OurHealth Richmond Oct/Nov 2014 Edition by OurHealth Media LLC

table of contents | october • november 2014

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

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

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

Beating Breast Cancer One Dance Step at a Time

A listing of new physicians, providers, locations and upcoming events in greater Richmond

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

FIT BITS!.........................................................................34 Work the ‘Back’ to Wear the ‘Black’ (Holiday Dress)

featuring the

WOMEN’S CHART for HEALTHY AGING foldout

OurHealth | The Resource for Healthy Living in Greater Richmond

p.36

The Resource for Healthy Living in Greater Richmond

THE ANATOMY CHALLENGE................................. 39 How much do you about our anatomy? In this issue, test your knowledge when it comes to the amazing MOUTH!

ANATOMY: A Beautiful Mouth and Face................40 What VCU Oral and Facial Surgeons Do Day in and Day Out.

It's Time to Speak Up!.................. 62

[series]

Breaking the Silence: Depression

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

Cameron Gallagher decided to take on the challenge of her own depression and mental health treatment and speak up.

hello, HEALTH!.............................. 64 Capturing the spirit of those working in healthcare and of people leading healthy lives through photos

NUTRITION........................ 66 HEALTHY EATS: Shop Seasonally for Better Flavorand Extra Value—Green Bean Summer Salad, Herb Roasted Vegetables, Vegan GlutenFree Apricot Muffins Cookies

LOOKING BACK........................... 70 Images reflecting the history of healthcare in Richmond * PLUS * a chance to win prizes!

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october • november 2014

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CONTRIBUTING RICHMOND MEDICAL EXPERTS Joy Black Kenneth A. Ellenbogen, MD Heather A. Hannon, MSN, RN Aarat M. Patel, MD, FAAP, FACR Daniel Van Himbergen, MD Rodrick N. Love, MD CONTRIBUTING PROFESSIONAL EXPERTS & WRITERS Susan Dubuque Michelle Smith Suzanne Ramsey Deidre Wilkes Diane York ADVERTISING AND MARKETING Richard Berkowitz Senior Vice President, Business Development P: 804.539.4320 F: 540.387.6483 rick@ourhealthvirginia.com SUBSCRIPTIONS To receive Our Health Richmond via U.S. Mail, please contact Jennifer Hungate at jenny@ourhealthvirginia.com or at 540.387.6482

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COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor-at-Large: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Information in all print editions of OurHealth and on all OurHealth’s websites (www.ourhealthrichmond.com, www.ourhealthcville.com and www.ourhealthvirginia.com), social media sites and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2014 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. The OurHealth Greater Richmond edition is published seven times annually by McClintic Media, Inc. 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthrichmond.com | Advertising rates upon request.

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

What is Reactive Arthritis?

What is “polypoid degeneration?”

What is Gestational Diabetes?

Reactive arthritis is a kind of arthritis in which joints swell and become painful after an infection. The infection that triggers reactive arthritis is usually an intestinal, genital or urinary tract infection. The majority of cases are after bacterial infections of the bowel (Salmonella, Shigella, Campylobacter and Yersinia) and genital bacterial infections (Chlamydia).

Polypoid degeneration is swelling of the membranous portion of both vocal folds. It is most often seen in middle aged men and women. Chronic irritation of the vocal folds due to misuse of the voice, acid reflux, and chronic sinus drainage are all causes. However, the most common cause is heavy smoking. It is more common to notice this in females due to the vocal changes (i.e., a very deep, husky, rough voice) being more pronounced in women.

Diabetes that begins in pregnancy is called gestational diabetes and is characterized by higher than normal blood sugar levels that can negatively affect a developing baby. In order to reduce their risk of complications, expectant moms with gestational diabetes will learn to manage their blood sugar levels through diet and exercise. Occasionally, diet and exercise are not enough and oral medication and/or insulin is needed to control blood sugar.

This form of arthritis falls under the family of arthritis conditions called spondyloarthropathies. Symptoms of reactive arthritis include joint pain and swelling that occur suddenly in any joint, but more commonly in the lower extremity joints. Tendonitis, plantar fasciitis and eye inflammation can also occur. Treatment of reactive arthritis can vary from anti-inflammatory drugs and antibiotics to disease-modifying antirheumatic drugs (those that are used in rheumatoid arthritis), depending on severity of disease. Some people with reactive arthritis may have a mild disease that will not require treatment while others may have persistent symptoms that will require longer courses of treatment. Aarat M. Patel, MD, FAAP, FACR Bon Secours Arthritis and Osteoporosis Center of Richmond Adult and Pediatric Rheumatology Richmond | 804.554.3880 www.bonsecours.com

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Usually surgical treatment is not necessary unless airway obstruction develops. Fortunately, this is quite rare. Cessation of smoking is essential in the treatment of this disease, and without this, the swelling almost immediately returns post surgery. Sometimes, cessation of smoking alone will result in a significant improvement in symptoms. Daniel Van Himbergen, MD

Virginia Ear, Nose, and Throat Associates Various Locations in Greater Richmond 804.484.3700 www.virginiaent.com

Maternal-fetal medicine specialists focus on high-risk pregnancy care and often work with women who have gestational diabetes. Additional testing is often indicated to monitor the baby’s health and reduce the risk of complications throughout pregnancy. For most women, gestational diabetes will go away once the baby is delivered. However, women with gestational diabetes are at higher risk of developing type II diabetes later in life. After pregnancy, a nutritious diet and regular exercise may help prevent or postpone the development of diabetes. Rodrick N. Love, MD

Maternal-fetal Medicine Specialist Virginia Women’s Center Mechanicsville | 804.288.4084 www.VirginiaWomensCenter.com

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

What role can meditation play in the healing process? When we become stressed, our bodies react with a built-in “fight or flight” response, which causes blood vessels to constrict, blood pressure and pulse to rise, and breathing rate to increase. A cascade of hormones is released to suppress our immune system and reduce inflammation. Glucose is increased in the bloodstream and non-essential body functions are slowed. Sadly, in our stressed out culture, we spend too many hours in this state, which can lead to illness. Meditation activates our “relaxation response” through powerful mind-body connections, enabling our bodies’ innate self-healing capacity. Dr. Deepak Chopra notes these meditation benefits: “stress reduction, better sleep, lower blood pressure, improved cardiovascular function, improved immunity, and the ability to stay centered in the midst of all the turmoil that’s going on around you.” There are many ways to meditate— find one you enjoy and stick with it. You can start with as little as one minute a day. Joy Black

Certified Healing Tao Qigong Instructor Good Energy for Life Midlothian-Richmond | 804.971.7135 www.goodenergyforlife.net

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What are some ‘uncommon’ symptoms of a heart attack that people should be aware of ? Patients with heart attacks can have atypical symptoms, and women are more likely to have these than men. Some examples of atypical presentations include sharp pain brought on by coughing or breathing; pain localized to the middle or lower abdomen, or epigastric region. Pain that has similarities to reflux or GERD, or associated with a “gas-like” sensation can also occur. Other, less common presentations, are pain reproduced with movement or by pressure on the chest wall; constant pain; brief pain that lasts only seconds; pain that radiates to the jaw or neck and mimics a toothache or “pulled muscle;” and pain that radiates only to the left arm or elbow. Kenneth A. Ellenbogen, MD Chair, Division of Cardiology VCU Medical Center’s Pauley Heart Center Richmond | 804.828.7565 www.intmed.vcu.edu

How can genetic education and screening help in determining a person’s risk for certain types of cancer? Cancer results when there is damage to our genes. While cancer is not inevitable in someone who has inherited a damaged gene, it does mean that fewer other things need to go wrong for cancer to develop. For example, women who inherit a damaged copy of one of their BRCA genes have a much greater chance of developing breast and ovarian cancer than women who do not, and men born with a mutation in a BRCA gene have a higher risk of breast and prostate cancer. Individuals with a strong family history often undergo genetic education and screening to find out whether they carry a faulty gene. This is important because if a mutation is found, the individual has the opportunity to take proactive steps to significantly decrease their risk of developing cancer, such as increased surveillance and/or preventative surgery. For instance, preventive mastectomy reduces the risk of breast cancer in women with a BRCA gene mutation by greater than or equal to 90 percent. Heather A. Hannon, MSN, RN

Breast Cancer Nurse Navigator and Breast Program Coordinator Genetic Nurse Educator The Thomas Johns Cancer Hospital Richmond | 804.330.2071

NEW

NOTEWORTHY

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

Local Orthopaedic Surgeon Performs First Trial Implant to Knee in Clinical Study Patient Aesculap Biologics, LLC Announces First Human Implantation of NOVOCART® 3D Autologous Chondrocyte Product Aesculap Biologics, LLC, a division of Aesculap,Inc. focused on biological approaches to the repair and regeneration of diseased or damaged tissues, is pleased to announce that the first clinical study patient was implanted with the company’s NOVOCART® 3D product in August 2014. NOVOCART 3D, part of an FDA Investigational New Drug (IND) Phase 3 randomized, partially blinded multicenter study, is a matrix induced autologous chondrocyte product designed to repair articular cartilage defects of the knee. Kenneth R. Zaslav, MD, a board-certified orthopedic surgeon with Advanced Orthopedics in Richmond, performed the first implantation during a knee surgery to repair diseased articular cartilage. Dr.

Zaslav implanted NOVOCART 3D’s cartilage scaffold that was regenerated from the patient’s chondrocytes, the basic cell of articular cartilage. “I am very excited to be one of the first entities in the U.S. to implant NOVOCART 3D,” said Dr. Zaslav, a founding member of the Cartilage Restoration Center at Advanced Orthopedics and a Clinical Professor of Orthopedic Surgery at Virginia Commonwealth University. “The product is easy to implant, there is no potential for leakage of cells out of the defect area as the cells are equally distributed within the implant [due to the nature of the scaffold]. The hope is that NOVOCART 3D will promote a hyalinelike repair of the cartilage to mimic the natural joint and provide homogenous ingrowth of articular cartilage for good long term results.” Articular cartilage gives synovial joints friction-free movement with even load

distribution to minimize peak stress on the bone. The loss or damage of articular cartilage can lead to osteoarthritis, the leading cause of chronic disability in the US.1 NOVOCART 3D aims to stop or slow down the deterioration of articular cartilage. NOVOCART 3D places healthy cartilage cells on a collagen-based scaffold grown from a small cartilage biopsy harvested from the patient. After a 21 - 25 day growth cycle, the final cell-scaffold is implanted into the cartilage defect, positioning the cells to grow into new cartilage tissue, with the intention of relieving pain and restoring normal function of the joint.

