Carilion Clinic

Inspiring better health.

FALL 2014

in this issue TREATING TEEN SPORTS INJURIES 8 THE HAZARDS OF DISTRACTED DRIVING 10 EXERCISE HELPS KEEP YOU SHARP 14 RX: READ TO YOUR KIDS 26

Exercise and Alzheimer’s: REGULAR EXERCISE CAN PREVENT OR DELAY MANY ILLS OF AGING

David Hurley of Roanoke County ran his fifth Blue Ridge Marathon this year at 72.

We were with Dave the moment he had his heart attack...

president’s message Alzheimer’s disease is a frightening prospect, but there are steps you can take to lower your risk. Exercising regularly, for instance. Older adults who exercise have a 40 percent lower chance of developing the disease, according to a recent study. In our cover story, Alison Weaver delves into the latest research and interviews local residents who are over 65 but still running or walking in marathons, rowing, or doing strength training. They are living proof that you can keep exercising at any age — and be healthier and happier for it.

...and we’ve been with him every step of the way since. Dave Cornett thought he was just having bad indigestion, but something much more serious was happening—a heart attack. After calling 911, Dave was rushed to Carilion Roanoke Memorial Hospital. Thanks to our Heart Alert program, our heart care team was ready and quickly diagnosed that Dave was having a massive heart attack. He was fast-tracked from the emergency room straight to our catheterization lab for life-saving treatment. Now Dave is recovering in our cardiac rehabilitation program, gaining strength every day.

We also take a look at the problem of distracted driving. Every day, more than nine Americans are killed and 1,000 injured in crashes involving distracted drivers. What most people don’t realize is that looking away from the road for five seconds to send or read a text message can be as dangerous as driving drunk. Dan Smith explores the extent of the problem in our region. In this issue, we introduce you to Mark Schoemann, M.D., Carilion’s first pediatric plastic surgeon, who brings Nancy Howell Agee (right), speaks with a Carilion Clinic employee. new skills to our region. Among other things, he is an expert in correcting a cleft lip or cleft palate, both birth defects. And we take you behind the scenes of a new program at local high schools, where Carilion certified athletic trainers are helping to prevent or treat injuries. Ever wonder how important it is to read to your kids? The American Academy of Pediatrics now recommends that parents read to them daily. Why? Reading stimulates brain development and helps children learn language skills, giving them a foundation for success in school and life. Our article also has suggestions on how to find age-appropriate books. Take a look. Your children will thank you!

By coordinating care inside and outside of the hospital, our nationally accredited Chest Pain Center and heart care team are helping patients live for the moments that matter. To watch Dave’s story and learn more about our Heart Alert program, visit CarilionClinic. org/heart.

Dave Cornett, 58 Roanoke, Va.

WARM REGARDS,

NANCY HOWELL AGEE PRESIDENT AND CEO CARILION CLINIC

If you experience any of the signs of a heart attack, call 911 immediately. | CarilionClinic.org/heart

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contents

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, she lives in Bridgewater.

Karen A. Chase is an award-winning novelist who has also written for Virginia publications such as The Richmond Times-Dispatch. She is writing a historical novel about the Declaration of Independence. She lives in Richmond.

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 Shirley Holland SENIOR DIRECTOR, MARKETING Mike Dame BRAND MANAGER Linda Staley EDITOR Maureen Robb

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LEAD DESIGNER David Porter DESIGNER Taryn Anderson

Dan Smith is an award-winning journalist and photographer, an essayist on public radio, and a member of the Virginia Communications Hall of Fame. He is the author of a novel and several nonfiction books.

Randolph Walker is a writer and musician in Roanoke. Formerly a staff writer with The Roanoke Times, his work has appeared in many publications including Virginia Living, Valley Business Front, and The Roanoker.

Alison Weaver is a freelance writer based in Roanoke. Her work has appeared in Valley Business Front, The Roanoke Times, Good Housekeeping, Woman’s Day, Redbook, and Seventeen.

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features

CONTRIBUTING WRITERS Karen Doss Bowman, Allison Buth, Karen A. Chase, Su Clauson-Wicker, Jay Conley, Sarah Cox, Bruce Ingram, Dan Radmacher, Dan Smith, Erica Stacy, Randolph Walker, Alison Weaver

5 SERVICE 

PHOTOGRAPHERS Darryle Arnold, Jared Ladia

Carilion trainers work in schools to help athletes.

Carilion CEO is named to a national post.

8  SPORTS INJURIES 

10  DISTRACTED DRIVING 

PRINTING Chocklett Press

It only takes a second to cause an accident.

12  BIRTH DEFECTS 

CARILIONCLINIC.ORG | 800-422-8482

departments 1  PRESIDENT’S MESSAGE  Exercise is good for your brain.

Carilion Clinic is a not-for-profit health care organization based in Roanoke, Va. Through our comprehensive network of hospitals, primary and specialty physician practices, and other complementary services, we work together to provide quality care close to home for nearly 1 million Virginians. With an enduring commitment to the health of our region, we also seek to advance care through medical education and research to help our community stay healthy and inspire our region to grow stronger. Copyright 2014 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.

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28  BETTER LIVING  How to quit smoking.

18 CO-WORKING 

It’s a new option for many professionals.

26  CHILD HEALTH 

6  IN YOUR COMMUNITY  New physicians and advanced care providers.

You can stay active and mentally sharp longer.

Why eating nuts may be good for you.

Tips from Carilion Clinic medical professionals.

21  NEW PROVIDERS 

14 AGING 

24 NUTRITION 

4  HEALTHY LIFESTYLES  Making a difference in western Virginia.

A pediatric plastic surgeon brings new skills to the region.

Reading to your kids pays dividends.

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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 direct@carilionclinic.org, or write to us at Strategic Development, 213 McClanahan St., Roanoke, VA 24014.

2    FALL 2014 | CarilionClinic.org

  CarilionClinic.org | FALL 2014    3

HEALTHY LIFESTYLES

tips from our medical professionals GLUTEN-FREE: HIP OR HYPE? The gluten-free industry is growing every year — doubling over the last two years to an estimated $10.5 billion in value. While restricting gluten or removing it from your diet can help manage symptoms of celiac disease such as abdominal pain and bloating, it isn’t a step you should take before getting tested. If you are considering a gluten-free diet, consider having formal laboratory screening for celiac disease first before embarking on this expensive and difficult diet.  — Richard A. Cordle, M.D., Pediatric Gastroenterology, Carilion Clinic Children’s Hospital SEEK OUT WAYS TO BE ACTIVE With such busy lives, many people struggle to find time to exercise on a daily basis. My health tip is to seek out the little things that will all add up on the days where the time just may not be there. Parking your car at the end of the lot, taking the stairs instead of the elevator, and using your lunch break to squeeze in a 20-minute walk are just a few examples of these little things. They don’t replace exercising, but they are healthier alternatives when busy schedules get the best of us.  — Jenna Kellstrom, Certified Physician Assistant Carilion Clinic Family Medicine, Vinton

SLEEP SOUNDLY IS IT HARD TO GET TO SLEEP? Avoid electronic devices for at least two hours before bed. The bright, full-spectrum light from tablets, computers, books, and phones affects sensors in your retina (back of the eye). These sensors send information to your thalimus, which is part of the brain stem that controls some automatic bodily functions. This causes arousals and will delay your ability to fall asleep. Likewise, do not turn on such devices if you wake up in the middle of the night. It will make it harder to go back to sleep.  — Frank H. Biscardi, M.D., Carilion Clinic Pulmonary and Sleep Medicine, Roanoke 4    FALL 2014 | CarilionClinic.org

IS IT A GALLBLADDER ATTACK? Gallbladder disease is very common. Gallbladder attacks often occur after a meal. Symptoms include pain or pressure in the upper abdomen and beneath the ribs, back pain, right shoulder-blade pain, nausea, or vomiting. The symptoms may last for several hours. Over time, gallbladder attacks may increase in frequency and intensity, prompting individuals to seek urgent care. An ultrasound of the abdomen is the most common test used to diagnose gallbladder problems. It is recommended that you see your primary care physician for evaluation of gallbladder disease. — Annette F. Dickerson, Certified Physician Assistant Carilion Clinic General Surgery, Roanoke WHY EAT BREAKFAST? Studies show that breakfast eaters tend to weigh less than breakfast skippers. This is believed to be due to the fact that eating a healthy breakfast reduces hunger throughout the day and helps people make better food choices at later meals. Eating too much for lunch and dinner will give you too many carbohydrates and calories that your body won’t be able to break down. Other benefits of a healthy breakfast include increased energy and concentration throughout the day, and better blood sugar and cholesterol control.  — Matt Schneider, M.S.P.A., Certified Physician Assistant Carilion Clinic Family Medicine, Blue Ridge WHEN SHIFT WORK DISRUPTS SLEEP Shift work is associated with a number of chronic health problems, including diabetes and heart disease. Getting adequate quality sleep can be challenging for those of us who work night shift. These tips may help: make sleep a priority; wear sunglasses after work and avoid direct exposure to bright lights; turn off your phone and other electronic devices; avoid caffeine for at least two hours before bed; optimize your sleep environment — lower the temperature, invest in room-darkening shades, and use a sound machine.   — Laura Jones, Family Nurse Practitioner, Hospitalist Group, Carilion Stonewall Jackson Hospital, Lexington

