Carilion Clinic Living - Spring 2016

Living Inspiring better health.

SPRING 2016

in this issue IVF PROGRAM’S FIRST BABY 8 THE INSTITUTE OPENS 10 A PATIENT’S HEART STORY 12 NATURE IS HEALING 14

Emily Painter of Roanoke County enjoys regular bike rides around the region.

Can poor sleep habits lead to weight gain?

Get the answer to this and many other health questions from Carilion Clinic Living’s Fact Check, hosted by Karen McNew. A new video is posted every Friday, so you’ll never have to wait long to find out what’s myth and what’s good medicine.

CARILIONLIVING.COM/FACTCHECK

President’s Message Getting out in nature is good for you! Studies show it increases your immune function, lowers your blood pressure, and improves mental focus. And it’s easy and fun to do. To learn more about how it affects you mentally and physically, check out our cover story.

After more than a year of anticipation, Carilion’s Institute for Orthopaedics and Neurosciences opened in January. Everything about it is designed to make care easier for patients with orthopaedic and neurological issues. ION has sophisticated, world-class services in an inviting, beautiful setting to help us deliver on our promise to you—Excellent Care!

We are so excited about the birth of the first baby born through our new in vitro fertilization program! After years of waiting for their dream to come true, the thrilled parents share their inspirational story with us.

We hope you’ll enjoy this magazine—full of exciting innovations in health care—just for you!

WARM REGARDS,

Carilion Clinic President and CEO Nancy Howell Agee meets with Carilion employees in Roanoke.

NANCY HOWELL AGEE PRESIDENT AND CEO CARILION CLINIC

CarilionClinic.org | SPRING 2016 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

Andie Gibson is a freelance writer and editor based at Smith Mountain Lake. She has also been the editor of Smith Mountain Laker magazine and special sections editor for The Roanoke Times.

Kathie Dickenson is an award-winning writer and editor whose work has appeared in Roanoke Business and RU, Radford University’s magazine. She has also edited books, websites, and other publications.

Sarah Beth Jones blogs about personal development, was an op-ed columnist for the Greensboro News & Record, and has written for publications including Valley Business FRONT, Mother Earth News online, and Today’s Woman magazine. She lives in Floyd.

CARILION CLINIC LIVING IS PRODUCED BY MARKETING, RESEARCH AND COMMUNICATIONS: VICE PRESIDENT Shirley Holland SENIOR DIRECTOR, COMMUNICATIONS Mike Dame SENIOR DIRECTOR, COMMUNICATIONS Amy Hoots-Hendrix CREATIVE SERVICES MANAGER John Griessmayer EDITOR Maureen Robb LEAD DESIGNER David Porter CONTRIBUTING WRITERS Karen A. Chase, Su Clauson-Wicker, Jay Conley, Kathie Dickenson, Sarah Beth Jones, Heidi Ketler, Donna Reynolds, Dan Smith, Randolph Walker, Alison Weaver PHOTOGRAPHERS Darryle Arnold, Jared Ladia

Heidi Ketler has been a writer and editor for Sentara Healthcare in Norfolk and for The Triangle Physician magazine in the RaleighDurham-Chapel Hill region of North Carolina.

She lives in Roanoke.

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.

PRINTING Chocklett Press

CARILIONCLINIC.ORG | 800-422-8482

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 2016 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 direct@carilionclinic.org, or write to us at Marketing, Research and Communications, 213 McClanahan St., Roanoke, VA 24014.

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CONTENTS

8 12 features 5 DENTAL HEALTH New services are available.

8 PREGNANCY

Meet the first IVF baby born at Carilion.

10 SPECIALTY MEDICINE The ortho-neuro institute opens.

12 CARDIAC CARE

14

departments 1 PRESIDENT’S MESSAGE Nature can influence your health.

28 RECIPE

Springtime is for salad.

19 PARENTING How to avoid “Dad Bod.”

22 FITNESS

6 IN YOUR COMMUNITY New physicians and advanced clinical practitioners.

Nature is good for your health.

Take your meds safely.

Chia seeds go mainstream.

26 GROWING TO SERVE YOU

14 COVER STORY

20 MEDICATIONS

4 SUPERFOODS Making a difference in western Virginia.

A team helps a patient get well.

Want high-intensity interval training?

19

25 PATIENT TRANSPORTATION Life-Guard gets a new helipad.

27 EMERGENCY MEDICINE

Do you need urgent care, or the emergency room?

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SUPERFOODS

Superfoods: Chia Seeds If your only association with the word chia is a novelty gift/pet substitute advertised on late-night TV, you’re in for a pleasant surprise.

Versatile chia seeds, a Central American staple, can enrich your diet and improve your health. They are more readily available than ever, and you can add them to your menu in multiple, simple ways.

These tiny seeds, smaller than sesame seeds, are rich in omega-3 fatty acids and have been shown to help balance cholesterol levels. The high fiber content also reduces cholesterol, while promoting bowel regularity and a feeling of fullness—thus helping dieters stave off snackgrabbing temptation. Chia seeds contain plenty of protein, calcium, and antioxidants. Studies have associated them with weight loss and reduction of triglycerides and blood glucose levels.

Just one tablespoon of chia seeds contains 20 percent of the recommended daily intake of fiber, six percent of calcium, and four percent of iron and zinc. They have no sugar. No cholesterol. And they are gluten free.

Two words: Super. Food.

Plus they are super easy to prepare and eat.

You can add them whole or ground to smoothies, oatmeal, yogurt, or salads. The gelling quality and high protein content make chia seeds an excellent egg substitute when mixed in water and used for baking.

Chia seeds, treasured by the ancient Aztec and Mayan cultures, are available in health food stores and in the health-food section of many mainstream groceries. You can also grow the plants yourself. The seeds are harvested from Salvia hispanica, a flowering plant in the mint family. Seeds can be white, black, or speckled, but if they are brown, put them back.

Uniformly brown seeds are immature, lack the nutritional punch of mature ones, and might taste bitter.

One other caution about chia seeds: they have a blood-thinning effect, which can be good, but if you are on a medicine like warfarin, check with your doctor before eating them.