Physicians Join VCU Medical Center’s Family Medicine Practice on Gaskins Road Giancarlo E. Pierantoni, MD, and Michael Edwin Pitzer, MD, have joined VCU Medical Center’s Department Family Medicine and Population Health and its MCV Physicians practice plan, and are now accepting patients. They join Brett M. Law, MD, at the medical center’s Gaskins Road outpatient location (formerly Altius Family and Sports Medicine), located in the Gaskins Professional Office Park at 2530A Gaskins Road. Drs. Law, Pierantoni and Pitzer are all board certified in Family Medicine, with Dr. Pitzer also being certified in Primary Care Sports Medicine. They offer comprehensive primary care to adults and children as well as provide diagnosis and treatment of sports-related injuries and illnesses. For more information or to schedule an appointment, visit mcvphysicians.vcu.edu or call 804.290.0593.

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Bon Secours Cancer Institute Physicians Offer New Hope to Advanced-Stage Stomach Cancer Patients Breakthrough treatment extends life expectancy from months to years. Two physicians with Bon Secours Cancer Institute were the lead investigators in a clinical trial at the National Institutes of Health (NIH) that has led to a breakthrough treatment for advanced-stage stomach cancer. The treatment, referred to as HIPEC + CRS, successfully extended the life expectancy of the clinical trial’s participants from months to years. This clinical trial is the only one of its kind in the world. The clinical trial, which was published in the September 2014 issue of the Journal of Surgical Oncology, compared the impact on 17 patients with metastatic cancer receiving standard systemic chemotherapy versus a unique two-step technique. This technique, in addition to the systemic drugs, includes cytoreductive surgery (CRS) or ‘debulking’ surgery, which is the removal of as many visible tumors or parts of tumors as possible, followed immediately by hyperthermic intraperitoneal chemotherapy (HIPEC), which delivers, only to the abdomen, a heated,chemotherapy solution.

Erin Alesi, MD

VCU Massey Cancer Center Medical Oncology Downtown Richmond 804.828.5116 www.massey.vcu.edu

Nikki Miller Ferguson, MD

Jonathan Avula, MD

“The NIH-National Cancer Institute intramural funded pilot demonstrated that the addition of HIPEC + CRS to systemic therapy may enhance chemotherapy treatment for the patient with late-stage gastric cancer by improving drug delivery to potential microscopic residual tumors, thereby destroying microscopic cancer cells that remain in the abdomen after surgery,” said Itzhak Avital, M.D., study lead-author and Bon Secours Cancer Institute executive medical director and surgical oncologist. “Patients with this disease who had six to eight months to live, or at the most with more aggressive treatment, 12 months, now have two years to live, with some even five years.” Stomach cancer is the fourth most common cancer and the second leading cause of cancer-related deaths worldwide. More than 22,000 Americans will be diagnosed with stomach cancer in 2014, and primarily because most patients in Western countries present with advanced cases, the disease remains challenging to cure. Difficult to bear, the prognosis for stomach cancer with peritoneal carcinomatosis (PC)—cancer that has spread to the lining of the abdomen—is most frequently measured only in months, not years.

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

Chandra S. Bhati, MD VCU Medical Center Transplant Surgery Downtown Richmond 804.828.4104 www.vcuhealth.org

Lloyd Bonner, MD

Ronald Flaster, MD

Jenny Fox, MD

Sylvia Gonsahn-Bollie, MD

HCA Virginia’s Henrico Children’s Hospital of Richmond Doctors’ Hospital Medical Director of Pediatric at VCU | Critical Care Hospitalist Program Downtown Richmond Richmond 804.828.CHOR (2467) www.hcahealthcare.com www.chrichmond.org

Children’s Hospital of Richmond at VCU Neonatal Medicine Downtown Richmond 804.828.CHOR (2467) www.chrichmond.org

Bon Secours Primary Health Care Associates Richmond | 804.644.1333 www.bonsecours.com

Bon Secours West End Internal Medicine Richmond | 804.282.7857 www.bonsecours.com

Kerri A. Carter, MD, FAAP

William Edgar Carter III, MD, MPH

Carol Gruber, NP

Roderick Haithcock, MD

Children’s Hospital of Richmond at VCU | Cardiology Downtown Richmond, West End 804.828.CHOR (2467) www.chrichmond.org

Virginia Urology Prince George & Hanover 804.288.0339 www.uro.com

VCU Medical Center, Physical Medicine and Rehabilitation Downtown Richmond 804.828.4097 www.vcuhealth.org

Bon Secours Primary Health Care Associates Richmond | 804.644.1333 www.bonsecours.com

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NEW

NOTEWORTHY

Vincent Lawson, MD

Bon Secours West End Internal Medicine Richmond | 804.282.7857 www.bonsecours.com

Giao Phan, MD

VCU Massey Cancer Center Surgical Oncology Downtown Richmond and Stony Point | 804.828.5116 www.massey.vcu.edu

Jennifer Snow, MD

HCA Virginia’s Henrico Doctors’ Hospital Medical Director of the Pediatric Intensive Care Unit Richmond www.hcahealthcare.com

Roshanak R. Markley, MD

VCU Pauley Heart Center General Cardiology West End | 804.740.1100 www.pauleyheart.vcu.edu

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

Don Mathew, MD

Children’s Hospital of Richmond at VCU, Neurology Downtown Richmond, Fredericksburg 804.828.CHOR (2467) www.chrichmond.org

Blake W. Moore, MD Virginia Urology Prince George & Stony Point 804.288.0339 www.uro.com

Shahriar Nabizadeh, MD

HealthSouth Virginia, Physical Medicine and Rehabilitation Richmond | 804.673.4479 www.healthsouth.com

Dennis J. Rivet II, MD, FACS

Emily B. Rivet, MD, MBA

Amandeep Sangha, MD

Robert Sealand, MD

Valerie South, NP

Jacqueline Stewart, MD

Inna Tchoukina, MD

Gregory Vorona, MD

VCU Medical Center Neurosurgery Downtown Richmond 804.828.9165 www.vcuhealth.org

Bon Secours Capitol Ob/Gyn Richmond | 804.371.1689 www.bonsecours.com

Colon & Rectal Specialists Stony Point | 804.249.2465 www.crspecialists.com

Bon Secours CrossRidge Pediatrics & Internal Medicine Glen Allen | 804.755.7581 www.bonsecours.com

Jason S. Wong, MD

VCU Medical Center Neurology Downtown Richmond 804.828.9350 www.vcuhealth.org

NEW PHYSICIANS,

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Bon Secours Neurology Clinic at St. Mary’s Richmond | 804.893.8656 www.bonsecours.com

VCU Pauley Heart Center Heart Failure and Transplant Downtown Richmond 804.828.4571 www.pauleyheart.vcu.edu

Bon Secours Richmond Diabetes and Endocrinology Mechanicsville | 804.764.7686 www.bonsecours.com

Children’s Hospital of Richmond at VCU Radiology Downtown Richmond 804.828.CHOR (2467) www.chrichmond.org

Colin Wozencraft, MD

Bon Secours Palliative Medicine Richmond 804.288.COPE (2673) www.bonsecours.com

Sherita N. Chapman Smith, MD VCU Medical Center Neurology Downtown Richmond 804.828.9350 www.vcuhealth.org

Tiffany Williams, DDS, MSD

Children’s Hospital of Richmond at VCU | Dentistry Downtown Richmond and Northside 804.828.CHOR (2467) www.chrichmond.org

HCA Virginia's Chippenham Hospital Opens New Cardiac Electrophysiology Lab David Gilligan, MD, electrophysiologist at the Levinson Heart Institute, leads a group during the ribbon cutting ceremony for Chippenham Hospital’s new EP lab.

HCA Virginia’s Levinson Heart Institute at Chippenham Hospital recently opened its new state-of-the-art electrophysiology (EP) lab, for the management and treatment of patients with arrhythmia disorders or abnormal heart rhythms, caused by problems with the heart’s electrical system. This will be the third EP lab at Chippenham Hospital. The new lab was created in response to an increased patient demand for ablations to treat atrial fibrillation - a known leading cause of strokes. It also will provide patients with faster care due to high demand and volume. David Gilligan, MD, electrophysiologist, Levinson Heart Institute, says that the addition of the new lab will allow Chippenham Hospital to offer services at a higher capacity than any other EP lab in the region.

The lab will feature the latest technology in low-dose fluoroscopy, a type of medical imaging that shows a continuous x-ray image on a monitor. Also available will be procedures involving the implantable cardiac defibrillator (ICD) to treat conditions ranging from irregular heart rhythms to cardiac arrest; pacemakers and the subcutaneous-ICD, a new option for patients at risk of sudden cardiac arrest that supplies reliable defibrillation without leads in the heart, leaving the heart completely untouched. In addition, EP studies, device implants and laser lead extractions will be performed in the new lab.

For more information, visit www.hcavirginia.com/locations/ chippenham-hospital/levinson-heart-institute/

www.OurHealthRichmond.com

T I P S , T I D B I T S A ND MO R E TO IN F O R M A ND ENT ERTA I N YO U

October is

Breast Cancer Awareness Month

Early Detection is Crucial When breast cancer is detected early, in the localized stage, the five-year survival rate is 98%* • Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health • Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over • Women should know how their breasts normally look and feel and report any

breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s.

Ways to Reduce the Risk Although you cannot prevent cancer, some habits that can help reduce your risk are:

Fun Facts About

CANDY HHH Happy Halloween!

H Candy accounts for only

6% of the added sugar in the American diet.

• Maintain a healthy weight

Soft drinks & juice account for

• Stay physically active • Eat fruits and vegetables • Do not smoke • Limit alcohol consumption *National Cancer Institute

46%.

Candy lacks the “health halo” of granola bars and fruit juice. But, nutritionally there is much less difference among them than would initially seem. It’s unbelievable now, but

Get Your Mammograms! Don’t neglect getting your yearly mammogram due to lack of insurance or resources. Every Woman’s Life (EWL) is a public health program offered through The Virginia Department of Health (VDH) that helps uninsured, low income women gain access to free breast and cervical cancer screening services. Screening and early detection reduces death rates, improves treatment options, and greatly increases survival. Contact the following locations for information on screenings in the Richmond Area: Bon Secours Richmond Health System

Nancy Davis

Chickahominy Health District

Michele Landry

CrossOver Health District

Christi Field

HCA Richmond Health System

Carrie Schaeffer

OurHealth | The Resource for Healthy Living in Greater Richmond

804.359.9355 804.365.4313 ext. 4328 804.622.0803 ext. 102 804.200.7020

candy once was advertised as health food.