Agee Named to National and State Posts Carilion Clinic President and CEO Nancy Howell Agee was named to the American Hospital Association’s Board of Trustees. She is one of eight new members from around the country selected to serve three-yearterms beginning January 1, 2015. “Nancy’s election to this prestigious board is reflective of the growing national reputation of Carilion and its leaders,” says James Hartley, chairman of the Carilion Clinic Board of Directors. The AHA is a not-for-profit association that serves as the national advocate for nearly 5,000 hospitals, health care systems, networks, and other providers of care. “I am honored to join the board of this exceptional organization and support its vital mission to improve the health of our communities,” Agee says. GOVERNOR’S ADVISORY COUNCIL

Agee was also recently appointed to the Governor’s Advisory Council on Revenue Estimates by Virginia Gov. Terry McAuliffe. The council is one of two bodies that advise the governor and the secretary of finance on revenue projections as they develop the state’s budget. As one of Virginia’s business leaders selected for this role, Agee will also represent the perspective of health care providers during the development of the state’s financial plan. BUSINESS HALL OF FAME

The American Hospital Association is the national organization that represents and serves nearly 5,000 hospitals, health care systems and networks, and other medical providers. AHA represents its members in national health policy development, legislative and regulatory debates, and judicial matters. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends.

Nancy Howell Agee was appointed to the Board of Trustees of the American Hospital Association.

Closer to home, Junior Achievement of Southwest Virginia has named Agee to the region’s Business Hall of Fame. She will be recognized during a ceremony at the Hotel Roanoke & Conference Center on Oct. 21, along with Boxley Materials Co. President and CEO Abney Boxley. They will join 49 other individuals who have been inducted into Junior Achievement’s regional Business Hall of Fame. 

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IN YOUR COMMUNITY

ROANOKE MEMORIAL RANKED FOURTH IN STATE

Carilion Roanoke Memorial Hospital was ranked the fourth best hospital in Virginia by U. S. News & World Report. The hospital was also recognized for having 10 high-performing adult specialties: cardiology and heart surgery; diabetes and endocrinology; gastroenterology and gastrointestinal surgery; geriatrics; gynecology; nephrology; neurology and neurosurgery; orthopaedics; pulmonology; and urology. These services treat the chronic conditions that cause the most harm. U. S. News & World Report issues its list of best hospitals around the country annually.

CARILION HOSPITALS EARN EXCELLENCE AWARDS Carilion Clinic hospitals received eight awards for excellence from Professional Research Consultants, a national health care research firm. Carilion Giles Community Hospital won four five-star inpatient services awards for communication with doctors, with nurses, and about medications, and for discharge information. The hospital’s Emergency Department services also won a four-star award for overall quality of care. Endoscopy at Carilion Roanoke Community Hospital and the Neonatal Intensive Care Unit at Carilion Clinic Children’s Hospital each won a five-star award for overall quality of care. Carilion Stonewall Jackson Hospital in Lexington received a five-star inpatient services award for communication with doctors.

Carilion Supports Virginia Science Festival

Carilion Partners with Feeding America Carilion Clinic is partnering with Feeding America Southwest Virginia to provide health education and health screenings. Carilion health educators will accompany Feeding America’s new mobile food wagon as it makes scheduled stops in low-income neighborhoods to distribute fruits and vegetables. Health educators will provide information on diabetes prevention and the importance of good nutrition, as well as health screenings.

Medical Center Named Employer of the Year

Healing Arts Program Welcomes ‘Burden Boat’ The Burden Boat, an interactive work of art designed to help people release their burdens, is on display at Carilion Roanoke Memorial Hospital. Created by artist Kurt Steger to help promote healing after the 2007 Virginia Tech shootings, the sculpture has been shown at the Smithsonian in Washington, D.C., and elsewhere. The public is invited to write down their burdens on bits of paper and place them in the boat, for release in a ceremony on Nov. 19 at 5 p.m. in the hospital lobby. “This is an uplifting event and a time for reflection and celebration, of moving forward in our lives and becoming wiser from our experiences,” says Steger. Carilion Clinic acquired the sculpture with contributions made to The Dr. Robert L. A. Keeley Healing Arts Program. 6    FALL 2014 | CarilionClinic.org

Eat a Pancake, Support Cancer Care

Famous Anthony’s will again sell pink pancakes in support of the Carilion Clinic Breast Care Center. Last year the restaurant sold over 5,000 pancakes and raised more than $1,000 for the center. The pancakes will be available throughout October (Breast Cancer Awareness Month) at all nine Famous Anthony locations in Roanoke, Lynchburg, and the New River Valley. For more information on breast cancer awareness, visit CarilionClinic.org/yesmamm.

Carilion New River Valley Medical Center was named 2014 Employer of the Year by the Virginia Division of Career Development and Transition. The award stemmed from the hospital’s work with Project Search, a national program that provides skills training for young adults with disabilities. Over the past four years, more than a dozen students have participated in Project Search at the hospital, with five being hired.

Carilion Clinic is a sponsor of the first Virginia Science Festival, to be held Oct. 4 in Blacksburg and Oct. 11 in Roanoke. Organized by the Science Museum of Western Virginia and Virginia Tech, the event will feature more than 100 exhibitors, hands-on activities, live performances, interactive demonstrations, and family-oriented science entertainment. The festival will showcase research and technical achievements in Virginia, with a goal of inspiring an interest in science as a career. It is hoped that the festival will become Virginia’s biggest annual celebration of science and technology. Visit virginiasciencefestival.org.

Outpatient Surgical Center Opens

The newly renovated Carilion Community Ambulatory Surgery Center is now seeing patients. The outpatient center houses operating rooms, procedure rooms, and expanded pre-op, post-op, and family areas, all designed with patient comfort and convenience in mind. The center is located within Carilion Roanoke Community Hospital.

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MEDICAL NEWS

G N I T A E TR S ’ N E E T A S T R O SP INJURY

Kaitie Mast, a senior at Rockbridge County High School, enjoys softball practice at the school (at left and right). Carilion Clinic Certified Athletic Trainer Courtney Simpkins (far right) pitches a ball to Kaitie.

How It Changed Her Life Story by Allison Buth  |  Photos by Jared Ladia Kaitie Mast has always loved sports. She has played volleyball, basketball, and softball throughout her years at Rockbridge County High School, where she is now a senior.

But playing so many sports, particularly ones that require overhead activity, eventually caught up with her. “I first noticed a lump on my collarbone,” Mast says. “But I’m used to playing through pain, and I don’t like to rest.” She kept playing through discomfort. When she started having shooting pain in her shoulder, Mast could no longer ignore her injury. That’s when she enlisted the aid of her certified athletic trainer. Through a community partnership, Carilion Clinic provides certified athletic trainers to work at many area high schools, offering a constant presence 8    FALL 2014 | CarilionClinic.org

READY AT A MOMENT’S NOTICE Carilion Clinic’s certified athletic trainers work on-site at many area high schools and are available the instant they’re needed, treating sprains, fractures, and other injuries. Carilion doctors also act as team physicians for almost every high school in the Roanoke Valley. Together they provide an ongoing presence in the schools and at sports events to give students the quickest and best care. For more information, go to CarilionClinic.org/sports-medicine.

in the schools and at sporting events. They in turn collaborate with physicians and other specialists to provide injury

prevention, emergency care, clinical diagnosis, therapeutic intervention, and rehabilitation. They also make sure that care is coordinated among the athletes and their physicians, coaches, and parents. DIAGNOSING HER INJURY

“Kaitie came in complaining of numbness and tingling in her right arm and had a pronounced collarbone,” says Courtney Simpkins, Carilion’s certified athletic trainer at Rockbridge County High School. “In coordination with Carilion’s sports medicine program, we had Kaitie try strength-training exercises and rest to see if the issue resolved.” When Mast didn’t improve, Simpkins referred her to Brent Johnson, M.D., a Carilion orthopaedic surgeon and sports medicine physician.

