OurHealth Richmond Mar/Apr 2015 Edition by OurHealth Media LLC

table of contents | march • april 2015

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

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

NEW & NOTEWORTHY.............14

Aggravating Allergies: There are Treatments that Can Help Allergens are everywhere. On the surface, they are often considered nothing more than a nuisance. But in some cases, allergens can be very debilitating and even deadly. To get a better understanding of how allergens affect us, OurHealth turned to three experts at Allergy Partners of Richmond.

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 you about Our Anatomy? In this issue, test your knowledge when it comes to the SINUS CAVITY!

ut Find o orite r fav if you provider service in the won of dition e 5 1 0 May2 alth! e H r u O

The Greater Richmond 6

Senior Health Awards OurHealth | The Resource for Healthy Living in Greater Richmond

Results Announced in the May 2015 Issue

The Resource for Healthy Living in Greater Richmond

FIT BITS!.........................................................................49

What in the world do all those acronyms, abbreviations and numbers mean?

Women’s Gynecological Health:

Decoding Blood Tests: Making (a little) sense of a mind-boggling topic

Spring Into Action This workout is based on a 7-day plan, including at least one rest day. Repeat for 4-6 weeks, and be ready to sport your shorts and tank tops just in time for the warmer weather!

Education and preventive care are the keys to better health at every age.

NUTRITION......................................................... 35 HEALTHY EATS: Shop Seasonally for Better Flavorand Extra Value Blueberry Lemon Zest Muffins, Greek Orzo and Peanut Butter Cookies

hello, HEALTH!............................................................... 38 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos

[ SERIES ] Breaking the Silence: ANEURYSM....................................................40

Women’s Health: Incontinence....................................57 Symptoms. Causes. Treatment. And ultimately, improved life.

LOOKING BACK..............................................................58 Images reflecting the landscape of healthcare in Richmond *

A chance to win prizes!

PLUS *

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

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•

april 2015

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CONTRIBUTING RICHMOND MEDICAL EXPERTS Dimi Barot, MD Steven Fiore, MD W. Colin Gallahan, MD Joe Niamtu, III, DMD Crawford Smith, MD CONTRIBUTING PROFESSIONAL EXPERTS & WRITERS John Dougherty Susan Dubuque Rich Ellis 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

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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor-at-Large: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482, ext. 1 Information in all print editions of OurHealth and on all OurHealth’s websites (www.ourhealthrichmond.com, www.ourhealthcville.com and www.ourhealthvirginia.com), social media sites and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2015 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Greater Richmond edition is published seven times annually by McClintic Media, Inc. 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthrichmond.com | Advertising rates upon request.

LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S

What is the ‘TeachingFamily Model’ (TFM)?

What is a Colon and Rectal Surgeon?

The Teaching-Family Model (TFM), an evidence-based model of care that works across the full continuum of residential, education, and community-based service settings, offers a framework for providing quality services in each of our program areas at Virginia Home for Boys and Girls. Qualified and trained Teaching Parents provide services in a therapeutic environment, building strengths-based relationships with the children. The Teaching Parents (married couples and supporting individuals) use precise intervention strategies to create daily opportunities for social skills development which are generalized by the youth’s natural environment. The approach is characterized by the belief that children belong in nurturing, family-style environments and features a strong commitment to preserving, maintaining, and reunifying the family unit.

Diseases of the colon, rectum and anus - the lower intestinal tract are often complex. These include rectal cancer, colon cancer, diverticulitis, inflammatory bowel disease and fistula and hemorrhoids. Appropriate surgical management of these diseases can be challenging.

During a youth’s stay on either one of our campuses, the TeachingFamily Model is utilized to help the youth develop skills associated with frustration tolerance, anger and/ or aggression management, healthy decision-making skills, conflict resolution and age-appropriate living skills. Through the establishment of safe, therapeutic relationships, practitioners implementing the Teaching-Family Model seek to instill core values that both speak to the healthy individual self and the incorporation of oneself in his or her immediate relationships and surrounding community. John Dougherty, Senior Vice President/CAO Virginia Home for Boys and Girls Henrico | 804.270.6566 www.vhbg.org

OurHealth | The Resource for Healthy Living in Greater Richmond

For this reason, the specialty of colon and rectal surgery was developed and because of the development of the specialty, the surgical care of these diseases has improved. Colon and rectal surgeons limit themselves to surgical management of colon and rectal cancer, diverticulitis, and inflammatory bowel disease, as well as anal and rectal diseases such as anal fissures and fistula and hemorrhoids. They also are experts in colonoscopies, which are done to prevent the development of colon cancer. Because their practice is focused solely on these areas, they develop a great deal of expertise in managing these diseases and can offer options such as minimally invasive approaches to colon surgery, appropriate and expert treatment of rectal cancer, timely management of anal diseases, as well as screening colonoscopies. Crawford Smith, MD

Colon and Rectal Specialists Richmond | 804.249.2465 www.crspecialists.com

What is Facet Syndrome? For every disc between the vertebrae on the front of the spine, there are two smaller stabilizing joints on the back half of the spine. These facet joints assist with stabilizing and limiting the motion of the spine. Just as with any joint in the body, wear and tear can lead to inflammation, causing pain. Facet syndrome is the group of signs and symptoms that are associated with facet joint pain. Symptoms include back or neck pain radiating to one side, which can affect the head, shoulder, back, buttocks or side of the thigh. The muscles overlying the joint can be in spasm and often there is slight tenderness over the joint. The pain is made worse by leaning back and twisting. Sitting for long periods of time can exacerbate the problem. Treatment options range from anti-inflammatory medication and physical therapy to steroid injections, radio frequency ablation or open surgery. Open surgery is only indicated in the late stages where there is severe joint destruction with instability and nerve compression. Steven Fiore, MD

Bon Secours Orthopaedic Institute Advanced Orthopaedics Richmond | 804.270.1305 www.advancedortho.me

H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS

What are the symptoms and causes of Gastroesophageal Reflux Disease (GERD)? GERD, or gastroesophageal reflux disease, is defined as symptoms which result when stomach acid flows into the esophagus. This can occur if the lower esophageal sphincter is weak or relaxes incorrectly. The stomach lining is designed to tolerate acid, but the esophageal lining is not. This leads to a burning sensation in the chest (heartburn) or regurgitation of sour liquid (acid reflux). Some people experience atypical symptoms such as hoarseness, cough, or asthma. Lifestyle issues play a role. Acidic/ spicy foods, chocolate, caffeine, and alcohol can worsen symptoms. Losing weight and elevating the head of the bed can help. Several over the counter medications can be used to treat GERD. Patients should speak with a doctor if they are taking these medications regularly, particularly if difficulty swallowing, vomiting, or unexplained weight loss occurs. Finally, a challenging issue for patients and doctors is that GERD symptoms can often mimic chest pain. If there is any question, then the heart should always be assessed first. W. Colin Gallahan, MD

Richmond Gastroenterology Associates Richmond | 804.560.9840 www.richmondgastro.com

OurHealth | The Resource for Healthy Living in Greater Richmond

What is new with facelift surgery?

How can poor sleep habits affect heart health?

Facelift is a word that scares many patients because “old style” facelifts were very aggressive and often made patients look unnatural and pulled. The biggest change with facelift is that it has become a less aggressive and more user friendly procedure due to advances in anesthesia, materials and technique. Whereas a facelift in the 1970’s required a 4-day hospital stay, patients can have a lift in an accredited office surgery center, and be at home 4 hours later.

Most of us do not realize how important sleep is to heart health. Poor sleep, including that from untreated sleep disorders, can both cause and worsen congestive heart failure, high blood pressure, and cardiac arrhythmias, along with a host of other medical conditions. In addition to a healthy diet and regular exercise, healthy and regular sleep promotes good heart health.

Another big change has been restoring lost facial volume. In the past, surgeons took aged, skeletonized faces and simply pulled the skin tight. It made patients look tighter but not younger. Contemporary facelift surgeons realize the importance of “putting something back” in the face and often perform facial implants, fillers or fat injection to add youthful volume to the rejuvenated face. One caveat! Don’t fall for short cut procedures or “miracle” mini facelifts you see on TV. There is always a trade off in results and how long the lift lasts. For a natural and long lasting facelift result, consider a “real” facelift. Short cut facelifts provide short cut results. Joe Niamtu, III DMD

Cosmetic Facial Surgery Midlothian | 804.934.3223 www.lovethatface.com

Most adults require between 7.5-8 hours of regular and restful sleep. Sleep interruptions, including those from sleep disorders such as sleep apnea, can not only cause impaired concentration and fatigue, but they can also compromise the heart’s ability to effectively pump blood and the body’s ability to regulate blood pressure. Often, the clue there is an underlying and unrecognized sleep disorder comes from the discovery of a cardiac problem. Should you or anyone you care about suffer from any heart complaints or problems, it may be worthwhile to have a proper sleep evaluation. A sleep-fellowship trained physician may be the best resource for both more information and appropriate care. Dimi Barot, MD

The Sleep Center at Chippenham Hospital Richmond | 804.323.8042 www.hcavirginia.com/service/sleepcenters

