OurHealth Richmond Oct/Nov 2013 Edition

DENTAL HEALTH: FACT OR FICTION?

DIABETES IN CHILDREN

OCTOBER

•

WOMEN’S HEALTH IN RICHMOND

NOVEMBER 2013 | GREATER RICHMOND EDITION | OURHEALTHRICHMOND.COM

in WAR and

FINDING PEACE

Howard Bullen

reflects on how his multiple

calls

to duty overseas have—and have not—impacted his life back at home.

NUTRITION: FALL FRUITS AND VEGETABLES

our health | BASIC

table of contents |october • november 2013

26

COVER STORY MEDI•CABU•LARY.....................10 Local experts define healthcare related terms

JUST ASK!..................................12

In War and in Finding Peace: Howard Bullen reflects on how his multiple calls to duty overseas have—and have not—impacted his life back at home.

A variety of health questions answered by local professionals

THE LATEST...............................13 A listing of new physicians, providers, locations and upcoming events in the greater Richmond community

HEALTH AND FITNESS ON THE GO..................................17 Health-focused apps you can download to your smartphone or tablet. new physicians, providers, locations and upcoming events

DENTAL HEALTH FOCUS...........19 Fact or fiction?

VETERAN CARE..........................35 Telehealth services for the McGuire Veterans Affairs Medical Center

NUTRITION.................................38 Healthy eats: Using the fruits (and veggies) of fall

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WOMEN’S HEALTH SPECIAL SECTION Three women’s stories of strength Robotics technology provides hysterectomy The emerging field of urogynecology Trends in childbirth: what’s old is new again

KIDS CARE..................................63 Rising to the challenge: Cassidy McAdams doesn’t let diabetes hold her back!

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READ THIS EDITION OF

OUR HEALTH RICHMOND MAGAZINE

october • november 2013

OUR HEALTH’S EXCLUSIVE MEDIA PARTNER McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Susan Sheppard Jennifer Hungate Karrie Pridemore Ed Ip Tom Veazey WEBMASTER Adapt Partners and Brain Swell Media

PUBLISHER PRESIDENT/EDITOR-IN-CHIEF ASSOCIATE EDITOR VICE PRESIDENT OF PRODUCTION CHIEF DESIGNER ORIGINAL PHOTOGRAPHY

CONTRIBUTING RICHMOND PROFESSIONAL EXPERTS Nathan D. Zasler, MD

ON YOUR TABLET

Bradley S. Ellison, MS, MD Misti Wilson, MD Sandra Spain, Master Medical Aesthetician John Quillin, PhD, MPH, CGC Robin Scott, RRT Joe Niamtu, III, DMD Mark Newton, MD, FACC Richard Marcus, DDS, MS Kanyon R. Keeney, DDS Patrice Harmon, DMD, George Levicki, DDS Harold J. Martinez, DDS CONTRIBUTING PROFESSIONAL WRITERS Sarah Cox Anika Imajo Susan Dubuque Edwin Schwartz Jennifer Romeo ADVERTISING AND MARKETING Richard Berkowitz Senior Vice President, Business Development P: 804.539.4320 F: 540.387.6483 rick@ourhealthvirginia.com

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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor: 305 Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.355.3071 Information in all print editions of Our Health and on all Our Health’s websites (www.ourhealthrichmond.com and www.ourhealthvirginia.com) social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations.

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Copyright © 2013 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The Our Health Southwest Virginia edition is published bi-monthly by McClintic Media, Inc. 305 Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthrichmond.com | www.ourhealthvirginia.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 hereditary breast and ovarian cancer syndrome?

About 5–10 percent of cancers are hereditary, meaning that the risk can be passed through genes from parent to child; the same cancer types may be seen over multiple generations. Hereditary cancers tend to occur at younger ages, and people with hereditary cancer are at greater risk of developing more than one cancer.

Hereditary Breast and Ovarian Cancer Syndrome (HBOCS) usually involves an inherited mutation in the BRCA1 or BRCA2 gene. Both men and women can carry a BRCA1 or BRCA2 mutation. Women with mutations in these genes have a 50–85 percent breast cancer risk, and about a 20–40 percent ovarian cancer risk. Men are at risk for breast cancer too. Genetic tests can tell some families if they have HBOCS. However, not everyone with hereditary cancer risk has a BRCA1 or BRCA2 mutation. Genetic counseling can help families decide if genetic testing is right for them and help them understand test results. To make an appointment with a genetic counselor at VCU Massey Cancer Center’s Familial Cancer Clinic, call 804.828.5116.

John Quillin, PhD, MPH, CGC Genetic Counselor Familial Cancer Clinic at VCU Massey Cancer Center Richmond | 804.828.5116

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What are signs and symptoms of sleep apnea in young children?

There are several signs and symptoms of sleep apnea in young children, including snoring, having enlarged tonsils, exhibiting a change in mood or behavior, possibly complaining of morning headaches and showing signs of being overly tired during the day— due to not having a restful night.

These issues need to be addressed with the child’s pediatrician, who can refer your child to a specialist who can better diagnose these symptoms. A sleep study is usually done to help determine the cause.

Some interventions that can help are sleep machines called CPAP or BiPAP. CPAP and BiPAP machines provide a constant flow of air through the mouth or nose, and sometimes through both. This helps keep breathing passages open, and decreases the amount of snoring or episodes of not breathing during sleep that a patient is having. Always share your concerns with your child’s physician, to see what is best for your child.

Robin Scott, RRT The Pediatric Connection Richmond | 804.675.4550

Is it difficult to have a mole removed from the face?

I just got back from my annual visit with my dermatologist, and I encourage everyone to get a full body mole exam at least once a year. Any suspicious mole should be biopsied for malignancy.

There are many ways to remove benign moles and lesions. Using liquid nitrogen, or surgically cutting and stitching the skin can cause depressed white scars that are very unsightly.

I prefer to use the newest technology in lasers and radiowave surgery to melt away the lesion.

By eliminating incisions and sutures, the final scar is usually undetectable. Although no surgeon can guarantee the lack of a scar, I’ve found these methods cause the least damage to underlying skin.

In my 30 years of experience with radiowave mole removal, I’ve been fortunate enough to treat thousands of patients from all over the country, and even some from out of the country. To find out more about the contemporary technology of mole and lesion removal with minimal scarring, visit my website at www.lovethatface.com.

Joe Niamtu, III, DMD Cosmetic Facial Surgery Midlothian | 804.934.FACE (3223)

What is vascular dementia?

Vascular dementia is a general term describing problems with loss of memory, mood changes, language comprehension and other thought processes caused by brain damage from impaired blood flow to your brain. It is the second most common form of dementia after Alzheimer’s disease. Patients can develop vascular dementia after a stroke, when blood flow to a part of the brain is cut off and causes permanent damage, or can live with other conditions that damage blood vessels and reduce circulation, depriving your brain of vital oxygen.

Factors that increase the risk of heart disease and stroke, which include high blood pressure, high cholesterol, smoking and atrial fibrillation, can also raise your vascular dementia risk. Controlling these conditions can help lower your chances of developing vascular dementia. If individuals are concerned about vascular dementia, the first step is to visit their family doctor and discuss symptoms, medical history and current lifestyle.

Mark Newton, MD, FACC Virginia Cardiovascular Specialists Midlothian | 804.915.1400

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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

Are certain parts of the brain more susceptible to injury than others?

Will my physical activity be limited by hip replacement?

Traumatic brain injury, or TBI, frequently occurs due to falls and vehicular accidents, although there are lots of other causes, including sports injuries and assaults, to name but two. The areas of the brain that are most susceptible to injury can be divided into two types based on whether the injury is localized or more diffuse. For localized injuries, the tips of the frontal and temporal lobes have a high incidence of damage because of the way the brain sits in the skull and is prone to damage when it “slams” up against the skull. With more diffuse injuries, the areas at the intersection of the grey and white matter tend to be the most prone to injury due to “over stretching,” as do certain transition areas between fiber tracts in the brain. It should be clear, however, that brain injury occurs along a spectrum from very mild, with no lasting impairment, to the most severe, with possibly fatal results.

Hip replacement and hip resurfacing are two of the most successful surgical treatments in the history of medicine, reducing pain, restoring mobility and enhancing quality of life. Most patients will be up walking the day of surgery and are expected to be home in two days. Some patients will need to follow certain precautions for a brief period following surgery, such as keeping the position of the hip within safe ranges, to allow proper healing.

After the initial month of recovery, most patients return to regular activities outside the home, including work and recreational exercise. At three months after surgery, most patients are comfortable enough to return to regular activities, such as travel, golf and dancing. At six months, the hip replacement should have healed enough to allow impact activities, such as distance running and triathlons, if this is the patient’s goal.

Nathan D. Zasler, MD Concussion Care Centre of Virginia, Ltd. Richmond | 804.346.1803

Bradley S. Ellison, MS, MD Advanced Orthopaedics Richmond | 804.270.1305

What are lifestyle-related risk factors that could increase the likelihood of developing breast cancer?

A risk factor is anything that affects your chance of getting a disease; some can’t be changed, but some can be. For developing breast cancer, risk factors that are beyond your control include gender, age, race, genetics, family history, a personal history of breast cancer and certain benign breast conditions. However, an individual can alter his or her lifestyle. For example, the consumption of alcohol is clearly linked to an elevated risk of developing breast cancer; studies show women who consume two to three alcoholic drinks per day have a 20 percent increased risk. Being overweight can also raise breast cancer risk (anywhere from 30–60 percent), particularly in women who have gone through menopause. Regular exercise (one to two hours per week of brisk walking) can reduce the risk of developing breast cancer by as much as 20 percent.

