Inspiring Better Health | CarilionClinic.org | Fall 2012
Local Food Movement Takes Root
Magnets in Toys Pose Risks for Kids The Genetic Link to a Common Womenâ€™s Cancer
The Smart, Safe Choice Maternity care focused on growing families Learning you are pregnant is an exciting time. But preparing for a new addition to the family also means making a lot of decisions before the baby arrives. At the top of the list: Find a doctor you trust. At Carilion Clinic, our providers have been caring for expecting moms and delivering their babies in southwest Virginia for generations of families. Our maternity services include a comfortable, homelike setting, childbirth and parenting classes, specialized care for high-risk pregnancies, infertility services, and the areaâ€™s only neonatal intensive care unit (NICU) at Carilion Roanoke Memorial Hospital (CRMH). Whether it's at CRMH or at The Birthplace at Carilion New River Valley Medical Center, it's no wonder more moms trust Carilion Clinic as the smart, safe choice to deliver their new bundle of joy. For more information about our maternity services or an obstetrician, call 800-422-8482 or visit CarilionClinic.org/maternity.
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Inspiring better health.â„˘
Fall 2012 FEATURES 7 Child Safety
Popular magnets pose risk if swallowed.
12 Endometrial Cancer 14 Neurology
Screening for a genetic link.
New treatment options are available.
16 Community Health 18 Healthy Eating 22 Good Ideas
Local food movement goes mainstream.
Improving the world—and our community.
25 Doctor Q & A 26 Quality Care
An interview with Dr. Paul Yeaton. A patient’s story.
31 Sharing Stories 33 Urgent Care
Assessing the needs of a community.
Celebrating the 30th anniversary of open-heart surgery.
For urgencies that aren’t emergencies.
DEPARTMENTS President’s Message 3 Healthy food choices abound. Healthy Lifestyles 5 Tips from Carilion Clinic medical professionals. In Your Community 8 Making a difference in western Virginia. New Providers 28 New physicians and advanced care practitioners
across our region.
Better Living 32 Your health calendar. Carilion Clinic
| Fall 2012 Inspiring Better Health | CarilionClinic.org
Local Food Movement Takes Root
Magnets in Toys Pose Risks for Kids The Genetic Link to a Common Women’s Cancer
On Our Cover Carolyn and Ian Reilly of Four Corners Farm in Rocky Mount hold eggs from their farm and their hen Penny.
p.31 CarilionClinic.org | Fall 2012
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
Karen Doss Bowman is a writer who contributes to health care publications, including the University of Virginia’s Vim & Vigor. A native of Bassett, Va., she now lives in Bridgewater.
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.
Jay Conley has been a reporter for newspapers including The Roanoke Times, a staﬀ writer for Randolph College in Lynchburg, and a writer for national publications such as U.S. News & World Report.
CARILION CLINIC LIvING IS PRODUCED BY STRATEGIC DEvELOPMENT: vICE PRESIDENT OF STRATEGIC DEvELOPMENT Shirley Holland SENIOR DIRECTOR, MARkETING Mike Dame EDITOR Maureen Robb LEAD DESIGNER David Porter DESIGNER Taryn Anderson CONTRIBUTING wRITERS Karen Doss Bowman, Mary Brewer, Allison Buth, Lois Caliri, Su Clauson-Wicker, Jay Conley, Laura Markowski, Otesa Middleton Miles, Erica Stacy, Randolph Walker PHOTOGRAPHER Darryle Arnold CONTRIBUTING PHOTOGRAPHERS David Hungate, Brett Winter Lemon
Brett Winter Lemon is an award-winning photographer based in Roanoke who has returned to his native Virginia after living abroad. He says he is proud to be part of the region’s strong creative arts community.
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.
Erica Stacy is a writer whose articles have appeared in regional and national health publications. She also works with nonproﬁt groups in Virginia and the Carolinas to promote health and education. She lives in Pulaski.
PRINTING Chocklett Press
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 2012 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 added to or removed from the mailing list for Carilion Clinic Living, please call 800-422-8482, email us at email@example.com, or write to us at Strategic Development, 213 McClanahan St., Roanoke, VA 24014.
Fall 2012 | CarilionClinic.org
President’s Message If you’d like to improve your eating habits, and those of your family, you’re not alone. Across Virginia, there is growing demand for more natural food. And increasingly, that means local food. Luckily, many choices are now available: about 100 farms in the region are devoted to growing organic fruits and vegetables and naturally raising livestock. Maureen Robb’s article about this local food movement is a must read! I’m already thinking about fresh tomato sauce for dinner tonight. Have you seen the desktop “toys” for adults made up of tiny magnetic balls that can be assembled into many shapes? What you may not know is that children have been hurt swallowing these balls. The U.S. Consumer Product Safety Commission has issued a warning about the toys, asking parents to keep them away from kids. Children and accidents—an all-toocommon problem. Jay Conley’s article gives us a lot Nancy Howell Agee with Dr. Robert L. A. to think about. keeley. For women diagnosed with endometrial cancer, there is a new test that could save the lives of others in their family. We’ve begun routinely screening endometrial tumors for Lynch syndrome, a genetic abnormality that dramatically increases the risk for endometrial, colon, and other cancers. I’m so proud that we’re oﬀering this important service. Carilion is the ﬁrst health care system in the region to provide it. I hope you’ll ﬁnd the story, on page 12, to be about courageous women. This magazine is chock-full of interesting and informative articles. I loved the helpful hints and new ideas. My favorite, though, is the story on page 11 about Dr. Keeley! It was a night to remember when we gathered to celebrate Dr. Keeley’s exemplary life of service. Saying thank-you and raising money for the Foundation to honor such an amazing physician was a treasured evening. Hope to see you at next year’s celebration! wARM REGARDS,
NANCY HOwELL AGEE PRESIDENT AND CEO CARILION CLINIC
CarilionClinic.org | Fall 2012
Tips from our Medical Professionals Immunizations Aren’t Just for Babies Adolescence is an important time to continue to vaccinate your child against harmful illnesses and diseases. Make sure your child has received the Tdap, Meningococcal, and Human Papillomavirus (HPV) vaccines. These can be administered at his or her 11-year, well-child checkup. If they are older, it’s not too late — they can still receive them! Their next checkup is a great time to ask your provider about these vaccines. — Erinn Hokanson, R.N., D.N.P., Pediatric Nurse Practitioner, Carilion Clinic Adolescent & Student Health Services, Roanoke
Take Your Medications Safely It’s good to remember: • Safe medication use is your responsibility. • Know the names of your medications and why you are taking them. • Take your medications as directed by your health care professional. • Be aware of what side effects may occur. • Do not take medications prescribed for other people. • Carry an up-to-date medication list or bring your medication bottles with you each time you visit your doctor or the hospital. — Amy Westmoreland, Pharmacy Manager, Carilion Giles Community Hospital
Be Sure to Get “Me” Time Give yourself permission to take time for yourself. Our lives are full with work and family. We are constantly stimulated by TVs, smartphones, and computers. Don’t lose yourself in all this. Make time to rest, enjoy each bite of food, reflect on what brings you joy, and, sometimes, simply do nothing. Give as much to yourself as you give to others. Health starts with you— body, mind, and spirit. — Arlene S. McCain, M.D. Carilion Clinic Family Medicine, Bridgewater
Participate in Your Care When you see your doctor or health care provider, be sure you tell them about things that could affect your care. Often they are working with less than all the needed information, which can affect outcomes. Also know your medicines and why, when, and how you take them—and your true allergies, not just side effects or reactions to medications. Patients often don’t use appropriate medications because they don’t understand certain reactions or side effects. And write down any questions you have about a procedure or medication. (Don’t just trust your memory.) — John M. Kerr, M.D., Bedford Surgery, Bedford
Got Milk? Research shows that drinking fatfree chocolate milk after an intense workout or sports may be most beneficial in helping to rebuild muscle. Fat-free chocolate milk has a balanced ratio of carbohydrates and protein— and provides double the amount found in most sports drinks. It also provides calcium, vitamins, and minerals and has less sodium and sugar than most sports drinks. — Christina Richardson, Physical Therapist Carilion New River Valley Medical Center
Stay Safe in the Sun Year-round We know the sun’s rays can damage skin during the summer, but you might also be getting more exposure than you bargained for during the rest of the year. The sun can still affect you on a cloudy day, and everyday exposure adds up over a lifetime. To stay safe, use a sunscreen with an SPF of 15 or higher when you’re outdoors. Also take care of your eyes. Wear sunglasses—they can help reduce your risk of getting cataracts later on. — Jared Campbell, Certified Physician Assistant, Carilion Clinic Emergency Medicine, Roanoke
CarilionClinic.org | Fall 2012
Resources to keep You Healthy Nurse Line Our physician referral and health information service is here to help. Call us at 540-266-6000 or 800-422-8482, or email us at firstname.lastname@example.org.