Otherwise, grab a handful and let the nutrition begin.

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MEDICAL NEWS

Dr. Lee R. Jones will oversee the expansion of Carilion's dental services in Roanoke.

Carilion Expands Dental Services

By Loren M. Blinde Your mouth is a key part of your overall health. Tooth and gum problems serve as an “early warning system” for serious conditions like cardiovascular disease, diabetes, and even osteoporosis. In addition, some medical conditions can increase the risk of dental problems.

Over one-third of the region’s residents receive no dental care, according to community surveys about health needs.

To meet the need for affordable dental care, Carilion is expanding dental services for adults and children.

EXPANDED ACCESS

Carilion Clinic Dental Care, on South Jefferson St. in Roanoke, provides dental care for people with complex medical conditions, such as heart problems, cancer, and bleeding disorders. The dentists and dental professionals also serve individuals with physical or developmental

disabilities. The team sees patients in an office equipped with on-site procedural sedation. Patients who need general anesthesia can go next door to Carilion Roanoke Memorial Hospital.

Carilion Clinic Dental Care – Pediatrics, located at Carilion Roanoke Community Hospital, provides comprehensive dental care, including orthodontics, to children from birth to age 21. “Although it is open to any child, the practice fills an important role in providing access for the region’s uninsured and underinsured children,” says Lee R. Jones, D.M.D., chief of Carilion Clinic Dental Care.

The expansion will add five treatment rooms, giving the dental office a third more treatment space and the pediatric clinic even more. The expansion will be completed in February.

“In our health assessments, we know that more dental awareness and services

are needed in our most vulnerable communities,” says Shirley Holland, Carilion vice president of community outreach.

“The expansion of our services will help address this.”

TRAINING THE NEXT GENERATION

Carilion’s dental residency program, established in 2013 to train the next generation of hospital dentists, will expand to four residents in July. The residency program received a five-year, $2.4 million federal grant from the Health Resources and Services Administration.

“We are using those funds to support our expansion and acquire state-of -theart technology, including a cone beam CT for implant case planning and a system for fabricating one-appointment crowns,” Dr. Jones says.

To learn more about Carilion Clinic Dental Care, visit CarilionClinic.org/dentistry.

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IN YOUR COMMUNITY

CARILION HOSPITALS ARE ‘TOP PERFORMERS’ Carilion Roanoke Memorial Hospital and Carilion Tazewell Community Hospital were named “Top Performers on Key Quality Measures” by The Joint Commission, which accredits U.S. hospitals. Roanoke Memorial was recognized for excellence in treating heart attacks, heart failure, pneumonia, and stroke, and for its surgical and perinatal care. Tazewell Community was recognized for pneumonia care and immunization. Only about a third of the country’s hospitals earned this distinction.

TRANSPORTATION CENTER RENAMED Carilion Clinic renamed the Patient Transportation Center in honor of George B. Cartledge, Jr., who has served 40 years on Carilion's Board of Directors. The George B. Cartledge Center for Transportation for Carilion Clinic Patient Transportation is the home base in Roanoke for Carilion ambulances and helicopters and houses educational and administrative offices.

Carilion Clinic President and CEO Nancy Howell Agee and long-time board member George B. Cartledge, Jr. at the naming ceremony.

HOME CARE NAMED TO ‘ELITE’ LIST All Carilion Home Care locations in Franklin, Radford, Roanoke, and Tazewell were named to the 2015 HomeCare Elite™ list, which recognizes the nation’s top 25 percent of home care agencies. Each year, the list is compiled by the National Research Corporation and DecisionHealth. The Radford location was also recognized as one of the Top 500 providers nationwide (out of about 2,000.)

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February is American Heart Month. Check out local heart health events, podcasts, and videos on our Facebook page and at CarilionClinic.org.

CARILION-VIRGINIA TECH PARTNERSHIP GROWS The court at Virginia Tech’s Cassell Coliseum has been renamed the Virginia Tech Carilion Court! Carilion is supporting scholarships for student-athletes who pursue health-care careers.

L to R: Dr. Greg Valdez, assistant professor at the Virginia Tech Carilion Research Institute; Whit Babcock, Virginia Tech’s director of athletics; Don Halliwill, Carilion’s chief financial officer; Nancy Howell Agee, Carilion’s president and CEO; Dr. Timothy D. Sands, Virginia Tech’s president; and Cynda Johnson, M.D., M.B.A., founding dean and president of the Virginia Tech Carilion School of Medicine.

ROANOKE MEMORIAL WINS CONSUMER CHOICE AWARD For the 12th consecutive year, Carilion Roanoke Memorial Hospital was named a Roanoke Valley preferred health care provider by consumers. National Research Corp. gave the hospital its 2015/2016 Consumer Choice Award, recognizing it as among the top hospitals in the country. NRC surveys over 250,000 households nationwide and asks consumers to rate the quality of their local hospitals.

CARILION PROVIDES OVER $146 MILLION IN COMMUNITY BENEFIT

$120.8 MILLION UNCOMPENSATED CARE

$20.8 MILLION EDUCATION

$3.6 MILLION

COMMUNITY OUTREACH

2014

$146.2 MILLION COMMUNITY BENEFIT

$1 MILLION RESEARCH

SLEEP COACH TO SPEAK IN LEXINGTON Join us on March 22 for a luncheon and talk: The Sleep Coach Approach for Good Health. Sleep specialist and clinical psychologist Barbara Hutchinson, Psy. D., will discuss how you can sleep better and be more healthy! For more information or to register, call 800-422-8482

In 2014, Carilion Clinic provided $146.2 million in community benefit. This included $120.8 million in uncompensated care; $20.8 million in investments in education to train new physicians and medical professionals; $3.6 million in community outreach such as free health screenings and community programs; and $1 million for research.

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MEDICAL NEWS

m a e r AD e u r T s e om C

By Heidi Ketler

8 SPRING 2016 | CarilionClinic.org

Left: Heather Draper cuddles her new son, Alecs.

