Carilion Clinic Living - Fall 2011
Premier Issue - Fall 2011. This new magazine is dedicated to promoting good health and quality of life in our community. In this and future issues, we’ll explore new developments in health care, and the resources our region offers for living a healthy and fulfilling life. We’ll also feature articles about those who are making a difference in our community. We hope you’ll find inspiration—and personal resources—in these pages.
Carilion Clinic Inspiring Better Health | CarilionClinic.org | Fall 2011 Acid Reflux There Is a Cure New Hope for a Common Women's Disorder A Hiker's Treat in the New River Valley What if healthcare worked the way you wanted? I could be back on the walking trail just a few weeks after hip surgery. When you need specialized care, our physicians are committed to one goal: getting you back to living your life. That's why we o er minimally invasive joint replacement surgery, which means smaller incisions, shorter rehabilitation and a quicker return to everyday activity. We work together as a team to coordinate care tailored to the needs of every patient, every day. That way you can get the specialized care you need --right here in your community. To nd a doctor, visit CarilionClinic.org or call 800-422-8482. Inspiring better health.TM Carilion Clinic Fall 2011 FEATURES 7 Teen Health A new health clinic opens. p.14 12 Polycystic Ovary Syndrome 14 Acid Reflux This common women's disorder often goes unrecognized. New incisionless surgery offers a cure. Four patients share their 16 Specialty Care Close to Home success stories. 22 The Cascade Trail 24 Kirk Avenue A hiker's treat in the New River Valley. There's a new vitality in downtown Roanoke. DEPARTMENTS President's Message 3 Welcome to Carilion Clinic Living. Healthy Lifestyles 5 Tips from our community health educators. In Your Community 8 Making a difference in southwest Virginia. New Physicians 20 New doctors across our region. Better Living 26 Your health calendar. Healthy Eating 27 Tips from our dietitians. Fitness Tips 28 Get your core muscles in shape. p.16 p.22 p.24 CarilionClinic.org | Fall 2011 1 Our Contributors CARILION CLINIC PRESIDENT AND CEO Nancy Howell Agee CARILION CLINIC 1906 BELLEvIEw AvE. P.O. BOx 13367 ROANOKE, vA 24033 540-981-7000 Rod Belcher is a Roanoke writer whose work has appeared in Virginia Living, Virginia Business, and other magazines. His first novel will be published by Tor Books next year. Su Clauson-Wicker is the author of two travel books and the former editor of Virginia Tech magazine. Her articles have also appeared in The Washington Post and other publications. She lives in Blacksburg. David Hungate is an award-winning photographer who has worked in television news and whose Roanoke-based commercial photography business takes him to photo shoots around the United States. CARILION CLINIC LIvINg IS PRODUCED BY STRATEgIC DEvELOPMENT: vICE PRESIDENT OF STRATEgIC DEvELOPMENT Shirley Holland DIRECTOR OF MARKETINg Mike Dame EDITOR Maureen Robb LEAD DESIgNER David Porter DESIgNERS Taryn Anderson, John Cornthwait CONTRIBUTINg wRITERS Rod Belcher, Mary Brewer, Allison Buth, Su Clauson-Wicker, Wendy Maxey, Otesa Middleton Miles, David Perry, Matthew Sams PHOTOgRAPHER Darryle Arnold CONTRIBUTINg PHOTOgRAPHER David Hungate PRINTINg Chocklett Press Wendy Maxey has been the managing editor of Lodging.com and a copy editor and entertainment editor for the Roanoke Times. She is now a freelance writer based in Roanoke. Otesa Middleton Miles has been a medical reporter for Dow Jones Newswires, a features writer for the Richmond Times-Dispatch, and a Knight-Wallace Journalism Fellow. She lives in Richmond. David Perry is assistant director of the Western Virginia Land Trust and a freelance writer whose articles have appeared in The Roanoker, Blue Ridge Country, and other magazines. He is a native of Blacksburg. CARILIONCLINIC.ORg | 800-422-8482 Carilion Clinic is a not-for-profit health care organization serving nearly one million people in Virginia through a multi-specialty physician group, advanced primary care practices, hospitals, and outpatient centers. Led by clinical teams with a shared philosophy that puts the patient first, Carilion is committed to improving outcomes for every patient while advancing the quality of care through medical education and research. Copyright 2011 by Carilion Clinic. No part of this publication may be reproduced or transmitted in any form or by any means without written permission from Carilion Clinic. Articles in this publication are written by journalists or authors who strive to present reliable, up-to-date health information. However, personal decisions regarding health, finance, exercise and other matters should be made only after consultation with the reader's physician or professional advisor. All editorial rights reserved. Opinions expressed herein may or may not reflect the views of Carilion Clinic. If you would like to be removed from Carilion Clinic mailing lists, please call 800-422-8482, e-mail us at firstname.lastname@example.org, or write to us at Strategic Development, 711 S. Jefferson St., Roanoke, VA 24016. 2 Fall 2011 | CarilionClinic.org President's Message Welcome to the first issue of Carilion Clinic Living, a magazine dedicated to promoting good health and quality of life in our community. In this and future issues, we'll explore new developments in health care, and the resources our region offers for living a healthy and fulfilling life. We'll also feature articles about those who are making a difference in our community. We hope you'll find inspiration--and personal resources-- in these pages. As you'll see on page 14, a highly effective new treatment is available for those suffering from acid reflux. Some 30 million Americans have been diagnosed with this condition, which often disrupts sleep and forces a change in eating habits. Our story discusses how many are finding relief. In this issue we also address another common disorder, polycystic ovary syndrome, which is believed to affect up to 10 percent of women. Left untreated, it can result in infertility or life-threatening complications, such as heart disease or stroke. The latest treatment is described on page 12. When it comes to living in southwest Virginia, we're intrigued by the creativity and talent flourishing around us. Nowhere is this more evident than in downtown Roanoke, where there's a new vitality along Kirk Avenue as musicians, filmmakers, and artists create new venues (see page 24). Together, we're adding vibrancy to our community. TO YOUR HEALTH, Promoting good health. NANCY HOwELL AgEE PRESIDENT AND CEO CARILION CLINIC CarilionClinic.org | Fall 2011 3 What if healthcare worked the way you wanted? Emily would get her treatments where she's happiest. At Carilion Clinic Home Care, we understand that familiar surroundings can help children recover from an illness or injury. Our pediatric programs help make the transition from high-tech hospital care to home care a little easier, allowing children and their families to continue healing in a more comfortable environment. That way kids can get back to being kids. Learn more at CarilionClinic.org/homecare or call 800-964-9300. Inspiring better health.TM 4 Fall 2011 | CarilionClinic.org Healthy Lifestyles Tips from Our Community Educators Doctors and nurses aren't the only health care professionals working to keep you healthy. At Carilion Clinic, health educators are active in the community, providing free health screenings and education programs. Here, two of them discuss steps you and your family can take to maintain good health. Be Stroke Smart A stroke is an attack on your brain, and just like a heart attack, it needs to be treated as an emergency. The sad thing is, when a stroke