“Eat Tootsie Rolls — The Luscious Candy That Helps Beat Fatigue.”

November is

National Diabetes Month Diabetes is a problem with the body that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. Type 2 diabetes is the most common form of diabetes. Several factors can increase your risk for developing Type 2 Diabetes, including being overweight. Lifestyle changes can be used as a foundation to help prevent Type 2 Diabetes: • Engage in regular exercise • Eat healthy • Include foods high in fiber such as beans, whole grains, vegetables, fruits and nuts • Eat plenty of whole-grain foods • Eat more fruits and vegetables

• Don’t crash diet. Instead, consider healthy, long-lasting weight loss solutions, and cut out fatty and fried foods that are often high in cholesterol and salt. • Drink plenty of water

DENTAL

BITE: maintain You should always

a distance of 6 feet between the toilet and where

air borne particles from the flush can travel up to 6 feet. you brush. The

GET

Moving on Thanksgiving

Morning!

2014 Thanksgiving Day Run The Richmond Road Runners put on a 10K on Thanksgiving Day. The RRRC is a non-profit organization whose goal is to foster fitness and a healthy lifestyle through running in the metro Richmond, Virginia area. The club is affiliated with the Road Runners Club of America. Date: Thanksgiving morning at 9:00 a.m. Location: University of Richmond Registration: www.rrrc.org Contact: rrrc@rrrc.org

ON THE WEB

More at ourhealthrichmond.com www.OurHealthRichmond.com

words |SUZANNE RAMSEY & MICHELLE STEPHENSON

On Saturday, October 25th, Lynn Kirk, Courtney Webb, Jackie Greenwald and four other local women will take to the dance floor at the 8th Annual Pink Tie Gala, as part of the Celebration of Life Dance Team. On that night, dressed to the nines and aglow, the women, breast cancer survivors and current patients, will each perform a ballroom dance. In front of friends, loved ones and others affected by breast cancer—and no doubt watched by many a tear-filled eye—the women will dance, not only to bring awareness to a disease that will strike one in eight women during her lifetime, but, as Lynn so aptly puts it, to “dance with joy.” Since she began organizing the Pink Tie Gala eight years ago, Susan Groves has met thousands of women who have been diagnosed with breast cancer, more than 60 of which have been chosen for the Celebration of Life Dance Team.

Reprints To order reprints of the original artwork featured on this issue’s cover, contact Jenny Hungate at 540.387.6482 or via email at jenny@ourhealthvirginia.com. To view additional work by our artist, Joe Palotas, visit www.salemartcenter.com

She’s watched these women, who she calls “the face of the Pink Tie Gala,” learn to ballroom dance for the first time. She’s watched them “get the full Cinderella treatment,” with hair and makeup, photo shoots and glamorous gowns. And she’s heard about what a difference it can make to be treated like a princess during what might be the worst of times. “I’ve gotten letters from [women] afterwards, about how special it is to have them be the focus,” Susan says, before apologizing for getting choked up. “They’re not ugly. There’s nothing wrong with them. They are strong, powerful women. For a year leading up to [the Gala], it’s all about them.” These women, Susan says, “do something way, way outside their element” and “give me a reason to get up every morning. If they can get up, I sure can.” www.OurHealthRichmond.com

“It seemed like, while others were celebrating their future that night, my family and I were wondering what our future would hold,” Lynn, a 58-year-old wife and mother of

Dancing to

Save L ives

three, says. “ ‘You have breast cancer.’ Those four words can change your world forever.”

Lynn says she was honored to be invited to be part of the Celebration of Life Dance Team, not because the experience would be fun — although she suspected it would be — but because, as president of the Central Virginia Affiliate of Susan G. Komen for the Cure®, she knows how important the fundraiser is to breast cancer programs and research. “It helps our affiliate extend meaningful community grants to local organizations that provide education, screening and treatment for women in need,” Lynn, who lives in Richmond, says. “A portion also goes toward research to find a cure. So, we’re dancing not only for the joy of it, but more importantly, to help save lives.”

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What is ductal carcinoma in situ? Ductal carcinoma in situ (DCIS) is the presence of abnormal cells inside a milk duct in the breast. DCIS is considered the earliest form of breast cancer. DCIS is noninvasive, meaning it hasn›t spread out of the milk duct to invade other parts of the breast. (MayoClinic.org)

Lynn’s breast cancer journey began on New Year’s Eve 2007. While others were popping champagne corks and making resolutions and plans for the next year, she was reeling from the news that she had breast cancer. Lynn was diagnosed with ductal carcinoma in situ (DCIS) during a routine mammogram. It’s a breast cancer that forms in the milk ducts, often without symptoms. “There was no detectable mass and no symptoms, so fortunately, my annual mammogram discovered it,” she says. “Even though it was a very rushed holiday season, I am so glad I had a mammogram, because I truly believe it saved my life.” While DCIS is described as “noninvasive,” Lynn’s cancer was aggressive. She underwent a lumpectomy in January of 2008. When the tissue was biopsied, physicians also found a small invasive ductal carcinoma (IDC). “The DCIS had spread across my breast, so that my entire breast was covered with it,” Lynn says. “On the mammogram, it looked almost like glitter covered the entire mammogram. The glitter was cancer. Fortunately, because I had gone for my mammogram and had this biopsy in a timely manner, they were able to remove it before it metastasized.” On her 19th wedding anniversary, in February 2008, Lynn underwent a modified radical mastectomy. Much to her relief, the cancer had not spread to her lymph nodes. “The lymph nodes were all clear, and it was such a blessing,” she says. “That was the best anniversary gift that we ever received, because I had a second chance.” Lynn wasted no time taking advantage of her new lease on life. About six months later, in August of 2008, she went on a mission trip to South Africa. “Looking back on that, no wonder my family was so concerned,” Lynn says. “My youngest daughter decided to go with me to help with the luggage and lend lots of TLC. What precious memories.”

six months after a radical mastectomy

Lynn went on a life-affirming mission trip to South Africa.

What is invasive ductal carcinoma? Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. About 80 percent of all breast cancers are invasive ductal carcinomas. (breastcancer.org) www.OurHealthRichmond.com

What does metastasize mean? Metastasize is the spread from one part of the body to another. When cancer cells metastasize and cause secondary tumors, the cells in the metastatic tumors are like those in the original cancer.

Lynn adds that going to South Africa proved to herself that “we fought the battle and we won. We were very blessed by the whole journey. My faith, my family, and my friends — that’s what got me through. Cancer is not something anyone would hope for, but I don’t regret the experience. It really taught me to treasure every day and to cherish my faith and my family.” This past summer, Lynn took on a new challenge: group ballroom dancing lessons at Rigby’s Jig Dance Studio. Like the other women selected for the Celebration of Life Dance Team, Lynn had little or no experience with ballroom dancing. She thought she might benefit from a head start before the “official” dance lessons started in the fall. As Lynn puts it, “My husband and I attempted dance lessons several years ago, but we only lasted one lesson. Our cha-cha was truly a haha!” Lynn’s first lesson with Gala dance partner Dale Jones was on September 16. She decided to learn the West Coast Swing, an energetic dance similar to the Jitterbug. “It looked jazzy and I wanted to have fun,” Lynn says, “but I can assure you I didn’t realize how hard that particular dance style is.” And the music? Why, the iconic, unmistakable theme from “The Pink Panther,” of course. “It’s playful,” Lynn says. “When you hear it, you can’t help but click your fingers or tap your toes, and it also reminds us of the power of pink. Breast cancer is no laughing matter, but as a survivor I dance with joy!”

What is a modified radical mastectomy? Modified radical mastectomy removes the entire breast, including the breast tissue, skin, areola and nipple. In some cases, one or more nearby lymph nodes may be removed. Modified radical mastectomy spares the chest wall muscles. (MayoClinic.org) 24

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I am Courtney ...

Hear Me Roar

Courtney Webb has a theme song, Katy Perry’s anthem to female empowerment, “Roar.” Whenever she’s feeling down or needs strength to face another test, procedure, exam or surgery related to the breast cancer she’s battled since 2009, she just cranks up “Roar,” no doubt belting out the chorus: “I got the eye of the tiger, a fighter, dancing through the fire. ’Cause I’m a champion and you’re going to hear me ROAR.” “It’s my song that I would have in the background while walking around if I could, like in a movie,” Courtney, a labor and delivery nurse at Bon Secours St. Mary’s Hospital, says.

“During the [second] ultrasound, the doctor started tearing up and said she was 98 to 99 percent sure that I had breast cancer,” Courtney says. “I thought this was a really, really bad dream and I was going to wake up.”

Courtney was just 27 years old when she was diagnosed with breast cancer. It was July and she was getting ready to go boating. “I was adjusting my bikini top when I felt a lump,” she says. “Being a nurse, I just thought it was nothing. I have no family history of breast cancer.” Still, Courtney wanted to have the lump checked out, so she had an ultrasound and mammogram, and then a second ultrasound. The news was not good. Two days later, on August 6, 2009, Courtney was told she had Stage II breast cancer. She underwent a partial mastectomy, chemotherapy and radiation. Fortunately, the cancer had not spread to her lymph nodes. For four years, everything seemed fine. In August of 2013, she had her yearly mammogram, which went well, and in October, she had her annual MRI. When she called for the MRI results, however, Courtney was asked if she’d been experiencing pain in her sternum or chest. She had, but she’d chalked it up to her workouts. “I had been working out,” she says, “and I told them that I felt better than I had in a long time.” When they said it looked like her breast cancer had returned and was now in her bones, Courtney says she lost it. “I had that movie meltdown, where you scream and fall to the floor,” she says. Further tests showed that Courtney had Stage IV cancer, and that it had spread to her sternum, the lymph node above her left collarbone, her spine and her left hip. Before the month was out, she had a complete hysterectomy, which was a blow for many reasons, among them that she wanted a child. When tested four months later, this past June, the news was more hopeful.

