Inspiring Better Health | CarilionClinic.org | Spring 2013
î€‚e Joy of Walking HEALING ARTS PROGRAM DEBUTS
Is Your Child Getting enough Sleep? The Latest in Joint Replacement and Heart Surgery
ABOUT THIS SMALL. Less than half an inch. That’s the length of incisions when you’re talking about the da Vinci® Surgical System. With that small cut, surgeons at Carilion can accomplish big things, and oﬀer you less discomfort and a shorter recovery. It’s a revolutionary approach to care, and only Carilion oﬀers it here. Ask your doctor about da Vinci. You may have less to talk about than you ever imagined. The da Vinci Surgical System is available at:
• Carilion Roanoke Memorial Hospital • AND NOW at Carilion New River Valley Medical Center
CarilionClinic.org/daVinci | 800-422-8482
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Child Safety Many kids don’t get enough sleep. Pregnancy New alternatives for childbirth. Innovations Healing arts program is launched.
Joint Replacements e newest options. Heart Disease Specialty care close to home. Activity Walking for fun and ﬁtness. Neighborhoods Wasena has more to oﬀer. Quality Care Awards recognize strides in health care. Retail Pharmacies How they can help you.
Advanced Care Epilepsy monitoring unit opens.
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President’s Message Walking beneﬁts mind and body. Healthy Lifestyles Tips from Carilion Clinic medical professionals. In Your Community Making a diﬀerence in western Virginia.
New Providers New physicians across our region. Better Living Your health calendar. Carilion Clinic
| Spring 2013 Inspiring Better Health | CarilionClinic.org
The Joy of Walking HEALING ARTS PROGRAM DEBUTS
Is Your Child Getting enough Sleep?
On Our Cover Katie Howey, a grad student at Virginia Tech, walks Willow, her 8-month-old Goldendoodle, on the Roanoke River Greenway.
The Latest in Joint Replacement and Heart Surgery
CarilionClinic.org | SPRING 2013 1
Our Contributors CARILION CLINIC PReSIDeNT AND CeO Nancy Howell Agee CARILION CLINIC 1906 BeLLeVIew AVe. P.O. BOx 13367 ROANOke, VA 24033 540-981-7000
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.
Marino Colmano is an award-winning photographer whose work has appeared in magazines, art exhibitions, and set pieces in ﬁlm and television. He has also directed documentaries and short ﬁlms. His studio is in Blacksburg.
Sam Dean, a former photographer for The Roanoke Times, has been published in The New York Times, The Washington Post, Time and People magazines, and other publications. He has won many state and national awards.
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, Allison Buth, Su Clauson-Wicker, Jay Conley, Rich Ellis, Laura Markowski, Otesa Middleton Miles, Erica Stacy, Randolph Walker, Alison Weaver PHOTOgRAPHeR Darryle Arnold CONTRIBuTINg PHOTOgRAPHeRS Marino Colmano, Sam Dean
Rich Ellis has written for many Roanoke Valley publications, including Our Health magazine. Nationally, he writes for Architectural Salvage & Antique Lumber News.
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 magazine.
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.
SPRING 2013 | CarilionClinic.org
President’s Message Have you taken a good walk lately? If so, you probably came away feeling refreshed and invigorated. Happily, more people are discovering the joys of walking— and the physical and mental beneﬁts that come with it. Randolph Walker’s article takes a look at local residents whose lives have been transformed by this simple activity—and the many ways you can incorporate walking into your daily life. I can’t wait to lace up my own walking shoes! Is your child getting enough sleep? That’s a challenging question for many parents, who struggle to help their kids strike a balance in the evening between homework, sports, and family life. Unfortunately we’ve all heard about teens who sleep with their cell phones, and who wake up to receive and answer texts. Jay Conley explores the latest research on how much sleep kids are getting—and how it may aﬀect their health. We also proﬁle several patients who have a new lease on life due to advanced treatments for heart disease. One of these, Vickie Hoﬄer of Vinton, is a heroine who personalizes inspiration. A year ago, Vickie was the ﬁrst patient to Nancy Howell Agee speaks at ferrum College, where she recently served as executive in residence. receive a mechanical heart pump at Carilion. It kept her — Photo courtesy of ferrum College alive and thriving until she was able to have a heart transplant a few months ago at UVA. I hope you’ll read her story of courage. Improving the quality of health care is our ongoing priority. Each year, we work to cut down on infections, reduce costs, and improve patient care in every way. On page 22, we’re proud to tell you about the 2012 Carilion Clinic Quality Awards, which recognize the achievements of our medical professionals. We thank all the recipients for their dedication and commitment to patient care!
NANCY HOweLL Agee PReSIDeNT AND CeO CARILION CLINIC
CarilionClinic.org | SPRING 2013 3
Tips from our Medical Professionals Start Small when Making Lifestyle Changes Break up signiﬁcant lifestyle changes into smaller, more manageable goals. If you need to change your diet, start by eliminating soft drinks. If you want to start an exercise program, walk or climb the stairs for ﬁve minutes a day. If you need to lose weight, focus on the ﬁrst 10 pounds. en, when you have achieved the smaller goal, you will be ready to tackle a larger one. — Catherine G. Rea, M. D. Carilion Clinic Family Medicine, Blue Ridge
Avoid Colds and flu Year-Round ere are many ways to prevent getting run down by colds and ﬂu. Hand washing is most important in preventing the spread of harmful germs. Getting adequate sleep helps to keep your immune system strong. Exercising regularly and drinking adequate ﬂuids also enhances the immune system. Avoid smoking. Smoking is an irritant that increases susceptibility to cold and ﬂu viruses. And remember, you can contract colds and ﬂu all year long—so don’t let your guard down. — Jennifer Adkins, M.S., Certiﬁed Physician Assistant Carilion Clinic Family Medicine, Brambleton Don’t Misuse Antibiotics Antibiotics are still often prescribed unnecessarily for viral respiratory infections. is is alarming as it can lead to antibiotic resistance and also development of “superbugs.” Part of this is due to patient expectations. Some patients have taken antibiotics for viral respiratory infections and gotten better, even though they would have improved without medication. Most of the time, symptomatic treatment is all that is needed. Rest, adequate hydration, and using natural remedies such as vitamin C can be very helpful. — Jeremy A. Llavore, M.D. Carilion Clinic Family and Internal Medicine, Boones Mill
SPRING 2013 | CarilionClinic.org
Create Balance in Your Life It is often diﬃcult to give equal time to professional, family, and recreational activities. But time away from work is essential to both our mental and physical health. Budget time to do the things you enjoy. Also, try to stay in shape, especially if you enjoy outdoor activities like skiing, water sports, or mountain biking. Nothing’s worse than ending your ski trip in the ﬁrst aid hut. Invest time and eﬀort in keeping ﬁt during the other 50 weeks of the year, so you can enjoy your two weeks on the mountain, river, or hiking trail. — J. Randy Howell, D.H.Sc., Certiﬁed Physician Assistant Carilion Clinic Emergency Department, Roanoke Make Sleep a Priority My health tip is to get at least seven to eight hours of sleep a night. Our bodies need a good night’s sleep to function properly. Cells need sleep to regenerate. A good night’s sleep can also help prevent overeating, improve your mood and motivation, and generally help you to feel better. So be disciplined. Turn oﬀ the TV and make it to bed on time and see how you feel! — Joy Badillo, Nurse Practitioner Carilion Clinic Family and Obstetric Medicine, Christiansburg know the Signs of a Concussion Concussions can occur with a fall or a biking or motor vehicle accident—not just a sports injury. Concussions are also under-reported because there may be no outward signs or symptoms. Be on the lookout for one or more of the following: headache, fogginess, moodiness, nausea/vomiting, and irritability. Loss of consciousness may not occur. If you suspect a concussion, please seek immediate medical treatment. — April Nichols, Physical erapy Assistant Carilion Clinic Outpatient erapy – Roanoke Athletic Club
Are Kids Getting enough Sleep? By Jay Conley
Does your child go to bed with a cell phone—and wake up at all hours to text or read new messages? If so, you’re not alone. Sleep researchers say that many children are scrimping on sleep due to this and other distractions. And that it can aﬀect their grades and health. School-age children have more distractions than ever preventing them from getting needed shut-eye, according to the National Sleep Foundation. Aside from homework, sports, and other extracurricular activities, they can have trouble turning oﬀ the TV, smartphone, and Internet. Combine that with early classes, and the window of time available for sleep seems to keep shrinking. Drowsiness or fatigue are also leading causes in at least 100,000 traﬃc accidents annually, and drivers age 25 or younger are involved in the majority of accidents where drivers fall asleep, says the National Sleep Foundation. “Even if you get into bed at 10 o’clock and you have to be up at 6, you’re only getting 8 hours of sleep in the best of worlds if you slept the whole time,” says Helene A. Emsellem, M.D., a neurologist and medical director of e Center for Sleep & Wake Disorders in Chevy Chase, Md. “We feel the adolescent population is sleep deprived in general.” A recent study from UCLA, published last August in the journal Child Development, indicates that when teens stay up late to study, the extra time studying not only doesn’t compensate for the lack of sleep, it has a negative eﬀect on their grades. “I think the real implication here is don’t sacriﬁce one for the other,” says Andrew Fuligni, a UCLA professor of developmental psychology who worked on the study. “If you have extra academic demands, you need to fulﬁll them, but don’t sacriﬁce sleep to fulﬁll them.” Another new study, however, indicates that kids may be getting enough rest. is study, conducted at UCLA and published in the Archives of Pediatrics & Adolescent Medicine last November, collected data on 1,500 to 2,800 children from 1997 to 2007. It indicated that they got the recommended amount of age-appropriate sleep. Researchers based their ﬁndings on parents’ reports of their children’s sleep habits. How much sleep do children need? It depends on their age. e U.S. Centers for Disease Control and Prevention recommends that kids ages 5 to 10 get 10 to 11 hours of sleep, and adolescents ages 10 to 17 get 8 1⁄2 to 9 1⁄4 hours. One thing we do know: Getting enough sleep is critical to learning, says Dr. Emsellem.
