the magazine from FirstHealth of the Carolinas
Weighty Matters Surgical weight loss success
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Weâ€™re near to You. Weâ€™re Here For You. Quality Cancer C are, Close To Home Our cancer treatment services and support system deliver true multidisciplinary care with the best doctors, nurses and specialists. This type of integrated care helps guide patients comfortably and confidently from diagnosis through treatment, recovery and survivorship. For more information on the services provided by FirstHealth Cancer Services, call (800) 213-3284 or visit us on the web at www.nccancercare.org.
www.nccancercare.org The FirstHealth Moore Regional Hospital cancer program is accredited with commendation by the American College of Surgeons Commission on Cancer 844-60-14
The “epidemic” called obesity
David J. Kilarski Chief Executive Officer FirstHealth of the Carolinas
he mere mention of the word “epidemic” prompts all manner of frightening thoughts. World War I-era influenza. Polio in the 1940s. Ebola. But the epicenter for one of the worst epidemics that may ever affect you and your family could be as close as your own dining room table. This epidemic is called obesity and, according to numbers from the Centers for Disease Control and Prevention (CDC), 78.6 million American adults (more than onethird of the adult population) are dealing with its effects. Federal data reported by the Trust for America's Health and the Robert Wood Johnson Foundation provides a state-by-state snapshot of this 21st century epidemic, pointing out that the 2013 adult obesity rate in every U.S. state exceeded 20 percent while 42 states reported rates above 25 percent and two—Mississippi and West Virginia—had rates above 35 percent. Last year, rates of adult obesity rose in six U.S. states and fell in none. It is also an accepted fact that many Americans are chronically ill, even dying because of their weight. Obesity is well-documented as a cause of type 2 diabetes, heart disease, stroke, orthopaedic problems and sleep disorders. But did you know that it also contributes to certain cancers and to liver and gall bladder disease and that it can even cause infertility? Just as alarming is the fact that obesity is a disease—yes, a disease—without generational boundaries. According to the CDC, 18.4 percent of American children age 12 to 19 are obese, 18 percent of children age 6 to 11 are obese and (are you ready for this?) 12.1 percent of children age 2 to 5 are obese. Now that we have established the epidemic status of obesity, the question becomes what can be done about it? Unfortunately, there is no easy answer, no quick fix to a disease (again, that word) with so many root causes. There are measures we can take, however. Some are more difficult than others, but all involve behavioral and lifestyle change. Throughout the country, hospitals and health care systems have ratcheted up what they consider to be a battle against obesity. As the leader of the charge in this region, FirstHealth of the Carolinas has long been an innovator in preventive medicine and has been recognized many times for its efforts to introduce healthy eating and active lifestyles to the communities it serves. In this issue of FirstHealth magazine, you will learn about some of the medical conditions related to obesity as well as about some of the approaches FirstHealth offers in the battle against obesity. Because obesity is an epidemic, it may and probably will take most of these measures in combination to begin to make a difference. FirstHealth is available to help.
(800) 213-3284 • www.firsthealth.org 1
155 Memorial Drive P.O. Box 3000 Pinehurst, NC 28374 Editor, FirstHealth of the Carolinas. . . . . . . . . . . . . . . . Brenda Bouser Managing Editor . . . . . . . . . . . . . . . . . . . . . . . . . Jason Schneider Creative Director . . . . . . . . . . . . . . . . . . . . . . . . . . Jan McLean Production Director . . . . . . . . . . . . . . . . . . . . . . . . Traci Marsh
f i r s t h e al t h .o rg
Brenda Bouser, Ellen Geanes Cooper
Brenda Bouser, John Gessner, Don McKenzie
Board of Directors FirstHealth of the Carolinas Mr. Hew Fulton, Chair Ms. Tracy A. Leinbach, Vice Chair/Secretary Mr. Sherwood Blackwood Mr. James H. Bulthuis David M. Cowherd, M.D. John N. Ellis, M.D. Mrs. Carolyn D. Helms Mrs. Anna G. Hollers, Treasurer Mr. David J. Kilarski
Mr. Julian W. King Mr. Don Padgett Bernard M. Stanfield, M.D. William L. Stewart, M.D. Mr. Robert E. Tweed Raymond Washington, M.D. Mrs. Rusti Welch
Corporate Officers Chief Executive Officer, FirstHealth of the Carolinas President, FirstHealth Moore Regional Hospital. . . . . Chief Financial Officer, FirstHealth of the Carolinas.
. . . Mr.
David J. Kilarski
. . . . Mrs.
Chief Medical Officer FirstHealth of the Carolinas .
. . . . . . . . . . . . . . . . . . . . . . . John
Chief Information Officer, FirstHealth of the Carolinas .
. . . . . . . . . . . . . . . . . . . . . . . Mr.
Lynn S. DeJaco F. Krahnert Jr., M.D.
Chief Nursing Officer, FirstHealth Moore Regional Hospital. . . . . . . . . . . . . . . . Mrs. Karen Robeano, DNP, R.N. President, FirstHealth Physician Group . . . . . . . . . . . . . . Daniel R. Barnes, D.O. President, Moore Regional Hospital-Hoke Campus. . . .Mrs. Susan K. Beaty, R.N. . . . Mr.
The weight-loss agenda of a determined bride-to-be
David B. Dillehunt
Chief Operating Officer, FirstHealth Moore Regional Hospital. . . . . . . . . . . . . . . . Mr. Brian T. Canfield
President, FirstHealth Richmond Memorial Hospital
On the cover: Ellen Geanes Cooper embarked on a program of medical supervision, healthy eating and regular exercise to help her with her weight-loss goals in anticipation of her recent wedding. Others, even including bariatric team member Jan Norris (second from right in inset), have turned to FirstHealth’s Bariatric Center and David Grantham, M.D.; Melissa Herman, R.D.; and Raymond Washington M.D., to guide them through the weightloss surgery process.