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NEW

NOTEWORTHY

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

Local Pharmacist, Baylor Rice, RPh, FIACP Elected to Serve as

IACP Board of Directors Vice President through 2016 Baylor Rice, RPh, FIACP, owner/pharmacist of South River Compounding Pharmacy in Richmond has been elected Vice President to the 2015 International Academy of Compounding Pharmacists (IACP) Board of Directors by the IACP membership, and will serve in this role through January 2016. Mr. Rice has served on the IACP Board since 2011. IACP is an association representing more than 4,000 pharmacists, technicians, students, and members of the compounding community who focus upon the specialty practice of pharmacy compounding. Pharmacy compounding is the long-established tradition in pharmacy practice that enables physicians to prescribe and patients to take medicines that are specially prepared by pharmacists to meet patients’ individual needs. “Having the clinical and professional expertise of individuals like Baylor Rice is essential to IACP’s role in developing the best practices of compounding pharmacists everywhere,” says, David G. Miller, RPh, IACP Executive Vice President/CEO. “Each of our volunteer Board members brings unique experience as both practitioners and business managers to guide IACP and its membership. We are fortunate to have Baylor as part of our leadership team.” Baylor Rice is a second generation pharmacist and has an impressive track record as a compounding pharmacist and health professional. He has been a licensed pharmacist since 1994. After earning his degree at the Medical College of Virginia, he worked in community pharmacies. In 1998, Mr. Rice and his wife opened South River Compounding Pharmacy, Inc. His vision of treating each patient based on their individual

needs and using a team approach by working together with the patients’ practitioner has proved to be quite successful with positive outcomes for the patients. In October 2002, Mr. Rice received the Human Health Care (HHC) Pharmacy Recognition Award from Eisai Inc. and U.S. Pharmacist. The award was presented “in recognition of his professional contributions in the Community practice of pharmacy, which improved the quality of care provided to patients with Alzheimer’s disease and demonstrated a commitment and dedication that reflects Eisai’s human health care philosophy.”

Additional awards: South River Compounding Pharmacy has been recognized by The Rising 25 as one of the fastestgrowing privately held companies in the Richmond area, and for its contribution to economic growth in the Richmond Community. Mr. Rice was a finalist for the 2006 and 2007 MUSE Awards, presented by The Virginia Museum of Fine Arts for Creativity in Business. Pharmacist of the Month, November 2007, presented by Professional Compounding Centers of America. Innovative Pharmacist of the Year, by the Virginia Pharmacist’s Association in 2008. Finished in the top 10 for “Retailer of the Year” for 2012 by the Retail Merchants Association of Richmond, Virginia. Runner up for the “The Best Bedside Manner” Award—Pharmacists Category 2013 in the Richmond edition of OurHealth magazine.

Robert Flynn, MD of Richmond Gastroenterology Associates has relocated

Find us on social media. Follow us on Facebook, Twitter, Linked In and You Tube. 14

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Dr. Flynn is now seeing patients in the Midlothian Center office located at 169 Wadsworth Drive in North Chesterfield. To make an appointment with Dr. Flynn, call 804.330.4021 or visit www.richmondgastro.com.

Lawrence Berndt, MPA-C

Daphne Bryan, MD

John Collins, MD

Timothy Harris, MD

Michelle Headley, MD

Tahir Khan, MD

Vicki LathamSolomon, MD

Ashlee Loughan, PhD

Philip Masterson, DNP, FNP-BC

Sarah Meyers, PA-C

Leland Rogers, MD

Katherine Skiff, NP

Mary Stettmeier, MD

Gaylen Tassell, NP

Richmond Gastroenterology Associates Richmond | 804.673.2806 www.richmondgastro.com

Bon Secours Canal Crossing Internal Medicine Richmond | 804.298.3460 www.bonsecours.com

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

Bon Secours Bermuda Crossroads Primary Care Chester | 804.287.4550 www.bonsecours.com

VCU Massey Cancer Center Neuro-oncology Richmond | 804.828.5116 www.massey.vcu.edu

Childrenâ&#x20AC;&#x2122;s Hospital of Richmond at VCU Neurosurgery Richmond | 804.828.CHOR www.chrichmond.org

Bon Secours FastCare Midlothian | 804.325.8888 www.bonsecours.com

VCU Massey Cancer Center Radiation Oncology Richmond | 804.828.5116 www.massey.vcu.edu

Bon Secours Canal Crossing Internal Medicine Richmond | 804.298.3460 www.bonsecours.com

Bon Secours Laburnum Medical Center Richmond | 804.226.2444 www.bonsecours.com

VCU Massey Cancer Center Radiation Oncology Richmond |804.828.5116 www.massey.vcu.edu

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

Bon Secours Canal Crossing Internal Medicine Richmond | 804.298.3460 www.bonsecours.com

Bon Secours Bermuda Crossroads Primary Care Chester | 804.287.4550 www.bonsecours.com

Ife Torrence, APRN, MSN, FNP-C

Bon Secours Primary Health Care Associates Richmond | 804.644.1665 www.bonsecours.com

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NEW

NOTEWORTHY

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

UVA, Bon Secours Expand Joint Clinical Programs

New Partnership Focused on Cardiac, Cancer, Population Health and Physician Recruitment University of Virginia Health System and Bon Secours Health System recently signed a nonexclusive agreement that will lead to new patient care partnerships in cardiovascular services, cancer, physician recruitment, population health, patient safety, and undergraduate and graduate medical education. UVA and Bon Secours now collaborate to provide a variety of patient care services in Richmond, including interventional neuroradiology, pediatric infectious diseases, pediatric genetics and heart care. For example, the heart care partnership has included the introduction of transcatheter mitral valve repair to Bon Secours St. Mary’s Hospital in Richmond. Bon Secours also has an academic affiliation with the UVA School of Medicine, which

enables UVA medical students to perform clinical rotations at Bon Secours facilities in Richmond as part of their education. Future collaborations between UVA and Bon Secours are expected to focus on additional heart care, cancer care, clinical trials and patient safety. The population health model focuses on keeping patients healthy while providing them with high quality care. The agreement also consolidates existing partnerships between the two health systems into a single agreement. “Through this expansion of our relationship, UVA and Bon Secours look forward to sharing our best practices in patient safety and care coordination to enhance the quality of care for patients in the Richmond and Charlottesville areas,” says Richard

P. Shannon, MD, UVA’s executive vice president for health affairs. “This expanded relationship with UVA will help us identify additional opportunities for collaboration to better serve our patients and our community,” said Peter J. Bernard, CEO of Bon Secours Virginia Health System. “This agreement will help increase coordination and enhance transitions of care between Bon Secours and UVA care providers.” The institutional agreement does not involve any exchange of money or ownership interest between UVA and Bon Secours. For more information visit www.uvahealth.com or the Bon Secours Virginia Health Care Foundation at www.bsvaf.org.

CEO of Bon Secours Virginia, Peter J. Bernard, to Retire at the End of Fiscal Year 2015 Bernard’s retirement marks 15 years of innovation, growth and prosperity for Bon Secours Virginia.

Bon Secours Health System, has announced that Peter J. Bernard, the company’s chief executive officer for Bon Secours Virginia, will retire from Bon Secours at the end of fiscal year, which is August 31, 2015. “Since joining Bon Secours as the chief executive officer for Richmond-area operations in 2000, Peter has been a dedicated leader, steering the ministry through challenging economic times, encouraging innovation and empowering the management team to pursue new market opportunities,” states Richard J. Statuto, the system’s chief executive officer and president. Statuto continues, “During his tenure, Peter established a strong track record, including the growth of Bon Secours Richmond and later adding Bon Secours Hampton Roads, growing the organization with approximately 4400 employees in Richmond to a successful organization with over 12,500 employees in Virginia and annual revenues of approximately $2.1 billion. Peter led the growth of the Bon Secours Medical Group from 50 providers in Richmond to 800 providers statewide. I’m confident that following his retirement, the local ministry that grew and prospered under Peter for more than 15 years will sustain its momentum for years to come.” Bernard’s tenure at Bon Secours brought a healthcare model centered on compassionate care combined with clinical excellence. He worked to improve

OurHealth | The Resource for Healthy Living in Greater Richmond

the health of the communities Bon Secours serves by providing educational programs and outreach services designed to empower those in need. He also enhanced the overall patient experience within Bon Secours Virginia by fostering innovative technologies and focused patient-centered care. During the remainder of this fiscal year, Bernard will continue to work with Toni Ardabell, who was recently promoted to CEO of Bon Secours Richmond, on her transition in this new role. He will also focus on the continued development of the East End neighborhoods around Richmond Community Hospital, statewide and national partnerships, and the formation of an independent children’s hospital in Richmond.

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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

March is...

NATIONAL

COLORECTAL

CANCER AWARENESS MONTH Among cancers that affect both men and women, colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer deaths in the United States. But this disease is highly preventable, by getting screened beginning at age 50.

What YOU Can Do If you’re age 50 to 75, get screened for colorectal cancer regularly. Screening tests help prevent colorectal cancer by finding precancerous polyps (abnormal growths) so they can be removed. Screening also finds this cancer early, when treatment can be most effective. • Be physically active

• Don’t drink too much alcohol

• Maintain a healthy weight

• Don’t smoke

Fast Facts Risk increases with age. More than 90 percent of colorectal cancers occur in people ages 50 and older. Precancerous polyps and colorectal cancer don’t always cause symptoms, especially at first. You could have polyps or colorectal cancer and not know it. That is why having a screening test is so important. If there are symptoms, they may include— • Blood in or on the stool (bowel movement) • Stomach pain, aches or cramps that do not go away • Losing weight and you don’t know why These symptoms may be caused by something other than cancer. If you have any of them, see your doctor. Some people are at a higher risk than others for developing colorectal cancer. If you think you may be at high risk, talk to your doctor about when and how often to get tested.