happens, denial is common. The average American waits 12 to 24 hours to get to the hospital--much Edie Naughton, R.N. too long. Every minute of delay means that more of your brain cells Health Educator can die. Getting treatment within the first two to three hours could mean the difference between walking out of the hospital with little or no disability and being permanently disabled, or worse. Stroke symptoms --like confusion, trouble speaking, severe headache, dizziness, trouble walking, and numbness of the face, arm, or leg-- also can come on suddenly. It's a myth that strokes can't be prevented or treated. In fact, 80 percent of all strokes could be prevented, according to the National Stroke Association. What can you do? Find out if you have high blood pressure, atrial fibrillation, diabetes, or high cholesterol and work with your doctor to control those stroke risk factors. If you are a smoker, get help to quit. If you drink alcohol, do so in moderation. Exercise daily and lower salt and fat in your diet. We can all make a difference in preventing stroke by taking this message to heart. Pass it along to friends and family. walk for Health Did you know that regular exercise reduces the risk of developing almost every preventable disease? The benefits of regular exercise are many, including decreased risk of heart disease, some cancers, high blood pressure, increased bone strength, and weight control. ReguJulie Blanchard, M.S. lar exercise can even help you sleep Health Educator better and can alleviate your need for an anti-depressant. But you have to do it! Make a commitment to doing it just about every day. And, if you're looking for a fun way to add some activity to your weekend, join the doctors of Carilion Clinic every Saturday morning at 8:30 for Physicians on Foot. Each Saturday a Carilion physician leads a 30-minute walk on the Roanoke River Greenway that's designed for all fitness levels, starting at the corner of Hamilton Terrace and Belleview Ave. in front of Carilion Roanoke Memorial Hospital. To learn more, visit CarilionClinic.org/walking. CarilionClinic.org | Fall 2011 5 Some Sounds Are Too Important to Miss. Hears the news about an invisible and comfortable hearing device Hearing aids can help those with hearing problems, but their bulky size and uncomfortable t can sometimes get in the way of everyday living. At Carilion Clinic, there is a much easier and better way to improve hearing. The Lyric hearing device, available in western Virginia only from Carilion Clinic, works with your ear's anatomy to deliver clear, natural sound. It is the world's rst 100-percent-invisible hearing aid that can be worn 24/7, for up to four months at a time*. With no batteries to change and no daily insertion or removal, the Lyric is hassle-free, giving you complete freedom to exercise, sleep, shower or talk on the phone. To nd out what you may be missing out on or to schedule an appointment, please call 540-581-0232. The Lyric ts deep in the ear canal next to the ear drum and works with your ear's anatomy to produce natural sound quality in both quiet and noisy environments. CarilionClinic.org * Individual replacement needs may vary. Lyric is not appropriate for all patients. Only a hearing professional can determine if Lyric is right for you. Teen Health Clinic to Open in Downtown Roanoke By Allison Buth When it comes to health and behavioral problems, teenagers are a high-risk group. Yet across the country, many adolescents and young adults lack access to health care--and end up in emergency rooms for problems that could have been prevented. Locally, the Roanoke Adolescent Health Partnership (RAHP) has been committed to giving adolescents access to health care. The nonprofit group has served thousands of teenagers at three clinics in Roanoke since 1994. Early this fall, however, the clinic now located in the Hurt Park neighborhood will move to a new, expanded location at 902 South Jefferson St. in downtown Roanoke. "We will have expanded hours, more room, and more providers," says Kim Robertson, Carilion Clinic director of ambulatory pediatrics and adolescent health. "We are excited about the future of this program, and we believe the downtown location will help provide more services." The move also reflects a new financial sponsorship of the clinics. After years of challenges in acquiring funding, RAHP approached Carilion Clinic for help, and Carilion has agreed to fund all three clinics, including those at Patrick Henry and William Fleming high schools. Accordingly, the new downtown clinic will be housed in a former Carilion Clinic pediatric office. Located near Carilion Roanoke Community Hospital, it will offer better access to many teenagers, with room for growth. All three clinics have physicians, nurses, and nurse practitioners who treat illness and injuries and provide physical exams, immunizations, well visits, STD screening and treatment, health education, and mental health counseling. The clinics are open to all Roanoke Valley youth 10 to 26 years of age. Those with insurance are asked for a co-payment; those without are treated under Medicaid or other eligibility programs, or through charity care. "Carilion Clinic began supporting RAHP 15 years ago through grants and volunteers," says Robertson. "We've always recognized what a great community service it provides, and we want to see it continue. The goal of the program is to bring awareness to prevention and to provide the necessary resources to adolescents to make better life choices and improve outcomes." For more information, call 540-857-7284 or 800-422-8482. CarilionClinic.org | Fall 2011 7 Local Interest In Your Community Cancer Program Named among Nation's Best Carilion Clinic's cancer treatment program in Roanoke has earned the Outstanding Achievement Award from the Commission on Cancer of the American College of Surgeons, placing it among the top 17 percent of accredited programs nationwide. The award recognizes the quality of care, which features a comprehensive, multi-disciplinary team approach, and the latest treatment options such as CyberKnife radiosurgery and targeted radiation technologies, as well as access to clinical trials. Carilion Clinic wins Service Awards Three Carilion Clinic hospital units have received top honors in service from Professional Research Consultants, Inc., a nationally known health care research firm. The Birthplace at Carilion New River Valley Medical Center earned a 5-star award in inpatient obstetrics and gynecology services, signifying that it is in the top 10 percent in its field. The 7 South Coronary Care Unit/Medical Cardiology Progressive Care Unit at Carilion Roanoke Memorial Hospital also earned a 5-star award in inpatient cardiac/telemetry services. And the Emergency Department at Carilion Giles Community Hospital received a 4-star award, indicating that it scored in the top 25 percent in its field. The awards are based on patient surveys. (Pictured: members of the Coronary Care Unit staff.) Jacobsen Recognized for Outstanding Community work William D. Jacobsen, M.H.A., F.A.C.H.E., chief executive officer of Carilion Franklin Memorial Hospital, has received two prestigious awards: the American Hospital Association's 2011 Grassroots Champion Award and the American William D. Jacobsen College of Healthcare Executives Senior-Level Healthcare Executive Regent's Award. The first recognizes him for his exceptional leadership in generating grassroots and community support of the hospital's mission. The second recognizes his significant contributions to the advancement of health care management excellence and his executive capability, leadership ability, and innovative and creative management, among other accomplishments. 