John J. Jackson
President, Foundation of FirstHealth . . . . . . . . . . . . . . . . Mrs. Kathleen Stockham President, FirstHealth Montgomery Memorial Hospital. . . . Mrs. Beth Walker Vice President, Human Resources, FirstHealth of the Carolinas . . . . . . .
. . . . . . . . . . . . . . . . . Mr.
Vice President, Strategy & Innovation, FirstHealth of the Carolinas . . . . . . . . . .
. . . . . . . . . . . . . . Mrs.
Vice President, Finance & Support Services, FirstHealth of the Carolinas . . . . . . . . . . . . . . Vice President, Quality, FirstHealth of the Carolinas .
Daniel F. Biediger
. . . . . . . . . . Mr.
Jeffrey A. Casey
. . . . . . . . . . . . . . . . . . . . . . . Mrs.
The not-for-profit FirstHealth of the Carolinas is headquartered in Pinehurst, N.C., and is composed of Moore Regional Hospital, Montgomery Memorial Hospital, Richmond Memorial Hospital (a division of Moore Regional Hospital), the Foundation of FirstHealth, FirstCarolinaCare Insurance Company, and Regional Health Services. Comments on FirstHealth of the Carolinas magazine or changes of address should be directed to firstname.lastname@example.org or to (910) 715-4278.
FirstHealth of the Carolinas is published by StayWell 407 Norwalk St. Greensboro, NC 27407 (336) 547-8970 President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William G. Moore Senior Staff Accountant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sharon Tesh © Copyright 2015 by StayWell, an operating company of StayWell/MediMedia USA, and FirstHealth of the Carolinas, Inc. No part of this publication may be reproduced or transmitted in any form or by any means without written permission from StayWell. Articles in this publication are written by professional journalists 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 adviser. All editorial rights reserved. Opinions expressed herein are not necessarily those of StayWell or FirstHealth of the Carolinas. Models are used for illustrative purposes only.
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10 Obesity and demographics 12 Too heavy? For more information on any of the programs or services offered by FirstHealth of the Carolinas, please call (800) 213-3284 or visit www.firsthealth.org. Specific web pages for the programs and services featured in this issue of FirstHealth magazine can be found throughout the publication.
Weight risks Kimberley Lingler, M.D., has at least two reasons for taking regular runs through her neighborhood with her two young children and the family dog: She wants to stay healthy and maintain a healthy weight, and she wants to be a healthy role model for her patients.
David Grantham, M.D., always tells his surgical weight-loss patients that surgery is just one component in their weight-loss journey. Lifestyle change that includes a healthy diet and regular exercise are also important.
imberley Lingler, M.D., sees patients at the beginning of their weightloss journey, when many of them still have a chance of benefiting from lifestyle changes related to a healthy diet and regular physical activity. David Grantham, M.D., sees them when they have exhausted those options and when their weight has created or worsened such chronic medical conditions as high blood pressure and diabetes and put them at high risk for heart disease and even some cancers. (800) 213-3284 â€˘ www.firsthealth.org 3
Despite the differences in timing and intervention, both Dr. Lingler, who specializes in family medicine, and Dr. Grantham, a bariatric surgeon, have pretty much the same message for their weightconcerned patients and it is this: There is no silver bullet for weight loss, no quick fix, and every move in the direction of meaningful weight loss—even something as dramatic as weight-loss surgery—has to involve lifestyle change and commitment if it’s to be effective. “Lifestyle change is appropriate across the board, no matter who we’re talking about,” says Dr. Lingler, of FirstHealth Family Medicine in Rockingham. “I tell our bariatric surgery patients that surgery is not their easy way out,” says Dr. Grantham, of the FirstHealth Bariatric Center. “It’s a tool in the process of hard work and lifestyle change.” While Dr. Lingler’s patients know they are overweight, some don’t realize that, medically speaking, they are obese, especially if their extra pounds are around the mid-section. “A lot of patients are surprised by how quickly they meet obesity criteria,” she says. “These patients, and society, may think they are overweight, but medically speaking they’re already in the obese range.” Education about their condition and its risks quickly enters the patient-doctor discussion, which is always individualized to the patient and his/her particular needs. “Right off the bat, I let them know what programs are available to them,” Dr. Lingler says, “dietary, Exercise is Medicine. There are medications, but they’re not suited to everybody and none are going to work alone. All work in tandem with permanent lifestyle improvements. If I had a pill that could help people lower their blood pressure, lower their sugar and put them at decreased risk for cancer, if I had a pill that could do that, people would be beating down my door. Diet and exercise do that. They do every one of those things.” On the other end of the weight-loss spectrum, Dr.
Grantham meets his patients for the first time during one of the free weight-loss surgery information sessions offered by the FirstHealth Bariatric Center.
There is no silver bullet for weight loss, no quick fix, and every move in the direction of meaningful weight loss—even something as dramatic as weightloss surgery—has to involve lifestyle change and commitment if it’s to be effective.
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By that time, some have already decided that surgery is the route for them while others still aren’t sure. Even when a patient decides to pursue surgery, it’s still a long way to a Moore Regional Hospital operating room. Potential surgical patients have to meet body mass index criteria and attend an information session. Before being cleared for surgery, they have to undergo a series of rigorous medical, psychological and nutritional evaluations. Some will need cardiac clearance. The idea is to ensure that the patient is medically and psychologically prepared for the surgery and for the often-difficult lifestyle changes that must follow. “We make sure surgery would be appropriate and safe,” Dr. Grantham says.
