Greater Richmond edition November/December 2012
UNINSURED RICHMOND and living in
* THE SCIENCE
OF SLEEP
*A DVANCEMENTS
IN LUNG CANCER TREATMENT
*C HILDHOOD
DEPRESSION
p. 16
our health | BASIC
table of contents | november/december 2012
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MEDI•CABU•LARY.....................10 Local experts define healthcare related terms
JUST ASK!..................................12 A variety of health questions answered by local professionals
THE LATEST...............................13 A listing of new physicians, providers, locations and upcoming events in the greater Richmond community
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COVER STORY Homeless in Richmond Where do more than 15,000 children in the local community turn for healthcare?
BASIC | our health
35
KIDS’ CARE
23
WEATHER PREPAREDNESS Get set for winter weather
Baby it’s cold outside: keeping kids warm this winter KIDS’ CARE.................................39 Overcoming dental anxiety in children
THE FOOT...................................41 What’s afoot in podiatry?
FINANCIAL HEALTH...................45 Medicare wellness visits: seniors missing out on free Medicare benefit
48
CUTTING EDGE lung cancer treatment in richmond
BODY BEAUTIFUL......................27 Winter time skin soothing solutions
SCIENCE OF SLEEP...................31 A long winters nap: creative napping
NUTRITION HEALTH..................33 Is everything I like bad for me?
SENIOR LIVING...........................51 Riverside PACE: a new model for senior care
MIND MATTERS..........................55 Childhood depression: beyond sadness
www.ourhealthrichmond.com | 7
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COMMENTS/FEEDBACK/QUESTIONS Our Health Richmond magazine welcomes your feedback. Please send your comments and/or questions to: “Letters,” Our Health Richmond, PO Box 8383, Richmond, VA 23226. You can also call 540.355.3071 or send an email to steve@ourhealthvirginia.com Content in this magazine is for informational purposes only. It 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 OR OTHER PROVIDER. All matters concerning physical and mental health should be supervised by a licensed 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 ©2012 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. Our Health Richmond is published monthly by McClintic Media, Inc. www.ourhealthrichmond.com. Advertising rates upon request.
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our health | MEDI•CABU•LARY & JUST ASK
me d i • ca bu • l ar y
T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D
What is Dyspareunia?
What is achondroplasia dwarfism?
What is Respite Care?
What is mole mapping?
Dyspareunia is pain before, during or after sexual intercourse. Between 20 – 50 percent of women may be affected by this condition; however, the actual number is undetermined as many women are hesitant to seek medical treatment. Causes of the condition can include: over activity of pelvic floor muscles or misalignment of the pelvic bone. There are treatment options available to treat this condition, including specialized therapy services performed by physical therapists.
This dominantly inherited disorder is the commonest form of shortlimbed dwarfism. The defect is an inability to convert the cartilage to bone by the process of ossification. All individuals with achondroplasia have short stature, especially short arms and legs, a large head and prominent forehead. Fingers are short, movement at the elbow is limited. Most individuals with achondroplasia have normal intelligence. Other health issues include problems from narrowing of the spinal canal, hydrocephalus (build up of fluid in the brain) and instability of the neck vertebra. The genetic change resulting in achondroplasia is identified and can be tested for.
Respite care can be defined as short-term, temporary relief to those who are caring for family members who require assistance with daily activities. Millions of Americans provide unpaid assistance each year to elderly family, friends, and neighbors to help them remain independent. Often these caregivers utilize respite care to balance their own daily activities and lifestyle. Respite provides the family caregivers with the help and break they need, and also ensures that their loved one is still receiving the attention that he or she needs. Some models of respite included in-home care, facilities and adult day care.
Mole Mapping: The patient steps onto a platform where cameras scan or take pictures of the patient capturing and tracking the skin’s surface from head to toe. The computerized system creates an accurate set of photos of moles. The high-resolution camera is connected to a computer and transfers all photos to the practice’s database. Each mole in the system is rated and assigned a risk score. A periodic sideby-side comparison of baseline and yearly follow-up overview pictures accurately tracks changes. Suspicious moles can be viewed through a dermoscope (second camera that can greatly magnify moles). “This service is part of the advanced preventative testing that you will find at the n1 Executive Health Group.”
If you sprained you ankle and couldn’t walk, would you get treated? You probably would. It’s not so embarrassing when you think about the musculoskeletal dysfunction of the pelvic muscles in that way. Please consider treatment and resolve your pain or “charlie horse” in the muscles surround the vagina. Cora T. Huitt PT, DPT, BCB-PMD Women’s Health Physical Therapy Richmond | 804.379.3002
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Arti Pandya, MD Associate Professor, VCU Department of Human and Molecular Genetics Children’s Hospital of Richmond at VCU
Joan Shifflett Always Best Care Senior Services Midlothian 804.912.5688
Christine D. Allen, MD n1 Executive Health Group Richmond 804.560.3295
our health | MEDI•CABU•LARY & JUST ASK
ju st a sk!
T H E L A N G U A G E O F H E A LT H C A R E E X P L A I N E D
What is the smallest bone in the body?
Why is good posture important for my overall health?
What is stress incontinence in women and how is it treated?
There are three small bones in the middle ear called the malleus (hammer), incus (anvil), and stapes (stirrup). These three bones transfer sound to the inner ear.
According to the renowned René Calliet, M.D. “To live a long, active, energetic life, few things matter more than good posture.”
Stress incontinence is the involuntary loss of urine that is generally associated with activity, such as coughing, sneezing, lifting or during exercise. Stress incontinence is extremely common and affects women of all ages.
The smallest of the three bones, the stapes (stirrup), is also the smallest bone in the body. The stapes averages 3.3 mm long. Rarely, the stapes forms incorrectly, or it can be fixed in place so that it cannot vibrate to amplify sound, or detached from the incus that is next to it in the chain. A child would have a stable hearing loss as a result that could be treated with a hearing aid or surgery if needed. We have tiny prosthesis to replace our bones that help us hear. Occasionally, someone can have a progressive hearing loss that is caused by a stiffening of the stapes such that eventually it becomes fixed in place and then cannot vibrate to amplify sound. Again, a hearing aid or surgery can improve this hearing loss. Amazing! Julie Kerr, MD Commonwealth Ear, Nose, & Throat Specialists PC Richmond | 804.525.4231
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A review of eight separate studies over a course of about 10 years indicates that there is strong evidence linking forward head posture to health disorders and disease. The following is a list of associated problems: increased pain, lower self-image, decreased function and activity, depression, muscle impairment, decreased respiratory function, significant risk of new vertebral fracture, and women with greater kyphosis were at increased risk for earlier death.
Having strong postural muscles and joint mobility is key to good posture.
Stress incontinence can be treated through conservative therapies including pelvic floor muscle strengthening. Behavioral changes such as changes to diet and fluid consumption, as well as weight loss, can also be effective. Minimally invasive outpatient surgeries are highly successful in patients not having success with conservative therapies. For example, a urethral sling is a synthetic support placed underneath the urethra to help restore continence. Your physician can help you decide which treatment is best for you.
Dr. William Roodman, DC, FIAMA Advanced Wellness Centre Richmond 804.673.9355
David E. Rapp, MD Virginia Urology Richmond 804.330.9105
Other studies confirm men are at similar risk.
Should I get a flu shot this year? Vaccination is the most effective protection against the flu. Everyone 6 months of age and older should be vaccinated. Certain groups are at a higher risk of developing serious complications from the flu and are highly encouraged to get their flu shot. High-risk groups include: • Patients with chronic medical conditions like asthma, diabetes, and chronic lung disease; • Patients older than 65 years of age; • Pregnant women; and • Those that live with or care for others who are at high risk of developing life threatening complications from the flu. If you have ever had a severe allergic reaction to eggs or a severe reaction to a previous influenza vaccination, please talk with your doctor before getting a flu shot. Victoria Rennie, MD Patient First Mechanicsville 804.559.9900
THE LATEST | our health
the l atest
N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S
Amy O. Marshall, MD Midlothian Family Practice division of Virginia Physicians, Inc. Midlothian | 804.744.0200
John Goreczny, MD Chesterfield Family Practice Center Richmond | 804.276.9305
Truc Lieng, MD Chesterfield Family Practice Center Richmond | 804.276.9305
Aarat M. Patel, MD Bon Secours Arthritis and Osteoporosis Center of Richmond Richmond | 804.217.9601
C. Greg Childress, MD CrossRidge Pediatrics & Internal Medicine Glen Allen | 804.755.7581
Mudassar Asghar, MD Bon Secours Neurology Clinic Chester | 804.285.6880
Ryan S. Raddin, MD Bon Secours Cancer Institute Medical Oncology at St. Francis Midlothian | 804.893.8717
William J. Irvin, Jr., MD Bon Secours Cancer Institute Medical Oncology at St. Francis Midlothian | 804.893.8717
Kumar Abhishek, MD Bon Secours Cancer Institute Medical Oncology at Memorial Regional Mechanicsville 804.764.7220
Steven M. Duffy, MD Bon Secours Cancer Institute Medical Oncology at St. Mary’s Richmond | 804.287.7804
Jay A. Shah, MD St. Francis Family Medicine Center Midlothian | 804.739.6142
Lubbna V. Alimohammad, MD Lee Davis Pediatrics Mechanicsville 804.730.4690
Uma Muthyala, MD Care Diabetes and Endocrinology Chester | 804.285.6858
James G. Bittner IV, MD VCU School of Medicine Assistant Professor, Department of Surgery Clinical Specialties: Robotic and laparoscopic foregut, complex hernia, primary and revisional bariatric, and solid organ procedures
Brian M. Cameron, MD VCU School of Medicine Assistant Professor, Department of Neurosurgery Clinical Specialties: Spine surgery, minimal access spine surgery
Judy L. Chin, MD, FACRO of Radiation Oncology Associates will now be serving patients in Colonial Heights. She will continue to see patients at the St. Francis location as well. 804.594.4900
lo cal relo cat ions Timothy J. Wallace, MD, PhD of Radiation Oncology Associates will now be serving patients at the office on the campus of Memorial Regional Medical Center. He will continue to see patients at the Reynolds Crossing location as well. 804.266.7762
Lang R. Liebman, MD of Radiation Oncology Associates will now be serving patients in the office at St. Mary’s Hospital. She will continue to see patients at the Reynolds Crossing location as well. 804.281.8350
www.ourhealthrichmond.com | 13
our health | THE LATEST
the l atest
N E W P H Y S I C I A N S , P R O V I D E R S , L O C AT I O N S A N D U P C O M I N G E V E N T S
Children’s Hospital of Richmond at VCU Building New Children’s Pavilion Children’s Hospital of Richmond at Virginia Commonwealth University began construction of a new Children’s Pavilion that will be the largest and most advanced outpatient facility dedicated to children in the region.
