table of contents | may 2014
MEDI•CABU•LARY.....................10 Local experts define health related terms
JUST ASK!.......................................12 Healthcare questions answered by local professionals
NEW & NOTEWORTHY.............14 A listing of new physicians, providers, locations and upcoming events in greater Richmond
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Cover Story: Everyone Cares
Richmond healthcare workers swap jobs for a day and learn why it takes a team to provide the best care to our communities.
HEALTH POINTS.........................18 Interesting facts and tidbits about health
THE ANATOMY CHALLENGE..................................21 How much do you about our anatomy? In this issue, test your knowledge when it comes to the human eye!
LOOK OUT FOR YOUR EYES THIS SUMMER ........................... 22 Along with summer activities comes a significant increase in eye injuries. Experts at Virginia Eye Institute and Commonwealth Eye Care Associates offer tips to keep eyes healthy throughout the summer season.
hello, HEALTH!.............................. 36 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos
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OurHealth | The Resource for Healthy Living in Greater Richmond
The Resource for Healthy Living in Greater Richmond
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Magnificence and Miracle Olympic Gymnast Shannon Miller springs back from ovarian cancer
NUTRITION.........................57 HEALTHY EATS: Eating Fruits and Vegetables in Season—Roasted Asparagus, Black Bean Salad and Gluten-Free Fudge Brownies
PERSONAL BEST........................ 60 Growing up with ADHD: ADHD diagnosis and treatment brings relief to a Richmond family of five
GIVING TO THE COMMUNITY............................... 68 CareMore: healthcare focused on treating the whole senior citizen
LOOKING BACK........................... 74 Images reflecting the history of healthcare in Richmond * PLUS * a chance to win prizes!
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[new series]
Breaking the Silence: Pancreatic Cancer This part of our series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now.
www.OurHealthRichmond.com
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may 2014
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CONTRIBUTING RICHMOND MEDICAL EXPERTS Jori S. Carter, MD, MS Leslie Davis, MD Derek Metzler, MPT Lydia Morris, PT, CMTPT Mark A. Reinke, BS, MAT Jayant Talreja, MD CONTRIBUTING PROFESSIONAL EXPERTS & WRITERS Becky Blanton Susan Dubuque Rich Ellis Lynette Mutter Laura Neff-Henderson, APR Edwin Schwartz
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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor-at-Large: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Information in all print editions of OurHealth and on all OurHealth’s websites (www.ourhealthrichmond.com and www.ourhealthvirginia.com), social media sites and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2014 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Greater Richmond edition is published seven times annually by McClintic Media, Inc. 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthrichmond.com | www.ourhealthvirginia.com | Advertising rates upon request.
LOCAL EXPERTS D E F I N E H E A LT H R E L AT E D T E R M S
What is DOMS (delayed onset muscle soreness)?
What is Intrauterine Contraception?
What is Myofascial Release (MFR™)?
DOMS is one of the less pleasant outcomes that typically follow resistance training in those just getting started, or following a very high level effort such as weightlifting, sprinting or heavy effort in water.
Intrauterine contraceptive devices, more commonly known as IUDs, are an increasingly popular form of long acting reversible pregnancy prevention. Almost 25% of women worldwide use these T-shaped devices for birth control. They are very effective for pregnancy prevention (over 99%), require very little maintenance, are cost effective for those not planning pregnancy within a year and are easily reversed.
Myofascial Release (MFR) is a form of whole body hands-on manual therapy that seeks to assist the body in self-correction. It does this by addressing the fascial system, which is a dense fibrous connective tissue that runs throughout the body. Much like the pith of an orange connects the peel to the fruit and then divides the wedges creating little pockets that hold in the juice, our body’s fascial system connects, separates, and contains everything within it.
Most typically, DOMS occurs 24 to 72 hours after the exercise bout, peaking near 48 hours, and is marked by soreness and stiffness of the muscles; and at most severe, muscles can be painful to the touch. DOMS is most commonly associated with intense eccentric muscular effort (think deceleration, or “yielding” to the weight); i.e. during a bicep curl, the “lowering” phase of the exercise. Although the effects of DOMS typically subside within 72 hours, light stretching, low intensity cardio (walking, cycling), time in a sauna or whirlpool are effective ways to reduce the duration and discomfort associated with DOMS. It is generally accepted that DOMS can be significantly reduced by implementing a training program that incorporates a conservative progression of load (weight used) and training frequency (number of days per week). Mark A. Reinke, BS, MAT ACAC Fitness www.acac.com
The IUD is placed by a trained provider into the uterus through the cervical canal. A thin thread hangs from the end of the device. This is visible to the provider and also allows the patient to check its position. The IUD is effective immediately. Recent information suggests that IUDs can be used by most women including those who have had no children. Three IUDs are currently available in the U.S. The Paragard, containing copper, is effective for up to 10 years. The menstrual cycle timing is unchanged, but can result in a slightly heavier flow. The Mirena (5 year) and Skyla (3 year) release a small amount of hormone (progestin) into the uterus. Menstrual flow is generally light to absent with these IUDs as the progestin thins the uterine lining. Your provider can help you decide which IUD is right for you. Leslie Davis, MD
Virginia Physicians for Women Midlothian | 804.897.2100 www.vpfw.com
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Myofascial restrictions are created when we injure ourselves. For example, when we fell out of a tree as a kid and were sore for 3 weeks, our body most likely laid down some scar tissue and restriction in this area. Add all of our past injuries, car accidents, surgical procedures on top of one another and we can begin to see how our body accumulates tightness creating imbalances and asymmetry. The good news is that these restrictions that are contributing to pain and limitation in the body can be reduced and sometimes completely eliminated through myofascial release treatment or MFR™. Derek Metzler, MPT
Restore-PT, Inc. Richmond | 804.644.1221 www.restore-pt.com
H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS
Can muscles cause pelvic pain? Often times we overload our muscles during exercise, child birth, or straining to lift, push, or pull. Our abdominal muscles work together with our back and pelvic floor muscles. These muscles coordinate movements that assist in keeping bodily functions normal. When dysfunction occurs, the muscles work against each other and not in harmony. Symptoms of urinary urgency or frequency, bowel constipation, or bladder incontinence, and pelvic pain may be due to muscular problems. An evaluation and treatment by a specialized physical therapist may reveal some answers. Treatments may include focus on trigger points that are causing pain. Lydia Morris, PT, CMTPT
Orthopedic Physical Therapy, Inc. Richmond | 804.285.0148 www.orthopedicptinc.com
Is a virtual colonoscopy better than a regular colonoscopy?
What are the recommended screening guidelines for cervical cancer?
Current guidelines recommend colorectal cancer screening for all average-risk individuals beginning at age 50. A normal colonoscopy for an average-risk individual can clear them for 10 years. If small precancerous polyps are detected and removed, the recommended interval for polyp surveillance is shorter (generally 5 years, but this can be even shorter based on the size and number of polyps).
A woman’s risk of cervical cancer can be reduced through regular screenings. This is an important and timely question since screening guidelines have changed in recent years.
A “virtual colonoscopy” is a specialized CT scan of the colon. While it can be as good as colonoscopy at detecting large polyps and cancers, it can miss smaller polyps. No sedation is required for a virtual colonoscopy, but a rectal tube is inserted and large amounts of air are insuffliated into the colon, which can result in discomfort. If a suspicious lesion is seen on virtual colonoscopy, a standard colonoscopy must then be performed to further investigate and likely remove the polyp. While the exposure is small, a virtual colonoscopy exposes the patient to radiation. A virtual colonoscopy may have a role in colorectal cancer screening, but it does not yet appear ready to replace conventional colonoscopy. Jayant Talreja, MD
Gastrointestinal Specialists Richmond | 804.285.8206
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Good cervical health starts with regular ob-gyn appointments. The first reproductive health exam should occur between the ages of 13 and 15, and routine annual pelvic exams and Pap tests should start at age 21. Women with routinely normal Pap results should have Pap tests every three years or every five years for human papillomavirus (HPV) testing. All women should have an annual ob-gyn exam. Research has shown that infection with HPV is the leading cause of cervical cancer. An extremely effective way to reduce the risk of cervical cancer is to receive the HPV vaccine before being exposed to HPV through sexual activity. The Centers for Disease Control recommend both boys and girls be vaccinated for the HPV virus between the ages of 9 and 13. Jori S. Carter, MD, MS
VCU Massey Cancer Center Richmond, Colonial Heights and Stony Point | 804.828.9080 www.massey.vcu.edu | www.gastrova.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
Virginia ENT Expands Tech Capabilities with CT Scanners Virginia ENT, the four-location comprehensive practice, serving as a single source of complete ear, nose and throat care for patients of all ages throughout the Richmond area, just added a ground-breaking piece of technology to their repository. Xoran MiniCAT CT Scanners are now accessible at their West End and Midlothian locations. The new technology is used to perform sinus and temporal bone CT scans on patients. The MiniCAT CT scanners will provide a new level of quick and comprehensive care for patients, with a more convenient, lower radiation, less costly alternative to traditional CT scanners. “With the MiniCAT CT scanners we are able to get sinus and temporal bone CT scans performed sooner for our patients, while significantly reducing their exposure to radiation as well as their costs,” says Van Himbergen, MD of Virginia ENT. “Being able to schedule the scans more efficiently also affords us the opportunity to make diagnoses and develop treatment plans faster.” The Xoran MiniCAT CT Scanner is a compact, upright system designed for high-resolution, bone window imaging of the sinuses, temporal bones and skull base. The open upright design and the lower radiation make the MiniCAT a particularly attractive alternative for children. The scanners are also very useful to the Virginia ENT doctors in helping identify candidates for balloon sinuplasty: a minimally invasive procedure performed in Virginia ENT’s offices that alleviate uncomfortable and reoccurring sinus symptoms. The scanners provide immediate and accurate diagnostic information, high-quality images with significantly less radiation to the patients. For more information about Virginia ENT’s new technology, email Sarah Murphy at sarahm@madisonmain.com. To learn more about Virginia ENT or to schedule an appointment at one of their locations, call 804.484.3700 or visit www.virginiaent.com.
Henrico Doctor, William D. Brickhouse MD with Advanced Orthopaedics, Celebrated as Humanitarian by Local Hospital William D. Brickhouse, MD, an orthopaedic surgeon and occupational health specialist with Advanced Orthopaedics, was recently honored by HCA Parham Doctor’s Hospital with the First Humanitarian Award. First Awards honor employees, volunteers and physicians at HCAaffiliated facilities on a local and national level. Awarded in memory of the humanitarian spirit and philanthropic work of the late Dr. Thomas F. First, Sr., a founder of Hospital Corporation of America, the predecessor company of HCA, recipients are chosen for their demonstration of extraordinary concern for the welfare and happiness of patients, co-workers and their communities. Dr. Brickhouse was recognized for his “extra time with patients” and “excellent bedside manner.” Dr. Brickhouse has been with Advanced Orthopaedics since 1993 and specializes in knee and hiprelated issues, as well as identifying and treating work-related musculoskeletal injuries. He has a long history in Richmond starting with his Internship at the Medical College of Virginia, followed by residencies at MCV and the Children’s Hospital with a chief residency in Orthopaedic surgery at MCV from 1982 until 1983.
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Advanced Orthopaedics Opens Copper-Infused Surgical Suite at St. Francis Medical Pavilion
Local Physicians Announce Initiative to Collect Sports Equipment First medical practice in U.S. to use the EPA-registered, antimicrobial product to lower infection rates As public concern for infections and outbreaks in hospitals continues to grow, a medical practice in Richmond, VA has partnered with two Virginia companies to turn their facility into an eco-friendly, state of the art battleground for infection. Advanced Orthopaedics has partnered with Richmond-based Cupron Inc. and Norfolkbased EOS Surfaces to install antimicrobial copper-infused surfaces throughout their new 30,000 square foot, LEED certified medical facility. The Advanced Orthopaedics space takes up the entire 2nd floor of the new St. Francis Medical Pavilion on the campus of St. Francis Medical Center comprised of the medical clinic, diagnostic imaging rooms, physical and hand therapy centers, and 27 exam rooms. Advanced Orthopaedics is the first medical practice in the US to use the copper-infused product to assist in infection control. Before this facility’s completion, it had only been used by hospitals. Copper, like that used in the Antimicrobial Cupron Enhanced EOS Surfaces, has natural intrinsic properties that destroy and protect against a wide range of microorganisms and have proven to kill more than 99.9% of disease-causing bacteria within two hours of exposure*, even after repeated contamination. Cupron Enhanced EOS Surfaces kill bacteria* within two hours of exposure, working continuously between routine cleaning and sanitizing steps. About Cupron: Cupron is a technology company that is continually researching novel methods to deliver the unique antimicrobial and health properties of copper, and integrates various copper compounds into textiles, solid products and other polymeric materials products during manufacturing. These copper infused polymers are embedded into the material, transforming it into an antimicrobial product that can provide protection against a broad range of microorganisms such as bacteria and fungi. For more information, visit www.cupron.com. *Testing demonstrates effective antibacterial activity against Staphylococcus aureus, Enterobacter aerogenes, Methicllin-Resistant Staphylocuccus aureus, Escherichia coli, and Pseudomonas aeruginosa.