Back and joint pain and weight Excess weight is well-documented as a cause of stress on the human back and the weight-bearing ankles, knees and feet. Losing weight may not reverse the damage, but even moderate weight loss can help relieve the pain. “Sometimes there can be too much damage, and you can’t turn back the clock,” says orthopaedic surgeon “Ideally, we want to try and manage the lifestyle by appropriate diet and exercise.” —James E. Rice, M.D. FirstHealth Orthopaedics
James E. Rice, M.D., of FirstHealth Orthopaedics. “But with weight reduction, you do take the stress off so you delay the need for surgical intervention. If surgery is still needed, any weight-loss reduction will help make it more successful.” According to the American Obesity Association (AOA), back and joint pain is widespread among the nearly one-third of Americans who are classified as obese. AOA also reports that more obese people say they are disabled and less able to complete everyday activities than people with other chronic conditions. Dr. Rice compares the stress of excess weight on the body to the effect caused by carrying around a 50-pound sack of potatoes all day. “The musculoskeletal system wasn’t intended to support that much body mass,” he says. www.firsthealth.org/ortho
Cancer and weight Obesity will soon become the leading preventable cause of cancer—even surpassing tobacco. According to the American Society of Clinical Oncology (ASCO), more than 40,000 cancer diagnoses are linked to obesity each year. So are 15 to 20 percent of all cancer deaths. Obesity is also linked to poor cancer outcomes, including a higher risk of recurrence. Evidence indicates that breast, prostate and colorectal cancers have especially strong obesity links, but weight is also suspected in a number of other cancers including childhood leukemia.
“Patients are always looking for things they can do to help prevent or reduce the risk of recurrence of cancer. While I think it is easier for them to see the link between obesity and hypertension or heart disease, there is also a link between obesity and certain types of cancer. Controlling their weight is a risk factor for certain cancers that they can control.” —Ellen M. Willard, M.D. FirstHealth Outpatient Cancer Center
According to the ASCO, obesity also presents challenges in cancer detection and treatment since obese patients are more likely to put off seeking medical care and less likely to participate in screening programs or get preventive testing. They also present challenges in terms of imaging quality, radiation therapy, chemotherapy and surgery. www.nccancercare.org
Depression and weight There is something of a chicken-and-egg relationship between excess weight and depression. Does the weight gain cause the depression or does the depression cause the weight gain?
“You can’t just have one foot in the door (with lifestyle change.) You’ve got to have both feet.” —Devon Burnore, M.S., LPC, LCAS, NCC FirstHealth Behavioral Services With some people, even something as routine as a “bad day” can send a person heading for the refrigerator and the comfort of a big dish of ice cream, according to Devon Burnore, M.S, LPC, LCAS, NCC. “We treat ourselves to things that are bad,” she says. “It’s a vicious cycle.” A licensed professional counselor and licensed clinical addictions specialist with FirstHealth Behavioral Services, Burnore does the psychological evaluations for FirstHealth patients who are being assessed for weightloss surgery. She also counsels people with eating disorders. She says it’s important to know why a person overeats and to identify when the struggle with food began. Is it a matter of real hunger or is it stress? Is it binge-eating or a way to self-medicate? It helps to have a support system—a friend or relative in similar circumstances or even the structure of an organization like Overeaters Anonymous. Filling free time with an activity can also help—reading, exercising, even cooking, as long as it’s healthy food. “Something that fulfills the need for food,” Burnore says. www.firsthealth.org/behavioral
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Diabetes and weight When you consider the various health risks associated with weight, diabetes ranks at or near the top of the list. More than 90 percent of people who are overweight, especially those who are obese, have type 2 diabetes, a condition in which the body does not properly use insulin, the hormone that produces energy for cells. “The more excess weight you have, the more resistant the muscle and tissue cells become and the more likely you are to eventually develop diabetes,” says Melissa Herman, R.D., LDN, CDE, CHC, a registered dietitian with the FirstHealth Diabetes & Nutrition Education Center. According to Herman, insulin “opens the doors” of muscle cells to allow the sugar from consumed food to enter. When a person develops insulin resistance (where the muscle wall gets so firm that the insulin cannot enter cells and produce energy), high blood sugar levels develop and the body produces higher amounts of the hormone in order to compensate. Because insulin is a fat-promoting steroid, the result means increased fat cells and weight gain—and sometimes diabetes. www.firsthealth.org/diabetes
“Working with a registered dietitian and/or diabetes educator who can thoroughly evaluate the diet and customize calories, nutrient intake and food preferences is the most effective way to combat diabetes.” —Melissa Herman, R.D., LDN, CDE, CHC FirstHealth Diabetes & Nutrition Education
GI problems and weight Gastroenterologist T.J. Pulliam, M.D., puts weight “at the top of the list” as a cause of gastrointestinal issues, especially in terms of risk factors that can be controlled. “You can’t pick your genetics, but you can pick what you eat, how much you eat and how much you weigh,” Dr. Pulliam says. “It’s a lifestyle that you have to invest in and buy into.”
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According to Dr. Pulliam, there are three main gastrointestinal concerns when it comes to obesity. The first is nonalcoholic fatty liver disease (excess fat in the liver), which usually isn’t serious unless it leads to inflammation, damage or cirrhosis. Second is an increased risk of digestive cancers (colorectal, esophageal and pancreatic).