“Kaitie had an overuse injury,” Dr. Johnson says. “Overuse injuries occur when there is damage to a bone, muscle, or ligament due to repetitive stress. Kaitie’s sports involve a lot of overhead activity, which resulted in increased motion of a portion of her shoulder blade which had not developed fully. It is a normal variant that we see from time to time. This created irritation of her rotator cuff.” After reviewing her options, Mast underwent arthroscopic surgery to remove the unstable portion of her scapula. Following surgery, she began a rehabilitative program, with Simpkins overseeing her recovery. “A week after my surgery, I started rehab exercises with Courtney,” Mast says. “During my study-hall period, Courtney helped facilitate my first round of rehab exercises for the day. I also met with her after school to do more rehabilitative work.” CATCHING INJURIES EARLY

“There are so many benefits that certified athletic trainers provide to the health care team and to the athlete,” says Dr. Johnson. “One big advantage is that they can catch and diagnose issues much sooner.

“Our certified athletic trainers are capable of making diagnoses and can begin treatment, with physician supervision, very quickly,” he says. “They are critical in the treatment, as well as the prevention of injuries.” They also help athletes like Mast follow their rehab programs and recover from injuries. Six weeks after her surgery, Kaitie was cleared to begin volleyball practice again, with some restrictions. “Honestly, Kaitie couldn’t have been a better patient,” says Simpkins. “She did rehab with me twice a day, five days a week, and followed instructions. And it was easy to communicate with Dr. Johnson and his team as Kaitie progressed so we could modify her Dr. Brent Johnson care.” After several months of physical therapy, Kaitie was cleared for overhead play and happily got back to playing without restrictions. “I was able to participate in a playoff game for volleyball, which was cool,” Mast says. “And everything is perfect now. I don’t have pain, and I had a great experience with everyone involved in my care.”

LOCAL SCHOOLS WIN SAFE SPORTS AWARD Aided by Carilion Clinic physicians and certified athletic trainers, these schools have been recognized for their safe athletic programs: Cave Spring High School; Floyd County High School; Franklin County High School; Giles County High School; Hidden Valley High School; Narrows High School; Northside High School; Pulaski County High School; Rockbridge County High School; and William Byrd High School. The schools each won a Safe Sports School Award from the National Athletic Trainers’ Association. The award recognizes secondary schools that take the crucial steps to keep their athletes injury-free.

Her experience also yielded an unexpected bonus. “After the entire experience with Courtney, Talena Williams, [a certified physician assistant], and Dr. Johnson, I decided that I want to pursue a career in sports medicine!” Kaitie says. “I want to be able to help other athletes, just as they helped me.” 

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REGIONAL INTEREST

G N I V I R D D E T C A R T DIS It Can Be as Dangerous as Drunk Driving By Dan Smith Each day more than nine Americans are killed and 1,000 injured in crashes involving distracted drivers.

In 2012, that came to more than 3,300 deaths and 421,000 injuries, according to the National Highway Traffic Safety Administration. What is distracted driving? Think harried commuters on cell phones, teenagers texting, multi-tasking mothers with crying kids in the back seat, women applying makeup, men shaving (don’t laugh, it happens!), people fumbling for a music CD, and just about anyone trying to do more than what they should be doing: driving carefully. “Every day I stop somebody who’s either talking on a cell phone, looking at an accident, eating, drinking, correcting a child, or trying to get to work,” says Roanoke police officer V.N. Saunders. “One lady recently totaled her car swatting a bee.” The most distracted driver she ever encountered was a woman “drinking her morning cup of coffee, putting on makeup, and talking on the phone while driving.” Almost 70 percent of Americans talk on their phones while driving, according

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Charlie Klauer (right), a transportation research scientist at the Virginia Tech Transportation Institute, says texting while driving is “extraordinarily dangerous.” Dan Freeman (far right), outreach coordinator for Carilion Clinic’s trauma services, teaches classes on the dangers of distracted driving at local high schools. to the U.S. Centers for Disease Control and Prevention. Neil Brown, another Roanoke police officer, sees a lot of texting. “The average text message takes approximately five to six seconds, equaling five to six seconds of not looking at the road while driving,” he says. “That’s more dangerous than DUI” for that period. It’s also the equivalent of driving the length of a football field at 55 mph without looking at the road. Charlie Klauer, a transportation research scientist and leader of the Teen Risk and Injury Prevention Group at the Virginia Tech Transportation Institute, has analyzed data on millions of miles of driving research and believes texting while driving is “extraordinarily dangerous.” A texting driver takes his hands off the wheel, diverts his eyes, and stops thinking about driving, she says. As recently as the first half of 2013, a driver in Virginia could be ticketed for texting only in the course of a traffic stop for another offense. But now texting while driving is a primary offense in the Commonwealth. Texting “is the most egregious” offense by distracted drivers, says Janet Brooking, executive director of Drive Smart Virginia, a Richmond-based non-profit group dedicated to improving driver safety through public education. “It is visual, manual, and cognitive and it increases the risk of a crash by 2,300 percent,” Brooking says. “People are reaching, moving objects, eating, grooming, reading, all sorts of things while driving, but it’s texting that seems the most dangerous now.”

EDUCATING THE COMMUNITY To help save lives, Carilion Clinic is working to educate the community about the dangers of distracted driving. Carilion’s Life-Guard helicopter team, along with trauma services at Carilion Roanoke Memorial Hospital and Carilion New River Valley Medical Center, has offered classes on distracted driving to high school and middle school students in the region for three years. “We present the information so teenagers can make informed decisions,” says Dan Freeman, outreach coordinator for Carilion’s trauma services. “A lot of these kids are preparing to get their licenses.” Freeman regularly visits schools, talking to students without preaching and taking a reasoned approach based on information and statistics. He doesn’t show graphic pictures of accidents. “Research shows that doesn’t work with them; they’ve seen too much of it on TV and in movies,” he says. To request a class, e-mail dwfreeman@carilionclinic.org. To watch a video on distracted driving, go to bit.ly/cc-distracted-driving.

“As a culture, we don’t take distracted driving seriously,” Brooking says. “We don’t seem to understand that we control crashes to a large degree.”

AN ONGOING EDUCATION EFFORT

Improvement is slowly being made in our region. Distracted driving crashes have fallen 26 percent recently in Roanoke, from 120 incidents in the first six months of 2013 to 89 in the same period this year, says Sgt. Jamey Bowdel of the Roanoke Police Department. In Blacksburg, they’re down 1.3 percent, from 76 cases in 2012 to 75 in 2013, says Sgt. Sedrick Hayes of the Blacksburg Police Department. “Increased education of the dangers is leading to a reduction of texting while driving,” says Bowdel. “We’re reaching elementary school kids,” says Brooking of Drive Smart Virginia’s initiatives. Teenagers are coming under special scrutiny because studies show that 58 percent admit to using their phones while driving. Twenty-five percent say they respond to a text message at least once every time they drive, and 20 percent admit to having multi-message text conversations while driving. “All our studies show that 10 to 20 percent of drivers are causing 75 to 80 percent of crashes,” says Klauer of the Virginia Tech Transportation Institute. “A huge number of people have no crashes and a small percentage have a lot.” “Distracted driving is not something new,” says Tammy Arnette, a spokesperson for AAA Mid-Atlantic. “However, mobile phones and in-vehicle technologies have created even more distractions for drivers. “A phone call, text, or e-mail should not be traded for someone’s life.”   CarilionClinic.org | FALL 2014    11

MEDICAL NEWS COMPASSION + EXPERTISE After medical school and his internship, residency, and fellowship in craniofacial and pediatric plastic surgery, Mark Schoemann, M.D., wanted to give back to the community. So at 35, before starting his own practice, he signed on as medical director of the Operation Smile Guwahati Comprehensive Cleft Care Centre in Assam, India. He spent a year there performing difficult cleft lip and palate surgeries.

Arlo McCombs, who was born with a cleft lip and palate, is shown before surgery (top left), and after. His parents, Stephanie Knight and Seth McCombs, cuddle with Arlo at home.

CORRECTING A BIRTH DEFECT

CARILION’S FIRST PEDIATRIC PLASTIC SURGEON BRINGS NEW SKILLS TO REGION By Sarah Cox

Arlo McCombs has gone through a lot in his first year of life. Born in July 2013 with a cleft lip and palate, tiny Arlo has already had two surgeries. When he’s 7 or 8, he’ll need a bone graft.