Advanced Orthopaedics and Ortho On-Call to get kids up and active through the programs of Fit4Kids. Beginning June 2, 2014 Advanced Orthopaedics and Ortho On-Call will kick off their second annual AdvanceItUp! (AIU!) collection. AIU! is a community initiative designed to increase recreation options and active living at home and school for area kids who do not have access to usable sports equipment. The public is encouraged to gather up sports equipment that they no longer use and that is still in good condition and donate it. This gently used sports gear is then used to fuel sports programs benefiting deserving area children through Greater Richmond Fit4Kids. Donations will be accepted between June 2 - June 30, 2014. Collection points include Advanced Orthopaedics on Shrader Road, both Ortho On-Call locations (Midlothian and Westbury), and the Science Museum of Virginia, location of the Greater Richmond Fit4Kids office. The program will accept most types of sporting equipment, excluding safety gear like helmets. The physicians and staff from Advanced Orthopaedics and Ortho On-Call, along with volunteers from Fit4Kids, will collect, organize, and clean the equipment before distribution. More details including a list of needed equipment can be found on the program’s web page, www.advancedortho. me/AdvanceItUp
ON THE WEB
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NEW
NEW PHYSICIANS,
NOTEWORTHY
P R O V I D E R S , L O C AT I O N S AND UPCOMING EVENTS
Richmond Cosmetic Surgeon is One of Few in Country to Receive Early Release of Neotensil™ Joe Niamtu, MD is one of the first cosmetic surgeons in the country to get an early release of Neotensil™, an at-home, non-invasive procedure that visibly tightens and reduces the appearance of under-eye bags and wrinkles within an hour, and he is impressed by the results. “Remember when you were a kid and put glue or rubber cement on your skin and it tightened up?” says Niamtu. “Well, this is the same theory with much more advanced technology. It’s not some drugstore or TV hype cream. This is a breakthrough product that produces a real, although temporary, improvement in the appearance of under-eye aging. We’ve only had it for a short time but we are already seeing a huge demand.” Developed by Obagi® as part of Jennifer Aniston’s Living Proof line, Neotensil™ requires a careful, two-step application. First, a base is applied to coat the skin’s surface, then a thin liquid which activates to create a smooth, invisible film. Neotensil™ takes about five minutes to apply and 10-15 minutes to develop into a matte finish. Results last for up to 16 hours and are not affected by perspiration or water. Special pads are included for gentle removal. At a price point of around $10 per application, Dr. Niamtu says most of his patients are choosing Neotensil™ for special occasions rather than every day use. “Cosmetic eyelid surgery (blepharoplasty) is one of my favorite procedures,” says Niamtu. “Neotensil™ will not replace lower lid surgery, but rather is a good option for those who are not ready for surgery or for some reason are not surgical candidates.”
Rebecca J. Cara Teresa Bedingfield, MD, MPH Golish, DO Virginia Physicians for Women St Mary’s & Henrico Doctors Richmond | 804.897.2100
Virginia Physicians for Women Henrico Doctors & St Mary’s Richmond | 804.897.2100
Tovia Martirosian Smith, MD
Virginia Women’s Center Urogynecology John Rolfe Commons and Mechanicsville | 804.288.4084
photo not available
Matthew Vogel, MD
Virginia Women’s Center Obstetrics & Gynecology Kilmarnock and Tappahannock 804.288.4084
Aimee Cocolin
Vice-President of Operations HCA John Randolph Medical Center Hopewell | 804.541.1600
Brandon Haushalter
Chief Executive Officer HCA Johnston–Willis Hospital Richmond | 804.330.2000
photo not available
Zach McCluskey
Chief Executive Officer HCA Parham Doctors’ Hospital Richmond | 804.747.5600
Matthew Oliver
Chief Financial Officer HCA John Randolph Medical Center Hopewell | 804.541.1600
Terika Richardson
Chief Executive Officer HCA Retreat Doctors’ Hospital Richmond | 804.254.5100
KidMed After Hours Urgent Care has opened its third location in the Greater Richmond area. Located at 8356 Bell Creek Road in Mechanicsville, KidMed After Hours Urgent Care is an alternative to the emergency room for treatment of many
KidMed After Hours Urgent Care Opens in Mechanicsville 16
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pediatric urgent care needs. The facility serves children and young adults, newborn through age 21. KidMed After Hours Urgent Care is open evenings, weekends and holidays. Hours are: Monday - Friday from 3 pm - 11 pm and Saturday and Sunday from 12 pm - 10 pm. For more information, visit www.kidmedva.com.
Nessan SalmonWilson, RN
Associate Chief Nursing Officer HCA John Randolph Medical Center Hopewell | 804.541.1600
Andrew Yee
Associate Vice-President of Operations HCA John Randolph Medical Center Hopewell | 804.541.1600
Nau Domah, MD
Bon Secours Laburnum Medical Center Richmond | 804.226.2444
David Cashwell
Chief Executive Officer HealthSouth Rehabilitation Hospital of Virginia Richmond | 804.288.5700
Jason A. Harris, FNP Bon Secours Glen Allen Internal Medicine Glen Allen | 804.612.2980
Robert D. LeNoir, DDS Lisa Davis, PA-C, RT(R) Gina Groome, RN, Brown, Reynolds, Snow Virginia Physicians, Inc – MSN, FNP Dentistry West End | 804.228.5324
Carol Gruber, MS, A-GNP-BC
Bon Secours Senior Care Services Richmond | 804.893.8627
Innsbrooke Primary Care Glen Allen | 804.346.1780
Burak Gumuscu, MD, PhD Bon Secours Pediatric Hematology-Oncology Richmond | 804.281.8182
Virginia Physicians, Inc – Cold Harbor Family Medicine Mechanicsville | 804.730.1111
Pamela Tetro, FNP-C, CDE
Bon Secours Senior Care Services Richmond | 804.893.8627
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T I P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U
Stay Healthy!
Live Longer! Each year,
7 in 10
American deaths are from
May is National Barbecue Month
Put it on the Grill! National barbeque month is an unofficial holiday and
an exciting way to start the summer.
lot of ways to celebrate this fun & interactive holiday: There are a
chronic diseases like
Diabetes and Heart Disease. Many of these diseases can be prevented with early
detection and the right care.
1. Organize a ‘Potluck’. Challenge family and friends to bring a healthy item for grilling. Try fresh fish, homemade pizza, quesadillas filled with grilled chicken, low fat cheeses or fresh veggies!
2. Think Vegetables! Try full vegetable kabobs and grill a handful for dinner. Grill a mixed variety of zucchini, corn and other “summer” vegetables for a healthy lunch.
3. Dessert Too! Before the fire goes out, use the rest of the heat to grill a sweet, but healthy treat. Use skewers and alternately add pieces of fresh fruit – such as peaches, plums, nectarines, pineapples and bananas. Place skewers on grill, and, brush with a light layer of apricot reserves, heated and mixed with water.
4. Take time to ‘chill out’. It takes more dishes and appliances to create a regular meal than it does if you use a grill. Take time out on a Sunday afternoon to grill and relax more at night before the work week starts again.
Source: Centers for Disease Control and Prevention
Don’t
skip it!
Benefits of Eating Breakfast • Increases energy • Improves concentration and focus • Aids in weight control • Boosts metabolism • Controls hunger for the rest of the day, and prevents overeating other meals • Helps lower ‘bad’ cholesterol (LDL)
• Produces brighter and happier moods • Improves memory
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‘I Can See Clearly Now’…
Tips for Eye Health
• Clean eyes with pure cold water regularly. This is one of the best ways to keep eyes healthy and disease free. • Avoid looking directly at the sun, artificial lights or shining objects. Direct rays of bright light can damage the retina. • Roll eyes up and down, then side to side. Then, move them in a circular motion. Repeat this exercise 5 to 10 times a day to relax eyes. • Maintain a good distance from the computer screen – sit approximately 22-28 inches away from it. Sitting too close or too far from the screen may increase eye strain.
Is it ADHD? • According to the National Institute of Mental Health two to three percent of children have ADHD. This means that in a typical classroom at least one child is ADHD. • The NIMH estimates that about 2 million children in the United States have ADHD. • It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.
A child with ADHD might: • • • • •
daydream a lot forget or lose things a lot squirm or fidget talk too much make careless mistakes or take unnecessary risks • have a hard time resisting temptation • have trouble taking turns • have difficulty getting along with others Source: Centers for Disease Control and Prevention
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Richmond History Walking Tours:
Explore 400 Years Of History! Richmond History Tour, a service of the Valentine Richmond History Center, offers a wide variety of guided walking tours that explore the rich and diverse history of the city. What a great way to exercise and spend family time learning about the great city of Richmond! Listed below are some of the upcoming tours scheduled: • May 17 (2-4pm): Hollywood Cemetery: Symbolism and Monument Styles Walking Tour • May 18 (2-4pm): Monument Avenue Walking Tour • May 22 (6-7:30pm): New Evening Tour! Highlights of Hollywood Cemetery Walking Tour • May 25 (2-4pm): Capitol Square: Jefferson, Washington and Spielberg Walking Tour • May 26 (10-1pm): Historic Cemeteries Tour, Revisited Bus Tour. Free for veterans! • May 31 (2-4pm): Hollywood Cemetery: The Civil War Walking Tour For more information, visit: www.richmondhistorycenter.com or call 804.649.0711 Sources: Valentine Richmond History Center www.OurHealthRichmond.com
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the
Anatomy CHALLENGE Here’s your chance to see how much you know about the human
eye! First,
find all the hidden words in the word search below. Next, match up the correct word with
______________
______________ ______________ ______________ ______________
the part of the body in the illustration.
______________
______________
______________
______________
______________
______________
______________
______________ ______________
[ the human eye ]
WORD SEARCH vitreous gel
iris
choroid
anterior chamber
optic nerve
cornea
macula
pupil
fovea
lens
retina
ciliary body
superior rectus muscle
inferior rectus muscle
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Look Out For This Summer words | EDWIN SCHWARTZ
As spring shifts to summer, Richmond residents will spend even more time enjoying outdoor activities. Unfortunately, along with the summer activities comes a significant increase in eye injuries. Our Health has turned to the experts at Virginia Eye Institute and Commonwealth Eye Care Associates for good tips to keep eyes healthy throughout the summer season.
Good Sunglasses are Essential Wearing sunglasses does more than make you look good or express your sense of style. Sunglasses block harmful ultraviolet (UV) rays. UV damage adds up over time, so you should start protecting your eyes today, regardless of your age. Wearing sunglasses may reduce your risk for macular degeneration, cataract formation and pterygium (a benign growth). “It’s about chronically wearing sunglasses to protect the eyes throughout your life,” says Joseph D. Iuorno, MD, of Commonwealth Eye Care Associates. “People who don’t are more likely to develop these conditions.” “UV sunglasses limit the amount of harmful, short wavelength light that enters the delicate structures inside the eye,” says Thomas S. Carothers, MD, of Virginia Eye Institute. “Through consistent use, they decrease the likelihood of degenerative diseases of the lens and retina.”
UV Rays:
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Ultraviolet rays are an invisible form of radiation and can cause skin damage during any season or at any temperature. Sunlight that reaches the earth has ultraviolet A (UVA) and ultraviolet B (UVB) rays. Both types contribute to conditions such as premature skin aging, eye damage and skin cancers. They also suppress the immune system and reduce your ability to fight off these and other diseases.
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“Sunglasses are important protection from harmful UV light and also serve as a barrier from things striking or getting in the eyes,” says Grover C. Robinson, IV, MD, of Virginia Eye Institute. “Patients with macular degeneration or conditions that cause increased sensitivity to light like eye surgery or inflammation should wear sunglasses.” Dr. Robinson adds, “Also, patients with dry eyes would likely experience improved comfort from sunglasses. UV rays can cause accelerated cataract growth and increase the risk for macular degeneration.” “Sunglasses are important because they protect our eyes from dangerous UV rays that can cause cataracts and damage the retina,” says Inna Marcus, MD, of Virginia Eye Institute. “UV rays also damage the skin around the eyes and can cause skin cancer. People with light skin and blue or green eyes are at especially high risk of UV damage since they have less melanin to protect their eyes.” According to Dr. Iuorno, there are four considerations when picking a pair of sunglasses. First, make sure they offer UV protection and are polarized. Second, look for side-protection. The third consideration is comfort, while the fourth should be how they look. “Lenses should be UV A/B protective (not all sunglasses are),” says Dr. Robinson, “And the larger the frames, the more protective they are.” “When selecting sunglasses you should look for glasses with UV protection,” concurs Dr. Marcus. “Anti-glare coatings and polarized lenses can also be helpful in very bright sunlight. Larger frame styles will cut down on sun exposure and glare. They also protect a larger area of the face from sun damage.”
Get Out the Sunscreen Sunscreen and hats are also essential items for eye health, as too much sun exposure can damage the delicate skin around the eyes. This may cause wrinkles as well as skin cancer. “Protecting the skin around the eyes from UV rays is important,” says Dr. Marcus. “Sunscreen should be applied to the face and
Macular Degeneration: Macular degeneration, or age-related macular degeneration (AMD), is a leading cause of vision loss in Americans 60 and older. AMD is caused by deterioration of a small central portion of the retina, known as the macula. The macula allows you to see fine detail. Early detection of AMD is crucial, because there are treatments that can delay or reduce the severity of the disease. around the eyes. But be careful not to get any into the eyes. Many cosmetic companies now make concealer and foundation with UV protection. These can be used on the face instead of (or in addition to) sunscreen.” “I do recommend sunscreen around the eyes but not in the eyes as it can cause a chemical burn (worst case) or increased irritation,” concurs Dr. Robinson.
Eye Care and Swimming It is generally considered good advice to swim without contact lenses. Eye infections are brought on by exposing contacts to water and improper cleaning. A good way to protect the eyes is to leave contacts out when you go to the beach or pool. “You shouldn’t swim with contact lenses as it increases the chance of getting an infection and can definitely cause increased irritation,” says Dr. Robinson. “Swim goggles can reduce irritation from chlorine and other pool irritants.” “Contact lenses depend on a proper mixture of water, plastic and salt in order to function and fit properly without excessive adherence,” says Dr. Carothers. “This balance is disrupted when lenses are exposed to pool water.” “Although it may be very tempting to swim with contact lenses, this
Joseph D. Iuorno, MD, with Commonwealth Eye Care Associates is an American Academy of Ophthalmology board certified ophthalmologist and fellowship trained in Corneal/External Disease and Refractive Surgery. Thomas S. Carothers, MD, of Virginia Eye Institute, specializes in pediatric eye care
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Cataract Formation:
Pterygium: Pterygium is a common, noncancerous eye growth that affects people who spend a lot of time outdoors. This formation of pink, fleshy tissue covers the white part of the eye (sclera) and extends onto the cornea. It is often slightly raised and contains visible blood vessels. Pterygium may occur on one or both eyes.