POPLAR SPRINGS HOSPITAL Earns ‘Top Performer on Key Quality Measures”™ Recognition from The Joint Commission Poplar Springs Hospital was named one of the nation’s Top Performers on Key Quality Measures by The Joint Commission, the leading accreditor of health care organizations in America. Poplar Springs Hospital was recognized by The Joint Commission for exemplary performance in using evidencebased clinical processes that are shown to improve care for certain conditions, including heart attack, heart failure, pneumonia, surgical care, children’s asthma, stroke and venous thrombo embolism, as well as inpatient psychiatric services. Poplar Springs Hospital is one of 620 hospitals in the U.S. earning the distinction of Top Performer on Key Quality Measures for attaining and sustaining excellence in accountability measure performance. Poplar Springs Hospital was recognized for its achievement on the Hospital Based Inpatient Psychiatric Services (HBIPS) measures. The ratings are based on an aggregation of accountability measure data reported to The Joint Commission during the 2011 calendar year. The list of Top Performers increased by 50 percent from its debut last year and represents 18 percent of more than 3,400 eligible accredited hospitals reporting data. “We understand that what matters most to patients at Poplar Springs Hospital is safe, effective care. That’s why Poplar Springs Hospital has made a commitment to accreditation and to positive patient outcomes through evidence-based care processes. Poplar Springs Hospital is proud to be named to the list of The Joint Commission’s Top Performers on Key Quality Measures,” says Richard W. Clark, CEO.
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The $168 million, 640,000-square-foot facility will house 72 exam rooms; a surgical area with two operating rooms and two procedure rooms; areas for diagnostic testing, imaging; and laboratory services. Construction also will include an attached parking garage with more than 600 spaces. It is being built adjacent to the existing Children’s Pavilion, across the street from the VCU Medical Center, and will bring under one roof the majority of outpatient pediatric services, which are currently spread throughout the medical campus. Sheldon Retchin, M.D., vice president for health sciences at VCU and CEO of the VCU Health System, said the pavilion speaks to VCU’s multiyear investment in people, programs and facilities that support the specific needs of children. Retchin highlighted milestones in children’s healthcare in Richmond from the joining together of VCU Health System and Children’s Hospital in 2010 to form Children’s Hospital of Richmond at VCU— the region’s only full-service hospital dedicated to enhancing the comprehensive, coordinated care of children—to increasing the medical and surgical faculty to more than 130 clinicians and clinician-scientists. John Duval, CEO of MCV Hospitals, said the Children’s Hospital of Richmond provides a continuum of care for children and cited several examples, including the development of a Center for Endocrinology, Diabetes and Metabolism; the creation of a comprehensive Concussion Management Program; and the establishment of the Pediatric Research Office that is actively managing more than 30 pediatric clinical trials. The pavilion, which is set to open in the summer of 2015, will have “clinic pods” organized for efficient multidisciplinary care. Each pod will include 12 exam rooms, a treatment room, support space and a centralized clinical team hub.
THE LATEST | our health
the l atest Virginia Cardiovascular Services Expands Reach in Central Virginia A heart attack can strike without warning. For many, it’s their very first sign of heart disease. With more than 8 million Americans suffering heart attacks each year, early detection is more important than ever. Virginia Cardiovascular Specialists (VCS) is expanding to serve more residents and identify heart disease long before symptoms appear. VCS will open its 6,000 square foot Harbourside location in Chesterfield in early October. VCS will open another office in Prince George by spring of 2013.
Ann E. Honeycutt, VCS Executive Director
“We are excited to expand our services, physicians’ schedules and accredited cardiovascular testing to the Southside of Richmond. The decision to expand was based upon our growing patient population and providing high quality outpatient care in convenient locations,” said Ann E. Honeycutt, VCS Executive Director.
Both centers will offer cardiology, vascular disease, and heart rhythm consultation as well as a full complement of accredited diagnostic testing onsite. These include: • Echocardiograms • Stress Testing: Nuclear, Echocardiogram and Exercise
“The first step to taking control of your heart health is understanding your risk,” said Dr. Ramesh Kundur, who practices out of the Harbourside location. “Consider your everyday habits, diet and frequency of exercise. Heart disease is also hereditary, so it’s always a good idea to learn about your family medical history.” Routine screenings for cholesterol levels, height and weight, BMI and heart rate help doctors determine risk of heart disease. As part of an open house event celebrating new Harbourside location, VCS will offer free health screenings from 9am-12:30 pm on October 13 and November 3. Residents can tour the center and have their screenings evaluated on site. Space is limited, so residents must register to participate by contacting Julie Miller at (804) 521-5815. “VCS has served the Richmond community for more than 35 years,” said Honeycutt. We are pleased to expand this legacy into the future with new locations, physicians and services offered in an independent setting.”
• EKG • Holter & Event Monitoring
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HOMELESS IN RICHMOND | our health
words | ANIKA IMAJO photography | ED IP
IN RICHMOND Healthcare is expensive. But not having it can be far costlier. And healthcare, like daily bread and shelter from the elements, seems most precious when access to it is limited or littered with obstacles. “If I want to live long and be a great-grandmother, I need to do something now,” says Toni, a 42-year-old mother who lost her home and health insurance after she was laid off. To get back on her feet, she entered HomeAgain’s Family INRICH Program (FIP), a transitional shelter and support resource for homeless women and their children in Richmond. But while she strives to make a better life for herself and her eight-year-old daughter, she’s plagued by worries about her health, wondering how she would cope with even minor illness or injury. Medicaid covers her eight-year old daughter, but Toni—now employed by a freight company—is still waiting to receive health benefits through her job. Like many people, she earns just enough to be ineligible for Medicaid but not enough to manage medical expenses. “I’m trying to be proactive and just eliminate any factors that would cause me to pay out of pocket,” she explains, saying she’s recently lost 40 pounds in an effort to offset her family history of high blood pressure and to be an active part of her daughter’s life for as long as possible. A number of Richmond families—about 1,040 men, women, and children—are homeless. Homeward, a planning and coordinating agency for local homeless services (and the source for the statistics used in this story), reports that 131 children sleep in area shelters each night. Of Richmond’s homeless, 9.4 percent are adults living with children and 41.2 percent of these adults are employed.
A number of Richmond families—about 1,040 men, women, and children—are homeless.
And when families are facing economic hardship, parents often put their healthcare last. “It’s a tragedy for families,” says Julie Bilodeau, Director of Operations at CrossOver Ministry, a free clinic for the low-income uninsured like Toni. How can a family function if a parent is ill and can’t afford treatment? How can they dig themselves out of poverty? Untreated health problems, Bilodeau points out, can make both parenting and employment difficult, if not impossible. “I personally believe that lack of good healthcare is a causal factor for many societal problems we deal with, whether it’s homelessness or unemployment or crime,” she says. Where the needs of people who struggle for food and shelter intersect with the passion and skill of those who treat them, local service organizations shine. One of Richmond’s two federally qualified medical centers, The Daily Planet opened its www.ourhealthrichmond.com | 17
our health | HOMELESS IN RICHMOND
Organizations such as The Daily Planet not only equip their clients to manage chronic illness, they also tackle the gamut of health issues—from the seemingly superficial to the potentially lifethreatening—that may impact their chances of survival and their opportunities for selfimprovement.
doors to Richmond’s homeless—and those at risk for homelessness—in 1969. Over the years, it has continued to find new ways to meet the needs of the people it serves. “The Daily Planet is key,” says Kelly King Horne, Executive Director of Homeward. “What really makes them stand out—not only in Richmond, but across the country— is their cultural competency in dealing with people in a housing crisis.” Caring for our indigent neighbors means recognizing the hurdles that often stand between them and the medical attention they require. In response, The Daily Planet goes to the places where the people most in need can be found. Its outreach sites include Homeless Point of Entry at the Conrad Center, Southside Child Development Center, and Richmond City Jail. “Transportation is such a barrier to our population,” explains Peter Prizzio, The Daily Planet’s Chief Executive Officer. “Early intervention, outreach in the community, is so important.” Its hospitable three-story home on West Grace Street, renovated in 2009, provides the “one-stop” convenience of multiple, coordinated services on site. Offering everything from primary, oral, behavioral, dental, and eye care to pharmaceutical and dietary counseling, the organization addresses the entire range of each client’s medical needs. Shared electronic records for the facility’s approximately 6,000 active patients streamline the process, which relies on cooperation between specialists and the active participation of all levels of employees. “The Daily Planet has been around for more than 40 years, so a lot of people know about it,” says Horne, “but I think they’d be surprised to see the sophistication of services. Anybody in the community would be comfortable going to that clinic.” According to The Daily Planet’s Medical Director Lisa Price-Stevens, MD, health problems among the homeless tend to progress unchecked. Without consistent access to medication and treatment, their conditions become more severe by the time they do receive medical attention. Organizations such as The Daily Planet not only equip their clients to manage chronic illness, they also tackle the gamut of health issues—from the seemingly superficial to the potentially life-threatening—that may impact their chances of survival and their opportunities for self-improvement. At the catastrophic end of this spectrum are diseases such as cancer. For example, Dr. Price-Stevens shares the story of a homeless man whose colon cancer was discovered and treated after a Daily Planet medical assistant—who met him at a soup kitchen—took action. “That’s all part of the integrated, shared-care model,” she says. “Our employees feel empowered, like they can make a difference.” At the other end of the spectrum are the less critical concerns that can make a huge difference to quality of life. “A toothache or cosmetic issues can really impact someone’s ability to get a job or how they think about themselves,” Horne explains.
Lisa Price-Stevens, MD is the Medical Director for The Daily Planet in Richmond.
Leaving behind an abusive marriage, 40-year-old “Carla” entered HomeAgain’s Family INRICH Program with her youngest son. She makes an income cleaning houses and offices and receives Medicaid benefits with limited dental coverage. A missing front tooth, which she lost in a car accident and can’t afford to replace, has left her discouraged about her prospects for finding better employment. “It has really knocked down my self-esteem,” she shares. “I used to have a pretty smile, but now I don’t smile a lot.”