His parents, Stephanie Knight and Seth McCombs of Callaway, learned of Arlo’s birth defect after a routine ultrasound when Stephanie was 19 weeks pregnant. “I Googled the worst-case scenario,” she says. “It was totally frightening. We then went through a battery of tests to rule out any other syndromes.” A cleft lip is a split in the upper lip and a cleft palate is a split in the roof of the mouth. Both are birth defects that occur when the mouth doesn’t close completely during pregnancy. Either may appear as an isolated birth defect but can also be associated with many genetic conditions or as a result of environmental factors. One in about 700 babies globally is born with a cleft lip or palate. SURGERY TO REPAIR THE MOUTH

After the ultrasound, Stephanie and 12    FALL 2014 | CarilionClinic.org

Seth met with specialists at Carilion Clin- just in case Arlo had to spend time there. ic’s Cleft and Craniofacial Center. They “They told us not to worry, that they were learned that a series of surgeries can crehere for us, and that we could call any ate normal function in most cleft babies, time,” Seth says. with minimal scarring. They also discovered that cleft babies may have other problems, including ear, dental, feeding, and speech difficulties. To give them the best care, the Carilion cleft center team includes an oral surgeon, otolaryngologist, and early intervention social worker, along with a plastic surgeon, speech pathologist, genetic counselor, and dentist. Everyone on the team helped StephaMARK SCHOEMANN, M.D. nie and Seth understand what to expect. Specialties: Plastic Reconstructive Before Arlo was born, they also met Surgery, Pediatric Plastic Reconstrucwith Mark Schoemann, M.D., Carilion’s tive Surgery first pediatric plastic surgeon, who heads College: Emory University the Cleft and Craniofacial Center. Dr. Internship: University of Kentucky Schoemann, who joined Carilion last year, discussed what would happen when he Residency: Duke University performed Arlo’s surgery. Fellowship: Craniofacial and PediatStephanie and Seth were then given a ric Plastic Surgery, Children’s Healthtour of the Neonatal Intensive Care Unit care of Atlanta at Carilion Clinic Children’s Hospital,

“I had spent a lot of time focusing on myself in medical school and in training,” Dr. Schoemann says. “I wanted to give something back.”

A FIRECRACKER

Red-haired Jasper Arlo McCombs was born on the Fourth of July and named after famed folk musician Arlo Guthrie. His initials (JAM) also reflect the fact that his parents met at FloydFest. Stephanie and Seth call Arlo their little firecracker. At four months, Arlo had his first surgery, when Dr. Schoemann repaired his lip and a collapsed nostril. “That went great,” says Stephanie. During his second surgery, at nine months, Dr. Schoemann repaired Arlo’s cleft palate. Prior to this, Arlo wore a NAM, or nasoalveolar molding device, which was tightened every week to facilitate joining the two sides of his mouth during surgery. The second operation was “majorly intense,” Stephanie says. “We left the hospital in 24 hours. Most patients stay two to three days.” For the following two weeks, Arlo was in pain. He had already started eating solid foods, but swallowing was difficult, and Stephanie and Seth had to teach him to drink from a cup. “I cried and wanted him to be happy again,” Stephanie says, describing Arlo as a typically smiling baby. After his second surgery, Arlo’s mouth was also slightly discolored. Stephanie and Seth called Dr. Schoemann, who reassured them that infections are rare, and that the discoloration was just bruising. Now Arlo is expected to return for a

checkup in January to assess how his ability to speak is developing. After that, he’ll be checked every six months; if he needs a speech therapist, one can be assigned for home visits. Otherwise, he is expected to need the bone graft when he is 7 or 8. Stephanie and Seth say they also appreciate being able to see all of Arlo’s specialists as needed in one trip to the cleft center. To minimize travel for parents—many of whom must drive several hours for visits—the cleft team coordinates all the care required during each appointment. The team also meets regularly to discuss cases and make recommendations to give patients the best outcomes. “It improves care,” says Dr. Schoemann. “All providers are on the same page, and there is no miscommunication.” ADVICE TO OTHERS

Looking back, Stephanie would tell other parents in their situation to do as much research as possible. “But don’t look at the worst cases, and don’t get scared by ‘Dr. Google,’” she says. Stephanie and Seth were also relieved to find that Dr. Schoemann was so accessible. “He takes his time and really cares about these kids,” Stephanie says. “He’s

The center in Assam is a partnership of Operation Smile India, the government of Assam, and India’s National Rural Health Mission. It performs about 2,500 cleft lip and palate surgeries annually. Operation Smile, in turn, is the largest volunteer-based children’s medical charity, and it has performed more than 220,000 free surgeries to correct cleft defects around the world since 1982. “India was a very interesting transition for me,” Dr. Schoemann says. In a third-world country, the number of cleft lips or palates is much higher than in the United States due to poor nutrition, he explains. Often a child will go untreated until he or she is 8 or 10, and at that point, must completely relearn how to enunciate. Dr. Schoemann plans to continue volunteering with Operation Smile, headquartered in Virginia Beach. Until then, he is bringing smiles to both adult and pediatric Carilion Clinic patients in western Virginia.

passionate about it. And he’s a genius.” Seth agrees. “We can’t imagine being any place other than Carilion,” he says. For more information, go to CarilionClinic.org/pediatric-plastic-surgery or call 800-422-8482.   CarilionClinic.org | FALL 2014    13

COVER STORY

K IS R ’S N O S R E P A E C U D E YR L T A E R G N A C E IS C R E X E REGULAR Left: Marathon runner David Hurley, 72, runs on the greenway in Roanoke. Top: Diana Christopulos, 66, and Mark McClain, 68, take a break from one of their long-distance walks. Right: Wayne Herkness, 97, stays active by working four days a week at his own business.

Story by Alison Weaver Photos by Jared Ladia David Hurley has completed marathons in all 50 states, and at age 72, he’s not slowing down.

The Roanoke County resident is a firm believer that exercise improves not just his body but also his brain. “Seventy is the new 50,” he says. “I think running keeps my mind and body in shape.” New research backs up Hurley’s assertions. A comprehensive 2013 analysis by the Ontario Brain Institute of more than 900 published medical articles, studies, and clinical trials found that older adults who continue to exercise have a 40 percent lower chance of developing Alzheimer’s disease. “Live healthy, live longer,” says Brian Unwin, M.D., chief of geriatrics and palliative medicine at Carilion Clinic. He also oversees Carilion’s Center for Healthy Aging. “Preserving your physical function contributes to longevity; reduces blood pressure, cholesterol, inflammation, and diabetes; and appears to help prevent or slow the onset of dementia,” he says.

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Dr. Unwin is adamant about prescribing exercise for his geriatric patients, but he emphasizes that diet, social interaction, and careful management of medical conditions and medicines are equally important. “Alzheimer’s doesn’t have a single, isolated cause,” he says. “While I’m tremendously excited about the studies showing the preventive effect of exercise, we have to keep in mind that age, genetics, and behaviors such as alcohol or drug abuse also play a big role.” The onset of Alzheimer’s typically occurs over a very long period — 20 years or so — making it difficult to accurately measure the benefits of exercise. “Despite all of the modern technology, our ability to measure how well the brain is working is still kind of limited,” Dr. Unwin says. “On the other hand, I have seen that if you take away a person’s physical outlet, the decline is dramatic. “In general, exercise is thought to be a benign, innocent intervention for patients. It has also been shown to improve mood and alleviate depression, which can impair cognition. Americans have a 1 in 5

chance of developing Alzheimer’s disease; if exercise can shift those odds, then I say go for it.” Research also supports Hurley’s comment that “70 is the new 50.” According to Dr. Unwin, brain studies of master’slevel athletes show that their vital capacities in their 50s and 60s mirror those of people in their 20s and 30s. “You don’t have to be a marathon runner,” Dr. Unwin stresses. “Gardening, walking, bowling, yoga — anything that gets you off the Dr. Brian Unwin couch, and especially activities that get you socially engaged, can provide tremendous benefits. The important thing is to strive to be active every day.” Even patients with advanced dementia benefit from exercise, he says. “Tiny increments of improvement in physical strength can be an enormous help, especially for the caregiver. If the patient can

stand up from a seated position, lower himself to the commode, or help transfer in or out of a car, it can mean a world of difference to the caregiver.” The U.S. Department of Health & Human Services recommends that older adults get at least 21/2 hours of moderate-intensity exercise each week and perform strength-training exercises that target all major muscle groups at least twice a week. In addition, older adults should add balance exercises to help prevent the risk of falls. AGE IS JUST A NUMBER

Wayne Herkness epitomizes successful aging. “I’m reasonably active for a person my age,” he says — an understatement for a 97-year-old who still works four days a week at the Damon Co., the Salem business he founded. Herkness says he was never an athlete but has always led an active life. As commander of a destroyer during World War II, he kept fit by exercising every night. “The bridge was 30 feet wide. I’d walk back and forth, back and forth, for sev  CarilionClinic.org | FALL 2014    15

B. B. Bagby, 70, works out on his rowing machine at home. He also swims, bicycles, scuba dives, and takes long walks.

David Hurley, 72, does strength-training at RAC Xpress in Roanoke. He says it helps him stay in shape to run marathons.