Heather Draper, 31, always planned to become a wife and mother. So it was unsettling when nature didn’t take its course after she and Will Draper married in 2008.

our patients rather than sending them to another physician to perform parts of it,” says Dr. Evans-Hoeker. She When Heather expressed concern to also performs key her gynecologist, she was given Clomid portions of the IVF for ovarian stimulation. Two separate Dr. Evans-Hoeker rounds of the fertility drug had no effect. cycle at UNC Fertility in Raleigh and Disappointed, the Drapers put their utilizes its excellent embryologists to hopes for a baby on hold until several develop the embryos. years later, when Will’s new job proAnd the Drapers? Four weeks after vided health insurance that covered their first IVF cycle, Heather and Will fertility services.

After another failed round of Clomid, waited anxiously by the phone for “Dr. Emily’s” call. At last, the long-awaited the Drapers were referred to Carilion good news arrived. Heather was pregClinic reproductive endocrinologist Robert L. Slackman, M.D. Initial exams nant! The Drapers couldn’t have been happier. of both spouses revealed a polyp in “I didn’t know what to say,” Heather Heather’s uterus. says. “We were so thankful it worked When he removed the polyp, Dr. the first time.”

Slackman also found Heather had blocked fallopian tubes—a common A LARGE NEED cause of infertility. The options? Major Infertility affects about 7.3 million abdominal surgery or in vitro fertilizaU.S. couples, or 12 percent of the reprotion (IVF). ductive-age population. It is defined as Heather and Will, who live in Roanoke, the inability to conceive after one year decided to pursue IVF with Carilion’s Emily Evans-Hoeker, M.D., who special- of unprotected intercourse for women under 35 and six months for those 35 izes in reproductive endocrinology and and older. infertility.

A quality embryology lab is critical to Dr. Evans-Hoeker now leads Carilion’s achieving IVF success, says Dr. EvansReproductive Medicine and Fertility Hoeker. “We could have worked with practice and developed Carilion’s first IVF program. Last year Carilion formed any lab, but the UNC Fertility lab is so good. Its success rates are among the an IVF partnership with UNC Fertility, best in the U.S.” one of the most successful embryology Other factors influencing IVF success labs in the region. are the quantity and quality of a wom“Our partnership allows me to peran’s eggs, which decline as a woman form every step of the IVF process for

ages. In the U.S., the age limit for using one’s own eggs is between 42 and 45.

Dr. Evans-Hoeker drives to the UNC embryology lab with her patients for egg retrieval and embryo transfer. Each process takes several hours and is performed three to five days apart.

She is also able to perform IVF using donor eggs, gestational carriers, and pre-implantation genetic testing, as well as fertility preservation for patients who want to freeze their eggs or embryos.

THE NEW BABY

At 4:30 a.m. on Oct. 3, Alecs Sclater Draper arrived at Carilion Roanoke Memorial Hospital, weighing in at 7 pounds, 11 ounces. He was the first baby conceived through Carilion’s IVF program.

“He is such a good baby,” Heather says today, as Alecs snuggles in his father’s arms.

The Drapers say they will always be grateful to Dr. Evans-Hoeker. “Dr. Emily was amazing,” says Heather. “She was so knowledgeable about infertility solutions. Any time we had questions or concerns, she answered them. She followed up after the lab work. She explained everything and made us feel really comfortable.”

Heather’s advice to others who have trouble conceiving? “Be patient— there’s a lot of waiting,” she says. “But if it can happen for us, it can happen for anybody.”

For more information or to make an appointment, call 540-985-8078.

CarilionClinic.org | SPRING 2016 9

MEDICAL NEWS

By Andie Gibson Innovative care. State-of-theart technology. Cutting-edge research.

Everything about Carilion Clinic’s newest medical facility is designed to make care easier and more accessible for patients with orthopaedic and neurological issues.

Perhaps the most exciting part of the multimillion-dollar Institute for Orthopaedics and Neurosciences (ION) in Roanoke is its integrated approach to patient care. The collaborative model lets leading specialists consult on diagnosis and treatment and will reduce the need for patients to make multiple visits.

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“This facility enables specialists to see patients together, conference together, and make high-level, complex decisions together on the spot, says Carilion’s Chief of Neurosurgery Gary Simonds, M.D. “The goal of our institute is to better coordinate patient care,” he says. For example, a patient with nagging lower-back pain may schedule an appointment with a spine specialist. While there, she may get an X-ray and see a pain management professional or a spine surgeon.

“The body is very well connected, so if you can start treating patients and all

their parts with all their providers in one area, the treatment is going to far exceed the sum of their problems with everyone working together,” says Chair of Orthopaedics Joseph T. Moskal, M.D. About 200 health care professionals provide services in orthopaedics, neurosurgery, pain management, physical medicine and rehabilitation, outpatient therapy services, and imaging at the institute, which opened in January on Franklin Road near the Carilion campus.

Skilled care is available for joints, brain and spine, sports medicine, hand and upper extremities, pediatric orthopaedics and

Dr. Joseph T. Moskal, whose specialties are orthopaedic surgery and joint replacement, was recently named to the prestigious Hip Society, whose members are thought leaders in the field of hip disorders who have demonstrated excellence in diagnosis, treatment, and research.

Dr. Gary Simonds, whose specialties are neurosurgery, pediatric neurosurgery, spinal surgery, and neuro-oncology, is also completing a master’s degree in health care delivery science from Dartmouth College.

Left and top: A 40-foot-long skylight lets in light to the institute’s lobby, where patients register.

STEP INSIDE neurosurgery, physical therapy, and occupational therapy. Diagnostic radiology, centrally located on the first floor, is another opportunity to reduce lag time for patient care. State-of-the-art bone density testing is available as well.

The institute will serve as a hub for education, leading-edge research, and future innovations. It’s a designation that already is drawing the attention of some of the nation’s leading physicians.

Five new orthopaedists and three new neurosurgeons have joined the institute, bringing the total number of these specialists to 34 in the Department of Orthopaedic Surgery and eight neurosurgeons. In addition, there are 22 advanced care practitioners.

Part of the attraction, Dr. Moskal says, is the facility’s affiliation with the Virginia Tech Carilion School of Medicine and Research Institute.