CarilionClinic.org | SPRING 2013 5
IN YOUR COMMUNITY
CARILION HOSPITALS RANKED MOST-PREFERRED Once again, Carilion Roanoke Memorial Hospital and Carilion New River Valley Medical Center received Consumer Choice Awards, placing them among the best in the country. e awards, from National Research Corp., are based on a national survey of more than 250,000 households. ey are given to hospitals ranked the highest in their market for overall quality, doctors, nurses, and image/reputation. Carilion Roanoke Memorial Hospital has received the award for nine consecutive years; Carilion New River Valley Medical Center for three.
Cardiac Lab Recognized e cardiac catheterization lab at Carilion Roanoke Memorial Hospital is the ﬁrst in Virginia, and one of only 10 nationwide, to earn accreditation from ACE (Accreditation for Cardiovascular Excellence). ACE’s mission is to ensure high-quality patient care and to promote patient safety in facilities where invasive cardiac and endovascular procedures are performed.
Dr. Carol M. gilbert Honored
e ﬁrst dragon boat race at Smith Mountain Lake was held to beneﬁt the Presbyterian Community Center. Carilion Clinic and VelocityCare, two of the main sponsors, entered one of the nine teams that raced; more than $10, 000 was raised. e Pan American Dragon Boat Association provided all boats and pre-race practice sessions.
SPRING 2013 | CarilionClinic.org
DRAGON BOAT RACE BENEFITS CHARITY SCAN TO WATCH A DRAGON BOAT RACE IN ACTION!
In honor of trauma surgeon Carol M. Gilbert, M.D., Carilion Clinic has established an award in her name. e Carol M. Gilbert Lectureship will be held annually, featuring a special guest speaker. Dr. Gilbert was recognized for her contributions as a mentor to medical students and residents and for her leadership in emergency medical services and search and rescue operations. Pictured: Dr. Gilbert with Christopher C. Baker, M.D., chair of surgery at Carilion.
CARILION CLINIC PROVIDES OVER $131 MILLION IN COMMUNITY BENEFIT ere are many ways an organization can give back to the community. Some pay taxes to support the cost of government services. As a tax-exempt organization, Carilion Clinic gives back in other ways. In 2011, Carilion Clinic provided $131.1 million in community beneﬁt. is meant that for every dollar of tax exemption, Carilion gave nearly $5 back to the community. is included an average of more than $292,000 in uncompensated care each day. Community beneﬁt, as deﬁned by the IRS, includes community outreach such as free health screenings and community programs, and investments in education to train new physicians and medical professionals.
Dr. Sidney Mallenbaum Heads Task Force Sidney Mallenbaum, M.D., was elected co-chair of the Virginia Stroke Systems Task Force for a two-year term. e task force’s purpose is to improve stroke care and access to care for stroke victims across Virginia. Dr. Mallenbaum is medical director of the stroke unit at Carilion Clinic and associate professor of neurology at the Virginia Tech Carilion School of Medicine.
UNCOMPENSATED CARE: $106.7 MILLION (CHARITY CARE: $65.4M)
EDUCATION: $20.4 MILLION COMMUNITY OUTREACH: $3.3 MILLION RESEARCH: $.7 MILLION
$131.1 MILLION TOTAL COMMUNITY BENEFIT
COMMUNITY BENEFIT $131.1 MILLION
Children’s Hospital Awarded grant Carilion Clinic Children’s Hospital received a $36,252 grant from Kohl’s Department Stores to provide free portable cribs to families in need in Roanoke and Lynchburg. e grant, through the company’s Kohl’s Cares program, will support a new initiative, Kohl’s Infant Safe Sleep. e No. 1 killer of infants is suﬀocation due to an unsafe sleep environment. For more information, go to CarilionClinic.org/kiss.
TRAUMA CENTER RECERTIFIED Carilion Clinic’s Level I Trauma Center received its three-year recertiﬁcation by the Virginia Department of Health. e center, at Carilion Roanoke Memorial Hospital, is one of only ﬁve Level I trauma centers in the state — the highest designation awarded. e trauma center has been certiﬁed since 1983.
$28.3 MILLION CarilionClinic.org | SPRING 2013 7
FOR EXPECTING PARENTS By Su Clauson-wicker
Sarah Gibbs, a permaculture garden designer, likes to do things naturally. But at 42, she wanted to deliver her second child in a hospital, as she had her ﬁrst. Gibbs wanted medical expertise, but she craved more control over her birth experience. Luckily for Gibbs, Carilion New River Valley Medical Center has three master’s-degree certiﬁed nurse-midwives on the hospital’s staﬀ. Gibbs met with both a physician and midwife Kris Conrad during her pregnancy, and delivered baby Kyle at the hospital’s “e Birthplace.” Midwives Conrad and Mattie Berry were on duty. “Kris and Mattie were wonderfully supportive throughout,” Gibbs says. “ey explained the facts and let me decide many things. I was so involved this time.” Since September, e Birthplace has oﬀered midwife services 24/7. Patients can choose whether to deliver with a physician or a midwife, and almost 20 percent request midwives. “We’re in partnership with our clients,” Conrad says. “We support their autonomy as well as their health.”
SPRING 2013 | CarilionClinic.org
Top: Midwife Sherrie Doss holds newborn Aubrei Stump. Bottom: Midwife Mattie Berry listens to fetal heart tones as she examines Aubrei’s mother, Tristi DeBord.
