Healthcare in Hampton Roads by Darden Publishing

Healthcare November August 2011 2012 Edition Edition

Bones Joints Muscles

& Pain Medicare for Dummies Hypnotherapy Nutrition Chiropractic Care

Local Advancements in Medical Treatments www.dardenpublishing.net

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Healthcare features

Cover Story

Bones & Joints

Materials for replacement joints have improved and orthopedic surgeons have improved their techniques over thousands of procedures.

Partners in Motion: Physical Therapists After joint surgery, commiting to completing your

Whatâ&#x20AC;&#x2122;s New in Orthopaedics and Pain Management?

Hypnotherapy and Chronic Pain Management

Backing Chiropractors

7 12

physical therapy routine from your doctor is one of the most important things you can do to keep yourself healthy.

departments

Senior Living

! r o l o c Think

Medicare for Dummies

Nutrition and Wellness Want to Improve your Diet?

Bone, Joints, Muscles & Pain

18 Healthcare in Hampton Roads

From the Publisher

Hello Neighbors

his edition is dedicated to my wife Jackie and to all of you orthopaedic surgeons, physical therapists, nurses, nutritionists and support staff that share a common practice “to help us live without pain”. www.HRHealth.net

In my wife’s own words: “I am one of those individuals that grew up with knee problems. Even as a young child I would wake up during the night crying because of my “leg aches”. As an adult I still experienced knee problems. I exercised, biked, walked, played golf but the pain continued. Finally I had had enough. The pain was constant in my right knee. My family doctor referred me to Atlantic Orthopaedic Specialists in Chesapeake for consultation with Dr. Shelton Cohn and then a MRI. Not only did I have arthritis but I had a torn cartilage and meniscus. My arthroscopic surgery was performed at The Surgery Center in the W. Stanley Jennings Outpatient Center and 4 days later I was in physical therapy at the Atlantic Orthopaedic Specialists office in Chesapeake. My PT Danielle put me through a series of measurements and then exercises not only to do during my therapy sessions but also at home. I was determined to “get back on my feet again” and without Danielle and my sessions I would not have accomplished it. I can honestly say I enjoyed my therapy sessions at AOS and am now walking pain free.” Can you relate to this scenario? As an aging senior trying to maintain an active lifestyle, I wake up some mornings unable to rise and shine like I did 30 years ago. Without our support group of friends it may be difficult to eat properly or maintain our habitual exercise programs. As baby boomers, it takes a daily conscious effort to keep our mind and muscles active, after all, we want to be able to enjoy every day for as long as we can. Sitting on the couch, watching TV is no way to avoid our pain. I have lost many friends in the blink of an eye. There are no guarantees in life…that we will wake up tomorrow to share and remember our life’s adventures with the love of our family and friends. Healthcare in Hampton Roads is my newest publication with a mission to spread the word about local health awards, accolades and quality of healthcare now available for people of all ages. I see it every day when I walk among the sick and listen to their stories of how our health professionals from Hampton Roads saved a life or recommended a new procedure that put bounce back in their step.

PUBLISHER

Paul Quillin Darden Copy Editor

Jackie Nelson Darden ART DIRECTOR

Sherril Schmitz CONTRIBUTING WRITERS

Brian Cole Paul Darden Natalie Miller Moore Alexandra Whiteside Shannon Woods Diane York

©Copyright 2012 by Darden Publishing. The information herein has been obtained from sources believed to be reliable: however, Darden Publishing makes no warranty to the accuracy or reliability of this information.

Healthcare in Hampton Roads

In upcoming editions we will present national health concerns in a way that you can understand and hopefully share your newfound knowledge with family and friends so we all can live longer, healthier lives with confidence that we are in good hands right here in Hampton Roads.

is a bi-annual publication with current distribution to area Chambers of Commerce, and a delivery program to selected health related businesses throughout Hampton Roads. To obtain a copy or to find a location nearest you, please contact:

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Bones & Joints By Natalie Miller Moore

It’s an amazing, almost science fiction-like process, to be able to remove worn out joints and to replace them with new ones, made of metal, ceramic or plastic. Materials for replacement joints have improved and orthopedic surgeons have improved their techniques over thousands of procedures.

ip and knee replacement surgeries topped over 1 million per year in 2009, according to the Centers for Disease Control. They are among the most successful operations performed in the US because of their low rate of complications and the quantity performed by surgeons, which improves the techniques. The result is better quality of life for patients, particularly less pain and improved levels of activity. But, the number of surgeries are also increasing due to obesity putting more pressure on joints, and the increase in arthritis diagnoses. Patients are benefitting from the innovations happening with the surgical aspect, but also from a better understanding of what makes for a good surgical candidate and what the best methods are for getting them back to their favorite activities. Physical therapists have refined their patient’s regimens to include pre- and post-surgery therapy. Recovery time has improved, and pain management during and after surgery has as well. Dr. James Dowd, a Joint Replacement Surgeon at the

Jordan Young Institute, performs more than 2,000 joint replacement surgeries a year. He tells a story about his brother’s ACL surgery in the mid-1980s, “He was in the hospital for three days, in a cast for six weeks, and had to go to physical therapy to get it to move. Today, the surgery is a half hour, you can leave the same day, wearing a knee brace a few days. With immediate physical therapy, you could be running again in six weeks.” Dowd feels that the innovations in joint surgery are better, and that it’s important to get people moving again because “motion is life.” Diagnostic tools aided doctors in assessing patient’s joint conditions, such as a CT scan or an MRI. Dr. Jeffrey Carlson, from Orthopedic Spine Center, said that “the MRI scan has revolutionized back surgery. It gives us a very clear view of back ahead of time. We have more tools now.” Computer assisted surgery started being used in the