8 Fall 2011 | CarilionClinic.org Medical School welcomes Second Class Forty-two students from 12 states comprise the second class of the Virginia Tech Carilion School of Medicine. Chosen from a field of 2,743 applicants, 18 students are from Virginia, and nine have graduate-level degrees. Twenty-five of the students are men; 17 are women. The average Medical College Admission Test score for the class is 33 -- above the national average score of 30. The range of scores was 30 to 40 for the entire class. Of all the applicants, 239 were invited to Roanoke for an interview. Carilion Clinic Announces Appointments Carilion Clinic has announced the following promotions and appointments: Melina Perdue, Senior Vice President with responsibility for Carilion's community hospitals, has been named Executive Vice President. She will assume responsibility for regional primary care in addition to her existing responsibilities. Carolyn Chrisman, Vice President for Quality and Process Improvement, has been named Senior Vice President. She will develop Carilion's new Innovation Center, an initiative to further advance quality and process improvements. Jeanne Armentrout, Vice President, has been named Senior Vice President with responsibility for Human Resources. Exploration Station Opens at Mill Mountain Zoo The Exploration Station, a new educational site for children at Mill Mountain Zoo, has opened to the public. Sponsored by Carilion Clinic Children's Hospital, the Exploration Station is a unique indoor space that offers presentations involving live animals. In addition, programs that link human health care to animal care in a fun and informative way are available. (Pictured: Sandra Hubbard and her son Aiden, at right, with zookeeper Bambi Godkin on opening day.) Paul Davenport, Senior Director of Carilion Clinic Patient Transportation, has been named Vice President with responsibility for the Department of Emergency Services. He will continue to lead Carilion's patient transportation services. Charles "Chuck" Carr has been named Vice President of Administration for Carilion Stonewall Jackson Hospital (CSJH). He has served on the hospital's board of directors since 1998 and on the Carilion Clinic board since 2004. He comes to CSJH with over 25 years of leadership experience at both Reeves Brothers and Modine Manufacturing Co. John Piatkowski, M.D. has been named Vice President of Administration for Carilion New River Valley Medical Center. Dr. Piatkowski comes to Carilion from HealthEast Care System in Saint Paul, Minnesota, where he served as Vice President and Executive Medical Director. Respiratory Therapy Programs Receive National Recognition Three Carilion Clinic hospitals have earned Quality Respiratory Care Recognition from the American Association for Respiratory Care. They are Carilion Roanoke Memorial Hospital, Carilion New River Valley Medical Center, and Carilion Franklin Memorial Hospital. Hospitals that earn this designation agree to adhere to a strict set of criteria governing their respiratory care services and provide a level of respiratory care that is consistent with national standards and guidelines. About 15 percent of hospitals in the United States have applied for and received this designation. CarilionClinic.org | Fall 2011 9 Local Interest MyChart Adds 12,000th Patient Carilion Clinic has added its 12,000th patient to MyChart, an online health care management tool. MyChart, which is offered in most of Carilion's primary care practices, gives patients secure access to portions of their electronic medical records and convenient ways to communicate with their doctor's office. Patients can view their medical records, renew prescriptions, get test results, request or cancel appointments, e-mail questions to their doctor, view their prescribed medications, request referrals, and check for reminders about immunizations or preventive care that is due. Health Educators Complete Mission to Honduras A team of Jefferson College of Health Sciences students and faculty is back from a health education mission to Honduras. The team, including Carilion employees, was led by Dean for Academic Affairs Lisa AllisonJones and her husband, Bruce. For more than a week, team members provided basic health education to a group of community health workers from Honduran villages. The students also took a three-credit course, "Transcultural Health Care," to prepare for the experience. Research Institute Launches visiting Scholars and Lecture Series Carilion Clinic Trains Physicians from Africa Earlier this year Carilion hosted 12 delegates from Africa as part of Legacy International's North African Community Health Initiative. The delegates were Egyptian and Moroccan community health care professionals, mostly physicians, who came to the United States to exchange ideas and learn new ways to improve public health in their communities. For two weeks, each delegate was assigned a mentor from Carilion Clinic to help with training and educational needs. Training emphasized ways to improve the health of women and children. 10 Fall 2011 | CarilionClinic.org The Virginia Tech Carilion Research Institute has launched a distinguished visiting scholars and lecture program that will bring nationally and internationally prominent biomedical scientists to Roanoke. While here, scholars will meet with VTC researchers and medical students and give lectures open to the public. The next speaker in the series will be Nora Volkow, M.D., Ph.D., director of the National Institute on Drug Abuse. She will speak on how the brain becomes addicted on September 29 from 5:30 to 6:30 p.m. at the Virginia Tech Carilion School of Medicine and Research Institute at 2 Riverside Circle in Roanoke. Free Prostate Screenings Prostate cancer has no symptoms in its early stages, but it can usually be detected with a quick test and examination by a physician. Statistics show that one in six men will be diagnosed with prostate cancer, and African Americans are at even greater risk. Free screenings will be offered this fall on a number of dates, including those on Sept. 22 in Roanoke (5 - 7 p.m.) and Sept. 28 in Vinton (5 - 7 p.m.). Those eligible for screening are men who are: age 50 or over; age 45 or over and African American; age 45 or over with a family history of prostate cancer; and those age 40 or over who meet additional criteria. For more information, call 540-2666000 or 800-422-8482 or go to CarilionClinic.org/Carilion/prostatescreenings. Registration is also required by calling the numbers shown. Better Breathers Support group Carilion Clinic's Better Breathers Club offers patients and their families the chance to learn ways to better cope with chronic lung disease--and get support from others with the same condition. The group, which meets the third Thursday of each month from 3 to 4 p.m. at 3 Riverside Circle in Roanoke, offers tools for achieving the best possible quality of life. Members receive guidance in such areas as breathing retraining, exercise, medications, preventing infections, sleep disorders, nutrition, airway clearance, oxygen therapy, travel, and emotional and social well-being. For more information and registration, call 540-266-6000 or 800-422-8482. vice President for Medical Affairs Named Maxine Lee, M.D., M.B.A. has been named Vice President for Medical Affairs for Carilion Roanoke Memorial Hospital. Dr. Lee received her medical degree from Harvard Medical School and completed a residency in anesthesiology at Yale New Dr. Maxine Lee Haven Hospital. She is board certified in anesthesiology. In her new role, she will promote the effective and efficient use of clinical resources through patient safety measures, provider quality improvement, medical staff credentialing, peer review, and the use of evidence-based medicine. Carilion Clinic Named to Top 100 Most wired Carilion