“Creating this synergy between Carilion Clinic, the medical school, and the research institute allows us to recruit, obtain, and actually be approached by some of the strongest candidates in their specialties,” Dr. Moskal says.

“They want to be part of the excellent care, teaching, and research that will take place here,” he says. “Physicians are looking forward to working together on case reviews and research projects. Here, they have the space and opportunity to make that part of their practice much stronger.”

Both doctors say the institute allows for growth as the premiere destination center for orthopaedics and neurosciences.

Go to CarilionClinic.org/ion for more information on the institute, including a virtual tour, multimedia gallery, directions, and physician biographies.

The atmosphere is bright, open, and airy. A 40-foot-long skylight provides abundant light to the lobby where patients register at kiosks with the help of greeters. Common work areas are organized by sub-specialty and are conveniently located next to exam rooms, waiting rooms, consult areas, and nurses’ stations.

Even the 117,000-square-foot building’s interior design enhances the collaborative model of care with color-coded hallways, door openings, and exam rooms. The arrangement makes it easier for patients to ensure they’re in the right place, too.

The first floor, which previously housed a grocery store, was completely remodeled, and a mezzanine level was expanded to create a second floor.

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MEDICAL NEWS

’ ? . . . t a h W d e v i v r u S URRAY’S AMAZING STORY OF RECOVERY ‘HLIe AN MCM JU K C A T T A T R A E H IS H R E T AF

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er

By Su Clauson-Wick

remembers from “Mac” McMurray n lia Ju g in th st la The nostic proceg told that his diag in be is 14 20 9, r Octobe 90 minutes. ospital for dure should last anoke Memorial H Ro n io ril Ca in s wa s workMac, 72, e how his heart wa se to n tio iza er et a cardiac cath c bypass surgery to ed a stent or cardia ed ne he if d an g— in ess of breath. up a week later address his shortn burg resident woke ns tia ris Ch e th d, ea Inst to a ventilator. care unit attached ry na ro co l’s ita sp procedure,” in the ho t attack during the ar he a d ha I’d id sa d CPR for “Dr. Ball nts of blood and di pi 12 e m ve ga ey Mac says. “Th artery to attach to they located a solid re fo be es ut in m 20 smoking hadn’t ne. Thirty years of hi ac m g un t-l ar he the done me any good.”

Left and top: Janet and Julian McMurray at home in Christiansburg and with their daughter and grandchildren. Right: Dr. Timothy Ball performed McMurray’s procedure at Carilion Roanoke Memorial Hospital.

Doctors do cardiac catheterization to check for blocked coronary arteries; the chance of major complications is quite low—less than one percent, says Carilion Clinic interventional cardiologist Timothy Ball, M.D., Ph.D. Mac says he was blessed to have his heart attack in one of the few locations with the technology and expertise to save his life.

“At first, everything proceeded smoothly,” Dr. Ball says. “But after we’d taken three images of his left main coronary artery, which was severely blocked, his blood pressure dropped. Because of the blockage, his heart wasn’t getting enough blood and oxygen, which caused it to pump less. A vicious cycle started.

We immediately began CPR and called in the cardiothoracic team.”

Carilion cardiothoracic surgeon Joseph Baker, M.D., quickly determined that bypass surgery was now too risky. Mac’s heart was barely pumping, and even moving him to the operating room was dicey.

They called in the ECMO (extracorporeal membrane oxygenation) machine to give him life support.

“Everything that could be a challenge here was,” says Dr. Ball. “Connecting him to the ECMO was problematic, drilling out the calcium in his arteries was diffi-

cult, and the procedure took six hours, not the usual 90 minutes.”

Having the ECMO oxygenating Mac’s blood gave Dr. Ball time to clean out his arteries and install stents in vessels narrower than strands of spaghetti.

“His atherosclerosis made it difficult,” Dr. Ball says. “His body had reacted to inflammation by creating calcified blockages inside the coronary arteries. I had to use three different hand drills to remove calcifications. When we finished drilling, we inserted balloons to stretch the vessels. We put in stent after stent to support the artery walls.”

With the stents, the team opened Mac’s left main coronary artery, left circumflex artery, and left anterior descending artery. “The ECMO made the difference,” says Dr. Ball. “If this had happened elsewhere, I couldn’t have saved him. He was lucky his crisis occurred here, with the cardiac cath staff, cardiothoracic surgeons, perfusions [blood transfusions], and other staff—15 people—here and ready to go.”

Mac was moved to the Coronary Care Unit, where he was given hypothermia therapy to lower his body temperature to save his brain while he healed. (Of those who survive cardiac arrest, many suffer brain damage.) By slowing Mac’s metabolism, doctors reduced his brain’s need for

oxygen while it recovered from a period of insufficient blood flow.

Mac does recall regaining consciousness a week later. “When Dr. Ball woke me up, he said, ‘You must still have a purpose on earth.’ That was the good part. Then I started therapy with a ‘drill sergeant’ named Dottie Cook, RN.” “I got him up, coughing and deep breathing,” says Cook. “That hurts, but it prevents lung problems. I got him to sit, then walk. Mr. McMurray had a great attitude.”

“I didn’t want to be an invalid,” Mac says, “so I worked.”

“He did exceptionally well and was able to leave 13 days after his cardiac arrest,” Cook says.

After he went home, Mac joined Carilion’s cardiac rehabilitation outpatient program, where he did aerobic and strength exercises monitored by physical therapists at Carilion New River Valley Medical Center. He was so motivated to return to playing golf that he sometimes had to be told to slow down.

Today he credits the entire team of experts who saved him and helped him get back on his feet.

“My heart tests are great,” he says. “I feel stronger than I have in 10 years.”

For more information on cardiac care or cardiac rehab, call 800-422-8482.

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COVER STORY

By Randolph Walker Getting outside is great for your health, recent studies show.

Bill Conner doesn’t need to read a study, though.

He already has first-hand experience.

“Part of it’s the beauty of God’s earth,” says Bill.

“The sunshine, the green leaves, the colors in the fall.

When we go hiking it brings out something inside of me that beams. Around every turn, every corner, there’s another beautiful scene. It’s the beauty that gets me out there.”