Healthcare in Hampton Roads

early 2000s, allowing for more precise reconstruction. Dowd said that an increase in minimally invasive techniques means less cutting, better pain control, and a quicker recovery. When the patient is more prepared for the surgery, the surgery itself is more precise, and the recovery and physical therapy protocols are improved, hospital stays become shorter. “When I was training 10-12 years ago, folks would stay in the hospital for weeks,” said Carlson. Replacement joints are lasting longer, too, which makes the replacement surgery more successful. He also said that “materials in knee replacements last 30 years rather than 10-15 years.” All hip and knee replacements involve a two parts: a bearing and a bushing, basically the ball and cup of the joint for a knee or hip, with some variations. These parts can be made from ceramic, metal or polyethylene plastic. “Think of it as going from 20,0000 miles to 100,000 miles of wear,” said Dowd. Parts that are attached to the bone may be cobalt chrome or titanium, because they don’t need to move like the joint parts. The doctor decides on the materials based on the patient, in a case by case fashion. Dowd said that a younger person who is highly active, might get a ceramic ball with a high density plastic liner. He said that more joint replacements are being done in

the 49-60 year old age group, and that the field has seen a drop in the average age of patient in past 10 years. That may be due to more people needing joint surgery, or it may be because people are doing it sooner than they used to. This is important because living with a disabled joint may severely limit mobility, and muscles may become damaged in compensating for the injured joint. “Don’t limit your life,” Carlson said. Newer treatments offer better results, and there are more advances on the horizon, such as genetic treatments, stem cell advancements and the ability to create replacement cartilage. Anesthetic techniques are much better than they used to be, including nerve blocks and epidurals for lower extremities. “This keeps patients awake, they are sleepy but there’s no tube down the throat. There’s less feeling a loss of control, and it helps patients, they are not worried about going to sleep and not nauseous from anesthesia,” Carlson said. Opinions vary about joint surgery as an outpatient procedure, but increased availability of home nursing care and physical therapy follow up seem to be leading in that direction. The orthopedic field seems to follow a fairly athletic mindset, one of “let’s get back on the field.” That means they are finding ways to innovate to get patients back into their lives. A Sentara coordinator for inpatient rehab and physical

A Sentara physical therapist assists an orthopedic surgery patient to get mobile as part of the rehabilitation process. Photo courtesy of Sentara

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Cover Story The Orthojoint Center is laid out in a triangle with three hallways and nurses stations at each corner of the triangle. Maps indicating the hallway’s distance in feet help encourage patients to continue working their new joints. If they take a longer route, they could go 352 feet rather than the shorter route where they turn at a smaller hallway, which is a total of only 216 feet. Whichever way they go, they are getting moving and that matters a great deal to patients who’ve had joint surgery. As part of the OrthoJoint program, patients and their families are asked to first attend a class to educate themselves about the process of having joint surgery and what kind of commitment they’ll need to make to their recovery. One person is designated the coach, usually a spouse or adult child, and

Photo courtesy of Natalie miller moore

therapist Sandy Slovak said, “We help people get back on the golf course. Someone might set the goal of a certain tee time, or to dance at their 60th anniversary party.” Here’s the scene at one Sentara hospital that shows just how they do that: On the whiteboard, the man saw that the woman had moved her marker ahead of him. So he took the long way to get in the extra feet to pull even with her. The most remarkable thing about this competition? It’s happening on the Sentara Orthojoint Center floor with people who had knee replacement surgery a few DAYS ago. Everything about joint replacement has changed, from the materials to the techniques, and especially the physical therapy to get people back on their feet again. The OrthoJoint program creates a class of people who have scheduled surgery around the same time, work together on physical therapy, and encourage each other to do the work needed to recover from their surgeries. They cheer each other on down the hall. Kay Domine, 64, was in for her second knee surgery in two years – she’d had the right knee joint replaced last year, and the left one in April 2012. “I can already tell the difference,” she said, as she worked her knee with the physical therapist. Domine said that she’d had problems with her knees since childhood. Was it daunting to have surgery and face the recovery process again? “I asked myself, ‘Could I do it again?’ and decided that I could.” KJ said that choosing to do the OrthoJoint program this time helped her feel stronger sooner. “I realized I could move my leg without my cane, and the muscles are healing sooner, she said. “It’s creating a different experience and I think it will be a different story than last time. Her competitive cohort, Donald Kent, 73, a former military man, worked equally as hard on stretching his leg after surgery. They compare notes on stitches, staples, glue and wraps. Each day, they measure the angle that the knee can bend to, with the same physical therapist, who knows what benchmarks they should be reaching, and where each patient was the day before. Physical therapy is for one hour twice a day. The goal is for patients who have surgery on Monday to be discharged by noon on Thursday. Rita Wade acts as the Orthopedic Patient Navigator for her patients, encouraging them to call her with questions. RN Rita Wade supervises the program for hip and knee replacements and she gave the Williamsburg unit a revolutionary theme. “People often say ‘I’ve had enough. Something has to change.’ We have them sign their ‘declaration of independence,’” she said. The markers on the leaderboard are even in the shape of small revolutionary soldiers. If there’s a big improvement, you get a cannon!

Donald Kent, 73, works his way down the hall after his knee replacement surgery to his physical therapy session, aided by staff at the Sentara Williamsburg OrthoJoint Center.

they encourage the patient to do their exercises during physical therapy in the hospital and at home. Wade provides them with a guidebook which includes what to expect prior to surgery, information about their hospital stay, as well as the exercises week by week for their “homework.” Surgeries are scheduled at the beginning of the week and every patient on the floor attends group physical therapy. The