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“The only [spot] that was left was the one in my sternum,” Courtney says. “Hopefully, by December, that one will be gone. I take a pill every night and I get a shot every 90 days. That’s to stimulate my bone growth and make my bones stronger.” Courtney says she also has acupuncture and chiropractic treatments, stays away from preservatives, and uses allnatural cosmetics and aluminum-free deodorant. When asked how she’s kept such a positive attitude, Courtney, whose exuberance is obvious even via email, says it’s because she doesn’t let breast cancer define who she is. She describes cancer as “one of the best and worst things that has ever happened to me” and says through it all, she’s discovered “how strong I really am.” While “Roar” may be on her life-movie soundtrack, when asked which song will play as she and her partner dance the rumba at the Pink Tie Gala, she’s not saying. “It’s kind of a secret, but I have a feeling it will make the crowd cheer,” she says. Courtney says she was “so very excited and honored” to be chosen as part of the Celebration of Life Dance Team. However, being a self-described “klutz,” she says she ought to wear protective gear during rehearsals. “I asked if could wear a helmet, knee and elbow pads but unfortunately that seems to be frowned upon,” she says. On a more serious note, Courtney says being a part of the dance team has been like joining a sorority.

“We are all different women from all different backgrounds and ages that have fought or are fighting a common cause,” she says. “We understand what each other has gone through. We get the anxiety, the living life to the fullest. We understand each other. We are survivors! It’s a pretty amazing feeling.”

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Jackie Greenwald and her husband attended the 2013 Pink Tie Gala, and Jackie says she is honored to have been chosen as one of the dancers for this year’s event. photography |WM PHOTOGRAPHY

“One day, this will take me, but it’s not taking me today,” says Jackie, a Chester resident. “I thank God for these six wonderful women with whom I’ve become great friends. It’s great to have people who are doing something to help people while they are fighting. The money stays here and helps people who are having a hard time financially with their bills and their treatment.” Jackie was diagnosed with Stage II ductal carcinoma in 2011. She was 40 years old and the cancer was found through a routine mammogram. She had a lumpectomy, followed by 35 radiation treatments, and says she was told the cancer had a “10 percent chance” of returning.

“When you have cancer and it comes back a second time, you pretty much know that day is going to come, but you’re fighting like hell because you want to make sure that it’s not coming anytime soon,” she says. “My motto is that I have cancer; cancer does not have me.”

Carl (son), Ainsley (daughter), Jackie, Stirling (daughter) and husband Derek Jackie’s photos courtesy of WM Photograpy

For two years, Jackie was cancer free, but in May of 2013, she developed a cough. Thinking it might be a side effect of her blood pressure medicine, she wasn’t all that concerned, but after having an MRI and mammogram in June 2013, her physician called her with a question. “He asked me if I had had pneumonia,” Jackie says. “I hadn’t, so I had a chest CT [scan], which showed cancer in the pleural areas of my lung. I had a thoracentesis done, which is a form of biopsy, and those cells came back the same as the breast cancer. I was diagnosed with Stage IV breast cancer that had metastasized to the pleural area of my lungs.” Jackie started chemotherapy in June and in December underwent a scan of her brain, bones and other areas to which cancer often spreads. The results: Stage IV bone cancer in her sternum. In the following months, cancerous cells also were found in fluid surrounding her heart and lungs. Jackie, a mother of three who says her “greatest love is being a Mom and wife,” vows to keep fighting. On her Facebook page, she’s listed, “A** Kicker at Fighting Breast Cancer and Winning” as her current occupation. There are photos of Jackie, wearing hot pink boxing gloves and a “Fight Like a Girl” T-shirt. In one, she’s leaning confidently against the ropes of a boxing ring. In another, she’s pounding a punching bag, looking every bit the fighter.

What is the pleura? Pleura is a membrane consisting of a layer of tissue that lines the inner side of the chest cavity and a layer of tissue that surrounds the lungs.

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The Pink Tie Gala and the

Celebration of L ife Dance Team Each year, several local breast cancer survivors and patients are selected as the

The 2014 Celebration Celebration of Life Dance Team. The dancers are each paired with a male partner and then of Life Dance Team is for 12 weeks—think “Dancing with the Stars —they take ballroom dancing lessons, provided by Rigby’s Jig Dance Studio in Richmond. The experience culminates with a performance at

comprised of the above the Pink Tie Gala, a fundraiser for Central Virginia Affiliate of Susan G. Komen for the Cure®. beautiful ladies. From “It’s the most amazing thing you’ve ever seen,” Susan Groves, director of Richmond’s Pink

left, Lynn Kirk, Gisele Tie Gala, says. “It’s so important for them to be able to show people, ‘Yes, I did this.’ Two [of Cazedamont, Sylvia the dancers] are Stage IV and may not make it, but they want so much to stand out in front

of people and say, ‘Look at me now!’ It changes everything about you ... it’s amazing. I didn’t

May, Hope Pritchell, know them before, but just from what I know of them, they’re totally different after this. Jackie Greenwald, Your life is never the same.”

Courtney Webb and Eleanor Robertson, who owns Rigby’s Jig Dance Studio, has worked with Pink Tie Gala dancers Cyndi Lynn Hiles. for the past seven years. She pairs the dancers up with instructors or accomplished male

dancers and then works with the teams, advising on choreography, music and costuming, and helping each women bring the dance she’s envisioned to life. “It’s such a joy,” she says. “We absolutely love it. We look forward to it so much.” Robertson says she enjoys watching the women, some of whom arrive on the first day of rehearsals as “timid and shy,” become “larger than life” on the dance floor on the night of the Gala.

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Breast Cancer Resources Foundations Ellen Shaw de Paredes Breast Cancer Foundation 4480 Cox Road, Suite 100 Glen Allen, VA 23060 804.523.3209 www.paredesfoundation.org

Susan G. Komen® Central Virginia 1433 Johnston Willis Drive Richmond, VA 23235 804.320.1772 www.komencentralva.org

Virginia Breast Cancer Foundation 5004 Monument Avenue, Suite 102 Henrico, VA 23230 804.285.1200 www.vbcf.org

Fundraisers Making Strides of Richmond October 19, 2014 Virginia War Memorial 804.527.3705 www.cancer.org

8th Annual Pink Tie Gala Presented by Bon Secours October 25, 2014 Greater Richmond Convention Center Ballroom 804.745.0006 www.pinktiegala.org

Medical Facilities / Imaging Centers Allison Breast Center 7231 Forest Avenue, Suite 102 Richmond, VA 23226 804.288.8321 www.monumentradiology.com

Ellen Shaw de Paredes Institute for Women's Imaging Richmond/Glen Allen 804.523.2303 www.paredesinstitute.com

Every Women’s Life (EWL) – Virginia Department of Health 109 Governor Street, 8th Floor Richmond, VA 23219 804.864.8204 www.vdh.virginia.gov/ofhs/prevention/ ewl/

HCA Virginia Breast Care Network Richmond/Midlothian/Colonial Heights 804.422.2273 www.hcavirginia.com/service/info/hcavirginia-breast-care-network

VCU Breast Imaging Two locations in Richmond 804.237.6666 www.breastimaging.vcu.edu

Virginia Cancer Institute Various locations in the Greater Richmond Area 804.673.0134 www.vacancer.com

Virginia Physicians for Women Various locations in the Greater Richmond Area 804.897.2100 www.vpfw.com

Virginia Women’s Center Richmond/Mechanicsville 804.288.4084 www.virginiawomenscenter.com/ services-mammography.html

Bon Secours Virginia Breast Center Midlothian/Richmond/Mechanicsville 804.594.3130 www.vabreastcenter.com 32

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“I can’t tell you how many have come to us afterwards and said, ‘This is one of the best things I’ve ever done,’” Robertson says. “It’s getting outside their comfort zone, doing something different. It challenges them a bit. It ends up being so fun and enjoyable, a special dance in front of friends and loved ones cheering them on. It’s a wonderful event that highlights them and let’s them be Cinderella for the night.” This year’s Pink Tie Gala, with the theme “Victorian Masquerade Ball,” will be held from 7 pm to 12:30 am on Saturday, October 25th, at the Greater Richmond Convention Center Ballroom. The event includes food, live music, dancing, silent auctions and performances by The Celebration of Life Dance team. In addition to Lynn, Courtney and Jackie, the team includes Sylvia May, Hope Pritchett, Gisele Cazedamont and Cyndi Lynn Hiles. One-hundred percent of net proceeds from the gala, which is presented by Bon Secours Cancer Institute, benefit the Central Virginia Affiliate of Susan G. Komen for the Cure®. According to Groves, the words “Pink Tie Gala” are owned by Komen, and there are Pink Tie Galas across the country, but the Richmond event is its own entity and funds raised stay in the area. “It funds grant programs here,” Groves says. “Women who can’t afford mammograms, health education, Bon Secours Cancer Institute’s Every Woman’s Life program, and provides breast health care... for women who can’t afford it.” According to the Bon Secours Richmond Health System website, the Every Woman’s Life program “has reached more than 300,000 women regarding the importance of early detection of breast cancer.” Tickets for the Pink Tie Gala are $85 and, if still available—they were nearly sold out in mid-September last year—may be purchased via the Gala’s website, www. pinktiegala.org or through Susan by calling 804.745.0006.

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FITBITS

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

Work the ‘Back’ to Wear the ‘Black’ (Holiday Dress) The holidays are right around the corner, and that may mean wearing that ‘little black dress’ or taking that holiday ‘getaway’ or cruise. Start working your back now, and see results in time to show it off before that first holiday event! For optimum results, perform three sets of 8-12 repetitions of the following exercises three - five times per week:

#1. Back Extension on Exercise Ball This exercise works the lower back muscles (erector spinae), even though these muscles actually run the entire length of the back along the spine. The erector spinae extend the spine backwards and provide torso stabilization.

2. Place the hands behind the head or under the chin - you can also keep the hands resting on the ball if you need a modification. 3. Round down over the ball and then squeeze the lower back to lift the chest off the ball.

1. Lie down with the ball under the belly and hips, legs straight out behind you (or knees bent for a modification).

4. Raise up until the body is straight (don’t hyperextend), lower down and repeat.

#3. Reverse Fly with Dumbells This exercise trains the back side of the shoulder muscles (rear deltoids). 1. Stand with feet shoulder width apart, bend knees slightly and lean forward. Upper body should almost be parallel to the floor. Look forward and don’t round back. Hold a dumbbell in each hand with palms facing each other. Elbows should be slightly bent. 2. Raise dumbbells sideways and backwards, until arms are parallel to the floor. Move weights slowly and concentrated. Exhale as you lift dumbbells and don’t create momentum. At the end of the movement, palms should face the floor. 3. Then lower dumbbells and return to the beginning position. Don’t let the weights fall. The down-motion should be slower than the up-motion. Inhale as you lower dumbbells. Notes: Make sure to keep back straight and exhale as you raise arms. The reverse dumbbell fly is not designed for heavy weights.