Grover C. Robinson, IV, MD, of Virginia Eye Institute, specializes in cataract surgery and general ophthalmology
A cataract is a painless, clouding of the eye lens. This clouding blocks light from reaching the retina and may cause vision problems. Cataracts are common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. is very dangerous,” says Dr. Marcus. “Tap water, hot tubs and even pool water may harbor bacteria and parasites that can infect and damage the eyes. Contact lens wearers are especially vulnerable to these infections.” Dr. Marcus continues, “Swimming goggles are a great option, but they should not be worn with contact lenses. Many sporting goods stores now sell inexpensive prescription goggles, which can be ordered online as well. Swimming goggles are great at protecting the eyes from pool chemicals. If you plan to use them outside, check to make sure they offer UV protection as well.”
Summer Sand and Your Eyes Nothing can ruin a day at the beach faster than getting sand in your eye. The first general rule is to not rub it. Rubbing promotes the risk of scratching the cornea, which is very painful. Next, irrigate the eye with water to flush out the piece of sand. Tilt your head back, and use your index finger and thumb to open your eye wide. Then flush the eye with a gentle but forceful stream of water. A sports‐cap water bottle, or a plastic water bottle with a hole poked into it, works well. If you have neither of these, use whatever fresh water is available. If the eye continues to hurt, see an ophthalmologist to ensure the cornea has not been scratched.
Inna Marcus, MD, of Virginia Eye Institute specializes in pediatric eye care
“Any injury from a foreign object needs immediate attention,” says Dr. Marcus. “If a piece of sand or dirt
gets in the eye, flush the eye with water for five minutes and see a doctor. Do not try to remove these objects at home, as that may cause additional damage. If you have a serious injury and need to go to the emergency room, do not eat or drink beforehand. This can delay surgery if you need it.” “See your doctor if you have light sensitivity, changes in central or side vision, visible debris on the eye or a sensation of adherent debris,” says Dr. Carothers. “Immediately after being exposed to outdoor debris, resist the urge to rub the eye. Try to let the natural tears that well up in the eye dislodge the grain.”
Protecting Your Eyes for Summer Sports and Yard Work Frisbees, baseballs, volleyballs and tennis balls are all part of the season. Protective eye wear should be as well. If someone is struck in the eye with a ball, apply ice immediately. If vision seems affected or gets worse, go to an ophthalmologist. “Sports glasses for contact sports are a must,” says Dr. Marcus. “An accidental finger or elbow to the eye during a basketball game can land you in the emergency room. Paintball injuries are far too common, because people don’t keep their protective goggles on at all times. Never fire a paintball at someone who isn’t wearing proper eye protection.” “Polycarbonate glasses that are impact and shatter-resistant are useful for all sports,” says Walter E. Bundy, III, MD, FACS, of Virginia Eye Institute. “And safety glasses for yard work are now made with bifocals.” According to Dr. Iuorno, the most common ocular injury comes from doing outdoor yard
work without protective eyewear. “Proper eye protection should be worn at all times with any high-speed machinery such as lawn mowers, weed trimmers, leaf blowers or any grinding metal on metal,” says Iuorno. “Highspeed machinery creates projectiles which can not only scratch but also penetrate deep into the eye, causing very serious – possibly blinding eye injury.” “If you’re potting a small plant, a pair of wide frame sunglasses will be fine,” says Dr. Marcus. “If you plan to do any big projects, especially with power tools or a lawn mower, you should wear safety goggles. These will prevent grass, dirt and other debris from flying up under the lenses.” “I would definitely wear safety goggles for all yard work,” says Dr. Robinson. “You can get a foreign object in the eye, or a harmful eye injury at any time. Wrap-around safety goggles are best.”
Fireworks and the Sparkler Myth The easiest way to enjoy fireworks is to leave the displays to the professionals and watch from a distance. Children are the most common victims of Fourth of July fireworks accidents. Young people, age fifteen or younger, account for half of all fireworks eye injuries in the United States. According to the U.S. Consumer Product Safety Commission, more than 9,000 fireworks‐ related accidents occur each year. Almost half of these are head‐related trauma, with nearly 30 percent of these injuries to the eyes. One‐ fourth of all fireworks eye injuries result in permanent vision loss or blindness.
Cold Therapy: Did you know chilled cucumbers or tea bags applied over the eyes do an amazing job of refreshing them after a long day in the summer sun?
Eye Exams Serve as Prevention Kids need to have an annual eye exam for school, so schedule one for yourself at the same time. Prevention is the best way to maintain healthy vision. This means seeing an eye doctor (either an optometrist or ophthalmologist) once a year and getting eyes dilated every other year. Dilation allows the eye doctor to look inside the eyes and diagnose any disease before becoming a problem. Too often, when symptoms of eye disease become noticeable the condition is too far along for effective treatment. Catching eye disease early could save your vision. “Summer can be a great time to start prescription glasses or contact lenses,” says Dr. Carothers. “Your child can get used to them without the pressure of a heavy school schedule, and learn to take care of the lenses by the time school rolls around.”
Walter E. Bundy, III, MD, FACS, of Virginia Eye Institute LASIK & vision correction surgery, glaucoma treatments and cataract surgery
“The absolute most dangerous thing is a sparkler,” says Dr. Bundy. “Sparklers really hurt people, as they produce heat similar to a welding rod. That kind of damage can do irreparable harm to an eye. It’s often said they’re perfectly safe for children, which is not true.” Dr. Bundy continues, “Sparklers are neither safe for children nor for drinking adults. From an ophthalmologist’s safety point of view, fireworks are best left to the professionals.”
Rest Acts Like a Bandage Nothing is better for the eyes than sleep. Closing the eyes acts like a bandage, and gives them time to heal from the activity of the day. You’ll wake up with eyes that are brighter and rejuvenated. So, take that nap!
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Everyone Cares Richmond Healthcare Workers Swap Jobs for a Day and Learn Why it Takes a Team to Provide the Best Care words | BECKY BLANTON
You can’t really appreciate another person’s life until you’ve walked a mile in their shoes, or so the saying goes. May is traditionally the month when healthcare organizations recognize their employees; both clinical and nonclinical. They recognize them for the work they do to improve the health of our communities, and for the contributions they make to their own organizations as well. This year, OurHealth Richmond decided to let healthcare organizations discover for themselves just how valuable their employees are by encouraging them to swap places to see what their coworkers really do during their shift. So, we created a “role reversal for a day” of sorts. Healthcare organizations were asked to select two employees in different areas within their organization. Each employee would either “work” or shadow the other employee during their job to see exactly what they did during the day. The overlying theme of the resulting articles is this:
it takes eVeRY person in the health organization working together to deliver quality care.
We expected each employee to learn something new, but even we were surprised at what came out of this short and simple swap. So were the employees themselves. The best thing about the swaps is that almost every participant learned something new that they say will help them do their own jobs better. From a nurse practitioner who learned that writing more detailed test requests could result in quicker test scheduling, to an administrator suggesting that families designate one spokesperson to communicate with nurses to ensure continuity of information, the experiment was educational and job changing. Read the interviews to see what each of the job swap participants learned, and were surprised by in the process.
Reprints The artwork featured on this issue's cover is in honor of the acclaimed artist, Norman Rockwell. To order reprints, please call Jenny Hungate at 540.387.6482 or contact her via email at jenny@ourhealthvirginia.com. To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com
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Kim Leavers Wendy Sauls
Oncology Nurse Patient Financial Counselor Virginia Cancer Institute
Getting patients the care they need requires more than just great medical treatment. It requires funding to pay for that treatment and a team of nurses, doctors and financial counselors who know where to go for grants, reimbursement and money. It also requires understanding that a team approach is what ensures patients don’t have to worry about how they’re going to pay for treatment. Wendy Sauls, Patient Financial Counselor at Virginia Cancer Institute says she often hears patients say the financial aspect of their cancer is more overwhelming than the diagnosis. “It’s heart wrenching to tell someone that their out-of-pocket cost is going to be $6,000 and then it’s going to be another $1,000 every time you walk in the door,” Wendy says. “I try to reassure patients that not having funding isn’t the end, it’s just a speed bump in the road. It’s not going to prevent them from getting care.” Kim Leavers, an oncology nurse with Virginia Cancer Institute, has been a nurse for 29 years, and agrees. “Patients have enough to worry about without wondering how they’re going to pay for their treatment too.” The two women already work closely together, but they learned a few unexpected things when they recently swapped jobs for the day. “Our job swap really goes on non-stop because I have such a close connection with Wendy,” Kim says. Every patient that comes into their offices has two things they’re concerned about - their diagnosis, and how they’re going to pay for treatment for the diagnosis. It means that Kim and Wendy have to be the perfect tag team—taking turns going to bat for their patient. It’s a partnership a lot of hospitals and physician groups don’t appreciate as much as they should. “Financial counselor is an underutilized role in a lot of offices,” Wendy says. From the minute a patient steps into her office, Wendy starts the process of verifying their benefits. She gets any authorizations that are required, and talks to them
about payment plans and if they anticipate having financial difficulties. From there, Wendy begins looking for foundations that might have funding based on the kind of cancer the patient has. She also begins applying for any grants or other money the patient might be eligible for. It’s a hard job, and one that’s getting more difficult. “The money and grants are getting slimmer and slimmer,” she says. “The manufacturers are helping more, and when you’re a Medicare patient there’s more money for payments because a lot of the co-pay foundations only give money to Medicare patients.” There’s a lot to it, she says. “There’s a lot of research involved. We may have to work on appeals and do a lot of work to make sure the claims get paid.”
As far as what each learned about their co-worker during the swap: “The amount of knowledge and care she has and gives to her patients is amazing,” Wendy says. “I’ve worked closely with Kim for a couple of years, and my respect for her and the other nurses is at the highest level it can be.” There wasn’t anything that surprised her, she says, but a lot that simply reinforced what she already knew. “The nurses put it all on the line for the patients. They have to answer patient questions and doctor’s questions. And, they have to deal with losing patients. Not everyone makes it. They’re a lot closer to these patients than I am, and I know that’s hard,” she says. “You can’t really do your job if you hold back, so I admire that.” Kim was most impressed with Wendy’s ability to “jump through so many hoops to make sure my patients get the money, care, drugs and treatment they need, and are already entitled to have.” Kim says, “I admire her so much for doing what she does. I couldn’t do her job. I wouldn’t want to because it would be so hard for me to jump through all those hoops. I’m glad we have her.”
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Kara Fisher Dorothy McCauley
Unit Manager, Charge Nurse Housekeeping HCA Chippenham Hospital Family, a job well done, a passion for the HCA patients and mission and a sense of community were just some of
Kara says her job is much the same, but different every day too. It’s one of the things she likes best about it.
the things that Kara Fisher and Dorothy McCauley discovered they have in common. Kara, a unit manager and charge nurse, and Dorothy, a housekeeper for HCA, also share a quiet appreciation for order, cleanliness and patient comfort and safety. The two women recently swapped jobs to see what the other’s day was like, and what the other’s job entails. It was eye opening for both, but also for the public and other staff members who were curious about what was going on.
“It’s multi-faceted, that’s for sure. Sometimes it involves meetings all day, sometimes it involves cleaning and organizing cabinets, and it always involves patient care. I make rounds every morning and help give baths, turn patients and general patient care. What I like best about my job is supporting our patients and our staff. I like doing things that help make their day better.”
“I jumped right in and cleaned too,” Kara says. “I was in my nurse’s uniform, but I was hands on and scrubbing toilets and cleaning. Staff members and members of the public would come up to us the whole time we were cleaning. They would ask why a nurse and housekeeper were both cleaning the hallways,” Kara says. “They loved it. They said, ‘I wish we could do that in our department.’ They absolutely loved it.” “We had a really good day and had a lot of fun talking, sharing and getting to know each other as well as each other’s jobs,” Kara says. Dorothy, or Dot as she is known, said she enjoyed seeing what Kara did. Dot isn’t afraid of hard work and enjoys people, but admitted she didn’t think she could do the medical aspect of Kara’s job. “There were a lot of IV’s, sticking people, blood. I couldn’t do it,” she says. What she admired most was Kara’s relationship with her patients. “She is awesome with her patients,” she says. “She has the perfect attitude with them. She puts them at ease and is really good with people. I could tell she’s been doing it for a long time.” Dot has been working in housekeeping for seven years and enjoys the variety of the tasks she does every day. While he same general tasks don’t change, the days are never the same.
‘Making other people’s days better,’ is what Dorothy says drives her as well.
As far as what each learned about their co-worker during the swap: “I was astounded at the volume of what Dot is responsible for,” Kara says. “And even though I’m young and physically active, there were a lot of different aches I had the next day. It’s hard work. I walked away from that day thinking everyone works really, really, really hard and takes great pride in their work. I think Dorothy really had more responsibility than most because she had the first floor, the public area. She’s responsible for all the restrooms, and there are a lot of restrooms. There’s all the seating areas, railings, dusting the artwork and cleaning the class. It doesn’t stop. It’s a lot to keep clean,” she says. Since public areas are the first place where germs, virus’ and illness come into the hospital, Dorothy does more than housekeeping. She’s a first line of defense for patients and those in the hospital. “Sterility and cleanliness,” Kara says, “Absolutely critical and she does a fantastic job.” Dot learned that she and Kara had more in common than she might have imagined. “We both care about the patients, about family, about a job well done. That’s what matters.”