Healthcare in Hampton Roads

Photo courtesy of Sentara

“class” gets to know each other during lunches and it “builds This new program emphasizes on the whole patient, and getcamaraderie and competition.” They wear loose street clothes, ting them moving more quickly after surgery. Research shows that mainly shorts and T-shirts, to emphasize that they are not sick. They with this method clinical outcomes improve, patient satisfaction are working towards returning to an active lifestyle. increases, and length of stay decreases. Sentara has five facilities ofIn a change from past philosophies, patients are encouraged fering this program currently, including Sentara Lee, Obici, Princess to walk sooner after surgery. Bev Sabourin, the Nurse Manager Anne, Virginia Beach and Williamsburg. on the floor, called this “early ambulation.” They have large blue “One of the benefits of this program is that you have teamrecliners that staff follow them down the hall with, and that’s what mates who get you moving, and raise expectations. We have they use in the PT people doing laps room. The recliners around the floor, are designed with laughing,” said no gaps between Wade. the seat and the Patients are footrest, preventing still followed after the leg from being they go home, to able to fall through. make sure their It’s a chair that’s all functional and one seamless piece, clinical results are and square plastic on track. As part exercise boards slide of the OrthoJoint under the legs to program, there’s allow more accesa reunion lunch sibility for PT. “People three months are surprised how after the surgerSentara OrthoJoint Class with OrthoJoint Navigator at Sentara Leigh Ann Phillips. One big quickly they can ies, so everyone element of the new patient centered experience of the OrthoJoint Centers is the OrthoJoint Navigator and her accessibility and collaboration with patients. walk. Sometimes it’s can get back tothe day of surgery, if gether with their they are stable, don’t have any nausea and their pain is managed.” classmates. Rita Wade acts as the Orthopedic Patient Navigator for Rita Wade. her patients, encouraging them to call her with questions. They “Quality of life triggers it (the decision to have surgery.) Pain meet in the same multipurpose room where they did their physical issues vary from chronic to severe. People wait as long as they can, therapy, as a reminder of how far they’ve come. Wade said that until it’s impeding their walking, or driving even. They might have patients are thrilled and showing off what they can do – and see to use a walker or a wheelchair,” Sabourin said. how far their new joints can move!

Consulting an Orthopedic Surgeon

• Are you limping? • Do daily activities seem to be getting more difficult? • Is pain keeping you awake? • Have you tried other treatments for a reasonable amount of time without success? • Are you in general good health except for your joint? • Have you given up activities you enjoy?

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Photo courtesy of Sentara

Here are some signs that you might want to consult an orthopedic surgeon:

The Sentara Patient Guide offers very detailed information about how to plan for joint replacement, pre-operative schedules, education and information about recovery.

Partners in Motion:

Photo courtesy of Tidewater Physical Therapy, Inc.

Physical Therapists

By Natalie Miller Moore

After joint surgery, one of the most important things you can do to keep yourself healthy and be on the road to recovery is to commit to completing your physical therapy routine from your doctor. Having to go to a physical therapy center three times a week can be time consuming – but it may be worth it. “The people who get better, do their homework,” said Tony Grillo, a physical therapist with Tidewater Physical Therapy. Going to a physical therapy center can be motivating. “People may do a small number of exercises at home, and they might do 1 or 2 of them, but not all 12,” Grillo said. Working with a physical therapist can make patients more compliant, and encourage them to keep the effort up. Grillo said he thinks it’s important to be an active participant in the recovery. Wayne MacMasters, the president of Tidewater Physical

Therapy, said that “Good therapy is timing.” Muscles heal best when they are activated and remain flexible, like rubber bands. Not following a therapist’s exercise prescription could cause them to help more like ropes, and become stiff. But besides those recovering from surgery, many people dealing with orthopedic issues, chronic illness, sports injuries or pain can benefit from physical therapy. A trained and licensed physical therapist is an expert in movement, so they can assess your issue and create a plan to strengthen muscle, Healthcare in Hampton Roads

Joe Flannery, DPT, CIMT Williamsburg Physical Therapy Clinical Director includes cuboid supination mobilization in plan of care for patient with persistent lateral ankle pain.

as well as control pain. There are a number of techniques, such as hands-on mobilization and manipulation, as well as heat to relax muscles, exercises, ice and compression. PTs (what physical therapists are often called) may also prepare patients for the surgery by helping them strengthen their body so it’s in better shape to recover. It’s also possible that physical therapy can help joint issues so that surgery isn’t needed, depending on the individual issues. Physical therapists can do manual procedures to check the function of different parts of the body, and assess whether a joint is hypermobile or unstable (moving too much) or if there is insufficient movement and it’s too stiff or there is too much scar tissue. The goal is strength and stability for long term function.

A physical therapist can also be like a detective looking for the cause of problem; for example, sometimes a knee hurts but it’s the actually hip that’s weak. MacMasters gave an example of a woman having pain on her right side, particularly her shoulder. When they discovered she worked in a narrow office where her phone and her door were sharply to her right, they suggested some counter exercises – and that she rearrange her office. MacMasters said that for patients, starting with physical therapy, or just having an evaluation, is a low risk proposition. “It’s non-invasive, we don’t use meds, and it’s a reasonable and conservative first stop option for a lot of patients,” he said. The Comber Physical Therapy practices in Williamsburg also promote physical therapy as an alternative for

Joe Flannery, DPT, CIMT Williamsburg Physical Therapy Clinical Director evaluates patient’s degree of shoulder impingement. Shoulder impingement dramatically limits patients’ ability to perform many overhead, behind back, and across body activities of daily living (ADLs).

A CIMT certified therapist is trained to identify the underlying CAUSE of patient’s complaint, not just treat the symptoms.

(Page 7) Tony Grillo, DPT, OCS, CIMT & Clinical Director at Tidewater Physical Therapy transitions patient from aquatic to land based therapeutic exercise. Aquatic Therapy allows patients with serious limitations to enjoy the benefits of gentle physical therapy with less pain. Conditions including: Leg fractures that cannot bear weight, Lower back problems, Post-surgery, especially lumbar laminectomy or reconstructive joint surgery, Arthritis, osteoporosis and fibromyalgia benefit from aquatic therapy.

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Photos courtesy of Tidewater Physical Therapy, Inc.

considering surgery, or at least as the first step. “People have a tendency to go down the surgical route, and we educate them on conservative treatments like lifestyle changes – because many of them haven’t exhausted conservative care plans yet,” said Erika Comber, the owner of Comber Physical Therapy. “We say, ‘let’s try this,’ or ‘we’ll strengthen you before surgery’ and they’ll tolerate it better,” she said. The Comber post-rehab program provides a safe place for people, particularly older patients, to continue their exercises. “They already know how to set up the equipment, so that level of comfort is already there,” she said. The atmosphere is positive and she said that “people feed off of the energy” as they work to build strength and endurance. “Our patients undergo a transformation, and we get rewards in the form of hugs. It’s the best job in the world,” Comber said. One of those patients is Claire Sink, age 68. After her second back surgery and recovery in 2004, Claire continued