#2. Reverse Hyperextension on Exercise Ball: The reverse hyperextension targets a number of posterior muscle groups, including the glutes, hamstrings, and lower back. 1. Place the stability ball on the floor, and lie on top of the ball 2. Place hands on the floor for stability. Slowly raise one leg off the floor until it is at least parallel. Try to keep your legs straight.

3. Complete the movement by lowering the leg back to the starting position, and repeat for desired number of repetitions 4. Repeat the movement using the other leg Notes: An advanced variation is to raise both legs at the same time. This exercise should not be done by anyone with existing lower back injuries or conditions.

Deidre Wilkes, AFAA, ACSM, Certified Personal Trainer Deidre is a certified personal trainer with more than 15 years experience in the health and fitness industry. She is the resident fitness specialist for OurHealth Richmond

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Local health. Anywhere you go. OurHealth magazine is Richmondâ&#x20AC;&#x2122;s only resource entirely dedicated to delivering information about local healthcare services and healthy living topics. Pick up our print edition at more than 900 locations throughout Richmond or get the digital edition by visiting www.ourhealthrichmond.com.

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The Anatomy Challenge is proudly sponsored by

the

Anatomy

CHALLENGE

Hereâ&#x20AC;&#x2122;s your chance to see how much you know about your amazing

Mouth! First, find all the hidden words in the word search below. Next, match up the correct word with the part of the body in the illustration.

[ the amazing MOUTH ]

WORD SEARCH canines central incisor frenulu linguae gums hard palate inferior labial frenulum inferior lip lateral incisors

palatoglossal arch palatopharyngeal archs

______________ ______________ ______________

______________ ______________ ______________ ______________

______________ ______________ ______________

premolars soft palate sublingual papilla submandibular gland

molars

superior labial frenulum

oropharunx

superior lip

palatine raphe

tongue

palatine tonsil

uvula

______________ ______________ ______________ ______________ ______________ ______________ ______________

______________

______________ ______________

______________

Visit our Facebook Page for answers

VCU Oral and Facial Surgery an affiliate of VCU Dental Care 521 North 11th Street | Richmond, VA | 804.628.3926 www.vcudentalcare.com/dental-services/oral-and-facial-surgery

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Beautiful

Mouthand Face words |DIANE YORK

What VCU Oral and Facial Surgeons Do

Day in and Day Out On any given day, the surgeons of the Oral and Facial Surgery Department of the VCU School of Dentistry, an affiliate of VCU Dental Care, may be asked to put back together the shattered face of a woman thrown through a windshield during an auto accident. They may reconstruct the jaws and mouth of a young man beaten during an assault. Or they may work as an important member of VCU Medical Center Cleft Lip and Palate team to reconstruct the harelip and its resulting mouth and face deformity on a teenager who has been ashamed of his appearance since his first years in school when taunted by classmates. VCU Health Center is a top medical, research and trauma center, hospital and dental school. Patients come from all over the Commonwealth to receive specialized care here.

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The Oral and Facial Surgery Department is no exception, practicing the full and contemporary scope of oral and facial surgery. Its’ faculty, on a daily basis, treat a wide variety of unique cases, including facial and mouth trauma, automobile accidents, tumors, sports injuries as well as congenital disorders. Many people do not realize that, in addition to the dental clinic, where you would be seen by a dental student or a resident (a licensed dentist who is receiving additional four years of training as an oral surgeon), you can be seen by one of these highly trained experts by calling and making an appointment. (See below.) A. Omar Abubaker, DMD, PhD, is both a Professor and the Oral and Facial Surgery Department Chair. His clinical specialties include dentoalveolar surgery and facial reconstructive surgery to correct conditions of the jaw and face, facial trauma and reconstruction of the jaws and face.

While it is functional problems that bring patients here, Dr. Abubaker adds, “the result of our work and collaboration with the orthodontists and prosthodontist and dentists always lead to an esthetic improvement of the face and teeth and mouth, leading to restoration of the face to a natural, symmetrical, attractive look.”

Dr. Abubaker states, “we manage everything from single jaw surgery to the most complex surgeries of the mouth and face, receiving referrals from orthodontists all over the Commonwealth of Virginia. We see people of all ages and all income levels.” He points out that the VCU Medical Center and the VCU Oral and Facial Surgery doctors accepts all insurance types and that almost all of the patients have a functional, medical problem associated with their jaw abnormalities. That is, their mouth, jaw or tooth problem is affecting their health, either because they can’t chew or eat properly or they are experiencing pain from jaws that don’t sit together properly. They might have speech problems, sleep apnea or problems caused by scar tissue from prior surgeries.

Dr. Abubaker says that new techniques such as laser surgery and three-dimensional computer generated imaging allows for much more precise planning of the surgery before the first cut is made. Laser surgery eliminates bleeding, which eases the stress on both the surgeon and patient. Also, the use of the laser helps control the threat of infection, because it sterilizes as it works and is less painful than conventional surgical treatments. Patients make a quicker recovery and experience virtually no post-operative pain or swelling. He says, “our doctors are well-trained to use this technology to perform the necessary surgical procedures best suited for this technique.”

Omar Abubaker, DMD, PhD at VCU Dental Care, located near VCU Medical Center in downtown Richmond.

Dentoalveolar surgery is the surgical treatment of disorders of the teeth and their supporting hard and soft tissues including: • surgical removal of the teeth • removal of impacted teeth • removal of benign cysts and growths of the jaw. Facial reconstructive surgery includes correction of developmental and acquired abnormalities of the teeth, jaws and face.

A. Omar Abubaker, DMD, PhD, is both a Professor and the Oral and Facial Surgery Department Chair. www.OurHealthRichmond.com

What are Dental Implants? Dental implants are titanium forms used to replace missing teeth. They are an option for tooth loss due to an accident or after removal for tumor surgery or infection as an alternative to bridges and dentures. The implants are tooth root substitutes that are surgically anchored in place in the jawbone and act to stabilize the artificial teeth to which they are attached. Candidates for dental implants need to have an adequate bone level and density, must not be prone to infection, and must be willing to maintain good oral hygiene practices.

George R. Deeb, DDS, MD, is an associate professor and director of graduate and undergraduate implant programs in the department.

George R. Deeb, DDS, MD, is an associate professor and director of graduate and undergraduate implant programs in the department. While he performs the full range of dentoalveolar surgery, his particular area of specialty is dental implants. Implants are the fastest growing segment of dentistry. Again, newer three-dimensional imaging developed in the last five years, has made dental implants a highly successful procedure. Many people, who have needed this kind of treatment for a long time, are now requesting it. Implants can be used for single or multiple teeth and for cases where jaw surgery is needed.

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Implants can be used for a wide variety of situations. Patients must be at least sixteen years old so that bones will be adequately developed. Dr. Deeb remarks, “we treated a nineteen yearold female who had lost her lower jaw to cancer. We gave her a new jaw using a section of her own leg bone, then gave her dental implants in her mouth using a prosthesis (an artificial body part) and new, artificial teeth. She has a whole new jaw and mouth!” Dental implants are a three-step process. The first step involves taking out the existing tooth and placing an implant (screw) beneath the gum to protect it from force while it heals. At the second stage, the gum is pulled back to expose the implant. A post or abutment penetrates the gum and goes into the implant. The gum is allowed to heal around the abutment and form a cuff or collar through which the dentist has access to the implant. In the third stage, the new tooth is placed on top of the post. The new tooth will take about three months of care (soft foods) before it can be used for hard chewing. Sometimes implants are not needed, “we see a lot of patients who have had a tooth knocked out accidentally, skateboarders, bike riders, auto accidents. If that happens, you should immediately go to an oral surgeon or an emergency room and often it can be successfully re-implanted. In some cases, a tooth can be transplanted from one part of your mouth to another,” adds Dr. Deeb.

Sleep Apnea Facts • Sleep apnea is serious. Obstructive sleep apnea can contribute to high blood pressure in people who have it. The frequent nighttime awakenings cause hormonal systems to go into overdrive, which results in high blood pressure levels at night. • Low blood-oxygen levels, caused by the cutoff of oxygen, may also contribute to hypertension in people with sleep apnea. Some people with high blood pressure who are treated for

Denture Wearers For first-time denture wearers, oral surgery can be done to correct any irregularities of the jaws prior to creating the dentures to ensure a better fit. Oral surgery can also help longterm denture wearers. Supporting bone often deteriorates over time, resulting in dentures that no longer fit properly. In severe cases, an oral surgeon can add a bone graft to areas where little bone remains. Dr. Deeb relates, “this morning, we had a challenging case. A lady in her mid-sixties who wore dentures for years had lost much of her jaw to atrophy from wearing the dentures so long. Her upper jaw was gone. We added bone to give her a base to hold a new screw-in denture. Dental implants, unlike dentures, help prevent bone loss by stimulating bone growth.” He adds, “I often see people come in who are virtually handicapped by the loss of their teeth. Some people stop going out socially or stop eating in public they are so afraid their dentures will fall out or they are embarrassed by how they look. After the dental work is done they feel so much more attractive and confident, it’s very gratifying. When I can fix that—that’s when I love my job.” Dr. Robert A Strauss, DDS, MD, is a Professor of Dentistry, and Director of Residence of the Oral Surgery Department. In addition to laser surgery of the head and neck, facial and jaw reconstructive surgery, he is best known for his expertise in sleep apnea surgery.

sleep apnea may be able to reduce their blood pressure medications. • Sleep apnea can also affect the heart. Stroke and atrial fibrillation—problems with the rhythm of the heartbeat are also associated with obstructive sleep apnea. The disrupted oxygen flow caused by sleep apnea makes it hard for the brain to regulate the flow of blood in arteries and the brain itself.

Obstructive sleep apnea, is a disorder that occurs when a persons’ breathing is interrupted during sleep. People with sleep apnea often have snoring problems as well. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain and the rest of the body may not get enough oxygen. Sleep apnea is a disorder with many damaging side effects including risk of death from heart attacks and hypertension. Sleep apnea can sometimes be caused by the structure of the mouth, tongue, soft palate, nose, tonsils sinus and adenoids. Oral surgeons can alter these structures to provide larger airways and increase breathing ability. Dr. Strauss says, “there are several courses of treatment for snoring and sleep apnea, ranging from reshaping of the soft palate through laser surgery to jaw or jaw and chin advancement surgery, which will help you get back on track for a good night’s sleep. People with sleep apnea can literally be at death’s door and we can save them.”