“The Metabolic Syndrome— obesity, hypertension, diabetes and hyperlipidemia (risk for fatty liver disease)—has become a real significant public health issue.” —T.J. Pulliam, M.D. FirstHealth Gastroenterology, Rockingham Third is reflux, also known as gastroesophageal reflux disease (GERD) or heartburn, a condition in which the liquid contents of the stomach back up into the esophagus to cause a burning pain in the middle of the chest. When Dr. Pulliam has patients whose weight is affecting their gastrointestinal health, he will usually prescribe a 15 to 20 percent weight loss by implementing a low-fat diet and increased physical activity. “Depending on how obese the patient is and after three to six months of guided but unsuccessful weight-loss attempts, we may have to consider bariatric surgery,” he says. www.firsthealth.org/GI
The heart and weight When your weight is in a healthy range, your blood circulates more efficiently and your fluid levels are more easily managed. People who have too much fat—especially around the waist—are at higher risk for heart disease, the leading cause of death in the United States. Being overweight can raise the cholesterol and triglyceride levels, lower “good” cholesterol and cause blood pressure to rise. Even apparently healthy hearts can be affected by excess weight. According to a study published in the journal Circulation, doctors found that carrying around extra pounds seems to weaken the heart’s ability to pump blood. This is one of the first steps in
“Not only is obesity independently associated with heart disease, but obesity is also directly linked to a number of other risks for heart disease—hypertension, diabetes and high cholesterol. These associations have made obesity a compelling risk factor for heart disease and a target for the American Heart Association for primary and secondary prevention of cardiovascular disease.” —Steven Filby, M.D. FirstHealth Cardiology Reid Heart Center the development of heart failure, a serious condition in which the heart can’t pump enough blood to meet the body’s needs. www.firsthealth.org/heart
Infertility and weight Women who are having trouble becoming pregnant may be advised to consider their weight as a reason why. According to a study in the British Medical Journal, both very thin and very obese women have lower conception rates than other women. Weight becomes an issue in matters of infertility when it leads to menstrual irregularity, a sign of inconsistent ovulation, says Walter Fasolak, D.O., an obstetrician and gynecologist with Southern Pines Women’s Health Center. Affected patients will typically have a body mass index of more than 30. “Weight makes consistent ovulation less likely, therefore leading to infertility,” Dr. Fasolak says. A woman who has been unsuccessful at becoming pregnant after more than a year of trying should contact “Weight loss by itself can often resolve infertility without the need for extensive infertility treatment. However, we all know that weight loss can be most difficult to achieve.” —Walter Fasolak, D.O. Southern Pines Women’s Health Center, a FirstHealth clinic
a specialist in infertility, and women with irregular periods should seek help earlier. If weight is a factor, the physician may recommend a specific program or programs to assist with the weight loss—the type depends on the amount of weight loss that is needed. www.firsthealth.org/women
Sleep disorders and weight Excess weight can also affect the way a person sleeps—or more appropriately doesn’t sleep. The most common weight-related sleep disorder is obstructive sleep apnea, which occurs when the muscles in the throat periodically relax and block the airway during sleep. Snoring is the most noticeable sign of the problem while other symptoms include gasping for air, choking, unrestful sleep, breathing pauses and daytime sleepiness. “The gold standard and most effective treatment for sleep apnea is positive airway pressure. The device prevents sleep apnea by providing air under pressure through a mask that is worn on the face. There are other treatments available including oral appliances, body positioning and surgery. A physician who specializes in sleep medicine can assist a patient in deciding the best treatment.” —Waldemar Riefkohl, M.D. FirstHealth Sleep Disorders Program
According to Waldemar Riefkohl, M.D., an ear, nose and throat specialist (otolaryngologist) with the FirstHealth Sleep Disorders program, it’s important to discuss any kind of sleep problem with your doctor, especially if sleep apnea is suspected to be the cause. “Sleep apnea not only leads to poor quality of life, but it also increases the risk for significant medical problems, including heart attack, stroke and pulmonary hypertension,” Dr. Riefkohl says. “If your doctor suspects sleep apnea, he/she will recommend a sleep study. This is the only objective way to determine if the sleep problems are due to sleep apnea.” www.firsthealth.org/sleep
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n Oct. 24, 2013, in one of the sweetest moments of my life, I got engaged. I had been waiting four years for this special time, and I will never forget it. Amidst the tears and excitement of the evening, though, was a thought I couldn’t get out of my mind. “It’s time to lose some weight.”
The weight-loss agenda of a determined bride-to-be By Ellen Geanes Cooper When I started my “Operation Wedding Dress” challenge, my goal was to get as skinny (about 60 pounds ago) as I was when I met my fiancé, Graham. That’s vain, I know, but I wanted to look like the perfect bride. What bride wouldn’t? After talking with my parents and primary care physician, Bo Kopynec, M.D., however, I came to understand that losing that kind of weight wouldn’t be just for looks … it would be for health. As a FirstHealth employee, I am reminded daily of the importance of being healthy. Eat healthy, drink more water, limit sodium intake, exercise daily—I work with people who live these cardinal rules. It should have been easy for me to incorporate them into my daily routine, but it wasn’t. I wouldn’t say I have ever been completely “unhealthy.” I grew up eating very healthy foods and was always instructed to make wise choices. I just chose to make the wrong choices. Because I loved food, making the right choices didn’t come easily. The extra pounds did, though. You name a diet, and I have probably tried it. I lost weight, but gained it back. My desire to eat always seemed to “outweigh” my desire to maintain a healthy weight. When I stepped on a scale in Dr. Kopynec’s office and saw a number I had never seen before, I realized that desire had to change. I weighed 201 pounds, and I was devastated. How, and when, did this happen? I was at my all-time healthiest when I met Graham. I worked out and counted calories. At some point in our relationship, however, I gained a lot of “happy weight” and discovered I couldn’t eat like he did. There was no easy answer or way out from Dr. Kopynec, who
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“It’s great to see that plain, old-fashioned determination and hard work—combined with a little dietary education—is still a valid option for successful weight-loss and the associated good health that follows. I wish more of my patients would avail themselves of this alternative rather than hoping for easy fixes that don’t offer the same lasting benefits.” —Bo Kopynec, M.D. FirstHealth Family Medicine, Ellerbe
To read about Ellen’s journey and other weight-loss success stories, visit www.firsthealth.org/firstblog. If you have a FirstHealth weight-loss story you would like to share, send it to email@example.com.