physical therapy at her doctor’s suggestion. “The surgeries significantly improved my quality of life, and so has in-depth physical therapy. My muscles have been reconditioned,” she said. She continued with the post-rehab program, and still exercises several times a week to keep her muscles in shape. She finds Comber’s post-rehab center very supportive and friendly. “I would go to Comber PT a couple times a week to work on my muscles, joints, and the overall mechanics of motion. In essence, the PT provides a comprehensive systems perspective to my exercising that is enhanced over working with a trainer at the gym. I do my own timing and charting, with the PTs and technicians overseeing my technique and form.” Sink said that her advice to other patients is that they develop a regular exercise routine, and stick with it. “Patients need to understand once they complete a physical therapy program, they just can’t stop exercising and expect to

stay fit. They should continue their own regimen, or do one under the guidance of a PT or trainer,” she said. She feels that having a regular place to work out gives her accountability and motivation. “I know that I’m expected to be there – it gets you there. Because you don’t want to go back to have to do rehab, you don’t want to lose ground, so you have to have motivation and dedication to do it,” Sink said. There are a variety of patients who visit physical therapy, including chronic illness, orthopedic issues and balance dysfunctions. Comber said that balance issues related to aging are often discouraging for people. “They lost hope and faith. But when you tell them they can be better and still be healthy, it makes them so happy,” Comber said. Physical therapy offices offer a variety of methods to help you get moving again, which truly makes them partners in motion.

The Strength of Tidewater Physical Therapy is Our people. Independence. Professionalism. Relationships with physicians and patients. Specialized therapy and professional growth. Belief that physical therapy is a noble profession. Dedication to clinical excellence and improving the lives of others. Knowledge that physicians use our services because they believe that we are the best option for their patients.

www.tpti.com 32 Locations in Richmond, the Peninsula & Southside Hampton Roads

SOUTHSIDE: Virginia Beach Smithfield Kempsville Western Branch Great Bridge Battlefield Windsor Franklin PENINSULA: Executive Drive Magruder Oyster Point Tidewater Performance Denbigh Hidenwood WILLIAMSBURG: Williamsburg PT Williamsburg ASC Williamsburg Hand Therapy Norge Gloucester Courthouse Gloucester Point RICHMOND: West Point Brandermill Colonial Heights Glen Allen Kings Charter Midlothian John Rolfe Mechanicsville Ironbridge Powhatan Laburnum West Hampton Healthcare in Hampton Roads

What’s New in Orthopaedics and Pain Management? By Shannon Woods, OSC Outreach Director

In keeping with the theme of this edition of Healthcare in Hampton Roads, the physicians at Orthopaedic & Spine Center have been asked to comment on the medical innovations that are providing the most relief to their patients or that are most-greatly impacting their quality of life.

Q: a:

What unique surgical innovation has most influenced the care of your shoulder pain patients?

The greatest single advance in management of shoulder pain in my career has been the development of arthroscopic shoulder surgery. Early in my career when the only alternative was painful open surgery for conditions such as rotator cuff tears, many patients, even physicians, chose to simply live with their pain. Today, the vast majority of patients with shoulder pain can be successfully treated via out-patient arthroscopic surgery, done through several small incisions. This allows us to see clearly all the details of the anatomy, and carry out repairs without large incisions, resulting in a shorter, less painful recovery. The “Scope” has revolutionized shoulder surgery, and this technique now represents the primary focus of my practice. Martin Coleman, MD – Orthopaedic Shoulder Specialist

What medical innovation(s) is having the biggest positive impact on the care that your Chronic Pain patients are receiving?

I believe that the biggest breakthrough we are seeing in the field of Pain Management is the development of the Interdisciplinary Pain Management team. This involves gathering experts in the areas of Interventional Pain Management, Orthopaedics, Physical Therapists and other Specialists (as needed) to collaborate in the care of Chronic Pain patients. Using this team approach, I find that we can actively manage patient care and work together to achieve the best outcome. The patient benefits from such concentrated attention and, as a result, they tend to live more active lives with less pain. Jenny L. Andrus, MD – Interventional Pain Management

As an Orthopaedic surgeon and Fellowshiptrained Spine Specialist, what advances in surgery, medical technology or delivery of pain medication do you believe most benefit your patient’s?

Minimally-invasive hip and knee replacement surgery offer my patients the biggest life changing experience in the least amount of time. My patients go into surgery, barely able to walk and suffering a great deal of pain. They come out of surgery, in much less pain, even after having a major operation, and walk with much greater ease the same day of their procedure. Their recovery time is relatively quick as well. Pain relief has been greatly aided by the use of the femoral nerve block for knee replacement patients. For patients with pinched nerves from herniated discs, Epidural steroid injections offer great pain relief for those who do not want to or cannot have surgery. Pain relief is usually felt within a week of having the injection, lasts months, or even years, in some cases. In the area of oral medications, extended-release formulations are affording patients longer-lasting, stronger pain control without having to ingest so many pills so often. In spine surgery, better instrumentation is allowing us to operate on the spine in a much more minimally-invasive way, minimizing blood loss, scarring and infection. The biologics (bone proteins used in spine fusion surgeries) are getting better and better and we are seeing more successful fusions with fewer non-unions. Mark W. McFarland, DO – Orthopaedic Spine/Total Joint Replacement

Orthopaedic & Spine Center is an independent, physician-owned Orthpaedic and Interventional Pain Management Specialty practice that provides world-class patient care in a state-of-the-art facility in Newport News, VA. To learn more, check out their website and patient success stories at www.osc-ortho.com. To make an appointment, please call 757-596-1900. 10

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Healthcare in Hampton Roads

Hypnotherapy and Chronic Pain Management By Alexandra Whiteside, CPC, CHT

The benefits of hypnosis as a therapeutic tool are wide ranging, including treatment of chronic pain, phobias, and unhealthy habits. Beyond empirical and anecdotal evidence, numerous clinical trials have returned impressive results on the effect of hypnotherapy in the management of various pain conditions, such as childbirth, burns and fibromyalgia. Through professionally guided suggestion by a hypnotherapist, the client is able to distance themselves from their pain and even decrease their perception of pain. Hypnotherapy also assists the client in peeling away mental layers of pain – memories of yesterday’s pain, anticipation of tomorrow’s pain – which are piled on top of the actual root cause of pain. By peeling away these mental and emotional memory layers, the perception of pain can be reduced to a level where medical care and physical therapy have a greater effect, the client can become more functional with an improved quality of life, and medications may even be decreased or discontinued (under the direction of a medical professional). A 1991 study by Haanen et al demonstrated that

