Nathan D. Zasler, MD services patients with acquired brain injury, stroke and post-traumatic pain problems associated with concussion.
A BRAINY MATTER words | SARAH COX
The brain, explains Nathan Zasler, MD is one of the body’s last remaining mysteries. It’s an organ that we continue to learn more about on a daily basis, one of many reasons that Dr. Zasler embraced brain injury medicine given its place at the “cutting edge” of neuroscience. Zasler is an internationally respected physician specialist in acquired brain injury (ABI) care and rehabilitation. He is CEO and Medical Director of the Concussion Care Centre of Virginia, an outpatient neurorehabilitation and pain management practice, as well as Tree of Life Services, Inc., a living assistance and transitional neurorehabilitation program for persons with acquired brain injury in the West end of Richmond, Virginia. He has been practicing medicine for 28 years in Richmond, and in that time has seen thousands of patients across the brain injury severity spectrum. Concussions account for 80 percent or more of all traumatic brain injuries and make up a large percentage of his patients; however, he also has a particular interest and expertise in treating people after the most severe forms of brain injury. Dr. Zasler started the Concussion Care Centre of Virginia and Tree of Life Services to fill gaps in the brain injury clinical service continuum in our www.ourhealthrichmond.com | 43
our health | MIND MATTERS
Concussion Care Centre of Virginia is an outpatient clinic that provides neuromedical and rehabilitative treatment for persons with traumatic brain injury including concussion.
region. His clinical practice focuses on evaluation and treatment of the physical, cognitive and behavioral consequences of acquired brain injury, as well as any other associated medical, psychological and rehabilitation issues including quite commonly pain management. His mission is to try to assist individuals and their families in reaching “realistic, reasonable goals.” The field is ever-evolving, and Dr. Zasler is an advocate for thorough assessment and understanding of a patient’s problems before making the most appropriate recommendations for care. Even with the most catastrophic brain injuries, there are often important and sometimes critical issues that go unaddressed or under treated. Although there is no magic bullets, there are things that one can do with the proper knowledge regarding brain injury and neurorehabilitation that can improve a patient’s (and family’s) quality of life and functional abilities The changes he has seen in brain injury medicine over nearly three decades include advances in neurological rehabilitation assessment including but not limited to new diagnostic tests, such as computer based cognitive testing, neuroimaging and laboratory markers of brain injury as well as
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MIND MATTERS | our health
new treatment techniques such as use of medications to improve arousal, attention, motor control, cognitive and behavior; neurotechnological advances for improved motor reeducation involving both arm and leg use, among other techniques. Appropriate use of such techniques can significantly complement a critical eye to proper differential diagnosis and holistic assessment…all critical to optimizing treatment outcomes. Ashley Harris, 12 years old, is a good example of this. She was hit in the head by a spiked volleyball while in gym class and was initially diagnosed with a mild concussion. Cherie Harris, her mother, said that while that diagnosis was correct that she also had a headache ever since she was hit five and one-half weeks ago. Ms. Harris also reported that prior to seeing Dr. Zasler, her daughter had consulted with their pediatrician and a pediatric rehabilitation doctor and had a brain MRI done.
Residents of Tree of Life Services receive a treatment approach that encompasses the mind as well as the body and considers medical, social and psychological aspects of acquired brain injury on function and recovery.
“He looked at things a bit differently, indicating that her headache was not due to her concussion, which he acknowledged, but to a neck injury,” said Harris. Her husband, Mike Harris, said that they were concerned that something else was going on – that something had been missed. She would wake up in morning, showing all typical concussion symptoms of irritability, sensitivity to light and noise, trouble reading and comprehending,” said Harris. Mike Harris added that they were worried that something permanent may have happened. “Once we took Ashley to see him, he was very thorough,” said Mike Harris. They explained that after they filled out a 28 page questionnaire and that Dr. Zasler sat down and reviewed it in detail with them and then did a thorough examination of their daughter that included both a neurological assessment and a hands-on exam of head, neck, and back assessing all relevant anatomical structures that could be contributing to her symptoms. “He was able to pinpoint certain muscles and nerve areas that were causing the headache, or at least making it worse,” said her father. “He found that her upper cervical vertebrae were very malaligned, so he did an adjustment on her neck. That afternoon Ashley was feeling better.” Dr. Zasler recommended that Ashley attend physical therapy to address the neck injury that he diagnosed but was very optimistic about her general www.ourhealthrichmond.com | 45
our health | MIND MATTERS
Nathan D. Zasler, MD, FAAPM&R, FAADEP, DAAPM, CBIST is an internationally respected physician specialist in acquired brain injury care and rehabilitation.