“well Said” Speaker’s Bureau If you’d like a speaker on a health topic for your community group or workplace, call 540-224-4961 or visit CarilionClinic.org/speakers.
Community Health Screenings Health screenings are available at little or no cost. Call 540-266-6000 or 800-422-8482, or email us at email@example.com.
website Tailored for You Check out these features at CarilionClinic.org: • Easy-to-use physician ﬁnder • Interactive maps to help you ﬁnd your way to our locations • Health and wellness content, including an A-Z library • A community health education and events calendar
News Blog Keep up with the latest news, photos, videos, and more at Carilion Clinic’s news blog. Visit newsblog.CarilionClinic.org.
Social Media Stay connected through Facebook, Twitter, YouTube, and LinkedIn: facebook.com/carilionclinic twitter.com/carilionclinic youtube.com/carilionclinic linkedin.com/companies/carilion-clinic pinterest.com/carilionclinic
Publications Pick up a copy of Carilion Clinic Living at magazine racks throughout our facilities, or access the digital edition at CarilionClinic.org/publications, where you can also read past issues of our publications. For health tips and news about upcoming health screenings events, subscribe to Living’s monthly e-newsletter at CarilionClinic.org/living.
Support Groups Support groups are available for a wide range of health needs, including gynecologic and breast cancer. Learn more at CarilionClinic.org/support.
Children’s Health For the latest news and perspectives on children’s health care, read Close to Home, a blog by Dr. Alice Ackerman, chair of the Department of Pediatrics at Carilion Clinic.
Fall 2012 | CarilionClinic.org
Giving to Carilion Clinic Foundation Be part of improving the health and vitality of communities in western Virginia. Make a gift at CarilionClinic.org/giving.
By Jay Conley
They may seem harmless, but tiny magnetic balls sold as desktop toys for adults are hurting children who swallow them. The high-powered BB-sized balls, which can be fashioned into various shapes, come in sets of 100 or more and are sold online and in office and gift stores. But they can clump together in the stomach when swallowed and cause obstructions or perforations. Across the country, there have been reports of serious injury or death. The U.S. Consumer Product Safety Commission has received 22 reports of incidents involving children and teenagers since June of 2009. Eleven of these required surgery.
The agency issued a warning about the magnets last fall and also noted that “many more” cases have been reported in the media. “We want parents to be aware of the danger associated with these innocent looking magnets,” said agency Chairman Inez Tenenbaum. In May, doctors in Louisiana removed most of a one-year-old boy’s intestine after they discovered he had swallowed eight of the magnets. In January, a Fairfax County, Va., fifth-grader pretending to have a pierced tongue placed the magnetic balls on the top and bottom of her tongue to resemble a stud. The magnets slid to the back of her throat, and she swallowed them. What ensued was a lengthy hospi-
tal stay during which the girl underwent a battery of X-rays and CT scans. Surgery followed to move the magnets into her appendix, which was then removed. In the most serious incident, a 20month-old toddler died after ingesting several magnets. Parents are advised to keep magnets away from children and to check the magnet sets, play areas, and carpets for missing balls. They should also warn teenagers not to put the balls near their faces to pretend they have piercings. If they suspect a child has swallowed a magnet, parents are advised to immediately contact their doctor. For more information, go to http://1.usa.gov/w1ZHKO.
CarilionClinic.org | Fall 2012
In Your Community
Hospitals win Quality Awards Two hospital units won 2012 Patient Perception Awards from Professional Research Consultants, Inc., a nationally known health care research firm. Carilion Roanoke Memorial Hospital’s 11 West Medical/Surgical Unit won a 5-star award for overall quality of care, signifying that it is in the top 10 percent in its field. Carilion Giles Community Hospital’s Emergency Department earned a 4-star award, indicating it places in the top 25 percent. It is also the second year in a row that Giles has won the 4-star award. All awards are based on confidential surveys of patients’ perceptions of their care. (Pictured: The staff of the Emergency Department.)
Grant to Launch Medication Management Program Carilion New River Valley Medical Center (CNRV) and several partners received a $4.1 million grant from the Center for Medicare & Medicaid Innovation. The grant will fund a new program to help patients in rural Virginia better manage their medications. Pharmacists will receive in-depth education about advanced care and chronic disease management to help patients. Fewer hospitalizations, emergency room visits, and adverse drug events are expected as a result. CNRV’s partners in this program are the Virginia Commonwealth University School of Pharmacy, Aetna Healthcare, and CVS/Caremark. (Pictured: Pharmacist Mike Czar and Ralph Goodson, a recent patient at CNRV.)
MyChart Introduces App Respiratory Care Earns Recognition All eight Carilion hospitals earned Quality Respiratory Care Recognition from the American Association for Respiratory Care. Only 15 percent of U.S. hospitals receive this designation, aimed at helping patients make informed decisions about respiratory care. Hospitals agree to meet strict criteria in their respiratory care services and provide a level of care consistent with national standards to earn this designation.
Fall 2012 | CarilionClinic.org
Carilion Clinic has launched a MyChart app for iPhones, iPads, and Android phones and tablets. MyChart, the first online health care management tool in western Virginia, gives patients secure access to portions of their electronic medical record. With the mobile app, patients can see test results, send a message to their doctor’s office, view upcoming appointments, and review their medication, allergy, and immunization listings. MyChart, which is offered in Carilion primary care practices, has over 20,000 patients active. To sign up, talk to your provider.
Hospitals Rated among Safest in Nation
Carilion Clinic Receives Community Beneﬁt Award Carilion Clinic received the Virginia Hospital & Healthcare Association’s 2012 Community Benefit Award. The award recognizes Carilion’s efforts to improve the health of the community through its Adolescent and Student Health Services Program at Carilion Clinic Children’s Hospital. This program operates three teen health centers that improve access to health care for children aged 10-19 and provide pregnancy prevention education and confidential services for teens. It is credited with reducing the rate of teen pregnancy in Roanoke.
Three Carilion Clinic hospitals received an A rating for safety from The Leapfrog Group, a national hospital rating organization. The group released its first Hospital Safety Score, which grades hospitals with an A, B, C, D, or F to reflect how safe they are. Carilion Roanoke Memorial Hospital, Carilion New River Valley Medical Center, and Carilion Franklin Memorial Hospital received an A, placing them among the 729 hospitals with this rating out of more than 2,600 U.S. hospitals graded. The Leapfrog Group used 26 measures of public hospital safety data to create its grading system.
Campus Recognized as ‘Bicycle Friendly’
President Leads Local walk Nancy Howell Agee, president and CEO of Carilion Clinic, led a two-mile walk for the community as part of Carilion’s ongoing Physicians on Foot program. She also spoke there about how walking promotes good health. “It helps us stay strong and fit,” she said. “It actually lowers the bad cholesterol and raises the good. It helps us lose weight. It does all sorts of good things for us, and it’s such an easy thing to do.” Physicians on Foot is a walking group that meets in Roanoke every Saturday morning. A different Carilion physician leads a walk each week. For more information, go to CarilionClinic.org/walking. (Pictured: Nancy Howell Agee speaks at the event.)
Carilion Clinic’s Riverside campus was recognized as a Bicycle Friendly Business by the League of American Bicyclists. The campus, which houses specialty physician practices and the Virginia Tech Carilion School of Medicine and Research Institute, encourages bike commuting by providing bicycle racks, showers, and locker rooms. Carilion also sponsors bicycling events for employees and the community. Almost 30 employees took part in its Bike to Work Day this year, and other events were held at Riverside as part of Carilion’s observance of national Bike Month. Carilion will also be a gold sponsor of the annual Artie Levin Memorial Century Ride staged by the Blue Ridge Bicycle Club. The scenic and challenging 105-mile ride originates in Fincastle. (Pictured: Annette Dickerson, Bill Flattery, Jay Hicks, and Clifford Nottingham III, M.D., who rode to work at Carilion Clinic on Bike to Work Day.)
CarilionClinic.org | Fall 2012
Car-Seat Safety Programs Recognized
Carilion Clinic received two awards from the Virginia Department of Health for its car-seat safety programs. The awards recognize that Carilion sponsored the most educational events on child safety seats, and inspected the most safety seats, in a medium-size Virginia community from 2010 to 2012. Motor vehicle crashes are the leading cause of death for children, and seven out of 10 car seats put in by parents are installed incorrectly. To have a child’s safety seat inspected, stop by the Carilion Clinic and City of Roanoke’s check station at 1333 Jamison Ave. It is open on the third Thursday of the month from 4 to 6 p.m. Or call Safe Kids at 540266-6563.
