OurHealth Richmond Mar/Apr 2016 Edition by OurHealth Media LLC

table of contents |march • april 2016

[series: part 2]

The Bridge to Better Health Starts with Primary Care MEDI•CABU•LARY.....................10 Local experts define health related terms

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

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

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

THE ANATOMY CHALLENGE..................................21 How much do you know about Our Anatomy? In this issue, test your knowledge when it comes to the PATHWAY OF AIRBORNE ALLERGENS INTO THE BODY

Sen

ds ar

Greater Richmond

ds ar

Living Aw ior

Sen

Pollen Allergy Sufferers: Seek treatment instead of suffering

Living Aw ior

ds ar

THE ANATOMY ........................... 22

ur d i d y oi t e favor ce servi er p r o v i d? win

Senior Living Awards

RESULTS ANNOUNCED IN THE MAY 2016 ISSUE

OurHealth | The Resource for Healthy Living in Greater Richmond

The Resource for Healthy Living in Greater Richmond

[new series: part 1]

Being unpregnant is not UNFAMILIAR

If you are having difficulty getting pregnant, you are not alone. Is it time to seek help? A year-long series focusing on how to prepare your child for a career in healthcare. This issue: The High School Years.

60 FIT BITS!........................................................................... 49 Where land meets water: Aqua Kickboxing is an energizing, powerful, uplifting and effective way to burn calories and tone muscles – that’s easy on the joints.

[series: part 2]

2016 Nutrition Series

New Kitchen, New Nutrition, NEW YOU

This series puts the focus on helping you get healthier in the kitchen — one ingredient at a time. This issue: Healthier Cobb Salad

hello, HEALTH!................................................................. 50 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos

A CLOSER LOOK............................................................. 66 Images reflecting the landscape of healthcare in Richmond

* PLUS * A chance to win prizes!

www.OurHealthRichmond.com

The Resource for Healthy Living in Greater Richmond

march • april 2016

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CONTRIBUTING RICHMOND MEDICAL EXPERTS Matthew Brengman, MD Lawrence Gelber, MD Christopher Lyons, MD Deidre McSweeney-Tyson, MD Joe Niamtu, III, DMD David Rapp, MD CONTRIBUTING PROFESSIONAL Geri Aston EXPERTS & WRITERS Cynthia BeMent Rich Ellis Deidre Wilkes Diane York 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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click on the magazine cover to view the digital edition! COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Ext. 1 Information in all print editions of OurHealth and on all OurHealth websites (websites listed below) and social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2016 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. OurHealth Lynchburg/Southside is published bi-monthly • Special editions are also published • McClintic Media, Inc. • 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. MAIN: ourhealthvirginia.com | ourhealthswva.com | ourhealthlbss.com | ourhealthrichmond.com | ourhealthcville.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

Most patients have blepharoplasty done on the upper and lower lids at the same time, but it can be done separately if desired.

What is Blepharoplasty?

What is Nocturia?

What is Turner Syndrome?

Blepharoplasty is a cosmetic surgery procedure to rejuvenate the eyelids. Blepharoplasty can be performed on either or both the upper and lower eyelids.

Nocturia is defined as getting up at night to urinate. Nocturia is quite common, especially with advancing age. One study estimates that more than 80 percent of adults over 80 years of age have nocturia. Because it is so common later in life, it is sometimes difficult to define when nocturia is normal or abnormal. Oftentimes treatment is beneficial when nocturia is significantly affecting someone’s quality of life.

Turner Syndrome’s classic features include short stature, absence of puberty, webbed neck and turning out of the arms at the elbows. Turner Syndrome occurs in one in 2,500 live female births. The syndrome results from a total or partial absence of the second X chromosome in females.

As we age, the skin on our upper eyelids becomes droopy and not only makes us look older, but can also obscure vision. The lower eyelids have even more distinct aging changes manifested by crinkly skin and protruding fat bags. This type of lower eyelid aging truly makes us look old and tired. Most patients have blepharoplasty done on the upper and lower lids at the same time, but they can be done separately if desired. [Pullout] These images show a patient before and after upper and lower blepharoplasty. Joe Niamtu, III DMD

These images show a patient before and after upper and lower blepharoplasty.

Cosmetic Facial Surgery Richmond | 804.934.3223 www.lovethatface.com

We perform upper and lower blepharoplasty with the CO2 laser which makes it a bloodless procedure. Less bleeding means more precise surgery, less bruising and faster healing. This procedure is usually performed with IV sedation and takes about 30 minutes and has about a one week recovery. — Joe Niamtu, III DMD

The causes of nocturia are varied. Some causes are related to your urinary tract and include overproduction of urine or limited bladder capacity. Other reasons come from external factors, such as how much fluid you drink, sleep habits, or even possible associated disorders like sleep apnea, diabetes, or prostate enlargement. Initial treatment often focuses on modifying fluid consumption. There are also several medicines that can be used to treat nocturia. Your physician can discuss these options with you and recommend the best approach to decrease your nightly trips to the bathroom. David Rapp, MD

Virginia Urology Richmond | 804.330.9105 www.uro.com

Most females with Turner Syndrome show a gradual decline in growth rate, and without treatment, the ultimate height range is between 4’7” and 4’10”. Females with Turner Syndrome may also have the following features: puffiness of the hands and feet, low posterior hairline, webbed neck, prominent ears, high arched palate, small jaw, broad chest, multiple moles, neurosensory hearing loss, mathrelated learning challenges and fingernails that turn up. When diagnosed, the most important considerations include the possibility of cardiac and kidney problems. These symptoms may include narrowing of the aorta in the heart and kidney abnormalities. Treatment usually includes growth hormones before the age of nine and estrogen therapy when puberty should occur, which can result in a satisfactory height and adult feminine appearance. Women with Turner Syndrome can experience the gift of motherhood, either through egg donation or adoption, while some women have spontaneously carried pregnancies to term. Deidre McSweeney-Tyson, MD

Bon Secours Pediatric Endocrinology and Diabetes Associates Richmond | 804.287.7322 www.bonsecours.com OurHealth | The Resource for Healthy Living in Greater Richmond

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

How can abdominoplasty help someone who has experienced a large weight loss? Patients who experience significant weight loss, whether through diet and exercise, balloon therapy, or surgery can develop significant extra skin on their abdomen. Removal of this skin is called abdominoplasty. There are medical reasons to consider removal of excess skin. The most frequent reasons are irritation and skin ulcer formation due to the folding of the skin. This is usually caused by a fungus called candida. In hot weather, candida can be particularly difficult to treat even with prescription medications. Skin removal usually resolves this issue. For those whose develop very low lying skin folds (usually to the mid thigh or knee) the fold can interfere with the patients walking and can lead to falls. Another reason patients seek skin removal is to improve body image. Abdominoplasty is often recommended as a cosmetic procedure in these cases. It is important to note that skin removal is not, by itself, a weight loss procedure. In addition, patients who have had weight loss surgery and are still losing weight should delay skin reduction surgery. The general recommendation is to wait until weight loss has been stabilized for three to six months. Matthew Brengman, MD

Bariatric Surgeon Advanced Surgical Partners of Virginia Richmond | 804.360.0600 www.advancedsurgicalpartnersofva.com

OurHealth | The Resource for Healthy Living in Greater Richmond

How does a colonoscopy help prevent colon cancer? Colon cancer is the second leading cause of cancer death among men and women in the U.S. It can strike at any age. However, 90 percent of colon cancers are found in people who are 50 or older. You can often prevent colon cancer from developing in the first place. Colon cancer arises from pre-cancerous growths or polyps in the colon. Identifying and removing polyps early eliminates the chance that colon cancer will develop from those polyps. How do you find polyps? There is a screening test called colonoscopy which allows a gastroenterologist to examine the entire colon and immediately biopsy and/or remove polyps. People at average risk should have their first colonoscopy at age 50. Some people are at higher risk and may need to be screened sooner. According to the American Cancer Society, the rate at which people are diagnosed with colon cancer has dropped 30 percent in the last decade for people 50 and older. Researchers believe this decrease is largely due to more people being screened. Christopher Lyons, MD

Richmond Gastroenterology Associates Richmond | 804.560.9863 www.richmondgastro.com

Does allergen immunotherapy work for all allergies? Allergen immunotherapy or “allergy shots” is a well-recognized treatment for children and adults with nasal and eye allergies, asthma, skin allergies, eczema, and stinging insect allergy who do not respond adequately to avoidance measures and medications, or just want to have a better quality of life. It can decrease symptoms from many allergic triggers, including dust mites, mold, pollen, animals, and insects, resulting in long-term relief even after shots are discontinued. Treatment may prevent the development of new allergies or progression of nasal allergies to asthma. Allergy injections are tailored to each patient’s specific allergies based on skin testing. Injections are administered twice weekly during a build-up phase with gradually increasing doses over several months, resulting in immunity or tolerance to the allergens. Once a maintenance dose is achieved, injections continue every couple of weeks for three to five years until the patient is symptom free without the need for medications. Local reactions may occur and in rare cases a severe reaction might require an epinephrine injection. Lawrence E. Gelber, MD

Richmond Allergy and Asthma Specialists Richmond | 804.285.7420 www.richmondallergy.com

NEW

NOTEWORTHY

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

First Annual 2016 Greater Richmond Holistic Expo On Saturday May 7th, Mother’s Day weekend, nearly 160 holistic practitioners and professionals will gather together at Henrico Hall on the grounds of the Richmond Raceway Complex for the 1st Annual Greater Richmond Holistic Expo. The Richmond Holistic Expo promises to be a fun-filled day. “It’s the most diverse expo I have ever produced or been a part of,” says Steven Wentworth, the show’s producer. “Every exhibitor offers a unique product and service.” The expo will feature healthy food concessions, speakers, demonstrations, and two 50/50 drawings that will benefit Noah’s Children hospice care in Richmond. Attendance and parking is free. Doors open at 10 a.m. For those interested in becoming an exhibitor, visit www.RichmondHolisticExpo.com or call 804.5037939.

Mobile App Connects Patients with High-Quality Medical Care from Virtually Anywhere, Anytime Bon Secours Richmond Health System has launched Bon Secours 24/7, a telehealth app that gives the community access to the health system’s medical group providers 24 hours a day, 365 days a year, no appointment necessary. Bon Secours is the first health system to introduce the Richmond market with this service. Bon Secours 24/7 will allow users to connect within minutes to a Bon Secours medical provider via a mobile device or tablet, or by logging in to a secure website from their desktop computer. Bon Secours launched the service to its employees nationwide January 7, 2016 and is now offering the service throughout Virginia. Bon Secours 24/7 visits are $49 and may be covered by health insurance. In-app credit card payment makes it convenient. The Bon Secours 24/7 app is available for Apple and Android devices and can be downloaded for free from the App Store or Google Play store, or by accessing www.bonsecours247.org.