L to R: Midwives kris Conrad, Mattie Berry, and Sherrie Doss.
e midwives also enjoy a collaborative relationship with physicians. “e care we give is complementary,” says Conrad. “We each have strengths to oﬀer, and the care we provide as a group gives women many options to meet their needs.” “We encourage all patients—even those requesting a midwife for labor—to see both a physician and midwife during their prenatal care,” adds Berry. “ere is always a possibility that a physician may need to be involved in the labor or birth. “What makes our practice so unique is that we share patients together, providing the most well-rounded maternity care possible.” Patients who choose a midwife for delivery can also ask for an epidural to relieve their pain. While many prefer to go through labor naturally with a midwife, it isn’t required. “Midwives also provide continuous labor support, which has been shown to decrease interventions in labor,” says Sherrie Doss, who in 2007 was the ﬁrst midwife to join the hospital’s staﬀ. Doss and Conrad have doctorates in nursing in addition to their master’s degrees. “It’s unique to guarantee midwife availability,” says Patrice M. Weiss, M.D., chair of Carilion Clinic’s Department of Obstetrics and Gynecology. “We oﬀer this to even high-risk patients, such as diabetics, because e Birthplace is in a hospital with OB/GYN availability to do a Caesarean section very quickly, if in the unlikely event this is needed.” e Birthplace has won the coveted ﬁve-star rating in patient satisfaction three times from Professional Research Consultants, Inc. e Birthplace team oﬀers family-centered care in homelike rooms with sleep sofas, refrigerators, televisions, and massage therapy for patients. “We’re here to oﬀer families the best possible birth experience,” says Dr. Weiss.
Women beginning labor are advised to soak in a warm tub. The water’s buoyancy lifts the baby’s weight oﬀ the mother’s back and relieves contractions. Now women have the labor tub option at Carilion Roanoke Memorial Hospital, where the tub was installed last fall. (Patients undergo labor in the tub, but do not deliver in it.) “I was thrilled that they installed the tub at Roanoke Memorial weeks before my delivery,” says Laura Godfrey of Roanoke. “I went from 5 cm to fully dilated and pushing in an hour. I didn't need pain medication.” Andrea Cobb, M.D., who practices at Carilion Clinic’s obstetrics and gynecology practice in Salem, recommends the tub for women foregoing epidurals. “Tension prolongs labor,” she says. “When a woman relaxes in the tub, her body proceeds naturally.”
Laura godfrey holds her daughter, Avery, at the labor tub.
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rt A as
Medicine HEALING ARTS PROGRAM DEBUTS By Rich Ellis
Soon there will be a new form of treatment available in the region—one that doesn’t involve medication or even oversight by a physician or nurse. A healing arts program that incorporates the literary, visual, and performing arts is being launched by Carilion Clinic. Named after the highly regarded Roanoke thoracic surgeon, e Dr. Robert L.A. Keeley Healing Arts Program will create inspiring and restorative environments for patients, visitors, and caregivers. (Dr. Keeley, 91, is medical liaison for nursing services at Carilion Roanoke Memorial Hospital.) “We’re beginning with a pilot project to introduce journaling in several units at the hospital,” says Marie Webb, senior director of community outreach for Carilion. “We’ll distribute journals and pens to patients who are often hospitalized for a longer period of time, such as oncology and cardiac surgery patients. “Patients want to express their feelings,” Webb says. “Journaling gives them that opportunity. Some patients may choose to create their own life map or tree of life in their journal.” Writing in a journal can also help patients ease their transition from the hospital to home by letting them write down questions about their care, along with their caregivers’ instructions.
A Healing environment As part of the program, a healing garden will be planted near the Roanoke River Greenway in partnership with the City of Roanoke. “We’re creating a small 10
SPRING 2013 | CarilionClinic.org
Boosting the Healing Process
garden near Roanoke Memorial between the greenway and the river,” says Daniel Dart, landscape designer for Roanoke’s Parks and Recreation department. “It will have benches and a swing surrounded by aromatic plants like rosemary, thyme, and butterﬂy bushes, as well as paved areas. We’re trying to create a secluded garden that’s sequestered from the rest of the world to encourage the healing process.” e garden is expected to open this spring or summer; a ceremony will be held to dedicate it in honor of Dr. Keeley.
A Community Collaboration Carilion is developing the healing arts program in collaboration with members of the local arts community. A steering committee is developing a list of potential oﬀerings, cultivating partnerships, identifying volunteer resources, and recommending artists and works. “is is something I’ve been interested in for a while,” says Susan Jennings, arts and culture coordinator for the City of Roanoke and a committee member. “One important aspect of the program is that it’s not just for patients but also for health care professionals. Involvement in the arts promotes healing as well as stress relief, and with health care being so stressful, this can help.” rough her interaction with the Roanoke Arts Commission, Jennings is also spreading the word about the healing arts program and seeking ideas from others in the art community. Integrating arts with the healing process isn’t a new idea at Carilion. Roanoke Memorial already oﬀers recorded music therapy and guided imagery for cardiac patients, live performances and arts and crafts projects in the pediatric unit, and expressive arts therapy for adult and pediatric patients in the behavioral health unit. Live bluegrass music performances are also staged weekly by volunteers in the outpatient oncology waiting room, and other live performances take place in the hospital’s lobby. An art wall displays paintings by local artists that are available for purchase. e formalization of the healing arts program, though, will greatly expand patients’ access to art as part of the healing process. Now that’s powerful medicine.
Healing arts programs create healing environments that support a patient’s mental and emotional recovery. Studies show that art can reduce anxiety, lower blood pressure and stress hormone levels, enhance sleep patterns and alertness, and raise pain thresholds and mood. Some hospitals around the country, including the Mayo Clinic and Cleveland Clinic, now have healing arts programs. In support of its new program, Carilion Clinic received a $25,000 grant from Epic Systems Corp. The grant, which will lay the foundation for the program, will pay for art materials for use by patients and their families at Carilion Roanoke Memorial Hospital. The funds may also be used to create public art spaces within the hospital. e Carilion Clinic Foundation is raising funds on behalf of the healing arts program. For more information about the program, and how you can support it, call 540-224-5398 or go to CarilionFoundation.org. CarilionClinic.org | SPRING 2013 11
Enjoying Life after a Hip Replacement By Karen Doss Bowman
As a cardiothoracic surgeon, Paul Frantz, M.D., doesn’t enter into surgery lightly. But once the degenerative arthritis in his left hip began keeping him from doing the outdoor activities he enjoyed most—such as skiing and hiking—he knew it was time to consider a hip replacement. “I was walking with a limp and was in pain,” says Dr. Frantz, Carilion Clinic’s director of cardiac services. “It was progressively getting worse, and when I had diﬃculty doing the things I wanted to do, I decided to schedule the surgery.” His hip replacement was done through the anterior approach—a relatively new technique. Joseph Moskal, M.D., section chief of orthopaedics, introduced it to the region nearly four years ago, and since then, he and his colleagues have performed more than 1,000 of these procedures at Carilion.
Minimally Invasive Surgery Minimally invasive surgery has many advantages, including smaller incisions, less discomfort and blood loss, shorter hospitalization and rehabilitation, and a quicker return to work. The surgical team at Carilion Clinic performs a number of minimally invasive, laparoscopic or endoscopic procedures, including partial and total hip, knee, and ankle replacement surgeries. 12
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Surgeons trained in the anterior approach technique: John Mann, M.D. Joseph Moskal, M.D. Michael Wolfe, M.D.
e computer-guided procedure involves making a small incision on the front (anterior) of the hip. Unlike the traditional approach to hip replacement, this method does not require the cutting or detachment of muscles and tendons. at means patients can expect less pain and a quicker recovery. ere is also a reduced risk of dislocating the joint. Dr. Frantz, whose wife, Susan, had traditional hip replacement surgery in Pittsburgh nearly a decade ago, believes the anterior approach is superior. “I had heard about it and read that recovery was faster,” he says. “Having been involved in my wife’s care after her surgery, I knew I wanted to try for a less painful course.” He was out of the hospital within a
few days of surgery and was walking without help soon after. He’s been pleased with his results. “I’m back to my full range of activity with no limitations, except running isn’t recommended after a hip replacement,” says Dr. Frantz, who regularly bikes, hikes, and works out on his elliptical training machine. “It took a while to get back the full range of motion I once had, but this surgery has made all the diﬀerence in the world.” e surgeons on the joint replacement team recommend that patients talk to their doctors to discuss potential alternatives to surgery. ey also advise patients to exhaust all other options, such as modifying their activities, getting more rest, and using appropriate
Reclaiming Her Life For Susan Marchon, a new hip has recharged her life. In June, Marchon underwent anterior hip replacement surgery on her deteriorated right hip. With her pain signiﬁcantly reduced, she is able to keep up with the demands of daily life. “It was the best thing I ever did,” says Marchon, the executive director of the New River Valley Alcohol Safety Action Program. “It’s been a miracle. I feel like I have my life back.” Marchon, who also had back surgery in 2011, had read about the anterior approach and knew she wanted to take that route. Joseph Moskal, M.D., section chief of orthopaedics at Carilion Clinic, performed the procedure. When she got home, Marchon discovered that everyday tasks were often the hardest. Wanting to help others, she created a brochure packed with advice on everything from how to put on compression stockings and going to the bathroom to organizing your home before surgery. “These are the things I needed to be as independent as I possibly could during my recovery,” she says. Marchon is grateful for the care she received and often recommends Dr. Moskal to others. “I’m a Dr. Moskal groupie,” she jokes. “If anyone I know has hip issues, I refer them to him.”
medications. ey believe that surgery is always the last option, but that for those who need it, the prognosis with the anterior approach is excellent. Dr. Frantz agrees. “e speed of recovery with this muscle-sparing approach was amazing.”