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Caryn Weir-Wiggins Whitney Burton Clinical Research Nurse Social Worker VCU Massey Cancer Center Caryn Weir-Wiggins, a clinical research nurse and Whitney Burton, a social worker, both with VCU Massey Cancer Center, recently had an opportunity to experience first-hand what the other does. As a research nurse, Caryn works with a lot of doctors and scientists, but she also works with many social workers. She recently spent a day shadowing Whitney on the job. Whitney also got a close up view of what Caryn must do once patients are actually in a trial. The day was an eye-opener for them both. Caryn explains that people skills and the resources social workers bring to patient care are just as, or even more important than cutting edge medicine and the potential of new clinical trials. “Without social worker’s support a lot of patients would never enroll, or stay enrolled in clinical trials,” she says. Caryn works with investigator-initiated clinical trials; meaning scientists at Massey come up with concepts that they test in various studies. The trials she works with include phase one and phase two trials. Patients in these trials are often the first to receive that treatment or drug. It can be rewarding, and also very stressful, since the stakes may often be those of life or death. “Social workers offer an array of services for all of our patients,” Caryn says. “I didn’t realize just how many services. Social workers do so much more than just enroll people in our trials. They do a lot of legal consulting, help our patients with transportation, bus tickets or gas cards, gift cards for food and provide psychological support for family members or patients. They help us find places for family members and patients to stay. They just wear so many hats and do so much. All of our social workers are always so astute and creative at finding all kinds of resources for the things our patients sometimes don’t even know they need,” Caryn says. “One of my patients told me what blew her away was that someone was out there thinking about her, and what she needed, what problems she had before she knew she would have them, and that that person was a social worker.”
For Whitney, watching Caryn at work was a lesson in the kind of exacting, rigorous detail clinical trials demand. “The complexity of what goes on behind the scenes was surprising. I didn’t realize how many details there are to running a trial. She’s got to know so much about research and medicine as well as all the details of each trial.” Even though the details and demands are exacting and rigid, another thing Whitney was impressed with was how flexible Caryn was. “If something went wrong, or something came up or didn’t work like it was supposed to, she just went with the flow. She thinks on her feet, and if things don’t go as planned she just finds a way to make it work or finds another solution. She’s not reactive, but proactive.”
As far as what each learned about their co-worker during the swap: “I’m a lot older than Whitney, in fact she could be my daughter, so I was very impressed with what a great handle she has on understanding what her patients need, not just where they are, but where they could be,” Caryn says. “This is a pilot program and she’s taken this huge leadership role. For someone so young she’s taken on this new program, and is developing the guidelines that other social workers could use to do this in the future. She’s a very impressive and proactive young woman.” “Everyone is in this together at Massey,” Whitney says. “It’s like a huge family of staff and patients. We’re very supportive of each other and this just reaffirmed that. One of my interview questions for this job, was, ‘Was there ever a problem that you thought couldn’t be solved? I said I thought there might be a perception that something couldn’t be solved, but that there was always an answer somewhere. I still believe that.”
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Erica Tyson Dustin Yudowich Lead Lab Assistant Wellness Programs Director Health Diagnostic Laboratory “Swapping jobs with coworkers is a lot like traveling,” says Dustin Yudowich, a wellness programs director for Health Diagnostic Laboratory (HD Lab). “When you travel out of country you get a new perspective on where you’re going, but you also get a new perspective on where you came from,” he says. “When you go to another department you learn what they’re doing, but you also learn how it affects what you do. It gives you a unique look at how everyone’s job impacts everyone else.”
“It made me aware of the fact there really does need to be continuity throughout the hospital for everything to run smoothly,” he says. “I’ve walked through the labs before when I’ve been talking to people about fitness classes, or handing out information,” he says. “I just never stayed in the lab long enough to see what they were doing. You can’t just hang out in a lab because they’re working on projects, but being able to follow Erica opened up that world for me. Now I have a better idea of all the things that go into what they do there.”
Dustin, and Erica Tyson, lead lab assistant at HD Lab, recently swapped jobs to see how other departments run. What Erica learned very quickly is that, “Dustin Yudowich is hard core” when it comes to ensuring the HD Lab employees stay healthy and well. “He really pushes people, in a good way!” she says. Hard, but dedicated and passionate was Erica’s strongest impression of Dustin during her job swap.
As far as what each learned about their co-worker during the swap:
“He had me doing planks, sit-ups and all kinds of things,” says Erica. “I’d taken some classes from him before, but this was more intense,” she says.
“I think I’d like doing his job and being involved in fitness training and total health work,” she says. That one day’s detour into Dustin’s world helped her re-evaluate her career path. “It’s a possibility for sure,” she said.
Her time in the gym was a change from her usual job as a lab assistant, prepping blood samples every day for the hospital’s techs to run. She’s in school now learning to be a health counselor. Her time with Dustin inspired her enough to consider becoming a trainer, and possibly a wellness expert herself. Dustin, a fitness professional and trainer, has a different approach to health—through physical activity and food. “I create, implement and execute internal wellness programs. I work with things dealing with exercise, diet, weight loss, diabetes and a variety of things.” Seeing how Erica’s job involves preparing blood samples for testing, and what it means to the people having those tests enhanced his awareness of how important the entire process is.
Both love fitness and personal health. Erica considers herself fit and healthy, but admitted Dustin pushed her to her limits, making her appreciate the potential of what is possible with her body.
Details matter, whether you’re in the gym or the lab. Dustin learned that the exacting, detail oriented process was a lot like a routine, or wellness program. Paying attention to results, being organized and prepared makes a difference, whether you’re preparing samples, or trying to get fit and healthy. “It’s really amazing how getting a different perspective on something can open you up to so many possibilities,” Dustin says. “I think this was a great experience, and I’d like to do it with other departments in the future.” Seeing how employees work, what their stressors are and the physical demands of their jobs can help him better design programs and exercises that address real needs. “Being able to help keep employees healthy is what matters and I can see now that this was a great idea. I’m glad I had the opportunity to swap!”
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OurHealth’s activities photographer, Sarah Mattozzi, captured Richmonders “getting their run on” at the
Ukrop’s Monument Avenue 10K—the 4th largest 10K in the country!
The Ukrop’s Monument Avenue 10K is Richmond’s signature annual running event. Established in 2000 and ran on historic Monument Avenue, the race has grown to be the fourth largest 10k in the country and the 22nd largest race of any distance. It has been named by USA Today as one of the 10 Great Road Races in the United States. 1. David Rogers and Donald Thurston of Louisa County 2. Participants from Sportable RVA 3. Runners on West Broad Street 4. First runners take off 5. Matthew Vincent of Hanover 6. Barb Juell and friends of Richmond 7. Spectators brave the rain 8. Jamie Ledwith and Hops (Cameron Hopper) of Richmond
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9. Melissa and Greg Ryman of Richmond 10. Young supporters cheering from the sidelines 11. John Vithoulkas and son, James of Henrico 12. Runners cross the finish line in the downpour 13. Supporters encourage runners on Monument Avenue 14. Runner Jen Whitlock stretches after finishing the race 15. Runners making their way along the route 16. Celebrating ‘post-race’
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magnificence and
Olympic Gymnast Shannon Miller Springs Back from Ovarian Cancer words | LYNETTE MUTTER
It is widely agreed that Shannon Miller dominated the sport of gymnastics for most of the 90s. In fact, in 1992 through 1996, she is regarded for executing routines with some of the highest difficulty in the world. For someone who describes herself as “neither the most talented nor the strongest athlete,” the fact that Shannon Miller remains America’s most decorated gymnast is astounding. Highlights of Shannon’s illustrious athletic career include: • Being a seven-time Olympic medalist, with two gold, two silver and three bronze. • Being the only American to rank among the Top 10 gymnasts, and the only female athlete to be inducted into the US Olympic Hall of Fame – twice! • Having won gold in half of her 108 international and national competition medals. • Winning five medals, the most by a U.S. athlete of any sport, at the 1992 Olympics. • Leading the “Magnificent Seven” to the US Women’s first ever team gold in gymnastics at the 1996 Olympics, and for the first time ever for an American, winning gold on the balance beam.
Shannon with her son. (Photo Credit: Liliane Hakim)
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At right: Shannon with her family (Photo Credit: Renee Parenteau) Below: Shannon sports her Olympic medals
Fast forward 20 years and Shannon was still vaulting to success and enjoying a rich, fulfilling life. She had earned undergraduate and law degrees, became a wife and mom, launched a company (www.shannonmillerlifestyles.com) to help women make their health a priority and started a foundation to fight childhood obesity. Shannon began hosting a weekly radio show, had written a series of fitness books and cookbooks, produced fitness DVDs, and was traveling the country as a highly sought after motivational speaker and advocate for the health and wellness of women and children. And that’s not all.
Facing a Ruthless Rival While still seemingly scoring a perfect 10.0 in all facets of life, Shannon was diagnosed with a rare form of ovarian cancer and began a rigorous routine that rivals her Olympic experience. As she puts it, she “competed with cancer,” which is also the title of her free e-book, written to share her story in hopes that it might help others.
Now Shannon adds “cancer awareness advocate” to her list
of roles, all of which she
relishes and approaches with a passion intimately known by those who have dealt with a cancer diagnosis.
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Shannon believes that her background as a competitive gymnast, as well as her roles as wife/mother and health advocate, is ultimately what saved her life. She won her match with cancer and even naturally conceived and gave birth to a daughter last year, referred to as her “miracle baby.” So how did this happen to a former Olympian and health and fitness advocate in her peak years of wellness? Well, the same way it happens to anyone. “While there are other factors that affect ovarian cancer risk, the single greatest risk factor is a family history,” according to Jori S. Carter, M.D., M.S., a gynecologic oncologist at VCU Massey Cancer Center. But, that wasn’t the case with Shannon. “Cancer doesn’t care... who you are, if you have time, whether you are launching a new business and have people depending on you, including a one-year old little boy,” she says. However, early diagnosis matters greatly with cancer. For Shannon, although it was caught quite early, it was not before a 7-centimeter tumor had grown inside of her. It might be called a stroke of luck that it was found early, maybe “an angel looking over my shoulder helping me do the right thing”, Shannon says. It was clear that the same determination and work ethic that propelled her to Olympic fame was also at work here.
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While waiting on hold to reschedule an annual exam appointment due to a business travel conflict, Shannon toyed with the idea to just skip it for now. But she had a nagging feeling and reasoned that as an advocate for women’s health and fitness, she had do as she did in gymnastics and “walk the talk!” So she took the earliest available appointment, which was the one at which the stage IA mixed germ cell tumor would be discovered. A flurry of tests culminated in surgery within a month after diagnosis. The tumor and an ovary were removed, and Shannon then endured nine brutal weeks of chemotherapy. In her book, Shannon describes chemotherapy as a game changer. “Unlike surgery, where I had no control, with chemotherapy, there were things I could do to affect the outcome,” she says. Things such as: • Developing a Game Plan • Keeping a journal • Exercising • Reaching out for and accepting support • Laughing Shannon says she “spent and her entire gymnastics career learning how to come back from defeat. When you fail, minimize the mistake, pick yourself up and keep going.” The mindset of a champion got her through the nausea, fatigue and hair loss. Just as the longest run in a floor exercise is two to three steps, Shannon told herself that she only had two tasks every day – prepare and do her best. A healthy dose of denial helped “block out the noise” and keep her focused. Ultimately, the Olympic gymnast landed on her feet.
A New Purpose Emerges Now Shannon adds “cancer awareness advocate” to her list of roles, all of which she relishes and approaches with a passion intimately known by those who have dealt with a cancer diagnosis. Today, Shannon’s message is “One of hope – and also of taking care of ourselves and making our health a priority.” When she was diagnosed and the doctors asked if she had symptoms, at first she said “no.” Afterward, when talking with her husband, he reminded her that she had been complaining about having a stomach ache for www.OurHealthRichmond.com
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months. She also recalled, “I had lost six pounds in a month, which I attributed to post-baby body and a lot going on at work.” “Here I was an advocate for women’s health, and I didn’t even know the symptoms of ovarian cancer. I realized that I needed to use whatever voice I had to reach out to others about the importance of taking care of ourselves and of knowing the symptoms of medical conditions that affect us.” Shannon encourages women to pay attention to their bodies and when something doesn’t feel right, to not be embarrassed or afraid to go to the doctor. “What is the worst case, or maybe the best case, scenario?” she asks, “That the doctor says you have a stomach ache or it’s nothing? It’s worth finding out for sure.” From left: Dorothy McAuliffe, First Lady of Virginia; Shannon Miller; and Gordon Ginder, MD, Director of VCU Massey Cancer Center
Recognizing that it can be difficult for women to find time to go to the doctor, Shannon recalls “all of the hours, days and months” she spent in bed during treatment and recovery. “Thanks to the helping hand of God, I was diagnosed early. We can’t prevent everything, but we can buy time to have more options.” After chemotherapy, Shannon was dealt a blow when she realized that for the rest her life, she would be “observed” – tests, scans, going to the doctor every few months. “I didn’t want that! I never wanted to think about cancer again!,” says Shannon. “I was depressed for a while, then I realized that I must do it, so I can know at the earliest moment if anything is wrong. Either there will be nothing to worry about or I will have more options.” “I learned that making health a priority is not about spending two hours in the gym and it’s not selfish,” says Shannon. “What it truly means is that we are being selfless and taking into consideration the people who depend on us. We simply just can’t put ourselves last, and we need to give ourselves the benefit of options for the best possible outcome.” “My message to women is not groundbreaking, but I hope that coming from a different source, it will resonate. I want women to accept that they don’t need permission to make their health a priority and that it’s okay to take the time they need to do so,” says Shannon.
A Journey of Discovery When diagnosed, Shannon was somewhat surprised by the outpouring of support she received. “While logically, we know there are many other people dealing with the same thing, when it’s you, it really hits home and the world disappears. You feel alone and begin to focus inwardly. I had the opportunity to focus outwardly.” 42
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Shannon encourages women to pay attention to their bodies and
When Shannon found out she had cancer, she and her husband decided they would be very open about it, hoping to help someone else by showing that cancer doesn’t care who you are.
be embarrassed or afraid to go to the doctor.