Bon Secours 24/7 features: • live video visits with secure messaging • easy access to board-certified physicians, licensed physician assistants and certified nurse practitioners • service available 24/7, year-round

Don’t miss the cover story

• expert preventive care advice about recommended tests and immunizations such as flu shots, mammograms, etc. Bon Secours partnered with American Well to develop Bon Secours 24/7. American Well is a national leader in telehealth software and services and works with leading health plans, private employers, health systems, government agencies, and retailers to make care more affordable, accessible and consumer-friendly. For more information, visit www.bonsecours247.org.

OurHealth | The Resource for Healthy Living in Greater Richmond

American Diabetes Association urges Virginians to Take Joel Ashworth, MD

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

Danielle Avula, MD

Bon Secours Aylett Medical Center Richmond | 804.746.1677 www.goodhelpdocs.com

Annie Barden, NP

Bon Secours Cardiovascular Associates of Virginia Richmond | 804.794.6400 www.goodhelpdocs.com

Amy Blakey, NP

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

the Diabetes Risk Test on Alert Day® This year’s annual American Diabetes Association Alert Day is Tuesday, March 22, 2016. The American Diabetes

Michelle Ellett, CPNP Children’s Hospital of Richmond at VCU Neurosurgery Downtown Richmond 804-828-CHOR www.chrichmond.org

Stephen Kates, MD

VCU Health Orthopaedic Surgery Richmond and Stony Point 804.828.7069 www.orthopaedics.vcu.edu

Megan Foege, DNPc, FNP-C, MSN, BSN, APRN

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

Megan Lemay, MD

VCU Health General Internal Medicine Richmond | 804.828.9357 www.vcuhealth.org

Stephanie Heath, NP

Bon Secours Cardiovascular Associates of Virginia Richmond | 804.794.6400 www.goodhelpdocs.com

Monica Morris, MD

VCU Massey Cancer Center Radiation Oncology South Hill | 434.774.2481 www.massey.vcu.edu

Mary Holsinger, FNP

Bon Secours Patterson Ave. Family Practice Richmond | 804.741.6200 www.goodhelpdocs.com

Allison Pariyadath, MD VCU Health Opthalmology Richmond and Stony Point 804.828.9315 www.eye.vcu.edu

Association is asking the public to use this day to take the Diabetes Risk Test to find out if they are at risk for developing type 2 diabetes. The risk test, found at www.diabetes.org/alert, includes a few simple questions about weight, age, family history and other potential risks for prediabetes or type 2 diabetes. Diabetes is a serious disease that strikes nearly 30 million Americans including nearly 900,000 in Virginia. A quarter of those affected by diabetes are not aware that they have the disease. Recent estimates project that as many as one in three American adults will have diabetes in 2050 unless we take the steps to Stop Diabetes®. Early intervention via lifestyle changes such as weight loss and increased physical activity can help delay or prevent the onset of type 2 diabetes. “The American Diabetes Association hopes that this Alert Day will encourage people to take the Diabetes Risk Test and share it with their loved ones, says Rick Blackwell, chair of the Association’s Central Virginia Community Leadership Board. “By understanding your risk, you can take the necessary steps to help prevent the onset of type 2 diabetes.” For your free Diabetes Risk Test visit www.diabetes.org/alert. For more information on the free diabetes education program offered by the Richmond office of the American Diabetes Association, call 804.225.8038.

Laura Polliard, AGACNP

Bon Secours Advanced Heart Failure Center Richmond | 804.287.3550 www.goodhelpdocs.com

Alan Rossi, MD

VCU Health Acute Care Surgery Richmond | 804.828.7748 www.surgery.vcu.edu

Evan Silverstein, MD

Children’s Hospital of Richmond at VCU Ophthalmology Downtown Richmond, Fredericksburg, Stony Point 804-828-CHOR www.chrichmond.org

Alex Valadka, MD

VCU Health Neurosurgery Richmond | 804.828.9165 www.vcuhealth.org

www.OurHealthRichmond.com

NEW

NOTEWORTHY Massey PhysicianResearcher Named

President of the Richmond Academy of Medicine

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

VCU Massey Cancer Center’s own Harry D. Bear, MD, PhD, director of the Breast Health Program and medical director of the Clinical Trials Office at VCU Massey Cancer Center, has officially been inaugurated as the Richmond Academy of Medicine’s (RAM) new president for 2016. RAM is an organized community of local physicians who engage through meetings and programs in an effort to advance health care practices and the medical profession for the benefit of the greater Richmond area and beyond. Serving as RAM’s spokesperson and the face of the academy’s membership through a two-year term, Dr. Bear will act as the lead governing officer over all functions of the academy and its affiliated organizations, including Access Now, Centralized Credentials Verification Service and RAM Services Corporation. In his newfound role, he has a vision to advocate for the expansion of RAM’s Honoring Choices Virginia initiative, which focuses on increasing the use of advance directives. He also hopes to drive up RAM member involvement, especially from VCU doctors along with younger generations of physicians and health care providers. “I’m both honored and excited to usher in a new chapter in RAM’s history of advancing health care delivery and practice in and beyond Richmond,” Dr. Bear says with anticipation toward his new position. Dr. Bear is the Walter Lawrence, Jr. Distinguished Professor in Oncology and chairman of the Division of Surgical Oncology, professor of surgery and microbiology and immunology at Virginia Commonwealth University. He has been a member of the faculty at VCU for 30 years. For more information about the Richmond Academy of Medicine visit www.ramdocs.org.

Retreat Doctors’ Hospital and ESPN 950 to Hold

Colorectal Cancer Awareness Event Retreat Doctors’ Hospital is partnering with ESPN 950 to offer a free colorectal cancer seminar in recognition of Colorectal Cancer Awareness Month. WHAT: Free Colorectal Cancer Seminar WHEN: Tuesday March 22nd, 5:00-7:30 pm

Trying to improve your eating habits?

NEW KITCHEN, NEW NUTRITION, NEW YOU

WHERE: The Branch Museum for Architecture and Design, 2501 Monument Avenue, Richmond The event will feature informational seminars from Harjit Bhogal, MD and Cary Gentry, MD on colorectal cancer prevention and the latest technology and treatment options.

OurHealth | The Resource for Healthy Living in Greater Richmond

According to the American Cancer Society, colorectal cancer is the third leading cause of cancerrelated deaths for men and women combined. Nearly 135,000 new cases of colon and rectal cancer will be diagnosed this year in the United States. Screening is also allowing more colorectal cancers to be found earlier when the disease is easier to cure- highlighting the importance of early detection. Space is limited and registration is required. Call 804.320.DOCS (3627) to register.

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 NUTRITION month

A healthy lifestyle includes nutrition

– what we put in our body for fuel and protection from disease and illness. Here are some helpful tips to keep you on track. • Eat more whole foods – avoid foods with more than five ingredients. • Plan healthy menus as a family • Don’t skip breakfast • Support your local farmer’s market – it is a great source for fresh fruits, vegetables and nuts. For additional resources on nutrition and healthy eating, visit the Academy of Nutrition and Dietetics at www.eatright.org.

Check out the BusFarm Indoor Market,

open on weekends year-round! You can purchase fresh produce, dairy products, organic meats and more – everything they sell is seasonal and local! Visit www.thefarmbus.com for more information.

NAP TIME-

It isn’t Just for Kids! According to the National Sleep

Foundation, people who don’t get enough sleep are more likely to eat more because sleep loss affects the

hormones associated with hunger. However, a mid-afternoon nap can reverse the negative metabolic effects of sleep loss.

did you know? Your

depends on your

to signal that it’s full,

but that message takes

minutes

to be delivered. So slow down

during meals, and you’ll be less likely to eat too much.

FASCIN -ATING

FACT

OurHealth | The Resource for Healthy Living in Greater Richmond

DIVE IN! During your lifetime, you will produce enough saliva to fill two swimming pools!

Anatomy

The Anatomy Challenge is proudly sponsored by:

the

Now accepting patients at all locations Mechanicsville 8485-B Bell Creek Road Mechanicsville, Virginia 23116 (804) 559-0370

CHALLENGE How much do you know about the

pathway of an airborne

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allergen into your body? Complete the word search below. Next, match the correct word with the part of the body in the illustration.

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[ the pathway of an allergen ]

WORD SEARCH nose

left lung

nasal cavity

bronchi

epiglottis

alveoli

larynx

left main bronchus

trachea

right main bronchus

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right lung For answers, visit OurHealth Richmond's

Facebook page at

____________________ ____________________

____________________

____________________ ____________________ ____________________ ____________________ ____________________

____________________ ____________________

____________________ www.OurHealthRichmond.com

POLLEN ALLERGY

SUFFERERS

TREATMENT words | RICH ELLIS

SEEK

INSTEAD OF SUFFERING As winter’s gray, daylight-starved, icy grip slowly fades with each flip of the calendar page toward spring and its promise of brighter days and warmer temperatures near, a small segment of the population quietly dreads April’s return. They’re not crazy, snow loving or winter sports fanatics. They’re simply allergy sufferers. While many welcome spring’s sunny return with open arms and outdoor activities, pollen-allergy sufferers are left to simply try to survive the annual pollen onslaught that occurs every year for months beginning in spring. They live in misery or in a heavily medicated state or both, with allergic rhinitis — swollen, itchy eyes; stuffy and running noses; and in some cases, wheezing and difficulty breathing. Forced indoors to seek relief — however minor it might be — they wait until the tree pollen’s spring bloom has subsided and, along with it, their allergy symptoms. Their relief is short-lived, however, as spring inevitably returns. Some don’t even have to wait for the following spring because their misery reappears every fall when ragweed pollinates and pollen proliferates once again. In general, tree pollen peaks during the spring, grass pollen in the summer and weed pollen in the fall. The life of allergy sufferers doesn’t have to be this way, and to protect their future health, it shouldn’t be.

www.OurHealthRichmond.com

Elaine Turner, MD, Parag Patel, MD, and Jeffrey Schul, MD, are physicians with Allergy Partners in Richmond. They estimate that anywhere from 10 to 30 percent of the population suffers from seasonal pollen allergies, and they offer hope in the form of immunotherapy — allergy shots — that reduce patients’ allergic symptoms.

Pollen’s invasion and the body’s reaction Pollen is breathed in through the nose and into the first part of the lungs, the larger bronchi, Dr. Turner explains. It doesn’t migrate to other parts of the body or enter the bloodstream. In some people, an allergic reaction occurs after exposure, which can then affect the nose, the sinuses and — in asthma — the bronchial tubes. It’s not what pollen contains that causes these symptoms, Dr. Turner says, but rather the body’s immune system reacting abnormally to the pollen.

Elaine Turner, MD is certified by the American Board of Internal Medicine and by the American Board of Allergy and Immunology. Dr. Turner is an allergist with Allergy Partners of Richmond.