Clinic has again been named as one of the 100 Most Wired by the American Hospital Association and its publication, Hospitals & Health Networks. Carilion has been named to the list a number of times in the past 12 years. CarilionClinic.org | Fall 2011 11 Medical News New Hope for a Common women's Disorder PCOS often Goes Unrecognized It's been called a hidden epidemic, and it is believed to affect up to 10 percent of women. Yet this common hormonal disorder often goes unrecognized by many who suffer from it. Polycystic ovary syndrome, or PCOS, is an imbalance of reproductive hormones that can affect women of any age --from girls as young as 13 to those entering menopause. The disorder is often characterized by small cysts on the ovaries and, if left untreated, can contribute to complications such as infertility, Type 2 diabetes, heart disease, or stroke. There is no cure at this time, but PCOS (pronounced pea-kose) can be managed to reduce the risk of more severe medical problems, and to help women who have trouble becoming pregnant. By Mary Brewer Recognizing the Symptoms Doctors don't know the exact cause of the condition, but several factors are thought to play a role. Excess insulin is one. Heredity is another; if your mother or sister has PCOS, you may have it, too. Low-grade inflammation may also be a culprit. Symptoms of PCOS include irregular or absent menstrual periods; excess hair on the face or body; and acne. In addition, more than half of women with PCOS are, or go on to become, obese--with the resulting threats of heart disease and Type 2 diabetes. If you have PCOS, you may also be predisposed to developing high blood pressure; cholesterol abnormalities such as high triglycerides; metabolic syndrome; sleep apnea; and nonalcoholic steatohepatitis, a severe liver inflammation caused by fat deposits in the liver. Dr. Robert Slackman with a sonogram showing an early pregnancy within the uterus. 12 Fall 2011 | CarilionClinic.org "The first thing I determine is, are they trying to get pregnant?" -- Dr. Robert Slackman Finding Treatment At Carilion Clinic, reproductive endocrinologist Robert Slackman, M.D. often sees women with PCOS. "The first thing I determine is, are they trying to get pregnant?" he says. "If so, I will induce ovulation with a medication like Clomid. We are usually very successful at getting women to become pregnant. "If they're not trying to become pregnant, then I might put them on birth control pills or progesterone 10 days a month to bring on a regular menses." lesterol. Healthy eating habits and regular exercise are key, because obesity makes insulin resistance worse. A Medical Specialty Dr. Slackman, who is the region's only full-time reproductive endocrinologist, also treats and manages other women's disorders. These include endometriosis, a condition in which cells from within the uterus grow outside the uterine wall, which can lead to pain and infertility. He also treats uterine fibroids--benign tumors found in the uterus--that can lead to painful menstrual periods, painful intercourse, and infertility. His success rate is approximately 80 percent when treating women with infertility due to PCOS. "We begin with a thorough evaluation, starting with the partner's semen," he says. "We next evaluate ovulation, the shape of the uterine wall, and so on. Then we know what direction to go in." But PCOS is expected to remain one of the main conditions that he and other specialists across the country must address. Keeping the hormones in balance is critical to maintaining good health. For more information, call 540-266-6000 or 800-422-8482. Symptoms of PCOS include: � Infertility � Irregular or infrequent menstrual periods � Excess hair on the face or body � Acne that gets worse Patients may also be prescribed metformin, an oral diabetes medication that lowers insulin levels. This improves ovulation and often leads to regular menstrual cycles. The general focus of treatment is to manage a woman's obesity, high blood pressure, and high blood cho- CarilionClinic.org | Fall 2011 13 Medical News Acid Reflux There Is a Cure By Matthew Sams Anyone who suffers from chronic heartburn--also known as acid reflux--can tell you how hard it can be to find relief. But a new treatment can greatly improve quality of life for those suffering from this condition. The procedure, which requires no incision, is a leap forward in minimally invasive surgery. It leaves no outside scarring, minimizes post-operative pain, and reduces recovery time. At Carilion Clinic, gastroenterologist Paul Yeaton, M.D., and general surgeon Mark O. Smith, M.D., are working together to bring this treatment to patients in western Virginia. 14 Fall 2011 | CarilionClinic.org A Common Problem The clinical term for heartburn is gastroesophageal reflux disease (GERD), and nearly 30 million Americans have been diagnosed with it. Various treatment options are available, including daily medications that suppress acid production. However, studies show that some of these interact poorly with other prescription drugs, and can lead to inadequate absorption of minerals such as calcium. In severe GERD cases, traditional surgery is also an option. But many patients would prefer to avoid the scarring often associated with invasive surgeries and the post-operative limitations on foods and beverages. "We are very excited to be able to offer our patients the same benefits as more invasive procedures with only minimal risk," Dr. Smith says. "We are very excited to be able to offer our patients the same benefits as more invasive procedures with only minimal risk." -- Dr. Mark O. Smith "It can be a real life-changer for our patients." see results in the management of the disease soon after the procedure." "Bringing the TIF procedure to this area demonstrates Carilion Clinic's dedication to offering cutting-edge surgical procedures," How the Procedure works There is a natural valve between the esophagus and the stomach that forms a physical barrier, preventing stomach acids from backwashing, or "refluxing," up into the esophagus. Patients who suffer from GERD have a faulty valve that lets reflux occur. With the new procedure, a surgeon inserts an endoscope (a tubular device) through the mouth and into the stomach. Using a tiny, fiber optic camera embedded within the surgical tools to view the surgical site, he or she then reconstructs the valve. The procedure is known as TIF (transoral incisionless fundoplication). Patients usually stay overnight in the hospital and are discharged the next day. They typically return to their normal activities within a few days. Clinical studies also show that two years after the TIF procedure, nearly 80 percent of patients can stop using daily reflux medications. And they can eat and drink foods and beverages they had avoided for years. "The TIF procedure can significantly improve quality of life for our patients," Dr. Smith says. "Because patients return to their daily lives so quickly, we're typically able to The new procedure is said to be ideal for acid reflux patients who: � Have moderate to severe symptoms � Are dissatisfied with prescription drug treatment � Have trouble adjusting to eating restrictions or changes in sleeping habits they must make � Suffer from non-acid symptoms of reflux such as asthma, persistent cough, or sore throat with the new procedure, a surgeon inserts an endoscope (a tubular device) through the mouth and into the stomach. Using a tiny, fiber optic camera embedded within the surgical tools to view the surgical site, he or she then reconstructs the valve. adds Christopher Baker, M.D., chair of the Department of Surgery at Carilion. "Dr. Yeaton and Dr. Smith have years of experience in managing chronic acid reflux, and they should be commended for their efforts in finding new ways to help patients." For more information, call 540-266-6000 or 800-422-8482. CarilionClinic.org | Fall 2011 15 Specialty Care Specialty Care-- Close to Home By Wendy Maxey Replacing a Heart valve A New Lease on Life On May 7, less than two weeks after heart surgery, Michael Logan and his bass fishing team won sixth place out of 178 participants in the Angler's Choice Tournament at Smith Mountain Lake. "Before, when I would go on fishing expeditions, it would take me three or four days to fully recover," says Logan, 43, who used to have severe mitral valve leakage. Today he recovers at a normal pace. Logan's condition used to cause half the blood being pumped by his heart to flow backward. It made his heart work twice as hard and left him constantly drained and short of breath. A further complication was the fact that he'd been diagnosed with a heart murmur at a young age. It was when he could barely keep his head up, literally, that he decided to go to the doctor. An abnormal echocardiogram spurred his physician to refer him to a cardiologist. "It didn't sound like a regular heartbeat at all," says Logan. "It sounded squishy." 