Misti Wilson, MD Bon Secours Virginia Breast Center Richmond | 804.594.3130

What are the benefits of vitamin C in skincare?

While young skin is full of vitamin C, aging skin naturally loses nutrients over time. Studies show vitamin C taken internally does not deliver adequate amounts to the skin; therefore, forms of vitamin C have become available in cosmeceutical and pharmaceutical skincare. Even then, though, vitamin C used in skincare products is not necessarily effective. However, L-ascorbic acid, a derivative of vitamin C, if applied topically to the skin has many benefits.

L-ascorbic acid, an antioxidant, is the key to a protein that aids in growth of cells and blood vessels, ultimately providing the skin its strength and firmness. Also, vitamin C in L-ascorbic form enhances the effectiveness of medical peels and procedures.

Research also shows that vitamin C may reduce sunburns caused

by UVB rays, which can lead to skin cancers. And it helps to repair the repigmentation of skin also known as “sun spots” and reduces inflammatory dermatoses. Overall, vitamin C has been proven to enhance and correct texture and tone, reduce hyperpigmentation, decrease the appearance of fine lines and wrinkles and protect skin from oxidative stress.

Sandra Spain, Master Medical Aesthetician Cosmedics at Richmond Plastic Surgeons Richmond | 804.521.3025

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THE LATEST | our health

the l atest

William R. Anderson, Jr, MD Bon Secours Hospice Richmond | 804.627.5360

Patricia Barnwell, MD Bon Secours Patterson Avenue Family Practice Richmond | 804.741.6200

Vidya Raghavan, MD Bon Secours Palliative Medicine Richmond and Midlothian 804.288.COPE (2673)

Christina Ching, MD General Pediatrics Children’s Hospital of Richmond at VCU Downtown Richmond 804.828.CHOR (2467)

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

Shelley B. Woodley, NP Bon Secours Surgical Dermatology Center Glen Allen | 804.977.8938

Rachel Gow, PhD Healthy Lifestyles Center Children’s Hospital of Richmond at VCU West End 804.828.CHOR (2467)

Scott C. Matherly, MD Gastroenterology, Hepatology and Nutrition VCU Medical Center Downtown Richmond and Fredericksburg 804.828.4060

Nancy Bell, FNP-BC Bon Secours Ironbridge Family Practice Chester | 804.717.5300

Aline Baghdassarian, MD Emergency Medicine Children’s Hospital of Richmond at VCU Downtown Richmond 804.828.9111

Marieka Helou, MD Hematology and Oncology Children’s Hospital of Richmond at VCU Downtown Richmond, Fredericksburg and Petersburg 804.828.CHOR (2467)

Tazuddin “Taj” Mohammed, MD Neonatal Medicine Children’s Hospital of Richmond at VCU Downtown Richmond 804.828.9956

Virginia Boothe, MD Bon Secours Palliative Medicine Richmond and Midlothian 804.288.COPE (2673)

Jesse Bain, DO Critical Care Medicine Children’s Hospital of Richmond at VCU Downtown Richmond 804.828.4987

Sudha P. Jayaraman, MD, MSc Trauma, Critical Care and Emergency Surgery VCU Medical Center Downtown Richmond 804.828.7748

Narendra Vadlamudi, MD Gastroenterology and Nutrition Children’s Hospital of Richmond at VCU Stony Point 804.828.CHOR (2467)

Nathan Lee, MD Bon Secours General Surgery at St. Mary’s Richmond | 804.893.8676

Nauman A. Chaudary, MD VCU Medical Center Adult Cystic Fibrosis Program West End | 804.527.4540

Jason Kidd, MD Nephrology VCU Medical Center Downtown Richmond and Glen Allen | 804.828.2161

Judy Voynow, MD Pulmonary Medicine Children’s Hospital of Richmond at VCU Downtown Richmond 804.828.CHOR (2467)

Mary Lucchesi, MD Bon Secours Associated Internists Richmond | 804.288.3079

Daniel P. Luppens, MD Plastic and Reconstructive Surgery VCU Medical Center Downtown Richmond and West End | 804.288.5222

Duane Williams, MD Critical Care Medicine Children’s Hospital of Richmond at VCU Downtown Richmond 804.828.4987

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our health | THE LATEST

the l atest

Doug Willson, MD Critical Care Medicine Children’s Hospital of Richmond at VCU Downtown Richmond 804.828.4987

Andrea Zepeda, MD Anesthesiology Children’s Hospital of Richmond at VCU Downtown Richmond 804.828.CHOR (2467)

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

Paige T. Holbert, DDS, MSD Dr. Baxter Perkinson & Associates Midlothian | 804.379.1011

Stephanie Voth, DDS, MS Dr. Baxter Perkinson & Associates Midlothian | 804.379.1011

Zach McCluskey, FACHE Chief Operating Officer HCA Retreat Doctors’ Hospital | Richmond

William Wagon, III Chief Executive Officer HCA’s Henrico, Parham, and Retreat Doctors’ Hospitals

Zinsser Plastic Surgery Offers New Technology in Cellulite and Body Contouring Treatments Zinsser Plastic Surgery announces the installation of Viora’s Reaction™, a leading medical aesthetics device.

The clinically proven, FDA-cleared device addresses the most requested and popular medical aesthetic body-shaping procedures.

John W. Zinsser, MD, owner of Zinsser Plastic Surgery, and board-certified plastic surgeon.

The technology of this new equipment will ensure client safety, comfort and efficiency, as well as faster treatment times. With Reaction™, Zinsser Plastic Surgery can now also offer ReFit™, an ideal noninvasive solution to the appearance of sagging skin following weight loss, whether by diet, exercise, surgery or childbirth.

“As the demand grows for

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nonsurgical solutions, we wanted to offer our patients a clinically proven solution. We are enjoying the flexibility that Reaction™ provides for contouring, skin tightening and cellulite reduction,” says John W. Zinsser, MD, owner and board-certified plastic surgeon.

“Our clients are pleased with the visible results.”

Zinsser Plastic Surgery offers a patient-centered philosophy; their clients receive the highest standard of care, ensuring that the experience is as safe and comfortable as possible. Practicing in the Richmond area since 1998, Dr. Zinsser has hospital privileges at local Bon Secours and HCA hospitals. For more information, contact Zinsser Plastic Surgery at 804.474.9805 or visit www.zinsserplasticsurgery.com/.

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

VCU Receives $18.1 Million Grant to Study Novel Tobacco Products Virginia Commonwealth University has received an $18.1 million federal grant – VCU’s third largest to date – to study so-called modified risk tobacco products and other novel tobacco products, such as electronic cigarettes, and to develop an evaluation tool to help inform United States tobacco regulatory policy.

Researchers in the VCU Department of Psychology’s Center for the Study of Tobacco Products in the College of Humanities and Sciences will study methods for evaluating modified risk tobacco products, or MRTPs, as one of 14 Tobacco Centers of Regulatory Science, a new program launched by the U.S. Food and Drug Administration and the National Institutes of Health.

Thomas Eissenberg, PhD, professor of psychology and director of VCU’s Clinical Behavioral Pharmacology Laboratory, and Robert Balster, PhD, professor of pharmacology and toxicology in the VCU School of Medicine, are the co-principal investigators on the grant.

The project will span both campuses of VCU involving the College of Humanities and Sciences, the Massey Cancer Center and the School of

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Medicine. As part of the project, Eissenberg and Balster will collaborate with Massey Cancer Center’s Cancer Prevention and Control research program.

Other VCU faculty leading portions of the research effort include Alison Breland, PhD; Randy Koch, PhD; Aashir Nasim, PhD; and Michael Weaver, MD “While the focus of the Center for the Study of Tobacco Products is on novel tobacco products generally, this grant will also allow us to provide a wealth of information regarding electronic cigarettes and is designed to have the flexibility and capacity to begin new research to address issues raised in today’s rapidly evolving tobacco marketplace,” Eissenberg said.

This is the third large grant that VCU has received in the past few years. Last month, VCU received the largest grant in its history -- a $62 million federal grant to lead a study of traumatic brain injuries in military personnel. And in 2010, the NIH awarded VCU a $20 million grant to become part of a nationwide consortium of research institutions working to turn laboratory discoveries into treatments for patients.

HEALTH AND FITNESS ON THE GO | our health

Health and Fitness

On the Go

Having information at your fingertips; that’s what mobile apps are all about. Empowering users to effectively manage their healthcare and a healthy lifestyle is important to everyone.

In our new Health and Fitness on the Go section, we recommend a variety of health-focused apps you can download to your smartphone or tablet.

WaveSense Diabetes Manager * Reviewed by the American Diabetes Association * Do you want to track your glucose results, carb intake, and insulin doses? The WaveSense Diabetes Manager can help. Enter your information in seconds, review the data with convenient charts and graphs, and gain a new perspective on diabetes management. Watch videos (courtesy of dLife) to learn about healthy eating, lifestyle choices, and hear from others who are living life with diabetes. If you need a second opinion you can email results to your trusted health care team.

Available for iPhone only through iTunes. Cost: free

iPhone

iBreastCheck Early detection of breast cancer means you have a better shot at winning, so it’s important to do your self-checks each and every month. iBreastCheck contains a video that shows you how to do an effective breast check and explains why it’s a crucial part of preventive health. Set up your reminder time and choose the frequency that works for you – weekly, every two weeks, or monthly.