For more information about colorectal cancer, visit www.cdc.gov. 18

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Celebrate

NATIONAL STRESS AWARENESS DAY

April 16, 2015

Taking a breath every once in a while is the best thing you can do for your overall health, and April 16, is a special day set aside for Americans to be aware of just how stressed they may have become!

Here are some tips:

• Exercise. Chemicals called endorphins are released during exercise that lend a feeling of relaxation and well-being.

• Meditate • Get enough rest • Pet your dog—or any other pet. Unconditional love that pets exhibit help to naturally lower blood pressure.

Be aware of the people or events that habitually cause stress in your daily life. Just knowing the usual triggers may go a long way in helping to avoid them.

*****

FASCINATING

FACT

When you exercise hard, your body BURNS UP ENERGY

TIMES AS FAST as normal!

Autism

World

Awareness Day World Autism Awareness Day (WAAD), celebrated each year on April 2, was adopted by the United Nations in 2007 to shine a bright light on autism as a growing global health crisis. Additionally, WAAD celebrates the unique talents and skills of persons with autism around the world. On World Autism Awareness Day, Autism celebrates its international Light

Speaks It Up Blue

Campaign. Thousands of iconic landmarks, communities, businesses and homes across the globe unite by shining bright blue lights in honor of the millions of individuals and families around the world affected by autism. Visit www.autismspeaks.org for more information on Light it Up Blue and World Autism Awareness Day.

GET OUT AND GET MOVING! DID YOU PICK ONE OR BOTH OF THESE UPCOMING LOCAL EVENTS! KNOW? 13th Annual

DOG JOG and 5K Run

The event includes a chip-timed, flat and fast 5K race, a leisurely one-mile dog jog for canines and their human companions, as well as a vendor fair featuring activities for pets and children, dog agility demonstrations, music, food, shopping and more! Benefiting the Richmond SPCA, presented by Holiday Barn Pet Resorts Date: Saturday, March 21 Time: 5K at 9:30 am Dog Jog at 11:00 am Location: Richmond SPCA 2519 Hermitage Road Richmond, VA For more information and to register, visit www.richmondspca.org/race

10th Annual ASK 5K & Fun Walk

Hosted by ASK Childhood Cancer Foundation and the Richmond Flying Squirrels. The 5K course will take runners and walkers around the historic stadium and end in the infield, crossing home plate. Following the race, stick around for a festival featuring live music with the Jangling Reinharts, food and activities for the kids. AND THEN….come back for more! All 5K participants will get a FREE ticket for that night’s game. Date: Saturday, April 25 Time: 9:00 am Location: The Diamond 3001 N. Boulevard Richmond, VA For more information about ASK Childhood Cancer Foundation and to register for the event, visit www.askweb.org

A baby’s brain is one of the fastest growing parts of its body! www.OurHealthRichmond.com

The Anatomy Challenge is

the

proudly sponsored by

Anatomy

CHALLENGE

Hereâ&#x20AC;&#x2122;s your chance to see how much you know about your Sinuses! First, fill in the word search puzzle below. Next, match up the correct word with the part of the body in the illustration.

[ the Sinus Cavity ]

WORD SEARCH frontal sinus

adenoid

superior turbinate

nasal vestibule

middle turbinate

nasal cavity

inferior turbinate

eustachian tube orifice

sphenoid sinus

fossa of rosenmuller

nosopharynx

_______________________ _______________________

_______________________

_______________________ _______________________

_______________________

_______________________ _______________________

For answers, visit

OurHealth Richmond's Facebook page at

_______________________

| | | |

(804) 559-0370 (804) 320-2419 (804) 288-0055 (804) 282-2471 www.OurHealthRichmond.com

there are treatments that can help words | EDWIN SCHWARTZ original artwork |JOE PALATOS

Allergens are everywhere. On the surface, they are often considered nothing more than a nuisance. But in some cases, allergens can be very debilitating and even deadly. To get a better understanding of how allergens affect us, OurHealth turned to three experts at Allergy Partners of Richmond. ••••• Most people know that allergens can be dangerous, especially for those allergic to bee stings or specific foods, such as peanuts. Fortunately, most everyday allergens, such as pollen and dust, are more likely to be life-altering than lifethreatening. However, even everyday allergens need to be treated correctly. “Nasal allergy may be only a once-a-year irritant for some, but it can significantly reduce sleep quality and the ability to effectively work at school or on the job,” says Jeffery Schul, MD, an allergy and asthma specialist at Allergy Partners of Richmond. Dr. Schul says that allergens such as dust mites, mold and pet dander are more insidious because they are present throughout the year, posing constant challenges to those who are allergic to them. In addition to having to deal with obvious symptoms, these patients also have demonstrable reductions in their concentration, energy levels and quality of sleep. But for some people, these common airborne allergens can be deadly.

Reprints To order reprints of the original artwork featured on this issue’s

“The exception is seen in an individual with allergic triggers for asthma,” explains Ananth Thyagarajan, MD, also an allergist at Allergy Partners of Richmond. “In these patients, a large exposure to some of these more common airborne allergens can cause significant shortness of breath and wheezing that can be life-threatening.” Even after an asthma attack has passed, its effects can be permanent.

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

“Asthma can cause the airways to be ‘remodeled’ in some patients,” says Elaine Turner, MD, who is also an allergist at Allergy Partners of Richmond. “This refers to actual structural changes in the airways that are irreversible and cause airflow limitations. This is more likely to happen in patients with severe asthma, particularly during childhood.”

www.salemartcenter.com www.OurHealthRichmond.com

Antibiotics aren’t for allergies A growing concern among allergists is the use of antibiotics to treat allergy-like symptoms. In these cases, it is important for patients to be tested for allergies for two important reasons — to get proper treatment and to avoid developing immunity to antibiotics. “Airborne allergy sensitivity can increase one’s susceptibility to recurrent, chronic sinus infections and bronchitis,” says Dr. Thyagarajan. “Not only can antibiotics have detrimental side effects to the individual, but the growing use of them leads to increased general antibiotic resistance, which has become a very significant problem. Treating the underlying allergies can lead to decreased frequency and severity of these infections and the unnecessary prescription of antibiotics.” Jeffery Schul, MD, of Allergy Partners of Richmond, is certified by the American Board of Allergy and Immunology.

Dr. Schul says that allergy evaluation and effective treatment improve day-to-day symptoms while also reducing the frequency and severity of respiratory infections. “If respiratory infections such as sinusitis or bronchitis lead to frequent doctor visits, it is quite likely that environmental allergy is a predisposing factor,” explains Dr. Schul. “Upper airway allergy not only causes sneezing, nasal congestion, postnasal drainage and sore throat, but it also reduces [the patient’s] ability to avoid and deal with viral and bacterial infections, which are

Facts and Myths about Food Allergies Lactose intolerance is often thought of as a food allergy. It isn’t. “Lactose intolerance is a condition caused by a deficiency of lactase in the digestive system, an enzyme that metabolizes milk sugar or lactose,” says Dr. Turner. “If this sugar is not metabolized, it stays in the digestive system, resulting in diarrhea and cramping.”

What’s the difference between lactose and lactase? Lactose is a natural sugar that is found in milk and other dairy products. Lactase is an enzyme produced in the small intestine that breaks down lactose so it can be digested. Lactose-intolerant people do not have enough lactase and therefore cannot adequately digest lactose, leading to digestive problems. According to the National Institute of Allergy and Infectious Diseases, eight foods or food groups are responsible for 90 percent of all food allergies. 24

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They are cow’s milk, egg, fish, shellfish, tree nuts (almonds, walnuts, pecans), wheat, peanuts and soy. The Federal Allergen Labeling and Consumer Protection Act of 2004 requires that U.S. food manufacturers clearly declare the presence of these major food allergens or proteins derived from them—such as hydrolyzed casein, a milk product—on their prepared food labels. Unlike peanuts, peanut oil does not have to be labeled as an allergen. However, that doesn’t necessarily mean it’s safe for people with peanut allergies. The Federal Drug Administration has concluded that highly refined peanut oil will not cause allergic reactions for the majority of peanut-allergic individuals because the peanut proteins have been removed during processing. Yet, unrefined or partially processed peanut oil— also referred to as crude, extruded, cold-pressed or expeller-pressed—contains concentrations of peanut protein that can trigger allergies. Those with peanut allergies should consult an allergist before consuming peanut oil.

Reactions of the respiratory tract include tongue swelling, difficulty swallowing, throat tightness and wheezing. Circulatory reactions include dizziness, cold sweat and low blood pressure. an inevitable part of life. Individuals with poorly controlled allergies are more likely to get sick, and underlying allergic inflammation makes it harder for the body to clear the infection.”

Being Proactive is Key In the United States, 100-200 deaths occur each year due to food allergy reactions. The great majority of serious reactions and deaths are caused by exposure to peanuts or tree nuts. There are immediate measures that can be taken should a person be exposed to a life-threatening allergen. “If there is a reaction that involves the respiratory tract or circulation, use your physician prescribed EpiPen,” says Dr. Turner. “An EpiPen contains epinephrine, a medication that can help decrease your body’s allergic reaction by relaxing the muscles in your airways to make breathing easier.”