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Untreated behavioral health issues are also among the challenges that confine many people to homelessness. “As they get more disabled by their problems, it becomes more difficult for them to overcome them and to get out of that vicious cycle of homelessness and illness,” notes Robert Osborne, Director of The Daily Planet’s behavioral health department. More than half of Richmond’s homeless population report having had a problem with alcohol or substance abuse at some point in their lives, and 34 percent report having had a mental health problem. In response to this need, The Daily Planet expanded mental health and substance abuse treatment resources. “A lot of people languish in homelessness because they don’t have benefits and they don’t qualify for benefits,” Osborne points out, explaining that substance abuse problems and the lack of treatment history necessary for demonstrating disabilities leave many people ineligible for assistance. Homeless veterans, who make up about 25 percent of The Daily Planet’s patients, experience a particularly high rate of behavioral health issues. About 20 percent of Richmond’s homeless are veterans, 21.5 percent of whom report being treated for posttraumatic stress disorder (PTSD). James Greenwalt, a 50-year old Army veteran, lost years of his life to self-destructive behavior and abuse of alcohol, cocaine, and methamphetamines. Unable to hold a job or keep a home, he eventually turned to the Veterans Administration (VA) medical system. He was diagnosed with severe depression, PTSD, and bipolar disorder–conditions that had gone untreated and unrecognized for decades. The VA referred him to HomeAgain’s Veteran’s Transitional Program (VTP), whose participants occupy 16 beds at the Hunter Holmes McGuire Veterans Center and eight beds at a downtown emergency shelter. Now receiving medical and behavioral health treatment through the VA, Greenwalt is applying for disability benefits and no longer feels the need to self-medicate. “Ever since I started taking medications and I’ve been leveling out, I haven’t even contemplated using drugs or alcohol,” he says. Daryl Goldsmith, who has worked as a VTP case manager since 2001, has observed an increase in both older and younger homeless veterans seeking assistance. But he also sees a trend toward younger homeless veterans seeking support sooner after their military discharge, which he attributes to increased outreach efforts on the part of the VA. Working with the VA, The Daily Planet commits half of the resources at its Safe Haven—a residential facility for the chronically homeless with severe mental illness —to veterans. Still, far more people are experiencing homelessness in Richmond than are officially counted. Free clinics, such as Fan Free Clinic and CrossOver, have fewer patients who live on the streets or in shelters, but these providers treat many people who reside on the couches of friends or family or share small apartments with multiple families. Overcrowded and inadequate accommodations, Bilodeau explains, are more common among CrossOver’s growing numbers of immigrant patients—from over 130 countries— whose responses to housing crises may reflect cultural distinctions.
More than half of Richmond’s homeless population report having had a problem with alcohol or substance abuse at some point in their lives, and 34 percent report having had a mental health problem.
our health | HOMELESS IN RICHMOND
“They’re not showing up in more traditional homeless places,” she notes. “I think, as we become more diverse, we’re going to have to reevaluate what we consider homeless.”
Bracing for Virginia’s possible expansion of Medicaid coverage in 2014, Richmond’s homeless service organizations anticipate a possible boom in demand for the care they provide—a demand they’ve already seen rise in recent years.
With three Greater Richmond locations, CrossOver offers primary healthcare, dentistry, HIV treatment, prenatal care, and a host of other specialized services. “Marie,” a 33-year old mother and participant in HomeAgain’s program, visited CrossOver when she was uninsured and suffering from shoulder pain. In addition to being treated by an orthopedist, she received nine months of physical therapy. “They have a wide range of doctors there,” she recalls. “It’s kind of amazing.” Providing preventive care and medical homes for their patients, organizations such as CrossOver and The Daily Planet help ease the burden that emergency rooms bear. With the cooperation of VCU Medical Center, Bon Secours, and the Hospital Corporation of America (HCA) System, they save the community money by giving people a place to turn for treatment of less urgent medical issues. Bracing for Virginia’s possible expansion of Medicaid coverage in 2014, Richmond’s homeless service organizations anticipate a possible boom in demand for the care they provide—a demand they’ve already seen rise in recent years. According to Prizzio, The Daily Planet saw more new patients during the economically trying years of 2009 and 2010. Among them, about 40 percent had been impacted within the prior six months by circumstances that most of us have come to understand —loss of jobs, insurance, or homes. “If you can say anything good has happened because of the economic downturn, it’s that everyone’s been able to personalize homelessness a little bit more. They know someone who’s lost their job, may even have lost their home, or had to file bankruptcy,” he remarks. Daniel Jannuzzi, MD, CrossOver’s Medical Director, has also seen something heartening arise from the hardship. “Our patient load has doubled since the recession, but our expense budget has remained flat,” says Dr. Jannuzzi, whose tenure with CrossOver dates back to 1989 when the clinic provided care at The Daily Planet. “But we’ve been able to accommodate the huge surge in patients with a surge in volunteer professionals,” including VCU students and faculty. In return, the volunteers receive valuable experience in giving back to the community. “As clinicians, that’s part of our professional ethic,” Dr. Jannuzzi points out, “and for students to see that in action, that’s probably more important than what they learn about blood pressure and diabetes.” Partnering with each other and with the major area health systems, Richmond’s homeless service organizations work tirelessly to meet mounting needs on limited budgets. But armed with their single most valuable resource – the people who pour their expertise, imagination, and energy into caring for our neighbors in need – they serve our entire community.
Daniel M. Jannuzzi, MD is the Medical Director for CrossOver Health Care Ministry in Richmond. photo courtesy of Hal Tyler
“I’ve enjoyed all different types of medicine, but the most rewarding has been in public health, working with the underserved,” says Dr. Price-Stevens. “That’s my true calling.”
For information about assistance available in Richmond, Homeward recommends calling 211. Homeless Point of Entry can be reached at 648-4177. 22 | www.ourhealthrichmond.com
WEATHER PREPAREDNESS | our health
GET SET FOR
WINTER WEATHER words | RICK PIESTER
It won’t be long now. In the Richmond area, we really start to feel winter’s chill in December and January, and in normal years, we can look for snow during those same months. Although we normally don’t get buried in snow—roughly a foot a year, according to Our Health media partner CBS6 (WTVR) chief meteorologist Zach Daniel—we’re always subject to sub-zero temperatures and the rare but dangerous blizzard or freezing rain that can bring everything to a halt for days. If that should happen, it’s almost certain that heat, power, and communications in your home or office will be interrupted — for hours, days, or longer. You’ll feel better prepared if you set aside the supplies you need to survive on your own for as long as 72 hours. The National Weather Service refers to winter storms as the “Deceptive Killers.” That’s because most deaths are not directly related to the storm. Instead, people die in traffic accidents on icy roads or of hypothermia from prolonged exposure to cold. So it’s important to be prepared for winter weather before it strikes. For your home, here’s a recommendation from the Federal Emergency Management Agency: Emergency Supplies. Water, food, and clean air are extra important if an emergency happens. Each family or individual’s kit should be customized to meet specific needs, such as medications and infant formula. It should also be customized to include important family documents.
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our health | WEATHER PREPAREDNESS
Recommended supplies to include: • Water – one gallon of water per person per day for drinking and sanitation Food – at least a three-day supply of nonperishable food • Battery-powered radio, NOAA Weather Radio with tone alert, and extra batteries for both • Cell phone and charger • Laptop computer or tablet device and chargers • At least one flashlight and extra batteries • First aid kit • Whistle to signal for help • Infant formula and diapers, if you have an infant • Moist towelettes, garbage bags, and plastic ties for personal sanitation • Dust mask or cotton t-shirt, to help filter the air • Plastic sheeting and duct tape for shelter • Wrench or pliers to turn off utilities • Can opener for food Clothing and Bedding. You have to think about warmth. It’s possible that the power will be out and you will not have heat. Rethink your clothing and bedding supplies to account for growing children and other family changes. One complete change of warm clothing and shoes per person, including: • Jacket or coat • Long pants • Long-sleeved shirt
• Paper and pencil • Personal hygiene items including feminine supplies • Disinfectant • Medicine dropper • Household chlorine bleach – You can use bleach as a disinfectant, diluted nine parts water to one part bleach, or in an emergency, you can also use it to treat water. Use 16 drops of regular household liquid bleach per gallon of water. Do not use scented, color safe, or bleaches with added cleaners. • Important family documents such as copies of insurance policies, identification, and bank account records in a waterproof, portable container Many people nowadays spend a lot of time away from home and hour after hour in their cars. If you’re one of them, it makes good sense to also have a winter weather survival kit in your vehicle, according to Shelly Whitaker, spokesperson for Virginia-based Advance Auto Parts. “No one wants to break down ever, but it could happen,” she notes “and a small survival kit is an ideal thing to carry with you at any time of the year.” She says that even if you never use it, or use only a few items from it, you’ll still feel a lot more safe and secure knowing that you have what you need if winter weather should strike while you’re on the road. “And you don’t necessarily have to be able to use it for yourself,” Whitaker adds. “Someone could come along to help you using the items in your car, or you could be a Good Samaritan to someone else.” Here are some things to include:
• Sturdy, weatherproof shoes
• Jumper cables
• Hat and gloves
• Flashlights and extra batteries
• Sleeping bag or warm blanket for each person
• First aid kit and necessary medications in case you are away from home for a prolonged time
Here are some other items to consider adding to your supply kit. Some of these items can be dangerous, so an adult should collect and store these items.
• Food items containing protein, such as nuts and energy bars, canned fruit, and a portable can opener
• Emergency reference materials such as a first aid book or a printout of the information on www.ready.gov
• AM/FM radio to listen to traffic reports and emergency messages
• Rain gear
• Cat litter or sand for better tire traction
• Mess kits, paper cups, plates and plastic utensils
• Shovel
• Currency, traveler’s checks, and change
• Ice scraper
• Paper towels • Fire extinguisher
• Warm clothes, gloves, hat, sturdy boots, jacket and an extra change of clothes
• Tent
• Blankets or sleeping bags
• Compass
• Fully-charged cell phone and phone charger
• Matches in a waterproof container
• Flares or reflective triangles
• Signal flares
• Baby formula and diapers if you have a small child
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• Water for each person and pet in your car
WEATHER PREPAREDNESS | our health
During the winter especially, keep your gas tank full, and if you do find yourself stranded, be safe and stay in your car. Put on your flashers, call for help, and wait until it arrives.
Know winter weather terms Compared to summer storms, it’s often easier to keep on top of winter weather because storm systems are usually slower to develop, giving meteorologists more of a warning so that they, in turn, can warn us of the approach of dangerous weather. But it’s important to really understand the meaning of winter weather terms.
has reduced visibility to less than ¼ mile, with conditions persisting for at least three hours. Those are the weather watchwords, along with the things you need to stay safe and warm during heavy winter weather, so please get prepared and have a safe season.