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Clockwise: Linda and Bill Conner hike on Mill Mountain in Roanoke; Emily Painter takes a break during a bike ride; Beth Lohman stands atop Camel’s Hump in Huntington, Vermont; Bill Conner captured the view from the Appalachian Trail near Fontana Lake, North Carolina.

Bill and his wife, Linda, both 67, are Salem residents. They hike together, and Linda also likes to run, garden, bike, and ski. “The benefits are psychological, mental, physical, and in the case of trail running and hiking, social,” says Linda. “We have many friends who hike also.”

“We’re not looking for the aerobic benefit so much,” she says. “It’s the peace, the solitude. It’s being out there, not being rushed. Your senses are free to smell and hear and see.”

Studies indeed show that just being outside, amid sunshine and greenery, has beneficial effects. “We think that there are two kinds of benefit that come from spending time in nature,” University of Kansas psychologist Ruth Ann

Atchley says. First, engagement with technology can tire out parts of the brain that are important for paying attention, being creative, and problem-solving, and nature can help repair that, she says.

Secondly, “natural environments reduce physiological arousal and allow us to better focus our attention in a way that is more consistent with how our brains optimally work,” she says.

Benefits are greatest after several days in nature, but even brief visits can help, according to Atchley. “We have recent research data, funded by the Kansas Sunflower Foundation, that shows significant improvement in our ability to work together on a group problem-solving task when we have spent just 45 minutes to

an hour immersed in a natural environment.”

To get the most benefit, pay attention to your environment, Atchley advises. “It is not enough to just go for a walk, also please leave your cell phone at home and allow your brain to take full advantage of the time you are spending in that psychologically healthy environment.”

Eva Selhub, M.D., is the author of Your Brain on Nature and Your Health Destiny.

“We know that 20 minutes outdoors may be all you need to provide folks with health benefits, be it working in the garden, walking in the park, or in a forest,” she told Carilion Clinic Living.

“You also benefit from having photos of nature to look at, plants in the room, CarilionClinic.org | SPRING 2016 15

COVER STORY

Top left: Matthew Allenbaugh likes to hike, run, and bike on the region’s mountain trails. Top right: Dr. Clifford A. Nottingham III encourages patients to reap the benefits of exercising outdoors.

using nature’s aromas to relax at home (like lavender baths or lemon balm aromatherapy), or even doing meditations involving nature imagery. There is also research pointing to folks finding they have less fatigue and discomfort when participating in ‘green exercise’ versus indoors.”

A study published in 2015 in the Proceedings of the National Academy of Sciences, by Gregory Bratman and others, found that a 90-minute walk through nature can reduce rumination, or negative self-preoccupation.

The New York State Department of Environmental Conservation cites numerous scientific studies showing that visiting forests boosts the immune system, lowers blood pressure, improves mood and focus, accelerates recovery from illness, and improves sleep. It’s like a prescription with no side effects, and it’s free.

In fact, your doctor may even suggest spending time outdoors, like Clifford A. 16 SPRING 2016 | CarilionClinic.org

Nottingham III, M.D., of Carilion Clinic Family Medicine. “I encourage patients to seek out activities that they really enjoy—especially walking, hiking, biking, and gardening—and to try to find a partner to help maintain motivation and accountability,” he says.

“It’s usually not necessary to purchase expensive equipment, but it is important to prepare for the activity with appropriate attire, including sun protection, and to remember to stay well-hydrated.”

Exercising outdoors “is a terrific way to improve fitness and enhance the body’s level of vitamin D,” Dr. Nottingham says.

“It can also improve mental clarity, elevate mood and self esteem, reduce anxiety and depressive feelings, and augment critical-thinking skills.”

People who are active outside report better sleep and less pain and have less functional decline than their peers, he says. “Simply put, the best outdoor recreation one can select is the one that’s easy and fun—so that you’ll do it regularly!”

Plenty of people in western Virginia, with its abundant outdoor opportunities, are already persuaded.

Matthew Allenbaugh of Roanoke likes to hike, bike, run, climb, fish, and garden.

“The physical benefits of being active in nature are evident, but for me the emotional aspect of being in nature is even more important,” he says. “If I’m having a rough day, going out for a trail run, hike, or bike ride is how I work through some of my issues and problems.

“Having an opportunity to sit by a lake, watching the sun set over a deserted beach or taking in the view from a summit really puts so many problems into perspective. You realize that you’re part of something much larger and whatever issue we’re dealing with is really small by comparison.”

“We have woods behind my house,” says Emily Painter of Roanoke County.

“Every morning I walk my dogs on trails in the woods. I ride road and mountain bikes, and I jog a little bit. I’m outside

ROCKY MOUNT TREE WALK Top left: Beth Lohman and Jerry Ford Jr. on one of their frequent hikes. Top right: Magnolia trees in bloom.

every day. I’m aware when I don’t have that time—my mood is harder to deal with, and I’m probably not as focused at work… It’s not just exercise, it really is time in trees and looking at clouds and watching sunrises and sunsets, which I try to do every day.”

Beth Lohman and her husband Jerry Ford Jr., Blacksburg residents, walk their collie three miles a day. “It’s a great opportunity to get out, to clear your head, to be in the fresh air,” says Lohman. “It’s good for us mentally to take a break from whatever it is that we’re working on.”

They also enjoy riding bikes. After a ride, “physically we feel so much better; we feel mentally refreshed,” says Lohman.

“You don’t have to take really long bicycle rides to get that feeling. And we enjoy the social aspect of riding together.”

“Our lives are very data-driven—we’re driven to be in constant communication with other people,” Lohman adds. “I find myself on some days being drawn in to the computer for hours at a time…

I think it’s important to get outside and break that attachment to all this data and things that overwhelm us mentally, and exercise our mind in a different way.”

John Mays, on the other hand, is constantly outdoors as manager of a canoe rental business in Botetourt County— but even that is not enough. During his spare time he enjoys paddling and camping. “I think it’s mostly psychological,” he says. “It’s the peace and quiet that you get from being outside, amongst the river, amongst the wildlife, and the solitude that you have.”