“Proteins on the pollen interact with macrophages — a type of white blood cell — in a process called ‘sensitization,’” Dr. Turner explains. “This leads to the development of memory cells, which can subsequently produce IgE antibodies. Once the patient is sensitized, the next time pollen contacts the mucous membranes, the IgE antibodies will interact with a type of cell called a mast cell. When this happens, the mast cell degranulates and releases all kinds of nasty chemicals involved in the allergic reaction, including histamine. This in turn causes itching, swelling and excess mucus production, leading to allergic symptoms that can include sneezing, coughing, wheezing, a runny or congested nose, itchy eyes and shortness of breath.” So pollen doesn’t enter the blood stream. Rather, the various chemicals that result from the allergic reaction are what cause the symptoms as they act on mucous membranes in the nose or bronchi. As for why some people’s immune systems react abnormally to pollen exposure while others never experience pollen allergies, the physicians agree that the culprit is genetics. It’s actually genetics combined with environmental exposure, Dr. Turner explains. Some people are more genetically predisposed, and if those people have enough environmental exposure to pollen, they’ll develop allergies. In some cases it’s been shown that an interaction with a virus could be to blame because after children had a virus, they developed allergies because the virus interacted in some manner with their genetics and environmental exposure. While it isn’t guaranteed or even a direct link, Dr. Schul says that if your parents have allergies, you’re predisposed to developing allergies too.

Jeffery Schul, MD is certified by the American Board of Internal Medicine and by the American Board of Allergy and Immunology. Dr. Schul is an allergist with Allergy Partners of Richmond.

Patients typically don’t outgrow their allergies, Dr. Patel adds, particularly if they continue to experience persistent or worsening symptoms as they grow older.

Seeking relief from the havoc pollen wreaks So what can allergy sufferers who’ve been exposed to pollen do to help alleviate their symptoms? The first step is to reduce exposure. Remaining indoors with the windows closed and the air conditioning on to filter out pollen helps lower pollen exposure levels. And taking a shower immediately after being outside helps remove pollen and further reduce exposure. Once they’ve reduced their exposure, allergy sufferers should work with their physicians to determine which of the various prescription and over-the-counter medications available will help alleviate — but not cure — their symptoms.

Medications that are used to combat allergic rhinitis include: • Antihistamines to block the histamine released during an allergic reaction. • Singulair to block leukotrienes released during an allergic reaction. • Steroid nasal sprays to reduce inflammation. Medications used to treat the asthma that those with allergies often experience include: • Inhaled bronchodilators that relax the smooth muscle surrounding the bronchi, which can tighten during an asthmatic episode. • Inhaled corticosteroids, which calm inflammation and reduce swelling and mucus inside the bronchi. A third step on the path to relief is working with an allergist. Allergists are physicians who specialize in allergy and asthma management. They can help patients by: • Identifying the specific environmental allergens, such as pollen, mold, dust and pet dander, that can cause respiratory symptoms. • Treating patients’ eye, nasal, sinus and lung symptoms with medication management and potential immunotherapy treatment, if appropriate. • Providing advanced diagnostic testing to best assess asthma and, when appropriate, recommending advanced asthma treatment with biologics such as omalizumab (Xolair) and new treatments that are on the horizon.

Parag Patel, MD is certified by the American Board of Allergy and Immunology. Dr. Patel is an allergist with Allergy Partners of Richmond.

www.OurHealthRichmond.com

Working with an allergist is the only way allergy sufferers can determine whether the gold standard in allergy treatment — immunotherapy — could significantly reduce their suffering. While medications can help, the only solution that works directly on the immune system is immunotherapy, Dr. Schul says.

Immunotherapy doesn’t deliver benefits overnight, but some patients see improvements in as little as six to eight weeks after beginning treatment.

More commonly referred to by patients as “allergy shots,” immunotherapy is the only specialized and customized treatment that can tackle not only patients’ symptoms but also the cause of respiratory allergies, Dr. Patel explains. Immunotherapy can help reduce sinusitis and better control and possibly even prevent asthma, thereby improving overall quality of life. And the benefits can last for years, even after treatment ends. Immunotherapy works by reducing allergic sensitization and thus reducing allergic symptoms and the need for medication, Dr. Turner says, and is the closest thing to the body developing immunity to pollen’s effects.

Preventing allergic progression Another reason to pursue immunotherapy is that it can help prevent allergic rhinitis from progressing into asthma. According to Dr. Patel, treating and controlling allergic inflammation in the upper airway (nasal passages and sinuses) helps control and possibly even prevent allergic inflammation in the lower airways (lungs). “It’s important to remember that it’s all one airway,” he says. “Treating the upper airway also helps treat the lower airway.” Adding credence to this “one airway” philosophy is the fact that approximately 70 to 80 percent of asthmatics have underlying allergic inflammation that is typically caused by environmental allergens. Immunotherapy doesn’t deliver benefits overnight, but Dr. Schul says some patients see improvements in as little as six to eight weeks after beginning treatment. “Studies show that optimal improvement takes a year, but a majority of people see improvement measured in months, not years.” As for effectiveness, Dr. Turner estimates that allergy shots deliver relief to approximately 85 percent of patients who receive the treatment. Another reason to treat pollen allergies with immunotherapy is to decrease symptoms of oral allergy syndrome. Dr. Turner says that a reaction to pollen can cause a cross reaction with certain foods, known as the “oral allergy syndrome.” It usually involves an allergic reaction to tree fruits, such as apples, pears, cherries or peaches, with sufferers experiencing an itchy mouth or swelling when the raw fruits are in the mouth (but not after they are swallowed) or when cooked fruits are eaten. With the help of a skilled team of allergists, allergy sufferers can improve both their quality of life and their health by first reducing exposure to pollen and using medications that alleviate the immune system’s reaction and accompanying symptoms following pollen exposure, while pursuing the solution that immunotherapy can provide.

Expert Contributors • Elaine Turner, MD, Allergy Partners of Richmond • Jeffery Schul, MD, Allergy Partners of Richmond • Parag Patel, MD, Allergy Partners of Richmond

ON THE WEB

More at ourhealthrichmond.com

series

the 2016 OurHealth Richmond Primary Care Series: an issue-by-issue overview

+++ january

| february

KNOW YOUR CARE: understanding your health and how to maintain it

+++ +++

march

words | GERI ASTON

YOUR

care

Taking action with your health

Your health is as unique as you are. It’s shaped by a combination of many factors — age, weight, gender, genetics, environment and lifestyle choices. In your first visit with your primary care provider, the doctor assesses each of these components and develops a care plan specific to you. Then it’s your turn. You have to act on that plan. You have to “do your care.” This article, the second in a yearlong OurHealth series about primary care, will focus on your part of the patient-physician partnership.

Eating healthy Although you can’t change your age, gender or genetics, you can change the lifestyle choices that affect your health. Helping patients make healthier choices is a major focus for Deborah Koehn, MD, a primary care physician at VCU Health at Stony Point. Many of her patients have diabetes or prediabetes, high cholesterol, high blood pressure or a mixture of all three. The underlying reason for each of these conditions more often than not is the same — overweight.

| april

DO YOUR CARE: taking action with your health

+++ +++ june

| july

SHARE YOUR CARE: setting good examples for others to learn and live by

+++ august

| september

INSPIRE YOUR CARE:

keeping creative with fresh care ideas

+++ october

| november

MEASURE YOUR CARE:

tracking your efforts to ensure you’re on the right path

+++ december

CELEBRATE YOUR CARE: rejoicing the rewards realized from taking good care of yourself

What does a healthy meal look like? The Healthy Eating Plate, developed by Harvard University, shows people what a healthy meal looks like. The U.S. Department of Agriculture has a similar tool, called MyPlate www.choosemyplate.gov. The American Diabetes Association offers Create Your Plate www. diabetes.org/food-and-fitness/ food/planning-meals/createyour-plate/?loc=ff-slabnav to help people control their blood sugar. You can ask your primary care provider whether one of these meal plans or a different one is right for you.

use healthy oils like

drink water–

olive oil and

minimum of

canola oil.

limit butter.

servings. limit dairy and juice

avoid trans fat.

eat a variety of whole grains. limit refined eat a great variety of

grains like white bread.

vegetables. choose fish,

poultry, beans eat plenty

and nuts. limit

of fruits of

red meat and

all colors.

cheese. avoid processed meats such as bacon and cold cuts.

Dr. Koehn spends a lot of time educating her patients about eating healthy meals. Together with her patients, she develops a plan that meets their health needs and sets reasonable, achievable goals for weight loss.

On the surface, eating healthy sounds simple, but Dr. Koehn realizes it’s usually easier said than done. “It’s behavior change, and behavior changes are harder than people think.” Eating healthy starts before going to the grocery store. It means planning healthy meals in advance, shopping often enough to have nutritious options on hand and reprioritizing your grocery budget. Healthy eating is just as important while dining out, Dr. Koehn says. Look at restaurant menus before you decide where to dine. If the restaurant makes it available, check the nutrition information too. Some eating plans, such as those for diabetic patients, affect the whole family. Sarah Meyers, a physician assistant at Bon Secours Canal Crossing Internal Medicine, urges patients to bring their families to diabetes education classes. Deborah Koehn, MD, FACP, ABCL is a primary care physician at VCU Health at Stony Point in Richmond. Dr. Koehn is certified by the American Board of Internal Medicine.

It’s usually not feasible for everyone in the household to eat different meals, so it’s important for family members to understand the role of food in the disease and to get on board with the diet change. Plus, if unhealthy eating is the cause for the disease, everyone at home is at risk.

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Get up and go Diet alone isn’t enough to achieve a healthy weight. The other half of the equation is exercise. Many people think of going to the gym when they think exercise. For people who can afford it and are motivated, Meyers often recommends joining a gym and working with a personal trainer. But for others, a membership is nothing more than a donation to the gym. Going to a health club isn’t for everyone, Meyers says. If that’s the case with you, the most important thing is to find an activity you like to do because you’re more likely to stick with it. It’s okay to start out small, Meyers says. Start at 10 minutes three times a week and add time when it gets too easy.

Sometimes, starting out small is the most healthy approach. Taking up running or an organized sport you haven’t played for years could result in an injury because your muscles aren’t conditioned for it.

Preventing Portion Distortion The type of food on your plate is important, but so is the amount. Did you know that portion sizes in America have increased over time? Many restaurants serve oversized portions, sometimes big enough for two people. Many food makers package food and drinks in large sizes to sell more of their product. For example, 20 years ago, the typical bagel was three inches in diameter and 140 calories. Today’s bagels are often six inches and 350 calories. As portions have grown, so have Americans’ waistlines. If you’re trying not to overeat when you’re at a restaurant, how can you tell how much is the right amount when you don’t carry measuring spoons or cups? It turns out you have a portable measuring tool at hand, literally. Dr. Koehn teaches patients how to use their hands to estimate serving sizes to avoid overeating at home and at restaurants. Check out OurHealth’s easy guide to portion control by scanning the QR code.

Walking is a great alternative. It doesn’t stress the joints and it’s free. A commonly heard goal is 10,000 steps a day, but that’s not an official government health recommendation. The Centers for Disease Control and Prevention says typical adults should get two hours and 30 minutes of moderate intensity aerobic activity — such as brisk walking — every week, and they should perform muscle-strengthening activities two or more days a week.