16 Fall 2011 | CarilionClinic.org Michael Logan says he feels better than he has in a long time. "Over time, Michael's murmur had worsened to the point that his valve was leaking so badly that he was short of breath," says Carilion Clinic cardiothoracic surgeon W. Scott Arnold, M.D., who performed Logan's surgery. Dr. Arnold also couldn't be sure whether he could repair Logan's mitral valve--or would have to replace it-- until surgery was under way. "There was an 80 percent chance I could repair it successfully," Dr. Arnold told Logan. In fact Dr. Arnold was able to repair the valve by removing a leaking segment and placing a small ring around the valve to reshape it. Following a three-day stay in the hospital, Logan was home on a Friday and in church on Sunday. "When it comes to the mitral valve, far and away, repair is a better option than replacement," Dr. Arnold says. For one thing, replacement requires patients to take blood thinners for the rest of their lives-- which presents its own risks and complications. "For someone young like Michael, we really wanted to strive for a repair," Dr. Arnold says. Logan is thankful he avoided a replacement, and his one-a-day baby aspirin is the sole reminder of his past heart condition. He is also able to exercise without problems. "I was extremely impressed with Dr. Arnold," says Logan, whose Catawba-based machine-shop business keeps him on the go. "This is very personal to him and that means a lot. I felt very comfortable." "I feel better than I have in a long time." Fighting Lung Cancer An Interdisciplinary Team Improves Care Dreama Poore's comforting manner invites you to confide your secrets to her. Recently, though, she was the one sharing secrets--by revealing her battle with lung cancer. "This is the first time I've really shared my story," says Poore, 58, of Elliston, who has been cancer-free for a year and a half. When she was diagnosed, Poore's tumor was relatively small. Because of its size, and the fact that she was otherwise healthy, Carilion Clinic cardiothoracic surgeon David Wyatt, M.D. was able to perform a lobectomy, removing a lobe of Poore's right lung. Dr. Wyatt also removed Poore's surrounding lymph nodes. Twenty years ago, this surgery would have required removing a rib and cutting through the muscles of the chest, greatly adding to recovery time. But Dr. Wyatt was able to perform the surgery after making only a small incision between Poore's ribs. "Thoracic surgery today takes advantage of lesser invasive techniques," Dr. Wyatt says. Poore also had the advantage of having her case reviewed by a thoracic oncology team that meets weekly at Carilion Clinic to evaluate patient cases from an interdisciplinary point of view. The team includes both Carilion and non-Carilion physicians who are sub-specialists in pulmonology, medical oncology, cardiothoracic surgery, radiation oncology, pathology, radiology, and interventional radiology. All the physicians focus on lung cancer and share the goal of giving patients the most advanced and effective treatments. "I couldn't believe it was me that this [cancer] was happening to," Poore says of her first reaction to her diagnosis. "But as soon as I realized I had no control, I just let it Dreama Poore says her life now has more meaning than ever. go and treated it like it was a bad cold." Apparently that attitude contributed to her recovery. "Dreama was a good patient and did her part," Dr. Wyatt says. "She was active and interested, and chose not to be a victim of her own problem." Following her surgery, Poore underwent four months of chemotherapy, and six months after her diagnosis, she was back at work fulltime at Roanoke College. This past May, she attended her 40th high school reunion in Wythe County. She doesn't have her next CT scan until December. She is loving life. "Life has more meaning than it ever has," says Poore. "I have a zest now, more than ever." CarilionClinic.org | Fall 2011 17 Specialty Care getting a Hip Replaced A New Approach Dr. Joseph Duckwall, 74, has had cause to celebrate lately. He and his wife commemorated their 50th wedding anniversary this summer at Smith Mountain Lake. His three children and seven grandchildren were also there. And -- he can now walk without a limp. Dr. Duckwall, who had his hip replaced in April, is walking with ease, and doesn't even need a cane. "I feel like I did 10 years ago," he says. "I feel like I could run if I had to, without any pain." The retired physician is one of about 400 patients at Carilion Clinic who have received a hip replacement via a new surgical method. Called the anterior approach, it is minimally invasive surgery that involves computerassisted techniques for increased accuracy and precision. Joseph Moskal, M.D., chief of orthopaedics, brought this new approach to Carilion Clinic. He is one of four Carilion Clinic orthopaedic surgeons who perform the procedure, which involves making an incision at the front (anterior) of the hip that is much less invasive than the incision required at the back or side for a traditional hip replacement. "The big difference with this approach and all the others is that no muscles or tendons are cut or detached from the bone," says Dr. Moskal. This reduces healing time immensely because the muscles and tendons are kept intact. Dr. Duckwall, who had his other hip replaced the traditional way three years ago, thinks the new approach is better. "I may not have had problems, but I have heard stories, specifically from my daughter who also had that procedure not too long ago, that post-op recovery can be difficult," he says. "I felt good after the first hip replacement," he adds, "but I felt great after the second. Getting the 18 Fall 2011 | CarilionClinic.org Dr. Joseph Duckwall walks with ease after having his hip replaced in April. second one done has really taken me back a few years physically." One thing he appreciates about Dr. Moskal is his exceptional protocol. "Dr. Moskal's program anticipates any problems ahead of time," says Dr. Duckwall. "His staff is well trained. I took a class before the surgery that prepared me for any problems that might arise. Having that education is essential." The pre-surgery class is part of Carilion's Points on Joints free educational seminar series, which is held throughout the region on a regular basis. Dr. Duckwall returned home two days after his surgery, and he never needed pain medication. He used a crutch only here and there, and was released to drive again after only two weeks (the typical waiting time is six weeks). "The way I feel now is so much better than how I felt for years," he