Ankle Replacement Ankle replacement surgery is now available at Carilion Clinic for patients with severely damaged ankle joints caused by end-stage arthritis or traumatic injury. The rare procedure, oﬀered by just a few surgeons in Virginia, provides an alternative to ankle fusion surgery and preserves ankle motion. The surgery involves replacing damaged bone in the ankle joint with artiﬁcial prosthetics. “This procedure provides patients with an option of maintaining joint motion while decreasing their pain,” says Carilion Clinic podiatrist J. Randolph Clements, D.P.M., who performs the procedure in tandem with orthopaedic surgeon Thomas E. Shuler, M.D. “If you can preserve the motion at the ankle joint, then it helps prevent other joints around the ankle from wearing out.” Though Drs. Clements and Shuler see many patients with debilitating conditions of the ankle joint, few qualify for the procedure. The typical candidate is over age 50 and not obese, with no foot deformities or nerve damage from diabetes. CarilionClinic.org | SPRING 2013 13
New Options for Ailing Hearts
By Allison Buth
Heart disease is complex, and treating it successfully requires specialized knowledge. In the Roanoke Valley, Carilion Clinic oﬀers three unique programs to patients with severe heart conditions. All have received a strong response from patients, many of whom previously would have had to travel outside the region for such care. Here are three of their stories.
Heart failure Clinic “e program has two main goals— to care for patients with severe heart failure who require vigilant follow-up, and to provide easy access for patients recently discharged from the hospital for heart failure,” says Carilion cardiologist Stephen Phillips, M.D. Heart failure patients typically have high hospital readmission rates. By seeing patients within a week after discharge, the heart failure clinic can educate them about their medications 14
SPRING 2013 | CarilionClinic.org
Heart patient Vickie Hoﬄer and her husband, Charlie.
and provide follow-up treatments that improve their quality of life. Some patients with advanced heart failure can beneﬁt from an innovation known as a left-ventricular assist device
(LVAD) —a mechanical heart pump that helps pump blood throughout the body when a patient’s heart is too weak to do so. “Our objective is to stay on the front edge of evolving science for advanced
treatment of heart failure,” says Carilion nearly a year in Germany. “Physicians cardiothoracic surgeon W. Scott Arnold, and patients often think that the elderly M.D. “One of those treatments is the population is too old for surgery,” he LVAD.” says. “But TAVI is typically oﬀered to paA year ago, Dr. Arnold implanted the tients who are 80 to 90.” ﬁrst LVAD at Carilion in patient Vickie Patient Ruby Poore, 86, was referred Hoﬄer of Vinton, who arrived at the to Dr. Foerst by Richard Konstance, hospital in dire condition. “Once Vickie M.D. “I was not a candidate for open proved that she was going to survive, heart surgery,” we put in the implantable device,” he she says. “When says. I found out I was “At that point, we didn’t know if a candidate for she would have it indeﬁnitely or just TAVI, I prayed a until she received a heart transplant.” lot about it. I Recently Hoﬄer did undergo a wanted to live heart transplant, but the LVAD kept for my son, her thriving until she received her grandchildren, new heart. “I am so thankful this imand great grandplant was available and I was able to son who will be Ruby Poore get it,” she says. “At that time, it was born in the my only option.” spring.” Prior to TAVI, she was in a lot of pain, Heart Valve Center wheezing and frequently out of breath. e heart valve center is available to “I feel very lucky,” says Poore, of patients with severe aortic stenosis, or Roanoke. “I can get around now to cook narrowing of the heart’s aortic valve, and clean a little. I sleep better now bewhich obstructs blood ﬂow. cause I breathe better, and I have inOne new treatment available to such creased stamina. TAVI gave me a new patients is transcatheter aortic valve im- lease on life.” plantation (TAVI). During the minimally Center for Atrial fibrillation (A-ﬁb) invasive procedure, an artiﬁcial heart “A-ﬁb is very common—the most valve is implanted by passing it through an artery in the leg up to the heart using common arrhythmia in the U.S., in fact—but with complex symptoms,” a tube, or catheter. Special imaging says cardiac electrophysiologist Carl equipment helps guide the valve into Musser, M.D. “We’re unique in that we place. have experts devoted to treat this.” TAVI was recently approved by the Within the program, doctors diagFDA as a treatment for high-risk panose, treat, and manage electrophysioltients and those who are not candidates ogy disorders and provide cardiac for traditional open heart surgery. It is ablation for a-ﬁb. only available in about 200 medical cenPatient Susan Hinchee of Roanoke, ters nationwide. Interventional cardiologist Jason Fo- for instance, was treated with cryoablaerst, M.D., brought the ground-breaking tion—a minimally invasive technique that uses coolant to freeze aﬀected tisprocedure to Carilion after training for
sue around the pulmonary vein to block irregular electrical signals. “Susan’s heart was having a hard time falling back into a normal rhythm after it went into a-ﬁb,” says Dr. Musser. “ere was a six- or seven-second delay where blood wasn’t pumping to her heart, causing dizziness. We put in a pacemaker to alleviate that problem. e pacemaker provided a safer recovery option for her, and we can forever monitor
her overall arrhythmia through the pacemaker, which is very helpful.” “I can’t say enough about Dr. Musser and his team,” says Hinchee. “I feel wonderful, absolutely wonderful. I don’t have any symptoms, and I can do what I want. I can exercise again, and I now feel how I felt before I had a-ﬁb.” For more information on these specialty care programs, visit carilionclinic.org/heart, or call 540-266-6000 or 800-422-8482.
CarilionClinic.org | SPRING 2013 15
JOY By Randolph Walker
Across our region, more people are going for a walk. And whether it’s by themselves or with friends, family, or a group, they’re discovering the physical and mental joys of walking. It’s one of the best forms of exercise. It can be adapted to any ﬁtness level. So it’s no surprise that people of all ages are re-discovering an activity that can be free and easy — or organized and vigorous. ey’re also burning calories, losing weight, improving their health, and relieving stress while they do it. Take Linda Foster of Salem. It’s hard to believe that this slender retired nurse was almost 50 pounds heavier a little over a year ago. Foster signed up for the Lose Big program at Roanoke County’s Green Ridge Recreation Center, where the program includes treadmill and track walking. “When I started, I couldn’t jog at all,” she says. “I could only walk.” She’s covered a lot of ground since then. Exercising at Green Ridge is a family aﬀair for Amy Maﬀe of Salem. She came ﬁrst, then brought her father, Steve DeHaven of Roanoke County. DeHaven in turn got Amy’s mom and grandfather to come. DeHaven likes the ﬂexibility of walking. “You can do it as hard as you want,” he says. “You Retired nurse Linda foster has lost almost 50 pounds by walking.