“I wanted to use this excruciating stumbling block in my life and hoped it would help others,” she says.
when something doesn’t feel right, to not
Always believing her husband, John Falconetti, was the “person you would turn to if the wheels fell off,” Shannon developed a new appreciation for his strength. As it turns out, John’s father had been diagnosed with stage four colon cancer and went into surgery the day before Shannon. The doctors were telling John that his father might never leave the hospital. And the very next day, his wife would be operated on. Thankfully, John’s father lived another two years, but throughout 2011, he needed to be there for his father, mother, wife and son – and he had a business to run, says Shannon. “During it all, I didn’t completely realize how hard it must have been for him until the following New Years’ Eve when he raised his glass and said, “Here’s to a better 2012.” His tone of voice and the look on his face revealed the enormous pressure he had been under and how well he handled it,” she says. After overcoming the initial trauma of losing her hair and shaving her head, Shannon also discovered that she liked wearing wigs. “It was so easy and it always looked perfect!” she says. “When I felt up to taking a little walk, I would go to the Starbucks in my neighborhood. Some days I would go in sweats, bald and with no make-up. On better days, I might wear a cap and a little make-up. And when I went back to shooting videos or film, I would be wearing a business suit, a wig and have my eyelashes on. The baristas didn’t know what to think! And not caring about that was liberating,” she says. Through cancer, Shannon says she gained a confidence she didn’t have before, except when she was wearing a leotard and on the competition floor. Otherwise, she was a bit shy growing up and through her 20s. “It wasn’t until cancer that I truly found my voice, and I learned that you don’t have to look or sound a certain way. What really matters is your faith and your family, and doing your best every day. Nothing else really matters,” she says. 44
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“Beyond the Medicine” “Faith has played an enormous role in my life,” Shannon says. “God has been with me during some very difficult times, and also brought me through this battle with cancer. I know that He is with me at all times, and that there is a reason for everything.” At this point in her life, Shannon believes that she is meant to use this experience as a reminder to take care of her own health, and to reach out and help others take care of their own. She stresses “the importance of hope and positive attitude, which comes from your faith and family support. Even doctors will tell you that there is something ‘beyond the medicine’ and having the right mental approach could make all the difference.” Shannon has been quoted as saying that “Everyone has obstacles, and you’re not going to have the right answer or do the right thing every time.”
Jori S. Carter, MD, MS, gynecologic oncologist at VCU Massey Cancer
However, it appears that a positive attitude and an athletic background of intense training, injuries, setbacks and sacrifices has prepared Shannon well for Olympic-scope challenges and even greater victories.
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Breaking the Silence
Pancreatic Cancer
words | SUSAN DUBUQUE
This series will explore diseases that can be devastating to the individuals and families they affect—yet no one is talking about them—until now. We will bring these orphan diseases into the light—and dedicate these stories to the courageous people afflicted and the providers and researchers who commit their lives to treating and seeking cures for these silent killers.
It was a freak accident. Catherine (Cathie) Elgin Herndon was pinned between two vans at work. Fortunately, the driver was moving slowly. A trip to Patient First, a minor emergency center, showed that she suffered no significant injuries from the mishap. But two days later, when her back pain became unbearable, Cathie went to Johnston-Willis Hospital emergency department for further assessment. While a CT scan confirmed that she had not sustained any injuries from the accident, it revealed something far more ominous—a mass on her pancreas. “It was a whirlwind,” says Cathie. The very next day she was seen by David M. Rose, MD, a general surgeon at Johnston-Willis. Then, Howard Haverty, MD, a gastroenterologist, performed a biopsy. “Dr. Haverty called me and said, ‘I don’t like these results,’ and he requested a second opinion from VCU Massey Cancer Center.” Finally, the testing was complete and the experts were all in agreement. At age 34, Cathie was among the youngest patients Dr. Rose had treated for pancreatic cancer—a distinction Cathie would rather not have.
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From left: Jennifer Valentine, of Chester, VA and Catherine (Cathie) Elgin Herndon, of Dinwiddie, VA
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“I told Dr. Rose, I want to fight this thing as aggressively as I can without killing me,” shares Cathie, “and he was ready to fight with me.” Cathie was diagnosed in March 2007, but waited until May to have surgery. “I needed time to process everything and get my affairs in order,” recalls Cathie. She knew it would be a long, hard road to recovery, and she had to make arrangements for her five children, ages four to 14. Dr. Rose performed a Whipple procedure, removing her tumor and reconstructing Cathie’s digestive organs. After surgery, Cathie underwent radiation therapy for 28 days and chemotherapy for an entire year. “When I got out of the hospital, I went to stay with my mom to recover, and the emotions just hit me—I fell apart,” says Cathie. But Cathie’s emotional paralysis didn’t last long. With caring support from her husband, children and parents, Cathie regained her strength and her determination. “I focused on my kids and the fact that they needed me,” reflects Cathie. “I set goals—I wanted to see my kids graduate from high school. And I realized that life just keeps going on.”
Happy Days: Cathie and her family
Cathie is a different person today. “I went into surgery weighing 300 pounds, and now I weigh half that,” says Cathie. And she came out with a new attitude to match her new physique. Cathie encourages others to be aware of the subtle signs that may indicate pancreatic cancer. “Sometimes I get frustrated,” says Cathie. “Everyone talks about breast cancer. There are pink ribbons everywhere. But who is talking about pancreatic cancer?” “I was losing a little weight and feeling tired, but I just thought it was because I had five kids to take care of. Who wouldn’t be tired? And my back ached, but I wrote that off to driving a van at work,” says Cathie, “The signs were all there. I just didn’t know it.” “I want people to know the signs so they can get help— while there is still time to do something about it. If it weren’t for being squished by a van, I wouldn’t be here today,” laughs Cathie. “My co-worker was horrified, thinking he hurt me. The truth is he saved my life. I call him my guardian angel.” As a 7-year survivor of pancreatic cancer, Cathie is defying the odds. She places her trust in the belief that, “Only God can put a time limit on me.” Today, a tattoo of a beautiful purple ribbon surrounded by rays of the sun—like a phoenix— adorns Cathie’s back. She wears it proudly as a continuous symbol of the fighting spirit that helped her return to a whole, vital life.
It’s time to get this conversation started. Let’s talk frankly and openly about pancreatic cancer— the nature of the disease, risk factors, current treatments and what the future holds. D. Michael Rose, MD is a surgical oncologist and Medical Director of Surgical Oncology at JohnstonWillis Hospital. Dr. Rose is also Medical Director of the Thomas Johns Cancer Hospital
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The pancreas—it’s one of those organs that we all know we have, but its purpose is a little muddled. So let’s begin with the most fundamental question—what is the pancreas and what does it do? The pancreas is an organ in the abdomen that sits in front of the spine above the level of the belly button. It performs two main functions. First, it makes insulin, a hormone that regulates blood sugar levels. Second, it makes enzymes that help break down proteins. The enzymes support
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digestion by chopping proteins into smaller pieces so that they can be more easily absorbed by the body and used for energy. Enzymes leave the pancreas through a system of tubes called “ducts” that connect the pancreas to the intestines. The pancreas sits deep in the belly, close to many important structures like the small intestine (called the duodenum) and the bile ducts, as well as important blood vessels and nerves.
Understanding Pancreatic Cancer
“I want people
Pancreatic cancer is the fourth leading cause of cancer-related deaths, in both men and women, in the United States.
to know the
Cancers that develop within the pancreas fall into two major categories—endocrine and exocrine. Cancers of the endocrine pancreas—the part that makes insulin and other hormones—are called “islet cell” or “pancreatic neuroendocrine” cancers. Islet cell cancers are rare and typically grow slowly. These tumors often release hormones into the bloodstream including insulin, glucagon and gastrin. Cancers of the exocrine pancreas—the part that makes enzymes—develop from the cells that line the ducts that deliver enzymes to the small intestine. These cancers—called pancreatic adenocarcinomas—comprise 95 percent of all pancreatic ductal cancers and will be the focus of this article. Cells that line the ducts in the exocrine pancreas divide more rapidly than the surrounding tissues. As they reproduce, the cells can make a mistake when they copy their DNA, resulting in an abnormal cell. When an abnormal ductal cell continues to divide, a growth can develop that is comprised of malformed looking and functioning cells called “dysplasia.” Dysplastic cells can undergo additional genetic mistakes over time and become even more abnormal. If these dysplastic cells penetrate the walls of the duct into the surrounding tissue, the dysplasia then becomes a malignant tumor or pancreatic cancer.
signs so they can get help while there is still time to do something about it..." - Cathie Herndon
Causes of Pancreatic Cancer and Risk Factors There are more than 45,000 new cases of pancreatic cancer diagnosed each year in the United States. Yet, most people who develop the disease have no known risk factors. There are genetic syndromes that run in families but these are rare. Perhaps the biggest risk factor is increasing age, as the majority of cases occur in individuals over the age of 60. Further, African-Americans may be at slightly greater risk as well as individuals with close family members who have been diagnosed with the disease. These are all factors beyond our control. But there are some behaviors that increase the likelihood of developing pancreatic cancer—these include smoking, obesity, a sedentary lifestyle and a fatty (Western) diet. Other factors associated with the disease are a history of diabetes, chronic inflammation of the pancreas (called pancreatitis), prior stomach surgery and certain chronic infections such as hepatitis B. Despite these identified risks, there is no specific cause found in most people who develop pancreatic cancer.
Symptoms of Pancreatic Cancer Because the pancreas lies deep in the belly, pancreatic cancer often grows silently for months before it is discovered. Early symptoms may be non-existent or may be so subtle that they are overlooked. Symptoms may only appear once the tumor grows large enough to press on other nearby structures such as nerves (causing pain), the intestines (affecting appetite and causing nausea and weight loss) or the bile ducts (resultng in jaundice or a yellowing of the skin, loss of appetite and itching). Different symptoms may occur if the pancreatic cancer metastasizes or spreads through the
Alexander Stojadinovic, MD is Medical Director at Bon Secours Cancer Institute, as well as Professor of Surgery and Professor of Medicine at Uniformed Services University in Bethesda, MD
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blood and lymph systems. Pancreatic cancer most commonly metastasizes to the liver, lymph nodes and the lining of the abdomen (called the peritoneum). There is no simple screening test for pancreatic cancer and since the symptoms are often vague, most pancreatic cancers are found when the disease is in an advanced stage and has spread to other organs.
How is Pancreatic Cancer Diagnosed?
Steven R. Grossman, MD, PhD is a hematologist-oncologist and Deputy Director at VCU Massey Cancer Center
Most people with pancreatic cancer first see their primary care physician complaining about an array of non-specific symptoms like digestive problems, weight loss or back pain. Such complaints may be further evaluated with a physical examination, blood tests, and sometimes, X-rays and an ultrasound. When pancreatic cancer is present, an ultrasound will reveal an abnormality in the pancreas about 75 percent of the time. The next step in the process is likely to be a computed tomography (CT) scan. If a pancreatic mass is identified and cancer is suspected, a biopsy is performed to make a definitive diagnosis. A biopsy may be performed using an “endoscope” that is inserted down the throat and into the intestines. An ultrasound device at the tip of the endoscope locates the area of the pancreas to be biopsied, and a biopsy needle is passed through a channel in the endoscope to obtain tissue from the suspected cancer.
Pancreatic cancer is a harsh disease. Even for tumors that are discovered at an early stage and can be treated surgically, the risk of cancer recurrence is high.
If it appears that the cancer may have spread to the liver, a needle biopsy of the liver may be obtained through the belly wall. This is called a percutaneous liver biopsy. While there is no simple screening test for pancreatic cancer, suspicion of the disease can arise from an elevated tumor marker called CA 19-9—a blood test which can be abnormally high in people with pancreatic cancer. Unfortunately, the CA 19-9 test is not specific for pancreatic cancer nor is it perfect. Other cancers as well as some benign conditions can cause the CA 19-9 to be elevated, and about 10 percent of the time the CA 19-9 will be at normal levels in the blood despite a confirmed diagnosis of pancreatic cancer. However, tracking the rise and fall of CA 19-9 during the course of illness, may be useful in guiding treatment.
Treatments for Pancreatic Cancer Treatment options for pancreatic cancer vary depending upon the stage of the disease when it is diagnosed. Pancreatic cancer is broken into four stages—stage I being the earliest stage and stage IV being the most advanced. The four stages are categorized into three groups.
Local, Resectable Cancer (Stage I and II) Patients with stage I and II cancers are classified as having “local” or “resectable” cancers. These are cancers that are contained in or around the pancreas and can be completely removed with surgery—the only treatment today that can cure pancreatic cancer. The type of surgery typically performed to remove a pancreatic cancer is called a pancreatoduodenectomy—but more commonly referred to as a “Whipple”— named after Allen O. Whipple, MD, who first performed this procedure in 1935. A Whipple involves removing a portion of the stomach, duodenum (the first part of the small intestine), pancreas, bile ducts, lymph nodes and gallbladder. This is a major surgical procedure that should only be performed by a surgeon with significant experience. After the Whipple surgery, patients typically spend a week or more in the hospital but full recovery can take months. Chemotherapy is often recommended following a Whipple procedure to lower the risk for recurrent cancer. This is called adjunctive therapy. Sometimes radiation therapy is also incorporated into the plan.
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Unfortunately, only about 20 percent of the patients diagnosed with pancreatic cancer have tumors that can be treated surgically. The rest have tumors that are too advanced to be completely removed, or have metastasized at the time of diagnosis.
Locally Advanced, Unresectable/Borderline Resectable Cancer (Stage III) If pancreatic cancer is diagnosed when the tumor has expanded to nearby major blood vessels or nerves but not spread to distant sites, this is described as “locally advanced” pancreatic cancer (stage III). At this point, the tumor cannot safely be removed with surgery and is therefore considered “unresectable.” The typical treatment for locally advanced cancer is a combination of low-dose chemotherapy and radiation therapy to the pancreas and surrounding tissues. Radiation treatment is used to lower the risk of local growth of the cancer and minimizes symptoms such as back or belly pain, nausea, loss of appetite, intestinal blockage and jaundice. Chemotherapy may improve the effectiveness of the radiation, and may lower the risk for cancer spreading beyond the area where the radiation is delivered. When the radiation is completed and the patient has recovered, more chemotherapy is often recommended. Pancreatic cancer is an aggressive disease, and fortunately the specialists in this field are embracing treatment protocols that are just as aggressive. They now offer a glimmer of hope to some stage III pancreatic cancer patients by reclassifying them as “locally advanced, borderline resectable.” Chemotherapy and radiation treatments are used to shrink the tumor so that it is no longer in close proximity to a vital structure. Following this pre-surgical—or neoadjunctive treatment—the patient is reassessed to determine if the tumor is now “resectable”, and can be removed surgically.