Many people remember their mothers telling them to “Go outside and play.” For Bill and Linda Conner, it’s a desire that now seems to come from within.

“When we’re off the trail for a few days,” says Bill, “we hear that call that says, “Come back to the outdoors to enjoy the beauty, to see the animals, to smell the leaves.’ We want to be out there.”

Enjoying nature is something everyone can do. In Franklin County, one place to start is the Rocky Mount Tree Walk.

Inaugurated in October 2015, the self-guided walk offers residents a chance to get some exercise and fresh air while learning about trees.

A map, available at the Franklin County Public Library, identifies 18 trees including a Siberian elm, a cedar of Lebanon, and a southern magnolia. Walkers who want to learn more can also check out a tree guide book from the library.

The project was spearheaded by Gail Nordhaus, R.N., a Carilion Clinic community health educator in Franklin County. “The goal is to get people out and walking and to get them reconnected with nature,” she says.

“It’s also a family-friendly activity.”

“This is one of our efforts in cooperation with ‘Healthy Franklin County’ initiatives to improve the health of our community,” adds William Jacobsen, a Carilion vice president and the administrator of Carilion Franklin Memorial Hospital.

CarilionClinic.org | SPRING 2016 17

MEDICAL NEWS

EAT RIGHT, BE FIT, REDUCE YOUR RISK Scientists estimate that two-thirds of the most common forms of cancers could be prevented: one-third by maintaining a healthy diet, healthy body weight, and being physically active, and one-third by avoiding tobacco.

EAT RIGHT. Eating a plant-filled diet and minimizing fatty meats can reduce the risk of cancer. » Eat at least 2 1/2 cups of fruits and vegetables each day » Avoid sugary, processed foods like cake, soda, and fast food » Choose whole-grain pastas, breads, and cereals over refined grains

BE FIT. Being active and reducing excess weight can significantly

reduce your cancer risk. » Exercise for 30 minutes at least five days every week » Fill your free time with active habits such as dancing, walking/hiking, and running » Find ways to increase the number of steps you take each day

REDUCE YOUR RISK. In combination with diet and exercise: » Avoid all tobacco products » Limit alcohol to no more than one (women) or two (men) drinks per day

The same recommendations can reduce your risk of heart disease, stroke, diabetes, hypertension, and Alzheimer’s disease. Learn more at CarilionClinic.org/cancer.

18 SPRING 2016 | CarilionClinic.org

By Maureen Robb

It isn’t only women who gain weight when starting a family. The average new dad puts on 3 ½ to 4 ½ pounds.

That is the finding of a new study by Northwestern University’s Feinberg School of Medicine, said to be the first of its kind, on the dreaded “Dad bod.”

The conclusions were reported in the American Journal of Men’s Health.

During the study, new fathers also had an increase in their body mass index (BMI), which measures body fat. Researchers suggested that lifestyle changes, such as adopting new sleep and eating habits, and having less time to exercise, may be the culprit.

“Many men need ‘milestones’ to serve as a reminder of the importance of their being healthy not just for themselves, but also for their loved ones,” says Mark H. Greenawald, M.D., vice chair of academic affairs and professional development for Carilion Clinic’s Department of Family and Community Medicine.

“The transition to fatherhood provides one such milestone,” Dr. Greenawald says. “I recommend men seize this opportunity and take a trip to their primary care physician BEFORE their child is born so together they can do an honest health assessment and plan for this major and life-altering change.

“Additionally, the time of pregnancy should provide a time for the couple to discuss together how they want to create a healthy lifestyle and how they can support each other in these efforts. Doing so is not always easy, but it’s worth it. Teaching our children how to be healthy by modeling it ourselves is a priceless legacy for them AND for us.

Seems like a bargain to me!”

Good luck to all the new dads out there who are navigating this new stage in their lives.

CarilionClinic.org | SPRING 2016 19

MEDICAL NEWS

5

Tips for Taking Medications Safely

By Stephanie Specht

1 MAKE A LIST

Make a list of your prescriptions, over-the-counter medications, and any supplements you take. Keep this list with you at all times and share it with your health care provider when you meet. Also show it to About 80 percent of adult Americans take at your pharmacist when you pick up least one medication, and 29 percent take five or prescriptions—especially a new more, according to the U.S. Centers for Disease Control. prescription—and give a copy to More medications increase the risk of adverse drug family and friends in case of interactions, says Adrian Wilson, Pharm.D., director of retail emergency. pharmacy operations for Carilion Clinic. Anyone who takes three or more medications could be at risk.

Not all drug interactions are significant or life threatening, but they can have an additive effect, Wilson says. “Multiple medications taken together can cause drowsiness and/or low blood pressure,” he notes. This can greatly increase the risk of falling—a very real threat for elderly patients.

Other practices that can increase the risk of a drug interaction include getting prescriptions from more than one doctor, filling prescriptions at more than one pharmacy, and using both online and community pharmacies. To stay safe, Wilson suggests taking these steps:

20 SPRING 2016 | CarilionClinic.org

2 EDUCATE YOURSELF Learn as much as possible about your medications to avoid making mistakes. Know your medicine by name, how to take it, how often you need to take it, how long you should take it, and any possible drug interactions. Don’t be afraid to ask your health care provider about your medications.

3

INFORM YOUR PROVIDERS

4

If you see more than one health care provider, let them all know which medications have been prescribed so they can work together. For example, Carilion uses an integrated electronic health records system that allows all Carilion providers to securely share information about your care.

ONE

GO TO PHARMACY

Some consumers buy medications at several pharmacies, looking for the best deal. But if your pharmacists can’t talk to one another, it can greatly increase your risk of an adverse interaction. Going to one pharmacy is your best option.

Finally, don’t be afraid to ask your pharmacist about your medications. While pharmacists may always look busy, they love to answer questions and advise patients, Wilson says.

5

DO A MEDICATION REVIEW Start scheduling regular medication reviews with your pharmacist. He or she will sit down with you for 30 minutes to an hour and review all your prescriptions and supplements.

Many insurance companies will cover this.