We talked with Richmond’s CBS6 chief meteorologist Zach Daniel (the television station and Our Health are media partners) to get his definition of the terms he uses when he talks to the television audience about upcoming weather, and we learned some interesting things. Daniel explains that a watch means that conditions are favorable for the development of a certain kind of severe weather within a certain period of time. “In the winter,” he says “a watch can be declared substantially ahead of a weather development—a half day to as much as two days.” In warmer weather, he continues, a watch for weather conditions such as a heavy thunderstorm or a tornado is declared much closer to the beginning of the actual event because weather patterns can develop more rapidly. A warning is your cue that the weather is imminent or has already started. “It means that it has started to snow or that a tornado has been spotted,” he says. That’s when it’s time for you to make immediate preparations for whatever type of weather is in the very immediate future or is happening at the moment.
A few more timely terms: • Alberta Clipper. This is a fast-moving storm system, Daniel says, that forms in Canadian skies and often brings gusty winds and cold Arctic air to the Mid Atlantic and the Northeast. • Black Ice. This is the dangerous stuff that looks like water, Daniel says, but is actually quickly-frozen ice. • Blizzard. There’s a formal definition of this term, Daniel says, and it’s basically summed up as snowin’ and blowin’. A blizzard occurs when there are sustained or frequent wind gusts over 35 mph and fallowing or blowing snow www.ourhealthrichmond.com | 25
winter time
SKIN SOOTHING SOLUTIONS words | SUSIE GALVEZ
If you’ve got the dry, red, itchy skin that often comes with winter, you’re in good company. Roughly seven in 10 American women say they have sensitive skin—a rate that seems to be on the rise thanks to increased use of potent, sometimes irritating, anti-agers and new sensitizing medications for certain health conditions. During the winter months even normal skin takes the brunt of chilly, cold temperatures and overly-brisk wind blasts. In addition, our skin is assaulted daily with drier, overlyheated air from heating systems in our homes, offices, and cars. With little to no humidity in the air, it’s no wonder that our skin feels dry, flaky, and itchy. To keep Jack Frost from nipping at your nose, cheeks—and any other parts this season—here are some skin tips to keep winter deep freeze skin at bay and your skin looking and feeling beautiful. Stay out of hot water…whether you’re cleansing your face or your body, stick with tepid to warm water, says Richmond dermatologist Victoria Gross, M.D. Hot water tends to dry out skin. “Follow bathing with a moisturizer to seal in moisture from the bath or the shower. Skin that holds in moisture is a stronger barrier against irritants than dry skin.” www.ourhealthrichmond.com www.ourhealthrichmond.com|| 27
our health | BODY BEAUTIFUL
Cleanse gently. Opt for a gentle facial cleanser, and choose a creamier body cleanser instead of gels or soap. Look for products with lots of skin loving ingredients in them such as sunflower oil, mondo grass, lavender, coconut oil, and other plant-based botanicals. The ingredients are gentle and work to hydrate and protect the skin. Remove excess dead skin. “Using a gentle face exfoliating product on the face will help remove skin debris, allowing for better absorption of day and night hydrating skincare,” reports Margaret LaPierre, esthetician and owner of Skin Therapy of Virginia. “For the body, opt for a softer type of skin exfoliator during this harsh time of the year. Instead of using products with abrasive ingredients such as ground nuts or fruit pits to remove dead, dry skin cells, choose finely milled grape seeds or sugar type exfoliants to whisk away the debris. Your skin will feel smooth and moisturized.”
I found my answers and help at
Women’s Health Physical Therapy. Learn more at www.obgyn-physicaltherapy.com Is it normal to leak when I laugh or sneeze?
It hurts to have intercourse with my husband. I wish there was something I could do.
I have chronic pain in my pelvis. I need to fix this.
Women’s Health Physical Therapy 1919 W. Huguenot Road • Ste 202 • Richmond VA • 804.379.3002
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If you need a little extra exfoliation, use a wash cloth with your exfoliator to aid in dead skin removal. But forget about “Bufpufs” and other abrasive skin tools as they are much too harsh. Instead save them to scrub your tub—never your face! Lip tip…Apply a small amount of your facial exfoliator on a warm wet washcloth and gently rub across the lips to help remove dead skin and keep them from chapping. Slather on the moisturizer – for this time of the year, thick is in and thin is out. I tell my clients to make the switch to a creamy moisturizer to protect the skin from the elements. If your skin is exposed to the outdoors a lot, consider using an emollient moisturizer (oilbased) for optimal protection. If you notice that your face looks and feels chapped, it could be that your water-
our health | BODY BEAUTIFUL
based moisturizer has frozen on your face! Oil-based moisturizers will not freeze and will protect the skin much better, especially if outdoors for extended periods of time. Margaret LaPierre is a Practitioner and Certified Aromatologist, and owner of Skin Therapy of Virginia in Richmond.
Victoria Gross, MD is a board certified dermatologist at Richmond Dermatology & Laser Specialists.
Save your neck... Your face doesn’t end at the chin; it goes all the way down to the décolleté. In fact, the neck needs all the extra attention it can get because neck skin is thinner, drier, and one of the first places to show wear and tear. Sunscreen is not just for summer. Be sure to add sunscreen to your daily routine – between the sun’s direct rays and the reflection off of everything from car windows to snow banks, protection is a must. Don’t forget your sunglasses when outside too! Forgo fragranced body lotions and cream. Fragranced products contain alcohol, which is drying to the skin. Instead, use an unscented body moisturizer and then add your favorite fragrance on top of the cream. Start fresh…with your razor blades, that is. Shaving your legs, underarms, or any place else can cause bumps and redness. To prevent this, use a razor that is no more than five shaves old and has at least two or three blades. Single-blade disposables are more apt to drag against the skin. Your best bet is to apply a sensitivity-safe shave gel before shaving, rather than soap that is more drying to the skin. You only have three minutes… After you wash, you only have three minutes to add moisture back to the skin – your skin pores are most receptive during this time. Wear natural fabric next to the skin, as opposed to synthetic micro-fibers, allows the skin to breathe and lessens the chance of irritation. Keep it dry…your clothes that is. Especially your gloves and socks. Wet or damp clothes, reports LaPeirre, can irritate the skin and cause it to itch, crack, and cause eczema to flare up. Keep it clean. For clothing, towels, washcloths, sheets, blankets, and throws, switch to a fragrance-free detergent. Also, it’s best to only add fabric softener to clothes, blankets, and throws. Keep your towels, washcloths, and sheets free of fabric softener or dryer sheets. The softening anti-static agent in softeners contains lots of known skin irritants that can transfer to the skin all too easily. Beauty is easy…once you know the tricks! ‘Tis the season to keep your skin looking its most beautiful best! Remember…it is not cotton that is the fabric of our lives… it’s skin!
Susie Galvez is a Richmond-based beauty, image, and wellness writer, speaker, and author of nine books. To learn more about Susie, go to www.SusieGalvez.com
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SCIENCE OF SLEEP | our health
a Long Winters Nap: CREATIVE NAPPING words | AINE NORRIS
Naps. Most associate these delightful midday periods of sleep with children or the elderly, but napping is quickly becoming more popular amongst nine-to-five’ers with designated napping areas and products like nap pods encouraging shut-eye during the day. Studies have found naps to benefit both mind and body, even helpful in promoting cardiovascular regularity and health in adults, lowering the risks of death by heart failure. “Power naps,” or sleep sessions averaging 20 minutes, have been proven and verified by both sleep therapists and psychologists to improve cognitive thinking and alertness. Naps are generally taken eight to ten hours after an individual wakes up in the morning, usually when fatigue becomes heaviest, often in mid-afternoon. “If you look at other cultures like the Spanish-speaking world, many people have what is called a ‘siesta,’” says Dr. Erika C. Mason, DDS. “This is where people take an afternoon rest after lunch—usually an hour or two. When we eat, our concentration levels go down. In the workplace, more productive work is seen from employees who have a break.” While the United States is not a culture that embraces the idea of a mid-afternoon siesta, many Americans seek a short nap on lunch breaks to feel better and enhance productivity in afternoons and evenings. Sleep experts agree that the “power nap,” or period of 20-minute sleep, is the most effective for mid-day napping. Unlike sleeping at night, napping does not usually result in REM sleep. REM sleep, or rapid eye movement sleep, is a normal sleep stage lasting approximately 90 minutes. “Our bodies need REM sleep to live and function, so if someone did not get into REM and is playing catch up from the night before, they www.ourhealthrichmond.com | 31
our health | SCIENCE OF SLEEP
might fall asleep and drift immediately into REM sleep during a nap, but it is usually based on a good night’s rest,” says Dr. Mason. Without REM sleep, a short nap can still result in stage 2 sleep, allowing for a refreshed and alert feeling.
The sleep lab at The Sleep Disorder Center of Pulmonary Associates.
Frequent napping can be a symptom of a deeper issue than fatigue associated with a busy schedule. Sleep apnea is a disorder correlated to abnormal or low breathing during sleep. The pauses in breathing are called apneas and can occur multiple times within a 30-minute period of rest, resulting in sleeplessness and fatigue. “Sleep apnea is a common disorder that affects up to 4% of the general population,” explains Dr. Mir T. Ali, medical director of Sleep Disorders Centers of Pulmonary Associates of Richmond. “The symptoms of sleep apnea, snoring and sleepiness as well as witnessed gasping and choking, occur due to repetitive collapse of the upper airway during sleep.” Sleep apnea can be mild, moderate, or severe based upon the amount and severity of apneas during the night. It is diagnosed through an overnight test with a detailed evaluation and monitoring system. People with low or limited muscle tone and soft tissue around their airways are most susceptible to sleep apnea. OSA or obstructive sleep apnea is treated with a CPAP (continuous positive air pressure) machine, a breathing device that provides pressurized air to the throat. The patient will wear a plastic facial mask, and air is generated to keep airways open during sleep. “Alternate treatment options include oral appliances or dental devices and certain surgical procedures,” says Dr. Ali. “CPAP devices work well for all severity of sleep apnea. Dental devices usually work best for milder cases.” One person with sleep apnea recalled the extreme fatigue and restlessness they experienced before being diagnosed with the disorder: “Even my body was exhausted. My legs ached and I was tired all day because of waking up so much during the night. I was finally referred to a sleep professional and it made all the difference in treating the disorder.” Depending on the degree of their disorder, patients may immediately opt for a CPAP machine after the initial overnight evaluation of symptoms due to its proven effectiveness.