says. "Walking without a limp, that's the biggie for me." Pre-Surgery Testing It Saves Lives Russell Meador has worked at CEI, formerly Elizabeth Arden, for 41 years. He works the third shift and is no stranger to 10- to 12-hour days, sometimes seven days a week if necessary. Meador knows what being tired feels like, so when he started feeling more tired than usual, he decided it was time to get a checkup. His physician diagnosed him with anemia, and gave him iron pills. He also scheduled a colonoscopy, during which a malignant tumor was found that was too large to remove without surgery. But before proceeding, Meador was given tests to gauge whether any problems might arise during surgery. As it turned out, he was flagged for an abnormal EKG, indicating a potential heart condition. Abnormal EKGs are considered high risk because the stress of surgery can compromise the heart and cause complications, possibly leading to death. A subsequent cardiac stress test and heart catheterization found extensive blockage, and the next day, Meador underwent a quintuple bypass operation. Had it not been for his testing, Meador might not be here today. The pre-surgery testing Meador received is provided by the Carilion Assessment Registration Education for Surgery (CARES) program, which specifically targets high-risk patients like Meador to improve patient outcomes. CARES expands on the traditional pre-surgery tests that surgery patients around the country typically undergo. And his is but one example of how the program is flagging high-risk patients. "If a patient is found to be high risk, the primary care physician is contacted for further evaluation," says Michele Berry, R.N., an operating room nurse and one of the facilitators of this new program. "Additional testing is completed when needed with the possibility of postponing surgery." Russell Meador is here today thanks to pre-surgery testing. gram. "That's 400 mothers or fathers, spouses, siblings, and children who leave the hospital alive who in previous times might not have," he says. "That's progress." In Meador's case, he recovered swiftly from his bypass surgery and went on to receive colon surgery. Today he has fully recovered, and he is back to working long hours at CEI and helping his wife, JoAnne, raise their 4-year-old grandson, Conner. He also feels fine. "I know all this is very life-threatening and serious stuff, but I just took it as it happened," says Meador. "I did what the doctors told me. The Lord's been good to me, and life is too short to get upset or angry." For more information on all these specialty services, call 540-2666000 or 800-422-8482. CarilionClinic.org | Fall 2011 19 Before the new high-risk program was instituted at Carilion, the results of patient tests were going to the surgeons, not the primary care physicians. "We've changed this so that the surgeon is not trying to deal with heart conditions, etc. but is only dealing with the surgery," says Berry. "The patient's primary care physician is the best resource in these situations, since they know the patient." "If all surgery patients at Roanoke Memorial Hospital went through CARES, we calculate that about 400 people per year would be spared unnecessary and preventable deaths, based on the total number of procedures done at the hospital and our improved survival rates so far," says surgeon Sandy L. Fogel, M.D.. Dr. Fogel has been a leader in starting the CARES pro- Physicians New Physicians Leading Urogynecologist Joins Carilion Clinic James A. Daucher, M.D., an obstetrician and gynecologist with particular expertise in female pelvic reconstruction surgery, has joined Carilion Clinic. Dr. Daucher comes to Carilion from Howard University, where James A. Daucher, M.D. he was director of clinical and translational research in the Department of Obstetrics and Gynecology at the College of Medicine. He has taught at several institutions, including Virginia Tech, Ross University's School of Medicine, East Carolina University Brody School of Medicine, Magee-Womens Hospital in Pittsburgh, and Howard University College of Medicine. He has published many papers on a range of topics, including urinary function after weight loss surgery, and co-authored papers with Anthony Fauci, M.D., head of the National Institute of Allergy and Infectious Disease at the National Institutes of Health. Dr. Daucher received his M.D. degree from Ross University School of Medicine in Dominica, West Indies. He completed his residency in obstetrics and gynecology at the East Carolina University Brody School of Medicine, and his fellowship in female pelvic medicine and reconstructive surgery at the Magee-Womens Hospital at the University of Pittsburgh School of Medicine. He practices at Carilion Clinic Urogynecology at 101 Elm Ave. in Roanoke and can be reached at 540-985-4099. Neurosurgeon and Spine Specialist to Practice at Carilion Clinic Nicholas Qandah, D.O., a neurosurgeon who specializes in complex spinal conditions, has joined Carilion Clinic. He has extensive training in spinal trauma, spine oncology, deformity, and minimally invasive spine surgery. throughout his residency, and he went on to complete a spine fellowship at the world-famous University of Washington-Harborview Medical Center. He has conducted research, authored scientific papers and book chapters, and has been a guest speaker at local and national conferences on a wide range of neurosurgical and spinal topics. Dr. Qandah received his doctorate of osteopathic medicine from Midwestern University's Arizona College of Osteopathic Medicine and his bachelor degree from the University of Michigan. He practices at 3 Riverside Center in Roanoke and can be reached at 540-224-5170. Nicholas Qandah, D.O. Dr. Qandah completed his neurosurgical residency in 2010 at Carilion, where he was chief neurosurgery resident. He was honored in 2010 by the American College of Osteopathic Neurosurgeons for his academic achievements 20 Fall 2011 | CarilionClinic.org Joseph J. Baum, M.D. Family Medicine Education: University of Iowa Medical Degree: University of Iowa Carver College of Medicine Internship: USAF Hospital Carswell 911 E. Main St., Floyd, VA 24091 540-745-2031 Colleen E. James, D.O. Family Medicine Education: Roanoke College Medical Degree: Edward Via Virginia College of Osteopathic Medicine Residency: Wake Forest University Baptist Medical Center 415 S. Pollard St., Vinton, VA 24179 540-983-6700 Gerald W. Beltran, D.O. Emergency Medicine Education: University of Massachusetts Medical Degree: University of New England College of Osteopathic Medicine Residency: Emergency Medicine, Medical College of Georgia Fellowship: EMS, Emory University 1906 Belleview Ave., Roanoke, VA 24014 540-981-7000 Jeremy A. Llavore, M.D. Family Medicine Education: University of Santo Tomas Medical Degree: University of Santo Tomas Faculty of Medicine and Surgery Residency: Carilion Clinic Family Medicine 22890 Virgil Goode Highway, Boones Mill, VA 24065 540-334-5511 Julia Bulkeley, M.D. Pediatric Orthopaedics Education: High Point University Medical Degree: Brody School of Medicine at East Carolina University Residency: Orthopaedic Surgery, University of Louisville Fellowship: Pediatric Orthopaedics, Baylor College of Medicine 3 Riverside Center, Roanoke, VA 24016 540-224-5170 Thomas R. Milam, M.D., M.Div. Psychiatry Undergraduate Education: West Virginia University Graduate Education: Yale University Medical Degree: University of Virginia School of Medicine Residency: Duke University Medical Center and University of Virginia Department of Behavioral Medicine 2017 South Jefferson St., Roanoke, VA 24014 540-981-8025 Ahmet Burakgazi, M.D. Neurology Education: Hacettepe University, Ankara, Turkey Medical Degree: Hacettepe University School of Medicine, Ankara, Turkey