prognosis. By taking a detailed history and understanding what exactly happened to Ashley, Dr. Zasler knew that the likelihood of a headache disorder coming from her neck, as opposed to her brain, was high….. even before actually examining her. Her father said that “Dr. Zasler was the only one who actually checked her neck and her head, and it made a night and day difference,” said Harris. Dr. Zasler notes that post-concussion related pain issues involving the neck and head can produce an array of symptoms that are often overlapping with concussion related problems or incorrectly attributed to concussion and may include cognitive difficulties, changes in behavior such as increased irritability, anxiety or depression and sleep problems. Concussions, being the most frequent type of traumatic brain injury, can be caused by vehicular accidents, falls, assaults, and sporting accidents. Usually recovery from a concussion occurs over days to several weeks, and after three to six months, 90 percent of persons with uncomplicated concussions have recovered. About 10 percent of persons with these types of injuries have persistent symptoms; however, there remains significant debate according to Dr. Zasler regarding the cause of those symptoms, particularly if they last more than 12 months. Bottom line, said Zasler, is that the earlier one intervenes, the fewer secondary issues develop – and patients may have other injuries, so all those things need to be a part of a thorough assessment. “These can be quite complex presentations that require an eye to detail,” he said. Important details following these types of injuries is to look for a history of loss of consciousness, or potentially an alteration in consciousness such as dazing, or confusion; and/or loss of memory (also called amnesia) around the time of the insult. Immediately following the injury there can be symptoms that can be quite scary including concussive convulsions, vomiting, and headache, among others. Some of the more common postconcussive symptoms that may persistent for days to weeks or longer include thinking and behavioral changes, balance and stability problems, sensory problems (i.e. light and/or sound sensitivity, smell loss, ringing in ears, etc.), headache, sleep difficulties, among other problems. Dr. Zasler advises that one should seek early medical attention when there is any doubt about the injury severity. He also notes that returning to activities, whether sports, work, or driving after a concussion should only occur after appropriate assessment and medical clearance to avoid potential significant complications.
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our health | MIND MATTERS
Dr. Zasler is an affiliate professor in the Department of Physical Medicine and Rehabilitation at VCU in Richmond, Virginia, as well as associate professor, adjunct, in the Department of Physical Medicine and Rehabilitation at the University of Virginia, Charlottesville, Virginia, where he also serves on the UVA Brain Injury and Sports Concussion Institute Professional Advisory Board. He is a fellow of the American Academy of Disability Evaluating Physicians and a diplomat of the American Academy of Pain Management as well as Chairperson of the International Brain Injury Association. Dr. Zasler has been involved in research, both nationally and internationally, is an international advocate for persons with traumatic brain injury, journal editor (Brain Injury and Neurorehabilitation) and author, who has had seven books published including most recently: Brain Injury Medicine: Principles and Practice, and Management of Adults with Traumatic Brain Injury, 2nd edition and Clinical Manual for the Management of Adults with Traumatic Brain Injury. The Concussion Care Centre practice is a specialty practice with medical, as well as therapy services and is fee for service or funded through Worker’s Compensation, although Dr. Zasler also accepts, but does not participate with, commercial insurances.
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Dr. Zasler also highly recommends that persons looking for more information on acquired brain injury contact either The Brain Injury Association of Virginia (BIAV) at 804.355.5748 or the Brain Injury Association of America (BIAA) at 1.800.444.6443.
PHYSICAL THERAPY | our health
a pain in the neck?