Dr. Robert A Strauss, DDS, MD, is a Professor of Dentistry, and Director of Residence of the Oral Surgery Department.

His department also does cosmetic face procedures. He says, “last week I had a thirtyyear old man who was in a car accident and had twenty fractures of the face. His eye sockets were broken and his nose flattened. After a successful eight-hour operation, he now looks normal.” One of Dr. Strauss’s favorite cases is a twentyyear old girl who was depressed because she had been ridiculed for her appearance. Her www.OurHealthRichmond.com

Jawbone Replacement Jawbone that has been lost due to disease or to injury can be surgically replaced. There are three sources of replacement bone: First, a piece of bone may be removed from somewhere else on your own body. Second, bovine (cow) bone that has been treated and irradiated can substitute for human bone. Third, bone from a cadaver, that has been treated and irradiated can be used. The rejection rate is extremely low in this kind of procedure. jaw was malformed. We replaced the bones needed in her jaw with bone from her own leg. After surgery she had a complete personality change. She now has a job, is engaged and her new handle is “Jawsome” These are common stories in the oral surgery department of VCU. Frequently, people who have a facial deformity from injury, disease or development can acquire self-confidence they lacked due to feelings about their appearance and past painful experiences with social interactions. Their eating habits can be enhanced, their health restored and their personal and professional lives improved. While oral surgeries can be complex and can take time to fully complete, their success rate is very high and, as Dr. Abubaker points out, these are not particularly painful surgeries. He says most patients never refill their pain prescriptions. He adds: “these dental and facial changes can change a person’s life and they last forever.” To make an appointment to see one of these doctors or others in the Oral and Facial Surgery Department of VCU, call 804.628.6637. To read more about them visit: www.vcudentalcare.com/dentalservices/oral-and-facial-surgery

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Breaking the Silence

Depression

words | SUSAN DUBUQUE

This series explores diseases that can be devastating to the individuals and families they affect—yet no one is talking about them. That is, until now. In each edition of OurHealth, we bring these diseases into the light—and dedicate these stories to the courageous patients and families living with them and the providers and researchers who commit their lives to treating and seeking cures for these silent killers.

Erik’s Story

As a kid, trying to find solace in life was difficult. I was an intelligent but rather uncoordinated individual, not unlike a young Sheldon Cooper. I was into art, building with LEGO® bricks and playing computer games. Unfortunately, this was before “nerd-culture” became chic. Being bullied in school was a way of life, an everyday occurrence. When I was about 11, I was diagnosed with Asperger syndrome—a high-functioning form of autism spectrum disorder. But that didn’t explain it all. Something was still not right.

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“Own what you are and what you have. It’s a lot harder to stigmatize something when you bring it out into the open. When you tell people about your depression, they are more likely to understand you. It takes strength of character to face down your own weaknesses.” — Erik Christenson

Another diagnosis was added to my chart—ADHD. And along with it came a new prescription. When I was 13, we moved from Okinawa to Virginia—but things didn’t get better. They got worse. Much worse. My teachers thought I was lazy. Other kids just thought I was weird. I was in a perpetual state of melancholy. Extreme mood swings—but mostly on the downside. There was no relief in sight. I’m not sure what set it off, but one day after track practice I felt overwhelmed with grief. I couldn’t take it for one more day. And on May 5, 2003, at the age of 14, Erik Christenson went behind the bleachers at his school, tied a rope around his neck and hanged himself. “It was nothing short of a miracle,” says Jesselle Christenson, Erik’s mother. “Two girls walked by and saw Erik. They ran for help. The rescue squad was called and they managed to resuscitate him.” Erik spent two days in the pediatric intensive care unit at VCU Medical Center. “It was touch and go. Erik suffered neurological damage from the lack of oxygen,” says 50

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Jesselle. “We just weren’t sure how much function he would regain.” But after two days, Erik had recovered sufficiently to be moved to a medical floor. It was here that the Christenson family learned about the Virginia Treatment Center for Children (VTCC). “I spent the next nine months in a combination of residential and day treatment at VTCC,” recounts Erik. “And Dr. Sood helped us figure out what was at the root of my problem.” Erik was correctly diagnosed with bipolar disorder—a cyclical form of depression. A side effect of the medication Erik was taking for ADHD is increased risk of suicide. “The drug sent him into a downward spiral of depression that nearly cost him his life,” reflects Jesselle. Today, Erik is much improved. But life still presents challenges. “Having Asperger’s makes it difficult for me to navigate social situations,” admits Erik. “I had to learn to read social clues—like body language and tone of voice.” At times it seems that Erik’s struggle with depression is unending. “On a scale of one to 10, I am usually a three—and never more than five,” says Erik. And then there is the anxiety. “I have a fear of failure—so most of the time I just don’t try.”

Erik with his parents Jesselle and Robert Christenson at the 2012 Butterfly Ball, an event to support the VCU Medical Center’s Virginia Treatment Center for Children.

“It’s hard to describe how I feel,” explains Erik, “but it’s like looking through a glass wall. I can see where I want to be—and who I want to be—but I just can’t seem to find the door to get there.” But in the grand scheme of things, Erik feels like he is doing OK. “I work in a customer service job—which is unusual for someone with Asperger’s,” says Erik with pride. “And I live independently,” although he acknowledges receiving some help from his parents. When asked what advice he would give other people who are coping with depression, Erik offers the following: “Own what you are and what you have. It’s a lot harder to stigmatize something when you bring it out into the open. When you tell people about your depression, they are more likely to understand you. It takes strength of character to face down your own weaknesses.” When it comes to strength of character, Erik is a powerhouse. He confronts his depression— compounded by the Asperger’s—with courage and dignity. With maturity and continued support from his family and therapist, there is little doubt he will find his way through the glass wall and discover the man he is destined to become.

Aradhana “Bela” Sood, MD, MSHA, FAACAP, Senior Professor of Child Mental Health Policy, Professor of Psychiatry and Pediatrics at Virginia Commonwealth University Health Systems and Secretary of the American Academy of Child and Adolescent Psychiatry

The time to speak out about depression is now. Let’s talk openly about this disorder—what it is and is not, the signs and symptoms, the faces of depression, how it is diagnosed and treated.

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What is depression? First of all, let’s look at what depression is not. We’re not talking about having a bad day, a case of the blues or intense sadness associated with the loss of someone or something that is dear—such as the death of a loved one or breakup of a marriage. Depression is not a sign of weakness or a character flaw. You can’t just “shake it off” or “snap out of it.” Most simply stated, depression is a medical condition. It is a mood disorder that is marked by a persistent feeling of sadness and loss of interest in activities that were once enjoyable. Depression can affect how you feel, think and behave and can lead to an array of emotional and physical problems. It may make it difficult to manage routine, day-to-day tasks and make it seem that life is not worth living. Depression can be a lifelong challenge. More than half of the people who experience one episode of major depression will have at least one more. Some people may feel depressed episodically or several times a year and others may have chronic ongoing problems. If untreated, bouts of depression can last anywhere from a few months to many years. And this is no small problem. Depression affects approximately 19 million Americans or 9.5 percent of the population in any given year. At some point in their lives, 10 to 25 percent of women and 5 to 12 percent of men will become clinically depressed. Studies show that rates of depression for Americans have risen dramatically in the past 50 years. In fact, the World Health Organization has classified depression as a worldwide epidemic. Martin Buxton, MD, chief of psychiatry at Chippenham and Johnston-Willis Hospitals, suggests that “better recognition, less stigma and more hopeful treatments may have contributed to this increase.” Depression exacts an economic cost of over $30 billion each year. It leads to absenteeism from work and decreased productivity and is the leading cause of disability in the United States. And the cost of human suffering is immeasurable. Depression is a deadly disease—resulting in nearly 40,000 suicides a year. But this story does have a bright side. Depression is among the most treatable forms of mental illness and 80 to 90 percent of those who receive treatment get better.

Types of Depression “Depression” is an umbrella term that encompasses gradations of symptoms that are categorized as a number of disorders. And just as symptoms vary from person to person, so do the actual diagnoses. Here are some of the types of depressive disorders: Major Depression. Major depression—also called clinical depression—may include extreme sadness, hopelessness, lack of energy, irritability, trouble concentrating, changes in sleep or

eating habits, feelings of guilt, physical pain and thoughts of death or suicide. To be diagnosed with major depression, an individual’s symptoms must last for more than two weeks. Persistent depressive disorder. This type of depression—also called dysthymia—is a milder yet more chronic form of major depression. Think of this like a low-grade fever—individuals can usually function adequately, but not optimally. They may appear to others to have negative personalities. Postpartum depression. More than a case of “baby blues,” postpartum depression can make a new mother feel sadness, loneliness and hopelessness. “In extreme cases, the mother may have suicidal thoughts or even thoughts of harming her baby,” says Susan G. Kornstein, MD, professor of psychiatry and obstetrics and gynecology and executive director of the Institute for Women’s Health at Virginia Commonwealth University. As many as 10 to 15 percent of women experience postpartum depression after giving birth. Seasonal affective disorder. Seasonal affective disorder—aptly called SAD—typically occurs during the winter months, when there is less natural sunlight. The symptoms tend to be mild and generally lift during spring and summer. Some patients respond to treatment with light therapy that simulates natural sunlight.

Susan G. Kornstein, MD, Professor of Psychiatry and Obstetrics and Gynecology at Virginia Commonwealth University and Founder and Executive Director of the VCU Institute for Women’s Health

Bipolar disorder. Bipolar disorder—sometimes called manic-depression—involves cycling mood changes—from periods of extreme lows (depression) to periods of elation and excitable behavior (mania). “Children who experience their first episode of major depression before puberty are at particularly high risk for bipolar disorder,” remarks Dr. Buxton. Psychotic depression. Psychosis is a serious mental illness involving false beliefs, known as delusions, or perceptions of false sights or sounds, known as hallucinations. When these combine with severe mood symptoms it is considered psychotic depression. According to the National Alliance on Mental Illness, about 20 percent of people with depression may have episodes so severe that they see or hear things that are not really there—such as voices telling the individual that he or she is a bad person or doesn’t deserve to live. Substance-induced mood disorder. The use of street drugs, alcohol, some prescription medications or other toxins can cause depression. Premenstrual dysphoric disorder (PMDD). “A small percentage of menstruating women suffer from PMDD— making them feel irritable and depressed for one or two weeks before their menstrual period each month,” says Dr. Kornstein.