SPRING 2013 | CarilionClinic.org
can get a good warm-up, or get aggressive and do a good workout.” Outdoors, the Roanoke River Greenway attracts many walkers—and their dogs. Katie Howey, a grad student at Virginia Tech, is one. “I lead a generally hectic life,” she says. “Between commuting to Blacksburg, working on my thesis, and my job, it is hard to ﬁnd time to go to the gym. at is why I like to walk. Walking is a physical and mental refresher. “During the week, I walk Willow [her 8-month-old Goldendoodle] on the greenway regularly. On the weekends my boyfriend, Willow, and I take advantage of the beautiful region we live in by hiking.” Roanoke residents Tom Johnson, 72, and Pat McMeekin, 63, can also be seen on the greenway with their Sheltie, Ruﬃan Ready, a.k.a. Ruﬀy. “He’s gone probably as much as eight miles in one walk,” says McMeekin. “We carry water for him.” Johnson, a former runner, switched to walking for health reasons. He’s not the only one, according to Jim Humphrey, president of the Star City Striders. “It’s mainly a running club,” he says, “but we’re looking into how to inte-
grate walking into it some, recognizing that walking is becoming more of a factor and more people are doing it. ey’ve aged out or have hip issues so they become walkers.” In November, the group’s Star City Half Marathon included a 10K walk for the ﬁrst time. “A lot of the races are becoming walk friendly,” says Blaine Lewis, co-owner of Fleet Feet Sports in Roanoke. In the Drumstick Dash, held annually to beneﬁt the Roanoke Rescue Mission, walkers outnumber runners almost two to one, he says. Group walking not your style? Opportunities abound for more solitary jaunts. Buddy Johnson, 60, works at Walkabout Outﬁtter in Lexington. “Within a three-mile proximity of Lexington, you’ve got four diﬀerent options,” he says: Woods Creek Trail, Chessie Nature Trail, Brushy Hill Preserve, and Boxerwood Nature Center & Woodland Garden. Johnson says he walks to get in shape for longer trips on the Appalachian Trail. In Roanoke, woodland wanderers can explore the trails that wind invitingly through the 500 acres of parkland on and around Mill Mountain. Nancy Dye, chairperson of the city’s Mill Mountain Advisory Committee, lives on the old switchback road up the
Making It a Habit Need a speciﬁc time and day to get motivated? You’re always welcome to join Physicians on Foot, a free walking program oﬀered by Carilion Clinic. The group meets at 8:30 every Saturday morning. From April through October, it meets on the Roanoke River Greenway near Carilion Roanoke Memorial Hospital; from November through March, at Tanglewood Mall. “It helps to have a group to walk with. It gives you a place and time to show up,” says Elizabeth Polk, M.D., a family medicine physician who started the program and who often walks with the group. “There’s no topic, the point is to get out and exercise.” “It gets me out walking on a regular basis,” says Stuart Zaikov, 64. Zaikov says he was introduced to the greenway through Physicians on Foot. Carilion has also sponsored Step by Step, a voluntary 12week walking program for its own employees. Each was given a pedometer, with the goal of walking 10,000 steps, or 30 minutes a day. Carilion is also a sponsor of many running and walking events throughout the region.
CarilionClinic.org | SPRING 2013 17
CrossFit Takes Oﬀ As rock music blasts, three women and four men lift barbells from a squatting position. Then they set down the weights, race down a grassy slope, pivot, and charge back up. Welcome to CrossFit, a ﬁtness program with varied highintensity activities, including weight-lifting. It is often practiced by law enforcement and military personnel to gain strength, endurance, and ﬂexibility. It has 4,500 aﬃliated gyms worldwide, including CrossFit Blacksburg, Roanoke Valley CrossFit in Salem, and Brickhouse CrossFit in Roanoke. “It’s big in any metropolitan area, and it’s starting to spread to some of the more rural regions,” says Tim Falke, coowner of Roanoke Valley
SPRING 2013 | CarilionClinic.org
CrossFit. His clients range in age from 14 to 65, with the average student in his or her late 30s to mid 40s. Most work out four or ﬁve days a week. The workout takes less than an hour. At his ﬁrst CrossFit workout, in Austin, Texas, Neil Strickland was paired with a 49-year-old woman. “She made it through the workout — I did not,” says Strickland, 26. “I had a lot to learn about ﬁtness.” Strickland, a Salem resident, has been practicing CrossFit for two years. “I’ve seen better results from this than anything else,” he says. Marit Berntson, 49, of Roanoke, is another regular. “I need to work on my bone density and overall strength and ﬂexibility,” she says. “I had a child pretty late in life, and I want to be able to keep up with him.”
mountain, closed to through-vehicles but open to bicyclists and walkers. “It’s enjoyed by people of all ages,” she says. “We see older people walking up it, young couples with babies, and everyone in between.” Popular walking trails elsewhere in the region include those along the Peaks of Otter in Bedford and in Explore Park in Roanoke, and Huckleberry Trail in Blacksburg and Christiansburg. (See Resources on page 19 for more trail locations.) Indoor tracks and treadmills with heart rate monitors are also available at the Roanoke and Botetourt Athletic Clubs, as well as certiﬁed personal trainers who can develop individualized programs to help walkers gain strength and endurance. In addition, both clubs oﬀer FIT Rx, a 60-day medical membership that includes ﬁtness consultations and weekly one-on-one training sessions with a certiﬁed personal trainer.
Health Beneﬁts Whether you’re walking solo or with 16,000 close friends in the Drumstick Dash, you’re getting all sorts of beneﬁts. “Walking is good because it is a cardiovascular exercise,” says Elizabeth Polk, M.D., a Carilion Clinic family medicine physician. “It also has a beneﬁt for bone health. It’s a weight-bearing exercise, so it helps prevent osteoporosis. And it helps improve your mood and your sleep. Plus it promotes weight loss, which helps manage and correct some chronic medical conditions like diabetes and high blood pressure and cholesterol.” How many calories are you burning? Dr. Robert Grange of Virginia Tech’s Department of Human Nutrition, Foods, and Exercise suggests using an online walking calorie calculator (see link in Resources). Enter your weight, the time you walked, and your estimated speed. Click “calculate” to ﬁnd out how many calories you burned. e beneﬁts of walking aren’t just physical. For group walkers, there’s a so-
Top: Linda foster works out on the treadmill at green Ridge Recreation Center. Right: Amy Maﬀe with her father, Steve DeHaven, at left, and her grandfather, Ray DeHaven.
cial beneﬁt as well, says Brad Kinkema, CEO and executive director of the Martinsville-Henry County Family YMCA. His Y oﬀers a free mid-day walking program called Activate tailored to seniors and those with low incomes. “You see a lot of people meeting at the same time,” says Kinkema. “It’s important for seniors to have social interaction as well, if they’re the only person at home.”
A National Trend With advantages like these, it’s no wonder that walking is growing in popularity. In 1994, the U.S. Department of Transportation started encouraging urban planners to accommodate pedestrians. Since then, “there has been measurable progress in improving conditions for bicycling and walking,” according to “e National Bicycling and Walking Study: 15-Year Status Report,” published by the department in 2010. In the National Health Interview Survey, the percentage of people who reported walking at least once for 10
minutes or more in the previous week rose from 56 percent in 2005 to 62 percent in 2010. e South showed a large increase. Dr. Dianna Carroll, an epidemiologist with Centers for Disease Control and Prevention, was one of the authors of the survey. Researchers didn’t know why walking increased in the South, but it might have been related to publicity about obesity in the region, she says. In any case, “we were happy to see it.” Another survey that addresses walking is the U.S. Census American Community Survey. From 2002 to 2008, workers who commute primarily by walking increased slightly to 2.82 percent. In addition to getting exercise, walking commuters avoid paying for fuel and vehicle maintenance. “e nice thing about walking is, it doesn’t require any equipment or training except maybe a pair of tennis shoes,” says Dr. Polk. However, if you’re the type who loves gadgets and gear, there are stores for that. Walkabout Outﬁtter in Roanoke and Lexington has quick-drying gar-
ments for summer and insulated ones for winter. Fleet Feet Sports, with a location in Roanoke, specializes in ﬁtting shoes for walking and other activities. One thing is clear: indoor or outdoor—alone or with a group—walkers are taking strides toward a better quality of life.