LOOK ELSEWHERE words | SARAH COX
Everything can depend upon the source of your pain. Source – not site. And that’s a crucial distinction. According to Tracey Adler, a physical therapist with Orthopedic Physical Therapy, Inc., in Richmond, finding the “trigger point” of pain is the first step in trigger point dry needling, a method that she has been practicing for 11 years. Dr. Adler, who holds a Doctorate of Physical Therapy from Virginia Commonwealth University and is certified in dry needling, says many patients are misdiagnosed because the source of their pain does not show up on any kind of imaging. The method is to find the nodule within the muscle – It’s that trigger point that refers pain and can limit motion. For instance, one might have a pain down one’s leg but the source of the pain may be a trigger point in the buttocks area. “A trigger point in a muscle can refer pain all the way down the leg, and many of people with this kind of pain have been told they have sciatica or a disc problem,” says Dr. Adler. She said the trigger points can be found anywhere in the body where this is a muscle.
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“In the clinic, we look for the source of pain. We do not treat the symptoms,” she says. Pain from trigger points can be the result of an injury, repetitive motion, poor posture, or even a vitamin D or B12 deficiency. Once Dr. Adler finds the nodule, she palpates it and the taut band. “I have to identify absolutely the trigger point. Then, I take a small, solid needle – no medicine – and put the needle into the nodule I feel, and when I do that, typically the patient feels the muscle cramping and grabbing around the needle, the muscle twitches, and then the patient feels a release. Typically they get significant relief immediately.” She says to imagine a piece of short rope that is stretched tight with a knot in it. The needle helps the muscle gain back length, stretch out, and release the pain. Dr. Adler has been certified in trigger point needling for 11 years; originally, Virginia was one of only four states that allowed physical therapists to do this. She was one of 10 in the United States. Now, she says, 28 states allow it, and there are about 2,000 trigger point dry needling therapists in the country. “I’ve been a therapist for almost 34 years,” Dr. Adler point out. “I can’t tell you how many people suffer from this. It’s all about finding the points and where they might be causing pain.” The significant and almost immediate relief has patients hugging her, particularly after seeing those who have never touched them to find their pain, or have too many who don’t really believe they are in pain. “When I touch it and treat it, and they can move like they haven’t been able to in a long time, they are pretty happy,” she says. She says her patients report 50 to 80 percent improvement in symptoms immediately. Dr. Adler, in contrast to those who deemed trigger point dry needling as controversial, calls it cutting edge.
Tracey Adler, DPT, OCS, CMTPT is a board certified orthopedic physical therapist specializing in spinal, TMJ/TMD, pelvic pain and musculosketeal dysfunctions.
baby, can you spare a pint?
A little blood, unlike time and money, is something that most of us can easily spare. And at some time or another, almost all of us will witness blood donations at work.
“Odds are, at some point in your life, you’re going to encounter someone who has needed a blood product,” says Joshua Smith, communications manager at Virginia Blood Services (VBS). “It could be someone that’s very close to you. It could be you.”
words | ANIKA IMAJO
Bridging the gap between eligible donors and the scores of patients in need, organizations such as VBS and the American Red Cross receive, process, and distribute the precious commodity that helps save lives— from premature babies to trauma victims—every day. “97% of us will either need blood or know someone who needs blood,” says Kristen Hatfield, marketing program manager for the American Red Cross’ MidAtlantic Blood Services Region. Blood products commonly play a critical role in surgeries -- cardiac, orthopedic, obstetric and gynecological—as well as treatments for cancer and blood disorders such as sickle cell disease, according to Chelsea Sheppard, MD, medical director of VBS. VBS is a member of America’s Blood Centers (ABC), a network of North American non-profits that collectively amass more than eight million units of whole blood annually, more than half the donor supply for the US and Quebec, according to the ABC website. With nine locations (three in the Greater Richmond area) supplying local health care systems throughout the commonwealth, VBS requires a daily minimum of 400 donations in order to meet Virginia’s average demand. Then there are the urgent situations, the accidents and even large-scale disasters, which require an immediate supply of prepared blood products, sometimes in large quantities.