Carilion Clinic Receives Outstanding Corporate Award Carilion Clinic received the Outstanding Corporate Award from the Greater Blue Ridge Chapter of the Juvenile Diabetes Research Foundation. Carilion has been a sponsor of the foundation for 20 years, and many of its employees have volunteered time and resources. One of the many ways Carilion has lent support is by operating Camp Too Sweet for children with diabetes, and by giving scholarships for area children to attend the camp. Carilion has also helped sponsor The Star City Gala and Walk to Cure Diabetes, an annual fund-raising event by the foundation. This year’s walk will be held Sept. 23 in downtown Roanoke.
Sports Clinic Opens for Fall The Saturday Morning Sports Injury Clinic is open for the fall athletic season. The clinic, which treats sports injuries in local athletes, will be open for walk-in patients and those with appointments every Saturday morning through November at 4064 Postal Drive in Roanoke. Walk-in patients are asked to register between 8:30 and 9 a.m. For more information, call Carilion Clinic at 540-776-0228.
Children’s Hospital Adopts Mascot Say hello to Ned, a new face at Carilion Clinic Children’s Hospital. A kid at heart, Ned is a friendly robot who loves meeting children and parents and guiding them around the hospital. Ned has a great way of explaining treatments so every child can understand. He is also good friends with all the hightech machines, so he can explain what they do. Those clunking noises the MRI makes? Just ask Ned. He can tell you all about it. 10
Fall 2012 | CarilionClinic.org
Most wired For the fourth consecutive year, Carilion Clinic has been named as one of the nation’s Most Wired health care providers by Hospitals & Health Networks magazine. Award recipients are chosen based on their use of information technology in business and administrative management, clinical quality and safety, clinical integration, and infrastructure.
Foundation Honors Physician’s Lifetime of Service In honor of Dr. Robert L.A. Keeley’s nearly 60 years as a physician, the Carilion Clinic Foundation has established an award in his name. It will be given annually to a health care professional for significant contributions to the health of the community. Dr. Keeley, 91, is a board-certified thoracic surgeon and one of the founders of Jefferson Surgical Clinic. He has served as chief of surgery for Jefferson Hospital and Carilion Roanoke Community and Memorial Hospitals, and on the board of directors for Community Hospital and Carilion. He is now medical director for nursing services at Roanoke Memorial, a position he has held since 1996. Dr. Keeley received the award at a dinner in his honor. Future recipients of the Dr. Robert L. A. Keeley Award will be individuals who best exemplify the standards that define Dr. Keeley, including integrity, moral character, respect, and compassion. The Foundation also announced that it will name a new “healing arts” program after Dr. Keeley. The Dr. Robert L. A. Keeley Healing Arts Program will integrate the creative arts into the healing process and feature literary, performing, and visual art experiences. The Work of the Foundation The Carilion Clinic Foundation establishes and maintains relationships that generate philanthropic support to enhance Carilion Clinic’s ability to provide excellence in health care. The focus of the Foundation is to provide resources for Carilion Clinic for equipment, programs, and services that otherwise would not be possible. Earlier this year, Krishan K. Tayal, M.D., of Radford pledged $100,000 to the foundation to establish an endowed fund for staff medical education. Carilion Clinic plans to name the vascular lab at Carilion New River Valley Medical Center after Dr. Tayal, who is credited with establishing the lab and making care more accessible for patients in the New River Valley and surrounding areas. “I hope my gift will raise awareness of the many ways to give to Carilion and that it will inspire others to make a gift of any size to something meaningful to them,” he says.
Dr. keeley and his wife, Nina, at the dinner in his honor.
CarilionClinic.org | Fall 2012
Carilion Begins Genetic Screening for Lynch Syndrome Condition Increases Cancer Risk When Deborah Browning learned she had endometrial cancer last year, she began to unravel a generations-old family mystery. Her diagnosis didn’t come as a surprise: Browning’s mother, grandmother, three aunts, and two sisters had all had endometrial cancer. But after her hysterectomy at Carilion Clinic, a test on her tumor revealed a potential genetic cause — a possibility Browning hadn’t considered. “I got real excited, because having this knowledge can save lives in your family,” says Browning, 57, of Princeton, W.Va. “Genetic testing is a miracle. Maybe this can save my grandchildren and great-grandchildren from having to die early.” Last fall, Carilion began routinely screening endometrial tumors for genetic abnormalities, since it is now known that some endometrial cancer is caused by a genetic defect. Carilion is the only health care provider in the region to provide such screening. After Browning was found to have abnormalities, she then consulted Carilion’s cancer genetic counselor, Thuy Vu, and opted for further screening. The results were positive for Lynch syndrome — a hereditary Thuy Vu condition that dramatically increases the risk for endometrial, colon, and other cancers. Armed with that knowledge, Browning can educate her relatives about the family’s genetic disorder, and they can employ early-detection measures, such as annual colonoscopies, to prevent future cancers. 12
Fall 2012 | CarilionClinic.org
By Karen Doss Bowman
“Endometrial cancer is the most common gynecologic cancer we deal with, and up to 10 percent of our patients might carry a genetic defect that causes it,” says Carilion gynecologic oncologist Janet Osborne, M.D. “So identifying that particular group of people is really important for the impact on their health. They’ll Janet Osborne, M.D. undergo intensive screenings for the other types of cancers that are included in the syndrome. For the patients and their families to have this information—you could save lives.”
knowledge is Power According to Lynch Syndrome International, the average person has a 6 percent chance of getting colon cancer in his or her lifetime. With Lynch syndrome— also known as hereditary nonpolyposis colorectal cancer (HNPCC)—that risk jumps to 60 to 80 percent. Women with the syndrome are at a 40 to 60 percent risk of developing endometrial cancer in their lifetime, compared to the 2 to 3 percent risk for the average woman. Cancers associated with Lynch syndrome tend to develop before age 50. Vu encourages genetic testing for a patient’s children and siblings, who each have a 50 percent chance of having inherited Lynch syndrome. Browning’s 37-yearold daughter, Christie Wilcox, tested negative for the syndrome. That means Wilcox’s two daughters could not have inherited the genetic mutation. “While it can be frightening to know that a genetic
“I got real excited, because having this knowledge can save lives in your family.” — Deborah Browning, Princeton, W.Va.
Deborah Browning (left), who recently tested positive for Lynch syndrome, and her daughter Christie wilcox.
condition is lurking in your family history and can be passed down, having the genetic testing makes people feel empowered,” Vu says. “If a patient knows she’s in a high-risk category for colon and endometrial cancer, she can become a better advocate for her own health. “But if a patient finds out she doesn’t have a genetic risk for cancer and that her children don’t— that can provide a huge relief.”
Tailoring Treatments Dennis Scribner, M.D., the gynecologic oncologist who Dennis Scribner, M.D. treated Browning, is excited about the rapid advances in genetics. “Someday, we should be able to genetically categorize people’s tumors and individualize treatments based on that information,” he says. “That will help us to tailor each patient’s
oncological management.” Browning is thankful that she knows her family’s genetic risk for cancer and encourages others with a strong family history of cancer to consider genetic testing. “Don’t be timid, and don’t be backward,” says Browning, who believes her brother’s death from colon cancer several years ago could have been prevented if the family had known about Lynch syndrome. “Allow those with the knowledge of genetics to help you and explain what’s going on in your family. There’s nothing scary about it. It’s all good information that you need. It’s not a death sentence—actually, it’s a life sentence. This gives you life.” For more information, call 540-2666000 or 800-422-8482.
Endometrial Cancer Endometrial cancer is the most common cancer of the female reproductive organs. It occurs in the tissue shed each month as part of a woman’s menstrual period. The most common symptom is abnormal bleeding. Menstrual periods may become heavier or longer, or bleeding may occur between periods. After menopause, any vaginal bleeding at all, no matter how slight, is considered abnormal. Risk factors include early menstruation, late menopause, never having had children, obesity, use of estrogen alone for hormone replacement, use of tamoxifen, and diabetes. CarilionClinic.org | Fall 2012
New Options for Treating Brain Injuries Care Is Available Close to Home
By Erica Stacy
After suﬀering a head injury on the set of the movie Syriana, actor George Clooney began experiencing excruciating headaches and memory loss. He described it as the most unbearable pain he’d ever had. A neurologist identified the problem: Clooney had torn the dura—a membrane surrounding the brain and spinal cord. He underwent a series of operations, and eventually recovered. Accidents like his happen every day, turning lives upside down. And while area residents once had to seek care for such accidents outside the region, treatments are now available close to home. “The options for patients with brain and spinal injuries in our region today are leaps beyond what was available just a decade ago,” says Gary Simonds, M.D., section chief of neurosurgery for Carilion Clinic. “Traditionally, neurosurgeons have opened the head and skull or spine for treatment. But new, minimally invasive alternatives ensure shorter recovery times and reduce risks,” he says.