Resources ROANOkeOuTSIDe.COM OuTDOOR.ORg.VT.eDu fRANkLINCOuNTYVA.gOV/PARkS MARTINSVILLeYMCA.COM CNYHIkINg.COM/BRP-PeAkSOfOTTeR CARILIONCLINIC.ORg/wALkINg STARCITYSTRIDeRS.COM CARILIONfITNeSS.COM
Mill Mountain trails map RVARC.ORg/MAPS/MILLMTNPARk.PDf
Roanoke Appalachian Trail Club RATC.ORg
Walking Energy Calculator exRx.NeT/CALCuLATORS/wALkRuNMeTS.HTML
CarilionClinic.org | SPRING 2013 19
HAVE you seen
LATELY? By Alison Weaver
SPRING 2013 | CarilionClinic.org
More than 100 years after its inception, one of Roanoke’s ﬁrst suburbs is undergoing a renaissance. Wasena, a small neighborhood nestled along the Roanoke River, is becoming a mecca for urban pioneers who cherish its dozens of acres of parkland, aﬀordable housing, and proximity to downtown Roanoke. Residents, developers, and city oﬃcials all point to the river and its greenway as the catalysts for what James Settle, president of the Wasena Neighborhood Forum and a resident since 1999, prefers to call a “rediscovery” of the area. “We’ve been here all along. It’s in the middle of everywhere you want to be. It’s close to downtown, Grandin Village, South Roanoke, Towers Shopping Center, and the interstate.” Wasena dates to 1910, when farmer George Howbert sold his acreage to Wasena Land Company to be developed as a suburb. Designed to be aﬀordable, lots could be purchased for a $2 down payment and $2 per week. It was the ﬁrst Roanoke neighborhood served by a bus line because the original metal bridge was too unstable to support a streetcar. Most of Wasena’s 469 structures were built before World War II and feature an eclectic mix of Colonial Revival, Craftsman, and Tudor Revival homes. Another
West End Revitalization
Left and upper right: The new wasena City Tap Room restaurant and The River House, a converted icehouse with 128 apartments. Lower right: wes Best plans to open a bicycle shop and café in wasena.
building surge after the war brought some of the ﬁrst ranch-style homes to the area. Sarah Hudson is a Wasena homeowner who purchased there seven years ago. “We got the most bang for our buck in Wasena in terms of location and cost per square foot,” she says. Another huge draw was Wasena Park and the Roanoke River Greenway that runs through it. According to Michael Clark, manager of the city’s Parks and Recreation department, some 20,000 people use the greenway every month. “We feel that the greenway is what’s driving the development in Wasena,” he says. It attracts cyclists, walkers, joggers, and rollerbladers year-round, as well as ﬁshermen and bird-watchers. In addition to the appeal of the greenway, the neighborhood’s designation in 2011 as a state and national historic district is fueling development. Using state and federal tax credits, developer Ed Walker converted an old icehouse into e River House, with 128 upscale apartments. e building also houses e Wasena City Tap Room restaurant, commercial space, and e River Rock, a rock- and rope-climbing gym expected to open in February. Brent Cochran, e River Rock’s managing partner, hopes the facility will be “a gateway to getting people oﬀ their couches. I picture people riding their
bikes along the greenway to the climbing gym.” To facilitate growth, the city created a new zoning designation called an “urban ﬂex district” that encourages mixed-use development in what it terms “underperforming” industrial areas not suited for heavy industrial use. City Planning Administrator Chris Chittum envisions the area along Main Street becoming like Grandin Village or Crystal Spring, with coﬀee shops, restaurants, and small shops. “e pieces are in place for development to take oﬀ,” he says. “We want to open the area to a lot of diﬀerent kinds of uses.” Wasena Park and the greenway are already magnets for businesses catering to outdoor enthusiasts. Last March, Chris Heslin opened UnderDog Bikes next to Vic omas Park, just over the pedestrian bridge from Wasena Park in the ad-
The City of Roanoke has targeted an area across the river from wasena for its next concentrated revitalization eﬀort. funding from HuD and other sources will pump $2.5 million a year into the west end, comprising portions of the Old Southwest, Mountain View, and Hurt Park neighborhoods known for high crime rates and low home ownership. The former Villa Sorrento restaurant on Patterson Avenue will be the site of an urban mix of commercial space, a community kitchen, meeting rooms, a branch of freedom first Credit union, and a pavilion. grants will also be awarded to encourage construction of new owner-occupied singlefamily housing and rehabilitation of existing owner-occupied homes. jacent Mountain View neighborhood. Open throughout the year, UnderDog provides rentals for greenway visitors. Wes Best, the owner of East Coasters cycling shop, has purchased the quaint building in Wasena that once housed the Roanoke Transportation Museum. Best says he ﬁrst spied the long-vacant, boarded-up building in 1999. “I thought, ‘Why is that cool building sitting there empty?’ I’ve dreamed about buying it ever since.” Best is shooting for an early spring opening for the business, which will oﬀer bicycle sales and rentals and repair services. He’s also ﬁnalizing plans to have a café on site. “Wasena has always had so much to oﬀer,” says Settle. “And now it has even more.” CarilionClinic.org | SPRING 2013 21
IMPROVING QUALITY SAV ING LI V E S QUAL ITY
ES D I R T AWARDS RECOGNIZE S
Every year, Carilion Clinic works to cut down on infections, reduce costs, and otherwise improve the safety and quality of health care. Carilion’s 2012 Quality Awards recognized such successes in many areas of patient care. e MVP Award for the best overall project went to the Carilion Roanoke Memorial Hospital team that reduced the Central Line-Associated Blood Stream Infection (CLABSI) rate to zero for 12 consecutive months. Because they are associated with inserting a central vascular catheter, proper insertion and care can cut the risk of CLABSI infections. Carilion was able to reduce its infections by forming a quality team that reviewed and instituted best practices. ese include choosing the optimal catheter site, using an insertion checklist, and following strict hand hygiene. An estimated 250,000 or more CLABSI infections occur in U.S. hospitals annually. According to the Centers for Disease Control and Prevention, these infections “result in thousands of deaths each year and billions of dollars in added costs to the U.S. health care system, yet these infections are preventable.” e Pioneer Award went to the Roanoke Memorial team that reduced cases of hospital-acquired pressure ulcers from 39 to two patients in the 8 Mountain Intensive Care Unit and from 37 patients to seven patients in the 10 Mountain Intensive Care Unit. And more than $1.5 million in costs were avoided. e Enterprise Award was given to the Roanoke Memorial team that improved the hospital’s processes for preventing such ulcers, resulting in a current rate of 1.3 percent, a signiﬁcant improvement over the 7.9 percent rate reported in 2009. A Roanoke Memorial team previously recognized for reducing ventilator-associated pneumonia won the Hold-the-Gains Award for cutting the incidence rate even further: from 1.29 percent to 0.5 percent. Team members potentially saved 71 lives and avoided costs of more than $5 million.
SPRING 2013 | CarilionClinic.org
Top: R. wayne gandee, M.D., executive vice president and chief medical oﬃcer of Carilion Clinic, presents the Provider excellence Award to gynecologist kaylene Logan, M.D., Residents and fellows Category winner. Middle: The team who won the Hold-the-gains Award for cutting the number of ventilator-associated pneumonia cases. Bottom: The team who won the MVP Award for reducing the Central Line-Associated Blood Stream Infection rate.
Pharmacist James Black helps patient Jon Thomas.
LOOKING OUT FOR YOU: Meet Today’s Pharmacist Your pharmacist does much more than just ﬁll prescriptions. He or she is an integral part of your health care team. Today’s pharmacists play new and vital roles in patient care. ey play a critical role in preventing medication errors and drug interactions. ey also advise doctors on the best drug choices and work with patients so they understand how to take their medications. Pharmacists are experts on the thousands of medications available, and how they work in the body. If he or she spots a problem, a quick call to the prescribing physician can often prevent side effects or health threats. A pharmacist also knows that medicines can react adversely with some foods—or may not be safe for people with certain health issues. Pharmacists who graduate today receive four years of education beyond their undergraduate studies. Many who practice in health care systems complete another year of study or a two-year specialist residency program. “We serve as counselors and advisors,” says James Black, lead pharmacist for Carilion Clinic’s Crystal Spring pharmacy near Carilion Roanoke Memorial Hospital. “Our goal is to ensure that each patient understands how to take their medicines and to determine any potential problems.” “It doesn’t matter if a medication is a miracle
By Erica Stacy
drug,” he says. “If patients don’t take it the way they’re supposed to, it won’t work. But when patients understand how and why they are taking a medication, it can improve their quality of life, cut their time away from work, and reduce hospitalizations.” Black and other pharmacists look at the whole picture. Are patients taking other medications that may interact with a new prescription? Do they have ﬁnancial challenges that could aﬀect their ability to get reﬁlls?