Honesty and Action An individualized eating and exercise plan can keep chronic conditions like diabetes, high blood pressure and high cholesterol in check without medication or with a lower dose. Think of diet and exercise as medicine, Dr. Koehn urges. Your plan will only be successful if you’re honest with your physician at the outset and as you work toward your goals. Be frank about how much exercise you get, what you eat and what your weaknesses are, Meyers says. If your only exercise is to walk to the mailbox and back, that’s what you should tell your doctor. Truthful information will help your physician determine what your first activity goals should be. Some patients are very motivated to change their habits, while others find it a struggle. Some patients falter, don’t let their doctor know and give up. If you have a hard time meeting your goals, your primary care provider would much rather you reach out to them for help than give up, say both Meyers and Dr. Koehn. They can offer tips to keep up your momentum when you hit a roadblock. For example, you’re able to reach 4,000 steps a day, but your goal is 10,000. It’s OK to send your doctor or nurse a quick message asking for advice on how to increase your steps. When emailing, a short, direct message is best, Dr. Koehn says. If you really are unable to change your behavior, you have to be honest about that, too. If you have high cholesterol but keep eating at McDonalds, a cholesterol-lowering statin drug might be your best choice, Meyers says. When you’re exercising and changing your eating habits because of a chronic illness, your doctor will make plans for follow-up visits. It’s important to keep those appointments so your physician can make sure your plan is working and make needed changes if it’s not. If it’s possible, make your next appointment before you leave your primary care provider’s office. That way, your follow-up slip visit won’t fall through the cracks. 32

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Most people remember getting vaccine shots when they were kids. You might even have your old vaccine booklet from when you were a child. But the need for immunization doesn’t end with childhood.

Vaccines aren’t just for kids

The Centers for Disease Control and Prevention recommends that adults get an annual flu vaccine, periodic booster shots for some diseases and a pneumonia vaccination at age 65. Most adults who are 49 and younger can get the flu vaccine in a nasal mist instead of a shot. For additional information about adult vaccinations, scan the QR code.

Dr. Koehn recommends that people use some sort of tool — be it a FitBit, a smart phone app or a pedometer — to measure how far they’re walking and to gauge their progress as they work toward reaching their goal over time.

Obese people have to take special care when starting their physicianrecommended exercise routine because the extra weight puts pressure on their joints. Exercising in a pool is often the best option because it’s easier on the joints. People who don’t like water or are shy about putting on a bathing suit can still safely add to their activities. Even getting up and moving about during TV breaks helps. You can gradually add more activity as time goes on.

Mental health Almost everyone experiences times in their life when they’re anxious or depressed. It’s important to let your primary care provider know when it happens to you. Your physician can help you determine whether your feelings are normal or a sign of a mental health problem.

“I can’t help [with medications, or other issues you’re having] if I don’t know there is a problem.”

– Sarah Meyers, PA-C,

Bon Secours Canal Crossing Internal Medicine in Richmond

If you are having a mental health problem, your doctor will likely refer you to a counselor who can help you work through it. Counselors also teach coping skills that you can use through your life.

Dr. Koehn often recommends counseling to overweight patients who are unable to change their eating habits. “So many people have dysfunctional relationships with food,” she says. “A lot of that comes from emotional issues.” Counseling can help people figure out what is blocking them from healthy eating. It’s important to find a counselor who is right for you, Dr. Koehn says. She suggests calling counselors on a referral list (often provided by your physician), explaining the basics of your issue and deciding whether that person will be a good fit for you based on your conversation.

Sarah Meyers, PA-C is a physician assistant and sees patients at Bon Secours Canal Crossing Internal Medicine in Richmond.

www.OurHealthRichmond.com

10 questions to be “medicine smart”

Patients who understand their medications are more likely to take them. Here are 10 questions you can ask your doctor or nurse to get the information you need to use medicines appropriately.

1. What is the name of the medicine and what is it for? Is this the brand name or the generic name? 2. Is a generic version of this medicine available? 3. How and when do I take it — and for how long? 4. What foods, drinks, other medicines, dietary supplements or activities should I avoid while taking this medicine? 5. When should I expect the medicine to begin to work, and how will I know if it is working? Are there any laboratory tests required with this medicine? 6. Are there any side effects, what are they, and what do I do if they occur? 7. Will this medicine work safely with the other prescription and nonprescription medicines I am taking? Will it work safely with any dietary or herbal supplements I am taking? 8. Do I need to get a refill? When? 9. How should I store this medicine? 10. Is there any written information available about the medicine? Credit: National Council on Patient Information and Education

OurHealth | The Resource for Healthy Living in Greater Richmond

In many communities there aren’t enough counselors to meet demand, so you might experience a wait for an appointment. That’s why it’s important to call counselors without delay. Exercise also helps to relieve mental health problems. Sunshine and exercise boost the level of serotonin — a chemical produced by your body that is important for brain function. Yoga can be a particularly good exercise option. Dr. Koehn recommends meditative yoga — not hot yoga, which focuses more on the workout and sweating. The typical yoga studio has lessons for beginners, and staff members can help you decide what type of yoga is best for you. Dr. Koehn often encourages adolescents who are struggling with anxiety to try meditative yoga. It gives them a tool besides medication that they can use to cope with stress. Sometimes counseling and exercise aren’t enough, and medication is needed. Primary care doctors handle prescribing for common mental health problems. For serious mental health disorders, the doctor will usually refer the patient to a psychiatrist.

Most mental health medications take up to six weeks to take full effect. The doctor will typically schedule a follow-up appointment a month or two after prescribing the medication to make sure it’s working.

Mental health: Know the warning signs Trying to tell the difference between normal feelings, especially in times of stress or loss, and what might be the signs of a mental illness can be hard. Tell your doctor if you are experiencing any of these common signs of mental illness in adults and adolescents. »» Excessive worrying or fear. »» Feeling excessively sad or low. »» Confused thinking or problems concentrating and learning. »» Extreme mood changes, including uncontrollable “highs” or feelings of euphoria. »» Prolonged or strong feelings of irritability or anger. »» Avoiding friends and social activities. »» Difficulties understanding or relating to other people. »» Changes in sleep habits or feeling tired and low energy. »» Changes in eating habits such as increased hunger or lack of appetite. »» Changes in sex drive. »» Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don’t exist in objective reality). »» Inability to perceive changes in one’s own feelings, behavior or personality. »» Abuse of substances like alcohol or drugs. »» Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing aches and pains). »» Thinking about suicide. »» Inability to carry out daily activities or handle daily problems and stress. »» An intense fear of weight gain or concern with appearance (mostly in adolescents). Credit: National Alliance on Mental Illness

www.OurHealthRichmond.com

Take your meds By some estimates, more than half of all prescription drugs either aren’t taken at all or aren’t taken according to the doctor’s instructions. The result is that a lot of people are in poorer health than they should be, and some even die.

By some estimates,

more than half of all prescription drugs either

aren’t taken at all or aren’t taken according to the doctor’s instructions.

There are lots of reasons why people don’t take medicine. People don’t understand what it does to treat their condition or they don’t understand the doctor’s instructions. Sometimes people can’t afford their prescription medication or the drug causes an unpleasant side effect. Regardless of the reason, your primary care doctor wants to know if you’re not taking your medication, why you’re not taking it and if you’re confused about how to take it. Tell them right away. They don’t want you to wait until your condition gets worse to find out there is a problem with your medication. If a medication is too expensive, your doctor often might be able to prescribe a lessexpensive option. Some pharmaceutical makers offer free or discounted drug programs. If you’re experiencing side effects, your doctor can find a different drug that will work better for you. If you hear a troubling rumor about the medication, your doctor or nurse can talk it over with you. “But I can’t help if I don’t know there is a problem,” Meyers says.

Sources: »» Centers for Disease Control and Prevention – www.cdc.gov »» National Alliance on Mental Health – www.nami.org »» National Council on Patient Information and Education – www.talkaboutrx.org »» National Heart, Lung, and Blood Institute – www.nhlbi.nih.gov

Expert Contributors: »» Deborah Koehn, MD with VCU Health at Stony Point »» Sarah Meyers, PA-C with Bon Secours Canal Crossing Internal Medicine

ON THE WEB

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the 2016

HOW TO IN

OurHealth Richmond

HOW TO IN HEALTHCARE SERIES:

HEALTHCARE part SERIES

when i words | CYNTHIA BEMENT

an issue-by-issue overview

m ’

GROW UP i

GOINGWORK

part one

HEALTHCARE OurHealth’s four-part series: How to in Healthcare, is a step-by-step guide to help prepare students in their journey toward a career in medicine.

Compassion for others. Grace under pressure. A thirst for knowledge and a commitment to excellence in the classroom and beyond. You recognize these qualities in your child, and as he/she grows and develops throughout high school and your conversations turn to possible career paths, one or both of you wonder if a career in healthcare would be a good fit. The ability save someone’s life; to make a difference in the well-being of people by preventing disease, fighting illness and improving their every-day lives by helping them see, walk, breathe, move and speak better (just to name a few) - these can be rewards of a healthcare career. But to get into that “it’s a matter of life and death” career space, a job in healthcare requires a deep commitment on any level. A diligent approach to studying, the potential of many years in school, dedication to accuracy on the job and, most of all, an unwavering desire to help others is what it takes to achieve and sustain a successful career in this exacting field. What if your child may not be a great fit for the rigors of medical school or doesn’t want to spend that much time in school, but still shows passion for impacting the lives of others? Take heart: healthcare is a booming field, and the commonly imagined paths of doctor or nurse are but two points of entry into the 21st century world of healthcare, one whose enormity now offers a widely varied number of steady jobs that don’t require a medical license (which means less time spent in school).

Preparing for a Career in Healthcare as Early as High School |

march

april

part two

Choosing The Right Undergraduate School For Your Healthcare Specialty |

june

july

part three

Entering Graduate School and Residency/Fellowship/ Clinical Training august

september

part four

Insight on How to Find the Right Job in One’s Field of Specialty october

november

HOW TO BUILD A

FOUNDATION FOR SUCCESS 1

HELP YOUR CHILD DEVELOP

SOLID STUDY SKILLS TEACH YOUR CHILD

2 SELF-SUFFICIENCY EXERCISE

3 CRITICAL THINKING 4

ENCOURAGE YOUR CHILD TO

ASK QUESTIONS

“Knowing who you are as a learner is the big picture, but it’s also important to become adept at the skill of test taking, and it is a skill. It can be learned.”

In December, 2015 the Bureau of Labor and Statistics (BLS) reported that healthcare will be the fastest growing industry in the United States and will add more jobs than any other to the employment sector between 2014 and 2024. Together with the social assistance sector, healthcare is poised to add another 3.8 million jobs to our economy during this period. How do you figure out if healthcare is right for your child and they are already interested, what does your student need to be doing now, as high school begins, to get onto the path toward a healthcare career? With this four-part series, OurHealth aims to guide you so that you can guide your child on the journey to a career in healthcare. In our first four installments, we will cover high school, undergraduate, graduate curricula/clinical studies and finding a job in your chosen healthcare career, respectively (see our sidebar at the beginning of the article). Following the fourth installment, we will begin an ongoing series in which we will focus on one position in healthcare and describe the specific steps from high school through the first day on the job.