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a group of fibromyalgia patients responded to hypnotherapy with reduced symptoms of pain and fatigue, and required less medication than the group that did not undergo hypnotherapy. His conclusion was that “in professional hands it is a safe and inexpensive mode of treatment.” Hypnosis is a natural state of mind that everyone passes in and out of multiple times each day. When you daydream, get lost in a book or are riveted by a good movie, when you’re driving and you realize that you don’t remember the last few miles you’ve just driven – you are experiencing a natural hypnotic state. Hypnosis is essentially a state of extreme focus, where the usually busy conscious mind (beta wave activity) is quieted down, and your subconscious (alpha and theta activity) is at the helm instead. This is deep relaxation but is not deep sleep. This is what allows you to experience mental imagery, to “get lost in thought,” and to suspend disbelief in order to enjoy a thrilling book or film. Clinical hypnotherapy harnesses the natural hypnotic state for therapeutic purposes. The hypnotherapist guides the client purposefully into a state of relaxation and intense focus on the issue to be treated. Many people express the fear of “handing over control” to the hypnotherapist. This fear stems from an erroneous mindset the general public has developed largely due to the fictional way that hypnosis is portrayed in movies. The Mayo Clinic reports, “Although you’re more open to suggestion during therapeutic hypnosis, your free will remains intact and you don’t lose control over your behavior.” Even in a deeply relaxed state, you can still hear what’s going on around you, and you have complete control over your ability

to move and respond to your environment. In natural hypnosis, you are able to instantly respond to the sound of your child suddenly crying, no matter how engrossed you are in a book, for example. The same holds true in a clinical hypnotherapy setting. You can move, scratch an itch, take a drink of water or respond instantly to an emergency. It is you, the client, who is in complete control during the session. The hypnotherapist simply provides verbal suggestions to guide you into a relaxed state and then to guide you through various therapeutic imagery techniques. You can choose to accept or reject any of these hypnotic suggestions, which means, if you are directed to cluck like a chicken, and you don’t want to cluck like a chicken, you simply are not going to cluck like a chicken. (Participants in stage hypnosis shows are chosen because they have naturally exhibitionist personalities and are highly likely to act on the hypnotist’s suggestions. They want to cluck like chickens! They are not being forced or controlled.) So, contrary to popular belief, hypnosis cannot be used to control someone else’s mind. The hypnosis session typically progresses through five stages: pre-induction, induction, deepening, therapeutic suggestion and termination. The pre-induction period is an interview between the hypnotherapist and the client to discuss the client’s issues and address any concerns the client has about hypnosis. Induction is the first stage of hypnosis, with the hypnotherapist guiding the client into a relaxed state, followed by deepening which takes the client into a deeper state of hypnosis where imagery and hypnotic suggestion can be utilized. Therapeutic suggestion can be accomplished via a wide range of modalities such as disassociation, guided imagery and anchoring. In chronic pain management, disassociation can help the client remove themselves from their pain. An example of guided imagery to help lower perceived pain levels would be envisioning cooling water washing away the pain. Of course, the guided imagery process is more involved and detailed than this brief description. Anchoring is a technique that enables the client to activate a mental pain control mechanism as-needed outside of hypnosis. A common anchor is pressing the thumb and forefinger together as a signal to the subconscious mind to “feel” the cooling water flowing over the area of pain. The anchor suggestion is implanted in the subconscious

prior to termination of the hypnotherapy session. Termination of the session is achieved by bringing the client back to a normal, conscious state, usually by counting to 5, and then re-orienting the client to time, since the awareness of time tends to be distorted during hypnosis, the same as “losing track of time” when you are totally immersed in an enjoyable activity. The emphasis of chronic pain management is on improving the quality of life. “Pain is a multifaceted, complex phenomenon which can be treated successfully by hypnosis.” (Dowd) Hypnotherapy offers numerous advantages with no side effects or risk of addiction. When carefully integrated with medical treatment, hypnosis can be clinically utilized to enhance the mind-body communication with impressive results. Sources: Haanen H et al. Controlled trial of hypnotherapy in treatment of refractory fibromyalgia; J Rheum 18:72-75 1991 Mayo Clinic online: http://www.mayoclinic.com/health/hypnosis/MY01020 Dowd, E. Thomas. Cognitive hypnotherapy in the management of pain; Journal of Cognitive Psychotherapy, Summer2001, Vol. 15 Issue 2, p87

Alexandra Whiteside is a certified life coach and certified hypnotist with advanced training in integrative clinical hypnotherapy. Ms. Whiteside owns and operates Selformations, a wellness coaching and hypnotherapy firm. www.selformations.com

Healthcare in Hampton Roads

Backing Chiropractors By Natalie Miller Moore

This specialty hasn’t always gotten respect – in fact, the American Medical Association boycotted chiropractic until 1987. This was determined to be illegal by the Supreme Court, but the residue of that bias still remains in the way that chiropractors interact with the medical establishment. But that is changing, both with the many people who turn to chiropractic care because of the emphasis on treating the whole person, and because of the evolving interaction with the medical community. Dr. Daniel Shaye, a second-generation chiropractor and acupuncture provider and co-founder of Performance Chiropractic, said that he gets referrals from medical doctors. “Modern chiropractic methods have a growing body of research supporting them; but there is a metaphorical, poetic aspect that is an advantage in communicating with the patient, but a disadvantage in communicating with the medical community,” Shaye said. He also said, “Some physicians refer with a better understanding of what we do, and some have less of an understanding. What referring physicians have in common is recognition that risks of chiropractic are relatively low compared to other options, our outcomes are positive, and patients have a very high level of satisfaction with their care.”