Create a Relationship Establishing a relationship with a single pharmacy also creates a safety net. It’s as important as selecting a family physician. A quality pharmacy should oﬀer guidance, information, and one-on-one education. Look for Medication erapy Management, or MTM, a new concept in pharmacy care that combines medication review with education, action plans, and follow-up. “MTM oﬀers the detailed instructions and information necessary to empower patients to take care of their own health,” says Black. “When we customize care, and our patients understand why and how they are taking a medication, the results are dramatic,” he says. “Our goal isn’t to simply count pills and measure medicines. It’s simple. We care for people.” CarilionClinic.org | SPRING 2013 23
NEW PROVIDERS Melanie D. Altizer, M.D. Obstetrics and Gynecology
Twana H. Faraj, M.D. Internal Medicine
Education: West Virginia University Medical Degree: West Virginia University School of Medicine Residency: Family Medicine; Obstetrics and Gynecology, West Virginia University School of Medicine 902 S. Jeﬀerson St., Roanoke, VA 24016 540-985-9862
Medical Degree: Salahaddin College of Medicine Residency: Internal Medicine, Roger Williams Medical Center 1107A Brookdale St., Martinsville, VA 24112 276-670-3300
Chinekwu Anyanwu, M.D. Neurology
Joshua D. Farrar, M.D. Otolaryngology; Plastic and Reconstructive Surgery
Education: University of Nigeria Medical Degree: University of Nigeria College of Medicine Residency: Neurology, Seton Hall University, New Jersey Neuroscience Institute Fellowship: Clinical Neurophysiology, Georgetown University Hospital 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
Ann Elizabeth Schleupner Austin, D.O. Internal Medicine
Mark E. Feldmann, Jr., M.D. Plastic and Reconstructive Surgery
Education: Virginia Tech Medical Degree: Edward Via College of Osteopathic Medicine Residency: Internal Medicine, New Hanover Regional Medical Center 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
Education: Hampden-Sydney College Medical Degree: Medical College of Virginia at Virginia Commonwealth University (VCU) Residency: General Surgery, Medical University of South Carolina Fellowship: Plastic and Reconstructive Surgery, Medical College of Virginia at VCU 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
Eric H. Bradburn D.O. General Surgery; Trauma/Surgical Critical Care
Jonathan L. Gleason, M.D. Urogynecology
Education: North Central College Medical Degree: Lake Erie College of Osteopathic Medicine Residency: General Surgery, Penn State Milton S. Hershey Medical Center Fellowship: Trauma and Critical Care, University of Tennessee Health Science Center 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
Education: College of Charleston Medical Degree: Medical University of South Carolina (MUSC) Residency: Otolaryngology/Head and Neck Surgery, MUSC Fellowship: Plastic and Reconstructive Surgery, MUSC 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
Education: University of Georgia Medical Degree: Medical College of Georgia Residency: Obstetrics and Gynecology, Hospital of the University of Pennsylvania Fellowship: Female Pelvic Medicine and Reconstructive Surgery, University of Alabama at Birmingham 101 Elm Ave., Roanoke, VA 24013 540-985-4099
Laura B. Cieraszynski, D.O. Family Medicine
Allison Greenstein, D.O. Internal Medicine
Education: University of Kentucky Medical Degree: Edward Via College of Osteopathic Medicine Residency: Family Medicine, Carilion Clinic - Virginia Tech Carilion School of Medicine 37 Laymantown Road, Troutville, VA 24175 540-977-1436
Education: Florida Southern College Medical Degree: Edward Via College of Osteopathic Medicine Residency: Internal Medicine, Blueﬁeld Regional Medical Center 2900 Lamb Circle, Christiansburg, VA 24073 540-639-9071
SPRING 2013 | CarilionClinic.org
Robert J. Heineck, M.D. Obstetrics and Gynecology Education: Virginia Tech Medical Degree: University of South Carolina School of Medicine Residency: OB/GYN, Carilion Clinic - Virginia Tech Carilion School of Medicine 1997 S. Main St., Blacksburg, VA 24060 540-961-1058
Kurtis E. Moyer, M.D. Section Chief, Plastic and Reconstructive Surgery Education: Franklin and Marshall College Medical Degree: Pennsylvania State College of Medicine, Milton S. Hershey Medical Center Residency: General Surgery, Pennsylvania State College of Medicine Fellowship: Plastic Surgery, Duke University Medical Center 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
Christian Klaus, D.O. Family Medicine
Jason V. Naldo, D.P.M. Podiatry
Education: University of North Carolina - Charlotte Medical Degree: Edward Via College of Osteopathic Medicine Residency: Family Medicine, Carilion Clinic - Virginia Tech Carilion School of Medicine 6415 Peters Creek Road, Roanoke, VA 24019 540-265-5500
Education: Virginia Tech Medical Degree: Temple University School of Podiatric Medicine Residency: Podiatry, Inova Fairfax Hospital 2900 Lamb Circle, Christiansburg, VA 24073 540-731-2436
Mitchell P. Kok, M.D. Diagnostic Radiology
Chidinma Osefo, M.D. Family Medicine with Obstetrics
Education: Georgia Institute of Technology Medical Degree: Medical College of Georgia Residency: Madigan Army Medical Center Fellowship: Neuroradiology, University of Virginia 1906 Belleview Ave., Roanoke, VA 24014 540-981-7122
Education: University of Maryland College Park Medical Degree: Howard University College of Medicine Residency: Family Medicine, Thomas Jeﬀerson University Hospital Fellowship: Maternal Child Health, PCC Community Wellness Center 1314 Peters Creek Road, Roanoke, VA 24017 540-562-5700
Michael S. Kolodney, M.D. Dermatology
Vishal M. Patel, M.D. Radiology
Education: Massachusetts Institute of Technology Medical Degree: Washington University Residency: Dermatology and Internal Medicine, UCLA School of Medicine Fellowship: Dermatology Research, UCLA School of Medicine 1 Riverside Circle, Roanoke, VA 24016 540-581-0254
Education: University of Florida Medical Degree: University of Florida College of Medicine Residency: Diagnostic Radiology, University of Florida College of Medicine Fellowship: MRI-Predominant Body Imaging, Northwestern University Feinberg School of Medicine 1906 Belleview Ave., Roanoke, VA 24014 540-981-7122
Hilton R. Lacy, M.D. Child and Adolescent Psychiatry
Michole C. Pineda, M.D. Child Development
Education: Hendrix College Medical Degree: University of Arkansas College of Medicine Residency: General Psychiatry, University of Arkansas for Medical Services Fellowship: Child and Adolescent Psychiatry, University of Virginia Medical Center 2017 S. Jeﬀerson St., Roanoke, VA 24014 540-853-0900
Education: University of Santo Tomas Medical Degree: University of Santo Tomas Residency: Pediatrics, Arnold Palmer Hospital for Children Fellowship: Developmental-Behavioral Pediatrics, University of Virginia Children’s Hospital 1030 S. Jeﬀerson St., Roanoke, VA 24016 540-224-4520
CarilionClinic.org | SPRING 2013 25
NEW PROVIDERS Ashish Raju, M.D. Vascular Surgery
Erik S. Storm, D.O. Radiology
Education: Lehigh University Medical Degree: Drexel University College of Medicine Residency: General Surgery, Cooper University Hospital Fellowship: Vascular and Endovascular Surgery, Monteﬁore Medical Center 2900 Lamb Circle, Christiansburg, VA 24073 540-731-7600
Education: North Carolina State University Medical Degree: Philadelphia College of Osteopathic Medicine Residency: Diagnostic Radiology, Walter Reed Army Medical Center Fellowship: Breast Imaging, Eastern Virginia Medical School 1906 Belleview Ave., Roanoke, VA 24014 540-981-7122