EXERCISE AND CANCER While the cardiovascular benefits reaped by exercise have long been known, a growing body of evidence suggests that physical activity also has powerful effects in warding off some types of cancer.

ONE-STOP RESOURCE FOR SENIORS

Breast cancer: More than 60 studies from around the world indicate that regular exercise can reduce the risk of developing breast cancer by anywhere from 20 percent to 80 percent. Women of normal weight who exercised saw the greatest benefits, but regardless of Body Mass Index (BMI), all saw a reduced risk. Moderate to vigorous exercise by adolescent females also appears to provide a high protective benefit later in life.

“The center provides services not just for patients but also for family members and caregivers,” says Brian Unwin, M.D., chief of geriatrics and palliative medicine. “The goal is to maximize independence and functionality for seniors.”

Colorectal cancer: The effects of exercise on reducing the risk of colorectal cancer is one of the most studied. More than 50 published studies show that the more active a person is, the lower the risk of developing colorectal cancer. Increasing the frequency, duration or intensity of physical activity reduces the risk of colon cancer by 30 percent to 40 percent, regardless of BMI. Endometrial cancer: Physically active women have a 20 percent to 40 percent lower risk of developing endometrial cancer. The higher the activity level, the lower the risk. Prostate cancer: Research is inconclusive about the protective effect of exercise against prostate cancer; however, a recent study suggests that men over 65 can slow the progression of this cancer through vigorous exercise. Source: National Cancer Institute

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Carilion Clinic’s Center for Healthy Aging offers a one-stop resource for a variety of geriatric-related services.

eral hours.” After settling down and marrying in the late 1950s, he began playing tennis. “I wasn’t a good player but I enjoyed it,” he says. “I started off playing two or three times a week and worked up to four or five times a week.” He attributes his good physical and mental health to staying active. “I don’t sit in the office. I run a machine shop and punch-press operation,” he says, “and I’m going to do it as long as I can.” B. B. Bagby, a 70-year-old who lives near Burnt Chimney, has a simple philosophy for keeping active: “I’ve always said that if it looks fun and it’s reasonably safe, I want to try it.” Bagby got his scuba certification a few years ago; he cycles, swims, works out on a rowing machine, and spends a lot of time walking near his Myrtle Beach vacation home. “I don’t seem confined by age restrictions. You won’t hear me say, ‘I’m too old to try that,’ ” he says. “I don’t have an exercise routine as such. If you’re looking for someone who runs X miles a day and spends two hours at the gym, that’s not me.” Bagby, who worked in the construction

industry and served two separate stints in the military, says he was never a very good athlete. “I was small and skinny. When I got out of the military, I was 125 pounds soaking wet.” His advice is, “Find something interesting and do it. If you enjoy it, you’ll stick with it. Why be miserable? Life’s too short not to have fun.” Salem resident Diana Christopulos, 66, is another fun-seeker. In 2010, she served as a volunteer marshal at the inaugural Blue Ridge Marathon in Roanoke. “It looked like such fun that I decided I’d do the half-marathon the next year.” Participating in a half-marathon seemed a bit ambitious for someone who wasn’t a lifelong athlete. “When I was growing up, there were no athletic teams for high school girls. I played some tennis and did some cycling, but when I was working full time and in grad school, it was easy not to be active,” she says. However, Christopulos has always been goal-oriented. She is the retired owner of a management consulting firm, and after moving to the Roanoke Valley in 2003, she decided to hike the

entire, 2,160-mile Appalachian Trail. “I did it in bits and finished in 2008,” she says. She joined the YMCA, started a strength-training program, and added yoga to her walking schedule. In April she completed her fourth Blue Ridge Half-Marathon. “I walk up the hills and jog down them,” she explains. “I posted my best time this year and feel like I’m more physically fit.” Mark McClain, 68, has been one of Christopulos’ walking companions for 20+ years. “Exercising with someone is an ideal situation — if the two people are compatible in their approach and goals,” he says. “It can be a true motivator to get you out there.” McClain, a retired corporate executive and past chair of the Roanoke Valley Greenway Commission, says the greenway has been a huge asset in giving people of all ages, backgrounds, and fitness levels easy access to scenic trails. “It draws all types: cyclists, walkers, and runners,” he says. David Hurley, the veteran marathoner, has competed in the Boston Marathon and the New York City Marathon but he says this year’s medal for finishing the Blue Ridge Marathon is the one he’s most

proud of. Two months before the race, Hurley noticed blood in his urine, not an uncommon occurrence for a hardcore athlete. His doctor quickly referred him to a urologist, who found a malignant tumor in his bladder. “I have no doubt that early detection and being in good physical condition helped me survive that cancer,” says the retired school teacher and administrator. After surgery and follow-up treatments, Hurley still insisted on running in the Blue Ridge Marathon, dubbed the nation’s toughest road race because of the extreme, 7,430 feet of elevation changes. “I made it to Mile 25 [of 26.2 miles] and then went down,” he says. After being taken away by ambulance, Hurley doggedly returned the next day and finished the course, posing for photos under the finish-line banner that was still in place. “My time of 27 and a half hours wasn’t my best,” he jokes, “but I’ll be back next year.” 

The Geriatric Assessment Clinic within the center evaluates a patient’s risk of falls, level of disability, and presence of dementia-related disorders. The Memory Disorders Clinic serves those who have already been diagnosed with Alzheimer’s or other types of dementia. Assessment and management of medicines is another important resource. “Many seniors take multiple prescriptions from various physicians,” Dr. Unwin notes. “We take a close look at how all of those medicines interact to see if they might be causing symptoms such as dizziness, forgetfulness, or cognitive impairment.” In addition, the center provides driving assessments, education for patients and families, geriatric psychiatry, and support groups for caregivers. For more information, go to CarilionClinic.org/geriatrics/center-forhealthy-aging.

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REGIONAL INTEREST

CO-WORKING

SPACES: They’re Taking Off Clockwise: Taylor Ricotta (left) and Samantha Steidle run CoLab in Roanoke; Stephan Sabo (left) and Adam Donato of the start-up firm Card Isle work at NuSpark in Blacksburg; Adam Moore is renovating 1111 Shenandoah Ave. in Roanoke, home of The Factory, a co-working shop for creating physical products; Mark Gibson opened the Athenaeum in Roanoke’s Old Southwest neighborhood; Monica Rokicki works at CoLab.

Story and photos by Randolph Walker For hundreds of people in our region, “going to the office” has a new meaning.

They’re not walking down the hall to a home office; nor are they going to a cubicle at corporate headquarters. Their work space offers camaraderie and networking, as well as traditional office technology such as a copier machine and Internet service. Yet most of them answer to no boss except themselves. “It’s walking into an innovative, energizing space, sitting next to someone who is doing something completely different, but you share the sense of collaborating,” says Taylor Ricotta, director of communications at Roanoke’s CoLab. “It’s like a building of co-workers who don’t work for the same company.” “It’s really ideal for people working in 18    FALL 2014 | CarilionClinic.org

the space to help each other,” says Sherry Walker, director of Blacksburg’s NuSpark. It’s called co-working—and it has hit western Virginia in a big way. Co-working attracts professionals, entrepreneurs, freelancers, and the self-employed who want an away-from-home work space but can’t afford or don’t want a traditional office. It’s flexible like a gym membership. For a monthly fee, individuals have access to common areas with desks, computers, a meeting room, Wi-Fi, a fax machine, and coffee maker. For a higher fee, they can have their own dedicated desk or cubicle. The first co-working space in the country is believed to have opened in 2005 in San Francisco. By 2012, co-working had made its way to Roanoke with the open-

ing of the Roanoke Business Lounge on Kirk Avenue. A mere two years later, the Business Lounge had outgrown its space. Founder Samantha Steidle packed up and moved with her members to a former drugstore building on Grandin Road. Owned by developer Ed Walker, the new CoLab there is run by Steidle and Taylor Ricotta. “We have connections with government, with academia, with entrepreneurs and service providers,” Steidle says. “That creates a sense of community that not every space has.” Indeed, that’s the feeling one gets at CoLab. Some people are working quietly on computers; others are smiling and talking in small groups. People seem happy. It’s like the common area of a

college dorm. Monica Rokicki, a principal at Better Building Works, energy and design consultants, has an office in downtown Roanoke but keeps a membership at CoLab as well. “Just now I had a conversation with someone who’s got a software development company,” she says. “I had some questions about software he was able to answer. “I also just spoke with an engineer who’s working out of this space and asked him some questions specific to another project. You can’t get those kinds of collaborative conversations going if you’re stuck in your own black box.” Need to get away from people? CoLab’s got that too. In a windowless corner office you’ll find Adam Linkenauger, 29, of

Freak Athletics, a start-up that creates basketball training videos that are popular on YouTube. Linkenauger and his two young colleagues don’t mind the lack of sunlight; often they come in the afternoon and stay until 3 a.m. “It doesn’t even feel like work,” says Jaime Garza, 25. Due to CoLab’s role in creating new business opportunities and community connections, Carilion Clinic has become a sponsor. “We have contributed to CoLab because of our commitment to this region’s growth and the effect of jobs on people’s health,” says Shirley Holland, vice president of Strategic Development at Carilion. UNIQUE ENVIRONMENTS

Each co-working space has its own feel.