Erika Mason, DDS specializes in sleep dentistry at Sleep Better Virginia in Midlothain.www. sleepbetterva.com
Mir T. Ali, MD specializes in pulmonary disease and sleep medicine at Sleep Disorders Center of Pulmonary Associates in Henrico.
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Overall, napping is a beneficial and healthy choice for those suffering from fatigue due to busy schedules or altered work schedules, such as shift work. Short, planned naps improve both mental and physical capacity and can improve job performance. “Napping may help people in certain professions that require shift work, for instance. A short, planned nap before a night shift will improve alertness and productivity and reduce mistakes. Research has even shown that naps improve performance and alertness in military pilots,” says Dr. Ali. Napping is a constructive exercise when practiced in moderation, but sleep professionals advise that if an adult needs consistent naps to get through the day, it may be a sign of underlying sleep disorders such as apnea. Getting the recommended 7-8 hours of sleep nightly, a healthy diet, and regular cardiovascular exercise will promote a healthy lifestyle free of regularly needed naps.
NUTRITION HEALTH | our health
IS EVERYTHING I LIKE
BAD FOR ME?
The line between healthy and unhealthy gets fuzzier every day with blogs, articles, tweets, pins, and broadcasts continually reporting that everything, from food to diet and exercise, is slowly killing us. With the line so blurry between seemingly healthy lifestyle choices and the reports of things that are quietly leading to human demise, how does one push forward and make good choices? To begin with, do a little research on health topics to try to get an idea of what the media has sensationalized and what may actually be factual, and build your healthy lifestyle around it. Diet and nutrition seem to be the top choice for exaggerated fact and information, such as perpetuating reports that all sugars are deadly, meat and dairy are assassins, and carbohydrates slowly dig your grave. But what about the misleading “healthy” substitutes, such as “light” salad dressings filled with sugar and sodium or diet meals packed with preservatives and high levels of the chemical diacetyl?
words | AINE NORRIS
In the end, there’s no one-size-fits-all recipe for a perfect diet. Nutritionists and dieticians are still dusting off the color-coded food pyramid and advising consumers to plan meals and diet based on Body Mass Index (BMI), health and weight goals, and FDAsuggested daily intake levels. Jeremy Akers, PhD, a registered dietician and assistant professor at James Madison University, urges moderation and balance when considering nutrition. “According to the current dietary guidelines,” he says, “all foods have their place in our daily meal plans. As with many things in life, however, too much can have detrimental effects.” That’s why the federal government has developed standards and guidelines for acceptable ranges for macronutrients (carbohydrates, protein, and fat) and dietary references and upper limits for micronutrients (vitamins and minerals). You can log onto the website myplate.gov to find individualized information on how many calories per day you should consume and what percentage of your diet should come from each macronutrient.
Jeremy Akers, PhD is an Assistant Professor James Madison University.
Stephen P. Sowulewski is an Associate Professor and Chair of Health at J. Sargeant Reynolds Community College.
“Ours bodies are designed for and require variety and balance in our meal plans,” Dr. Akers continues, “and eliminating or acquiring excess can cause vitamin or mineral deficiencies and/or chronic disease.” While it isn’t a perfect science, with moderation and a customized diet, nutrition is easily sustainable day-to-day. What about diet and nutrition’s partner in crime—exercise? The mantra used to be that all exercise is good and healthy, helping build muscle and eliminate fat, essentially adding years to a person’s life. But now, conflicting reports claim that certain exercises are detrimental to the human body or even that exercise itself contributes to injury and long-term health complications. Here again, as with many things in life, there is fine print associated with each study, as well as exercising in general. It can be summed up like this: all exercise www.ourhealthrichmond.com | 33
our health | NUTRITION HEALTH
has risk associated with it when it’s pushed to extreme levels. When choosing a fitness regimen, it’s always best to alternate strength training (weights, machines) with cardio (running, cycling). This is an approach used by fitness professionals because it gives the body time to heal, keeps exercise fresh and non-routine, and allows muscles and ligaments to move differently each time. Trainers and physical therapists also note that people with heart disease and other potentially harmful conditions should consult with a doctor and fitness professional before creating a workout regimen. Much like nutrition, each body needs a custom plan to ensure physical success and the results you want. While nutrition and exercise are outward-facing issues to tackle, mental health and stress also affect us and our day-today lives. With so many stress studies on the market leading to therapy and medication, what can truly be trusted as sound advice to combat the issue proactively, and are the media and research studies correct in labeling all stress as harmful and negative? Stephen P. Sowulewski, Associate Professor and Chair of Health at J. Sargeant Reynolds Community College, offers insight into “good” versus “bad” stress. “When it comes to stress, not all of it is considered harmful to our health,” he says. There are varying types of stress, according to Sowulewski, including
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eustress, distress, and neustress. For example, eustress is positive for the most part. Some may think of marriage or the arrival of a newborn baby as stressful, but it’s not necessarily a stressful situation that is negative. Most individuals, though, normally think of distress as negative. The human organism needs a degree of stress to make us better, more productive, and more successful at our endeavors. We often call this “challenging ourselves.” An important factor when dealing with stress is something most humans take for granted and do not factor into a healthy living plan—sleep. Stress levels affect nutrition and a human’s inclination to exercise or be active, and stress levels go up considerably with inconsistent sleep patterns. Erratic sleep also makes us feel hungrier, which in turn leads to weight gain. So at the end of the day, the old adage “everything in moderation” rings surprisingly true in the face of studies and reports claiming that everything in life is deadly. Moderating the intake of high-calorie or sodium rich food can improve overall nutrition. Incorporating a purposeful, active exercise regimen can improve cardiovascular health while assisting in weight-loss, and maintaining a consistent sleep schedule and a low level of harmful stress improve day-to-day interactions and health. Don’t let the supposed studies and media worry you into an early grave. Moderation and educated lifestyle choices are the keys to a healthy life.
BABY IT’S COLD OUTSIDE words | AINE NORRIS photography | ??????? ????????
words | AINE NORRIS
Keeping Kids Warm This Winter
Winter is on its way and children can’t wait to play outside despite the chilly temperature. Don’t let the fear of cold or Richmond’s notoriously unpredictable weather keep them inside all season—with the right clothes children can be warm and cozy while having fun outdoors, whether playing or on the way to school. First things first: Make sure kids are protected from cold weather by layering specialized clothing items such as thermals and fleece. Layering keeps heat within each layer, warming from the inside out. Such items as vests and coats with removable fleece lining add insulation without adding bulk. Children should also have proper headwear when playing outside and walking to and from the bus stop. Hats with earflaps or fleece lining are snuggly and trendy, as are fleece headbands or patterned earmuffs. It’s also important to make sure kids have waterproof shoes and warm socks, especially when snow is melting and puddle jumping is irresistible. Lastly, buy scarves with enough length to wrap around little faces in cool breezes, as well as mittens and gloves. For longer playtimes or sledding trips, pack pockets with reusable hand warmers. Available in sporting good or camping stores, hand warmers can be used again and again. They are also available in inexpensive disposable multi-packs, so kids don’t have to worry about losing them during playtime. Dangers of not dressing children warmly during winter months include risk of flu and common cold, as well as hypothermia and frostbite. Frequently, kids don’t go www.ourhealthrichmond.com | 35
our health | KIDS’ CARE
Coats for Kids • Drop off your donated coat at any Puritan Cleaners location between November 1 and November 30. • While the greatest need is kid’s coats, any size is appreciated. • Visit www.puritancleaners. com for more info on how your business, school, or club can participate. At Left: The Staff of Puritan Cleaners during the 2011 Coats for Kids Drive.
outside to play during school or have recess if it’s cold or freezing, which leads to their being in close proximity during the entire school day. If one child gets a cold, the others will inevitably get it as well from sneezing or coming into contact with the infected person. Teachers and parents are encouraged to remind their children of the importance of washing hands before eating and after playtime and restroom use, as well as using antibacterial gel in between. “What parents often don’t realize is that cold weather doesn’t cause the common cold. Viruses cause colds. During winter months a child’s immune system is stressed by the lower temperatures, putting them at risk to catch a cold,” says Gayle Schrier Smith, MD, of Partners in Pediatrics. Frostbite can be a threat when kids are active outdoors in winter months. Help children avoid the risk of frostbite by dressing them in layers to trap body heat and making sure all outer layers are waterproof, especially when dealing with snow and ice. Snow boots and waterproof gloves and jackets will help trap heat while repelling moisture—the main cause of frostbite in cold weather. For most families, the winter months are the most expensive, with holiday shopping, higher heating bills, and increased travel. With the help of local Richmond organizations, these budget concerns don’t have to mean forgoing a warm coat or jacket for your child this season. 36 | www.ourhealthrichmond.com
KIDS’ CARE | our health
Puritan Cleaners, with its thirteen locations throughout Richmond, hosts the largest coat drive in the area every year. In conjunction with the Salvation Army, Puritan’s Coats for Kids program allows individuals or businesses to donate coats of all sizes to be donated to those in need. In 2011, over 16,000 coats were donated thanks to shared publicity from Puritan Cleaners, the Richmond Flying Squirrels, and WRIC TV8’s Juan Conde leading the effort. Richmond clubs and businesses also help keep kids warm through coat and clothing drives. Richmond Ad Club, a monthly gathering of advertising and marketing professionals within the metro Richmond area, boosts community outreach during winter months. In recent years, the club has been working hard to develop programs outside of the popular happy hours, and one of those pillars is to increase community involvement. The coat drive during the Christmas season benefits Richmond Friends of the Homeless. Other businesses that hold annual, local coat drives include Downtown Short Pump, Health Diagnostic Laboratory, Knights of Columbus, and Michael & Sons. Coats and warm clothing are accepted at all locations or designated drop-off locations during the months of November and December. Items collected are distributed to specific organizations in Richmond whose missions are to benefit those in need. Keeping children warm during winter outdoor activities is an important goal for parents, teachers, and the greater community. Staying cozy doesn’t have to mean keeping youngsters inside or out of the elements; layering comfortable clothing with a waterproof top layer will both trap heat and prevent cold moisture from touching the skin. Educating children on the importance of staying warm (and keeping those layers on while playing) will help safeguard them.
Gayle Schrier Smith, MD, of Partners in Pediatrics.