A primary part of Ellen Geanes Cooper’s weight-loss journey involved healthy eating, and she found plenty of great seasonal fruits and vegetables at the Moore County Farmers Market that was held April-October on the campus of FirstHealth Moore Regional Hospital. She also exercised, taking long walks with Graham Cooper (her husband since Dec. 6, 2014), and working out at FirstHealth FitnessPinehurst under the watchful eye of personal trainer Lauren Williams.
ordered thyroid and diabetes tests. When they came back negative, he looked me in the eye and told me I had to join the gym and change my diet. It was that simple. I joined FirstHealth Fitness in Pinehurst and started to work on my diet. Now, this is where I am supposed to say I worked out, ate salads every day and lost weight, but it didn’t work that way. Working out was hard and no fun. I had no desire to go to the gym. I didn’t like being there, and I didn’t like sweating. I didn’t like any of it. I did like the way I felt at the end of the workout, however, and that seemed to make everything worthwhile. I took a metabolic test offered through the FirstHealth Diabetes & Nutrition Education Center and learned how many calories—1,900—I burned and could consume in a day. I met with a dietitian who helped guide me toward a (new) diet plan and proper food choices. I started a high-fiber, high-protein, low-carb diet and began seeing results. I didn’t necessarily have to give up anything or really “diet,” but I did have to change my lifestyle. I felt better than ever before. My energy level, and my confidence, improved and I started to feel more like my old self again. This weight-loss journey took time, months actually, but I got into a groove. There were some tumbles, but my goals stayed with me the whole time. Weekly weigh-ins with a personal trainer at FirstHealth Fitness helped keep me accountable, and everything became easier when I saw the number on the scale start to go down. My trainer has encouraged me to continue this journey—even after the wedding. At some point along the way, how I would look on my wedding day became secondary to living a healthy life and being a healthy wife—and one day a healthy mother. Losing 40-plus pounds has made me feel like a new person, and I LOVE the way my body feels these days. With time and dedication, you can feel the same way.
Ellen Geanes Cooper is a public relations and marketing specialist for FirstHealth Corporate Communications. She became Mrs. Graham Cooper on Dec. 6, 2014.
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Information about the nation’s obesity epidemic is widespread. Despite numerous programs and services designed to combat it, the problem appears to be worsening and with it the general state of American health. From head to toe, from depression to foot and ankle pain, obesity is acknowledged to have sometimes devastating effects.
Obesity and demographics • The 2013 adult obesity rate exceeds 20 percent in every state. • Continuing a years-long trend, nine of the 10 states with the highest rates of obesity are in the South. • Two states, Mississippi and West Virginia, have obesity rates above 35 percent. • The West and Northeast had the healthiest BMIs. • With 21.3 percent, Colorado boasts the lowest adult obesity rate. • High rates of obesity correspond with poverty, which is associated with lower availability of healthy foods and fewer safe neighborhoods where people can walk and children can play for exercise. • One-third of adults who earn less than $15,000 per year are obese compared with one-quarter who earn at least $50,000. *These statistics are from a September 2014 report issued by the Trust for America’s Health and the Robert Wood Johnson Foundation and are based on government data.
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Psychosocial effects. Culture in the U.S. often values a body image that's overly thin. Overweight
and obese people are often blamed for their condition. Other people may think of them as lazy or weak-willed. Depression is more common in people who are overweight and obese.
Heart disease and stroke. Atherosclerosis, or hardening of the arteries, happens more often in obese people. Coronary artery disease is also more common in obese people because fatty deposits build up in arteries that supply the heart. Narrowed arteries and reduced blood flow to the heart can cause chest pain called angina or a heart attack. Blood clots can also form in narrowed arteries and travel to the brain, causing a stroke. High blood pressure. Excess weight makes the heart work harder, because it must pump more blood
against more resistance from the blood vessels. More circulating blood and more resistance also means more pressure on the artery walls. Higher pressure on the artery walls increases the blood pressure. Excess weight also raises blood cholesterol and triglyceride levels and lowers HDL ("good") cholesterol levels, adding to the risk of heart disease.
Sleep apnea and respiratory problems. Sleep apnea causes people to stop breathing for brief periods during sleep. Sleep apnea interrupts sleep and causes sleepiness during the day. It also causes heavy snoring. Sleep apnea is also linked to high blood pressure. Breathing problems tied to obesity happen when added weight of the chest wall squeezes the lungs. This restricts breathing. www.firsthealth.org/sleep
Cancer. Among obese women, the risk increases for cancer of the endometrium, or the lining of the uterus in younger women, and breast cancers in those who have gone through menopause. Men who are overweight have a higher risk for prostate cancer. Both men and women who are obese are at increased risk for colorectal cancer. www.nccancercare.org
Type 2 diabetes. Obesity can make your body resistant to insulin, the hormone that regulates blood sugar. When obesity causes insulin resistance, your blood sugar level rises. Even moderate obesity dramatically increases the risk for diabetes. www.firsthealth.org/diabetes
Joint problems, including osteoarthritis. Obesity can affect the knees and hips because extra weight stresses the joints. Joint replacement surgery may not be a good choice for an obese person because the artificial joint has a higher risk of loosening and causing further damage.
Metabolic syndrome. Metabolic syndrome has several major parts: abdominal obesity, high blood cholesterol, high blood pressure and insulin resistance (severe type 2 diabetes). www.NCWeightLossSurgery.com
Physical activity. For those who are obese, daily life itself is harder, studies show. Simple tasks like carrying groceries, walking up stairs, kneeling and stooping are more difficult for the obese.
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Too heavy? Here are some measures you can take …
y the time Hoke County resident Clara Graham decided to make real changes to her lifestyle, she was overweight, plagued by high cholesterol and high blood pressure, and disabled by arthritis.
Being fit may have saved a life She cut out junk food and generally began to eat more healthily. She also dusted off her neglected FirstHealth Fitness–Raeford membership card and started working out on the Technogym equipment and enjoying group exercise classes. She lost between 80 and 90 pounds. It’s a good thing she did. Graham had a heart attack. Because there was no damage to her heart—no blockage or need for stents or surgery, her physicians believe the episode was caused by “broken-heart syndrome,” a temporary disruption of the heart’s normal pumping function. They also told her that her outcome probably would have been a lot worse if she hadn’t been in such good physical shape otherwise. Since the heart attack, Graham has been in the care of a cardiologist and has successfully completed the FirstHealth Cardiac Rehabilitation program. As soon as she got the medical OK, she returned to the fitness center, where she enjoys the fellowship of other members almost as much as she appreciates the health benefit of her regular five-day-a-week workout/group exercise schedule. “I love a good workout, and we have some great instructors,” she says.