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According to Dr. Turner, the sequence people should follow when exposed to a life-threatening allergen is: • Use your EpiPen. • Call 911. • Take Benadryl™, as prescribed. “If an EpiPen is needed, a trip to the emergency room must always follow,” emphasizes Dr. Turner.

Over-the-counter medications? Maybe. Maybe not. Ananth Thyagarajan, MD, of Allergy Partners of Richmond, is certified by the American Board of Allergy and Immunology. He has special interests in environmental allergy, asthma and food allergy.

Due in part to insurance plans with high deductibles, there is a growing temptation to selfmedicate and mask allergy symptoms with over-the-counter medications rather than addressing the source of the problem. This raises the question of when patients should shift from addressing their symptoms to actual disease management. “There are many high-quality over-the-counter medications that treat typical allergy symptoms,” explains Dr. Thyagarajan. “The portfolio of allergy medications that are available without a prescription is becoming broader each year. Unfortunately, these medications still only treat the symptoms without addressing the cause.” Dr. Schul agrees that there are more-effective OTC medicines to treat allergic diseases than ever before. “While many patients will be able to use these medicines for adequate symptom control, they will not be sufficient for some.” Dr. Thyagarajan thinks the decision to move beyond OTC medicines can be determined by having the patient answer three questions: • Do the OTC medications help your symptoms? • Do you have any negative side effects from these medications?

Elaine Turner, MD, of Allergy Partners of Richmond, is certified by the American Board of Allergy and Immunology. She specializes in childhood and adult asthma, nasal and sinus disease, hives, eczema, food allergy and asthma during pregnancy.

• Are you willing to stay on these medications for the long term? “These are the types of discussions patients should be having with their healthcare providers to see if a more-active disease management strategy is appropriate for them,” says Dr. Thyagarajan. “If you have continued symptoms during the day, problems with sleep or frequent infections despite the use of regular medication, you should seek a comprehensive evaluation by an allergist who can formulate a long-term treatment plan aimed at modifying the disease rather than just treating symptoms. This might include allergen avoidance, medication and perhaps immunotherapy [allergy shots].”

How can a person make the best choices when it comes to treating allergies? “Healthcare is changing in front of our eyes,” says Dr. Thyagarajan. “Patients are now being asked to become more educated about assessing the value of whatever tests and treatments are recommended.” Dr. Thyagarajan says it is very important for patients to have open, transparent discussions with their doctor regarding the medical benefits of recommended treatments. “Through these open discussions, we hope our patients can make the most-educated decisions for themselves and their families,” concludes Dr. Thyagarajan.

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decoding

lab tests Making (a little) sense of a mind-boggling topic

words |Suzanne Ramsey

A few years ago, I had some lab work done at my physician’s office. At this point, I don’t even recall what led me to make the appointment in the first place, but when I got my results back, the only readily recognizable thing on the two-page report was a handwritten note from my physician: “Your lab is all essentially normal.” That was good news, of course — who wouldn’t want to be essentially normal? — But what in the world did all those acronyms, abbreviations and numbers mean? One can deduce that “L” means low and “H” means high, but what’s a CBC or an HCT, and what the heck is osmolality? Wouldn’t it be nice if there was some user-friendly, online source that could explain it all, without having to pester your physician unnecessarily? Well, there is: LabTestsOnline.org, which bills itself as “a public resource on clinical lab testing from the laboratory professionals who do the testing.”

Susan Wolver, MD is a board certified internal medicine provider at VCU Medical Center in Richmond.

“It’s a wonderful website,” says Susan Wolver, MD, associate professor of General Internal Medicine at VCU School of Medicine and MD Informaticist in the Office of Clinical Transformation at VCU Health System, adding that it’s a “very reputable place” to learn more about your lab results.

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So I took a peek at Lab Tests Online and found Dr. Wolver to be absolutely correct. There, on the easy-to-navigate website, one can find an explanation for what appears to be every lab test known to mankind, from A/G Ratio to Zinc Protoporphyrin. I quickly discovered that osmolality is a test “to help evaluate the body’s water and electrolyte balance,” among other things, and that CBC means “complete blood count” and HCT stands for “hematocrit.” I also found that many of the dozen or so tests listed on my “comprehensive metabolic panel” are used to identify kidney and liver problems. A lot also suggest anemia, caused by iron deficiency in the blood, and infections. While deemed “essentially normal,” a couple of my results were a little high and a couple a teensy bit low. For example, my TCO2 — also known as “bicarbonate” — was 30 instead of within the “reference range” of 20 to 28. My RBC — red blood cell count — was 3.96 instead of 4.20 to 5.50. Should I have been concerned? According to Dr. Wolver, probably not. “If your doctor sends you something with those lab results and says everything is fine, I probably wouldn’t worry about a couple of things that are out of range,” she says. “When we get a CBC, there are 22 parameters. ... you always know something’s going to be a smidge off.” If something does appear to be more than a little off, Dr. Wolver says she almost always repeats the test before taking action. Something might have happened to the sample, she says, or “it could be an anomaly.” Kevin Harrison, DO, of Richmond Center for Healing, agrees. The range Dr. Wolver spoke of — called a “reference range” or “reference interval” — is “kind of like a bell curve,” he says. “About 90 percent of the population falls into those normal ranges. Some will fall on the low or high side and that might be normal for them. Being outside the range doesn’t necessarily mean you have a disease, but it could be a red flag that you have something going on.” Having high white blood cells might indicate an infection or even leukemia, for example. Low red blood cells could mean anemia. Abnormal levels of electrolytes — sodium, potassium and a few others — could point to a problem with the kidneys. On the other hand, Dr. Harrison says, sodium could also be a little high because a patient is “a little on the dehydrated side.” What’s important, he says, is to keep an eye on trends. “You can look back over the years and if you see your white count, three years ago, is a little bit high and over the years it stays about the same,” Dr. Harrison says. “That’s not a concerning thing, probably, but if you see each time it’s bumping up a little higher, that could be suggesting there’s something concerning going on.”

What is a comprehensive metabolic panel? A comprehensive metabolic panel is a blood test that measures your sugar (glucose) level, electrolyte and fluid balance, kidney function, and liver function. Glucose is a type of sugar your body uses for energy. Electrolytes keep your body’s fluids in balance. Source: WebMD

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What is a complete blood count? A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. A CBC helps your doctor check any symptoms, such as weakness, fatigue, or bruising, you may have. A CBC also helps him or her diagnose conditions, such as anemia, infection, and many other disorders. Source: CDC.gov

Kevin Harrison, DO with Richmond Center for Healing, is certified by the American Board of Internal Medicine.

For this reason, Dr. Harrison recommends patients keep copies of their lab reports. He also says patients should “take responsibility” for their health to some extent, learning what they can about labs pertaining to anemia, high blood sugar, kidney and liver functions, “at least some of the basics.” “Doctors are one person,” he says. “We take care of a lot of people. We do our best, but everybody has a responsibility for their health in the long run. It makes sense for people to at least understand the basics of what their lab results are. That’s what I try to review with my patients.”

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words

What do all those and MEAN anyway?

acronyms

Using information from Lab Tests Online, below are some of the lab tests routinely ordered by physicians:

Sodium: To determine whether your sodium concentration is within normal limits and to help evaluate electrolyte balance and kidney function; to monitor chronic or acute hypernatremia or hyponatremia (higher or lower than normal levels of sodium in the blood).

Potassium: To determine whether your potassium level is within normal limits and to help evaluate an electrolyte imbalance; to monitor chronic or acute hyperkalemia or hypokalemia (higher or lower than normal levels of potassium in the blood).

Chloride: To determine if there is a problem with your body’s electrolyte balance and/or to monitor treatment.

Acid-base balance: The body’s maintenance of a healthy pH range for blood and tissues that is slightly basic (pH between 7.35 - 7.45). This balance is achieved through the use of systems in the blood (which help to minimize pH changes) and by the lungs and kidneys, which eliminate excess amounts of acids or bases from the body.)

TCO2 (Bicarbonate): As part of an electrolyte panel to identify or monitor an electrolyte imbalance or acid-base (pH) imbalance

Glucose: To determine if your blood glucose level is within a healthy range; to screen for and diagnose diabetes and prediabetes and to monitor for high blood glucose (hyperglycemia) or low blood glucose (hypoglycemia); to check for glucose in your urine.

Urea Nitrogen (Blood Urea Nitrogen, BUN): To evaluate kidney function; to monitor the effectiveness of dialysis and other treatments related to kidney disease or damage.

Creatinine: To determine if your kidneys are functioning normally and to monitor treatment for kidney disease.

Blood Testing Basics • Blood testing is basic to confirming good health and diagnosing disease. • Blood testing shouldn’t hurt. If a phlebotomist needs more than two tries to find a vein, ask for someone else. • When your doctor orders fasting blood tests, it is very important to be actually fasting when you arrive at the lab. This means no food for 12 hours, and no black coffee or diet sodas either. • Fasting isn’t always required for blood testing. In fact, it’s a good idea to have non-fasting (postprandial) testing of blood sugar levels for early detection of diabetes. • Laboratory values differ from lab to lab. Each report comes with a reference range. Source: SteadyHealth.com

Calcium: To screen for, diagnose, and monitor a range of conditions. Acronyms—continued on page 32

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Acronyms—continued from page 31

Total Protein: As part of a general health checkup, to determine your nutritional status or to screen for and help diagnose certain liver and kidney disorders as well as other diseases.