BUILD A FOUNDATION

FOR SUCCESS

While a career in healthcare is more accessible than ever before, it still requires advanced planning and a strong high school transcript that includes extra-curricular activities, high SAT and/or ACT scores and a spotless personal conduct record to gain entry onto its path. After all, the reason healthcare careers are so demanding is because they focus on the health and lives of people, an area where there is no room for error.

Starting in 9th grade, when most students enter high school, a child’s transcript becomes an official record of his or her success, one that’s scrutinized for acceptance to colleges and universities. So it’s important to start out strong from the gate, both for producing a competitive high school track record and to build the necessary skills with which to error-proof oneself as much as possible over the long haul of studying for and performing in a healthcare career.

Kevin Harris is the Interim Associate Vice President for Health Sciences Strategic Initiatives and Engagement; and Assistant Vice President for Health Sciences Student Initiatives and Inclusion at Virginia Commonwealth University in Richmond.

First, set your child up for success. That means creating solid study skills that will serve well in high school and college. Even more foundational, says Kevin Harris, assistant vice president of health sciences at Virginia Commonwealth University, is to discover and work with the students natural learning style first. “Understand who you are as a learner. Take some assessments online, which will help you consider your personality, your cognitive abilities and your temperament. There are all kinds of worthwhile assessments that can help you understand what triggers learning for you and what keeps you motivated,” he says. “We tend to introduce that [assessment] only for study skills. It’s a lot more than study skills or test taking - it’s how you become a life-long learner.”

OurHealth | The Resource for Healthy Living in Greater Richmond

Visit www.vark-learn.com and www.educationplanner.org for learning style self-assessment questionnaires for students to determine if they fall into visual (learning by seeing), aural (learning by hearing), read/write (learning by reading and taking notes), or kinesthetic (learning by simulation/demonstration) and for strategies to help your student learn better using to their style. Test taking, of course, is a big part of the study skill set, and one to actively develop, even if your student already gets good grades. “Just because school is easy, doesn’t mean they have the best study habits,” says Murphy. “Now is the time to make sure they’ve got good study habits and not just good grades. They’re looking at a lot of years in the classroom and need a strong outcome. Many medical professions have a state board or require certification so they have to be strong test takers which means they have to know how to study for a test,” she says. Harris agrees. “Knowing who you are as a learner is the big picture, but it’s also important to become adept at the skill of test taking, and it is a skill. It can be learned,” he says. “A lot of students will say, ‘I’m not a good test taker.’ There is no such thing. There are only people who have not nurtured the skill.” One way to become a better test taker, according to researchers at Washington University in St. Louis, Missouri, is to incorporate what they call “retrieval practice” into a student’s study habit skill set. Retrieval practice is as it sounds – the practice of calling up information from memory. Once a student is asked to recall or produce a piece of information (who was the fourth president of the United States, for example) they are is much more likely to remember it in the future. While retrieval is often used as a method for assessing how much a student has learned (test taking), being tested multiple times on facts a student needs to know for a test before taking the actual exam is more effective than simply reviewing those facts, according to Washington University researchers. In short: start taking practice tests. Encourage your student to ask teachers for any available practice tests on course material rather than simply reviewing books and notes, and offer to test your student periodically prior to exam time. (For a more on retrieval practice, visit Washington University’s retrievalpractice.org.)

DO YOUR HOMEWORK ON HEALTHCARE

CAREERS

With the foundation in place, do some exploring. Research career options in the healthcare field, says Murphy, because the industry offers a wide variety of positions that extend beyond a doctor or nurse. “It’s easy to point to a doctor or a nurse, but there are so many career paths within healthcare – medical assistant, lab technician, medical coding and reimbursement – each of which require different levels of education,” she says. “Therefore, early in the high school career is a great time for parents and students to start researching and

EARLY TRAINING FOR A

CAREER IN HEALTHCARE VCU PIPELINE PROGRAMS The Virginia Commonwealth University Health Sciences and Health Careers Pipeline, also called the VCU Pipeline, features programs and initiatives intended to support students in their journey toward a health profession. With a variety of programs and services from elementary school through the postbaccalaureate level, the VCU Pipeline strives to improve the academic and experiential profiles of participants from diverse backgrounds. While each program has its own distinct goals and benefits for students, all of the programs aim to: hh Educate and excite students about careers in the health sciences hh Provide resources to strengthen students’ academic skills in math and science, as well as in verbal and written communication

hh Ensure students make informed decisions while pursuing the health career of their choice For more information on VCU Pipeline Programs, visit their website at www.dhsd.vcu.edu.

HEALTHCARE

CAMPS & PROGRAMS looking at ‘what interests me and what type of time commitment am I looking at?’ and start to plot a path.”

VCU DENTAL HYGIENE CAREER EXPLORATION PROGRAM

SOUTHSIDE HEALTH EDUCATION FOUNDATION

The Dental Hygiene Career Exploration program (DCE) is designed to expose students to the dental hygiene profession. Program participants will gain hands-on laboratory experience dealing with dental hygiene instrumentation, dental anatomy, scaling, mock interviews and more.

Southside Health Education Foundation is providing a one-of-a-kind camp that offers a unique health career exploration experience for rising 10th, 11th & 12th graders. This week long, half day camp will give participants real-life experiences in health care and higher education around the Tri-Cities.

hh Date: June 21 – 23, 2016, 9:30 am – 3:30 pm hh Criteria: For rising 11th, and 12th grade students

hh Application: Apply online through 5/2/2016 at www.dhsd.vcu.edu

hh Contact: Lindsay Smith | 804.628.2283 or at smithlj2@vcu.edu n

VCU DENTAL CAREER EXPLORATION PROGRAM The Dental Career Exploration program (DCE) is offered to students who are interested in exploring a career in dentistry. hh Date: July 5 – 15, 2016, 9:00 am – 3:30 pm

hh Criteria: For rising 10th, 11th, and 12th grade students and those students who will graduate in June 2016.

hh Application: Apply online through 5/2/2016 at www.dhsd.vcu.edu hh Contact: Lindsay Smith | 804.628.2283 or at smithlj2@vcu.edu n

VCU MARY ELIZABETH MAHONEY (MEM) HEALTH CAREER CAMP The VCU MEM Health Career Camp, named after the first African American nurse in the U.S., helps students explore nursing as a potential career. hh Date: July 11 – 15, 2016

hh Criteria: For rising 7th, 8th, and 9th grade students

HEALTH CAREER EXPLORERS CAMP

hh Date: July 11-15, 2016 – 9:00 am – 12 noon hh Location: John Tyler Community College, Chester Campus hh Cost: $110

hh Criteria: For rising 10th, 11th, and 12th grade students

hh Application: Send application requests to schannell@shefva.org. n

VIRGINIA GOVERNOR’S SCHOOL FOR MEDICINE AND THE HEALTH SCIENCES The mission of the Virginia Governor’s School for Medicine and the Health Sciences is to provide an enhanced curriculum that explores the health sciences and medicine through a systems-based, problem-solving approach that utilizes case studies, laboratory investigations and real-world shadowing experiences. Students selected for the program spend a total of four weeks during the summer at VCU discovering the newly emerging fields and advancements that will revolutionize healthcare in the 21st century. hh Date: June 26 – July 23, 2016

hh Criteria: Students will be submitted by their high school guidance counselor for approval at the division level, and then sent to the state level where the final selection process will take place. hh Application: Begins at home high school for each student.

hh Application: Apply online at www.dhsd.vcu.edu

hh Contact: Contact Karen Hill at Karen.hill@vcuhealth.org or Theresa Mondovics at Theresa.mondovics@vcuhealth.org 42

OurHealth | The Resource for Healthy Living in Greater Richmond

Healthcare career options don’t always require an advanced degree and licensure – some administrative and support staff positions can require a four-year degree or a two-year associates degree, along with additional training and certification in some cases. Medical health services managers, for instance, are responsible for the day-to-day administrative management of physician’s offices, hospitals and clinics and typically require a four-year Bachelor’s degree in health administration. An occupational therapy assistant (OTA) assists an occupational therapist with patients who’ve lost or have difficulty with key every-day independent living skills such as brushing their teeth and getting dressed due to injuries, illnesses, or lifelong conditions such as cerebral palsy. OTA requires a two-year associate degree (offered by Bryant and Stratton College in Richmond) along with additional fieldwork in a healthcare setting and a certification exam administered by the National Board for Certification in Occupational Therapy. U.S. News and World Report ranked OTA #1 on its best healthcare support jobs list and #25 on its Top 100 Jobs list for 2016.

Consult online resources for healthcare career information with your student as well – websites such as www.explorehealthcarecareers.org, www.allalliedhealthschools.com and www.healthcarepathway.com offer specific information on a vast number of healthcare careers, including individual career educational requirements, links to schools that offer those required degrees, cost of education and job market predictions for specific positions. Research colleges online and ask questions of admissions representatives to find out what their graduate placement rates are in your student’s healthcare interest area. “When we are in the exploration phase for college, we should be able to dive in once we see the career path and pull up schools to see which are having success with certain programs of study,” says Murphy. Also consider making appointments with colleges as early as 9th and 10th grade. Take a campus tour and make appointments with admissions representatives to ask about specific degree options. Find out what corresponding course maps are to get an idea of what your student’s actual classwork might look like at that institution. Ask about opportunities for your student to sit in on actual classes in an area of interest. It’s smart to research scholarship opportunities while you’re exploring careers. Together with AP and dual enrollment classes offered by high schools, considerable savings on tuition await. In fact, according to the National Center for Education Statistics (NCES), the percentage of first-time, full-time four year, degree-seeking students receiving some kind of financial aid increased from 80% to 85% from the 2007-2008 to the 2012-2013 academic year. Research a wide variety of scholarships online via the College Board’s Big Future (www.bigfuture.collegeboard.org) and the U.S. Department of Education’s federal student aid site (www.studentaid.ed.gov). Explore through school, too. Many high schools offer an introduction to health occupations course or EMT course, which can give students a taste of what it’s like to work in healthcare on a daily basis. Colleges also offer exploration opportunities for high schoolers. VCU Medical Center’s Division for Health Sciences Diversity, for example, partners with Richmond-area schools in its Health Sciences Academy, a health sciences education course that offers lectures from healthcare professionals and mentoring from VCU undergraduates. Program dates vary by school and students are accepted to the program via application.

MAKE CURRICULUM

COUNT

VIRGINIA SCHOLARSHIP

OPPORTUNITIES

SCAN HERE

for a full list of Virginia scholarship opportunities. According the National Center for Education Statistics (NCES), the percentage of first-time, full-time four year, degree-seeking students receiving some kind of financial aid increased from 80% to 85% from the 2007-2008 to the 2012-2013 academic year.