NOW OPEN
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KIDS’ CARE | our health
Local Richmond Dentist Helps Children with Disabilities Overcome Dental Anxiety words | SARAH COX
Dr. John Unkel knows how to calm his patients. After all, he is a pediatric dentist as well as a physician who takes care of healthy and sick children, and many do not like the dentist’s chair. He knows this, and has been trained to work with children, ages infant through adolescents. His new practice in Richmond, Bon Secours Pediatric Dental Associates, is designed to be patient- and family-friendly. The first step in reassuring a frightened or anxious patient is to meet with the child and parent or guardian. Since he sees a wide spectrum of patients—those who are healthy, and those who have special medical needs such as autism and spectrum disorder, seizure disorders, brain tumors or any neurodevelopmental disability — many of his patients are way too familiar with doctor’s offices. Reassuring the parent as well as the child is key, he says, because once the child sees that the parent is calm, he will also calm down. During his training as a pediatric dentist, Unkel learned the many alternatives in behavior management, including both pharmacologic and nonmedical approaches. “We have a family room, so the child can sit on mom’s lap while I get a history,” he said. “The child can assess me while I assess him.” Next, he does a physical exam of the patient, checking hands, feet, eyes, shoulders, head and neck. “And then, I speak to them, have them point to their nose and www.ourhealthrichmond.com | 39
our health | KIDS’ CARE
mouth, and then evaluate the mouth,” he said. He has the parent help him with a “knee-to-knee” position: He sits kneeto-knee with the parent, while the baby lies on his back with his head in Unkel’s lap. “That way, I can view the mouth. If the child is uncooperative, I have a direct view of the mouth because he’s crying.” He knows that if a child has bad associations with a dentist office—many who have cleft palates, for instance, have had multiple surgeries—then the child will be frightened and will need extra reassurance. Unkel said that early grade school children are challenging because many have already seen a dentist before and may have a myriad of dental issues. “Those kids are at the age of reason and can figure out what’s going on. They can’t sit on their parent’s lap, but must be in the dentist chair; however, I repeat almost the same sequence as I do with the knee-toknee. I have the parent sit on one side of the chair, I sit on the other side, and I calm the parent, and then explain the procedure to the child.” If the child has questions or anxieties, he addresses those directly. There are times when simply calming a child won’t help. “If that child has had another procedure, for instance a cleft palate with lots of surgery, they will know what’s coming. They are very, very nervous and rightly so.” He may use nitrous oxide—also known as laughing gas—administered through a “piggy nose” that comes in flavors such as bubble gum and strawberry. The child puts the piggy nose on their own nose. If that doesn’t work, and the child has a lot of oral disease or infection, then Dr. Unkel must consider other modalities such as an operation on an out-patient basis. Because Unkel knows that the mouth is part of the body, and it is important to maintain a health “gateway” into the body, he feels that the new acceptable age for children to be seen from age one year onwards, once a year, can prevent infection that can lead to further complications. However, he has also seen insurance coverage challenges and is currently working on a plan with St. Mary’s/Bon Secours so that the child will have the best care, and if they must be sedated, they can be monitored by an anesthesiologist, which Unkel considers premium. Unkel sees bacteria developing in mouths as early as six months; this, he explains, can lead to far more complicated issues. He mentioned Deamonte Driver, the 12-year old boy who died on February 28, 2007, of a toothache at Children’s Hospital in Maryland because of lack of insurance. “Your mouth is attached to your head, and your head is attached to your body. Cavities are an infectious disease and the most common chronic disease in childhood—more so than asthma,” said Unkel. From a cavity to an abscess in your jawbone, and in a child like Deamonte, this can lead to a brain abscess. Unkel’s practice has one overriding goal: We not only treat the mouth, but the mouth as part of the whole child. 40 | www.ourhealthrichmond.com
THE FOOT | our health
What’s afoot in Podiatry?
words | ANIKA IMAJO
Even while leading the nation through its most trying internal conflict, Abraham Lincoln found time to tend to his aching feet. It is often said that the 16th president suffered from corns, seeking relief from Dr. Isachar Zacharie, a renowned podiatrist—or chiropodist, as they were called back then—who reportedly earned the following recommendation from his prestigious patient: “Dr. Zacharie has operated on my feet with good success and considerable addition to my comfort.” Carrying more than their share of weight and put through their paces every day, feet will usually protest loudly when they’ve had enough. “The old adage that when your feet hurt, you hurt all over is basically true,” says Simon J. Mest, DPM, a podiatrist at Virginia Commonwealth University Medical Center’s Department of Orthopedic Surgery. Foot discomfort can damage quality of life in many ways, he explains, from hindering exercise to decreasing productivity. And in some cases, foot problems can set off what Dr. Mest calls a “kinetic chain,” spelling potential trouble for the knees, hips, and back. Corns, calluses, and ingrown toenails are among the nagging foot ailments that commonly compel people to visit specialists such as Dr. Mest, who notes that fewer people are ignoring foot discomfort these days. Forefoot issues, including bunions, bony humps that form at the joint where the base of the big toe attaches to the foot, and hammer toes, a condition that arises when the toe joint becomes stuck in a bent position, are among the most prevalent problems that draw patients into his office, he says. The field of podiatry has embraced a number of new treatment methods to address such issues. According to Dr. Mest, techniques have improved even within the last five years. For example, in cases where surgery is recommended, implants have begun to replace k-wires—or externally fitted correctional devices—to keep errant digits straight. But surgery isn’t the only path to foot health. While Dr. Mest doesn’t believe that www.ourhealthrichmond.com | 41
our health | THE FOOT
footwear is the sole culprit behind pedal pain, he emphasizes the importance of wearing shoes that suit your particular feet and the particular demands you make of them. “Everybody blames shoes,” he observes, “and shoes do cause a lot of problems. But a lot of times, the foot has a problem as it is, and the shoes just aggravate or accentuate it.”
• According to the American Podiatric Medical Association, seventy-five percent of all Americans will develop a foot problem in their lifetime. • Approximately 88 percent of American women wear shoes that are too small for them. • The average American woman’s foot size is 8 wide, yet the bestselling shoe size is 7 1/2 medium. • Ill-fitting shoes are the main reason that women account for 90 percent of the ìfoot repairî surgery in the United States for common foot problems such as hammertoes, bunions, and neuromas. This surgery costs approximately $3.5 billion annually and results in 15 million lost workdays.
Helena Edwards, who has suffered a host of foot-related miseries, recognizes that her mother’s struggle with bunions and other foot ailments probably set her up for the same unpleasant lot. And her unfortunate predisposition, she says, was likely made worse by years of working on her feet. But the trouble really started during her fiveyear tenure as a server and bartender at a fashionable restaurant, where footwear requirements for female staff members were less than merciful. “They had to be 2-1/2-inch heels,” she recalls, “and every now and then management would randomly measure to make sure they were at least that height.” Despite the use of over-the-counter inserts, running around for several hours on hardwood floors in high heels would take its toll on Edwards and her female co-workers, most of whom were uninsured college students for whom podiatric treatment wasn’t a realistic option. “All of us who worked there have had foot issues in one way or another,” she notes. Continuing to work on her feet as a restaurant manager and eventually a teacher until she recently started a more sedentary position in an educational coordinating capacity, Edwards has endured foot woes ranging from severely ingrown toenails to plantar fasciitis—a straining of the ligament connecting the heel bone to the toes, often felt acutely in the heels. Heel pain, according to Dr. Mest, is one of the biggest problems that podiatrists see and is often attributable in part to improper footwear. However, feet that are flat or have lower arches are more naturally predisposed to plantar fasciitis. Jason Smith, a 14-year veteran of United Parcel Service (UPS), began to experience extreme pain in his heels about three years after he started his physically demanding work as a service provider. “Each step feels like somebody’s driving a railroad spike through your heel,” Smith explains of his encounters with plantar fasciitis. “It changes your whole attitude about physical activity.” Smith, whose job requires him to repeatedly walk, jump, lift, and step into and out of a truck—all while carrying often weighty packages—sought podiatric help for his chronic discomfort. Relief for him would come in the form of stretching, observing ergonomically sound work habits, donning more supportive footwear, and wearing custom-made orthoses (often called “orthotics”), which are prescribed shoe inserts that neutralize foot positioning and provide cushioning and support. Although the inserts were initially uncomfortable, they’ve made Smith’s feet far less angry. “There was definitely an adjustment period,” he explains, “but once I got adjusted, I noticed a marked difference in the amount of pain I was having.” While Dr. Mest notes that most people, like Edwards and Smith, will receive very
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THE FOOT | our health
clear messages from their feet when it’s time to seek professional help, he explains that diabetics do need to have their feet more closely evaluated. “Unfortunately, as a result of sensory peripheral neuropathy (nervous system damage often associated with diabetes), people with diabetes often can’t feel their feet,” he points out, “and they may end up with problems down the line like ulcers or sores on the feet.” Such conditions, compounded by circulation issues that accompany diabetes, “put them at risk for amputation.” Dr. Mest has seen diabetic patients who have walked around with nails or tacks sticking through the bottoms of their shoes, failing to notice that their feet have been punctured until they actually see blood. Daily use of a foot emollient is also important for diabetics and is recommended for everyone, Dr. Mest advises. Moisturizing, he says, helps to stave off cracks and fissures that could lead to infections and other problems. He continues, “Diabetics need to wear much more supportive, much more comfortable shoes, and they need to be fitted.” Some footwear outfitters specialize in customizing and fitting shoes to accommodate diabetic foot needs, orthotics, and other medicinal foot gear. Richey & Co., a familyrun business with locations throughout Virginia, Maryland, and North Carolina, employs at least one certified pedorthist at each store. Owner Brett Richey, whose grandfather founded the company in 1938, describes pedorthists as “foot pharmacists” who fill the footwear prescriptions provided by podiatrists. While Richey & Co. is well qualified in the field of therapeutic footgear—boasting the only accredited foot orthotic lab in Virginia—the company prides itself on finding the balance between fashion and function and understanding that some occupations require certain shoe styles. They can cover the footwear needs of people such as Smith, the UPS employee who wears orthotics, Edwards, the former waitress for whom both comfort and style are important, and anyone who either has—or wants to prevent—foot discomfort. In addition to providing the traditional pedorthic services, “we also have a full range of European comfort, dress comfort, and athletic shoes,” Richey says. Whether poor footwear choices or strenuous activities have contributed to foot problems, people should listen to what their feet are telling them and get the care they need. Dr. Mest explains: “It’s not normal to get corns and calluses. There’s a reason that people get them, and it’s usually as a result of some type of foot deformity that can be addressed through some kind of an insole, change of footgear, or surgery.”
Simon J. Mest, DPM is a podiatrist at VCU Medical Center’s Department of Orthopedic Surgery.