SHARE YOUR FAVORITE HEALTH AND FITNESS APP!

Available for iPhone and Android. Cost: free. Link to apps for iPhone and Android: http://www.ibreastcheck.com/

Share your favorite health and fitness app! Scan this QR code with your smartphone or tablet to visit and “Like” Our Health’s Facebook page, then post a “Comment” with your favorite health and fitness APP! www.ourhealthrichmond.com | 17

DENTAL HEALTH FOCUS

FICTION or FACT? words | JENNIFER ROMEO

A smile is your best accessory, so naturally you’ll want to ensure your pearly whites stay healthy for life. We all know about the basics—brushing, flossing and using mouthwash— but separating fact from fiction isn’t always so easy.

For many, visiting dental professionals for healthcare advice can be a stressful and intimidating experience. In fact, according to a report by the surgeon general’s office, 4.3 percent of Americans are so afraid of going to the dentist that they simply don’t go at all.

Rather than let the dentist’s chair deter you from getting the answers you need, brush up on the facts. We asked the experts to clarify some of the most common misconceptions surrounding your and your family’s oral health. (http://silk.nih.gov/public/hck1ocv.@www.surgeon.fullrpt.pdf)

A child must lose all his/her baby teeth before being fitted with braces.

Makes sense, doesn’t it? Why would I put any braces on before my child has all his teeth?

Aren’t they just going to change when the new ones come in anyway? The answer to both questions is “yes.” Teeth will change as the new ones come in, and then it is likely that a full set of braces is needed. However, the answer to our original question is “fiction.”

The American Association of Orthodontics recommends that all children visit the orthodontist by the age of seven. Why? The goal of orthodontics is not only to straighten the teeth, but also www.ourhealthrichmond.com | 19

our health | DENTAL HEALTH FOCUS

to make sure the patient has a good bite. This way the proper teeth mesh together to make chewing and speaking easier. By seeing children who are still growing, the orthodontist can correct the bite in ways that are not possible in adults or nongrowing patients.

Richard Marcus, DDS, MS Dr. Baxter Perkinson & Associates Family Dentistry & Orthodontics

Here is an example. Your child bites together and shifts her jaw to the side. This results in a condition called crossbite, or a scissors bite. The cause of this is that the upper jaw is too narrow, and for comfort your child shifts so that her teeth fit better. In the growing patient, the orthodontist can use an appliance called an expander to widen the upper jaw. This is a completely painless procedure in the child. The reason is that in the child, the two bones that make up the roof of the mouth, or palate, have not yet fused together. About the time of puberty, these bones fuse and expansion becomes difficult or impossible without surgical intervention. This treatment is designed to correct the bones of the growing patient so that the bite is better. A full set of braces may be required once all the teeth are present, in order to achieve proper alignment and to create that Hollywood smile.

So remember, while your little angel still has lots of teeth to lose, it still might be necessary to correct his bite early for this or any number of other circumstances.

Your orthodontist can guide you to help you decide what is right for your child.

Richard Marcus, DDS, MS – Dr. Baxter Perkinson & Associates Family Dentistry & Orthodontics

The only hope for lost permanent teeth are dentures.

Absolute fiction! When you lose teeth, you lose bone. Dentures accelerate bone loss!

The centuries-old use of dentures provides the appearance of teeth, but causes bone loss that impairs the ability to chew, severely compromises the diet, provides embarrassment and lack of confidence, contributes to gastric problems, requires adhesives or glue to reduce mobility and contributes to an early elderly appearance.

Kanyon R. Keeney, DDS Virginia Oral & Facial Surgery

Dental implants maintain bone. The stability and function that implants provide, particularly for a patient missing all the teeth in the upper or the lower jaw, are life-changing! They will allow you to chew as well as or better than you did before you lost your teeth. They will also help to maintain a younger appearance, restore lost confidence and allow you to enjoy a more balanced nutritional diet.

Dental implants remain the most successful medical or dental device to use today.

Kanyon R. Keeney, DDS – Virginia Oral & Facial Surgery

Permanent teeth are not affected by the lack of care to baby teeth.

This is most definitely fiction! Permanent teeth are greatly affected by the lack of care to baby teeth.

Patrice Harmon, DMD, is an associate dentist with Hawkins Family Dentistry.

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The most common effect of poor care to baby teeth we see is crowded, rotated and poorly aligned permanent teeth. When a baby tooth is lost early (from decay, trauma or otherwise), the neighboring teeth move into the space of the lost tooth. As a result, space is lost for the permanent tooth that belonged in that place. If your child loses a baby tooth early, talk to your dentist about ways to maintain the space (usually with a simple device attached to your child’s teeth) to allow the permanent tooth to come into its proper position when it is ready to erupt. This will reduce the chances of needing orthodontics in the future.

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DENTAL HEALTH FOCUS | our health

Secondly, infection in baby teeth can spread to the underlying developing permanent teeth, which sit between the roots of baby teeth. Infection in baby teeth can cause problems with the development of enamel, the protective outer covering of permanent teeth. When enamel does not form correctly, the affected permanent tooth will often have dark or chalky-looking spots on it and can be more susceptible to decay than a normal tooth. If you suspect your child has an infected tooth, contact your dentist immediately.

Lastly, the most common cause of problems in permanent teeth is inadequate care. Habits developed when a child is young are likely to continue as he or she starts to get permanent teeth (usually around age six). Starting good habits early with your child is essential to improve the chances of a healthy smile throughout his or her lifetime! Remember your 1-2-2-2s: Floss once a day, brush twice a day for two minutes and visit your dentist twice a year for a checkup (starting at age one).

Patrice Harmon, DMD, is an associate dentist with Hawkins Family Dentistry.

Poor dental health can affect the overall health of the body.

“Yes, this is true. In fact recent studies have shown that when your mouth is healthy, the rest of your body stays healthier too,” answers Dr. George Levicki, president and CEO of Delta Dental of Virginia, the leading dental insurance provider in the commonwealth. “Stroke, heart disease and low birth weight can all be tied to gum disease, which clearly indicates that taking good care of your teeth and gums is a healthy, preventive measure.”

Dr. Levicki, a 40-year veteran of the dental health profession, also noted that “your mouth is one of the first places medical professionals look when searching for symptoms of disease.

Many conditions such as diabetes, leukemia, cancer, heart disease and kidney disease can be diagnosed and treated much sooner when discovered during a simple oral examination.

For this reason, getting regular oral exams and cleanings, and flossing and brushing twice daily with fluoride toothpaste will not only improve your smile, but may even improve your overall health.”

George Levicki, DDS President and CEO of Delta Dental of Virginia

“Routine dental visits are crucial to good health,” emphasizes Dr. Levicki. “Choosing to have dental coverage, and using those benefits, can go a long way to keeping you and your family healthy.”

George Levicki, DDS – President and CEO of Delta Dental of Virginia

Little can be done for long-lasting pain after a root canal.

Fiction. Numerous studies have shown that tooth pain associated with an inflamed or dead pulp can be perfectly managed by root canal treatment and pre- and posttreatment pain medications. The pulp is a soft tissue containing blood vessels and nerve supply, encased inside the hard structure of the tooth. Root canal treatment removes the pulp, or “nerve,” within the tooth when this tissue has been damaged by extensive caries, repeated restorations, cracked tooth or dental trauma, and cannot repair itself.

The root canal treatment in itself should be painless; however, patients will still experience some degree of pain or sensitivity for a few days following the procedure. The preexisting condition of the tooth before the procedure, i.e., inflammation and disease of the pulp and surrounding supporting tissues, determines posttreatment symptoms.

Harold J. Martinez, DDS Commonwealth Endodontics

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our health | DENTAL HEALTH FOCUS

The dentist can customize a pain management plan for each individual patient based on the diagnosis and definitive treatment provided. The majority of patients can effectively manage their symptoms by taking a nonsteroidal anti-inflammatory drug (NSAID) (e.g., ibuprofen, aspirin, naproxen) alone or in combination with acetaminophen (Tylenol) prior to the treatment and following the procedure, before the local anesthetic has worn off.

NSAIDs address pain control more adequately when taken around the clock, two to three days following the procedure, rather than as needed. Some patients cannot use ibuprofen or other NSAIDs, due to their health history or interaction with other medications. If that is the case, they have to rely on Tylenol or narcotic analgesics that do not help reduce the inflammation associated with the diseased pulp. In that case the tooth may feel sore or tender for a longer duration. Antibiotics are indicated only for immunocompromised patients or patients who have developed facial swelling and fever associated with a dental infection of the surrounding tissues of the tooth, and should not be prescribed for pain control.

Harold J. Martinez, DDS – Commonwealth Endodontics

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in WAR and words | ANIKA IMAJO photography | ED IP

FINDING The territory that separates life in the war zone from life at home is familiar to Howard Bullen. He’s traversed it many times.

As a sergeant serving in the 4th Combat Engineer Battalion, United States Marine Core (USMC), he deployed to Iraq in 2005 and from 2006 through 2007, and to Honduras in 2008. As a civilian worker in Afghanistan, he provided aerial logistics for deliveries of food and ammunition to FOBs (forward operating bases) from 2008 through 2010, in 2012 and in 2013, returning home most recently this April.