Residency: Neurology, George Washington University School of Medicine Fellowship: Clinical Neurophysiology, George Washington University School of Medicine 3 Riverside Circle, Roanoke, VA 24016 540-224-5170 Chheany W.C. Ung, M.D. Interventional Pain Management Education: University of Pennsylvania Medical Degree: Penn State College of Medicine Residency: Milton S. Hershey Medical Center Fellowship: Chronic Pain Management, Milton S. Hershey Medical Center 3 Riverside Center, Roanoke, VA 24016 540-224-5170 Franco Coniglione, D.O. Orthopaedic Trauma Education: New York University Medical Degree: New York College of Osteopathic Medicine Residency: Michigan State University, Botsford Hospital Fellowship: Orthopedic Trauma, Florida Orthopedic Institute, Tampa General Hospital 1906 Belleview Ave., Roanoke, VA 24014 540-224-5170 Janet Young, M.D. Emergency Medicine Education: University of North Carolina at Chapel Hill Medical Degree: East Carolina University Brody School of Medicine Residency: Emergency Medicine, Boston Medical Center 1906 Belleview Ave., Roanoke, VA 24014 540-981-7000 CarilionClinic.org | Fall 2011 21 Regional Interest Hiking the Cascade Trail By Su Clauson-Wicker You hear the Cascade Falls before you see them. Two miles deep within the Jefferson National Forest, you approach them via a boulderstrewn path, until the drumbeat of water becomes a roar. Then, when you round a final boulder, a steel-blue waterfall towers above you--sheets of water plummeting over a vertical cliff into an inky pool--69 feet of liquid majesty. 22 Fall 2011 | CarilionClinic.org U ntil the mid-20th century, few people had witnessed this spectacle. The Cascade gorge and surrounding forests in Giles County were privately owned and heavily logged. Hikers can still see the rusting remains of a portable boiler used to power a sawmill. But in 1965, the U.S. Forest Service acquired the area surrounding the gorge, and hardwood trees and hemlocks were allowed to flourish once again. And the government opened the four-mile Cascade Trail to the public. Hikers arriving at the Jefferson National Forest parking area can choose between two paths: the winding, creekside Lower Trail or the more aerobically challenging Upper Trail. The Lower Trail meanders through colonies of mosscovered boulders and skirts the edges of gushing flumes. The gurgle and splash are often loud enough to block out the calls of nearby vireos, phoebes, and scarlet tanagers. Cool air drifts down the gorge from the high plateau, keeping the temperatures lower than that of the outside world. Hiking here can feel like passing through the interior of a cave. But there's no taking the Lower Trail on automatic pilot. Hikers need to be alert to slick rocks and protruding roots--or the flash of a rainbow trout in shallow water. (Little Stony Creek, whose waters create the waterfall, is also a native trout stream, and those who fish here must use single-barbed hooks and artificial lures only.) The Upper Trail, a steady 740-foot climb, offers wide-angle, aerial views of Little Stony Creek. The higher the trail goes, the rougher the terrain. Stone walkways are rammed into the side of the gorge with steel spikes and mortar. Frothy water rips between boulders. Either way, when you arrive at the falls, you'll be rewarded with one of Mother Nature's most amazing sights. About 150,000 visitors come to the Cascade Trail every year, lured by the prospect of viewing one of the most spectacular waterfalls on the entire East Coast. For more information, call the Blacksburg Ranger District at 540-552-4641. CASCADES WATERFALL DIRECTIONS: FROM INTERSTATE 81, TAKE ExIT 118C AND FOLLOw US 460 wEST ABOUT 25 MILES TO PEMBROKE. TURN RIgHT ON vA 623 AND gO 4 MILES TO THE CASCADE PARKINg LOT. DIFFICULTY: MILD TO MODERATE. WOODLAND TRAIL Bridge 2 Halfway point CREEKSIDE TRAIL DISTANCE: AROUND 4 MILES TO THE TOP AND BACK, APPROxIMATELY 2 MILES EACH wAY. FACILITIES: 15 PICNIC TABLES wITH gRILLS; BATHROOMS. FEES: $3 PER vEHICLE. DROP YOUR MONEY IN AN ENvELOPE IN THE COLLECTION BOx AND PICK UP A HANg TAg FOR YOUR CAR. OPEN YEAR-ROUND. Sawmill Boiler Bridge 1 Little Stony Creek PARKING LOT & PICNIC AREA CarilionClinic.org | Fall 2011 23 Regional Interest Kirk Avenue gets Hip By David Perry What's so special about Roanoke's Kirk Avenue, anyway? On one end is a parking lot for City Hall. On the other, a tire store. Its four one-way blocks change direction midway at Jefferson Street, making it hard to drive. And Kirk Avenue doesn't even appear in Google Street View. But to those attuned to new trends, it's the most happening place in town. What turned these four blocks into one of the most culturally vibrant streets in southwest Virginia? The metamorphosis began about four years ago, when the Kirk Avenue Music Hall opened on the block between Jefferson and First Street. Music promoter Gary Jackson had just stopped doing shows at 202 Market when he was approached by Roanoke developer Ed Walker. Walker and his wife Katherine missed the music and wanted Jackson to set up shop in a space that Walker owned on Kirk. "Ed said, `What you did at 202 Market made such a difference in our lives,' " says Jackson. And so the Music Hall's fourth season will begin this fall and is expected to feature about 100 shows. The mission of the Music Hall is to "bring in as high-quality talent as possible to Roanoke," Jackson says. Past acts have run across the entire live music spectrum and featured both national and local talent. The Music Hall was also once home to the Downtown Music Lab, an after-school music program (now at the Jefferson Center), and today it shares its space with the Shadowbox, a cinema 24 Fall 2011 | CarilionClinic.org that shows independent and experimental films. "We're trying to encourage local filmmaking," says Shadowbox owner Jason Garnett. "We give local filmmakers a venue to show their work." The Shadowbox's projector first rolled in March of 2010. Like Jackson, Garnett was approached by Walker, who suggested an open projector night when the Music Hall wasn't booked for a show. "It's like an open mic night for filmmakers," says Garnett. "We call the Shadowbox Roanoke's community micro-cinema. It's like a big living room where you get to watch films with other strangers," he jokes. Nearby in another space owned by Walker is Lucky Restaurant, a bistro where the menu is all-local, all the time. "As much as possible, we try to go from farm to table," says Lucky co-owner John "J.P." Powell. "We pay very close attention to where we buy our food and the quality of the source." (Fans of the oysters, the cassoulet, and the watercress salad will attest to that.) Lucky opened in October of 2010. Powell describes its fare as "American comfort meets country French." Everything at Lucky is homemade, says Powell. Even the ketchup is made in-house. Another new eatery on the block is Freckles (formerly GET), which combines a caf� with a vintage clothing shop. Owner Stephanie Sowder rents the space from Walker and serves up a menu that features coffee, tea, and ramen. "Business has been great," she says, adding that each month "more and more people are discovering us." That theme is true up and down Kirk Avenue, which also features venues like the Uttara Yoga Studio and the POParazzi portrait studio and gallery, along with recently renovated live/work space. "I feel like it's a great time to be on this street," says Sowder. "It's turning into part of that vibrant downtown scene that exists over to- Above: A shopper checks out vintage clothing at Freckles. Left: A couple enjoys sidewalk dining at Lucky. Below: A street sign for newly popular Kirk Avenue. ward the market square." Says Garnett of the Shadowbox: "Kirk has changed so much in the past few years. Five years ago it was this