Albumin, Serum: To screen for and help diagnose a liver disorder or kidney disease, sometimes to evaluate nutritional status, especially in hospitalized patients.

AST (GOT): To detect liver damage and/or to help diagnose liver disease.

Alk. Phosphatase (ALP, Alkaline Phosphatase) To screen for or monitor treatment for a liver or bone disorder.

Total Bilirubin: To screen for or monitor liver disorders or hemolytic anemia.

ALT (GPT) (ALT, Alanine Aminotransferase): To screen for liver damage and/or to help diagnose liver disease

GFR (Calculated Glomerular Filtration Rate, cGFR, Estimated Glomerular Filtration Rate): To assess kidney function and diagnose, stage, and monitor chronic kidney disease (CKD).

Osmolality (CALC): To help evaluate the body’s water and electrolyte balance; to investigate low sodium levels in the blood (hyponatremia) and increased or decreased urine production; to detect alcohol poisoning due to ingestion of toxins such as methanol or ethylene glycol; to monitor the effectiveness of treatment for conditions affecting osmolality; to help determine the cause of chronic diarrhea. Acronyms—continued on page 33

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Acronymsâ&#x20AC;&#x201D;continued from page 32

TSH Reflex (Thyroid Function Panel): To help evaluate thyroid gland function and to help diagnose thyroid disorders.

RBC (Red Blood Cells): To evaluate the number of red blood cells (RBCs); used to screen for, help diagnose, or monitor conditions affecting red blood cells.

HGB (Hemoglobin): To evaluate the hemoglobin content of your blood as part of a general health checkup; to screen for and help diagnose conditions that affect red blood cells (RBCs); if you have anemia or polycythemia, to assess the severity of these conditions and to monitor response to treatment.

HCT (Hematocrit): To determine the proportion of your blood that is made up of red blood cells (RBCs), thus to screen for, help diagnose, or monitor conditions that affect RBCs; as part of a routine health examination or if your doctor suspects that you have anemia or polycythemia.

MCV, MCH, MCHC, RDW: These are measurements or calculations related to red blood cells (RBCs) and are components of the complete blood count (CBC), a commonly requested test used for a variety of purposes.

MCV (Mean Corpuscular Volume): Indicates RBCs are larger than normal (macrocytic), for example in anemia caused by vitamin B12 or folate deficiency.

MCH (Mean Corpuscular Hemoglobin): Mirrors MCV results; macrocytic RBCs are large so tend to have higher MCH.

MCHC (Mean Corpuscular Hemoglobin Concentration): Increased MCHC values (hyperchromia) are seen in conditions where the hemoglobin is more concentrated inside the red cells, such as autoimmune hemolytic anemia, in burn patients, and hereditary spherocytosis, a rare congenital disorder.

RDW (RBC Distribution Width): Indicates mixed population of small and large RBCs; Acronymsâ&#x20AC;&#x201D;continued on page 34

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Acronyms—continued from page 33

immature RBCs tend to be larger. For example, in iron deficiency anemia or pernicious anemia, there is high variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis), causing an increase in the RDW.

Platelet Count:

Your Health in One Drop • 70% of data needed for accurate diagnosis and health management is in your blood. This data is critical for wellness and prevention.

70%

• Your blood cells regenerate every 120 days, so you can quickly measure significant improvement from lifestyle and nutritional changes.

To determine the number of platelets in a sample of your blood as part of a health exam; to screen for, diagnose, or monitor conditions that affect the number of platelets, such as a bleeding disorder, a bone marrow disease, or other underlying condition.

WBC (White Blood Cells): To screen for or diagnose a variety of conditions that can affect white blood cells (WBC) such as an infection, inflammation or a disease that affects the production or survival of WBCs; to monitor treatment of a blood disorder or to monitor therapy that is known to affect WBCs.

White Blood Cell Differential (LYMPH, MONO, NEU, EOS, BASO): White blood cell differential may or may not be included as part of the panel of tests. It identifies and counts the number of the various types of white blood cells present. There are five types:

LYMPH (Lymphocytes): Leukocyte (white blood cell) that normally makes up about 25% of the total white blood cell count but can vary widely. Lymphocytes occur in two forms: B cells, which produce antibodies, and T cells, which recognize foreign substances and process them for removal.

• Blood diagnostic testing can provide greater knowledge about risks for heart disease and other chronic illnesses.

MONO (Monocytes):

Source: NIH.gov

EOS (Eosinophils):

Leukocyte (white blood cell) that functions in the ingestion of bacteria and other foreign particles. Monocytes make up 5-10% of the total white blood cell count.

NEU (Neutrophils, also Granulocyte): Normally the most abundant type of white blood cell in healthy adults. Leukocyte (white blood cell) with granules that are stained by the dye, eosin. Eosinophils, normally about 1-3% of the total white blood cell count, are believed to function in allergic responses and in resisting some infections.

BASO (Basophils): Type of white blood cell (leukocyte), with coarse granules that stain blue when exposed to a basic dye. Basophils normally constitute 1% or less of the total white blood cell count but may increase or decrease in certain diseases.

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HealthyEats Blueberry Lemon Zest Muffins Ingredients 2½ cups whole wheat flour 1 tablespoon baking powder ½ teaspoon baking soda ½ teaspoon salt ¼ pound butter- melted

Directions

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5. Scoop into muffin tins (grease or use muffin liners) sprinkle sugar on top. 6. Bake at 350 degrees for 20-25 minutes or until toothpicks comes out clean. 7. Cool 15 minutes then remove from pan.

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Peanut Butter Cookies Ingredients 2½ cups whole wheat flour 2 cups of sugar 1 cup peanut butter ½ pound of butter 2 whole eggs 1½ teaspoons baking soda 1 teaspoon baking powder ½ teaspoon salt ¾ cup chopped peanuts

Directions 1. Cream butter, sugar and peanut butter in mixer. Scrape sides then add eggs and vanilla. Scrape sides again. 2. In a small bowl mix flour, baking powder, baking soda and salt. Add to butter mixture until just combined. Scrape sides. 3. Add peanuts and mix together for 30 seconds. 4. Scoop onto greased cookie sheet. Bake at 350 degrees for about 10-12 minutes. Let cool then remove from pan.

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CBS 6 HEALTHY LIFESTYLE EXPO

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This yearâ&#x20AC;&#x2122;s Healthy Lifestyle Expo featured presentations from leading health experts in Richmond. People learned how to prevent heart disease, achieve permanent weight loss and protect themselves against cancer. The Healthy Lifestyle Expo also provided free health screenings, fun activities and information on products and services related to healthy living.

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Breaking the Silence

Aneurysm 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 OurHealth, we bring these medical issues into the light—and dedicate these stories to the courageous patients and families living with them and the healthcare providers and researchers who commit their lives to treating and seeking cures for these enigmatic conditions.

Malissa’s Story August 20, 2012, was a day like any other. Right after work, Malissa Bradshaw hit the gym at Altria and began working out with her trainer. Suddenly, she experienced a “bring-you-to-your-knees” explosion of pain in her head. She sat on the bench to rest, thinking it would pass. But the pain intensified and Malissa blacked out. When she came to, her speech was slurred and the left side of her face was drooping. Fortunately, her friends and colleagues recognized the signs of a stroke and called 911. Malissa was rushed to the closest hospital then transferred to VCU Medical Center where her diagnosis was confirmed. At age 25, Malissa had suffered a hemorrhagic stroke caused by a ruptured aneurysm. She was admitted to the neuro intensive care unit. The plan was to perform open surgery and “clamp” the aneurysm after she had stabilized. But two weeks later, Malissa had a second stroke and grand mal seizure, and was rushed into emergency surgery. John Reavey-Cantwell, MD, a neurovascular surgeon at VCU Medical Center, performed a “coil” procedure to block the aneurysm and she was placed in a medically induced coma for 10 days to allow her brain to rest and heal. Her body temperature was lowered to 30 degrees, a feeding tube was inserted and she was placed on a ventilator. A ventricular drain and spinal tap were used to relieve the pressure on her brain. For 45 days Malissa remained in intensive care. Her mother, Stella Bradshaw, never left her side.