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The people who walk through the doors of chiropractic clinics often come due to complaints of pain in their neck, back, spine, or arthritis, headaches, sprains, or strains. Sometimes they are patients who distrust the conventional medical community or who have exhausted other options, but more commonly, they are people just looking for the least invasive path. “I have seen a chiropractor for my back pain because they are really good at keeping things aligned correctly and can suggest exercises or lifestyle adjustments to help prevent a reoccurrence. They help me fix the problem without surgery and don’t try to mask the pain with pain killers,” said Heather Hughes Ostermaier, from Newport News. Erika Comber, founder of Comber Physical Therapy, actually added a chiropractor to her staff last year, because she’d seen a demand for it from her patients. They were going to see a chiropractor off-site anyway, so she thought she’d make it one stop shopping for them. Comber said she wanted to have her practice centered around “treating the whole person” and the practice currently includes a chiropractor, in addition to physical therapists. Keeping with that philosophy, the practice also offers massage therapists and recently added a holistic nutritionist. The chiropractor at Comber Physical Therapy, Dr. Michelle Booth, said that one of the best ways a chiropractor can help a patient is to alleviate chronic pain. Booth said she sees people in pain, mainly in their back or neck, and it tends to be recurring rather than sudden, traumatic pain. “It doesn’t have to be catastrophic…we are improving quality of life. It might not be a life or death situation, but we are helping people do things they want to do again,” she said. She also said that chiropractic is becoming more understood and more conventional, and that working with physical therapist has helped open doors. “It might take a PT telling a patient, ‘I can work on muscles, but the alignment or rotation – this is hindering your progress. The best way to get at that is to be adjusted’ (by a chiropractor.)” Booth enjoys working in a multi-disciplinary environment. “We are working together here to give patients the best of both worlds. There’s a multiple care approach

for a single patient -- several people with different disciplines looking at them and communicating with each other,” she said. For example, she said she might notice a patient’s shoulder is tight after an adjustment, and refer them to a PT. Many people see physical therapists after injuries or to recover from orthopedic

surgery. For people who are seeing a chiropractor after joint surgery, there can be a change in the dynamics of the body, and the chiropractor can make sure everything is aligned, adjusting to a new hip or knee. Booth mentioned that during the recovery process, a patient may experi-

ence some low back discomfort from leaning or using crutches. Adjustments “can really help, with function improved and discomfort lessened,” she said. It’s up to you to decide who makes up your team of health care providers – a chiropractor may be an addition you’d like to make.

When should you see a chiropractor? You know your body the best, so ask these questions: • Do you have recurrent injuries or aches that don’t seem to heal over time? • Do you have neck pain, back pain, or chronic aches and stiffness that you attribute to “just getting older?” • Do you feel out of balance or uneven? • Do your shoes show uneven wear patterns, or do you suspect you have a short leg? • Are you unable or unwilling to tolerate the negative side effects of pain medications? • Do you turn your whole body to check your blind spot rather than just your head? • Are you sitting at a computer 8 hours a day, or performing any repetitive, physically stressful activity? • Have you historically had back pain, neck pain, or sprain/ strain injuries?

Healthcare in Hampton Roads

Make yourself a cup of your favorite beverage, something warm and comforting, tea, hot chocolate or something stronger. Depending on your perspective you want to either sharpen your senses with caffeine or dull them with something else. Find a comfy chair

Medicare for Dummies By Diane York

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with good light, get your pen and legal pad and listen up as I tell you about one of the most mind-deadening topics of all time, the wonders of Medicare and supplemental health insurance. Medicare â&#x20AC;&#x201C; what it provides and how you get it. Medicare is a program designed to help the elderly (65 and over) to get their medical needs covered. If you are receiving Social Security benefits now you will automatically receive a little pulp paper card in the mail with your Medicare number on it. If you are not receiving benefits yet- you can call and apply for both Social Security and Medicare. Medicare will cost you about $99 â&#x20AC;&#x201C; deducted from your social security check. There are two parts. Part A covers hospital bills and part B is for doctors and other medical expenses. Part A, (hospital bills) pays for the first 60 days in the hospital and most of the cost for the next 61-90 days. Part B pays 80% of your other medically related expenses. This is a good deal but you will still have a deductible for both

part A, hospital (around $1,000) and for doctorâ&#x20AC;&#x2122;s bills, part B (usually about $135.) Simple, right? Yes, until you start looking at supplemental insurance (also called Medigap) to cover extra hospital days and that 20% leftover from part B. Supplemental insurance that you buy may cover an additional 365 days in the hospital (very handy) and the 20% for doctors and other services not paid by Medicare. Since hospital bills can be astronomical this is a good idea. The cheapest supplemental insurance is called Part C or Medicare Advantage. These plans can be virtually free. You still pay the $99 for Medicare but there is often no other monthly charge. These plans operate like your typical HMO or PPO plans. There are significant limits to charges and co-pays and deductibles. They may work for you if

SENIOR LIVING

you are very healthy and plan on staying that way. But because your choice of providers is limited to your network, it won’t work if you travel a lot or spend your winters in some warm, sunny place other than your home state. Other supplemental insurance plans are simply private insurance plans that fill in that 20% gap that Medicare Part B does not pay and perhaps the deductibles for Part A & B. The cost runs anywhere from about $40 to $170 or more per month. Most major health insurance companies offer their own Medigap plan and AARP is associated with one through United Healthcare. These rates depend on where you live and which insurers are in your area. Confused yet? No, that’s good because there’s more. Each company may offer as many as 5-14 different plans designated by the letters A-N. The plans are similar company to company. For example, the “F” policies provide the most benefits and cost the most and are similar with United Healthcare, Aetna, Anthem and others. What are the differences in these plans? Predictably, the higher the price, the more coverage you get. The biggest other differences in options are below: Differences in supplemental insurance:

1. Whether or not the price will increase each year per your age or stay the same. Policies labeled age-related increase as you age while others called community or issue related do not. All of these Medigap policies may increase in price each year, but age related policies will definitely increase each year. 2. The number of extra in-hospital days the supplement will pay for. (Some pay as much as 365 extra days.) 3. The number of skilled nursing home days the policy will pay for. 4. The amount of part B (doctor and other services) each plan will pay for. For example, each company may

have 5 or more plans. Some will pay 100% of Part B expenses not covered by Medicare, some 75%, some 50%. 5. “Excess charges,” charges from hospital or doctor that Medicare does not find necessary or acceptable. 6. Foreign travel emergency care.