Fall 2012 | CarilionClinic.org
At Carilion, five neurosurgeons provide treatments that are on the cutting edge. “There is no need to leave the region for neurosurgery,” says Dr. Simonds. “We have brought state-of-the-art care right to your backyard.” For example, 80 percent of brain aneurysms can now be treated here by threading a catheter through a tiny incision in the groin all the way up to the head. Certain tumors of the brain and pituitary may be removed using transphenoidal procedures, in which a surgeon accesses brain tissue through the back of the nose. Carilion Clinic is the only health care system in the region to perform this procedure. Similarly, endoscopic spinal surgery uses cameras and instruments passed through small incisions to
Neurosurgeons care for people who are experiencing problems related to the nervous system, which is formed by the brain, spinal cord, and peripheral nerves. The brain serves as command central, controlling the body from movements and sensations to understanding and speech. The nerves are like electric wires that transfer information to and from the brain. Most of them pass through the spine.
reach and repair damaged areas of the back. Most of these new procedures require shorter hospital stays than do traditional surgeries, and they let patients resume normal life more quickly.
Surgeons can now perform many minimally invasive procedures to treat brain injuries. New options for managing spinal pain —a growing concern for many Americans —involve implanting wires in the spinal column that are connected to a special control device. The device manipulates the nerves, essentially tricking them into masking pain. This device, a pacemaker for the spine, isn’t a cure, but it is an effective treatment for certain, qualified patients. Carilion Clinic has also opened a multi-disciplinary spine center where physicians from several specialties, including neurosurgery, collectively help Gary Simonds, M.D. patients with spinal ailments. “Targeted radiation for tumors using CyberKnife is another advance available at Carilion,” says Simonds. “We use a computer to position low-dose beams of radiation from various angles. Where the beams cross, a concentrated dose of radiation targets a tumor, but does not harm other tissue in the area.”
Carilion has expanded its neurosurgery program rapidly in the last decade. In addition to the neurosurgeons, three specialized physician assistants now serve patients in western Virginia. “Many of the health problems we treat are the results of accidental injuries to the head, neck, and back,” says Dr. Simonds. “We care for patients of all ages, including children, and we have the expertise to successfully treat a broad spectrum of problems from injuries and tumors to aneurysms and issues with the spine. “Because every patient is different, our approach involves a team of medical professionals working together to determine the treatment
Time can be of the essence with a head injury, making quick access to specialized care invaluable. Trauma is the leading cause of death in children older than one in the United States, for instance. Head trauma accounts for 80 percent or more of those injuries.
that offers each individual the best possible outcome.” In 2007, Carilion also launched a residency program in neurosurgery. “These doctors-in-training enhance the personal care available for our patients,” Dr. Simonds says. “And in order to teach effectively, our physicians are always considering new ideas and evaluating new treatments. We stay informed about the latest techniques and technologies. It’s a winning combination for our patients.” For more information, call 540-2666000 or 800-422-8482.
CarilionClinic.org | Fall 2012
e s l u P e h t g n i k Ta y e l l a V e nok a o R e h t f o
By Allison Buth
How healthy are the residents of the Roanoke valley? With the mission of improving the community’s health, Carilion Clinic recently took the lead in conducting a Community Health Needs Assessment. Fifty-six community organizations served as partners. “This has been a true community effort with the involvement of literally thousands of people,” says Shirley Holland, vice president of Strategic Development at Carilion Clinic and project director. “Since our goal is to improve community health, we had to first understand the issues and needs.” The assessment team developed a 24-question survey to learn about the incidence of chronic illness, access to health care and insurance, and demographics. Over 4,000 residents completed the survey, which was distributed throughout the community. After combining the results with feedback from focus groups, site surveys, secondary data, and other assessment tools, a clearer picture of health needs emerged. The survey revealed five areas with unmet needs: access to adult dentistry, access to primary care, access to mental health services, coordination of care, and wellness or health literacy. “The input from focus groups was rich with useful information,” says Eileen Lepro, executive director of New Horizons Healthcare, a project partner. “Participants didn’t hesitate to share their honest thoughts about their own needs and those of the community. “I’m encouraged by what we gleaned. It suggests real shifts in thinking about priorities that focus on wellness and prevention, and not just treatment of illness.”
Access to Resources The survey showed various reasons why many people did not get adult dentistry or primary care, or use mental health services.
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These included waiting lists for medical care, a lack of reliable transportation, and a lack of extended hours. The survey also found that social stigma, a lack of health literacy, and other factors were involved. “People who cannot get the appropriate care they need often use the Emergency Department, which isn’t always best for the patient and results in very busy, stressed EDs,” says Holland. “This work points to the need to improve and expand access—especially for the underserved and uninsured populations.” Improving the coordination of care is expected to help connect more residents with a primary care provider, and improve care by helping patients navigate through the system. To increase wellness in the community, project managers say that promoting a healthy lifestyle, a nutritious diet, and an optimal body weight can help residents avoid or manage chronic disease. “We are identifying neighborhoods where we can influence behaviors to improve health,” says Pat Young, consultant for CommunityWorks and project manager of the health assessment. “It is more than just making sure you get a flu shot each year. We are looking at access to affordable healthy foods and ways to engage in physical activity. “To me the health assessment is a gift to the community. While we spent time looking at what the needs are and who is impacted the most by disparities, the project allowed us to engage the community in the process and begin to create a health improvement plan that will impact those who live here.” The assessment was largely funded through an $80,000 federal grant.
The health survey found the community has made improvements in these areas: • Children’s health: Medical care is available for children regardless of their insurance status • Prenatal care: Roanoke has a low rate of late entry into prenatal care • Education: Roanoke City school drop-out rates have declined from 19 percent in 2010 to 12.2 percent in 2011 • Diabetes care: Diabetes death rates have declined from 25.6 per 100,000 in 2009 to 14.4 in 2012, making Roanoke’s rate lower than the state’s rate of 18.7 • Community resources: More programs are available through organizations such as New Horizons Healthcare, Carilion Pediatric Dentistry, Project Access, Mission of Mercy, Fralin Clinic, and Bradley Free Clinic • Community involvement: Eﬀorts by residents have led to an expanded greenway system and more community gardens and markets
Strategies are now being drafted to improve health care where needed; they are expected to be implemented over the next few years. Evaluation measures for gauging whether goals are met will also be developed. “All of the health care and human services safety net organizations in the Roanoke Valley can benefit from what we have learned through this
The survey found ﬁve areas that need improvement: • Access to adult dentistry • Access to primary care services • Access to mental health services • Coordination of care • Wellness
assessment,” says Lepro. “It provides the basis for us to write better grants, formulate strong strategic plans, and answer calls to action— individually and collectively.” It has been 12 years since a Roanoke Valley community health survey was conducted. “The health assessment is a community-driven project and its success is highly dependent on the involvement and commitment of the community,” says Holland. For more information about free community services available in the Roanoke Valley, dial 2-1-1. A trained professional will listen to your situation and suggest sources of help. To read the assessment, visit carilionclinic.org/chna.
CarilionClinic.org | Fall 2012
By Maureen Robb
When it comes to food, local is better. Thatâ€™s the growing consensus across western Virginia, where grass-fed meat, pastured eggs, and organic fruits and vegetables are in demand. The local food movement, which has been gaining momentum for some time, is going mainstream. The documentary Food, Inc., along with books and articles on the poor quality of American diets, have served as a wake-up call for many parents who want their kids to grow up healthy. And increasingly, that means seeking out meat, seafood, milk, and produce that are fresh and free of hormones and additives. Parents are also concerned about the obesity epidemic linked to over-processed and fast food. Luckily, consumers in our region enjoy considerable choice. About 100 farms in western Virginia now produce meat from pastured animals and organic produce. Their products are sold throughout the region at farmers markets, individual farms, grocery stores, and food grower co-ops. 18
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Fresh tomatoes and peppers are for sale at the west End Community Market in Roanoke. Market manager Tee Reynolds (left) buys produce from vendor Betsy Stewartson.