“After two ruptured aneurysms, Malissa not only survived, she thrived,” says John Reavey-Cantwell, MD

pictured from left: Malissa with her mother and

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When she came out of the coma, Malissa realized that the left side her body was completely paralyzed. “It was terrifying,” recalls Malissa. “Dr. Reavey-Cantwell assured me I could recover—but that the journey would be long and it would take a lot of work.” This young woman was up to the challenge. “Before my strokes, I did everything full force,” says Malissa. “Whether it was college, my career or my personal fitness, 100 percent was never enough.” It was this same intense level of determination and tenacity that helped Malissa to regain her physical and mental capabilities. Physical, occupational and speech therapy all started while she was in the intensive care unit and continued when she was transferred to the Brain Injury Rehabilitation Unit. “I had to relearn everything—from walking to the most basic skills of daily living. I just took it one tiny step at a time. First, I had to be able to sit up in bed. Then turn so my feet could be on the floor. Then stand. Every step could take as much as a week,” says Malissa. She even had to rebuild her higher-level thinking skills—such as memory, organization and impulse control. “The part of my brain that was affected by the strokes is responsible for ‘executive functions’—I was like a little child with no filters. I said whatever came into my mind.” The emotional toll on Malissa was nearly as distressing as her physical injuries. “I went through every stage of grieving— denial, anger and sadness,” says Malissa. “I was a young, fit woman in the prime of my life. Why did this happen to me?” But that period of self-pity was short lived and Malissa set out to get her life back. In early October, she was released from the hospital and continued therapy on an outpatient basis. In occupational and speech therapy Malissa focused on the fine motor skills and critical thinking needed to return to work. Incredibly, she was able to resume working part-time by mid-December. “I would go into the office three days a week from 8 am to 12 noon,” says Malissa, “and then I had to go home to take a nap. This was the ‘new normal’ for me.”

Malissa Bradshaw and her running partner, Troy Savenko, supported each other throughout the 2013 Half-Marathon. They are shown here at mile 11, both runners still going strong.

Malissa set two personal goals for physical therapy—to run again and to wear high heels. In January, her therapist took her to the Vitacourse at Byrd Park to give running a try. “It took 18 minutes and a lot of hard work—but I managed to jog one mile,” says Malissa. From that moment on, she was unstoppable. In February, Malissa returned to work full-time—wearing a smashing pair of heels—and in April she ran the Monument Avenue 10k. But that still wasn’t enough. Malissa ramped up her training and in 2013 and 2014 she completed the Richmond Half-Marathon. “Before my strokes, I ran 5 and 10k runs, but never thought I could run 13.1 miles,” says Malissa with pride. Her doctors are amazed by Malissa’s recovery—attributing her outcome not only to receiving the right medical care, but also to her positive attitude and the tremendous support of her family and friends.

John Reavey-Cantwell, MD, of VCU Medical Center, is certified by the American Board of Neurological Surgery.

But Malissa also recognizes the importance of a higher power. “Before I got sick my relationship with Christ wasn’t a priority,” shares Malissa. “But together we got www.OurHealthRichmond.com

through this. And now I am committed to spending the rest of my life fulfilling whatever purpose there is for me to still be here.” In gratitude, Malissa volunteers at the VCU Medical Center Rehab Unit, offering support and hope to patients who are recovering from debilitating illness and injury. “This is one patient I will never forget,” remarks Dr. Reavey-Cantwell. “She truly defied the odds. After two ruptured aneurysms, Malissa not only survived, she thrived.”

It’s time to learn more about brain aneurysms —the nature of the condition, various causes, risk factors, treatment options and what the future holds.

Understanding Aneurysms

Dr. John Reavey-Cantwell and Neurovascular Radiation Technologist Christina Shepard discuss a case in VCU’s specialized hybrid neuroendovascular operating room.

A brain aneurysm—also called a cerebral aneurysm or intracranial aneurysm (IA)—is a weak, bulging spot on the wall of an artery that supplies blood to the brain. “Envision, if you will, a balloon with a thin spot,” describes John R. Gaughen, Jr., MD, neurointerventional surgeon at St. Mary’s Hospital. “Over time, blood flowing through the artery can cause the weakened wall to bulge and swell outward. Occasionally, pressure may cause the aneurysm to rupture and release blood into the skull around the brain.” This is referred to as a subarachnoid hemorrhage or more commonly a hemorrhagic stroke. Most brain aneurysms are small—from 1/8 inch to less than one inch. Aneurysms larger than one inch are called “giant” aneurysms and can pose a particularly high risk. “Brain aneurysms are most prevalent in adults age 35 to 65,” says Dr. Gaughen, “although I have treated patients from less than one year to 93 years old.” Aneurysms may be caused by high blood pressure, congenital (present at birth) abnormalities in the artery, infection, trauma or injury to the brain, a tumor or plaque build-up on the artery walls. A number of factors increase your chance of developing a brain aneurysm, including: • Age over 40 • Gender - women are more likely to have an aneurysm than men • Family history of brain aneurysm • Smoking • High blood pressure • Drug use, particularly cocaine and amphetamines

John Gaughen, Jr., MD, a neurointerventional surgeon at Bon Secours Neurology Clinic at St. Mary’s, is certified in diagnostic radiology by the American Board of Radiology with a Certificate of Advanced Qualification (CAQ) in diagnostic neuroradiology.

• Certain medical conditions like Marfan syndrome, polycystic kidney disease and fibromuscular dysplasia Brain aneurysms are not as rare as you may think. In fact, six million people in the United States have unruptured brain aneurysms—that’s one in 50 people. “Many aneurysms are silent and do not cause symptoms,” says Dr. Reavey-Cantwell, “They

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are often discovered when a patient has a test to evaluate an unrelated condition such as a head injury.” There are instances, however, when an unruptured aneurysm is pressing on an area of the brain that does cause problems, such as headaches, pain above and behind the eye, blurred vision, numbness and changes in speech. Every year about 30,000 people in this country suffer a brain aneurysm rupture. The symptoms of a ruptured aneurysm may come on suddenly and include: • Severe headache, often described as the worst headache of your life • Stiff neck • Nausea and vomiting • Sensitivity to light, fainting or loss of consciousness • Blurred or double vision • Pain above or behind the eye • Seizures • Weakness or numbness • Trouble walking or dizziness • Change in mental status or awareness A ruptured aneurysm is a life-threatening condition. If you experience some or all of these symptoms, or you observe them in someone else, don’t wait. Call 9-1-1 immediately. When an aneurysm leaks or ruptures, it can result in a number of serious complications. Blood can enter the space around the brain called the subarachnoid space. As the blood clots it can irritate, damage or destroy nearby brain cells. A ruptured aneurysm can also cause a build-up of pressure on the brain, called hydrocephalus. A “shunt” may be placed in the ventricles to drain off the blood and reduce the pressure. A third complication of a ruptured aneurysm is called vasospasm. Here, the blood vessels constrict and narrow, reducing the blood flow to the brain. Certain medications and the use of balloons to open the vessels may be used to treat vasospasm. Ruptured aneurysms are fatal in about 40% of cases, and patients who survive are likely to have serious neurological disabilities.

How is an Aneurysm Diagnosed and Treated? Aneurysms are diagnosed using a variety of imaging techniques— CT scan (computed tomography), MRI (magnetic resonance imaging) or angiogram. In some cases a contrast dye is injected into a vein to enhance the image. Millions of people are walking around with brain aneurysms and don’t even know it. “We suspect that the number of brain aneurysms has not increased,” says Dennis J. Rivet, II, MD, a neurovascular surgeon at VCU, “but they are being diagnosed with greater frequency due to the increased use of these imaging studies.” www.OurHealthRichmond.com

If an unruptured aneurysm is detected, a number of things will determine whether or not it should be treated or if watchful waiting is the best course of action. “We consider the size, shape and location of the aneurysm and the patient’s age, general health and family history,” says Dr. Rivet. “Then we will weigh the risk of the aneurysm’s rupturing against the risk of treatment. Of course, the patient and family are actively involved in the decision-making process.”

Dr. Rivet explains that there are two general types of treatment that are used to treat aneurysms—clipping and coiling. Dennis Rivet, II, MD, a neurovascular surgeon at VCU Medical Center, is certified by the American Board of Neurological Surgery.

These same procedures are used to treat both ruptured and unruptured aneurysms. Clipping is an effective and well-researched surgical treatment for aneurysm that has been used since the 1930s. The patient is put under general anesthesia and the neurosurgeon makes an incision in the scalp and a small opening in the skull. Working under a microscope, the surgeon approaches the aneurysm in the space between the brain and the skull, not through brain tissue. The neck of the aneurysm is then sealed off with a tiny titanium clip that prevents blood from entering the aneurysm. As a result, the aneurysm cannot grow and future bleeding or rupture is avoided. The skull bone is replaced and held in place with a tiny metal plate and screws and the incision is closed. “Coiling—or endovascular embolization—is a newer procedure that became available in the 1990s,” adds Dr. Reavey-Cantwell. Endovascular means “within the blood vessel”—and that is just how the brain is accessed— through an artery. A neurosurgeon or interventional radiologist performs this procedure by making an incision in the artery—most commonly the femoral artery located in the upper thigh. A catheter (hollow plastic tube) is placed in the artery and carefully guided through the blood system to the brain. The physician uses continual x-ray visualization throughout the process. Once the aneurysm is located and evaluated, tiny platinum coils are placed inside the aneurysm, reducing or blocking the flow of blood. The blood then clots around the coils, essentially sealing off the aneurysm and preventing it from progressing or bleeding. In some instances the opening of the aneurysm may be wide. Here, a balloon or stent (small mesh tube) may be used to assist in the coiling procedure. If the balloon is used, it is deflated and removed once the coils are in place. If a stent is used, it is permanently placed inside the artery where it serves as scaffolding to hold the coils in place in the neck of the aneurysm.