What Causes Depression? The exact cause of depression is not known. But it most likely results from a combination of genetic, biological, environmental and psychological factors. First, climb your family tree. “Depression runs in families,” says Aradhana “Bela” Sood, MD, senior professor of child mental health policy and professor of psychiatry and pediatrics at Virginia Commonwealth University. “If you have a parent or sibling who has had major depression, you may be 1.5 to 3 times more likely to develop a depressive disorder than people who do not have a close relative with the condition. And when www.OurHealthRichmond.com

one identical twin has clinical depression the other will also develop depression approximately 76 percent of the time. Even when identical twins are raised apart from each other, they will both become depressed about 67 percent of the time.” But unlike with gender or eye color, research has yet to identify a specific gene that directly causes depression. Most likely a number of genes act together to make a person more susceptible to depression. But just because a person inherits a predisposition does not mean that he or she is destined to develop the illness. The genetic influence is only partially responsible for causing depression; other factors also play a role. Depression is a disorder of the brain. And brain-imaging studies—like magnetic resonance imaging (MRI)—show that the parts of the brain involved in mood, thinking, sleep, appetite and behavior look different in people who have depression than in those without depression. But these images do not reveal why the depression has occurred. Brain chemistry can play a role in depression. Neurotransmitters are naturally occurring chemicals that transmit messages between nerve cells—or neurons—in the brain. Three primary neurotransmitters— serotonin, norepinephrine and dopamine—affect the parts of the brain that regulate emotions, reactions to stress and the physical drives of sleep, appetite and sexuality. When these neurotransmitters are out of balance, depression may result. Hormones are chemical substances produced by glands of the endocrine system—such as the pituitary glands, thyroid, ovaries, gonads and pancreas. Hormonal imbalances can affect mood, physical development, appetite and energy levels and may be involved in causing or triggering depression. Traumatic events such as the death or loss of a loved one, divorce, a natural disaster, a serious medical illness or injury, financial problems or childhood trauma can trigger depression in some people. But that is not the same as a direct cause. “Think of it like this,” says Dr. Buxton. “If an individual has a biogenetic predisposition, a hormonal or

brain chemistry imbalance, and then experiences a significant loss or trauma, that event may spark depression.” Depression can lead to pessimistic thoughts. That seems logical. But it may also surprise you to learn that negative thoughts can lead to depression. According to Dr. Sood, “When an individual habitually experiences negative thoughts—called cognitive distortions—that person’s feelings may follow their thoughts, and they can spiral down into depression.” Some types of cognitive distortions are overgeneralization, should statements and disqualifying the positive. Depression and alcohol or substance abuse commonly occur together but the relationship between the two disorders seems to be multifaceted. A person suffering from depression may drink or use drugs in an attempt to self-medicate and feel better. Alcohol and some drugs are depressants, which in turn, may intensify the depression. Stress contributes to many serious medical conditions and depression is no exception. Chronic stress leads to elevated hormones including cortisol—called the “stress hormone”—and reduced serotonin and other neurotransmitters in the brain. When these chemical systems are out of balance, depression can be the result. Researchers have found that changes in the brain during an episode of depression resemble the effects of severe, prolonged stress.

Martin Buxton, MD, Chief of Psychiatry at Chippenham and Johnston-Willis Hospitals and Medical Director of Tucker Pavilion

Let’s consider the mind-body connection. Depression can occur with other serious illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes and Parkinson’s disease. Studies show that treating the depression can help improve the outcome of the co-occurring illness.

Signs and Symptoms of Depression People with depression do not all experience the same symptoms and the severity, frequency and duration of their symptoms may vary. Here are the generally agreed upon symptoms for major depression: • Persistent sad, anxious or “empty” feelings • Feelings of guilt, worthlessness or helplessness • Irritability, restlessness • Loss of interest in activities or hobbies once pleasurable, including sex • Fatigue and decreased energy • Difficulty concentrating, remembering details and making decisions • Insomnia, early-morning wakefulness or excessive sleeping • Overeating or appetite loss • Thoughts of suicide, suicide attempts • Aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

Different Faces of Depression Depression is an equal opportunity disorder—no one is immune. Let’s see how different groups of people experience clinical depression. “Women are more than twice as likely to be diagnosed with depression as men. Before adolescence, the rate of www.OurHealthRichmond.com

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depression is about the same for girls and boys,” comments Dr. Kornstein. “However, with the onset of puberty, girls are at greater risk possibly due to changes in hormone levels that occur throughout a woman’s life. Women may also be diagnosed at a higher rate because they are more willing than men to seek treatment.” Men are more apt to suppress their emotional distress through the use of alcohol or other substances that “mask” the clinical depression. For women, depression is expressed as sadness. Men who are depressed are more likely to be frustrated, discouraged, irritable, angry and sometimes abusive. Although more women attempt suicide, men are more successful. In the United States, almost four times as many males as females die by suicide. Marriage plays an interesting role in the risk for depression. Married women are more likely to be depressed than unmarried women; however the reverse is true for men. Marriage seems to create a protective buffer against depression for men, but not for women. And if you think depression is a problem that only adults have to face, think again. About 11 percent of all adolescents experience depression by the age of 18. What’s even more staggering is the fact that suicide is the third leading cause of death among youth ages 15 to 24 and the fourth leading cause of death for children between 10 and 14. “Depression is not something children outgrow,” remarks Dr. Sood. “Childhood depression can continue into adulthood, especially if left untreated. And depression in children doesn’t necessarily look the same as it does in adults. A young child may refuse to go to school, cling to a parent or worry that a parent may die or have physical complaints like stomachaches and headaches. Older children may sulk, get into trouble at school, be negative and irritable and feel misunderstood.” Because these behaviors may be seen as “phases” that children and adolescents go through as they develop, it may be difficult to accurately diagnose a young person with depression. Depression in children and adolescence often occurs with other disorders such as attention deficit disorders, anxiety, eating disorders or substance abuse.

Scan the QR code below to download and print the Childhood Depression Checklist.

Document what you observe in your child and share with your child's doctor or mental health worker.

Let’s look at the other end of the age spectrum. Depression is not a normal part of aging. But when older adults do have depression, it may be overlooked. Seniors may be less likely to admit that they have feelings of sadness. Older adults have more medical conditions— like heart and vascular disease, stroke and cancer—which may cause depressive symptoms. And they may be taking medications with side effects that contribute to depression. Most people assume that the highest rates of suicide are among young people. But white males age 85 and older actually have the highest suicide rate in the United States.

Diagnosing Depression There is no simple test for diagnosing depression and the process may take a little time and help from several www.OurHealthRichmond.com

healthcare providers. If you or a loved one is experiencing the signs and symptoms of clinical depression, a good place to start is with your primary care physician. Your doctor will first determine if there are any medical conditions causing your depression—such as thyroid problems, a viral infection, vitamin or mineral deficiencies, hormonal changes or side effects of medications. If there is no apparent reason why you should be experiencing signs of depression, further assessment will be conducted by your physician or by referral to a mental health professional. A thorough evaluation will include asking you a number of questions designed to fully understand the nature of your problem: • What are your symptoms? • How long have you had these symptoms? • How severe are your symptoms? • Have you had these symptoms before? • Have you been treated for depression before? • Do any of your relatives have depression? • Is there anything happening in your life right now that is particularly upsetting or stressful? • Do you use drugs or drink alcohol? • Have you thought about death or suicide? The findings from this evaluation will be compared to the diagnostic criteria for depression found in a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Treatment Options There are a variety of effective methods for treating depression. Unfortunately, only about one-third of those who are depressed actually receive professional help. Some people with mild depression do well with psychotherapy or counseling alone, while individuals with moderate to severe depression most often benefit from antidepressant medications. Dr. Buxton observes, “Patients have the best outcome with a combination of treatments—medication to provide quick relief from symptoms and psychotherapy to learn more effective ways of dealing with the challenges of life.” Although antidepressants can help ease the feelings of sadness and hopelessness associated with depression, they are not “happy pills. Medications are not designed to cover up problems. Rather, they modify the neurotransmitters—or brain chemical—that regulate mood. “There is new evidence that antidepressants can reverse the changes in the brain that come about with depression,” comments Dr. Buxton. “But these medications don’t work overnight. It can take several weeks before a patient begins to feel significant relief.” 58

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There are a number of antidepressants available and they each work in a slightly different way. The side effects also vary from one antidepressant to another and from person to person. They range from dry mouth and constipation to weight gain and sexual dysfunction. With so many options now available, a doctor can help each patient find just the right medication—or combination of medications—to achieve the greatest relief of symptoms with the fewest side effects. “Special care has to be taken when prescribing antidepressant to children and adolescents,” indicates Dr. Sood. “People rarely develop suicidal thoughts while on antidepressants. But this may occur with younger patients—so it is important to monitor them very closely in the first few weeks of treatment.” Dr. Buxton further elaborates: “Managing medications with children does require careful scrutiny. When the FDA implemented warnings that use of antidepressants in children and young adults leads to increased suicidal ideation, the number of prescriptions written for this population dropped. At the same time, the rate of actual suicide has increased. It takes a delicate balance by a trained child psychiatrist.

At some point in their lives, 10 to

25 percent of women and 5 to 12 percent of men will become clinically depressed.

There are several types of psychotherapy—or “talk therapy”—that can help people with depression. Interpersonal therapy (IPT) helps people understand and work through troubled relationships that may set off their depression or make it worse. Cognitive-behavioral therapy (CBT) approaches emotional problems by changing the way a person thinks about his or her life. People coping with depression tend to have negative thoughts. CBT provides a mental tool kit that can be used to challenge these negative thoughts and change the way a depressed person sees the world. CBT also helps patients modify behaviors that come from dysfunctional thinking. When patterns of thought and behavior are changed, so is mood. For young children who lack the ability to express themselves verbally, play therapy may provide a helpful way for the child to share feelings and experiences. Dr. Sood adds, “And even young children can benefit from learning coping strategies to handle stress.” Electroconvulsive therapy (ECT) may be useful for individuals whose depression is severe or life threatening and when antidepressant medications are not effective. In recent years, ECT has improved a great deal. Patients receive a muscle relaxant before treatment and the procedure is done under anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses that cause a brief—about 30 seconds—seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. ECT may cause some side effects, such as confusion, disorientation and memory loss, but usually these are short-term. In 2008, the U.S. Food and Drug Administration (FDA) approved the use of transcranial magnetic stimulation (TMS) for patients with major depressions who do not respond to medication. This is not an experimental treatment; it has been studied by researchers for more than 20 years. TMS works by stimulating the nerve cells in the part of the brain that is linked to depression and mood regulation—reducing the duration and severity of depressive episodes. Treatments are given on an outpatient basis five days a week over a six- to nine-week period—typically for a total of 36 treatments. www.OurHealthRichmond.com

Researchers have found that changes in the brain during an episode of depression resemble the effects of severe, prolonged stress.