Now settled into his career as a broker for United Parcel Service (UPS) in Richmond, the 29-year-old veteran reflects on how his multiple calls

PEACE to duty overseas have—and have not—impacted his life back at home.

Contemplation of fellow service members who didn’t fare as well as he weighs heavily on the Marine, and is accompanied by the unsettling realization that he might easily have been in their place, he explains.

VETERAN CARE | our health

In addition, lingering mementos of his combat experience emerge in mundane situations, at times presenting themselves as increased irritability, agitation or discomfort in large crowds.

“You don’t want to be in situations where you’re reminded of things and you experience that heightened stress. Unfortunately for me, and I don’t think I’m alone in this, you avoid situations where you think about it.”

Bullen—who has been out of the Marine Corps for five years—doesn’t expect those residual effects to evaporate altogether.

“I don’t think you necessarily get over it. I think you just adapt and that becomes the new norm. Rather than those thoughts going away, you just get used to them.”

According to Catherine Wilson, U.S. Navy, retired, who is the executive director of the Virginia Wounded Warrior Program (VWWP) and deputy commissioner of the Virginia Department of Veterans Services, soldiers and sailors seldom leave the battle zone unaltered.

Likening the challenges of postdeployment acclimation to any radical change in status—such as retirement or loss of employment—Bullen remarks: “When you go from having a very defined role in life, having perceptions about your own day-to-day reality, and then you have a drastic event that changes that, I think more than anything else, it’s helpful to try to maintain some sort of balance.”

Threads of continuity that remain with Bullen through all his experiences have helped him make the adjustment over and over again.

“I learned through trial and error—through different deployments—that just maintaining healthy habits gives you a good base to build on,” he shares, noting that carrying some military-style regimentation into his everyday existence has eased the process of reassimilation.

“I always make the comment that not all service members come back damaged, but we all come back changed,” she comments. “The sights, the sounds and the smells of combat really don’t leave you for a long period of time.

— Catherine Wilson, U.S. Navy, retired, executive director of the Virginia Wounded Warrior Program (VWWP) and deputy commissioner of the Virginia Department of Veterans Services

The support of a tight-knit family—his mother, Mary (“Missy”); his father, Howard; three brothers, John (who served in his unit), Charles and Graham; and his sister, Katie—has been a reliable source of security and encouragement.

And his studies, which he pursued at Virginia Tech between deployments, helped him focus his energy in a positive direction. At the end of what he describes as “a 10-year odyssey,” he received a degree in English literature in 2011.

Bullen considers his personal circumstances to be blessings, recognizing that many other veterans aren’t as fortunate. www.ourhealthrichmond.com | 29

our health | VETERAN CARE

“I observed a lot of guys I served with dealing with the frustrations and the fallout that can be part of coming back from a deployment overseas without having that safety net. I couldn’t imagine going to an environment like that and then coming back without that support structure. I think that would make a world of difference.”

But the way in which a veteran—or any individual—manages acute stressors may depend on any number of personal variables.

“How people readjust from those deployments and reintegrate into their lives, I think that can be a real challenge,” notes Wilson, “whether you cope well or whether you choose avenues of poor coping mechanisms, which can lead to substance abuse, family discord, domestic violence or dangerous behaviors.”

Heightened public awareness of post-traumatic stress disorder (PTSD), particularly when it comes to soldiers exposed to the combat environment, has been a positive development for veterans who suffer from it.

But Bullen points out that it can also lead to sweeping generalizations.

“From the beginning of the Iraq War, when we started going over there, there wasn’t a whole lot of interest in or thought given to PTSD. Were I to return from Iraq or Afghanistan now, I’d probably be a little guarded about the assumption that everyone has PTSD.” A more nuanced understanding of the range of responses veterans may experience, he argues, would be helpful.

“I don’t think it’s fair, or constructive, to use PTSD as a catchall for the assortment of issues that accompany returning from a deployment. I think it’s more of a spectrum, rather than an absolute. Whether it is readjustment to a drastically different physical environment, new work tempos or changes in home and life balances, there is an inherent amount of stress that is natural and to be expected,” he explains.

“Depending on the individual and the experiences they had while deployed, there can also be physical and mental conditions associated with what they were exposed to. I think it’s important to distinguish between ‘healthy’ reactions to these changes and those that might require professional evaluation. I think there is a harmful tendency to dismiss many of these related issues as ‘PTSD’ and not address the real conditions.”

PTSD and traumatic brain injury (TBI), Wilson explains, do often manifest themselves in confusingly similar ways.

And left undiagnosed or untreated, they may have dire consequences for service members and their families alike.

“The survival rate on the battlefield has really improved,” Wilson observes. “But whether it’s a physical or an invisible wound, some individuals face a lifetime of struggle and hardship.”

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our health | VETERAN CARE

The deputy commissioner, whose work with VWWP represents a robust outreach and support effort, urges veterans to seek help in addressing any harmful effects of combat experience. The state-funded program offers five regional networks connecting veterans in need with counseling services and an array of treatment and employment resources.

I observed a lot of guys I served with dealing with the frustrations and the fallout that can be part of coming back from a deployment overseas without having that safety net. I couldn’t imagine going to an environment like that and then coming back without that support structure. I think that would make a world of difference.

A widespread reluctance to admit the need for professional help, says Wilson, is one of the most daunting hurdles to overcome in promoting care for veterans.

Military culture in particular can send the message that soldiers and sailors should bear their emotional burdens in silence.

“There has been a negative stigma for many in seeking healthcare. There’s fear of retribution, or fear of not being promoted at the normal pace, or of somehow being perceived as weak. So I think the perceived stigma and really getting folks to seek behavioral healthcare are true challenges throughout the country.”

The absence of adequate intervention to address behavioral health problems may erode a veteran’s ability to fully thrive. Or in the most tragic cases, it may lead to catastrophically self-destructive measures. Wilson, who says that responding to the alarming rise in military suicides has become a top priority of the VWWP, points out that roughly half of these heartbreaking cases occur among service members who have never been deployed to Iraq or Afghanistan.

But the veterans of those conflicts who do find themselves in crisis, she says, may suffer under the burden of their frontline trials, a burden often compounded by the rigors of multiple deployments in rapid succession.

Explaining that the health of communities throughout Virginia—whose population comprises a relatively high percentage of veterans—is enhanced when the critical needs of service members are addressed, Wilson remarks: “I think that in Virginia, we’ve really been a vanguard in trying to get integrated support services for our veterans and their families, because I think we’re just seeing the tip of the iceberg.”

She continues, “We’ve been touted as a national model, but I think—more importantly—we’re just making a difference in the lives of our Virginia veterans and their families.”

Bullen, who has repeatedly demonstrated that it is possible for veterans to resume a fruitful course following deployment, divulges another personal strategy that

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VETERAN CARE | our health

has served him well: He makes a concerted effort to leave his war stories on the terrain that spawned them.

“It’s not something that I would like to keep bringing up on a recurring basis. That part of your life—good or bad—it’s over with,” he explains, adding this qualification. “But the downside to that is when you compartmentalize things, sometimes it’s harder to access them.”

He recounts his combat recollections only in situations where they might serve a productive purpose and is reluctant to share them with people who simply can’t relate to them, conscious of the discomfort they may create.

And for those with an insatiable appetite for war-zone details, he affably offers this tongue-in-cheek suggestion: “If you’d like the firsthand experience, the last time I checked, they’re still enlisting.”

The survival rate on the battlefield has really improved,” Wilson observes. “But whether it’s a physical or an invisible wound, some individuals face a lifetime of struggle and hardship.

For more information about the Virginia Wounded Warrior Program, please visit http://www.wearevirginiaveterans.org/.

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VETERAN CARE | our health

TeleHealth Service

for the McGuire Veterans Affairs Medical Center words | ANIKA IMAJO

The U.S. Department of Veterans Affairs (VA) has constructed a virtual bridge between their geographically remote patients and the medical services they need.

A technology that allows a liver transplant patient in San Juan to receive treatment from specialists here in Richmond—without stepping foot outside Puerto Rico, telehealth advances the organization’s mission to provide all veterans with access to quality health services, even those in rural communities and remote locations.

“One of the things that really drives this is the belief that there is one VA,” explains Phillip Tarkington, MD, chief of Health Informatics and Telehealth Service for the McGuire Veterans Affairs Medical Center. The VA, he notes, has a mandate to make its resources and specialists equally available to all veterans, despite physical distance and mobility challenges.

McGuire is a core facility that serves smaller community-based outpatient clinics www.ourhealthrichmond.com | 35

our health | VETERAN CARE

(CBOCs) in Emporia, Fredericksburg and Charlottesville. But through telehealth, the array of services available at McGuire—including its Parkinson’s Disease and Movement Disorder clinic and Spinal Cord Injury programs—are reaching veterans throughout the country.

Harnessing the vast potential of this innovative approach to healthcare, the VA employs telehealth in a number of ways.

Sharon Rhone, Rural Health Integrator for McGuire VAMC

In its Store and Forward modality, images captured at CBOCs or other medical centers can be forwarded for review by providers at a later date. Store and Forward is employed for teleretinal imaging that ophthalmologists and optometrists can examine for indications of diabetic retinopathy. Similarly, images of skin lesions can be analyzed by dermatologists to detect the presence of possible cancers.

Chronic diseases may be managed effectively by means of the Home Telehealth program, which enables case managers—who are registered nurses—to remotely monitor indicators such as blood pressure, pulse, weight, blood sugar and pulse oximetry on a consistent basis, without having to see the patient in person.