At Blacksburg’s TechPad, the atmosphere is quiet and intense. About a dozen young men and a few young women sit in front of computers or quietly talking. Most are software developers. “They don’t like to be disturbed,” says Lauren Rose, the director. At TechPad, “nomads” who use any available desk pay $75 a month; dedicated desks start at $250. JumpStart Community is another Blacksburg co-working space. It is part of VT KnowledgeWorks, a program of the Virginia Tech Corporate Research Center, which in turn is owned by the Virginia Tech Foundation. “Working among other entrepreneurs motivates me in my work, and I can easily get their advice,” says JumpStart   CarilionClinic.org | FALL 2014    19

NEW PROVIDERS PHYSICIANS Sherry Walker, director of NuSpark, works at the Blacksburg co-working space.

ROANOKE The Athenaeum Coworking Center 203 Albemarle Ave. S.W. athenaeum.biz Modern amenities in the Old Southwest historic district

member Atieh Haghdoost, a mechanical engineer who is marketing a new type of coating used on surfaces exposed to water. Bob Fielder is a business consultant who helps other companies get research and development funding and commercialize new technologies. Fielder says he joined JumpStart because he and his first employee needed a better place to work than the kitchen table. He pays $400 a month for two dedicated work stations. Then there is NuSpark in Blacksburg, which offers programs and guidance to its members as a kind of bridge between academia and the business world. “We have community members and students who use NuSpark,” says Sherry Walker. “We use a framework similar to that used in the National Science Foundation’s Innovation Corps with the teams in NuSpark to help them develop their ideas.” “We are all recent students and this was kind of an extension of a school project that we did, so this is our first office space,” says Stephan Sabo of Card Isle, which creates kiosks that print customized greeting cards. “There’s a wealth of knowledge here. We get to share a lot with each other.” Like many co-working spaces, NuSpark has a modern, modular, wired look. For those who prefer a more traditional feel, there’s Roanoke’s Athenaeum. Mark Gibson, an architect, bought a 1908 building in Roanoke’s Old Southwest in 2003. The fireplaces, fluted columns, and parquet 20    FALL 2014 | CarilionClinic.org

floors create a mood of elegance and grace. “The Athenaeum is such a beautiful environment,” says member William Dye, owner of Pumpernickel Pickle Catering, who brings clients here for tastings. While co-working spaces are typically oriented toward those providing services or software, there’s a space in Roanoke with a different twist. The Factory, being developed in a warehouse/industrial district on Roanoke’s Shenandoah Avenue, will offer co-working space for companies creating physical products. Aaron Dykstra, owner of Six-Eleven Bicycle Co., is already there (making custom-built bikes), but additional members are on hold while founder Adam Moore finishes renovations. “It’s co-working for creatives and manufacturers,” says Moore. Members will have access to woodworking equipment, a metal shop, and 3-D printers. Membership with off-hour access to tools and machinery will start as low as $100 per month. Here’s yet another angle: Lynchburg offers TOOLRY, a co-working space with special appeal to artists, though everyone is welcome. Lynchburg is also home to Momentum, where the options start with single-day access. From Blacksburg to Roanoke to the Hill City, this new model called co-working is attracting people who welcome a sociable, affordable alternative to the home office and a traditional office rental. It’s clearly an idea that’s working. 

Shyam Balakrishnan, M.D. Family Medicine

Rahul Chavan, M.D., Ph.D. Dermatology

Medical Degree: Medical College of Thiruvananthapuram Residency: Hennepin County Medical Center Fellowship: Geriatric Medicine, University of Virginia 1107A Brookdale St., Martinsville, VA 24112  540-670-3300

Medical Degree: University of South Florida, Morsani College of Medicine Internship: Mayo Clinic  Residency: Mayo Clinic  Fellowship: Dermatopathology, Mayo Clinic 1 Riverside Circle, Suite 300, Roanoke VA 24016  540-581-0254

Caleb J. Behrend, M.D. Orthopaedic Surgery

Frank Clark, M.D. Psychiatry

CoLab 1327 Grandin Road S.W. grandincolab.com Range of co-working options plus community events and education

Medical Degree: University of California Internship: University of Rochester Residency: University of Rochester Fellowship: Spine Surgery, Thomas Jefferson University 3 Riverside Circle, Roanoke, VA 24016 540-725-1226

The Factory 1111 Shenandoah Ave. sparksflyhere.com Co-working shop for physical products. Opening this fall.

Medical Degree: Northwestern University Feinburg School of Medicine Internship: University of South Carolina School of Medicine – Palmetto Health Residency: University of South Carolina School of Medicine – Palmetto Health 2900 Lamb Circle, Christiansburg, VA 24073  540-731-7311

Carol A. Bernier, D.O. Emergency Medicine

Thomas Donohue, M.D. Pediatric Medicine

Medical Degree: University of New England College of Osteopathic Medicine Internship: Carilion Clinic - Virginia Tech Carilion School of Medicine Residency: Carilion Clinic - Virginia Tech Carilion School of Medicine 1906 Belleview Ave., Roanoke, VA 24014

Medical Degree: Sackler School of Medicine Internship: Medical College of Virginia  Residency: Medical College of Virginia 4040 Postal Drive, Roanoke, VA 24018  540-772-4453

William Blaskis, D.O.  Family Medicine

Emily Evans-Hoeker, M.D. Reproductive Endocrinology and Infertility

BLACKSBURG JumpStart Community 2200 Kraft Drive, Suite 1350 vtknowledgeworks.com/acceleration_ services/jumpstart Make connections at Virginia Tech Corporate Research Center NuSpark 460 Turner St., Suite 102 nuspark.org Open to students and the community TechPad 432 N. Main St., Suite 200 techpad.org Software-oriented work space in downtown Blacksburg

Medical Degree: West Virginia School of Osteopathic Medicine Internship: Bluefield Regional Medical Center  Residency: Bluefield Regional Medical Center 2102 W. Main St., Salem, VA 24153  540-375-0600

LYNCHBURG Momentum 700 12th St., Suite 101 momentumcoworking.com Wide range of packages TOOLRY 901 Jefferson St., Suite G7 toolry.com In the Riverviews Artspace in downtown Lynchburg

Victor Buckwalter, M.D. Family Medicine Medical Degree: Temple University School of Medicine Internship: Lancaster General Hospital Residency: Lancaster General Hospital  1151 Keezletown Rd., Suite 101, Weyers Cave, VA 24486 540-234-9241

Medical Degree: Case Western Reserve University School of Medicine Residencies: University of Illinois at Chicago and University of Alabama at Birmingham Fellowship: Reproductive Endocrinology and Infertility, University of North Carolina 102 Highland Ave., Suite 304, Roanoke, VA 24013  540-985-8078

Megan Forster-Hill, M.D. Emergency Medicine Medical Degree: Virginia Commonwealth University School of Medicine Internship: Carilion Clinic - Virginia Tech Carilion School of Medicine Residency: Carilion Clinic - Virginia Tech Carilion School of Medicine 1906 Belleview Ave., Roanoke, VA 24014

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NEW PROVIDERS Randy Gallagher, D.O. Emergency Department

Brent Jones, M.D. Emergency Medicine

Jeff Wilson, M.D. Child and Adolescent Psychiatry

Caroline Cerio, P.A.-C. Hospitalist

Medical Degree: Oklahoma College of Osteopathic Medicine and Surgery Internship: Oklahoma Osteopathic Hospital (OSU Medical Center) 1 Health Circle, Lexington, VA 24450 

Medical Degree: New York University Internship: Louisiana State University Residency: Louisiana State University 390 S. Main St., Rocky Mount, VA 24151

Medical Degree: University of Medicine and Dentistry of New Jersey Residencies: Albert Einstein College of Medicine and Stanford University College of Medicine Fellowship: Columbia University Medical Center 2017 S. Jefferson St., 2nd Floor, Roanoke, VA 24014  540-853-0900

Undergraduate Degree: Providence College Graduate Degree: Jefferson College of Health Sciences 1906 Belleview Ave., Roanoke, VA 24014 540-981-7268

Charles Gilliland, M.D. Hospitalist

Ayesha Kelly, M.D. General Surgery

Carol Felts, N.P. Psychiatry

Medical Degree: Temple University Internship: Temple University Hospital  Residency: Temple University Hospital  2900 Lamb Circle, Christiansburg, VA 24073  540-731-2000