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Clara Graham (left), shown with facility manager Suzanne Kim, is a regular at FirstHealth Fitness–Raeford.
irstHealth’s five fitness centers are more than gyms. Their programs are medically based and physician-supervised. Participants are assisted by personal trainers and fitness coaches with college degrees in the fitness field as well as a licensed dietitian.
From nutrition counseling and fitness centers to bariatric
Programs and services vary from location to location, but the flagship facility in Pinehurst offers the region’s largest free-weight area, innovative group exercise programs, an aquatic center, swimming lessons, children’s programming and—through its new Wellness Center—Exercise is Medicine, nutrition counseling and massage therapy. For more information on FirstHealth Fitness and the medically based fitness centers located in Pinehurst, Southern Pines, Rockingham, Raeford and Troy, visit www.firsthealth.org/fitness.
surgery, FirstHealth of the Carolinas offers a variety of measures that can assist with an individualized weight-loss journey. For information on any of the following services, call (800) 213-3284.
“My life now revolves around eating healthily and exercising regularly.” —EIM participant and surgical weight-loss patient Cassie Cloninger
Exercise is Medicine
xercise is Medicine (EIM) is a health care call to action launched by the American College of Sports Medicine and the American Medical Association that encourages health care providers to make exercise a part of their regular patient treatment plans. While regarding physical activity as much a vital “(EIM) is just what sign as weight, blood I needed. I have never pressure and temperature, they encourage patients been fond of exercising, to use exercise as a tool in but I am now.” improving their own health. —EIM participant After a discussion of Alice Glisson lost 55 physical activity needs, pounds after starting participating providers refer EIM. their patients to FirstHealth Fitness–Pinehurst for a professional exercise assessment and treatment plan developed by a trained exercise technologist. Participation in the program also includes communication with physicians so they can help the patient use exercise as a disease prevention or treatment method. The Technogym equipment used by Exercise is Medicine participants was funded by The Foundation of FirstHealth. www.firsthealth.org/fitness
(800) 213-3284 • www.firsthealth.org 13
The lifelong commitment of weight-loss surgery
little more than two years ago, Jackie McAuley weighed 210 pounds. For the past several months, she’s been “constant” at 127. The difference? Weight-loss surgery. Since David Grantham, M.D., performed her gastric bypass procedure at FirstHealth Moore Regional Hospital, McAuley’s health has improved so much that she’s now down to one medication a day (in addition to the vitamins necessary to sustain her nutritional needs) from a pre-surgery high of about a dozen. Name a weight-related medical condition and McAuley had it: high blood pressure, high Jackie McAuley’s introduction to FirstHealth’s surgical weightcholesterol, sleep apnea, gastrointestinal issues, joint pain loss program came during a free information session conducted and diabetes. There were so many prescriptions that, as by Raymond Washington, M.D. (left). David Grantham, M.D. (right) actually performed her surgery. McAuley says, “It got to the point that my medications weren’t playing nice with each other.” distances—and generally enjoys life more than she has for A billboard promoting the free weight-loss information sessions offered by the FirstHealth Bariatric a long time. “I feel great,” says McAuley, who lives in Ellerbe Center started her weight-loss journey. She attended and works for the Richmond County Soil and Water a session and, after consulting with physicians and Conservation District in Rockingham. completing a battery of medical and psychological tests, www.NCWeightLossSurgery.com decided surgery was the route for her. “After that, it was like one step after the other,” McAuley says. “Everything seemed to fall right into place.” McAuley learned very quickly Healthy Kitchen that surgery would be just one of the Healthy Kitchen is a nutrition education program offered by weight-loss tools in her weight-loss FirstHealth Community Health Services. In these classes, participants tool chest. Surgical success requires learn how to prepare tasty, healthy and inexpensive meals. They also a lifetime commitment that also learn principles of good nutrition, how to get the most food for their includes behavior modification, money and hands-on cooking techniques. physical activity and diet change. Her diet now includes “very, very People Living Active Year Round (PLAY) little (red) meat,” lots more fruits This Community Health Services class teaches individuals such and vegetables and close attention core concepts as the importance of cardiovascular activity, strength to carbohydrates, sugars and fats. training and flexibility exercises. Each week for six weeks, participants She now walks when she previously learn a strategy to help them meet their fitness goals. would have gotten into her car *Payment for each of these programs is based on a sliding scale. and driven—even for very short www.firsthealth.org/healthyliving
Community Health Resources
14 Winter 2015
Wellness and Nutrition Coaching
here are lots of resources out there telling you what you should do to lose weight. Diets, supplements and media advice abound. So why do we still struggle with weight loss? Like any good student of science, registered dietitian Ashley Carpenter, R.D., knows the biochemistry behind metabolism and weight management. She also knows that weight loss is about a lot more than food. To achieve lasting success, we need to be motivated to create change. As a wellness coach and dietitian for the Wellness Center at FirstHealth Fitness–Pinehurst, Carpenter helps clients bridge the gap between science and behavior modification. She uses her wellness coaching skills to empower clients by helping them draw out their own needs. She also works with them on how to rise above their personal barriers to good health and thrive. “The effectiveness in working with a wellness coach is in the power of being asked what you want, and why it matters to you,” she says. “Coaching provides guidance and support as you translate your vision into specific and personally meaningful goals.” The idea is to get away from the “one-size-fits-all” perspective and work toward sustainable change in mindset and behavior using personal motivators. “You are the expert on yourself, and a wellness coach can be your catalyst for transformational change,” says Carpenter, who is completing requirements to become certified by Wellcoaches, an organization that works in collaboration with the American College of Sports Medicine. www.firsthealth.org/fitness
Be active Get at least 30 to 60 minutes of physical activity (intense enough to make you breathe slightly harder, but not so hard that you're huffing and puffing or unable to carry on a conversation) on most days of the week, and 60 to 90 minutes per day for weight loss and maintaining weight loss. You don’t have to get all the exercise at one time; 10 minutes of activity at a time is fine.