CarilionClinic.org | SPRING 2016 21

MEDICAL NEWS

READY TO TAKE ON

TABATA?

By Patrick Dunham How would you like to work out for only four minutes, but get maximum benefits? Then you need to try Tabata.

Introduced by Izumi Tabata, Ph.D., to help increase performance for athletes, Tabata is high-intensity interval training that consists of a sprint-like effort for 20 seconds followed by a brief rest period of 10 seconds, all for a total of four minutes. But don’t let the short time-frame deceive you. This workout will push your limits, increase strength, and help you slim down.

22 SPRING 2016 | CarilionClinic.org

EXERCISE EXAMPLES SQUATS

MOUNTAIN CLIMBERS

V SIT-UPS

PUSH-UPS

The secret is the effort and the workto-rest ratio. Tabata’s work-to-rest ratio is 2:1, which forces you to work at a higher intensity for a longer period of time. As opposed to most interval training, which has a work-to-rest ratio of 1:1, allowing for a longer rest period.

What this means is that in just four minutes (a really hard four minutes) you can increase your aerobic capacity, anaerobic capacity, VO2 max, resting metabolic rate, and burn more fat than in a traditional 60-minute aerobic workout.

Plus, according to the American

College of Sports Medicine, Tabata will improve your blood pressure, cardiovascular health, insulin sensitivity (which helps the exercising muscles more readily use glucose for fuel to make energy), cholesterol, and decrease abdominal fat and body weight while maintaining muscle mass.

Tabata can be used for just about any type of aerobic exercise such as running or swimming, but to really get maximum benefits I like to perform three-to-five body-weight exercises to get both strength and cardiovascular benefits.

For example, if you want to do squats or push-ups: do them for 20 seconds, then rest for 10 seconds, and repeat until you reach four minutes.

The great thing about Tabata training is that YOU are the architect!

Patrick Dunham is the clinical training manager at Carilion Wellness. For more of his sample exercises, go to bit.ly/take-on-tabata.

Before beginning an exercise program, consult your physician. Stop exercising immediately if you feel lightheaded, dizzy, or have chest pains.

CarilionClinic.org | SPRING 2016 23

RESOURCES TO KEEP YOU HEALTHY CARILION DIRECT

Our physician referral and health information service is here to help. Call us at 540-266-6000 or 800-4228482, or email us at direct@carilionclinic.org.

“WELL SAID” SPEAKER’S BUREAU If you’d like a speaker on a health topic for your community group or workplace, call 540-266-6561 or visit CarilionClinic.org/speakers.

COMMUNITY HEALTH SCREENINGS Health screenings are available at little or no cost.

Call 540-266-6000 or 800-422-8482, or email us at direct@carilionclinic.org.

WEBSITE TAILORED FOR YOU Check out these features at CarilionClinic.org: »» Easy-to-use physician/provider finder »» Interactive maps to help you find your way to our locations »» Health and wellness content, including an A-Z library »» A community health education and events calendar

SOCIAL MEDIA Stay connected to Carilion Clinic through social media: facebook.com/carilionclinic twitter.com/carilionclinic youtube.com/carilionclinic google.com/+carilionclinic pinterest.com/carilionclinic

ONLINE HEALTH NEWS For the latest health and wellness news, and expert advice from Carilion’s own providers, visit our online Carilion Clinic Living news site at CarilionClinicLiving.com.

NEWS BLOG Keep up with the latest news, photos, videos, and more at Carilion Clinic’s newsroom.

CarilionClinic.org/blogs/newsblog.

24 SPRING 2016 | CarilionClinic.org

PUBLICATIONS Pick up a copy of Carilion Clinic Living at magazine racks throughout our facilities, or access the digital edition at CarilionClinic.org/living, where you can also read past issues. For health tips and news about upcoming health screenings events, subscribe to Living’s monthly e-newsletter at CarilionClinic.org/living.

MOBILE RESOURCES Stay connected with our mobile apps, available for iPhone and Android: Carilion Clinic Mobile Health Resource – Use our interactive symptom checker to access the most relevant information in our digital health library, then connect with Carilion services by using the search feature to find Carilion health care providers, hospitals, and urgent care locations near you MyChart – Access your medical record, request an appointment or prescription refill, and stay in touch with your doctor, all while on the go. If you are interested in MyChart, speak with your doctor.

SUPPORT GROUPS Support groups are available for a wide range of health needs, including gynecologic and breast cancer. Learn more at CarilionClinic.org/support.

CHILDREN’S HEALTH For the latest news and perspectives on children’s health care, read Close to Home, a blog by Alice Ackerman, M.D., chair of the Department of Pediatrics at Carilion Clinic. Visit CarilionClinic.org/ blogs/ackerman.

GIVING TO CARILION CLINIC FOUNDATION Be part of improving the health and vitality of communities in western Virginia. Make a gift at CarilionFoundation.org.

Everyte inu Mh

When survival depends on getting to the hospital fast, Carilion’s Life-Guard crews respond at a moment’s notice. Every day, they transport patients to Carilion Roanoke Memorial Hospital, a designated Level I Trauma Center (the highest designation).

Life-Guard and other air ambulances land on Roanoke Memorial’s rooftop helipad for all in the air to see.

Life-Guard will celebrate its 35th anniversary on Saturday, June 11. Stay tuned for more information.

Happy Birthday!

CarilionClinic.org | SPRING 2016 25

GROWING TO SERVE YOU PHYSICIANS Peter Apel, M.D., Ph.D.

Daniel Lollar, M.D.

Jesse Seamon, M.D.

Anthony Capito, M.D.

Terrence May, M.D.

Cardiology 2001 Crystal Spring Ave., Suite 203, Roanoke, VA 540-982-8204

Kathryn C. Self, M.D.

Pediatrics 1030 S. Jefferson St., Suite 106, Roanoke, VA 540-982-8230

Maria Cirino-Marcano, M.D.

Mary-Ellen Mick, D.O.

Internal Medicine 2900 Lamb Circle, Suite 250, Christiansburg, VA 540-639-9071

William Tanner, M.D.