Medical Degree: University of North Carolina School of Medicine Internship: Carilion Clinic - Virginia Tech Carilion School of Medicine Residency: Carilion Clinic - Virginia Tech Carilion School of Medicine 100 Spottswood Drive, Lexington VA 24450  540-463-7108

Ali Ziaolhagh, M.D. Hospitalist, Internal Medicine Medical Degree: Azad University Internship: Azad University Residency: Case Western Reserve/St. Vincent Charity Medical Center 2900 Lamb Circle, Christiansburg, VA 24073  540-731-1898

Undergraduate Degree: Radford University Graduate Degree: Radford University 2900 Lamb Circle, Christiansburg, VA 24073  540-731-7311

ADVANCED CARE PROVIDERS Alison Hester, D.O. Emergency Medicine

Martina Dianna Peri, M.D. Family Medicine Community Care

Lauren Baker, N.P. General Surgery

Danielle Ogle, N.P. Family Medicine

Medical Degree: Virginia College of Osteopathic Medicine Internship: Carilion Clinic - Virginia Tech Carilion School of Medicine Residency: Carilion Clinic - Virginia Tech Carilion School of Medicine 2900 Lamb Circle, Christiansburg, VA 24073

Medical Degree: St. Matthews University School of Medicine Internship: Carilion Clinic - Virginia Tech Carilion School of Medicine Residency: Carilion Clinic - Virginia Tech Carilion School of Medicine 101 Elm Ave., Roanoke, VA 24013  540-985-8044

Undergraduate Degree: James Madison University Graduate Degree: Old Dominion University 3 Riverside Circle, Roanoke VA 24016  540-224-5170

Undergraduate Degree: Jefferson College of Health Sciences Graduate Degree: East Tennessee State University 150 Market Ridge Lane, Daleville, VA 24083 540-966-0400

David Iglesias, M.D. Gynecologic Oncology

Michael Priest, M.D. Family Medicine

Charles Bullins, N.P.-C. Cardiothoracic Surgery

Matt Schneider, P.A.-C. Family Medicine

Medical Degree: University of Florida, College of Medicine Residency: University of Florida, College of Medicine Fellowship: Gynecologic Oncology, M.D. Anderson Cancer Center 1 Riverside Circle, Suite 300, Roanoke VA 24016 540-581-0160

Medical Degree: St. George’s University School of Medicine Residency: Carilion Clinic - Virginia Tech Carilion School of Medicine 282 Westlake Road, Hardy, VA 24101  540-721-2689

Undergraduate Degree: Bluefield State College Graduate Degree: University of Virginia 2001 Crystal Spring Ave., Suite 201, Roanoke, VA 24014  540-853-0100

Undergraduate Degree: Gordon College Graduate Degree: Jefferson College of Health Sciences 37 Laymantown Rd., Troutville, VA 24175  540-977-1436

Natalia Jaimes, M.D. Pediatric Medicine

Amy Sullivan, M.D., Ph.D. Neurology

Timothy Carroll, P.A.-C. Cardiology

Leigh Wingo, N.P.-C. General Surgery

Medical Degree: University of South Florida, Morsani College of Medicine Internship: Mayo Clinic  Residency: Mayo Clinic  Fellowship: Headache, Mayo Clinic  3 Riverside Circle, Roanoke VA 24016  540-224-5170

Undergraduate Degree: Virginia Commonwealth University Graduate Degree: Jefferson College of Health Sciences 1906 Belleview Ave. Roanoke, VA 24014  540-981-7268

Undergraduate Degree: Jefferson College of Health Sciences Graduate Degree: Old Dominion University  3 Riverside Circle, Roanoke VA 24016  540-224-5170

Medical Degree: Pontificia Universidad Javeriana – Bogota, Colombia Internship: Mount Sinai School of Medicine Residency: Mount Sinai School of Medicine 1030 S. Jefferson St., Suite 106, Roanoke, VA 24016 540-985-8230

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  CarilionClinic.org | FALL 2014    23

! s t u N Go By Karen Doss Bowman

Can eating a handful of nuts each day help you live longer? A number of studies suggest it can. The most recent, from the Harvard School of Public Health, Dana-Farber Cancer Institute, and Brigham and Women’s Hospital, found that people who ate nuts at least once a day had a 20 percent lower death rate from all causes than those who never ate them. The risk of death from heart disease fell by 29 percent, and the risk of death from cancer dropped 11 percent. Earlier studies have also linked eating nuts to a reduction in heart attacks and deaths from heart disease. Besides being rich in protein, nuts have heart-healthy, omega-3 fatty acids and fiber that lower cholesterol. Walnuts in

The American Heart Association recommends eating four servings of unsalted, unoiled nuts a week. particular have alpha linoleic acid, which research suggests may help prevent heart arrhythmias. Almonds are rich in calcium and vitamin E. Other nuts have other beneficial vitamins and minerals. The Harvard study examined data on the eating habits of more than 115,000 healthy men and women over 30 years; the data were collected from two existing studies. Participants answered diet and lifestyle questions — including how often they ate nuts. “Our study revealed that over different categories and different populations, there’s a consistent inverse association between nuts and disease,” says epidemiologist Ying Bao, Sc.D., M.D., of Harvard-affiliated Brigham and Women’s Hospital in Boston, the study’s lead researcher. “So the takeaway would be that consuming a handful of nuts each day could be beneficial to your health,” she 24    FALL 2014 | CarilionClinic.org

says. “The positive effects of nuts last a long time.” The study, published in the November 2013 issue of the New England Journal of Medicine, was funded by the National Institutes of Health and the International Tree Nut Council Nutrition Research & Education Foundation. The nut organization did not design the study. Harvard researchers also found that nut eaters were less likely to smoke, exercised more, and ate more fruits and vegetables. Another plus: Nut eaters were trimmer. “In our study, we repeatedly saw that people who ate more nuts were leaner,” Bao says. “That’s contrary to the common idea that nuts make you gain weight. That could be because the high content of fatty acids in nuts cause a person to feel full after eating just a few. Maybe nuts replace other, less healthy foods in the diet.” The key is to eat a moderate amount—a small handful or 1.5 ounces, or two tablespoons of nut butter — and to eat them as part of a heart-healthy diet low in saturated fats. Eating too many nuts can lead to weight gain. The American Heart Association recommends eating “four servings of unsalted, unoiled nuts a week.” How to eat them? Add them to yogurt, cereal, muffins, stir-fries, or salads. Nut butter can be added to smoothies. The U. S. Department of Agriculture’s Choose My Plate recommends eating unsalted nuts as a snack or as a replacement for meat or poultry in main dishes. Try toasting them in the oven to bring out the flavor. How you buy nuts is also important. Because the oils found in nuts are delicate and can spoil, buy them in small amounts. If you can, buy nuts still in the shell or those that are freshly shelled and refrigerated. Laurie Lubinski, an assistant manager at the Roanoke Natural Foods Co-Op,

CAUTION: NUT ALLERGIES One thing to keep in mind: Some people are allergic to nuts, particularly peanuts. Some schools and daycare centers don’t allow kids to bring food containing nuts, while others have designated “peanut-free zones.” Talk to your children and help them understand the dangers of food allergies that may affect their classmates. If you are hosting a dinner, ask your guests if they have dietary restrictions. If it’s a potluck or buffet-style, post cards next to food items listing the ingredients.

recommends storing nuts in the refrigerator or freezer. “Their natural oils will turn rancid if they’re in a warmer environment,” she says. This is also true for nut butters and nut oils once you’ve opened the jars. “We have a high turnover on nuts, and that means they’re always fresh,” Lubinski says. “Nuts have always been a popular choice for our shoppers.” 

  CarilionClinic.org | FALL 2014    25

HEALTH NEWS agrees. Reach Out and Read started in Boston in 1989, after pediatricians there found that in conversations with parents during routine visits, many weren’t reading regularly to their children and had few, if any, books in their homes.

About two-thirds of children in the United States aren’t meeting reading proficiency benchmarks.

“It’s an opportunity for the child to sit on the parent’s lap and have that bonding moment where the child is feeling the love of the parent through the book, hearing their voice,” says Gallagher. “Then again it’s that exposure from an early age to the letters on the page, and the words. As children get into those preschool years, all of that culminates into early literacy skills, which help children as they’re getting ready for kindergarten.” REACHING ALL KIDS

DOCTOR’S ORDERS:

Read to Your Kids By Jay Conley

Do you have young children? Don’t be surprised if the next time you see your pediatrician, you’re advised to start reading to them.