“The close observation that Home Telehealth affords”, says Dr. Tarkington, “facilitates early intervention should the need arise”.

According to Tamara Broadnax, RN, MSN, Facility Telehealth Coordinator for McGuire, Home Telehealth encourages increased compliance among patients and affords them more immediate access to providers who can address their questions and problems—which yields improved results, including reduced hospital visits. “And when patients do end up in the hospital, we have found a reduction in the readmission rate, length of stay and bed days of care when compared to patients whose conditions have not been followed as closely.”

“We’re able to track how well the person does,” she explains. “And what we’ve found is that most people who come into Home Telehealth have much better outcomes once they have this person here checking on them on a regular basis.”

Sharon Rhone, Rural Health Integrator for McGuire VAMC, agrees that the convenience of telehealth helps nudge patients in the direction of seeking the care they need. “A veteran who has a high no-show rate may benefit from mental health services via telehealth, because they have transportation problems out in the rural communities.”

A third telehealth application is Clinical Video Telehealth, which Dr. Tarkington describes as “a Skype-like process” that brings patient and provider together for an interactive encounter. Patients are able to visit their closest medical facility anywhere in the country and have clinic visits with providers here in Richmond. Among the most effective functions of this telehealth program are preoperative and postoperative evaluations, mental health visits and shared medical appointments or group visits, says Dr. Tarkington, who points out

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VETERAN CARE | our health

that McGuire has introduced a pilot program that would provide some patients suffering from spinal cord injuries or mental health conditions to engage in Clinical Video Telehealth at home.

“If the patient has a webcam,” Broadnax explains, “we’re able to connect through it, which works really well for our patients with mobility issues, who are homebound, who are paralyzed.”

Through SCAN-ECHO (Specialty Care Access Network-Extension for Community Healthcare Outcomes), providers may tap into the expertise of far-flung colleagues and specialists throughout the VA network.

“That is a provider-to-provider mentoring program that we use to broadcast specialty care out to areas that don’t have it,” says Dr. Tarkington. “We use our SCAN-ECHO program to help providers in our VA network get comfortable with the technology, get to know the specialists they’re working with and get some continuing medical education in the process of getting the care they need for their patients.”

To illustrate SCAN-ECHO in action, he explains that hepatologists at McGuire— one of few liver transplant centers in the nation—partner with hepatologists at the VAMC in Durham to provide weekly conference calls. Providers who don’t have onsite liver specialists can dial in for advice and participate in educational discussions about the subject at hand. Such information-sharing sessions may focus on any number of areas, such as diabetes.

Chronic diseases may be managed effectively by means of the Home Telehealth program, which enables case managers— who are registered nurses—to remotely monitor indicators such as blood pressure, pulse, weight, blood sugar and pulse oximetry on a consistent basis, without having to see the patient in person.

According to Broadnax, since 2011, when the VA expanded its telehealth services, the program has taken great strides. McGuire has conducted over 3,000 different types of clinical appointments via telehealth this year, up from 230, and 700 patients are now receiving Home Telehealth service, up from 500 last year.

“And we’re planning to partner with our colleagues in the community to expand our services as well,” she says.

Identifying eligible veterans and educating communities in areas of need, Rhone shares, are important first steps toward increasing telehealth services.

“In the rural health program, we really try to make a difference in letting our veterans know what they’re entitled to. A lot of people don’t know. A lot of physicians don’t know. A lot of family members don’t know what we can offer for our veterans.”

Dr. Tarkington, who imagines that telehealth technology will play an increasingly important role in healthcare, explains that the VA’s commitment to eradicating geographic and economic disparities when it comes to treating veterans has placed the organization at the forefront of this promising trend.

“I would say the VA is on the cutting edge of the use of telehealth technology.”

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HealthyEats PRODUCE S ’ L L G FA N I US

Ingredients: 1 cup quinoa 2 cups water

One of the most satisfying things about

1½ teaspoons fresh ginger

fall is the abundance of fresh produce

1½ tablespoons brown rice vinegar

available. Serve warm food and keep the

3 tablespoons orange Juice

chill at bay. At Good Foods Grocery we love

1 teaspoon orange zest

combining seasonal foods with fresh herbs

1 cup dried cranberries

and spices to give our customers hearty

¼ cup parsley

and delicious vegetables. Stop by for

½ cup minced apple soaked in the orange juice

lunch, or come shop our extensive bulk and organic produce. Our offerings will keep

¼ cup scallions

proudly sponsored by

Good Foods Grocery

2 tablespoons olive oil ¾ teaspoon sea salt ¼ teaspoon pepper

Directions: 1.

Place 1 cup quinoa in 2 cups of water.

Bring to a boil. In medium saucepan.

Reduce to simmer, cover and cook for 20 minutes until water is absorbed.

Let cool.

2.

In a bowl, combine cooled quinoa, dried cranberries, scallions, parsley, mint, walnuts, salt & pepper. Soak apple in 1 tablespoon of orange juice and add to quinoa mixture. Wisk in remaining orange juice, olive oil, vinegar & ginger.

Add to mixture and toss.

your family happy and healthy.

Quinoa, Apple and Walnut Salad Serves 10

Good Foods Grocery’s

FRUITY QUINOA SALAD

Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | (804) 740-3518 & Stony Point Shopping Center (Southside) | 3062 Stony Point Road | (804) 320-6767

HealthyEats

proudly sponsored by

Good Foods Grocery

PRODUCE S ’ L L G FA N I US

Roasted Autumn Butternut Squash

¼ teaspoon cinnamon

Serves 4

2

tablespoons honey

2

tablespoons pecans or almond

1 teaspoon lemon zest

2 pounds butternut squash (about 1 large squash)

1 tablespoons lemon juice

¼ cup olive oil ½ teaspoon veggie pepper

3.

Put on cookie sheet and roast for 15 minutes.

4.

Remove from oven, add honey and nuts and roast for five more minutes.

5.

Toss with lemon juice and zest.

Directions 1.

¼ teaspoon salt

Toss the cut up squash with olive oil, red onion, curry powder, salt, veggie pepper & cinnamon.

1 teaspoon curry powder

Ingredients

¾ cup red onion, minced

2.

Preheat oven to 400 F. Cut off outer skin of butternut squash and pull out seeds. Cut into ½” -1” thick slices.

Good Foods Grocery’s

ROASTED FALL SQUASH

Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | (804) 740-3518 & Stony Point Shopping Center (Southside) | 3062 Stony Point Road | (804) 320-6767

HealthyEats PRODUCE S ’ L L A NG F I S U

be mostly covered. Simmer them in the pot for about 1 to 2 hours. When you can easily glide a toothpick or fork through them, they are ready. Add water to them while they are cooking, if necessary. Cool the oranges for a few minutes slice them into wedges and remove any pits or inedible parts (like the nub where the stem was). Process the oranges in a food processor until you have a smooth, orange paste without lumps.

Orange Cake Ingredients: 2 organic Valencia oranges 4 eggs 1 cup of honey 2 cups of blanched almond flour 1 teaspoon of baking soda 1 teaspoon of sea salt

Directions: 1.

Place 2 whole organic Valencia oranges in a pot with enough water to cover them. Add a tightly sealed lid.

The oranges will float, but they should

2.

Preheat the oven to 325 degrees F.

3.

In a bowl, beat eggs (or egg yolks if separated) until well blended, then beat in the honey and dry ingredients (baking soda, salt, and almond flour).

proudly sponsored by

Good Foods Grocery

4.

Fold in the almond flour and orange paste into the egg and honey mixture and blend well.

5.

Butter or oil the bottom of a 9” spring form pan, no need to butter the sides.

6.

Pour the batter into the pan and bake for about 1 hour, or until a toothpick inserted into the center comes out clean. Make sure to bake it thoroughly, especially in the center, or it may settle when it cools. Even if it settles, it will still taste wonderful.

7.

Garnish with an orange slice and a little powdered sugar.

Enjoy!

Good Foods Grocery’s

YUMMY ORANGE CAKE

Good Foods Grocery—two convenient, neighborhood stores: Open 9am -9pm Mon - Sat. Closed Sundays. | www.goodfoodgrocery.com Gayton Crossing Shopping Center (West End) | 1312 Gaskins Road | (804) 740-3518 & Stony Point Shopping Center (Southside) | 3062 Stony Point Road | (804) 320-6767

Womens Health Our extensive women’s health section highlights three women’s stories of strength about their battle against

breast cancer, advancements in local healthcare services, including robotic technology to perform minimally invasive hysterectomy surgery, the emerging field of urogynecology and a look into trends in childbirth.

www.ourhealthrichmond.com | 41

THREE WOMEN’S STORIES OF

Strength words | SARAH COX Michelle Tapscott, Noelle de photography | TOM VEAZEY & Lioncourt, Suzanne Howard: KEITH THIENEMANN These three women are just like any others. They work, they have family, and they never thought they would contract breast cancer. But they did, and their resounding message is to be your own advocate, to be strong, to be a fighter.

Tapscott, who underwent 31 chemotherapy treatments, lost 17 pounds off her already-thin frame, shed her hair, and had 28 rounds of radiation, has come out on the other end of this struggle volunteering at VCU Massey Cancer Center and spreading the message that, while “a lot of women can be people pleasers, and can be afraid to seem annoying or bugging, persistence pays off. So what if it’s annoying? I’m so glad I continued,” she now says.