Metastatic Cancers (Stage IV) Once a pancreatic cancer has metastasized or spread beyond the pancreas to other organs, it is classified as stage IV. At this point, chemotherapy is used to fight the disease “systemically.” Chemotherapy travels through the bloodstream and can therefore attack a cancer that has spread wherever it is found in the body. In metastatic pancreatic cancer, chemotherapy is recommended for individuals well enough to tolerate it as a means of extending and improving the quality of life. Unfortunately the overall benefit from chemotherapy in pancreatic cancer treatment is modest, and chemotherapy prolongs life for the average patient by only a few months. Side effects of treatment for pancreatic cancer vary depending on the type of treatment. Side effects of radiation therapy tend to accumulate throughout the course of treatment and may include fatigue, nausea and diarrhea. Chemotherapy side effects may include fatigue, loss of appetite, changes in taste, hair loss and lowering of the immune system with risk of infections (immunosuppression). Today, patients have access to much better supportive medications to control any nausea, pain, diarrhea or immunosuppression related to treatment www.OurHealthRichmond.com
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than were available in the past. The discomforts associated with treatment must be weighed against the inevitable and devastating risks of uncontrolled pancreatic cancer.
Prognosis of Pancreatic Cancer Pancreatic cancer is a harsh disease. Even for tumors that are discovered at an early stage and can be treated surgically, the risk of cancer recurrence is high. About 20 percent of patients who have curable pancreatic cancer—stage I and II— live five years. For patients with locally advanced or metastatic pancreatic cancer—which represents about 80 percent of the cases—survival is even shorter and is typically measured in months.
What Does the Future Hold? Doctors and researchers across the nation and around the world are collaborating on the development of better treatments for pancreatic cancer. Progress over the past quarter century has been slow, but there are promising developments on the horizon. Here are a few: New chemotherapy agents are now available and clinical trials are testing different combinations of these drugs for treating pancreatic cancer. Other studies are testing the best ways to combine chemotherapy with radiation therapy or newer targeted therapies. “Targeted cancer therapies” get at the root of what drives pancreatic cancer. Many of these therapies focus on proteins in the cells that are involved in “signaling pathways.” By blocking signals that tell cancer cells to grow and divide uncontrollably, targeted cancer therapies can help stop cancer progression and may cause cancer cell death, called apoptosis. Other targeted therapies can cause cancer cell death by stimulating the immune system to recognize and destroy cancer cells or by delivering toxic substances directly to the cancer cells. This January, findings related to a vaccine therapy for the treatment of metastatic pancreatic cancer were presented at a 2014 Gastrointestinal Cancers Symposium held in San Francisco, CA. 52
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Enjoying Life: Jennifer, her husband, Dustin and their son, William
Living with Pancreatic Cancer: Jennifer’s Story
She is strong and courageous. Eighteen years in the U.S. Air Force with multiple overseas assignments—including war zones. Yet, nothing could prepare Jennifer Valentine for the battle of her life—pancreatic cancer. An instructor stationed at Fort Lee, south of Richmond, VA, Jennifer was getting ready for her second tour of duty in Afghanistan. A nagging pain in her upper back sent her to the post doctor for relief. But the pain continued and, in fact, got worse. “I knew I couldn’t go to Afghanistan like this,” says Jennifer. “I simply couldn’t do my job and I would be putting myself and others in danger.” In July 2013, the post physician, Sandra Smith, MD, referred Jennifer to Yiping Rao, MD, a gastroenterologist in Colonial Heights, where she had an array of further tests, including an endoscopy, ultrasound and CT scan. The tests revealed cancer cells in the pancreas, and Jennifer was referred to VCU Massey Cancer Center. Here, Brian Kaplan, MD, a surgical oncologist, discovered that the tumor in Jennifer’s pancreas was wrapped around a major blood vessel. The location of the tumor was the cause of the intense pain. It was the pain—and Jennifer’s determination to resolve it—that ultimately saved her life. On August 7, 2013, Jennifer had a Whipple procedure, then six weeks of radiation therapy, followed by chemotherapy. Being in top physical condition, Jennifer recovered from surgery in record time, but the chemo was another matter. “I couldn’t tolerate the IV chemotherapy— my white blood cell count bottomed out,” says Jennifer. Fortunately, a different chemotherapy agent was available in pill form that allowed Jennifer to continue her aggressive treatment with fewer side effects. “I was completely overwhelmed—actually shocked—by my diagnosis,” admits Jennifer. “I was only 36-years old and I thought I was strong and healthy.” Advanced medical treatment works on the disease, but it took something else to heal Jennifer emotionally. “Pancreatic cancer messes with your head. If it weren’t for my family, I don’t know how I could have gotten through this.” Jennifer and her husband, Dustin Bartlett, were married for just six months when she was diagnosed. When Dustin recounts the story of Jennifer’s treatment, it is always in terms of what “we” went through. “‘We’ finished radiation in October. ‘We’ have chemo for two weeks on, then one week off.” In her fight with pancreatic cancer, Jennifer is never alone. Her seven-year-old son, William, is part of Jennifer’s support team, too. “In a program at school called Later Gators, the kids got to design their own t-shirts. William made one for me with a
Brian J. Kaplan, MD is a surgical oncologist at VCU Massey Cancer Center and Professor in the Department of Surgery at the VCU School of Medicine
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purple cancer ribbon and one for himself with his name forming the ribbon,” says Jennifer. “He came up with the idea all by himself. It touched my heart.” Despite coping with a life-threatening disease, Jennifer is no different than any other young woman. “One of the toughest moments was when my hair started to fall out,” reflects Jennifer. She had long blond hair down to the middle of her back. “Every time a handful of hair came out, it reminded me I had cancer. My mom told me just to cut it all off and I would be free. And she was right. It was like a rebirth.” With all branches of the military downsizing, Jennifer was offered early retirement from the Air Force. Jennifer says, “I would like to have put in my full 20 years, but I can’t handle a full-time workload—just yet.” Steven M. Duffy, MD is with Bon Secours Cancer Institute Medical Oncology at St. Mary’s Hospital
“I feel like I have a monkey on my back,” says Jennifer. “I am counting the days. It’s been seven months since my surgery. If I can make it to two years, I have a good shot.” Thanks to the location of Jennifer’s tumor and the resulting pain, she is one of the lucky ones to be diagnosed with pancreatic cancer at an early stage when it is curable. That, along with advances in cancer treatment, the unflagging love and support of her family and her own indomitable spirit, it is promising that Jennifer will be among the fortunate people to be called a pancreatic cancer survivor.
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Pancreatic Cancer:
Arm Yourself with Knowledge words | SUSAN DUBUQUE
At this time, there is no simple screening test to reduce the risk of pancreatic cancer for the general population. Doctors do not routinely screen individuals with family members who have been diagnosed with the disease, aside from the rare instance where a known genetic risk factor is present. The best strategy to protect oneself is to understand the disease. Know the risk factors, as well as the signs and symptoms, and discuss them with your physician. Knowledge that leads to early diagnosis is the key to surviving pancreatic cancer.
Pancreatic Cancer Snapshot • Pancreatic cancer is the fourth leading cause of cancer-related death among both men and women in the United States, yet it makes up only 3 percent of all cancers • In 2014, an estimated 46,400 people will be diagnosed with pancreatic cancer in this country and more than 38,000 will die of this disease • Because pancreatic cancer usually is diagnosed at an advanced stage, the survival rate is extremely low compared with those of many other types of cancer • The incidence rate of pancreatic cancer has increased since 1999 and the mortality rate also has increased slightly since 2000 • More than $2 billion is spent annually in the United States for pancreatic cancer treatment
Risk Factors While there is no known cause of pancreatic cancer, there are factors that are associated with the increased risk for the disease. They include:
• Gender – men are 30 percent more likely to get pancreatic cancer than women
• Itching
• Ethnicity – African-Americans are at greater risk for pancreatic cancer than Caucasians or other racial/ethnic groups
Seeking Support for Pancreatic Cancer
• Blood clots
• Inflammation of the pancreas
Many hospitals provide special services for patients and families battling pancreatic cancer. The American Cancer Society and Pancreatic Cancer Action Network (PANCAN) both provide information and support for people living with this disease. The American Society of Clinical Oncology website contains a wealth of information for patients, families and professionals interested in learning more about pancreatic cancer.
• Obesity
• American Cancer Society - cancer.org
• Fatty diet – high consumption of sugar and red meat, low consumption of fruits and vegetables
• Pancan - pancan.org
• Age – most cases occur after age 60, while cases before age 40 are uncommon • Cigarette smoking – accounts for approximately 20 percent of cases • Family history – 5-10 percent of pancreatic cancer patients have a family history of the disease • Diabetes
• Prior history of stomach surgery
• American Society of Clinical Oncology - cancer.net or asco.org
• Chronic infections such as hepatitis B
Local Resources
Signs and Symptoms
Richmond is replete with the advanced medical services for patients coping with pancreatic cancer. Here is a summary of what each of the major health systems has to offer.
Early pancreatic cancer often does not cause symptoms, and the later symptoms may be nonspecific and varied. For that reason, pancreatic cancer is often not diagnosed until it is advanced. Common symptoms may include: • Pain in the upper abdomen that radiates to the back • Heartburn - acid stomach • Poor appetite or nausea and vomiting • Diarrhea • Significant weight loss • Diabetes • Jaundice - yellow tint to skin and whites of the eyes
Bon Secours Health System The Bon Secours Cancer Institute provides comprehensive, interdisciplinary and evidence-based cancer treatment, as well as supportive survivorship programs, for oncology patients throughout Virginia. The Cancer Institute has received referrals for rare endocrine tumors and peritoneal surface malignancies from across the nation, as well as international sites. The Bon Secours Cancer Institute combines the science to cure with the art of compassion to serve those in need, a cornerstone of Bon Secours’ care model. www.OurHealthRichmond.com
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The cancer team is made up of accomplished and renowned surgical, medical and radiation oncology experts, as well as certified oncology nurses and nurse navigators. Together, they offer the latest and most effective inpatient and outpatient cancer treatments. As the community’s caregiver, Bon Secours has taken definitive steps to treat the cancers that afflict our population. This includes bringing together the most skilled, internationally recognized cancer surgeons and researchers from such leading institutions as Memorial Sloan-Kettering Cancer Center, the National Institutes of Health, and Walter Reed National Military Medical Center. Bon Secours Cancer Institute has personalized cancer treatments for many tumor types including cancers of the breast, colon, lung, liver, stomach, kidney, pancreas, peritoneal surface, and endocrine organs such as the thyroid, parathyroid and adrenal glands.
has performed nearly 70 total pancreatic resections, including 42 Whipple procedures, at one of the highest volume pancreatic centers in Richmond.
cancer. Other services include genetic counseling, palliative care (pain and symptom management), support groups and the free Magical Touch Wig Salon.
At HCA Virginia, the multidisciplinary team discusses a patient’s care and plans for treatment, recovery and follow-up focused on the individual’s needs. Patients can see all specialists in one visit and receive personalized care from a nurse navigator, who provides guidance to patients and families, helping them to move smoothly from initial assessment and diagnosis to treatment and survivorship.
To schedule an appointment, get a second opinion or learn more about clinical trial offerings, call (877) 4-MASSEY or visit massey.vcu.edu.
With the largest multidisciplinary cancer care team in Virginia, HCA Virginia’s Cancer Care Network gives patients access to a wide range of medical experts from award-winning cancer facilities, including Thomas Johns Cancer Hospital at Johnston-Willis Hospital and The Cancer Center at Henrico Doctors’ Hospital.
The Cancer Institute is committed to delivering individualized, patientcentered, compassionate care This care is personalized to meet the medical, social, emotional and spiritual needs of each patient.
To learn more, call the HCA Virginia Cancer Care Network at 804.HCA.CARE (804.422.2273) or visit hcavirginia.com/ service/cancer-care.
Currently, Bon Secours is conducting multiple clinical trials, one of which addresses the unmet needs in pancreatic cancer research today.
VCU Massey Cancer Center is recognized as a Complex and Rare Cancer Center by Blue Cross & Blue Shield due to its’ success in treating complex cancers such as pancreatic cancer. Massey pioneered the multidisciplinary treatment approach in the region, and continues to lead the way with the largest and most comprehensive teams of nationally renowned medical and radiation oncologists, surgeons, pathologists, imaging experts, clinical researchers, social workers and others. This coordinated, personalized care culminates in rapid diagnosis and the best possible outcomes for patients.
Nearly 240 patients with pancreatic cancer are seen at Bon Secours each year. For more information on the pancreatic cancer study, call 804.893.8681.
HCA Virginia HCA Virginia is the only community health system with clinics and experts dedicated to particular types of cancer such as pancreatic and hepatobiliary (liver, gallbladder and bile ducts). Among the specialists is D. Michael Rose, MD. Dr. Rose is Medical Director of Surgical Oncology at Johnston-Willis Hospital and medical director of the Thomas Johns Cancer Hospital. Since 2009, Dr. Rose 56
VCU Massey Cancer Center
In addition to offering treatments such as the Whipple procedure, minimally invasive robotic surgery, chemotherapy and radiation therapy, Massey conducts clinical trials testing cutting-edge therapies and medical devices to find better ways to prevent, detect and treat pancreatic
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Expert Contributors Thanks to the following medical experts who shared their time and knowledge to provide the technical information for this article, and especially for their tireless dedication to pursue more effective ways to treat—and ultimately cure—pancreatic cancer. • Steven M. Duffy, MD, Bon Secours Cancer Institute Medical Oncology at St. Mary’s Hospital • Steven R. Grossman, MD, PhD, Deputy Director, hematologistoncologist and Dianne Nunnally Hoppes, Endowed Chair in Cancer Research at VCU Massey Cancer Center • Brian J. Kaplan, MD, Surgical Oncologist at VCU Massey Cancer Center and Professor in the Department of Surgery at the VCU School of Medicine • D. Michael Rose, MD, Surgical Oncologist, Medical Director of Surgical Oncology at Johnston-Willis Hospital and Medical Director of the Thomas Johns Cancer Hospital • Alexander Stojadinovic, MD, Medical Director, Bon Secours Cancer Institute, Professor of Surgery and Professor of Medicine, Uniformed Services University, (Bethesda, MD)
Additional References • American Cancer Society • National Cancer Institute, General Information about Pancreatic Cancer
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HealthyEats Fruits and vegetables have a prime time when they are at their seasonal best. Some are great for over half of the year; others only hit their peak for a month. Either way, peak season means extra flavor, extra crunch, extra juiciness—all super-fresh and great value. Shopping seasonally not only helps your budget, but offers a great way to add variety to your diet. At Good Foods Grocery, we work closely with local farmers to bring you farm ripened, fresh picked produce.