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VBS delivers blood products to three level one trauma centers in Virginia, including the Virginia Commonwealth University Health System. “Distribution to hospitals varies from standard to STAT order,” Dr. Sheppard explains. “Because traumas can happen at any time, at any volume, it’s important that we have the supply to meet local patients’ needs.” Through the Red Cross’ nationwide blood system, your donation here in Virginia may support life-saving efforts in other parts of the country. The regional center satisfies needs close to home first, supplying blood products to more than 50 Virginia hospitals. But Hatfield points out that its inventory may also be routed to disaster-struck areas -- such as the Northeast following its recent colossal snowstorm -where demand is high and conditions may stall local blood drive efforts. “Clearly no one’s coming out in two feet of snow to donate or collect blood,” she remarks. “And we always say, ‘The need for blood never gets a day off.’ The ongoing need for a ready supply of blood products demands an efficient and safe system of delivery from the donor’s vein to health care facilities. Blood can be collected as whole blood donations, to be separated into various components in a centrifuge. “That one donation can actually help save three lives,” Smith emphasizes, “because we make the products out of one unit – plasma, platelets, and red blood cells.” But current technology also permits collection of isolated components from the source. Once blood is drawn from the donor, the desired component may be removed and the remaining parts returned to the donor, explains Dr. Sheppard, whose background includes a fellowship in transfusion medicine at Emory University. Double red cell donation, through which donors can safely give two units of red blood cells at once, is also now possible. Such donations yield more units of blood without taxing the donor. “Because platelets and plasma are returned to donors, in
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addition to saline, fluid levels are maintained and some donors report feeling more hydrated after their completed donation,” Dr. Sheppard says. A 115-day waiting period is required between double red cell donations from a single donor, she adds, explaining that the body needs that time in order to restore blood cells. Blood donations must also undergo a process of testing for both bacteria and disease, according to Dr. Sheppard, who says HIV, hepatitis B and C, syphilis, and West Nile virus are among the infections they test for in screening donations. Because blood products don’t keep indefinitely in storage, a steady influx of fresh donations is critical. Packed blood cells have life spans commonly ranging from 35-42 days, depending on the preservative added, according to Dr. Sheppard.
For a current update on which blood types are most needed in our area, please visit www.vablood.org or use your smart phone or tablet to scan this QR code.
While plasma and cryoprecipitate, or the frozen product derived from plasma, may last frozen for one year, Dr. Sheppard explains, “Platelets must be stored at room temperature for their utility and thus must be used within five days in order to avoid bacterial growth.” This especially brief shelf life makes platelet donations -- which may be made by a single donor every two weeks -- of particular importance to the blood supply. Blood must, of course, be matched by type between donor and recipient. According to Dr. Sheppard, blood types are determined by inherited antigens – or proteins and sugars on the surface of red blood cells. “The most common antigens that people hear about are A,B, and O (which is actually the lack of A or B),” she explains. The types in this group of antigens are further distinguished as positive or negative, depending on the presence or absence of the D antigen, which belongs to the group known as the Rh system. Type O negative is the universal donor, meaning it can be transfused into patients who have any of the eight major blood types, but contributions of all blood types are valuable. www.ourhealthrichmond.com | 57
American Red Cross blood drive participant in Richmond.
Meeting an unyielding demand on a continuous basis means raising awareness of the need for blood donations. “The number one reason people don’t donate blood is because they just haven’t been asked to donate blood,” observes Smith, adding, “We’ve got 37% of the entire population that can donate blood. Less than 10% of that 37% actually does.” As the eligibility criteria for blood donations are subject to change based on FDA guidelines, both organizations encourage potential donors to undergo the screening process to find out if their blood can make a critical difference to others. As Hatfield put it, “Blood donors are heroes!” If you have a tattoo, have lived in certain parts of the world, or have been deferred as a donor in the past, don’t count yourself out as a candidate to give blood. And those who find they can’t donate blood can still make a significant contribution to the effort, Smith says, by helping to get the word out about the importance of blood donations. Donating blood at Virginia Blood Services in Richmond.
“If you can’t donate, advocate.” To learn more or to get involved, please contact Virginia Blood Services (http://Vablood.org) at 1800.989.4438 or the American Red Cross (redcrossblood. org) at 1.800 RED CROSS.
Chelsea Sheppard, MD, medical director of VBS
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