Hang in there- we are almost done. One last wrinkle, none of these plans cover your prescriptions. So if you want that coverage you need Part D, (think D for drugs.) If you are not on any long term meds right now and do not have a chronic illness you can let the drug coverage go until later. If you wait to get drug coverage, you will be able to apply only once a year and there is a penalty to wait. For example, let’s say you are in good health now and not taking any medications and so you do not elect to get drug coverage. Five years from now however, you decide you need it. Your penalty for waiting would be 1% of the average monthly cost (now about $40) which is .40 cents multiplied by the number of months you waited, in this case 60 months. Your drug coverage would cost the normal price- say $40 plus $24 a month penalty. Drug coverage would then cost you $64 per month if you wait till year five to subscribe. These are pretty much the basics of Medicare. But just in case you were wondering what Medicaid vs. Medicare is, let me explain. Medicaid was designed to provide critical medical care for those with little or no income and for those who are disabled. If you are already receiving Social Security Disability income you will qualify for this regardless of age. If you are Medicare eligible by virtue of your age and have virtually no income and less than $2,000 in the bank, you may qualify for Medicaid in addition to Medicare. In that case Medicaid will kick in that extra 20% that Medicare does not pay as well as the $99 per month charge for Medicare (and you won’t need to read about all those supplemental plans.)

Now for some good news. A really great thing about both Medicare and Medicaid is that they both cover some preventive services that your health insurance may not. These tests are not provided every year, so check the Medicare website (below) or call to get more specific information. Some preventive services covered by Medicare and/or Medicaid include: Abdominal Aortic Aneurysm Screenings, Alcohol Abuse Counseling, Bone Mass Measurements (Bone density tests for Osteoporosis.) Cardiovascular Disease and Screenings – Cholesterol, lipid and triglyceride levels and a once a year visit with your doctor to discuss prevention of heart disease, hypertension and dietary recommendations. Colorectal screening tests to detect any signs of colon or rectal cancer. Depression Screenings, Diabetes Screenings and Diabetes Self-Management Training, EKG Screenings, Flu Shots, Glaucoma Tests, Hepatitis B Shots, HIV Screenings, Mammograms, Medical Nutrition Therapy Services, Obesity Screening and Counseling, Pap Tests and Pelvic Exams, Pneumococcal Shots, Prostate Cancer Screenings, Sexually Transmitted Infections Screening and Counseling, Smoking Cessation (counseling to stop smoking.) And you were wondering what to do with all that free time once you retired……

This US government website lists all the carriers in your area and will help you compare respective plans http://www. medicare.gov. You can call Medicare at 1 800 Medicare or 1 800 633-4227. They will ask for your Medicare number. If you don’t have one yet simply say “agent.”

Healthcare in Hampton Roads

Want to improve your diet? Small steps can move you forward! By Natalie Miller Moore

hether you are facing joint surgery or chronic joint pain, improving

your diet can improve your symptoms, and how you feel about your overall health. Two dieticians want you to know small steps are the way to making healthier eating choices.

Both dieticians said that there is no proven way to change the progression of a disease, but that changes to your diet can decrease inflammation, and a healthier diet can benefit your entire body. Dietician Chantye Johnson, a certified diabetes educator and outpatient dietician from Sentara, said, “Healthy eating helps, no matter the reason. Maintaining a healthy weight is important for joint health, because it puts less pressure on the joints.” Katherine Alice Werner, a registered dietitian at the Riverside Medical & Surgical Weight Loss Center, said that, “Both eating right and incorporating physical activity into your day are key components for a healthy lifestyle. Eating the right foods – whole grains, fresh fruits and vegetables, lean meats, fish, bean, legumes, and nuts – can help our bodies recover faster from illness, injury, or surgery.” One of the biggest tips they have is easy: “Think color!” Johnson said. “People should ask themselves, ‘How colorful is my meal plan?” Specific studies showed that pigmented foods, such as cherries, onions, ginger, berries, turmeric apples, showed

a decrease in joint inflammation. It’s also a great way to increase antioxidants, by consuming dark red and purple fruits, such as plums, grapes, cherries. You want to avoid having a monochrome diet of tan fried foods! It’s a dietician’s job to help people change the way they eat – and they often are great resources for small steps to improve eating habits. Johnson said that many people make assumptions about what “seeing a dietician” might involve. “It can be so positive if dietician knows how to individualize,” she said. “It’s about helping them to their goals. People often say ‘I don’t know what to do… where should I start?’ and that’s where we can help.” Johnson said that people often confess that they don’t want to see a dietician because they think the dietician will forbid them from eating their favorite food. “I don’t do diets. You aren’t on a diet -This is you making slow changes. My job is to let people know that all foods can fit – but the key is: frequency and amount!” Unfortunately, the typical American diet is made up of refined grains, and high sodium foods, saturated fats, transfats, and cholesterol, all of which contribute to the development of heart disease. Our bodies were not designed to consume or digest these foods in large amounts. We’ve gotten off track and dieticians are trying to help steer everyone towards healthier options.

! r o l o c k n i h T

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If you would like more tips, or a more personalized plan for your life, think about consulting a dietician. They can help, or they can reinforce that you are making good choices. Ask your doctor if you can be referred to a dietician or find out if your hospital system provides this service. If you want to do more research about diet or joint health, see resources next page.

Nutrition and Wellness

Concrete tips from the dieticians to help you improve your diet:

• Use olive oil whenever you can in cooking – it can decrease inflammation. Johnson recommended popping popcorn on the stove using olive oil for a healthier alternative to microwave popcorn.

• Replace meat dishes with beans or fish several times a week. Good quality complete proteins – fish, chicken, beef, pork, turkey, soybeans, and tofu – are key to reducing inflammation, healing, and preventing infection post operation.

• Dairy is commonly thought of as source of calcium, but other fortified items, such as almond milk, soy milk, and some juices can also provide calcium with less calories.

• If given a choice between whole grain and something else, always go for the whole grain! Switching to whole grain sandwich bread, or whole grain pasta is an easy first step.

• Add berries to whatever you are eating for a quick burst of colorful antioxidants. They can be your dessert or added to a dish you are eating, such as oatmeal or a salad.