What she continued was to ask questions when she discovered a painful cyst on her breast during a self-examination. She went straight to the radiologist, who did a mammogram and an ultrasound and declared it a cyst, telling Tapscott that if it was painful, that meant it was not breast cancer. According to the University of Michigan’s “16 Common Myths About Breast Cancer,” there is “no correlation between whether the lump is painful and whether it’s cancerous.” Tapscott found this out the hard way.

WOMEN’S HEALTH | our health

Michelle Tapscott RICHMOND www.ourhealthrichmond.com | 43

WOMEN’S HEALTH | our health

She said the radiologist showed her the ultrasound—which she couldn’t read. “Why should I doubt him?” she recalls thinking.

But the lump became larger and more painful, especially when she exercised. She returned in October, four months after the first ultrasound, to have another. Again, the radiologist told her it was nothing but a cyst.

One of her friends told her about Ellen Shaw de Paredes, MD, a nationally recognized expert in breast imaging and breast cancer diagnosis. She went to see her, and was taken seriously. Dr. De Paredes did a biopsy immediately, and after a few long days of waiting, Tapscott was told the bad news. By then it was February 2009, and the cancer had spread to her lymph node. She was directed to Massey Cancer Center, where she underwent a sectional mastectomy, which was formerly known as a lumpectomy. The pathology report indicated all her lymph nodes needed to be removed.

Noelle de Lioncourt RICHMOND

She said her recovery was not bad, but what was hard was seeing herself in the mirror —“a bald, extremely thin person coming out of the shower.” The other difficult thing was telling her children, a son in college and a daughter now attending grad school.

Tapscott, who is fiercely independent, learned how valuable her community, her family, and her friends were. “I’m a Type A, go-go-go task-oriented person, and all that went out the window as I was forced to slow down,” she says.

So was Noelle de Lioncourt, a 43-year-old software developer who was diagnosed with stage 2B cancer. She had suffered a bad head-on car collision, but the accident, it turned out, was a good thing: de Lioncourt was in pain, but noticed a particular pain on her upper right breast. She, too, went to the doctor, who told her it was a hematoma from the car accident.

“He felt that I should come back in five months, but as the weeks passed, the lump kept growing and was painful. It was not decreasing, but increasing, and grew from the size of a raisin to a walnut,” she says. She went back to her general practitioner, insisting that this didn’t seem right. She was finally referred to Rashmi Vaidya, MD, of Bon Secours Richmond Health System.

“She was wonderful, kind, and you could tell she cared,” recalls de Lioncourt. Dr. Vaidya called her patient the next morning, saying that she had struggled with this through the night and felt that de Lioncourt should come in for a biopsy immediately. One week later, de Lioncourt got the news that she had stage 2 cancer of a particularly aggressive type.

In September 2012 she had surgery — an ancillary dissection, removing her lymph nodes

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our health | WOMEN’S HEALTH

as well. She underwent eight chemotherapy treatments once she had healed, then 33 rounds of radiation.

“I’m complete as of July,” says de Lioncourt. “I still have bouts of weakness, and I was put into early menopause.” She was so weak at one point, she recalls, that she fell walking into her office building and had to go home.

While all de Lioncourt’s scans and MRIs are good as of now, her type of cancer has a high reoccurrence rate. She says she feels well, but is still recovering emotionally from the trauma of the car accident coupled with her breast cancer. And she knows that she was, and is, her best advocate.

“You have your own life in your own hands, and you need to be proactive about it. Be concerned with your own body, and even if the doctor says it’s nothing to be concerned with, get another opinion.

Getting a second opinion is a validation to you,” she advises.

Suzanne Howard had just had a clean mammogram months before she found a large lump in her breast. She, too, is glad that she was vigilant about her own health. Her sister had had breast cancer, so she pursued when her lump turned red and her breast started swelling. She was diagnosed with stage 3 inflammatory breast cancer.

Suzanne Howard RICHMOND

“I didn’t want to burst into tears. I tried to keep control of my feelings, but when the doctor came into the room to tell me the results, initially I heard the first three or four words and then my ears felt like they were humming,” she recalls. Howard is a medical assistant in a family practice, and had encountered many patients who had been diagnosed with breast cancer. Despite that, she says, “I never thought I would be the one.”

Now, she’s 46 and has undergone a bilateral mastectomy and left lymph node dissection. As of April, she is cancer free, feels healthy once again, and is on the cancer medicine tamoxifen for the next five years. Her words of advice are to seek support from family and friends.

“I can’t imagine not having any help. I have an active-duty daughter in the Navy, and her whole leave time was spent running to my appointments with me,” she says. She says to women who are reading this to “fight every single day, to wake up every day and fight another day. Breast cancer survivors have given me so much inspiration.”

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Robotics Technology Provides Hysterectomy words | EDWIN SCHWARTZ

48 | www.ourhealthrichmond.com

Bon Secours St. Mary’s Hospital now offers women hysterectomy procedures performed with a single-incision in the belly button. In May 2013, Danny Shaban, MD, director of GYN Robotics at Bon Secours Richmond Health System and the president of Dominion Women’s Health, performed one of the first single-site da Vinci Surgical System hysterectomies in the United States.

Hysterectomies are the second most common surgical procedure for women in the United States, and about one-third of all women will have one by age 60.

“Many people think having a full or partial hysterectomy means they will immediately enter menopause,” says Dr. Shaban. “This is not necessarily true. As long as you maintain your ability to keep your ovaries you won’t enter menopause.”

WOMEN’S HEALTH | our health

When Ann Marie Silva of King William County learned she had an ovarian cyst, Dr. Shaban recommended she have the singleincision procedure to lessen the long-term impact.

da Vinci single-site instrumentation is inserted into a single incision in or below the belly button

“It wouldn’t take six weeks to recover, and the healing would be quicker,” says Silva.

On July 2, Dr. Shaban performed her partial hysterectomy, in which he removed the cyst, the ovary and the uterus.

Hysterectomies traditionally are performed robotically using three to five incisions or one large incision. The single-site da Vinci hysterectomy offers many benefits, including minimal scarring, little pain, low blood loss, short hospital stays and speedy recoveries. Most hospital stays are less than 24 hours.

“The single-site hysterectomy procedure takes about an hour,” says Dr. Shaban.

“Women are getting back to their lives faster without the usual recovery following major surgery.”

Dr. Shaban adds that women can generally return to their normal lifestyle within a week.

“For the surgeon there is really only one benefit, making one incision versus multiple incisions,” says Dr. Shaban. “The biggest benefits are for the patient. It is virtually scarless. Cosmetically, it is amazing. The recovery is as well, because there’s only one incision to heal. Everything is done at or through the belly button.”

Dr. Shaban makes a single incision in or near the patient’s belly button for a daVinci single-site hysterectomy at Bon Secours St. Mary’s Hospital

“I have a very small scar right below my belly button. It’s almost unnoticeable,” says Silva.

“This is so surprising to me given that I was told my ovarian cyst was almost the size of a cantaloupe.”

Dr. Shaban recommends surgeons invest in the necessary training and equipment only if they plan on performing frequent surgeries.

“It’s not for every GYN surgeon. You will adapt and make modifications with it over time,” he says.

“What you’ll see are more physicians referring to robotic surgeons,” continues Dr. Shaban.

“This procedure is not a wide-tie/thin-tie trend. It’s here to stay, because it’s only going to improve over the next few years rather than fizzle away.”

While performing the procedure the surgeon sits at a console and watches a high-definition, three-dimensional image of the patient’s internal organs. No movement occurs outside the patient’s abdomen as the surgeon holds controls that move the instrument arms and camera. In real time, the system relays the surgeon’s hand, finger and wrist movements

A partial hysterectomy is surgery to remove a patient’s uterus, while a total hysterectomy removes both the uterus and cervix. The single-site da Vinci procedure may perform both through a single, 2.5-centimeter incision in the navel. The procedure may also be used to remove cysts from ovaries and fibroids from the uterus.

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our health | WOMEN’S HEALTH

into precision instrument operations. As a result, the surgeon receives subtle physical “feedback” while holding the controls. This feedback serves as a substitute for the sense of touch and is enhanced by the vision provided by the high-definition, three-dimensional view.

Dr. Shaban says there are no limitations placed on candidates for the operation.

“There is no weight limit. Even candidates with biopsy-proven cancers can still be treated if referred to a GYN robotic cancer specialist,” says he continues. “The ideal candidates are those who have had open surgeries or previous surgeries because of their weight. With a tiny incision, the risk of infection makes this a preferred option for high-risk patients. There are less interoperative or postoperative complications.”

Dr. Shaban’s advice to patients considering the procedure is simple.

“Today, we are dealing with a highly educated population that is highly knowledgeable about what’s being offered,” he says. “You want to ask if the surgeon does it on a regular basis.”

Silva also offers high praise for the singlesite hysterectomy.

“If your doctor recommends you have one, I definitely recommend doing it this way, especially if you’re someone who needs to get back to work and is concerned with time loss,” she says. “For people who are worried about getting back to a routine, I can’t imagine wanting to do it the old way, being sore for six weeks with limits on what you can do.”

Silva adds, “The recovery was pretty easy.

The main thing to overcome was being tired and getting my strength back. On the second day, July 4th, I made it to two barbecues, with a nap in between. And by the fourth day I was fine.”

Danny Shaban, MD, director of GYN Robotics at Bon Secours Richmond Health System and the president of Dominion Women’s Health

50 | www.ourhealthrichmond.com

Meghana Gowda, MD, recently joined Virginia Urology as a urogynecologist.