Easy Roasted Asparagus Serves 4
Ingredients: 2 pounds asparagus 1 T. olive oil 1 tsp garlic 1 tsp grated lemon peel 1 tsp parsley
Salt and pepper to taste
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Good Foods Grocery
3. Lay the asparagus spears out in a single layer in a baking dish or a foilcovered roasting pan. 4. Mix olive oil and garlic together and drizzle over the spears. 5. Roll the asparagus back and forth until they are all covered. 6. Place in oven for 8-10 minutes until lightly brown and tender. 7. Sprinkle evenly with lemon zest, parsley and salt & pepper.
Directions: 1. Preheat oven to 400°F. 2. Rinse clean the asparagus and break off the ends.
Good Foods Grocery’s
ROASTED ASPARAGUS
Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodsgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | 804.740.3518 | Stony Point Shopping Center (Southside) | 3062 Stony Point Road | 804.320.6767
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Black Bean Salad Serves 6
Ingredients: 6 cups canned black beans, drained & rinsed ½ cup minced red pepper ½ cup minced red onion 4 T. minced cilantro 2 cups roasted corn 2 T. scallion 2 T. cilantro
Ingredients for Dressing: 1 T. cumin 1 tsp coriander 1 tsp garlic 1 T. lime zest ½ cup olive oil 3 T. lime juice
Salt & pepper to taste
Directions: 1. Mix salad ingredients in a medium bowl and toss. 2. In a separate bowl, combine dressing ingredients and pour over salad. 3. Toss again. 4. Chill for 1 hour before serving. Salad can also be served at room temperature.
Good Foods Grocery’s
BLACK BEAN SALAD
Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodsgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | 804.740.3518 | Stony Point Shopping Center (Southside) | 3062 Stony Point Road | 804.320.6767
HealthyEats Gluten Free Fudge Brownies
Directions
Ingredients
3. Melt butter & chocolate over double boiler, blending gently. Allow to cool slightly.
½ c. chocolate chips, unsweetened 6 oz butter
2. Spray 9 x 9 pan with nonstick spray.
4. Combine eggs, sugar & vanilla in a mixing bowl.
3 whole eggs 1 c. + 2T turbinado sugar 1 t vanilla extract 1
1. Preheat oven to 375ºF.
T. baking soda
¼ c. Bob’s Gluten Free flour ½ c. walnuts (optional)
5. Beat using wire whisk until thick and light in color. Scrape down sides of bowl as needed.
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6. Blend 1/3 of the egg mixture into the chocolate-butter mixture. 7. Blend chocolate mixture into egg mixture, scraping down sides of bowl as needed. 8. Add flour, baking soda, and nuts blending gently. 9. Batter will be wet. 10. Pour into prepared pan. 11. Bake for about 45 – 50 minutes, or until crust forms but product is still moist in center. 12. Allow to cool completely before cutting and unmolding.
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ADHD
GROWING UP WITH
words | LAURA NEFF-HENDERSON, APR
ADHD Diagnosis and Treatment Brings Relief to Richmond Family of Five Growing up with ADHD
Paula Phieffer grew up in the suburbs of Andover, Massachusetts, an affluent town in Essex County, with her mother and father. By all accounts, Phieffer and her older brother and sister had it all. They had parents who loved each other and their children, financial stability, and access to the best schools and community resources. The Phieffer’s read to their children regularly, and exposed them to arts and cultural activities in the community. While her siblings excelled academically, Phieffer struggled. She did well in elementary school, but that began to change in sixth grade. For many students with ADHD, their unraveling begins in middle school when the demands for productivity, independence, and organization increase dramatically. This is a time when there is a sharply increased demand on the “executive functions” of the brain. In elementary school, students are not expected to monitor themselves, keep track of time accurately, keep their own schedule, or plan, organize, and prioritize. Those responsibilities tend to fall to the child’s parents and teachers. That’s not the case in middle school though, when students are suddenly expected to adapt to a complex schedule, multiple teachers, and greatly increased organizational demands.
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Individuals who learn how to harness the impulsivity that’s characteristic of the disorder are more apt to pursue the things they want in life —often with great success.
By the time Phieffer started high school, it was clear to everyone around her that she had a problem. Her grades plummeted and she was always in trouble at home. Her relationships with her friends, classmates, teachers, and parents suffered. Within a few months, her teachers had begun to write her off, chalking her “problems” up to an unwillingness to work hard. Phieffer spent a lot of time in the guidance counselor’s office. “They were trying to figure out what was wrong with me,” she says. At the same time, Phieffer was struggling to figure that out too. It was hard, she says, to be the failure in the family. I was disappointed in myself.” “The school counselor was my best friend my senior year,” she says. “I went to her every day.” All the while, her brother and sister, three and four years older respectively, had excelled through a private high school, graduating with honors. They were also both doing well in their undergraduate college programs. After high school, Phieffer took a year off, and then went on to community college. During her two years there, she changed her major several times. She went from wanting to work as a nurse to an executive secretary to a travel agent. In 1994, at the age of 21, she finally gave up – resigned to the fact that she would never earn her associates degree, much less go on to get a bachelor’s degree at a four-year college or university. From 1994 to 2010, Phieffer had a string of minimum wage jobs, working as a waitress and a nanny. When times got really tough, Phieffer found herself up early picking through items left on the curb for trash pickup in the cities she lived in.
Stephanie Smith, MD, FAAP is the medical director of Focus-MD in Mechanicsville, VA
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She hadn’t become a doctor, like her sister, who also lives in Richmond and is married to an attorney, or her brother, who’s a civil engineer and is married to a surgeon, but she’s getting by.
Adult Diagnosis It would take more than a dozen very difficult years and several doctors before Phieffer figured out what was wrong. At 37 years old, two years before she moved from Ohio to Richmond, Va., she was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The underlying problem for patients with ADHD lies in not having enough of the brain chemicals (neurotransmitters) that allow the brain to focus. ADHD wasn’t something that anyone had ever considered when she was growing up, says Phieffer. Perhaps because her mom was opposed to medicine and probably because ADHD just wasn’t something people knew much about, or talked about back then, says Phieffer. “It was a totally different time when I was growing up,” says Phieffer. These days, Phieffer takes Adderall, which has been a godsend, she says. “I’m so much more focused and optimistic,” she says, explaining that before she was on the medication, she was also struggling with the depression associated with feeling like she couldn’t do anything in life. “Now I can actually make and complete a list for the day,” she says. “Back then, I couldn’t get anything done.” Phieffer strongly believes that her life would be very different if she had been diagnosed as a child.
Phieffer could then sell the items to local thrift and consignment stores. She also collected metal and other recyclable materials and turned that in for cash. On a good day, she would make about $125. It wasn’t much, she says, but it was enough to at least make ends meet.
“If I had been taking this medication back when I was in high school, I’m sure I would have been as successful in life as my brother and sister who don’t have ADHD are.”
“Times were tough, but I wanted to teach my kids that ‘if there’s a will, there’s a way’, says Phieffer. “That’s the motto I live by every day, it’s what’s gotten me though all these years of struggling.”
Phieffer’s story doesn’t end there. She and her longtime boyfriend, have three daughters, ages 11, 9, and 2.
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A Family Affair
Focus-MD is a medical practice for children and adults with ADHD and related problems, and devoted solely to individuals with ADHD. The company has eight offices in four states; Alabama, South Carolina, North Carolina, and Virginia. The practice was founded by James Wiley, MD. Focus-MD doctors maintain very close relationships with all of their patients via regular office visits, phone calls, and emails. They work with adolescent and adult patients to consider behavior modification, tutoring/coaching, and nutrition - all of which play a role in ADHD management – and tailor treatment to the individual patient. During the last few years, both of her older daughters and boyfriend have all been diagnosed with ADHD. Phieffer suspects that her two year old will have to be tested for the disorder when she gets older.
about everything, says Phieffer.
Stephanie Smith, MD, FAAP, is the medical director of FocusMD on Chamberlayne Road, in Mechanicsville, VA. FocusMD is a medical practice for children and adults with ADHD and related problems, and devoted solely to individuals with ADHD. Dr. Smith treats Phieffer, her long-time boyfriend and their two older daughters.
Even in families where no one has been diagnosed with ADHD, it’s likely that one of the parents has ADHD – even if it’s very mild, explains Dr. Smith. Often, people who are undiagnosed learn to adapt and mature.
Phieffer and her boyfriend have also both been diagnosed with anxiety, which is a common secondary diagnosis for individuals with ADHD, according to Dr. Smith. “Anxiety, depression, and ODD (oppositional defiance disorder) go in hand-in-hand,” says Dr. Smith, who was diagnosed with ADHD as a child. “I began to see the signs in my older daughters and knew we needed to see a doctor,” says Phieffer explaining that she couldn’t ignore the signs. Pheiffer’s 11 year old daughter, who is in fifth grade at Short Pump Elementary School (SPES), has learned to manage her impulsiveness and hyperactivity since she began taking medication to help with her ADHD symptoms. Her middle daughter, who is nine years old and in third grade at SPES, has had speech therapy, occupational therapy, and physical therapy to overcome some developmental weaknesses. She’s also struggled with reading comprehension, but has progressed dramatically since she began taking medication. “She’s making straight A’s now and I tell her all the time that she’s a math genius,” says Phieffer. Both girls have struggled with self-esteem and confidence, but have really grown assured now that they feel better about just
The exact causes of ADHD are not known with certainty, but experts do know that ADHD has a strong genetic component.
The good news is that their home is a much happier place to be now that they’ve all been diagnosed and are receiving treatment. “There’s not as much arguing, tasks are completed, we are all just more focused,” says Phieffer. “It’s led to a much better family life for us. We are all more at ease, because we don’t fight constantly anymore.” “ADHD is really a family diagnosis,” says Dr. Smith. ADHD doesn’t just affect the child, it affects the whole family.” Dr. Smith advises the parents of her adolescent patients to do plenty of research and to ask questions about the disorder to make sure they understand it. “It’s a big diagnosis, and much of this is really complicated,” said Dr. Smith. “The biochemistry of dopamine and its impact on medication – and how those things affect you – there are just so many details.”
Understanding and Recognizing ADHD ADHD is one of the most common childhood disorders, with an estimated 5.4 million children diagnosed in the U.S., according to the U.S. Centers for Disease Control and Prevention. That equates to approximately 9.5 percent of American children between four and 17-years-old. While still commonly used in conversation, ADD is the antiquated term for ADHD. In medical literature, the term www.OurHealthRichmond.com
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ADD has been dropped. The condition, briefly classified as two separate disorders, includes three different kinds of ADHD: hyperactive-impulsive, inattentive, and combined. People tend to think of ADHD in terms of the most well-known symptoms of hyperactivity and impulsivity -- symptoms more often exhibited in boys. But ADHD in children can also take other forms, particularly in girls. Forgetfulness, being easily distracted losing or misplacing things, disorganization, academic underachievement, poor follow-through with assignments or tasks, poor concentration and poor attention to detail are other ADHD symptoms. Boys with ADHD are typically more hyperactive and impulsive. Girls with ADHD are often more likely to be inattentive than hyperactive or impulsive. “They’re often the day dreamers,” says Dr. Smith. Because girls are quieter and often keep to themselves, they don’t catch the attention of the teacher as frequently as boys in the classroom with ADHD, who can’t sit seem to sit still and often disrupt the class. Unfortunately, that means boys are diagnosed more often and girls tend to be under diagnosed.
Stereotypes These days, ADHD is said to be over diagnosed, and kids are believed to be over medicated. The stereotypes abound, and it seems everyone has something to say about kids with the behavioral and academic problems associated with the diagnosis. “ADHD is the most extensively studied pediatric mental health disorder, yet controversy and public debate over the diagnosis and medication treatment of the disorder continue to exist,” according to Psychiatric Times. Many parents fear an ADHD diagnosis, afraid their child will be labeled. “The truth is that patients with ADHD are already labeled or more accurately mislabeled,” says Dr. Wiley. “Younger kids may be labeled as having behavior problems while teenagers get tagged with being lazy or underachieving as though they were choosing to underperform. Adults are often labeled unreliable or underperforming.”
Medication Medication is also a huge concern for parents, and rightfully so, says Dr. Smith. While parents should proceed with medication cautiously, Dr. Smith always talks with patients about how research shows that ADHD medications have almost no long term side effects, and are among the safest long term medications in use. 64
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Dr. Smith assures them that long term studies have significantly decreased or eliminated concerns about heart issues, chemical dependence, addiction, and growth problems. It is also important for parents to know that medication doesn’t cure ADHD. It provides relief of symptoms. When the medication is stopped, the symptoms return.
Finding the Right Medication can be Incredibly Difficult, too “There’s no blood test. No way to tell which family [of drugs] works best for each patient,” says Dr. Smith. “The only way to determine what will work for each patient is to try.” There are more than 50 different medications currently on the market for the treatment of ADHD, including stimulants, and nonstimulant drugs that come in various short-acting (immediate release), intermediate-acting, and long-acting forms. These medications come in liquid, chewable, and capsule forms. Stimulant drugs that treat ADHD include Adderall and Adderall XR, Concerta, Dexedrine, Focalin and Focalin XR, Metadate CD and Metadate ER, Methylin and Methylin ER, Ritalin, Ritalin SR, Ritalin LA, Vyvanse, Daytrana, and Quillivant XR. Nonstimulant medications include Strattera, Intuniv and Kapvay, for use alone or in combination with a stimulant, to enhance effectiveness. These medications can all improve concentration and impulse control. When stimulants and nonstimulants are not effective or welltolerated, or when certain conditions are present, several other medications are available to treat ADHD. These medications include: Elavil, Norpramin, Pamelor, Tofranil or other tricyclic antidepressants, Catapres, Duraclon, Kapvay, Nexiclon, Tenex, and Wellbutrin. As children grow physically, and especially during puberty, medications often stop working and the family has to find another medication that will work. The majority, about 90 percent of Dr. Smith’s patients, are on medication. For those patients who don’t want to take medication, we work on diets and behavioral strategies,” says Dr. Smith.