Family Medicine 415 S. Pollard St., Vinton, VA 540-983-6700

Benjamin R. Coobs, M.D.

Ijeoma Okogbue, M.D.

Erik Womeldorf, M.D.

Orthopaedic Surgery, Hand Surgery 2331 Franklin Road, Roanoke, VA 540-725-1226

Hand Surgery, Plastic Reconstructive Surgery 2331 Franklin Road, Roanoke, VA 540-725-1226 2107 Rosalind Ave., Roanoke, VA 540-853-0510

Pulmonary Medicine, Critical Care Medicine 2001 Crystal Spring Ave., Suite 300, Roanoke, VA 540-985-8505

Orthopaedic Surgery 2331 Franklin Road, Roanoke, VA 540-725-1226

Acute Care Surgery, Surgical Critical Care 3 Riverside Circle, Roanoke, VA 540-224-5170

Cardiology 2001 Crystal Spring Ave., Suite 203 Roanoke, VA 540-982-8204

Orthopaedic Surgery 3 Riverside Circle, Roanoke, VA 540-725-1226

Family Medicine 1818 Electric Road, Roanoke, VA 540-772-8950

ADVANCED CLINICAL PRACTITIONERS Kristi Abraham, Au.D.

Brook Helmer, M.D.

Kelly Rebkovich, D.O. Family Medicine 141 Ben Bolt Ave., Tazewell, VA 276-988-8850

Otolaryngology 3 Riverside Circle, 4th floor, Roanoke, VA 540-224-5170

Jamie King, M.D.

Kenneth Rogotzke, D.O.

Crista A. Saunders, N.P.

Chine Logan, D.O.

Robert Schopf, D.P.M.

Family Medicine 548 Blue Ridge Ave., Bedford, VA 540-586-4723

Family Medicine 199 Hospital Drive, Suite 7, Galax, VA 276-236-5181

Neurosurgery 2331 Franklin Road, Roanoke, VA 540-224-5170

26 SPRING 2016 | CarilionClinic.org

Otolaryngology 2900 Lamb Circle, Suite 300, Christiansburg, VA (Temporary location through March 2: 120 Akers Farm Road., Christiansburg, VA) 877-827-2836 1150 Holston Road, Wytheville, VA 877-827-2836

Podiatry 3 Riverside Circle, Roanoke, VA 540-725-1226 390 S. Main St., Suite 103, Rocky Mount, VA 540-725-1226

Family Medicine 3369 Colonial Ave., Roanoke, VA 540-772-0555

URGENT CARE or the EMERGENCY ROOM? Sometimes you need medical attention fast, but where should you go?

GO TO URGENT CARE FOR:

UC»

Minor cuts

UC»

Minor burns

UC»

Possible broken bones/simple fractures (if the facility does X-rays)

UC»

Sprains and strains

UC»

Vomiting and diarrhea

UC»

GO TO THE EMERGENCY ROOM FOR: Major trauma/injuries

«ER

Injuries following a motor vehicle crash, being struck by a motor vehicle, or a fall from a height

«ER

Serious head injury (with loss of

consciousness, changes in normal behavior, multiple episodes of vomiting)

«ER

Burns with blisters or white areas, or large burns

«ER

Obvious broken bone in the leg or arm

«ER

Asthma (mild or moderate wheezing)

Severe difficulty breathing/ respiratory distress

«ER

UC»

Rashes

Fever in infants eight weeks old or less

«ER

UC»

Mild allergic reactions

Severe pain

«ER

UC»

Fever

Seizures

«ER

Urgent care is a more efficient and usually cheaper alternative to the emergency room. For a downloadable PDF of this chart, go to bit.ly/Urgent-Care-or-ER. CarilionClinic.org | SPRING 2016 27

RECIPE

SNAP PEAS

A Sweet Start to Spring

Sugar snap peas, a fresh and vibrant sign of spring, are perfect for salads. With their crunch and slight sweetness, they pair beautifully with herbs and baby lettuces.

They’re also a good source of vitamins A and C, iron, fiber, and protein.

SNAP PEAS WITH FRESH HERB-SCENTED GREENS

SERVES: 6 INGREDIENTS

• • • • • • • • • •

8 ounces sugar snap peas, stringed 12 grape tomatoes, halved 2 tablespoons sliced almonds 2 tablespoons extra-virgin olive, walnut, or almond oil 2 tablespoons fruity vinegar, such as raspberry or pomegranate ¼ teaspoon salt 1/8 teaspoon freshly ground pepper 4 cups packed mixed baby lettuce ¼ cup snipped fresh chives (½-inch pieces) ¼ cup chopped fresh tarragon

PREPARATION 1. Bring a medium saucepan of water to a boil. Add snap peas and cook until bright green

but still crisp, 1 to 2 minutes. Drain and rinse under cold water 2. Toast almonds in a small dry skillet over medium-low heat, stirring constantly, until

fragrant and lightly browned, 2 to 4 minutes.

3. Whisk oil, vinegar, salt, and pepper in a large bowl. Add lettuce, tomatoes, chives,

tarragon, and the snap peas and toss. Serve sprinkled with the almonds.

PER SERVING (11/2 CUPS)

Calories: 182; Fat: 11 g; Protein: 8 g; Fiber: 3 g 28 SPRING 2016 | CarilionClinic.org

haPPY Kids.

ALL KIDS.

Carilion Children’s is dedicated to the brave kids, the strong kids, the big and small kids—all kids.

CarilionClinic.org/kids | 540-266-KIDS

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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DESIGNED BY DOCTORS. BUILT FOR PATIENTS. Carilion Clinic’s Institute for Orthopaedics and Neurosciences takes an innovative approach to advanced patient care through collaboration across specialties. From bone and joint injuries to brain and spine disorders, our care team works together to help patients achieve their best possible outcome.

Hand and Upper Extremity | Joint Replacements Neurosurgery | Pain Management | Pediatric Neurosurgery Pediatric Orthopaedics | Physical Medicine and Rehabilitation Physical and Occupational Therapy | Spine | Sports Medicine

Institute for Orthopaedics and Neurosciences

800-422-8482 | CarilionClinic.org/ION