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FINANCIAL HEALTH | our health
MEDICARE SENIORS MISSING WELLNESS OUT ON FREE VISITS MEDICARE BENEFIT words | EDWIN SCHWARTZ
There’s a relatively new, easy, and free service to help people covered by Medicare stay healthy and spot early indications of health problems. But few people know about or take advantage of the free wellness visit provided by the Affordable Care Act that went into effect in January of 2011. According to the Centers for Medicare & Medicaid Services, only 3 percent of Virginia Medicare recipients, or about 26,000 seniors, have used the annual wellness benefit. This is just below the national average. And less than half of Virginia’s Medicare beneficiaries have used any of the free preventive services. There are no easy answers for how Medicare can increase awareness of these new preventive services. J. James Cotter, Ph.D., Associate Professor at Virginia Commonwealth University’s Department of Gerontology, believes one of the challenges has to do with human nature. “When you go on Medicare at age 65, you’re not necessarily thinking of a preventive visit. Most people eligible for Medicare do www.ourhealthrichmond.com | 45
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not define themselves as frail and needing a full work-up. They’re only thinking of particular issues that may be causing them problems,” says Dr. Cotter. Traditionally, Medicare has focused on treatment of seniors’ health problems rather than on preventive care. But since January 2011, Medicare has offered the free annual wellness visit as a way to provide seniors early medical care to avoid costly hospitalizations later.
The prevention discussions focus on several topics: the care you are currently receiving from other healthcare providers; health advice concerning your risk factors and specific health conditions (such as weight loss, physical activity, smoking cessation, fall prevention and nutrition); and referrals to other appropriate health education or counseling services. The planning component includes creating a schedule for the Medicare screening and preventive services you will need over the next five to 10 years.
In addition to the annual wellness visit, Medicare covers a one-time preventive visit within the first 12 months you Although the annual wellness visit is not a physical exam, have Medicare Part B, the part of Medicare that helps pay for the intent is to offer the same opportunity to discuss your doctors’ fees, outpatient hospital visits, health concerns with your doctor. After and other medical services and supplies. your initial annual wellness visit, you Medicare covers a oneThis is called the “Welcome to Medicare” are eligible for a follow-up or subsequent time preventive visit preventive visit. During this exam, your wellness visit every 12 months. doctor will record your medical history, within the first 12 months The preventive services offered as part give you a simple vision test, calculate your you have Medicare Part B, of beneficiaries’ individualized plans body mass index and check your height, include cardiovascular screenings (to the part of Medicare that weight, and blood pressure. check cholesterol and other blood fat/ helps pay for doctors’ Additional tests might be ordered lipid levels), cervical and vaginal cancer fees, outpatient hospital depending on your general health screening, breast cancer screening and medical history. You will be given (mammograms), colorectal cancer visits, and other medical preventive tips to stay well and a checklist screening, prostate cancer screening, services and supplies. informing you which screenings and other shots (flu, pneumococcal, hepatitis B), preventive services you need. diabetes screening and self-management training. Services also include bone mass measurements, This “Welcome to Medicare” visit occurs only once, and you medical nutrition therapy, glaucoma tests, HIV screening, and must have it within the first 12 months you’re enrolled in Part tobacco use cessation counseling. Costs, if any, to the Medicare B. According to the Centers for Medicare & Medicaid Services, recipient and the frequency for eligibility will vary according you pay nothing if you have original Medicare and your doctor to the service. The annual wellness visits are not subject to accepts it. Medicare Part B deductibles, co-insurance, or copayments. If you’ve had Part B for longer than 12 months, you are eligible for the yearly wellness visit. This visit is not a physical exam. Rather, it is a way for a doctor to inquire about chronic conditions. Services in the annual wellness visit that are not part of the “Welcome to Medicare” physical include a personalized prevention plan to review your current care and a cognitive function checkup. The intent is that both you and your doctor can develop a strategy to manage your healthcare. The annual wellness visit benefit has four components: routine measurements, reviews of various histories, prevention discussions, and future planning.
Despite the offerings of these new preventive services, the challenges of getting the word out are considerable, according to Dr. Cotter. “Those most in need are often not tied into the healthcare system,” he says, “so it’s difficult to interact with them.” But once older residents learn about the new benefit and start seeing their physicians for the free wellness visit each year, it will be a very good opportunity for people to work with their physicians to make preventive services an important part of their healthcare plan.
The routine measurements include height, weight, blood pressure, and body mass index. The reviews of various histories examine the following: your individual medical and family history; medications, supplements, and vitamins you’re taking; your functional ability and level of safety (for example, your risk of falling at home); cognitive impairments; and a screening for depression. 46 | www.ourhealthrichmond.com
J. James Cotter, PhD is an Associate Professor at VCU’s Department of Gerontology.
LUNG CANCER
CUTTING EDGE | our health
The news coming out of Radiation Oncology Associates in Richmond is good: The treatment for patients suffering from lung cancer has advanced to the degree that those who are candidates for stereotactic body radiation therapy (SBRT) have witnessed a high success rate. In the last four years, Dr. George Trivette and a skilled team of specialists have delivered this type of radiation therapy – it is not surgery – to patients who qualify. Because the radiation delivers high-energy beams directly to the tumor, other areas that are not cancerous are not destroyed. It is considered a local treatment, has few if any side effects, and is covered by insurance. The assembled team from Radiation Oncology Associates that will deliver this treatment includes the radiation oncologist, a medical physicist, a dosimetrist (one who, along with the team members, calculates radiation dose distributions and dose calculations), a radiation therapist and oncology nurses. While the procedure is painless and non-invasive, it is also very complex and entails one to two weeks of planning.
TREATMENT
IN RICHMOND
The advantage of this type of treatment for lung cancer patients who have small, localized tumors in early stages, explains Trivette, is that it is highly successful with few if any side effects. According to the American Society for Radiation Oncology (ASTRO), SBRT “provides better overall survival rates than surgery for lung cancer patients with COPD.” It provides an extremely high rate of local control – 98 percent – for those with inoperable lung cancer. It has become an important alternative to surgery, especially for those who may be in ill health with a poor prognosis for surgery. It is a method that is also used to treat malignant or benign, small- to medium-sized tumors in the lungs, liver, abdomen, spine, prostate, head and neck, including the brain. Trivette is board certified with the American Board of Radiology and spent his residency with Radiation Oncology, National Cancer Institute, Bethesda, MD. He explains that in addition to avoiding surgery, this treatment also avoids recovery and anesthesia. He said it is an excellent choice for patients who are not good surgery candidates, and usually entails from three to five treatments given over a two-week period. The actual treatment time is five to 10 minutes, and the patient feels nothing, and only hears the whirring of a machine. It involves a 3D model that generates a radiation beam to match the contours of the tumor. This allows delivery of a dose of high-energy radiation precisely to the tumor site to minimize the amount of harmful radiation that reaches the surrounding healthy tissue. “We are destroying the cancer by delivering a dose that will destroy the cancer cell. We then reassess, post-treatment, with a PET CT,” he explained “With many people with lung cancer, this is a wonderful option to surgery. It just makes more sense. It is a true advantage as the technologies have gotten more amazing. It can target tumors better, and to me, this is really exciting,” said Trivette, who has been practicing radiation oncology for 30 years. He said that theirs is a small specialty, one of maybe three in the Richmond area. His practice is part of the Bon Secours Cancer Institute. According to the Encyclopedia of Surgery, SBRT is quite successful in extending the length of survival in cancer patients. ASTRO’s Emerging Technology Committee Chairman Dr. Andre Konski states that his committee “believes that some lung cancer patients will greatly benefit from this treatment as it will shorten their treatment time and improve their quality of life.”
words | SARAH COX
Stereotactic body radiotherapy (SBRT) is a method of radiation therapy used on cancer patients. This non-invasive, highly successful method delivers high doses of ionizing radiation to small target areas. This entails sending highlyfocused beams of radiation so that the area being exposed is limited. It is used to treat patients with cancerous lung tumors and is a good treatment option for those patients who cannot or will not undergo surgery. Those patients include ones with COPD, or chronic obstructive pulmonary disease; those with early stages 1 and 2 lung cancer; and those who are in ill health and cannot undergo surgery successfully.
Additionally, according to the March 2012 issue of the International Journal of Radiation Oncology•Biology•Physics, the official scientific journal of ASTRO, SBRT provides better outcomes than surgery for cancer patients with common lung diseases.