Back to the Farm A number of farms in western Virginia are using environmentally conscious practices to grow vegetables and raise livestock. They also have a commitment to humane and ethical treatment of animals and to producing healthy food. Many are new to farming. Ian and Carolyn Reilly of Four Corners Farm in Rocky Mount, for instance, moved their family from Gainesville, Fla., two years ago for a more rewarding life. After reading a book by Dr. Matthew Sleeth about the joy inherent in a less materialistic, healthier lifestyle and seeing Food, Inc., they resolved to simplify their lives. They also adopted a new dream: growing “real food” and making a difference in their community. “Food really is medicine,” says Carolyn, a former marketing specialist and graphic designer. “More people are becoming aware of this, and we are seeing a huge demand for locally produced food.” “Real food may be a little more expensive up front, but in the long run, eating cheap food will cost you more in medical expenses,” says
what natural foods can you buy locally? How about: • Grass-fed beef, pork, lamb, goat, rabbit, and buﬀalo • Pastured eggs • Fresh and smoked trout • Organic fruits and vegetables including bok choy, escarole, baby lettuces, leeks, sorrel, apricots, Asian pears, blackberries, plums, and currants • Hormone-free milk, ice cream, and artisan cheeses • Culinary herbs • Honey
Ian, who has been an IT systems administrator for the University of Florida. (He still does some work here for the university.) “More and more people are look-
ing for local and grass-fed beef, pigs, and chickens,” he says. “It’s amazing.” The Reillys, who sell whole pastured chickens and eggs, fresh herbs, and produce, say they are selling their eggs “as fast as the chickens can lay them.” They are also happy in their 1907 farmhouse, and have been joined by Carolyn’s parents, who help watch the kids and maintain the farm. “We have a great pasture, woods, creeks, and a pond,” Carolyn says. “We all love it here.” Others, such as the Tilson family of Broadview Ranch in Lexington, have long been rooted in Virginia and are carrying on a family tradition. The Tilsons run a multi-generational farm specializing in sustainably raised grass-fed beef, woodland pork, and pastured eggs. “We are focused on producing good food—good for the body, good for the palate, good for the land, good for the animals, and good for our community,” says Lee Atwood, a member of the extended family. Like other farmers who raise grass-fed cows, he says that beef produced without grain, antibiotics, hormones, and pesticides tastes
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better and is more nutritious than mass-produced supermarket beef. He also cites its lower fat content, higher Omega 3 fatty acids and beta-carotene, and greater cancerfighting CLAs (conjugated linoleic acids). Perhaps the most famous farm in western Virginia is Polyface, Inc., a family-owned farm outside Staunton. It has been featured in the best-selling book The Omnivore's Dilemma, the movie Food, Inc., and a BBC documentary as a superb example of sustainable agriculture. Family head Joel Salatin, noted for his own books on the subject, says it’s just not natural to eat food that has traveled 1,500 miles to your table. Many other farms in the region also proclaim their dedication to producing nutritious and delicious foods. They include: Shadowchase Farm, near Blacksburg; Border Springs Farm in Patrick Springs; Garden Mountain Farm in Burke’s Garden (near Tazewell); IdleWild Farm in Bedford; Weathertop Farm in Check; Homestead Creamery in Wirtz; Sizer Farm in New Castle; Journeys End Farm in Fincastle; and Rolling Meadows Farms in Martinsville. (To locate farms that raise pastured livestock and grow organic produce, see Resources on page 21.)
Ripple Eﬀect The effects of the local food movement are being felt far and wide. The state of Virginia, for instance, is sponsoring a Farm to School Program that promotes the use of fresh produce. More than 75 schools in western Virginia participate, according to the Virginia Department of Agriculture and Consumer Services. Agri-tourism is also blossoming. The Black Diamond Ranch in New Castle says it is developing an agritourism business that will feature a bed and breakfast, general store, and a cafe. Others have announced similar plans. 20
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Director of Happy Healthy Cooks Heather Quintana (center) with students Avalon Flowers (left) and Tatum Jepson.
kids who Love kale How do you get kids to eat their vegetables? By involving them in the cooking process, says Heather Quintana, a certiﬁed health coach and director of Happy Healthy Cooks. Quintana ought to know. She’s taught many local children how to chop, shred, and grate veggies, and she regularly gets such feedback as: “No fair, he has more cabbage than me!” and “Lentil soup is awesome!” The mission of Happy Healthy Cooks is to teach kids to love healthy and delicious whole foods. Every week, volunteers conduct lessons in elementary schools. A “no yuck rule” applies: children are asked to give all foods a chance before they jump to conclusions about whether they like it. “They usually do, after they try it,” says Quintana. Children are also taught about dietary fat and exercise, vitamins, knife and kitchen tool safety, and how to wash their hands properly. Lessons incorporate ethnic foods from around the world. Parents rave about the program. “We’ve changed our eating habits at home,” says Jenny Taylor of Roanoke. Her children now seek out fruits or vegetables at the grocery store, instead of always asking for pizza. And they help out in the kitchen. Susan Mabery of Roanoke says: “Since my son and his classmates started eating kale with Happy Healthy Cooks, they want it for dinner.” The program now teaches children at Grandin Court Elementary, Virginia Heights Elementary, Lincoln Terrace Elementary, and TAP Head Start. It is sponsored by Carilion Clinic, United Way of Roanoke Valley, New Horizons Healthcare, and other local organizations, businesses, and individuals. For more information and kid-friendly recipes, go to happyhealthycooks.com or facebook.com/HappyHealthyCooks.
Left: Free-range chickens, and their eggs, at Broadview Ranch in Lexington. Center and right: A cow grazes and sheep run to their dinner in Floyd County.
Restaurants across the region, meanwhile, are championing “farm to table” fare. The newest of these, The River and Rail in Roanoke, says it changes the menu weekly based on what is available in season from local providers.
employees. It is operated by Good Food-Good People of Floyd, a collaborative of more than 30 farms. Carilion Clinic is also conducting a community health needs assessment for the Roanoke Valley that will consider access to healthy food. (See page 16.)
Farmers Markets The number of farmers markets in the region also keeps growing. There are dozens in western Virginia alone, including ones in Blacksburg, Radford, Pulaski, Tazewell, Troutville, Vinton, Martinsville, Lexington, Staunton, Westlake (Smith Mountain Lake), and Salem. Statewide, the value of sales at farmers markets has more than doubled over the past five years, according to the Virginia Department of Agriculture and Consumer Services. In 2011, sales topped $42 million. Roanoke alone has several farmers markets, including the Roanoke City Market downtown and those at Grandin Village and the West End. Perhaps the newest market is the Farmers Table at Carilion Roanoke Memorial Hospital. Open Tuesday afternoons from May to October, it is one of Carilion Clinic’s programs to promote health in the community— this time primarily among its
Urban Gardens Community gardens are another trend, particularly in Roanoke. Three are now flourishing in the heart of the city: one on 14th St. in southeast Roanoke; another in the Hurt Park neighborhood in southwest Roanoke; and one adjacent to RAM house on Campbell Ave. S.W. All are run by the Roanoke Community Garden Association. Each is open to the public, and individuals can pay $15 to $20 annually for a plot. Gardeners can grow whatever they like, provided they do it organically. The result: fragrant plots carefully tended by long-time Roanoke residents as well as by recent immigrants from Burma, Mexico, Russia, Honduras, the Sudan, and Afghanistan. Most of the 250 gardeners involved grow food for their families. Roanoke native Mark Powell launched the garden association in 2007 while living in an apartment with no land to grow his own food.
His association, which has received grants from local agencies and businesses, is also developing several new gardens—and an urban orchard. “Locations for new gardens and orchards are being scouted,” Powell says. Funding and community participation are also being explored. “Beyond the gardens, there’s much more to come,” he adds. “Expanded access to community markets, more local food in restaurants, community kitchen programs, greenhouse production, rooftop gardens, and yearround hydroponic operations are all
Resources roanokevalleylocavore.com eatwild.com buylocalvirginia.org virginia.org/farmersmarkets localharvest.org slowfoodusa.org vdacs.virginia.gov/vagrown roanokecommunitygarden.org foodforthoughtva.org franklincountyfreshfoods.org plentylocal.org CarilionClinic.org | Fall 2012
Have You Met TED?
Fun and Engaging Talks Win Fans, Build Community
By Su Clauson-Wicker
Moderator katherine Fralin walker introduces a TED talk.