Tejal Raju, M.D. Interventional Pain Management
Richard R. Truxillo, D.O. Family Medicine
Education: University of Virginia Medical Degree: St. George’s University School of Medicine Residency: Anesthesiology, Cooper University Hospital Fellowship: Pain Management, St. Luke’s - Roosevelt Hospital Center 3 Riverside Circle, Roanoke, VA 24016 540-224-5170
Education: University of North Carolina - Wilmington Medical Degree: West Virginia School of Osteopathic Medicine Residency: Family Medicine, Carilion Clinic - Virginia Tech Carilion School of Medicine Fellowship: Medical Informatics, Carilion Clinic 1314 Peters Creek Road, Roanoke, VA 24017 540-562-5700
Guyton Register, M.D. Psychiatry
J. Eric Vance, M.D. Child and Adolescent Psychiatry
Education: Armstrong Atlantic State University Medical Degree: Medical College of Georgia Residency: Internal Medicine and Psychiatry, East Tennessee State University 2017 S. Jeﬀerson St., Roanoke, VA 24014 540-981-8025
Education: College of William and Mary Medical Degree: University of Virginia Medical School Residency: Psychiatry and Child Psychiatry, Dartmouth Medical School 2017 S. Jeﬀerson St., Roanoke, VA 24014 540-853-0900
Julia Sargent, D.O. Family Medicine
Christopher D. Wood, D.O. Geriatric Medicine
Education: Appalachian State University Medical Degree: Edward Via College of Osteopathic Medicine Residency: Family Medicine, Self Regional Healthcare 2829 Virginia Ave., Narrows, VA 24124 540-726-7900
Education: Virginia Tech Medical Degree: West Virginia School of Osteopathic Medicine Residency: Internal Medicine, Carilion Clinic - Virginia Tech Carilion School of Medicine Fellowship: Geriatric Medicine, Carilion Clinic 2001 Crystal Spring Ave., Roanoke, VA 24014 540-981-7653
Matthew Schumaecker, M.D. Cardiology Education: Northwestern University Medical Degree: McGill University Faculty of Medicine Residency: Internal Medicine, New York Presbyterian Hospital (Weill-Cornell Campus) Fellowship: Cardiovascular Disease, University of Pittsburgh Medical Center 127 McClanahan St., Roanoke, VA 24014 540-982-8204
SPRING 2013 | CarilionClinic.org
EEG technologist Larissa Sellers monitors a patient by video and watches his brain activity.
EPILEPSY MONITORING UNIT OPENS By Maureen Robb
The ﬁrst epilepsy monitoring unit in the region has opened at Carilion Roanoke Memorial Hospital. The unit oﬀers specialized care to patients who would otherwise have to travel beyond western Virginia. Epilepsy, a brain disorder, is marked by seizures or convulsions. It can occur as a hereditary condition or can develop at any age due to a head injury, infections, brain disease, or other causes. It aﬀects almost 3 million Americans, and about 200,000 new cases are diagnosed each year, according to the Epilepsy Foundation of Virginia. One in 10 Americans has a seizure over his or her lifetime. A one-hour electroencephalogram (EEG), which measures electrical activity in the brain, can help to diagnose epilepsy. But the test has limitations. A more accurate diagnosis can be made during a three- to-ﬁve-day stay in an epilepsy monitoring unit. In the unit, three dozen tiny electrodes are attached to a patient’s skull to measure and record brain activity. A patient is also continuously monitored by video. If a seizure occurs, the patient or a family member who is always present pushes an event button. It records when and where in the brain the seizure occurred and transmits the data to medical staﬀ in a nearby control room. Depending on the type of seizure, patients may be prescribed anti-seizure medication, or referred for surgery. One doctor who has referred patients to the unit is neurologist Chinekwu Anyanwu, M.D. She recently joined Carilion after completing her residency at New Jersey Neuroscience In-
stitute and a fellowship in neurophysiology/epilepsy/EEG at Georgetown University Hospital. “e unit is designed to diagnose diﬀerent types of seizures and to help patients on multiple medications whose epilepsy is uncontrolled or who make frequent ED visits,” says Dr. Anyanwu. “We also treat patients with seizure-like activities, inDr. Chinekwu Anyanwu cluding dizziness, jerking, memory losses, hallucinations, staring spells, or sleep disorders.” In addition, the unit can do pre-surgical evaluations for refractory seizures, or seizures not controlled by medication. ree beds at Roanoke Memorial have been designated as the epilepsy monitoring unit. A day room with a refrigerator, microwave, and games is also available to give patients more mobility during their stay. Patients admitted to date have been from all age groups, says Nikki Atkinson, respiratory and EEG director at Carilion Roanoke Memorial Hospital. For more information, call 540-266-6000 or 800-422-8482.
CarilionClinic.org | SPRING 2013 27
Your Calendar for Better Health SPRING 2013 feb
Speaker: Carl W. Musser, M.D. 6 p.m. Carilion New River Valley Medical Center, Fireside Room
Speaker: W. Scott Arnold, M.D. 3 p.m. Trinity Ecumenical Church, Moneta
Speaker: Robert Slackman, M.D. 9 a.m. - noon South County Library, Roanoke To register, please call 800422-8482.
wOMeN’S HeALTH uNIVeRSITY
Patrice M. Weiss, M.D., will speak about emotional intelligence 11:30 a.m. - 1:30 p.m. Fitzpatrick Hall at the Jeﬀerson Center $15, includes lunch To register, please call 800-422-8482.
PHYSICIANS ON fOOT
Every ay Meet inside Tanglewood Saturd Mall from November
HeART VALVe DISeASe
Speakers: Jason Foerst, M.D, and Joseph Rowe III, M.D. 6 p.m. South County Library, Roanoke Selecteind Days h Marc
ReD HOT MAMAS: eVeRYTHINg YOu wANT TO kNOw ABOuT INTIMACY, BefORe AND AfTeR MeNOPAuSe
6 p.m. South County Library, Roanoke To register, please call 800422-8482.
If you are 45 or older with hip or knee joint pain or limited motion, join us for free seminars on arthritis and options for joint care. For more information, please call 800-4228482.
through March and at the corner of Hamilton Terrace and Belleview Avenue (in front of Carilion Roanoke Memorial Hospital) from April through October. Rain location: Tanglewood Mall For more information, please call 800-422-8482 or visit CarilionClinic.org/walking.
HuNTINgTON’S DISeASe SuPPORT gROuP
5:30 - 6:30 p.m. 3 Riverside, Conference Room 2D, Roanoke For more information, please call 800-422-8482.
For more events, classes, and screenings, visit CarilionClinic.org/calendar or call 540-266-6000. 28
SPRING 2013 | CarilionClinic.org
At Carilion Clinic, we care for our neighbors in ways that optimize their health. It’s what we do each day. Our neurosurgeons work as a team with each patient, using new techniques and innovative minimally invasive treatments speciﬁc to their needs, to reduce recovery time and improve life. Complex neurosurgical care for the brain, nervous system, and spine are all being performed at Carilion Roanoke Memorial Hospital. Our team of specialists is focused on your health and committed to helping you get back to your life as quickly as possible. Lisa Apfel, M.D. Zev elias, M.D. John fraser, M.D. Nicholas Qandah, D.O. gary Simonds, M.D. edgar weaver, Jr., M.D.
Inspiring better health.™ CarilionClinic.org | 800-422-8482
CARILION CLINIC P.O. BOx 13727 ROANOke, VA 24036-3727
NON-PROfIT ORg. u.S. POSTAge
PAID ROANOke, VA PeRMIT NO. 247
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Published on Feb 1, 2013
Published on Feb 1, 2013
Carilion Clinic Living is dedicated to promoting good health and quality of life in our community. In this issue: The Joy of Walking; Healin...