WOMEN’S HEALTH | our health

The Emerging Field of Urogynecology For many people the subject of incontinence has always been a very private matter. But these issues are quite normal, easily treatable and nothing to be embarrassed about.

words | EDWIN SCHWARTZ

“Incontinence is a general term that refers to the leakage of urine or feces,” says Meghana Gowda, MD, who recently joined Virginia Urology as a urogynecologist. “It is a symptom that can result from a broad set of medical conditions.”

The types of urinary incontinence are: stress incontinence (caused by physical activities like laughing, sneezing or straining), urgency incontinence (sudden urge to urinate), mixed incontinence (combination of urge and stress incontinence) and overflow incontinence (bladder does not empty properly).

Multiple factors may cause urinary incontinence in women, yet the leading culprits are neurologic disease (such as multiple sclerosis or Parkinson’s disease) and obstetric factors (the number of children a woman has had and how they were delivered). www.ourhealthrichmond.com | 53

Poor general health may trigger incontinence as well.

Diabetes, high blood pressure, stroke, pulmonary disease, back problems, Alzheimer’s, smoking history and obesity are all possible causes. Age plays a role, too. As the body gets older, muscle weakness occurs around the urinary tract area.

Menopausal women can also experience urine loss resulting from decreased estrogen levels.

Traditionally, women who suffered from urinary incontinence would seek treatment from a urologist. But today these patients may consult a urogynecologist. “A urogynecologist is a subspecialty surgeon who has been trained to care for women with pelvic floor disorders,” says Dr. Gowda.

“The pelvic floor refers to the set of muscles, ligaments and connective tissue that surround and provide support to the pelvic organs such as the bladder, uterus, vagina, rectum and bowel,” adds Dr. Gowda. “Pelvic floor disorders include incontinence (leakage of urine or feces), prolapse (descent of the pelvic organs, pressure or bulge), emptying disorders (difficulty with urinating or moving bowels) and overactive bladder (frequency, urgency or difficulty with control). There are a variety of conditions urogynecologists can treat.”

“Urogynecologists are unique because they have undergone additional training after a primary residency in either urology or gynecology,” continues Dr. Gowda. “This includes further experience in colorectal issues, neurologic conditions and pelvic surgery. Urogynecologists have a certification in female pelvic medicine and reconstructive surgery.”

A urologist, gynecologist or primary care physician may be educated about these disorders. But a urogynecologist can offer both special surgical expertise and nonsurgical options.

“You should see a urogynecologist if you experience leakage, prolapse, loss of control or problems with emptying your bowel or bladder,” says Dr. Gowda. “Typically, urogynecologists are exclusively dedicated to these problems and have a breadth of experience with these issues.”

Factors considered when developing a treatment plan include: patient’s wishes, severity of symptoms, patient lifestyle and other medical conditions. Since urogynecologists are specialty surgeons, many patients may wonder if their only options are surgical.

“Nonsurgical options can include pelvic exercises, working with a physical therapist, medications, lifestyle modifications (weight control, dietary modifications, or smoking cessation) or a pessary (a removable device inserted into the vagina),” says Dr. Gowda.

Patients can assist their urogynecologist in developing a treatment plan prior to their visit.

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“Sometimes it can be helpful if you keep a log of your symptoms,” explains Dr. Gowda.

“Keeping a record of symptoms such as leaking versus urgency as well as the timing and type of fluid intake (coffee, alcohol or water) helps when determining a course of action. If you have a complicated medical history, you can write out a list of medical conditions, surgeries, medications and allergies. And always feel free to bring a list of questions.”

Certain medications can contribute to urinary incontinence. Elevated blood pressure and diuretics or fluid pills can affect leakage. Caffeine has also been implicated as a culprit, as well as alcohol and cigarettes.

“Issues related to leakage and prolapse are treatable and not just a ‘normal part of aging’ that must be endured,” says Dr. Gowda. “There are so many women who experience these problems that an entire field, urogynecology, is devoted to these conditions.”

Bladder, bowel and sexual functions are very private and sensitive topics. But urogynecologists deal with these issues all day, every day.

“There are a number of options available to women. Urogynecologists are committed to tailoring a treatment plan that fits your goals. We do a thorough examination and evaluation in order to care for and resolve your individual situation,” Dr. Gowda concludes.

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Trends in Childbirth: WHAT’S OLD IS NEW AGAIN words | SUSAN DUBUQUE

Trends come and go. From skirt lengths and hairdos, to colors and music. Similarly, there are trends in childbirth. Although women have basically been giving birth the same way since the beginning of time, the environment and practices that surround the birth of a baby are everchanging—and in some cases cyclical.

Let’s zip back in time and explore the developments in childbirth in the U.S. through the last century.

In 1900, fewer than five percent of women gave birth in hospitals.

Physicians attended about half of all the nation’s births, including nearly all births to middle- and upper-class women. Lay midwives took care of women who could not afford a doctor.

The first maternity clothes were introduced in 1904 by Lane Bryant.

In 1914, “twilight sleep”—use of morphine and scopolamine to wipe out the memory of the pain of childbirth— was introduced into the United States and upper-class women formed “Twilight Sleep Societies” in an effort to force hospitals to offer the procedure. At this time, obstetrical anesthesia became a symbol of progress in medicine and women flocked to the hospital seeking pain-free childbirth.

The 1920s saw the establishment of professional training programs for nurse-midwives.

By the late 1930s, 50 percent of all women and 75 percent of urban women gave birth in hospitals.

The medical profession engaged in hot debate over the use of pain medications for childbirth.

During the 1950s, the concept of “family-centered maternity care” was first introduced, the La Leche

WOMEN’S HEALTH | our health

League was founded as the leading advocate for breastfeeding and Robert Bradley, MD, and Ferdinand Lamaze, MD, introduced their approaches to natural childbirth.

In the early 1970s, a combination of feminism and the back-to-nature movement led to a revival of midwifery. Many women proclaimed that childbirth is not a disease and that normal deliveries do not require hospitalization or supervision by an obstetrician. Husband demanded to be present for labor and birth—serving as “coaches” for their wives.

Melanie Hartman, CNM, Bon Secours St. Francis The Woman’s Center

In 1980, midwives attended only 1.1 percent of births. By 2011, 7.8 percent of all births and 11.7 percent of vaginal births were managed by midwives—many with master’s degrees in nurse-midwifery.

The 1990s, brought another wave of painless childbirths with the introduction of epidurals. In 1995, Cesarean sections (C-sections) accounted for 21 percent of all births, trending upward to a high of 33 percent in 2009. Since 2011, the C-section rate has stabilized at 31 percent.

With so many developments in the past 100 years, let’s now explore the latest innovations—as well as tried-and-true childbirth practices—occurring right here in our community in 2013.

Meghann Batten, CNM, drirecor of midwifery services at VCU Medical Center

Sources: National Vital Statistics Reports; Center for Disease Control; The History of Midwifery and Childbirth in America: a Time Line, Midwifery Today; research on the History of Cesarean Sections conducted by Dr. Sumac Diaz and presented at Wayne State University in August 2013.

Empowering Women Today, women have very decided opinions about childbirth— and Bon Secours Richmond Health System (BSRHS), HCA Virginia Health System and VCU Medical Center are responding to consumer needs and wishes in a variety of ways.

Each year HCA Virginia has about 3,100 deliveries at Henrico Doctors’ and 3,000 at HCA Chippenham and HCA JohnstonWillis Hospitals combined; BSRHS has 2,745 at Bon Secours St. Mary’s Hospital, 1,800 at Bon Secours Memorial Regional Medical Center and 1,800 at Bon Secours St. Francis Medical Center; and VCU Medical Center has 2,200. But no matter if the hospital is large or small, every effort is made to provide each mother with a truly customized birth experience.

(Source: Virginia Health Information) One of the first choices an expectant mother will make is who will guide her through pregnancy and delivery. “Women today have so many choices in birthing. We recommend that they educate themselves as to what type of birthing experience they desire and then interview providers to determine if they are compatible,” suggests Melanie Hartman, CNM, Bon Secours St. Francis The Woman’s Center.

HCA Virginia offers a choice of obstetricians in multiple groups—including male and female providers. VCU Medical Center has obstetricians and five certified nurse-midwives who work in a collaborative practice. BSRHS has a cadre of obstetricians and four certified nurse-midwives and nurses trained as doulas. www.ourhealthrichmond.com | 59

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Sue Lindner, director of the VCU School of Nursing volunteer doula program

“The nurse-midwives at VCU specialize in natural childbirth—high-touch/lowintervention care,” says Meghann Batten, CNM, director of midwifery services at VCU Medical Center. Obstetricians attend the full range of deliveries—from uncomplicated births to high-risk patients.

Throughout their hospital stays, patients are cared for by teams of experienced mother-baby nurses. Patients are also welcome to have doulas and other support persons with them through labor and delivery at all facilities.

A doula—sometimes called a labor coach—is typically a nonmedical person who assists women before, during and after childbirth. Sue Lindner, director of the VCU School of Nursing volunteer doula program, says, “Many of our third-year nursing students act as volunteer doulas, gaining valuable professional experience and providing our patients with physical assistance and emotional support.”

The program is offered free of charge and is available to any patient.