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SENIOR LIVING | our health
RIVERSIDE PACE A New Model for Senior Care
words | EDWIN SCHWARTZ
“It is a beautiful program.” That’s how Janis Jackson of Short Pump describes her experience with Riverside PACE, an innovative program whose mission is to promote live-at-home independence for the elderly. Riverside PACE serves frail seniors in metro Richmond/Petersburg and on the Virginia Peninsula by providing comprehensive medical and social services for participants along with their caregivers. By empowering participants to live in their homes, PACE (Program of All-Inclusive Care for the Elderly) is a community-based alternative to institutional long-term care. Participant costs are paid by Medicare and Medicaid. Today there are five Riverside PACE centers. The two Richmond sites are the Manchester Center (701 Gordon Avenue) and the MacTavish Center (1300 MacTavish Avenue), along with the Petersburg Center (309 Brown Street). In Lynchburg, a PACE facility is operated by the Centra health system. www.ourhealthrichmond.com | 51
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“PACE is a future model of healthcare in that we’re focused on preventive care and keeping people safe in their homes,” says Emily Osl, Site Director of the MacTavish center. The MacTavish site conveys a feeling of spaciousness. The building has a history of promoting wellness and activity – it was originally a roller skating rink and later used by the Richmond Volleyball Club. “We refer to our seniors here as participants,” says Osl, “because they are in a program as opposed to being residents in a nursing home.” PACE centers are supportive outlets for participants as they enjoy activities and meals while receiving a wide range of medical services. Participants also get a sense of family from being with other seniors and their individual care teams. In the afternoons, they return home knowing PACE is supporting them 24/7, 365 days a year. Mable Kizzie, a resident of the West End, is at the MacTavish center three days a week. “I feel good about it. I really like the staff. They are all friendly and very good people,” says Kizzie. “I also really like our monthly Red Hat Society meetings.” Participants also enjoy trips to places like the Virginia Museum of Fine Arts and the Federal Reserve Bank. “It’s really meant to be a home-away-from-home environment,” says Osl. “It doesn’t have an institutional feel; it’s more relaxed and comfortable.” PACE also enhances participants’ lives at home. The PACE team conducts home visits to ensure safety and can make minor home adaptations. This supports PACE’s mission to keep participants safe, healthy and independent for as long as possible. The MacTavish center has 38 participants age 55 to 99 years old. And the programs are as unique as the participants and the team members. “I like the camaraderie. The staff is beautiful,” says Jackson, who visits PACE three days a week. “They encourage me to write plays and do watercolors.” The staff has even performed one of her plays. “What’s common is there’s nothing common,” says Shannon Marling, Recreation Therapy Manager at the MacTavish center. “It really does meet the needs of a diverse group not met by other models.” Participants receive their own individualized care. The inter-disciplinary team (IDT) creates a custom care plan for participants and their families. The IDT then meets every morning with the site director to review any issues that may have come up over the past 24 hours. Each IDT consists of a primary care physician, registered nurse, social worker, dietitian, occupational therapist, physical therapist, recreation therapist, homecare coordinator, and transportation coordinator. In addition, the MacTavish center has a therapy and wellness gym, cafeteria, chaplain, clinic, and pharmacy. “People refer to PACE as a one-stop shop because everything is taken care of,” says Osl. “We essentially become their medical and social home.” 52 | www.ourhealthrichmond.com
MEN’S HEALTH | our health
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The centers provide shuttle transportation to and from participants’ homes and medical appointments. In addition, Riverside PACE coordinates hospital stays, nursing facility services, and special medical services such as hearing, dentistry, vision, psychiatry, and speech therapy. “It’s a culturally relevant model for individuals who don’t believe in long term care,” says Marling. This tradition can be traced to PACE’s San Francisco roots in the 1970s. During this time, the Asian and Italian residents of the Chinatown-North Beach sections were experiencing a need for senior care. Because tradition required the elderly to live at home with their families, nursing homes were not an option. Community leaders established On Lok Senior Health Services (“On Lok” means “happy, peaceful abode” in Cantonese). And the first adult day care center opened in 1973. By 1996, 21 PACE programs were operating in 15 states. And by 2009, the number had grown to 72 PACE programs in 30 states. Riverside PACE is a not-for-profit program. Typically services available through Medicare and Medicaid are also available through PACE. Participants in Riverside PACE must be age 55 or older, be able to live safely in the community, reside in the Riverside PACE service areas, and be able to qualify for nursing facility care. This final requirement is determined by the Virginia Uniform Assessment Instrument (UAI), an assessment form used by the Department of Social Services and local Department of Health. Like all innovations, PACE has its challenges. “It’s a relatively new program and is so different from hospitals and nursing home care,” says Osl. “But as baby boomers age, it’s something new for many people to consider.” Regardless of the obstacles, Riverside PACE meets them with the same optimism held by its participants. Two new Riverside PACE centers are in the works – a Newport News facility opened on October 1, and it will be followed by a Charlottesville site next year. “It gets me in good physical shape,” says Jackson. “It’s a good place for seniors because it occupies your mind. You don’t think about your aches and pains.” Note: More information on Riverside PACE is available online at http://www. riversideonline.com/pace/. For information on PACE programs in general, the National PACE Association has information online at www.npaonline.org.
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MIND MATTERS | our health
Childhood Depression:
BEYOND SADNESS
words | SUSAN DUBUQUE
Childhood depression. It seems like a contradiction of terms – an oxymoron. As a society, we find it difficult to even think of young, innocent boys and girls as being depressed. It defies every stereotype of a joyful, carefree childhood. But think again. An estimated 5 percent of youth—2.5 percent of children and 8.3 percent of teens— suffer from clinical depression. When it comes to the subject of depression in children, I am an expert. I’m not an M.D. or a PhD. I’m a M.O.M. And my journey into the world of testing, psychotherapy, antidepressants, and mile-long guilt trips started a number of years ago when my son —then age 11—began struggling with depression. Let me take you along on a bit of that journey, and I’ll share some of the lessons I learned along the way.
Depression is Real. Clinical depression is not a case of the blues. It’s not having a bad day because you didn’t make the cheerleading squad. It’s not a personal weakness or a character flaw. Individuals suffering from depression cannot simply “get over it.” Depression is a medical condition that affects the whole body—it impacts the way one feels, thinks, and acts. There are a variety of factors—genetic, physical, psychological, and environmental— that may contribute to depression. Climb your family tree and take a look around. Depression tends to run in families. One study reveals that children who have depressed parents are two to three times www.ourhealthrichmond.com | 55
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more likely to develop a major depression than children whose parents are not depressed. Some depressed people have too much or too little of certain brain chemicals (called neurotransmitters). Negative thought patterns, side effects from medications, and difficult life events—such as a death or divorce in the family—can all increase a child’s risk for depression.
depression, yet most remain undiagnosed and untreated. Depression may look different in children than it does in adults. In fact, children often wear two faces of depression. Here is a simple way of visualizing the two manifestations of childhood depression: the Turtle and the Dragon.
Depression is not a phase or something children will outgrow. A large proportion of adult psychiatric problems actually first appear in childhood. Left untreated, depression in childhood can lead to adolescent adjustment problems ranging from academic failure, to substance abuse, to suicide.
A Turtle—more often than not a girl—is withdrawn, quiet, and compliant. She is often described by her parents as sensitive and shy. She may be a bit clingy and dependent and have vague physical complaints. Her teacher—who is coping with 28 other kids in the class, half of whom are bouncing off the walls—may consider her more of a blessing than a concern. And there goes one depressed little girl, slipping between the cracks.
Each year, in this country alone, almost 5,000 young people, ages 15 to 24, kill themselves. The rate of suicide for this age group has nearly tripled since 1960, making it the third-leading cause of death in adolescents and the second-leading cause of death among college-age youth.
Dragons on the other hand—more frequently boys—appear to be aggressive and angry. They have a difficult time getting along with other kids and they may act out at home and school. It is not uncommon for these children to be misdiagnosed (or half diagnosed) with attention deficit or conduct disorder.
Depression is Misunderstood.
As a parent, you need to be alert to changes in your child’s behavior. Here are symptoms that may indicate depression,
Depression is Serious.
There are millions of kids in this country suffering from
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particularly when they last for more than two weeks: • Changes in eating or sleeping patterns • Vague physical complaints like stomach ache and headache (especially in younger children) • Withdrawal from friends and activities • Sadness and hopelessness • Lack of enthusiasm, energy, or motivation • Anger and rage • Overreaction to criticism • Poor self-esteem or guilt • Indecision, lack of concentration, or forgetfulness • Marked decline in school performance • Cutting classes or skipping school • Restlessness and agitation • Use of drugs, alcohol, and other dangerous substances • Problems with authority • Suicidal thoughts or actions
Depression is Treatable. There is good news. Depression is among the most treatable forms of mental illness. But professional help is essential. You wouldn’t hesitate for a minute to take your child to the doctor for a broken bone or an asthma attack. The same should hold true for depression. Remember, you are dealing with a medical condition—not a petulant child or sulky teen. The most common treatments for depression include any combination of the following: • Psychotherapy to help the child explore feelings and events that are painful or troubling and to teach coping skills • Cognitive-behavioral therapy to help change negative patterns of thinking and acting • Medication to relieve symptoms of depression and correct chemical imbalances
Parent’s Survival Tips Parenting is a tough job under the best of circumstances and a task made infinitely more challenging when your child is suffering from depression. Here are some tactics to help you— and your child—traverse this rocky road: Become an expert. When my son was young, there was virtually no information available on depression in children. Today,
our health | MIND MATTERS
there are numerous resources to help guide your journey and empower you with knowledge. Be brave and honest. If your child were diagnosed with cancer or diabetes, you would be frightened and sad, but you wouldn’t be embarrassed. And you would seek support from your friends and family. Let me say it for the third time—depression, like other forms of mental illness, is just that—an illness—not a social faux pas. Be open and forthcoming. The only way we will break down the stigma of mental illness is to bring it into the light and talk about it like any other medical problem. Look in the mirror. Depressed parents have depressed kids. In addition to the genetic implications, depressed parents are depressed role models. My son comes by his illness honestly – depression in my family can be traced back at least three generations. Seeking treatment for my own depression was perhaps the most therapeutic thing I ever did for my son. Don’t lose sight of the child. You may love your child dearly, but there are times it is hard to like a kid who is oppositional, irritable, or unresponsive. Don’t forget, inside every depressed child—no matter how prickly and off-putting their behavior may be—is a deeply saddened and distressed boy or girl. So don’t forget to tickle your Turtle and give your Dragon a hug.
According to Dr. Bela Sood, medical director of the Virginia Treatment Center for Children at VCU, there are more than 70,000 children in Virginia who are in need of mental health services, and the typical waiting period to see a mental health provider is three months. The future looks bright. Dr. Sood says, “Knowing the things that put children at risk for developing depression alerts parents to seek help when their child begins to display these behaviors. Research shows that the earlier we catch depression and start treatment the better the outcome.” Let’s hope someday soon Turtles and Dragons will just be girls and boys.
About the Author Susan Dubuque is a volunteer with the Virginia Treatment Center for Children, a division of the VCU Department of Psychiatry. She is the author of A Parent’s Survival Guide to Childhood Depression and Kid Power Tactics for Dealing with Depression. She is a principal of Neathawk Dubuque & Packett, an advertising and marketing firm based in Richmond, VA.
Resources:
Get a life. Don’t allow your family’s entire existence to be centered around your child’s emotional disorder. Take time for yourself and cultivate your own interests. A comment by Dr. Thomas Gordon speaks to this very issue. “A parent with a half-filled cup cannot give his child a drink.” Don’t forgo an outing or activity because you are afraid your child will act out or somehow embarrass you. If the child acts out, he acts out. (You can always do what I did. During one of my son’s particularly contentious outbursts, I simply pretended to be the babysitter.)
Editor’s note: For a free Depression Checklist that can be completed and shared with your child’s doctor or mental health worker, visit vcuhealth.org/vtcc. Other good online sources of information include the Children’s Mental Health Resource Center (mentalhealth4kids. org) and Mental Health America (nmha.org).
Take action. Depression is a serious disease, but there is no simple blood test or X-ray to diagnose it. Document your child’s behavior and share that information with your child’s doctor, school counselor, or psychologist. A free Depression Checklist can be downloaded by visiting vcuhealth.org/vtcc.
• Checklists – livestrong.com
• Children’s Mental Health Resource Center 1506 Willow Lawn Dr., Suite 205, Richmond, VA 23230 (804) 447-2124 • mentalhealth4kids.org • Mental Health America – nmha.org
Looking to the Future I am pleased to report that today my son is a happy, healthy adult. He is married and lives and works in Richmond. But there are many children and families out there who are still on this journey and looking for help.
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Bela Sood, MD is the medical director of the Virginia Treatment Center for Children at VCU.