Carrot Oat Bran Muffins 1 1 1 1 1 2
cup oat bran cup powdered nonfat milk teaspoon baking powder teaspoon baking soda teaspoon cinnamon Tablespoons Splenda® brown sugar blend 3 large eggs, beaten (alternative: egg whites or egg substitute) ½ cup applesauce, no sugar added 1 cup grated carrots (approximately 2 large or 3 small) ¼ cup raisins 12 paper muffin cup liners or cooking spray Preheat oven to 350 degrees. Prepare a 12-muffin tin by inserting paper liners or spraying lightly with cooking spray. In a large bowl, mix oat bran, powdered milk, baking powder, baking soda, cinnamon and Splenda. Add eggs and applesauce and mix well. Stir in grated carrots and raisins. Divide batter among 12 muffin cups. Bake 20 minutes. Cool on a rack. Store in an airtight container. Freeze extras. Yield: 12 muffins. Each muffin contains about 109 calories, 6 g protein, 2 g fat, 60 mg cholesterol, 17 g carbohydrates, 3 g fiber and 201 mg sodium.
(800) 213-3284 • www.firsthealth.org 15
FirstHealth Bariatric Center
or people who are morbidly obese (more than 100 pounds overweight) and who have been unsuccessful in controlling their weight through diet and exercise, weight-loss surgery may be an effective treatment option. The Bariatric Center at FirstHealth Moore Regional Hospital offers Roux-en Y divided gastric bypass surgery, the adjustable gastric banding system, and sleeve gastrectomy or gastric sleeve surgery. Surgery is usually performed eight to 12 weeks after prospective patients attend a required information session with a bariatric surgeon. They must also be evaluated by a bariatric dietitian and a mental health provider and undergo tests to ensure they do not have a medical condition that could affect their surgery. Since it began in 1999, FirstHealthâ€™s bariatric surgical program has helped more than 1,000 patients lose weight and return to a healthy lifestyle. www.NCWeightLossSurgery.com
Genetic and Metabolic Testing
eople who are interested in learning why they eat what they eat as well as the number of calories necessary for their unique metabolism to work efficiently will find help with the FirstHealth Diabetes & Nutrition Center. A simple 10-minute breath test called indirect calorimetry measures the resting metabolic rate to determine the number of calories an individualâ€™s body burns at rest in a given day. From there, a more precise estimate of daily caloric needs accounting for weight goals and activity levels can be calculated and a registered dietitian can provide effective dietary recommendations. A saliva test called Pathway Fit examines more than 75 genetic markers associated with diet, nutrition and exercise response. This highly personalized information allows a registered dietitian to make patient-specific recommendations on achieving or maintaining a healthy weight and lifestyle. www.firsthealth.org/diabetes
16 Winter 2015
N E W Anesthesiology
Rod S. Silverman, M.D. Oban Anesthesiology Consultants
Brian Mann, PA-C FirstHealth Convenient Care Whispering Pines
Markus A. Boin, M.D. Sandhills Emergency Physicians
Frank L. Christopher, M.D. Sandhills Emergency Physicians
Daniel T. Goodberry, M.D. Sandhills Emergency Physicians
John M. Schwarz, PA-C Sandhills Emergency Physicians
Tabitha M. Bedini, M.D. FirstHealth Family Medicine
Karen L. Smith, M.D. Raeford
P R O V I D E R S Gastroenterology
Amy D. Harris, FNP Pinehurst Medical Clinic
Rebecca A. Johnston, PA-C Pinehurst Medical Clinic
Melanie J. Blacker, M.D. Moore Regional, Richmond Memorial
Crystal M. Coen, FNP Montgomery Memorial, Moore Regional, Richmond Memorial
Peter S. Fleming, M.D. Moore Regional
Crystal P. McKenzie, FNP Moore Regional, MRH–Hoke Campus
Marc G. Granata, M.D. Moore Regional, Richmond Memorial
Stephanie A. Grotzke, M.D. Moore Regional
Julie L. Jones, M.D. Moore Regional, Richmond Memorial, MRH–Hoke Campus
Kenneth S. Shedarowich, PA-C Moore Regional, Richmond Memorial, MRH–Hoke Campus
Brian T. Trezak, M.D. Moore Regional, Richmond Memorial, MRH–Hoke Campus
Catherine M. Vanco, PA-C Moore Regional
Mary Belle McGill Weitzel, D.O. Moore Regional, Richmond Memorial, MRH–Hoke Campus
Scott M. Luneau, M.D. Pinehurst Medical Clinic
William L. Harris M.D. FirstHealth Cardiology
Thomas S. Ivester, M.D. Moore Regional
(800) 213-3284 • www.firsthealth.org 17
N E W P ROV I DE R S Maternal-Fetal Medicine
Julie M. Johnson, M.D. Moore Regional
David M. Stamilio, M.D. Moore Regional
Dennis M. Campbell, M.D. FirstHealth Neurosurgery
Obstetrics & Gynecology
Obstetrics & Gynecology
Lissette Machin, M.D. Pinehurst Surgical
Lara K. Campagna, PA-C Pinehurst Hip & Knee
Timothy M. Gast, PA-C Pinehurst Surgical
Scott E. Olson, PA-C FirstHealth Orthopaedics
Matthew R. Grafenberg, M.D. Pinehurst Surgical
Mark K. LaVigne, M.D. Pinehurst Surgical
Pediatric Hospital Medicine
Sara M. Ebel, PA-C Pinehurst Medical Clinic
Myra Flor A. Nario, PA-C Pinehurst Medical Clinic
Allen M. Joseph, M.D. Pinehurst Radiology
Rodney D. Welling, M.D. Pinehurst Radiology
Adam D. Clark, PA-C Pinehurst Surgical
Paul Anthony Vieta Jr., M.D. Pinehurst Surgical
Do you need help in finding a primary care provider or medical specialist? If so, visit www.firsthealth.org and click on Directory on the
Lee Lowery, M.D. Moore Regional
18 Winter 2015
Christopher M. Johnson, M.D. Pinehurst Surgical
Nicole S. McMahon, M.D. Moore Regional
Fabulous care I am writing to compliment your staff in the Emergency Department at Moore Regional Hospital for the fabulous care they delivered to me. I had acute cholecystitis, which came on at 5 p.m., and it was unrelenting. When I went to the ER at 7:15 p.m., I was immediately brought back and had a very professional and complete work-up thanks to the nursing staff and the outstanding physicians. I ultimately had an ultrasound and CT scan, which were accomplished by a professional and expert staff and left the ER with a diagnosis of acute gall bladder stones by 10:45 p.m. This efficiency is unbelievable, and the caring staff you have in the ER are a testament of the quality of your institution. I have long thought that FirstHealth of the Carolinas was an excellent hospital, but my opinion is now elevated to outstanding. I have the highest regard for you and your staff, and I would like you to share this letter with the chief of nursing, chief of radiology and the Emergency Department physicians. Harold C. Pillsbury III, M.D. Thomas J. Dark Distinguished Professor of Otolaryngology/Head and Neck Surgery Professor and Chair Otolaryngology/Head and Neck Surgery UNC School of Medicine Chapel Hill, N.C.