Strength of schedule should be a top high school priority in addition to making good grades. “In high school, you’re focusing on getting the right schedule,” says Murphy. “You want to make sure your student is taking the right classes from the get-go.” In short: make friends with math. And science. Most high schools require three years of math for a standard diploma and four for an advanced diploma, and many health career education programs require four years of both math and science for acceptance, which includes biology, chemistry, and algebra I and II. www.OurHealthRichmond.com

HEALTHCARE VOLUNTEER AND

MENTORING PROGRAMS

JUNIOR VOLUNTEERS AT VCU HEALTH

BON SECOURS VOLUNTEER OPPORTUNITIES

The Junior Volunteer Program is a summeronly program that provides high school an opportunity to volunteer in a large, urban medical center where they are able to see the benefits of donating their time and services to their community. They are also given the opportunity to develop and appreciate their own abilities, and to learn about career opportunities in the healthcare field.

A variety of activities are available as a volunteer that can involve direct contact with patients. Some may entail working with families, visitors, or community members while others occur behind the scenes. Volunteer opportunities are available for high school students, age 15 and older at the following hospitals within the Bon Secours Health System:

hh Date: June 27 – September 2; Weekdays, 9:00 am – 12:00 pm or 12:00 pm – 3:00 pm

hh St. Mary’s Hospital

hh Memorial Regional Medical Center

hh Cost: Free

hh Richmond Community Hospital

hh Criteria: High school students, ages 14 and up

hh St. Francis Medical Center

hh Contact: VCU Volunteer Services, 804.828.0922

For more information, visit www.bonsecours.com

hh Deadline to Register: March 4 n

HEALTHCARE ACADEMIC

PROGRAMS

VCU HEALTH SCIENCES ACADEMY Developed in 2008, the Health Sciences Academy (HSA) helps high school students make informed choices about the health professions they wish to pursue while providing resources to pursue their chosen careers. The program offers a health sciences exploration course that includes interactive lectures from healthcare workers, a mentoring program with VCU undergraduates and field trips to the Monroe Park and VCU Health campuses. hh Eligibility: Students currently enrolled at a participating high school may apply hh Application: Submitted online through VCU website

hh Contact: For more information about the Health Sciences Academy, contact Shelly Schuetz, HSA Program Coordinator at 804.828.1716 or email HSACADEMY@vcu.edu n

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“Let’s say you do want to become a doctor. You need to attend the right college in order to be accepted into a medical school and that means you’ve got to be taking the right classes and getting the right grades while you’re in high school. So, obviously, if you’re interested in medicine, you should be focusing on sciences and math,” Murphy says. “It makes sense, but you really have to work backwards [from career to college to high school] on it.” The great news in these subjects is that dual credit and AP options are plentiful. They not only give your student a leg up by transcript strengthening, they also provide valuable experience in college course work while earning college credits. Also, science and math classes encourage critical thinking and because math and science are covered on the SAT and ACT, taking these classes all four years keeps skills sharp come exam time.

WIDEN YOUR SCOPE

TO STAND OUT

Becoming an attractive prospect to colleges, especially those on a career path to healthcare, is about more than a 4.0. Colleges are seeking applicants who can distinguish themselves from the pack via demonstration of their abilities to get good grades while also contributing to the world around them, both from a socially conscious perspective and a time management perspective. Community service, extra-curricular activities, and school leadership roles show you can take on more than just an accelerated course load. The same volunteer activities your student performs can also serve dual purpose as discovery and experience in real-world healthcare settings. “Colleges are looking for that well-rounded individual,” says Murphy. “You need to be taking on leadership roles at your school and within your community, so that you can speak to those on your college application.”

By broadening their scope, your child can seek to develop and showcase well-roundedness, while simultaneously getting some real-world exposure to caregiving situations. This will help in deciding if their environment might be a good fit in a future career. “This is a great time to volunteer at a hospital, nursing home or homeless shelter,” says Murphy. “It’s a great thing to put on an application, but it also gives you a really true idea of what patient care really is, and of the breadth of it all.”

REPUTATION MANAGEMENT MATTERS Finally, on the social side of the equation, students seeking a healthcare career need to be cognizant of their reputations outside of the classroom. In today’s lightning-fast information age, it’s more important than ever to be aware of what’s circulating on social media and the internet and how their conduct could affect them for years to come. “I think something people might not be aware of is that even in high school, you need to conduct your life with the highest ethical standards. Many medical professions require background checks, because of the responsibility of handling confidential information and distributing drugs to people,” says Murphy. “We live in a society where so much is made public. You have to be very, very careful and a lot of people just don’t make the connection. You have to realize that the things you do, even as early as high school, can impact you long-term.” The process of discovering and navigating an educational career path into healthcare can seem overwhelming at first. Focus on creating a partnership with your child that fosters exploration, research, and a drive to do one’s best right from the start. Your student’s passion will then begin to emerge and ‘click’ into place along the road to the healthcare field. — continue on page 48

HEALTH FAIRS/SEMINARS AMERICAN RED CROSS Opportunities for training through the American Red Cross are available for teens. They offer a wide range of health and safety classes, such as CPR/AED and First Aid Training. The Basic Life Support for Healthcare Providers (BLS) is designed to train healthcare professionals, public safety personnel and other professional-level rescuers to respond to breathing and cardiac emergencies in adults, children and infants. This program has a particular focus on healthcare emergency response. Successful completion of the BLS training course includes a two-year certificate, and can be used for those interested in joining their local volunteer rescue squad. Check with your local rescue squad for age requirements, and visit www.redcross.org for information about BLS and other training courses in your area. Age requirements vary by course, but most are suitable for teens 15 and older. n

RED CROSS YOUTH Join the Red Cross Youth – join or start a Red Cross Club in your high school. There are many volunteer opportunities for teens within the Red Cross, from blood drive services to health and safety preparedness and disaster recovery. Speak to your guidance counselor to find out if your high school has a Red Cross Club, or visit www.redcrossyouth.org for more information on starting a club in your school. n

VCU HEALTH FROM JUMP ROPE TO STETHOSCOPE (FJR2S) FJR2S seeks to encourage middle and high school students to consider a career in healthcare. n

Date: March 28th, 2016 from 9:00 a.m. – 3:00 p.m. Eligibility: For current 8th-12th grade students R egistration: online at www.dhsd.vcu.edu Information: Contact Karen Hill at Karen.hill@vcuhealth.org or Theresa Mondovics at Theresa.mondovics@vcuhealth.org n

STATISTICS

Healthcare occupations and industries are expected to have the fastest employment growth and to add the most jobs between 2014 and 2024, according to a report issued in December, 2015 by the U.S. Bureau of Labor Statistics. According to the study, healthcare support occupations and healthcare practitioners and technical occupations are projected to be the two fastest growing occupational groups during this period. These groups are projected to contribute the most new jobs, with a combined increase of 2.3 million in employment representing about one in four new jobs.

U.S. NEWS AND WORLD REPORT TOP 10 HEALTHCARE JOBS FOR 2016 These rankings are based on greatest hiring demand, or, in other words, those with the highest projected number of openings from 2014 to 2024, as categorized by the U.S. Bureau of Labor Statistics.

8TH-12TH GRADE HEALTH CAREER/FINANCIAL FITNESS WORKSHOP

HEALTHCARE INDUSTRY

1. Orthodontist 2. Dentist 3. Nurse Anesthetist 4. Physician Assistant 5. Nurse Practitioner 6. Psychiatrist

NURSING CAREER SEMINAR

7. Pediatrician

Date: April 30th, 2016 from 9:30 a.m. – 2:00 p.m. Eligibility: For current 9th-12th grade students interested in a career in nursing. Registration: online at www.dhsd.vcu.edu Information: Contact Karen Hill at Karen.hill@vcuhealth.org or Theresa Mondovics at Theresa.mondovics@vcuhealth.org

8. Anesthesiologist

VCU HEALTHCARE QUEST

9. Obstetrician and Gynecologist 10. Oral and Maxillofacial Surgeon

The Division for Health Sciences Diversity along with the VCU Schools of Allied Health, Dentistry, Medicine, Nursing and Pharmacy partner with schools from Richmond Public Schools, Henrico County Schools, and Communities in Schools of Richmond to bring more than 500 middle school students to VCU for an afternoon of health career exploration. The purpose of Healthcare Quest at VCU is to provide students with early exposure to multiple health science careers and encourage students to consider health careers in their future. Middle school students travel through VCU’s Health Sciences Campus for two and a half hours learning about healthcare careers and engaging in hands-on activities with the VCU schools of Dentistry and Medicine for sixth-grade students, with VCU schools of Nursing and Pharmacy for seventh grade students, and with VCU school of Allied Health for eight grade students. www.OurHealthRichmond.com

“It’s easy to point to a doctor or a nurse, but there are so many career paths within healthcare – medical assistant, lab technician, medical coding and reimbursement – each of which require different levels of education.”

— continued from page 46

WHAT’S

NEXT?

We hope the information and resources available in this article will help begin your child’s journey to a career in healthcare. Throughout this series, we will provide additional information on our website, www.ourhealthrichmond.com. Look for Part II of the How-To in Healthcare series where we will focus on your students plan for undergraduate school. Beth Murphy is the Richmond Campus Director at Bryant & Stratton College in Richmond.

If you have additional questions that you would like to see highlighted in our series, please reach out to us anytime by email at steve@ourhealthvirginia.com. We are proud to be a resource in your plan for an education in healthcare.