There are several important benefits to TMS compared to other treatment modalities. No sedation or anesthesia is required so the patient can drive and return to work or other daily activities immediately following the treatment. And TMS does not have side effects that are common with antidepressant medication and ECT. TMS offers significant improvement for about 60 percent of the patients and complete remission for about a third of the patients.

What does the future hold? Genetics and the brain are the two final frontiers of medicine—and both areas of research will contribute to more effect ways of preventing, diagnosing and treating depression. Here are a few of the new and exciting developments that are on the horizon: • A recent study shows that people with a certain genetic mutation that causes them to produce less of the brain chemical neuropeptide have a more intense negative emotional response to stress and may be more inclined to develop depression. • “We can now perform a relatively simple genetic test to evaluate a patient’s metabolism. The results can help determine the right medication and proper dosage for that particular individual,” says Dr. Buxton. • Deep brain stimulation (DBS)—which has been historically used to treat Parkinson’s disease and essential tremor—is now being investigated as a promising new treatment for severe depression. DBS uses a tiny electrode that is surgically implanted to stimulate the part of the brain that regulates mood. VCU Medical Center was recently involved in the FDA approval study for this treatment modality. • One of the most innovative studies is a clinical trial using botulinum toxin (Botox) for the treatment of major depressive disorder. This study, headed by Dr. Kornstein, is being conducted at VCU Medical Center along with other sites across the country. “There are a number of theories how this works,” explains Dr. Kornstein. “The facial feedback hypothesis states that facial expressions feed back to the brain and influence emotions. Botox has been tested for many medical conditions— ranging from chronic migraine and psoriasis, to restless legs syndrome and tennis elbow just to name a few.” • Another novel area of investigation, says Dr. Buxton, is the use of anti-inflammatory drugs to treat depression in people who do not respond to antidepressant medications and psychotherapy.

Joel J. Silverman, MD, Chairman, Department of Psychiatry at Virginia Commonwealth University

The last great stigma of the twentieth century is the stigma of mental illness. —Tipper Gore Individuals who suffer from depression face many challenges—but perhaps the worst is social stigma. No one is embarrassed to admit that they have heart disease or that a family member has cancer. People are not reluctant to get help for their diabetes or asthma. Yet, depression is still talked about in hushed voices. The mere mention of mental illness makes people feel uncomfortable. It evokes a sense of shame and humiliation. “It is imperative that we all play a role in conquering depression and the stigma that surrounds it,” notes Joel Silverman, MD, chair of the Department of Psychiatry at Virginia Commonwealth University. “Be aware of the signs. If you experience these symptoms, and they continue for more than two weeks, don’t be embarrassed or ashamed to seek treatment from your personal physician, a counselor or mental health professional. Similarly, if you believe that a family member, friend or associate may be suffering from depression, let that individual know you are concerned and encourage them to get help.”

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“Clinical depression is a major illness with serious consequences. But the good news is that depression is eminently treatable,” concludes Dr. Silverman. “The medications we have available today are just as effective as medications used to treat other physical disorders.” Hopefully, as more strong and brave people like Erik tell their stories and as we increase understanding that depression is a medical condition with a genetic and biological basis, the barriers that prevent people from seeking treatment and giving support to those who are struggling with this disorder will come down.

Medical Experts • Martin Buxton, MD, Chief of Psychiatry at Chippenham and Johnston-Willis Hospitals and Medical Director of Tucker Pavilion • Susan G. Kornstein, MD, Professor of Psychiatry and Obstetrics and Gynecology at Virginia Commonwealth University and Founder and Executive Director of the VCU Institute for Women’s Health • Joel J. Silverman, MD, Chairman, Department of Psychiatry at Virginia Commonwealth University • Aradhana “Bela” Sood, MD, MSHA, FAACAP, Senior Professor of Child Mental Health Policy, Professor of Psychiatry and Pediatrics at Virginia Commonwealth University Health Systems and Secretary of the American Academy of Child and Adolescent Psychiatry

Sources: • Centers for Disease Control and Prevention (CDC) • National Alliance on Mental Illness (NAMI) • National Institutes of Health (NIH) • National Institute of Mental Health (NIMH)

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It’s Time to

SPEAK UP

One young woman decided to take on this challenge and “speak up” about her own depression and mental health treatment.

I have fought the good fight, I have finished the race, I have kept the faith. (2 Timothy 4:7)

On March 16, 2014, Cameron Gallagher, age 16, died unexpectedly from an irregular heartbeat just after finishing the Shamrock Half-Marathon in Virginia Beach. But her legacy will live on. Her parents, David and Grace Gallagher, decided to fulfill Cameron’s dream to host a 5K run to create awareness of childhood and teen depression and help crash through the stigma associated with the disease. To the outside world, Cameron’s life was idyllic. She was pretty, smart, well-liked and a talented athlete. She had a loving family and a secure home. But inside, she suffered from depression. “There were times when her sadness was so intense that she couldn’t go to school. We stayed with her and got her help,” says Cameron’s father, David Gallagher. By nature, Cameron was a warm, caring person. Always ready to give a friend a hug or offer a smile or word of encouragement. When it came to dealing with her depression Cameron also demonstrated strength of spirit and tenacity. “Even on her worst day,” says David, “Cameron never gave up. She was constantly working on new strategies to cope with her sadness. She would fill notebooks with positive quotes, she would write them on paper and hang them on her walls. She fought every day to become the person she knew she could be—happy and optimistic.” Shortly after Cameron’s death, the Gallaghers found a Bible verse that captured Cameron’s essence: I have fought the good fight, I have finished the race, I have kept the faith. (2 Timothy 4:7) “Grace and I see Cameron in these words. She lived this verse,” says David, “and she inspired others to do likewise.” Cameron Gallagher showed tremendous courage in completing her race—and more importantly in speaking up and sharing her battle with depression. She wanted to combat the stigma—making it OK for kids to be honest about their emotional problems and unashamed to seek help. Now, it’s up to us. Let’s finish this.

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SPEAK UP 5K

Let’s Finish This! at Byrd Park in Richmond Saturday, September 6

OurHealth’s photographer, Lew Fraga, was among nearly 3500 runners and walkers in Richmond’s Byrd Park on Saturday September 6th. Runners and walkers celebrated the life of Cameron Gallagher during the first annual Speak Up 5K. Virginia Treatment Center for Children will be the beneficiary of the $150,000 raised from the race. Organizers are already planning for next year’s race scheduled for Saturday September 12, 2015. Visit www.speakup5k.com for more details on how you can participate!

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Check out Reilly Gallagher's event day interviews. Scan the QR code below. http://youtu.be/AyliE-v5xJU

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HealthyEats One of the most satisfying things about fall is the flavors of fresh produce available. As the air starts to get chilly, warm food can be both nutritious and comforting. At Good Foods Grocery we love combining seasonal foods with fresh herbs and spices to give our customers rich and hearty flavors. Stop by for lunch, or come shop our extensive bulk and organic produce. Shopping seasonally not only helps your budget, but offers a great way to add variety to you diet. At Good Foods Grocery, we work closely with local farmers to bring you farm ripened, fresh picked produce.

Green Bean Summer Salad Ingredients:

1 pound of green beans till tender in salted water 2 cups of fresh or frozen corn ½ cup of red onion 1 tsp of fresh garlic 1 cup of cubed fresh mozzarella

proudly sponsored by

Good Foods Grocery

Directions:

1. Blanch green beans till tender in salted water 2. Roast corn in oven for 10 minutes at 350°F with ½ cup of red onion and 1 t of fresh garlic 3. Toss all together. When they are cooled down you may not need all the vinaigrette so slowly add until vegetables are glistening.

2 cups of grape tomatoes 1/3 cup of balsamic vinegar 2/3 cup of olive oil

fresh basil 6 leaves sliced thin

salt and pepper

Good Foods Grocery’s

GREEN BEAN SALAD

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

HealthyEats Herb Roasted Veggies Ingredients: 1 eggplant 1 zucchini 1 yellow squash 1 small red pepper 1

small yellow pepper

1 pound of mushrooms

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Good Foods Grocery

Directions:

1. Roast the eggplant, mushrooms, the peppers, zucchini and yellow squash. 2. In convection oven at 375°F/ conventional oven at 400°F roast on sheet pan lined with parchment paper (for ease of clean up) about 15 minutes or until you see slight browning.

3. Dribble the olive oil on the separate serving bowls and sprinkle the seasonings on them. Place veggies in bowls.

1/2 cup of olive oil 1 t garlic powder 1 t dried basil 1 t oregano

salt and pepper to taste

Good Foods Grocery’s

HERB ROASTED VEGGIES

HealthyEats Vegan Gluten Free Apricot Muffins Yields: 15 muffins

Ingredients: 2 cups oat flour ¼ cup flax meal ¾ cup dried apricots in pieces soaked in 1 cup water *

Directions:

1. Preheat oven to 350°F. 2. In a large mixing bowl, combine oat flour, flax meal, shredded coconut, cinnamon, baking powder and baking soda. 3. In a second bowl, combine apricots in water, dates in water, chia seeds in

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almond milk, maple syrup and vanilla. 4. Pour wet mixture into dry mixture; mix well until just combined. 5. Scoop into greased muffin pans. 6. Top with sprinkled coconut if desired. 7. Bake 20-25 minutes. Enjoy!

5 dates, chopped, soaked in ½ cup water* 1 ½ T. chia seeds soaked in ½ cup almond milk* ½ cup shredded coconut, unsweetened 1 t. baking powder ½ t. baking soda ¼ cup maple syrup 1 ½ tsp vanilla 1 T. cinnamon

*for best results, soak overnight.

Good Foods Grocery’s

VEGAN APRICOT MUFFINS off your entire purchase next time you visit Good Foods Grocery

One per customer, one time use. Valid at both Good Foods Grocery locations (West End & Southside) thru November 30, 2014.

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photo courtesy of Special Collections & Archives, VCU Libraries

where is this?

Post the correct answer on our facebook page by November 7, 2014.

You could win some great food from Good Foods Grocery! Cool, right? The winner will be announced on our facebook page November 14, 2014.

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