Wonderful people The people of the third-floor staff of FirstHealth Montgomery Memorial Hospital are very wonderful people. They took care of me like their own. They should be commended for their work. I thank them for their help. Iâ€™m still at home and have stopped smoking. I am going to hold to it. I seem to be getting better every day. God bless you all and, once again, thanks. Michael F. Tucker Troy, N.C.
A different tune I did not have any particular feeling about Moore Regional Hospital prior to my recent surgery, but I am now singing a different tune. I had a TURP (prostate) procedure and was kept overnight. I have nothing but the highest regard for the professionalism and caring attention given to me by everyone from admission through attending physicians and anesthetists and the after-care nursing staff. I would particularly single out the nurses who covered my confinement on the day and night shifts. Each reflected an organizational pride that redounds to the credit of the entire hospital staff. Thank you for the leadership that results in such a positive experience for the patients. Charles T. Duttweiler Sanford, N.C.
(800) 213-3284 â€˘ www.firsthealth.org
“Difference in our lives” I am writing to thank your staff for the wonderful care my husband received while he was a patient at FirstHealth Moore Regional Hospital. I’m certain that you must receive numerous letters applauding your employees, but I just wanted to take the time to reinforce what you already know. My husband is retired from the military and, on May 20, 2014, he was informed that he had a cancerous mass on his right kidney. This came as a terrible shock to both of us, as he is the epitome of good health and is only 54 years old. Our first order of business was to ensure that he received the best possible medical care to resolve his situation, and we found just that at your hospital. David’s doctor, Dr. Greg Griewe, was remarkable—competent, caring, straightforward and both personally and professionally confident. Throughout David’s stay at Moore Regional Hospital, he was surrounded by other health care professionals who were just as accomplished. The nursing and support staff who cared for David in the Cancer Center were wonderful. Nothing was ever a problem, and any little need David may have had was addressed with a cheerful and capable response. The professionals who readied David for his surgery were reassuring and welcoming. The volunteer in the family surgical waiting room was a joy and blessing. And everyone else—the folks in the cafeteria, the housekeeping staff, the people who delivered the meals, the wonderful pastor who paid us a call—everyone was kind and helpful and encouraging. Never in our wildest dreams did we ever think we’d find ourselves in a hospital setting this year, especially facing a medical reality that struck fear and complicated stress into our lives and hearts. The last thing we needed to worry about was “Is David going to get good care … is he going to make it?” I can appreciatively report that the care was wonderful, and I can say in gratitude that “Yes, he made it.” Please share our thanks with everyone who made a wonderful, positive, appreciated difference in our lives. The truth be known, my husband and I have a future now, whereas it would have been a much different story without the wonderful health care that he received. We are grateful and will always be so, and we tell our story to everyone with the hope that if the need ever arises in their family, they will find their way to FirstHealth Moore Regional Hospital.
Kind, supportive staff I am sure you receive a lot of letters when people are not satisfied with their level of care; however, today I am writing because I would like to express my gratitude for the wonderful care I received at Moore Regional Hospital. I had a total knee replacement performed at the hospital. Although my doctors tried to warn me about the level of difficulty and pain I would experience after surgery, no amount of words could have truly prepared me for that day or its immediate aftermath. Yet the care I received by all the nurses and support staff during my four-day stay was exceptional. I couldn’t have asked for a kinder or more supportive staff. From the moment I walked in to the moment I walked out of the hospital, everyone worked to make my stay as comfortable as possible. They were patient, informative, supportive and responsive to my needs, concerns and fears. I hope you will share this letter and my gratitude with the surgical staff, the physical therapy staff, and especially the nursing and support staff who work on 2C. Each and every one of them is a great caregiver, and I can’t say thank you enough. Jane H. Layton Rockingham, N.C.
Lori R. Dauria Fayetteville, N.C.
Always pleased with care I had a total shoulder replacement performed by Dr. Mark Brenner. I express my sincere thanks for the services provided by the scheduling personnel, pre-operation, surgical preparation, anesthesiologists and Dr. Brenner. Following the operation, the care in recovery and the hospital room were also excellent. My wife and I have utilized your facility on several occasions and have always been pleased with the attention and care. Robert F. Wetherbie Aberdeen, N.C.
20 Winter 2015
(800) 213-3284 â€˘ www.firsthealth.org 3
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