Safe and Warm “We encourage women to prepare a written birth plan to make sure her delivery physician is fully aware of her preference,” says Courtney Legum-Wenk, DO, an OB/GYN practicing at HCA Henrico Doctors’ Hospital. The birth plan might include the specific people whom the mother would like to support her through labor, soft lighting, soothing music, pain management techniques and the like. The plan could also articulate how the mother would like the baby treated—such as delayed cord clamping and initiation of breastfeeding as soon as possible.

Local nurse practitioner, author and doula trainer Kathy Stewart has written a book on birth plans, available at yourbirthplanbook.com.

Comfort is a high priority when it comes to childbirth. Our local health systems have made considerable investments to provide mothers with accommodations that you would expect to find in a fine hotel. “Henrico Doctors’ Hospital is underway with a five-year plan to completely redo its Women’s 60 | www.ourhealthrichmond.com

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Pavilion,” says Legum-Wenk. VCU Medical Center recently unveiled a $23 million renovation of the labor and delivery unit, soon to be followed by an extensive facelift for the mother-infant unit. Bon Secours St. Mary’s completed renovation of it obstetrical services in spring 2013.

“Many women are seeking the warmth of a birthing center or home delivery in the security of a hospital,” says Sumac Diaz, MD, an OB/GYN who practices at HCA Chippenham Hospital. In response, Richmond hospitals feature a variety of amenities, from à la carte dining and valet parking to spacious patient rooms with private labor tubs and showers. Intermittent and remote fetal monitoring ensure that baby’s progress can be tracked, while allowing mother to walk around, use a birthing ball or bar or even relax in the water during labor. Flexible visiting policies further enhance the family-friendly nature of obstetrical care. For an additional fee, VCU Medical Center offers patients the accommodations similar to a five-star hotel in the Gumenick Suites.

When it comes to childbirth, women should be empowered. “We do everything we can to meet each individual’s desires,” indicates Christine Isaacs, MD, OB/GYN at VCU Medical Center, “but always with the priority of safety for mother and baby.” Access to a neonatal intensive care unit (NICU) can provide an added degree of assurance. Level III NICUs—offering the highest level of care for premature or critically ill babies—are located at VCU Medical Center, Bon Secours St. Mary’s Hospital, Henrico Doctors’ Hospital, Chippenham Hospital and Johnston-Willis, Hospital. VCU Medical Center has the only private-room NICU in central Virginia, allowing the parents to remain with the baby at all times.

Courtney LegumWenk, DO, an OB/ GYN practicing at HCA Henrico Doctors’ Hospital

Christine Isaacs, MD, OB/GYN at VCU Medical Center

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The use of pain medication during labor and delivery is a very personal choice. “With or without medication, sometimes being patient and allowing nature to take its course can be the difference between a vaginal and a Cesarean delivery,” says Diaz. Steve Bendhaim, MD, who practices at Bon Secours St. Mary’s and Bon Secours St. Francis, says, “Medical intervention saves lives when needed. But when not medically indicated, the complex process of birth should be supported, not interfered with. Mother Nature knows what she is doing.” All Richmond hospitals have C-section rates below the national average.

Source: Virginia Health Information

Similarly, Isaacs notes, “At VCU we encourage women who wish to attempt a vaginal delivery after previously having a Cesarean section (VBAC).

With a full delivery team and anesthesia on hand 24/7, this is a safe environment for a VBAC.” “Skin-to-skin contact is a wonderful way for mother and baby to bond in the first precious moments after birth,” says Hartman. BSRHS has a program called the “Magic Hour,” in which the staff attempt to keep the mother and baby skin-toskin, undisturbed, for at least the first hour of life.

Hartman explains, “This helps facilitate a smooth transition for the baby and early breastfeeding for those mothers who choose to breastfeed.”

Getting Ready for Baby Local hospitals provide a multitude of ways for new parents to learn and prepare for pregnancy and beyond with a broad selection of educational programs—from childbirth preparation, nutrition and exercise to infant CPR and newborn care.

There are even special classes for siblings and dads. Bon Secours’ community-based independent “Parenting Partners” teaches a variety of childbirth preparation techniques, including hypnobirthing, which was recently used by the Duchess of Cambridge. “Rooming-in allows the new family to spend time together and to gain confidence in caring for the newborn before going home,” said Legum-Wenk.

Certified lactation consultants and nurses are available to assist mothers with breastfeeding while in the hospital, and breastfeeding classes provide ongoing support after discharge. Bon Secours’ Woman’s Place—a center dedicated to helping new mothers have a successful and more comfortable breastfeeding experience— 62 | www.ourhealthrichmond.com

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offers classes, support groups and an answer line and sells breastfeeding items and accessories.

“CenteringPregnancy® is a form of group prenatal care,” Batten explains. “Each group is made up of eight to 12 women with similar due dates. Together, they learn, share and develop a wonderful support network.” CenteringPregnancy is offered by both VCU Medical Center and BSRHS, with sessions at VCU Medical Center at Stony Point, VCU Medical Center downtown campus and Bon Secours St. Francis Medical Center.

Personalization is the hallmark of a progressive childbirth service—and today women are fortunate to have abundant choices. But if you think the latest trends like birthing balls and laboring pools are mere fads, think again. Women are reaffirming the notion that childbirth is a beautiful, natural occurrence—not an acute medical event. They are playing an active role in planning their pregnancies and deliveries.

Conducting thoughtful research and doing their homework. And along with childbirth professionals, they are continually seeking better ways to ensure the safe delivery of healthy babies. And that’s a trend we can all embrace.

Here’s how you can learn more about the innovative, family-friendly childbirth services available in our community.

Bon Secours: bonsecoursforwomen.com HCA: HCAVIRGINIA.com or call HCA’s Consult-A-Nurse® line at 804-320-DOCS (3627) VCU Medical Center: VCUmom.com

Susan Dubuque is principal and co-founder of Neathawk Dubuque & Packett, a marketing and advertising firm based in Richmond, VA, that has a special group dedicated to healthcare and wellness. A nationally recognized speaker, Susan has published more than 100 articles on healthcare and service marketing, and has assisted more than 200 hospitals and healthcare organizations with marketing and branding initiatives. Author of two books, A Parent’s Survival Guide to Childhood Depression and Kid Power Tactics for Dealing with Depression, she launched a national campaign to increase public awareness of childhood depression.

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RISING to the CHALLENGE words | SARAH COX

Cassidy McAdams is a 13-year-old musician, rodeo rider and lover of horses and the great outdoors. She writes songs, she plays the guitar and she raises money for Guardian Angel Medical Service Dogs. Why? Her life was saved by one.

Cassidy was diagnosed at the age of seven with type 1 diabetes. By that time, she had already had multiple surgeries to fix a birth defect that left her with essentially no neck on the left side of her body. Her mother, Lisa McAdams, explains that her daughter had to wear devices to support her neck and somehow picked up a virus.

Once she had recovered, it was discovered that she had contracted type 1 diabetes.

“We thought she had contracted a urinary tract infection,” says Lisa. “But, her blood sugar was 836, and the doctor told us she must have had a virus that killed off the pancreas cells. She had already had an endocrinologist for a lump on her tongue, and from that point on, she has been a pretty severe diabetic.”

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Cassidy’s diabetes is hard to control. Her blood sugar swings between 50 and 600, for no logical reason, Lisa states. That is the reason she’s homeschooled—no school could or was willing to accommodate her needs. She tests her glucose levels about 14 times a day, Cassidy says, but doing that “helps me play the guitar because I get calluses on my fingers” from sticking herself. She changes her pump every three days, and she has become remarkably independent, even as a high school freshman. She spent the night away with a friend this past summer, and was responsible for taking her thyroid medicine, making sure her pump was working (and if it wasn’t, taking a shot) and counting her carbs.

Cassidy had another stumbling block, besides being born with a thyroid problem and a birth defect. She had a severe stutter. Her mother was told to put her in speech therapy, but that didn’t work. Next, they tried dancing, and through this program discovered weekly voice lessons. At age four, Cassidy had to do a recital. “She sang ‘This Little Light of Mine’ and never stuttered from that day forward,” says Lisa.

Cassidy has written songs and put them on iTunes; the money from that goes to Guardian Angel Medical Service Dogs. She raised her own money for Pepper, her lifesaving black Labrador, by making dog treats and dog bandanas and selling them at Bass Pro Shops. She has music gigs all over, raising money to give back to the Juvenile Diabetes Research Foundation.

“Her spirit is enduring,” says her mother. “She is always looking for the good in others. I’m very proud of her. She has never used diabetes as an excuse to not give 100 percent every day of her life. This is motivation for me—it gives me strength.”

Cassidy explains that she’s not your typical type 1 diabetic. Her blood sugar is very hard to control, but she says it hasn’t prevented her from doing anything. “I’m outside every day, all day. I’m not a dull person at all.”

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Pepper is her hero. At three months old (Pepper is now four), she woke Cassidy up one night. She sensed something was terribly wrong, and it was. Cassidy’s blood sugar had dipped to 21. “I would never have known that if she had not barked her head off,” says Cassidy.

In addition to raising money for other type 1 diabetics to be able to afford a service dog, Cassidy has reached out to a friend who also has the disease. “Her family doesn’t know much about the disease, so we share stories and talk about it,” she says.

Her future is wide open. Cassidy wants to be involved with animals, perhaps start to train diabetic service dogs. She’s looking into engineering, the field her father is in. And then there’s her music—the Virginia State Fair this year, recording songs, barrel racing at rodeos—not your typical kid.

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