SOURCES: • American Association of Colleges of Nursing – www.aacn.nche.eud • National Center for Education Statistics – www.nces.ed.gov • U.S. Bureau of Labor Statistics – www.bls.gov

EXPERT

CONTRIBUTORS: • Beth Murphy with Bryant and Stratton College in Richmond • Kevin Harris with Virginia Commonwealth University in Richmond

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FITBITS

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

Where Land Meets Water

Aqua Kickboxing words | DEIDRE WILKES

Have you ever tried a kickboxing class? It’s an energizing, powerful, uplifting and effective way to burn calories and tone muscles – but, it is also very tough on the joints. Kickboxing in water helps prevent injuries by lessening joint impact, but the additional resistance created by the water strengthens and tones muscles for an extremely intense and effective workout! Aqua kickboxing is an innovative way to combine the benefits of water’s buoyancy and resistance to increase muscle strength, endurance, agility, coordination, balance, and core stability. By incorporating traditional kickboxing moves – kicks and punches in the water. Work at your pace while gaining new skills to boost overall fitness. This workout is suitable for all fitness levels. To check out an aquatic kickboxing class, or other water based fitness classes, visit one of these facilities near you:

Find a Class:

Workout Stats:

American Family Fitness • Midlothian www.charlottesville.org

ACAC

• Short Pump/Midlothian www.acac.com

YMCA of Greater Richmond

• Richmond Area www.ymcarichmond.org

Intensity:

moderate Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer

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

strength balance toning cardio www.OurHealthRichmond.com

Richmond Road Runners’ Sweetheart 8K Love was in the air and on the roads in Midlothian a week before Valentine’s Day this year when a “trial run” wedding highlighted the annual running of the Richmond Road Runners’ Sweetheart 8K. Most noticeable among the 384 finishers in the 8K were Jeff Van Horn and fiancée Desiree Wilson, who were getting in some practice for their real nuptials scheduled for five weeks later. Van Horn, owner of two Lucky Foot running stores in the Richmond area, and Wilson were wed in a pre-race outdoors ceremony in The Millworks, adjacent to the Midlothian branch library. Van Horn wisely finished the race one step behind his bride-to-be, whose normal 8K time was hindered by the train of her wedding dress. Along with the usual post-race bananas and cookies was a brightly decorated wedding cake. A special range of prizes was offered to top finishers in the couples category. Always thinking of the next generation of runners, Sweetheart 8K organizers also featured a shorter kids race that brimmed over with youthful exuberance. 50

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being UNPREGNANT is not words | DIANE YORK

UNFAMILIAR

Emily Sill was 29 years old, and she wanted to have a baby. She had tried

for more than a year and was frustrated and concerned. Her physician, Corinne Tuckey-Larus, MD, an Ob-Gyn with Virginia Physicians for Women in Richmond, put Sill and her husband through several tests. All the results were negative. So what was wrong? If you are having difficulty getting pregnant, you are not alone. According to the Centers for Disease Control and Prevention, about 1 in 8 couples have trouble conceiving, and 7.4 million women (approximately 11 percent of women in the U.S.) have received some type of infertility assistance in their lifetime.

When is it time to seek help? “With most women, I suggest continuing to try for a year,” says Keith Berkle, MD, an OB-GYN with the Virginia Women’s Center in Midlothian. “However, if a woman is at higher risk because of a medical issue or is over the age of 35, I would say she and her partner should seek help at six months.”

Dr. Berkle adds that some of the increases in fertility problems can be due to women delaying pregnancy to a later age or using certain types of contraception. Age does matter: For women in their 20s and early 30s, the infertility rate is between 7 and 9 percent. After age 35, that rate goes up to 25 percent.

Taking the first baby steps “There are a number of tests that can be performed to get you started,” says Dr. Berkle. These can include multiple hormone tests, thyroid function, semen analysis and estimation of the number and quality of eggs. One of the most common problems occurs when women are not ovulating normally. “We perform a test that shows how many eggs a woman has at a point in time and tells us about the quality of the eggs,“ he says. “Antral follicle counts by ultrasound are one of the best ovarian reserve tests that we currently have available.” An OB-GYN can handle the initial work-up for a woman who is having trouble getting pregnant. This would include a careful history and physical exam. Dr. Tuckey-Larus says that some of the important information the doctor needs may include: • Prior pregnancies of the couple. • Any history of infections. Corinne Tuckey-Larus, MD is certified by the American Board of Obstetrics and Gynecology. Dr. Tuckey-Larus see patients in the West Creek and Midlothian offices of Virginia Physicians for Women.

• Sexually transmitted diseases. • Injuries (especially in men). • Tobacco and drug use. • Environmental factors (use of lubricants, douches, urination habits). • Habits and positions related to intercourse.

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Exams can often reveal obvious problems related to conception. “These initial work-ups can work in conjunction with awaiting an appointment with a referring specialist,” says Dr. Tuckey-Larus. “Many gynecologists will refer to an infertility specialist sooner if the reports of trying for pregnancy are at the year mark in the older population and if all obvious parameters (like regular menses) are met.” Dr. Tuckey-Larus tried putting Sill on Metformin, a drug traditionally used for diabetes control but known to affect ovulation. It had a positive effect for Sill, giving her a regular cycle; however, she was still not producing eggs. Then Dr. Tuckey-Larus started her on Clomid, a fertility drug. After increasing the dose several times, Sill was producing eggs in a regular cycle. Sixteen months after her first consult with her doctor, Sill was pregnant and later delivered a healthy baby, Mason. For Sill and her husband, it took some time but was a relatively simple process. For others it can be much more complex.

What causes infertility?

Keith Berkle, MD is certified by the American Board of Obstetrics and Gynecology. Dr. Berkle sees patients in the St. Francis Medical Pavilion office of Virginia Women’s Center.

“First and foremost, infertility is a couple’s disease, with 60 percent of issues attributed to the female partner and 40 percent attributed to the male partner,” says Dr. TuckeyLarus. Researchers say that the causes of infertility are never discovered in about — unpregnant continued on page 57

www.OurHealthRichmond.com

Eight Ways to Improve the Chances of Conception

• Too fat, too thin or just right? Studies at Baylor College of Medicine found that women who had a pre-pregnancy body mass index of 25-39 (considered overweight or obese) took twice as long to get pregnant. For thin women with a BMI of less than 19 (18.5 to 24.9 is considered normal), the results were even worse. Researchers found that time to conception was increased fourfold in women with a BMI below 19. To measure your BMI, see the National Institutes of Health online body mass calculator at www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm . • Timing is everything – Probably the most critical piece of information a woman should know is the days in her menstrual cycle when pregnancy is possible. Technically, these are only the five days before ovulation through the day of ovulation. These six days are the “fertile window” in a woman’s cycle and reflect the lifespan of sperm (five days) and the lifespan of the ovum (one day). If a woman has sex six or more days before she ovulates, the chance she will get pregnant is virtually zero. If she has sex five days before she ovulates, her probability of pregnancy is about 10 percent. The probability of pregnancy rises steadily until the two days before through the day of ovulation. At the end of the fertile window, the probability of pregnancy declines rapidly, and by 12 to 24 hours after ovulation, a woman is no longer able to get pregnant during that cycle. For those women who are not aware of their fertile window or when they ovulate, sexual intercourse is recommended every two to three days to help optimize their chance of conceiving.

Days of the Average Menstrual Cycle

• Save that sperm – Recent studies show that repeated exposure to heat (as in hot tubs or hot baths or using your laptop on your lap for long periods) reduces men’s fertility. One study showed that keeping a cell phone in your pants pocket exposes the scrotum to radiation, which adversely affected the sperm of the men in the study. • You are what you drink – Drinking more than two glasses of alcohol or more than five cups of coffee a day reduced women’s fertility in studies. Moderation is key. The March of Dimes suggests that women who are pregnant or trying to get pregnant should consume fewer than 200 — eight ways continued on page 58

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— unpregnant continued from page 55

25 percent of cases. By using some of the advanced therapies for infertility that are available today, conception can still occur even if the root problem remains unknown.

Many issues can block successful conception: • Ovulation dysfunction. • Polycystic ovarian syndrome. • Uterine fibroids. • Abnormal hormone levels. • Endometriosis. • Pelvic inflammatory disease. • Irregular menstrual cycles. • Male tubal blockages. • Poor sperm quality or quantity. • Sperm allergy. • History of cancer and chemotherapy. If no specific cause is found, an OB-GYN can prescribe Clomide, which induces ovulation. This drug has a 5 percent rate of success by itself. The next step might be intrauterine insemination, a process in which the sperm is spun down and injected into the uterus and followed up with additional medication. Women have a 10 to 20 percent chance of getting pregnant with just one IUI cycle. The more cycles of IUI undergone, the higher the chance is for a pregnancy. With three to six cycles of IUI, pregnancy rates can be as high as 80 percent. Steps beyond these would be handled by a fertility specialist who can provide advanced measures. In vitro fertilization would be considered. Dr. Berkle explains that IVF involves several steps: hyperstimulating ovulation to produce multiple eggs, harvesting the eggs, checking them for quality and health, mixing the eggs and sperm in a lab and then the implanting the fertilized egg in the woman’s uterus.

Increasing the odds of getting pregnant Dr. Tuckey-Larus says, “Most couples can increase their chances of conceiving by taking a few simple steps.” • “If the couple uses a lubricant, they should choose a water-based lubricant and avoid spermicidal lubricants. Commercial lubricants have chemicals and/or spermicides designed to prevent pregnancies,” cautions Dr. Tuckey-Larus. • To find the optimum time to attempt conception, a woman should take the average number of days in her menstrual cycle (from the first day of menstrual flow to the next month’s first day and subtract 14 days; that day should be the day of ovulation). For example, if a woman has a 34-day cycle, she is ovulating on or about day 20. Dr. Tuckey-Larus recommends that couples have intercourse at least daily or every other day during the seven-day period surrounding ovulation. — unpregnant continued on page 59

— eight ways continued from page 56

milligrams of caffeine per day. In limited studies, women who drink higher amounts of caffeine had an increased risk for miscarriage. • Smoking isn’t good for anything – In men, smoking can reduce sperm production and damage DNA. Smoking while pregnant boosts the risk of miscarriage. • Lubricants – Many commercial lubricants have spermicides in them. It’s best to use something natural like organic aloe or organic coconut oil. • Avoid exposures to toxins – Exposures to pesticides, especially agricultural pesticides, can harm both men and women’s fertility. And exposure to some solvents and toxins — including those used in printing businesses and dry cleaning establishments — can adversely affect women’s fertility.

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— unpregnant continued from page 57

She also suggests lying in bed for approximately 20 minutes following intercourse to promote sperm availability. • Men should wear loose boxer shorts rather than jockey shorts, enabling the testicles to move away from the body. (Sperm require a lower temperature for their production.) • “The importance of the partners’ general health cannot be overemphasized,” says Dr. Berkle. “A woman’s weight, for example, can have a significant effect on the ability to conceive because obesity can make ovulation irregular. Have a healthy lifestyle with exercise and no smoking.” • Stay calm and accept and work through the process and problems as they arise. Anxiety about an inability to get pregnant can become a negative force in people’s lives and relationships. Worrying about it won’t help. Because this process can take anywhere from a few months to years, it’s best not to get into a state of angst about it. Probably the single most important suggestion here is that the couple should optimize when they have intercourse to coincide with ovulation.

The good news Sill was so thrilled by her success of her first pregnancy, she is ready to try again. For some time after Mason was born, she had regular cycles with egg production, but it didn’t last. So she will soon go back on Clomid to try for a brother or sister for Mason. Positive news for all want-to-be parents is that the arena of reproductive health is evolving faster than many other areas of medicine. While the cost of these treatments is high, as Dr. Berkle says, “It’s a very successful field.” According to the CDC National Survey of Family Growth, approximately 44 percent of women with infertility have sought medical assistance, and of those who seek medical intervention, approximately 65 percent successfully give birth. Most Virginia insurers pay for diagnostic testing but not treatment. Some treatments could be covered, depending on the employer. Expert Contributers: • Keeth Berkle, MD with Virginia Women’s Center • Corinne Tuckey-Larus, MD with Virginia Physicians for Women

The vocabulary of fertility • concentration of motile sperm – a measurement of the sperm that can readily swim to fertilize the egg. According to the World Health Organization, there should be a minimum of 10 million motile sperm per milliliter of semen. • endometriosis – a medical condition that involves the presence of tissue similar to the uterine lining in abnormal locations. This condition can affect both fertilization of the egg and embryo implantation. • intrauterine insemination – procedure in which the man’s sperm is cleaned (fast-moving sperm separated from slow-moving sperm) and injected into the woman’s uterus with a catheter. This is generally attempted before in vitro fertilization. If not successful, egg collection is initiated. • in vitro fertilization – the most common type of assisted reproductive treatment. The woman is injected with medications designed to stimulate egg production. If multiple eggs result, they are harvested through OCR. The eggs are then fertilized with sperm in a lab. The resulting eggs with embryos are then transferred to the woman’s uterus. • ovulatory dysfunction – A diagnostic category used when a woman’s ovaries are not producing eggs normally.