Have you ever wondered what we learn before we’re born? Or how Sixth Sense works? And why good design matters? These are just a few of the topics explored in TED talks given by leaders in their fields, including Steve Jobs and J.K. Rowling, author of the Harry Potter books. The videotaped talks have been watched by millions of people online and are the focal point of TED discussion groups around the world. TED is a nonprofit organization dedicated to what it calls “Ideas Worth Spreading.” It began as a conference to bring together people from the worlds of technology, entertainment, and design, hence the acronym. It has grown into an international phenomenon that now sponsors two annual conferences— one in California and one in Edinburgh, Scotland— along with an annual TED Prize, a Fellows program, a TED talks website, and other projects. The online site offers a thousand free talks on science, psychology, art, business, and other subjects. (Apple also has a TED talks app, Twitter has a feed, YouTube shows the top ten talks, and Linkedin has a TED discussion group.) “We believe passionately in the power of ideas to change attitudes, lives, and ultimately, the world,” says TED’s mission statement. The group challenges “the world’s most fascinating thinkers and doers” to give the talk of their lives in 18 minutes or less. Many have. TED discussion groups are coordinated independently by interested communities and are designed to stimulate discussion
Fall 2012 | CarilionClinic.org
“People trust TED talks to be interesting, and they always are.” — Katherine Fralin Walker
Summer interns from the Taubman Museum of Art were in the front rows at a recent talk. and create connections within the community. Locally, a videotaped talk is shown each Wednesday at noon in downtown Roanoke. Area residents are invited to watch and discuss the talk over a brown bag lunch. Until recently, the talks have been held at the Kirk Avenue Music Hall.* “People trust TED talks to be interesting, and they always are,” says Katherine Fralin Walker, who moderates the event. “I don’t advertise the weekly topics. Once people come, they know TED talks are worthwhile.” Walker and her husband, attorney and developer Ed Walker, own the music hall and believe strongly in the power of individuals within communities to create positive change. Walker is also the founding director of the Batten Leadership Institute at Hollins University. “I usually select the talks the day I show them,” she says. “I want to expose people to something new— not necessarily something they’re already interested in.”
Transportation planner Mark McCaskill values the public policy aspects of TED discussions. Sometimes as many as 40 attend, although on a recent sunny Wednesday, only eight were present. This didn’t bother Walker, who noted that smaller audiences make for better discussions. In Roanoke, the talks attract a diverse group including entrepreneurs, public officials, designers, artists, and retirees. “Everyone has a chance to say something, and no-
TED Topics TED talks cover all types of subjects, including: • Enhancing your creative ﬂow • What’s left to explore? • Plant fuels that could power a jet • Don't regret regret • How games make kids smarter • Health and the human mind • Can astronomers help doctors? • How to make choosing easier • Building the musical muscle • The power of cities • Four lessons from robots about being human • What makes us happy? • How many lives can you live? CarilionClinic.org | Fall 2012
Left: Frequent attendees include ﬁnancial consultant Bob Cole and sustainable design specialist Sharlyn Underwood. Right: katherine Fralin walker leads a discussion.
body can rant,” Walker says. “I ask them to speak their piece in five sentences or less. People tend to glaze over when someone speaks much longer.” “Based on people’s life experiences, reactions to the presentations can be very different,” says Sharlyn Underwood, a Roanokebased specialist in sustainable design who does green building consulting and commercial furniture sales. “The discussions let us safely express these differences. It’s refreshing to spend an hour each week listening, reflecting, forming an opinion, being heard, and being appreciated for who we are as individuals within this community.” “I go because of the public discussion around ideas,” says Mark McCaskill, a senior transportation planner for the Roanoke ValleyAlleghany Regional Commission. “I am a long-range planner and I see TED talks and the discussion that follows as a form of public involve24
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ment in public policy concepts and issues. Hopefully, I can bring some ideas back to the office.” Artist and commercial painter John Wiercioch comes to the talks straight from house painting jobs. “I relish the opportunity to hear a variety of responses to topics,” he says. “Very often my view is enlarged by insights from someone else’s perspective.” Walker also wins praise for her moderating skills. “Katherine is a superb facilitator—she believes in building community,” says Bob Cole, owner of Financial Designers LLC in Roanoke, who’s been attending since 2010. “You can’t find many places where everyone can speak with equal weight the way we can here.” Before the group adjourns each week, Walker asks participants what struck them as they listened to each other. “The audiences here seem really interested in one another’s take,” she says. “Discus-
sions rarely get heated.” She smiles. “But that would be okay too.” * The TED talks are now being held at 16 West Marketplace at 16 West Church Ave. in Roanoke. The new moderator is Aaron Garland, who has a background in recreation management and restoring historic properties. Virginia Tech has also scheduled its own live TEDx event (a regional conference) on Nov. 10, 2012. For information, go to tedxvirginiatech.com/.
Resources • Ted.com • youtube.com/ted • hulu.com/tedtalks • facebook.com/TED • wikipedia.org/wiki/ List_of_TED_speakers
Q & A with Dr. Paul Yeaton, Gastroenterologist By Matthew Sams
Paul Yeaton, M.D., joined Carilion Clinic Gastroenterology last year. An international leader in advanced endoscopic techniques, Dr. Yeaton also joined the faculty of the Virginia Tech Carilion School of Medicine. He brought a new expertise to the region using endoscopic ultrasound to diagnose pancreatic and liver diseases—as well as new options for non-surgical treatments of these illnesses. Recently, Dr. Yeaton discussed his medical background, his experience at Carilion Clinic, and his love of ﬁddling. Q. Why did you choose to be a gastroenterologist? I had a number of careers before choosing medicine, and I ended up spending a lot of time learning to play the fiddle from older people who were sick, and it looked like it was time for me to make a new choice. I felt like medicine was a good opportunity to impact people’s lives.
Q. How does your specialty help patients? Most of my patients are inflicted with yellow jaundice or have conditions of the pancreas, including cancers. I do unique interventions that either make ultimate surgery easier, or they replace the need for surgery.
Q. What makes your practice unique in the region? Probably the most unique service we offer now at Carilion would be endoscopic ultrasound. So much of what I do is a combination of endoscopes, which are devices that are passed into the intestine [to examine it, combined with a type] of radiology, in this case, ultrasound. The scope that’s inserted actually has the ultrasound probe on it, and this allows me to examine organs and structures that are close to the intestine, but outside the intestine. From there, I can make biopsies, I can put drains, or any number of things to provide a non-invasive form of an intervention [rather than surgery].
Q. What do you enjoy about southwest Virginia? The move to Carilion and the Roanoke area was an easy one for me because I love the region. We sit in the heart of old-time music and fiddling, and because I’m a fiddler myself, I was attracted just so I could be immersed in the culture and region.
Q. What else attracted you to Carilion? Another attractive thing for me was the creation of the [Virginia Tech Carilion] medical school. Carilion Clinic has a strong foundation in patient care and this represented, for me, the opportunity to build on that foundation and to create an environment where we not only offer exceptional care for our patients, but also we create the new generation of doctors and physician educators. For more information, call 540-266-6000 or 800-422-8482.
To watch a video of the interview with Dr. Yeaton, scan this code. CarilionClinic.org | Fall 2012
Correcting Carpal Tunnel — and an Unstable Hip: A Patient’s Story By Randolph Walker
Carleen Ellis spent her working life teaching future nurses. So when she had surgery recently at Carilion Roanoke Memorial Hospital, she kept a professional eye on her caregivers. Ellis, 83, was facing two problems —fingers that went to sleep, and an unstable hip. The numbness in her fingers was mostly just an irritation, until she had trouble gripping the steering wheel. “I'd be driving long distances and my hands would go to sleep,” she says. Carpal tunnel syndrome was diagnosed by Deborah Robinson, a nurse practitioner at Carilion Family Medicine, North Roanoke. After consulting with hand surgery specialist Cesar Bravo, M.D., Ellis had outpatient surgery last December. Carpal tunnel release is just one of many orthopaedic services offered by Carilion, according to Dr. Bravo. “More than 25 orthopaedic physicians are available, and the majority of them are fellowship-trained,” he says. “We have one of the largest comprehensive practices in the state.” Even as she recovered, Ellis knew she would be facing another surgery, this one more complicated. For a decade, her right hip had been unstable, combining with a back problem to slow down an active woman. “I was at the point of getting someone to help with
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buying groceries—grocery shopping would totally exhaust me,” says Ellis, an independent living resident at Friendship Retirement Community in Roanoke. In February, Ellis had hip replacement surgery by Phillip Patterson, M.D. Five months post-surgery, the benefits were apparent. “I was amazed when casual acquaintances said to me, ‘You’re taller now, you’re standing better.’ That told me a lot.” Ellis found both surgeries to be positive experiences. “Carilion’s operative experience—the same-day surgery and the inpatient surgery—were highly personalized,” says Ellis, who taught at Arizona State and the University of Arizona before retiring and moving to Roanoke. “The nursing care that I observed being given to others, plus what I experienced myself, makes me really proud to be a nurse. “I can't say enough about the caring staff on 9 West. Safety and comfort were their obvious priorities, and they are good at what they do.” Ellis also gives high marks to her surgeons, their office assistants, the pre-op staff, and the recovery room nurses. “The entire experience, beginning with the excellent valet service at the Riverside complex and on through the follow-up, earns my highest praise.”