The American Academy of Pediatrics has issued a new policy statement urging pediatricians to encourage parents to read to their kids from infancy. It will prepare them to succeed in school and life, says the AAP’s Council on Early Childhood. Reading stimulates brain development and builds parent-child relationships at a crucial period of a child’s development, according to the AAP. This in turn is said to build “language, literacy, and social-emotional skills.” AN INVALUABLE FOUNDATION

Research indicates that reading to children at a young age 26    FALL 2014 | CarilionClinic.org

not only makes them more successful in school, but also later in life. Reading proficiency by the third grade is the most important predictor of high-school graduation and career success, notes the AAP. About two-thirds of children in the United States aren’t meeting that benchmark. Pediatricians have a unique opportunity to advise parents on how to raise healthy children. They are the first professionals that parents establish a consistent relationship with around the care of their child. Recommendations to read that are given out at the doctor’s office are more likely to be heeded by parents, according to the AAP. Brian Gallagher, executive director of Reach Out and Read, a nonprofit organization that promotes literacy to health care providers, and who helped draft the AAP’s policy statement,

“Pediatricians realized they had a pretty powerful platform to begin to change parents’ behavior, attitude, and understanding about why reading matters and how it helps their children learn, grow, and develop, especially in those early years,” says Gallagher. “Parents do tend to listen to what pediatricians have to say because parents want what’s best for their child.” Studies indicate every new word a child learns is important to language development. Children whose parents read to them are able to significantly increase the

WHAT TO READ? Ask your pediatrician or librarian about age-appropriate books to read to your infant or toddler. Or see the lists of books recommended by: » Reach Out and Read at reachoutandread.org. » Goodreads at bit.ly/infant-toddler-books. » The National Association for the Education of Young Children at bit.ly/naeyc-books. » Building Baby’s First Library: 25 Must-Have Books at bit.ly/first-library.

richness of their vocabulary and their understanding of complex syntax. Studies also show that reading time as part of a well-connected pattern of vocal interaction between parent and child builds nurturing relationships that are significant to a child’s cognitive, language, and social-emotional development.

The AAP’s new policy is based on data that indicate a more than decade-long lag in parents reading to their children — especially for those from low socioeconomic backgrounds. These children are much more likely to develop reading problems, repeat a grade, and to be diagnosed with learning disabilities, states the AAP, citing information from the National Center for Education Statistics. Later in life, their inadequate reading skills are associated with modest economic potential and the perpetual cycle of poverty, poor health, and dependency on others. Reach Out and Read helps pediatricians and family health care providers put age-appropriate books into the hands of parents and children. It also trains doctors and nurses on how to speak with parents about the importance of reading to kids. Affiliated providers distribute 6.5 million books to children to take home each year, and Reach Out and Read cites studies showing that children served by the program score three to six months ahead on vocabulary tests versus their peers who haven’t accessed the program. The organization now serves 20,000 health care providers — Carilion Clinic among them — in 50 states. It recently received a donation from Scholastic Inc. of 500,000 books to distribute to doctors’ offices. “We are extremely enthusiastic about Reach Out and Read,” says Donna Deadrick, B.S.N., R.N., C.P.N., of Carilion’s General Pediatrics in Roanoke and regional chairperson for the program.

“It brings books into our exam rooms along with an emphasis on early literacy. “Doctors give new books to children at each well-child visit from 6 months of age to 5 years,” she says. “They also give parents developmentally appropriate advice about reading to their child.” “Our patients look forward to taking home books at their well-checks,” says Kelly D. Henchel, M.D., F.A.A.P., Carilion chief of general pediatrics. “We also have a nice library of donated, gently used books in the office for distributing to children who are asking for books at other visits.”

PRACTICE THE FIVE R’S The American Academy of Pediatrics encourages parents of young children to practice the Five R’s to build the social, emotional, and language skills that support healthy brain development. They are: 1. Reading together as a daily fun family activity. 2. Rhyming, playing, talking, singing, and cuddling together throughout the day. 3. Routines and regular times for meals, play, and sleeping, which help children know what they can expect and what is expected of them. 4. Rewards for everyday successes, especially for effort toward worthwhile goals such as helping. Praise from those closest to a child is a very potent reward. 5. Relationships that are reciprocal, nurturing, purposeful, and enduring, which are the foundation of healthy early brain and child development.

Carilion is the only provider in the region to participate in Reach Out and Read. Since March 2005, the office has given more than 30,000 books to local children.  The office is also looking for volunteer readers to expand the program.  To volunteer as a reader, call 540-985-8284.   CarilionClinic.org | FALL 2014    27

BETTER LIVING

Just took your last pill and need a refill?

Want to help Mom keep up with her appointments and prescriptions?

Quit Smoking! Here’s How By Michael J. Camardi, M.D.

In over three decades of medical practice, the pain and suffering I have seen caused by smoking has been devastating. When I think of all the people I’ve tried to help who were robbed of their lives because of tobacco… well, I don’t want that to happen to you. Consider this: According to the American Lung Association, cigarette smoking costs us almost $11 per pack in terms of lost productivity and direct medical costs. In human terms, this represents about 5.1 million years of lost life per year. Let’s stop it before it’s too late! How? Honestly, quitting smoking is not fun — it’s difficult and often uncomfortable. I can say this with experience. I myself have quit smoking. I had my last cigarette about 30 years ago and haven’t looked back. But, you’ll feel like a new person once you succeed. First, find a reason apart from yourself to stop. Your kids, for instance. Secondary smoke can make addicts of children and weaken their health at an early age. If you’re smoking to deal with the stress of work, think about the fatigue and shortness of breath your smoking causes. This is definitely associated with poor work performance. Should you quit “cold turkey?” Bad idea. Over 95 percent of those who try fail after three days. But studies show that nicotine gum, lozenges, and patches can help. Here’s the key: They have to be used with an intensive behavioral program to get you through the rough spots. Most insurance companies offer such programs. Also, have a family meeting to get support. Feel like the hero you are for working to overcome a difficult problem. Then clean your house thoroughly, wash all clothes with an odor-masking fabric softener, and have your carpets and drapes cleaned to erase the smell of cigarettes. This may sound surprising, but the lingering smell of cigarette smoke can set off cravings and lead to failure. Now comes the most important part: dealing with with28    FALL 2014 | CarilionClinic.org

drawal and finding a way to relax. The best way I know of doing both is to get physical. Talk to your doctor, then, gradually and gently, get back in condition. When you look in the mirror, you’ll like what you see. This will also help you fight the usual weight gain that comes with quitting. But be wary of smoking triggers. By far, coffee is the most common trigger, followed by alcohol. If you’re used to waking up with a cup of coffee and a cigarette or having a few with friends on a Friday night, try nicotine gum instead. Just don’t smoke a cigarette when doing so, since it can be dangerous. This is also the time to fight those hunger pangs and eat more fruits and vegetables. European studies have suggested that certain trace nutrients that are depleted while smoking can ease the discomfort of smoking withdrawal. Leafy green vegetables, tomatoes, and blueberries are among those that can help. Now, here comes the fun part: Take the money you would have spent on smoking every week and do something just for you. On average, people are stunned to learn they have at least $15 to $20 more per week. Finally... you probably won’t succeed the first time. The national average is four to six times! But that’s okay, because you’ll be stronger after each try. It’s called a learning experience. You think about the emotions that set you up to fail and understand them. Those lessons will get you ready for the next try.  And don’t feel like a failure. Failure is when you don’t pick yourself up and try again. This is a long struggle — you really are on a mission. I know I was. And failure is just not an option. So, you will succeed, with sacrifice, hard work, and perseverance. And when you do, you’ll look at yourself in a different light, and those who care about you will be proud. Good luck. I know you can do it!  Dr. Camardi specializes in internal medicine and geriatrics. For more information on how to stop smoking, go to CarilionClinic.org/quitsmoking.

Can’t remember when little Suzy needs her next booster shot?

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MyChart It! MyChart—western Virginia’s first online healthcare management tool—offers 24/7 access to your health records. Request an appointment, view lab results, refill a prescription and much more, all on your schedule. With more than 70,000 users, MyChart provides the tools you need to manage your healthcare.

WHY WAIT? GET ACTIVE ON MYCHART TODAY!

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Acclaimed sculptor Betty Branch was going about her life, doing what she loved, when the grenade went off in her head. That’s precisely what her brain hemorrhage felt like. The interventional radiologists and neurosurgeons at Carilion Roanoke Memorial Hospital took action. Working through a remote incision, they skillfully plugged Betty’s hemorrhage. Her team of nurses, doctors, and therapists got to work right away, helping Betty regain control of her left side, and her whole life. Now Betty is well along the way to recovery and back in her studio, where everything is possible. Especially Betty.

i’m possible the

happens here.

CarilionClinic.org/neurosurgery 800-422-8482