alley that no one ever went down. It's very eclectic. People have been calling it `Quirk Avenue.' " "I think it's going to continue to evolve," says Lucky's Powell of the latest additions to Kirk Avenue. "We all have similar things in common." "I give all the credit to Ed Walker," says the Music Hall's Jackson. And what does Walker say about the Renaissance on Kirk? "Kirk Avenue is just another example, or ex- periment, exploring the inter-relationship between commerce and place-making in a positive way," says Roanoke's revitalization king, whose other downtown projects include the Patrick Henry Hotel and The Cotton Mill lofts. Walker also hopes that others in the region will take the Kirk Avenue example and run with it. "What would be nice in five to 10 years would be for other parts of the city and for other community-minded business people to be pursuing similar ideas that make Roanoke more interesting and dynamic," he says. CarilionClinic.org | Fall 2011 25 Better Living Your Calendar for Better Health Fall 2011 BLOOD PRESSURE & BLOOD SUgAR CHECK CAR SEAT CHECK Sept. 14 9 � 10:30 a.m. Christiansburg Recreation Center Free Please call 800-422-8482 for more information. Oct. 20 4 � 6 p.m. Fire Station # 6 1333 Jamison Ave., Roanoke Free Please call 800-422-8482 for more information. PEARLS OF HOPE: wOMEN'S HEALTH TEA Sept. 29 HEALTHY U SEMINAR: POINTS ON JOINTS Sept. 19 10:30 � 11:30 a.m. Carilion Stonewall Jackson Hospital, Lexington Free Please call 540-458-3568 for more information. Facts about breast health and living with breast cancer 1 - 2:30 p.m. Bedford Central Library Community Room Free Registration required by calling Carilion Direct at 540-266-6000. INFANT CPR & SAFETY Oct. 13 CHOLESTEROL SCREENINg/HEALTH FAIR Sept. 20 Sept. 8 � 10 a.m. Tanglewood Mall, Roanoke $15 Please call 540-266-6000 to register. 6:30 � 9 p.m. Carilion Roanoke Memorial Hospital $20 per couple Please call 800-422-8482 for more information. PHYSICIANS ON FOOT 8:30 a.m. Every ay Roanoke River Greenway Saturd For more information, call 540-266-6000 or visit CarilionClinic.org/walking. FIRED UP FOR THE CURE 24 9 a.m. � 2 p.m. Roanoke Civic Center Please call 540-853-5785 for more information. For more events, classes, and screenings, visit CarilionClinic.org/calendar or call 540-266-6000. 26 Fall 2011 | CarilionClinic.org Healthy Eating Tips from Our Dietitians Carilion Clinic's registered dietitians provide individual nutrition counseling and group nutrition programs for churches, schools, and civic groups. They offer community support through supermarket teaching tours, health fairs, weight management programs for adults and children, and Camp Too Sweet for children with diabetes. They also assist individuals with celiac disease and those who are in cardiac rehab or who have had bariatric surgery. To contact a registered dietitian in your community, call 540-266-6000 or 800-422-8482. Cheryl Tutwiler, R.D., M.S. Registered Dietitian, Carilion Stonewall Jackson Hospital Kate Jones, R.D., C.D.E. Registered Dietitian and Certified Diabetes Educator, Carilion Diabetes Management Jill Traegde-Halstead, R.D., C.L.C. Registered Dietitian, Carilion New River Valley Medical Center Make the Most of Your Food Budget Even with food costs on the rise, it isn't as hard as you may think to eat healthy and not blow your budget. Sit down, make a list, and stick to it. Try to shop once a week, and cut out coupons from the paper. Don't erries Blueb berries go shopping on Straw nas an empty stomBana ch ach. Shop the a Spin a perimeter of the o store first for the Quin do healthiest foods, Avoca and choose fruits and vegetables that are on sale. Those are usually in season and taste the best. Also consider buying generic products--they can provide great savings. Finally, buy some healthy snacks and baggies and make your own 100-calorie portions! A Little Planning goes a Long way A crucial part of healthy eating is the often overlooked "meal plan." This means thinking ahead about what's needed for all your family's meals and snacks and shopping accordingly so ingredients are available during the busy work week. It also helps stave off the otherwise inevitable fast food run -- and its often unhealthy choices. So, as the kids head back to school and schedules get even more hectic, take some time to think about the week's schedule. Consider cooking extra at a particular meal so you'll have leftovers to quickly reheat for lunch or dinner another day. Not only will meal planning save you time and stress during the week, it will save money too! get the Nutrition You Need In June, the USDA replaced its food guide pyramid with the new "Choose My Plate." The most obvious change is that the pyramid has become a circle-- and that half of it consists of fruits and vegetables. The other half is divided into whole grain starches and a lean protein choice. In addition, a low-fat serving of dairy (skim or 1 percent milk) is included. If your plate doesn't yet resemble the USDA's, go to www.ChooseMyPlate.gov and check out "10 Tips to a Great Plate." CarilionClinic.org | Fall 2011 27 Fitness Tips Strengthening Your Core Allison Brelyn-Porter Roanoke and Botetourt Athletic Clubs Core fitness is all the rage in exercise programs right now. But what is core fitness, you ask? Our core is a complex layer of muscles around our midsection that includes our upper/lower abdominals and obliques. To get a better sense of their function, lie flat with one hand over your belly button. Take a deep breath. As you exhale, contract your abdominal muscles. It may help to visualize pulling your belly button closer to your spine during the contraction. You should feel these core muscles tightening under your fingers. Practice contracting your core in this way for 10-second intervals throughout the day. A strong core is an essential foundation for a fit body. It can prevent injury and improve your quality of life. And remember, no fitness routine is complete without proper nutrition. Isometric exercises like planks and side planks can help you tighten your abdominal and oblique muscles, improving your overall core strength. Roanoke and Botetourt Athletic Club fitness instructors Brooke Carlin (left) and Tiffany McCormack demonstrate side planks (above). Using bands can also help you to activate your core stabilizing muscles and increase your core function. 28 Fall 2011 | CarilionClinic.org What if healthcare worked the way you wanted? I could get the specialty care I need -- right here in my community. Imagine undergoing surgery with barely a scar to show for it. Or bouncing back from hip replacement surgery in weeks instead of months. Or having cancer treatments that don't interfere with your plans for the day. All are possible today at Carilion Clinic, where our specialists work as a team to meet the unique needs of every patient, every day. Because when you need specialized care, we are committed to one goal: getting you back to living your life. To nd a doctor, visit CarilionClinic.org or call 800-422-8482. Inspiring better health.TM CarilionClinic.org | Fall 2011 29 CARILION CLINIC P.O. BOx 13727 ROANOKE, vA 24036-3727 NON-PROFIT ORg. U.S. POSTAgE PAID ROANOKE, vA PERMIT NO. 247 M Scan this code to sign up for the Carilion Clinic Living e-newsletter. Learn more at CarilionClinic.org/qrcode Hospice Is... When someone you love dies, how do you deal with the memories? You may experience depression and lose the will to carry on normal activities. Or you try to lose yourself by staying busy, not having to face your grief. To help you savor the great memories, we provide bereavement counseling and our Journey of Hope support group. We even o er Camp Treehouse, a special haven for children who've lost someone they love. CarilionClinic.org/hospice | 800-964-9300