da vinci Surgical System Arrives in the New River Valley By Allison Buth
A robotic surgical system that lets surgeons perform complex operations with a few tiny incisions is now available at Carilion New River Valley Medical Center (CNRV) for gynecologic procedures. The state-of-the-art da Vinci Surgical System will give New River Valley patients access to the latest advancements in minimally invasive surgery. “We are proud to offer a new level of surgical service to New River Valley residents,” says John Piatkowski, M.D., vice president and hospital administrator at CNRV. “This is yet another step in our development as the premier center for medical care in the area.” “Patients and their families continue to realize world-class care is no longer an hour plus commute from Blacksburg, Wytheville, etc. It is available right here at Carilion New River Valley Medical Center.” The da Vinci system allows surgeons to perform difficult surgeries with increased accuracy by controlling the tiny, precise hands of the robot to execute movements about five times smaller than they could achieve with their own hands. Patients in turn have shorter hospital stays, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, and quicker recoveries. Using the da Vinci system, a surgeon sits at a console showing a 3-D image of the surgical field. He or she then uses instrument controls below the display to precisely maneuver the surgical instruments. From a clinical perspective, surgeons benefit from greater surgical precision, increased range of motion, improved dexterity, enhanced visualization, and improved access. The da Vinci system, which has been praised as an effective alternative to both traditional open and laparoscopic surgery, is also available at Carilion Roanoke Memorial Hospital.
Top (L to R): Cecilia Irvin, R.N., Tamera Howell, M.D., and Alice Huﬀ, R.N. with the da vinci Surgical System at Carilion New River valley Medical Center. Left and below: Dr. Howell at the instrument panel.
For more information, go to CarilionClinic.org/davinci.
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New Providers Leading Trauma Surgeon Joins Carilion Clinic Bryan Richard Collier, D.O., a surgeon who specializes in trauma, critical care, and nutrition, has joined Carilion Clinic. He is board certiﬁed in general surgery and surgical critical care and is a certiﬁed nutrition specialist-physician. Dr. Collier comes to Carilion from Vanderbilt University Medical Center in Nashville, where he served in several capacities, including as associate director for surgical critical care education. At Vanderbilt University School of Bryan Richard Collier, D.O. Medicine, he served as assistant professor of surgery and internal medicine. Since 2008, he has also been a clinical adjunct faculty member at Lincoln Memorial University’s DeBusk College of Osteopathic Medicine. He has been active in research, acting as lead investigator on two sepsis studies and as sub-investigator on
11 other trials. He has served as a manuscript reviewer for several peer-reviewed medical journals, including The New England Journal of Medicine, Hospital Practice, and the Journal of Emergencies, Trauma, and Shock. While in Tennessee and Pennsylvania, Dr. Collier volunteered in several community organizations including the Vanderbilt University Medical Center’s Shade Tree Family Clinic in Nashville, which provides free medical care to those without health insurance. He also volunteered at the Johnstown Free Medical Clinic in Johnstown, Pa. He received his D.O. degree from the Philadelphia College of Osteopathic Medicine and completed his internship and residency at Memorial Medical Center in Johnstown, Pa. He did his fellowship in surgical critical care and trauma at Vanderbilt University Medical Center. He practices at 3 Riverside Circle in Roanoke and can be reached at 540-224-5170.
Heart Specialist Joins Carilion Clinic Jason R. Foerst, M.D., whose specialties are interventional cardiology and structural heart disease, brings expertise in a new advanced heart procedure to Carilion Clinic. Dr. Foerst has just completed a fellowship at the University of Dusseldorf in Germany and training in a minimally invasive procedure called Transcatheter Aortic Valve Implantation, or TAVI. It is a life-extending option for patients who are too high-risk for open-heart surgery. Jason R. Foerst, M.D. Called one of the most revolutionary developments in cardiology in the past decade, TAVI can help those with a severely narrowed aortic valve. During the procedure, a special heart valve made of cow tissue and stainless steel is passed through an artery in the leg up to the heart using a tube, or catheter. Special imaging equipment helps
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guide the valve into place. Dr. Foerst most recently served concurrently as staﬀ physician at the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and the V.A. Medical Center in White River Junction, Vt. He won the Excellence in Teaching Award nine times while at Dartmouth-Hitchcock. He also taught at Dartmouth Medical School. He has published numerous articles about the natural history of coronary stents and recently completed book chapters on coronary thrombectomy and the pathology of drug eluting stents. Dr. Foerst received his M.D. degree from the University of Missouri at Columbia School of Medicine. He completed his residency in internal medicine, and postdoctoral training in cardiovascular disease and interventional cardiology, at Dartmouth-Hitchcock Medical Center. He practices at 127 McClanahan St. and 2001 Crystal Spring Ave. in Roanoke and can be reached at 540982-8204 and 540-266-6505, respectively.
Lisa Alleyne, M.D. Family Medicine
Joseph Ferrara, M.D. Neurology
Education: Liberty University Medical Degree: Eastern Virginia Medical School Residency: Lancaster General Hospital 1371 Lee Highway, Verona, VA 24482 540-248-3413
Education: Bates College Medical Degree: SUNY Upstate Medical Center Residency: Duke University Medical Center Fellowship: Baylor College of Medicine 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
Saira Arif, M.D. Psychiatry
Jason R. Foerst, M.D. Interventional Cardiology
Education: Government Science College, Karachi, Pakistan Medical Degree: Dow Medical College Residency: UVa Roanoke-Salem Psychiatry Program Fellowship: Carilion Clinic 2017 South Jeﬀerson St., Roanoke, VA 24014 540-981-8025
Education: University of Missouri - Columbia Medical Degree: University of Missouri - Columbia School of Medicine Residency: Dartmouth-Hitchcock Medical Center Fellowship: Dartmouth-Hitchcock Medical Center; University of Dusseldorf, Dusseldorf, Germany 127 McClanahan St., Roanoke, VA 24014 540-982-8204
Amy K. Barnhart, M.D. Pediatrics
David Edward Johnsen, M.D. Radiology
Education: University of Virginia Medical Degree: American University of the Caribbean School of Medicine Residency: Medical College of Virginia Hospitals 4040 Postal Drive, Roanoke, VA 24018 540-772-4453
Education: University of Chicago Medical Degree: Medical College of Virginia Residency: Geisinger Medical Center 2900 Lamb Circle, Christiansburg, VA 24073 540-731-2000
Brandon Coates, M.D. Family Medicine and Urgent Care
Karol L. Gordon, D.O. Family Medicine and Urgent Care
Education: Hampden-Sydney College Medical Degree: Virginia Commonwealth University School of Medicine Residency: Carilion Clinic 46 Wesley Road, Daleville, VA 24083 540-591-9440
Education: Blueﬁeld College Medical Degree: West Virginia School of Osteopathic Medicine Residency: Carilion Clinic Fellowship: Carilion Clinic 434 Peppers Ferry Road, Christiansburg, VA 24073 540-382-6000
Bryan R. Collier, D.O. Trauma and Surgical Critical Care
Anthony L. Loschner, M.D. Pulmonary and Sleep Medicine
Education: Wake Forest University Medical Degree: Philadelphia College of Osteopathic Medicine Residency: Memorial Medical Center Fellowship: Vanderbilt University Medical Center 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
Medical Degree: Charles University First Faculty of Medicine, Prague Residency: University of North Carolina School of Medicine Fellowship: West Virginia University 2001 Crystal Spring Ave., Suite 205, Roanoke, VA 24014 540-985-8505
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Providers Vydia Permashwar, M.D. Pediatrics
Richard Weiss, M.D., M.B.A. Physical Medicine and Rehabilitation
Education: The University of the West Indies School of Medicine Medical Degree: The University of the West Indies School of Medicine Residency: Children’s Hospital of Michigan 1030 South Jeﬀerson St., Roanoke, VA 24016 540-985-8230