In the Classroom Dr. Smith also works with the parents and teachers of her adolescent patients to create school environments in which children can thrive. Students with ADHD benefit from structured schedules and small class sizes. They also need to sit in front of class and shouldn’t be near windows or anything else that could
be a distraction. Some children do well with a fidget toy and others benefit from highlighters they can use to color code assignments. When it comes to that structured schedule, most elementary age students with ADHD benefit from being in a classroom where the daily schedule is “written down on bright colorful calendar hanging on the wall,” says Dr. Smith. Fidget toys, which come in all different shapes, sizes, and textures, are self-regulation tools that help with focus, attention, calming, and active listening. Almost all children with ADHD require extra time to get assignments and tests completed, and need breaks about every 15 minutes while doing independent work. Kids with ADHD also tend to have terrible handwriting. What’s most important, Dr. Smith says, is that they learn the material, by whatever means necessary. Rather than allowing students to get caught up with, and frustrated by, having to write things down, Dr. Smith advises teachers and parents to allow children to use tablets and computers instead of writing things down. She also suggests to teachers that children with ADHD be allowed to help in the classroom by handing out papers, sharpening pencils, delivering things to the office – anything that gets them up and moving. For middle and high school students, a secret symbol can often make all the difference. Teachers who use some sort of secret symbol (a handshake, nod, tap on the shoulder, hand on the desk, etc.) with teenage students are able to make the student aware of what they are doing without the student feeling embarrassed. When embarrassed, these students will often react negatively and become oppositional. “It’s a matter of working with the child instead of against them,” says Dr. Smith “to reduce the possibility of conflict in the classroom.” While these accommodations can sometimes be a challenge for educators, they make all the difference for children who are struggling to be successful in the classroom and at home. And often, kids with ADHD are the smartest in the classroom.
Learning to Manage ADHD “You don’t grow out of ADHD, you learn to adapt,” says Dr. Smith. As children mature into adults, they learn they can’t run around during a meeting. Instead, they tend to fidget. They might twirl their hair, tap their legs, repeatedly take the cap on and off the pen, etc. The five year old who used to throw a ball at his sister often www.OurHealthRichmond.com
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becomes a seventeen year old who swerves his car into other lanes. Traffic accidents and speeding are two of the most common struggles that young adults with ADHD face. “ADHD is not an excuse,” says Dr. Smith. “It’s not a reason to be lazy. We just learn differently. Things are harder for us, by they are not impossible,” says Dr. Smith.
The Bright Side of ADHD ADHD is associated with positive attributes, such as creativity, a drive to achieve, a tendency toward entrepreneurship, and “out-of-the-box” thinking.
Some of the Most Successful Individuals with ADHD Include: • Walt Disney, founder of Disneyland • Michael Phelps, most decorated Olympian of all time • Justin Timberlake, singer/actor/producer/businessman • Jim Carrey, actor/comedian/producer • David Neeleman, JetBlue Airways founder • Will Smith, actor/producer/rapper • John F. Kennedy, 35th president of the United States • Albert Einstein, theoretical physicist The very same hyperactivity that can be problematic in certain situations can be very valuable in other situations, especially when it comes to getting things done. Individuals with ADHD typically excel in career fields that require fast talking or movement, such as working as a real estate agent, physical therapist, or retail manager. Individuals who learn how to harness the impulsivity that’s characteristic of the disorder are more apt to pursue the things they want in life -- often with great success. Additionally, some people with ADHD feel things very deeply. Being a sensitive person can make you a good friend, a caring partner, and a sympathetic human being. Sensitive people bring a lot of great qualities to their relationships, such as compassion, caring, introspection, and conscientiousness. On the relationship front, adults with ADHD may take in more details in their environment, grasp more in certain situations, and perceive more about the people they encounter. Having a broader view, or the ability to capture lots of clues, can help people with ADHD hone their intuitive skills. That’s a very helpful skill in life -- especially when it comes to forging close, interpersonal relationships.
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders, and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).
ADHD has three subtypes: • Predominantly hyperactive-impulsive • Most symptoms (six or more) are in the hyperactivity-impulsivity categories. • Fewer than six symptoms of inattention are present, although inattention may still be present to some degree. • Predominantly inattentive • The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree. • Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD. • Combined hyperactive-impulsive and inattentive • Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present. • Most children have the combined type of ADHD Source: National Institutes of Mental Health
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CareMore’s Patterson/ Richmond West office
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Healthcare Focused on Treating the Whole Senior Citizen A Holistic Approach Saves Seniors and Medicare Money While Improving Health
management Many senior programs located citizens will in four CareMore agree that aging words | RICH ELLIS Care Centers in select is accompanied by a zip codes in Richmond and unique set of benefits, surrounding counties. not the least of which is knowledge and wisdom gained through life In addition to helping protect seniors’ and experiences. But, seniors are also quick to point Medicare’s finances, CareMore describes its mission out that aging’s benefits come with a hefty price – as providing innovative healthcare for the complex health problems that often appear and grow in direct problems of aging, prolonging members’ active, proportion to one’s age. independent lifestyles, and providing support, One company has made it their mission to help education and services to caregivers and family seniors manage their diseases, improve their health, members. and save money, while at the same time helping Medicare save money too. That company is CareMore. Driving that mission is CareMore’s belief that the current healthcare model for seniors is flawed, in that healthcare delivery is fragmented and inefficient. On Who They Are its website, the company cites a statistic that shows Headquartered in Cerritos, California, and founded seniors with a serious medical condition see, on in 1993 by physicians focused on chronic disease average, 11 physicians. This leads to a lack of care management, CareMore functions today as both a coordination, which in turn yields poor results and health plan and as a provider of care in four states – increased costs. Arizona, California, Nevada and Virginia. It serves as a health plan through provider partners – in Virginia; it CareMore’s health plans are Medicare Advantage is available exclusively to members enrolled in Anthem plans. Members have to be either 65 or disabled to HealthKeepers MediBlue Medicare Advantage participate, which essentially means that anyone plans – and as a provider of care through disease who qualifies for Medicare qualifies for CareMore. www.OurHealthRichmond.com
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The CareMore Model Linda Larue, based in Richmond, is CareMore’s general manager in Virginia. She explained CareMore’s focus on treatment and prevention. “CareMore is a holistic approach to healthcare that includes partnering with our member’s primary care physician to make sure we’re helping the primary care doctor care for those members, especially the ones with chronic conditions,” she explains. Their solution is based on the CareMore model or wheel, at the center of which is the patient, surrounded by the patient’s primary care provider, a CareMore Care Center, a CareMore Case Manager, and what CareMore calls “Extensivists.” Ross Girardi at CareMore's Patterson/Richmond West Office
“The primary care physician is still the captain of the ship,” Larue explains. “We don’t replace them – we supplement what the primary care physician does for that member.” Disease management programs – which form the wheel’s outermost ring – are at the heart of CareMore’s integrated health delivery. These programs generally fall under one of two categories – programs for the frail, or programs for chronic conditions. Programs for the frail include “Shape Up. Levels Down.™ Exercise and Strength Training,” home care, mental health programs, social services, podiatry, and hospice, as well as others. Programs to manage chronic conditions include those targeted at diabetes, end stage renal disease, chronic obstructive pulmonary disease, and hypertension and congestive heart failure. The supplemental care is delivered through several avenues, the first of which are the CareMore Care Centers. The Centers focus on proactive, integrated health care through a combination of wellness and medical supervision. The second avenue through which CareMore delivers supplemental care is through CareMore’s Extensivists – a group of doctors tasked with visiting hospitalized CareMore members to monitor each patient’s care. “They’re called Extensivists,” Larue explains, “because their care goes beyond the hospital – it extends out into a skilled nursing facility, for example. They also follow patients back to the Care Center to make sure patients have the appropriate follow up.” CareMore Case Managers Make Up the Third Avenue. “Our case managers reach out and touch every single one of our members,” Larue says, “especially those that are in the hospital. They will make sure that before a patient is discharged, they have anything they need for home health, they have wheelchairs, they make arrangements if the member needs to go to rehab, or if they need to come back to the Care Center.” The holistic approach to health care generates impressive results, according to data provided by CareMore. These results include fewer hospital admissions than the national average, dramatically decreased falls and fractures in frail seniors, reduction in bed days for patients, reduced instances of stroke over the long term, and amputation rates – often a result of vascular disease brought on by diabetes – that are below the national average.
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Receiving the Help He Needs One CareMore member, who says the program helps him, is Ross Girardi of Richmond. Girardi, who is in his 70s, and his wife, Rae, are both members. He says that one of the first things CareMore did for him was help him sort out all his medications. “They have a pharmacist [at the CareMore Care Center] who’s unbelievably helpful,” Girardi explains. “He went over all my medications when I brought them in, took the time to look at each one and tell me what it was for, and he even wrote it on the bottle. I want to know what each drug is for and what it means for me.” Girardi said the physicians at the Care Center also examined his feet, and provided him with helpful information related to foot care that no one had ever told him before. “They are the most receptive, friendliest, most knowledgeable people that I have seen in a long time,” Girardi says, “everyone from the doctors to the nurses to the staff. They know who you are after just the first visit. I have nothing but good things to say about them and I tell a lot of my friends. They’re just great, great people.” Girardi knows a thing or two about dealing with people too, having served as a salesman for Mohawk Flooring for many years and traveling extensively throughout Virginia and West Virginia as part of his work. “With the CareMore people – I’m totally comfortable about calling them or going there to ask them a question about insurance or if we’re covered for something or even where to look,” Girardi explains. “They’re nice people, and not just for a short period of time, but all the time.” What sparked Girardi’s initial interest in CareMore was their “Nifty After 50” program, the centerpiece of which is a gym at the Care Center tailored specifically to seniors. “Everything is hydraulic and low to the ground,” Larue explains in describing the gym’s machinery. “You won’t find treadmills at our Center because they tend to be dangerous but you will find, for example, a recumbent stair stepper.” Members first meet with a personal trainer to complete an assessment that helps confirm that they are physically well enough to use the machinery, which includes evaluating their balance. Each member also receives a fob that they insert into each piece of exercise equipment. The fob contains that member’s specific information, such as how much weight they’re lifting and how many repetitions they’re performing on a specific machine. Each machine is automatically programmed and set www.OurHealthRichmond.com
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up for them based on that information. The gym also features prescribed exercise programs that are designed specifically for patients suffering from a particular disease, such as COPD, to help them maintain or improve their fitness levels. Another part of the holistic equation that the Centers fulfill relates to members’ social needs. Whether through aerobics classes, yoga or quarterly coffee club meetings, members have opportunities to socialize, and that can be powerful medicine.
Caremore Saved My Life
“They’re nice people, and not just for a short period of time, but all the time.” – Ross Girardi
“One member said to me, ‘I think CareMore saved my life,’” Larue recalls. “She said when she retired from work, she tended to sit and watch TV, and eat, and continue to gain weight, and she became very depressed. She joined CareMore last year and said that the personal trainer got her into Nifty After 50 and worked with her three or four times a week. As a result, she lost 60 pounds, got off all her depression medication, her diabetes was well-contained, and she was generally much happier. Even though she was followed by the clinician, it was really the exercise, the friends and the social activities that helped her become happier and have a generally better sense of well-being.” Larue uses the analogy of preventive maintenance for a car when discussing the Care Centers. “You take your car in for a tune up, and that’s really what the Care Center is for – you’re coming in for a tune up with your diabetes or exercise program, and that’s going to make you last a lot longer.” The Care Centers are not designed to be used for urgent care or to serve as the members’ primary care physician. Today, CareMore has approximately 85,000 members, 75 percent located in Southern California. There are approximately 2,000 members in Virginia, following WellPoint’s acquisition of CareMore in 2012. “We believe that this is healthcare of the future,” Larue explains. “It’s very member-centric healthcare that goes back to preventive medicine and is very closely monitored by the case management. It deals with the fragmentation of healthcare. Our network is not a huge, huge network. If you look at a typical health plan, they’ll have thousands and thousands of doctors. Our model is more personal in that we contract with smaller numbers so that we know our doctors. It’s important for us to get to know our patients as well as their providers, and really be able to advocate on behalf of our members with their doctors.” Larue says that being a smaller network enables them to address the issue of fragmented healthcare so that members don’t have to see multiple providers and are referred to a specialist when they really need one. “You still get the care you need, but you’re not wasting resources,” Larue says. And for seniors, whether it is time, money, or their health, resources are definitely something they aren’t interested in wasting.
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CareMore FACTS • Founded in Southern California in 1993 by a group of physicians to treat senior citizens. • Acquired by WellPoint, Inc. in 2012. • Serves 85,000 members in California, Nevada, Arizona and Virginia. • 85% of members are located in California. There are 2,000 member patients in Virginia. • Serves as a Medicare Advantage plan and is open to anyone eligible for Medicare. • There are four CareMore Care Centers in Richmond, with expansion plans in other areas of Virginia. • CareMore’s Model – it’s a wheel • Patients are at the wheel’s center. • The patient’s primary care physician (PCP), along with CareMore’s case manager, Care Centers, and Extensivists surround the patient, with the PCP serving as the leader. • Disease prevention and treatment programs form the outer ring and include fall prevention, dietary counseling, strength training, a mental health program, strength training, podiatry services and many other avenues of care.
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where is this? Post the correct answer on our facebook page by June 7, 2014.
You could win some great food from Good Foods Grocery! Cool, right? The winner will be announced on our facebook page June 14, 2014.
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