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In 2016,

our New Kitchen,

New Nutrition, New You series puts the focus on helping you get healthier in the kitchen — one ingredient at a time. Each edition of OurHealth will highlight small changes you can make in your food

2016 Nutrition Series

prep and shopping habits that can add up to a major positive impact on your nutrition and health. Our goal is to present you with suggestions you can use and build on that will help you create a healthier kitchen — and life — by year’s end.

NEW KITCHEN, NEW

words | CYNTHIA BEMENT

NUTRITION, Spring. Itâ&#x20AC;&#x2122;s that wonderful time of year when blooms burst, the landscape turns green and life seems to offer a fresh, new start. This sense of renewal carries over to our tables â&#x20AC;&#x201D; salads and fresh produce are the stuff of al fresco dining dreams. But alas, not all salads have your best nutritional interest at heart. Here, we show you how to take your spring fling with salads to the healthiest level possible by building them right, from the plate up, with healthy swaps from our resident nutritionist that will please your taste buds without foiling your nutrition goals.

NEW

YOU

Keep it green A truly healthy green salad starts with lots of — you guessed it — greens. Start by searching out a better salad base by deepening the color of your greens, as we’ve done in our Cobb salad. “Swapping out the iceberg lettuce for a blend of arugula and romaine lettuce increases the nutrient value of the salad without adding a lot of calories,” says Tricia Foley, OurHealth’s resident nutritionist and a member of the Southwest Academy of Nutrition and Dietetics. “Arugula contains about eight times the calcium; five times the vitamin A, vitamin C and vitamin K; and four times the iron as the same amount of iceberg lettuce,” Foley says. And substituting romaine for iceberg lettuce brings 10 times more vitamin A to the salad and contains vitamin K that supports bone health and blood clotting.

Capitalize on the crunch After upgrading your base, look to the vegetable content in your salad and add some smart extras for crunch, flavor, texture and juiciness. Colorful, nonstarchy veggies like peppers and tomatoes are great options; according to Foley, both are rich in vitamins C and A and potassium. For many, the crispy allure of croutons is tough to avoid, but they can load on calories without providing any nutritional value. In our Cobb salad, we’ve swapped these nutritional saboteurs for almonds. “Almonds have polyunsaturated fat that can help raise good cholesterol while lowering bad cholesterol levels,” says Foley. “Using a small amount will provide a nice crunch without bombarding the salad with calories.” Tricia Foley is a registered dietitian and a certified LEAP (Lifestyle Eating and Performance) therapist with The Weigh Station in Richmond.

Skip salad sabotage Let’s face it: salad toppings are fun. Along with the aforementioned croutons, most salad bars offer nuts, seeds, dried fruits and cheeses that can spice up a potentially boring salad. Choose these additions wisely, however, to avoid downgrading the nutritional value of your salad. Skip dried fruits, which can add high concentrations of sugar and calories, and pay careful attention to the quantity of seeds and nuts you’re adding so as not to drive up the calorie and fat content, as in our unhealthy version of the Cobb. You don’t have to skip these entirely though. “Using a garnish is a great way to incorporate color, taste and interest into a salad without overdoing the calorie content. Using a light coating of cheese, for example, does the trick,” says Foley. One salad garnish that should be managed carefully, says Foley, is avocado. Though they are nutritional all-stars (they’re high in folate, as well as B, C and E vitamins and potassium), avocados are high in monounsaturated fat, which — while great for lowering LDL or bad cholesterol — still comes with a high calorie and fat price tag. “Although avocados are very heart healthy, a small amount can go a long way,” says Foley, noting that one-fifth of an avocado is considered a serving, so use them sparingly in your salad.

WATCH FOR IT: In our next issue, we’ll be grilling out with healthy summer barbeque tips and tricks in part III of New Kitchen, New Nutrition, New You.

Balance it out with (the right) protein While protein is always an important nutrient, when it comes to your salad, the inclusion of protein can often introduce unwelcome fat and calories. Getting the protein right in your salad, both in type and quantity, requires some scrutiny. In our Cobb salad recipe, we substituted grilled chicken for fried chicken. “By simply switching out the fried chicken for grilled, we save on calories from unhealthy fats and refined carbohydrates used to coat the chicken,” says Foley. When creating your salad, consider all the protein sources you’re using in addition to meat — eggs, seeds, nuts and cheeses all contain protein and will contribute to the total amount you’re getting. How much is enough protein? “On average, women should aim for about three to four ounces of protein per portion (21-28 grams) and men four to five ounces (28-35 grams),” Foley says. One egg, one-quarter cup of cheese and 20 almonds each equal one ounce of protein.

Dress it up right The dressing might be the icing on the cake, but it’s another salad saboteur if you choose the wrong one. Most people know that full-fat and -calorie salad dressings poured on in pool-like quantities will essentially negate the nutritional benefit of a salad, but the kind of dressing you choose (or make) can also play a significant role in the salad’s healthfulness. “This healthy dressing swap has a Greek yogurt base, which is low in fat and rich in protein,” says Foley. “This allows the creamy texture to be enjoyed without all the saturated fat and calories that mayonnaise and sour cream tend to add in traditional cream-based dressings.”

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Cobb Salad Unhealthy Recipe: Cobb Salad (SERVINGS: 6)

Healthy Swap: Cobb Salad (SERVINGS: 6)

Ingredients:

12 ounces fried chicken

swap for this

8 ounces grilled chicken

16 Cups iceberg lettuce

swap for this

16 Cups Lettuce (8 Cups Romaine & 8 Cups Arugula)

Croutons (60)

swap for this

¼ Cup of slivered almonds

4 boiled eggs, diced

swap for this

4 boiled farm fresh eggs, diced

swap for this

Black olives (20)

Black olives (16)

1 each red bell pepper & green bell pepper, sliced ½ Yellow onion, chopped

½ Yellow onion, chopped 12 cherry tomatoes

½ Cup bacon bits

swap for this

¼ Cup bacon bits

½ Cup sunflower seeds

swap for this

1 Cup Cheddar cheese, shredded

swap for this

¼ Cup cheddar cheese, grated

Avocado-for garnish

directions:

1. Rinse lettuce and chop, then add to a large bowl, add cooked chicken, olives, diced eggs, onion, cheese, bacon bits, seeds and croutons to bowl, toss and set aside.

1. Rinse lettuce, chop, then add to a large bowl. Add cooked chicken, all vegetables, cheese, bacon bits and almonds, toss and divide into 4 portions. Garnish each portion with sliver of avocado and cheddar cheese, set aside.

Dressing: (SERVINGS: 4)

Nutrition Values:

Ingredients:

Nutrients in salad without dressing (per serving): 634.5 Calories, 39.75 grams fat (without dressing), 33.75 grams protein

1 avocado 1 tablespoon chives ½ garlic clove 2

tablespoon parsley

¼ lime, juiced 2 tablespoon mayonnaise

Total Calories and fat with dressing = 783.5 calories and 50.15 grams fat

Ingredients: ⅔ cup Plain Greek yogurt 1 tablespoon olive oil 2 garlic cloves, crushed 1 tablespoons capers, finely chopped

Juice of ½ a lemon

1 teaspoon salt

2 tablespoons white wine vinegar

Salt and pepper for seasoning

directions for dressing:

½ C butter milk

1. Combine yogurt, oil, garlic, capers, lemon juice and Parmesan. Whisk until well combined; add salt and pepper to your tastes, and whisk again.

1½ tablespoons Sour Cream

directions for dressing: 1. Peel avocado and remove seed. Then combine all ingredients into a blender or food processor. Blend until smooth and add to salad.

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Recipes imilar Ingredients

with S

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Nutrients with dressing/ serving: 388.45 calories, 16.7 grams fat, 32 grams protein

3 tablespoons freshly grated parmesan cheese

¼ teaspoon pepper

Nutrition Values: Nutrients in salad without dressing (per serving): 313.7 calories, 25.75 grams protein, 12 grams fat

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An oil-based dressing is also a wise choice, and Foley’s personal choice is to make her own (use our simple recipe and try it yourself). If you’d like to add spices to your dressing, Foley suggests experimenting with your own blend of dried or fresh herbs instead of buying packet dressing mixes, which can contain hidden sugars and maltodextrin — a common food additive made by partial hydrolysis of starch. Check the labels of low-fat and nonfat versions of your favorite bottled dressings as well because they are often high in sugar. Choose versions that contain no more than four grams of sugar per serving, Foley advises. Lastly, some vinaigrettes can also lead your salad into the danger zone. “Vinaigrettes should be used with caution because many of the fruited vinaigrettes are high in sugar and use high fructose corn syrup as an additive,” says Foley. “Look for Greek or Italian vinaigrettes instead.” The amount of dressing you use, of course, is also a factor. One way to ensure a light hand while still maximizing flavor is to pour some dressing into a small bowl and dip your fork into it before the salad. Another is to pour one serving of bottled dressing (as defined on the nutrition label) into a small bowl and use only that much. You will become adept at eyeballing a serving size so that when eating out — after ordering the dressing on the side — you can use the same amount.

Get restaurant-ready Are salads a sure bet when you eat out? There are no guarantees, and in fact some restaurant salads, by nature of their large portion sizes and ingredients, can equal or surpass the fat and calorie content of a burger and fries meal — and that’s before the dressing is factored in. The key: Plan ahead when possible by checking out the restaurant’s menu and the nutrition information for its salads. At fast food chains, check to see if ingredients like dried cranberries, croutons, seeds and cheeses come in their own packages instead of being premixed into the salad. Foley notes that cheeses like feta, cheddar and blue can add 80-100 calories and 10-plus grams of fat per serving. And while dried fruits hardly seem like salad disaster, they can be. “After reviewing a popular fast food salad, we found that omitting the Craisins saved about 100 calories and 18 grams of sugar,” says Foley. Armed with our healthy swaps, nutrition-savvy tips and a little planning, you can uphold salad’s good name as a fresh and healthy mealtime option in your new kitchen, new nutrition arsenal — one that you can serve to your family with confidence this spring and year-round.

Watch for it: In our next issue, we’ll be grilling out with healthy summer barbeque tips and tricks in part 3 of New Kitchen, New Nutrition, New You.

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