• For those specifically concerned with their bone and joint health, Werner recommends discussing supplements with your doctor. “Calcium, phosphorus, and vitamin D play a huge role in bone health. Those consuming the typical American diet will most likely need supplementation to ensure they are getting enough,” she said.

• Avoid fried foods. Americans who eat diets that are high in Omega 6 fatty acids, which come from cooking oil, fried food, and processed foods, have more joint inflammation. Omega 6s, which are different from Omega 3s, should be a small part of any diet.

• Dairy products should always be low fat – that’s not 2%, that’s 1% or skim milk. Please consider a calcium / citrate supplement if you aren’t consuming your amount daily. Most patients don’t.

Healthy Eating resources: Mayoclinic.com/health/weightloss My.clevelandclinic.org Webmd.com/diet Resources for people dealing with arthritis or joint problems: Arthritis Foundation website: Arthritis.org American College of Rheumatology: Rheumatology.org John Hopkins arthritis center: Hopkins-arthritis.org Mayoclinic.com and www.mayoclinic.com/health/arthritis

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Healthcare in Hampton Roads

Bones, Joints, Muscles Some common diagnoses include: • Stenosis - a narrowing of the spinal canal causing nerve compression • Spondylolithsesis - one or more vertebrae are out of proper alignment • Sciatica - a symptom of an underlying problem not a diagnosis of the cause. The 5 sciatic roots originate in the lower spine and run thru the muscles of the buttocks and down the back of each leg. Compression can occur in the muscles or at the spine. • Herniated disc, pinched nerve, bulging disc, ruptured disc, etc. - all are terms that describe essentially the same condition. This is not necessarily a permanent and often can be treated successfully. • Degenerative disc disease - not as bad as it sounds. MRI scans will show some degree of it in most of us with and without any pain or discomfort.

Just about every movement of the human body involves the low back (lumbar) area so it can be very debilitating. Low back pain and the common cold are the two most frequent Dr. visits and the two most cited reasons Americans miss work.

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Very few problems actually occur as a result of an “event”. Most trouble is a result of repetitive stress either from poor biomechanics, faulty recruitment, poor posture and/or weak musculature. Many post-rehab techniques still focus on increasing range of motion in the back and hamstrings (the muscles down the back of the legs) by stretching and also on strengthening the abdominals. It is doubtful the cause of back pain is excessive tightness. In fact, in muscles with a postural function, weakness precedes tightness. The muscles are “tight” to protect themselves and provide some semblance of posture because they are too weak to perform as intended. Armed with tons of up-to-date supportive research, I’m

Nutrition and Wellness

& Pain

By Brian Cole

saying this old approach is not addressing the issue. Range of motion in the hips is usually poor in symptomatic backs. This results in too much back range of motion especially when under load. Put another way, if we free the gluteals (buttocks) and the hip flexors to operate efficiently, pressure is properly proportioned and the back is relieved of improper duties. While we work differently with say, spondylolithsesis than with spondylosis, the goal is the same. THE GOAL IS STABILITY. The back should be stabilized by exercise not have its range of motion increased. The supportive muscles all should be strengthened to provide stability and to be capable of sustaining improved posture. This prepares our vulnerable lumbar region to withstand the many forces that attack us, to enjoy a lifetime of activity and to be able to hold proper posture during our short stay in this life. Our Training approach incorporates many of the beneficial aspects of Pilates and Yoga which we combine with specific strength work. Again, this is not about increasing the back’s flexibility. This is focused on stability. Many of the Pilates principles train the back and core to be stable during limb movements. Many Yoga poses are designed to free the ball and socket hip joint. This is a joint which is made for efficient movement. Unfortunately our forward-flexion ( seated) lifestyle deprograms our hips and they just don’t operate freely which puts undue strain on our spines. We sit to eat our meals, to drive everywhere we go, at our desks, to watch television, at most entertainment shows,… As a result the muscles that operate the hip joint become shortened and weakened. This is why I don’t recommend biking/ pedaling in any form as the primary calorie burning cardiovascular work. The position is just more forward flexion and therefore doesn’t allow the hip flexors or extensors to move freely through necessary range of motion. As a secondary supplement to upright movement ( walking, running, elliptical, strider,…) pedaling is fine but we benefit by exercising in a vertical position while holding good posture. What is the most common condition that lets us know something is not right in our back? Muscle spasm. The muscles tighten and restrict just about everything we try to do. Naturally that makes us think we should try to gently stretch to address the tightness. Sounds like reasonable common sense. Except it isn’t. These muscles have a postural function. Their job is to hold us up-

right. So if they’re weak they can’t just atrophy or we’d be lying on the ground in a heap. If your biceps aren’t trained, they atrophy and you have weak arms. But weak back muscles still have postural responsibility so their tightness is the sign they’re too weak to do their job. In postural muscles weakness precedes tightness. Whether your back has recurrent spasms, hasn’t had them yet, or is in spasm as you read this, the goal is the same. These overly tight muscles must be strengthened. This takes time, effort and knowledge of how to do this safely. I’ve focused here on our muscular system because improving it is within everyone’s capability. Many of the conditions listed above will necessitate intervention by a doctor of orthopedics, chiropractic or neurology. But muscular function improvement will complement any of those modalities and is essential for lasting relief.

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Management and/or have National Certification by the American College of Sports Medicine or the American Council on Exercise. In addition, we regularly earn Advanced Specialty Certifications in a variety of disciplines. We help you feel better, move better and have more energy with better posture and balance. We also are experienced working with: UÊ* ÃÌÊ,i >L —Hip and Knee ,i« >Vi i ÌÃ —ACL Tears —Spinal Fusion, Laminectomy, Discectomy

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As I age, I will control my destiny in a place of my choosing. A Different WAy to think About Aging It’s about honoring and supporting what people want as they get older — “As I age, I will control my destiny in a place of my choosing.” Seems simple enough. But in the world of healthcare where “we know best” has been the tradition, asking people what they value as they get older is a true innovation that’s making a difference in the lives of thousands. It’s an approach that promises to change the way people think about aging. And it all begins by asking what matters most. That’s what happens at Riverside, where we have world class physicians and the most comprehensive network of services in the state dedicated to helping you reach your life goals as you age. For a personal consultation with our senior care navigator call (757) 856-7030 or visit riversideonline.com/services/seniors.

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