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“There are advantages and disadvantages of both coiling and clipping,” says Dr. Gaughen. “While coiling is a less invasive procedure, clipping may be more durable. That’s why it is important to consider the whole medical picture when helping a patient to make an informed decision about the best option to treat his or her aneurysm.” “For some patients with unruptured aneurysms—particularly those who are elderly, medically fragile or whose aneurysms are small (less than 3 mm or about an 1/8 of an inch)—a very conservative ‘wait and watch’ approach may be recommended,” says Dr. Rivet. In these cases, the patent is advised to keep his or her blood pressure under excellent control and avoid smoking and heavy alcohol intake to reduce the risk of the aneurysm progressing and rupturing. Repeated brain imaging will be used to monitor the situation and determine if more aggressive treatment is warranted. In addition to the physical assault of a brain aneurysm, the emotional impact can be just as devastating. “Individuals can be immobilized by the fear of living with an unruptured aneurysm,” notes Dr. Gaughen, “and patients who have had an aneurysm rupture may experience depression and various neuro-cognitive symptoms. Family members and caregivers also need support in coping with the lifestyle changes and emotional turmoil that can result from an aneurysm.”

What does the future hold? The newest innovation for treating aneurysms is called flow diversion. “The FDA [Food and Drug Administration] has approved one such device—called Pipeline®—with two more presently in clinical trials,” reports Dr. Gaughen. A flow-diverting stent is placed inside the artery across the opening of the aneurysm. It “diverts” the blood flow away from the aneurysm and in a short period of time the aneurysm clots off. “Whenever you enter an aneurysm to insert a coil there is a risk of causing bleeding or rupture. Since the flowdiverting stent doesn’t require the surgeon to actual manipulation the aneurysm, this may offer a safer alternative, especially for large or ‘giant’ aneurysms.” Aneurysms are a major health issue in the United States—and pose a www.OurHealthRichmond.com

serious threat to millions of people. While we can’t control our genetic make-up and any possible predisposition to aneurysms, there are steps we can take to protect ourselves. “The most important things you can do to reduce your risk,” says Dr. Reavey-Cantwell, “are don’t smoke, manage your blood pressure, ask your doctor about being screened if you have two or more family members with a brain aneurysm and know the warning signs and symptoms of aneurysm. Fortunately, Malissa’s friends didn’t hesitate to seek medical help. And with expert intervention and resolute determination, she now can look forward to many years of vibrant health, completing more races and enjoying wearing high heels to work.

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Resources for Patients and Families

Patient and Family Support Group

Brain Injury Association of Virginia

Meets 2nd Tuesday of each month | 6:30 to 8 pm Evelyn D. Reinhart Guest House, 1100 Libbie Ave, Richmond VA 23226

Christine Baggini, MSW, CBIS Senior Resource Coordinator 1506 Willow Lawn Drive, Suite 212 Richmond, VA 23230 804.355.5748 or 800.444.6443 (toll free from Virginia) info@biav.net | BIAV.net

Offers information about acquired brain injury including brain aneurysm and referral to various types of support services.

Contacts: Brenda Sawyer, MSN, RN, NP brenda_sawyer-pardis@bshsi.org | 804.381.9937 Sharon Adams | Sharon@joeneikrofoundation.org Provides patients and caregivers with support, tools and strategies to cope with emotional, social and physical issues resulting from aneurysm, arteriovenous malformations (AVM) and stroke.

Medical Experts: • John R. Gaughen, Jr., MD, Neurointerventional Surgery, Bon Secours Virginia Neuroscience Institute, Assistant Professor of Radiology, University of Virginia • John Reavey-Cantwell, MD, Director, Cerebrovascular and Endovascular Neurosurgery, Reynolds Associate Professor of Neurosurgery, VCU Medical Center • Dennis J. Rivet, II, MD, Associate Professor of Neurosurgery, VCU Medical Center

Sources: • Brain Aneurysm Foundation – bafoundation.org

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FITBITS

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

Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer

THE GO

Spring into Action!

Deidre is a certified personal trainer with more than 15 years experience in the health and fitness industry. She is the resident fitness specialist for OurHealth Richmond.

This workout* is based on a 7-day plan, including at least one rest day. Repeat for 4-6 weeks and be ready to sport your warm weather wear just in time for summer! *Consult with your physician/provider before beginning any new fitness program.

Make sure you are properly warmed up before you begin this workout! Your warm-up should consist of 5-7 minutes of low-impact movement, such as marching in place or walking.

Day 1:

Strength Training Program Perform each exercise per diagram at right for one minute with a 15-second transition between each step (Completing steps 1-10 is one set). Rest two minutes between each set. Complete 2-3 sets.

Day 2:

Take a cycle class or spend 45minutes on an elliptical machine.

Day 3:

REST DAY!

Upright Row with Tubing 15-second rest

Hamstring Curl on Ball 15-second rest

Squats

15-second rest

Overhead Press with Weights

Day 4:

Strength Training Program (repeat day 1)

Day 5:

Take a mind/body class, such as yoga, pilates or barre.

Day 6:

Engage in 45-minutes of outdoor cardio, such as walking/jogging/ biking (weather-permitting). Take advantage of nice weather days! (In case of inclement weather, take it ‘indoors’ using the treadmill, bike or elliptical machine.)

Day 7:

Take a group fitness class or do an ‘at-home’ workout such as the one featured in the January/ February 2015 issue of OurHealth Richmond (scan this QR code to view the January/February digital version of Fit Bits located on page 41) or, if

needed, Day 7 can be used as another ‘rest’ day!

10.

15-second rest

DAY 1 Strength Training

Plank

15-second rest

Reverse Fly with Weights 15-second rest

Triceps Kickbacks with Weights

Alternating Lunges

Bicep Curls with Weights 15-second rest

Push-Ups 15-second rest

15-second rest

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Women’s

words | RICH ELLIS

GYNECOLOGICAL

HEALTH

Education and preventive care are the keys to better health at every age. Many women are so focused on and busy caring for others—an aging parent, children, siblings, spouse, neighbor, co-worker or good friend—that their own health often takes a back seat to helping someone in need. Whether spending time with a father suffering from dementia or comforting a toddler with a stuffy nose, the demand for a woman’s care, time, and attention is never ending, so much so that it often takes a personal healthcare crisis for a woman to realize the importance of caring for herself first. To increase the likelihood of enjoying good health throughout life and well into her later years, a woman must not only realize that her personal wellbeing is important, but also act on that awareness by pursuing preventive care at every age.

Pediatrician to gynecologist—know when to make the switch, and why it’s important. The American College of Obstetricians and Gynecologists recommends that adolescent females have their first visit with a gynecologist between the ages of 13 and 15. Making the switch from a pediatrician or family practitioner to a gynecologist, however, shouldn’t be a decision made by a young woman or her parents based strictly on age alone. Difficulties with menstrual cycles, being or considering becoming sexually active, experiencing a gynecological health problem, or having questions related to sexuality or sexual activity are all signs that it’s time for a young woman to begin seeing an OB/GYN, regardless of age, explains Erica Royal, MD, an obstetrician gynecologist with Virginia Physicians for Women in Richmond.

At the same time, explains Gregory Moore, MD, an OB/GYN with James River Obstetrics and Gynecology, also in Richmond, that transition to seeing a gynecologist can be difficult for some young women because they have developed a certain comfort level with their pediatricians, having seen them for many years. Dr. Royal also points out that in Virginia, young women older than 12 are protected by confidentiality laws, even though they are minors, and can receive STD testing â&#x20AC;&#x201C; including for HIV â&#x20AC;&#x201C; and contraception, without parental notification.

Erica Royal, MD, FACOG, a Ob/Gyn specialist with Virginia Physicians for Women in Richmond, is certified by the American Board of Obstetrics and Gynecology.

In addition to discussing with women the importance of protecting their health and answering any questions they may have, Dr. Moore says another important consideration and reason OB/GYNs want to see women at a young age and before they become sexually active is related to the vaccine for the Human Papillomavirus or HPV. HPV is one of the most common sexually transmitted diseases. It affects women as well as men and can cause health problems in the future, including genital warts and cancer. Ideally, women should receive the HPV vaccination between the ages of 11 and 12, but may receive it as early as age nine, Dr. Moore explains.

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Young women who are considering becoming sexually active or already are should be seen by a gynecologist to discuss contraception and sexually-transmitted diseases (STD), among other issues. This is particularly important, Dr. Royal says, because studies have shown that 16 percent of women report being sexually active by age 15, 48 percent by age 17, 61 percent by age 18, and 71 percent by age 19.

“We try to explain to young girls that STDs are actually on the rise,” Dr. Moore says. “For a lot of young folks, they really are in this stage of life where they feel like they are immune to most of these problems or that it will happen to a friend, but not to them. We try to help them understand that they are at risk and we also talk with them about birth control.”