Education: Duke University Medical Degree: St. George’s University School of Medicine Residency: Pitt County Memorial Hospital Fellowship: Orthopaedic Specialists of the Carolinas 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
A D VA N C E D C A R E P R O V I D E R S
Jose Rivero, M.D. Cardiology
Jessica D. Hall, M.S.N., F.N.P.-B.C. Nurse Practitioner, Family Medicine
Education: University of Miami Medical Degree: American University of the Caribbean Residency: Brooklyn Hospital Center Fellowship: Brooklyn Hospital Center 1201 Elm St., Christiansburg, VA 24073 540-382-6711
Undergraduate Degree: Blueﬁeld State College Graduate Degree: Marshall University 141 Ben Bolt Ave., Tazewell, VA 24651 276-988-8850
Randall A. Ruppel, M.D. Pediatric Critical Care
Edward McDowell, P.A.-C. Physician Assistant, Orthopaedics
Education: Kalamazoo College Medical Degree: University of Michigan Medical School Residency: Children's National Medical Center Fellowship: Children's Hospital of Pittsburgh 1906 Belleview Ave., Roanoke, VA 24014 540-981-7000
Undergraduate Degree: Winston-Salem State University Graduate Degree: Wake Forest University, Physician Assistant Program 2900 Lamb Circle, Suite 380, Christiansburg, VA 24073 276-773-8145
John Sedovy, M.D. General Surgery
Heather Norden, M.S.N., F.N.P.-B.C. Nurse Practitioner, Family Medicine
Education: Temple University Medical Degree: Temple University Residency: Carilion Roanoke Memorial Hospital 100 Spottswood Drive, Lexington, VA 24450 540-463-7108
Undergraduate Degree: Hope College Graduate Degree: University of North Carolina, Chapel Hill 205 Roanoke St., Christiansburg, VA 24073 540-381-6000
Pheston G. Shelton IV, M.D. Child Psychiatry and Behavioral Medicine
Randal Luke Swatzyna, P.A.-C. Physician Assistant, Family Medicine
Education: East Carolina University Medical Degree: Brody School of Medicine Residency: Brody School of Medicine Fellowship: Brody School of Medicine 2017 S. Jeﬀerson St., Roanoke, VA 24014 540-981-8025
Fall 2012 | CarilionClinic.org
Undergraduate Degree: Roanoke College Graduate Degree: Jeﬀerson College of Health Sciences 1314 Peters Creek Road, Roanoke, VA 24017 540-562-5700
Sharing Stories By Laura Markowski
Quilts Commemorate 30 Years of Open-heart Surgery Every quilt square tells a story. Many bear images of hearts. Some contain thank you notes to doctors and nurses. All are eloquent reminders of patients who’ve had open-heart surgery at Carilion Roanoke Memorial Hospital. Now, on the 30th anniversary of open-heart surgery in the region, 74 quilts line four floors of Roanoke Memorial. And their squares were all created by patients or their families. What began in 1992 as an idea to celebrate the 10th anniversary of open-heart surgery here has become an ongoing symbol of cardiac care at Carilion Clinic. When heart patients were first asked to decorate a quilt square, hospital staffers only expected to get a few dozen squares back. “But we received about 1,600,” says Cathy Jennings, R.N., D.N.P., a clinical nurse specialist and leader of the quilt project. “It was meant to be a one-time thing, but after the initial quilts were completed, we kept getting requests to create more. So we did!” The only requirements were that the squares had to include the patient’s name and surgery date. Anything else was up to the patient. “It’s amazing how much thought patients and families have put into their squares,” Jennings says. “Each time I think I’ve seen every possible design, another totally unique square comes in. It’s wonderful to see such creativity — and the pride our patients take in their squares.” People also view the quilts as a memorial to their
loved ones. “Recently a mother was waiting while her son had surgery and actually found her husband’s square on a quilt in the waiting room,” Jennings says. “Her husband had since passed away,
Setting the Standard As leaders in cardiac care, Carilion Clinic performs advanced heart procedures every day. Carilion Roanoke Memorial Hospital, for instance, is the only hospital in the region to oﬀer transcatheter aortic valve implantation (TAVI) for patients with advanced valve disease, who are too sick to undergo open-heart surgery. Last year 1,839 cardiac patients were transferred to the hospital for advanced care from 36 other hospitals, including three in West Virginia. but seeing his square was special to her.” Carilion Clinic’s entire cardiac team takes pride in the impact their care has had on so many patients and their families.
CarilionClinic.org | Fall 2012
Your Calendar for Better Health Fall 2012 wOMEN’S HEALTH UNIvERSITY
wELL BABY CARE
A registered nurse covers the basics of caring for a newborn 7 – 9 p.m. Carilion New River Valley Medical Center Fireside Room B $10 Please call 540-266-6000 to register.
Women Take Charge of Health: Leading the Way in Health Care 11:30 a.m. – 1 p.m. Jefferson Center, Roanoke $15 (includes lunch) Please call 540-266-6000 to register.
8 a.m. Carilion Franklin Memorial Hospital Free Please call 800-422-8482 to register.
4TH FRIDAY DANCE
Every Fourtahy Frid
Every 4th Friday of the month starting Sept. 28 All levels are welcome for a one-hour dance lesson. Stay and continue dancing until 10:30 p.m. Latin and swing music. No partner required! 7:30 – 10:30 p.m. Roanoke Athletic Club $10/non-members; $8/members For more information, please call 540-772-2238.
ROANOkE HEART wALk
Heart-healthy three-mile walk, benefiting the American Heart Association 9 a.m. Green Hill Park
PHYSICIANS ON FOOT
POSITIvELY PINk PARADE AND PARTY
11 a.m. – 12:30 p.m. Begins at Panera Bread at Valley View Mall For more information, please call 800-422-8482.
Every ay Meet at the corner of HamilSaturd ton Terrace and Belleview Avenue (in front of Carilion Roanoke Memorial Hospital) through October. Rain location: Tanglewood Mall Beginning in November, meet inside Tanglewood Mall. For more information, please call 800-422-8482 or visit CarilionClinic.org/walking.
For more events, classes, and screenings, visit CarilionClinic.org/calendar or call 540-266-6000. 32
Fall 2012 | CarilionClinic.org
velocityCare Opens across Region velocityCare, a new urgent care service by Carilion Clinic, has opened in Roanoke, Christiansburg, Daleville, and westlake (Smith Mountain Lake). Designed to bridge the gap between primary care and the emergency room, VelocityCare provides walk-in medical services for non-life-threatening illnesses and injuries. These include allergic reactions, back injuries, bee stings, upper respiratory illnesses, coughs, colds, sore throats, earaches, eye infections/irritations, minor burns, minor cuts and wounds, rashes, sprains, and sports-related injuries. Many medical services are also available, including: • Sports physicals • Occupational health services • Common prescriptions • Lab and X-ray services • Routine and seasonal vaccinations (call 48 hours in advance) VelocityCare is open seven days a week with extended hours. No appointments are necessary. For more information, go to velocitycarebycarilion.com.
Roanoke 4035 Electric Road, Suite A Roanoke, VA 24018 540-772-8670 Christiansburg 434 Peppers Ferry Road Christiansburg, VA 24073 540-382-6000
Daleville 46 Wesley Road Daleville, VA 24083 540-591-9440 Westlake 13205 Booker T. Washington Highway Hardy, VA 24101 540-719-1815 Opening day celebrations were held in (top to bottom) Roanoke, Daleville, and Christiansburg.
CarilionClinic.org | Fall 2012
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MEET TEAM DIANE Coordinated care for gynecologic cancers here in our community
After learning she was at risk of ovarian cancer because of her genetics, Diane decided to take a proactive step and sought the care of Carilion Clinic’s gynecologic oncology practice. Diagnosed with ovarian cancer in 2006, Diane has been treated by a coordinated care team, led by
“I’ve had ﬁve surgeries, four rounds of chemotherapy, I’m in remission, and I feel great! It’s all thanks to Dr. Scribner and his team.” — Diane williams ovarian cancer survivor
Dennis Scribner, M.D., and Janet Osborne, M.D., both board-certiﬁed gynecologic oncologists. To learn more about Diane’s story or Carilion Clinic’s gynecologic oncology services, please call 800-422-8482 or visit CarilionClinic.org. Pictured L-R: Dennis Scribner, M.D.; Janet Osborne, M.D.; Thuy Vu, genetic counselor; Nicole Bush, L.N.P.; Lisa Manning, R.N.
Inspiring better health.™ CarilionClinic.org | 800-422-8482