Women’s health through adulthood One of the most important steps a woman can take to protect her health throughout adulthood is an annual visit with her OB/GYN. Dr. Moore stresses that recent media coverage about Pap smears – a procedure during which cells are collected from the cervix and tested for cervical cancer – not needing to be performed annually has erroneously led some women to believe that they don’t need to see their OB/GYN annually. Nothing could be further from the truth. One of the theories about why women, as a rule of thumb, tend to be generally healthier than men, Dr. Moore says, is that they see their physician more often than men, who are often reluctant to seek medical care, particularly when they aren’t experiencing any problems. Because of those annual visits, diseases can be identified at an earlier stage in life, and as a result, tend to be easier and faster to treat, resulting in healthier people. That’s why we strongly encourage an annual visit, Dr. Moore explains. In addition to the Pap smear and pelvic exam, there are other tests women should be aware of and discussing with their OB/GYN during those annual visits. Dr. Royal says that routine screenings should include annual mammograms beginning at age 40 and a clinical breast exam by a healthcare provider every two years, in addition to women conducting a monthly breast self-exam at home. Women also need to stay up to date with routine vaccines, in addition to having received the HPV vaccine, and every pregnant woman should receive the Tdap (tetanus, diphtheria, pertussis [whooping cough]) vaccine in their third trimester. Dr. Royal says that screening for sexually transmitted infections is also an important part of routine healthcare for women. As women delay childbearing because of their career, Dr. Royal believes it’s important to help women understand that age 35 is considered advanced maternal age and that the ability to conceive declines exponentially every year thereafter. And, contrary to popular belief, there is no “quick test” to determine whether a woman will conceive when she is ready.

“Testing on Pap smears has improved so much over the years in terms of what we’re able to test for that we feel in many cases it’s not necessary to actually send a test to the lab every year to ensure that someone doesn’t have cervical cancer,” Dr. Moore explains. “Unfortunately many people read that as meaning they don’t need to come in period. I think every OB/GYN will tell you they would love to see you every year.“

Gregory Moore, MD, an obstetrics and gynecology provider at James River Ob/Gyn in Richmond, is certified by the American Board of Obstetrics and Gynecology. www.OurHealthRichmond.com

Hot flashes, decreased libido, disrupted sleep, weight gain, night sweats, depression, moodiness – there are a lot of myths about what every woman can expect as she approaches and enters menopause, and they’re not all true. “A lot of women think they can come to the gynecologist or obstetrician and there’s a panel of tests that you run and, ‘check, check, check – yep, you’re going to have a baby,’” Dr. Royal says. “Well there is no such panel. We tell women to try (to conceive) and if they’re not successful within the first year, then we’ll refer them to a reproductive endocrinologist.” The reproductive endocrinologist generally will not use a woman’s own eggs if she is over age 40, Dr. Royal explains, which is why she also talks with her patients about their reproductive goals and shares this information with them, including a discussion about the option of freezing eggs until she is ready to try and conceive. Other health considerations include minimizing risks from the leading causes of death for women in the 20 to 35 age group, which are unintentional injuries (accidents), then cancer – with lung cancer being the leading cancer death, followed by breast cancer and colorectal cancer – and then heart disease. Both Dr. Royal and Dr. Moore also counsel their patients who have a family history of breast or ovarian cancer that they may want to consider genetic testing to determine whether they have inherited mutations in the BRCA1 or 2 gene. Having the mutations increases the risk of developing breast or ovarian cancer.

Women, hormones, and the 40’s and 50’s Menopause is defined as occurring 12 months after a woman’s last menstrual period, with the average age in the U.S. for menopause being 51. For some women it occurs in their late 40s, for others not until the late 50s. Perimenopause – the time around or leading up to menopause – marks the body’s natural progression toward menopause and can last for a number of years – eight to 10 years, according to Dr. Royal – and usually occurs during a woman’s 40s but can begin as early as the mid-30s. Dr. Moore explains that a large segment of the population, contrary to popular belief, won’t experience any symptoms related to menopause, while other women will have a variety of physiological and psychological symptoms caused by perimenopause and menopause, and the decreasing estrogen levels that accompany them. Hot flashes, mood changes, depression, diminished libido and difficulty sleeping, in part because of night sweats, are all common symptoms that many – but not all – women experience, with sleep loss potentially causing other problems, including poor memory, depression and irritability. “Symptoms are highly variable from woman to woman,” Dr. Moore says. “Some women have effectively nothing in the way of symptoms while others are literally incapacitated by them – it’s all across the board. Most women tend to be somewhere near the middle.” Dr. Royal explains to patients that one of the first changes they may notice is a change in their bleeding pattern, and that they could experience hot flashes and/or night sweats, or that they may never have a symptom. There are a lot of myths related to menopause, Dr. Royal agrees, including that every woman becomes depressed, gains weight and is no longer sexually active. It’s not

true, she says, adding that many women at this stage of their lives are healthier and feel better than they ever felt, and are very sexually active. And because women who haven’t reached menopause can still become pregnant, Dr. Royal reminds them of the importance of continuing to use birth control.

Additional preventive health considerations for a woman in her 50s include a colonoscopy at age 50 to establish a baseline, and if the results are normal, another one approximately 10 years later, Dr. Moore recommends. He also stresses the importance of bone-density testing to look for signs of osteoporosis because you can’t, as he explains, discern thinning bones simply by looking at someone.

There are treatment options for women experiencing symptoms related to menopause, including hormone-replacement therapy, which Dr. Moore is a proponent of. He explains that it’s a hotly debated topic, in part because of a misplaced fear of an increased risk for developing breast cancer in women taking hormones, based on a study published some 15 years ago. That study by the Women’s Health Initiative (WHI) sought to determine whether hormone replacement reduced the risk of heart attacks in women. What it found was that heart attack rates were actually increasing, as were breast cancer rates, in women receiving hormone replacements. “The problem with the study was they had taken older women, already well-established in menopause, and put them on hormones,” Dr. Moore explains. “When they went back and looked at it (study results) years later, they realized the results were not as bad as they previously imagined. The reason being that if you take women who have already developed hardening of the arteries, rather than taking women who recently entered menopause, and you put them on hormones which can thicken their blood and promote clotting, that can cause higher rates of heart attack.” Dr. Moore says a similar finding came out of that study related to breast cancer and hormone replacement therapy. Estrogen wasn’t causing the tumor, as was initially believed. Rather estrogen, which is known to stimulate growth of existing tumors, was making a pre-existing tumor grow www.OurHealthRichmond.com

faster and be discovered sooner, instead of taking many years to become clinically apparent in women who werenâ&#x20AC;&#x2122;t receiving hormone treatment. Dr. Royal recommends patients use the lowest dose possible for the shortest period of time and says that while hormone replacement therapy can certainly benefit patients, not every patient needs it. Caring for another is a noble cause, but itâ&#x20AC;&#x2122;s a practice that should begin with oneâ&#x20AC;&#x2122;s own health. The first step can be establishing and maintaining a relationship with an obstetrician gynecologist and seeing them annually, followed by practicing and maintaining a lifelong commitment to preventive healthcare measures. Only when women care for themselves first and consistently can they effectively help care for those who care most about them.

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incontinence symptoms. causes. treatment.

words | RICH ELLIS

Female incontinence – the involuntary loss of urine – affects approximately 40 percent of women at some point in their lives, according to Bruce Rowe, MD, a urogynecologist at Virginia Urology, which has seven locations throughout the greater Richmond area and central Virginia. The condition occurs across a wide age span in women, from reproductive through post-menopausal age. While there are several types of incontinence, the two most common – accounting for roughly 90 percent of the cases seen at Virginia Urology – are stress incontinence and urge incontinence. Stress incontinence can occur when a woman coughs, laughs, stands up, or does anything that increases abdominal pressure, Dr. Rowe explains. It can be caused or exacerbated by pregnancy and vaginal delivery due to changes that occur in the anatomy of the vagina, urethra and bladder, as well as by menopause when decreasing estrogen levels reduce these areas’ vascularity – blood vessels’ function and definition – and tissues become thinner and weaker. Urge incontinence is characterized by an involuntary bladder contraction and has numerous causes, Dr. Rowe explains. “Sometimes there are chemical irritants we’re ingesting, such as caffeine and acidic juices in particular, that can cause a bladder irritation,” Dr. Rowe says. “The aging phenomena can also be a cause with the reduction of estrogen receptors in the urethra and at the base of the bladder.” Treatments for stress incontinence often start with Kegel exercises to strengthen the pelvic floor muscles supporting the bladder. A pelvic floor physical therapist can be particularly helpful for women who aren’t achieving the desired results as therapists report that approximately 50 percent of women aren’t performing Kegel exercises properly, Dr. Rowe says. Another treatment option is a 15- to 20-minute outpatient procedure to install a sling constructed of polypropylene mesh or natural tissue under the urethra to increase pressure on it.

Bruce Rowe, MD, FACOG, an Ob/Gyn specialist with Virginia Urology in Richmond, specializes in gynecology and female incontinence.

Urge incontinence treatment often begins with a “voiding diary” in which women track for three days what and how much they drink, and how often and the volume they urinate. Determining a history of co-existing conditions is also helpful as many can affect urge incontinence, including obesity, COPD (chronic, obstructive pulmonary disorder), and neurological disorders, including MS (multiple sclerosis) or having suffered a stroke. Medications a woman is taking also will be reviewed, as muscle relaxants and diuretics can cause or worsen incontinence. A physical exam will gauge the urethra and bladder’s condition and function, evaluate pelvic muscle tone and reflexes, and test for a simple bladder infection or the presence of bladder stones as causes. When incontinence negatively impacts a woman’s life to the point that they view it as a problem, such as it forces them to change their behavior by avoiding social situations or traveling away from home because of the fear of having an “accident,” that’s when they need to seek help from their urologist or urogynecologist who can determine a cause and treatment, Dr. Rowe explains.

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The Egyptian Building, built in 1845, now

part of Virginia Commonwealth University, was the first permanent

home of the medical department of

what college?

Post the correct answer on our Facebook page by April 7, 2015.

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